Pub Date : 2014-12-01DOI: 10.1590/0104-1843000000055
P. Andrade, Fábio Salerno Rinaldi, Igor Ribeiro de Castro Bienert, Robson Alves Barbosa, Marcos Henriques Bergonso, Milena Paiva Brasil de Matos, Maycon Soto Simplício, Ederlon Ferreira Nogueira, V. Esteves, Sérgio Kreimer, Marden André Tebet, L. A. Mattos, André Labrunie
Failure of the Transradial Approach in a High-Volume Center background: The mechanisms and predictors of failed transradial approach in centers dedicated to this technique are not well characterized and were the main objective of this analysis. methods: 6,808 consecutive patients undergoing transradial coronary procedures by operators with utilization rate greater than 90% were included. Simple and multiple logistic regression models were used to identify the predictors of failed transradial approach. Results: Transradial failure rate was 1.7%. Vascular complications were observed in 5%, with a prevalence of asymptomatic arterial occlusion and subcutaneous hematomas. Predictors of failure were female gender (OR = 1.87; 95% CI 1.29-2.71; p = 0.01), age > 70 years (OR = 1.78; 95% CI 1.06-2.98; p = 0.03) and presence of chronic peripheral arterial disease (OR = 5.71; 95% CI 2.40-13.54; p < 0.01). Conclusions: In a high-volume radial center, failure rate was < 2% and variables associated with technical failure were female gender, advanced age and peripheral arterial disease. DesCRIPToRs: Radial artery. Percutaneous coronary intervention. Hemorrhage. Ischemia.
在大容量中心背景下，经桡骨入路的失败:在专门采用该技术的中心，经桡骨入路失败的机制和预测因素尚未得到很好的表征，这是本分析的主要目的。方法:连续6808例经桡动脉冠状动脉手术患者，手术使用率大于90%。使用简单和多元逻辑回归模型来确定失败的预测因素。结果:经桡动脉失败率为1.7%。血管并发症发生率为5%，伴有无症状动脉闭塞和皮下血肿。失败的预测因素为女性(OR = 1.87;95% ci 1.29-2.71;p = 0.01)，年龄> 70岁(OR = 1.78;95% ci 1.06-2.98;p = 0.03)和存在慢性外周动脉疾病(OR = 5.71;95% ci 2.40-13.54;P < 0.01)。结论:在大容量放射状中心，失败率< 2%，与技术失败相关的变量为女性、高龄和外周动脉疾病。描述:桡动脉。经皮冠状动脉介入治疗。出血。缺血。
{"title":"Insucesso da Técnica Radial em Centro com Alto Volume de Procedimentos","authors":"P. Andrade, Fábio Salerno Rinaldi, Igor Ribeiro de Castro Bienert, Robson Alves Barbosa, Marcos Henriques Bergonso, Milena Paiva Brasil de Matos, Maycon Soto Simplício, Ederlon Ferreira Nogueira, V. Esteves, Sérgio Kreimer, Marden André Tebet, L. A. Mattos, André Labrunie","doi":"10.1590/0104-1843000000055","DOIUrl":"https://doi.org/10.1590/0104-1843000000055","url":null,"abstract":"Failure of the Transradial Approach in a High-Volume Center background: The mechanisms and predictors of failed transradial approach in centers dedicated to this technique are not well characterized and were the main objective of this analysis. methods: 6,808 consecutive patients undergoing transradial coronary procedures by operators with utilization rate greater than 90% were included. Simple and multiple logistic regression models were used to identify the predictors of failed transradial approach. Results: Transradial failure rate was 1.7%. Vascular complications were observed in 5%, with a prevalence of asymptomatic arterial occlusion and subcutaneous hematomas. Predictors of failure were female gender (OR = 1.87; 95% CI 1.29-2.71; p = 0.01), age > 70 years (OR = 1.78; 95% CI 1.06-2.98; p = 0.03) and presence of chronic peripheral arterial disease (OR = 5.71; 95% CI 2.40-13.54; p < 0.01). Conclusions: In a high-volume radial center, failure rate was < 2% and variables associated with technical failure were female gender, advanced age and peripheral arterial disease. DesCRIPToRs: Radial artery. Percutaneous coronary intervention. Hemorrhage. Ischemia.","PeriodicalId":101093,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva","volume":"71 1","pages":"333-338"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77991045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1590/0104-1843000000054
R. Souza, R. Costa, Alexandre Abizaid, Mônica Buchalla, R. R. L. Bueno, George César Ximenes Meireles, K. Martins, J. R. M. Filho, C. O. Costantini, Décio Salvadori, Wilson A. Pimentel-Filho, Andrea C. Abizaid, Juliana P. Castro, E. Ribeiro, Fausto Feres
Background: The Firebird sirolimus-eluting stent has proven to be effective in inhibiting neointimal hyperplasia in selected patients undergoing percutaneous coronary intervention. Our objective was to evaluate the performance and long-term outcomes of Firebird in patients undergoing percutaneous coronary intervention in daily practice in Brazil. Methods: The CLARIFIRE Registry was a prospective, non-randomized, multicenter study enrolling 455 patients (536 lesions) in 14 Brazilian sites between December 2008 and May 2011. Clinical follow-up was performed at 1, 6, 12, and 24 months, and adverse events were adjudicated by the independent Clinical Events Committee. Results: Mean age was 61.1 ± 10.4 years, 30.8% were women, 41.9% had diabetes, and 58.2% had stable angina. The left anterior descending artery was the most prevalent target vessel (46.5%), 29.9% were restenotic lesions, and 8% were bifurcations. Six hundred and thirteen stents were implanted, and the mean nominal stent length and diameter were 22.0 ± 6.4 mm and 2.90 ± 0.40 mm, respectively. Procedural success was 97.6%. The cumulative major adverse cardiac events rate at 12 months (primary endpoint) was 8.1%. Considering post-discharge events up to 24 months (409/455), major adverse cardiac events were observed in 9.8%, cardiac death in 3.9%, and target vessel revascularization in 7.6% of the patients. Definite/probable stent thrombosis was observed in nine cases (2%) up to 30 days, and no further occurrences were found. Conclusions: The Firebird sirolimus-eluting stent has demonstrated good performance and sustained safety and efficacy for patients treated in daily practice, as evidenced by the high procedural success rates and relatively low adverse event rates after 2 years.
{"title":"Resultados Clínicos Tardios do Stent Farmacológico Liberador de Sirolimus Firebird® no Tratamento de Pacientes com Doença Arterial Coronária na Prática Diária – Seguimento de 24 Meses do Registro CLARIFIRE","authors":"R. Souza, R. Costa, Alexandre Abizaid, Mônica Buchalla, R. R. L. Bueno, George César Ximenes Meireles, K. Martins, J. R. M. Filho, C. O. Costantini, Décio Salvadori, Wilson A. Pimentel-Filho, Andrea C. Abizaid, Juliana P. Castro, E. Ribeiro, Fausto Feres","doi":"10.1590/0104-1843000000054","DOIUrl":"https://doi.org/10.1590/0104-1843000000054","url":null,"abstract":"Background: The Firebird sirolimus-eluting stent has proven to be effective in inhibiting neointimal hyperplasia in selected patients undergoing percutaneous coronary intervention. Our objective was to evaluate the performance and long-term outcomes of Firebird in patients undergoing percutaneous coronary intervention in daily practice in Brazil. Methods: The CLARIFIRE Registry was a prospective, non-randomized, multicenter study enrolling 455 patients (536 lesions) in 14 Brazilian sites between December 2008 and May 2011. Clinical follow-up was performed at 1, 6, 12, and 24 months, and adverse events were adjudicated by the independent Clinical Events Committee. Results: Mean age was 61.1 ± 10.4 years, 30.8% were women, 41.9% had diabetes, and 58.2% had stable angina. The left anterior descending artery was the most prevalent target vessel (46.5%), 29.9% were restenotic lesions, and 8% were bifurcations. Six hundred and thirteen stents were implanted, and the mean nominal stent length and diameter were 22.0 ± 6.4 mm and 2.90 ± 0.40 mm, respectively. Procedural success was 97.6%. The cumulative major adverse cardiac events rate at 12 months (primary endpoint) was 8.1%. Considering post-discharge events up to 24 months (409/455), major adverse cardiac events were observed in 9.8%, cardiac death in 3.9%, and target vessel revascularization in 7.6% of the patients. Definite/probable stent thrombosis was observed in nine cases (2%) up to 30 days, and no further occurrences were found. Conclusions: The Firebird sirolimus-eluting stent has demonstrated good performance and sustained safety and efficacy for patients treated in daily practice, as evidenced by the high procedural success rates and relatively low adverse event rates after 2 years.","PeriodicalId":101093,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva","volume":"30 1","pages":"324-332"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91469461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1590/0104-1843000000065
Adriano Gonçalves de Araújo, F. H. Souza, Fernando Henrique Fernandes, Flávio Passos Barbosa, José Antônio Jatene, Paulo Cézar Guimarães Câmara
An elderly patient with non-dialysis renal failure and oxygendependent chronic obstructive pulmonary disease was admitted to the emergency room with lancinating abdominal pain. Angiotomography of the abdomen revealed the presence of a large aortic aneurysm with involvement of visceral arteries. Due to the high surgical risk, endovascular repair was proposed, using the chimney graft technique for the preservation of the visceral vessels. This technique is promising because it enables endovascular repair of aneurysms, be it in elective cases, emergencies, or rescue of a visceral artery accidentally covered by an aortic stent graft.
{"title":"Tratamento Endovascular de Aneurisma de Aorta Abdominal pela Técnica de Chaminé","authors":"Adriano Gonçalves de Araújo, F. H. Souza, Fernando Henrique Fernandes, Flávio Passos Barbosa, José Antônio Jatene, Paulo Cézar Guimarães Câmara","doi":"10.1590/0104-1843000000065","DOIUrl":"https://doi.org/10.1590/0104-1843000000065","url":null,"abstract":"An elderly patient with non-dialysis renal failure and oxygendependent chronic obstructive pulmonary disease was admitted to the emergency room with lancinating abdominal pain. Angiotomography of the abdomen revealed the presence of a large aortic aneurysm with involvement of visceral arteries. Due to the high surgical risk, endovascular repair was proposed, using the chimney graft technique for the preservation of the visceral vessels. This technique is promising because it enables endovascular repair of aneurysms, be it in elective cases, emergencies, or rescue of a visceral artery accidentally covered by an aortic stent graft.","PeriodicalId":101093,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva","volume":"1144 ","pages":"386-389"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91450625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1590/0104-1843000000058
T. Vargas, Barbara Cardoso Campos, Naury de Jesus Danzi Soares, Luciano Magalhães Vitorino, S. Ibrahim, Bruno Laurenti Janella
Background: There is controversy in the literature about the advantages of the radial vs. femoral access route for diagnostic catheterizations. This study aimed to compare the radial and femoral access for procedural and fluoroscopy times and for contrast volume. Methods: This was an observational, retrospective study based on the records of consecutive patients undergoing cardiac catheterization from July 2012 to December 2013. Results: We evaluated 192 patients and the radial access was used in 78.1% of the cases. Mean age was 63.1 ± 11.9 years, most were male (55.7%) and 21.4% had diabetes. Procedural time was lower in the radial group: 12.0 minutes (9.0 to 17.2 minutes) vs. 18.3 minutes (12.0 to 34.5 minutes), p < 0.01. Fluoroscopy time was 270.0 seconds (180.0 to 389.5 seconds) vs. 244.0 seconds (175.3 to 705.0 seconds), and there was no difference between groups (p = 0.59). Contrast volume was lower in the radial group: 100.0 mL (75.0 to 117.5 mL) vs. 100.0 mL (80.0 to 150.0 mL), p < 0.01. Conclusions: In this laboratory, which favored the radial access for cardiac catheterization, procedural and fluoroscopy times, as well as contrast volume, were lower or comparable to the femoral access.
背景:关于桡骨与股动脉导管入路在诊断性置管中的优势，文献中存在争议。本研究旨在比较桡骨入路和股骨入路的手术时间和透视时间以及造影剂体积。方法:基于2012年7月至2013年12月连续心导管置入术患者的观察性、回顾性研究。结果:我们对192例患者进行了评估，78.1%的患者采用了桡骨通路。平均年龄63.1±11.9岁，男性居多(55.7%)，糖尿病患者占21.4%。桡骨组手术时间较短:12.0分钟(9.0 ~ 17.2分钟)vs. 18.3分钟(12.0 ~ 34.5分钟)，p < 0.01。透视时间分别为270.0秒(180.0 ~ 389.5秒)和244.0秒(175.3 ~ 705.0秒)，组间差异无统计学意义(p = 0.59)。桡动脉组造影剂体积较低:100.0 mL (75.0 ~ 117.5 mL)比100.0 mL (80.0 ~ 150.0 mL)， p < 0.01。结论:在本实验室，桡动脉入路更适合心导管插管，手术和透视时间，以及造影剂体积，比股骨入路更低或相当。
{"title":"Comparação entre os Tempos de Procedimento e Fluoroscopia e o Volume de Contraste das Vias de Acesso Radial e Femoral em Pacientes Submetidos a Cateterismo Cardíaco","authors":"T. Vargas, Barbara Cardoso Campos, Naury de Jesus Danzi Soares, Luciano Magalhães Vitorino, S. Ibrahim, Bruno Laurenti Janella","doi":"10.1590/0104-1843000000058","DOIUrl":"https://doi.org/10.1590/0104-1843000000058","url":null,"abstract":"Background: There is controversy in the literature about the advantages of the radial vs. femoral access route for diagnostic catheterizations. This study aimed to compare the radial and femoral access for procedural and fluoroscopy times and for contrast volume. Methods: This was an observational, retrospective study based on the records of consecutive patients undergoing cardiac catheterization from July 2012 to December 2013. Results: We evaluated 192 patients and the radial access was used in 78.1% of the cases. Mean age was 63.1 ± 11.9 years, most were male (55.7%) and 21.4% had diabetes. Procedural time was lower in the radial group: 12.0 minutes (9.0 to 17.2 minutes) vs. 18.3 minutes (12.0 to 34.5 minutes), p < 0.01. Fluoroscopy time was 270.0 seconds (180.0 to 389.5 seconds) vs. 244.0 seconds (175.3 to 705.0 seconds), and there was no difference between groups (p = 0.59). Contrast volume was lower in the radial group: 100.0 mL (75.0 to 117.5 mL) vs. 100.0 mL (80.0 to 150.0 mL), p < 0.01. Conclusions: In this laboratory, which favored the radial access for cardiac catheterization, procedural and fluoroscopy times, as well as contrast volume, were lower or comparable to the femoral access.","PeriodicalId":101093,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva","volume":"53 1","pages":"349-352"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88790758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1590/0104-1843000000059
M. J. C. Cantarelli, H. Castello, Rosaly Gonçalves, Silvio Gioppato, Ednelson Cunha Navarro, J. B. Guimarães, E. Ribeiro, Danilo Maksud, Julio Cesar Francisco Vardi
Background: Cardiovascular disease has shown increasing occurrence rates among young people and data of percutaneous coronary intervention (PCI) in this group are scarce. Our objective was to perform a retrospective evaluation of the profile and in-hospital clinical outcomes of young patients in this PCI registry. Methods: From 2006 to 2012, 6,288 patients were consecutively submitted to PCI, of whom 151 were 0.99), myocardial infarction (3.3% vs. 2.3%; p = 0.41) or emergency revascularization (0.6% vs. 0.03%; p = 0.56) were similar between groups. In the multivariate analysis, age and presence of functional class Killip III and IV were the variables that best explained the occurrence of MACCE. Conclusions: Patients with age < 40 years represented a small fraction of the cases in this series and had a clinical and angiographic profile different from the older patients, suggesting the need to establish primary prevention measures earlier in individuals with the observed profile.
背景:心血管疾病在年轻人中的发病率越来越高，而经皮冠状动脉介入治疗(PCI)在这一群体中的数据很少。我们的目的是对该PCI登记的年轻患者的概况和住院临床结果进行回顾性评估。方法:2006 - 2012年，6288例患者连续行PCI，其中151例(0.99)，心肌梗死(3.3% vs. 2.3%;P = 0.41)或紧急血运重建术(0.6% vs. 0.03%;P = 0.56)组间相似。在多变量分析中，年龄和功能等级Killip III和IV的存在是最能解释MACCE发生的变量。结论:年龄< 40岁的患者只占本系列病例的一小部分，其临床和血管造影特征与老年患者不同，这表明有必要在观察到的个体中早期建立一级预防措施。
{"title":"Intervenção Coronária Percutânea em Pacientes Jovens","authors":"M. J. C. Cantarelli, H. Castello, Rosaly Gonçalves, Silvio Gioppato, Ednelson Cunha Navarro, J. B. Guimarães, E. Ribeiro, Danilo Maksud, Julio Cesar Francisco Vardi","doi":"10.1590/0104-1843000000059","DOIUrl":"https://doi.org/10.1590/0104-1843000000059","url":null,"abstract":"Background: Cardiovascular disease has shown increasing occurrence rates among young people and data of percutaneous coronary intervention (PCI) in this group are scarce. Our objective was to perform a retrospective evaluation of the profile and in-hospital clinical outcomes of young patients in this PCI registry. Methods: From 2006 to 2012, 6,288 patients were consecutively submitted to PCI, of whom 151 were 0.99), myocardial infarction (3.3% vs. 2.3%; p = 0.41) or emergency revascularization (0.6% vs. 0.03%; p = 0.56) were similar between groups. In the multivariate analysis, age and presence of functional class Killip III and IV were the variables that best explained the occurrence of MACCE. Conclusions: Patients with age < 40 years represented a small fraction of the cases in this series and had a clinical and angiographic profile different from the older patients, suggesting the need to establish primary prevention measures earlier in individuals with the observed profile.","PeriodicalId":101093,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva","volume":"21 1","pages":"353-358"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83277544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1590/0104-1843000000061
Julian Rathke, H. S. Menezes, Raul Ivo Rossi-Filho, J. L. Manica
Background: Patent ductus arteriosus is a congenital condition with high morbidity, especially in preterm infants of extremely low birth weight, representing 5% to 10% of congenital heart diseases. Our objective was to describe the approaches used at a reference hospital for the percutaneous occlusion of PDA. Methods: We conducted a retrospective study on the transcatheter treatment of patent ductus arteriosus from April of 2008 to April of 2010. Results: Forty-seven cases were reviewed and most of them (78.8%) were treated with FlipperTM coils while the remaining patients received the AmplatzerTM device. Ductal morphological configuration was Krichenko type A in 89.4% (34 in the FlipperTM coil group and 8 in the AmplatzerTM group), type D in 6.4% (2 in the FlipperTM coil group and 1 in the AmplatzerTM group) and type E in 4.2% (1 in each group) of patients. Pre-catheterization minimum diameters were 2.6 ± 0.8 mm and 3.8 ± 1.6 mm for the FlipperTM coil and AmplatzerTM groups, respectively. Immediate total occlusion of the defect was obtained in the control angiography in 72.3% of the patients. Seven patients treated with the FlipperTM coil received additional coils and two patients treated with the AmplatzerTM device presented minimal residual shunts. There were no procedure-related complications. In the follow-up after hospital discharge, one patient presented minimal residual shunt at the echography, 45 days after catheterization. Conclusions: Percutaneous patent ductus arteriosus occlusion has proven to be safe and effective in most cases.
{"title":"Oclusão Percutânea da Persistência do Ducto Arterioso","authors":"Julian Rathke, H. S. Menezes, Raul Ivo Rossi-Filho, J. L. Manica","doi":"10.1590/0104-1843000000061","DOIUrl":"https://doi.org/10.1590/0104-1843000000061","url":null,"abstract":"Background: Patent ductus arteriosus is a congenital condition with high morbidity, especially in preterm infants of extremely low birth weight, representing 5% to 10% of congenital heart diseases. Our objective was to describe the approaches used at a reference hospital for the percutaneous occlusion of PDA. Methods: We conducted a retrospective study on the transcatheter treatment of patent ductus arteriosus from April of 2008 to April of 2010. Results: Forty-seven cases were reviewed and most of them (78.8%) were treated with FlipperTM coils while the remaining patients received the AmplatzerTM device. Ductal morphological configuration was Krichenko type A in 89.4% (34 in the FlipperTM coil group and 8 in the AmplatzerTM group), type D in 6.4% (2 in the FlipperTM coil group and 1 in the AmplatzerTM group) and type E in 4.2% (1 in each group) of patients. Pre-catheterization minimum diameters were 2.6 ± 0.8 mm and 3.8 ± 1.6 mm for the FlipperTM coil and AmplatzerTM groups, respectively. Immediate total occlusion of the defect was obtained in the control angiography in 72.3% of the patients. Seven patients treated with the FlipperTM coil received additional coils and two patients treated with the AmplatzerTM device presented minimal residual shunts. There were no procedure-related complications. In the follow-up after hospital discharge, one patient presented minimal residual shunt at the echography, 45 days after catheterization. Conclusions: Percutaneous patent ductus arteriosus occlusion has proven to be safe and effective in most cases.","PeriodicalId":101093,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva","volume":"93 1","pages":"364-368"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80516317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1590/0104-1843000000064
F. Chamié, Daniel Chamié, L. C. Simões, Ê. Guérios, João Carlos Tress
Left atrial appendage occlusion has been successfully employed to prevent embolic events in patients with atrial fibrillation as an alternative to oral anticoagulation. Left atrial access through the patent foramen ovale or ostium secundum atrial septal defect has been discouraged due to the fear that entering the septum in a higher position through the foramen would prevent adequate device positioning. In this manuscript we report a case in which the left atrial appendage and the foramen ovale were sequentially occluded avoiding transseptal puncture, making the procedure simpler and faster.
{"title":"Oclusão Percutânea do Apêndice Atrial Esquerdo e do Forame Oval Patente no Mesmo Procedimento sem Necessidade de Punção Transeptal","authors":"F. Chamié, Daniel Chamié, L. C. Simões, Ê. Guérios, João Carlos Tress","doi":"10.1590/0104-1843000000064","DOIUrl":"https://doi.org/10.1590/0104-1843000000064","url":null,"abstract":"Left atrial appendage occlusion has been successfully employed to prevent embolic events in patients with atrial fibrillation as an alternative to oral anticoagulation. Left atrial access through the patent foramen ovale or ostium secundum atrial septal defect has been discouraged due to the fear that entering the septum in a higher position through the foramen would prevent adequate device positioning. In this manuscript we report a case in which the left atrial appendage and the foramen ovale were sequentially occluded avoiding transseptal puncture, making the procedure simpler and faster.","PeriodicalId":101093,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva","volume":"58 1","pages":"382-385"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86817407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1590/0104-1843000000057
R. R. Barbosa, F. Cesar, Renato Giestas Serpa, Vinícius Fraga Mauro, J. Edson Ferreira Jr., Denis Moulin dos Reis Bayerl, Walkimar Ururay Gloria Veloso, R. Cesar, Pedro Abílio Ribeiro Reseck
Background: The use of radial access in cardiac interventions is associated with reduced vascular complications, however it demands a longer learning curve and may increase fluoroscopy time. This study aimed to evaluate the fluoroscopy time as a surrogate marker of radiation exposure, during diagnostic cardiac catheterization by radial and femoral routes. Methods: Retrospective observational study including patients who underwent cardiac catheterization from July 2013 to October 2014. Radial and femoral groups were compared for total procedural time, fluoroscopy time, fluoroscopy to procedural time ratio and vascular complications. Results: The study included 1,915 procedures, 11.2% of which performed by radial approach and 88.8%, by femoral approach. A male prevalence was found in the radial group (80% vs. 54.1%, p < 0.01), but age (61.6 ± 9.7 years vs. 62.4 ± 11.6 years, p = 0.13), total procedural time (8.7 ± 3.8 vs. 8.1 ± 4.1 minutes, p = 0.91), fluoroscopy time (4.8 ± 2.7 vs. 4.1 ± 2.6 minutes, p = 0.89), fluoroscopy/procedure time ratio (0.56 ± 0.24 vs. 0.49 ± 0.32, p = 0.89), and major complications (0.0% vs. 0.3%, p = 0.55) were similar between groups. Conclusions: The use of the transradial approach for diagnostic procedures by experienced operating physicians may be used with an acceptable total procedural time without increasing the radiation exposure of the patient and staff, and with a low incidence of complications.
{"title":"Comparação do Tempo de Fluoroscopia Durante Cateterismo Cardíaco pelas Vias Radial e Femoral","authors":"R. R. Barbosa, F. Cesar, Renato Giestas Serpa, Vinícius Fraga Mauro, J. Edson Ferreira Jr., Denis Moulin dos Reis Bayerl, Walkimar Ururay Gloria Veloso, R. Cesar, Pedro Abílio Ribeiro Reseck","doi":"10.1590/0104-1843000000057","DOIUrl":"https://doi.org/10.1590/0104-1843000000057","url":null,"abstract":"Background: The use of radial access in cardiac interventions is associated with reduced vascular complications, however it demands a longer learning curve and may increase fluoroscopy time. This study aimed to evaluate the fluoroscopy time as a surrogate marker of radiation exposure, during diagnostic cardiac catheterization by radial and femoral routes. Methods: Retrospective observational study including patients who underwent cardiac catheterization from July 2013 to October 2014. Radial and femoral groups were compared for total procedural time, fluoroscopy time, fluoroscopy to procedural time ratio and vascular complications. Results: The study included 1,915 procedures, 11.2% of which performed by radial approach and 88.8%, by femoral approach. A male prevalence was found in the radial group (80% vs. 54.1%, p < 0.01), but age (61.6 ± 9.7 years vs. 62.4 ± 11.6 years, p = 0.13), total procedural time (8.7 ± 3.8 vs. 8.1 ± 4.1 minutes, p = 0.91), fluoroscopy time (4.8 ± 2.7 vs. 4.1 ± 2.6 minutes, p = 0.89), fluoroscopy/procedure time ratio (0.56 ± 0.24 vs. 0.49 ± 0.32, p = 0.89), and major complications (0.0% vs. 0.3%, p = 0.55) were similar between groups. Conclusions: The use of the transradial approach for diagnostic procedures by experienced operating physicians may be used with an acceptable total procedural time without increasing the radiation exposure of the patient and staff, and with a low incidence of complications.","PeriodicalId":101093,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva","volume":"50 1","pages":"343-348"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79149359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1590/0104-1843000000053
Cristiano de Oliveira Cardoso, Cláudio Vasques de Moraes, J. V. D. S. Teixeira, L. S. Fischer, Gabriel Garcia Broetto, Bruna dos Santos Silva, Rogério Fachel de Medeiros, Rogério Sarmento-Leite, C. A. Gottschall
Introducao: Procedimentos cardiologicos invasivos expoem Medicos e enfermeiros/tecnicos de enfermagem aos riscos da radiacao ionizante. O objetivo deste estudo foi determinar os padroes de exposicao radiologica em profissionais da saude durante procedimentos cardiologicos. Metodos: Estudo prospectivo incluindo pacientes submetidos a procedimento cardiologico invasivo entre dezembro de 2011 e agosto de 2012 em equipamento com detectores do tipo plano. Caracteristicas clinicas, angiograficas e de exposicao a radiacao foram registradas em banco de dados especifico. Os padroes de exposicao a radiacao foram determinados em pacientes submetidos ao cateterismo cardiaco diagnostico. Correlacao entre dose do medico operador e enfermeiro/tecnico de enfermagem tambem foi efetuada. Resultados: Amostra incluiu 119 pacientes submetidos ao cateterismo. A dose de kerma no ar e o produto dose-area medio de radiacao recebida pelos pacientes foram de 549 ± 220 mGy e 29.054 ± 14.696 mGy.cm2, respectivamente. Medicos e enfermeiros/tecnicos de enfermagem foram expostos a dose efetiva media por exame de 0,47 ± 0,16 e 0,28 ± 0,13 mSv, respectivamente. A correlacao entre dose efetiva dos Medicos e enfermeiro/tecnicos de enfermagem foi de 0,54 ( p < 0,001). Conclusoes: Medicos e enfermeiros/tecnicos de enfermagem sao expostos a doses pequenas de radiacao ionizante durante cateterismo cardiaco diagnostico. Enfermeiros/tecnicos de enfermagem sao expostos a cerca de 60% da dose do medico operador.
{"title":"Padrão de exposição radiológica em profissionais da saúde durante procedimentos cardiológicos invasivos","authors":"Cristiano de Oliveira Cardoso, Cláudio Vasques de Moraes, J. V. D. S. Teixeira, L. S. Fischer, Gabriel Garcia Broetto, Bruna dos Santos Silva, Rogério Fachel de Medeiros, Rogério Sarmento-Leite, C. A. Gottschall","doi":"10.1590/0104-1843000000053","DOIUrl":"https://doi.org/10.1590/0104-1843000000053","url":null,"abstract":"Introducao: Procedimentos cardiologicos invasivos expoem Medicos e enfermeiros/tecnicos de enfermagem aos riscos da radiacao ionizante. O objetivo deste estudo foi determinar os padroes de exposicao radiologica em profissionais da saude durante procedimentos cardiologicos. Metodos: Estudo prospectivo incluindo pacientes submetidos a procedimento cardiologico invasivo entre dezembro de 2011 e agosto de 2012 em equipamento com detectores do tipo plano. Caracteristicas clinicas, angiograficas e de exposicao a radiacao foram registradas em banco de dados especifico. Os padroes de exposicao a radiacao foram determinados em pacientes submetidos ao cateterismo cardiaco diagnostico. Correlacao entre dose do medico operador e enfermeiro/tecnico de enfermagem tambem foi efetuada. Resultados: Amostra incluiu 119 pacientes submetidos ao cateterismo. A dose de kerma no ar e o produto dose-area medio de radiacao recebida pelos pacientes foram de 549 ± 220 mGy e 29.054 ± 14.696 mGy.cm2, respectivamente. Medicos e enfermeiros/tecnicos de enfermagem foram expostos a dose efetiva media por exame de 0,47 ± 0,16 e 0,28 ± 0,13 mSv, respectivamente. A correlacao entre dose efetiva dos Medicos e enfermeiro/tecnicos de enfermagem foi de 0,54 ( p < 0,001). Conclusoes: Medicos e enfermeiros/tecnicos de enfermagem sao expostos a doses pequenas de radiacao ionizante durante cateterismo cardiaco diagnostico. Enfermeiros/tecnicos de enfermagem sao expostos a cerca de 60% da dose do medico operador.","PeriodicalId":101093,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva","volume":"13 1","pages":"320-323"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87008799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-12-01DOI: 10.1590/0104-1843000000060
Marcelo Sabedotti, Rogério Sarmento-Leite, A. Quadros
Background: The ankle-brachial index is a simple and effective tool for diagnosing peripheral artery disease, but has not been validated for the diagnosis of coronary artery disease. The aim of this study was to evaluate the ability of the ankle-brachial index to predict coronary artery disease in patients undergoing coronary angiography. Methods: Patients with clinical suspicion of coronary artery disease and indication for coronary angiography were prospectively evaluated. Significant coronary artery disease was defined as the presence of stenosis > 70% of at least one major epicardial coronary artery or any of their major branches. A ROC curve was developed to define the ankle-brachial index cutoff that best predicts coronary artery disease. Results: A total of 312 patients were evaluated: mean age was 57 ± 11 years and 50% were male. One hundred and sixteen (37.2%) patients had significant coronary disease. Ankle-brachial index measurement in these patients was significantly lower than in those without coronary artery disease (0.88 ± 0.14 vs. 0.96 ± 0.87; p < 0.01). Ankle-brachial index < 0.87 showed a sensitivity of 31%, specificity of 95.4%, positive predictive value of 75.9% and negative predictive value of 71.6%. The area under the ROC curve was 0.73 (95% confidence interval of 0.67-0.79). Conclusions: Ankle-brachial index < 0.87 had a high specificity to predict significant coronary disease. Considering its low cost and ease of use, measurement of ankle-brachial index may be incorporated to daily clinical practice to help diagnose significant coronary artery disease.
{"title":"Índice Tornozelo-Braquial como Preditor de Doença Coronariana Significativa em Pacientes Submetidos à Angiografia Coronária","authors":"Marcelo Sabedotti, Rogério Sarmento-Leite, A. Quadros","doi":"10.1590/0104-1843000000060","DOIUrl":"https://doi.org/10.1590/0104-1843000000060","url":null,"abstract":"Background: The ankle-brachial index is a simple and effective tool for diagnosing peripheral artery disease, but has not been validated for the diagnosis of coronary artery disease. The aim of this study was to evaluate the ability of the ankle-brachial index to predict coronary artery disease in patients undergoing coronary angiography. Methods: Patients with clinical suspicion of coronary artery disease and indication for coronary angiography were prospectively evaluated. Significant coronary artery disease was defined as the presence of stenosis > 70% of at least one major epicardial coronary artery or any of their major branches. A ROC curve was developed to define the ankle-brachial index cutoff that best predicts coronary artery disease. Results: A total of 312 patients were evaluated: mean age was 57 ± 11 years and 50% were male. One hundred and sixteen (37.2%) patients had significant coronary disease. Ankle-brachial index measurement in these patients was significantly lower than in those without coronary artery disease (0.88 ± 0.14 vs. 0.96 ± 0.87; p < 0.01). Ankle-brachial index < 0.87 showed a sensitivity of 31%, specificity of 95.4%, positive predictive value of 75.9% and negative predictive value of 71.6%. The area under the ROC curve was 0.73 (95% confidence interval of 0.67-0.79). Conclusions: Ankle-brachial index < 0.87 had a high specificity to predict significant coronary disease. Considering its low cost and ease of use, measurement of ankle-brachial index may be incorporated to daily clinical practice to help diagnose significant coronary artery disease.","PeriodicalId":101093,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva","volume":"37 1","pages":"359-363"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88897832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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