Adriano Márcio de Melo Milanez

Modificação de antigo método (Vineberg) na era das células tronco: nova tática?

Innumerous patients present with refractory angina despite optimized management whether with drug or surgical treatment. Currently, we are not uncommonly asked about the possibility of reintervention on patients that have already undergone several hemodynamic procedures, with repeated angioplasties and stent placement. Frequently, these patients have also already been operated on once or more times, some of them presenting with still patent although little effective grafts due to the diffuse pattern of their coronary diseases. Many of them show good left ventricular function, with high degrees of myocardial ischemia.In this context, we have worked on replacing early techniques for more modern and alternative ones, or even on giving a new focus to original techniquesCorrespondencia: Adriano Milanez • Rua Dr. Eneas de Carvalho Aguiar, 44 Bloco II 2o Andar, Sala 11 05403-000 Jardim Paulista Sao Paulo – SP E-mail: milanez@secrel.com.br Articulo recibido el 04/04/08; revisado recibido el 22/08/08; aceptado el 21/10/08. Introduccion Un sinnumero de pacientes son portadores de angina refractaria, a pesar del tratamiento optimizado, medicamentoso o quirurgico. Actualmente, no es raro ser consultados sobre la posibilidad de reintervenir sobre pacientes ya sometidos a diversos procedimientos hemodinamicos, con seguidas angioplastias y stents. Con frecuencia, esos paciente tambien ya fueron operados una o mas veces, algunos presentando todavia injertos previos, pero con poca efectividad, debido al grado difuso de la enfermedad coronaria. Muchos de ellos presentan buena funcion ventricular izquierda, siendo portadores de elevados niveles de isquemia miocardica. En ese contexto, hemos actuado apuntando a sustituir tecnicas iniciales por otras mas modernas y alternativas, o incluso intentando dar a tecnicas originales1,2 un nuevo enfoque, proporcionando soluciones quirurgicas para soluciones antes inabordables.

Modification of an Old Procedure (Vineberg) in the Stem Cell Era - a New Strategy?

Innumerous patients present with refractory angina despite optimized management whether with drug or surgical treatment. Currently, we are not uncommonly asked about the possibility of reintervention on patients that have already undergone several hemodynamic procedures, with repeated angioplasties and stent placement. Frequently, these patients have also already been operated on once or more times, some of them presenting with still patent although little effective grafts due to the diffuse pattern of their coronary diseases. Many of them show good left ventricular function, with high degrees of myocardial ischemia.In this context, we have worked on replacing early techniques for more modern and alternative ones, or even on giving a new focus to original techniquesCorrespondencia: Adriano Milanez • Rua Dr. Eneas de Carvalho Aguiar, 44 Bloco II 2o Andar, Sala 11 05403-000 Jardim Paulista Sao Paulo – SP E-mail: milanez@secrel.com.br Articulo recibido el 04/04/08; revisado recibido el 22/08/08; aceptado el 21/10/08. Introduccion Un sinnumero de pacientes son portadores de angina refractaria, a pesar del tratamiento optimizado, medicamentoso o quirurgico. Actualmente, no es raro ser consultados sobre la posibilidad de reintervenir sobre pacientes ya sometidos a diversos procedimientos hemodinamicos, con seguidas angioplastias y stents. Con frecuencia, esos paciente tambien ya fueron operados una o mas veces, algunos presentando todavia injertos previos, pero con poca efectividad, debido al grado difuso de la enfermedad coronaria. Muchos de ellos presentan buena funcion ventricular izquierda, siendo portadores de elevados niveles de isquemia miocardica. En ese contexto, hemos actuado apuntando a sustituir tecnicas iniciales por otras mas modernas y alternativas, o incluso intentando dar a tecnicas originales1,2 un nuevo enfoque, proporcionando soluciones quirurgicas para soluciones antes inabordables.

Cardiogenic shock due to coronary artery disease associated with interrupted aortic arch

Acute pulmonary edema is a serious event. Its occurrence in association with interrupted aortic arch and coronary heart disease is rare. Recently, an old patient developed cardiogenic shock and acute pulmonary edema due to acute coronary insufficiency, associated with interrupted aortic arch. The coronary angiography revealed occlusion of the right coronary artery and 95% obstruction in the left main coronary artery, associated with interruption of the descending aorta. Coronary artery bypass graft was performed, without extracorporeal circulation, to the anterior descending coronary artery. We discuss the initial management, given the seriousness of the case.

Modificación del antiguo método (Vineberg) en la era de las células madre: ¿nueva táctica?

Innumerous patients present with refractory angina despite optimized management whether with drug or surgical treatment. Currently, we are not uncommonly asked about the possibility of reintervention on patients that have already undergone several hemodynamic procedures, with repeated angioplasties and stent placement. Frequently, these patients have also already been operated on once or more times, some of them presenting with still patent although little effective grafts due to the diffuse pattern of their coronary diseases. Many of them show good left ventricular function, with high degrees of myocardial ischemia.In this context, we have worked on replacing early techniques for more modern and alternative ones, or even on giving a new focus to original techniquesCorrespondencia: Adriano Milanez • Rua Dr. Eneas de Carvalho Aguiar, 44 Bloco II 2o Andar, Sala 11 05403-000 Jardim Paulista Sao Paulo – SP E-mail: milanez@secrel.com.br Articulo recibido el 04/04/08; revisado recibido el 22/08/08; aceptado el 21/10/08. Introduccion Un sinnumero de pacientes son portadores de angina refractaria, a pesar del tratamiento optimizado, medicamentoso o quirurgico. Actualmente, no es raro ser consultados sobre la posibilidad de reintervenir sobre pacientes ya sometidos a diversos procedimientos hemodinamicos, con seguidas angioplastias y stents. Con frecuencia, esos paciente tambien ya fueron operados una o mas veces, algunos presentando todavia injertos previos, pero con poca efectividad, debido al grado difuso de la enfermedad coronaria. Muchos de ellos presentan buena funcion ventricular izquierda, siendo portadores de elevados niveles de isquemia miocardica. En ese contexto, hemos actuado apuntando a sustituir tecnicas iniciales por otras mas modernas y alternativas, o incluso intentando dar a tecnicas originales1,2 un nuevo enfoque, proporcionando soluciones quirurgicas para soluciones antes inabordables.