Terapia fibrinolítica para trombose de próteses valvares cardíacas: resultados imediatos e tardios / Fibrinolytic therapy for thrombosis in cardiac valvular prosthesis short and long term results

OBJECTIVE: To assess the short- and long-term results of the use of streptokinase (SK) for the treatment of thromboses in cardiac valvular prostheses. METHODS: Seventeen patients with cardiac prosthetic thrombosis diagnosed by clinical, echocardiographic, and radioscopic findings underwent fibrinolytic treatment with a streptokinase bolus of 250,000 U followed by 100.000 U/hour. Short- and long-term results were assessed by radioscopy and echocardiography. RESULTS: Of the 17 patients, 12 had mechanical double-disk prostheses (4 aortic, 6 mitral, 2 tricuspid), 4 had single-disk prostheses (2 aortic, 1 mitral, and 1 tricuspid), and 1 had a tricuspid bioprosthesis. The success rate was 64.8 percent, the partial success rate was 17.6 percent, and the nonsuccess rate was 17.6 percent. All patients with a double-disk prosthesis responded, completely or partially, to the treatment. None of the patients with a single-disk prosthesis had complete resolution of the thrombosis. The time of streptokinase infusion ranged from 6 to 80 hours (mean of 56 h). The mortality rate due to the use of streptokinase was 5.8 percent and was secondary to cerebral bleeding. During streptokinase infusion, 3 (17.6 percent) embolic episodes occurred as follows: 1 cerebral, 1 peripheral, and 1 coronary. The rethrombosis index was 33 percent in a mean follow-up of 42 months. CONCLUSION: The use of fibrinolytic agents was effective and relatively safe in patients with primary thrombosis of a double-disk prosthesis. A fatal hemorrhagic complication occurred in 1 (5.8 percent) patient, and embolic complications occurred in 3 (17.6 percent) patients. In a mean 42-month follow-up, 67 percent of the patients were free from rethrombosis

Fatores prognósticos dos resultados de ressuscitaçäo cardiopulmonar em um hospital de cardiologia / Prognostic factors of the results of cardiopulmonary resuscitation in a cardiology hospital

OBJECTIVE: To analyze the early and late results of cardiopulmonary resuscitation in a cardiology hospital and to try to detect prognostic determinants of both short- and long-term survival. METHODS: A series of 557 patients who suffered cardiorespiratory arrest (CRA) at the Dante Pazzanese Cardiology Institute over a period of 5 years was analyzed to examine factors predicting successful resuscitation and long-term survival. RESULTS: Ressuscitation maneuvers were tried in 536 patients; 281 patients (52.4 percent) died immediately, and 164 patients (30.6 percent) survived for than 24 hours. The 87 patients who survived for more than 1 month after CRA were compared with nonsurvivors. Coronary disease, cardiomyopathy, and valvular disease had a better prognosis. Primary arrhythmia occurred in 73.5 percent of the >1-month survivor group and heart failure occurred in 12.6 percent of this group. In those patients in whom the initial mechanism of CRA was ventricular fibrillation, 33.3 percent survived for more than 1 month, but of those with ventricular asystole only 4.3 percent survived. None of the 10 patients with electromechanical dissociation survived. There was worse prognosis in patients included in the extreme age groups (zero to 10 years and 70 years or more). The best results occurred when the cardiac arrest took place in the catheterization laboratories. The worst results occurred in the intensive care unit and the hemodialysis room. CONCLUSION: The results in our series may serve as a helpful guide to physicians with the difficult task of deciding when not to resuscitate or when to stop resuscitation efforts

Valor do uso da milrinona no tratamento das crises de agudização em portadores de insuficiência cardíaca congestiva / Use of Milrinone in the Treatment of Acute Phase of Congestive Hecert Failure

PURPOSE--To assess the hemodynamic effects of milrinone in a 48h intravenous infusion in patients with severe congestive heart failure (CHF) (NYHA class III or IV). METHODS--Forty patients with CHF were sequentially evaluated. Right heart catheterization was performed in order to measure, before and after administration of milrinone, several hemodynamic parameters (cardiac index, pulmonary wedge pressure, systemic and pulmonary vascular resistance). RESULTS--There was a significant improvement in hemodynamic parameters (cardiac index, cardiac output), and a decrease in systemic vascular resistance and pulmonary vascular resistance. Serious side effects were not observed in these patients. CONCLUSION--These findings indicate that milrinone is effective in the treatment of deteriorating phases of CHF and suggest that milrinone should be used in these select patients.

Objetivo - Verificar os efeitos hemodinâmicos a curto prazo, da infusão intravenosa de milrinona em portadores de insuficiência cardíaca congestiva (ICC), grau funcional (GF) III e IV da NYHA. Métodos - Foram estudados, prospectivamente, 40 pacientes, com ICC de diversas etiologias, GF III e IV da NYHA e, através do cateter de Swan-Ganz, analisados vários parâmetros hemodinômicos como, índice cardíaco (IC), pressão capilar pulmonar, resistência vascular sistêmica (RVS) e pulmonar (RVP), antes e após a infusão de milrinona. Analisaram-se, também, os efeitos clínicos e possíveis efeitos colaterais da droga. Resultados - Significante melhora clínica e hemodinâmica, avaliada pelo cateter de Swan-Ganz. Aumento significante do IC, com queda expressiva da RVS, RVP, sem causar hipotensão e ou taquifilaxia. Não houve aparecimento de efeitos colaterais graves que justificassem a interrupção do tratamento. Conclusão - Este tipo de fármaco inodilatador pode e deve ser usado em fases agudas da descompensação cardíaca nestes pacientes

Angina instavel: aplicacao da revascularizacao percutanea e da terapeutica adjunta / Unstable angina: role of percutaneous revascularization and adjuntive therapy

Nesta revisao, os autores discorrem acerca do papel da revascularizacao percutanea (angioplastia corornaria, aterectomias e implante de "stent") no manuseio da angina instavel, enfatizando tambem a importancia que uma terapeutica adjunta criteriosamente indicada e conduzida tem nos resultados

Infarto do miocardio com onda Q: analise evolutiva dos fatores que influenciam a mortalidade / Q wave myocardial infarction: evolutive analysis of factors that influence motality

Nesta atualizacao, os autores relatam, com detalhes, os principais fatores clinicos e angiograficos relacionados a mortalidade pos-infarto agudo do miocardio. Tambem e comentado o impacto do uso das drogas tromboliticas na reducao da morbi-mortalidade secundaria a este evento, tema de grande interesse no contexto desta entidade