Uso de duplo cateter-guia como auxílio para tratamento de perfuração coronariana durante angioplastia primária / Use of Double guide catheter to assist coronary perforation treatment during primary angioplasty

Relatamos o caso de um paciente de 64 anos que, ao ser submetido a uma angioplastia primária por via transradial, apresentou uma complicação grave: perfuração coronariana classe III de Ellis. O paciente evoluiu com tamponamento cardíaco e necessidade de drenagem pericárdica, sendo a perfuração selada com implante de dois stents recobertos Jomed Covered Stent Graft (JCSG), Jomed International AB, Helsingborg, Sweden), permitindo a restauração do fluxo TIMI III coronariano. O paciente recebeu alta hospitalar sete dias após o procedimento. O successo do procedimento no tratamento da complicação e do infarto, sem a necessidade de suporte ventilatório e hemodinâmico ou de cirurgia de revascularização miocárdica, foi alcançado devido à abordagem ter sido realizada pela técnica do duplo cateter-guia, minimizando o tempo de efusão pericárdica.

Here we reported on the case of a 64-years-old patients, who, on being submitted to primary angioplasty by transradial access, presented with a severe complication: Ellis Class III coronary perforation. The patient evolved with cardiac tamponade and required pericardial drainage. The perforation was sealed with the deployment of two Jomed Covered Stent Grafts (JCSG; Jomed International AB, Helsingborg, Sweden), thereby restoring TIMI III flow. The patient was released from hospital seven days after the procedure. The success of the procedure in the treatment of the complication and infarctation, without the necessity of ventilatory and hemodynamic support or revascularization surgery was achieved as the approach used a double guide catheter, thereby minimizing the time of pericardial effusion.

Cirurgia de revascularização do miocárdio com anestesia regional, sem tubo orotraqueal em pacientes acordados / Myocardial revascularization surgery with regional anesthesia without an endotracheal tube in conscious patients

OBJECTIVE: To report initial experience with myocardial revascularization surgery (MRS) performed on patients who were totally awake and without an endotracheal tube.METHODS: Between January 1994 and May 2001, 272 patients underwent MRS without extracorporeal circulation. In 24, the operations were performed without the use of an endotracheal tube and with the patients totally awake and breathing normally. The age ranged from 51-75 years with the predominant male sex. Epidural thoracic administratios of the anesthesia was performed. Surgery was performed through a habitual anterolateral thoracotomy. During the entire procedure, the left lung remained partially collapsed.RESULTS: The 24 patients progressed well through the surgery. Pneumothorax time ranged from 70-190 minutes. No electrocardiographic, echocardiographic, or enzymatic alterations occurred that characterized pre- and postoperative infarcts. Twenty-three patients were stable enough to be released after 24 hours.CONCLUSION: This technique could be performed on an large number of selected patients. However, more experience is necessary