Navegando por Palavras-chave "coronary angiography"
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- ItemAcesso aberto (Open Access)Anatomia angiográfica do sistema venoso coronário. Aplicações em eletrofisiologia clínica(Sociedade Brasileira de Cardiologia - SBC, 1998-06-01) Melo, Wesley Duílio S. [UNIFESP]; Prudencio, Luis A. Renjel [UNIFESP]; Kusnir, Cássia E. [UNIFESP]; Pereira, Ana Lucia N. [UNIFESP]; Marques, Vera [UNIFESP]; Vieira, Magno César [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To study the angiographic anatomy of human coronary veins and the possibility of epicardial venous mapping through microelectrode catheters. METHODS: We evaluated 30 patients with sustained ventricular tachycardia using a catheter which provided occlusion of the coronary sinus ostium during venous angiography. They were 25 males, 5 females, ages ranging from 24 to 76 years (mean=52.7). The veins were studied according to their number, caliber and distribution in the anterior and posterior wall of the left ventricle. RESULTS: Coronary sinus was catheterized in all patients. No discomfort or complications were observed. The number of veins from posterior wall of the left ventricle was 3.1 and anterior wall, 1.9, p<0.05. The caliber of the coronary veins were: anterior interventricular vein (distal segment = 1.19±0.22mm, midle segment = 1.65±0.35mm), posterior interventricular vein (distal segment = 1.83±0.47mm, midle segment = 2.00±0.52mm), left posterior vein (distal segment = 1.45±0.25mm, midle segment = 2.49±0.92mm); p<0.05. CONCLUSION: The balloon occlusion technique for coronary venous angiography is feasible and safe. The number and the caliber (distal and midle) of the veins from the posterior wall of the left ventricle were significantly greater than those from the anterior wall. Anatomic conditions for venous epicardial mapping are more adequate in the posterior wall of the left ventricle.
- ItemSomente MetadadadosAngiographic and electrophysiological substrates for ventricular tachycardia mapping through the coronary veins(British Med Journal Publ Group, 1998-01-01) De Paola, Angelo Amato Vincenzo [UNIFESP]; Melo, Wesley Duilio Severino de [UNIFESP]; Tavora, Maria Zildany Pinheiro [UNIFESP]; Martinez, E. E. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective-To study the value of epicardial mapping through the coronary venous system in patients with sustained ventricular tachycardia.Design-20 consecutive patients with sustained ventricular tachycardia who were candidates for radiofrequency ablation.Setting-Electrophysiological laboratory.Interventions-Coronary venous angiography was performed with a catheter, which provided coronary sinus occlusion during injection of contrast media. Multipolar microelectrode catheters were then manoeuvred into the tributaries of coronary sinus, using an over-wire system or an on-wire system. An endocardial ablation catheter was positioned in the left ventricle. Conventional programmed ventricular stimulation was performed for sustained ventricular tachycardia induction. Endocardial radiofrequency ablation was performed using impedance or temperature monitoring.Results-Coronary veins were catheterised in all patients; 20 had induction of sustained ventricular tachycardia, 14 were stable. Presystolic epicardial electrograms were recorded in six patients and concealed entrainment in two, helping as a landmark for endocardial ablation. After simultaneous epicardial and endocardial mapping, successful endocardial radiofrequency ablation was achieved in nine of 14 patients with stable ventricular tachycardia (64%).Conclusions-Epicardial mapping through the coronary veins in patients with ventricular tachycardia is feasible, safe, and can be a useful landmark for endocardial catheter mapping and ablation.
- ItemAcesso aberto (Open Access)Comparação da coronariografia de mulheres diabéticas e não-diabéticas com síndrome coronariana aguda sem supradesnivelamento de ST(Sociedade Brasileira de Cardiologia - SBC, 2006-02-01) Sousa, José Marconi Almeida De [UNIFESP]; Herrman, João L. V. [UNIFESP]; Teodoro, Marco [UNIFESP]; Diogo, Sergio [UNIFESP]; Terceiro, Bernardino Bandeira [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Santa MarcelinaOBJECTIVE: Compare hemodynamic and angiographic patterns, as well as atherosclerotic lesion morphology, in diabetic and non-diabetic females with unstable angina or non-ST-segment-elevation myocardial infarction (UA/NSTEMI). METHODS: Two interventional cardiologists determined the presence of severe atherosclerotic lesion, defined as those > 70%; plaque morphology, according to the American Heart Association classification; collateral circulation; plus ventricular and aortic pressures. Ejection fraction was calculated by angiography or echocardiography. RESULTS: During eight and a half years, 645 coronary angiographies were performed in women with UA/NSTEMI. In the present study, 593 female patients were assessed (215 diabetic - 36%). This group differed from the non-diabetic in the following aspects: older age (61 ± 10.6 x 58.1 ± 11.4), higher prevalence of postmenopausal women and lower prevalence of the smoking habit. Severe three-vessel disease was significantly more frequent in diabetic patients (28% x 10%), as well as totally occluded vessels: 51 (23%) x 54 (14.3%), p < 0.005. Additionally, ejection fraction < 50% was more common in diabetic patients. CONCLUSION: These findings confirm the diffuse pattern of atherosclerotic disease in diabetic patients, as well a greater deterioration of ventricular function, which may be associated to the poorer prognosis seen in this population both in the short- and long-term.
- ItemAcesso aberto (Open Access)Estudo de perfusão miocárdica e cineangiocoronariografia em pacientes com lúpus eritematoso sistêmico(Sociedade Brasileira de Reumatologia, 2004-08-01) Sella, Elaine Marcelina Claudio [UNIFESP]; Sato, Emilia Inoue [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate coronary artery findings using coronary artery angiography in systemic lupus erythematosus (SLE) patients with myocardial perfusion abnormalities. METHODS: Ninety female SLE patients, ages from 18 to 55 years old, more than 5 years of disease duration, without current or previous confirmed coronary artery disease (CAD), and who were either in use or had used steroid treatment for at least 1 year were evaluated. Myocardial perfusion scintigraphy was performed using a singlephoton emission computed tomography employing Technetium 99m-sestamibi. Images were captured at resting and after dipyridamole-induced stress. The CAD risk factors (RF) considered were the traditional ones in general population and SLE-related factors. All patients who had abnormal findings on myocardial perfusion tests were invited to undergo coronary angiography. RESULTS: The mean age was 38 ± 10 years old, with mean disease duration of 128 ± 59 months, American College of Rheumatology (ACR) number 7 ± 1, Disease Activity Index for SLE (SLE-DAI) score 6 ± 5 and Systemic Lupus International Collaborating Clinics/ACR Damage Index for SLE (SLICC/ACR-DI) score 2 ± 2. Thirty-three percent of patients presented myocardial perfusion scintigraphy abnormalities. Regression logistic analysis was performed considering the traditional CAD-RF and SLE-related variables in 48 SLE patients on regular follow-up. Current vasculitis was associated with abnormal myocardial perfusion. There was no association between other clinical and/or serologic features, cumulative dose or duration of prednisone use and myocardial perfusion scintigraphy results. Twenty-one patients with abnormal myocardial scintigraphy agreed to undergo coronary angiography. Atherosclerotic plaques were identified by angiography in eight patients (38%). Abnormal angiography subgroup presented higher number of traditional CAD-RF (p = 0.006). Arterial hypertension, postmenopausal status and higher triglyceride level showed a significant association with abnormal angiography (p = 0.046, 0.024 and 0.043, respectively). The number of ACR criteria, SLE-DAI and SLICC/ACR-DI scores were also higher in the sub-group with coronary abnormalities (p = 0.018, 0.010 and 0.003, respectively). CONCLUSIONS: Current vasculitis was an important variable associated with abnormal myocardial scintigraphy. This study suggests that myocardial scintigraphy can be used as a screening test for CAD in SLE patients with high-risk of cardiovascular disease, even in the absence of ischemic heart symptoms. Patients with abnormal myocardial perfusion results and at least four CAD-RF had higher risk of presenting coronary stenosis on coronary angiography.
- ItemAcesso aberto (Open Access)Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico(Sociedade Brasileira de Cardiologia - SBC, 2012-12-01) Gomes, Vitor O.; Lasevitch, Ricardo; Lima, Valter C. [UNIFESP]; Brito Jr., Fábio S.; Perez-alva, Juan Carlos; Moulin, Bruno; Arruda, Airton; Oliveira, Denise; Caramori, Paulo; PUCRS Hospital São Lucas; Universidade Federal de São Paulo (UNIFESP); Hospital São Camilo; Hospital General de Puebla; Hospital da Unimed; Hospital Intercath Meridional; UFRGSBACKGROUND: Radiographic contrast media exposition can cause acute renal function impairment. There is limited and conflicting evidence that hydration with sodium bicarbonate prevents contrast-induced nephropathy (CIN) in patients undergoing cardiac catheterization. OBJECTIVE: The present study was aimed at determining whether sodium bicarbonate is superior to hydration with saline to prevent nephropathy in patients at risk undergoing cardiac catheterization. METHODS: Three hundred and one patients undergoing coronary angiography or percutaneous coronary intervention with serum creatinine > 1.2mg/dL or glomerular filtration rate (GFR) < 50ml/min were randomized to receive hydration with sodium bicarbonate starting 1 hour before the procedure and 6 hours after the procedure, or hydration with 0.9% saline. CIN was defined as an increase of 0.5mg/dL in creatinine in 48h RESULTS: Eighteen patients (5.9%) developed contrast induced nephropathy: 9 patients in the bicarbonate group (6.1%) and 9 patients in the saline group (6.0%), p = 0.97. The change in serum creatinine was similar in both groups, 0.01 ± 0.26 mg/dL in the bicarbonate group and 0.01 ± 0.35 mg/dL in the saline group, p = 0.9. No statistical difference was observed between the change in glomerular filtration rate (0.89 ± 9 ml/min vs. 2.29 ± 10 ml/min, p = 0.2 bicarbonate group and saline group, respectively). CONCLUSION: Hydration with sodium bicarbonate was not superior to saline to prevent contrast media induced nephropathy in patients at risk undergoing cardiac catheterization.