New ischemic lesions seen on DW-MRI were present in both groups in >60%, but the number of lesions per patient was greater in the ANGIOGUARD group. No death or disabling stroke occurred during at least 1 year of follow-up in both cohorts.

SummaryBackground: Stroke is a feared complication after coronary artery bypass grafting surgery (CABG), with an incidence between 1.3 and 4.3%.

We report an eight-year-old child presented with classical features of hypertrophic obstructive cardiomyopathy and with New York Heart Association (NYHA) class III symptoms, eight months after myectomy and refractory to medical treatment. Cardiac transplantation was indicated due to the severity of symptoms. But the lymphocyte reaction test showed almost 100% reaction of antibodies, and the surgeons rejected the heart transplantation for fear of hyperacute rejection. Then an alcohol septal ablation (ASA) was proposed, which was successfully performed on August 17, 2005. The post-extrasystolic gradient was reduced from 160 to 60 mm Hg immediately and no other complications were seen. The child is being followed since then and echocardiography changes include a further reduction of septum thickness and gradient (P = 0.001), and important symptoms relieved after 3.5 years of follow up. ASA may be an option to be considered in children with critical hypertrophic obstructive cardiomyopathy in NYHA functional class III/IV, when other methods of treatment failed. © 2010 Wiley-Liss, Inc.

Introdução: O tipo de proteção cerebral utilizado durante o implante de stent carotídeo é controverso em idosos. Nosso objetivo foi avaliar os resultados dos dispositivos de proteção embólica cerebral (PEC), proximal e distal, em pacientes > 70 anos de idade, por meio da ressonância magnética ponderada de difusão (RM-PD). Métodos: Entre 2008 e 2011, 60 pacientes com indicação de stent carotídeo foram randomizados para PEC com Mo.Ma ® ou Angioguard ® , dos quais 26 tinham > 70 anos de idade. Os resultados da RM-PD realizada antes e 48 horas após o procedimento foram avaliados por neurologista independente e cego para o tipo de PEC utilizado. Foram analisados o número de novos focos isquêmicos, sua localização e o tamanho. Resultados: Novos focos isquêmicos cerebrais foram encontrados em 8/12 (66,7%) pacientes do grupo Mo.Ma ® e em 12/14 (85,7%) pacientes do grupo Angioguard ® (P = 0,37). A maioria das lesões (> 90%) era ipsilateral à artéria tratada em ambos os grupos, e o tamanho das lesões foi < 0,5 cm na maioria dos casos. O número de lesões por paciente foi menor com o dispositivo Mo.Ma ® (mediana [variação]: 3 [1 a 8] lesões vs. 15 [2 a 76] lesões; P < 0,001). Todos os pacientes que tiveram mais de 40 lesões pertenciam ao grupo Angioguard ®. Conclusões: Mesmo utilizando PEC (proximal ou distal), novas lesões isquêmicas foram observadas em ambos os grupos em pacientes idosos. Proporcionalmente maior número de pacientes com Angioguard ® teve novos focos isquêmicos se comparados aos pacientes do grupo Mo.Ma ®. O dispositivo de PEC Mo.Ma ® parece diminuir o número de lesões por paciente. DESCRITORES: Idoso. Estenose das carótidas. Ressonância magnética ponderada por difusão. Angioplastia. Stents. Angiografia cerebral.

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70% who were treated with percutaneous stent placement in the carotid arteries. We assessed the rate of success of the implantation and of the procedure, the types of stents used, mortality rate, and neurological complications. RESULTS: Successful implantation was obtained in 98.9% of the cases, and the procedure was successful in 91.8%. The Wallstent was the most frequently used stent (73 patients - 77%). Cerebral strokes occurred as follows: 3 (3.2%) transient ischemic attacks, 1 (1.1%) minor stroke, and 3 (3.1%) major strokes. One (1.1%) patient died during hospitalization. CONCLUSION: The high rate of success of stent implantation (98.9%) in addition to the low rate of cerebral stroke/death (4.2%) showed the efficiency and safety of percutaneous stent placement in carotid arteries.]]>

Objective -Analyze the dromotropic disturbances (vector-electrocardiographic) The appearance of decreasing exercise capacity in patients with obstructive hypertrophic cardiomyopathy under optimal medical treatment has spawned the introduction of different techniques to reduce left ventricular outflow tract gradient and to relieve symptoms. Percutaneous septal ablation is a promising alternative to myotomy/myectomy surgery and to DDD pacemaker implantation for the treatment of obstructive hypertrophic cardiomyopathy with significant septal thickness and gradient (thickness always > 18 mm and gradient > 50 mmHg at rest) in the absence of intrinsic mitral disease or significant systolic dysfunction 1 in patients with limiting symptoms refractory to drug treatment, who refuse to undergo surgery or who have a high surgical risk.The procedure consisted of causing a septal infarction by injecting absolute alcohol into the first great perforating septal branch of the anterior descending artery, reducing septal thickness with fibrosis and relieving the obstructive component 2 . Although promising, this is still an experimental method, because less than 1,000 cases have been reported worldwide, and, in Brazil, only 5. Randomized comparative studies with the widely accepted transaortic invasive surgical technique are still lacking. The transaortic invasive surgical technique has an acceptable estimated mortality lower than 5%, ranging from 3% (large centers) to 15% 3,4 , and a mean complication rate of 6% of the patients operated on. The complications include significant residual aortic insufficiency, which is present in almost 4% of surgical patients 5 , endocarditis, complete left bundle-branch block, and total atrioventricular block.In this report, vector electrocardiographic alterations secondary to percutaneous septal ablation are described, the theoretical and anatomic bases of intraventricular dromotropic disorders are discussed, and they are compared with the alterations observed after transaortic myotomy/ myectomy surgery.

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