2005;84(3) – ABC CARDIOL

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Anomalous T waves in the complete left bundle branch block in the non-compaction cardiomyopathy of the left ventricle

Lurildo R. Saraiva et al. Ricardo Loureiro Djair Brindeiro Filho

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Anemia as a prognostic factor in a population hospitalized due to decompensated heart failure

Ana Luíza F. Sales et al. Humberto Villacorta Leandro Reis Evandro Tinoco Mesquita

OBJECTIVE: To study the prevalence and prognostic value of anemia in a population hospitalized due to decompensated heart failure. METHOD: From July to September, 2001, 204 patients were included in a multicenter hospital registry of heart failure (EPICA Study _ Niterói). This retrospective analysis comprised 142 patients with data about hematocrit and hemoglobin levels collected on hospital admission. The mean age was 69.5±13.3 years, and 72 (50.7%) patients were men. Hemoglobin levels < 13.5 g/dL for men and < 12 g/dL for women were considered anemia. The relation between anemia and in-hospital mortality was assessed through univariate and multivariate analysis with logistic regression. RESULTS: Anemia was observed in 89 (62.6%) patients, 52 (58%) men and 37 (42%) women. Mortality in anemic patients was 16.8% and, in nonanemic, it was 8% (P=0.11). In both sexes, the mortality rates in anemic and nonanemic patients were, respectively, 19.2% vs 0% (P=0.034) and 13.5% vs 12.2% (P=0.86). Through multivariate analysis, the following variables were found to be independently related to in-hospital mortality: hyponatremia [RR=7.0; 95% confidence interval (95% CI)=6.1 to 8.7; P=0.0001], anemia (RR=3.1, 95% CI=2.4 to 4.3; P=0.024), and presence of NYHA functional class IV (RR=1.9; 95% CI=1.3 to 2.6; P=0.04). CONCLUSION: In the population studied with decompensated heart failure, the presence of anemia was an independent marker of in-hospital mortality. Mortality in the group with anemia was significantly high among men.

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Editorial

Myocardial revascularization in patients with multivessel disease

Alexandre A. C. Abizaid et al. Dimytri Alexandre Siqueira

EDITORIAL

Myocardial revascularization in patients with multivessel disease

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Case Report

Pheochromocytoma in childhood

Gesmar Volga Haddad Herdy et al. Maria Cecília Olivaes Vânia Glória Silami Lopes Carlos Adriano Gazanego Pontes … João Batista Ormond Filho Eliene C. Fonseca

Pheochromocytoma is a neoplasia of chromaffin cells that is very rare in children. Its signs and symptoms result from the release of catecholamines. We report the case of a child with pheochromocytoma of difficult clinical management, confirmed on the anatomicopathological study, and cured after surgical resection.

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Artigo Original

Relation between left atrial dimension and exercise capacity in endomyocardial fibrosis

Charles Mady et al. Vera Maria Cury Salemi Barbara Maria Ianni Fábio Fernandes Edmundo Arteaga

OBJECTIVE: To assess whether exercise capacity is related to left atrial dimension (LAD) in patients with biventricular endomyocardial fibrosis. METHODS: This study comprised 38 patients in sinus rhythm, with a mean age of 37.5 ± 11.5 years (range, 11 to 59 years), 25 of whom were women. They were divided into 2 groups according to the NYHA functional class on hospital admission as follows: group A (12 patients) and group B (26 patients). All patients underwent cardiopulmonary exercise testing to determine their maximum oxygen consumption (VO2 max), and their left atrial dimension was determined on echocardiography. RESULTS: The VO2max values for groups A and B were 21.8 ± 4.8 mL.kg-1.min-1 and 13.7 ± 3.5 mL.kg-1.min-1, respectively, and the left atrial dimensions were 3.7±0.7cm and 4.4±0.7cm for groups A and B, respectively. A significant and inverse correlation was found between VO2max and LAD in the groups studied. CONCLUSION: The increase in left atrial dimension is associated with impairment in exercise capacity in patients with endomyocardial fibrosis. Our findings support the use of left atrial dimension to estimate a more complex and difficult to assess index of functional capacity, such as VO2max.

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Quantitative assessment of left ventricular regional wall motion in endomyocardial fibrosis

Charles Mady et al. Vera Maria Cury Salemi Barbara Maria Ianni Edmundo Arteaga … Fábio Fernandes Felix J A Ramires

OBJECTIVE: To analyze left ventricular (LV) regional wall motion in patients with endomyocardial fibrosis (EMF). METHODS: The study comprised 88 patients, 59 of the female sex, with a mean age of 39±13 years (range, 9 to 65) and with echocardiographic and angiographic evidence of left ventricular EMF. The intensity of fibrous tissue buildup on contrast cineventriculography was classified as mild, moderate, or severe. The overall left ventricular ejection fraction (LVEF) was determined by using the area-length method on ventriculography. The motion was measured in 100 equidistant chords perpendicular to the centerline drawn in the middle of the final diastolic and systolic contours and normalized to cardiac size. Five left ventricular segments were analyzed: A – apical; AL – anterolateral; AB – anterobasal; IA – inferoapical; IB – inferobasal. Abnormality was expressed in units of standard deviation of the mean motion in a normal population of reference, comprised of 103 patients with normal LV according to clinical and electrocardiographic data, and angiographic standards. RESULTS: Mean LVEF was 0.47±0.12. Fibrous tissue buildup in the left ventricle was mild in 12 patients, moderate in 40, and severe in 36. The regions with the poorest ventricular wall motion were A (-1.4±1.6 standard deviation/chords) and IA (-1.6±1.8 standard deviation/chords) compared with that in AB (-0.3±1.9 standard deviation/chords), AL (-0.5±1.8 standard deviation/chords) and IB (-0.9±1.3 standard deviation/chords). No relation was observed between the intensity of fibrous tissue buildup and regional ventricular wall motion. CONCLUSION: A change in LV regional wall motion exists in EMF, and it is independent of the intensity of fibrous tissue buildup qualitatively assessed. Nonuniform involvement of the LV should be considered when planning surgery for this disease.

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Batimastat-eluting stent implantation for the treatment of coronary artery disease: results of the Brazilian pilot study

Cristiana Marques de Araujo et al. Gustavo Adolfo B. Rando Maria Fernanda Z. Mauro Salvador A. B. Cristóvão … Isaac S. Moscoso Sanchez Adnan Ali Salman João B. de Oliveira Neto José Armando Mangione

OBJECTIVE: The excellent results obtained with sirolimus (rapamicin)-eluting stents for preventing restenosis have motivated the evaluation of other substances with that property. Batimastat is a highly effective metalloproteinase enzyme blocker, with the potential to reduce the degradation of extracellular matrix and to inhibit the migration of smooth muscle cells, with the consequent capacity to control coronary restenosis. METHODS: From October 2001 to April 2002, 34 patients were prospectively selected with de novo lesions in a native coronary artery >50% and < 100%, which could be treated with stents of 3 to 4 mm in diameter and 18 mm in length. The primary outcome of the study was to assess the occurrence of major cardiovascular events (death of cardiac origin, acute myocardial infarction, and the need for revascularizing the target vessel) by the 30th day and fourth month; the secondary outcome of the study was to assess the rate of coronary restenosis 4 months after implantation and subacute thrombosis by the 30th day. RESULTS: The success rate of the procedure was 97.1%. The primary outcome occurred in 2.9% and 27.2% of the patients by the 30th day and fourth month, respectively. The binary restenosis rate on angiography was 39.3%. No episode of subacute thrombosis occurred. The comparative analysis between groups with and without restenosis showed no significant difference between both, except for late luminal loss, which was greater in G-I. CONCLUSION: Batimastat-eluting stents had a good safety profile; however, they were not effective in controlling coronary restenosis.

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Amiodarone causes endothelium-dependent vasodilation in canine coronary arteries

Alfredo José Rodrigues et al. Paulo Roberto Barbosa Evora Ayako Maruo Hartzell V. Schaff

OBJECTIVE: To assess the vasodilating effects of amiodarone on canine coronary arteries by using solutions of amiodarone dissolved in polysorbate 80 or water. METHODS: Rings of coronary arteries, with or without intact endothelium, were immersed in Krebs solution and connected to a transducer for measuring the isometric force promoted by a vascular contraction. The arteries were exposed to increasing concentrations of polysorbate 80, amiodarone dissolved in water, amiodarone dissolved in polysorbate 80, and a commercial presentation of amiodarone (Cordarone). The experiments were conducted in the presence of the following enzymatic blockers: only indomethacin, Nw-nitro-L-arginine associated with indomethacin, and only Nw-nitro-L-arginine. RESULTS: Polysorbate 80 caused a small degree of nonendothelium-dependent relaxation. Cordarone, amiodarone dissolved in water, and amiodarone dissolved in polysorbate 80 caused endothelium-dependent relaxation, which was greater for amiodarone dissolved in polysorbate and for Cordarone. Only the association of indomethacin and Nw-nitro-L-arginine could eliminate the endothelium-dependent relaxation caused by amiodarone dissolved in polysorbate 80. CONCLUSION: The results obtained indicate that vasodilation promoted by amiodarone in canine coronary arteries is mainly caused by stimulation of the release of nitric oxide and cyclooxygenase-dependent relaxing endothelial factors.

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Case Report

Large coronary-pulmonary artery fistulae: percutaneous embolization with microcoils and disposable balloons

Antenor Portela et al. Benjamim Pessoa Vale Raldir Bastos João Francisco de Sousa … Itamar Costa Jayro Paiva

A 43-year-old symptomatic woman (dyspnea and palpitation) had multiple coronary-pulmonary artery fistulae with high output; percutaneous embolization was successfully performed using controlled-release microcoils and disposable balloons.

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Artigo Original

Effects of the prolonged inhibition of the angiotensin-converting enzyme on the morphological and functional characteristics of left ventricular hypertrophy in rats with persistent pressure overload

Edson Antonio Bregagnollo et al. Katashi Okoshi Isamara Fernanda Bregagnollo Carlos Roberto Padovani … Marina P. Okoshi Antonio Carlos Cicogna

OBJECTIVE: To assess the effects of lisinopril (L) on mortality (M) rate and congestive heart failure (CHF), and the characteristics of geometrical myocardial remodeling and left ventricular function in rats with supravalvular aortic stenosis (SAS). METHODS: Some Wistar rats underwent SAS or the simulated surgery (CG, n=10). After 6 weeks, the animals were randomized to receive lisinopril (LG, n=30) or no treatment (SG, n=73) for 15 weeks. Cardiac remodeling was assessed in the sixth and 21st weeks after the surgical procedures through concomitant echocardiographic, hemodynamic, and morphological studies. RESULTS: The M were 53.9% and 16.7% in SG and LG, respectively; the incidence of CHF was 44.8% and 20%, in SG and LG, respectively, (P<0.05). At the end of the experiment, the values of LV systolic pressure in SG and LG were equivalent and significantly greater than those in CG;(P<0.05) and did not differ from those observed 6 weeks after the surgical procedures. The values of LV diastolic pressure in SG were greater than those in LG;(P<0.05), and both were greater than those in CG;(P0.05), and both were greater than those in SG;(P<0.05). Similar results were obtained with the values of the positive and negative first derivate of LV pressure. CONCLUSION: In rats with SAS, the treatment with L reduced M rate and ICC and had beneficial effects on geometrical myocardial remodeling and left ventricular function.

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Initial analysis of the use of the L-D-Hydro (Eato L-D-Hydro) organic tubular graft for performing the modified Blalock-Taussig procedure in congenital heart diseases with decreased pulmonary blood flow

Wilson Luiz da Silveira et al. Mirna de Sousa Fernanda A. Oliveira Peixoto Rogério Souza Lobo … Mailza A. Costa Rios Carlos César Elias de Souza Fabiana A. Penachi Bosco Ferreira Lincoln Henrique Costa João Alberto Pansanni Adélio Ferreira Leite

OBJECTIVE: To analyze the initial results of the use of an organic tubular graft for systemic-pulmonary anastomoses. METHODS: From March 2002 to April 2003, 10 patients underwent systemic-pulmonary shunt of the modified Blalock-Taussig type, using a new type of biological graft originating from the bovine mesenteric artery treated with polyglycol, the so-called L-D-Hydro. The patients’ ages ranged from 3 days to 7 years, and 60% of them were of the male sex. The diagnoses of heart disease were determined on echocardiography. All patients had clinical signs of severe hypoxia (cyanosis). The heart diseases were as follows: tetralogy of Fallot (40%), tricuspid atresia (50%), and atrioventricular septal defect (10%). RESULTS: One patient died due to sepsis and 9 had an immediate improvement in O2 saturation on pulse oximetry and in the partial oxygen pressure on arterial blood gas analysis. The intensive care unit length of stay ranged from 2 to 6 days. No patient had obstruction of the shunt on the immediate postoperative period or any other complication. All patients had a patent shunt on the echocardiographic studies performed in the immediate postoperative period and later, in the third postoperative month. No bleeding occurred during surgery or in the postoperative period. CONCLUSION: The tubular L-D-Hydro graft proved to be promising for performing systemic-pulmonary shunt as an alternative for the inorganic products available in the market, however, we need a greater number of implantations and late follow-up for definitive assessment.

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Comparative study of the results of coronary artery bypass grafting and angioplasty for myocardial revascularization in patients with equivalent multivessel disease

Paulo Roberto Dutra da Silva et al. Whady Armindo Hueb Luiz Antônio Machado César Sérgio Almeida de Oliveira José Antônio Franchini Ramires

OBJECTIVE: To investigate the relative efficacy of different therapeutic strategies in patients with symptomatic multivessel coronary artery disease with preserved ventricular function. The primary objectives were defined as a combination of death of cardiac origin, acute myocardial infarction (AMI), and refractory angina that required revascularization, and the secondary objectives were defined as anginal state and exercise-induced ischemia. METHODS: Of the 20,769 patients assessed on cine coronary angiography at InCor, 210 were chosen for this study and were randomized either for coronary artery bypass grafting (CABG, n=105) or transluminal coronary angioplasty (TCA, n=105). RESULTS: A mean of 3.2±0.8 vessels received anastomoses and 2.1±0.8 were successfully dilated in the CABG and TCA groups, respectively. In a 5-year follow-up, the rates of events in the CABG and TCA groups were, respectively: mortality, 9.52% and 12.38%; acute myocardial infarction, 2.85% and 8.57% (P = 0.0668); and additional intervention, 2.85% and 24.76% (P < 0.001). The survival rate was 88.39% for CABG and 84.93% for TCA; the respective AMI-free percentages were 84.40% and 77.40%. In the CABG and TCA groups, 62% and 60% of the patients had no angina, respectively. The exercise tests were considered nonischemic in 62.5% and 62.1% of the patients in the CABG and TCA groups, respectively. CONCLUSION: In multivessel patients, compared with angioplasty, coronary artery bypass grafting was associated with a lower incidence of long-term events and a reduced need for new interventions (P=0.001).

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Comparative analysis of the flows of left internal thoracic artery grafts dissected in the pedicled versus skeletonized manner for myocardial revascularization surgery

Gustavo Peressoni Castro

OBJECTIVE: To compare the free blood flow, caliber, and length of the left internal thoracic artery (LITA), dissected in the pedicled (P) and skeletonized (S) manners, during surgery before and after topical vasodilator (TV) application. METHODS: A randomized, blind, clinical trial was carried out with 50 patients undergoing elective myocardial revascularization to assess the use of the LITA in situ in its pedicled or skeletonized form. The 25 patients in the pedicled group (GP) had NYHA class II or III angina, ejection fraction (EF) of 50.8±9.2%, and 16 were of the male sex. The patients in the skeletonized group (SG) had NYHA class II angina, EF of 46.8±9.3%, and 19 were of the male sex. The measurements were performed before extracorporeal circulation and divided into 2 phases: phase 1 (before topical papaverine application) and phase 2 (15 min after topical application of papaverine, 2.5 mg/mL, at 37ºC). During the measurements, mean blood pressure, central venous pressure, and heart rate were monitored. RESULTS: The phase 1 and 2 results are as follows: 1) PG: blood flow, 46±16 and 77±28 mL/min; caliber, 1.4±0.1 and 1.7±0.1 mm, respectively; 2) SG: blood flow, 57±27 and 97±35 mL/min; and caliber, 1.4±0.1 and 1.8±0.2 mm, respectively. No significant differences were observed in length. CONCLUSION: The LITA in SG had a significant increase in blood flow and caliber after the use of TV compared with blood flow and caliber in PG (P=0.03 and P=0.01, respectively).

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Multiple simultaneous embolisms of right and left coronary arteries

Moacir Fernandes Godoy et al. Thiago Augustus Portes Paulo Leandro Alves Bernardo Flávio Correa Pivatelli

IMAGEM

Multiple simultaneous embolisms of right and left coronary arteries

[…]

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Editorial

Cardiovascular risk factors in Brazil: the next 50 years!

Carisi Anne Polanczyk

EDITORIAL

Cardiovascular risk factors in Brazil: the next 50 years!

[…]

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Artigo Original

Echocardiographic monitoring of balloon atrial septostomy

Carlos Henrique de Marchi et al. Moacir Fernandes de Godoy Márcio Antônio dos Santos Airton Camacho Moscardini … Sírio Hassen Sobrinho Ulisses Alexandre Croti

OBJECTIVE: To assess balloon atrial septostomy monitored with echocardiography. METHODS: From August 1997 to January 2004, 31 infants with congenital heart diseases indicated for balloon atrial septostomy underwent the procedure with exclusive echocardiographic monitoring. Success was defined as the obtainment of an atrial septal defect diameter > 4 mm and ample mobility of its margins. RESULTS: The male sex predominated (83.9%). The median age was 5 days (1 – 150), and the median weight was 3,300 g (1,800 – 7,500). Transposition of the great arteries occurred in 80.6% of the patients, tricuspid valve atresia in 12.9%, total anomalous pulmonary venous drainage in 3.2%, and pulmonary atresia with intact septum in 3.2%. The procedure was successful in all patients. The size of the atrial septal defect increased from 1.8 ± 0.8 mm to 5.8 ± 1.3 mm (P < 0.0001) and oxygen arterial saturation from 64.5 ± 18.9% to 85.1 ± 9.2% (P < 0.0001). The following complications occurred: 3 balloon ruptures, one lesion of the right femoral vein, one supraventricular tachycardia, and one atrial flutter. CONCLUSION: Balloon atrial septostomy monitored with echocardiography is a safe and effective procedure. It may be performed at bedside, avoiding transporting of the patient, identifies the catheter location, reduces the occurrence of severe complications, and assesses the immediate result of the procedure.

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