[Long-term results of percutaneous mitral valvuloplasty in patients over 50 years old]. / Resultados de valvuloplastía mitral percutánea en pacientes mayores de 50 años y seguimiento a largo plazo.

UNLABELLED: Advanced age has been identified as a predictor factor for complications and poor outcome at Percutaneous Mitral Valvulotomy (PMV) with balloon, nevertheless this has been associated to the inadequate valvular anatomy, whereby the contribution of each factor needs to be determinate. OBJECTIVE: Describe the immediate and final outcome of PMV with Inoue balloon in patients over 50 years old and associate complications with age and Wilkins score. MATERIAL AND METHODS: A retrospective and analytic study was performed with a data base of 430 patients. We included all the patients proceeding from the Centro Medico Nacional Siglo XXI Cardiology Hospital. From January 1996 to December 2005. RESULTS: We selected 137 patients with rheumatic mitral stenosis. We found a Mitral Valvular Area (MVA) before the PMV proceeding of 1.01 cm2 +/- 0.18 and 1.99 cm2 +/- 0.30 post PMV (P < 0.001), with pre procedure transmitral gradient of 14.3 +/- 3.18 mm Hg and of 4.3 +/- 2.6 mm Hg post (P < 0.001). In 128 (93%) the immediate proceeding was considered successful. The Wilkins score was 8.41 +/- 1.31. The observed complications were present in 19 (13.8%), stroke in 3 (2.2%), tamponade in 3 (2.2%), conduction disorder in 5 (3.7%), severe mitral insufficiency in 7 (5.1%), residual interatrial communication in 1 (0.7%). A clinical and echocardiographic follow-up was performed in 113 (83%) MVA was > 1.5 cm2 in 113 at 70 [IBM1] months average, 1.1 to 1.49 cm2 in 14 (10.2%) and < 1 cm2 in 9 (7%). CONCLUSIONS: PMV with Inoue balloon in patients over 50 years old is a procedure with an immediate high successful index and of acceptable risk. We found a restenosis index of 27 (19%) after long follow-up 70 months average.

Resultados de valvuloplastía mitral percutánea en pacientes mayores de 50 años y seguimiento a largo plazo / Long-term results of percutaneous mitral valvuloplasty in patients over 50 years old

Advanced age has been identified as a predictor factor for complications and poor outcome at Percutaneous Mitral Valvulotomy (PMV) with balloon, nevertheless this has been associated to the inadequate valvular anatomy, whereby the contribution of each factor needs to be determinate. OBJECTIVE: Describe the immediate and final outcome of PMV with Inoue balloon in patients over 50 years old and associate complications with age and Wilkins score. MATERIAL AND METHODS: A retrospective and analytic study was performed with a data base of 430 patients. We included all the patients proceeding from the Centro Medico Nacional Siglo XXI Cardiology Hospital. From January 1996 to December 2005. RESULTS: We selected 137 patients with rheumatic mitral stenosis. We found a Mitral Valvular Area (MVA) before the PMV proceeding of 1.01 cm2 +/- 0.18 and 1.99 cm2 +/- 0.30 post PMV (P < 0.001), with pre procedure transmitral gradient of 14.3 +/- 3.18 mm Hg and of 4.3 +/- 2.6 mm Hg post (P < 0.001). In 128 (93%) the immediate proceeding was considered successful. The Wilkins score was 8.41 +/- 1.31. The observed complications were present in 19 (13.8%), stroke in 3 (2.2%), tamponade in 3 (2.2%), conduction disorder in 5 (3.7%), severe mitral insufficiency in 7 (5.1%), residual interatrial communication in 1 (0.7%). A clinical and echocardiographic follow-up was performed in 113 (83%) MVA was > 1.5 cm2 in 113 at 70 [IBM1] months average, 1.1 to 1.49 cm2 in 14 (10.2%) and < 1 cm2 in 9 (7%). CONCLUSIONS: PMV with Inoue balloon in patients over 50 years old is a procedure with an immediate high successful index and of acceptable risk. We found a restenosis index of 27 (19%) after long follow-up 70 months average.

Division or occlusion of patent ductus arteriosus?

The traditional and most effective form of treatment of persistent ductus arteriosus is surgical ductal division. New therapeutic techniques such as intraluminal ductal occlusion are currently recommended to replace the traditional treatment procedure. The purpose of this paper is to analyze the state of the art of these new therapeutic modalities. From reports in the medical literature, the authors analyzed the indications, results, and complications of the intraluminal ductal occlusion procedures. They applied the Student's t test for independent samples to evaluate the results of intraluminal patent ductus arteriosus occlusion by means of umbrellas, buttons, coils, and Gianturco-Grifka and Amplatzer occluders, respectively, in 2,691 patients collected from the medical literature. According to their analysis the results of intraluminal ductal occlusion with coils were as follows: success 83.7 +/- 12.2%, failure 3.9 +/- 2.8%, incomplete ductal occlusion 17.5 +/- 15.3%, need for surgery 2.8 +/- 3.8%, need for a second intraluminal procedure 5.8 +/- 9.9%, and device embolization 6.2 +/- 7.2%. The use of the Gianturco-Grifka device showed the following results: success 96.0 +/- 5.6%, failure 4.0 +/- 5.6%, incomplete ductal occlusion 4.0 +/- 5.6%, need for surgery 0%, need for a second intraluminal procedure 4.0 +/- 5.6%, and device embolization 4.0 +/- 5.6%. The Amplatzer occluder showed the following results: success 92.8 +/- 6.1%, failure 7.2 +/- 6.1%, incomplete ductal occlusion 2.0 +/- 4.3%, need for surgery 0%, need for a second intraluminal procedure 0.8 +/- 1.7%, and device embolization 0.5 +/- 1.3%. According to the state of the art, intraluminal ductal occlusion with Gianturco-Grifka device and Amplatzer occluder reduces the proportion of incomplete obstructions and need for surgery. Additionally, the use of the Amplatzer occluder reduces need for a second procedure and the embolization rate. Although the results obtained with the new procedures are better than those obtained previously, they are still not totally satisfactory.

[Immediate and long-term results of implantation of the new platinum coronary stent (atlas stent) in patients with coronary artery disease]. / Resultados inmediatos y a largo plazo del implante de un nuevo stent coronario de platino (stent Atlas) en pacientes con enfermedad arterial coronaria.

BACKGROUND AND OBJECTIVES: We evaluated the technical and clinical results of implantation of the Atlas stent, the hospital stay, and the short and long-term clinical and angiographic outcome. PATIENTS AND METHOD: The study included 169 patients (60.1 10.8 year-old), 60.3% of which had acute coronary syndromes and complex lesions. Immediate success was achieved in 98% of cases. The clinical follow-up in 85.7% of the patients at 14.3 6.8 months, revealed that 89% remained free of adverse events and most (94.4%) were functional class I of the CCS. Angiographic follow-up at 8.4 4.1 months of 40.9% of the cases revealed restenosis in 27.9%. There were 2 cases of subacute thrombosis. CONCLUSIONS: The application of the Atlas stent in patients with a diverse clinical spectrum demonstrated good immediate and long term results, with a rate of restenosis similar to that of other stents available on the market.

Resultados inmediatos y a largo plazo del implante de un nuevo stent coronario de platino (stent Atlas) en pacientes con enfermedad arterial coronaria / Immediate and long-term results of implantation of the new platinum coronary stent (Atlas stent) in patients with coronary artery disease

Introducción y objetivos. Evaluamos el resultado técnico y clínico de la aplicación del stent coronario de platino, la evolución hospitalaria, así como la evolución clínica y angiográfica, tanto a corto como a largo plazo. Pacientes y método. Incluimos a 169 pacientes consecutivos de 60,1 +/- 10,8 años, en su mayoría (60,3 por ciento) con síndromes isquémicos agudos y lesiones complejas. Se obtuvo éxito inmediato en el 98 por ciento de los casos. El seguimiento clínico en el 85,7 de los pacientes a los 14,3 +/- 6,8 meses reveló qu el 89 por ciento se mantuvo libre de acontecimientos adversos y la mayoría (94,4 por ciento) en clase funcional I. El seguimiento angiográfico a los 8,4 +/- 4,1 meses en 40,9 por ciento de los casos puso de manifiesto reestenosis en el 27,9 por ciento. Hubo 2 casos de trombosis subaguda. Conclusiones. La aplicación del sten Atlas TM en pacientes con espectro clínico diverso demostró buenos resultados inmediatos y tras el seguimiento, con tasas de reestenosis similares a las obtenidas con otros stents disponibles en el mercado (AU)

Cardiopatía isquémica aterosclerosa en pacientes con dextrocardia en situs viscerum inversus / Ischemic heart disease in two patients with dextrocardia in situs inversus

Se presentan la incidencia, manifestaciones clínicas, hallazgos radiológicos, electrocardiográficos, ecocardiográficos, gammagráficos y de cateterismo cardiáco de dos casos con la asociación de dextrocardia en situs viscerum inversus con cardiopatía insquémica por aterosclerosis coronaria, así como su evolución clínica y seguimiento a dos años. El primer paciente fue intervenido quirúrgicamente y evoluciona asintomático con prueba de esfuerzo máximo negativa. El segundo paciente, diabético, con anatomía coronaria desfavorable, no fue operado y está en la actualidad con angina estable en clase funcional II de la NYHA. Las características electrocardiográficas y encacardiográficas, y las estrategias angiográficas, son comentadas

Angiografía por substracción digital: experiencia inicial en México / Angiography by digital substraction: initial experience in México

La angiografia por substracción digital es una nueva técnica radiológica que utiliza una computadora de alta velocidad para procesar las imágenes, convertirlas en valores digitales y resaltar la información subliminal; así mismo elimina estructuras sin interés en la imagen fluoroscópica. En este artículo se informan la experiencia inicial en México y las aplicaciones clínicas del sistema digital de imágens durante los primeros 15 meses de estudio en el Hospital de Cardiología y Neumología del IMSS. El equipo consta de un sistema computarizado integrado a un aparato radiológico de una sala de hemodinamia para el procesado, la manipulación y la exposición de los datos o imágenes. La administración endovenosa de material de contraste con esta técnica produce angiografías adecuadas de corazón y arterias carótidas, torácicas, abdominale y femorales, y substituye a la angiografía arterial ordinaria en varias situaciones clínicas. Este método no es selectivo; sin embargo, ofrece menor riesgo, es más rápido y se puede realizar en pacientes externos con reducción de costos y molestias para el enfermo. El procedimiento endovenoso no es selectivo pero su utilidad se extiende a los procedimientos intrarteriales