[Blood cell count, sodium, potassium, calcium, osmolality and viscosity during pediatric angiocardiography with ioxaglate]. / Hemograma, sódia, potássio, cálcio, osmolalidade e viscosidade durante angiocardiografia pediátrica com ioxaglato.

PURPOSE: Children's blood changes during angiocardiography may not be only due to the contrast media (CM). METHODS: We studied the presence and severity of changes in those parameters in 35 pediatric patients undergoing angiocardiography with ioxaglate aiming to identify independent variable responsible for those changes. Blood samples were taken at the beginning of the procedure (SI), at the end (S2) and two hours later (S3). RESULTS: Hematocrit: S1 = 47.3 +/- 6.9%; S2 = 40.7 +/- 7.4% (p < 0.001), (related to the CM volume r=0.37, (p < 0.05). Hemoglobin: S1 = 15 +/- 2.1g%; S2 = 13.2 +/- 2.4g% (p < 0.001), and S3 = 12.7 +/- 2.5g% (NS). White blood cell count: S1 = 7940 +/- 3040 leukocytes/mm3; S2 = 6950 +/- 2700/mm3 (NS); S3 = 10830 +/- 4690 leukocytes/mm3 (p < 0.001). Procedure duration (r = 0.83, p < 0.05) and 5% glucose fluid given between S2 and S3 (r = 0.49, p < 0.05) were isolated. Sodium: S1 = 134.5 +/- 0.4mEq/L, S2 = 130.7 +/- 0.4mEq/L (p < 0.001) (due to 5% glucose fluid injected, r = 0.61, p < 0.01). Potassium: S1 = 4.22 +/- 0.45mEq/L, S2 = 300.6 +/- 13.3mOsm/kg (p < 0.001). Calcium: S1 = 9.13 +/- 1.03mg%; S2 = 8.4 +/- 0.91 mg/dL. (related to the CM, r = 0.43, p < 0.01.) Osmolality: S1= 293.3 +/- 12.5mOsm/kg; S2 = 3.83 +/- 0.4mEq/L (p<0.001). Viscosity: S1 = 3.36 +/- 0.81; S2 = 3.09 +/- 0.74 (p < 0.01); S3 = 3.87 +/- 0.89, p < 0.001. There was an indirect linear regression with the CM. CONCLUSION: There were profound differences among the dependent variables observed but the ioxaglate was partially related to changes in hematocrit/hemoglobin, total calcium and viscosity. We failed to demonstrate significant regression coefficient between CM and changes in leukocytes, sodium, potassium, and osmolality.

Hemograma, sódio, potássio, cálcio, osmolalidade e viscosidade durante angiocardiografia pediátrica com ioxaglato / Blood cell count, sodium, potassium, calcium, osmolality and viscosity, during pediatric angiocardiography with ioxaglate

OBJETIVO - Os meios de contraste (MC) introduzem alteraçöes em alguns parâmetros sangüíneos, adquirindo, assim, mais importância na angiocardiografia pediátrica. MÉTODOS - Estudamos a presença e a severidade das mudanças no hematócrito, hemoglobina, leucócitos, sódio, potássio, cálcio, osmolalidade e viscosidade, em 35 crianças submetidas a angiocardiografia com ioxaglato, identificando, também, as variáveis independentes responsáveis por essas alteraçöes. As amostras sangüíneas foram colhidas no início do procedimento (S1), no fim (S2) e 2h após (S3). RESULTADOS - (...fórmula...). CONCLUSÄO - Variaçöes significativas nas variáveis dependentes medidas foram observadas durante e após o procedimento. O uso do ioxaglato foi parcialmente relacionado a mudanças no hematócrito/hemoglobina, cálcio total e viscosidade mas näo as das variáveis restantes.

[Percutaneous valvuloplasty in congenital aortic valve stenosis]. / Valvuloplastia percutânea em estenose valvular aórtica congênita.

PURPOSE: To show the initial experience of Institute of Cardiology of Rio Grande do Sul in the treatment of congenital valvular aortic stenosis with percutaneous balloon aortic valvuloplasty. METHODS: Twenty four patients were submitted to the procedure, 14 males and 10 females. The mean age 7 years (4 days-17 years). Four patients were aged below 30 days and three patients had previous surgical valvuloplasty. The percutaneous balloon aortic valvuloplasty were made the retrograde approach in all patients. RESULTS: The peak systolic pressure gradient was reduced from 65.96 +/- 22.68 to 27.08 +/- 18.74 mmHg. The procedure resulted in aortic regurgitation in seven patients and worsened aortic regurgitation in two patients. One patient had cardiac arrest that was reverted by cardiopulmonary resuscitation, this patient had hospital discharge without sequel. Five patients had acute femoral artery thrombosis, and hemorrhage in the site of puncture happened in one patient. CONCLUSION: The percutaneous balloon aortic valvuloplasty results in effective reduction of the peak systolic pressure gradient, it is a save and effective therapy in patients with congenital valvular aortic stenosis. Further evaluation of the long term results are necessary for definitive conclusions.

[Coronary transluminal angioplasty after the use of thrombolytic therapy in acute myocardial infarction]. / Angioplastia transluminal coronária após o uso de trombolítico no infarto agudo do miocárdio.

PURPOSE: To present the Cardiology Institute of Rio Grande do Sul experience with percutaneous coronary angioplasty (PTCA), after thrombolytic therapy in acute myocardial infarction (AMI). METHODS: Fifty-three patients with transmural AMI in whom early successful intravenous streptokinase recanalization was followed by PTCA. The mean age was 50 years, male patients were more frequent, the predominant area of infarct was anterior wall and more frequently the "culprit" coronary was the left anterior descendent. The main indication of PTCA was uniarterial lesion with less than 20 mm of length. RESULTS: The success comes out in 44 patients (81.5%). Ten patients (18.5%) were considered unsuccessful and were referred to emergency bypass graft surgery. The in-hospital AMI rate after PTCA was 5.5%. In the follow-up the reestenoses rate was 11% and reocclusion was 3.7%. New PTCA was necessary in 3 patients (5.5%) and in one, by-pass graft (1.8%). CONCLUSIONS: PTCA is an important and secure modality of complementary therapy after thrombolytic therapy with low morbidity and mortality.

[Atrio-septostomy using a Rashkind catheter in complete transposition of the great arteries. Immediate and late results]. / Atrioseptostomía con catéter de Rashkind en la transposición completa de las grandes arterias. Resultados inmediatos y tardíos.

Seventy one patients with complete transposition of the great arteries (TGA) who underwent balloon atrial septostomy (BAS) were studied, with the purpose to evaluate its early and late results within the first year of life. Fifty four patients were male (76,1%) and 17 female (23,9%), aged 2 days to 11 months (mean = 2,3 +/- 0,3%), being 46,5% less than 1 month old. Increase in mean aortic oxygen saturation (Ox. Sat.) after BAS was highly significant (p less than 0,001), irrespective of age and morphological features of TGA. Analysis of the group of 55 patients who underwent only BAS during the first year of life showed: mean age in the 13 non-survivors was 3,3 +/- 0,2 months; increase in Ox.Sat. was highly significant in the 42 survivors and not significant in the 13 patients who died; mortality in children with and without patent ductus arteriosus was 23,1% and 23,8%, respectively. Death directly related do BAS occurred in 2 patients (2,8%), without other complications being observed. We conclude that BAS is an effective and low-risk procedure, even in neonates with poor clinical condition. Early response to BAS is predictive of survival in the first year of life.

Associacao entre lesoes coronarianas, idade e angina em pacientes valvopatas. / Association of coronary lesions, age and angina in patients with heart valve diseases

Foram estudados, quanto a frequencia de lesao coronariana significativa (LCS) na cinecoronariografia e sua relacao com angina de peito tipica (APT) e idade, 181 pacientes com valvolopatias - aortica (114), mitral (48) e mitro-aortica (19), sendo 117 homens e 64 mulheres, de 26 a 70 anos, com media de 48,9.Vinte e seis pacientes (14,3% do total) evidenciaram LCS e estas mostraram-se: 1) mais frequentes nos valvopatas em APT (43,9%) que nos assintomaticos (4,3%) e nos com dor toracica atipica (8,3%); 2) ausentes nos pacientes com menos de 40 anos e nos com menos de 50 anos sem APT; dos 50 anos em diante, foi 3 vezes mais frequente (23,0%) que dos 40 aos 49 (7,0%); 3) 4 vezes mais frequente nos pacientes com 50 ou mais anos e APT (52,0%) que nos da mesma idade sem APT (12,1%); 4) 3 vezes mais frequente nos aorticos sem LCS (20%) que nos mitrais e mitro-aorticos sem LCS (6,5% e 6,6%, respectivamente). Conclui-se que a ausencia de APT em pacientes valvopatas abaixo de 50 anos praticamente exclui presenca de LCS, e que dos 50 anos em diante esta indicada a realizacao sistematica de cinecoronariografia nesses pacientes, quando candidatos a cirurgia corretiva da valvopatia