An atherosclerotic aneurysm of the right coronary artery complicated by a recent myocardial infarction was successfully treated with coronary artery stenting, using a device consisting of 2 stents with a layer of expandable polytetrafluorethylene (PTFE) placed between them. A follow-up angiograph 5 months after the procedure showed sustained initial results.
A 43-year-old symptomatic woman (dyspnea and palpitation) had multiple coronary-pulmonary artery fistulae with high output; percutaneous embolization was successfully performed using controlled-release microcoils and disposable balloons.Coronary fistulae are communications between these arteries and the cardiac cavities or other mediastinal vessels; frequently, they are alterations in embryo development 1 . Several fistulae arising from both coronaries and ending in the pulmonary artery, such as in our patient's case, are rare clinical entities 2 . Fistulae with marked hemodynamic repercussions leading to symptoms of heart failure and thoracic pain are, classically, treated with surgery 3 ; however, catheter occlusion is currently increasing in frequency [4][5][6][7][8] . Case ReportA 43-year-old woman was referred to the hospital because of frequent episodes of palpitations and exercise-related dyspnea, with symptoms progressing in recent years. Specific clinical examination revealed a continuous cardiac murmur, heard at the left sternal border at the third and fourth intercostal spaces. Twelvelead electrocardiography revealed complete left bundle-branch block. Echocardiographic Doppler performed at another hospital showed large patent ductus arteriosus and pulmonary artery hypertension. The patient was referred for hemodynamic study because of this diagnosis. Manometry revealed a mild increase in pressure in the right chamber and pulmonary artery. A pulse oximetric recording peaked at the level of the pulmonary artery trunk. Patent ductus arteriosus was not found. Cardiac scintigraphy demonstrated large right coronary ( fig.1) and left coronary fistulae ( fig. 2) in the pulmonary artery.Percutaneous embolization was performed, using the right femoral artery for Access with a JR 4 6F guidewire catheter (Cordis, brite tip) for the right coronary and a JL 4 6F for the left coronary.After venous administration of 5000 U unfractionated heparin, a large fistula of the right coronary ostium was catheterized selectively (Excelsior microcatheter, Boston Scientific). Controlled-release coils were used to completely occlude fistula (MicroPlex, Microvention). Microcatheters were used to perform catheterization of the 2 large fistulae in the proximal and medium third of the anterior descending artery, the fistula being successively occluded with the same type of microcoils. These coils are produced by Microvention. New platinum microcoils were introduced into the market in 2002 for the embolization of brain aneurysms. We used 11 devices for the embolization of the fistulae: 2 microplex 4mm/8cm, 2 microplex 6mm/15cm, 2 microplex 8mm/20cm, 1 microplex 4mm/10cm, 1 microplex 5mm/12cm, 1 microplex 7mm/ 18cm, 1 microplex 7mm/30cmm, and 1 microplex 9/30cm ( fig. 3).A residual flow was left in the right coronary fistula by a lateral branch emerging before the site where the coils were released. The patient under local anesthesia tolerated the procedure well. Distal embolization was not observed for the coronary branches.After the ...
RESUMOO presente trabalho apresenta um estudo sobre as perdas de água e como estas se tornaram um problema recorrente no Brasil. Demonstrando a importância da água e como ela contribui em diversas atividades humanas. Mostrando, mais especificamente no bairro da Roda de Fogo, na cidade do Recife/PE, como o crescimento desordenado das cidades, os problemas sociais e a falta de contribuição da população eleva o percentual de perdas de água. Essas perdas recebem duas classificações, perdas reais (físicas) e perdas aparentes (não físicas). As perdas reais correspondem ao volume de água não consumido, ou seja, volume perdido em vazamentos ou rompimentos de tubulação. Já as perdas aparentes, correspondem ao volume de água consumido, mas não contabilizado, caracterizando uma perda financeira a empresa de saneamento; As perdas aparentes estão mais ligadas a furtos de água ou problemas na inscrição de algumas residências. O objetivo do trabalho foi demonstrar como a ocupação desordenada no bairro de Roda De Fogo, Recife/PE, aliada a atitudes da população que levam a perdas de água e com isto evidenciar como o período de incentivo a industrialização brasileira iniciada na década de 50 e acontecimentos históricos na cidade do Recife, desencadearam um processo de urbanização desordenada e por fim aos problemas de saneamento e a números alarmantes de perdas, ressaltar o quanto os problemas sociais estão diretamente ligados aos problemas de saneamento e perdas de água, demonstrar como as perdas interferem diretamente na prestação de serviço da companhia de saneamento, e como a população é impactada com isso, caracterizar a área da comunidade Roda de Fogo, realizar um levantamento histórico da formação da comunidade. O estudo demonstrou a percepção da comunidade sobre o atendimento quanto ao abastecimento de água, coleta de resíduos urbanos e saneamento, constatando que 80% da população relata a falta de atendimento e continuidade quanto ao abastecimentos de água.
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