RESUMO
Although drug-eluting stents are increasingly used to treat coronary disease, restenosis remains the major limitation of these devices. We report a case of complete metal jacket using 17 stents for triple-vessel coronary disease in a 73-year-old man, for whom surgery would have been the best choice.
Assuntos
Doença da Artéria Coronariana/terapia , Reestenose Coronária/terapia , Metais , Intervenção Coronária Percutânea/instrumentação , Stents , Idoso , Angiografia Coronária , Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/etiologia , Stents Farmacológicos , Evolução Fatal , Humanos , Masculino , Seleção de Pacientes , Intervenção Coronária Percutânea/efeitos adversos , Desenho de Prótese , Retratamento , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: As the population ages, bioprosthesis are increasingly being used in cardiac valve replacement. Pericardial bioprosthesis combine an excellent hemodynamic performance with low thrombogenicity, but valve failure associated with calcification remains a concern with these valves. We describe distortion of the bioprosthesis ring as a risk factor for early calcification. METHODS: A total of 510 patients over the age of 70 years underwent isolated aortic valve replacement with the Mitroflow (A12) pericardial bioprosthesis. Thirty two patients (6,2%) have undergone a second aortic valve replacement due to structural valve dysfunction resulting from valve calcification. In all patients a chest radiography and coronary angiography was performed before reoperation. A 64 Multidetector Computed Tomography (MDCT) with retrospective ECG gating study was performed in four patients to evaluate the aortic bioprosthesis. RESULTS: Chest radiography showed in all patients an irregular bioprosthesis ring. At preoperative coronary angiography a distorted bioprosthesis ring was detected in all patients. Macroscopic findings of the explanted bioprostheses included extensive calcification in all specimens. CONCLUSION: There was a possible relationship between early bioprosthetic calcification and radiologic distortion of the bioprosthesis ring.
Assuntos
Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Calcinose/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Radiografia Torácica , Reoperação , Fatores de RiscoRESUMO
This report describes a 41-year-old man who had atypical angina resulting from coronary steal by left atrial myxoma. The tumor was completely excised and the patient was symptoms free after operation.
