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Ferrosorp® Plus (FSP) is a commercial adsorbent obtained from the sludges of drinking water treatment plants, composed of mainly amorphous ferric oxy(hydroxides) and calcite among others impurities. This product is indicated to remove arsenic along with phosphates in water treatments[1]. A novel application can be the in-situ remediation of arsenic polluted aquifers through injection of modified product of a smaller size, allowing higher reactivity and mobility through porous media, as already observed for phosphates[2]. To this end, the original granular product (G-FSP) was sonicated (S-FSP), reducing the size from 0.5-2 mm to 0.001-0.1 mm, and increasing the surface area from 218 m2/g to 233 m2/g, respectively. The only crystalline phase detected with x-ray diffraction (XRD) was calcite, which accounted for 8.3%, as determined by thermogravimetric analysis (TGA). Batch kinetics studies of arsenite and arsenate adsorption on these two materials were evaluated at initial pH 4 and pH 9, the two extremes of pH range application according to the manufacturer. Adsorption equilibrium was reached after ~48 h and the experimental results fitted to a pseudo-second order kinetics model. Adsorption isotherms were determined in batch studies at the equilibrium pH (around 9.5) and fitted to a Freundlich model. It was observed that, despite the slight increase on the surface area in the sonicated by-product, the amount of arsenic adsorbed on both material sizes were similar; the Freundlich constant for granular and sonicated FSP were, respectively, 10.0 and 12.8 mg(1‑1/n)·L(1/n)/g for As(III), and 5.1 and 5.3 mg(1-1/n)·L(1/n)/g for As(V). The adsorbed arsenic concentrations at equilibrium were simulated using the PHREEQC software and the Dzombak and Morel (1992) surface complexation model. Simulations were fitted to reproduce the experimental results and to elucidate the role of calcite and of the released bicarbonate anions on arsenic adsorption onto FSP[3]. These experiments provide evidence about the role of the material size and of the calcite on arsenic adsorption, which can be extended to other applications, like aquifers polluted by acid drainage. In this case, the presence of calcite is advantageous as it counteracts acidity while adsorbing arsenic. Acknowledgements This work received the financial support of the Torres Quevedo (2019) grant number PTQ2019-010503. [1] HeGo BIOTEC GmbH, 2015, accessed 09/01/2022, [2] Martí, V., Jubany, I., Ribas, D., Benito, J. A., & Ferrer, B. (2021). Improvement of Phosphate Adsorption Kinetics onto Ferric Hydroxide by Size Reduction. Water, 13(11), 1558 [3] Appelo, C. A. J., Van der Weiden, M. J. J., Tournassat, C., & Charlet, L. (2002). Surface complexation of ferrous iron and carbonate on ferrihydrite and the mobilization of arsenic. Environmental Science & Technology, 36(14), 3096-3103.

Objectives This study sought to assess the value of bioresorbable vascular scaffolds (BVS) in patients with in-stent restenosis (ISR). Background Currently both drug-eluting stents (DES) and drug-eluting balloons (DEB) are recommended in patients with ISR. However, the value of BVS in this setting remains unclear. Methods RIBS VI (Restenosis Intra-stent: drug-eluting Balloon vs everolimus-eluting Stent) was a prospective multicenter study (19 Spanish sites) that included 141 patients treated with BVS for either bare-metal stent (BMS) ISR or DES-ISR. Late angiography was scheduled at 6 to 9 months. Inclusion/exclusion criteria were similar to those used in the RIBS IV (patients with DES-ISR) and RIBS V (patients with BMS-ISR) trials, where DEB (n = 249) was compared with everolimus (EES)-DES (n = 249). Results of BVS in RIBS VI were compared with those obtained with DEB and EES in the RIBS IV and V trials. Results On late angiography (n = 134; 95% of eligible) the in-segment minimal lumen diameter (primary endpoint) was 1.87 ± 0.5 mm, late lumen loss was 0.23 ± 0.4 mm, and restenosis rate was 11%. At 1-year follow-up (100% of patients) no patient died, 4 (2.8%) experienced a myocardial infarction, and 16 (11.3%) required target lesion revascularization. One patient (0.7%) who discontinued antiplatelet therapy experienced definitive BVS thrombosis. Freedom from cardiac death, myocardial infarction, and target lesion revascularization was 86%. The minimal lumen diameter at follow-up after BVS was similar to that obtained with DEB (1.88 ± 0.6 mm; p = NS) but smaller than that achieved after EES (2.16 ± 0.7 mm; p Conclusions This study suggests the safety and efficacy of BVS in patients with ISR. In this challenging anatomic scenario BVS obtained late angiographic and clinical results similar to DEB but inferior to EES. (Restenosis Intrastent: Bioresorbable Vascular Scaffolds Treatment [RIBS VI]; NCT02672878 )

Treatment of patients with in-stent restenosis (ISR) remains a challenge. This study sought to compare the efficacy of everolimus-eluting stents (EESs) and drug-eluting balloons (DEBs) with paclitaxel in patients with ISR. A pooled analysis of the Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent (RIBS IV) and Restenosis Intra-Stent of Bare-Metal Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent (RIBS V) randomized trials was performed using patient-level data. In both trials, EESs were compared with DEBs in patients with ISR (RIBS V included 189 patients with bare-metal ISR; RIBS IV included 309 patients with drug-eluting ISR). Inclusion and exclusion criteria were identical in both trials. A total of 249 patients were allocated to EES and 249 to DEB. Clinical follow-up at 1 year was obtained in all (100%) patients and late angiography (median 249 days) in 91% of eligible patients. Compared with patients treated with DEBs, patients treated with EESs obtained better short-term results (postprocedural minimal lumen diameter 2.28 ± 0.5 vs 2.12 ± 0.4 mm, p

ResumenIntroduccion y objetivos El tratamiento invasivo y farmacologico del infarto agudo de miocardio con elevacion del segmento ST comporta una reduccion de los eventos isquemicos, no asi de las complicaciones hemorragicas. El objetivo del estudio es evaluar en estos pacientes los resultados clinicos y las complicaciones hemorragicas comparando el acceso femoral frente al radial. Metodos Se evaluo a la poblacion del estudio Examination, que es un ensayo clinico multicentrico aleatorizado que incluyo a 1.498 pacientes con infarto agudo de miocardio con elevacion del segmento ST remitidos para angioplastia de emergencia. Sobre esta poblacion, efectuamos un subanalisis en el que se analizaron dos grupos segun el tipo de acceso (femoral frente a radial). Se establecio como objetivo primario la variable compuesta por: muerte por cualquier causa, infarto de miocardio, revascularizacion y hemorragia. Resultados El acceso fue por via femoral en 825 pacientes (55%) y por via radial en 673 (45%). Se observo mas hemorragias (mayores y menores) con acceso femoral que con acceso radial (el 5,9 frente al 2,8%; p

Introduction and objectives: Invasive and pharmacological treatment of ST-segment elevation acute myocardial infarction reduces the rate of ischemic events but not bleeding complications. The objective of this study was to compare clinical results and bleeding complications between femoral and radial access routes in patients with ST-segment elevation acute myocardial infarction. Methods: An evaluation was performed of the population of the Examination study, a randomized, multicenter, clinical trial that included 1498 patients with ST-segment elevation acute myocardial infarction who underwent emergency angioplasty. Subanalysis of this population was conducted to compare patients by type of access (femoral vs radial). The primary end point was a composite of: all-cause death, myocardial infarction, revascularization, and bleeding. Results: Femoral and radial access routes were used in 825 (55%) and 673 (45%) patients, respectively. More bleeding complications (major and minor) were seen with femoral access than radial access (5.9% vs 2.8%; P < .004), largely due to a greater incidence of minor bleeding with femoral access (4.6% vs 1.9%; P = .005). After adjustment for confounders, survival analysis showed a reduction in the primary composite end point in patients with radial access (hazard ratio = 0.73; 95% confidence interval, 0.56-0.96; P = .022). Conclusions: In patients with ST-segment elevation acute myocardial infarction, the radial approach is an effective technique that improves prognosis and reduces bleeding complications. (C) 2014 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

BACKGROUND It is unknown if lack of polymer can provoke a different edge response in drug-eluting stents. The aim of this study was to compare edge vascular response between polymer-free paclitaxel-eluting stent (PF-PES) and polymer-based paclitaxel-eluting stents (PB-PES). METHODS AND RESULTS: A total of 165 eligible patients undergoing percutaneous coronary intervention were prospectively randomized 1:1 to receive either PF-PES or PB-PES. Those patients with paired intravascular ultrasound (IVUS) after procedure and at 9-month follow-up were included in this analysis.Seventy-six patients with 84 lesions, divided into PB-PES (38 patients, 41 lesions) and PF-PES groups (38 patients, 43 lesions) had paired post-procedure and 9-month follow-up IVUS and were therefore included in this substudy. There was a significant lumen decrease at the proximal edge of PF-PES (from 9.02±3.06 mm(2)to 8.47±3.05 mm(2); P=0.040), and a significant plaque increase at the distal edges of PF-PES (from 4.39±2.73 mm(2)to 4.78±2.63 mm(2); P=0.004). At the distal edge there was a significant plaque increase in the PF-PES compared to PB-PES (+8.0% vs. -0.6%, respectively; P=0.015) with subsequent lumen reduction (-5.2% vs. +6.0%, respectively; P=0.024). CONCLUSIONS PF-PES had significant plaque increase and lumen reduction at the distal edge as compared to PB-PES, probably due to difference in polymer-based drug-release kinetics between the 2 platforms.

Objectives This study sought to assess the effectiveness of a strategy of using drug-eluting stents (DES) with a different drug (switch) in patients with DES in-stent restenosis (ISR). Background Treatment of patients with DES ISR remains a challenge. Methods The RIBS-III (Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent) study was a prospective, multicenter study that aimed to assess results of coronary interventions in patients with DES ISR. The use of a different DES was the recommended strategy. The main angiographic endpoint was minimal lumen diameter at 9-month follow-up. The main clinical outcome measure was a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results This study included 363 consecutive patients with DES ISR from 12 Spanish sites. The different-DES strategy was used in 274 patients (75%) and alternative therapeutic modalities (no switch) in 89 patients (25%). Baseline characteristics were similar in the 2 groups, although lesion length was longer in the switch group. At late angiographic follow-up (77% of eligible patients, median: 278 days) minimal lumen diameter was larger (1.86 ± 0.7 mm vs. 1.40 ± 0.8 mm, p = 0.003) and recurrent restenosis rate lower (22% vs. 40%, p = 0.008) in the different-DES group. At the last clinical follow-up (99% of patients, median: 771 days), the combined clinical endpoint occurred less frequently (23% vs. 35%, p = 0.039) in the different-DES group. After adjustment using propensity score analyses, restenosis rate (relative risk: 0.41, 95% confidence interval [CI]: 0.21 to 0.80, p = 0.01), minimal lumen diameter (difference: 0.41 mm, 95% CI: 0.19 to 0.62, p = 0.001), and the event-free survival (hazard ratio: 0.56, 95% CI: 0.33 to 0.96, p = 0.038) remained significantly improved in the switch group. Conclusions In patients with DES ISR, the implantation of a different DES provides superior late clinical and angiographic results than do alternative interventional modalities.

The treatment of coronary chronic total occlusions (CTO) remains a challenge for the interventional cardiologist. Failure of balloon angioplasty is the second more common cause of an unsuccessful procedure. We describe our experience with the use of the new Tornus ® catheter (Asahi Intecc, Aichi, Japan) designed specifically for the treatment of “nondilatable” CTO. Between November 2008 and March 2010, 17 patients (age 62 years, 88% men, 82% dyslipidemia, 52% hypertension, 29% diabetes) were treated in whom balloon dilatation had failed after crossing the lesion with the guide. The use of Tornus ® catheter was successful without complications in 15. All patients underwent clinical follow-up (median, 573 days) with no documented major adverse events. The use of the Tornus ® catheter is safe and feasible in those patients with CTO lesions in whom balloon angioplasty has been unsuccessful.

Resumen El tratamiento percutaneo de las oclusiones coronarias cronicas (OCC) representa un desafio. La segunda causa del fracaso de la tecnica es la imposibilidad de dilatarlas con un balon. Describimos nuestra experiencia con el nuevo cateter Tornus ® (Asahi Intecc; Aichi, Japon), disenado especificamente para facilitar el tratamiento de OCC «no dilatables». Desde noviembre de 2008 hasta marzo de 2010, hemos tratado a 17 pacientes (media de edad, 62 anos; el 88% varones, el 82% dislipemicos, el 52% hipertensos, el 29% diabeticos) en los que no se consiguio dilatar la lesion con ningun cateter balon tras haber cruzado la lesion con una guia de angioplastia. El cateter se utilizo con exito en 15 casos, sin complicaciones, y se consiguio finalizar la revascularizacion del vaso. Durante el seguimiento clinico (mediana, 573 dias), no se registraron eventos de importancia. El uso del cateter Tornus ® es seguro y factible en las OCC de lesiones previamente no dilatables de manera convencional.

Objectives We sought to assess the long-term effectiveness and safety of sirolimus-eluting stents (SES) in patients with in-stent restenosis (ISR). Background Treatment of patients with ISR remains a challenge. The long-term outcome of patients with ISR treated with SES remains unknown. Methods The RIBS-II (Restenosis Intra-stent: Balloon angioplasty vs. elective sirolimus-eluting Stenting) study was a randomized trial conducted in 150 patients with ISR (76 SES, 74 balloon angioplasty [BA]). The long-term (>1 year) clinical outcome and pre-specified subgroup analyses were pre-defined secondary study end points. Results At 1 year, the event-free survival (death, myocardial infarction, target vessel revascularization [TVR]) was better in the SES group (88% vs. 69%, p 3 years) clinical follow-up was obtained in 97% of patients (median 3.3 years). After the first year, 3 patients died (1 SES, 2 BA), 5 suffered myocardial infarction (4 SES, 1 BA), and 7 required TVR (4 SES, 3 BA). At last follow-up, definitive/probable/possible stent thrombosis was similar in both groups (2/2/1 SES vs. 1/0/3 BA, p = NS). At 4 years, the event-free survival was 76% in the SES arm and 65% in the BA arm (p = 0.019). On multivariate analysis, SES implantation was an independent predictor of event-free survival. Subgroup analyses were consistent with the main outcome measure. Conclusions In patients with ISR, SES implantation remains effective and safe at very long-term clinical follow-up.

Spatial distributions of fifteen trace elements (As, Be, Cd, Co, Cr, Cu, Mo, Ni, Pb, Sb, Sn, Tl, U, V, and Zn) potentially harmful for the human health and the ecosystem have been studied in the so...

The aim of this study was to assess early and late outcomes following treatment of chronic constrictive pericarditis by pericardiectomy. A retrospective analysis was carried out in 31 consecutive patients who underwent surgery between 1982 and 2005. The mean follow-up period was 6.7 years. In-hospital mortality was 16% (5/31 patients). The cause of death was low cardiac output syndrome in three patients, septic shock in one, and hemorrhage in the remaining patient. In six of the 26 surviving patients, functional class did not substantially improve and, in one patient, it worsened. The cumulative actuarial survival probability was 82% at 6 months, 82% at 1-9 years, and 64% at 10 years. In conclusion, pericardiectomy improved symptomatology in the majority of patients during late follow-up. A subgroup of patients did not experience an amelioration in clinical symptoms, probably because myocardial function did not completely recover.

Fundamento y objetivo Los objetivos del presente estudio han sido analizar el pronostico en pacientes recuperados de una muerte subita cardiaca extrahospitalaria que ingresaron en la unidad de cuidados intensivos coronarios, asi como identificar los factores asociados a la morbimortalidad. Pacientes y metodo Analizamos a 63 pacientes consecutivos (47 varones), con una edad media (desviacion estandar) de 61 (12) anos, que ingresaron entre noviembre de 1999 y enero de 2004 recuperados de una muerte subita cardiaca y permanecieron en la unidad de cuidados intensivos coronarios. Se examino la relacion de las caracteristicas clinicas y lectrocardiograficas con la mortalidad y las secuelas neurologicas. Resultados Sobrevivieron 35 pacientes (55,5%), mientras que 28 (44,5%) fallecieron transcurridos una media de 28 (4) dias desde el ingreso, la mayoria en el hospital. El sustrato anatomico principal fue la cardiopatia isquemica (80,9%). En los pacientes que fallecieron, comparados con los que sobrevivieron, las variables que se asociaron a un peor pronostico fueron la diabetes mellitus (un 68,4 frente al 17,1%; p Conclusiones La supervivencia en pacientes recuperados de una muerte subita cardiaca extrahospitalaria es alta, aunque la mortalidad todavia sigue siendo elevada. Las complicaciones neurologicas son la principal causa de mortalidad. El pronostico viene determinado por la presencia de factores relacionados con la enfermedad subyacente, el tiempo en iniciar las maniobras de recuperacion y la lesion cerebral postanoxica.

A Randomized Comparison of Sirolimus-Eluting Stent With Balloon Angioplasty in Patients With In-Stent Restenosis: Results of the Restenosis Intrastent: Balloon Angioplasty Versus Elective Sirolimus...

Background Vasospastic angina usually responds well to medical treatment. Hypothesis The present study describes our experience in patients who received a coronary stent because of recurrent variant angina refractory to medical treatment and evaluates stent implantation as an alternative treatment. Materials and methods Between March 1998 and February 2005, recurrent variant angina was diagnosed in 22 patients admitted to our coronary care unit. Of these, five patients (22.7%), were refractory to pharmacologic treatment. Coronary angiography and coronary stents were indicated. Clinical follow-up was 29 ± 6 months. Results Stenting was performed during diagnostic coronary angiography in two patients. In the other three patients, the stent was implanted 24–48 h later. We observed coronary spasm recurrences proximal or distal to the stent in four patients—two during the stent implantation procedure and the other two in the coronary care unit within 48 h post angioplasty. Three patients where treated with additional stenting and the fourth patient improved with pharmacologic treatment. During follow-up three patients remained asymptomatic. The fourth patient had diffuse in-stent restenosis in the third month, and the fifth patient showed a de novo lesion in the treated segment 2 years later. Conclusions Stent implantation in patients with recurrent variant angina refractory to medical treatment may be an alternative treatment in carefully selected, clinically unstable patients. Spasm recurrences may occur in other segments of the treated artery, probably due to the diffuse nature of the disease. Immediate and continued surveillance is recommended because of the risk of adverse clinical events. Copyright © 2006 Wiley Periodicals, Inc. Wiley Periodicals, Inc.

Introduction and objectives Intravascular ultrasound (IVUS) studies in conventional stent angioplasty with predilatation have demonstrated that late luminal narrowing is caused by neointimal proliferation. In the present study, we analyzed the degree and distribution of in-stent neointimal proliferation after direct stent implantation and aimed to identify variables that predict a proliferative response. Material and method We studied 45 patients who underwent successful stent implantation without predilatation and 23 patients with similar clinical and angiographic characteristics who underwent conventional stent angioplasty with predilatation. IVUS imaging was performed at 7.85±2.81 months. The cross-sectional area was measured at five predetermined points in the stented coronary segment. The inflation pressure used in patients who underwent direct stent implantation was higher than that employed in those who underwent conventional angioplasty with predilatation (13±3 atm vs 10±2 atm; P = .005). Results Luminal and stent cross-sectional areas were greater in the group that did not undergo predilatation than in the group that did. Neointimal proliferation in the 5 sections analyzed along the axis of the stent was similar in the 2 groups. There was a weak linear relationship between the amount of plaque outside the stent and neointimal proliferation in both the group that underwent predilatation ( r = 0.37; P = .005) and the group that did not ( r = 0.33; P = .005). Conclusions As with conventional angioplasty, the neointimal proliferation that occurred after direct stent implantation showed a diffuse homogeneous pattern along the length of the stent. There was a weak correlation between this proliferative response and the amount of plaque outside the stent.

Introduccion y objetivos En la implantacion de stent con predilatacion la ecografia intracoronaria ha demostrado que la reduccion luminal tardia se debe a la proliferacion neointimal. En la presente serie analizamos el grado y la distribucion de la proliferacion neointimal intra-stent despues de la implantacion sin predilatacion, asi como las variables implicadas en esta respuesta proliferativa. Material y metodo Se analizo a 45 pacientes despues de la implantacion exitosa de un stent sin predilatacion y 23 pacientes con lesiones de caracteristicas clinicas y angiograficas similares despues de la implantacion de un stent con predilatacion. La ecografia intracoronaria en el seguimiento se realizo a los 7,85 ± 2,81 meses. Se midieron las areas transversales (AT) en 5 segmentos predeterminados del segmento con stent. En el grupo de stent directo se empleo una presion de hinchado mayor que en el grupo con predilatacion (13 ± 3 atm frente a 10 ± 2 atm; p = 0,005). Resultados Los AT luminal y del stent fueron mayores en el grupo sin predilatacion que en el grupo con predilatacion. La proliferacion neointimal en los 5 segmentos a lo largo del eje axial del stent fue similar en los dos grupos. Se observo una ligera relacion lineal entre la placa fuera del stent y la proliferacion neointimal en el grupo con predilatacion (r = 0,37; p = 0,005) y sin predilatacion (r = 0,33; p = 0,005). Conclusiones De forma similar a la angioplastia convencional, en el stent directo la respuesta neointimal presenta un patron difuso y homogeneo a lo largo del eje longitudinal del stent. Esta respuesta proliferativa se correlaciono ligeramente con la placa excluida por el stent.

Introduccion y objetivos La cirugia de derivacion aortocoronaria ha sido considerada el tratamiento de eleccion de la estenosis del tronco comun. Diversos estudios multicentricos sugieren la posibilidad de la angioplastia con stent. El objetivo del presente estudio fue analizar los resultados inmediatos y a largo plazo de la angioplastia con stent en el tronco comun, asi como identificar los factores predictores de mortalidad. Pacientes y metodo Se incluyo a 38 pacientes no consecutivos de 69 ± 8 anos de edad con una lesion severa del tronco comun a los que se implanto un stent entre noviembre de 1997 y marzo del 2003. La indicacion de la angioplastia fue «electiva» en 27 pacientes y «urgente » en los 11 restantes. El tronco comun no estaba protegido en 23 pacientes (60,5%). En todos los pacientes se realizo el seguimiento clinico a los 25 ± 20 meses. Resultados En todos los pacientes, el procedimiento angiografico se realizo con exito. Un paciente presento una oclusion aguda 1 h despues. En 4 pacientes (10%) se produjo un infarto de miocardio no transmural. La mortalidad hospitalaria fue del 15,8%. En el grupo con indicacion urgente, 5 de 11 pacientes (45,4%) fallecieron por fallo cardiaco severo (clase Killip III-IV) en el contexto de un infarto agudo de miorcadio. En cambio, solo fallecio 1 de los 27 pacientes (3,7%) del grupo electivo (p = 0,007). Durante el seguimiento se produjeron eventos clinicos mayores en 5 pacientes (13%): 3 fallecieron y los 2 restantes presentaron recurrencia de la angina. Todos los pacientes que fallecieron tenian el tronco comun desprotegido. La probabilidad acumulada de supervivencia para el grupo electivo fue del 92 ± 0,5, 88 ± 0,6 y 86 ± 0,7% a los 6 meses, 1 y 3 anos, respectivamente. En cambio, para el grupo urgente fue del 54 ± 0,2% a partir del sexto mes (p Conclusiones La angioplastia con stent del tronco comun en pacientes seleccionados se asocia con una elevada tasa de exito inmediato. En la angioplastia electiva, la incidencia de eventos cardiacos durante el seguimiento es relativamente baja. La angioplastia urgente y la presencia de signos de disfuncion ventricular izquierda son los principales predictores de mortalidad.

Impairment of endothelium-dependent vasodilatation in response to acetylcholine reflects an abnormal endothelial function. Labelled indium-111 monoclonal antimyosin antibodies enable detection of myocardial cell damage. We analysed whether endothelial dysfunction correlates with myocardial antimyosin uptake in a selected group of patients with idiopathic dilated cardiomyopathy. Methods: Twenty-two consecutive patients with chronic stable idiopathic dilated cardiomyopathy (18 males and four females) were included. The duration of heart failure symptoms was 46±34 months. At inclusion, the functional class of New York Heart Association was 2.1±0.7. Endothelial function was evaluated using intracoronary graded concentrations of acetylcholine. Vasomotor responses of the left anterior descending coronary artery were measured by quantitative coronary analysis. Myocardial uptake of antimyosin antibodies was quantified by means of a heart-to-lung ratio (HLR). Results: Eighteen patients showed endothelial dysfunction (82%) and the remaining four patients showed a normal endothelial function. There were no statistically significant differences between patients with and without endothelial dysfunction in relation to clinical, echocardiographic and hemodynamic parameters. In addition, these variables did not correlate with the magnitude of the vasomotor response to acetylcholine. Eighteen patients (82%) showed abnormal antimyosin uptake; 15 of them (83%) showed endothelial dysfunction. The global mean HLR of antimyosin uptake was 1.73±0.24. The coronary vasomotor response to acetylcholine correlated with the intensity of uptake of antimyosin antibodies ( r =−0.45, P Conclusions: Coronary endothelial dysfunction and myocardial antimyosin uptake was found in a high percentage of patients with chronic stable idiopathic dilated cardiomyopathy. The abnormal vasomotor response seems to be related to the degree of myocardial damage.

It is unknown if lack of polymer can provoke a different edge response in drug-eluting stents. The aim of this study was to compare edge vascular response between polymer-free paclitaxel-eluting stent (PF-PES) and polymer-based paclitaxel-eluting stents (PB-PES). METHODS AND RESULTS: A total of 165 eligible patients undergoing percutaneous coronary intervention were prospectively randomized 1:1 to receive either PF-PES or PB-PES. Those patients with paired intravascular ultrasound (IVUS) after procedure and at 9-month follow-up were included in this analysis.Seventy-six patients with 84 lesions, divided into PB-PES (38 patients, 41 lesions) and PF-PES groups (38 patients, 43 lesions) had paired post-procedure and 9-month follow-up IVUS and were therefore included in this substudy. There was a significant lumen decrease at the proximal edge of PF-PES (from 9.02±3.06 mm(2)to 8.47±3.05 mm(2); P=0.040), and a significant plaque increase at the distal edges of PF-PES (from 4.39±2.73 mm(2)to 4.78±2.63 mm(2); P=0.004). At the distal edge there was a significant plaque increase in the PF-PES compared to PB-PES (+8.0% vs. -0.6%, respectively; P=0.015) with subsequent lumen reduction (-5.2% vs. +6.0%, respectively; P=0.024).PF-PES had significant plaque increase and lumen reduction at the distal edge as compared to PB-PES, probably due to difference in polymer-based drug-release kinetics between the 2 platforms.

Antiphospholipid syndrome (APS) is an autoimmune coagulation disorder that manifests clinically as venous and arterial thrombosis, and may affect any tissue or organ. Coronary artery involvement, however, is very rare. Case reports in the literature describing patients with coronary acute syndrome and APS treated with coronary angioplasty show conflicting results.We report an adult male patient with APS who presented with an acute myocardial infarction. Given the high risk of thrombosis in these patients, he was treated percutaneously with thrombectomy and abciximab. We review the few cases of coronary angioplasty in patients with APS reported to date. To our knowledge, this is the first case in which acute myocardial infarction due to thrombotic coronary occlusion was treated with thrombectomy and abciximab without stenting the artery. Resumo: A síndrome antifosfolipídica (SAF) é uma doença autoimune da coagulação que se manifesta clinicamente por tromboses venosas e arteriais, podendo afetar qualquer tecido ou órgão. Contudo, o envolvimento das artérias coronárias é extremamente raro. Os casos relatados na literatura de síndrome coronária aguda e de SAF tratados com intervenção coronária percutânea (ICP) apresentam resultados controversos.Relata-se o caso de um doente do sexo masculino com SAF que se apresentou com um enfarte agudo do miocárdio (EAM). Dado o alto risco de trombose nestes doentes, optou-se por ICP com trombectomia e abciximab. Faz-se uma revisão dos poucos casos relatados na literatura de ICP em doentes com SAF. De acordo com a nossa pesquisa, este trata-se do primeiro caso publicado em que um doente com SAF e EAM devido a oclusão coronária trombótica foi tratado com trombectomia e abciximab, sem implantação de stent. Keywords: Antiphospholipid syndrome, Acute coronary syndrome, Thrombectomy, Abciximab, Palavras-chave: Síndrome antifosfolipídica, Síndrome coronária aguda, Trombectomia, Abciximab

Background— Most drug-eluting stents currently in use are coated with a polymer carrying the drug that is released for several weeks. However, a durable polymer may provoke hypersensitive reaction, delayed artery healing, and eventually stent thrombosis. The aim of this study was to investigate the safety and efficacy of a polymer-free paclitaxel-eluting stent (PF-PES) versus a polymer-based PES (PB-PES). Methods and Results— Eligible patients undergoing percutaneous coronary intervention were randomized 1:1 to receive either PF-PES or PB-PES. The primary end point was late loss at 9 months. Intravascular ultrasound analysis at 9 months and final 2-year clinical follow-up were also performed. From October 2007 to April 2009, 164 patients were enrolled and randomized into 2 groups (PF-PES: n=84; PB-PES: n=80). Mean in-stent lumen loss was 0.90±0.59 mm for PF-PES and 0.49±0.52 mm for PB-PES ( P 2 ; P P =0.004), mainly driven by a higher rate of target vessel revascularization (PF-PES: 35.7%; PB-PES: 13.8%; P =0.001). One late stent thrombosis was observed in PF-PES. Conclusions— Compared with PB-PES, PF-PES was associated with increased neointimal proliferation and subsequent clinical restenosis. Polymer plays an essential role in the performance of drug-eluting stents. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01375855.

Objectives This study sought to compare the efficacy of drug-eluting balloons (DEB) with that of everolimus-eluting stents (EES) in patients with bare-metal stents (BMS) in-stent restenosis (ISR). Background Treatment of patients with ISR remains a challenge. Methods This was a prospective, multicenter, randomized trial comparing DEB with EES in patients with bare-metal stents (BMS) in-stent restenosis (ISR). The primary endpoint was the minimal lumen diameter at 9 months' follow-up. Results A total of 189 patients with BMS-ISR from 25 Spanish sites were included (95 were allocated to DEB and 94 to EES). Procedural success was achieved in all patients. At late angiography (median 249 days; 92% of eligible patients), patients in the EES arm had a significantly larger minimal lumen diameter (2.36 +/- 0.6 mm vs. 2.01 +/- 0.6 mm, p < 0.001; absolute mean difference: 0.35 mm; 95% confidence interval [CI]: 0.16 to 0.53) and a lower percent of diameter stenosis (13 +/- 17% vs. 25 +/- 20%, p < 0.001). However, late loss (0.04 +/- 0.5 mm vs. 0.14 +/- 0.5 mm, p = 0.14) and binary restenosis rate (4.7% vs. 9.5%, p = 0.22) were very low and similar in both groups. Clinical follow-up (median 365 days) was obtained in all (100%) patients. Occurrences of the combined clinical outcome measure (cardiac death, myocardial infarction, and target vessel revascularization; 6% vs. 8%; hazard ratio [HR]: 0.76; 95% CI: 0.26 to 2.18, p = 0.6) and the need for target vessel revascularization (2% vs. 6%; HR: 0.32: 95% CI: 0.07 to 1.59, p = 0.17) were similar in the 2 groups. Conclusions In patients with BMS-ISR, both DEB and EES provided excellent clinical results with a very low rate of clinical and angiographic recurrences. However, compared with DEB, EES provide superior late angiographic findings. (Restenosis Intra-stent of Bare Metal Stents: Paclitaxel-eluting Balloon vs. Everolimus-eluting Stent [RIBS V]; NCT01239953) (C) 2014 by the American College of Cardiology Foundation

Introduction -There is scant information about the effects of thrombolysis in the evolution of right bundle-branch block (RBBB) in the setting of acute anterior myocardial infarction.The aim of this study has been to analyse these effects and its impact on prognosis. Methods -We studied 54 patients who presented a RBBB related to an acute anterior myocardial infarction. We defined two groups: those who received thrombolytic treatment and those who did not.We analysed the evolution of RBBB (transience, moment of onset, moment of disappearance) and its relationship with in-hospital mortality. Twenty-one patients (39%) received thrombolytic treatment (group T) and 33 patients (61%) (group NT) did not. Results - The incidence of late appearance (> 6 h) of RBBB was less frequent in group T compared with group NT (10% vs. 33%, p = 0.04). The incidence of transient block was similar in the two groups (57% vs. 45%, p ns). However, early disappearance of RBBB (in < 6 hours) was more common in group T than in group NT (33% vs. 9%, p = 0.04). Mortality was higher in patients with RBBB present at 24 h after admission) than in those with RBBB resolved in less than 24 hours (in group NT, 55% vs. 8%, p = 0.02 and in group T 50% vs. 0%, p = 0.02, respectively). Conclusions -Thrombolysis seems to influence the moment of onset and disappearance of RBBB by promoting its early disappearance and avoiding its late appearance. Disappearance of RBBB is associated with a better prognosis.

The cutting balloon is a new device for coronary angioplasty, which, by the combination of incision and dilatation of the plaque, is believed to minimize arterial wall trauma, the neoproliferative response, and subsequent restenosis. In this study, we sought to determine predictors of the restenosis using this technique. Seventy-seven patients underwent successful coronary angioplasty with cutting balloon alone. In 67 of these patients (87%), we performed a control angiogram at 6-month follow-up. Pre-, post-, and late angiographic results were evaluated by quantitative coronary analysis. Clinical and angiographic variables were correlated with restenosis as a binary variable and a continuous variable (late loss and late minimum luminal diameter). Univariate analysis showed that the immediate postprocedure minimum luminal diameter (MLD) was smaller in the restenotic group (defined as MLD > 50% by quantitative coronary angiography) than in the nonrestenotic group (1.90 +/- 0.47 mm vs. 2.19 +/- 0.56 mm, P < 0.05). In addition, the immediate percentage of stenosis was higher in the restenotic group than in the nonrestenotic group (37% +/- 10% vs. 27% +/- 11%, P < 0. 003). Multivariate analysis identified the immediate postcutting balloon percentage of stenosis as an independent determinant of binary restenosis (P < 0.008). When restenosis was defined as a continuous variable, the immediate postprocedure MLD was an independent predictor of late loss (P < 0.02) and of late MLD (P < 0. 0002). No clinical, preprocedure angiographic, or technical variables tested were associated with restenosis. The degree of postprocedural residual stenosis after cutting balloon angioplasty is predictive of late restenosis.

The development of capillary zone electrophoresis (CZE) methods for the determination of metal cyanide complexes in real samples showed some problems, such as the low detection signal of Au (CN)2- and the low resolution between Ni(II) and Fe(II) cyanides in gold processing solutions, and the lack of separation of Pt(CN)4(2-) and Pd(CN)4(2-) in the leachates from automobile catalytic converters. To optimize some analytical parameters, the present study thus focused on the application of experimental designs and multiregression models. The following factors were examined by a two-level factorial design: applied voltage, injection time, detection wavelength, buffer ion, ionic strength and buffer modifiers. For optimization of the CZE method, subsequent response-surface experiments with the important factors were made with the two kinds of leaching solutions. Optimal analytical conditions were obtained in each case, giving good detection signals and resolution for the components of the studied leachates.

Functional tricuspid regurgitation (TR) occurs as a result of asymmetric dilatation and deformation of the tricuspid anulus owing to right ventricular enlargement. Although TR may spontaneously regress after correction of left-sided valvular lesions, increasing experience shows that in the presence of significant insufficiency, tricuspid annuloplasty (TA) decreases postoperative morbidity and mortality. 2 In the present report we describe a simple technique of TA for patients with significant TR. We evaluated the efficacy of the procedure by clinical and Doppler echocardiography at follow-up. Patients. The study group comprised 34 patients (26 female and 8 male, aged 61 6 36 years) who underwent TA for correction of TR. Isolated TR repair was performed in six patients in whom the valve had previously been repaired by the De Vega annuloplasty. Seventeen patients underwent concomitant mitral replacement, six a mitral-aortic valve replacement, and five an additional coronary bypass grafting. Nine patients had undergone a From the Departments of Cardiac Surgery and Cardiology, Hospital de la Santa Creu i Sant Pau, and Clinica Quiron, Barcelona, Spain.

Introduccion y objetivos El stentintracoronario Multi-Link es un cilindro de acero inoxidable compuesto de anillos con multiples enlaces que proporcionan flexibilidad y adaptabilidad conservando la fuerza radial. Presentamos los resultados de nuestra experiencia inicial con la utilizacion de este stent. Pacientes y metodos Entre mayo de 1996 y abril de 1997 se implantaron 124 stentsMulti-Link consecutivos con el sistema monorrail en 97 pacientes. La edad media fue de 62,2 ± 11 anos. Todos los pacientes incluidos tenian un diametro de arteria superior a 2,7 mm. La clinica que motivo su implantacion fue angina estable en 20 pacientes, inestable en 72 e infarto de miocardio en 5. Segun la clasificacion de la ACC/AHA las lesiones eran tipo A en 6 pacientes, tipo B en 72 y tipo C en 19. La indicacion de la implantacion fue en lesiones arteriales «de novo» en 85 pacientes y en lesiones reestenoticas en 12. El tratamiento despues del procedimiento fue ticlopidina y acido acetilsalicilico en todos los pacientes excepto en 6 que recibieron acenocumarol y acido acetilsalicilico. Dieciseis enfermos fueron tratados concomitantemente con Abciximab. El grado de estenosis se determino mediante angiografia cuantitativa. Resultados La colocacion del stentfue se realizo con exito en todos los pacientes. El porcentaje de estenosis antes del procedimiento, del 79,6 ± 13,1%, disminuyo despues de la implantacion del stental 17,7 ± 11,4%. Las complicaciones fueron infarto de miocardio sin onda Q en tres pacientes. Dos enfermos presentaron una trombosis subaguda del stent, falleciendo uno de ellos por insuficiencia cardiaca. Durante el seguimiento clinico de 4,7 ± 2,6 meses, cinco enfermos reingresaron por recurrencia de la angina (4 por reestenosis y 1 por oclusion del vaso) y un paciente con insuficiencia cardiaca postinfarto agudo de miocardio presento una muerte subita a las tres semanas del procedimiento. Conclusiones El stentMulti-Link se implanto con exito en todos los pacientes con una baja incidencia de complicaciones, presentando en el seguimiento una reducida tasa de reestenosis clinica.

One hundred thirty patients with idiopathic-dilated cardiomyopathy were referred for heart transplantation to our center and followed for 18 months. Heart transplantation was performed on 63 patients, 17 patients died before transplantation due to heart failure, and 50 patients never had transplantation. Clinical, electrocardiographic, echocardiographic, and hemodynamic data of the 50 nontransplanted survivors and the 17 patients who died were used to identify independent risk variables with discriminant analysis. Using a statistical model based on the results of discriminant analysis, each of the remaining 63 transplanted patients were predicted as being alive or dead in absence of transplantation. The discriminant analysis identified right atrial pressure, cardiac index, and the New York Heart Association functional class as the strongest predictors of 18-month outcome. The accuracy of the model in predicting survival without transplantation in the nontransplanted group of patients, based on the concordance between actual and predicted outcome, was 85% (κ = 0.62). Subsequent application of this model to the transplanted group of patients suggested that the decision for transplantation was appropriate in 41 of the 63 patients, and could have been premature in the remaining 22 patients predicted as alive. These results suggest that two-thirds of patients receiving transplants would have died without intervention, but the decision to transplant could have been premature in the remaining patients.

This study was designed to determine the value of automatic corrected QT-interval measurement in Holter tapes in patients after myocardial infarction as a marker of life-threatening ventricular arrhythmias. We compared the corrected QT interval, automatically measured in 24-hour Holter recordings, in two groups of patients after myocardial infarction: group I was composed of 14 patients admitted consecutively to our hospital for documented sustained ventricular tachycardia or out-of-hospital cardiac arrest. Group II consisted of 28 patients with previous myocardial infarction with characteristics similar to those of group I, but without malignant ventricular arrhythmias in the follow-up. The global mean 24-hour corrected QT interval was longer in group I (425 +/- 20 msec) than in those patients after myocardial infarction without arrhythmias (group II) (405 +/- 17 msec; p0.01). Furthermore, a significant proportion of patients of group I (seven of 14) exhibited more peaks of corrected QT longer than 500 msec compared with patients of group II (two of 28; p0.005). A circadian rhythm of corrected QT peaks was observed in group I, having a significantly higher incidence from 11 PM to 11 AM (p0.05). We conclude that automatic corrected QT-interval measurement on Holter electrocardiogram is now available and feasible. Our results suggest that this is a marker for risk assessment of life-threatening ventricular arrhythmias. Large-scale trials are needed to confirm these results and to determine the predictive value of this technique for risk stratification.

Distal coronary artery perforation with an angioplasty guidewire is a rare complication that may cause cardiac tamponade, myocardial infarction, arrhythmia, and even death. The use of platelet IIb/IIIa glycoprotein receptor inhibitors increases the risk of potentially fatal complications that are difficult to manage. We report a patient on treatment with abciximab who presented coronary perforation in a distal branch of the right coronary artery caused by the coronary guidewire tip, and complicated by acute cardiac tamponade. Blood extravasation to the pericardium was stopped by releasing two metallic coils into the distal vessel, thereby avoiding the need for emergent cardiac surgery.

La perforacion coronaria con la guia de angioplastia es una complicacion rara que puede ocasionar taponamiento cardiaco, infarto, arritmias e incluso la muerte. La utilizacion de farmacos inhibidores de los receptores glucoproteicos IIb/IIIa de las plaquetas aumenta considerablemente el riesgo de complicaciones agudas y dificulta el manejo terapeutico. Describimos el caso de un paciente tratado con abciximab que durante la angioplastia presento una perforacion en una rama distal de la arteria coronaria derecha producida con la punta de la guia, que se complico con taponamiento cardiaco agudo. El sangrado al pericardio se resolvio mediante la liberacion de 2 coils o espirales metalicas en la luz distal del vaso perforado, y se evito la cirugia emergente

Unprotected left main (ULM) coronary disease is considered by contemporary guidelines a class I indication for surgery. However, percutaneous coronary intervention (PCI) is often carried out in the ULM in either emergent or high-risk elective procedures. The aim of this study was to evaluate ULM-PCI as a feasible and safe procedure in the emergent setting, and to analyze outcomes in both scenarios.Angiographic and clinical data were collected retrospectively for all patients who underwent emergent or elective PCI on ULM at our center from January 2006 to June 2009. All patients were followed up with a clinical visit or telephone interview. Main outcomes included major adverse cardiac events (MACE) and its individual components: cardiac death, myocardial infarction (MI) and target lesion revascularization. These were analyzed at the longest follow-up available.A total of 98 consecutive patients with significant LM disease were included. Fifty-seven of them were treated as a planned procedure (elective group) and 41 as an emergent procedure (emergent group). Procedural success was achieved in 100% of cases in the elective group and in 88% of the emergent group (p = 0.011). Higher use of drug-eluting stents (DES) was recorded in the elective group (75% versus 45% in the emergent group; p0.002). The emergent group presented a higher in-hospital mortality (24% versus 2% in the elective group; p0.001). At a mean follow-up of 626 ± 380 days, the overall MACE rate was similar betweeen the two groups (23% in the emergent group versus 17% in the elective group; p = 0.52). Independent predictors of MACE after discharge follow-up were postprocedure minimal diameter and DES use.Emergent PCI of the ULM exhibits worse in-hospital outcomes as compared to elective procedures. However, after discharge, long-term outcomes remain comparably good between groups.

We describe two patients in whom stents dislodged from the unexpanded balloon during angioplasty and remained trapped in the coronary tree. In one patient the stent was located in the curvature of the circumflex artery and, in the other patient, it was detected in the distal left main artery. Retrieval of the undeployed stents was accomplished in the first case after advancing a low profile balloon through the stent and, in the second case, after placing a second guidewire exterior to the stent. In both cases, the balloon was inflated distally and the stents were dislodged after pulling the balloon back towards the guiding catheter and then withdrawing the whole system.

Aims: To evaluate outcomes of the endothelial progenitor cell (EPC) capture stent in patients on chronic anti-vitamin K (AVK) regimen, requiring percutaneous coronary intervention (PCI). Methods and results: Between February 2007 and February 2008, 78 consecutive patients under chronic AVK treatment undergoing PCI were enrolled in the registry and received an EPC capture stent. The incidence of comorbid conditions was analysed by the Charlson index. Dual antiplatelet therapy (DAT, aspirin and clopidogrel) was prescribed for one month only together with the AVK treatment, after PCI. Major adverse clinical events (MACE) rate, included death, acute myocardial infarction (MI) or target lesion revascularisation (TLR), incidence of stent thrombosis and rate of haemorrhagic events were collected. A Charlson index >3 was present in 89% of patients. At 14 8 months the cumulative rate of MACE was 22%: 10 deaths (six cardiac deaths), and six TLR. No MI or definitive/probable stent thromboses occurred during follow-up. Four major haemorrhagic episodes occurred during follow-up, all of them after the first month. Conclusions: Patients on AVK treatment represent a highly comorbid population with a high event rate after PCI. The strategy of PCI with an EPC capture stent and short duration of DAT may be used in patients who need a short-term DAT.

Spontaneous coronary dissection of a coronary artery is a rare cause of acute coronary syndrome. Optimal treatment has not yet been established. We describe a woman with spontaneous dissection of the left anterior descending artery who presented transitory angina and electrocardiographic ST segment elevation in precordial leads. Conservative treatment was carried out. The angina and electrocardiographic changes recurred 3 days later. An intravascular vascular ultrasound was performed and the patient was stabilized following stenting. Stress testing was negative at 6-month follow-up and she remained asymptomatic at 18 months. We discuss the usefulness of an intravascular ultrasound study to establish the therapeutic strategy. (C) 2011 Wiley Periodicals, Inc. J Clin Ultrasound 39: 175-178, 2011; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jcu.20796

We present a patient with an anomalous left coronary artery arising from the right sinus of Valsalva with effort angina. Diagnosis was made by coronary angiography. The course of the proximal segment was assessed with magnetic resonance imaging (MRI). An internal mammary artery was successfully grafted with symptomatic improvement.

The Barcelona harbour is one of the biggest and most important in commercial and passenger traffic in the Mediterranean Sea. In 2003, construction works for the enlargement of the port were carried out with the opening of a new entrance for large boats in the northern area. Following the opening of this new mouth, the redistribution of heavy metals (Hg, Cd, Pb, Cu, Zn, Ni and Cr), As and polychlorinated biphenyls (PCBs) was investigated to discuss their origin and to evaluate the environmental implications. A previous study of the sediments provided a first picture of high levels of heavy metals and PCBs in the innermost harbour (Port Vell). Then, the opening of the northern mouth led to a remarkable decline in the contaminant concentrations and to an improvement of the sediment quality. During the period 2002–2005, the percentage of concentration decreases in Port Vell for Hg, Pb and PCB (from 20% to 34%), for Zn and Cd (from 10% to 15%) and for the remaining metals with values lesser than 10%. This general decline was probably due to a more efficient water flushing between the original and the new northern entrance. Concentrations of target contaminants were also compared against sediment quality guidelines to assess the ecotoxicological significance of sedimentary contaminants on the benthic communities.

Long-term performance assessment of nuclear waste repositories is affected by the ability of the outer barrier systems to retain radionuclides after possible corrosive leakage of waste containers. The mobility of the radionuclides released from the spent fuel depends strongly on the processes that take place in the backfill material. The interaction of steel corrosion products and radionuclides is part of such a scenario. In this work, the sorption of Th(IV) onto 2-line-ferrihydrite (FeOOH center dot H2O) and magnetite (Fe3O4), used as models for steel corrosion products, has been studied using EXAFS spectroscopy. Sorption samples were prepared in 0.1 M NaClO4 solutions at acidic pH (initial pH values in the range 3.0-4.2) either from undersaturation and supersaturation conditions with respect to amorphous ThO2. Two oxygen subshells, one at 2.37 angstrom and another at 2.54 angstrom, were observed in the first hydration sphere of Th in the case of the ferrihydrite samples. Th-Fe distances for the different ferrihydrite samples are similar to 3.60 angstrom. These results indicate a corner sharing surface complex of Th(IV) ion onto the ferrihydrite surface where the Th atom shares one 0 atom with each of two coordinated octahedra. The longer Th-O distance accounts for coordinated water molecules. No significant changes in the structural environment of Th in terms of coordination numbers and distances were detected as a function of Th(IV) concentration. Magnetite samples sorbing Th(IV) also showed also a strong distortion of the 0 shell, but in contrast to ferrihydrite, two types of nearest Fe atoms were detected at 3.50 angstrom and 3.70 angstrom. These results indicate that Th(IV) ion sorbs onto the magnetite surface as bidentate-corner sharing arrangements to [FeO6] octahedra and [FeO4] tetrahedra.

In a 4-year interval, 3/55 (7.8%) heart transplant recipients developed (greater than 4 weeks) severe sinus node dysfunction. An epicardial ventricular pacemaker was implanted at 90, 40, and 38 days after operation. Follow-up ranged from 7 to 20 months. In two of the three cases, failure of stimulation or sensing was detected at the 3rd and 4th month after pacemaker implantation. Sinus rhythm reappeared in two of the three patients at the 2nd and 4th months after transplantation. Severe sinus node disease requiring pacemaker implantation can improve following the first 3 months after transplantation. Failure of stimulation or sensing may not be uncommon.

Purulent pericarditis is a rare disease associated with high mortality, even with appropriate antibiotic therapy. The authors report the case of a patient with purulent pericarditis with no identifiable primary source that presented clinically as cardiac tamponade. The patient required emergency pericardiocentesis and surgical pericardiectomy due to persisting signs of tamponade. Microbiology cultures isolated anaerobic agents of Fusobacterium spp., Corynebacterium spp. and Peptostreptococcus. The authors review the etiology and treatment of this entity and its main complication, the development of constrictive pericarditis.

We sought to assess the long-term effectiveness and safety of sirolimus-eluting stents (SES) in patients with in-stent restenosis (ISR).Treatment of patients with ISR remains a challenge. The long-term outcome of patients with ISR treated with SES remains unknown.The RIBS-II (Restenosis Intra-stent: Balloon angioplasty vs. elective sirolimus-eluting Stenting) study was a randomized trial conducted in 150 patients with ISR (76 SES, 74 balloon angioplasty [BA]). The long-term (1 year) clinical outcome and pre-specified subgroup analyses were pre-defined secondary study end points.At 1 year, the event-free survival (death, myocardial infarction, target vessel revascularization [TVR]) was better in the SES group (88% vs. 69%, p0.005). Additional long-term (3 years) clinical follow-up was obtained in 97% of patients (median 3.3 years). After the first year, 3 patients died (1 SES, 2 BA), 5 suffered myocardial infarction (4 SES, 1 BA), and 7 required TVR (4 SES, 3 BA). At last follow-up, definitive/probable/possible stent thrombosis was similar in both groups (2/2/1 SES vs. 1/0/3 BA, p = NS). At 4 years, the event-free survival was 76% in the SES arm and 65% in the BA arm (p = 0.019). On multivariate analysis, SES implantation was an independent predictor of event-free survival. Subgroup analyses were consistent with the main outcome measure.In patients with ISR, SES implantation remains effective and safe at very long-term clinical follow-up.