Endocardite infecciosa em paciente portador de marcapasso com explante do sistema e uso de circulaçao extra-corpórea

A endocardite infecciosa do cabo-eletrodo endocavitário de marcapasso definitivo (MP) é rara, mas nao excepcional. O uso indiscriminado de drogas injetáveis está aumentando esses quadros. O seu diagnóstico é muito bem demonstrado pelo ecocardiograma 2 D e o tratamento cirúrgico, com circulaçao extra-corpórea (CEC) e explante do sistema, é de fundamental importância para a cura completa desses pacientes, pois a valva tricúspide pode estar envolvida no processo, o que nao ocorreu neste caso. O paciente está curado e sem uso de MP há mais de um ano, totalmente assintomático e com eletrocardiograma mostrando apenas BCRD

Clinical impact of myocardial ischemia and viability after treatment of proximal left anterior descending artery chronic total occlusions

BACKGROUND: Evaluation of myocardial ischemia and viability is recommended prior to percutaneous coronary intervention (PCI) for chronic total occlusions. We evaluated late adverse cardiovascular events of patients with PCI for proximal left anterior descending artery occlusions, comparing patients with or without myocardial ischemia or viability. METHODS: Patients were allocated to groups with myocardial ischemia/viability (G1, n = 91) and without myocardial ischemia/viability (G2, n = 65) and adverse cardiovascular events (death, myocardial infarction, target-vessel revascularization and congestive heart failure) were compared. RESULTS: Most patients were male (68.1% vs 69.2%; P = 0.56), with a mean age of 65.4 ± 10 years vs 63.5 ± 8.7 years (P = 0.61) and almost one third were diabetics (33% vs 29.2%; P = 0.76). No differences regarding the clinical and angiographic profile were observed, except for the left ventricular ejection fraction (48.6 ± 13.7% vs 39.5 ± 11.8%; P = 0.04) and the degree of angiographic collateral flow grade to the left anterior descending artery, which was more evident in G1 (P = 0.03). The 3-year follow-up incidence of composite adverse cardiovascular events was lower in patients with myocardial ischemia/viability (12.5% vs 31.1%; P < 0.01). The factors that contributed the most for this difference were the incidence of congestive heart failure (3.3% vs 15.3%; P = 0.02) and death (2.2% vs 7.7%; P = 0.13). CONCLUSIONS: Treatment of proximal left anterior descending artery chronic total occlusions in patients with evidence of myocardial ischemia or viability reduces the incidence of adverse cardiovascular events in the long term.INTRODUÇÃO: A avaliação da isquemia e viabilidade miocárdicas é recomendável antes da intervenção coronária percutânea (ICP) em oclusões crônicas. Avaliamos os eventos cardiovasculares adversos tardios de pacientes com ICP da oclusão crônica no segmento proximal da artéria descendente anterior, comparando pacientes de acordo com a presença ou não de isquemia ou viabilidade miocárdicas. MÉTODOS: Os pacientes foram alocados nos grupos com isquemia/viabilidade miocárdicas (G1, n = 91) e sem isquemia/viabilidade miocárdicas (G2, n = 65) e avaliados os eventos clínicos combinados tardios (óbito, infarto do miocárdio, revascularização do vaso-alvo e insuficiência cardíaca congestiva). RESULTADOS: A maioria dos pacientes era do sexo masculino (68,1% vs. 69,2%; P = 0,56), com média de idade de 65,4 ± 10,4 anos vs. 63,5 ± 8,7 anos (P = 0,61), e quase um terço era de diabéticos (33% vs. 29,2%; P = 0,76). Os grupos não mostraram diferenças em relação ao perfil clínico-angiográfico, com exceção da fração de ejeção do ventrículo esquerdo (48,6 ± 13,7% vs. 39,5 ± 11,8%; P = 0,04) e do grau de circulação colateral para a artéria descendente anterior, mais evidente no G1 (P = 0,03). A incidência de eventos clínicos combinados em um período de três anos foi menor nos pacientes com isquemia/viabilidade miocárdicas (12,5% vs. 31,1%; P < 0,01). Os fatores que mais contribuíram para essa diferença foram a incidência de insuficiência cardíaca congestiva (3,3% vs. 15,3%; P = 0,02) e óbito (2,2% vs. 7,7%; P = 0,13). CONCLUSÕES: O tratamento de oclusão crônica no segmento proximal da artéria descendente anterior com stent farmacológico, em pacientes com evidência de isquemia ou viabilidade miocárdicas, reduz eventos clínicos a longo prazo.Hospital Beneficência Portuguesa de São PauloHospital Beneficência Portuguesa de São Paulo Equipe de Cardiologia Intervencionista-Wilson PimentelUniversidade Federal de São Paulo (UNIFESP) Hospital do Rim e HipertensãoUNIFESP, Hospital do Rim e HipertensãoSciEL

Orally administered rapamycin does not modify rat aortic vascular tone

Rapamycin (RP; rapamune, sirolimus) is a potent inhibitor of vascular smooth muscle cell proliferation and migration. RP was demonstrated to reduce vascular neointimal formation in different animal models of vascular smooth muscle cell proliferation, and clinical use of RP-eluting stents promotes significant reductions in in-stent resterrosis rates. However, high costs still preclude the widespread use of these devices. Oral administration of RP associated to bare metal stent delivery has been advocated as an effective and considerably less expensive alternative for restenosis prevention. It is noteworthy that the presence of RP-eluting stents has been associated with reduced endothelial-dependent vasodilation and coronary spasm. In addition, RP has been demonstrated to prevent vasculo-genesis. This study evaluated the effects of R-P on endothelium-dependent vascular tone and demonstrated that in vitro incubation with high concentrations of RP did not modify either contraction or relaxation of aortic rings. Similar results were obtained after in vivo administration of the drug. These findings suggest that function of adult, non-proliferative rat endothelial cells involved in vascular tone control is not affected by orally administered RP.Univ Fed Sao Paulo, Div Nephrol, Dept Med, BR-04023900 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Cardiol, Dept Med, BR-04023900 Sao Paulo, BrazilUniv Fed Sao Paulo, Div Nephrol, Dept Med, BR-04023900 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Cardiol, Dept Med, BR-04023900 Sao Paulo, BrazilWeb of Scienc

The use of primary stenting or balloon percutaneous transluminal coronary angioplasty for the treatment of acutely occluded saphenous vein grafts. Results from the Brazilian National Registry - CENIC

OBJECTIVE: We conducted a comparative analysis of the in-hospital outcomes of patients who underwent primary percutaneous transluminal angioplasty (PTCA) or stent implantation because of an acute myocardial infarction (AMI) related to an acute vein graft occlusion. METHODS: Since 1991 the Brazilian Society of Hemodynamic and Interventional Cardiology has maintained a large database (CENIC). From these, we selected all consecutive patients, who underwent primary PTCA or stenting in the first 24 hours of AMI, with the target vessel being an occluded vein graft. Immediate results and major coronary events occurring up until hospital discharge were analyzed. RESULTS: During this period, 5,932 patients underwent primary PTCA or stenting; 158 (3%) of the procedures were performed because of an acute vein graft occlusion. Stenting was performed in 74 (47%) patients. Patients treated with stents had a higher success rate and lower mean residual stenosis compared with those who underwent primary balloon PTCA. The incidence of reinfarction and death were similar for stenting and balloon PTCA. CONCLUSION: Primary percutaneous treatment of AMI related to acute vein graft occlusion is still an uncommon practice. Primary stenting improved luminal diameter and offered higher rates of success; however, this strategy did not reduce the in-hospital reinfarction and death rate, compared with that occurring with PTCA treatment