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.

Seguimento de 9 anos da bioprótese valvar cardíaca de pericárdio bovino IMC Biomédica / 9 years follow-up of cardiac valvar bioprosthesis with bovine pericardium IMC Biomédica

De dezembro de 1977 a novembro de 1986 foi usado o bioenxerto valvar cardíaco de pericárdio bovino "IMC-Biomédica" na posiçäo mitral, em 798 pacientes, com idade média de 42 anos. Os 722 pacientes sobreviventes foram observados por um período de até 9 anos, representando 27.036 meses ou 2.253 anos. O estudo indicou um índice de sobrevida de 66% para os adultos e 69% para os jovens, sendo de 94% e 80% o índice de sobrevida para os adultos e jovens, respectivamente, com pós operatório de até 5 anos. A freqüência das complicaçöes diante da amostra analisada foi: 0,4% rotura do tecido, 0,4 escape paravalvar, 2,7% acidente vascular cerebral, 3.2% endocardite infecciosa, 4.4% calcificaçäo. A curva atuarial de calcificaçäo entre os anos de 1978 e 1982 (Grupo I) mostrou 94% dos adultos e 12% dos jovens livres dessa complicaçäo. Por outro lado, de 1982 a 1986 (Grupo II) esse mesmo índice subiu para 99.0% entre os adultos e 92.0% para os jovens. Dese modo concluímos que a nossa opçäo pela bioprótese valvar de pericárdio bovino foi apropriada, visto que 96% dos pacientes estiveram livres de complicaçöes fatais relacionadas a bioprótese, o que significa que em 9 anos o potencial da bioprótese foi apenas de 4%