[Predictive value of acute electrocardiographic changes and therapeutic response in unstable angina].
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Biomedical subjects
Publications and source records attributed to D Vitola.
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Subannular aortic aneurysms are a rare entity occurring predominantly in young black men. Five white patients have been reported who underwent surgical correction, but long-term survival occurred in only two. We report two white men, 36 and 45 years old, who survived aortic valve replacement and direct suture of subannular aneurysms, with no symptoms at 29 and 42 postoperative months.
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Out of 145 patients with unstable angina hospitalized at CCU of the Instituto de Cardiologia do Rio Grande do Sul (Brazil) in 1981, 69 were studied: group I = 23 case (33.3%) with transient ST segment depression, group II = 13 cases (18.8%) with transient ST segment elevation, group III (control) = 33 cases (47.8%) without acute EKG changes. Group I showed a higher incidence of double-triple coronary artery involvement: 71.4% VS 53.8 and 63.3% respectively (non significant). This group also showed a higher number of patients with severe angina and who suffered acute myocardial infarction during follow-up, although without statistical significance. There were 8 deaths (34.8%) in group I, 3 (23.1%) in group II and 4 (12.1%) in group III (chi 2 = 4.11, p greater than 0.05). The 36 months survival rate was lower in group I than in groups II and III: 52.9% VS. 75.2% (NS) and 89.7% (P less than 0.02) respectively. We conclude that acute EKG changes, mainly transient ST segment depression, in unstable angina, are markers of high risk patients.
Countercurrent aortography performed through left brachial artery in 8 children, aging 27 days to 42 months. Systemic-pulmonary anastomosis was possible to be assessed in 3 out of 4 cases, even in one aging 42 months. Aortic coarctation could be evaluated in another 3 patients. In the last case with a clinical suspection of vascular ring, countercurrent aortography disclosed an anomalous right subclavian artery. We concluded that the procedure is safe and useful to assess some conditions involving thoracic aorta, even in older children.
Seventy one patients with complete transposition of the great arteries (TGA) who underwent balloon atrial septostomy (BAS) were studied, with the purpose to evaluate its early and late results within the first year of life. Fifty four patients were male (76,1%) and 17 female (23,9%), aged 2 days to 11 months (mean = 2,3 +/- 0,3%), being 46,5% less than 1 month old. Increase in mean aortic oxygen saturation (Ox. Sat.) after BAS was highly significant (p less than 0,001), irrespective of age and morphological features of TGA. Analysis of the group of 55 patients who underwent only BAS during the first year of life showed: mean age in the 13 non-survivors was 3,3 +/- 0,2 months; increase in Ox.Sat. was highly significant in the 42 survivors and not significant in the 13 patients who died; mortality in children with and without patent ductus arteriosus was 23,1% and 23,8%, respectively. Death directly related do BAS occurred in 2 patients (2,8%), without other complications being observed. We conclude that BAS is an effective and low-risk procedure, even in neonates with poor clinical condition. Early response to BAS is predictive of survival in the first year of life.