RESUMO
The authors describe a rare case of circumflex coronary artery perforation during rotational coronary atherectomy complicated with cardiac tamponade and good outcome. The possible causes of perforation are discussed and the burr oversize (burr/artery ratio was 0.58) was refused. Shortening and artery plicature (accordeon effect) might have been the cause of this event. Quantitative measurement was made in order to strengthen this hypothesis. It is emphasized the importance of selecting lesions that should be submitted to rotational coronary atherectomy.
Assuntos
Aterectomia Coronária/efeitos adversos , Tamponamento Cardíaco/etiologia , Doença das Coronárias/cirurgia , Vasos Coronários/lesões , Aterectomia Coronária/instrumentação , Cineangiografia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To verify the efficacy and safety of the creation of a barrier with radiofrequency (RF) in the tricuspid annulus and the vena cava ostium (TA-IVC). METHODS: Nine consecutive patients, 7 males, with age ranging from 36 to 76 years, with paroxysmal (7 patients) or permanent (2) type I atrial flutter (negative P wave in lead II, III and F) were submitted to RF ablation of TA-IVC istmo. One deflectable catheter with 4mm size tip was introduced into the right ventricle apex and pulled back to the inferior vena cava. When the atrial electrogram was detected the RF application was started. The RF was applied (20 watts during 60s) up to the proximity of inferior vena cava ostium. The end point was to stop atrial flutter. Then a vigorous atrial stimulation protocol, including isoproterenol infusion was used. In the next day, patients were submitted to transesophageal stimulation with the same protocol. RESULTS: Atrial flutter was interrupted in all patients (100%) with 4 to 28 (mean 16.7 +/- 7.7) applications. Eight patients (88.8%) with one session and 1 (11.1%) with two sessions. The mean time spent to stop the atrial flutter with one application was 30.5 +/- 18.5s. There were no complications. After a mean follow up of 3 +/- 1.6 month all patients (100%) are asymptomatic. Two of them are taking propranolol to control symptomatic atrial and ventricular ectopic beats. CONCLUSION: RF ablation of the TA-IVC istmo is efficient and safe in a short term follow up to interrupt and prevent re-induction and recurrence of type I atrial flutter.
Assuntos
Flutter Atrial/cirurgia , Ablação por Cateter , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Two patients with transposition of the great arteries submitted to Jatene surgery at ages of 6 days and 6 months respectively, presented in the postoperative period stenosis of the aorto-pulmonary anastomosis. The diagnosis was made three and six years after the surgery. In both patients successful percutaneous transluminal angioplasty (PTA) was performed, respectively six months and immediately after the diagnosis. Pressure gradients decreased from 83 mmHg to 24 mmHg in the first case, and from 76 mmHg to 13 mmHg in the other case, with clear improvement of the angiographic image. Complications of the procedure did not occur in any case. This application for PTA was not previously reported and should be considered as an alternative to the surgical correction of the "new" pulmonary trunk stenosis in the Jatene surgery.
Assuntos
Angioplastia Coronária com Balão , Complicações Pós-Operatórias/terapia , Estenose da Valva Pulmonar/terapia , Transposição dos Grandes Vasos/cirurgia , Criança , Pré-Escolar , Seguimentos , Humanos , Masculino , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/etiologia , RadiografiaRESUMO
From October 84 to September 88 we performed pulmonary valvuloplasty with balloon catheter (PVBC) in 90 patients (pt) with pulmonary valve stenosis (PVS). The patients were divided in 3 groups (Gr) by their ages: group I (Gr. I) 7 pt (8%) aged 4 days to 11 months, Gr. II 66 pt (73%) aged 1 year to 12 years and Gr. III 17 pt aged 13 to 34 years. This study consists of clinical and echocardiographic evaluation adopting the following parameters of indication: a) transvalvar pulmonary gradient (G); b) absence of dysplasia or hypoplasia of the pulmonary annulus. There were associated lesions which were found in each group: Gr. I atrial septal defect (ASD) in 2 pt and tricuspid insufficiency (TI) in 1 pt, in Gr. II supra valvar stenosis (SVS) in 1 pt and patent arterial ductus (PAD) in 1 pt and in the Gr. III (ASD) in 1 pt. The results after pulmonary valvuloplasty with balloon catheter (PVBC) were: (Gr.I) in 5 pt the G were reduced below 50 mmHg and the average of right ventricular systolic pressure (RVSP) changed from 92 to 62 mmHg and the average of G from 76 to 44 mmHg. One of these pt was submitted to surgery 1 month after the procedure and 2 developed restenosis in 2 and 3 years respectively, being submitted to another dilatation with good results. The 2 pt in which the procedure was not effective were submitted to surgery. In the second group the PVBC was effective in 61 pt (92%) showing the RVSP changed from 118 to 64 mmHg and G changed from 86 to 23 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Cateterismo , Estenose da Valva Pulmonar/terapia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Eletrocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , PrognósticoRESUMO
Central vein cannulation is used as routine for long-time treatment in paediatric intensive care units. The Sylastic catheter is now a days the most common used because of its non-thrombogenic effect. However, in the case here reported, fragmentation during its removal occurred in a eleven month baby. Non surgical removal was done by percutaneous technique using the grasping forceps from Cook Co. into a Lehman 7F catheter. The problem of being no radiopaque, was solved by using the echocardiography study as the guideline for the successful removal of the catheter.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Corpos Estranhos , Veia Cava Inferior , Cateteres de Demora/efeitos adversos , Ecocardiografia , Corpos Estranhos/diagnóstico por imagem , Humanos , Lactente , Masculino , RadiografiaRESUMO
O sangramento excessivo seguindo-se à cirurgia cardíaca com CEC representa ainda um problema a ser equacionado. Várias causas têm sido apresentadas: a heparina näo neutralizada adequadamente surge como uma das principais. A introduçäo do TCA para o controle de heparinizaçäo e sua inativaçäo pela protamina tem sido aceita como definitiva. O objetivo deste trabalho é avaliar a eficácia do TCA (VN =80 a 120s) comparando-o com o TT (VN =10 a 12s). Serviram como parâmetros: o sangramento pós-operatório e protamina de duas marcas (A e B). Foram estudados 30 pacientes distribuídos em dois grupos (I e II) com nove coronarianos e seis valvares em cada. Todos os pacientes apresentavam coagulograma normal no pré-operatório, sendo a idade, peso, tempo de CEC, tipo de perfusato, duraçäo da operaçäo, semelhantes para os dois grupos. A dose inicial de heparina foi de 3 mg.kg-1 venosa e as subseqüentes guiadas pelo TCA quando inferior a 450s. A neutralizaçäo foi feita com protamina, inicialmente com 0,8 a 1 mg para a dose correspondente de heparina. Doses adicionais foram administradas até o TCA situar-se abaixo de 120s. No grupo I a dose de protamina (A) foi de 340 mg e de heparina 330 mg: TCA final de 100s, sangramento em 12h (520ml), TT de 50s (pós-CEC) e 40s no pós-operatório imediato. No grupo 2 a dose de protamina (B) foi de 270mg e de heparina 350mg: TCA final 90s, TT de 20s (pós-CEC e 17s no pós-operatório imediato, sangramento de 350ml em 12h. Os demais parâmetros do coagulograma (TT e TTPa) e contagem de plaquetas näo diferiram entre os dois grupos. Concluímos que: 1) O TCA falhou em acusar a neutralizaçäo da heparina, persistindo excesso de heparina com TCA "normal"; 2) A heparina näo neutralizada foi a principal causa do sangramento; 3) Protamina de diferentes marcas têm maior ou menor potência de neutralizaçäo; 4) Na vigência de sangramento com TCA "normal" recomenda-se a reavaliaçäo do TT