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 ...

We report the case of a 21-year-old male with highoutput heart failure due to a femoral arteriovenous fistula caused by a firearm wound. A new balloon expandable stent covered with polytetrafluorethylene was implanted in the artery to occlude the arteriovenous fistula. The fistula was immediately occluded and the artery remained patent. On the following day, the patient felt much better, with no symptoms of heart failure. Additional follow-up is required to assure the usefulness of this less invasive procedure in the treatment of arteriovenous fistulas.Peripheral arteriovenous fistulas caused by vascular trauma are rare and are difficult to repair surgically 1 . Their recognition and repair are mandatory to avoid local and systemic complications, such as ischemia and ulceration of the limbs and congestive heart failure 2,3 . Surgical repair of arteriovenous fistulas is the traditional treatment. In recent years, percutaneous treatment has been used more and more 3 . We report the case of a femoral arteriovenous fistula in a young male, who had a firearm wound in his left thigh causing high-output congestive heart failure. Endoluminal repair of the femoral arteriovenous fistula was performed with a metallic prosthesis covered with polytetrafluorethylene (PTFE). Case reportA 21-year-old male was admitted to the emergency department complaining of dyspnea and tachycardic palpitations one month after suffering a firearm wound in his left thigh.On physical examination, the patient was tachypneic, tachycardic (120bpm), with paleness (++/4) in mucosas and skin, wide pulses, his blood pressure being 140/60mmHg. A pulsing mass was palpated in the middle third of his thigh with local elevation of the temperature, where a regurgitating murmur was present. Heart auscultation showed cardiac sounds of normal intensity, arrhythmic, tachycardic, and with no murmurs. Pulmonary auscultation was within the normal range. The electrocardiogram showed signs of left ventricular hypertrophy, supraventricular extrasystoles, and sinus tachycardia. Doppler echocardiogram showed a mild enlargement in the cavitary diameters, and a cardiac output of 10 L/min. A peripheral arteriography was performed, depicting the extension and location of the arteriovenous fistula in the middle third of the left thigh, measuring approximately 12 mm of extension ( fig. 1).In view of the technical difficulties of the conventional surgical treatment with the possibility of venous vascular lesion, bleeding, and difficulty of access, we chose the percutaneous treatment.We punctured the right femoral artery, implanted a 9F valvate introducer, inserted a Simmons 6F catheter, which was manipulated to the contralateral superficial femoral artery. An arteriography was performed and showed a highoutput femoral arteriovenous fistula in the middle third of the left thigh, measuring about 12mm. A 0.35'' exchange guidewire with 260cm of length was placed through the catheter. The catheter was withdrawn and a peripheral JOS-TENT Graft (standard version Jomed) of 38 mm of l...

In spite of the small annual procedural volume and the use of conventional equipment, the initial success rate in our institution was excellent in a diverse and complex patient population while the complication rates were similar to that of the literature.

O presente trabalho tem como foco principal a discussão acerca da legalidade dos contratos de seguro de responsabilidade civil de diretores, administradores ou demais gestores das sociedades de economia mista que desenvolvem atividade econômica, conhecido como seguro "D & O". Os posicionamentos contrários a sua aplicação se fundamentam no aspecto de que não há permissão constitucional para a cobertura securitária de gestores públicos, tendo em vista a responsabilidade pessoal desses agentes. O contraponto refere-se ao fato de que tais entes estatais desempenham atividade econômica e atuam livremente no mercado em paridade de armas com entes "puramente" privados, o que exige tomada de decisões sujeitas a risco tanto enquanto ente estatal como quanto ente que exerce atividade econômica. Essa dualidade assumida por gestores de uma sociedade de economia mista agrava o risco ao qual os seus gestores estão expostos diariamente em suas tomadas de decisões.