Prevalência do shunt residual após fechamento de canal arterial persistente com umbrellas de Rashkind / Residual Shunt Prevalence after Closure of Patent Ductus Arteriosus with Rashkind Double Disc Occluding Device

PURPOSE--To determine the prevalence of residual left-to-right shunt in patients submitted to closure of patent ductus arteriosus with use of Rashkind double-disc ductal occluding device, analyzing predictive factors that determine short and long-term prevalence of residual shunt. METHODS--Thirteen patients were submitted to percutaneous closure of patent ductus arteriosus with use of Rashkind double-disc device. Ten patients were male with mean age of 5.7 years. A 12mm diameter device was used in 7 cases and a 17mm device in the remaining six patients. All patients had clinical, radiological and echocardiographic follow up, after 24h, 1 month, 6 months and one year after the procedure. Morphology and length of the ductus arteriosus and the presence of residual shunt after 15 min, 24h and one year after the procedure, were correlated. RESULTS--In one case, embolization of the device to the pulmonary artery determined the in success of the procedure. Residual shunt was present in 75 of the patients after 15 min of the procedure, in 33.3 after 24h, in 25 after 1 month and 6 months and in 16.6 after 1 year. The most important and isolated predictive factor leading to a high prevalence of residual shunt after 24h and after 1 year of the procedure was the presence of ductus arteriosus diameter > or = 4.5mm at the site of its insertion in the pulmonary artery. CONCLUSION--Prevalence of residual left-to-right shunt decreases over the time, with a low incidence after one year follow-up. A higher incidence of residual shunt at 24h and 1 year after the procedure occurred in the cases where the diameter of the ductus arteriosus was > or = 4.5mm, at the site of its insertion in the pulmonary artery.

Angioplastia coronária com o uso do laser: análise crítica dos primeiros pacientes / Laser Facilited Coronary Angioplasty. A Critical Analysis of the Initial Cases

PURPOSE--To evaluate the success rate and complications, as well as the technical difficulties involved catheter laser coronary angioplasty, making evident the unsuccessful cases. METHODS--Twenty eight patients were treated with laser from August to November, 1993. The treatment was complemented with balloon angioplasty. Lesions were complex: 10 (36 per cent) were type B and 18 (64 per cent), type C. Concerning the obstruction grade, 18 (64 per cent) were > or = 95 per cent. Laser generator CVX 300(TM) Spectranectics as well as Extreme(TM) and Vitesse(TM) catheters with 1.4, 1.7 and 2.0mm in diameter, concentric and excentric, were used. Laser procedure success was defined as a reduction > 20 per cent in the obstruction grade. The procedure success was attended when the residual stenosis was < 50 per cent after a 15-minute observation, after balloon complementation. RESULTS--The unsuccess rate with laser catheter (Lc) was 34 per cent (10 lesions) of which 3 cases were solved by other methods, 5 were not successful because of anatomic difficulties in surpassing the lesion and, in the two others the success criterium in the reduction of the obstruction grade of the coronary artery was not achieved, although the lesion surpassing was possible with the use of balloon catheter. The final success reached 89 per cent (21 lesions). The procedure complications were a case of thrombosis, a perforation accompanied by a myocardial infarction and another myocardial infarction (non-Q wave), all with good outcome. CONCLUSION--The use of laser in the treatment of coronary artery obstructive lesions is a viable method. Nonetheless, more experience is necessary to demonstrate its actual value, optimizate the results and may be reduce restenosis rate

Análise da composição e disposição espacial de placas ateroscleróticas localizadas em bifurcaçöes das artérias coronárias epicárdicas de adultos / Analysis of the Composition and Spatial Disposition of Atherosclerotic Plaques Located in Bifurcation of Epicardical Coronary Arteries in Adults

PURPOSE--To analyze macro and microscopic features of atherosclerotic plaques located in bifurcation of coronary arteries, defining their spatial disposition in those sites. METHODS--We studied 38 bifurcations of coronary arteries of patients whose cause of death was related to coronary artery disease. Histologic sections of 0.5mm were sequentially made from the main artery to the secondary branches. They were stained with hematoxilin-eosin technique. Histological analysis evaluated: a) morphologic composition of the plaques, b) degree of obstruction and c) plaque's disposition. RESULTS--a) Plaque's composition: fibrolipid plaques constituted 80 per cent of the cases and mingled focal atrophy of the media at the base of the plaque in 61 per cent with spots of total destruction and rupture of the elastic layers in 30 per cent ; b) degree of obstruction: ranged from 20 per cent to 95 per cent , with average 60 +/- 28 per cent ; c) disposition of plaques: we verified morphologic variation along the plaque, most of them (71 per cent ) being eccentric at bifurcation and not reaching the beginning of flow divider walls. CONCLUSION--Atherosclerotic plaques located in bifurcation of coronary arteries of adults are often fibrolipid plaques, eccentric, and their spatial disposition on those sites spare the beginning of the inner walls, reaching the outer walls

Dextrocardia em situs inversus totalis com doença obstrutiva coronária: tratamento pela angioplastia coronária por via braquial / Dextrocardia with coronary disease in situs inversus totalis. treatment with coronary angioplasty by brachial approach

A dextrocardia em "situs inversus totalis" com lesão obstrutiva coronária é uma situação rara, existindo na literatura referência a apenas alguns casos tratados pela angioplastia coronária por via femoral. No presente trabalho descreve-se o caso de um paciente de 61 anos submetido com sucesso à dilatação de duas artérias por via braquial. Discutem-se aspectos técnicos relacionados com o procedimento, o qual pode ser facilmente executado, desde que se disponha de material adequado

Dextrocardia in "situs inversus totalis" with obstructive coronary disease is a rare clinical situation, with few cases treated by coronary angioplasty using the femoral approach being reported. In this report we describe the case of a 61-year-old male patient who underwent successful! dilatation of two arteries by the brachial approach. We discuss technical aspects related to the procedure, which may be easily performed when proper equipment is available

Terapêutica endoarterial / Therapeutics

Apresenta o método de desobstrução de uma artéria coronária por via endoarterial. Relata os resultados obtidos

Fratura e retençäo intracoronariana de cateter guia de angioplastia transluminal percutânea: relato de caso / Injury and intracoronary retention of guidewire catheter of percutaneous transluminal angioplasty: a case report

Apresentamos o caso de um paciente de 55 anos de idade, do sexo masculino, que sofreu uma rara complicaçäo de angioplastia no qual o arame guia de um cateter de angioplastia rompeu-se no interior do ramo circunflexo da artéria coronária esquerda. O fragmento de 19 cm foi retirado cirurgicamente com perfeita recuperaçäo do paciente