Luciane Barreneche Narvaes

Proteína C reativa e instabilidade clínica na doença obstrutiva de artérias carótidas

BACKGROUND: Inflammatory activity in atherosclerosis has been exhaustively studied; however, the relevance of C-reactive protein as a marker of clinical instability in carotid artery obstructive disease has not been well established yet. OBJECTIVE: To identify whether high-sensitivity C-reactive protein serum levels are associated with clinical presentation (stable vs. unstable) of carotid artery severe obstructive disease. METHODS: Seventy consecutive patients underwent carotid endarterectomy based on NASCET or ACST criteria, and were classified according to clinical presentation: group 1 - asymptomatic or with hemispheric symptoms for more than 90 days; group 2 - with hemispheric symptoms for less than 90 days. Blood samples were collected by peripheral vein puncture; high-sensitivity C-reactive protein was dosed by nephelometry and comparison between groups was performed using Students t test; p < 0.05 was considered significant. RESULTS: Neurological clinical status was considered stable in 28 (40%) patients, whereas 42 (60%) cases were considered unstable. High-sensitivity C-reactive protein levels were significantly higher in clinically unstable patients, when compared with neurologically stable cases (1.54±1.7 vs. 0.67±0.8 mg/dL, respectively; p = 0.006). There was no difference in high-sensitivity C-reactive protein levels, when compared with percentages of angiographic stenosis. CONCLUSIONS: The fact that high levels of high-sensitivity C-reactive protein are associated with unstable carotid plaque, possibly anticipating clinical events, could contribute to redefining indications for cerebrovascular interventions.

Correção cirúrgica da coartação da aorta nos primeiros seis meses de vida

OBJECTIVE: To evaluate early and late results of aortic coarctation (CoAo) surgical repair in early months of life. MATERIAL AND METHODS: Between January 1994 and May 2001, 89 patients were submitted to CoAo repair by subclavian artery flap angioplasty (Group 1 - n=49) or resection with end-to-end anastomosis (Group 2 - n=40). We analyzed and compared the mean age at operation, associated cardiac malformations, pre and postoperative aortic pressure gradient, surgical complications and mortality, and actuarial freedom from events curve. RESULTS: Most of patients were male (n=60 - 68%) and underwent to aortic repair under than one month of age, with severe heart failure (n=62 - 70%). CoAo was associated with intracardiac defects in 66 cases (74%). The aortic pressure gradient before and after surgery was 42 mmHg and 4,5 mmHg, respectively. Postoperative complications were persistent arterial hypertension (n=27), residual stenosis (n=5) and bleeding (n=3), and operative mortality was 10,2% (n=9), markedly higher in patients with associated cardiac malformations (12% vs. 4% - p<0,05). There were no differences in complications and mortality in both groups. Late re-coarctation was 16% in group 1 and 15% in group 2 (NS) and actuarial freedom from events in 60 months was 76% and 81%, respectively (NS). CONCLUSIONS: Most of surgical repair in symptomatic CoAo during early months is a life-saving procedure, due to severe heart failure; operative mortality is significant in patients with others cardiac defects; there were no differences in morbidity, mortality and recurrent coarctation rate between two surgical techniques performed.