2005;85(5) – ABC CARDIOL

Relato de Caso

Left internal thoracic artery to left pulmonary artery fistula after coronary artery bypass graft surgery: a rare cause of myocardial ischemia

Gustavo Luiz Gouvêa de Almeida Júnior et al. José Kezen Camilo Jorge Augusto César de Araújo Neno Fernanda Beloni dos Santos Nogueira … Bruno Hellmuth Roberto Hugo da Costa Lins Renato Vilella Valdo José Carreira Ivo Thadeu José Pedro da Silva

We report a patient who developed dyspnea on mild exertion six years after coronary artery bypass graft surgery (CABG). Myocardial ischemia was documented by radionuclide imaging, and coronary angiography showed patency of all grafts and a large fistula between the left internal thoracic artery (LITA) and the left pulmonary artery (LPA). The patient was submitted to surgical closure of the fistula and made an excellent recovery.

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Image

Aorta-right ventricle fistula: an unexpected complication of bacterial endocarditis

Gustavo Carvalho et al. Reinaldo B. Bestetti Moacir Godoy Patrícia Cury Antônio C. Leme Neto

IMAGE

Aorta-right ventricle fistula. An unexpected complication of bacterial endocarditis

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Artigo Original

Balanced cardiovascular disease mortality from 1980 to 1999 – Brazil

Gláucia Maria Moraes Oliveira et al. Nelson Albuquerque Souza e Silva Carlos Henrique Klein

OBJECTIVE: To compare trends in mortality rates from cardiovascular diseases (CVD), ischemic heart diseases (IHD) and cerebrovascular diseases (CBVD) in the States of Rio de Janeiro (RJ), São Paulo (SP) and Rio Grande do Sul (RS) and respective capitals from 1980 to 1999. METHODS: Data regarding CVD deaths were obtained from Datasus, and those regarding populations were obtained from IBGE. Crude and sex and age-adjusted mortality rates were calculated using the direct method (standard population: State of Rio de Janeiro’s population twenty years of age or older in 2000). Because of the relevant increase in mortality from ill-defined causes in the city and State of RJ as of 1990, the deaths were balanced prior to adjustments. The trends were analyzed using linear regressions. RESULTS: Annual declines of balanced and adjusted mortality ranged from -11.3 CVD deaths/100,000 inhabitants in the city and State of RJ to -7.4 in the city of SP. IHD mortality rates were similar in the State and city of RJ and in Porto Alegre, and lower in the city of SP (-2.5 deaths/100,000 inhabitants). CBVD mortality rates ranged from -6.0 to -2.8 deaths/100,000 inhabitants in the State of RJ and in Porto Alegre, respectively. CONCLUSION: A decline in balanced and adjusted CVD, IHD and CBVD mortality rates was observed from 1980 to 1999 in the three States and capitals. In the State and city of RJ declines in IHD were clear as of 1990, whereas declines in CBVD occurred throughout the period studied.

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Artigo Original

Serial clinical and echocardiographic evaluation in children with Marfan syndrome

Victor Manuel Oporto Lopez et al. Ana Beatriz Alvarez Perez Valdir Ambrósio Moisés Lourdes Gomes … Patricia da Silveira Pedreira Célia C. Silva Orlando Campos Filho Antônio Carlos C. Carvalho

OBJECTIVE: To describe the clinical cardiac manifestations and temporal evolution of Marfan syndrome in children; to estimate the incidence of annuloaortic ectasia and mitral valve prolapse; and to evaluate tolerability and efficacy of beta-blockers in these patients. METHODS: During one year, 21children with Marfan syndrome underwent serial clinical and echocardiographic examinations. Echocardiograms assessed: the presence of mitral valve prolapse, aortic root diameter, mitral and aortic valves regurgitation, and aortic enlargement during beta-blocker therapy. Eleven patients had two measurements of the aortic root taken one year apart. RESULTS: The children were asymptomatic throughout the study. Mitral prolapse was found in 11 (52%) children. Annuloaortic ectasia occurred in 16 (76%) patients and found to be mild in 42.8%, moderate in 9.5%, and severe in 23.8%. One of these patients underwent aortic valve replacement and repair of the ascending aorta by the Bentall-De Bono technique, with good results. Heart rate decreased by 13.6% (from 85 to 73 bpm; p < 0.009) with the use of beta-blockers; however, aortic root diameter increased by 1.4 mm/year (p<0.02). One child could not be given beta-blockers due to bronchial asthma, and no significant side effects were observed in the remaining children, including one who also had bronchial asthma. CONCLUSION: The children remained asymptomatic throughout the study, the use of beta-blockers led to a significant decrease in heart rate, and no significant adverse effects were observed. Contrary to the literature, incidence of annuloaortic ectasia was high among the study population, greater than that of mitral valve prolapse, even during beta-blocker therapy.

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Relato de Caso

Mycotic femoral pseudoaneurysm after 11 years of catheterism

Marcello Barbosa Barros et al. Arturo Almazán Francisco S. Lozano

The authors report the unusual case of a 52-year-old mountain climber that presented with pain and swelling in his right thigh which revealed to be a ruptured mycotic pseudoaneurysm with no history of recent trauma or other apparent cause. The patient reported a past history of myocardial infarction 11 years before, with the performing of two femoral catheterisms for coronary angiography. He denied any episode of fever or diagnosis of bacteraemia at that time or later, nor any other complaint during these 11 years. The rarity of the case, the appearance of this extremely late complication together with the patient’s kind of sportive activity prompted us to publish the case.

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Relato de Caso

Mechanism of cardiac resynchronization therapy by real-time three-dimensional echocardiography in patients with heart failure

Marcelo Luiz Campos Vieira et al. Prasad V. Maddukuri Robert S. Phang Natesa G. Pandian … Wilson Mathias Júnior José A. F. Ramires

We report the case of a 66-year-old man with heart failure NYHA class IV treated with biventricular pacing for cardiac resynchronization. The patient was evaluated by real-time three-dimensional transthoracic echocardiography before and 48 hours after pacemaker implantation. The use of three-dimensional echocardiography contributed to understanding the underlying mechanism involved in cardiac resynchronization therapy by demonstrating enhanced synchrony of myocardial segments, which resulted in the patient’s clinical improvement.

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Relato de Caso

Coronary artery aneurysm one year and five months after sirolimus-eluting stent placement

Luciano Abreu et al. George César Ximenes Meireles Antonio Artur Forte Marcos Sumita … Jorge Hayashi José Solano

A 52-year-old man with diagnosis of post-infarction unstable angina. Coronary angiography revealed 90% luminal obstruction in the middle third of the right coronary artery and 90% in the marginal branch of the circumflex artery. After the administration of clopidogrel 300 mg associated with acetylsalicylic acid, the patient underwent the implantation of a sirolimus-eluting stent (CYPHER; Johnson & Johnson Cordis) 2.5 x 1.8 mm in the lesion located at the left marginal branch. One year and five months after the CYPHER stent implantation, a new angiography showed intrastent coronary aneurysm at the left marginal branch. This case report suggests that the implantation of a sirolimus-coated coronary stent may cause late formation of coronary artery aneurysm.

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Ponto de Vista

Treating hypertension in the doctor's office

Paulo César B. Veiga Jardim

POINT OF VIEW

Treating hypertension in the doctor’s office

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Artigo Original

Heart failure mortality trend in Salvador, Bahia, Brazil

Adriana Lopes Latado et al. Luiz Carlos Santana Passos Rodrigo Guedes Alessandra B. Santos … Marianna Andrade Simone Moura

OBJECTIVE: To assess mortality trend due to heart failure (HF) in Salvador – Bahia, from 1979 to 1995. METHODS: HF was defined by notations from the 9th Review of International Disease Code (IDC9) 428.0, 428.1 and 428.9. HF death and population data (metropolitan area of Salvador) were obtained by means of Secretaria de Saúde da Bahia (Bahia State Health Secretariat) and Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Mortality rates (/100,000) were total or per gender and age, and gross or adapted per age (straight standardization). RESULTS: Mortality rates due to HF had a progressive reduction in the period of time assessed, for both genders, especially up to 1992. From then and up to 1995, there was an apparent stabilization of the curves. Gross mortality rate went from 25.0/10(5), in 1979, to 16.4/10(5) inhabitants, in 1995 (a decrease of 34.4%). The reduction was 34.0% (23.3/10(5), in 1979, to 15.4/10(5) inhabitants, in 1995) for male sex and 35.2% (26.7/10(5), in 1979, to 17.3/10(5) inhabitants, in 1995), for female sex. The same trend took place in several age ranges, including the population > 40 years old, which has a greater risk for HF. After adaptation per age (standard population of 1979), it is observed that relative reductions in the rates were even greater. CONCLUSION: Mortality due to HF, in Salvador-Bahia, decreased from 1979 to 1992, becoming stable from then to 1995.

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Atualização

Visiting immunology

Nelson Monteiro Vaz et al. Vitor Pordeus

UPDATE

Visiting immunology

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Editorial

Health indicators in Brazil

Aloyzio Cechella Achutti

EDITORIAL

Health indicators in Brazil

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Artigo Original

Depression and acute coronary syndromes: gender-related differences

Glória Heloise Perez et al. José Carlos Nicolau Bellkiss Wilma Romano Ronaldo Laranjeira

OBJECTIVE: Investigate whether social and demographic characteristics, clinical diagnosis, smoking status, alcohol consumption, and anxiety are associated with depression in patients with Acute Coronary Syndromes (ACS) stratified by gender. METHODS: Three hundred forty-five consecutive patients with unstable myocardial ischemic syndrome (206 with myocardial infarction and 139 with unstable angina) were interviewed. The interviews included questions about sociodemographics, smoking status, screening for depression (Prime MD e BDI), trait and state anxiety, (IDATE), and alcohol consumption (AUDIT). RESULTS: Diagnosis of depression has significantly correlated with female gender, age under 50 years, and higher average scores on trait anxiety and state anxiety. Depressed men (245) were usually younger than 50 years of age, smokers and had higher average score on trait anxiety and state anxiety than those non-depressed. The multivariate analysis highlights that age is negatively associated with depression (OR 0.9519 95% CI 0.9261 – 0.9784) and that higher scores on trait anxiety are positively associated (OR 1.0691 95% CI 1.0375 – 1.1017) with depression in the male gender. In the female sample (100), depressed women differ from non-depressed women in that they have a higher average score on trait anxiety and state anxiety. In the multivariate analysis of the female sample, a higher score on trait anxiety was independently associated with depression (OR 1.1267 95% CI 1.0632 – 1.1940). CONCLUSION: It was concluded that, among hospitalized patients with ACS, women, as well as men under 50 years and who suffer from anxiety are more likely to experience depression.

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