Biomedical subjects

W A Pimentel Filho

Publications and source records attributed to W A Pimentel Filho.

At least 19 recordsLinked to original sources

PubMed1994

[Excimer laser in the treatment of obstructive coronary disease. Initial experience].

The aim of this study is to evaluate a group of four male patients aged between 47 and 77 years (mean 52 +/- 4.5) with coronary artery disease who underwent excimer laser with classical indication for this method. The vessels considered were the left anterior descending artery in three patients and the right coronary artery in one. Conventional percutaneous transluminal coronary angioplasty (PTCA) was applied in all patients after the laser procedure. Reduction to 50% or less of the internal diameter was considered a satisfactory result. Early success (laser plus PTCA) was obtained in 100%. There were a decreasing in number of obstruction from 75-100% (mean of 80 +/- 8.5%) to 0-50% (mean of 20 +/- 6%) after the procedure (laser plus PTCA). During hospitalization no complication have been found. In conclusion, we certified that excimer laser has been applied in special situation (complex lesions) with high rate of success than conventional angioplasty but these results will require further studies.

Aged↗

PubMed1992

[Current approach in the treatment of isolated coronary arterial stenosis associated to arteriovenous coronary fistula].

Congenital coronary arteriovenous fistulae are commonly associated with complications which include congestive heart failure, bacterial endocarditis, angina pectoris, secondary to "coronary steal" phenomenon and fistula rupture. Conventional treatment of large coronary arteriovenous fistulae is surgical ligation. In this report we describe the data and therapeutic approach of a patient with a severe coronary stenosis in a large diagonal branch in whom PTCA was successfully conducted, while, in this opportunity no embolization of the fistula was performed.

Angioplasty, Balloon, Coronary↗

PubMed1992

[Directional atherectomy and coronary angioplasty: a therapy complementary to myocardial revascularization surgery].

A white male patient, 59 years old, with two prior surgical myocardial revascularization and unstable angina, was submitted to coronary arteriography that showed: all the saphenous vein grafts patent and obstruction of 75% in the saphenous vein graft to the second marginal branch of left circumflex artery. Left internal mammary artery (LIMA) was angiographically normal and 80% stenosis was detected in the distal segment of the left anterior descending coronary artery (LAD). The patient was submitted to directional coronary atherectomy for saphenous vein graft and coronary angioplasty for distal-LAD. Both procedures were successfully performed.

Angioplasty, Balloon, Coronary↗

PubMed1992

[Angioplasty in native coronary circulation in patients treated with myocardial revascularization].

PURPOSE: To evaluate the clinical results after angioplasty in the native coronary vessels in patients who had undergone previous coronary artery surgery. METHODS: From June 1987 to July 1990, 69 patients with previous coronary artery surgery underwent coronary angioplasty in the native arteries. Age ranged from 31 to 82 (mean = 57.5) years, fifty eight were males. Angina was present in all patients. The patients were classified in three groups according to the following criteria: group I--incomplete revascularization following bypass surgery (28 patients); group II--progression of the disease in ungrafted vessels (24 patients) and group III--progression of the disease in grafted vessels (17 patients). RESULTS: Primary success was achieved in 94% (65/69). Ninety-five percent in group I, 92% in group II and 94% in group III. Complications occurred in 4%; emergency surgery or deaths were not observed in this study. Forty patients (61%) repeated coronary arteriography an average follow-up of 4 months and restenosis was detected in 10 (25%); 8 of them were redilated. Survival rates was 95% and 75% of them were free of coronary events after an average follow-up of 13 months. CONCLUSION: Coronary angioplasty in these patients is a safe and effective interventional procedure in the treatment of coronary artery disease in native coronary vessels.

Adult↗

PubMed1992

[Directional coronary atherectomy. The initial experience].

Four male patients, 38 to 59 years old (mean 49 +/- 2.5), with angina and the angiographic features has been the classical indications for the method, underwent directional coronary atherectomy. Vessels treated were, respectively, left anterior descending artery (LAD), right coronary artery (RCA), saphenous vein graft (SVG) to LAD and SVG to left marginal branch. Reductions to 50% or less of the internal diameter was considered a satisfactory result. Early success was obtained in all four patients. Obstructions of 75 to 95% (mean of 83 +/- 7.5%) were reduced to 0-25% (mean 12 +/- 5%) after atherectomy. Only one patient died suddenly five days after de procedure. So, directional coronary atherectomy may represent a reliable and safe method for special situations.

Adult↗

PubMed1992

[Coronary angioplasty in octogenarians].

PURPOSE: To evaluate the indications, results and follow-up of patients with 80 years old and over, who had undergone percutaneous transluminal coronary angioplasty (PTCA). METHODS: From July 1987 through July 1990, 36 patients, 80 years of age and over, had PTCA as an alternative method to treat coronary artery disease. Their age ranged from 80 to 85 (mean = 83) years. Twenty five were male. Significative obstruction was considered when 70% or more of the internal diameter was stenosed. Satisfactory results were achieved when reduction of 50% or more of the coronary artery obstruction was obtained. RESULTS: In 34 of 36 patients (94.4%), PTCA was successfully performed. Forty four of 46 coronary arteries were successfully dilated. One patient had acute coronary occlusion with acute myocardial infarction treated clinically. There were no emergency surgeries or early deaths. Clinical follow-up was obtained in 15 of the 34 patients. Four had repeated coronary arteriography (at 1, 3, 6 and 12 months after primary PTCA) due to angina. Two of them had restenosis and were successfully redilated (the patients restudied at 3 and 6 months, respectively). Within a mean clinical follow-up period of 9.6 (ranging from 1 from 21) months the following features were observed: two of 15 patients (13.3%) had acute myocardial infarction and were clinically followed; late death occurred in 3 patients (20%) with only one related to cardiac events. Survival has been observed in 12 of these 15 patients (80%). CONCLUSION: PTCA represents an alternative, safe and effective invasive procedure to treat octogenarians with coronary artery disease.

Aged↗

PubMed1992

[The dilatation of the residual stenosis due to a Blalock-Taussig anastomosis by percutaneous transluminal angioplasty].

A ten-months-old white infant had undergone surgical modified Blalock-Taussig anastomosis at 2 months of age. An interposition of bovine mammary artery was anastomosed with the right subclavian artery. A satisfactory clinical follow-up after surgery was achieved, until the last three months when cyanotic spells were observed. A new angiographic study showed tricuspid and pulmonary atresia and severe stenosis (+/- 80%) at the anastomosis between the subclavian artery and the bovine mammary tissue. Percutaneous transluminal angioplasty was successfully performed. An immediate improvement of cyanosis and oxygen saturation were observed.

Anastomosis, Surgical↗

PubMed1992

[Anatomical limitations for the performance of angioplasty in coronary multivessel disease].

PURPOSE: To study anatomical limitation of coronary angioplasty, as alternative therapy in patients with multivessel disease and submitted to bypass surgery. METHODS: In 380 patients with multivessel disease and submitted to previous coronary bypass surgery, age ranged from 41 to 72 (average = 51) years, being 68% males. The following parameters were analyzed in the coronary arteriographies: anatomic aspects of the coronary arteries and distribution of the atherosclerotic stenosis. The patients were arranged in accordance to the criteria: complete revascularization, incomplete and no indication for coronary angioplasty. RESULTS: The patients were arranged in 3 different groups: I-80 (21%) patients included those in whom complete revascularization would be possible; II--55 (14.5%) patients in whom only incomplete revascularization but satisfactory would be possible and III--245 (65.5%) those patients in whom coronary angioplasty would no have indication. The data referind the patients of groups I and II were analyzed together--135 (35.5%) and arranged according to the number of arteries involved. It was observed: two vessel disease--71.8%, three vessel--18.6% and 4 or more vessel--9.6%. In group III it was observed 51.0% of the patients with 3 or more vessel disease. The major factors to contra indicate coronary angioplasty in group III included: chronic coronary obstruction 99 (40.4%); diffuse disease 11 (4.5%); technical difficulties 10 (4.1%); left main coronary artery obstruction 5 (2%) or when two or more causes were combined 120 (49%). CONCLUSIONS: Patients with multivessel disease and classic indication for coronary bypass surgery, have a basic limitation for angioplasty due to several anatomic factors. However, coronary angioplasty could be beneficial for a selected group of patients (35.5%) whenever a complete or incomplete revascularization could be obtained.

Adult↗

PubMed1991

[Coronary atherectomy using the transluminal endarterectomy extraction catheter. Initial experience].

PURPOSE: To describe a new alternative technique for treating coronary artery disease: the coronary atherectomy with the transluminal endarterectomy-extraction catheter. METHODS: Four patients, 1 female and 3 males age 46 to 65 years (mean 53 +/- 8.5 years), were submitted to coronary atherectomy with the transluminal endarterectomy-extraction catheter. One patient presenting stable angina, one presenting recent angina, one with residual stenosis after acute myocardial infarction treated with intravenous streptokinase and one with two episodes of syncope and ECG alterations. The treated arteries were: left anterior descending in 3 patients and left circumflex in one. Two lesion were concentric and two were segmentary and eccentric. RESULTS: The coronary artery stenosis ranged from 80 to 95% (mean of 90 +/- 7.1%) before the atherectomy and from 20-50% (mean of 32.5 +/- 12.6%) after the atherectomy. Except the first patient, the other 3 were discharged in less than 48 hours after the atherectomy. None presented chest pain during the procedure and in three of them were no recordings of dissection or coronary artery perforation. In one patient the treated artery presented total occlusion (thrombus) 15 minutes after the procedure, but was immediate and successfully reopened with balloon angioplasty. CONCLUSION: Coronary atherectomy with the "transluminal endarterectomy-extraction catheter" has shown to be a safe and feasible procedure and to bring satisfactory immediate results.

Aged↗

PubMed1991

[Coronary angioplasty in young patients].

PURPOSE: To evaluate the results of coronary angioplasty in patients at the age of 40 years old or under. METHODS: From July 1987 to July 1990, 878 coronary angioplasty procedures were performed. Sixty six patients (7.5%) were 40 years old or under. The coronary obstruction was considered significant when 70% or more of the arterial diameter was involved and the post angioplasty results were considered satisfactory when residual obstruction was less than the 50%. RESULTS: Fifty four patients (81.8%) were male with an average age of 37 years (ranging from 29 to 40). Forty four patients (67%) had stable angina, 18 (27%) unstable angina, 3 (4%) acute myocardial infarction (AMI) and one (1.5%) AMI after streptokinase treatment. Eight of these patients had previous report of AMI and 3 (4.5%) had undergone coronary bypass grafting surgery. Fifty five patients (83%) had single vessel disease and 11 (17%) had multivessel disease. Eighty coronary arteries had balloon dilatation. In 32 patients (58%) with single vessel artery, 12 (22%) in the RCA, 10 (18%) in the left circumflex and one (2%) into a saphenous vein bypass grafting. In 12 patients (48%) with multivessel disease it was performed in the LAD coronary artery, 8 (32%) in the RCA and 5 (20%) in the left circumflex. Angioplasty was successfully performed in 53 (96%) patients with single vessel disease and in 10 (01%) with multivessel disease. One of the patients died immediately after the procedure. A follow up of 11.6 months (ranged from 1 to 27 months) was possible in 63 patients. Re-stenosis was depicted in 10 (19%) of the 55 patients with single vessel disease and in 3 of the 11 patients (30%) with multivessel disease. Nine patients had a successful redilatation in the first group and 2 in the second one. The two remaining patients had undergone coronary bypass surgery. The clinical evaluation among patients who had been dilated as the first procedure and those who had redilatation (61 patients) showed: 92% were asymptomatic and 8% had mild angina. CONCLUSION: Coronary angioplasty performed in young patients is an effective procedure with very low rate of early complications and favorable clinical follow-up.

Adult↗

PubMed1988

Transient platelet aggregation as a mechanism of unstable angina. Aggressive treatment with coronary angioplasty.

Decreased oxygen supply rather than increased demand may be the primary pathogenic mechanism of myocardial ischemia in patients with unstable angina. Coronary artery spasm and in vivo platelet aggregation may play an important role in the mechanism by which the magnitude of fixed obstruction secondary to coronary atherosclerosis is transiently exacerbated. In this case report, we describe a patient who developed chest pain accompanied by ischemic ECG changes during coronary arteriography, due to a transient thrombotic aggravation of a fixed, significant coronary stenosis. Percutaneous transluminal coronary angioplasty was performed with relief of the coronary stenosis and of the symptoms.

Angina Pectoris↗

PubMed1988