2004;82(1) – ABC CARDIOL

Artigo Original

Effectiveness of metoprolol in preventing atrial fibrillation and flutter in the postoperative period of coronary artery bypass graft surgery

Eraldo de Azevedo Lúcio et al. Adriana Flores Celso Blacher Paulo E. Leães … Fernando A. Lucchese Jorge Pinto Ribeiro

OBJECTIVE: To assess the effectiveness of metoprolol in preventing clinically detectable atrial fibrillation (AF) and flutter after coronary artery bypass graft (CABG) surgery . METHODS: An open, randomized study was carried out to treat 200 patients who had undergone isolated CABG surgery with extracorporeal circulation. The patients were randomized to either receive metoprolol orally or not to receive the medication in the postoperative period. The outcomes were the detection of sustained atrial AF and flutter, which were symptomatic or required treatment. The patients with the following characteristics were excluded from the study: baseline left ventricular ejection fraction < 35%; previous AF; history of bronchospasm; second- and third-degree atrioventricular blocks, low cardiac output, and heart failure. RESULTS: Arrhythmias occurred in 11 out of 100 patients in the metoprolol group and in 24 out of 100 patients in the control group (P=0.02). The relative risk (RR) was 0.46 (95% CI = 0.24-0.88), and the number necessary to treat (NNT) and avoid the outcome was 8 patients. AF was the arrhythmia most frequently observed (30/35). In 38 patients aged 70 years or more, the arrhythmias occurred in 2 out of 19 patients in the metoprolol group and in 10 out of 19 patients in the control group (c2 Yates: P=0.01). The relative risk was 0.20 (95% CI = 0.05-0.79) and the number necessary to treat was 2 patients. CONCLUSION: Metoprolol is effective in preventing AF and flutter in the postoperative period of CABG surgery, and this effect was more evident in the group of elderly patients.

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Artigo Original

Prenatal study of fetal endocardial hyperrefringence and its relation to maternal toxoplasmosis

Luiz Henrique Soares Nicoloso et al. Tiene Zingano Henke Paulo Zielinsky

OBJECTIVE: To compare a group of fetuses whose mothers had acute or recent toxoplasmosis with a group of fetuses whose mothers had no systemic disease, analyzing the presence of changes in endocardial refringence. METHODS: This study assessed 91 fetuses of mothers diagnosed with acute or recent toxoplasmosis, detected by seroconversion or the presence of elevated IgM and IgG titers, confirmed through the IgM-capture ELISA. They were compared with a control group comprising 182 fetuses selected from a low-risk population participating in a prenatal screening program for heart diseases. RESULTS: No significant difference was observed between the mean gestational (29.2±4.6 weeks; 29.2±4.6 weeks) and maternal (25.7±6.7 years; 26±5.4 years) ages in the 2 groups. Areas of endocardial hyperechogenicity were observed in 69 fetuses whose mothers had toxoplasmosis (75.8%) and in only 6 fetuses of the control group (3.3%) (P<0.001). In 52 patients of the group studied (75.4%), endocardial hyperrefringence was diffuse, and, in 17 (24.3%), it was focal. In the control group, focal distribution was observed in 5 fetuses (83.3%). CONCLUSION: The prenatal echocardiographic image of focal or diffuse endocardial hyperrefringence is more prevalent in pregnancies with maternal toxoplasmosis than in the healthy ones, and an association between fetal endocardial hyperechogenicity and maternal disease exists.

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Artigo Original

Effects of propafenone associated with propofol on myocardial contractility, heart rate, coronary flow, and the incidence of arrhythmia in isolated hearts of rats

Nilcéa Leal de Moraes Assis et al. Otoni Moreira Gomes Silvério Leonardo Macedo Garcia Guilherme Gustavo do Valle

OBJECTIVE: To study the influence of propafenone associated with propofol on myocardial contractility (dP/dt and heart rate), coronary flow, and the incidence of arrhythmia in isolated rat hearts. METHODS: Forty albino rats were anesthetized with sulfuric ether, a modified Langendorff method was performed, and the rats were fed with Krebs-Henseleit (K-H) solution, (95% O2, 5% CO2, pH 7.4±0.1, perfusion pressure between 90 and 100cm of water, and temperature 37± 0.5ºC). Control records were obtained after a stabilization period and rats were distributed into the following 4 groups: I (control), II (100mcg propafenone), III (25mcg propofol), and IV (propafenone-propofol). RESULTS: A decrease (P<0.05) in the heart rate in groups II and IV was observed, with a greater decrease in group II. A decrease was noted in the dP/dt ratio (P< 0.05) in groups II and IV, during all periods. Group III experienced depression from the 1st to the 3rd minute. Coronary flow had a decrease (P<0.05) in all groups, compared with the control group, especially in group IV with a decrease from 14mL/min to 11mL/min. Arrhythmogenic effects of propafenone (pro-arrhythmia) were verified in 50% of group II. In the association with propofol (group IV), no significant difference occurred, and arrhythmias (pro-arrhythmic effect) were observed in 40% of the hearts. CONCLUSION: The association propafenone-propofol was not harmful to the use of propafenone solely, regarding the effects observed in myocardial contractility, coronary flow, and in the incidence of arrhythmias.

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Artigo Original

Correlation between oxygen consumption calculated using Fick's method and measured with indirect calorimetry in critically ill patients

Flávio Marson et al. Maria Auxiliadora Martins Francisco Antonio Coletto Antonio Dorival Campos Anibal Basile-Filho

OBJECTIVE: To compare the oxygen consumption index measured by using indirect calorimetry (VO2I Delta) with a portable metabolic cart and calculated according to Fick’s principle (VO2 I Fick) in critically ill patients. METHODS: Fourteen patients (10 men and 4 women, mean age 39.4 ± 5.4 years) were analyzed, 5 of them trauma victims and 9 sepsis victims. The following mean scores were obtained for these patients: APACHE II = 21.3±1.8, ISS = 24.8±6, and sepsis score = 19.6±2.3. The mortality risk (odds ratio), calculated from APACHE II, was 41.9±7.1%. All patients underwent mechanical ventilation and invasive hemodynamic monitoring with a Swan-Ganz catheter. VO2 was obtained using the 2 methods (VO2I Delta and VO2I Fick) at 4 different times (T1-T4). RESULTS: A good correlation was found between the 2 methods (r=0.77) for the mean of the 4 serial measurements. No statistically significant differences were observed between indirect calorimetry and Fick’s equation at T1 (VO2I Delta = 138±28 and VO2I Fick = 59±38 mL.min-2.m-2, P=0.10) and T3 (VO2I Delta = 144±26 and VO2I Fick = 158±35 mL.min-2.m-2, P=0.14), but a significant difference was observed at T2 (VO2I Delta = 141±27 and VO2I Fick = 155±26 mL.min-2.m-2, P=0.03) and T4 (VO2I Delta = 145±24 and VO2I Fick = 162±26 mL.min-2.m-2, P=0.01). CONCLUSION: We may state that indirect calorimetry can be used for oxygen consumption analysis in critically ill patients and is as efficient as Fick’s reverse equation, with the benefit of being a noninvasive and risk-free procedure.

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Artigo Original

Prevalence of risk factors for cardiovascular disease in employees of the Research Center at Petrobras

Maria de Fátima Duarte Matos et al. Nelson Albuquerque Souza e Silva Armando Jorge Marques Pimenta Antonio José Ledo Alves da Cunha

OBJECTIVE: To determine the prevalence of risk factors for cardiovascular diseases in employees of the research center at Petrobras. METHODS: In a cross-sectional study, employees of the research center at Petrobras were assessed clinically and by laboratory testing from March 2000 and February 2001. Those who did not attend the periodical annual medical examination of 2000 were excluded from the study. The percentage of risk factor occurrence and the mean standard deviation of the biochemical variables, blood pressure, and body mass index were calculated. RESULTS: Of 1,911 employees, 970 were studied, 75.4% were men and 24.6% were women with a mean age of 42.2 years old. The risk factors were lack of exercise (67.3%), cholesterol > 200 mg/dL (56.6%), overweight (42%), obesity (17%), blood hypertension (18.2%), smoking (12.4%), and diabetes mellitus (2.5%). CONCLUSION: The high prevalence of risk factors for cardiovascular disease in young individuals draws attention to the need for the adoption of workplace programs to encourage healthy lifestyles and to prevent diseases.

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Case Report

Percutaneous balloon aortic valvuloplasty in a pregnant adolescent

Rogério T. Tumelero et al. Norberto T. Duda Alexandre P. Tognon Iselso Sartori Silvane Giongo

We report the case of a 16-year-old pregnant patient with severe aortic stenosis and pulmonary congestion clinically uncontrolled, in whom percutaneous balloon aortic valvuloplasty was used as the first choice of treatment in an emergency procedure. The clinical findings, pathophysiology, diagnostic features, and indications for percutaneous treatment are reported. Severe congenital aortic stenosis is rare in children and young individuals. Bicuspid aortic valve occurs in 3% to 6% of patients with congenital heart disease; when associated with commissural fusion, significant stenosis may be present in childhood. The association of severe congenital aortic stenosis and pregnancy is difficult to control clinically, carrying a high risk of maternal and fetal mortality, mainly when manifested with symptoms of pulmonary congestion 1,2.

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Artigo Original

Surgical treatment of coarctation of the aorta using trapezoidal aortoplasty

Jarbas Jakson Dinkhuysen et al. Tarcisio Luiz Valle de Almeida Ibraim Masciarelli Francisco Pinto Luiz Carlos Bento de Souza

OBJECTIVE: Trapezoidal aortoplasty is a technical variant of end-to-end anastomosis, which, based on elements of geometry, aims at increasing the diameter of the aorta at the level of the suture, therefore reducing the occurrence of residual or recurrent pressure gradients in the short and long run. METHODS: After resecting the coarcted area and ductal tissue, 3 trapezoids are confected in each aortic stump, which, when confronted, create a suture line with a sinusoidal aspect (zigzag). Thirty-three patients underwent surgery with this technique, 22 (66.7%) males, with ages ranging from 3 months to 36 years (mean of 9.84 ± 9.69). RESULTS: No immediate or late deaths occurred. Follow-up ranged from 1.1 to 7.6 years (mean of 3.6 ± 3.4). Most patients became asymptomatic with normal blood pressure levels, enabling the discontinuation of antihypertensive therapy (P<0.0001). A significant reduction in the pressure gradients was observed on Doppler echocardiography and during cardiac catheterization (P<0.001). The analysis of the images of aortography showed good anatomical continuity in the region of the anastomosis, and the morphometric study of the aorta revealed the beneficial effects of the technique indicated by the increase in the caliber of the aorta in the distal segment of the arch, isthmus, and descending portion. CONCLUSION: Trapezoidal aortoplasty showed satisfactory clinical results that allow its application in all cases indicated for end-to-end anastomosis.

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Artigo Original

Association between the effect of spontaneous contrast in the thoracic aorta and recent ischemic stroke determined by transesophageal echocardiography

Flavio José Petersen Velho et al. Fernanda Dotta Leonora Scherer Eduardo Bartholomay … Daniela Augusta da Silva Jefferson Gomes Fernandes Marco Antonio Rodrigues Torres

OBJECTIVE: To assess the independent association between the presence of spontaneous echo contrast in the aorta and recent stroke events. METHODS: Two hundred and twenty-four individuals with a diagnosis of recent stroke and 85 control individuals who were examined due to various present/suspected heart diseases were studied through transesophageal echocardiography. The effects of spontaneous contrast in the aorta and the presence of other potential sources of cardiac embolism associated with them were researched and a questionnaire was completed about patients’ clinical risk factors at the time of examination. RESULTS: The effects of contrast in the aorta was associated with stroke (OR=2.83; CI = 95%, 1.65-4.46; P 60 years, a history of systemic blood hypertension and smoking, and dyslipidemia were risk factors independently associated with the effects of contrast in the aorta. The presence of a spontaneous contrast effect in the left atrium and Lambl’s excrescences were echocardiographic factors independently associated with the effects of contrast in the aorta. CONCLUSION: The effect of contrast in the aorta was independently associated with recent stroke and with its clinical risk factors. These results reinforce the hypothesis that the phenomenon is a predictor of several risk factors.

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Artigo Original

Ambulatory blood pressure monitoring in normotensive individuals undergoing two single exercise sessions: resistive exercise training and aerobic exercise training

Ambrosina Maria Lignani de Miranda Bermudes et al. Dalton Valentim Vassallo Elisardo Corral Vasquez Eliudem Galvão Lima

OBJECTIVE: To assess the influence of 2 single exercise sessions on blood pressure in sedentary normotensive individuals: one of resistive exercise training (circuit weight training) and the other of aerobic exercise training. METHODS: Using ambulatory blood pressure monitoring, this study assessed 25 individuals as follows: in a controlled situation at rest (ABPM 1); after resistive exercise training (ABPM 2); and after aerobic exercise training (ABPM 3). Resistive exercise training was performed as circuit weight training with an intensity of 40% of each individual’s maximum strength. The aerobic exercise training was performed on a cycloergometer with intensity between 60% and 70% of the maximum heart rate (HR) reached during previous exercise testing. RESULTS: Systolic blood pressure (SBP) values during 24 hours and during subperiods of wakefulness and sleep showed no statistically significant variations when the results obtained at rest were compared with those of ABPM2 and ABPM3, and when the results of ABPM2 were compared with those of ABPM3. The mean heart rate during 24 hours and in the wakefulness period showed significant increases (P<0.05), when ABPM2 was compared with ABPM3. CONCLUSION: A single session of resistive exercise training in normotensive individuals was sufficient to cause significant reductions in blood pressure levels after exercise in the period of sleep. The session of aerobic exercise training in these same individuals was more effective in significantly reducing blood pressure levels.

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