1998;71(2) – ABC CARDIOL

Relato de Caso

Right ventricle-dependent coronary circulation in pulmonary atresia with intact ventricular septum. Absence of origin of the coronary arteries from the aorta

Ivan Romero Rivera et al. Valdir Ambrósio Moises Celia Camelo Silva Pedro Abujamra … José Lázaro Andrade Antonio Carlos Carvalho

This report describes the clinical, echocardiographic and angiographic aspects of a five-day old boy with pulmonary atresia and intact ventricular septum. Both the echocardiogram and the aortography did not show any coronary arteries arising from the aorta. Two-dimensional echocardiography was able to identify the coronary arteries originating from the right ventricle and so did the right ventricular angiogram. No retrograde flow into the aorta or pulmonary trunk was identified after opacification of the coronary arteries. As far as we know this is the first case diagnosed by echocardiography, and is a vivid example of the necessity of identifying the coronary arteries in patients with pulmonary atresia and intact ventricular septum.

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Ensaios Terapêuticos

Effects of carvedilol (beta1,beta2,alpha1-blocker) on refractory congestive heart failure

Edimar Alcides Bocchi et al. Fernando Bacal Giovanni Bellotti Dirceu Carrara José Antonio Franchini Ramires

PURPOSE: The effects of beta-blockers on severe heart failure are not well known. We investigated the effects of carvedilol (b1,b2,a1-blocker) on symptoms, functional class (FC), and left ventricular function in patients with refractory heart failure. METHODS: We studied 21 patients, mean age 56±10 years, 9 in FC IV, e 12 in FC III (intermittently with class IV). The initial dosage was 6.25mg, and it was increased progressively as tolerated. The mean dose was 42±11mg. The patients were submitted to routine clinical evaluation, and electrocardiogram. We determined after 196±60 days of follow-up the left ventricular end diastolic dimension (by echocardiogram), and left ventricular ejection fraction (using MUGA). RESULTS: Carvedilol was well tolerated by 16 (76%) patients. One patient is in FC II during increment of the dosage. Eight patients were in FC I, and 7 in FC II at 196±60 days of follow-up. Heart rate decreased from 96±15 to 67±10bpm (p<0.0001), left ventricular end diastolic diameter from 73±13 to 66±12mm (p<0.009), and the left ventricular ejection fraction increased from 0.21±0.06 to 0.34±0.12 (p<0.0003). CONCLUSION: Carvedilol may have beneficial effects on cardiac function, remodeling process, and FC. If tolerated, it seems to be a potential alternative option in the medical treatment of refractory heart failure. However, investigations are still necessary to clarify the long-term effects of carvedilol on this specific subgroup of patients.

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Artigo Original

Persistence of AV conduction over the slow pathway after AVRNT radiofrequency ablation and its relation to the recurrences

Márcio A. Silva et al. Maurício I. Scanavacca André D'Avila Ricardo Kuniyoshi Eduardo A. Sosa

PURPOSE: The aim of this study is to verify whether the persistence of conduction over the slow pathway is related to an increased trend for recurrence. METHODS: Recurrence rate was retrospectively analyzed in 126 patients who underwent slow pathway radiofrequency (RF) catheter ablation during a follow-up of 20±12 months. The ablative procedure was interrupted when AVNRT was no longer induced by atrial stimulation after intravenous infusion of isoproterenol. Ninety-eight patients had no evidence of slow pathway whereas 28 patients persisted with AV node jump and atrial echo beat. RESULTS: There were 15 recurrences: 9% of those who had no evidence of slow pathway (9 of 98 patients) and 21% of those with AV node jump and/or atrial echo beat but this difference was not statistically significant. CONCLUSION: As long as AVNRT cannot be induced by atrial pacing and isoproterenol infusion after slow pathway RF catheter ablation, the presence of AV node jump and/or atrial echo beat does not increase the risk of recurrence of AVNRT.

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Relato de Caso

Left atrial myxoma and isquemic stroke in a child

Isabela Thomaz Takakura et al. Moacir Fernandes de Godoy Marcelo José Soares Airton Camacho Moscardini Domingo Marcolino Braile

The authors present a case of left atrial myxoma with stroke in an 8-year-old female child. The tumor was removed and two months after the surgery a left atrial septum mass was observed suggesting recurrence. The child was asymptomatic. Literature review emphasizes the rarity and clinically aggressive behavior of this tumor at this age group and demonstrates rare recurrence rates after surgery.

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Artigo Original

Perinatal asphyxia and heart problems

Gesmar Volga H. Herdy et al. Vânia Glória S. Lopes Maria Luiza S. Aragão Carlos Alberto M. Pinto … Plínio A. Tavares Jr. Fabiano B. Azeredo Pablo M. C. Nascimento

PURPOSE: To evaluate the severity of cardiac complications of neonatal asphyxia in relation to the length and degree of hipoxia. METHODS: Ninety babies with an Apgar score <6 were examined in the intensive care unit at our institution during seven years. Arterial blood for measuring pH, glucose, LDH and MB fraction of CK, together with serial electrocardiogram (ECG), echocardiogram and chest X rays was obtained. The fatal cases were studied with macro and microscopic examination. RESULTS: From a total of 90 cases, 73 were premature: 30 (41%) appropriate for gestation age (AGA) and 43 (59%) small for gestation age (SGA). Twenty one (23%) cases had arterial pH <7.2. The most common clinical conditions were: pneumonia 28 (31%), anemia 24 (26%) and jaundice 12 (13%). The main cardiological findings were: systolic murmur in 46 (50%), signs of heart hypertrophy in 18 (20%) and heart failure in 8 (9%). On ECG the main findings were ST and T abnormalities. The echocardiogram showed a patent ductus arteriosus (PDA) in 20 (22%), tricuspid regurgitation in 6 (7%), pulmonary hypertension in 6 (7%), dyskinesia and ventricular dilatation in 4 (5%). Necropsy was performed in 23 cases and macro and microscopy obtained in 14; the most frequent findings were: myocite necrosis in 8 (54%), congestion, vacuolization and loss of striae in 4 (29%). CONCLUSION: In the majority of cases, patients had a benign course, even those presenting with severe acidemia. Many abnormal EKGs and echocardiograms became normal after a few weeks. Among those who had a fatal outcome, the severity of histological lesions was observed in babies who had suffered asphyxia for more prolonged periods.

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Artigo Original

Prevalence of hypertension in the Passo Fundo (Brazil) metropolitan area

Ibsen S. Trindade et al. Gilberto Heineck Josemar Roberto Machado Henrique Ayzemberg … Maurice Formighieri Mosara Crestani Jefferson Gusso

PURPOSE: To evaluate the present prevalence of hypertension in the Passo Fundo metropolitan area. METHODS: This is an observational, descriptive, crossectional design with populational base, of a representative random sample of the adults of this urban region. The criteria for hypertension were blood pressure >160/95mmHg or antihypertensive treatment. The average of the last three measurements was used in the analysis. Two hundred and six subjects were selected. The interview was made with standardized questionnaires. Blood pressure was corrected for arm diameter. RESULTS: The prevalence of hypertension was 21.9% (CI=19.3 to 24.5) of 45 hypertensive subjects, 53.3% were using anti-hypertensive drugs regularly, however only 20% had normal BP levels. Among the study population 4.4% were diabetics, 33.0% were smokers, 31.4% of the women were using contraceptives, 2.9% were heavy alcohol users, 29.6% were obese. The following conditions of interest were significatively associated with hypertension: age, obesity and diabetes; there was no association with sex, color, heavy alcohol use, smoking and contraceptive use. CONCLUSION: The prevalence of hypertension in the Passo Fundo metropolitan area is within the expected range, however the level of control in this population is not acceptable.

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Relato de Caso

Idiopathic chylopericardium

Fábio Fernandes et al. Edmundo Arteaga Mauro Sérgio Stateri Carvalho Barbara Maria Ianni … Paulo Pego Fernandes Charles Mady

We describe a case of a patient with idiopathic pericardial effusion that during investigation proved to be a chylopericardium. Lymphangiography showed the chylopericardium to be due to partial aplasia of the thoracic duct. A brief review the etiology, clinical feature, diagnostic procedures and therapeutic possibilities of chylopericardium is presented.

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Relato de Caso

Apical hypertrophic cardiomyopathy associated with coronary artery disease

Francisco Manes Albanesi Fº et al. Justiniano Simões Lopes José David Aron Diamant Marcia Bueno Castier … João Alexandre Rezende Assad Rosangela Cruz Lyra

A fifty-nine year old man, known to have hypertrophic cardiomyopathy, presented worsening of angina. Multivessel coronary artery disease was diagnosed, and he underwent myocardial revascularization (mammary and two safenous grafts were implanted) with good evolution and reduction of left atrium dimension.

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Right ventricle-dependent coronary circulation in pulmonary atresia with intact ventricular septum. Absence of origin of the coronary arteries from the aorta

Effects of carvedilol (beta1,beta2,alpha1-blocker) on refractory congestive heart failure

Persistence of AV conduction over the slow pathway after AVRNT radiofrequency ablation and its relation to the recurrences

Left atrial myxoma and isquemic stroke in a child

Perinatal asphyxia and heart problems

Prevalence of hypertension in the Passo Fundo (Brazil) metropolitan area

Idiopathic chylopericardium

Apical hypertrophic cardiomyopathy associated with coronary artery disease

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