Evaluación de revascularización coronaria: comparación entre perfusión con Tc99m sestamibi-dipiridamol gatillado y ecografía-amrinona como predictores de viabilidad / Assessment of coronary revascularization: comparison between perfussion with Tc99m sestamibi-dipyridamol spect and echography-amrinone as predictors of viability

We studied left ventricular perfusion and motility in 37 patients with coronary artery disease and disturbances of parietal motility, aged 57 ñ 9 years old, before and after revascularization. Perfusion was assessed with dipyridamole-Tc99m SPECT and motility was assessed with 2 dimentional echocardiography with amrinone. Myocardial segments were defined as normal, viable or necrotic in both studies. Eighteen subjects were subjected to angioplasty and 19 to coronary bypass surgery. Submitted SPECT and echography were repeated 64 ñ 15 and 69 ñ 23 days after revascularization respectively. The concordance between SPECT and echocardiographic prerevascularization diagnosis was 60.1 percent. Eighty one percent of segment considered viable with SPECT and 71 percent thus considered with echocardiography improved after revascularization. Likewise, 50 percent of segments considered necrotic with SPECT and 68 percent of segment thus considered with echocardiography did not improve. It is concluded that althought there is a good concordance between both methods, they have limitations on the study of myocardial viability and should be considered as second choice

Tromboembolismo pulmonar masivo tratado con infusión selectiva de estreptoquinasa: comunicación de 2 casos / Massive pulmonary thromboembolism treated with selective infusion of streptokinase: report of 2 cases

We report 2 patients who developed massive pulmonary embolism with > 50% occludion of the pulmonary arterial circulation. Hypotension, syncope and right sided failure were the clinical manifestations. Immediately after diagnostic pulmonary arteriography, 20,000 U of streptokonase (SK) were delivered in the pulmonary artery nest to the thrombotic mass. A continous infusion of SK, 10,000 U/h was maintained for 24h in one patient and 72h in the other. Rapid clincial improvement was observed in the following 24h. Control angiography showed lysis of the embolus with residual obstructions of segmentary branches. The clinical value of this form of treatment for pulmonary embolism is discussed