[Acute hemodynamic effects of ibopamine, captopril, and placebo in patients with severe heart failure]. / Efeitos hemodinâmicos agudos da ibopamina, captopril e placebo em pacientes com insuficiência cardíaca grave.

PURPOSE: To evaluate the acute hemodynamic effects of ibopamine (IBO), captopril (CAP) and placebo (PLA) in patients with severe congestive heart failure at rest. METHODS: Twelve male patients in sinus rhythm with dilated cardiomyopathy and NYHA class IV were studied with Swan-Ganz hemodynamics. Drugs were given in a blinded fashion. Rest, 30 min and every hour for 5 h measurements were made after oral ingestion of 100 mg IBO, 25 mg CAP or PLA. Prior to the study, patients were on diuretics as the only medication for at least 48 h. Comparisons were made with analysis of variance of repeated measurements and Duncan's multiple comparisons procedure. RESULTS: Significant increase in cardiac index and stroke volume index and reduction in systemic vascular resistance were observed with IBO and CAP for 2 h after ingestion. IBO however increased right and left filling pressures in the first hour after its administration. Ventricular tachycardia occurred in 2 patients 1 h after IBO administration. CONCLUSION: Both IBO and CAP improved hemodynamic parameters in the first two hours after oral ingestion in patients with dilated cardiomyopathy in class IV.

[Percutaneous retrieval of intravascular foreign bodies]. / Retirada percutânea de corpos estranhos intravasculares.

PURPOSE: To report our experience on percutaneous vascular foreign body retrieval and to analyse current techniques employed. METHODS: From 1985 to 1991, 15 (0.18%) of 7,963 procedures performed in the Cardiac Catheterization Laboratory-Hospital São Paulo were intravascular foreign body retrieval: 9 (60%) intracath, 4 (26.8%) diagnostic catheters, one Swan Ganz catheter entrapped at superior cava vein and one fragment of angioplasty guide-wire in the circumflex branch of the left coronary artery. The snare technique was used in 11 cases, a endomyocardial bioptome device in 1 case and modified snare technique for the intracoronary wire fragment retrieval was used in 1 case. In two cases of embolized fragment in peripheral arteries, no attempt was done for retrieval. RESULTS: All (100%) of the 13 attempted procedures were successful. The two foreign bodies not removed had an uneventful follow-up. CONCLUSION: The snare technique for percutaneous retrieval of intravascular foreign bodies is safe and has excellent results. The management peripheral fragments is not well defined yet.