[Percutaneous retrieval of intravascular foreign bodies]. / Retirada percutânea de corpos estranhos intravasculares.

PURPOSE: To report our experience on percutaneous vascular foreign body retrieval and to analyse current techniques employed. METHODS: From 1985 to 1991, 15 (0.18%) of 7,963 procedures performed in the Cardiac Catheterization Laboratory-Hospital São Paulo were intravascular foreign body retrieval: 9 (60%) intracath, 4 (26.8%) diagnostic catheters, one Swan Ganz catheter entrapped at superior cava vein and one fragment of angioplasty guide-wire in the circumflex branch of the left coronary artery. The snare technique was used in 11 cases, a endomyocardial bioptome device in 1 case and modified snare technique for the intracoronary wire fragment retrieval was used in 1 case. In two cases of embolized fragment in peripheral arteries, no attempt was done for retrieval. RESULTS: All (100%) of the 13 attempted procedures were successful. The two foreign bodies not removed had an uneventful follow-up. CONCLUSION: The snare technique for percutaneous retrieval of intravascular foreign bodies is safe and has excellent results. The management peripheral fragments is not well defined yet.

The effects of glucose on myocardial substrate utilization in acute myocardial infarction or angina pectoris.

Infusion of glucose-insulin-potassium during acute myocardial infarction has favorable clinical and hemodynamic effects, presumably as a result of decreased myocardial utilization of free fatty acids. In 14 patients with coronary artery disease, hypertonic glucose (a bolus of 10 g followed by infusion of a 30% glucose solution at a constant rate of 10 mg/kg/min) was infused and arterial and coronary sinus levels of glucose, lactate and free fatty acids were measured before and after 15 and 30 minutes of infusion. Arterial glucose and lactate levels increased significantly after glucose infusion, whereas free fatty acid levels decreased significantly. Modest but significant correlations also existed between glucose arterial levels and the arterial-coronary sinus glucose difference (r = 0.53, p less than 0.001); arterial lactate and the arterial-coronary sinus lactate difference (r = 0.35, p less than 0.01); arterial free fatty acids; and the arterial-coronary sinus free fatty acid difference (r = 0.62, p less than 0.001). These results with a hypertonic glucose infusion are similar to those reported after infusion of glucose-insulin-potassium without the potential for harmful adverse effects from infusions of insulin or potassium. Therefore, infusion of hypertonic glucose may be beneficial in patients with coronary artery disease. Further work is necessary to study its effects in different subgroups of patients with coronary artery disease.

Tumor hemangiomatoso de artéria coronária. Apresentação de um caso / Hemangiomatous tumor of the coronary artery. Report of a case

Os autores relatam um caso de tumor hemangiomatoso do coracao, diagnosticado pela cinecoronariografia em homem de 49 anos, que apresentou quadro de dor precordial prolongada, acompanhada de supradesnivelamento ST no eletrocardiograma. O paciente foi tratado cirurgicamente, sendo feita exclusao do tumor atraves da ligadura do ramo terminal do segmento AV da arteria circunflexa

Revascularizacao miocardica pela anastomose mamario-coronaria. Analise critica dos resultados imediatos e tardios. / Myocardial revascularization through mammary-coronary anastomosis. Critical analysis of immediate and late results

Os autores estudam um grupo de 75 pacientes, consecutivos e nao selecionados, submetidos a revascularizacao miocardica, nos quais a anastomose mamario-coronaria foi utilizada como procedimento isolado ou associado a pontes de safena. Nesses pacientes a idade variou de 38 a 72 anos predominando o sexo masculino (82%). Em 43 pacientes (57,3%) associou-se uma ou mais pontes de safena e em dois aneurismectomia do VE. A mortalidade hospitalar foi de 5 casos (6,7%) nao se observando morbidade especial decorrente deste tipo de procedimento. Considerou-se como fatores de sucesso a sobrevida e a ausencia de sintomatologia anginosa que na analise atuarial, foram obtidos em 90,8% e 80,4% em 5 anos, respectivamente. As vantagens e desvantagens da utilizacao desse tipo de enxerto sao analisadas, bem como suas limitacoes. Em vista dos resultados obtidos os autores consideram a anastomose mamario-coronaria, quando adequadamente indicada, a melhor opcao na revascularizacao do territorio da arteria descendente anterior e seus ramos diagonais