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

{"title":"An intriguing lesion at the left main coronary artery bifurcation","authors":"David Neves,&nbsp;Pablo Salinas,&nbsp;Nieves Gonzalo","doi":"10.1016/j.rbciev.2016.07.006","DOIUrl":"https://doi.org/10.1016/j.rbciev.2016.07.006","url":null,"abstract":"<div><p>Optical coherence tomography (OCT) can provide essential information on unclear coronary angiography images. In current consensus documents of OCT imaging interpretation, calcium is usually described as a signal-poor or heterogeneous region with a sharply delineated border, but it may have atypical features, such as the proposed “calcified nodule” entity. In this case, a stable patient presented a hazy intracoronary angiographic image. OCT imaging showed an odd-looking convex, protruding lesion with irregular borders and high attenuation likely related to a calcified nodule. The lesion had a complex relation to the left circumflex artery take-off, which was better understood after three-dimensional reconstruction.</p></div><div><p>A tomografia de coerência óptica (TCO) pode fornecer informações essenciais sobre imagens de angiografia coronária pouco claras. Em documentos de consenso atuais de interpretação de imagem de TCO, o cálcio é geralmente descrito como uma região de sinal óptico de baixa intensidade ou heterogêneo, com uma borda bem delineada, que pode ter características atípicas, como a que caracteriza o nódulo calcificado. Neste caso, um paciente estável apresentava uma imagem angiográfica intracoronária nebulosa. A imagem da TCO mostrava uma lesão convexa protuberante de aparência estranha, com bordas irregulares e alta atenuação, provavelmente relacionada a um nódulo calcificado. A lesão tinha uma relação complexa com a origem da artéria circunflexa, o que foi melhor compreendida após a reconstrução tridimensional.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 3","pages":"Pages 226-228"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2016.07.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91599704","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":"Aortic valve-in-valve and hemodynamic outcomes: where are we?","authors":"Matheus Simonato ,&nbsp;Ruhina Rana ,&nbsp;Danny Dvir","doi":"10.1016/j.rbciev.2016.07.002","DOIUrl":"10.1016/j.rbciev.2016.07.002","url":null,"abstract":"","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 3","pages":"Pages 162-163"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2016.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92897385","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 valve-in-valve implantation for surgical aortic bioprosthesis dysfunction","authors":"Rafael Alexandre Meneguz-Moreno ,&nbsp;Dimytri A. Siqueira ,&nbsp;Auristela Isabel de Oliveira Ramos ,&nbsp;Antônio de Castro Filho ,&nbsp;Andreia Dias Jeronimo ,&nbsp;Tannas Jatene ,&nbsp;David Le Bihan ,&nbsp;Rodrigo Barretto ,&nbsp;Magaly Arrais ,&nbsp;Adriana Moreira ,&nbsp;Alexandre Abizaid ,&nbsp;Amanda Guerra M.R. Sousa ,&nbsp;J. Eduardo M.R. Sousa","doi":"10.1016/j.rbciev.2015.08.001","DOIUrl":"10.1016/j.rbciev.2015.08.001","url":null,"abstract":"<div><h3>Background</h3><p>Recent studies have demonstrated the efficacy of the transcatheter valve-in-valve implantation for the treatment of bioprosthesis dysfunction in high-risk surgical patients. This study presents the initial experience with valve-in-valve implantation.</p></div><div><h3>Methods</h3><p>Clinical, echocardiographic, and procedural profiles were characterized, and the mid-term results of patients with surgical bioprosthesis dysfunction submitted to valve-in-valve implantation in the aortic position were reported.</p></div><div><h3>Results</h3><p>Seven male patients were included, aged 72.6 ± 10.0 years. The STS score was 9,6 ± 10,5%, and the logistic EuroSCORE was 22.7 ± 14.7%. Three patients had combined aortic bioprosthesis failure; two had isolated regurgitation; and two had isolated stenosis. The transfemoral access was used in six cases, and the transapical access in one case. Implanted devices included Sapien XT (n = 5) and CoreValve (n = 2) prostheses. Procedural success was achieved in six (85.7%) cases. After the procedure, the mean gradient decreased from 38.2 ± 9.6<!--> <!-->mmHg to 20.9 ± 5.9<!--> <!-->mmHg, and the valve area increased from 1.2 ± 0.4<!--> <!-->cm² to 1.5 ± 0.5<!--> <!-->cm². After 1 year, there were no deaths and no other significant adverse outcomes; 80% of patients were in NYHA functional class I/II. The transvalvular gradients and valve area remained unchanged in this period.</p></div><div><h3>Conclusions</h3><p>The valve-in-valve procedure was effective in most high-risk surgical patients with bioprosthesis dysfunction. When performed in well-selected patients, it results in satisfactory clinical and hemodynamic outcomes.</p></div><div><h3>Introdução</h3><p>Estudos recentes têm demonstrado a eficácia do implante transcateter <em>valve-in-valve</em> para o tratamento de disfunção de biopróteses em pacientes de alto risco cirúrgico. Apresentamos nossa experiência inicial com o implante <em>valve-in-valve.</em></p></div><div><h3>Métodos</h3><p>Caracterizamos o perfil clínico, ecocardiográfico e do procedimento, e reportamos os resultados de médio prazo de pacientes com disfunção de bioprótese submetidos a implante <em>valve-in-valve</em> em posição aórtica.</p></div><div><h3>Resultados</h3><p>Incluímos sete pacientes do sexo masculino, com idade de 72,6 ± 10,0 anos. O escore STS foi 9,6 ± 10,5%, e o EuroSCORE logístico foi 22,7 ± 14,7%. Três pacientes apresentavam dupla disfunção; dois tinham insuficiência; e dois exibiam estenose isolada. A via transfemoral foi utilizada em seis casos, e a transapical, em um caso. Os dispositivos implantados incluíram as próteses Sapien XT (n = 5) e CoreValve (n = 2). O sucesso do procedimento foi obtido em seis (85,7%) casos. Após o procedimento, o gradiente médio reduziu-se de 38,2 ± 9,6<!--> <!-->mmHg para 20,9 ± 5,9<!--> <!-->mmHg, e a área valvar elevou-se de 1,2 ± 0,4<!--> <!-->cm² para 1,5 ± 0,5<!--> <!-->cm². ","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 3","pages":"Pages 166-172"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"95873989","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":"Is there an association between hospital costs and door-to-balloon time?","authors":"Marcus Vinicius de Freitas Moreira,&nbsp;Luciana Alves Ribeiro,&nbsp;Edson Elviro Alves,&nbsp;Fernando Carvalho Neuenschwander,&nbsp;Renato Rocha Rabelo,&nbsp;Ubirajara Lima Filho,&nbsp;Raimundo Antônio de Melo,&nbsp;Manoel Augusto Batista Esteves,&nbsp;Augusto Lima Filho,&nbsp;Ricardo Wang","doi":"10.1016/j.rbciev.2015.08.005","DOIUrl":"10.1016/j.rbciev.2015.08.005","url":null,"abstract":"<div><h3>Background</h3><p>Door-to-balloon time (DBT) has become a measure of performance and is the focus in quality of care improvement initiatives. This study aimed to evaluate the association between DBT and its impact on hospital costs.</p></div><div><h3>Methods</h3><p>Patients treated with primary percutaneous coronary intervention between 2008 and 2013 were divided according to the DBT &lt; or ≥ 90<!--> <!-->minutes. All costs recorded at hospital discharge were adjusted by the Medical-Hospital Cost Variation Index.</p></div><div><h3>Results</h3><p>A total of 141 patients were included, grouped as DBT &lt; 90<!--> <!-->minutes (n = 77) and DBT ≥ 90<!--> <!-->minutes (n = 64). DBT was 64.0 ± 14.1<!--> <!-->minutes and 133.8 ± 35.2<!--> <!-->minutes, respectively. There were no differences in clinical outcomes between the groups. The costs were R$ 34,883.24 ± 27,749.46, with the mean cost for DBT &lt; 90<!--> <!-->minutes being R$ 33,194.24 ± 27,387.61 and the cost for DBT ≥ 90<!--> <!-->minutes R$ 36,947.58 ± 28,267.80 (<em>p</em> = 0.43). The costs, according to the culprit artery, were R$ 29,588.53 ± 16,358.85 for the right coronary artery; R$ 48,494.62 ± 44,015.04 for the left circumflex artery; and R$ 34,016.96 ± 26,503.94 for the left anterior descending artery. There was a difference between the costs of procedures related to the left circumflex artery when compared to the right coronary or left anterior descending arteries (<em>p</em> = 0.01), but there was no difference between the costs related to the right coronary, when compared to the left anterior descending artery (<em>p</em> = 0.68).</p></div><div><h3>Conclusions</h3><p>There was no difference in hospital costs regarding the private health insurance, when the groups were divided according to the DBT. Clinical outcomes were similar and a difference in costs was found for patients with the circumflex artery as the culprit vessel.</p></div><div><h3>Introdução</h3><p>O tempo porta-balão (TPB) tornou-se uma medida de desempenho e é foco de iniciativas de melhoria da qualidade assistencial. Este estudo teve como objetivo avaliar a relação entre o TPB e seu impacto nos custos de internação hospitalar.</p></div><div><h3>Métodos</h3><p>Pacientes tratados com intervenção coronária percutânea primária, entre 2008 e 2013, foram divididos de acordo com o TPB &lt; ou ≥ 90 minutos. Todos os custos registrados na alta hospitalar foram ajustados por meio do Índice de Variação de Custos Médico-Hospitalares.</p></div><div><h3>Resultados</h3><p>Foram incluídos 141 pacientes, agrupados em TPB &lt; 90 minutos (n = 77) e TPB ≥ 90 minutos (n = 64). Os TPB foram 64,0 ± 14,1 minutos e 133,8 ± 35,2 minutos, respectivamente. Não foram observadas diferenças nos desfechos clínicos entre os grupos. Os custos foram de R$ 34.883,24 ± 27.749,46, sendo o custo médio para TPB &lt; 90 minutos de R$ 33.194,24 ± 27.387,61, e para TPB ≥ 90 minutos, de R$ 36.947,58 ± 28.267,80 (<em>p</em> = 0,43). Os custos, segundo","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 3","pages":"Pages 195-200"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.08.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"97064889","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":"Immediate and medium-term outcomes of ductal stenting in neonates and infants","authors":"Carlos Mariño Vigo ,&nbsp;Gorky Mori Pinedo ,&nbsp;Cesar Salinas Mondragón ,&nbsp;Maria Lapoint Montes ,&nbsp;Silvia Alegre Manrique ,&nbsp;Geen Huaringa Bejarano ,&nbsp;Edilberto Estela Chunga","doi":"10.1016/j.rbciev.2016.07.005","DOIUrl":"https://doi.org/10.1016/j.rbciev.2016.07.005","url":null,"abstract":"<div><h3>Background</h3><p>The implantation of stents to keep the ductus arteriosus patent in cyanotic congenital heart disease is an alternative to the modified Blalock-Taussig surgery (mBT) in high-risk patients. This study describes the immediate and medium-term outcomes of stent implantation in neonates and infants with duct-dependent pulmonary circulation.</p></div><div><h3>Methods</h3><p>This was a descriptive and prospective study including different cyanotic congenital heart diseases treated between 2014 and 2015.</p></div><div><h3>Results</h3><p>Fourteen patients with a mean age of 46 days, and mean weight of 4.5<!--> <!-->kg were assessed, and pulmonary artresia with interventricular communication was the most treated condition. The femoral artery approach was used in 70% of procedures; carotid approach was used in the remaining cases. Stents of 3.5 x 12<!--> <!-->mm were used in most cases, and implant success was achieved in 78% of interventions (11/14). The failed cases were referred to surgery – one of them was an emergency, which resulted in death. Ductal spasm occurred in &lt; 48<!--> <!-->hours in three patients who required mBT, with favorable outcome. Complications after discharge and within the first 30 days included stent thrombosis (2/11), one of which was controlled with redilation, another progressed to death, and one sudden death (1/11). The overall mortality was 21.4% (3/14). A patent ductus arteriosus in the first 6 months was present in five cases, which underwent palliative surgery.</p></div><div><h3>Conclusions</h3><p>The initial experience of ductal stenting showed favorable immediate outcomes, but in the medium term, little more than a third of the cases maintained a patent ductus arteriosus within 6 months.</p></div><div><h3>Introdução</h3><p>O implante de stents para manter o ducto arterial patente na cardiopatia congênita cianótica é uma alternativa à cirurgia de Blalock-Taussig modificada (BTm) em pacientes de alto risco. Descrevemos os resultados imediatos e de médio prazo do implante de stent em neonatos e lactentes com circulação pulmonar ducto-dependente.</p></div><div><h3>Métodos</h3><p>Trata-se de estudo descritivo e prospectivo, que incluiu diferentes cardiopatias congênitas cianóticas tratadas entre 2014 e 2015.</p></div><div><h3>Resultados</h3><p>Avaliamos 14 pacientes, com média de idade de 46 dias e pesando 4,5<!--> <!-->kg, sendo a atresia pulmonar associada à comunicação interventricular a cardiopatia mais tratada. A abordagem pela artéria femoral ocorreu em 70% dos procedimentos e, nos demais, por via carotídea. Stents de 3,5 12<!--> <!-->mm foram usados na maioria dos casos, e o sucesso do implante foi obtido em 78% das intervenções (11/14). Os casos de insucesso foram encaminhados para cirurgia uma delas em situação de urgência, que resultou em óbito. Ocorreu espasmo ductal &lt; 48 horas em três pacientes que necessitaram de BTm, com evolução favorável. Complicações após a alta e nos primeiros 3","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 3","pages":"Pages 211-215"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2016.07.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91599706","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":"Impact of oral contraceptive use on the characteristics and clinical evolution of women undergoing primary percutaneous coronary intervention","authors":"Giordana Zeferino Mariano ,&nbsp;Márcia Moura Schmidt ,&nbsp;Maria Augusta Maturana ,&nbsp;Eder Quevedo ,&nbsp;Bianca de Negri ,&nbsp;Cristina Gazeta ,&nbsp;Alexandre Schaan de Quadros ,&nbsp;Carlos Antonio Mascia Gottschall","doi":"10.1016/j.rbciev.2015.08.004","DOIUrl":"10.1016/j.rbciev.2015.08.004","url":null,"abstract":"<div><h3>Background</h3><p>In Brazil, it is estimated that approximately 27% of women of childbearing age use oral contraceptives (OC). The presentation and clinical course of acute myocardial infarction (AMI) in these women has yet to be described in Brazil. The aim of this study was to analyze the clinical profile, angiographic characteristics, technical aspects of the procedure, and the outcomes in women using OC who had an AMI and were submitted to primary percutaneous coronary intervention (PCI).</p></div><div><h3>Methods</h3><p>Women aged &lt; 55 years who had acute ST segment elevation myocardial infarct and were referred to primary PCI were sequentially included and categorized into two groups: with and without current use of OC.</p></div><div><h3>Results</h3><p>We have included 257 patients, of whom 19 (7.4%) used OC. These patients were younger (42.3 ± 6.2 years vs. 48.4 ± 5.7 years; <em>p &lt;</em> 0.001), with fewer traditional risk factors for coronary artery disease, but had higher serum levels of C-reactive protein and fibrinogen. The delta T was similar (4.00 [1.25 to 6.86] hours vs. 4.50 [2.50 to 7.64] hours; <em>p</em> = 0.54), but the door-to-balloon time was longer in patients taking OC (1.41 [0.58 to 1.73] hours vs. 1.16 [0.91 to 1.51] hour, <em>p</em> = 0.02). These patients were more frequently submitted to thrombus aspiration (52.6% vs. 25.6%; <em>p</em> = 0.04). After the index event, they had no atherothrombotic outcomes in up to 2 years of follow-up (0 vs. 15.2%; <em>p</em> = 0.08).</p></div><div><h3>Conclusions</h3><p>In this study, different clinical profiles and outcomes were found among women of reproductive age, users or non-users of OC, and submitted to primary PCI. Studies with a larger number of patients are required to confirm these results.</p></div><div><h3>Introdução</h3><p>Em nosso, país estima-se que aproximadamente 27% das mulheres em idade fértil utilizem anticoncepcional oral (ACO). A apresentação e a evolução clínica do infarto agudo do miocárdio (IAM) nessas mulheres ainda não foi descrita em nosso meio. O objetivo do presente estudo foi analisar o perfil clínico, as características angiográficas, os aspectos técnicos do procedimento e os desfechos de usuárias de ACO que tiveram IAM e foram encaminhadas à intervenção coronariana percutânea (ICP) primária.</p></div><div><h3>Métodos</h3><p>Mulheres &lt; 55 anos que apresentaram IAM com supradesnivelamento do segmento ST e foram encaminhadas à ICP primária foram sequencialmente incluídas e categorizadas em dois grupos: com e sem uso atual de ACO.</p></div><div><h3>Resultados</h3><p>Incluímos 257 pacientes, sendo que 19 (7,4%) usavam ACO. Estas eram mais jovens (42,3 ± 6,2 anos vs. 48,4 ± 5,7 anos; <em>p &lt;</em> 0,001), com menos fatores de risco tradicionais para doença arterial coronariana, mas apresentavam proteína C-reativa fibrinogênio séricos mais elevados. O delta T foi semelhante (4,00 [1,25 a 6,86] horas vs. 4,50 [2,50 a 7,64] horas; <em>p</em>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 3","pages":"Pages 190-194"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.08.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"93039181","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":"Outcomes after implantation of superflexible nitinol stents in the superficial femoral artery","authors":"Patrick Bastos Metzger,&nbsp;Marilia G. Volpato,&nbsp;Maria Claudia Folino,&nbsp;Fabio Henrique Rossi,&nbsp;Ana Claudia Gomes Petisco,&nbsp;Mohamed Hassan Saleh,&nbsp;Nilo Mitsuru Izukawa,&nbsp;Antonio Massamitsu Kambara","doi":"10.1016/j.rbciev.2015.08.009","DOIUrl":"https://doi.org/10.1016/j.rbciev.2015.08.009","url":null,"abstract":"<div><h3>Background</h3><p>Endovascular interventions in the superficial femoral artery for the treatment of peripheral arterial occlusive disease have increased over the last decades. The first- and second-generation stents in the superficial femoral artery have failed to demonstrate improved patency of the treated vessel due to high fracture rates. The aim of this study was to evaluate the clinical, short-term outcomes of using third-generation superflexible nitinol stents in the treatment of atherosclerotic lesions in the superficial femoral artery.</p></div><div><h3>Methods</h3><p>This was a retrospective study carried out in a single center, from June 2013 to May 2014. A total of 27 patients underwent angioplasty with third-generation, superflexible nitinol stents in atherosclerotic lesions of the superficial femoral artery.</p></div><div><h3>Results</h3><p>The mean age was 68 ± 12 years, 55.6% were females, and 74.1% were diabetics. Patients were classified as TASC B and C in 77.7% of cases. Technical success was 100%. There was an increase in the ankle-brachial index from 0.35 ± 0.1 before the intervention to 0.75 ± 0.2 at hospital discharge. The mean follow-up of patients was 6.7 ± 2.3 months. The primary patency rate was 96.3%. The limb salvage rate was 100%. There were no stent fractures documented by X-rays.</p></div><div><h3>Conclusions</h3><p>Angioplasty with third-generation superflexible nitinol stent placement was shown to be effective in the treatment of atherosclerotic lesions of the superficial femoral artery.</p></div><div><h3>Introdução</h3><p>As intervenções endovasculares na artéria femoral superficial para o tratamento da doença arterial oclusiva periférica têm crescido nas últimas décadas. A primeira e a segunda geração de stents na artéria femoral superficial falharam em demonstrar a melhora da perviedade do vaso tratado, devido às altas taxas de fratura. O objetivo deste estudo foi avaliar os desfechos clínicos no curto prazo com o uso de stents de nitinol superflexíveis de terceira geração no tratamento de lesões ateroscleróticas na artéria femoral superficial.</p></div><div><h3>Métodos</h3><p>Trata-se de um estudo retrospectivo, realizado em único centro, no período de junho de 2013 a maio de 2014. Um total de 27 pacientes foi submetido à angioplastia com stents de nitinol superflexíveis de terceira geração em lesões ateroscleróticas da arterial femoral superficial.</p></div><div><h3>Resultados</h3><p>A média de idades foi de 68 ± 12 anos, 55,6% eram do sexo feminino e 74,1%, diabéticos. Os pacientes foram classificados em TASC B e C em 77,7% dos casos. O sucesso técnico foi de 100%. Houve aumento do índice tornozelo-braquial de 0,35 ± 0,1 pré-intervenção para 0,75 ± 0,2 na alta hospitalar. O seguimento médio dos pacientes foi de 6,7 ± 2,3 meses. A taxa de patência primária foi de 96,3%. A taxa de salvamento de membro foi de 100%. Não ocorreram fraturas de stent documentadas por raios X.</p></div><div><h3>Conclusões</","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 3","pages":"Pages 220-225"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.08.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91759380","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":"Percutaneous treatment of mitral regurgitation by MitraClipTM: report on the first two procedures in Brazil","authors":"Fabio S. Brito Jr. ,&nbsp;Alexandre Siciliano ,&nbsp;Claudio H. Fischer ,&nbsp;Marcelo L. Vieira ,&nbsp;Arnaldo Rabischoffski ,&nbsp;Fabio Papa ,&nbsp;Marcelo R. Fernandes ,&nbsp;Bernardino Tranchesi Jr. ,&nbsp;Paulo Dutra ,&nbsp;Marco A. Perin","doi":"10.1016/j.rbciev.2015.12.018","DOIUrl":"10.1016/j.rbciev.2015.12.018","url":null,"abstract":"<div><p>The MitraClip^TM system has been recently approved for clinical use in Brazil for percutaneous treatment of mitral valve regurgitation. This device is based on the Alfieri surgical procedure, creating a double orifice by bringing together the central segments of the two mitral valve cusps. This report describes the first two procedures performed in Brazil using this device. Two female patients considered to be at high surgical risk due to advanced age and presence of comorbidities were treated, with degenerative mitral regurgitation due to prolapse/flail, associated with <em>chordae tendineae</em> rupture. In both cases, significant mitral regurgitation intensity reduction was obtained using the MitraClip^TM, demonstrating the great potential of this innovative technology for the percutaneous treatment of mitral valve regurgitation.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 2","pages":"Pages 156-160"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.12.018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"95762372","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":"Gender differences in primary percutaneous coronary intervention outcomes in patients with ST-elevation myocardial infarction","authors":"Roberto Ramos Barbosa ,&nbsp;Valmin Ramos da Silva ,&nbsp;Renato Giestas Serpa ,&nbsp;Felipe Bortot Cesar ,&nbsp;Vinicius Fraga Mauro ,&nbsp;Denis Moulin dos Reis Bayerl ,&nbsp;Walkimar Ururay Gloria Veloso ,&nbsp;Roberto de Almeida Cesar ,&nbsp;Pedro Abilio Ribeiro Reseck","doi":"10.1016/j.rbciev.2015.12.006","DOIUrl":"10.1016/j.rbciev.2015.12.006","url":null,"abstract":"<div><h3>Background</h3><p>Higher mortality is reported among women with ST-elevation myocardial infarction (STEMI). This study aimed to evaluate the clinical and angiographic profiles, as well as outcomes of patients submitted to primary percutaneous coronary intervention (pPCI), according to gender.</p></div><div><h3>Methods</h3><p>Retrospective study that included patients with STEMI undergoing pPCI between March 2012 and May 2013 at a regional referral center, followed from admission until hospital discharge or death.</p></div><div><h3>Results</h3><p>208 patients underwent pPCI, of whom 51 (24.5%) were women and 157 (75.5%) men. A significant difference was observed for age (65.5<!--> <!-->±<!--> <!-->14.0 vs. 58.8<!--> <!-->±<!--> <!-->11.0 years; <em>p</em> <em>=</em> <!-->0.001), diabetes (43.1% vs. 24.8%; <em>p</em> <em>=</em> <!-->0.02), Killip-Kimball class III/IV (7.0% vs. 17.6%; <em>p</em> <em>=</em> <!-->0.02), pain-to-door time (181<!--> <!-->±<!--> <!-->154<!--> <!-->minutes vs. 125<!--> <!-->±<!--> <!-->103<!--> <!-->minutes; <em>p</em> <em>=</em> <!-->0.004), and door-to-balloon time (181<!--> <!-->±<!--> <!-->87 vs. 133<!--> <!-->minutes<!--> <!-->±<!--> <!-->67<!--> <!-->minutes; <em>p</em> <em>=</em> <!-->0.001). The success of the procedure was similar (92.1% vs. 91.1%; <em>p</em> <em>=</em> <!-->0.22). In-hospital mortality was higher for females (23.5% vs. 8.9%; <em>p</em> <em>=</em> <!-->0.006). Multivariate analysis identified age ≥<!--> <!-->70 years (odds ratio - OR<!--> <!-->=<!--> <!-->2.75; 95% confidence interval - 95% CI: 1.81–3.64; <em>p</em> <em>=</em> <!-->0.029) and Killip-Kimball class III/IV (OR<!--> <!-->=<!--> <!-->2.45; 95% CI: 1.49–4.02; <em>p</em> <em>=</em> <!-->0.002) as independent predictors of mortality.</p></div><div><h3>Conclusions</h3><p>Women with STEMI had a more severe clinical profile and longer pain-to-door and door-to-balloon times than men. Females had higher in-hospital mortality after pPCI, but the female gender was not identified as an independent predictor of death.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 2","pages":"Pages 96-101"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.12.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"100960835","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":"Renal sympathetic denervation in patients with implantable cardioverter-defibrillator and electrical storm","authors":"Rodolfo Staico,&nbsp;Luciana Armaganijan,&nbsp;Dalmo A.R. Moreira,&nbsp;Paulo T.J. Medeiros,&nbsp;Jônatas Melo Neto,&nbsp;Dikran Armaganijan,&nbsp;Amanda G.M.R. Sousa,&nbsp;Alexandre Abizaid","doi":"10.1016/j.rbciev.2015.12.004","DOIUrl":"10.1016/j.rbciev.2015.12.004","url":null,"abstract":"<div><h3>Background</h3><p>Implantable cardioverter-defibrillators (ICDs) are usually indicated for patients with malignant arrhythmias considered as high risk. Sympathetic hyperactivity plays a critical role in the development, maintenance, and worsening of ventricular arrhythmias. New treatment options in this population represent a clinical necessity. This study's objective was to report the outcomes of patients with ICDs and electrical storm submitted to renal sympathetic denervation for arrhythmia control.</p></div><div><h3>Methods</h3><p>Eight patients with ICDs admitted for electrical storm refractory to optimal medical therapy underwent renal sympathetic denervation. Underlying diseases included Chagas disease (n<!--> <!-->=<!--> <!-->6), non-ischemic dilated cardiomyopathy (n<!--> <!-->=<!--> <!-->1), and ischemic cardiomyopathy (n<!--> <!-->=<!--> <!-->1). Information on the number of episodes of ventricular tachycardia/ventricular fibrillation and antitachycardia therapies in the week before the procedure and 30 days after treatment were obtained through interrogation of the ICDs.</p></div><div><h3>Results</h3><p>The median numbers of episodes of ventricular tachycardia/ventricular fibrillation, antitachycardia pacing, and shocks in the week before renal sympathetic denervation were 29 (9 to 106), 23 (2 to 94), and 7.5 (1 to 88), and significantly reduced to 0 (0 to 12), 0 (0 to 30), and 0 (0 to 1), respectively, 1 month after the procedure (<em>p</em> <em>=</em> <!-->0.002; <em>p</em> <em>=</em> <!-->0.01; <em>p</em> <em>=</em> <!-->0.003, respectively). No patients died during follow-up. There were no major complications related to the procedure.</p></div><div><h3>Conclusions</h3><p>In patients with ICDs and electrical storm refractory to optimal medical treatment, renal sympathetic denervation significantly reduced arrhythmia load and, consequently, antitachycardia pacing and shocks. Randomized clinical trials in the context of renal sympathetic denervation to control refractory cardiac arrhythmias are needed to further support these findings.</p></div>","PeriodicalId":101094,"journal":{"name":"Revista Brasileira de Cardiologia Invasiva (English Edition)","volume":"23 2","pages":"Pages 84-90"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbciev.2015.12.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85757431","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}