RESUMEN
The coarctation of the aorta [CoA] is rare in adulthood. Diagnosis is made by clinical suspicion and physical findings such as blood pressure difference between the upper and lower extremities, pulse delay in the femoral artery, and systolic murmur over the thoracic spine. The CoA in adulthood and in patients with associated aneurysm is challenging and different complications even with proper treatment can occur. Covered stents are indicated in concomitant aneurysm, older age, and tight coarctation. A 26-year-old male with resistant hypertension due to a CoA diagnosed by computed tomography angiography referred to our center for an attempted stent implantation. Cardiac catheterization and aortography revealed a long CoA after the origin of the left subclavian artery with a 60 mmHg gradient. Moreover, there was a large aneurysm in the site of the coarctation. Under general anesthesia and fluoroscopic guidance, two balloon-expandable covered Cheatham-Platinum stents [size 18 in 44 millimeters and size 18 in 50 millimeters] were successfully implanted across the CoA with no residual gradient. On 2 years' follow-up, the patient had no symptoms except for mild hypertension. In this patient, the use of a covered stent within the aneurysm was safe and effective
RESUMEN
Device closure of an isolated secundum type atrial septal defect [ASD] has been used as an alternative method for open surgical closure with comparable success and lower morbidity. In this study we evaluated the procedural success and mid-term follow-up results of percutaneous closure of secundum ASD with an Amplatzer TM Septal Occluder [ASO] device or a Figula ASD occluder device. From June 2001 to January 2009, 74 consecutive patients were scheduled for percutaneous device closure in two centers in Tehran, Iran. All patients had a stretched defect diameter of 30mm or less. After using a sizing balloon to measure the stop-flow diameter, device implantation was performed under the guidance of a trans-esophageal echocardiography [TEE].The size was generally 1 - 2 mm larger than the stretched diameter. Patients were followed for an average of 11 +/- 4 months. The median stretched diameter of the defect was 20.7 +/- 4.8 mm [range: 8 - 30 mm].A total of 73 devices were used in this study. Device closure was successful in 72 [97.2%] out of 74 patients. Repositioning of the device was required in one patient. Major complications [including significant residual shunt and device embolization] occurred in 3 [4%] patients. There was no procedure-related mortality in our patients. Mild-to-moderate residual shunt was detectable in 10 [13.7%] patients immediately following the procedure and in 5 [6.7%] patients 24 hours after the procedure. None had residual flow across the device at the end of the follow-up period. Device closure of ASD has a safety profile comparable to open surgical repair and can effectively close the defect with excellent procedural and mid-term results
RESUMEN
Obesity is a common public health problem reaching epidemic proportions in recent decades. Increased BMI imposes a pro- inflammatory state, releasing factors such as high sensitivity-C reactive protein which is strongly associated with plaque rupture and acute cardiovascular events. Also the prevalence of type 2 diabetes has reached epidemic level. A total of 400 consecutive patients recruited in this cross sectional study from April 2009 to December 2009 who was candidate for coronary angiography. Baseline clinical characteristics and coronary angiography data collected. Data analysis performed using 2-sided independent-sample t-tests. Out of 400 patients recruited in the study 253 were male. Obesity and diabetes observed in 65.7% and 32.5% of these patients respectively. Hypertension was more prevalent in obese patients [p=0.013] while dyslipidemia was not significantly different. The severity of coronary artery lesions were significantly associated with diabetes but not related to obesity [pvalue=0.0001 and 0.316 respectively]. The main finding of this preliminary study was that diabetes is significantly related to severity of coronary artery disease and hypertension and hyperlipidemia is more prevalent in diabetic patients. Moreover, obesity is not significantly related to severity of coronary artery lesions