1997;69(2) – ABC CARDIOL

Artigo Original

Prognostic value of dobutamine-atropine stress echocardiography

Mathias Jr Wilson et al. Ulisses Stella Flávio Baruta Adriana Cordovil … José Lázaro Andrade Antonio Carlos Carvalho Expedito Ribeiro Renata Duprat Eulógio Martinez

PURPOSE: To determine the prognostic value of dobutamine-atropine stress echocardiography (DASE). METHODS: We studied 452 consecutive patients at high risk for coronary artery disease, using DASE. They were followed during a mean period of 23 months. RESULTS: There were 9 cardiac deaths and 2 acute myocardial infarctions in the group of patients with positive tests, and there were 2 myocardial infarctions and 1 cardiac death in patients with negative DASE. CONCLUSION: We conclude that DASE reliably identifies patients at high risk for hard cardiac events.

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Relato de Caso

Coronary steal due to collateral circulation from circumflex coronary to right pulmonary artery leading to unstable angina in Takayasu's arteritis

Paulo R. Viecili et al. David Pamplona Fernando H. Y. Cesena Protásio L. da Luz

A sixty three year old woman suffering from Takayasu’s arteritis with involvement of the aortic arch, subclavia arteries and occlusion of the right pulmonary artery, developed progressive precordial pain. Exercise electrocardiogram disclosed ST segment depression. Coronary arteriograms demonstrated no coronary stenosis, but collateral circulation arising from circumflex coronary artery to right pulmonary artery. The collateral blood flow was considered to be of great importance, and causing the coronary steal syndrome, leading to angina pectoris.

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Artigo Original

Cardiac amyloidosis. A disease with many faces and different prognoses

Antonio Carlos Pereira Barretto et al. Dalton Precoma João Batista Serro-Azul Mauricio Wajngarten … Humberto Pierri Ligia Pivotto Amit Nussbacher Otavio Celso Eluf Gebara Giovanni Bellotti

PURPOSE: To identify the principal forms of cardiac amiloydosis presentation in a terciary hospital. METHODS: Eight cases whith cardiac amyloidosis were identified. Five were woman, their ages ranged from 23 to 83 years (mean 62). After a medical history and clinical examination the patients, were submitted to complementary tests: electrocardiogram (EKG), echocardiogram (ECHO), scintigraphy with technecium pirophosfate and cardiac biopsy these results allowed the identification of their clinical situation. RESULTS: Seven patients refered dyspnea, 6 were in heart failure, 1 patient had syncope. The EKG identified complete atrioventricular (AV) block in 4 patients, and antero septal inactive area in the other 4. The ECHO showed normal cardiac diameter in all (mean left ventricular diastolic diameter of 46.8) and slight reduction of left ventricular ejection fraction; hypertrophy of the left ventricular septal and posterior walls in all cases, in 7 cases there was a hyper refractile granular sparkling ECHO. Two different groups were identified: one with complete AV block and the second with restrictive cardiomyopathy. The prognosis was different in these two groups. Those with complete AV block evolved better after pacemaker implantation and those with restrictive cardiomyopathy had refractary heart failure and 3 of them died. CONCLUSION: The increased free wall and septal thickness, the slight systolic dysfunction and the infiltration aspect at ECHO allow us to identify the great majority of the cases. Those patients with restrictive cardiomyopathy evolve with refractory heart failure and most of them die in a few months.

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Relato de Caso

Severe dysfagia due to retroesophageal hematoma after thrombolytic therapy for right axillosubclavian vein thrombosis

Antonio Claudio do Amaral Baruzzi et al. Maria Emília Cardoso Gadelha Claudio Cirenza Elias Knobel

We report the case of a 72 year-old man with advanced, stage IV, prostate cancer who underwent osteosynthesis of the cervical spine for nerve root decompression due to metastasis which was causing severe pain in his right upper limb. After three months in the hospital, he developed occlusive thrombosis of the right axillosubclavian vein as a complication of prolonged catheterization of the right subclavian vein for treatment of septicemia secondary to a hospital acquired pneumonia. The patient received thrombolytic therapy with IV streptokinase in the contralateral arm in the following dosage: 250,000 units in 15 minutes followed by 100,000 units per hour during five days. This led to total recanalization of the thrombus, with significant reduction of the arm edema. Twenty-four hours after the end of the thrombolytic therapy, the patient started to complain of dysfagia to solids and liquids and a contrasted esophagogram revealed extensive extrinsic compression of the esophagus due to a probable retroesophageal hematoma. The patient required enteral nutrition via nasoenteral tube during three months after which swallowing returned to normal and a repeat upper GI series confirmed that the hematoma had been reabsorbed, with normal passage of contrast through the esophagus. On late follow-up, the patient did not show evidence of any sequelae of deep venous thrombosis nor any residual dysfagia and is currently in use of elastic stockings and low molecular weight heparin.

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Artigo Original

Activation of the cardiac angiotensin-converting enzime after infarction in rats and its role in ventricular remodeling

José Geraldo Mill et al. Maria da Conceição Milanez Vera Cristina W. Busatto Andréa Cruz de Moraes Maria da Glória S. Gomes

PURPOSE: To determine angiotensin converting enzyme (ACE) activity in the heart of infarcted rats and to investigate the effects of captopril and losartan on the post- infarction remodeling process. METHODS: Myocardial infarction (MI) was produced in Wistar rats by ligature of the left coronary artery. Control rats (Con) underwent a sham surgery. MI and Con rats remained untreated or were treated with captopril (30mg/kg/day) or losartan (15mg/kg/day) for 30 days. ACE activity was determined in right (RV) and left ventricular (LV) muscles and in the scar tissue. The effects of captopril therapy was also investigated in the hydroxiproline (OH-Pro) and protein in RV and LV . RESULTS: ACE activity increased 25% in the RV and 70% in the remaining LV muscle. The highest ACE activity was found in the scar tissue, where it was 4.5 times the value of the LV muscle (420±68 vs 94±8nmoles/g/min; P<0.01). An increase of the end-diastolic pressure and of the muscle mass was found in the RV and LV of MI rats. Captopril and losartan treatments were equally efficient to attenuate these parameters in both ventricles. Captopril also reduced the total OH-Pro content in the RV and LV muscles. The Prot concentration was significantly reduced in the myocardium of MI rats, an effect enhanced by captopril therapy. CONCLUSION: The AII concentration in the blood draining from the scar to the surrounding muscle is probably high. It is likely that this elevated local generation of AII contributes to hypertrophy and to collagen deposition. The effects of ACE inhibitors on remodeling are likely to depend on the reduction of the locally generated AII.

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Artigo Original

Is the apical hypertrophic cardiomyopathy seen in one population in Rio de Janeiro city similar to that found in the east?

Francisco Manes Albanesi Fº et al. Marcia Bueno Castier Alberto Siqueira Lopes Paulo Ginefra

PURPOSE: To investigate the differences between clinical aspects and evolution of apical hypertrophic cardiomyopathy (AHCM) seen in Rio de Janeiro and the Oriental form, which was the first described. METHODS: In 156 patients with AHCM diagnosed in our institution, there were 13 (8.34%) with the apical form of the disease, whose clinical settings, diagnostic procedures and evolution were studied. RESULTS: There were 8 males and 5 females, between 19 and 75 years old, all white. Electrocardiogram (EKG) showed giant T waves in precordial leads in 10 (76.92%), echocardiogram (ECHO) demonstrated apical hypertrophy in all, 10 (76.92%) had only in the left ventricle, 2 in right ventricle and one involving both. Cineangiography corroborated ECHO findings. Follow-up ranged from 6 to 294 months (x= 95.4). Two deaths occurred in patients with RV involvement, due to large atria, atrial fibrillation, tricuspid or mitral insufficiency and thromboembolism. Among the survivors, the patient with RV disease has diastolic restriction and the ones with LV involvement, 9 are asymptomatic using either propranolol (8) or amiodarone (1), and one uses no medication. CONCLUSION: A HCM seen in Rio de Janeiro is similar to that found in the Orient (Japan) regarding presentation, diagnosis and evolution; but in 3 patients we have found RV disease, not described in Japan, characterizing a distinct group with a worse evolution.

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Relato de Caso

Partial ventriculectomy in a child – the Batista operation

Luiza Mara Elias et al. Raynold Monteiro Rosângela Fittaroni Marcelo Zaninotto … Eduardo Coelho de Souza Maria Alejandra Rivero Daniela Chaves Randas José Vilela Batista Magnus Coelho de Souza

We present the case of a two and a half year old child with idiopatic dilated cardiomyopathy and end-stage congestive heart failure (NYHA III-IV) who underwent “partial ventriculectomy”. The operation was performed under normothermic cardiopulmorary bypass and normothermic oxygenated blood cardioplegia and consisted of removal of a large wedge of muscle from the lateral wall of the left ventricle beginning at the apex and extending between the papillary muscles, ending proximal to the mitral annulus. Pre-operative the left ventricular ejection fraction (EF) was 13% by echocardiography and 20% by radionuclide ventriculography. Postoperative avaliation showed improvement of EF to 50% and 30%, respectively. The child was in functional class I (NYHA) on discharge from hospital (16th postoperative day).

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Artigo Original

Late evaluation of bovine pericardium grafts as aortic substitutes by spiral computed tomography

Renato A. K. Kalil et al. Carlos Jader Feldman Fernando W. B. Ludwig Alessandro D'Avila da Silva … Paulo Roberto Prates João R. M. Sant'Anna Ivo A. Nesralla

PURPOSE: To evaluate morphologically by spiral computed tomography (SCT) bovine pericardial grafts as aortic substitutes. METHODS: Ten patients were submitted to aortic graft evaluation with SCT. There were 8 ascending and 2 descending grafts. Examination was done after 2 to 7 years post operative. Ages ranged from 49 to 67 years, with 6 male and 4 female patients. All had implanted smooth surface naked pericardial grafts. RESULTS: Surgical result was good in all. Distal dissection persisted in some cases. One had a peri-graft hematoma, 5 had no structural changes and 4 presented mild graft dilatation. There were no graft calcification or pseudoaneurysm. CONCLUSION: Glutaraldehyde preserved naked smooth surface bovine pericardial aortic grafts present satisfactory structural aspect, as seen by SCT, at medium term follow-up. Mild dilatation may be seen in some cases.

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Prognostic value of dobutamine-atropine stress echocardiography

Coronary steal due to collateral circulation from circumflex coronary to right pulmonary artery leading to unstable angina in Takayasu's arteritis

Cardiac amyloidosis. A disease with many faces and different prognoses

Severe dysfagia due to retroesophageal hematoma after thrombolytic therapy for right axillosubclavian vein thrombosis

Activation of the cardiac angiotensin-converting enzime after infarction in rats and its role in ventricular remodeling

Is the apical hypertrophic cardiomyopathy seen in one population in Rio de Janeiro city similar to that found in the east?

Partial ventriculectomy in a child – the Batista operation

Late evaluation of bovine pericardium grafts as aortic substitutes by spiral computed tomography

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