1999;73(4) – ABC CARDIOL

Original Article

Exercise and heart failure. Relation of the severity of the disease to the anaerobic threshold and the respiratory compensation point

Guilherme Veiga Guimarães et al. Giovanni Bellotti Mauricio Wajngarten Luzimar Teixeira … José Franchini Ramires Edimar Alcides Bocchi

OBJECTIVE – To identify, the anaerobic threshold and respiratory compensation point in patients with heart failure. METHODS – The study comprised 42 Men,divided according to the functional class (FC) as follows: group I (GI) – 15 patients in FC I; group II (GII) – 15 patients in FC II; and group III (GIII) – 12 patients in FC III. Patients underwent a treadmill cardiopulmonary exercise test, where the expired gases were analyzed. RESULTS – The values for the heart rate (in bpm) at the anaerobic threshold were the following: GI, 122±27; GII, 117±17; GIII, 114±22. At the respiratory compensation point, the heart rates (in bpm) were as follows: GI, 145±33; GII, 133±14; GIII 123±22. The values for the heart rates at the respiratory compensation point in GI and GIII showed statistical difference. The values of oxygen consumption (VO2) at the anaerobic threshold were the following (in ml/kg/min): GI, 13.6±3.25; GII, 10.77±1.89; GIII, 8.7±1.44 and, at the respiratory compensation point, they were as follows: GI, 19.1±2.2; GII, 14.22±2.63; GIII, 10.27±1.85. CONCLUSION – Patients with stable functional class I, II, and III heart failure reached the anaerobic threshold and the respiratory compensation point at different levels of oxygen consumption and heart rate. The role played by these thresholds in physical activity for this group of patients needs to be better clarified.

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Original Article

Percutaneous handling of coronary lesions >20mm through stents. Is there a first choice strategy?

Luiz Fernando L. Tanajura et al. Ibraim M. F. Pinto Luiz Alberto P. Mattos Fausto Feres … Alexandre Abizaid Rodolfo Staico Marinella P. Centemero Áurea J. Chaves Andrea C. Abizaid Amanda G. M. R. Sousa J. Eduardo M. R. Sousa

OBJECTIVE – This study compared the early and late results of the use of one single stent with those of the use of multiple stents in patients with lesions longer than 20mm. METHODS – Prospective assessment of patients electively treated with stents, with optimal stent deployment and followed-up for more than 3 months. From February ’94 to January ’98, 215 patients with lesions >20mm were treated. These patients were divided into 2 groups as follows: Group A – 105 patients (49%) with one stent implanted; Group B – 110 patients (51%) with multiple stents implanted. RESULTS – The mean length of the lesions was 26mm in group A (21-48mm) versus 29mm in group B (21-52mm) (p=0.01). Major complications occurred in one patient (0.9%) in group A (subacute thrombosis, myocardial infarctionand death) and in 2 patients (1.8%) in group B (one emergency surgery and one myocardial infarction) (p=NS). The results of the late follow-up period (>6 months) were similar for both groups (group A = 82% vs group B = 76%; p=NS), and we observed an event-free survical in 89% of the patients in group A and in 91% of the patients in group B (p=NS). Angina (group A = 11% vs group B = 7%) and lesion revascularization (group A = 5% vs group B = 6%; p=NS) also occurred in a similar percentage. No infarction or death was observed in the late follow-up period; restenosis was identified in 33% and 29% of the patients in groups A and B, respectively (p=NS). CONCLUSION – The results obtained using one stent and using multiple stents were similar; the greater cost-effectiveness of one stent implantation, however, seems to make this strategy the first choice.

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Original Article

Percutaneous mitral valvotomy in patients eighteen years old and younger. Immediate and late results

Cláudia Mattos et al. Sérgio Luiz Navarro Braga César Augusto Esteves José Matos Brito Castello Branco … Nisia Lira Gomes Mercedes Maldonado Valmir Fernandes Fontes

OBJECTIVE – To analyze immediate and late results of percutaneous mitral valvotomy (PMV) in patients <= 18 year. METHODS – Between August '87 and July '97, 48 procedures were performed on 40 patients. The mean age was 15.6 years; 68.7% were females four of whom were pregnant. RESULTS – Success was obtained in 91.7% of the procedures. Immediate complications were severe mitral regurgitation (6.3%) and cardiac tamponade (2.0%). Late follow-up was obtained in 88.8% of the patients (mean value=43.2±33.9 months). NYHA functional class (FC) I or II was observed in 96.2% of the patients and restenosis developed in five patients, at a mean follow-up of 29.7±11.9 months. Three patients presented with severe mitral insufficiency and underwent surgery. Two patients died. CONCLUSION – PMV represents a valid therapeutic option in young patients. In these patients, maybe because of subclinical rheumatic activity, restenosis may have a higher incidence and occur at an earlier stage than in others persons.

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Case Report

Growth hormone for optimization of refractory heart failure treatment

Edimar Alcides Bocchi et al. Zyun Massuda Guimarães Guilherme Dirceu Carrara … Giovanni Bellotti Amilcar Mocelin Carlos Roberto Martins Rodrigues Sobrinho José Franchini Ramires

It has been reported that growth hormone may benefit selected patients with congestive heart failure. A 63-year-old man with refractory congestive heart failure waiting for heart transplantation, depending on intravenous drugs (dobutamine) and presenting with progressive worsening of the clinical status and cachexia, despite standard treatment, received growth hormone replacement (8 units per day) for optimization of congestive heart failure management. Increase in both serum growth hormone levels (from 0.3 to 0.8 mg/l) and serum IGF-1 levels (from 130 to 300ng/ml) was noted, in association with clinical status improvement, better optimization of heart failure treatment and discontinuation of dobutamine infusion. Left ventricular ejection fraction (by MUGA) increased from 13 % to 18 % and to 28 % later, in association with reduction of pulmonary pressures and increase in exercise capacity (rise in peak VO2 to 13.4 and to 16.2ml/kg/min later). The patient was “de-listed” for heart transplantation. Growth hormone may benefit selected patients with refractory heart failure.

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Clinicoradiological Session

Syncope in a twenty-three-year-old male

Clinicopathologic Session

Clinicopathologic Session

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Original Article

Edmar Atik et al. Miguel Barbero-Marcial Elisa R. Iwahashi Jorge Y. Afiune Munir Ebaid

OBJECTIVE – To assess neonates with aortic stenosis with early decompensation operated upon. (LCO) (CHF). METHODS – A and retrospective study analyzing 6 neonates with LCO, group I (GI), and 12 neonates with CHF, group II (GII). Clinical radiographic, electrocardiographic and echocardiographic findings also provided comparative bases for the study, as did surgical and evolutional findings. RESULTS – The mean ages at hospitalization and surgery (p = 0.0031) were 14.3 and 14.8 days in GI and 35.4 and 42.8 days in GII, respectively. Cardiac murmurs were more intense in GII (p = 0.0220). The aortic ring was smaller in GI (8.0 ± 2.5mm) as compared to GII (11.4±1.4mm) (p = 0.2882). Ventricular function was reduced to 18±5.5% and 33.3±7.6% in GI and GII, respectively (p = 0.0162). Aortic atresia, however, was present only in 2 neonates in GI. Five of 6 patients in GI died but all patients in GII survived (p=0.0007). In the latter group, 84.6% of the patients were in functional class I (FC-I) in the long-term follow-up, with moderate residual lesions in 6 neonates, discrete residual lesions in 4, and reoperation in 2. CONCLUSION – Aortic stenosis is a severe anomaly of the neonate, whose immediate evolution depends on the pre-operative anatomic and functional findings, and the late evolution essentially depends on the anatomic features of the valve.

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Original Article

Effects of lisinopril on experimental ischemia in rats. Influence of infarct size

Leonardo A. M. Zornoff et al. Beatriz B. Matsubara Luiz S. Matsubara Sérgio A. R. Paiva … Maria T. T. Tornero Joel Spadaro

OBJECTIVE – Angiotensin-converting enzyme inhibitors (ACEIs) have gained importance in preventing or attenuating the process of ventricular remodeling after myocardial infarction. The significance of infarct size in regard to the response to ACEIs, however, is controversial. This study aimed to analyze the effects of lisinopril on mortality rate, cardiac function, degree of cardiac hypertrophy and fibrosis in rats with different infarct sizes. METHODS – Lisinopril (20 mg/kg/day) dissolved in drinking water was administered to rats immediately after coronary artery occlusion. After being sacrificed, the infarcted animals were divided into two groups: one group of animals with small infarcts ( 40% of the left ventricle). RESULTS – The mortality rate was 31.7% in treated rats and 47% in the untreated rats. There was no statistical difference between the groups with small and large infarcts in regard to myocardial concentration of hydroxyproline. In small infarcts, the treatment attenuated the heart dysfunction characterized by lower levels of blood pressure and lower values of the first derivative of pressure and of the negative derivative of pressure. The degree of hypertrophy was also attenuated in small infarcts. In regard to large infarcts, no differences between the groups were observed. CONCLUSION – Treatment with the ACEIs had no effect on mortality rate and on the amount of fibrosis. The protective effect of lisinopril on heart function and on the degree of hypertrophy could only be detected in small infarcts

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Case Report

Chylothorax after myocardial revascularization with the left internal thoracic artery

Paulo Manuel Pêgo-Fernandes et al. Gustavo Xavier Ebaid Gustavo Henrique Nouer Robinson Tadeu Munhoz … Fábio Biscegli Jatene Adib Domingos Jatene

A 38-year-old male underwent coronary artery bypass grafting (CABG). A saphenous vein graft was attached to the left marginal branch. The left internal thoracic artery was anastomosed to the left anterior descending artery (LAD). The early recovery was uneventful and the patient was discharged on the 5th postoperative day. After three months, he came back to the hospital complaining of weight loss, weakness, and dyspnea on mild exertion. Chest X-rays showed left pleural effusion. On physical examination, a decreased vesicular murmur was detected. After six days, the diagnosis of chylothorax was made after a milky fluid was detected in the plural cavity and total pulmonary expansion did not occur. On the next day, both anterior and posterior pleural drainage were performed by videothoracoscopy, and prolonged parenteral nutrition (PPN) was instituted for ten days. After seven days the patient was put on a low-fat diet for 8 days. The fluid accumulation ceased, the drains were removed and the patient was discharged with normal pulmonary expansion.

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Exercise and heart failure. Relation of the severity of the disease to the anaerobic threshold and the respiratory compensation point

Percutaneous handling of coronary lesions >20mm through stents. Is there a first choice strategy?

Percutaneous mitral valvotomy in patients eighteen years old and younger. Immediate and late results

Growth hormone for optimization of refractory heart failure treatment

Syncope in a twenty-three-year-old male

Effects of lisinopril on experimental ischemia in rats. Influence of infarct size

Chylothorax after myocardial revascularization with the left internal thoracic artery

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