RESUMO
Coronary artery aneurysm is a rare congenital or acquired anomaly. The commonest location of coronary artery aneurysms is the right coronary artery and they are found slightly more often in males. We report an unusual case of multiple and extremely large aneurysms, therefore potentially at risk of rupture or thrombosis.
Assuntos
Aneurisma Coronário/diagnóstico , Idoso , Procedimentos Cirúrgicos Cardíacos , Aneurisma Coronário/cirurgia , Angiografia Coronária/métodos , Humanos , Masculino , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Bicuspid aortic valve is one of the most common congenital cardiac anomalies and it may be accompanied by other cardiovascular anomalies. Sinus of Valsalva aneurysm is a rare anomaly in adult population, but it coexists with bicuspid aortic valve quite often. This report describes a 57 years-old patient who had a bicuspid aortic valve accompanied by unruptured Valsalva sinus aneurysm with significant left anterior narrowing and who underwent successful surgery with ascending aorta and aortic valve replacement as well as coronary by-pass grafting.
Assuntos
Aneurisma Aórtico/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular , Ponte de Artéria Coronária , Estenose Coronária/cirurgia , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca , Seio Aórtico/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Aortografia/métodos , Angiografia Coronária , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Seio Aórtico/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
INTRODUCTION: In-stent restenosis still remains a serious clinical problem. Local intramural drug delivery (LDD -- Local Drug Delivery) seems to be an interesting alternative to drug-eluting stents (DES). AIM: The aim of the study was to assess the safety and effectiveness of local intramural paclitaxel administration in the treatment of recurrent in-stent restenosis (ISR). METHODS: Five patients were enrolled in the study (3 men, mean age 50+/-7 years) with at least a second episode of ISR within the same stent. Percutaneous coronary angioplasty was performed on a total of 11 vessel segments. Remedy delivery catheters (Boston Scientific) were used for balloon angioplasty. Inflation pressure was calibrated to obtain a balloon/vessel lumen ratio of 1.1:1. Then the pressure was lowered to 3 atmospheres and 100 microg of paclitaxel diluted in 2 ml of 0.9% NaCl was given over 60 seconds under the pressure of 2-3 atmospheres. This dose was used for each 10 mm of lesions. Control coronary angiography was performed six months after the procedure. RESULTS: In all patients effective target vessel revascularisation was achieved. No adverse events were observed in the periprocedural period or during the 6-month follow-up period. Control angiography revealed ISR in three segments (27.2%) and in-stent late lumen loss of 0.21+/-0.93 mm. CONCLUSIONS: Local intramural paclitaxel delivery is a safe and effective method of ISR treatment. The optimal paclitaxel dose should be established in further studies.
