[Evaluation of the patency of left internal mammary artery graft by transcutaneous Doppler flow velocity analysis]. / Evaluación de la permeabilidad de los injertos de arteria mamaria interna izquierda mediante análisis de la velocidad del flujo por técnica Doppler transcutánea.

OBJECTIVE: To analyze the features of Doppler flow velocity curve of left internal mammary artery by-pass grafts in relation with their permeability as assessed by selective angiography. METHODS: Twenty-five consecutive patients with a left mammary artery graft were studied by angiography and transcutaneous Doppler technique. From the Doppler tracings, peak velocity and time-velocity integral of the systolic and diastolic components were determined. Patency of the graft and the characteristics of the distal native coronary artery were evaluated at angiography. RESULTS: Doppler flow signal was obtained in 23 (92%) of 25 analyzed patients. The graft was angiographically patent in 17 (68%) of 25 patients; in 15 (88%) of them the Doppler flow velocity signal was mainly diastolic and in only 2 (12%) it was predominantly systolic. In 8 (32%) of the 25 patients the graft was angiographically occluded, 6 (75%) of these patients showing a predominantly systolic Doppler signal, while the remaining 2 (25%) patients were those in whom the signal could not be elicited. Sensitivity and specificity of a predominantly diastolic Doppler flow pattern for the presence of graft patency was 88% and 100% respectively, with a predictive positive value of 100% and a negative one of 80%. CONCLUSIONS: Doppler flow velocity pattern of internal mammary artery by-pass grafts is related with patency of the graft, the presence of a predominantly diastolic curve being highly indicative of a patent graft.

Clinical and sequential angiographic follow-up six months and 10 years after successful percutaneous transluminal coronary angioplasty.

Sequential angiographic follow-up is needed for interpreting coronary events that occur after successful percutaneous translumial coronary angioplasty (PTCA). One hundred eight consecutive patients who had undergone successful dilatation were followed for 10 years, and quantitative sequential angiograms were recorded at 6 months (n = 101) and 10 years (n = 68). The 10-year event rate was: 5.8 +/- 2.4% for cardiac death, 9.7 +/- 3.3% for Q-wave acute myocardial infarction, 18.3 +/- 4.5% for additional surgery, and 22.4 +/- 4.9% for repeated angioplasty. Using Cox's proportional-hazards regression, multivessel coronary artery disease (CAD) (RR 5.6; 95% confidence intervals [CI] 1.2 to 24.7; p = 0.02), restenosis within 6 months (RR 7.8; 95% CI 3.1 to 20.0; p = 0.0001), and CAD progression over 10 years (RR 10.6; 95% CI 1.3 to 87.1; p = 0.004) were the strongest predictors of all-cause death, repeated PTCA, and additional surgery, respectively, after controlling for age and coronary risk factors. The minimal luminal diameter of 48 narrowings with complete sequential angiographic follow-up and without restenosis remained stable from 6 months (2.13 +/- 0.60 mm) to 10 years (2.18 +/- 0.61 mm). Disease progression was similar in nondilated arteries and dilated arteries (32% vs 30%). The 10-year risk of coronary events was higher in patients with baseline multivessel CAD than in those with 1-vessel CAD because of more frequent progression of CAD (RR 3.8; 95% CI 1.6 to 6.8; p = 0.001). Thus, early cardiac events after successful PTCA were related to restenosis, and late events to CAD progression. Nevertheless, after the restenosis period, the target lesion remained stable for the next 10 years. Coronary disease progression was not related to the angioplasty procedure.

Percutaneous transluminal coronary angioplasty as alternative treatment to coronary artery bypass surgery in iatrogenic stenosis of the left main coronary artery.

The present report describes three patients with iatrogenic left main coronary artery after aortic valve replacement. All three patients were successfully treated by percutaneous transluminal coronary angioplasty. No clinical or angiographic signs of restenosis were seen during the long-term follow-up (4, 6, and 11 years). These patients show the feasibility of percutaneous transluminal coronary angioplasty in iatrogenic left main coronary artery stenosis as alternative of coronary artery bypass surgery. However, it should be only considered in patients who would otherwise be deemed inoperable, refused reoperation, and are willing to take the risk involved.

[The hemodynamic profile of the response to amrinone treatment in severe heart failure]. / Perfil hemodinámico de la respuesta al tratamiento con amrinona en la insuficiencia cardíaca severa.

The hemodynamic response to amrinone was analyzed in 19 patients with severe heart failure (NYHA III or IV). In 17 patients, 2 bolus of amrinone (0.75 mg/kg) were administered with an interval of 30 minutes, while a single bolus only was administered in 2 patients. In all patients the initial bolus was followed by continuous perfusion of Amrinone (10 micrograms/kg/min in 17 patients; 7 and 5 micrograms/kg/min in the remaining two). Cardiac index increased from 1.8 +/- 0.2 to 2.5 +/- 0.4 l/min/m2 (p less than 0.01), and pulmonary capillary wedge pressure and mean right atrial pressure decreased significantly (from 24 +/- 5.2 to 14 +/- 6 mmHg, p less than 0.01; and from 8.7 +/- 6.5 to 3.2 +/- 3.4, p less than 0.05 respectively). There were no significant changes in mean blood pressure (93 +/- 17 versus 88 +/- 13), heart rate (81 +/- 15 versus 84 +/- 14 beats per minute) and systolic work index (26.4 +/- 10.7 versus 37.7 +/- 12.3 g-m/m2). The maximum effect was obtained at 60 minutes and maintained throughout the period of monitoring (8 hours). In the 2 patients who received a single bolus of amrinone the maximum effect was reached at 30 minutes (cardiac index 1.3 +/- 0.1 versus 2.5 +/- 0.1 l/min/m2; pulmonary capillary pressure 24 +/- 5 versus 16.8 +/- 6.5 mmHg; mean right atrial pressure 11 +/- 1 versus 3.5 +/- 3.5 mmHg), and was followed by a progressive loss of efficiency, until effect had totally disappeared and situation basal returned, between the third and fourth hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Sutureless repair of postinfarction cardiac rupture.

A 62-year-old female with a history of progressive angina experienced an acute myocardial infarction. Seven days later, cardiac rupture ensued. She underwent surgical repair without the aid of extracorporeal circulation. A Teflon patch was glued over the myocardial tear with medical adhesive. She recovered and is leading a normal life, 15 months after surgery.