[The immediate results of percutaneous transluminal coronary angioplasty at Hospital San José de Monterrey]. / Resultados inmediatos de la angioplastía coronaria percutánea transluminal en el Hospital San José de Monterrey.

We analyzed 69 consecutive PTCA performed upon 64 patients from January 1990 to May 1992. Age was 55 +/- 12 years and 80% were male. Fifty-nine percent were smokers, 32% had hypertension, 16% a remote myocardial infarction, 14% diabetes, 12% previous PTCA, and 6% previous coronary artery bypass surgery. Total cholesterol was 238 +/- 75 mg/dl. Most of the subjects had an acute coronary syndrome, with unstable angina in 31 and a recent myocardial infarction in 23. Angiographically, 52% had single vessel disease, 39% had double vessel and 9% triple vessel disease. LVEF was 55 +/- 11%, LVEDP 17 +/- 10 mm Hg, and 44% had wall motion abnormalities. We dilated 1.4 lesions/patient (1-4), for a total of 100 lesions. Luminal stenosis was reduced from (mean +/- SEM) 88.5 +/- 1.1% to 22.6 +/- 2.2% (p < 0.0001). The procedure was a total clinical success in 85.6% of the patients and a partial clinical success in 4.3%. Complete revascularization was achieved in 62.3% and incomplete but adequate revascularization in 26%. Multiple lesions dilatation was performed in 30% of the patients and multiple vessel angioplasty in 17%. Forty-seven lesions were on the LAD distribution (91.5% angiographic success), 24 on the circumflex (95.8% angiographic success), 26% on RCA (88.4% angiographic success) and 3 in others. There was a 10% failure and 13% complication rates, but more than half of them were successfully managed medically, although 5.7% required urgent CABG. One patient died.

[Cardiac myxoma, diagnostic methods and curative surgery. Report of 5 cases]. / Mixoma cardiaco, metodos diagnósticos y cirugía curativa. Informe de 5 casos.

We report five patients with Myxomas of the left atrium studied by catheterization and/or Echocardiography between november 1976 and october 1978. Four patients were operated immediately with extracorporeal circulation which confirmed the diagnosis. The last patient died before surgical intervention due to a severe hepatorenal syndrome and extensive pulmonary infection. Another patient died postoperatively on the second day due to irreversible pulmonary hypertensión. The remaining three patients are asymptomatic (average 28 months after surgery). Reviewing the diagnostic methods, particularly the Echocardiogram, we found that it is a good diagnostic tool, making catheterization with the risks of myxomatous embolization unnecessary. Furthermore, the Echo facilitates simple and economic observation for the detection of relapses. Finally, broad and careful surgical management most be emphasized in order to avoid transoperative emboli, tumoral dissemination, and latent relapses, mediated by the greater use of filters and a broad resection of the implantation pedicule.

Survival predictors in coronary artery disease. Medical and surgical comparisons.

Linear discriminant function analysis was used to test the independent prognostic value of nine variables in patients with coronary artery diseaase. For 68 medically treated patients who met the criteria for inclusion in the discriminant function analysis, the most reliable predictor of 2-year survival status was the left ventricular ejection fraction. The prognostic value of the ejection fraction was not improved by the addition of the number of vessels diseased. Comparisons of the survival of 130 medical and 284 surgical patients were made using subsets based on the ejection fraction. When the ejection fraction was greater than or equal to 50%, the probability of 4-year survival was high for both medical (91%) and surgical (96%) groups. When the ejection fraction was less than 25%, the probability of 2-year survival was low in both groups. However, for patients with ejection fraction 25 through 49%, the surgical patients had a better chance (P less than 0.05) for a 3-year survival (89%) than did medical patients (68%). This study emphasizes the prognostic significance of the left ventricular ejection fraction, which should be considered in any comparison of survival in medically and surgically treated patients.

Echo-phonocardiographic and contrast studies in conditions associated with systemic arterial trunk overriding the ventricular septum: truncus arteriosus, tetralogy of Fallot, and pulmonary atresia with ventricular septal defect.

Echocardiography was performed in 62 patients--20 with truncus arteriosus, 14 with tetralogy of Fallot, and 28 with pulmonary atresia with ventricular septal defect. Features common in all three groups were: large single systemic arterial trunk overriding the ventricular septum, mitral-semilunar continuity, large right ventricular dimension, and normal septal motion. Indocyanine green contrast flow patterns were similar and were most helpful in detecting an associated atrial septal defect and in studying the timing and pattern of right-to-left shunting. Echo-phonocardiographic studies revealed that the ejection click coincided with the point of maximal opening of aortic or truncal valve. Left atrial dimension was measured in 55 patients and was normal or small in 41 patients and large in 14 patients. Our observations indicate that left atrial dimension provides a good index of pulmonary flow and can help differentiate those patients with increased pulmonary flow and can help differentiate those patients with increased pulmonary flow (truncus arteriosus) from those patients with reduced pulmonary flow (tetralogy of Fallot and pulmonary atresia with associated ventricular septal defect).

Aorta-coronary artery saphenous vein bypass surgery: clinical and angiographic results.

In a series of 500 consecutive patients undergoing aorta-coronary artery saphenous vein bypass surgery, operative mortality was 2.5% (1% with one-vessel disease, 2% with two-vessel disease, and 3% with three-vessel disease). Transmural myocardial infarction occurred within 30 days after operation in 67 cases (13%) and caused 10 of the 16 deaths in that period. Among 484 patients followed 1 to 58 months (median, 26 months), there have been 20 deaths. Of the 464 survivors, 65% had complete relief of angina, 24% were improved, and 11% were unimproved. In 162 patients who underwent postoperative graft angiography between 1 and 42 months after surgery, a strong positive relationship existed between clinical response and completeness of myocardial revascularization as defined by the presence of a patent graft to all major coronary arteries with greater than 50% stenosis. A similar relationship was found between postoperative multistage treadmill exercise response and completeness of myocardial revascularization. Thus, 82% of patients completely revascularized were asymptomatic at the time of postoperative graft visualization, and 91% had a negative treadmill exercise response.

Relation of intraoperative or early postoperative transmural myocardial infarction to patency of aortocoronary bypass grafts and to diseased ungrafted coronary arteries.

Serial preoperative and postoperative electrocardiograms and vectorcardiograms were obtained in 500 patients undergoing saphenous vein aortocoronary artery bypass graft surgery. Evidence of transmural myocardial infarction was found early postoperatively in 67 patients (13 percent). Age and sex distributions, number of vessels diseased or vessels grafted, and preoperative and postoperative New York Heart Association functional classification (mean follow-up, 26 months) did not differ in the groups with and without infarction. Increased duration of cardiopulmonary bypass time (more than 120 minutes) was slightly greater in the group with infarction (P smaller than 0.05). Multivariate analysis revealed that 60 percent of patients in the group with infarction were identified by a 1st day serum glutamic oxaloacetic transaminase value greater than 100 U/liter; however, for each such patient identified, there was approximately one false positive result. Use of other values (creatine phosphokinase, cardiopulmonary bypass time and total anoxic rest time) did not improve discrimination. Twenty-five percent of all transmural infarctions occurred within the zone of myocardium supplied by a diseased ungrafted artery. In 32 patients with early evidence of transmural mycardial infarction in a zone of myocardium supplied by a grafted artery, postoperative angiography showed as many with patent as with occluded grafts. Of 154 patients in the group without infarction who had early postoperative graft angiograms, 30 (19 percent) had one graft occluded and yet no evidence of transmural infarction by our criteria. Therefore, early postoperative evidence of transmural myocardial infarction as defined in this study is an unreliable indicator of the status of the graft supplying the zone of infarction.

Aorta-coronary artery saphenous vein bypass grafts. Isolated and combined with other procedures.

The results in 578 patients who underwent a saphenous vein bypass graft operation (isolated SVBG) or a SVBG combined with other procedures (combined SVBG) from 1969 through 1972 were analyzed. The operative mortality rate was low (3 percent) for isolated SVBG but increased considerably for combined SVBG. The late mortality rate was also low (4 percent) for isolated SVBG and also increased markedly for combined SVBG. The operative mortality rate did not change in the group undergoing left ventricular aneurysmectomy or mitral valve surgery for postinfarction mitral insufficiency, whether or not SVBG was used; however, late results were better in both groups when SVBG was performed. Among all groups, patients with postinfarction mitral insufficiency or rheumatic mitral incompetence associated with coronary artery disease had the poorest outcome. Despite the operative and late deaths, patients undergoing SVBG with aortic valve replacement showed excellent results in the group of survivors.

Serum enzyme data in diagnosis of myocardial infarction during or early after aorta-coronary saphenous vein bypass graft operations.

In 397 cases, serum glutamic oxaloacetic transaminase (GOT) and creatine phosphokinase (CPK) values were determined on the first, second, and third days after aorta-coronary artery saphenous vein bypass graft operations. Electrocardiographic (ECG) or vectorcardiographic (VCG) evidence of postoperative transmural infarction was found in 48 cases. Multivariate analysis indicated that GOT and CPK concentrations on day 1 had substantial discriminatory value regarding infarction. Discrimination by GOT values was not significantly improved by addition of CPK. Of the 61 cases positive by GOT values measured 1 day postoperatively (greater than 100 U. per liter; normal smaller than 24), 32 (52 percent) were negative by ECG or VCG; of the 336 cases negative by GOT, 19 (6 percent) were positive by ECG or VCG. GOT and CPK values increased with the number of vessels grafted and with the use of ventricular rather than atrial vents. Total serum enzyme values lack specificty in diagnosis of transmural infarction after the saphenous vein bypass operation.