RESUMO
In order to identify subjects at higher risk for carotid stenosis and to provide insights into mechanisms of disease development at different age-intervals, a color duplex ultrasound of extracranial arteries was performed in 624 consecutive patients (mean age 62.9+/-10.7, 483 males) undergoing coronary angiography. Significant carotid atherosclerosis (> or =50% stenosis) was documented in 87 patients (14%): the disease was moderate (50/69% stenosis) in 51 patients (8%), severe (> or =70% stenosis) in 36 patients (6%). Age (P<0.0001), smoking (P<0.0001), diabetes (P=0.0002), renal dysfunction (P=0.0119) and hypertension (P=0.0202) were independent predictors of significant carotid atherosclerosis; age (P=0.0001), smoking (P=0.0009) and diabetes (P=0.0201) were independent predictors of severe disease. Among 262 candidates for cardiac surgery, significant carotid artery disease was identified in 57 cases (2.63 Relative Risk, 95% Confidence Intervals: 1.32/5.24). Correlation and regression tree analysis demonstrated that diabetes was associated with greater severity of carotid stenosis in younger patients and hypertension in older ones. In conclusion age is the primary determinant of carotid artery disease; diabetes and smoking accelerate progression of atherosclerosis in younger patients, hypertension and smoking in older ones. Among patients undergoing coronary angiography, carotid ultrasonography should be recommended in high risk subgroups of patients.
Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia Coronária , Fatores Etários , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Complicações do Diabetes , Feminino , Humanos , Hipertensão/complicações , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Fatores de Risco , Fumar/efeitos adversos , UltrassonografiaRESUMO
The higher long-term patency of internal mammary artery grafts has stimulated the search for alternative conduits in order to achieve a complete arterial myocardial revascularization. Percutaneous angioplasty is often the preferred strategy for the treatment of recurrent ischemia in patients who previously underwent bypass surgery, but there is limited experience in the treatment of arterial grafts. We describe two cases of percutaneous treatment of diseased radial artery (RA) grafts. In the first case, two disarticulated stents were deployed through an RA graft: half stent inside the anastomosis to the left anterior descending (LAD) artery, and half stent in the distal LAD artery. Diffuse spasm of the RA graft, resistant to ic nitrates, was successfully reversed after ic calcium antagonists. Absence of restenosis was confirmed two years later. In the second case, after simultaneous catheterization of both the left coronary artery and RA graft, two long stents were implanted in the LAD artery and a final "reversed" kissing-balloon dilation through the stent struts was performed; four months later the patient showed proximal occlusion of the LAD artery and the stenotic RA distal anastomosis was successfully dilated.
Assuntos
Angioplastia Coronária com Balão , Idoso , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , RecidivaRESUMO
An 83-year-old woman with previous closed transventricular commissurotomy was admitted for congestive heart failure. Echocardiogram and angiography demonstrated a mitral restenosis and a large-mouthed false aneurysm of the left ventricle.
Assuntos
Falso Aneurisma/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Angiografia Coronária , Ecocardiografia , Feminino , Humanos , Estenose da Valva Mitral/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagemRESUMO
The activities of glutathione peroxidase (GSH-px), glutathione reductase (GSSG-rx) and glutathione transferase (GST) were measured in myocardial specimens obtained from right atria of patients subjected to different period of ischaemic arrest (aortic clamping ranging from 10 min to 90 min) followed by 60 min. of reperfusion, during open heart surgery 41-90 min. period of aortic clamping induced a significant increase of GSH-px activity with both H2O2 (p less than 0.05) and cumene hydroperoxide (p less than 0.025) as substrates when compared with baseline levels. Aortic clamping and reperfusion, however did not significantly change the myocardial activities of glutathione transferase and glutathione reductase. It is suggested that the increase of GSH-px in ischaemic-reperfused human hearts may render the myocardium less susceptible to oxidative attack particularly during the reoxygenation period when the level of active oxygen species is greatly elevated.
Assuntos
Glutationa Peroxidase/metabolismo , Glutationa Redutase/metabolismo , Glutationa Transferase/metabolismo , Parada Cardíaca Induzida , Reperfusão Miocárdica , Miocárdio/enzimologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoAssuntos
Aspirina/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Ponte de Artéria Coronária , Dipiridamol/uso terapêutico , Administração Oral , Aspirina/administração & dosagem , Fatores de Coagulação Sanguínea/análise , Transfusão de Sangue , Dipiridamol/administração & dosagem , Hematócrito , Humanos , Contagem de Plaquetas/efeitos dos fármacos , Estudos ProspectivosRESUMO
The changes in thrombocythemia in patients subjected to extracorporeal circulation (ECC) and pretreated with dipyridamole per os have been examined and compared with a control group in whom the drug was not used; in all patients a circuit with bubble oxygenator was employed. Measurements were carried out before sternotomy, 10' and 60' after ECG, 1 h after the start of intensive therapy and on the 1st surgical day. The variations in thrombocythemia were assessed in consideration of the thrombocythemia/Ht ratio, so as to eliminate the dilution variable. On the basis of the results obtained, it is considered that preoperative treatment with dipyridamole is effective in limiting the fall in thrombocythemia during ECC. The effect of the drug is prevalent in the initial stage of ECC, probably reducing platelet aggregation to non-biological surfaces of the circuit.