Valvoplastia por cateter-balão associada a acidente vascular encefálico em gestante com estenose mitral grave / Percutaneous ballon valvotomy leeding to ischemic stroke in a pregnant patient with severe mitral stenosis

Relata-se o caso de gestante admitida na 23.ª semana de gestação com cardiopatia classe funcional IV pela NewYork Heart Association por estenose mitral reumática. Submeteu-se ao tratamento com betabloqueador e, na 29.ª semana de gestação, à valvoplastia pela técnica do duplo balão. Imediatamente após o procedimento, manifestou hemiparesia à esquerda e teve trabalho de parto prematuro, inibido com indometacina. A ressonância magnética decrânio mostrou infarto das artérias cerebral média e anterior direita. O tratamento instituído foi ácido acetilsalicílico eheparina, que se manteve até a 36.ª semana de gestação. O parto vaginal ocorreu com 37 semanas de gestação, eo recém-nascido, com 2.500 g de peso, tinha ânus anterior ectópico e luxação congênita das articulações coxofemorais.A paciente persiste com sequela leve da isquemia vascular cerebral e com remissão da insuficiência cardíaca,e o concepto evoluiu satisfatoriamente.

A case of a 23rd gestational week patient with the New York Heart Association functional class IV rheumatic mitral stenosis cardiopathy is reported. She was submitted to beta-blocker treatment and, at the 29th week, to double-balloon valvuloplasty technique. Immediately after the procedure she developed left sided hemiparesis and early labor, which was inhibited with indometacin. Cranial magnetic ressonance showed right middle and anterior cerebral artery infarction. Treatment was initiated with acetilsalicilic acid and heparin and held until the 36th week. Vaginal labor occurred at 37 weeks of gestation. The newborn weighted 2,500 g and presented with anterior ectopic anus and congenital hip luxation. The patient remains with mild stroke sequelae and the infant has developed satisfactorily.

Angioplastia coronariana com suporte circulatório por baläo intra-aórtico: experiência inicial

Objective - To evaluate the use of the intraaortic balloon (IaoB) in association with coronary angioplasty in high-risk patients. Methods - Fourteen high-risk patients unresponsive to clinical therapy and with formal contraindication to surgical revascularization were treated by coronary angioplasty, most of which was followed by stenting. All procedures were performed with circulatory support with the IaoB. This study reports the early results and the late findings after 12 months of follow-up. Six patients had multivessel coronary disease; of these, four had left main equivalent lesions and two had unprotected left main coronary artery disease, one of whom had severe "endvessel" stenosis and the other was a patient with Chagas' disease with single-vessel lesion. Eleven patients had a left ventricular ejection fraction <30 per cent. Results - In 100 per cent of the patients, the procedures were intially successful. Two patients had severe bleeding during the withdrawal of the left femoral sheath. At the of twelve months, 4 patients were asymptomatic and the others were clinically controlled. There were two late deaths in the 7th and 11th months. Conclusion - The combined use of the intraaortic balloon pump and percutaneous coronary angioplasty in high-risk patients with acute inschemic syndromes provides the necessary hemodynamic stability to seccessfully perform the procedures.