Clinical and angiographic outcomes of coronary dissection after paclitaxel-coated balloon angioplasty for small vessel coronary artery disease.

The mechanism of how angiographic results following paclitaxel-coated balloon (PCB) treatment for small vessel disease affect patient outcome remains unknown. In the present study, we aimed to investigate the correlation between coronary dissection immediately after PCB angioplasty and midterm outcome. From March 2014 to March 2017, 171 consecutive patients with 228 native coronary artery lesions who received PCB angioplasty at a single center were enrolled retrospectively. Lesions with a reference vessel diameter > 2.8 mm were excluded. There were dissections in 80% of the lesions immediately following PCB angioplasty. Of these, 38% were type A, 29% were type B, and 13% were type C or more severe dissection. No patient required revascularization during hospitalization. We were able to follow 159 patients (212 lesions) clinically for > 6 months, from among whom target lesion revascularization (TLR) was performed in 7% of the patients. Follow-up angiography was performed on 143 lesions (67%), and complete healing of all dissections was noted. The rates of restenosis and late lumen enlargement were 12% and 56%, respectively. Multivariate analysis identified that a bending lesion was an independent predictor of TLR, and type C-E dissection and imaging device use were independent predictors of restenosis. Conversely, lesions with type B dissection had a larger net gain than lesions with type A or no dissection. Leaving the dissection uncovered after PCB angioplasty seems to be safe, resulting in a low acute event rate. The type B dissection after PCB angioplasty was the most therapeutic dissection.

Iatrogenic left main coronary artery dissection: incidence, classification, management, and long-term follow-up.

BACKGROUND: Although rare, iatrogenic left main coronary artery (LM) dissection is a feared complication of coronary catheterization. Its incidence, optimal therapeutic management, and prognosis remain largely unknown. The aim of the present study was to estimate the incidence, characterize the population at risk, depict the initial management, and evaluate the long-term prognosis of iatrogenic LM dissection. METHODS: Thirty-eight patients who fulfilled the National Heart, Lung, and Blood Institute diagnostic criteria for iatrogenic LM dissection were retrieved from our database and followed up by telephone or physician visit. The primary end point was freedom from major adverse cardiac events (MACE) at 5 years. RESULTS: The overall incidence of iatrogenic LM dissection during the study period was 0.07% (38/51,452 patients) and almost twice as common with percutaneous coronary intervention than coronary angiography. From 38 patients, 1 (3%) patient died before any therapeutic attempt was performed, 6 (16%) patients were treated conservatively, and 31 (82%) patients underwent stent implantation and/or coronary artery bypass grafting (CABG). In-hospital outcome was favorable irrespective of the therapeutic strategy. During the 5-year follow-up, among 31 patients who underwent revascularization treatment by stenting or CABG, one patient died in each group from a cardiac cause, and MACE were observed in 12 patients (39%). Kaplan-Meier cumulative survival estimates showed no significant difference between different revascularization treatment strategies. CONCLUSIONS: Iatrogenic LM dissection is a rare complication of cardiac catheterization procedures with favorable early and long-term outcome when recognized timely and managed properly.

El tratamiento conservador parece la mejor opción para los aneurismas coronarios sin estenosis / Conservative treatment is apparently the best option in coronary aneurysms without associated stenosis

Los aneurismas coronarios son una patología infrecuente, con una incidencia variable según la población estudiada. La causa más frecuente es la aterosclerosis coronaria, por lo que suele asociarse a estenosis en las coronarias. Realizamos una revisión de todos los estudios angiográficos efectuados en los últimos 10 años en nuestro laboratorio, más de 12 000 pacientes. Trece pacientes mostraron dilataciones aneurismáticas en las coronarias sin relación con estenosis adyacentes. El motivo de ingreso fue un síndrome coronario agudo en la mayoría de los casos, lo que pone de manifiesto la elevada morbilidad asociada de esta patología. Tiene una clara relación con el sexo masculino, sin que hayamos podido encontrar una explicación para esta asociación. A pesar de la ausencia de estenosis coronarias asociadas, creemos que la enfermedad aterosclerótica podría ser su causa etiológica. Debido a la ausencia de grandes registros no se conoce la evolución real de los aneurismas coronarios sin estenosis significativas asociadas y de probable etiología aterosclerótica. En función de nuestra experiencia y de la revisión bibliográfica efectuada, el tratamiento farmacológico conservador es una buena opción en la mayor parte de los pacientes, con buen pronóstico en la evolución a mediano y largo plazo.

Estudio clínico y evolutivo de 10 casos de enfermedad de Kawasaki / Study of the clinical features and course of 10 cases of Kawasaki disease

Objetivo: Describir nuestra experiencia en la enfermedad de Kawasaki, así como características clínicas, evolución, tratamiento y complicaciones cardiológicas de los pacientes diagnosticados en nuestro Centro. Material y método: Valoración clínica, analítica y cardiológica de 10 casos de enfermedad de Kawasaki diagnosticados en nuestro hospital desde 1988 a 2000. Resultados: Edad media de 2 años y 8 meses (rango: de 4 meses a 10 años). Relación hombre-mujer: 1,5/1. En todos ellos se cumplieron 5 de los 6 criterios considerados fundamentales, estando siempre presentes: fiebre, lesiones orofaríngeas, exantema, inyección conjuntival y descamación de manos y pies. En menor medida hubo: eritema indurado de manos y pies, adenopatías cervicales y fisuras labiales (80%), eritema oral difuso (60%) y descamación perineal (30%). Existió retraso diagnóstico en el paciente que debutó con una gran adenopatía cervical. Se presentaron alteraciones cardíacas en la fase aguda, leves y transitorias en el 40% de pacientes, y un paciente manifestó un aneurisma coronario cuyo tamaño aumentó tras un nuevo brote febril no tratado. El tratamiento se realizó en todos con ácido acetilsalicílico, y en siete de ellos, con gammaglobulina intravenosa. No hubo ningún caso de infarto de miocardio ni de fallecimiento. Conclusión: Todos los casos fueron típicos, presentando cinco criterios diagnósticos. Existió retraso diagnóstico en los de presentación no habitual. Hubo recaída de la enfermedad en un paciente, en el que empeoró el aneurisma que previamente sufría. Existió retraso diagnóstico en los de presentación no habitual. Hubo recaída de la enfermedad en un paciente, en el que empeoró el aneurisma que previamente sufría. Existió retraso del tratamiento en el 80% de los casos (AU)

Objective: To report our experience in Kawasaki disease, describing the clinical characteristics, course, treatment and cardiological complications of patients diagnosed in our center. Material and method: Clinical, analytical and cardiological evaluation of 10 cases of Kawasaki disease diagnosed in our hospital from 1988 to 2000. Results: The mean patient age was 2 years 8 months (range: 4 months to 10 years). The male-to-female ratio was 1.5 to 1. All the patients met 5 of the 6 criteria considered fundamental, with fever, oropharyngeal injuries, exanthema, conjunctival injection and desquamation of hands and feet. Some also presented indurated rash on hands and feet, cervical lymphadenopathy and cracked lips (80%), diffuse oral rash (60%) and perineal desquamation (30%). Diagnosis was delayed in a patient who presented with marked cervical lymphadenopathy. Cardiac symptoms appeared in the acute phase; they were mild and transient in 40% of patients, and one child had a coronary aneurysm which increased in size after an untreated bout of fever. All were treated with acetylsalicylic acid, accompanied by intravenous gammaglobulin in 7. There were no cases of myocardial infarct and no deaths. Conclusion: All the cases were typical, with patients meeting 5 diagnostics criteria. Diagnosis was delayed in those in whom the presentation was unusual. One patient had a relapse, which produce a negative effect on his aneurysm. Treatment was delayed in 80% of cases (AU)

Pseudoaneurysm of the left ventricle.

Pseudoaneurysm of the left ventricle most often occurs after transmural myocardial infarction but may also follow cardiac operations, trauma, inflammation, or infection. In contrast to patients with true ventricular aneurysm, those with false aneurysm most commonly die of hemorrhage. Review of the reported surgical experience and of our 14 cases confirms that standard chest radiographs with an abnormal cardiac silhouette and rapidly expanding size may alert the physician to this sometimes overlooked diagnosis. Noninvasive tests such as color-flow Doppler echocardiography, 2-dimensional echocardiography, cineangiographic computed tomography, and transesophageal echocardiography allow relatively easy recognition of these apparently rare lesions with increasing frequency. Cardiac catheterization, however, is usually still necessary for a clear picture of the location and anatomy of the aneurysm and the state of the coronary arteries. Finally, a new classification is proposed, consisting of true aneurysm, false aneurysm, pseudo-false aneurysm, and mixed aneurysm.