The aim of this study was to evaluate long-term clinical follow-up and echocardiographic data on pregnant patients with mitral stenosis who underwent percutaneous mitral valvuloplasty (PMV) in our center and the development of their infants. PMV has proven to be an effective alternative to treat pregnant patients with mitral stenosis. However, long-term outcome of these patients, as well as the potential harmful effects caused by radiation on their infants, still awaits to be determined. From January 1988 to February 1999, 30 pregnant women (mean gestational duration, 24.95 +/- 5.59 weeks) underwent PMV. Twenty-three (77%) were subsequently followed by a medical interview during 5.33 +/- 3.12 years. Clinical variables such as NYHA functional class (FC), the need of a repeat PMV or surgical procedure, the presence of embolic events, and mortality rate were evaluated during follow-up. Mitral valve area, mean transmitral gradient, and the presence of mitral regurgitation were also assessed by Doppler echocardiography. Clinical data on the development of the infants were obtained from the assistant pediatricians. All patients were in NYHA FC III or IV before the procedure. During follow-up, 91% of them were in FC I and II. Two patients (9%) who had remained in FC III underwent a repeat successful PMV; no further surgery was required. There were no embolic events or death related to the procedure. Echocardiography showed an initial increase in mitral valve area from 1.14 +/- 0.22 cm(2) to 2.01 +/- 0.21 cm+/- (P < 0.0001). During long-term follow-up, it decreased to a mean of 1.75 +/- 0.24 cm(2) (P < 0. 0001). Initial transmitral valve gradient decreased from 17.73 +/- 4. 56 mm Hg to 5.91 +/- 1.80 mm Hg (P = 0.0001) and 8.95 +/- 3.58 (P = 0.002) during long-term follow-up. Twenty one children (96%), aged 4. 91 +/- 2.8 years, showed normal growth and development, and no clinical abnormalities were observed. These favorable long-term results suggests PVM to be the procedure of choice to treat pregnant women with mitral stenosis who remain in FC III or IV despite adequate medical therapy. No harmful effects due to the use of radiation were observed in the children.

Coronary stenting in diabetic patients is an efficient procedure, with a high angiographic and clinical success rate similar to that in nondiabetic patients. Diabetic patients, however, had a higher incidence of in-hospital myocardial infarction and a greater need for additional myocardial revascularization.

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We report the case of a rare anomaly of the right coronary artery originated from the middle third of the left anterior descending (LAD) coronary artery with a proximal atheromatous obstructive lesion immediately before the emergence of the right coronary artery (RCA). The patient underwent successful angioplasty with stent implantation in the left anterior descending coronary artery. Only 7 cases of this anomaly of distribution have been reported in the literature, but none of them was treated with percutaneous revascularization.Anomalies of the coronary arteries occur in 1 to 2% of the population, constituting a rare, but important, type of nonatherosclerotic coronary artery disease. These anomalies may cause sudden death on exertion and increase the risk of coronary arterial trauma during surgical procedures. In addition, certain types of anomaly may lead to myocardial ischemia 1 .The single coronary artery (SCA), described as an isolated coronary artery, has no gender predominance, being a rare entity with an incidence of 0.024% when isolated, and of 0.03 to 0.04% when associated with other cardiac abnormalities 2-4 . Its main characteristic is being originated from the aortic root through a single ostium, with no evidence of a second ostium, being then responsible for the irrigation of the entire heart, independently of its distribution 2 . In these cases, proximal atherosclerotic obstructions may have severe consequences for the patient 4 .We report the case of a patient who underwent percutaneous coronary intervention with stent implantation and whose RCA originated from the LAD. The cases of only 7 patients with that anomaly have so far been reported in the literature, but none of them was treated with coronary angioplasty 5 . Case ReportThe patient is a 73-year-old, white, male, retired lumber jack, bornt and residing in the town of Maria da Fé, in the state of Minas Gerais. The patient has type II diabetes, hypertension and quit smoking 20 years earlier. He was referred to our service for coronary angiography due to a one-year history of oppressive chest pain on exertion, which irradiated to the left upper limb, was relieved with rest, and had no aggravating factors. The patient reported that in the preceding 2 months the pattern of the chest pain evolved progressively until being triggered at rest.On physical examination, the patient had no alterations, except for his cardiac auscultation, which had a regular cardiac rhythm with the presence of S4. The chest teleradiography was normal. The rest electrocardiogram ( fig. 1) showed a sinus rhythm, SÂQRS +70º, heart rate of 75 bpm, with no ventricular repolarization alterations. During the exercise test ( fig. 2), a significant 3-mm depression of the ST segment was observed on the MC5 lead with a load of 1.7 mph 10% at 3 minutes, characterizing an ischemic myocardial response to exercise.The patient underwent coronary angiography according to the Sones technique on July 14th, 2003, which revealed a LAD originating from the left Valsalva sinus, and dividin...

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Batimastat-eluting stents had a good safety profile; however, they were not effective in controlling coronary restenosis.

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