Pub Date : 2015-07-01DOI: 10.1016/j.rbciev.2016.07.006
David Neves, Pablo Salinas, Nieves Gonzalo
Optical coherence tomography (OCT) can provide essential information on unclear coronary angiography images. In current consensus documents of OCT imaging interpretation, calcium is usually described as a signal-poor or heterogeneous region with a sharply delineated border, but it may have atypical features, such as the proposed “calcified nodule” entity. In this case, a stable patient presented a hazy intracoronary angiographic image. OCT imaging showed an odd-looking convex, protruding lesion with irregular borders and high attenuation likely related to a calcified nodule. The lesion had a complex relation to the left circumflex artery take-off, which was better understood after three-dimensional reconstruction.
A tomografia de coerência óptica (TCO) pode fornecer informações essenciais sobre imagens de angiografia coronária pouco claras. Em documentos de consenso atuais de interpretação de imagem de TCO, o cálcio é geralmente descrito como uma região de sinal óptico de baixa intensidade ou heterogêneo, com uma borda bem delineada, que pode ter características atípicas, como a que caracteriza o nódulo calcificado. Neste caso, um paciente estável apresentava uma imagem angiográfica intracoronária nebulosa. A imagem da TCO mostrava uma lesão convexa protuberante de aparência estranha, com bordas irregulares e alta atenuação, provavelmente relacionada a um nódulo calcificado. A lesão tinha uma relação complexa com a origem da artéria circunflexa, o que foi melhor compreendida após a reconstrução tridimensional.
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Pub Date : 2015-07-01DOI: 10.1016/j.rbciev.2015.08.001
Rafael Alexandre Meneguz-Moreno , Dimytri A. Siqueira , Auristela Isabel de Oliveira Ramos , Antônio de Castro Filho , Andreia Dias Jeronimo , Tannas Jatene , David Le Bihan , Rodrigo Barretto , Magaly Arrais , Adriana Moreira , Alexandre Abizaid , Amanda Guerra M.R. Sousa , J. Eduardo M.R. Sousa
Background
Recent studies have demonstrated the efficacy of the transcatheter valve-in-valve implantation for the treatment of bioprosthesis dysfunction in high-risk surgical patients. This study presents the initial experience with valve-in-valve implantation.
Methods
Clinical, echocardiographic, and procedural profiles were characterized, and the mid-term results of patients with surgical bioprosthesis dysfunction submitted to valve-in-valve implantation in the aortic position were reported.
Results
Seven male patients were included, aged 72.6 ± 10.0 years. The STS score was 9,6 ± 10,5%, and the logistic EuroSCORE was 22.7 ± 14.7%. Three patients had combined aortic bioprosthesis failure; two had isolated regurgitation; and two had isolated stenosis. The transfemoral access was used in six cases, and the transapical access in one case. Implanted devices included Sapien XT (n = 5) and CoreValve (n = 2) prostheses. Procedural success was achieved in six (85.7%) cases. After the procedure, the mean gradient decreased from 38.2 ± 9.6 mmHg to 20.9 ± 5.9 mmHg, and the valve area increased from 1.2 ± 0.4 cm2 to 1.5 ± 0.5 cm2. After 1 year, there were no deaths and no other significant adverse outcomes; 80% of patients were in NYHA functional class I/II. The transvalvular gradients and valve area remained unchanged in this period.
Conclusions
The valve-in-valve procedure was effective in most high-risk surgical patients with bioprosthesis dysfunction. When performed in well-selected patients, it results in satisfactory clinical and hemodynamic outcomes.
Introdução
Estudos recentes têm demonstrado a eficácia do implante transcateter valve-in-valve para o tratamento de disfunção de biopróteses em pacientes de alto risco cirúrgico. Apresentamos nossa experiência inicial com o implante valve-in-valve.
Métodos
Caracterizamos o perfil clínico, ecocardiográfico e do procedimento, e reportamos os resultados de médio prazo de pacientes com disfunção de bioprótese submetidos a implante valve-in-valve em posição aórtica.
Resultados
Incluímos sete pacientes do sexo masculino, com idade de 72,6 ± 10,0 anos. O escore STS foi 9,6 ± 10,5%, e o EuroSCORE logístico foi 22,7 ± 14,7%. Três pacientes apresentavam dupla disfunção; dois tinham insuficiência; e dois exibiam estenose isolada. A via transfemoral foi utilizada em seis casos, e a transapical, em um caso. Os dispositivos implantados incluíram as próteses Sapien XT (n = 5) e CoreValve (n = 2). O sucesso do procedimento foi obtido em seis (85,7%) casos. Após o procedimento, o gradiente médio reduziu-se de 38,2 ± 9,6 mmHg para 20,9 ± 5,9 mmHg, e a área valvar elevou-se de 1,2 ± 0,4 cm2 para 1,5 ± 0,5 cm2.
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Pub Date : 2015-07-01DOI: 10.1016/j.rbciev.2015.08.005
Marcus Vinicius de Freitas Moreira, Luciana Alves Ribeiro, Edson Elviro Alves, Fernando Carvalho Neuenschwander, Renato Rocha Rabelo, Ubirajara Lima Filho, Raimundo Antônio de Melo, Manoel Augusto Batista Esteves, Augusto Lima Filho, Ricardo Wang
Background
Door-to-balloon time (DBT) has become a measure of performance and is the focus in quality of care improvement initiatives. This study aimed to evaluate the association between DBT and its impact on hospital costs.
Methods
Patients treated with primary percutaneous coronary intervention between 2008 and 2013 were divided according to the DBT < or ≥ 90 minutes. All costs recorded at hospital discharge were adjusted by the Medical-Hospital Cost Variation Index.
Results
A total of 141 patients were included, grouped as DBT < 90 minutes (n = 77) and DBT ≥ 90 minutes (n = 64). DBT was 64.0 ± 14.1 minutes and 133.8 ± 35.2 minutes, respectively. There were no differences in clinical outcomes between the groups. The costs were R$ 34,883.24 ± 27,749.46, with the mean cost for DBT < 90 minutes being R$ 33,194.24 ± 27,387.61 and the cost for DBT ≥ 90 minutes R$ 36,947.58 ± 28,267.80 (p = 0.43). The costs, according to the culprit artery, were R$ 29,588.53 ± 16,358.85 for the right coronary artery; R$ 48,494.62 ± 44,015.04 for the left circumflex artery; and R$ 34,016.96 ± 26,503.94 for the left anterior descending artery. There was a difference between the costs of procedures related to the left circumflex artery when compared to the right coronary or left anterior descending arteries (p = 0.01), but there was no difference between the costs related to the right coronary, when compared to the left anterior descending artery (p = 0.68).
Conclusions
There was no difference in hospital costs regarding the private health insurance, when the groups were divided according to the DBT. Clinical outcomes were similar and a difference in costs was found for patients with the circumflex artery as the culprit vessel.
Introdução
O tempo porta-balão (TPB) tornou-se uma medida de desempenho e é foco de iniciativas de melhoria da qualidade assistencial. Este estudo teve como objetivo avaliar a relação entre o TPB e seu impacto nos custos de internação hospitalar.
Métodos
Pacientes tratados com intervenção coronária percutânea primária, entre 2008 e 2013, foram divididos de acordo com o TPB < ou ≥ 90 minutos. Todos os custos registrados na alta hospitalar foram ajustados por meio do Índice de Variação de Custos Médico-Hospitalares.
Resultados
Foram incluídos 141 pacientes, agrupados em TPB < 90 minutos (n = 77) e TPB ≥ 90 minutos (n = 64). Os TPB foram 64,0 ± 14,1 minutos e 133,8 ± 35,2 minutos, respectivamente. Não foram observadas diferenças nos desfechos clínicos entre os grupos. Os custos foram de R$ 34.883,24 ± 27.749,46, sendo o custo médio para TPB < 90 minutos de R$ 33.194,24 ± 27.387,61, e para TPB ≥ 90 minutos, de R$ 36.947,58 ± 28.267,80 (p = 0,43). Os custos, segundo
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Pub Date : 2015-07-01DOI: 10.1016/j.rbciev.2016.07.005
Carlos Mariño Vigo , Gorky Mori Pinedo , Cesar Salinas Mondragón , Maria Lapoint Montes , Silvia Alegre Manrique , Geen Huaringa Bejarano , Edilberto Estela Chunga
Background
The implantation of stents to keep the ductus arteriosus patent in cyanotic congenital heart disease is an alternative to the modified Blalock-Taussig surgery (mBT) in high-risk patients. This study describes the immediate and medium-term outcomes of stent implantation in neonates and infants with duct-dependent pulmonary circulation.
Methods
This was a descriptive and prospective study including different cyanotic congenital heart diseases treated between 2014 and 2015.
Results
Fourteen patients with a mean age of 46 days, and mean weight of 4.5 kg were assessed, and pulmonary artresia with interventricular communication was the most treated condition. The femoral artery approach was used in 70% of procedures; carotid approach was used in the remaining cases. Stents of 3.5 x 12 mm were used in most cases, and implant success was achieved in 78% of interventions (11/14). The failed cases were referred to surgery – one of them was an emergency, which resulted in death. Ductal spasm occurred in < 48 hours in three patients who required mBT, with favorable outcome. Complications after discharge and within the first 30 days included stent thrombosis (2/11), one of which was controlled with redilation, another progressed to death, and one sudden death (1/11). The overall mortality was 21.4% (3/14). A patent ductus arteriosus in the first 6 months was present in five cases, which underwent palliative surgery.
Conclusions
The initial experience of ductal stenting showed favorable immediate outcomes, but in the medium term, little more than a third of the cases maintained a patent ductus arteriosus within 6 months.
Introdução
O implante de stents para manter o ducto arterial patente na cardiopatia congênita cianótica é uma alternativa à cirurgia de Blalock-Taussig modificada (BTm) em pacientes de alto risco. Descrevemos os resultados imediatos e de médio prazo do implante de stent em neonatos e lactentes com circulação pulmonar ducto-dependente.
Métodos
Trata-se de estudo descritivo e prospectivo, que incluiu diferentes cardiopatias congênitas cianóticas tratadas entre 2014 e 2015.
Resultados
Avaliamos 14 pacientes, com média de idade de 46 dias e pesando 4,5 kg, sendo a atresia pulmonar associada à comunicação interventricular a cardiopatia mais tratada. A abordagem pela artéria femoral ocorreu em 70% dos procedimentos e, nos demais, por via carotídea. Stents de 3,5 12 mm foram usados na maioria dos casos, e o sucesso do implante foi obtido em 78% das intervenções (11/14). Os casos de insucesso foram encaminhados para cirurgia uma delas em situação de urgência, que resultou em óbito. Ocorreu espasmo ductal < 48 horas em três pacientes que necessitaram de BTm, com evolução favorável. Complicações após a alta e nos primeiros 3
背景:在青紫型先天性心脏病患者中，植入支架以保持动脉导管通畅是改良的Blalock-Taussig手术(mBT)的一种替代方法。本研究描述了导管依赖性肺循环的新生儿和婴儿支架植入术的近期和中期结果。方法采用描述性、前瞻性研究，纳入2014 - 2015年收治的不同紫绀型先天性心脏病患者。结果14例患者平均年龄为46天，平均体重为4.5 kg，其中合并室间通讯的肺动脉阻塞是治疗最多的情况。70%的手术采用股动脉入路;其余病例采用颈动脉入路。大多数情况下使用3.5 x 12 mm的支架，78%的干预措施成功植入(11/14)。失败的病例被转介到手术-其中一人是急诊，导致死亡。导管痉挛发生于<3例患者接受mBT治疗48小时，结果良好。出院后及前30天内的并发症包括支架血栓形成(2/11)，其中1例经再扩张控制，1例进展至死亡，1例猝死(1/11)。总死亡率为21.4%(3/14)。5例前6个月出现动脉导管未闭，行姑息性手术。结论导管支架置入术的初步经验显示出良好的立竿见影的效果，但在中期，略多于三分之一的病例在6个月内保持动脉导管未闭。IntroducaoO implante de支架对位不论o ducto动脉patente na cardiopatia congenita cianotica e乌玛alternativa cirurgia de Blalock-Taussig modificada em pacientes de alto risco (BTm)。摘要本文讨论了肺动脉导管依赖的新生儿气道导管内支架植入时，气道导管内支架内支架的直接植入效果。该研究包括2014 - 2015年期间不同的心脏病congênitas cianóticas。结果本组14例患者中，有46例患者的胸源性脂肪含量为4、5 kg，出现肺动脉联合闭锁、通讯性脂肪含量为4、5 kg或心间性脂肪含量为5 kg。一种先天性先天性髋部动脉粥样硬化性股骨头病变，其发生率为70%。植入3、5个12mm孔支架，植入成功率为78% (intervenções(11/14))。因此，casos de insuccesso foram encaminhados para ururgia uma delem situation () o de urgência, que resultou em óbito。脑瘫导管;48 horas em três paciences que necessitaram de BTm, com evolutional o favorável。Complicações após a alta e nos primeiros 30 dias incluíram trombose de stent (2/11)， uma delas controlada com redilata o e outra que evoluiu para óbito, e uma morte súbita(1/11)。死亡总数为21.4%(3/14)。1例patência动脉起始导管6例，1例5例，5例为腹膜下孔状，2例为缓和性腹膜痛。作为初步治疗ConclusoesA experiencia implante de支架导管mostrou resultados imediatos favoraveis, e, em五分镍币prazo,但是de嗯terco dos pacientes com circulacao pulmonar ducto-dependente manteve seu canais专利。
{"title":"Immediate and medium-term outcomes of ductal stenting in neonates and infants","authors":"Carlos Mariño Vigo , Gorky Mori Pinedo , Cesar Salinas Mondragón , Maria Lapoint Montes , Silvia Alegre Manrique , Geen Huaringa Bejarano , Edilberto Estela Chunga","doi":"10.1016/j.rbciev.2016.07.005","DOIUrl":"https://doi.org/10.1016/j.rbciev.2016.07.005","url":null,"abstract":"<div><h3>Background</h3><p>The implantation of stents to keep the ductus arteriosus patent in cyanotic congenital heart disease is an alternative to the modified Blalock-Taussig surgery (mBT) in high-risk patients. This study describes the immediate and medium-term outcomes of stent implantation in neonates and infants with duct-dependent pulmonary circulation.</p></div><div><h3>Methods</h3><p>This was a descriptive and prospective study including different cyanotic congenital heart diseases treated between 2014 and 2015.</p></div><div><h3>Results</h3><p>Fourteen patients with a mean age of 46 days, and mean weight of 4.5<!--> <!-->kg were assessed, and pulmonary artresia with interventricular communication was the most treated condition. The femoral artery approach was used in 70% of procedures; carotid approach was used in the remaining cases. Stents of 3.5 x 12<!--> <!-->mm were used in most cases, and implant success was achieved in 78% of interventions (11/14). The failed cases were referred to surgery – one of them was an emergency, which resulted in death. Ductal spasm occurred in < 48<!--> <!-->hours in three patients who required mBT, with favorable outcome. Complications after discharge and within the first 30 days included stent thrombosis (2/11), one of which was controlled with redilation, another progressed to death, and one sudden death (1/11). The overall mortality was 21.4% (3/14). A patent ductus arteriosus in the first 6 months was present in five cases, which underwent palliative surgery.</p></div><div><h3>Conclusions</h3><p>The initial experience of ductal stenting showed favorable immediate outcomes, but in the medium term, little more than a third of the cases maintained a patent ductus arteriosus within 6 months.</p></div><div><h3>Introdução</h3><p>O implante de stents para manter o ducto arterial patente na cardiopatia congênita cianótica é uma alternativa à cirurgia de Blalock-Taussig modificada (BTm) em pacientes de alto risco. Descrevemos os resultados imediatos e de médio prazo do implante de stent em neonatos e lactentes com circulação pulmonar ducto-dependente.</p></div><div><h3>Métodos</h3><p>Trata-se de estudo descritivo e prospectivo, que incluiu diferentes cardiopatias congênitas cianóticas tratadas entre 2014 e 2015.</p></div><div><h3>Resultados</h3><p>Avaliamos 14 pacientes, com média de idade de 46 dias e pesando 4,5<!--> <!-->kg, sendo a atresia pulmonar associada à comunicação interventricular a cardiopatia mais tratada. A abordagem pela artéria femoral ocorreu em 70% dos procedimentos e, nos demais, por via carotídea. Stents de 3,5 12<!--> <!-->mm foram usados na maioria dos casos, e o sucesso do implante foi obtido em 78% das intervenções (11/14). Os casos de insucesso foram encaminhados para cirurgia uma delas em situação de urgência, que resultou em óbito. Ocorreu espasmo ductal < 48 horas em três pacientes que necessitaram de BTm, com evolução favorável. Complicações após a alta e nos primeiros 3","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 3","pages":"Pages 211-215"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2016.07.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91599706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-01DOI: 10.1016/j.rbciev.2015.08.004
Giordana Zeferino Mariano , Márcia Moura Schmidt , Maria Augusta Maturana , Eder Quevedo , Bianca de Negri , Cristina Gazeta , Alexandre Schaan de Quadros , Carlos Antonio Mascia Gottschall
Background
In Brazil, it is estimated that approximately 27% of women of childbearing age use oral contraceptives (OC). The presentation and clinical course of acute myocardial infarction (AMI) in these women has yet to be described in Brazil. The aim of this study was to analyze the clinical profile, angiographic characteristics, technical aspects of the procedure, and the outcomes in women using OC who had an AMI and were submitted to primary percutaneous coronary intervention (PCI).
Methods
Women aged < 55 years who had acute ST segment elevation myocardial infarct and were referred to primary PCI were sequentially included and categorized into two groups: with and without current use of OC.
Results
We have included 257 patients, of whom 19 (7.4%) used OC. These patients were younger (42.3 ± 6.2 years vs. 48.4 ± 5.7 years; p < 0.001), with fewer traditional risk factors for coronary artery disease, but had higher serum levels of C-reactive protein and fibrinogen. The delta T was similar (4.00 [1.25 to 6.86] hours vs. 4.50 [2.50 to 7.64] hours; p = 0.54), but the door-to-balloon time was longer in patients taking OC (1.41 [0.58 to 1.73] hours vs. 1.16 [0.91 to 1.51] hour, p = 0.02). These patients were more frequently submitted to thrombus aspiration (52.6% vs. 25.6%; p = 0.04). After the index event, they had no atherothrombotic outcomes in up to 2 years of follow-up (0 vs. 15.2%; p = 0.08).
Conclusions
In this study, different clinical profiles and outcomes were found among women of reproductive age, users or non-users of OC, and submitted to primary PCI. Studies with a larger number of patients are required to confirm these results.
Introdução
Em nosso, país estima-se que aproximadamente 27% das mulheres em idade fértil utilizem anticoncepcional oral (ACO). A apresentação e a evolução clínica do infarto agudo do miocárdio (IAM) nessas mulheres ainda não foi descrita em nosso meio. O objetivo do presente estudo foi analisar o perfil clínico, as características angiográficas, os aspectos técnicos do procedimento e os desfechos de usuárias de ACO que tiveram IAM e foram encaminhadas à intervenção coronariana percutânea (ICP) primária.
Métodos
Mulheres < 55 anos que apresentaram IAM com supradesnivelamento do segmento ST e foram encaminhadas à ICP primária foram sequencialmente incluídas e categorizadas em dois grupos: com e sem uso atual de ACO.
Resultados
Incluímos 257 pacientes, sendo que 19 (7,4%) usavam ACO. Estas eram mais jovens (42,3 ± 6,2 anos vs. 48,4 ± 5,7 anos; p < 0,001), com menos fatores de risco tradicionais para doença arterial coronariana, mas apresentavam proteína C-reativa fibrinogênio séricos mais elevados. O delta T foi semelhante (4,00 [1,25 a 6,86] horas vs. 4,50 [2,50 a 7,64] horas; p
在巴西，据估计约有27%的育龄妇女使用口服避孕药。急性心肌梗死(AMI)在这些妇女的表现和临床过程尚未描述在巴西。本研究的目的是分析急性心肌梗死(AMI)妇女经皮冠状动脉介入治疗(PCI)的临床特征、血管造影特征、手术技术方面和结果。方法:老年妇女;55例急性ST段抬高型心肌梗死患者接受首次PCI治疗，并依次纳入并分为两组:目前使用和未使用OC。结果共纳入257例患者，其中19例(7.4%)使用OC。这些患者年龄较小(42.3±6.2岁vs 48.4±5.7岁;p & lt;0.001)，冠状动脉疾病的传统危险因素较少，但血清c反应蛋白和纤维蛋白原水平较高。δ T相似(4.00[1.25 ~ 6.86]小时vs. 4.50[2.50 ~ 7.64]小时;p = 0.54)，但服用OC的患者到球囊的时间更长(1.41[0.58 ~ 1.73]小时vs. 1.16[0.91 ~ 1.51]小时，p = 0.02)。这些患者更频繁地发生血栓抽吸(52.6% vs. 25.6%;P = 0.04)。在指数事件发生后，他们在长达2年的随访中没有出现动脉粥样硬化血栓结局(0比15.2%;P = 0.08)。结论:在本研究中，育龄妇女，使用或不使用OC，并接受了初级PCI治疗，发现了不同的临床特征和结果。需要更多患者的研究来证实这些结果。介绍代孕剂(oo4)， país估计约有27%的患者使用抗孕药(ACO)治疗。本文介绍了一种新型的演化 o clínica do infarto agudo do miocárdio (IAM)，它描述了一种新的方法。我们的目标是提供关于执行情况分析的报告clínico，如características angiográficas，以及关于执行情况分析的报告usuárias关于执行情况分析的报告和关于执行情况分析的报告(ICP) primária的报告。MetodosMulheres & lt;55 .另一个问题是，目前IAM . com已超越了对ST . com的分段进行了分类，并将其分类为com . ICP . primária按顺序进行了分类，并将其分类为com . com .似乎是实际的ACO. com。ResultadosIncluímos 257例患者，19例(7.4%)使用avam ACO。Estas eram mais jovens(42,3±6,2 anos vs. 48,4±5,7 anos);p & lt;(2001)， com menos fatores de risco tradiisais para donenacra动脉冠状动脉，mas代表proteína -reativa fibrinogênio ssamicos主要升降机。O δ tfoi semelhante (4,00 [1,25 a, 6,86] horas vs. 4,50 [2,50 a, 7,64] horas;p = 0,54)，主要疾病的诊断与诊断(1,41[0,58 ~ 1,73])和(1,16 [0,91 ~ 1,51]);P = 0,02)。Estas pacentes foram mais经常出现在中耳膜下(52.6% vs. 25.6%;P = 0,04)。Após o evento índice, elas n o presentaram desfechos aterotrombóticos em at 2 anos de acompanhamento (0 vs. 15.2%;P = 0,08)。ConclusõesNeste estudo, encontramos perfil clínico e desfechos不同点entre mulheres em idade reproduction, usuárias o o de ACO, e submetidas ICP primária。Estudos com major número de pacientes s o necessários para确认结果。
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Pub Date : 2015-07-01DOI: 10.1016/j.rbciev.2015.08.009
Patrick Bastos Metzger, Marilia G. Volpato, Maria Claudia Folino, Fabio Henrique Rossi, Ana Claudia Gomes Petisco, Mohamed Hassan Saleh, Nilo Mitsuru Izukawa, Antonio Massamitsu Kambara
Background
Endovascular interventions in the superficial femoral artery for the treatment of peripheral arterial occlusive disease have increased over the last decades. The first- and second-generation stents in the superficial femoral artery have failed to demonstrate improved patency of the treated vessel due to high fracture rates. The aim of this study was to evaluate the clinical, short-term outcomes of using third-generation superflexible nitinol stents in the treatment of atherosclerotic lesions in the superficial femoral artery.
Methods
This was a retrospective study carried out in a single center, from June 2013 to May 2014. A total of 27 patients underwent angioplasty with third-generation, superflexible nitinol stents in atherosclerotic lesions of the superficial femoral artery.
Results
The mean age was 68 ± 12 years, 55.6% were females, and 74.1% were diabetics. Patients were classified as TASC B and C in 77.7% of cases. Technical success was 100%. There was an increase in the ankle-brachial index from 0.35 ± 0.1 before the intervention to 0.75 ± 0.2 at hospital discharge. The mean follow-up of patients was 6.7 ± 2.3 months. The primary patency rate was 96.3%. The limb salvage rate was 100%. There were no stent fractures documented by X-rays.
Conclusions
Angioplasty with third-generation superflexible nitinol stent placement was shown to be effective in the treatment of atherosclerotic lesions of the superficial femoral artery.
Introdução
As intervenções endovasculares na artéria femoral superficial para o tratamento da doença arterial oclusiva periférica têm crescido nas últimas décadas. A primeira e a segunda geração de stents na artéria femoral superficial falharam em demonstrar a melhora da perviedade do vaso tratado, devido às altas taxas de fratura. O objetivo deste estudo foi avaliar os desfechos clínicos no curto prazo com o uso de stents de nitinol superflexíveis de terceira geração no tratamento de lesões ateroscleróticas na artéria femoral superficial.
Métodos
Trata-se de um estudo retrospectivo, realizado em único centro, no período de junho de 2013 a maio de 2014. Um total de 27 pacientes foi submetido à angioplastia com stents de nitinol superflexíveis de terceira geração em lesões ateroscleróticas da arterial femoral superficial.
Resultados
A média de idades foi de 68 ± 12 anos, 55,6% eram do sexo feminino e 74,1%, diabéticos. Os pacientes foram classificados em TASC B e C em 77,7% dos casos. O sucesso técnico foi de 100%. Houve aumento do índice tornozelo-braquial de 0,35 ± 0,1 pré-intervenção para 0,75 ± 0,2 na alta hospitalar. O seguimento médio dos pacientes foi de 6,7 ± 2,3 meses. A taxa de patência primária foi de 96,3%. A taxa de salvamento de membro foi de 100%. Não ocorreram fraturas de stent documentadas por raios X.
Conclusões
背景:在过去的几十年里，外周动脉闭塞性疾病的治疗中，对股浅动脉的血管介入治疗有所增加。由于骨折率高，第一代和第二代股浅动脉支架未能改善治疗血管的通畅性。本研究的目的是评估使用第三代超柔韧性镍钛诺支架治疗股浅动脉粥样硬化病变的临床和短期效果。方法2013年6月至2014年5月为单中心回顾性研究。共有27例患者在股浅动脉粥样硬化病变处接受了第三代超柔性镍钛诺支架血管成形术。结果患者平均年龄68±12岁，女性占55.6%，糖尿病患者占74.1%。77.7%的患者被分类为TASC B和C。技术上的成功率是100%。踝关节-肱指数从干预前的0.35±0.1增加到出院时的0.75±0.2。患者平均随访6.7±2.3个月。原发性通畅率为96.3%。残肢保留率100%。x光片未见支架骨折。结论第三代超柔镍钛合金支架置入术治疗股浅动脉粥样硬化病变是有效的。IntroducaoAs intervencoes血管内na股浅动脉对位o tratamento da doenca动脉oclusiva periferica tem crescido nas的创世纪decadas。一个刚刚e乙级联赛geracao de支架na股浅动脉falharam em demonstrar melhora da perviedade做vaso tratado, devido为阿特拉斯德克萨斯州德fratura。目的:探讨治疗股骨头表面病变的方法:clínicos no curto prazo como;治疗股骨头表面病变的方法:superflexíveis no terceira geral; lesões ateroscleróticas no治疗股骨头表面病变。msamodosta -se de um estudo retrospective, realize em único centro, no período de junho de 2013 and maio de 2014。嗯总de 27 pacientes信息自由submetido angioplastia com支架de镍钛诺superflexiveis德特塞拉岛geracao em lesoes ateroscleroticas da股浅动脉。结果男性和女性的性别比例分别为(68±12)和(74.1%)。10例患者在分类中出现了TASC B和C，占76.7%。因此，成功的成功是100%的成功。霍夫·阿尔塔医院:índice tornozelo-braquial de 0,35±0,1 pr - inter o，第0,75±0,2段。(6,7±2,3)例。一个分类群patência primária占96,3%。A taxa de salvamento de memberbro foi 100%。Nao ocorreram fraturas de支架documentadas运动通过X.ConclusoesA angioplastia com uso de支架de镍钛诺superflexivel德特塞拉岛geracao demonstrou ser efetiva没有tratamento das lesoes ateroscleroricas da股浅动脉。
{"title":"Outcomes after implantation of superflexible nitinol stents in the superficial femoral artery","authors":"Patrick Bastos Metzger, Marilia G. Volpato, Maria Claudia Folino, Fabio Henrique Rossi, Ana Claudia Gomes Petisco, Mohamed Hassan Saleh, Nilo Mitsuru Izukawa, Antonio Massamitsu Kambara","doi":"10.1016/j.rbciev.2015.08.009","DOIUrl":"https://doi.org/10.1016/j.rbciev.2015.08.009","url":null,"abstract":"<div><h3>Background</h3><p>Endovascular interventions in the superficial femoral artery for the treatment of peripheral arterial occlusive disease have increased over the last decades. The first- and second-generation stents in the superficial femoral artery have failed to demonstrate improved patency of the treated vessel due to high fracture rates. The aim of this study was to evaluate the clinical, short-term outcomes of using third-generation superflexible nitinol stents in the treatment of atherosclerotic lesions in the superficial femoral artery.</p></div><div><h3>Methods</h3><p>This was a retrospective study carried out in a single center, from June 2013 to May 2014. A total of 27 patients underwent angioplasty with third-generation, superflexible nitinol stents in atherosclerotic lesions of the superficial femoral artery.</p></div><div><h3>Results</h3><p>The mean age was 68 ± 12 years, 55.6% were females, and 74.1% were diabetics. Patients were classified as TASC B and C in 77.7% of cases. Technical success was 100%. There was an increase in the ankle-brachial index from 0.35 ± 0.1 before the intervention to 0.75 ± 0.2 at hospital discharge. The mean follow-up of patients was 6.7 ± 2.3 months. The primary patency rate was 96.3%. The limb salvage rate was 100%. There were no stent fractures documented by X-rays.</p></div><div><h3>Conclusions</h3><p>Angioplasty with third-generation superflexible nitinol stent placement was shown to be effective in the treatment of atherosclerotic lesions of the superficial femoral artery.</p></div><div><h3>Introdução</h3><p>As intervenções endovasculares na artéria femoral superficial para o tratamento da doença arterial oclusiva periférica têm crescido nas últimas décadas. A primeira e a segunda geração de stents na artéria femoral superficial falharam em demonstrar a melhora da perviedade do vaso tratado, devido às altas taxas de fratura. O objetivo deste estudo foi avaliar os desfechos clínicos no curto prazo com o uso de stents de nitinol superflexíveis de terceira geração no tratamento de lesões ateroscleróticas na artéria femoral superficial.</p></div><div><h3>Métodos</h3><p>Trata-se de um estudo retrospectivo, realizado em único centro, no período de junho de 2013 a maio de 2014. Um total de 27 pacientes foi submetido à angioplastia com stents de nitinol superflexíveis de terceira geração em lesões ateroscleróticas da arterial femoral superficial.</p></div><div><h3>Resultados</h3><p>A média de idades foi de 68 ± 12 anos, 55,6% eram do sexo feminino e 74,1%, diabéticos. Os pacientes foram classificados em TASC B e C em 77,7% dos casos. O sucesso técnico foi de 100%. Houve aumento do índice tornozelo-braquial de 0,35 ± 0,1 pré-intervenção para 0,75 ± 0,2 na alta hospitalar. O seguimento médio dos pacientes foi de 6,7 ± 2,3 meses. A taxa de patência primária foi de 96,3%. A taxa de salvamento de membro foi de 100%. Não ocorreram fraturas de stent documentadas por raios X.</p></div><div><h3>Conclusões</","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 3","pages":"Pages 220-225"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.08.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91759380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1016/j.rbciev.2015.12.018
Fabio S. Brito Jr. , Alexandre Siciliano , Claudio H. Fischer , Marcelo L. Vieira , Arnaldo Rabischoffski , Fabio Papa , Marcelo R. Fernandes , Bernardino Tranchesi Jr. , Paulo Dutra , Marco A. Perin
The MitraClipTM system has been recently approved for clinical use in Brazil for percutaneous treatment of mitral valve regurgitation. This device is based on the Alfieri surgical procedure, creating a double orifice by bringing together the central segments of the two mitral valve cusps. This report describes the first two procedures performed in Brazil using this device. Two female patients considered to be at high surgical risk due to advanced age and presence of comorbidities were treated, with degenerative mitral regurgitation due to prolapse/flail, associated with chordae tendineae rupture. In both cases, significant mitral regurgitation intensity reduction was obtained using the MitraClipTM, demonstrating the great potential of this innovative technology for the percutaneous treatment of mitral valve regurgitation.
{"title":"Percutaneous treatment of mitral regurgitation by MitraClipTM: report on the first two procedures in Brazil","authors":"Fabio S. Brito Jr. , Alexandre Siciliano , Claudio H. Fischer , Marcelo L. Vieira , Arnaldo Rabischoffski , Fabio Papa , Marcelo R. Fernandes , Bernardino Tranchesi Jr. , Paulo Dutra , Marco A. Perin","doi":"10.1016/j.rbciev.2015.12.018","DOIUrl":"10.1016/j.rbciev.2015.12.018","url":null,"abstract":"<div><p>The MitraClip<sup>TM</sup> system has been recently approved for clinical use in Brazil for percutaneous treatment of mitral valve regurgitation. This device is based on the Alfieri surgical procedure, creating a double orifice by bringing together the central segments of the two mitral valve cusps. This report describes the first two procedures performed in Brazil using this device. Two female patients considered to be at high surgical risk due to advanced age and presence of comorbidities were treated, with degenerative mitral regurgitation due to prolapse/flail, associated with <em>chordae tendineae</em> rupture. In both cases, significant mitral regurgitation intensity reduction was obtained using the MitraClip<sup>TM</sup>, demonstrating the great potential of this innovative technology for the percutaneous treatment of mitral valve regurgitation.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 2","pages":"Pages 156-160"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.12.018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"95762372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1016/j.rbciev.2015.12.006
Roberto Ramos Barbosa , Valmin Ramos da Silva , Renato Giestas Serpa , Felipe Bortot Cesar , Vinicius Fraga Mauro , Denis Moulin dos Reis Bayerl , Walkimar Ururay Gloria Veloso , Roberto de Almeida Cesar , Pedro Abilio Ribeiro Reseck
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.
研究背景:st段抬高型心肌梗死(STEMI)的女性死亡率较高。本研究旨在评估经皮冠状动脉介入治疗(pPCI)患者的临床和血管造影特征，以及根据性别的结果。方法回顾性研究纳入2012年3月至2013年5月在地区转诊中心接受pPCI治疗的STEMI患者，随访时间为入院至出院或死亡。结果208例患者行pPCI，其中女性51例(24.5%)，男性157例(75.5%)。年龄差异有统计学意义(65.5±14.0∶58.8±11.0岁;P = 0.001)，糖尿病(43.1% vs. 24.8%;p = 0.02)， Killip-Kimball III/IV级(7.0% vs. 17.6%;P = 0.02)，痛到门时间(181±154分钟vs 125±103分钟);P = 0.004)，门到球囊时间(181±87 vs 133±67分钟;p = 0.001)。手术成功率相似(92.1% vs. 91.1%;p = 0.22)。女性住院死亡率更高(23.5%比8.9%;p = 0.006)。多因素分析确定年龄≥70岁(优势比- OR = 2.75;95%置信区间- 95% CI: 1.81-3.64;p = 0.029)和Killip-Kimball III/IV级(OR = 2.45;95% ci: 1.49-4.02;P = 0.002)作为死亡率的独立预测因子。结论女性STEMI患者比男性患者有更严重的临床症状和更长的疼痛上门和上门气囊时间。女性在pPCI后的住院死亡率较高，但女性性别并未被确定为死亡的独立预测因子。
{"title":"Gender differences in primary percutaneous coronary intervention outcomes in patients with ST-elevation myocardial infarction","authors":"Roberto Ramos Barbosa , Valmin Ramos da Silva , Renato Giestas Serpa , Felipe Bortot Cesar , Vinicius Fraga Mauro , Denis Moulin dos Reis Bayerl , Walkimar Ururay Gloria Veloso , Roberto de Almeida Cesar , Pedro Abilio Ribeiro Reseck","doi":"10.1016/j.rbciev.2015.12.006","DOIUrl":"10.1016/j.rbciev.2015.12.006","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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; <em>p</em> <em>=</em> <!-->0.001), diabetes (43.1% vs. 24.8%; <em>p</em> <em>=</em> <!-->0.02), Killip-Kimball class III/IV (7.0% vs. 17.6%; <em>p</em> <em>=</em> <!-->0.02), pain-to-door time (181<!--> <!-->±<!--> <!-->154<!--> <!-->minutes vs. 125<!--> <!-->±<!--> <!-->103<!--> <!-->minutes; <em>p</em> <em>=</em> <!-->0.004), and door-to-balloon time (181<!--> <!-->±<!--> <!-->87 vs. 133<!--> <!-->minutes<!--> <!-->±<!--> <!-->67<!--> <!-->minutes; <em>p</em> <em>=</em> <!-->0.001). The success of the procedure was similar (92.1% vs. 91.1%; <em>p</em> <em>=</em> <!-->0.22). In-hospital mortality was higher for females (23.5% vs. 8.9%; <em>p</em> <em>=</em> <!-->0.006). Multivariate analysis identified age ≥<!--> <!-->70 years (odds ratio - OR<!--> <!-->=<!--> <!-->2.75; 95% confidence interval - 95% CI: 1.81–3.64; <em>p</em> <em>=</em> <!-->0.029) and Killip-Kimball class III/IV (OR<!--> <!-->=<!--> <!-->2.45; 95% CI: 1.49–4.02; <em>p</em> <em>=</em> <!-->0.002) as independent predictors of mortality.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 2","pages":"Pages 96-101"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.12.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"100960835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1016/j.rbciev.2015.12.004
Rodolfo Staico, Luciana Armaganijan, Dalmo A.R. Moreira, Paulo T.J. Medeiros, Jônatas Melo Neto, Dikran Armaganijan, Amanda G.M.R. Sousa, Alexandre Abizaid
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.
{"title":"Renal sympathetic denervation in patients with implantable cardioverter-defibrillator and electrical storm","authors":"Rodolfo Staico, Luciana Armaganijan, Dalmo A.R. Moreira, Paulo T.J. Medeiros, Jônatas Melo Neto, Dikran Armaganijan, Amanda G.M.R. Sousa, Alexandre Abizaid","doi":"10.1016/j.rbciev.2015.12.004","DOIUrl":"10.1016/j.rbciev.2015.12.004","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 (<em>p</em> <em>=</em> <!-->0.002; <em>p</em> <em>=</em> <!-->0.01; <em>p</em> <em>=</em> <!-->0.003, respectively). No patients died during follow-up. There were no major complications related to the procedure.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 2","pages":"Pages 84-90"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.12.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85757431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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