Felipe Navarro

Asociación del síndrome tako-tsubo con la arteria coronaria descendente anterior con extensa distribución por el segmento diafragmático

Introduccion y objetivos. El sindrome de disfuncion ventricular transitoria tako-tsubo ha sido descrito en Japon y se han publicado casos aislados en Occidente. Mostramos una de las primeras series descritas fuera de Japon y presentamos nueva informacion sobre su anatomia coronaria. Pacientes y metodo. Entre enero de 1998 y abril de 2003 identificamos a 11 pacientes con sospecha de infarto agudo de miocardio, arterias coronarias normales y disfuncion ventricular transitoria tipo tako-tsubo. Estudiamos la anatomia coronaria de estos 11 pacientes, asi como de 44 controles ajustados por edad y sexo: 22 con coronarias normales y 22 con infarto agudo de miocardio en relacion con oclusion en la arteria coronaria descendente anterior. Resultados. Al igual que en los pacientes japoneses, el sindrome tako-tsubo en pacientes caucasicos generalmente ocurre en mujeres en la septima u octava decadas de la vida y con frecuencia se precede de estres emocional o fisico. La arteria coronaria descendente anterior de nuestros pacientes con sindrome tako-tsubo tiene mayor longitud y un segmento diafragmatico (recurrente) mas largo que la de los controles. Para compararlos disenamos un indice de recurrencia ([segmento recurrente de descendente anterior/longitud total de la descendente anterior] x 100). En los pacientes con sindrome tako-tsubo, este indice fue del 22,3 ± 1,5%, en controles normales fue del 10,9 ± 6,7% (p < 0,001) y en los pacientes de control con infarto del 11,3 ± 7,7% (p < 0,001). Los pacientes de control con infarto presentaban una ventriculografia identica a la de los enfermos con sindrome tako-tsubo cuando su indice de recurrencia era alto (= 16%). Conclusiones. Todos nuestros pacientes con sindrome tako-tsubo presentan una descendente anterior con un gran segmento recurrente. La morfologia identica de la ventriculografia de los pacientes con sindrome tako-tsubo y los controles con infarto con un elevado indice de recurrencia de la descendente anterior puede deberse a una etiopatogenia comun.

Factores relacionados con la aparición de complicaciones vasculares periféricas tras procedimientos intervencionistas cardiovasculares percutáneos

Antecedentes La aparicion de complicaciones vasculares en los procedimientos cardiovasculares percutaneos conlleva una mayor morbilidad para el paciente, una prolongacion de la estancia hospitalaria y motiva un aumento de costes. Diversas variables clinicas y del procedimiento se han asociado como predictores de la aparicion de complicaciones vasculares, pero no existe informacion sobre que influencia ejercen variables relacionadas con la experiencia en el desarrollo de complicaciones vasculares. Objetivo El proposito de este estudio fue determinar el tipo e incidencia de complicaciones vasculares en pacientes sometidos a procedimientos cardiovasculares percutaneos, asi como identificar factores predictores y determinar la influencia de la experiencia profesional y la complejidad de la tecnica utilizada en la aparicion de estas complicaciones. Metodos y resultados Se incluyeron en el estudio 1.008 pacientes consecutivos sometidos a procedimientos cardiovasculares percutaneos (750 diagnosticos y 258 terapeuticos). El 70% eran varones con edad media de 63 ± 23 anos. Se produjeron un total de 55 complicaciones vasculares (5,6%): 36 hematomas (3,6%), 14 seudoaneurismas (1,4%), 2 fistulas arteriovenosas (0,2%), 2 episodios isquemicos en los miembros inferiores (0,2%) y un hematoma retroperitoneal (0,1%). Unicamente 28 pacientes presentaron complicaciones graves (2,8%). Por analisis multivariado, las variables asociadas con una mayor incidencia de complicaciones vasculares fueron la experiencia en la realizacion de la hemostasia (odds ratio [OR], 3,36; intervalo de confianza del 95% [IC del 95%], 1,37-8,22), el tratamiento previo con aspirina (OR, 2,69; IC del 95%, 1,31-5,52), la puncion en la arteria femoral izquierda (OR, 2,53; IC del 95%, 1-1,02), la permanencia del introductor mas de 60 min (OR, 1,02; IC del 95%, 1,01-1,04) y la duracion de la hemostasia mas de 30 min (OR, 1,01; IC del 95%, 1-1,02). Conclusiones Las complicaciones vasculares perifericas tras procedimientos cardiovasculares percutaneos son bajas y la mayoria relacionadas con aspectos del procedimiento que son potencialmente evitables con un adecuado plan de formacion y entrenamiento.

Efectos renales y sistémicos en la prevención de la nefrotoxicidad por contraste con sueros salino (0,9%) e hiposalino (0,45%)

Introduction and objectives. Physiological and hypotonic saline solutions have been used interchangeably for preventing contrast media nephrotoxicity. No analysis of the possible differential effects of the 2 solutions on the milieu interieur or intercompartmental fluid volumes has been performed. Our aim was to study the systemic and renal effects of 2 types of saline solution regularly used to prevent contrast media nephrotoxicity in patients undergoing coronary angiography. Methods. Changes in electrolyte levels and volume distribution were studied in 71 individuals who were randomized to receive either 0.9% isotonic saline (n=36) or 0.45% hypotonic saline (n=35) during the 12 hours before and after contrast injection (2000 mL in each period). Results. The creatinine level was elevated equally often in the isotonic and hypotonic saline groups. Isotonic saline administration led to reductions in hemoglobin level, hematocrit, and plasma albumin level, and to increases in plasma volume, by 12.3% and 10.4% at 24 and 48 hours, respectively. These changes were significant compared with baseline measurements and compared with the group that received hypotonic saline. Neither of the 2 saline solutions resulted in a change in plasma atrial natriuretic peptide level. Plasma and urine osmolality decreased only with hypotonic saline. The increase in plasma creatinine level was similar with both isotonic and hypotonic saline. Conclusions. During standard therapy for preventing contrast media nephrotoxicity: a) isotonic saline, but not

Tako-Tsubo Transient Left Ventricular Apical Ballooning Is Associated With a Left Anterior Descendig Coronary Artery With a Long Course Along the Apical Diaphragmatic Surface of the Left Ventricle

Introduction and objectives Tako-tsubo-like transient left ventricular apical ballooning has been described in Japan, but few cases have been reported in Western countries. We report one of the first series outside Japan, which provides new information on the coronary anatomy of this disorder. Patients and Methods From January 1998 to February 2003 we observed 11 patients with a clinical suspicion of acute myocardial infarction, normal coronary arteries, and transient tako-tsubo-like systolic left ventricular apical ballooning. We compared the coronary artery anatomy in these 11 patients with that in 44 controls matched for age and sex: 22 with normal coronary arteries and 22 with acute myocardial infarction related with an obstructive thrombus in the left anterior descending coronary artery. Results As in Japanese patients, tako-tsubo syndrome in Caucasian patients frequently occurs in women in their seventh or eighth decades of life, and is usually preceded by emotional or physical stress. The left anterior descending in our patients with tako-tsubo syndrome was longer overall, and its recurrent diaphragmatic segment was longer, than in controls. To compare these groups we designed a measure termed recurrent segment index (left anterior descending recurrent segment length/total left anterior descending length x 100). In tako-tsubo syndrome this index was 22.3 (1.5)%, vs 10.9 (6.7)% in normal controls (P Conclusions All our patients with tako-tsubo syndrome had a left anterior descending with a long recurrent segment. The identical ventriculographic findings in patients with tako-tsubo syndrome and those with acute myocardial infarction with a long recurrent segment may be due to a common etiology.

Successful Treatment of Compression of an Anomalous Circumflex Artery After Aortic Valve Replacement With Percutaneous Coronary Intervention

A 74-year-old woman was admitted to the intensive care unit with acute pulmonary edema requiring endotracheal intubation. The presence of an unknown critical aortic stenosis was revealed with markedly calcified mitral annulus and preserved left ventricular ejection fraction. Because the patient

Pure Right Ventricular Infarction Resulting from Coronary Ectasia: Importance of Diagnostic Imaging

Isolated right ventricular (RV) infarction may occur during percutaneous coronary intervention resulting from selective occlusion of a ventricular branch of the right coronary artery (RCA). We present a case of a pure RV infarction without iatrogenic origin that at the initial electrocardiographic analysis was suggestive of a left anterior descending artery-related acute myocardial infarction. Coronary angiography results made us suspect thrombotic occlusion of a small branch of the ectatic RCA resulting from slow flow. Final diagnosis was confirmed by coronary computed tomographic angiography and cardiac magnetic resonance imaging, underlining the essential diagnostic role of these imaging modalities.

Síndrome coronario agudo y enfermedad coronaria multivaso

that describes a retrospective study of 75 consecutive patients with acute coronary syndrome (ACS), with and without ST segment elevation, who underwent coronary angiography and angioplasty. These patients (Group A) hade the peculiarity that, other than the treated culprit lesion, theyhad at least one severely stenotic lesion (≥75%) different from the one that caused the ACS and was not complex in appearance (no thrombus, ulceration, or dissection present and showing normal flow). The control group included 75 patients (group B) with ACS who underwent angioplasty of the lesion that caused the ACS and who had no other coronary lesions. Both groups were followed clinically for one year. During follow-up, mortality was noted to be higher in group A, even though the differences were not statistically significant (5.3% vs 1.3%). Similarly, more patients in group A required a new revascularization procedure (13.3% vs 2.6%; P=.04). Among patients in group A, 8% had to undergo new angioplasty on lesions other than the ones that had caused the ACS and that had not been treated initially. The results of this study make sense, since multivessel coronary heart disease is predictive for cardiovascular events in patients with ACS, whether complete revascularization is performed or not, as opposed to single vessel disease. In a retrospective analysis of patients in the TACTICS study, 2 patients with single vessel disease had fewer cardiovascular events (death and AMI) than patients with multivessel disease over a 6-month follow-up (17.5% vs 22.2%; P=NS). Among patients with multivessel disease who underwent angioplasty of the culprit lesion only, the frequency of such events was higher, though not to a statistically significant degree, than among those who underwent