Tratamento endovascular da persistência do canal arterial em adulto / Patent ductus arteriosus: endovascular treatment in adult patient

A persistência do canal arterial (PCA) é uma anomalia relativamente freqüente e de simples correção. A correção envolve a ligadura do ducto com ou sem a sua secção. A anomalia em adultos pode provocar hipertensão pulmonar persistente e disfunção ventricular. A correção em adultos é controversa e de maior risco. Um caso de correção endovascular com acesso intra-abdominal da PCA em adulto é descrito.

The patent ductus arteriosus (PDA) is a common type of congenital heart defect and its correction is simple when performed early in life. Surgery is performed using stitches or clips. In adults, the anomaly can lead to pulmonary hypertension and ventricular dysfunction. Surgery in adults is controversial and high-risk. This report describes an alternative endovascular approach in an adult patient.

Evoluçäo temporal com a utilizaçäo da angioplastia coronariana primária no infarto agudo do miocárdio no Brasil. Análise dos preditores de sucesso e dos eventos adversos hospitalares em 9.434 pacientes / Primary coronary angioplasty in 9, 434 patients during acute myocardial infarction: predictors of major in- hospital adverse events from 1996 to 2000 in Brazil

OBJECTIVE: To verify the results after the performance of primary coronary angioplasty in Brazil in the last 4 years. METHODS: During the first 24 hours of acute myocardial infarction onset, 9,434 (12.2 percent) patients underwent primary PTCA. We analyzed the success and occurrence of major in-hospital events, comparing them over the 4-year period. RESULTS: Primary PTCA use increased compared with that of all percutaneous interventions (1996=10.6 percent vs. 2000=13.1 percent; p<0.001). Coronary stent implantation increased (1996=20 percent vs. 2000=71.9 percent; p<0.001). Success was greater (1998=89.5 percent vs. 1999=92.5 percent; p<0.001). Reinfarction decreased (1998=3.9 percent vs. 99=2.4 percent vs. 2000=1.5 percent; p<0.001) as did emergency bypass surgery (1996=0.5 percent vs. 2000=0.2 percent; p=0.01). In-hospital deaths remained unchanged (1996=5.7 percent vs. 2000=5.1 percent, p=0.53). Balloon PTCA was one of the independent predictors of a higher rate of unsuccessful procedures (odds ratio 12.01 [CI=95 percent] 1.58-22.94), and stent implantation of lower mortality rates (odds ratio 4.62 [CI=95 percent] 3.19-6.08). CONCLUSION: The success rate has become progressively higher with a significant reduction in reinfarction and urgent bypass surgery, but in-hospital death remains nearly unchanged. Coronary stenting was a predictor of a lower death rate, and balloon PTCA was associated with greater procedural failure

Resultados do Registro Brasileiro CENIC com o implante primário de stents ou da angioplastia com baläo para o tratamento de oclusöes agudas de enxertos de veias de safena / The use of primary stenting or balloon percutaneous transluminal coronary angioplasty for the treatment of acutely occluded saphenous vein grafts. Results from the Brazilian National Registry - CENIC

OBJECTIVE: We conducted a comparative analysis of the in-hospital outcomes of patients who underwent primary percutaneous transluminal angioplasty (PTCA) or stent implantation because of an acute myocardial infarction (AMI) related to an acute vein graft occlusion. METHODS: Since 1991 the Brazilian Society of Hemodynamic and Interventional Cardiology has maintained a large database (CENIC). From these, we selected all consecutive patients, who underwent primary PTCA or stenting in the first 24 hours of AMI, with the target vessel being an occluded vein graft. Immediate results and major coronary events occurring up until hospital discharge were analyzed. RESULTS: During this period, 5,932 patients underwent primary PTCA or stenting; 158 (3 percent) of the procedures were performed because of an acute vein graft occlusion. Stenting was performed in 74 (47 percent) patients. Patients treated with stents had a higher success rate and lower mean residual stenosis compared with those who underwent primary balloon PTCA. The incidence of reinfarction and death were similar for stenting and balloon PTCA. CONCLUSION: Primary percutaneous treatment of AMI related to acute vein graft occlusion is still an uncommon practice. Primary stenting improved luminal diameter and offered higher rates of success; however, this strategy did not reduce the in-hospital reinfarction and death rate, compared with that occurring with PTCA treatment

Estudo comparativo do ecocardiograma dopller transtorácico, tomografia computadorizada e aortografia no diagnóstico de dissecçäo da aorta torácica / Comparative Evaluation of Transthoracic Doppler Echocardiogram, Computed Tomography and Aortography in the Diagnosis of Thoracic Aortic Dissection.

PURPOSE--Comparative and prospective evaluation of three methods (transthoracic echo-Doppler (TTE), computerized tomography (CT) and aortography (AORT) utilized for aortic dissection diagnosis. METHODS--The 39 patients with confirmed aortic dissection (surgery or autopsy) underwent, within a few hours of each other, all three methods scrutinized. There were 19 cases of type A and 20 of type B dissection. RESULTS--In type A dissection the methods were equivalent (TTE = 73.7//, CT = 84.2//, AORT = 73.7//p = NS) but for type B, TTE was significantly inferior to the other two methods (TTE = 60//, TC 90//, AORT = 80//, p < 0.05 for TTE, for TC and AORT p = NS). In three occasions, even though all three methods were performed, the diagnosis was not obtained. CONCLUSION--The methods which were evaluated make the diagnosis in the majority of cases. In type A all methods are similar, however, in type B, TC and AORT are superior to TTE. Even performing all three methods in each patient, in three instances the diagnosis was not made