Search

Introduccion y objetivos El tratamiento percutaneo de las lesiones bifurcadas se asocia con una menor tasa de exito y una mayor frecuencia de complicaciones y de nueva revascularizacion de la lesion tratada. El objetivo de este estudio prospectivo fue evaluar los resultados clinicos y angiograficos iniciales y a medio plazo de la tecnica de crush T stenting . Metodos Este metodo de tratamiento percutaneo de las lesiones bifurcadas con implante de stents coronaries reproduce la tecnica T stenting modificada con la diferencia de que el stent de la rama lateral protruye dentro de la rama principal a 3-4 mm de la carina. El proposito es asegurar que el ostium de la rama lateral es cubierto circunferencialmente con la malla de los stents . Resultados Entre diciembre de 2003 y febrero de 2005 se incluyo a 82 pacientes en este estudio. La lesion afectaba al tronco coronario izquierdo en bifurcacion en el 53%, a la arteria descendente anterior/diagonal en el 29%, a la arteria circunfleja/marginal en el 11% y a la coronaria derecha/descendente posterior-posterolateral en el 7%. Exito angiografico y clinico se obtuvo en el 100 y el 96,4%, respectivamente. Se realizo posdilatacion con doble balon en el 87%. Se obtuvo seguimiento clinico a los 12 meses en el 100% y angiografico en el 77%. El tiempo medio de seguimiento angiografico fue 8,7 ± 3,3 meses. Se realizo una nueva revascularizacion de la lesion tratada en el 10,8%. Conclusiones El tratamiento de las lesiones bifurcadas con tecnica de crush T stenting es segura y efectiva, y presenta una baja tasa de eventos cardiacos mayores y de necesidad de nueva revascularizacion.

Fundamento Y Objetivo Son conocidas la prevalencia del sincope vasovagal y su morbilidad. Con objeto de cuantificar la calidad de vida relacionada con la salud (CVRS) de los pacientes que lo sufren y evaluar la influencia de la edad y el sexo, se compararon los resultados obtenidos tras la administracion de la version espanola del Cuestionario de Salud SF-36 en esta poblacion con los valores de la poblacion general y de pacientes con insuficiencia cardiaca. Ademas se ha analizado la influencia de diversos parametros clinicos. Pacientes y metodo Se incluyo consecutivamente a todos los pacientes con sincope vasovagal sometidos a test de tabla basculante desde enero de 2001 hasta diciembre de 2002. El cuestionario se contesto previamente a la realizacion del test. Se calcularon los valores utilizando estadisticos apropiados a la distribucion de la muestra, se analizaron segun la edad y el sexo, y se correlacionaron con diversos parametros clinicos. Resultados Se incluyo a 271 pacientes (50,5% mujeres). La CVRS en estos pacientes fue inferior a los valores poblacionales y similar a la de los pacientes que sufren insuficiencia cardiaca. En el varon solo 4 dimensiones del SF-36 fueron inferiores a la poblacion general, y en la mujer lo fueron las 8. La mujer tuvo peor percepcion de su CVRS que el varon (p Conclusiones En nuestra serie, los pacientes con sincope vasovagal tienen peor CVRS respecto a la poblacion general de referencia y similar a la que sufre insuficiencia cardiaca. La CVRS es peor en la mujer y empeora con la edad en ambos sexos. Nuestra serie indica que el numero de sincopes es el parametro clinico que mejor se correlaciona con la CVRS.

A double-chambered right ventricle is a relatively uncommon congenital cardiac defect characterized by the presence of anomalous muscle bundles dividing the right ventricle into a high-pressure proximal chamber and a low-pressure distal chamber. This pathology is often wrongly diagnosed in adult patients. We report the first case of a patient with double-chambered right ventricle associated with a mural and pulmonic valve endocarditis caused by Streptococcus parasanguis diagnosed with two-dimensional echocardiography. During the course of treatment, the patient suffered from a septic pulmonary embolism, and subsequently required surgical intervention, which confirmed the echocardiographic findings. (ECHOCARDIOGRAPHY, Volume 21, February 2004)

Introduction and objectives Percutaneous coronary intervention for coronary bifurcations is usually associated with a low success rate, a high rate of complications, and a more frequent need for target lesion revascularization. The aim of this prospective study was to evaluate immediate and medium-term clinical and angiographic outcomes after the application of crush T stenting. Methods This approach to bifurcation stenting follows the same steps as modified T stenting. The only difference is that the side branch stent protrudes 3–4 mm into the main vessel from the carina. The aim is to ensure that the circumference of the side branch ostium is covered by the stent strut. Results Between December 2003 and February 2005, 82 patients were included in the study. The lesion involved the left main coronary artery in 53% of patients, the left anterior descending or diagonal coronary artery in 29%, the circumflex or marginal branch in 11%, and the right coronary artery or the posterior or posterolateral descending branch in 7%. Angiographic and clinical success was obtained in 100% and 96.4% of cases, respectively. Final dilatation was performed using a kissing balloon in 87%. Overall, 100% of patients were followed up clinically for 12 months and 77% were followed up angiographically for a mean of 8.7 (3.3) months. Target lesion revascularization was performed in 9 patients (10.8%). Conclusions Treatment of coronary bifurcation lesions using the crush T stenting technique is safe and effective. It reduces both the restenosis rate and the major adverse cardiac event rate at one year.

After abnormal head-up tilt test (HUT), several trials have evaluated treatment strategies for vasovagal syncope (VVS). However, few unequivocal results have been obtained. The aim of the study was to prospectively analyze the natural history of patients with VVS who did not undergo specific treatment but received education for avoiding syncope after an abnormal HUT.From 1996, 334 consecutive patients with VVS and an abnormal HUT result were followed. All of them received education for avoiding syncope as first-line therapy.During 30.4 +/- 21 months, there were no cardiac deaths. However, 101 patients (30.2%) had recurrences (1 recurrence, n = 64;or =2, n = 37), which were not influenced by the type of response during HUT or by age. Time to first recurrence was correlated with the number of recurrences (r: -0.34, P =.0001). Mean recurrence-free time was 50.1 months (95% CI 46-54) and the cumulative probability of no recurrence was 69.8%. Receiver operator character curve analysis, demonstrated significant differences in the recurrence rate between patients with5 oror =5 previous episodes of syncope (25.1% vs 44%; P =.001). In addition, the mean recurrence-free time of patients with5 episodes was significantly longer (54.1 months) than in patients withor =5 episodes (39.6 months; P =.0005). Multivariate logistic regression identified the previous number of episodes as an independent risk marker of recurrences (odds ratio 2.34, 95% CI 1.4-3.8, P =.001). Age (at HUT performance) as a continuous variable was not a predictor of outcome.Survival of patients with VVS presenting after an abnormal HUT is excellent. Although the broad majority of those patients do not suffer recurrences after education, the number of previous syncopal episodes critically influences the recurrence rate.