RESUMEN
Percutaneous balloon valvuloplasty has been used with good results to treat rheumatic mitral stenosis. However, its use in degenerative aortic stenosis has shown many limitations. There is little information about balloon valvuloplasty in tricuspid and aortic rheumatic stenosis. This article describes two patients with combined rheumatic mitral, aortic and tricuspid stenosis in which triple percutaneous valvuloplasty was performed in a single procedure.
Asunto(s)
Estenosis de la Válvula Aórtica/terapia , Cateterismo , Estenosis de la Válvula Mitral/terapia , Cardiopatía Reumática/terapia , Estenosis de la Válvula Tricúspide/terapia , Adulto , Estenosis de la Válvula Aórtica/etiología , Femenino , Humanos , Masculino , Estenosis de la Válvula Mitral/etiología , Estenosis de la Válvula Tricúspide/etiologíaRESUMEN
BACKGROUND AND OBJECTIVES: Previous noncontrolled studies yield conflicting data about the influence of long inflation times on restenosis rate after PTCA. To clear these differences, we designed an open, prospective and randomized study to assess the effect of long versus standard balloon inflations in the incidence of restenosis. METHODS: 153 consecutive patients selected for one-vessel PTCA (62 LAD, 43 LCx, 48 RCA), were randomized to prolonged inflation (13.5 +/- 3.3 min) at 6 atmospheres using an autoperfusion catheter (72 patients) or to standard inflations (3.1 +/- 1.6 min) using conventional catheters (81 patients). Vessel diameter < 2.5 mm, lesions located at distal segments, complete occlusions, tortuous, long, bifurcated or thrombotic lesions were excluded. RESULTS: No significant differences in age, gender, coronary risk factors, ejection fraction, incidence of unstable angina or previous myocardial infarction existed between the two groups. There were no differences either between the dilated vessel, type of lesion (A, B, C) or the segment (proximal, mid) attempted. Successful dilation was obtained in 77/81 (95.0%) cases with standard inflation and in 58/72 (80.5%) with prolonged inflations (p = 0.01), leading to a decrease in the percentage of stenosis from 79.1 +/- 10.6% to 20.2 +/- 15.8% and from 81.4% +/- 9.9% to 21.0 +/- 13.0%, respectively (p = NS). A follow-up coronary arteriogram was obtained in 72/77 patients (93.5%) with standard inflation (mean: 18 +/- 6 weeks) and in 54/58 patients (93.1%) with prolonged inflation (mean: 17 +/- 3 weeks). Restenosis (arterial diameter reduction > 50%) was present in 23/72 (31.9%) of the standard inflation and in 22/54 (40.7%) of the prolonged inflation group (p = 0.4). CONCLUSIONS: These results suggest that longer balloon inflation periods do not reduce the restenosis rate after balloon coronary angioplasty.
Asunto(s)
Angioplastia Coronaria con Balón/métodos , Enfermedad Coronaria/terapia , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Recurrencia , Factores de TiempoAsunto(s)
Angioplastia Coronaria con Balón/métodos , Adulto , Anciano , Anciano de 80 o más Años , Angina Inestable/epidemiología , Angina Inestable/terapia , Angioplastia Coronaria con Balón/instrumentación , Angioplastia Coronaria con Balón/estadística & datos numéricos , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Microondas , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/terapia , Terapia por Radiofrecuencia , Recurrencia , TemperaturaRESUMEN
We describe five cases of posttraumatic anterior acute myocardial infarction in young patients, without previous heart disease. One case was treated with intracoronary thrombolysis and angioplasty, 3 cases received systemic thrombolysis, and the last one did not have any re-permeabilization therapy, having arrived to the hospital 72 hours after the episode. The coronary angiograms showed at the left anterior descending artery: thrombosis in 3 cases, coronary dissection in one case, and slow flow with no morphological lesions in the other. The case which not received thrombolytic therapy developed a severe left ventricular dysfunction. In conclusion we emphasize an early angiographic study, in order to decide the re-permeabilization therapy.
Asunto(s)
Infarto del Miocardio/diagnóstico , Traumatismos Torácicos/diagnóstico , Heridas no Penetrantes/diagnóstico , Accidentes de Tránsito , Adulto , Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/diagnóstico , Humanos , Masculino , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/etiología , Fútbol/lesiones , Traumatismos Torácicos/complicaciones , Terapia Trombolítica , Factores de Tiempo , Heridas no Penetrantes/complicacionesRESUMEN
We describe four cases of acute myocardial infarction in young patients, secondary to blunt chest trauma. One case was treated with intracoronary thrombolysis and angioplasty, two cases received systemic thrombolysis, and the last one did not have any reperfusion therapy. The coronary angiograms of the left anterior descending artery showed thrombosis in two cases, coronary dissection in one case, and no morphological lesions in the other. We encourage the early performance of angiographic studies in these patients, adjusting the therapy to their pathophysiologic mechanism.