Biomedical subjects
Publications and source records attributed to S Arie.
We present a rare coronary complication of angioplasty in which the steerable catheter was broken within the circumflex artery. Surgical removal of the fragment was possible and the patient had an uneventful recovery. Considerations on this serious problem, its possible causes, prevention and management are made.
From October 84 to September 88 we performed pulmonary valvuloplasty with balloon catheter (PVBC) in 90 patients (pt) with pulmonary valve stenosis (PVS). The patients were divided in 3 groups (Gr) by their ages: group I (Gr. I) 7 pt (8%) aged 4 days to 11 months, Gr. II 66 pt (73%) aged 1 year to 12 years and Gr. III 17 pt aged 13 to 34 years. This study consists of clinical and echocardiographic evaluation adopting the following parameters of indication: a) transvalvar pulmonary gradient (G); b) absence of dysplasia or hypoplasia of the pulmonary annulus. There were associated lesions which were found in each group: Gr. I atrial septal defect (ASD) in 2 pt and tricuspid insufficiency (TI) in 1 pt, in Gr. II supra valvar stenosis (SVS) in 1 pt and patent arterial ductus (PAD) in 1 pt and in the Gr. III (ASD) in 1 pt. The results after pulmonary valvuloplasty with balloon catheter (PVBC) were: (Gr.I) in 5 pt the G were reduced below 50 mmHg and the average of right ventricular systolic pressure (RVSP) changed from 92 to 62 mmHg and the average of G from 76 to 44 mmHg. One of these pt was submitted to surgery 1 month after the procedure and 2 developed restenosis in 2 and 3 years respectively, being submitted to another dilatation with good results. The 2 pt in which the procedure was not effective were submitted to surgery. In the second group the PVBC was effective in 61 pt (92%) showing the RVSP changed from 118 to 64 mmHg and G changed from 86 to 23 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
Central vein cannulation is used as routine for long-time treatment in paediatric intensive care units. The Sylastic catheter is now a days the most common used because of its non-thrombogenic effect. However, in the case here reported, fragmentation during its removal occurred in a eleven month baby. Non surgical removal was done by percutaneous technique using the grasping forceps from Cook Co. into a Lehman 7F catheter. The problem of being no radiopaque, was solved by using the echocardiography study as the guideline for the successful removal of the catheter.
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From 1982 to 1984 nine of 300 patients undergoing transluminal coronary angioplasty died. The nine coronary arteries and one saphenous aorto-coronary by-pass graft affected by angioplasty were studied by light microscopy. The following types of lesions were found, frequently in association: rupture of the plaque, circumscribed or reaching to the intimal layer or extending beyond it, dissections (fissures) between arterial layers, intra-plaque haemorrhage, plaque emboli and thrombosis. In two cases the therapeutic approach was considered to be clinically and pathologically successful; the patients survived 24 h (case 6) and forty days (case 4). Case 6 which presented recent lesions indicative of success showed, in contrast with the other non-successful cases, rupture affecting not only the intimal layer but also deeper structures of the arterial wall. There were also more extensive fissures. Case 4 which presented late alterations indicative of success showed a plaque fracture whose borders were kept apart by fibrous tissue. In conclusion, we believe that angioplasty allows the re-establishment of arterial blood flow by provoking deep intimal and medial rupture producing a small fissure between the arterial layers and a widening of the lumen; in cases with good late results these alterations cicatrize leaving a wider arterial lumen.
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To study the physiopathology of myocardial bridges, we assessed the degree of systolic coronary artery constriction (%SC) in different hemodynamic situations in six patients submitted for coronary angiograms. There was an increase of %SC (p less than 0.05) with sodium nitroprusside (NP), no modification during fast atrial stimulation (AS), and a decrease (p less than 0.05) during noradrenaline infusion (Nor). Hemodynamic studies indicate an inverse relation (p less than 0.05) between %SC and systolic and diastolic aortic pressure and left ventricular dP/dt. There was no correlation between changes in %SC and changes in Vmax or heart rate. Thus we conclude that changes in systemic arterial pressure and coronary perfusion pressure may significantly affect the degree of severity of myocardial bridges, possibly through an influence upon intraluminal coronary pressure and an intramyocardial tension relationship.
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