ABSTRACT
INTRODUCTION: Hyperbaric oxygen therapy (HBOT) is a promising treatment modality for ischemic heart disease including myocardial infarction where outcomes are frequently poor despite early revascularization. OBJECTIVE: To compare single-photon emission computed tomography (SPECT) findings in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) treated with HBOT vs. control at 6â¯weeks. METHODS: In this pilot study, 24 patients were randomly allocated to HBOT (nâ¯=â¯13) and control groups (nâ¯=â¯11). Both groups underwent PPCI and were treated following the guidelines for STEMI management. The HBOT group received additional 15 and 90-minute HBOT sessions. All participants underwent SPECT at initial presentation (within 48â¯h of PPCI) and at follow up. RESULTS: Baseline characteristics were similar in both groups. The number of affected SPECT segments in the HBOT group at baseline and 6â¯weeks were 47.1⯱â¯14.6% vs. 33.7⯱â¯16.2%, respectively, with pâ¯=â¯0.039, and in the control group, the number of affected segment at these times were 55.5⯱â¯19.5% vs. 45.9⯱â¯17.9%, respectively, with pâ¯=â¯0.090. At follow-up, a decrease in the summed rest score was noted in both groups (HBOT: 20⯱â¯6.0 vs. 12.7⯱â¯8.1; pâ¯=â¯0.0017; control: 23⯱â¯8.2 vs. 16.7⯱â¯6.6; pâ¯=â¯0.031). The left ventricular ejection fraction in the HBOT group improved from 44⯱â¯22.1% to 57.2⯱â¯15.4% (pâ¯=â¯0.011) and in the control group from 45.9⯱â¯18.2% to 55⯱â¯12.1% (pâ¯=â¯0.044). CONCLUSIONS: HBOT use in STEMI patients was associated with an improvement in perfusion and an increase in ejection fraction following PPCI. These observations warrant a larger randomized clinical trial.
Subject(s)
Hyperbaric Oxygenation , Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/therapy , Percutaneous Coronary Intervention/adverse effects , Pilot Projects , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/surgery , Stroke Volume , Treatment Outcome , Ventricular Function, LeftABSTRACT
Background: Aortic stenosis (AS) is one of the most frequent valvulopathies in elderly patients. The treatment for AS is heart surgery; however, many patients do not benefit from this treatment because they are considered to be at high surgical or inoperable risk. Transcatheter aortic valve implantation (TAVI) was developed for these patients. Objective: To disseminate the feasibility and safety of other access routes for the implantation of transcatheter aortic valves and that it can also be performed in the hemodynamic laboratory. In addition to the rapid growth in technology and knowledge, there is a lot of experience with TAVI already. Methodology: One of the limitations is the diameter of the femoral, subclavian, and axillary vascular accesses. This is why other approaches such as the direct aortic approach are sought after, despite the invasive nature of mini-thoracotomy and aortotomy is technically feasible, familiar, and easy to learn for cardiac surgeons. Results: In addition, it has been associated with favorable outcomes and a lower rate of complications (bleeding and risk of myocardial injury) and shorter length of stay in the intensive care unit compared to surgery or transapical access. Conclusions: Our center successfully implanted the self-expandable aortic valve Evolut™ through direct aortic for presenting a dissection in transverse aorta with possibilities of embolization.
Antecedentes: La estenosis aórtica es una de las valvulopatías más frecuentes en el paciente mayor. Su tratamiento es la cirugía de corazón, sin embargo, muchos pacientes no se benefician de este tratamiento por considerarse de alto riesgo quirúrgico o inoperables. Para estos últimos pacientes se desarrolló el implante de válvula aórtica transcatéter (TAVI). Objetivo: Dar a conocer la factibilidad y seguridad de otras vías de acceso para la implantación de válvulas aórticas transcatéter y que además se puede realizar en el laboratorio de hemodinámica. Además de un rápido crecimiento en tecnología y conocimientos, actualmente ya se tiene mucha experiencia con TAVI. Metodología: Una de las limitantes es el diámetro de los accesos vasculares femorales, subclavio y axilar. Es por esto por lo que se buscan otros accesos como el aórtico directo, a pesar del carácter invasivo de la minitoracotomía y aortotomía es técnicamente factible, familiar y fácil de aprender para los cirujanos cardíacos. Resultado: Se ha asociado con resultados favorables y una menor tasa de complicaciones (sangrado, riesgo de lesión miocárdica) y menor duración de la estancia en la Unidad de Cuidados Intensivos en comparación con la cirugía o el acceso transapical. Conclusión: Nuestro centro implantó con éxito la válvula aórtica autoexpandible Evolut™ vía aórtica directa por presentar una disección en la aorta transversa con posibilidades de embolización.
Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Aged , Female , Humans , Mexico , Prosthesis DesignABSTRACT
Background: Aortic stenosis is one of the most frequent valvulopathies in the elderly patient. The treatment for aortic stenosis is heart surgery, however many patients do not benefit from this treatment because they are considered to be at high surgical or inoperable risk. Transcatheter aortic valve (TAVI) was developed for these patients. Objective: To make known the feasibility and safety of other access routes for the implantation of transcatheter aortic valves and that it can also be performed in the hemodynamic laboratory. In addition to rapid growth in technology and know-how, TAVI is already very experienced. Methodology: One of the limitations is the diameter of the femoral, subclavian, and axillary vascular accesses. This is why other approaches such as the direct aortic approach are sought, despite the invasive nature of mini-thoracotomy and aortotomy is technically feasible, familiar and easy to learn for cardiac surgeons. Results: In addition, it has been associated with favorable outcomes and a lower rate of complications (bleeding, risk of myocardial injury) and shorter length of stay in the Intensive Care Unit compared to surgery or transapical access. Conclusion: Our center successfully implanted the self-expandable aortic valve Evolut™ via direct aortic for presenting a dissection in transverse aorta with possibilities of embolization.
Antecedentes: La estenosis aórtica es una de las valvulopatías más frecuentes en el paciente mayor. Su tratamiento es la cirugía de corazón, sin embargo, muchos pacientes no se benefician de este tratamiento por considerarse de alto riesgo quirúrgico o inoperables. Para estos últimos pacientes se desarrolló el implante de válvula aórtica transcatéter (TAVI). Objetivo: Dar a conocer la factibilidad y seguridad de otras vías de acceso para la implantación de válvulas aórticas transcatéter y que además se puede realizar en el laboratorio de hemodinámica. Además de un rápido crecimiento en tecnología y conocimientos, actualmente ya se tiene mucha experiencia con TAVI. Metodología: Una de las limitantes es el diámetro de los accesos vasculares femorales, subclavio y axilar. Es por esto por lo que se buscan otros accesos como el aórtico directo, a pesar del carácter invasivo de la minitoracotomía y aortotomía es técnicamente factible, familiar y fácil de aprender para los cirujanos cardíacos. Resultado: Se ha asociado con resultados favorables y una menor tasa de complicaciones (sangrado, riesgo de lesión miocárdica) y menor duración de la estancia en la Unidad de Cuidados Intensivos en comparación con la cirugía o el acceso transapical. Conclusión: Nuestro centro implantó con éxito la válvula aórtica autoexpandible Evolut™ vía aórtica directa por presentar una disección en la aorta transversa con posibilidades de embolización.
ABSTRACT
Resumen Antecedentes: La estenosis aórtica es una de las valvulopatías más frecuentes en el paciente mayor. Su tratamiento es la cirugía de corazón, sin embargo, muchos pacientes no se benefician de este tratamiento por considerarse de alto riesgo quirúrgico o inoperables. Para estos últimos pacientes se desarrolló el implante de válvula aórtica transcatéter (TAVI). Objetivo: Dar a conocer la factibilidad y seguridad de otras vías de acceso para la implantación de válvulas aórticas transcatéter y que además se puede realizar en el laboratorio de hemodinámica. Además de un rápido crecimiento en tecnología y conocimientos, actualmente ya se tiene mucha experiencia con TAVI. Metodología: Una de las limitantes es el diámetro de los accesos vasculares femorales, subclavio y axilar. Es por esto por lo que se buscan otros accesos como el aórtico directo, a pesar del carácter invasivo de la minitoracotomía y aortotomía es técnicamente factible, familiar y fácil de aprender para los cirujanos cardíacos. Resultado: Se ha asociado con resultados favorables y una menor tasa de complicaciones (sangrado, riesgo de lesión miocárdica) y menor duración de la estancia en la Unidad de Cuidados Intensivos en comparación con la cirugía o el acceso transapical. Conclusión: Nuestro centro implantó con éxito la válvula aórtica autoexpandible Evolut vía aórtica directa por presentar una disección en la aorta transversa con posibilidades de embolización.
Abstract Background: Aortic stenosis is one of the most frequent valvulopathies in the elderly patient. The treatment for aortic stenosis is heart surgery, however many patients do not benefit from this treatment because they are considered to be at high surgical or inoperable risk. Transcatheter aortic valve (TAVI) was developed for these patients. Objective: To make known the feasibility and safety of other access routes for the implantation of transcatheter aortic valves and that it can also be performed in the hemodynamic laboratory. In addition to rapid growth in technology and know-how, TAVI is already very experienced. Methodology: One of the limitations is the diameter of the femoral, subclavian, and axillary vascular accesses. This is why other approaches such as the direct aortic approach are sought, despite the invasive nature of mini-thoracotomy and aortotomy is technically feasible, familiar and easy to learn for cardiac surgeons. Results: In addition, it has been associated with favorable outcomes and a lower rate of complications (bleeding, risk of myocardial injury) and shorter length of stay in the Intensive Care Unit compared to surgery or transapical access. Conclusion: Our center successfully implanted the self-expandable aortic valve Evolut via direct aortic for presenting a dissection in transverse aorta with possibilities of embolization.
Subject(s)
Aged , Female , Humans , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Prosthesis Design , MexicoABSTRACT
Resumen El oxígeno hiperbárico (HBO2) es un tratamiento útil para enfermedades isquémicas; sin embargo, como tratamiento coadyuvante en el infarto al miocardio (IAM), existe muy poca experiencia a nivel mundial; ha sido utilizado en algunos trabajos de investigación como tratamiento único en una sola exposición en el contexto de un infarto agudo con elevación del segmento ST (IAMCEST) y adicional a la trombólisis. Nuestro estudio describe la factibilidad y seguridad de dosis continuas de tratamiento con HBO2 después de un infarto al mejorar la función del ventrículo izquierdo. Objetivo El objetivo de este trabajo es describir la experiencia y la seguridad de las dosis de HBO2 en el paciente con IAMCEST llevado a angioplastia primaria para mejorar la función del ventrículo izquierdo. Material y métodos Se reunieron 24 pacientes aleatorizados en dos grupos: 13 en el de casos y 11 controles. Ambos grupos fueron llevados a angioplastia primaria y tratamiento convencional. Se valoró la función ventricular izquierda con SPECT CT; el grupo de casos recibió 15 sesiones repetidas de 90 minutos de isopresión a 2.0 ATA. Resultados Los dos grupos eran de similares características; ingresaron al hospital con un IAMCEST y fueron llevados a angioplastia primaria, aleatorizados en dos grupos; el de casos fue llevado a la cámara hiperbárica para recibir dosis diarias por 15 días de HBO2 a 2 ATA por 90 minutos de isopresión. No se presentaron durante el tratamiento con oxígeno hiperbárico complicaciones cardiovasculares: reinfarto, sangrados, descontrol hipertensivo, arritmias ni datos de insuficiencia cardiaca. En cuanto a complicaciones propias de la cámara hiperbárica, sólo un paciente presentó claustrofobia importante. Además, se observó un beneficio adicional al tratamiento convencional del IAMCEST: la fracción de expulsión del ventrículo izquierdo (FEVI) en el IAM anteroseptal mejoró significativamente en el grupo de casos. Conclusiones El oxígeno hiperbárico a dosis continuas es seguro y factible como tratamiento adicional al paciente con IAMCEST llevado a angioplastia primaria, además de mejorar la función ventricular izquierda en los infartos extensos.
Abstract Hyperbaric oxygen (HBO2) is a useful treatment for ischemic diseases; however, as an adjuvant treatment in myocardial infarction (MI), there is very little experience worldwide. It has been used in some research work as a single treatment in a single exposure in the context of an ST-segment elevation myocardial infarction (STEMI) and in addition to thrombolysis. Our study describes the feasibility and safety of continuous doses of HBO2 after a heart attack by improving left ventricular function. Objective The objective of this study is to describe the experience and safety of HBO2 doses in the patient with STEMI taken to primary angioplasty to improve left ventricular function. Material and methods 24 randomized patients were collected and divided into two groups: 13 in the case group and 11 control patients. Both groups were taken to primary angioplasty and conventional treatment. Left ventricular function was assessed with SPECT CT; the case group received 15 repeated 90-minute sessions of isopressure at 2.0 ATA. Results The two groups were similar in characteristics; they were admitted to the hospital with an STEMI, taken to primary angioplasty, randomized into two groups. The group of cases was taken to the hyperbaric chamber to receive daily doses of HBO2 for 15 days at 2 ATA for 90 minutes of isopressure. There were no cardiovascular complications during the treatment with hyperbaric oxygen: reinfarction, bleeding, hypertensive disorder, arrhythmias or heart failure data. Complications typical of the hyperbaric chamber: only one patient presented significant claustrophobia. In addition to the benefits of the conventional treatment of STEMI, the left-ventricular ejection fraction (LVEF) in anteroseptal MI was significantly improved in the group of cases. Conclusions Continuous-dose hyperbaric oxygen is safe and feasible as an additional treatment for patients with STEMI taken to primary angioplasty, in addition to improving left ventricular function in extensive heart attacks.
ABSTRACT
Resumen Introducción El implante de la válvula aórtica transcatéter (TAVI) es un tratamiento de mínima invasión e innovador con buenos resultados, para pacientes con estenosis aórtica de riesgo quirúrgico intermedio o alto; sin embargo, la gran mayoría de los pacientes son de edad avanzada y con múltiples comorbilidades que condicionan un aumento de la mortalidad y en muchos casos de las complicaciones. Un punto crucial y determinante para una buena evolución es el papel del equipo de corazón de una institución, ya que un equipo incompleto o con poca experiencia conlleva a una mala selección de pacientes. En nuestra institución el equipo de corazón pasó a ser un equipo multidisciplinario integrado por varias especialidades para la valoración integral de los pacientes. Material y Métodos Se llevó a cabo una cohorte de 36 pacientes en el Hospital Central Militar desde septiembre del 2013 a octubre del 2017. Se reunieron 36 pacientes con estenosis aórtica y tratados con TAVI; los primeros 17 pacientes fueron evaluados por un cirujano cardiovascular, dos cardiólogos intervencionistas, y dos cardiólogos clínicos. Posteriormente se evaluaron 19 pacientes en donde se incluyó en el equipo multidisciplinario a una geriatra, neumólogo, neurólogo, entre otras especialidades. Resultados De los 36 pacientes en total que fueron llevados a TAVI, los primeros 17 pacientes fueron seleccionados por el equipo de corazón desde el inicio del programa hasta el 2015 (47.2%) y los últimos 19 pacientes (del 2015 a la fecha) valorados por el equipo multidisciplinario (52.7%). En el primer grupo fallecieron durante el seguimiento a un año, por muerte de causa no cardiaca, ocho de 17 pacientes (47%) y en el segundo grupo, dos pacientes de 19 (10.5%), una muerte cardiaca y otra no cardiaca. Conclusiones Los resultados de un programa para TAVI están basados en tres puntos fuertes: las instalaciones, la formación del equipo de corazón y la experiencia del equipo implantador de válvulas; sin embargo, nosotros formamos un equipo multidisciplinario integrado por el equipo de corazón y otro personal de salud trascendental en la selección y seguimiento de los pacientes con mejores resultados a corto y largo plazo.
Abstract Introduction The implantation of the transcatheter aortic valve (TAVI) is a minimally invasive and innovative treatment with good results for patients with aortic stenosis of intermediate or high surgical risk; However, the vast majority of patients are elderly and have multiple co-morbidities that lead to increased mortality and in many cases to complications. A crucial and determining point for a good evolution is the role of the heart team of an institution, since an incomplete team or with little experience leads to a poor selection of patients. In our institution, the heart team became a multidisciplinary team composed of several specialties for the comprehensive assessment of patients. Material and Methods A cohort of 36 patients was carried out at the Central Military Hospital from September 2013 to October 2017. Thirty-six patients with aortic stenosis and treated with TAVI were met; The first 17 patients were evaluated by a cardiovascular surgeon, two interventional cardiologists, and two clinical cardiologists. Subsequently, a geriatrician, a pulmonologist, and a neurologist were included in the multidisciplinary team, among other specialties. Results Of the 36 patients in total who were taken to TAVI, the first 17 patients selected by the heart team from the beginning of the program until 2015 (47.2%) and the last 19 patients (from 2015 to date) valued by the multidisciplinary team (52.7%). In the first group, they died during the follow-up at one year, 8 of 17 patients (47%) and in the second group, 2 patients of 19 (10.5%). Conclusions The results of a program for TAVI are based on three strengths, the facilities, the training of the heart team and the experience of the valve implantation team, however, we form a multidisciplinary team composed of the heart team and another transcendental health personnel in the selection and follow-up of patients.
ABSTRACT
Resumen La aterosclerosis es una enfermedad que involucra múltiples mecanismos fisiopatológicos cuyo conocimiento no se ha dilucidado por completo. Con frecuencia, los avances científicos sobre la fisiopatología aterogénica generan que a diversas moléculas no consideradas previamente en el panorama de dicha enfermedad se les atribuyan acciones sobre el inicio o progresión de la misma. Un ejemplo representativo es el estudio de un nuevo mecanismo involucrado en el proceso aterogénico, consistente en la asociación entre el sistema de factores de crecimiento similares a la insulina (IGF) y la proteína plasmática A asociada al embarazo (PAPP-A). El sistema IGF es una familia de péptidos compuesto por 3 hormonas peptídicas, 4 receptores transmembranales y 6 proteínas transportadoras. El factor de crecimiento similar a la insulina tipo 1 (IGF-1) es el principal ligando del sistema IGF involucrado en la aterosclerosis coronaria y ejerce sus efectos mediante la activación del receptor IGF-1R en células de músculo liso vascular de las arterias coronarias o en macrófagos de placas ateroscleróticas. En células de músculo liso vascular promueve la migración y previene la apoptosis aumentando la estabilidad de la placa, y en macrófagos disminuye el transporte reverso de colesterol propiciando la formación de células espumosas. La regulación de la biodisponibilidad de IGF-1 en el endotelio se lleva a cabo por las proteasas de proteínas IGFBP, principalmente por la PAPP-A. En la presente revisión se abordan los mecanismos involucrados entre el sistema IGF y la PAPP-A en aterosclerosis coronaria con énfasis en los efectos moleculares producidos en células de músculo liso vascular y en macrófagos.
Abstract Atherosclerosis is a condition that involves multiple pathophysiological mechanisms and whose knowledge has not been fully elucidated. Often, scientific advances on the atherogenic pathophysiology generate that molecules not previously considered in the scene of this disease, were attributed actions on the onset or progression of it. A representative example is the study of a new mechanism involved in the atherogenic process, consisting of the association between the insulin-like growth factor (IGF) system and pregnancy-associated plasma protein-A (PAPP-A). Insulin-like growth factor system is a family of peptides that include 3 peptide hormones, 4 transmembrane receptors and 6 binding proteins. Insulin-like growth factor-1 (IGF-1) is the main ligand of the IGF system involved in coronary atherosclerosis. IGF-1 exerts its effects via activation of the IGF-1R receptor on vascular smooth muscle cells or macrophages. In vascular smooth muscle cells promotes migration and prevents apoptosis which increases plaque stability while in macrophages reduces reverse cholesterol transport leading to the formation of foam cells. Regulation of IGF-1 endothelial bioavailability is carried out by IGFBP proteases, mainly by PAPP-A. In this review, we address the mechanisms between IGF system and PAPP-A in atherosclerosis with emphasis on molecular effects on vascular smooth muscle cells and macrophages.
Subject(s)
Humans , Animals , Pregnancy-Associated Plasma Protein-A/physiology , Coronary Artery Disease/etiology , Insulin-Like Growth Factor I/physiologyABSTRACT
Atherosclerosis is a condition that involves multiple pathophysiological mechanisms and whose knowledge has not been fully elucidated. Often, scientific advances on the atherogenic pathophysiology generate that molecules not previously considered in the scene of this disease, were attributed actions on the onset or progression of it. A representative example is the study of a new mechanism involved in the atherogenic process, consisting of the association between the insulin-like growth factor (IGF) system and pregnancy-associated plasma protein-A (PAPP-A). Insulin-like growth factor system is a family of peptides that include 3 peptide hormones, 4 transmembrane receptors and 6 binding proteins. Insulin-like growth factor-1 (IGF-1) is the main ligand of the IGF system involved in coronary atherosclerosis. IGF-1 exerts its effects via activation of the IGF-1R receptor on vascular smooth muscle cells or macrophages. In vascular smooth muscle cells promotes migration and prevents apoptosis which increases plaque stability while in macrophages reduces reverse cholesterol transport leading to the formation of foam cells. Regulation of IGF-1 endothelial bioavailability is carried out by IGFBP proteases, mainly by PAPP-A. In this review, we address the mechanisms between IGF system and PAPP-A in atherosclerosis with emphasis on molecular effects on vascular smooth muscle cells and macrophages.
Subject(s)
Coronary Artery Disease/etiology , Insulin-Like Growth Factor I/physiology , Pregnancy-Associated Plasma Protein-A/physiology , Animals , HumansABSTRACT
OBJECTIVE: Transcatheter aortic valve implantation (TAVI) is an alternative treatment for patients with severe symptomatic aortic stenosis, inoperable or at high surgical risk. The purpose of this communication is to report the results of the experience of this new technique and compare them with literature. METHODS: Review of 17 patients data with symptomatic severe aortic stenosis at high surgical risk or inoperable, treated with a transcatheter implantation aortic valve (TAVI) via femoral surgical access with Core Valve (Medtronic, EE.UU.) between September 2013 and July 2014. RESULTS: All patients had severe aortic stenosis with a mean gradient of 46Ìæ14 mmHg received CoreValveTM (Medtronic, USA). Half of patients was performed under general anesthesia, the other half with regional and local anesthesia. In-hospital mortality was 11.7% and one death in follow-up from September 2013 until the time of preparing this report (5.9%).Total mortality at one year follow-up was 17.6%. The technical success rate was 82.4%, with an immediate post-implantation gradient of 5.4Ìæ3.4 mmHg. Aortic regurgitation I degree was observed in 5 patients (29.4%); 2 patients (11.7%) had aortic regurgitation grade II. Post dilatation was made in 6 patients (35.2%). We did not have any vascular complications. Permanent pacemaker implantation was needed in 6 patients (35.2%). One patient complicated with acute renal failure, 2 had in-hospital ischemic stroke (11.7%), none had need for cardiac surgery; 2 patients had major bleeding complications that required transfusion. CONCLUSIONS: In patients with high surgical risk or inoperable, TAVI is a treatment option that improves life quality, survival and diminsh the need of hospitalizations. There can be some complications and even death, so that a proper patient selection and a multidisciplinary team is needed and fundamental for a successful procedure.
Subject(s)
Mitral Valve Stenosis/surgery , Transcatheter Aortic Valve Replacement , Aged , Aged, 80 and over , Female , Hospitals, Military , Humans , Male , Middle AgedABSTRACT
AIM: To review the results of myocardial perfusion during rest and post-pharmacological stress induced by dipyridamole and analyze the SPECT images in patients with complete left bundle branch block LBBB, comparing the results in the presence of a normal coronary angiographic study and with critical coronary obstructions. METHODS: Results from 50 studies of myocardial perfusion of patients with complete block of the LBBB were reviewed and segmental perfusion was analyzed comparing these results with those obtained with those from the diagnostic coronariography. RESULTS: From the 15 studied patients, divided in two groups, 9 with angiographically normal coronaries and 6 with significant coronary lesions, it was not possible to establish a typical perfusion pattern due to the small size of the sample, revealing that the perfusion defects cannot be explained only by the electrocardiographic alterations since other factors participate, such as left ventricular telediastolic hypertension on the interventricular septum as a consequence of the loss of synchrony in ventricular contraction. CONCLUSIONS: Regional myocardial perfusion in patients with complete block of the LBBB is altered in 95% of the cases without relation with the presence of significant coronary alterations.
Subject(s)
Bundle of His , Dipyridamole , Heart Block/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Tomography, Emission-Computed, Single-Photon , Vasodilator Agents , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , PerfusionABSTRACT
Propósito del trabajo: Revisar los resultados de perfusión miocárdica en reposo y post estrés farmacológico con dipiridamol e imágenes SPECT en pacientes con Bloqueo Completo de Rama Izquierda del Haz de His y comprar resultados cuando se tienen coronarias angiográficamente normales y con obstrucciones coronarias críticas. Método: Se revisaron los resultados de 50 estudios de perfusión miocárdica de los pacientes con Bloqueo de Rama Izquierda del Haz de His y se analizó la perfusión segmentaria comparándola con la coronariografía diagnóstica. Resultados: De los 15 pacientes estudiados, divididos en 2 grupos, 9 con coronarias angiográficamente normales y 6 con lesiones coronarias significativas, no es posible establecer un patrón de perfusión típico para cada entidad por el pequeño tamaño de la muestra y pone de manifiesto que los defectos de perfusión no se explican únicamente por las alteraciones electrocardiográficas pues influyen factores como la hipertensión telediastólica ventricular izquierda sobre el septum interventricular como consecuencia de la pérdida de sincronía en la contracción ventricular. Conclusiones: La perfusión miocárdica regional en pacientes con BRIHH está alterada en el 95% de los casos sin relación a la presencia de lesiones coronarias significativas.
AIM: To review the results of myocardial perfusion during rest and post-pharmacological stress induced by dipyridamole and analyze the SPECT images in patients with complete left bundle branch block LBBB, comparing the results in the presence of a normal coronary angiographic study and with critical coronary obstructions. Methods: Results from 50 studies of myocardial perfusion of patients with complete block of the LBBB were reviewed and segmental perfusion was analyzed comparing these results with those obtained with those from the diagnostic coronariography. Results: From the 15 studied patients, divided in two groups, 9 with angiographically normal coronaries and 6 with significant coronary lesions, it was not possible to establish a typical perfusion pattern due to the small size of the sample, revealing that the perfusion defects cannot be explained only by the electrocardiographic alterations since other factors participate, such as left ventricular telediastolic hypertension on the interventricular septum as a consequence of the loss of synchrony in ventricular contraction. Conclusions: Regional myocardial perfusion in patients with complete block of the LBBB is altered in 95% of the cases without relation with the presence of significant coronary alterations.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bundle of His , Dipyridamole , Heart Block , Radiopharmaceuticals , Tomography, Emission-Computed, Single-Photon , Vasodilator Agents , PerfusionABSTRACT
The efficacy and safety of the transcatheter patch (TP) correction of a secundum atrial septal defect (ASD) was studied acutely and on short-term follow-up in 20 patients, successfully implanted with the device. TPs are made of polyurethane foam and require temporary balloon catheter immobilization on the atrial septum for 48 hours. Eighteen patients were not suitable for disk-device repair. The patient median age and ASD diameter were 37 years and 26 mm, respectively. Eighteen patients had immediate effective ASD occlusion; 2 patients had significant residual shunts. Premature leaks of the supportive balloons were responsible for the residual shunts. One of the patients with residual shunt received a second patch 6 months later with full occlusion. All patients with implants were doing well up to 24 months after implantation. Existing symptoms improved although residual shunts remained; septal anatomy was normalized, with the patched area becoming progressively indistinguishable from the rest of the septum. In conclusion, TP occlusion of secundum ASD is feasible and effective even for defects unsuitable for disk-device repair. The method appears safe acutely and on short-term follow-up, with symptomatic improvement and normalization of septal anatomy.
Subject(s)
Cardiac Surgical Procedures/instrumentation , Catheterization/instrumentation , Heart Septal Defects, Atrial/surgery , Prostheses and Implants , Adolescent , Adult , Aged , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Catheterization/adverse effects , Catheterization/methods , Child , Echocardiography , Echocardiography, Transesophageal , Follow-Up Studies , Foreign-Body Migration/etiology , Foreign-Body Migration/surgery , Humans , Middle Aged , Monitoring, Physiologic , Patient Selection , Prostheses and Implants/adverse effects , Reoperation , Treatment OutcomeABSTRACT
Se presentan los resultados quirúrgicos en cinco pacientes con obstrucción del conducto nasolagrimal, todos con epífora de por lo menos un año de evolución, manipulados con sondeos en al menos dos ocaciones; tres tenían antecedentes de dacriocistitis aguda. Se usó un novedoso sistema de ablación rotacional, utilizando una fresadora de acero de 1.5 a 2 mm , recubierta con polvo de diamante, manejada a través de una camisa flexibe. Se hace rotar a 190,000 r.p.m. en el sitio de la obstrucción, bajo monitorización endoscópica y fluoróscopica. En un seguimiento de 6 meses, se comprobó la permeabilidad del conducto nasolagrimal, así como desaparición de la epífora en el 60 por ciento de otras: no altera la anatomía ni la fisiología del sistema lagrimal, trata únicamente el sitio afectado sin lesionar estructuras anatómicas adyacentes y no deja cicatrices visibles en la cara. Los autores se encuentran ya desarrollando una férula intralagrimal para mejorar los resultados y seguir participando en las cirugías consideradas limítrofes entre las diversas especialidades