[Clinical investigation must always be possible...].
The author reports his Research Group and the Iberian Multicentre Group experiences in order to find a therapeutical solution for the rupture of the ventricular free wall (WR) in acute myocardial infarction (AMI). The study includes seven phases. In a 1st phase of the study it was confirmed, by retrospective analysis, that the WR in AMI was a frequent event. In the 2nd phase of the investigation proceeding it was decided to set up a prospective anatomical and clinical protocol to evaluate this entity. Necropsic studies were performed in 71% of the patients who died in UTIC and we verified an incidence of 26% of WR in AMI. The WR were not uniform, in what concerns necropsic and clinical findings. The 3rd phase of the study consisted in the discrimination not only of the anatomo-pathological pictures but also of the clinical ones of this entity. Under the morphological point of view four types of rupture were described and the patient profile with AMI who has WR risk was defined. During the 4th phase of the study the progressive WR was identified and defined which was found in approximately 50% of the cases, corresponding the WR to a terminal accident with an average duration of 4 hours in the so called type 2, and of 10 h 50 min in the so called type 3. In the 5th phase of the study the objective consisted in the evaluation of the importance of the Ecocardiography and of the Hemodynamical Examinations with Swanz-Ganz catheter in the WE diagnosis. Based on the referred criteria it was possible to operate on 37 cases in Madrid (57% of mortality) and 6 cases in Lisbon (2 deaths). We are now in the 6th phase of the study. It consists in the diffusion of a medical and surgical approach fluxogram of patients with WR in AMI. In the end of this Editorial the author discusses the role of arterial hypertension, physical activity, anticoagulant and fibrinolitic therapeutics, microcirculation characteristics haemorheological changes in the WR genesis during AMI.
Ribeiro
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D002985:Clinical Protocols; D006341:Heart Rupture / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D006342:Heart Rupture, Post-Infarction / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D006801:Humans; D015337:Multicenter Studies as Topic; D011174:Portugal
A investigação clínica tem de ser sempre possível...