interventional cardiology

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Coronary intervention perfomed in a general hospital in the State of Piauí

Antenor Portela et al. Carlos Linhares Raldir Bastos Jayro Paiva

PURPOSE: To evaluate retrospectively success and complication rates of coronary interventions performed in a general hospital with no digital equipment in the State of Piauí with a small annual number of procedures. METHODS: From August/91 to January/98, 122 patients underwent 146 procedures using a fluoroscope with camera and TV monitor of 525 lines. The variables analyzed included the initial success of procedures (residual stenosis less than fifty percent and TIMI III flow) and more serious complications (acute occlusion, infarcts, emergency surgeries and death). The clinical data and the morphological characteristics of the lesions (ACC/AHA Task Force) were also analyzed. RESULTS: Eighty five percent of the patients presented with an acute ischemic syndrome (acute myocardial infarction, post infarction angina, rest angina), 5% were in cardiogenic shock and 88% had type B lesions. The initial success rate was 93% while the more serious complications occurred in 3.5% of the cases. CONCLUSION: In spite of the small annual procedural volume and the use of conventional equipment, the initial success rate in our institution was excellent in a diverse and complex patient population while the complication rates were similar to that of the literature.

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Original Article

Predictive factors of complications after coronary stent implantation

Alexandre Schaan de Quadros et al. Carlos A. M. Gottschall Rogério Sarmento-Leite Miguel Gus … Rodrigo Wainstein André Bussmann

OBJECTIVE: To analyze the predictive factors of complications after implantation of coronary stents in a consecutive cohort study. METHODS: Clinical and angiographic characteristics related to the procedure were analyzed, and the incidence of major cardiovascular complications (myocardial infarction, urgent surgery, new angioplasty, death) in the in-hospital phase were recorded. Data were stored in an Access database and analyzed by using the SPSS 6.0 statistical program and a stepwise backwards multiple logistic regression model. RESULTS: One thousand eighteen (mean age of 61±11 years, 29% females) patients underwent 1,070 stent implantations. The rate of angiographic success was 96.8%, the rate of clinical success was 91%, and the incidence of major cardiovascular complications was 7.9%. The variables independently associated with major cardiovascular complications, with their respective odds ratio (OR) were: rescue stent, OR = 5.1 (2.7-9.6); filamentary stent, OR = 4.5 (2.2-9.1); first-generation tubular stent, OR = 2.4 (1.2-4.6); multiple stents, OR = 3 (1.6-5.6); complexity of the lesion, OR = 2.4 (1.1-5.1); thrombus, OR = 2 (1.1-3.5). CONCLUSION: The results stress the importance of angiographic variables and techniques in the risk of complications and draw attention to the influence of the stent’s design on the result of the procedure.

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Original Article

Percutaneous closure of atrial septal defects. The role of transesophageal echocardiography

Simone R. F. Fontes Pedra et al. Carlos Augusto Cardoso Pedra Jorge Eduardo Assef Renata de Sá Cassar … César Augusto Esteves Sérgio N. Braga Sérgio Pontes Jr Valmir Fernandes Fontes

PURPOSE: Evaluation of the role of transesophageal echocardiography in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. METHODS: Patients were selected for percutaneous closure of ASD by transesophageal echocardiography (TEE), which was also used to monitor the procedure, helping to select the appropriate size of the Amplatzer device, to verify its position, and to access the immediate results of the procedure. During the follow-up, TEE was used to evaluate the presence and magnitude of residual shunt (RS), device position, and right cardiac chamber diameters. RESULTS: Twenty-two (40%) of a total of 55 studied patients were selected. Thirteen underwent Amplatzer device implantation, eight are still waiting for it, and one preferred the conventional surgical treatment. All procedures were successful, which was mainly due to proper patient selection. Six (23%) patients acutely developed RS, which spontaneously disapeared at the three-month follow-up examination in three patients. There was a significant reduction in the right ventricle diastolic diameter, from 27mm (average) to 24mm and 20mm, one and three months after the procedure, respectively (p<0.0076). CONCLUSION: With the aid of TEE, percutaneous closure of ASD can be successfully, safely, and effectively performed.

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Overall experience with percutaneous occlusion of the patent ductus arteriosus

Carlos Augusto Cardoso Pedra et al. Simone Rolim Fenandes Fontes Pedra César Augusto Esteves Sérgio Luís Navarro Braga … Maria Aparecida Paula Silva Tarcísio Luís Valle de Almeida Maria Virgínia Tavares Santana José Eduardo Moraes Rego Sousa Valmir Fernandes Fontes

PURPOSE: To evaluate the overall experience of our institution with percutaneous occlusion of the patent ductus arteriosus. METHODS: Since December/92, 150 patients underwent 178 procedures (85 – Rashkind technique; 87 – Gianturco coils; 6 – Duct Occlud). Median age was 6.5 years (1 to 57). Mean minimum ductal diameter was 3.05±1.24mm (1 to 8). Clinical and echocardiographic evaluations were performed periodically. RESULTS: Adequate implantation was achieved in 143 (95.3%) patients. Prevalence of immediate residual shunting was 52.1%, falling to 15.9% during follow-up. This figure decreased to 5.2% after new additional procedures. Umbrella and coil embolization occurred in 1 and 12 procedures, respectively. Hemolysis and mild stenosis of left pulmonary artery were observed in one patient each. There was no mortality. CONCLUSION: This therapeutic modality is safe and efficacious with good follow-up results.

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Coronary intervention perfomed in a general hospital in the State of Piauí

Predictive factors of complications after coronary stent implantation

Percutaneous closure of atrial septal defects. The role of transesophageal echocardiography

Overall experience with percutaneous occlusion of the patent ductus arteriosus

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