Síndrome de ALCAPA en adulto: caso clínico / Anomalous left coronary artery origin from the pulmonary artery causing angina: report of one case

Anomalies of the origin of coronary arteries are detected in 0.5-1.5% of all angiographies. Anomalous origin of the left main trunk is the most uncommon and its origin from pulmonary artery in adults is exceptional, usually because it is associated with a short survival. We report a 49-year-old female, presenting with a two months history of angina. The exercise electrocardiogram suggested ischemia. A coronary angiography was performed, showing the absence of the left main trunk in the left coronary sinus, a dilated right coronary artery, with no lesions and extensive collateral circulation to the anterior descending and circumflex arteries, with inverted flow and the left main trunk draining to the pulmonary artery. The left ventricle was mildly dilated with middle and apical anterior hypokinesia. Global systolic function was conserved. A surgical correction was decided, occluding the left main anomalous origin and performing a coronary artery bypass grafting from the left internal thoracic artery. The patient was discharged with no complications. At two years of follow-up she is symptom free and has a normal physical capacity.

Resultados clínicos inmediatos y alejados del implante de stents metálicos no recubiertos: ¿Se justifica un reemplazo total por los stents liberadores de drogas? / Acute and long-term clinical results of bare metal coronary stenting

Background: Since the introduction of stents in 1994, improved clinical results have boosted the development of coronary angioplasty in Chile. Drug eluting stents, that have a reduced rate of restenosis, are being increasingly used. Aim: To assess the acute and long-term results of bare metal stent implantation. Patients and Methods: Acute and long-term clinical, procedural and angiographic results were assessed in non acute myocardial infarction patients undergoing coronary stent implantation between August 1996 and December 2003. Results: During the study period, 932 patients aged 30 to 87 years (194 women) had at íeast one stent implanted. Twenty two percent were diabetic, 33 percent had recent myocardial infarction, 53 percent unstable angina and 22 percent stable angina. Angiographic and clinical success were 99.6 percent and 98.2 percent, respectively. In hospital death was 0.5 percent. During a mean follow-up of 19.1 months, all cause mortality was 3.9 percent, cardiac death 1.9 percent and survival free of major cardiac ischemic events was 85.3 percent. Only 6.4 percent of lesions underwent target vessel revascularization (TVR). Independent predictors of TVR were previous surgery, íeft anterior descending artery, small post stent minimum luminal diameter. Ostial location, in-stent restenosis, and younger age were non significant predictors. Conclusions: Acute and long-term results of bare metal stents in this population were excellent. An intriguingly low rate of TVR was seen. Selective bare metal stenting should continue in lesions and patients with a low risk of clinical restenosis.

Angioplastía en infarto agudo de miocardio: resultado inicial y seguimiento alejado / Angioplasty in acute myocardial infarction: early and late results

Background: The usefulness of angioplasty in the first hours of an acute myocardial infarction is widely demonstrated. However, its long term effects are less well known. Aim: To report the effects of coronary angioplasty on early and late outcome of patients with acute myocardial infarction. Patients and methods: A non-randomized, consecutive and retrospective analysis of the hospital and late outcome of 70 patients, aged 35 to 85 years, subjected to coronary angioplasty during an acute myocardial infarction. Patients were followed during 12 to 60 months. Results: Angioplasty was performed 5.3 ñ 5 hours after the initial symptoms. Anterior descendent artery was occluded in 63 percent of patients with a 99.5 percent luminal occlusion and TIMI 0-1 anterograde flow. An angiographic success was achieved in 83 percent of procedures with a residual stenosis of 32.3 percent. Recurrent ischemia was observed in 6 percent of patients, that were treated with a new revascularization procedure. Thirteen percent of patients died, all due to cardiogenic shock. Severe ventricular failure and failure of revascularization influenced mortality. During the first year of follow up there was a 3.3 percent mortality and 3.3 percent of patients required a new revascularization procedure. Eighty percent of patients were asymptomatic and event-free. Conclusion: Angioplasty was a useful therapeutic procedure in this group of patients