Estudo comparativo entre os efeitos terapêuticos da revascularizacão cirúrgica do miocárdio e angioplastia coronária em situacões isquêmicas equivalentes: análise através da cintilografia do miocárdio com 99mTc-Sestamibi / Comparative study between the therapeutic effects of surgical myocardial revascularization and coronary angioplasty in equivalent ischemic situations: analysis through myocardial scintigraphy with 99mTc-Sestamibi

OBJETIVO: Avaliar a carga isquêmica do miocárdio prévia e ulterior à revascularizacão do miocárdio. MÉTODOS: Foram avaliados 96 pacientes randomizados, portadores de doenca arterial coronariana multivascular, angina estável, funcão do ventrículo esquerdo preservada e isquemia miocárdica esforco-induzida tratados com revascularizacão cirúrgica (RCM) ou angioplastia coronariana (ATC). Cintilografia do miocárdio com 99mTc-Sestamibi foi realizada antes e 6 meses após a revascularizacão do miocárdio. RESULTADOS: A RCM determinou índice significantemente maior de revascularizacão completa (p=0,001), aumento no número de testes ergométricos máximos (p=0,001) e reducão no número de testes ergométricos positivos com angina de esforco (p=0,018). Ambos os procedimentos ofereceram melhora importante na classe funcional da angina (p=0,001), aumento no valor médio do duplo produto de pico (p=0,009), e do tempo de tolerância ao esforco (p<0,001), além de reducão no valor médio da somatória do escore do esforco (p<0,001) e da diferenca da somatória dos escores (p<0,001) nos dois grupos. CONCLUSAO: ATC e RCM não diferiram significantemente quanto à reducão da carga isquêmica do miocárdio 6 meses após o procedimento. A revascularizacão do miocárdio foi mais completa com a RCM do que com a ATC, mas não representou fator significante para reducão da carga isquêmica do miocárdio.

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.

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

Artéria coronária única e infarto agudo do miocárdio / Single coronary artery and acute myocardial infarction

We describe the rare angiographic finding of the right coronary artery arising from the middle portion of the left anterior descending coronary artery in a patient with atherosclerotic coronary artery disease and acute myocardial infarction. This anatomic variation has been previously described only four times in the modern literature.

Relatamos raro achado angiográfico da artéria coronária direita saindo do terço médio da artéria coronária descendente anterior em paciente com doença aterosclerótica coronariana e infarto agudo do miocárdio. Apenas 4 casos desta variação anatômica foram encontrados na literatura

Origem anômala da artéria circunflexa e espasmo coronariano / Anomalous origin of the circumflex artery and coronary spasm

A 43 year-old female patient with angina pectoris and vasospasm demonstrated in the anomalous left circumflex (Cx) and right coronary (RCD) arteries by coronary angiograph. Origin of the left Cx from the RCD is the most common coronary anomaly and generally, is considered to be benign. Nevertheless, myocardial ischemia in patient with this anomaly has been described. To our knowledge, this is the first reported case of coronary vasospasm occurring simultaneously in the anomalous left Cx and RCD arteries. The diagnostic troubles and the potential danger of this association were emphasized.