RESUMO
Acute myocardial infarction in association with the replacement of recombinant factor VIII in hemophiliacs has not been documented. We describe the use of PTCA in a hemophiliac A patient who developed acute myocardial infarction during factor VIII replacement. Because surgery in hemophiliac A patients remains hazardous, PTCA seems to be an attractive alternative.
Assuntos
Angioplastia Coronária com Balão , Fator VIII/efeitos adversos , Hemofilia A/tratamento farmacológico , Infarto do Miocárdio/induzido quimicamente , Proteínas Recombinantes/efeitos adversos , Adulto , Fator VIII/administração & dosagem , Humanos , Infusões Intravenosas , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/terapia , Ventriculografia com Radionuclídeos , Proteínas Recombinantes/administração & dosagemRESUMO
Ninety-one patients with dilated cardiomyopathy were studied by two-dimensional, pulsed, and color Doppler echocardiography (1) to detect and quantify mitral regurgitation (MR), (2) to record apical flow velocities in systole and diastole, and (3) to detect the presence of left ventricular thrombi. MR was detected in 57% of the patients and thrombi were present in 40%, but the occurrence of both MR and thrombus was rare (8%). Apical flow velocity was significantly higher throughout the cardiac cycle in the group with MR (diastole 15 +/- 7 vs 9 +/- 7 cm/sec; systole 29 +/- 12 vs 16 +/- 13 cm/sec; p less than 0.001 for both), accounting for the rarity of thrombi in this group. Follow-up data on 89% of the patients showed markedly decreased survival in the group with MR (22% vs 60% at 32 +/- 6 months, p less than 0.005), and this was evident even in patients with mild MR. Thus although MR is a noninvasively obtainable marker of a large subgroup of patients with dilated cardiomyopathy "protected" from left ventricular thrombus formation, it is a sensitive marker of decreased survival.