2005;85(4) – ABC CARDIOL

Relato de Caso

State of the art percutaneous procedure: octogenarian patient successfully submitted, in a single session, to a pulmonary valvotomy, coronary stent implant and permanent pacemaker implant

Wilson Albino Pimentel Filho et al. Milton de Macedo Soares Neto Gil Vicente Cividanis Rubens Vaz Feijó Júnior

This report describes a case involving an 82 year old patient with mild renal insufficiency, severe pulmonary valve stenosis (PVS), severe anterior descending artery stenosis and complete atrioventricular block, who successfully underwent, in a single session, coronary angioplasty and a stent implant, pulmonary valvotomy and a permanent pacemaker implant.

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Ponto de Vista

Myocardial revascularization without extracorporeal circulation

Enio Buffolo

POINT OF VIEW

Myocardial revascularization without extracorporeal circulation

[…]

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Correlação Anatomoclínica

A 88 year-old man with acute pulmonary edema, cardiogenic schock and holosystolic murmur of recent onset

Fernando Eduardo Cordeiro Barreto et al. Jussara Bianchi Castelli

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Editorial

The meaning of the South American Society of Cardiology

Gilson Soares Feitosa

EDITORIAL

The meaning of the South American Society of Cardiology

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Artigo Original

Erectile dysfunction: a marker for myocardial perfusion impairment?

Juarez Ortiz et al. Sergio Tranchesi Ortiz Claudia Gianini Monaco Cristina Harumi Yamashita … Miriam Cássia Mendes Moreira Carlos Alberto F. Monaco

OBJECTIVE: To study the correlation between erectile dysfunction (ED) and myocardial perfusion impairment in men with suspected or diagnosed coronary artery disease (CAD). METHODS: In this prospective study a self-administered IIEF-5 questionnaire was answered by 287 patients that underwent myocardial perfusion imaging under both resting and stress condition with technetium-99m sestamibi, through gated SPECT nuclear scintigraphy technique, before and after physical or pharmacological stress. RESULTS: Some degree of erectile dysfunction (group ED+) was found in 137 (47.8%) patients and in these, age was significantly higher (60.60±9.84 vs 50.67±9.94 – p<0.001)) than in those without erectile dysfunction (group ED-). In the ED+ group, it was observed a higher prevalence of hypertension, diabetes, myocardial infarction (MI) and percutaneous coronary angioplasty (PCTA). Regardless of the age factor, ED+ patients also presented higher occurrence of myocardial perfusion impairment (necrosis and/or ischemia) and left ventricular systolic wall motion and thickening abnormalities. CONCLUSION: Patients with ED have higher estimated probability of presenting segmental myocardial perfusion and functional contraction impairment and, therefore, CAD, independent of the aging factor. The authors conclude that ED may be considered not only a marker for CAD but also a condition related to the occurrence of major coronary events such as MI and PCTA.

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Atualização

Catheter ablation of atrial fibrillation: techniques and results

Mauricio Ibrahim Scanavacca et al. Eduardo Sosa

UPDATE

Catheter ablation of atrial fibrillation. Techniques and results

[…]

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Artigo Original

Advanced heart failure therapy adapted to hemodynamic objectives acquired from invasive hemodynamic monitoring

Gustavo Luiz Gouvêa de Almeida Júnior et al. Roberto Esporcatte Fernando Oswaldo Dias Rangel Ricardo Mourilhe Rocha … Gustavo de Miranda Gouvêa e Silva Bernardo Rangel Tura José Kezen Camilo Jorge Luiz Eduardo Fonseca Drumond Francisco Manes Albanesi Filho

OBJECTIVE: To assess advanced heart failure (HF) treatment in relation to reduction of ventricular filling pressures, with the use of greater doses of vasodilators, through invasive hemodynamic monitoring. METHODS: Nineteen advanced HF patients were studied, in whom Swan-Ganz catheter was inserted to direct administration of diuretic intravenously (IV) and sodium nitroprusside, with the aim of significantly reduce ventricular filling pressures. After achieving such objective or 48 hours, oral drugs were introduced until venous medicines were removed, keeping hemodynamic benefit. RESULTS: From 19 patients studied, 16 (84%) were of male sex. The average age was 66 ± 11.4 years old; average ejection fraction was 26 ± 6.3%; 2 patients (10.5%) showed functional class (FC) III and 17 (89.5%), FC IV. There was a decrease of pulmonary artery occlusion pressure from 23 ± 11.50 mmHg to 16 ± 4.05 mmHg (p = 0.008), of systemic vascular resistance index from 3,023 ± 1,153.71 dynes/s/cm-5/m² to 1,834 ± 719.34 dynes/s/cm-5/m² (p = 0.0001) and an increase of cardiac index from 2.1 ± 0.56 l/min/m² to 2.8 ± 0.73 l/min/m² (p = 0.0003). A subgroup with hypovolemia was identified. CONCLUSION: It was possible to reduce ventricular filling pressures to significantly lower values, obtaining a significant improvement of cardiac index, systemic vascular resistance index and pulmonary artery mean pressure, by using significantly higher doses of vasodilators.

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Relato de Caso

Percutaneous management of penetrating aortic ulcer

Gustavo Carvalho et al. Maurício de Nassau Machado Robson B. de Carvalho Antônio Carvalho Leme Neto

Penetrating aortic ulcer is a variant of classic aortic dissection having distinct histopathological characteristics. If not appropriately treated, it evolves to combined morbidity and mortality rates as high as those of classic dissection. This condition, therefore, warrants special attention with accurate diagnosis and treatment. Percutaneous management using endoprosthesis is the method of choice, since the patients are usually elderly and have comorbidities that would increase the complication rates of traditional surgery. A 78-year-old woman complaining of thoracic pain was admitted to the hospital; her pain had been radiating to the interscapular and left lumbar regions for four months. Upon diagnostic investigation, a penetrating aortic ulcer was found, and after being successfully treated percutaneously with stent implantation, the patient became asymptomatic and is under outpatient follow-up.

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Image

Fat pulmonary embolism during orthopedic surgery monitored through transesophageal echocardiogram

João Mansur Filho et al. Gustavo Luiz Gouvêa de Almeida Júnior José Kezen Camilo Jorge Serafin Gomes Sá Júnior … João Renato Alcino Affonseca

IMAGE

Fat pulmonary embolism during orthopedic surgery monitored through transesophageal echocardiogram

[…]

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Ponto de Vista

I forbid, therefore I assist

Max Grinberg

POINT OF VIEW

I forbid, therefore I assist

[…]

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Artigo Original

Prospective risk analysis in patients submitted to myocardial revascularization surgery

Antonio Carlos Mugayar Bianco et al. Ari Timerman Ângela Tavares Paes Carlos Gun … Rui Fernando Ramos Ronald Brewer Pereira Freire César Nicolas Conde Vela Antonio Aurélio de Paiva Fagundes Junior Luís Cláudio Behrmann Martins Leopoldo Soares Piegas

OBJECTIVE: To perform a stratified risk analysis in Myocardial Revascularization Surgery (MRS). METHODS: 814 patients were prospectively studied by applying two prognostic indexes (PI): Parsonnet and Modified Higgins. The Higgins PI was modified by substituting the variable “cardiac index value” by “low cardiac output syndrome” at the Intensive Care Unit (ICU) admission. The discriminatory capacity for morbimortality of both indexes was analyzed by ROC (receiver operating characteristic) curve. Logistic reaction identified the associated factors, independently from the events. RESULTS: Mortality and morbidity rates were 5.9% and 35.5%, respectively. The Modified Higgins PI, which analyzes pre- and intra-operative and physiological variables at the ICU admission showed areas under the ROC curve of 77% for mortality and 67% for morbidity. The Parsonnet PI, which only analyzes pre-operative variables, showed areas of 62.2% and 62.4%, respectively. Twelve variables were characterized as independent prognostic factors: age, diabetes mellitus, low body surface, creatinine levels (>1.5 mg/dL), hypoalbuminemia, non-elective surgery, prolonged time of extracorporeal circulation (ECC), necessity of post-ECC intra-aortic balloon, low cardiac output syndrome at the ICU admission, elevated cardiac frequency, decrease in serum bicarbonate concentrations and increase of the alveolar-arterial oxygen gradient within this period. CONCLUSION:The Modified Higgins PI showed to be superior to the Parsonnet PI at the surgical risk stratification, showing the importance of the analysis of intraoperative events and physiological variables at the patient’s ICU admission, when prognostic definition is achieved.

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Artigo Original

In-hospital post-cardiopulmonary-cerebral resuscitation survival prognostic factors

André Mansur de Carvalho Guanaes Gomes et al. Ari Timerman Carlos Alfredo Marcílio de Souza Carlos Maurício Cardeal Mendes … Heitor Portella Póvoas Filho Adriano Martins de Oliveira José Antonio de Almeida Souza

OBJECTIVE: To assess clinical and demographic characteristics of patients who had cardiopulmonary resuscitation and identify short- and long-term survival prognostic factors. METHODS: Four hundred and fifty-two (452) resuscitated patients in general hospitals from Salvador were prospectively assessed through bivariate and stratified analysis in associations between variables and survival curve for a nine-year evolution assessment. RESULTS: Age ranged from 14 to 93 years old, mean of 54.11 years old. Male gender patients prevailed and half of them had at least a base disease. Cardiovascular disease was the responsible etiology in 50% of cases. Cardiac arrest was observed in 77% of cases and only 69% of patients were immediately resuscitated. Initial cardiac rhythm was not diagnosed in 59% of patients. Asystole was the most frequent rhythm (42%), followed by ventricular arrhythmia (35%). Immediate survival was 24% and hospital discharge survival 5%. Cardiac arrest etiology, initial cardiac rhythm diagnosis, ventricular fibrillation or tachycardia as arrest mechanism, pre-resuscitation estimated time lower than or equal to 15 minutes and resuscitation time lower than or equal to 5 minutes were recognized as short-term prognostic factors. Non-administration of epinephrine, being resuscitated in private hospital and resuscitation time lower than or equal to 15 minutes were nine-year evolution survival prognostic factors. CONCLUSION: Data may help healthcare professionals decide when start or stop in-hospital resuscitation.

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Artigo Original

Cardiac longitudinal study of children perinatally exposed to human immunodeficiency virus type 1

Maria Suely Bezerra Diógenes et al. Regina Célia de Menezes Succi Daisy M. Machado Valdir Ambrósio Moisés … Neil Ferreira Novo Antonio Carlos Carvalho

OBJECTIVE: To determine the frequency of cardiac abnormalities and its natural history in children perinatally exposed to HIV-1. METHODS: Eighty-four children exposed to HIV-1 were evaluated by serial clinical, electrocardiographic (ECG), and Doppler-echocardiographic (ECHO) examinations. RESULTS: Group I – (seroreversion) – 43 children (51.2%). Absence of clinical abnormalities. ECG: incomplete right bundle branch block (RBBB) 5 cases. ECHO: atrial septal defect (ASD) and ventricular septal defect (VSD) – 1 case each. Group II – 41 HIV-infected children (48.8%), of whom 51.2% were found to have cardiac abnormalities. Asymptomatic or mildly symptomatic children without immunosuppression: no clinical and echocardiographic abnormalities; ECG: incomplete right bundle branch block (RBBB) – (2 cases). Children with moderate and severe symptoms and immunological impairment: the following abnormalities were found: 1) clinical (31.7%)-isolated tachycardia (1 case), congestive heart failure (12 cases). 2) electrocardiographic (43.9%)- sinus tachycardia associated with other abnormalities (10 cases), incomplete right bundle branch block (5 cases), left anterior hemiblock (1 case), right anterior hemiblock (1 case), changes in ventricular repolarization (11 cases), right ventricular overload (2 cases), left ventricular overload (1 case), right QRS axis deviation (1 case), and arrhythmias (3 cases). 3) echocardiographic (26.8%)- dilated cardiomyopathy (5 cases), pericardial effusion with tamponade (2 cases), pulmonary hypertension (2 cases), and mitral valve prolapse (1 case). CONCLUSION: Cardiac involvement was a characteristic of the HIV-infected group. Higher prevalence of abnormalities was found among children belonging to the most advanced clinical and immunological category. The most commonly observed clinical, electrocardiographic and echocardiographic findings were congestive heart failure (CHF), changes in ventricular repolarization, and dilated cardiomyopathy, respectively. The latter was reversible in one case. Electrocardiogram changes were significantly more frequent than clinical and echocardiographic changes.

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