J. Segura

Percutaneous Interventions on Severe Coarctation of the Aorta: A 21-Year Experience

Different percutaneous interventions can be used to treat coarctation of the aorta. However, a great amount of information is still needed regarding the long-term course. This article reviews our experience spanning 21 years in the percutaneous treatment of aortic coarctation. Four different conditions for treatment were considered. The first condition 1 (group 1) was balloon angioplasty in neonates and infants with untractable heart failure (n = 54; mean age, 1.2 ± 1.4 months). After balloon angioplasty, most infants sustained significant clinical improvement. However, 9 patients died in the hospital (17%). As a result, we monitored the course of the 45 survivors during a mean period of 10 ± 6 years (range, 1–19). During this follow-up period, 17 patients needed a single additional intervention on coarctation (8 underwent surgery and 9 were treated percutaneously). After this second treatment, 11 patients needed one or more further interventions. The actuarial survival probability was 83% at 19 years, with 43% of patients remaining surgery free and 23% re-intervention free. The second condition (group 2) was balloon angioplasty in children and adults with coarctation of the aorta before the stenting era (n = 28; mean age, 13 ± 8 years). After treatment, serial hemodynamic and angiographic studies were performed. The long-term relief was higher in patients with a discrete type of coarctation. The rate of late aneurysm formation was 6%. The third condition (group 3) was stent palliation in infants and children younger than the age of 6 years (n = 17; mean age, 2.1 ± 1.7 years). The stent was implanted for nondilatable stenoses, as a nondefinitive procedure. Stent palliation provides complete initial relief in hypoplastic coarctations or life-threatening conditions. However, further stent expansion is required to ensure adequate stent diameter in the growing aortic wall. In addition, late intrastent proliferation may occur in small stent diameters (18%) and aneurysm formation in hypoplastic coarctations (18%). Both late complications can be managed percutaneously. The fourth condition (group 4) was stent repair of severe aortic coarctation in adults, adolescents, and children older than the age of 6 years (n = 73; mean age, 20 ± 12 years). Significant relief was observed after treatment, which persisted at follow-up. One patient died at treatment (1.3%). After a mean follow-up of 5 ± 3 years, all 72 patients remained symptom free and no restenosis or late aneurysm were detected.

Functional Recovery Following Intracoronary Infusion of Autologous Mononuclear Bone Marrow Cells in Patients With Chronic Anterior Myocardial Infarction and Severely Depressed Ventricular Function

INTRODUCTION AND OBJECTIVES Studies have shown that intracoronary infusion of mononuclear bone marrow cells improves ventricular function in patients with acute myocardial infarction. However, less information is available about the use of this therapy during the chronic phase of a myocardial infarction. This study involved an analysis of the clinical, echocardiographic and angiographic changes observed in 19 patients with a revascularized chronic anterior myocardial infarction and depressed ventricular function who were treated by cell therapy. METHODS A series of patients were monitored during treatment and 6 months and 1 year after treatment. Autologous bone marrow was obtained by needle aspiration of the iliac crest and mononuclear cells were isolated by density-gradient centrifugation. An in vitro biological study of a sample of the infused cells was performed using fluorocytometry, phenotype marking and an analysis of the chemotactic properties of the cells. RESULTS Six months and 1 year after cell therapy, a modest improvement was observed in clinical status and ventricular function, which was most pronounced in the group of patients who responded. Characteristically, these patients were revascularized close to the time of cell therapy. There was an inverse relationship between functional recovery and biological parameters that reflected a state conducive to cell migration. CONCLUSIONS The intracoronary infusion of mononuclear bone marrow cells into patients with chronic anterior myocardial infarction appeared to result in a modest clinical and functional improvement after 6 months which was sustained up to 1 year after treatment.

Recuperación funcional tras infusión intracoronaria de células mononucleadas de médula ósea autóloga en pacientes con infarto crónico anterior y depresión severa de la función ventricular

Introduccion y objetivos Diferentes estudios han demostrado que la infusion intracoronaria de celulas mononucleadas de la medula osea en pacientes con infarto agudo de miocardio mejora la funcion ventricular. Sin embargo, existe menos informacion sobre esta terapia en la fase cronica de un infarto. Este estudio analiza los cambios clinicos, ecocardiograficos y angiograficos observados en 19 pacientes con infarto anterior cronico revascularizado y funcion ventricular deprimida que fueron tratados con terapia celular. Metodos Se estudio a los pacientes de forma seriada durante la fase del tratamiento, a los 6 meses y al ano. La medula osea autologa fue extraida mediante puncion aspirativa sobre cresta iliaca, y las celulas mononucleadas se aislaron por centrifugacion en gradiente de densidad. Se efectuo un estudio biologico in vitro de una muestra de las celulas infundidas, para citofluorometria, marcacion fenotipica y analisis de la capacidad quimiotactica de las celulas infundidas. Resultados A los 6 meses y al ano de la terapia celular se observo una ligera mejoria clinica y de la funcion ventricular, mas acusada en un grupo de pacientes respondedores. Estos se caracterizaban por haberse sometido a revascularizacion de forma mas cercana a la terapia celular. Se observo una relacion inversa entre los parametros funcionales y los biologicos que traducen un estado de actividad proclive a la migracion. Conclusiones La infusion intracoronaria de celulas mononucleares de la medula osea en pacientes con infarto anterior cronico parece producir una ligera mejoria clinica y funcional a los 6 meses que se mantiene al ano del tratamiento.

Time of Pacemaker Implantation After Percutaneous Aortic Valve Replacement. Response

who present with factors that are clearly recognized in the medical literature to be predictive of CAVB after transcatheter aortic valve implantation, such as right bundle branch block and the depth of 2. Avanzas P, Muñoz-Garcı́a AJ, Segura J, Pan M, Alonso-Briales JH, Lozano I, et al. Implante percutáneo de la prótesis valvular aórtica autoexpandible CoreValveW en pacientes con estenosis aórtica severa: experiencia inicial en España. Rev Esp Cardiol. 2010;63:141–8. valve implantation, will require close follow-up.