Revista Brasileira de Cardiologia Invasiva (English Edition)最新文献

{"title":"Transition between ticagrelor and two different doses of clopidogrel at hospital discharge in patients with acute coronary syndrome submitted to percutaneous coronary intervention","authors":"Pedro Beraldo de Andrade ,&nbsp;Fábio Salerno Rinaldi ,&nbsp;Igor Ribeiro de Castro Bienert ,&nbsp;Robson Alves Barbosa ,&nbsp;Roberto Cestari Cardoso ,&nbsp;Marcos Henriques Bergonso ,&nbsp;Leonardo Marostica Alves Silva ,&nbsp;Ederlon Ferreira Nogueira ,&nbsp;André Labrunie ,&nbsp;Sérgio Kreimer ,&nbsp;Vinícius Cardozo Esteves ,&nbsp;Marden André Tebet ,&nbsp;Luiz Alberto Piva e Mattos","doi":"10.1016/j.rbciev.2017.10.006","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.10.006","url":null,"abstract":"<div><h3>Background</h3><p>The transition from ticagrelor to clopidogrel is not based on pharmacodynamic or clinical studies, but it is a common practice. The aim of the present study was to test, in an exploratory way, the transition to two different doses of clopidogrel at the time of hospital discharge in patients diagnosed with acute coronary syndrome submitted to percutaneous coronary intervention who were initially treated with ticagrelor.</p></div><div><h3>Methods</h3><p>Patients previously treated with ticagrelor were randomized to receive a loading dose of 300<!--> <!-->mg clopidogrel at hospital discharge, or 75<!--> <!-->mg without the loading dose. The primary endpoint was the incidence of cardiovascular adverse events or bleeding at 30 days.</p></div><div><h3>Results</h3><p>Of 348 selected patients, 132 were enrolled and completed the study. The incidence of ischemic and hemorrhagic events at 30 days was similar between the groups, resulting in a rate of cardiac and cerebrovascular events of 6.1% vs. 9.1% (RR: 0.787; 95% CI: 0.361-1.715; <em>p</em> = 0.74).</p></div><div><h3>Conclusions</h3><p>The transition to clopidogrel with a dose of 75<!--> <!-->mg at discharge, without a loading dose, appears to be a possible strategy. Studies with greater statistical power are needed to confirm these findings.</p></div><div><h3>Introdução</h3><p>A transição do ticagrelor para o clopidogrel não está fundamentada em estudos farmacodinâmicos ou clínicos, mas é uma prática comum. O objetivo do presente estudo foi testar, de forma exploratória, em pacientes com diagnóstico de síndrome coronariana aguda submetidos à intervenção coronariana percutânea, inicialmente tratados com ticagrelor, a transição para duas diferentes doses de clopidogrel no momento da alta hospitalar.</p></div><div><h3>Métodos</h3><p>Pacientes previamente tratados com ticagrelor foram randomizados para receber uma dose de ataque de 300<!--> <!-->mg de clopidogrel no momento da alta hospitalar, ou 75<!--> <!-->mg, omitindo-se a dose de ataque. O objetivo primário foi a incidência de eventos adversos cardiovasculares ou sangramento aos 30 dias.</p></div><div><h3>Resultados</h3><p>Dentre 348 pacientes selecionados, 132 foram incluídos e completaram o estudo. A incidência de eventos isquêmicos e hemorrágicos aos 30 dias foi similar entre os grupos, traduzindo-se em uma taxa de eventos cardíacos e cerebrovasculares de 6,1% vs. 9,1% (RR: 0,787; IC 95%: 0,361-1,715; <em>p</em> = 0,74).</p></div><div><h3>Conclusões</h3><p>A transição para clopidogrel com a dose de 75<!--> <!-->mg no momento da alta, omitindo-se uma dose de ataque, aparenta ser uma estratégia possível. Estudos com maior poder estatístico são necessários para confirmar estes achados.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 30-34"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.10.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72260618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter pulmonary valve implantation. Clinical treatment protocol and accreditation requirements for centers and interventionists in Brazil","authors":"Marcelo Silva Ribeiro ,&nbsp;Rodrigo Nieckel da Costa ,&nbsp;Raul Ivo Rossi ,&nbsp;Hélio Roque Figueira ,&nbsp;Marcelo Matos Cascudo ,&nbsp;Simone Rolim F. Fontes Pedra ,&nbsp;Isabel Cristina Britto Guimarães ,&nbsp;Ângelo Amato Vincenzo de Paola ,&nbsp;Marcelo Antônio Cartaxo Queiroga ,&nbsp;Carlos Augusto Cardoso Pedra","doi":"10.1016/j.rbciev.2017.08.003","DOIUrl":"10.1016/j.rbciev.2017.08.003","url":null,"abstract":"<div><p>Transcatheter pulmonary valve implantation (TPVI) has evolved significantly since its introduction in the early 2000s. Currently, this technique is a safe and effective option for the treatment of severe valve dysfunction (stenosis and/or regurgitation) in bioprostheses or surgical conduits in pulmonary position, in several centers worldwide. In Brazil, the initial results with this procedure in reference centers were similar to those observed in the overall experience. TPVI was proven to be feasible, safe, and effective in trained hands in Brazil. However, prior to the widespread application of this technique to other centers in this country, it was necessary to establish some criteria for patient selection, implantation technique, and clinical follow-up, as well as for the training and accreditation of new interventionists and centers. The guidelines described here were determined by a group of experts with well-known experience in congenital heart disease and TPVI, and were referred to the Conselho Federal de Medicina (CFM, portuguese for Federal Council of Medicine). Representatives of the different medical societies were involved in the creation of this document, including the Sociedade Brasileira de Cardiologia (SBC, portuguese for Brazilian Society of Cardiology), the Sociedade Brasileira de Hemodinâmica e Cardiologia Invasiva (SBHCI, portuguese for Brazilian Society of Hemodynamics and Invasive Cardiology), and the Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV, portuguese for Brazilian Society of Cardiovascular Surgery). The authors believe that strict adherence to the recommendations contained in this official document is crucial for patient safety and for optimal results to be achieved in both the short and long term. Once consolidated in Brazil, TPVI will open doors for the introduction of new valve therapies in congenital cardiopathies.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 53-58"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.08.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"109076622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare form of coronary fistula draining into the right ventricular apex","authors":"Jorge Haddad,&nbsp;Gustavo Novaes,&nbsp;André Schmidt,&nbsp;Moysés Oliveira,&nbsp;Geraldo Figueiredo,&nbsp;José A. Marin Neto","doi":"10.1016/j.rbciev.2017.10.009","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.10.009","url":null,"abstract":"<div><p>Coronary fistulas are congenital heart diseases of generally low incidence. The fistulous vessel drainage occurs in the cardiac cavities or large vessels of the right heart, like the pulmonary artery or vena cava. The authors report the case of an asymptomatic young woman with a large fistula of the left anterior descending artery draining into the right ventricular apex, with no communication between this segment and the remainder of the ventricular cavity. This unusual presentation of a coronary-cavitary fistula has not been previously described.</p></div><div><p>As fístulas coronárias são usualmente cardiopatias congênitas de baixa incidência. A drenagem do vaso fistuloso ocorre nas cavidades cardíacas ou nos grandes vasos do coração direito, como a artéria pulmonar ou as veias cavas. Relatamos o caso de uma paciente adulta jovem, assintomática, portadora de grande fístula da artéria descendente anterior drenando no ápice do ventrículo direito, sem comunicação deste segmento com o restante da cavidade ventricular. Esta forma incomum de apresentação de uma fístula coronário-cavitária não foi previamente descrita.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 44-46"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.10.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72260619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of primary percutaneous treatment of acute myocardial infarction at a reference hospital in southern Brazil","authors":"Áurea Jacob Chaves (Editor)","doi":"10.1016/j.rbciev.2017.10.011","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.10.011","url":null,"abstract":"","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Page 1"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.10.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72260700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intercoronary communication: a rare coronary abnormality","authors":"Renato Sanchez Antonio,&nbsp;André de Oliveira Fonseca,&nbsp;José Fábio Fabris Jr.,&nbsp;Vicente Paulo Resende Jr.,&nbsp;José Luis Attab dos Santos,&nbsp;Ricardo de Souza Alves Ferreira","doi":"10.1016/j.rbciev.2017.10.001","DOIUrl":"10.1016/j.rbciev.2017.10.001","url":null,"abstract":"<div><p>Intercoronary communication or coronary arcade is a rare congenital abnormality. The authors report the case of a patient with intercoronary communication, chest pain, and electrocardiogram showing an early ventricular repolarization pattern, but no significant atherosclerosis at the coronary angiography. Nevertheless, an intercoronary communication with unidirectional flow between the right coronary artery and the left circumflex artery was visualized, and later assessed by physical stress echocardiography, which did not detect ischemia. Although intercoronary communication is usually unrelated to ischemia, there are reports in the literature that unidirectional flow can cause myocardial ischemia through coronary steal.</p></div><div><p>Comunicação intercoronária ou arcada coronária é uma anomalia congênita rara. Relatamos o caso de um paciente com comunicação intercoronária, com quadro de dor torácica e eletrocardiograma com padrão de repolarização ventricular precoce, mas sem aterosclerose significativa à cineangiocoronariografia. No entanto, foi visualizada comunicação intercoronária com fluxo unidirecional entre a coronária direita e a artéria circunflexa, que foi avaliada pela ecocardiografia sob estresse físico, sem detecção de isquemia. Embora a comunicação intercoronária geralmente não esteja relacionada à isquemia, há relatos na literatura de que o fluxo unidirecional pode causar isquemia miocárdica por meio do roubo coronariano.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 47-49"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.10.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"105816782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SAVEME (Myocardial Salvage After Rescue Angioplasty: Evaluation by Magnetic Resonance) Study: Rationale and Study Design","authors":"Marco Túlio de Souza ,&nbsp;Luiz Fernando Ybarra ,&nbsp;Thiago Pouso Oliveira ,&nbsp;Marly Uellendahl ,&nbsp;Ana Carolina Correa de Souza ,&nbsp;Eryca Vanessa Santos de Jesus ,&nbsp;Antônio Célio Camargos Moreno ,&nbsp;Adriano Henrique Pereira Barbosa ,&nbsp;José Marconi Almeida Sousa ,&nbsp;Adriano Caixeta ,&nbsp;Cláudia Maria Rodrigues Alves ,&nbsp;Antônio Carlos de Carvalho","doi":"10.1016/j.rbciev.2017.08.001","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.08.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Atherosclerotic disease accounts for one-third of deaths annually, as it often leads to complications such as ST-elevation myocardial infarction (STEMI). Rescue percutaneous coronary intervention (PCI) is indicated in case of thrombolytic therapy failure administered in this scenario. However, the benefits regarding mortality rate reduction and the amount of myocardium that is actually salvaged are not well established. The development of new tools, including cardiac magnetic resonance imaging, to identify the myocardium at risk and the infarcted area has increased diagnostic accuracy. Differently from the context of primary PCI, little is known about the association between epicardial and microvascular coronary flow following rescue PCI and the salvaged myocardial area. The aim of this study is to evaluate whether there is an association between coronary flow and the salvaged myocardial area identified by magnetic resonance imaging.</p></div><div><h3>Methods</h3><p>This will be a prospective, open, single-center, intervention study. A total of 72 patients with STEMI who underwent rescue PCI after documented failure of the fibrinolytic therapy, and were transferred to our institution, will be selected, observing a pharmacoinvasive strategy.</p></div><div><h3>Conclusions</h3><p>At the end of this study, the authors expect to contribute to the knowledge about coronary flow and its association with the amount of salvaged cardiac muscle after rescue PCI. This type of information that can help to understand which cases can benefit the most from rescue PCI.</p></div><div><h3>Introdução</h3><p>A doença aterosclerótica é responsável por um terço dos óbitos ocorridos anualmente, pois frequentemente leva a complicações como infarto do miocárdio com supradesnivelamento do segmento ST (IMCST). A intervenção coronária percutânea (ICP) de resgate é indicada caso ocorra falha da terapia trombolítica administrada neste cenário. No entanto, os benefícios, em termos de redução da taxa de mortalidade e da quantidade de miocárdio efetivamente salvo, não são bem estabelecidos. O desenvolvimento de novas ferramentas, entre elas a ressonância magnética cardíaca, para identificar a área miocárdica em risco e infartada, elevou a acurácia diagnóstica. Diferentemente do contexto da ICP primária, pouco se sabe sobre a relação entre o fluxo coronário epicárdico e microvascular após a ICP de resgate e a área de miocárdio salva. O objetivo deste estudo é avaliar se existe relação entre tais fluxos e a área de miocárdio salva identificada pela ressonância magnética.</p></div><div><h3>Métodos</h3><p>Estudo prospectivo, aberto, unicêntrico, de intervenção. Serão selecionados 72 pacientes com IMCST que tiverem realizado ICP de resgate após falha documentada da terapia fibrinolítica transferidos para este serviço, obedecendo uma estratégia fármaco-invasiva.</p></div><div><h3>Conclusões</h3><p>Ao término desta pesquisa, esperamos contribuir para o conhec","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 9-13"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72260717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome evaluation after percutaneous coronary intervention with drug-eluting stent implantation in multivessel diabetic patients: incremental impact of SYNTAX and residual SYNTAX scores on long-term clinical outcomes","authors":"Rômulo Francisco de Almeida Torres,&nbsp;Suellen Lacerda Bezerra,&nbsp;Márcia Beatriz de Jesus Lima,&nbsp;Tercyo Leonardo Coelho Cunha,&nbsp;Marcela Moraes Cury,&nbsp;Guilherme Barreto Gameiro Silva,&nbsp;Daniel Bouchabki de Almeida Diehl,&nbsp;Alexandre Abizaid,&nbsp;Amanda Guerra M.R. Sousa,&nbsp;J. Ribamar Costa Jr","doi":"10.1016/j.rbciev.2017.10.005","DOIUrl":"10.1016/j.rbciev.2017.10.005","url":null,"abstract":"<div><h3>Background</h3><p>Despite the advent of drug-eluting stents (DES), diabetic patients still have increased risk of major adverse cardiovascular and cerebrovascular (MACCE) after percutaneous coronary intervention (PCI). Our aim was to evaluate the incidence of MACCE (death, stroke, non-fatal acute myocardial infarction, or target-lesion revascularization) during a follow-up of at least 1 year, in addition to the ability of the SYNTAX and residual SYNTAX scores to predict events.</p></div><div><h3>Methods</h3><p>Single-center, retrospective study of diabetic patients with multivessel coronary disease, including left main coronary artery (LMCA) lesions treated with DES between 2012 and 2014.</p></div><div><h3>Results</h3><p>A total of 158 patients were included, with a mean age of 65.1 ± 9.1 years. In 44.2% of the cases, there was a proximal lesion in the left anterior descending artery and 9% had a lesion in the LMCA. Most procedures were performed with second-generation DES (91.1%). Mean follow-up was 1,054 ± 725 days, and MACCE occurred in 17.4% of the patients. Among those with a low SYNTAX score (&lt; 23), 10.2% had MACCE, while among those classified as having a moderate/high SYNTAX score (≥ 23), the incidence was 33.3% (<em>p</em> = 0.003). Of the patients with zero residual SYNTAX score (complete revascularization), 7.5% progressed with MACCE, compared with 22.0% with incomplete revascularization (<em>p</em> = 0.01).</p></div><div><h3>Conclusions</h3><p>The present study points to the feasibility and safety of performing PCI in multivessel diabetic patients, especially among those with low angiographic complexity. Incomplete revascularization was a predictor of a higher occurrence of MACCE in the medium/long-term follow-up.</p></div><div><h3>Introdução</h3><p>Apesar do advento dos stents farmacológicos (SF), diabéticos ainda experimentam risco aumentado de eventos cerebrovasculares e cardiovasculares maiores (ECCAM) após intervenção coronária percutânea (ICP). Nosso objetivo foi avaliar a incidência de ECCAM (óbito, acidente vascular cerebral, infarto agudo do miocárdio não fatal ou revascularização da lesão alvo) no seguimento de pelo menos 1 ano, além da capacidade de os escores SYNTAX e SYNTAX residual predizerem eventos.</p></div><div><h3>Métodos</h3><p>Estudo unicêntrico, retrospectivo, de diabéticos com doença coronariana multiarterial, incluindo lesões de tronco de coronária esquerda (TCE), tratados com SF entre 2012 a 2014.</p></div><div><h3>Resultados</h3><p>Foram incluídos 158 pacientes, com média de idades de 65,1 ± 9,1 anos. Em 44,2% dos casos, havia lesão proximal da artéria descendente anterior e 9% apresentavam lesão de TCE. A maioria dos procedimentos foi realizada com SF de segunda geração (91,1%). A média de seguimento foi de 1.054 ± 725 dias, e o ECCAM ocorreu em 17,4% dos pacientes. Entre aqueles com escore SYNTAX baixo (&lt; 23), 10,2% apresentaram ECCAM, enquanto que entre os que foram categorizados como com SY","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 25-29"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.10.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"109713407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of scattered radiation and impact of local protective devices in an interventional cardiology laboratory","authors":"Igor Ribeiro de Castro Bienert ,&nbsp;Luiz Carlos Ferreira Jr. ,&nbsp;Paulo André da Silva ,&nbsp;Daniela Tomie Kasama Miwa ,&nbsp;Carla Liberato Bastos Florêncio ,&nbsp;Rodrigo Lupp Mota ,&nbsp;Fabio Salermo Rinaldi ,&nbsp;Pedro Beraldo de Andrade","doi":"10.1016/j.rbciev.2017.10.008","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.10.008","url":null,"abstract":"<div><h3>Background</h3><p>Medical applications are the main source of ionizing radiation exposure, and in this context the issue of occupational risk is particularly important. Although the different organs of the human body present different radiation sensitivities, specific assessments of the impact on the different regions of the interventionist's body with diverse radioprotection devices are rare in Brazil.</p></div><div><h3>Methods</h3><p>A scattered radiation test was performed using an ionization chamber in a fluoroscopy station, with standard radioprotection accessory kit of the equipment (lower skirt and upper movable shield, in two different positions), at sequential distances from the source, using acrylic phantoms as human chest simulation.</p></div><div><h3>Results</h3><p>Differences in radiation were identified in relation to distance and use of radioprotection devices. The median radiation reduction was 50.6% (interquartile range – IQ from 39.42% to 51.05%) using the lower skirt shield, 71.3% (IQ from 67.66% to 77.05%) with the addition of an upper shield in angulated position, and 84.7% (IQ from 83.75% to 85.87%) with the addition of an upper shield aligned with the lower shield. Significant differences were also found regarding height and distance from the source.</p></div><div><h3>Conclusions</h3><p>The use of the assessed local radioprotection devices was effective in reducing the overall radiological impact to the interventionist. However, there were radiation escape routes, especially with non-ideal positioning, demonstrating the importance of the additional use of individual protection devices.</p></div><div><h3>Introdução</h3><p>As aplicações médicas representam a maior fonte de exposição radiológica ionizante e, neste contexto, é de especial importância a questão do risco profissional. Embora existam diferentes sensibilidades à radiação dos distintos órgãos do corpo humano, avaliações específicas do impacto nas diversas regiões do corpo do operador, com diferentes dispositivos de radioproteção, são raras em nosso meio.</p></div><div><h3>Métodos</h3><p>Teste de radiação espalhada foi realizado com câmara de ionização em estação de fluoroscopia, com jogo de acessórios de radioproteção padrão do equipamento (saia inferior e escudo móvel superior, em duas diferentes posições), a distâncias sequenciais em relação à fonte, utilizando fantoma de acrílico em simulação de tórax humano.</p></div><div><h3>Resultados</h3><p>Foram identificadas diferenças na radiação em relação à distância e ao uso dos dispositivos de radioproteção. A redução mediana da radiação foi de 50,6% (intervalo interquartil − IQ de 39,42% a 51,05%) com uso do escudo saia inferior, 71,3% (IQ de 67,66% a 77,05%) com adição de escudo superior em posicionamento angulado e 84,7% (IQ de 83,75% a 85,87%) com adição de escudo superior em linha ao escudo inferior. Diferenças significativas foram encontradas ainda em relação à altura e à distância da fonte.</p></div><di","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 38-43"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.10.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72260622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular outcomes in patients treated with primary percutaneous coronary intervention in a general tertiary hospital","authors":"Gustavo Neves de Araujo ,&nbsp;Felipe Homem Valle ,&nbsp;Guilherme Pinheiro Machado ,&nbsp;Fernando Pivatto Jr. ,&nbsp;Bruno Fuhr ,&nbsp;Elvis Pellin Cassol ,&nbsp;Stéfani Mariani ,&nbsp;Luis Carlos Corsetti Bergoli ,&nbsp;Ana Maria Krepsky ,&nbsp;Rodrigo Vugman Wainstein ,&nbsp;Sandro Cadaval Gonçalves ,&nbsp;Marco Vugman Wainstein","doi":"10.1016/j.rbciev.2017.10.002","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.10.002","url":null,"abstract":"<div><h3>Background</h3><p>There are few national data on the results of primary percutaneous coronary intervention (PCI), and registries are a great tool for assessing patient profiles and post-procedure outcomes. The aim of this study was to describe the profile of patients with primary PCI in a general tertiary hospital, as well as to evaluate in-hospital and 30-day cardiovascular outcomes.</p></div><div><h3>Methods</h3><p>The study included all patients submitted to primary PCI between 2012 and 2015. This was a prospective registry, in which the analyzed clinical outcomes were the occurrence of death, infarction, or stroke, and major cardiovascular and cerebrovascular events (MACCE).</p></div><div><h3>Results</h3><p>The study included 323 patients, aged 60 ± 12 years, of whom 66.7% were males, 28.5% diabetics. At admission, 13.5% of the patients were classified as Killip class III/IV. The pain-to-door time was 4.4 ± 2.5<!--> <!-->hours and the door-to-balloon time was 68.0 ± 34.0<!--> <!-->minutes. Hospital mortality was 9.9%, and 18.3% of the patients presented MACCE in 30 days.</p></div><div><h3>Conclusions</h3><p>Patients submitted to primary PCI had high rates of MACCE, which can be attributed to the more severe clinical presentation and to a long time of ischemia. The faster treatment of these patients, a modifiable variable, demands immediate attention from the health system.</p></div><div><h3>Introdução</h3><p>Existem poucos dados nacionais a respeito dos resultados da intervenção coronária percutânea (ICP) primária, e os registros são uma ótima ferramenta para a avaliação do perfil dos pacientes e dos desfechos pós-procedimento. O objetivo deste estudo foi descrever o perfil dos pacientes com ICP primária em um hospital geral terciário, bem como avaliar os desfechos cardiovasculares hospitalares e em 30 dias.</p></div><div><h3>Métodos</h3><p>Foram incluídos todos os pacientes submetidos à ICP primária entre 2012 a 2015. Trata-se de um registro prospectivo, no qual os desfechos clínicos analisados foram a ocorrência de morte, infarto ou acidente vascular cerebral, e eventos cardiovasculares e cerebrovasculares maiores (ECCAM).</p></div><div><h3>Resultados</h3><p>Foram incluídos 323 pacientes, com idade 60 ± 12 anos, sendo 66,7% do sexo masculino, 28,5% diabéticos. Na admissão, 13,5% dos pacientes apresentavam-se em Killip III/IV. O tempo dor-porta foi de 4,4 ± 2,5 horas e o tempo porta-balão foi 68,0 ± 34,0 minutos. A mortalidade hospitalar foi de 9,9%, e 18,3% dos pacientes apresentaram ECCAM em 30 dias.</p></div><div><h3>Conclusões</h3><p>Os pacientes submetidos à ICP primária apresentaram taxas elevadas de ECCAM, que podem ser atribuídas à apresentação clínica mais grave e a um longo tempo de isquemia. Um atendimento mais rápido destes pacientes, variável modificável, demanda uma atenção imediata do sistema de saúde.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 4-8"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72260716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right heart catheterization through ultrasound-guided antecubital vein approach","authors":"Felipe Homem Valle ,&nbsp;Paola Severo Romero ,&nbsp;Bruno da Silva Matte ,&nbsp;Sandro Cadaval Gonçalves ,&nbsp;Luiz Carlos Corsetti Bergoli ,&nbsp;Ana Maria Rocha Krepsky ,&nbsp;Gustavo Neves de Araújo ,&nbsp;Eneida Rejane Rabelo da Silva ,&nbsp;Marco Vugman Wainstein ,&nbsp;Rodrigo Vugman Wainstein","doi":"10.1016/j.rbciev.2017.08.002","DOIUrl":"https://doi.org/10.1016/j.rbciev.2017.08.002","url":null,"abstract":"<div><h3>Background</h3><p>Complications in right heart catheterization are almost all access-site related. Forearm veins may be a target to reduce access-site complications during the procedure. However, data regarding wide application of this technique is scarce.</p></div><div><h3>Methods</h3><p>This is a case-series that reports our first experiences in right heart catheterization through the antecubital approach.</p></div><div><h3>Results</h3><p>We attempted to perform right heart catheterization in 20 patients using antecubital approach on January 2016. The antecubital approach was successful in 19 (95.0%) cases. All venous access were obtained with ultrasound guidance. Simultaneous right and left heart catheterization was performed in 12 cases (60.0%). Left heart catheterization was performed through right radial artery in 11 cases (91.7%) and through the right brachial artery in 1 case (8.3%). Antecubital access was obtained through the basilic vein in 18 (94.7%) cases and through the cephalic vein in 1 (5.3%) case.</p></div><div><h3>Conclusions</h3><p>Right heart catheterization through the antecubital fossa veins appears to be feasible and safe. Further controlled studies are required to establish the best access site to perform right heart catheterization.</p></div><div><h3>Introdução</h3><p>As complicações no cateterismo cardíaco direito estão quase sempre relacionadas ao local de acesso. As veias do antebraço podem ser um alvo para reduzir tais complicações durante o procedimento. No entanto, dados relativos à ampla aplicação desta técnica são escassos.</p></div><div><h3>Métodos</h3><p>Série de casos que relata nossas primeiras experiências com o cateterismo cardíaco direito por acesso venoso antecubital.</p></div><div><h3>Resultados</h3><p>Tentamos realizar o cateterismo cardíaco direito em 20 pacientes com abordagem antecubital em janeiro de 2016. A abordagem antecubital foi bem-sucedida em 19 casos (95,0%). Todos os acessos venosos foram obtidos guiados por ultrassonografia. Os cateterismos cardíacos direito e esquerdo foram realizados simultaneamente em 12 casos (60,0%). O cateterismo cardíaco esquerdo foi realizado através da artéria radial direita em 11 casos (91,7%), e da artéria braquial direita em 1 caso (8,3%). O acesso antecubital foi obtido pela veia basílica em 18 (94,7%) casos, e pela veia cefálica em 1 (5,3%) caso.</p></div><div><h3>Conclusões</h3><p>O cateterismo cardíaco direito através das veias da prega antecubital parece ser viável e seguro. Outros estudos controlados são necessários para estabelecer o melhor local de acesso para realizar o cateterismo cardíaco direito.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"24 1","pages":"Pages 35-37"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2017.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72260617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}