Angioplastia com excimer-laser para o tratamento de reestenose pós implante de stent de Wiktor e Gianturco-Roubin. Uma nova alternativa de tratamento / Excimer-Laser Angioplasty for the Treatment of Restenosis after Wiktor and Gianturco-Roubin stent placement. A New therapeutic Alternative

We report the use of excimer-laser angioplasty for the treatment of Wiktor and Gianturco-Roubin in-stent restenosis of in two patients. Case 1-a 48-year-old man presented unstable angina five months after Wiktor stent was deployed in right coronary artery. Cardiac catheterization revealed stenosis (95) within the stent. Case 2-a 65-year-old man presented stable angina four months after Gianturco-Roubin stent was deployed in left anterior descending artery. Cardiac catheterization revealed stenosis (80) within the stent. Excimer-laser angioplasty within the stent reduced the stenosis to 19and 30, respectively. The patients recovered and currently, six months post-procedure, are free of chest pain, and cardiac catheterization revealed stenosis to 30and 35, respectively, within the stent. Therefore, the procedure was an effective means of treating restenosis after coronary stent placement, and a prospective comparison of excimer-laser angioplasty and other management alternatives to in-stent restenosis is needed.

Angioplastia transluminal coronária em octogenários / Percutaneous Transluminal Coronary Angioplasty in Octogenarians

PURPOSE: To evaluate the immediate and long term results of percutaneous transluminal coronary balloon angioplasty (PTCA) in patients over 80 years old. METHODS: From 1/1/89 to 6/31/95, 97 patients with 80 years of age or older were submitted to PTCA and were divided into three groups: group A (GrA)-30 patients with stable angina, mean age of 82.5 years, 24 (80) men; group B(GrB)-40 patients with unstable angina, mean age 81.2 years, 31 (77.5) men; group C (GrC)-27 patients with myocardial infarction (MI), mean age of 82 years, 16 (59.2) men. RESULTS: Early outcome-general success rate of 84.5 and mortality rate of 5.1. The success and mortality rate were in GrA 83.3 and 3.3, in GrB 85 and 5 and in GrC 85.2 and 7.4, respectively. Late outcome-the number and percentage of patients with late follow-up and the clinic-angiographic and angiographic restenosis rates were for GrA 19(76), 52.9, 75; GrB 30(88.2), 30.8, 61.5 and GrC 12(52.2), 66.6, 85.7, respectively. CONCLUSION: PTCA can be considered an important revascularization alternative in octogenarian patients because of high early success rate, low mortality and acceptable long-term outcome.

Dupla origem do ramo descendente anterior--das coronárias esquerda e direita--associada a origem anômala à direita do ramo circunflexo / Origin of Anterior Descending Artery - from the Left and Right Coronary Arteries - Associated with Anomalous Origin of the Circunflex Artery

A 65 year-old white man, with typical angina pectoris, underwent coronary angiography that showed dual left anterior descending artery (LAD), originating from the right coronary artery (RCA), associated with anomalous origin of the left circumflex artery (LCX) also from the RCA. This an extremely rare coronary artery anomaly and, it is the first case reported, so far. This rareness and clinical significance are emphasized.

Emprego do stent de Palmaz-Schatz na fase aguda do infarto do miocárdio em paciente com choque cardiogênico / Palmaz-Schatz Stent Implantation in Acute Myocardial Infarction in Patient with Cardiogenic Shock

A 56-year-old female patient underwent myocardial revascularization with three saphenous bypass grafts. One month after surgery she had an acute myocardial infarction with cardiogenic shock and was treated with a Palmaz-Schatz stent implantation in the left main coronary artery (that was occluded) and a PTCA of the graft to the right coronary artery. The in hospital outcome was uneventful and angiographic study after six months showed no restenosis and important improvement in the left ventricular function.

Paciente de 56 anos, submetida à revascularização do miocárdio, com implante de três pontes de safena, apresentou um mês após à cirurgia infarto agudo do miocárdio, evoluindo para choque cardiogênico. Foi implantado stent de Palmaz-Schatz no tronco da coronária esquerda que se encontrava ocluído e realizada angioplastia com cateter balão na ponte de safena para a coronária direita. A evolução hospitalar foi favorável e o reestudo após seis meses mostrou manutenção dos resultados obtidos com o procedimento e importante melhora da função ventricular esquer

Endomiocardiofibrose com calcificaçäo endocárdica maciça biventricular / Endomyocardial Fibrosis with Massive Biventricular Endocardial Calcification

Endomiocardiofibrose é uma doença cardíaca endêmica caracterizada pela presença de tecido fibroso no endocárdio, eventualmente se estendendo para o miocáardio.CAlcificaçäo endocárdica maciça de ventrículo esquerdo é um achado raro, com poucos casos descritos na literatura.Relatamos o primeiro caso, de nosso conhecimento, de calcificaçäo endocárdica maciça biventricular associada a endomiocardiofibrose em mulher de 22 anos.

Perfuração de artéria coronária com rotablator / Coronary artery perforation with rotational coronary atherectomy

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

É relatado caso raro de perfuração da artéria circunflexa durante aterectomia rotacional (AR), complicado com tamponamento cardíaco, que evoluiu favoravelmente. São discutidas as prováveis causas, afastando a possibilidade da ocorrência de um superdimensionamento da oliva utilizada (relação de diâmetro oliva-artéria foi de 0,58), e é sugerido o encurtamento e plicatura da artéria (efeito sanfona) como provável causa dessa perfuração. São feitas medidas quantitativas para reforçar essa hipótese, e ressaltam-se os cuidados necessários na escolha das lesões a serem submetidas à ablação com AR

Prevalência do shunt residual após fechamento de canal arterial persistente com umbrellas de Rashkind / Residual Shunt Prevalence after Closure of Patent Ductus Arteriosus with Rashkind Double Disc Occluding Device

PURPOSE--To determine the prevalence of residual left-to-right shunt in patients submitted to closure of patent ductus arteriosus with use of Rashkind double-disc ductal occluding device, analyzing predictive factors that determine short and long-term prevalence of residual shunt. METHODS--Thirteen patients were submitted to percutaneous closure of patent ductus arteriosus with use of Rashkind double-disc device. Ten patients were male with mean age of 5.7 years. A 12mm diameter device was used in 7 cases and a 17mm device in the remaining six patients. All patients had clinical, radiological and echocardiographic follow up, after 24h, 1 month, 6 months and one year after the procedure. Morphology and length of the ductus arteriosus and the presence of residual shunt after 15 min, 24h and one year after the procedure, were correlated. RESULTS--In one case, embolization of the device to the pulmonary artery determined the in success of the procedure. Residual shunt was present in 75 of the patients after 15 min of the procedure, in 33.3 after 24h, in 25 after 1 month and 6 months and in 16.6 after 1 year. The most important and isolated predictive factor leading to a high prevalence of residual shunt after 24h and after 1 year of the procedure was the presence of ductus arteriosus diameter > or = 4.5mm at the site of its insertion in the pulmonary artery. CONCLUSION--Prevalence of residual left-to-right shunt decreases over the time, with a low incidence after one year follow-up. A higher incidence of residual shunt at 24h and 1 year after the procedure occurred in the cases where the diameter of the ductus arteriosus was > or = 4.5mm, at the site of its insertion in the pulmonary artery.

Neurological complications of coronary arteriography

Este artido relata um caso de uma mulher de 46 anos submetida a cateterismo cardíaco femoral direito, que desenvolveu paresia do olhar conjugado para cima, para baixo, déficit de convergência e nistagmo para cima logo após o procedimento. Ressonância nuclear magnética mostrou hipersinal de T-2 paramediana mesencefálica esquerda. Dextran 40 proporcionou progressiva regressäo do déficit do olhar vertical. Nistagmo e convergência regrediram parcialmente. Possíveis mecanismos lesionais: lesäo vasscular pelo cateter e tromboembolismo ou dissecçäo da intima; arritmia cardíaca; espasmo arterial pelo cateter ou contraste; combinaçäo de dois ou mais destes fatores säo discutidos

Angioplastia coronária em oclusäo crônica de nove anos e meio: utilizaçäo do laser com um novo cateter para recanalizaçäo / Coronary angioplasty in chronic occlusion of nine and half years: use of laser with a new catheter for recanalization

A chronic total occlusion lasting 9.5 years, was successfully treated with a Prima (TN) Laser catheter, of Spectranectics. The authors report a case of a fifty seven year old male that suffered an inferior myocardial infarction 9.5 years ago. Although the morphological characteristics of the lesion seemed easy to pass through the obstruction with the guide wire, the balloon dilatation was not possible because of the hardness of a chronic lesion lasting that long. The intervention was concluded successfully in another opportunity using the laser catheter with certain facility. This case, reported as the first one in Latin America, rises new possibilities and increases the success rate of coronary angioplasty of total chronic occlusions. We hope that in the following cases we will be able to reach the same result, widening the indications of coronary angioplasty

Angioplastia coronária com o uso do laser: análise crítica dos primeiros pacientes / Laser Facilited Coronary Angioplasty. A Critical Analysis of the Initial Cases

PURPOSE--To evaluate the success rate and complications, as well as the technical difficulties involved catheter laser coronary angioplasty, making evident the unsuccessful cases. METHODS--Twenty eight patients were treated with laser from August to November, 1993. The treatment was complemented with balloon angioplasty. Lesions were complex: 10 (36 per cent) were type B and 18 (64 per cent), type C. Concerning the obstruction grade, 18 (64 per cent) were > or = 95 per cent. Laser generator CVX 300(TM) Spectranectics as well as Extreme(TM) and Vitesse(TM) catheters with 1.4, 1.7 and 2.0mm in diameter, concentric and excentric, were used. Laser procedure success was defined as a reduction > 20 per cent in the obstruction grade. The procedure success was attended when the residual stenosis was < 50 per cent after a 15-minute observation, after balloon complementation. RESULTS--The unsuccess rate with laser catheter (Lc) was 34 per cent (10 lesions) of which 3 cases were solved by other methods, 5 were not successful because of anatomic difficulties in surpassing the lesion and, in the two others the success criterium in the reduction of the obstruction grade of the coronary artery was not achieved, although the lesion surpassing was possible with the use of balloon catheter. The final success reached 89 per cent (21 lesions). The procedure complications were a case of thrombosis, a perforation accompanied by a myocardial infarction and another myocardial infarction (non-Q wave), all with good outcome. CONCLUSION--The use of laser in the treatment of coronary artery obstructive lesions is a viable method. Nonetheless, more experience is necessary to demonstrate its actual value, optimizate the results and may be reduce restenosis rate

Análise da composição e disposição espacial de placas ateroscleróticas localizadas em bifurcaçöes das artérias coronárias epicárdicas de adultos / Analysis of the Composition and Spatial Disposition of Atherosclerotic Plaques Located in Bifurcation of Epicardical Coronary Arteries in Adults

PURPOSE--To analyze macro and microscopic features of atherosclerotic plaques located in bifurcation of coronary arteries, defining their spatial disposition in those sites. METHODS--We studied 38 bifurcations of coronary arteries of patients whose cause of death was related to coronary artery disease. Histologic sections of 0.5mm were sequentially made from the main artery to the secondary branches. They were stained with hematoxilin-eosin technique. Histological analysis evaluated: a) morphologic composition of the plaques, b) degree of obstruction and c) plaque's disposition. RESULTS--a) Plaque's composition: fibrolipid plaques constituted 80 per cent of the cases and mingled focal atrophy of the media at the base of the plaque in 61 per cent with spots of total destruction and rupture of the elastic layers in 30 per cent ; b) degree of obstruction: ranged from 20 per cent to 95 per cent , with average 60 +/- 28 per cent ; c) disposition of plaques: we verified morphologic variation along the plaque, most of them (71 per cent ) being eccentric at bifurcation and not reaching the beginning of flow divider walls. CONCLUSION--Atherosclerotic plaques located in bifurcation of coronary arteries of adults are often fibrolipid plaques, eccentric, and their spatial disposition on those sites spare the beginning of the inner walls, reaching the outer walls

Critério de relação ecocardiográfica. Um novo método para a indicação da valvotomia mitral com cateter-balão / Pulse Therapy (High Dosis of Intravenous Methyl-Prednisolone) in Children with Rheumatic Carditis. Prospective Study of 40 Episodes

PURPOSE--To find out new subjects that could be useful to select patients between 9 and 12 points, according to Block's Criteria, to mitral balloon valvotomy. METHODS--One hundred and forty patients underwent mitral balloon valvotomy. Among them, 29 (21) had between 9 and 12 points. These patients were divided into two groups: group A-patients with mitral valve area > or = 1.5cm2, immediately after balloon valvotomy and in the follow-up period; group B-patients with mitral valve area < 1.5cm2 immediately after or during the follow-up period, patients with severe mitral regurgitation after the procedure and patients who died in the follow-up period. All patients were analyzed by echocardiographic relation criteria (ERC): calcification + subvalvar disease/thickness + mobility. Each one was quantified from 1 to 4 points according to the degree of valvular disease. RESULTS--Group A was composed of 17 (51) and group B 12 (41) patients. The variables age, sex, previous mitral commissurotomy and atrial fibrillation did not show difference between groups. In group A mitral valve area (cm2) increased from 1.15 +/- 0.25 to 1.97 +/- 0.26 (p < 0.00001) keeping stable during the follow-up period. In group B percutaneous mitral balloon valvotomy resulted in an increase from 1.26 +/- 0.19 to 1.77 +/- 0.16 (p < 0.00001), however, there was an important decrease in the follow-up period to 1.34 +/- 0.15 (p < 0.00001). The ERC showed that all group A patients had a relation < 1. However, in group B, 10 patients (83), the relation was > or = 1, and in only 2 patients (17) was < 1 (p < 0.00001). CONCLUSION--The group of patients between 9 and 12 points in the Block's criteria is heterogenic, therefore, each case might be evaluated individually and the echocardiographic relation criteria should be used in order to select these patients to the procedure.

Objetivo - Diminuir o prazo de uso de corticoterapia na cardite reumática, mantendo o paciente internado e avaliar o tempo para negativação das provas de atividade da doença. Métodos - Foram tratados 36 pacientes entre 6 e 17 anos (40 episódios) com metilprednisolona venosa (1g/dia) em séries de três dias semanais. O número de séries variou de duas a quatro, dependendo da gravidade. Todos os pacientes preenchiam os critérios de Jones para diagnóstico de febre reumática. Todos foram submetidos a erradicação estreptocócica, PPD, tratamento de verminoses e dos focos dentários antes da corticoterapia. Resultados - Todos os pacientes melhoraram da insuficiência cardíaca na época da alta. Em 6 casos ocorreram intercorrências durante a pulsoterapia, mas foram controladas rapidamente. Foram realizadas duas séries em 10 pacientes, três em 9 e quatro em 21 episódios. Oito foram encaminhados para troca de válvula. O tempo de negativação das provas de atividade reumática e da alta hospitalarioi 41,2±13,3 dias. Conclusão - O esquema utilizado encurtou o tempo total de uso dos corticosteróides, podendo assim manter o paciente internado e eliminando-se a interrupção do tratamento da cardite. Não ocorreu diferença significativa quanto ao prazo de negativação das provas de atividade reumática entre o esquema clássico oral e a pulsoterapia

Dextrocardia em situs inversus totalis com doença obstrutiva coronária: tratamento pela angioplastia coronária por via braquial / Dextrocardia with coronary disease in situs inversus totalis. treatment with coronary angioplasty by brachial approach

A dextrocardia em "situs inversus totalis" com lesão obstrutiva coronária é uma situação rara, existindo na literatura referência a apenas alguns casos tratados pela angioplastia coronária por via femoral. No presente trabalho descreve-se o caso de um paciente de 61 anos submetido com sucesso à dilatação de duas artérias por via braquial. Discutem-se aspectos técnicos relacionados com o procedimento, o qual pode ser facilmente executado, desde que se disponha de material adequado

Dextrocardia in "situs inversus totalis" with obstructive coronary disease is a rare clinical situation, with few cases treated by coronary angioplasty using the femoral approach being reported. In this report we describe the case of a 61-year-old male patient who underwent successful! dilatation of two arteries by the brachial approach. We discuss technical aspects related to the procedure, which may be easily performed when proper equipment is available

Revascularizaçäo miocárdica após reperfusäo na fase aguda do infarto do miocárdio / Myocardial revascularization after reperfusion in the acute phase of myocardial infarction

Objetivo - Avaliar a revascularizaçäo cirúrgica (RC) após reperfusäo por estreptoquinase (EQ) ou angioplastia coronária (AC) no infarto agudo do miocárdio (IAM). Casuística e Métodos - De 245 pacientes submetidos à reperfusäo com sucesso, 47 (19,2%) foram revascularizados na fase aguda do IAM. As indicaçöes cirúrgicas mais freqüentes foram lesöes multi-arteriais (31%), lesäo residual (20%) e angina pós-reperfusäo (17%). Houve 2 períodos distintos: junho de 1981 a junho de 1983 onde foram operados 34 pacientes com intervalo médio de 47 horas entre a reperfusäo e a RC; julho de 1983 a novembro de 1986, quando foram operados 13 pacientes e intervalo médio de 7 dias entre reperfusäo e a RC. Resultados - A mortalidade foi de 21% (7 óbitos) no 1§ período e de 8% (1 óbito) mo 2§. Conclusäo - Observou-se relaçäo entre o intervalo de reperfusäo até a cirurgia e a mortalidade, que foi significativamente mairo (p < 0,05) no grupo mais precocemente operado.

Níveis plasmáticos de lipoproteína (a) em indivíduos normais e portadores de doença coronariana confirmada por cinecoronariografia / Lipoprotein (a) plasma levels in normal subjects and patients with coronary disease carriers subjects confirmed by coronary cineangiography

Avaliar a concentraçäo plasmática da lipoproteína (a) - Lp(a) - em indivíduos com cinecoronariografia normal ou com sinais de aterosclerose. Trinta e um indivíduos com cinecoronariografia normal e 131 com alteraçöes compatíveis com aterosclerose, de ambos os sexos. Foram medidos os níveis plasmáticos de Lp(a) por radioimunoensaio e também os de colesterol, triglicérides, apolipoproteínas A, A1 e B e avaliados fatores de risco como hipertensäo arterial sistêmica, tabagismo, diabetes, além de atividade física. Os indivíuduos com doença coronariana apresentaram Lp(a) plasmática média de 41,9 mg/dl, em comparaçäo com 23,9 mg/dl no grupo normal. O risco de desenvolvimento de doença coronariana entre os com Lp(a) igual ou acima de 25 mg/dl foi de 2,3 vezes, em comparaçäo com os indivíduos com valores abaixo. Houve correlaçäo entre tabagismo e doença coronariana, o que näo foi confirmado estatísticamente no tocante aos outros fatores de risco avaliados. Confirma-se a importância da Lp(a) como fator de risco da doença coronariana

Intervençäo cirúrgica em pacientes submetidos a procedimento para valvoplastia mitral por cateter-baläo / Surgery in patients undergoing to a catheter balloon mitral valvoplasty procedure

Objetivo: Estudar as características d e pacientes submetidos a valvoplastia mitral por cateter-balão (VMPB) que necessitaram de intervenção cirúrgica após a mesma. Casuística e Métodos: 105 pacientes submetidos a VMPB divididos em grupo I (Gl) composto por 18 pacientes operados e Grupo II (GII) por 87 não submetidos à intervenção cirúrgica no coração. Foram analisados: 1 ) idades; 2) sexo; 3) área valvar mitral (AVM) e gradiente transvalvar mitral médio (G) ao ecodopplercardiograma; 4) caráter da VMPB; 5) método utilizado na VMPB; 6) intervalo de tempo entre VMPB e cirurgia relacionado à indicação operatória; 7) achado operatório; 8) operação efetuada; 9) evolução pós-operatória...

Purpose: To study the characteristics of patients undergoing catheter-balloon mitral valvoplasty (CBVM) procedure who needed surgical intervention after CBMV. Patients and Methods: One hundred and five patients submitted a CBMV were divided in to Group I (GI) of eighteen surgical patients and Group II (GII) of eighty-seven non-surgical patients. The following parameters were analyzed. 1) age; 2) sex; 3) mitral valve area (MVA) and mean transvalvar gradiente (G) by echodopplercardography (2D); 4) Character of CBMV; 6) Relation of time between CBMV and Surgery with surgical indication; 7) Surgical fidings; 8) Surgical procedure and 9) Post-operative evolution...

Ruptura de aorta durante aortoplastia por cateter-baläo em paciente com recoarctaçäo de aorta: relato de caso / Aortic rupture during balloon catheter aortoplasty in patient with aortic recoarctation: report of a case

Aortoplastia por cateter-baläo foi realizada em um paciente de seis anos de idade, que apresentava sinais de recoarctaçäo da aorta, 17 meses após cirurgia. Ao término do procedimento, em que se evidenciou desaparecimento do gradiente sistólico entre aorta ascendente e descendente, o paciente apresentou choque hipovolêmico de difícil controle. Enviado ao centro cirúrgico, realizada toracotomia, visualizado hemotórax a esquerda, que foi drenado, e pequeno orifício no local da cicatriz cirúrgica da coarctaçäo, que foi suturado. Apresentou boa evoluçäo clínica, tendo alta no décimo dia do pós-operatório

Angioplastia transluminal da anastomose aorto-pulmonar da cirurgia de Jatene: aplicaçäo em dois casos / Aorto-pulmonary anastomosis transluminal angioplasty in Jatene surgery: report of 2 cases

Dois pacientes portadores de Transposiçäo de grande artérias submetidos a cirurgia de Jatene aos seis dias e aos seis meses de idade apresentaram no período pós-operatório estenose na anastomose aorto-pulmonar, diagnosticada aos 3§ e 6§ anos de evoluçäo. Procedeu-se a angioplastia transluminal percultânea da referida obstruçäo, com sucesso, seis meses e imediatamente após o diagnóstico, respectivamente. Houve reduçäo dos gradientes de pressäo, respectivamente de 83 mmHg para 24 mmHg, e de 76 mmHg para 13 mmHg, com nítda melhora do aspecto angiográfico. Nenhum dos pacientes apresentou complicaçöes durante ou após o procedimento. Esta aplicaçäo da angioplastia trasluminal percutânea, inédita na literatura, deve ser cogitada como alternativa a correçäo cirúrgica da estenose do "novo" tronco pulmonar da cirurgia de Jatene

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 altennative to the surgical correction of the new pulmonary trunk stenosis in the Jatene surgery

Tratamento por cateter-baläo da estenose pulmonar valvar / Treatment with balloon catheterization of pulmonary valve stenosis

Realizou-se em outubro de 1984 a setembro de 1988, valvoplastia pulmonar com cateter-baläo (VPCB) em 90 pacientes portadores de estenose pulmonar valvar (EPV). Constituíram-se três grupos segundo a idade: grupo I (GI) - 7 pacientes (8%) com idades de 4 dias a 11 meses; grupo II (GII) - 66 pacientes (73%) entre um e 12 anos e grupo III (GIII) - 17 pacientes (19%) entre 13 e 34 anos. Utilizaram-se os seguintes critérios para indicaçäo de VPCB: a) gradiente transvalvar pulmonar (ecoDopplercardiográfico) acima de 50 mmHg; b) ausência de displasia ou hiplasia do anel valvar pulmonar. As lesöes associadas encontradas foram: GI - comunicaçäo interatrial (CIA) em dois casos e insuficiência tricúspide (IT) em um; GII - estenose supravalvar (ESV) em um caso e persistência de canal arterial (PCA), em um paciente e no GIII - CIA, em um paciente. Os resultados da VPCB foram: GI - cinco (71%) pacientes tiveram reduçäo do gradiente transvalvar para níveis abaixo de 50 mmHg, da média da pressäo sistólica do ventrículo direito (PSVD) de 92 para 62 mmHg e da média dos gradientes de 76 para 44 mmHg. Destes pacientes, um foi submetido à cirurgia um mês após a VPCB e dois apresentaram reestenose após dois e três anos, respectivamente, sendo novamente dilatados com resultado favorável. Outros 2 pacientes, nos quais o procedimento näo foi eficaz foram submetidos à cirurgia imediatamente após VPCB. No GII, a VPCB foi eficiente em 61 (92%) pacientes, com reduçäo da média de PSVD de 118 para 46 mmHg e do...