RESUMO
We assessed the effectiveness of distal hemoperfusion support during gradual, prolonged balloon inflation during percutaneous transluminal coronary angioplasty in high-risk patients. The patients were identified as having a poor left ventricular ejection fraction ( < 35%), > 50% of viable myocardium at risk percutaneous coronary balloon angioplasty, or both. A total of 64 procedures were performed in 61 patients. Angiographic success was achieved in 83 of 86 (96.5%) lesions treated with hemoperfusion support. Hospital complications included 1 patient who had a non-Q-wave infarction, 1 who had to undergo redo percutaneous coronary balloon angioplasty, and 5 who required coronary artery bypass operations. The hospital mortality was 7.8% (5 patients). This preliminary study indicates that hemoperfusion support can enable expeditious, simple, economical, and effective percutaneous transluminal coronary balloon angioplasty in a subset of labile patients in whom procedural failure frequently leads to sudden death.
Assuntos
Angioplastia Coronária com Balão/métodos , Doença das Coronárias/terapia , Coração Auxiliar , Angioplastia Coronária com Balão/economia , Angioplastia Coronária com Balão/instrumentação , Estudos de Casos e Controles , Doença das Coronárias/mortalidade , Doença das Coronárias/fisiopatologia , Custos e Análise de Custo , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Posttraumatic formation of either aortico-ventricular or coronary arterio-ventricular fistulas are rare, albeit well-documented events. A case is presented involving crush injury to the chest complicated by an acute inferior wall myocardial infarction and later associated with an aortico-right ventricular fistula. Progressive right ventricular dilatation dictated subsequent surgical repair in this case, although similar fistulas without dilatation may safely be observed.
Assuntos
Doenças da Aorta/etiologia , Fístula/etiologia , Cardiopatias/etiologia , Traumatismos Cardíacos/complicações , Ferimentos não Penetrantes/complicações , Adulto , Aorta Torácica , Humanos , MasculinoRESUMO
We evaluated the automated system Blood Pressure Measuring System (BPMS) developed by NASA on 277 adult males who elected to have a treadmill test as part of their annual physical. The BPMS uses acoustic transduction with a computer-assisted ECG gating to detect nonsynchronous noise. The BPMS readings were compared to pressures simultaneously measured by trained technicians. For all stages of work, BPMS readings were higher for systolic and lower for diastolic than technician readings. At peak stages of work, BPMS systolic pressures were about 20 mmHg higher than technician readings. Within each 3-min workstage, BPMS readings were found to be more inconsistent than technician readings. The standard errors of measurement for BPMS were from two to three times higher than technician values. These data showed automated blood pressure readings were significantly different than technician values and subject to more random fluctuations. These findings demonstrate the need to view exercise blood pressure measured by automated systems with caution.
