[Peripheral and coronary angioscopy: its correlation with endovascular procedures]. / Angioscopía periférica y coronaria: su correlación en procedimientos endovasculares.

The efficacy of any method of transluminal angioplasty has been evaluated with angiography, this can show the major anatomic results. Angioscopy can detect by direct observation, the induced changes in the vessel wall morphology after the recanalization method. We studied 5 coronary arteries and 9 peripheral arteries with total occlusion in 7, and the other 7 with more than 75% of obstruction. All of them were evaluated with angiography and angioscopy, before and after the transluminal angioplasty. Eleven of the arteries were treated by transluminal ultrasound angioplasty, we obtained recanalization in 90% of them, in 6 (55%) of this we found angioscopic evidence of dissection in variable degrees. Two cases were treated only with balloon angioplasty, and the angioscopy image was of dissection too. In the only case of laser angioplasty we observed dark brown coloration in the treated lesion suggesting carbonization changes. The initial angiography analysis did not suggest the presence of complication of the atheroma plaque. However in 21% of the cases the angioscopy inspection demonstrated and hemorrhagic dye of the endothelium, and thrombosis in situ in 29%. We no found correlation in angiography and angioscopy aspect in 25% of the cases. Some of the endothelial alterations that can not be detectable by angiography, can be demonstrated by angioscopy, this changes could improve the appreciation of any recanalization method results, that could suggest its possible immediate and late complications.

Percutaneous transluminal ultrasonic angioplasty: preliminary clinical report of ultrasound plaque ablation in totally occluded peripheral arteries.

Peripheral arterial obstructive disease has been treated with ultrasound ablation. Thirty two patients (pts), mean age 67 +/- 10 years underwent angiosonoplasty, with a prototype ultrasonic system, due to severe claudication (31%), rest pain (44%), rest pain and ulceration (25%). Angiosonoplasty was successful in 26/32 (81%) stenoses, (1/2 iliac, 9/2 femorals, 11/12 popliteal, 5/6 tibial). Angiography before and after angiosonoplasty confirmed that the lesions were successfully opened, (81%, p less than 0.05). A mean of 3 +/- 2 passes were required to adequately remove sufficient plaque. Balloon angioplasty was used in combination with angiosonoplasty in 11/32 (34%) occluded vessels. Complications included groin hematoma in 4 pts (12%) and vascular spasm in two patients (6%). Within 24 hours, 27/32 (94%) pts were discharged clinically improved. Reocclusion occurred in 4 pts (12%) immediately after the procedure. Ankle brachial indices significantly increased from 0.52 +/- 0.10 before to 0.70 +/- 0.12 after (p less than 0.05). In conclusion, the use of ultrasound energy to ablate atherosclerotic plaque would appear safe, and has shown no restenosis and a low incidence of complications over a six month period.

[In vitro effects of argon laser radiation the human healthy and atherosclerotic aorta]. / Efectos in vitro de la radiación del laser de argón en aorta sana y aterosclerosa.

Argon laser exposures in vitro were done on human aortas. The laser energy applied on a fresh aorta section (A) was from 100mw to 1000mw. A second aorta section (B), formalin fixed, was irradiated under saline solution by a fiberoptic system. Laser energy was from 400mw to 720mw. The time exposures were all different in both sections. A and B histologic findings of thermal damage were similar Three zones of tissue injury were observed: I) crater because of tissue vaporization; II) coagulative necrosis surrounding it; and III) multiple vacuoles in the adjacent tissue produced by acoustic or shock injury. Tissue damage was related directly with total energy delivered: less than or equal to 500mw showed inner vascular wall necrosis, and at greater than or equal to 720mw it was perforated. Atherosclerotic tissue was more resistant to laser thermal injury than normal tissue. We could not find time relation with thermal damage. This preliminary information is an early step for the possible use of Argon laser on cardiovascular area.

[Simplified method for the early detection of post potentials in patients with acute myocardial infarct]. / Método simplificado para la detección temprana de postpotenciales en el paciente con infarto agudo del miocardio.

The risk of suddenly presenting ventricular tachyarrhythmias or death was analyzed in a prospective way in 71 patients with acute myocardial infarction and in 21 patients without any apparent cardiopathy. The average surface signal was measured when the patient was admitted in the hospital and on the following days of the acute phase of the infarction. Holter 24 hours monitoring and determination of the ejection fraction with radionuclide angiocardiography were also performed. Patients were divided into 4 groups, depending on the existence of arrhythmias and if late electric activity was recorded or not. Fifty-five patients (group I), presented an abnormal signal analysis (voltage in the 40 msec of the QRS period higher than 20 microvolts), and ventricular arrhythmias. Group II was formed by 8 patients who presented arrhythmogenic activity but did not present late electric activity. Group III was formed by 6 patients who did not present arrhythmias but presented late electric activity. Twenty-three patients who did not present late electric activity or ventricular arrhythmias formed group IV. Late electric activity that was registered at 41 +/- 1 msec with a QRS complex lasting 115 +/- 4 msec and with a voltage lower than 20 microvolts in group I showed meaningful differences with the other groups: Group II: (24 +/- 5 msec, QRS 111 +/- 4 msec, P less than 0.001); Group III: (41 +/- 2 msec, QRS 109 +/- 5 msec, P less than 0.01); Group IV: (26 +/- 5 msec, QRS 80 +/- 7 msec, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Transluminal coronary angioplasty using ultrasound]. / Angioplastía coronaria transluminal por ultrasonido.

The application of ultrasonic energy for ablation of atherosclerotic plaques was studied. This study was performed in 92 segments obtained from human coronary arteries which belonged to eleven hearts obtained from patients who have died from acute myocardial infarction. An ultrasound generating system (Cavitron 600) was used, and an ultrasonic probe wire (P-150 Endosonic), was attached to it. A stainless steel wire (0.36 mm in width and 145 cm length), was fixed to this probe. Sonic pulsed stimulations 20 sec long and 25 kHz in frequency were performed. The sound transmitting characteristics of the angioplasty guide wire were studied, as well as the ultrasound effects upon atherosclerotic plaques, blood elements, coagulation, and it's lysis effects upon recently formed clots. The anatomic pieces were filmed in cineangiocoronary graphy in two planes, anterior right oblique an anterior left oblique, to be studied later under light microscopy. The results were as following: in the 100% obstructions, a 41% recanalization was obtained; in the 95% obstructions, a 79%, in the 75% obstructions, a 37%. We did not work in the 50% or less obstructions. Under the procedure, no artery suffered perforations. Under Light microscopy, a plaque fragmentation was observed in 24% of the cases; rupture and fragmentation, in 14%, cavitations in 10%; ondulations in 9%; plaque rupture and thermic lesion in 8%; 22% did not present changes. The collected detritus had 110 +/- microns diameter. Erythrocytes exposed to 30 or 60 sec of ultrasound were found to present crenocytosis, central cavitation, hypochromia, and poikilocytosis; these ones exposed less than 22 sec did not show changes. The fibrinogen levels after the application of ultrasound were 19% lower. Coagulation time did not change with exposure 20 sec long at 20 kHs. The angioplasty guide wires attenuation coefficients were: with the guide wire outside the Miller's catheter, 44%; and with the guide wires inside, 65%. Coronary transluminal angiosonoplasty is a new interventionist technic designed to remodel an obstructive lesion of the coronary arteries, in order to diminish or nullify the obstruction. It's clinic use in the acute myocardial infarction, as a mechanical method to achieve clot's lysis, could be an alternative or a co-helper therapeutics to thrombolysis.

[X syndrome. Angiographic findings]. / Sindrome X. Signos angiográficos.

Coronary artery spasm is the most frequent cause of ischemic heart disease without coronary atherosclerosis once other causes such as cardiomyopathy, arteritis, coronary ectasia, valvular heart disease or hypertensive heart disease are eliminated. We report 23 patients, 15 males and 8 females, whose ages ranged from 34 to 63 years, with a mean age of 47 years, with demonstrated angina pectoris and myocardial ischemia, whose cardiac cineangiography showed no signs of atherosclerosis. Nevertheless, a significant retardation in the progression speed of the contrast medium was observed, as indirect evidence of the increment in coronary resistance at the arteriole level. Coronary spasm was ruled out by administration of intracoronary ergonovine, and other causes of myocardial ischemia, such as muscular bridges, were also discarded. The clinical presentation of the ischemic heart disease was unstable angina (UA) in 21 patients and myocardial infarction (MI) in 2. In the UA group, 14 patients showed ischemic changes in the ECG while the pain lasted, and in 8 patients the changes were present during the stress test. In all of them, the stress test perfusion scan with thallium 201 showed myocardial ischemia. In the IM group, the diagnosis was based on the clinical findings, the ECG, the enzyme curve, and the technetium 99 cardiac scintigram. In the two-year follow-up the prognosis has been favorable with treatment based on calcium antagonists. Nowadays 18 patients are asymptomatic, four have stable angina and only one has unstable angina.

[Left ventricular mural thrombus in acute anterior myocardial infarct]. / Trombo mural del ventrículo izquierdo en el infarto agudo del miocardio de localización anterior.

Fifty-six consecutive patients with acute anterior infarction were studied by two-dimensional echocardiography to determine the incidence and complications of left-ventricular thrombosis. Mean follow-up period was 4.4 months. Left-ventricular thrombus was demonstrated in 14 patients (25%) between 25 and 54 days after infarction (group A), in 42 patients (group B) it was not demonstrated. Apical and septal dyskinesis, and Forrester's hemodynamic subset-III were significantly (P less than 0.02) associated with thrombus development. Ten patients of group A received heparin (6.6 days mean); the remaining four patients received aspirin and dipyridamole. Thrombi formation were not significantly prevented with both treatments (chi 2 = 0.635). During follow-up period, thrombus persisted in 6 patients of group A, all of them with apical and septal dyskinesis. Three patients had a cerebrovascular accident (5.3%), one of them of group A; no heparin anticoagulation was administered in two. We conclude that apical and septal dyskinesis during acute anterior infarction is generally associated with mural thrombi development. Due to the embolic risk therapeutic anticoagulation must be considered in these patients.

[Angina pectoris with normal coronary arteries]. / Angor pectoris con coronarias normales.

Twelve patients 8 females and 4 males, whose ages varied from 33 to 60 years (median 50.6 years), were seen at the Hospital for Cardiology and Neurology of the Mexican Institute for Social Security. All were diagnosed as having angor pectoris, through the clinical history and physical exam. Three patients had stable angor and in nine it was of an unstable type. The resting ECG showed signs of subepicardial ischemia in five cases. In eight the stress ECG according to the Bruce technic showed depression of the ST segment over 1 mm. In one patient atrial stimulation was performed with a pacemaker and ischemic changes of the ST segment were normal in all cases; in two however, coronary spasm that reversed with nitroglycerin appeared. The left ventriculogram was normal in all but one that revealed diaphragmatic hypokinesia associated with right coronary spasm. All patients were followed from two to fifty six months (median 19.4), and only in one case the angor pectoris remained unchanged. In all others it decreased or disappeared. During this time there were no deaths, myocardial infarctions or severe arrhythmias.

Angor pectoris con coronarias normales. / Angina pectoris with normal coronary arteries

Se comunican 12 casos de aparente angor pectoris (cuyo estudio coronariografico fue normal), cuyas edades variaron de 33 a 60 anos, con una media de 50.6. Ocho pertenecian al sexo femenino y 4 al masculino. El diagnostico de angor fue hecho en base a la historia clinica. Fue considerado con caracter estable en 3 casos y en 9 inestable. El electrocardiograma (ECG) de reposo mostro signos de isquemia subepicardica en 5. En 8, el ECG de esfuerzo (Bruce) revelo desnivel negativo del ST mayor de 1 mm; en uno se efectuo estimulacion auricular con marcapaso, mostrando cambios inquemicos del ST. Las coronarias fueron angiograficamente normales en todos. En dos se presento espasmo coronario que fue reversible con nitroglicerina. El ventriculograma izquierdo fue normal en todos, excepto en uno que revelo hipocinesia diafragmatica asociada a espasmo de la coronaria derecha. Seguidos de dos a 56 meses (media de 19.4),el angor pectoris persistio igual solo en uno habiendo disminuido o desaparecido en el resto. En este lapso no hubo defunciones, infartos del miocardio ni arritmias graves

[Postero'inferior aneurysm of the left ventricle following myocardial infarction. Diagnosis and surgical treatment]. / Aneurisma posteroinferior del ventrículo izquierdo postinfarto del miocardio. Diagnóstico y tratamiento quirúrgico.

This is a report of the first four cases of left ventricle aneurysm of the posterior and inferior segments successfully treated surgically in the Hospital de Cardiología y Neumología del Centro Médico Nacional, México D. F., and represent the twelve per cent of all realized aneurysmectomies. The patients were all men with 57 years mean age, and a previous history of posteroinferior myocardial infarction, complicated in three of them with angor and severe ventricle arrythmias; chest X ray in lateral view showed a bump of the posteroinferior border of the cardiac silhouette; the echocardiography increase in the ventricular diameter below the mitral valve; the ventriculography made evident a diastolic bulging with systolic expansion of posterior and inferior segments of the left ventricle and no mitral regurgitation; selective coronary arteriography showed a dominant right pattern with 100 per cent proximal occlusion. Aneurysmectomy was done in all four cases and aortocoronary by-pass in two. The posteromedial papilar muscle was found respected in all cases and in two cases a mural thrombus was detected.