RESUMO

A review of some historical accounts in Medicine reveals concepts, clinical descriptions and prognosis of coronary atherosclerosis and ischemic heart disease in the recent past and in remote antiquity. Herein, the historical accounts disclosed include some concepts and terms utilized in reference to atherosclerosis: the oldest documentation of coronary atherosclerosis and myocardial infarction in Egyptian mummies; the clinical syndrome of angor pectoris in the Ebers' papyrus, as well as clinical and prognostic data in the Corpus Hippocraticum regarding possible cases of angina, infarction and sudden death. These reports give a better insight into primitive medicine in the Ancient Western World, revealing the evolving concept of atherosclerosis and the existence of this disease in humanity's remote past.

Assuntos

RESUMO

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.

Assuntos

RESUMO

In 121 patients (93 males, mean age 53.9 years), percutaneous transluminal coronary angioplasty (PTCA) of 140 lesions was performed as treatment of symptomatic, single or multiple vessel disease, with the following clinical syndromes: stable angina pectoris (Group I) in 59 cases (48.8%), unstable angina (Group II) in 40 (33%), and angina or residual ischemia after thrombolysis for myocardial infarction (MI) (Group III) in 22 patients (18.2%). PTCA was successfully accomplished in 123 of 140 segments (87.8%), with a reduction in mean luminal stenosis from 87.3 +/- 13% (range 70-100) to 15 +/- 10% (range 0-30, p less than 0.00001). Successful results were obtained in 85.9% of patients (104/121) and they were 84.7%, 82.5% and 95.5% in Groups I, II and III, respectively. The procedure failed in 17 cases (14.0%), and within this group, 14 complications occurred (11.6%): 2 deaths (1.6%), 3 cases of MI, acute closure in 4, and emergency coronary bypass surgery in 5 patients. Late evaluation (6-8 months) revealed clinical and functional improvement in 71/98 patients (72.4%), and recurrent ischemic symptoms (no improvement) in 27 cases. Coronary angiography performed in 20, showed restenosis in 10, and progressive disease in 7 patients. In conclusion, PTCA is an effective therapeutic option in selected cases of symptomatic ischemic heart disease with suboptimal results to medical management alone.

Assuntos

RESUMO

Percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon catheter (IBC) was performed in 11 adult, symptomatic patients with moderately severe, pure of predominant mitral stenosis (MS). The transseptal approach and a valvuloplasty technique of progressive and controlled valvular dilatation were utilized. The procedure failed in one patient due to an inadequate transseptal puncture, and it was successful in the other 10. The mitral valve area increased from 1.00 +/- 0.27 to 2.19 +/- 0.31 cm2 (p less than 0.001); the diastolic mitral gradient decreased from 20.9 +/- 4.6 to 5.9 +/- 3.3 mmHg (p less than 0.001); similar reduction was obtained in the mean atrial pressure from 22.3 +/- 5.8 to 11.6 +/- 4.2 mmHg (p less than 0.001), and the mean pulmonary arterial pressure from 41.3 +/- 16.1 to 26.4 +/- 10.5 mmHg (p less than 0.05). There were no complications. Left to right shunting at the atrial level, due to the transseptal approach, was moderately significant in only 2 patients (QP/QS = 1.4 and 1.3 respectively). Grade I, and grade I-II mitral insufficiency occurred in 2 patients, one of them with previous mitral regurgitation, and it was not demonstrated or disappeared (if preexistent) in the rest. Patients were discharged in 48 hs at the most. They all referred improvement in their functional class, and at 4.3 months of average follow-up they are asymptomatic. In conclusion, PTMC with the IBC is a safe, simple and successful technique to separate the fused commissures, increase the mitral valve area and improve the functional class in selected cases of rheumatic MS. A long term follow-up is required for evaluation of late results.

Assuntos

Assuntos