Revista Brasileira de Cardiologia Invasiva最新文献

Background

Accurate aortic valve annulus sizing has critical importance for the planning of percutaneous transcatheter aortic valve implantation (TAVI) in patients with severe aortic valve stenosis. Although there is a recommendation to perform the measurement during systole, little is known about the importance of the differences between systolic and diastolic dimensions of the annulus.

Methods

Consecutive patients referred for TAVI were evaluated with computed tomography for valve annulus sizing during systole and diastole. Area, circumference, minimum and maximum diameters, and their mean derived diameters were obtained in both phases of the cardiac cycle. Bland‐Altman plots were constructed to evaluate the differences between the measures.

Results

The analysis included 41 patients with severe aortic stenosis. Mean area, circumference, and diameters were slightly greater in systole. However, in 35% of patients, diastolic dimensions were greater. These differences, although statistically significant, were small (the greatest difference of 0.6 mm in mean diameter). Bland‐Altman plots showed good agreement between systolic and diastolic measurements on all parameters evaluated.

Conclusions

Small differences were observed in the systolic and diastolic dimensions of the aortic valve annulus with computed tomography scan, which, although statistically significant, probably do not impact the selection of prosthesis or the procedure outcome.

Background

Higher mortality is reported among women with ST‐elevation myocardial infarction (STEMI). This study aimed to evaluate the clinical and angiographic profiles, as well as outcomes of patients submitted to primary percutaneous coronary intervention (pPCI), according to gender.

Methods

Retrospective study that included patients with STEMI undergoing pPCI between March 2012 and May 2013 at a regional referral center, followed from admission until hospital discharge or death.

Results

208 patients underwent pPCI, of whom 51 (24.5%) were women and 157 (75.5%) men. A significant difference was observed for age (65.5 ± 14.0 vs. 58.8 ± 11.0 years; p = 0.001), diabetes (43.1% vs. 24.8%; p = 0.02), Killip‐Kimball class III/IV (7.0% vs. 17.6%; p = 0.02), pain‐to‐door time (181 ± 154 minutes vs. 125 ± 103 minutes; p = 0.004), and door‐to‐balloon time (181 ± 87 vs. 133 minutes ± 67 minutes; p = 0.001). The success of the procedure was similar (92.1% vs. 91.1%; p = 0.22). In‐hospital mortality was higher for females (23.5% vs. 8.9%; p = 0.006). Multivariate analysis identified age ≥ 70 years (odds ratio ‐ OR = 2.75; 95% confidence interval ‐ 95% CI: 1.81–3.64; p = 0.029) and Killip‐Kimball class III/IV (OR = 2.45; 95% CI: 1.49–4.02; p = 0.002) as independent predictors of mortality.

Conclusions

Women with STEMI had a more severe clinical profile and longer pain‐to‐door and door‐to‐balloon times than men. Females had higher in‐hospital mortality after pPCI, but the female gender was not identified as an independent predictor of death.

Background

Implantable cardioverter‐defibrillators (ICDs) are usually indicated for patients with malignant arrhythmias considered as high risk. Sympathetic hyperactivity plays a critical role in the development, maintenance, and worsening of ventricular arrhythmias. New treatment options in this population represent a clinical necessity. This study's objective was to report the outcomes of patients with ICDs and electrical storm submitted to renal sympathetic denervation for arrhythmia control.

Methods

Eight patients with ICDs admitted for electrical storm refractory to optimal medical therapy underwent renal sympathetic denervation. Underlying diseases included Chagas disease (n = 6), non‐ischemic dilated cardiomyopathy (n = 1), and ischemic cardiomyopathy (n = 1). Information on the number of episodes of ventricular tachycardia/ventricular fibrillation and antitachycardia therapies in the week before the procedure and 30 days after treatment were obtained through interrogation of the ICDs.

Results

The median numbers of episodes of ventricular tachycardia/ventricular fibrillation, antitachycardia pacing, and shocks in the week before renal sympathetic denervation were 29 (9 to 106), 23 (2 to 94), and 7.5 (1 to 88), and significantly reduced to 0 (0 to 12), 0 (0 to 30), and 0 (0 to 1), respectively, 1 month after the procedure (p = 0.002; p = 0.01; p = 0.003, respectively). No patients died during follow‐up. There were no major complications related to the procedure.

Conclusions

In patients with ICDs and electrical storm refractory to optimal medical treatment, renal sympathetic denervation significantly reduced arrhythmia load and, consequently, antitachycardia pacing and shocks. Randomized clinical trials in the context of renal sympathetic denervation to control refractory cardiac arrhythmias are needed to further support these findings.

Renal artery fibromuscular dysplasia is a condition of unknown etiology, with non‐inflammatory, non‐atherosclerotic origin, associated to the development of stenosis and aneurysms. The authors report a case of bilateral renal artery fibromuscular dysplasia associated with a large renal artery aneurysm, treated with balloon angioplasty and a multilayer stent.

Background

Although same‐day discharge (SDD) after elective uncomplicated percutaneous coronary intervention (PCI) be adopted worldwide, it remains poorly studied in our country. We aim to evaluate our initial experience with SDD after elective PCI, regarding its safety and predictors of success.

Methods

A hundred and sixty‐one single‐center consecutive patients, selected in a specialized outpatient clinic, were included for SDD. To identify the factors associated with SDD, single and multiple logistic regression models were adjusted.

Results

SDD was successfully performed in 114 patients (70.8%) and the remaining 47 patients remained hospitalized (45 with discharge in the following morning and 2 patients after 2 days). No patient with SDD presented major adverse cardiac events or major vascular complications at 30 days or at a median follow‐up of 12 months. In the inpatient group, there was only one case of acute myocardial infarction due to a lateral branch occlusion and two patients with > 5 cm hematoma related to the access site. The SDD predictors were radial access route (OR = 5.92; 95%CI 1.73‐20.21; p = 0.005), presence of type A/B1 lesions (OR = 14.09; 95%CI 1.70‐116.49%; p = 0.01) and contrast volume (OR = 0.76; 95%CI 0.65‐0.88; p < 0.001).

Conclusions

SDD was safe and could be successfully performed in most patients selected for elective PCI, and its predictors were the radial access, less complex coronary lesions and a and lower contrast volume.

Background

Multiple congenital defects are traditionally corrected surgically, but nowadays can be treated percutaneously. There are few reports in the literature attesting to its efficacy and safety. We aimed to describe an experience with combined procedures to treat different congenital and structural defects, in a single therapeutic session.

Methods

Since 2007, different defects were treated in a single treatment session. All were selected by echocardiography. The procedures were performed using traditional techniques already described for each defect.

Results

Ten patients were treated, five males, aged 1‐67 years, weighting 11‐90 kilograms. The most prevalent isolated defect was patent ductus arteriosus (PDA, n = 5), followed by ostium secundum atrial septal defects (ASD, n = 4) and ventricular septal defects (VSD, n = 4). The most common combinations were VSD with PDA (n = 2) and VSD with osASD (n = 2). Two pulmonary valve stenosis were dilated with ASD and patent foramen ovale (PFO), and one aorta coarctation with PDA. Additionally, a left atrial appendage with PFO was occluded and an aortopulmonary fistula with PDA was embolized. All procedures were successful. The mean follow‐up was 31 ± 28.1 months, with only two complications. There were no deaths.

Conclusions

The small number of reported cases showed that the combined procedures were safe and effective and can be reproduced by experienced operators in specialized centers and may be considered as the first therapeutic option in these patients.

Background

The Xience V^TM everolimus‐eluting stents is a new generation drug‐eluting stent (DES) that incorporates a low profile cobalt‐chromium platform (81 μm) and a highly biocompatible polymer (fluoropolymer), which carries and controls the release of everolimus. Recent studies have demonstrated sustained safety and efficacy of the Xience V^TM in the treatment of real‐world populations. Our aim was to report the clinical results of 12 months of the BRAVO Brazilian protocol.

Methods

The BRAVO Registry was a prospective, non‐randomized, single‐arm, multicenter (25 centers) study that evaluated the late clinical results of 535 minimally selected patients treated with the drugeluting stent Xience V^TM in Brazilian daily practice.

Results

Overall, 40% of patients had diabetes, 25% prior myocardial infarction, and 42% presented with acute coronary artery syndrome. The majority of lesions (69%) was highly complex (ACC/AHA type B2 or C). The mean length and the nominal stent diameter were 19.9 ± 5.3 mm and 3.0 ± 0.4 mm, respectively. The angiographic and procedural successes were 99.7 and 98%, respectively. At 12 months, the cumulative rate of major adverse cardiac events, available in 100% of patients, was 5.6% (cardiac death: 1.3%; acute myocardial infarction: 3.0%; revascularization of the target lesion: 2.2%). Stent thrombosis occurred in 5 patients (0,9%), and only 1 case was reported between 6 and 12 months.

Conclusions

The drug‐eluting stent Xience V™ demonstrated sustained safety and efficacy up to 12 months in the treatment of complex coronary lesions in patients from daily practice.

The anatomy of the coronary arteries is well known, but there is a wide variety in their origin and distribution. The dual left anterior descending artery is defined as the presence of two left anterior descending arteries within the anterior interventricular sulcus and is classified into four types. It is a benign anatomical variant that should be recognized, especially before interventional procedures. We report a patient with type I dual left anterior descending artery, with acute anterior wall ST elevation myocardial infarction, referred for primary percutaneous coronary intervention.