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We reviewed our work and evaluated clinical and angiographic results, as well as the follow up of young adult patients < 40 years that were subject to percutaneous trans-clinical coronary angioplasty (PTCA) with an endovascular prostheses (stent). From January 1995 to December 1999, 896 PCTA's performed using stents in 770 patients. Only one selected group of 30 patients (with 32 procedures, and an average of 1.06 stents per patients. Patients age ranged from 21 to 39 years old with an average of 32.8 + 52, 2, 29 (96%) were male and only one woman (3.3%). Nine patients (30%) had a severe angina, class III Braunwald and 21 (70%) had a previous history of myocardial infarcts. The average percent of arterial obstruction was 90.88 +/- 5.22 and the expulsion fraction. (EF) had a percent of 46.8 +/- 4.3 with ranges of 35 to 60%. Immediate angiographic success was 93.75% in only two patients (6.25%) with a 100% occlusion, and more than twelve weeks. There was no mortality, nor infarct, and no patient was sent to an urgent revascularization surgery. Clinical follow up lasted 50 weeks in all patients with the effort test using the electric Bruce type and for nuclear medicine. Only in 3 patients EF was reported, and tHalium with a slight septal ischemia. Angiographic control was included in 27 (90% patients between the 4th and 6th month. PTA with stent is a successful angiographic and clinical procedure in young adults < 40 years old; it constitutes a complete and efficient therapeutical revascularization procedure, and is an excellent option before undertaking an aortocoronary revascularization surgery.

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We report the results obtained of 23 patients in whom 25 intracoronary stents (SAQ) were placed. All had atherosclerotic coronary artery disease with different clinical types of presentation, such as stable angina, unstable angina, myocardial infarction. In others cases the reason for the procedure was postangioplasty complications. The majority of cases had complex lesions: total occlusion, long plaques and patients in critical and unstable state. The immediate results were considered satisfactory due to the fact that there was angiographic improvement compared to just conventional angioplasty, the final flow was TIMI-3 in 23 and TIMI-2 en two others, in these cases the initial flow was TIMI-0. The arterial diameter improved compared to prior angioplasty. Acute thrombosis occurred in one case and was resolved with repeated dilatation, in two cases the atherosclerotic plaque protruded within the stent, in both cases the occlusion was considered non significant, without modifications in the flow. All patients had a 3 months follow up with treadmill test. In 10 cases angiography was indicated, in 4 due to positive treadmill. Restenosis was resolved in three cases, in another coronary arterial by-pass was necessary. In all other cases angiographic findings were normal, included one patient with two stents.

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UNLABELLED: We examined the immediate and short-term outcomes after stenting protected and unprotected left main coronary artery (LMCA) stenoses, in patients with normal ventricular function. Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty, because it has been associated with high procedural morbidity and poor mid-term results. Between february 1995 and february 1999, 596 procedures were performed in 468 patients. Ten patients who had disease involving the left main coronary artery were included. They were not candidates for coronary surgery. The post-stent antithrombotic regimens were aspirin and ticlopidine. The procedural success rate was 100% without episodes of subacute thrombosis. Three to six months follow-up angiography was performed in all, restenosis occurred only in two patients, there were two repeat PTCA (20%) and there were no deaths. CONCLUSIONS: Stenting of unprotected and protected left main coronary artery stenoses may be a safe and effective alternative to surgery in carefully selected patients with normal left ventricular function. The results of our study suggests that when patients have prohibitive surgical risks, elective LMCA angioplasty and/or stenting maybe undertaken with a high procedural success rate as an effective alternative to CABG in carefully selected patients. Further studies in larger patient populations are needed to assess late outcome.

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UNLABELLED: We review our experience and also evaluate the clinical and angiographic results of octagenarians patients subjected to percutaneous transluminal angioplasty and endovascular prosthesis (stents). In the period between february 1995 and august 1998, 532 procedures were performed in 400 patients, we describe a subgroup of 51 patients, who rejected surgical treatment or were considered non appropriate candidates for this therapeutic approach. Ages ranged 71 a 85 years mean (74.09 +/- 3.1). Sex: 37 male and 14 female, their clinical presentation was severe angina according to Canadian Society of Cardiology (CSC) in 64%. In 64% previous myocardial infarction and multivessel disease in 58.8%. The mean percentage of coronary obstruction was 90 +/- 9.2 and ejection fraction 51.6 +/- 8.8, the immediate angiographic success was 88.3% six patient (12%) died during 36 to 72 hours post-procedure from different causes. The follow-up period was 3 to 48 months, but had angiographic control just eighteen patients (35%). Eighteen cases were lost to follow-up for different reasons. Two patients died of non cardiac causes. CONCLUSIONS: Stent implantation has an angiographic and clinical success with low complications profile. It is a therapeutic option in the management of advanced coronary artery disease in this frail group.

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UNLABELLED: Several diagnostic tools have been used in the evaluation of the severity transvalvular gradient and aortic valve area. The advances in cardiac catheterization and Doppler echocardiographic measure these items accurately. We designed a retrospective, observational open and transversal survey that included patients with severe aortic stenosis that required transseptal cardiac catheterization. Their echocardiographic and hemodynamic studies were reviewed. From January 1991 to December 1996 we studied 30 patient from a population of 256. All of them with severe aortic stenosis. There were 17 males and 13 females with an age range from 32 a 71 years. RESULTS: the transvalvular gradient measured by catheterization vs. Doppler echocardiogram was 98.80 +/- 37.29 mmHg vs. 96.63 +/- 38.64 mmHg respectively P = 0.84. The valvular area measured by catheterization vs Doppler echocardiographic 0.63 +/- 0.17 cm2 vs 0.62 +/- 0.15 cm2 respectively P = 0.63. There was not difference in the gradients using these two methods. We conclude that patients with severe aortic stenosis could be referred to surgical procedure without the need of cardiac catheterization if no concurrent coronary disease is suspected.

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The practice of percutaneous transluminal coronary angioplasty has shown that the major complications are acute dissection as well as suboptimal results and restenosis. The effort to reduce these complications has led to create an intravascular device called Stent. The technology is complex and very expensive, for this reason we designed and made a new model of stent named SAQ. We introduce: The methodology of development, fabrication and modifications of a new intravascular device Stent SAQ. The results obtained in coronary arteries of ex vivo hearts of pigs and humans. The results in two model of animals, rabbit aorta and peripheral arteries in dogs. This investigation at this phase, shows satisfactory properties of SAQ which is secure and effective, with similar properties to the stents in use.

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Five cases with cor triatriatum were diagnosed in less than a two years period. There were 4 females and one male. The mean age was 3.6 years. Three patients were operated on successfully. One patient died shortly after cardiac catheterization in acute pulmonary edema, another case is waiting for surgery with mild obstruction. We do not have a complete explanation for this high incidence of cor triatriatum. The utility of Echo Doppler color in diagnosis is highlighted. A literature review is made.

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From April 1986 to June 1994 we performed percutaneous transvenous mitral commissurotomy in 689 patients with rheumatic mitral stenosis in a multicenter study. Mean age was 40 +/- 11 years, of then 84.9% female, 2.7% to had previous surgical treatment and in 1.4% the procedure was performed during pregnancy. Inoue balloon was used in 89.4%, double balloon 9.7% and monoballoon 0.9%. Mitral valve area (MVA) increased from 0.93 +/- 0.20 to 1.85 +/- 0.37 cm2 (p < 0.001) and mean pulmonary artery pressure from 31.5 +/- 15.8 to 22.4 +/- 11.5 mmHg (p < 0.001), mean left atrial pressure decreased from 20.9 +/- 8.1 to 10.0 +/- 5.9 mmHg (p < 0.001), transvalvular gradient (TVG) from 15.4 +/- 6.4 to 3.4 +/- 3.1 mmHg (p < 0.001) and mean pulmonary artery pressure from 31.5 +/- 15.8 to 22.4 +/- 11.5 mmHg (p < 0.001). Complete procedure without mayor complications was achieved in 93.1%. Severe mitral regurgitation (MR) was present in 3.9%. Optimal result in 82.1%, suboptimal in 8.2% and failure in 9.7%. Major complications 4.7%. Mortality was 0.9%. Six months follow-up MVA decreased to 1.77 +/- 0.38 (p < 0.001) and no changes to 24 months (1.78 +/- 0.37 p ns). Twenty four months follow-up 93.3% are in NYHA class I. Only MVA (> 1 cm2) and good predilatation NYHA class were predictors of optimal results. Severe MR were more frecuently in patients with atrial fibrillation and with high score (> 8). Our results were similar the international experience. We conclude that the technique of PTMC is a safe and effective technique.

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Thirty eight transcatheter umbrella closure (TUC) of a persistently patent ductus arteriosus using the Rashkind umbrella occluder (USCI), were attempted in thirty four patients. Mean age 8.5 +/- 9.0 years (range 1.5 to 31). Internal diameter of ductus arteriosus (DA) average 4.0 +/- 1.5 mm (range 2 to 9 mm). Successful implantation was achieved in 36 procedures (94.7%). Complete closure immediately postimplantation was achieved in 15 (45.4%), 12 (36.3%) had trivial and 6 (18.1%) severe residual shunt. In four cases we implanted successfully a second device. At the follow-up (average 24 months) in 31 patients, 87.0% (n = 27) had complete closure and 96.7% (n = 30) did not need another intervention. Device embolization to distal left pulmonary artery occurred in two cases (5.2%), one was retrieved by surgery and in the other case it was allowed to remain. No mortality was observed. This results confirm the efficacy, with low morbidity and no mortality of TUC, especially in those with smaller PDA (< 4 mm).

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We describe a 65-years-old female, with percutaneous balloon angioplasty (PBA) of inferior vena cava. The patient had massive calcification of the right atrium, the tricuspid anulus as well as obstruction of the tricuspid valve (percutaneous tricuspid valvuloplasty was performed 2.5 years before). The only predisposing factor for calcification was, a cerebral-right atrial shunt (cerebral cysticercosis) for 32 years. PBA was performed. We discuss some events that occurred after dilatation. We describe the technique in this uncommon case. We conclude that percutaneous balloon angioplasty is another alternative to surgical repair in inferior vena cava obstruction.

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We describe a 3-years-old boy, with congenital mitral stenosis, who underwent percutaneous transvenous mitral commissurotomy (PTMC) with Inoue balloon. The mitral gradient decreased from 24 to 4 mmHg, the mitral valvular area (MVA) increased from 1.2 to 1.6 cm2 without modification in mitral regurgitation. One year later the recatheterization showed decreased pulmonary pressures, and a 7.5 mmHg mitral valvular gradient without mitral insufficiency. MVA by echo is 1.8 cm2 with mild regurgitation. As far as we know there is no experience with Inoue balloon in children. We conclude that PTMC with Inoue balloon could be an attractive alternative in some patients with congenital mitral stenosis.

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From May 1991 to August 1994, we performed transcatheter closure of patent ductus arteriosus with Rashkind umbrella system in 25 patients. In one, the device had embolism, to the right pulmonary artery and was operated 24 hs afterwards without complications. Seven had residual shunts, two had subsequent surgery, two are being followed (one for mild and one for moderate residual shunt). In the other three cases we inserted a second device. We used a 12 mm device in two cases and a 17 mm device in the other. Two cases had total occlusion 24 hrs after and in one had mild residual shunt without clinical repercussion. There were no complications. All had electrocardiographic and clinical improvement, take no medication, and their cardiomegaly had decreased (Cardiac index pre 61 vs post 54%). In conclusion the insertion of a second device is safe and effective alternative for residual shunt after first Rashkind occluder.

Assuntos

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From March 1986 to January 1993, we performed percutaneous balloon mitral commissurotomy (PBMC) in ninety-one patients with rheumatic mitral stenosis, two of them during pregnancy. The gestational age at the time of valvotomy was thirty and twenty-seven weeks respectively. Balloon Inoue technique in both cases resulted in improvement in mitral valve area (0.8 vs 1.6 and 0.7 vs 1.9 cm2) and in mean mitral gradient (19 vs 4 and 12 vs 0 mm Hg) immediately after dilation, without residual atrial septal defect or mitral insufficiency. There were no complications. The estimated radiation exposure to the fetus was of 6.4 minutes of fluoroscopy and 6 seconds of angiography. To limit of X-ray irradiation, we used color Doppler echocardiography during dilatation in both cases. The subsequent course of gestation was uncomplicated and normal babies were delivered in both cases. Fetus protection against ionising radiation was assured by lead mantles. In the follow-up the mitral valve area was 1.7 and 2.1 cm2, 15 and 4 months later respectively. PBMC can be performed safely during pregnancy and is effective in increasing the valvular area and relieving symptoms. It offers an excellent alternative for the pregnant patients, with severe mitral stenosis. The risk to the fetus appears lower than previous reports of surgical commissurotomy performed during pregnancy.

Assuntos

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This report describes the first successful case of tricuspid valve stenosis by percutaneous double balloon valvuloplasty in Mexico. The gradient decreased from 5 to 0 mmHg, with an increase in valve area by echocardiography and improvement of the jugular vein pulse and disappearance of symptoms. The feasibility of the balloon percutaneous valvuloplasty was demonstrated unequivocally.

Assuntos

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From October 1985 to February 1992 we performed 80 percutaneous transluminal angioplasty (PTA) in 76 patients with coarctation of the aorta (CoAo). Sixteen of them with ages ranging from 12 to 62 years (mean = 21.1). We describe the experience in these cases. Fifteen with native and one with post-surgical coarctation. The gradient decreased from 72 +/- 33 to 18 +/- 17 mmHg immediately after dilation, in the follow-up (1 to 69 months m = 25) was 23 +/- 20 mmHg. In one patient we performed simultaneously angioplasty of CoAo and mitral valvuloplasty with excellent results in both lesions. We redilated two cases for residual gradient successfully. We had one failure in a patient with long coarctation. He needed surgery. In the initial experience we had one severe complication (cerebral stroke). No deaths or aneurysms. In conclusion we believe that PTA is an adequate alternative in adolescents and adults with native or post-surgical coarctation of the aorta with minimum incidence of complications.

Assuntos

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Percutaneous transluminal angioplasty (PTA) was performed in 34 patients with aortic coarctation (Ao Co). One of them with coarctation after surgical correction, the rest were native Ao Co. We used one balloon in 28 patients and two balloons simultaneously in 6. They were separated in three groups according to the degree of aortic arc hypoplasia. Group I (mild to moderate hypoplasia N = 9) the gradient dropped 39% with angiographic improvement of 48% during the follow-up (m = 13.1 months). Three cases with restenosis, 2 were satisfactory dilated and one was sent to surgery. In Group II (severe hypoplasia N = 4) the gradient dropped 31% with angiographic improvement of 30% (follow-up 16.3 months). Two cases with recoarctation were sent to surgery. In Group III (without hypoplasia N = 21) we obtained dropped of gradient of 71% with angiographic improvement of 60% (follow-up 18.5 months). Two cases were redilated successfully. The complications were: cerebral hemorrhage with death due to hypertensive crisis, (1) cerebral embolism, (1) thrombosis in the puncture site 1 and small aneurysm in dilated zone. (1) We think PTA is a good choice to conventional surgery with low rate of morbidity-mortality. The results depend basically on the anatomic type of coarctation and degree of aortic arch hypoplasia.

Assuntos

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Percutaneous transluminal balloon angioplasty has been used successfully in the treatment of valvular and vascular stenosis. This article describes our experience with this technique to improve pulmonary blood flow in a patient with a severely stenotic Blalock-Taussig (B-T) systemic-to-right pulmonary artery anastomosis, with improvement in oxygen peripheric saturation from 33 to 78% immediately postdilatation and 69% three months later. Hemoglobin decreased from 20.4 to 18.9 gm/dl and hematocrit from 64% to 58.5%. In conclusion we think that this technique is an alternative instead of cardiac surgery, in these cases the procedure is only palliative.

Assuntos

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We performed catheter balloon valvuloplasty (CBV) on 8 stenotic operatively-excised bioprosthetic valves (2 Hancock and 6 Ionescu Shiley). Pathology of valves before CBV included degenerative changes: commissural fusion by mounds of calcific deposits (2 valves), fibrotic and focally calcified leaflets (7 valves) and stiff and thick valves (1 valve). Inflation of the balloon resulted in commissural splitting (2 valves), leaflet cracks and fractures (3 valves). Removal of the deflated balloon catheter was associated with debris dislodgement (3 valves). In one case the valve was unable to close with potential for acute regurgitation. Thus, CBV of bioprosthetic valves can split fused commissures by similar mechanisms as in native valves. CBV may fracture calcific deposits causing acute emboli. It can also disrupt the leaflets causing acute insufficiency. The findings suggest a limited role of CBV in the treatment of stenotic bioprosthetic valves in mitral and aortic position.

Assuntos

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Percutaneous angioplasty was performed in twenty consecutive patients, with congenital pulmonary valve stenosis. Ages ranged from eight months to thirty-two years (mean 9.5 years old). We achieved a valvular gradient dropping from 91 +/- 39 to 19 +/- 11 mm Hg (P less than 0.001) in early post angioplasty level and it was practically unchanged at three months and one year later. (19 +/- 12, 19 +/- 17 mm Hg) (P less than 0.001). Similar change was observed in the right ventricle systolic pressure which was diminished in a progressive way during the follow-up from 113 +/- 37 to 39 +/- 35 (P less than 0.001), 59 +/- 18 and 53 +/- 25 mm Hg (P less than 0.001) immediately, three months and one year later, respectively. The ratio right ventricle systolic pressure/left ventricle was diminished from 0.96 +/- 29 to 0.63 +/- 0.35 in the early post angioplasty period and later from 0.50 +/- 0.16 and 0.44 +/- 0.22 (P less than 0.001). Only one case had restenosis one year later and we repeated the angioplasty with good results. Most of the patients are asymptomatic, the pulmonary murmur features changed. We observed improvement in electrocardiographic and echocardiographic signs. One patient died of anesthetic complications. The remainder of patients did not have severe complications and they were discharged from 48 to 72 hours after angioplasty. In conclusion, valvuloplasty is an effective procedure in a short and long term basis. We considered valvuloplasty in congenital pulmonary valve stenosis the treatment of choice in this group of patients.

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Assuntos