RESUMO
Based on the patient's symptoms and examination, a decision was made to recanalize his totally occluded RCA via retrograde approach through the SVG to the OM. Due to inadequate visualization of the epicardial collaterals and distal RCA via SVG, triple-access was used and injection via left main. In selected CTO cases, triple access may facilitate the retrograde approach, allowing optimal collateral visualization.
Assuntos
Circulação Colateral , Oclusão Coronária , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico , Oclusão Coronária/cirurgia , Humanos , Resultado do TratamentoRESUMO
Dissection re-entry is a widely used technique in many chronic total occlusion centers. This account of a failed re-entry attempt provides in vivo photographic evidence of how the vessel looked after such an attempt. Operators are advised to keep dissection of subintimal space and hematoma limited and use dedicated materials and techniques for controlled re-entry.
Assuntos
Aterectomia Coronária , Vasos Coronários , Hematoma , Complicações Intraoperatórias , Intervenção Coronária Percutânea , Lesões do Sistema Vascular , Idoso , Aterectomia Coronária/efeitos adversos , Aterectomia Coronária/métodos , Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Oclusão Coronária/diagnóstico , Oclusão Coronária/fisiopatologia , Oclusão Coronária/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/lesões , Vasos Coronários/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/prevenção & controle , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controleRESUMO
Bifurcation lesions may be encountered in approximately 15%-20% of percutaneous coronary interventions. A 2-stent approach is required in up to 30% of these procedures. We describe a novel technique based on a modification of TAP stenting, suitable for procedures where a 2-stent strategy is predetermined.
Assuntos
Angioplastia Coronária com Balão , Angiografia Coronária/métodos , Estenose Coronária/cirurgia , Stents Farmacológicos , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Estenose Coronária/diagnóstico , Stents Farmacológicos/efeitos adversos , Stents Farmacológicos/normas , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Reprodutibilidade dos Testes , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
We present a patient without primary heart disease in whom subclinical hyperthyroidism was accompanied by manifestations of dilated cardiomyopathy, as evaluated by echocardiography, coronary angiography, and radionuclide ventriculography. His condition was reversed 6 months after conventional treatment (furosemide, carvedilol, angiotensin-converting-enzyme inhibitor and thiamazole administration). This patient represents an exceptional case, as overt congestive heart failure with left ventricular dilatation and depressed ventricular ejection fraction is not a common finding in patients with hyperthyroidism, let alone patients with subclinical hyperthyroidism and no underlying heart disease.
Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/etiologia , Hipertireoidismo/complicações , Adulto , Cardiomiopatia Dilatada/tratamento farmacológico , Angiografia Coronária , Humanos , Hipertireoidismo/tratamento farmacológico , Masculino , Resultado do Tratamento , UltrassonografiaRESUMO
The movement of thrombi migrating from the veins of the lower limbs can give rise to pulmonary emboli within 24 hours. This is manifested as massive pulmonary embolism in 30% of cases, with a mortality rate of around 50%. Free-floating thrombi within the right cardiac cavities are rare, and the diagnosis is made mainly by transthoracic and transoesophageal echocardiography. Treatment includes surgery, invasive percutaneous embolectomy, thrombolysis and heparin administration. Here we report the case of an 80-years-old patient with massive pulmonary embolism caused by a free floating thrombus within the right atrium. Tenecteplase was administered with excellent results.
Assuntos
Coração , Embolia Pulmonar/etiologia , Trombose/complicações , Acenocumarol/uso terapêutico , Idoso de 80 Anos ou mais , Ecocardiografia , Fibrinolíticos/uso terapêutico , Átrios do Coração , Ventrículos do Coração , Humanos , Masculino , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Índice de Gravidade de Doença , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológicoRESUMO
AIMS: Sinus node function is commonly evaluated by the atropine test. The isoproterenol test is less used. The aim of this study was to evaluate chronotropic reserve in patients with asymptomatic sinus bradycardia using the combined administration of atropine and isoproterenol. METHODS AND RESULTS: A total of 100 patients were studied, 18-70 years old, with permanent, asymptomatic, sinus bradycardia and no detectable cardiac disease. The standard administration protocols for atropine and isoproterenol were used and successive heart rate recorded. Patients were stratified into three groups: Group A (control), showing normal response to atropine and isoproterenol; Group B, demonstrating abnormal response to atropine; Group C, with abnormal response to atropine and isoproterenol. No statistically significant difference was observed between Groups A and B (P = 0.11), whereas Group C differed statistically from both Groups A (P < 0.000001) and B (P = 0.000003) to a significant extent. By the end of the 3-year follow-up period, 47% of the Group C patients had undergone permanent pacemaker implantation (DDDR)--Kaplan-Maier survival curves predict only 35% survival without pacing--whereas none did so in Groups A and B. CONCLUSIONS: In patients with deficient chronotropic response to atropine administration, isoproterenol tests could differentiate those with inadequate chronotropic reserves, possibly requiring preventive pacemaker implantations.