2005;84(5) – ABC CARDIOL

Artigo Original

Valve replacement with the Omnicarbon valve prosthesis: a 10-year follow-up

Santiago Florez et al. Salvatore Di Stefano Yolanda Carrascal Juan Bustamante … Enrique Fulquet José Ramón Echevarria Casquero Elena Javier Gualis Luis Fiz

OBJECTIVE: We retrospectively examined the outcomes of 264 patients who underwent consecutive Omnicarbon valve implantation surgery between April 1985 and May 1995. METHODS: At the time of surgery, patients who received this mechanical prosthesis averaged 57±11 years of age. Omnicarbon valves were placed in the aortic position in 36% of the cases, in the mitral position in 44%, and in both positions in 20%. Follow-up was carefully performed, with most patients undergoing physical examination at our clinic. While taking the case history, cardiac physicians specifically questioned the patient about valve-related complications. RESULTS: Accumulated total patient-years is 1291, with a mean follow-up time of 5.4 years. Survival at 10 years is 79.4±3.9%, including all causes of death and early mortality. Complications recorded during the 11-year study include: thromboembolism (0.1%), hemorrhage (0.4%), endocarditis (0.2%), and nonstructural failure (1.2%). No hemolytic anemia, valve thrombosis, or structural failure was detected during this long-term experience. Functional capability of these patients was subjectively assessed by the NYHA classification system. With follow-up time averaging over 5 years, 97% of our Omnicarbon valve patients are in NYHA I or II. CONCLUSION: The Omnicarbon mechanical prosthesis provides a good clinical performance for up to 10 years in both the aortic and mitral positions. Results indicated a low incidence of thromboembolism and of hemorrhagic complications.

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Artigo Original

Texture of mitral bioprosthesis, ventricular function and formation of thrombus: analysis through transesophageal echocardiography and use of bioscore

Henry Abensur et al. Max Grinberg José A. F. Ramires

OBJECTIVE: Facing the hypothesis of participation of mechanical stress as a cause of mitral bioprosthesis dysfunction, we decided to assess the relation of preservation of the texture of the mitral bioprosthesis leaflets with left ventricular function, in addition to the casual formation of thrombus in left atrium in patients with left ventricular dysfunction from the implant of mitral bioprosthesis. METHODS: Forty 40 patients with mitral bioprosthesis through multiplane transesophageal echocardiogram were studied and divided in two groups: with left ventricular dysfunction (FE=0.40±0.09) since the bioprosthesis implant (20 patients: age 47.75±11.10 years old and surgery time 5.3±2.6 years) and with normal left ventricular function (FE=0.73±0.06) since the implant (20 patients: age 49.75±13.59 years old and surgery time 5.7±3 years). The texture of bioprosthesis leaflets was analyzed through a transesophageal echocardiographic score (FACIMT Bioscore): 1) Fusion of leaflets (score 1 to 3); 2) Apposition of tissues (score 1 to 3); 3) Calcium in leaflets (score 1 to 5); 4) Integrity of leaflets (score 1 to 3); 5) Motility of leaflets (score 1 to 4) and 6) Thickness of leaflets (score 1 to 3). The presence of thrombi in left atrium was assessed through multiplane scanning of the left atrium and left atrial appendage in the transesophageal study. RESULTS: There was no significant difference in the texture of bioprosthesis mitral position between the groups, for the total score (8.7±2.4 vs. 7.9±2.1, p=0.259), and for each analyzed item. A greater incidence of thrombi in left atrium and left atrial appendage was detected in patients with ventricular dysfunction (65% vs. 20%, p=0.004). CONCLUSION: The left ventricular dysfunction was not a protecting factor of the texture of bioprosthesis leaflets in mitral position in the tardive post-surgery period. The patients with left ventricular dysfunction showed a more favorable environment for the formation of thrombi in left atrium.

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Artigo Original

Cost of heart failure in the Unified Health System

Denizar Vianna Araujo et al. Leandro Reis Tavares Renata Veríssimo Marcos Bosi Ferraz Evandro Tinoco Mesquita

OBJECTIVE: To describe the direct and indirect costs of ambulatory and in-patient treatments of heart failure during 2002, in the University Hospital Antônio Pedro, Niterói. METHODS: A cross-sectional and retrospective study on utilization and valuation of resources in 70 patients, consecutively selected, under ambulatory and in-patient treatment. Questionnaires and records of the patients were used for data collection. The resources used were valuated in Brazilian Reais (2002). The study’s point of view was the perspective from society. The data were analyzed in the EPINFO program, 2002 version. RESULTS: The studied population consisted of 70 patients (39 women), with average age of 60.3 years old. 465 in-patients days (28.5% of the patients) took place. There were 386 ward hospitalizations and 79 in ICUs. The cost with ambulatory appointments was R$ 14.40. The expenses with ambulatory medications amounted R$ 83,430.00 (R$ 1,191.86/patient/year). The cost per hospitalized patient was R$ 4,033.62. The cost with complementary examinations totaled R$ 39,009.50 (R$ 557.28/patient/year). Twenty patients retired due to heart failure, which represented a loss in productivity of R$ 182,000.00. The total cost was R$ 444,445.20. Hospitalization represented 39.7% and the use of medications 38.3% from direct costs. CONCLUSION: The hospitalization cost and the expenses with medications represented the main components of direct costs. Indirect costs represented economic impacts similar to direct costs.

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Artigo Original

Sustained improvement in symptoms and exercise capacity up to six months after autologous transendocardial transplantation of bone marrow mononuclear cells in patients with severe ischemic heart disease

Hans Fernando R. Dohmann et al. Emerson C. Perin Radovan Borojevic Suzana A. Silva … Andre L. S. Souza Guilherme V. Silva João A. R. Assad Maria I. D. Rossi Claudio T. Mesquita Hans J. Dohmann

OBJECTIVE: This study aimed at assessing the effects of autologous transendocardial transplantation of bone marrow mononuclear cells (ATTBMMC) on symptoms, exercise capacity, myocardial perfusion and contractility in patients with severe ischemic heart disease during a 6-month follow-up period. METHODS: This prospective study comprised 21 patients as follows: the first 14 patients forming the treated group, and the last 7 patients forming the control group. Initially, all patients underwent clinical and laboratory assessment, treadmill testing, echocardiography, myocardial scintigraphy, and 24-hour Holter. The bone marrow mononuclear cells (BMMC) were isolated, washed, and diluted in 0.9% saline solution for transendocardial injection in areas of viable myocardium in the treated group, (15 0.2-mL injections). All patients were reassessed in the end of 2 and 6 months of follow-up. RESULTS: The demographic data and other characteristics did not significantly differ between the groups in the initial evaluation. No major adverse events related to the ATTBMMC were observed. In the end of 6 months, a reduction in the ischemic area was observed on nuclear perfusion imaging (P=0.05), as was a significant improvement in symptoms, functional capacity, and left ventricular overall function. CONCLUSION: This study showed that transendocardial injections of BMMC are safe in human beings with ischemic heart disease associated with severe ventricular dysfunction. The effects observed in the short run were maintained up to the sixth month of follow-up.

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Artigo Original

Assessment of the correlation between hemoglobin concentration and the echographic measurement of biventricular outer diameter in anemic fetuses of isoimmunized women

Rosangela Lopes Miranda Rodrigues et al. Alamanda Kfoury Pereira Marcos Roberto Taveira Isabela Gomes de Melo … Gabriel Costa Osanan Antônio Carlos Vieira Cabral

OBJECTIVE: To assess whether a significant correlation exists between the echographic measurement of biventricular outer diameter and the pretransfusional serum concentration of fetal hemoglobin and whether that echographic measurement can be used as a noninvasive marker of fetal anemia. METHODS: A prospective cross-sectional study was carried out comprising 65 cordocenteses performed in 36 anemic fetuses of mothers with isoimmunization to the Rh antigen. The biventricular outer diameter (BOD) was obtained by M-mode evaluation. Previous to the transfusion, a 0.5-mL fetal blood sample was obtained for hemoglobin measurement with spectrophotometry in the Hemocue device. The minimum square regression was used with p < 0.05 and multivariate analysis were used as statistical analysis. RESULTS: An inverse correlation was observed between the fetal hemoglobin concentration before transfusion and the BOD measurement, and a direct correlation was observed between the BOD measurement and gestational age. In addition, multivariate analysis showed that fetal hemoglobin concentration decreases as BOD increases, independently of the influence of gestational age on that parameter. CONCLUSION: An inverse correlation exists between fetal hemoglobin concentration and BOD measurement, regardless of gestational age. The findings suggest that BOD may become an echographic predictor of the hemoglobin level of fetuses of isoimmunized pregnant women.

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Artigo Original

The role of echocardiography as an isolated method for indicating surgery in patients with congenital heart disease

Lilian Maria Lopes et al. Ana Paula Damiano Gláucia Neusa Oliveira Moreira Terezinha J. F. Azevedo … Célia Toshie Nagamatsu Gláucia Maria Penha Tavares Victor Coimbra Guerra José Pedro da Silva Gláucio Furlanetto André Bavaresco Cristóvão Salvador

OBJECTIVE: To determine the diagnostic accuracy of echocardiography for indicating surgery without catheterization in patients with congenital heart disease through a prospective analysis and comparison of the echocardiographic diagnosis with the intraoperative findings, or invasive study, or both. METHODS: From February 2000 to January 2001, 493 patients with congenital heart diseases indicated for surgery were followed up. They underwent echocardiography with color-flow mapping for a therapeutic decision. The results were compared with the findings of surgery or catheterization, or both, when the latter were performed for diagnostic reasons. RESULTS: Of the patients studied, 94.3% (465 cases) underwent congenital heart disease correction based only on echocardiographic findings, without a diagnostic catheterization. The invasive study was performed for diagnostic reasons in 28 (5.6%) patients, the surgical treatment was performed in more than 95% of the patients, and therapeutic catheterization was performed in 3.6%. The echocardiographic findings were confirmed in 464 (94.1%) patients, which showed the high accuracy of the method. False-positive findings occurred in 8 (1.6%) patients, and false-negative findings in 39 (7.9%). According to surgeons, no diagnostic error led to complications or adversely affected the surgical results. CONCLUSION: Echocardiography proved to be a sensitive and safe method for indicating surgery, making catheterization, often, unnecessary. The invasive study was restricted to diagnostic or therapeutic uses.

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Relato de Caso

Magnetic resonance imaging in a patient with pacemaker

Jaime Giovany Arnez Maldonado et al. Maria Euda Pereira Karina Rabelo de Albuquerque Jorge Pires

The patient is a 24-year-old female with a dual-chamber pacemaker, who had intracranial hypertension, progressive visual loss, and several inconclusive cranial tomographies. She underwent magnetic resonance imaging, even though that diagnostic method is absolutely contraindicated in patients with pacemakers.

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Artigo Original

Percutaneous mitral balloon valvotomy: long-term outcome and assessment of risk factors for death and major events

Ivana Picone Borges et al. Edison Carvalho Sandoval Peixoto Rodrigo Trajano Sandoval Peixoto Paulo Sergio de Oliveira … Mario Salles Netto Pierre Labrunie Marta Labrunie Ricardo Trajano Sandoval Peixoto Ronaldo de Amorim Villela

OBJECTIVE: To identify the factors that predict death and combined events, (death, new mitral balloon valvotomy, or mitral valve surgery) in long-term follow-up of patients undergoing percutaneous mitral balloon valvotomy. METHODS: Follow-up was 49.0±31.0 (1 to 122) months. Techniques used were the single-balloon (84.4%), Inoue-balloon (13.8%), and double-balloon techniques (1.7%). RESULTS: Included in the study were 289 patients 38.0±12.6 years of age (range, 13 to 83). Before the procedure, 244 patients had echocardiographic score 8. Females comprised 85%, and 84% patients were in sinus rhythm. During follow-up, survival of the total group was 95.5%, that of the group with 8 was 82.2% (P<0.0001), whereas combined event-free survival was 83.4%, 86.1%, and 68.9%, respectively (P 8 and the presence of severe valvular mitral regurgitation during the procedure. The events that predicted combined events were a previous history of mitral valvular commissurotomy and atrial fibrillation and the presence of severe mitral valvular regurgitation during the procedure, and postprocedure mitral valvular area < 1.5 m² (failure). CONCLUSION: Percutaneous mitral balloon valvotomy is an effective procedure, and over 2/3 of the patients were event-free at the end of follow-up. Survival in the group was high, even higher in the group with lower echocardiographic scores.

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Artigo Original

Evaluation of the Omron 705-CP blood pressure measuring device for use in adolescents and young adults

Erika Arai Furusawa et al. Maria Franqueline Osório Ruiz Maria Ignês Saito Vera Hermina Koch

OBJECTIVE: To assess the Omron 705-CP monitor for measuring blood pressure in adolescents and young adults. METHODS: According to the protocols of the British Hypertension Society and the Association for the Advancement of Medical Instrumentation, we performed validation of the device in 60 adolescents. The Omron monitor was connected in Y to a mercury column. Four consecutive and simultaneous measurements were taken with the mercury column sphygmomanometer and the test device, were independently analyzed, and the mean differences between the blood pressure measurements and the standard deviations of those differences were calculated. The results were analyzed according to the grading system of the protocol used. RESULTS: Two hundred and forty measurements were evaluated. The mean age of the patients was 16.3 years. When the measurement performed with the mercury column sphygmomanometer was compared with that taken with the device, a difference < 15 mmHg was observed in 97.9% of the systolic and 98.8% of the diastolic blood pressure measurements; a difference < 10 mmHg was observed in 86.3% of the systolic and 90.4% of the diastolic blood pressure measurements, which was classified as grade A; a difference < 5 mmHg was observed in 59.1% of the systolic and 67% of the diastolic blood pressure measurements, and was classified as grade A/B. The mean difference and the standard deviation of that difference for the systolic blood pressure was 2.91±6.42 mmHg, and, for the diastolic blood pressure, it was 1.16±5.79 mmHg. CONCLUSION: The Omron 705-CP monitor proved to be useful for measuring blood pressure in adolescents according to the protocol used.

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Artigo Original

Prevalence of cardiovascular risk factors in child and adolescent students in the city of Maceió

Maria Alayde Mendonça da Silva et al. Ivan Romero Rivera Maria Roseane Mendonça Tenório Ferraz Aluísio José Tavares Pinheiro … Sheyla Waleska dos Santos Alves Adriana Ávila Moura Antonio Carlos Camargo Carvalho

OBJECTIVE: To determine the prevalence of systemic arterial hypertension (SAH), “risk of overweight,” overweight, sedentary lifestyle, and smoking in children and adolescents from 7 to 17 years of age, of both sexes, in public and private schools in the city of Maceió, in the state of Alagoas. METHODS: A cross-sectional epidemiological study with sampling from a population pool was carried out. It comprised elementary and middle schools, randomly selected. The sample was calculated based on the expected lower prevalence of the variables studied. The assessment protocol comprised a structured questionnaire, anthropometry, and blood pressure measurements. The chi-square test was used to analyze the association among variables. RESULTS: In 2001, 1,253 students (547 of the male sex; mean age, 12.4±2.9 years) were assessed. The results were as follows: 1.172 students participated in no moderate to intense physical activity; “risk of overweight” and overweight were present in 116 and 56 individuals, respectively; blood pressure in the > 95th percentile was identified in 97 students; and only 30 students admitted smoking regularly. The following significant associations were observed: “risk of overweight” and overweight in private school students (*P=0.0001) and sedentary lifestyle in the female sex (*P=0.0001). CONCLUSION: The prevalence of a sedentary lifestyle, “risk of overweight,” overweight, systemic arterial hypertension, and smoking in the population studied was 93.5%, 9.3%, 4.5%, 7.7%, and 2.4%, respectively.

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Editorial

Stem cell therapy: a new perspective for the treatment of ischemic heart failure

Domingo Marcolino Braile et al. Moacir F. de Godoy

EDITORIAL

Stem cell therapy. A new perspective for the treatment of ischemic heart failure

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Artigo Original

Temporal tendency of in-hospital lethality due to acute myocardial infarction: 1994-2003

Marco Antonio de Mattos et al. Daniele Gusmão Toledo Carlos Eduardo de Mattos Bernardo Rangel Tura … Diego Neri Benevides Gadelha Aristarco Gonçalves de Siqueira Filho

OBJECTIVE: To analyze the temporal tendency of lethality due to acute myocardial infarction (AMI) and if the change in behavior directly interfered in such lethality. METHODS: 1055 non-selected patients, who were hospitalized in coronary unit from 1994 to 2003, were assessed. Clinical and therapeutic profile-related variables were analyzed. The statistic analysis used the exponential damping of temporal series and other techniques, such as the logistic linear regression. RESULTS: The average lethality was 10.8%, being 12% in 1994 and 7% in 2002 (p=0.000), a relative reduction of 58%. There was no significant variation in the risk profile of the patients. There were 67.4% of men and 32.4% of women, with an average age of 60.93 and 64.84 years old, respectively. It was observed a significant increase in the percentage of cardiac catheterization (from 14% to 51%), in the angioplasty carried out 24 hours after the infarction (from 2% to 33%), in the surgery for myocardial revascularization (from 4% to 7%) and in the primary angioplasty (from 4% to 11%) with p=0.000, p=0.021, p=0.000 and p=0.000, respectively, for linear tendency. In the first 24 hours there was an increase of the use of aspirin and beta-blockers, from 78% to 100% and, from 33% to 76% (p=0.003 and p=0.004, respectively) along the years. After the analysis, the myocardial reperfusion therapy, the use of aspirin and beta-blocker in the first 24 hours of the AMI (p=0.010, p=0.024 and p=0.035, respectively) kept on being lethality determiners. CONCLUSION: There was a decrease in lethality and the change of behavior in the treatment of AMI along the years was responsible for the reduction of lethality in that temporal series.

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Artigo Original

Post-extrasystolic potentiation in chronic Chagas' heart disease: a radiologic contrast ventriculography study

José Mário M. Brandão et al. Andrea Miziara Geraldo Luiz de Figueiredo Moysés O. Lima-Filho … Elias M. Ayres-Neto José Antonio Marin-Neto

OBJECTIVE: To determine the existence and frequency of the phenomenon of post-extrasystolic potentiation in dysynergic myocardial areas of patients with chronic Chagas’ heart disease studied by use of radiologic contrast ventriculography. METHODS: This study is a semiquantitative retrospective analysis of radiologic contrast ventriculography in patients with chronic Chagas’ disease, who were consecutively studied to assess the mechanisms of ventricular tachycardia. RESULTS: Of the 72 patients initially included, in only 20 patients was possible the ventriculographic analysis for the purposes of this study. The phenomenon of post-extrasystolic potentiation was observed in 11 (55%) of these patients, and a 15.31% improvement was observed in the contractility score from the baseline to the post-extrasystole condition (P=0.0001). That phenomenon occurred even in ventricular segments with an intense deficit in contractility. CONCLUSION: The phenomenon of post-extrasystolic potentiation is observed in a significant proportion of patients with chronic Chagas’ heart disease, in whom the phenomenon could be angiographically analyzed, indicating the existence of potentially recruitable contractile reserve in ventricular regions, showing marked dysynergy. Additional studies for clarifying the underlying mechanisms are required.

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Artigo Original

Lipidic profile of individuals without cardiopathy with overweight and obesity

Fernando Araújo et al. Alice T. Yamada Marinalva V. M. Araújo Maria do Rosário D. O. Latorre Alfredo J. Mansur

OBJECTIVE: To assess the lipidic profile of overweight and obese individuals submitted to cardiologic assessment and who did not show evidences of cardiopathy. METHODS: Sample with 684 individuals, 389 (56.9%) women and 295 (43.1%) men, with age ranging from 14 to 74 (average of 40.6) years old, without evidences of cardiopathy after clinical assessment and analysis of electrocardiogram, thorax radiography, ergometric test on treadmill and two-dimensional Doppler echocardiogram. The serum profile of lipids and glucose regarding sex and ranges of body mass index (BMI) – eutrophic up to 24.9 Kg/m², overweight 25-29.9 Kg/m² and obese > 30 Kg/m², was studied. RESULTS: The following means showed a significant statistic difference between the sexes: glucose (mg/dL) in women 90.21±23.13 and men 95.28±28.64 (p<0.001); triglycerides (mg/dL) in women 97.27±55.24 and men 141.47±57.06 (p<0.001) and HDL-C (mg/dL) in women 52.63±13.92 and men 43±10.88 (p<0.001). The average BMI in women was 26.15 and in men 26.33 (p=ns). In the analysis through BMI ranges there was a significant difference between the sexes (p=0.037). In the categories of overweight and obesity, only the means of triglycerides in women showed a significant statistic difference: overweight women with 102.25±60.68 mg/dL and obese 121.64±63.57 mg/dL (p=0.034). CONCLUSION: Women without cardiopathy showed serum levels of glucose, triglycerides and HDL-cholesterol lower than men's. In both sexes, the means are lower in the comparison with eutrophic and overweight, and only the triglycerides average of women with overweight and obesity showed significant statistic difference.

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