RESUMO
STUDY OBJECTIVE: To determine the angiographic patency of cryopreserved saphenous vein grafts used as conduits during coronary artery bypass surgery and whether this is affected by postoperative immunosuppressive therapy. DESIGN AND SETTING: A retrospective review of medical records and coronary angiograms of patients at a university hospital. PATIENTS: Eleven patients undergoing 12 coronary artery bypass operations during which a total of 26 distal coronary anastomoses were created using cryopreserved vein grafts. MEASUREMENTS: Eight postoperative coronary angiograms were performed in 10 patients surviving longer than 1 week. All angiograms were performed on the basis of symptoms of suspected myocardial ischemia. Angiographic results, postoperative anticoagulation, and therapy with immunosuppressive agents were analyzed. RESULTS: Seventeen cryopreserved vein grafts were studied; one (6%) was patent, 12 (71%) were occluded, and 4 (23%) were stenosed. In patients treated with azathioprine, seven of the eight cryopreserved vein grafts were occluded. In patients not receiving immunosuppression, five were occluded, three were stenosed, and one was patent. All internal mammary grafts were widely patent. CONCLUSION: Cryopreserved vein grafts have a poor angiographic patency which did not appear to be affected by immunosuppressive therapy with azathioprine. The use of this graft should be restricted and alternative arterial conduits utilized.
Assuntos
Ponte de Artéria Coronária/métodos , Criopreservação , Oclusão de Enxerto Vascular/diagnóstico por imagem , Veia Safena , Idoso , Azatioprina/uso terapêutico , Angiografia Coronária , Feminino , Seguimentos , Oclusão de Enxerto Vascular/epidemiologia , Oclusão de Enxerto Vascular/etiologia , Humanos , Imunossupressores/uso terapêutico , Masculino , Cuidados Pós-Operatórios , Estudos Retrospectivos , Veia Safena/fisiologia , Veia Safena/transplante , Fatores de Tempo , Grau de Desobstrução Vascular/efeitos dos fármacos , Grau de Desobstrução Vascular/fisiologiaRESUMO
We describe a double-balloon technique for performing a percutaneous balloon pericardiotomy. This technique was employed when the large, single dilation balloon customarily used for this procedure failed to fully inflate across the parietal pericardium. Two smaller balloons were advanced through the same skin tract and simultaneously inflated, thus producing an adequate pericardial window. This double-balloon technique allowed for the more secure anchoring of the balloons across the pericardium and for the delivery of greater dilation pressures.
