1998;70(6) – ABC CARDIOL

Artigo Original

Utilization of self-expandable prosthesis (Stent) introduced through the femoral artery for treatment of dissection of the descending aorta

José Honório Palma da Fonseca et al. Enio Buffolo Antonio Carlos Carvalho Nikolaus Geisthovel … Dirceu Rodrigues Almeida José Augusto Marcondes de Souza Ivan Paula Machado Cláudia Maria Rodrigues Alves

PURPOSE: We present four cases of dissection of the thoracic descending aorta that underwent treatment with an auto expandable dácron®-covered stent. METHODS: The stent was deployed through the femoral artery in the hemodinamic laboratory after sedation, local anesthesia in both inguinal areas and systemic heparinization. The catheter with the stent was introduced through a cutdown in the left femoral artery until the area in the thoracic aorta with the previously diagnosed tear. RESULTS: The stent was expanded with immediate occlusion of the false lumen. The whole proccedure took 90 minutes and the patients were discharged without complications. CONCLUSION: Stent utilization is an important step to improve treatment results in type B aortic dissection.

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Artigo Original

Comparison between percutaneous balloon valvuloplasty and open commissurotomy for mitral stenosis

Luiz Francisco Cardoso et al. Miguel Antonio Neves Rati Pablo Maria Alberto Pomerantzeff Caio Cesar Jorge Medeiros … Flávio Tarasoutchi Eduardo Giusti Rossi Walkiria Samuel Ávila Max Grinberg

PURPOSE: To compare immediate and late (12 months) follow up of clinical and Doppler echocardiographic results between percutaneous mitral balloon valvuloplasty and open commissurotomy in a prospective and randomized trial. METHODS: Eighty eight symptomatic patients with severe mitral stenosis and favorable anatomy were randomized in a prospective trial comparing the two procedures. All patients were submitted to clinical and Doppler echocardiographic evaluation before the procedures and immediate and twelve months thereafter. RESULTS: Mean mitral gradient (mmHg) decreased from 12.2±5.8 to 5.80±2.7 (p<0.001) in commissurotomy group (CG) and from 11.7±6.1 to 5.0±2.4 (p<0.001) in the balloon valvuloplasty group (VG). Mitral valve area (cm²) increased from 0.98±0.21 to 2.52±0.46 in CG and from 1.05±0.25 to 2.18±0.40 in VG (p<0.001). In both groups there was a slight decrease in mitral valve area at 12 month follow-up. There was no death in either group. One patient in the VG had moderate mitral regurgitation and underwent surgery. At the 12 month follow-up, all patients in CG and 97.7% of patients in VG were in New York Heart Association functional class I or II. CONCLUSION: Both procedures were safe and showed similar immediate improvement in mitral gradient and functional class. Mitral valve area had a greater increase immediately after commissurotomy, however there was a significantly greater reduction in the CG after 12 months of follow-up, when compared to balloon valvuloplasty. In both groups, mitral gradient remained reduced and most patients did not change functional class during the follow-up.

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Artigo Original

Angiography of the coronary venous system. Usefulness in clinical cardiac electrophysiology

Wesley Duílio S. Melo et al. Luis A. Renjel Prudencio Cássia E. Kusnir Ana Lucia N. Pereira … Vera Marques Magno C. Vieira Angelo Amato V. de Paola

PURPOSE: To study the angiographic anatomy of human coronary veins and the possibility of epicardial venous mapping through microelectrode catheters. METHODS: We evaluated 30 patients with sustained ventricular tachycardia using a catheter which provided occlusion of the coronary sinus ostium during venous angiography. They were 25 males, 5 females, ages ranging from 24 to 76 years (mean=52.7). The veins were studied according to their number, caliber and distribution in the anterior and posterior wall of the left ventricle. RESULTS: Coronary sinus was catheterized in all patients. No discomfort or complications were observed. The number of veins from posterior wall of the left ventricle was 3.1 and anterior wall, 1.9, p<0.05. The caliber of the coronary veins were: anterior interventricular vein (distal segment = 1.19±0.22mm, midle segment = 1.65±0.35mm), posterior interventricular vein (distal segment = 1.83±0.47mm, midle segment = 2.00±0.52mm), left posterior vein (distal segment = 1.45±0.25mm, midle segment = 2.49±0.92mm); p<0.05. CONCLUSION: The balloon occlusion technique for coronary venous angiography is feasible and safe. The number and the caliber (distal and midle) of the veins from the posterior wall of the left ventricle were significantly greater than those from the anterior wall. Anatomic conditions for venous epicardial mapping are more adequate in the posterior wall of the left ventricle.

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Artigo Original

Value of pericardial biopsy in the etiologic diagnosis of pericarditis

Fábio Fernandes et al. Barbara Maria Ianni Edmundo Arteaga Luis Benvenutti Charles Mady

PURPOSE: To determine the value of pericardial biopsy as a complementary exam in the etiology of pericardial effusion. METHODS: We analyzed retrospectively (from 1990 to 1997) 38 patients with pericardial effusion. The age ranged between 3 months and 79 years (mean 41.15± 21.78 years). Pericardial biopsy was perfomed in all cases through a subxiphoid incision. RESULTS: In 4 patients (10.5%) the biopsy was able to define etiology, 2 had tuberculosis and 2 neoplasias (1 undetermined adenocarcinoma, 1 mesotelioma). In 34 patients the biopsy showed inespecific chronic pericarditis. CONCLUSION: Pericardial biopsy was not an effective method to determine the etiological diagnosis in pericardial effusion patients. We believe that we have to individualise the indication of pericardial biopsy especially if tuberculosis or neoplasia are suspected.

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Artigo Original

Clinical relationship between Chagas' disease and primary arterial hypertension in an outpatient reference service

Maria Elena Guariento et al. José Eduardo Bagnara Orosz José Antonio Rocha Gontijo

PURPOSE: To evaluate the clinical relationship between Chagas’ disease and primary arterial hypertension. METHODS: The study involved 878 chronic chagasic outpatients followed by the Chagas’ Disease Study Group of the University Hospital (Unicamp), over a 15-year period. Initially, the age, gender, race, clinical form of Chagas’ disease and the presence of hypertension were noted for each patient. Subsequently, the data for matched hypertensive and normotensive chagasic patients were compared. RESULTS: Of the chagasic patients 37% were hypertensive, of those, 65% had some form of heart disease compared to 49% in the normotensive group. Of those patients with Chagas’ disease and arterial hypertension, 41% were blacks and 35% were caucasians. Fifty percent of the hypertensive chagasic patients were over 45 years old compared to only 29% of the non-hypertensive patients. CONCLUSION: Most of the hypertensive chagasic patients were 45 or more years old and showed some degree of heart failure compared to the normotensive group.

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Artigo Original

Valve cardiac surgery during pregnancy. Experience of eight cases

Pablo Maria Alberto Pomerantzeff et al. Anderson Benício Carlos Manuel de Almeida Brandão Walkiria Samuel Ávila … Paulo Cesar Luiz Bueno Max Grinberg Maria Rita Lemos Bortolotto Noedir Antonio Groppo Stolf Adib Domingos Jatene

PURPOSE: To analyze the results of the valve cardiac surgery in pregnant women and cardiopulmonary bypass consequences to the patients and their fetuses. METHODS: Study of 8 pregnant women who underwent cardiac surgery between January of 1986 and December of 1996. Patients’ average age was 31.4±8.9 years and the gestation age ranged from 12 to 31 (average of 26,6±7,1) weeks . Fetus monitorization was performed in all patients. The temperature was always higher than 34°C, as well as high flow rates during the cardiopulmonary bypass. Four surgeries of aortic valve and four of mitral valve were performed, in which two were reoperations. RESULTS: There was no mortality. There were two premature births and in one child there was neurological damage. The other children did not have growth problems. CONCLUSION: Valve cardiac surgery in pregnant women may have good results as long as care in the cardiopulmonary bypass and fetus monitorization are undertaken.

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Relato de Caso

Cardiac asystole during dobutamine stress echocardiography

Rita Pinton et al. Hermínio Haggi Fº Walmor Lemke Olimpio R. França Neto

We report a case of cardiac asystole during dobutamine stress echocardiography in a 59 year-old woman presenting with chest pain and a positive treadmill test for ischemia. Cardiac asystole was not associated with myocardial ischaemia and was probably related to a powerful cardioinhibitory reflex caused by dobutamine stimulation.

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Artigo Original

Comparison of hypercholesterolemic men and women at high risk for atherosclerosis. Study of risk factors and response to pravastatin treatment

Raul D. Santos et al. Raul C. Maranhão

PURPOSE: To compare the prevalence of risk factors, and the response to pravastatin treatment between men and women. METHODS: We evaluated 486 men and 386 women, of these 230 men and 187 women received 10mg of pravastatin for three months. RESULTS: There were differences between women and men in respectively: arterial hypertension (45.5% vs 40.8%; p=0.0012), left ventricular hypertrophy (33.0% vs 22.0%; p=0.0041), sedentarism (94.8% vs 87.8%; p=0.0005), smoking (43.0% vs 61.8%; p<0.0001), Framingham scores (20.0±7.1 vs 16.0±7.6 p<0.001), HDL-C (43.0±11.0 vs 38.0±9.0mg/dL; p<0.001), triglycerides- TG (216.0±115.0 vs 271.0±172.0mg/dL; p<0.001) and Castelli's indexes (CI) I and II (7.7±2.6 vs 8.6±3.2; p=0.002 and 5.0±1.5 vs 5.5±2.0; p=0.015). In men under pravastatin treatment there was a greater reduction in TG (32.0 vs 21.0% p<0.05) and CI I (-41.0% vs -37.0%; p<0.05) and II (-40.0 vs -38.0%; p<0.05). CONCLUSION: Men and women differed in risk factors prevalence and response to treatment with pravastatin.

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Artigo Original

Percutaneous myocardial revascularization procedures in Brazil during 1996-1997 compared to the 1992-1993 period. A report from the Brazilian national registry — CENIC

Amanda G. M. R. Sousa et al. Luiz Alberto P. Mattos Cantídio de Moura Campos Neto Heitor G. Carvalho … Francisco P. Stella Gilberto Nunes

PURPOSE: To report the results of percutaneous coronary interventions, in Brazil, in the years 1996-97, comparing them to those of 1992-93. METHODS: Data were collected in a standard form and the 1996-97 results were compared to those of 1992-93. RESULTS: The current Registry received data from 79% effective members of the SBHCI in 127 hospitals, including 22,025 patients, 60.67% of whom underwent PTCA, 36.57% stent implantation, 2.3% PTRA, 0.06% DCA and 0.4% laser angioplasty. Balloon angioplasty was the most frequent procedure in 1996-97, but its overall rate fell from 65.7% to 55.8% (p=0.0001) concomitantly, there was a 35% relative increase in the use of stents from 1992-93 to 1996-97. The success rate of the later period was higher (89.7% vs 92.8%, p=0.000001), with lower residual stenosis (22% vs 19%, p=0.001). Besides, there were lower major complications rates: acute myocardial infarction (2.5% vs 1.2%, p=0.002) and death (1.8% vs 1.4%, p=0,0003). CONCLUSION: The procedures most often carried out in both periods were balloon angioplasty (60.67%) and implantation of stents (36.57%); the success rate high, abrupt closure rate was low (1.5%). These favorable results corroborate the high standards of the Brazilian Interventional Cardiology.

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Artigo Original

Morphology and stereology of the myocardium in hypertensive rats. Correlation with the time of nitric oxide synthesis inhibition

Leila Maria Meirelles Pereira et al. Glória Maria Moraes Vianna Carlos Alberto Mandarim-de-Lacerda

PURPOSE: To study structural changes of the myocardium in relation to the time of nitric oxide synthesis inhibition. METHODS: Four groups of 10 rats each were studied: 2 control groups and 2 groups with administration of L-Name (50mg/kg/day), one during 25 days and the other during 40 days. The animals were then sacrificed and the hearts were prepared for study in light microscopy, where sections stained by picro-sirius were studied with and without polarized light for analysis of the cardiac interstitium collagen. Volume densities of myocytes (Vv[m]) and interstitium (Vv[int]), the numerical density of myocytes (Nv[m]) and the mean cross-sectional area of myocytes were (A[m]) also determined. RESULTS: The L-Name animals were compared with the respective controls. In the L-Name rats, the tail arterial pressure increased 74.5 and 90.2% in the 25 days group and in the 40 days group, respectively. The heart weight increased 50% in the 25 days group and 28.6% in the 40 days group. The myocardium of the L-Name animals presented myocyte hypertrophy with increased A(m), perivascular and interstitial fibrosis, thickness of the tunica intima and tunica media of the intramyocardial arteries. In the 40 days group the L-Name animals had decreased Vv(m) and Nv(m) and increased Vv(int). CONCLUSION: Inhibition of nitric oxide synthesis provokes myocardial changes that progress with the time of L-Name administration. The stereology is useful to determine and to evaluate the myocardial changes in this model of arterial hypertension.

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