2010;94(5) – ABC CARDIOL

The pericardium can be affected by infectious, neoplastic, inflammatory and metabolic diseases. Many conditions require specific treatment and, consequently, an accurate diagnosis is important. Therefore, the pericardial biopsy has an important role in the evaluation of pericardial effusions. The pericardioscopy offers the advantage of the traditional subxiphoid approach, as it allows access to parts of the pericardium that would not be reached by digital palpation, as well as direct visualization through the subxiphoid window or thoracoscopy. We report the case of a patient with a large pericardial effusion and an undiagnosed mediastinal mass, in which video-assisted pericardioscopy was fundamental in the diagnosis and treatment of the disease.

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Clinicoradiological Session

Case 3/2010 – Two-month-old male infant with fistula from the anterior interventricular coronary artery to the pulmonary trunk

Edmar Atik et al. Alexandre S. Cauduro Marcelo Jatene

CLINICORADIOLOGICAL SESSION

Case 3/2010 – Two-month-old male infant with fistula from the anterior interventricular coronary artery to the pulmonary trunk

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Case Report

Noncompaction of the myocardium in a patient with acute myocardial infarction

Emanuel Correia et al. Luís Ferreira Santos Bruno Rodrigues Pedro Gama … Costa Cabral Oliveira Santos

Left-ventricular non-compaction (LVNC) is a rare congenital cardiopathy, which results from the failure of the myocardial compaction process, leading to the persistence of numerous and deep trabeculations communicating with the ventricular cavity. Its main clinical manifestations are heart failure, arrhythmias (supraventricular or ventricular) and episodes of arterial embolism. The present case reports on a Brazilian patient living in Portugal, who was hospitalized due to acute myocardial infarction, which resulted in severe LV systolic dysfunction. During the patient’s assessment, LVNC was diagnosed. The clinical presentation is described, as well as the echocardiographic evaluation (two-dimensional and three-dimensional), nuclear magnetic resonance (NMR) imaging and ventriculography results. The diagnostic criteria and therapeutic options are discussed.

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Case Report

Ectopic positioning of pacemaker electrode

Gildo Mota et al. Juliana Prazeres Nelmacy Freitas Luiz Magalhães … Francisco Reis Roque Aras

The present case reports on a patient presenting the cardiac form of Chagas disease, with left ventricular dysfunction and second-degree atrioventricular block Mobitz type II, associated with several syncope episodes. The patient underwent a double-chamber definitive artificial pacemaker implant. One year after the implant, the displacement of the atrial electrode was diagnosed and the patient was submitted to re-implantation of the atrial electrode. Two years after the first surgical procedure, the patient presented dyspnea on exertion. The physical evaluation included an echocardiogram, which detected the presence of a foreign body with metallic characteristics in the left cardiac chambers, consistent with that of an ectopic pacemaker electrode.

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Review Article

Heart failure with normal ejection fraction

Meliza Goi Roscani et al. Luiz Shiguero Matsubara Beatriz Bojikian Matsubara

Heart failure with normal ejection fraction (HFNEF) is a complex syndrome that has been broadly studied since the last decade. It is caused by diastolic ventricular dysfunction demonstrated by complementary methods, such as hemodynamic study or echocardiogram, in the presence of a normal ejection fraction (EF). It affects primarily elderly individuals with comorbidities, such as systemic arterial hypertension, coronary failure and obesity. The physiopathological mechanisms are complex and multifactorial, involving the myocardial passive stiffness, the ventricular geometry, the pericardial restraint and the interaction between the ventricles. The main objectives of the treatment were to decrease the pulmonary venous congestion and the heart rate and control the comorbidities. There is no strong evidence that the use of specific medications, such as the angiotensin-converting enzyme inhibitors or beta-blockers can influence mortality. The poorer prognostic factors include advanced age, presence of kidney dysfunction, diabetes, functional class III and IV (NYHA) and advanced-stage diastolic dysfunction, with a restrictive pattern of ventricular filling. Another aspect that has been increasingly cited in the literature is the analysis of the role of the systolic function in HFNEF cases. All these aspects are analyzed in detail in the present review.

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Review Article

Redox unbalance: NADPH oxidase as therapeutic target in blood pressure control

Luiza A. Rabêlo et al. Valéria Nunes de Souza Lucas José Sá da Fonseca Walkyria O. Sampaio

Several studies refer to reactive oxygen and nitrogen species (RONS) as important agents in the pathogenesis of a number of heart diseases, including high blood pressure, arteriosclerosis and heart failure. Such species are highly bioactive molecules and a short life due chiefly to reduction of molecular oxygen. The enzyme complex of NADPH oxidase is the main source of these reactive species in vascular system. Under physiological conditions, formation and elimination of these substances seem balanced in vascular wall. During redox Unbalance, nonetheless, there is increase in NADPH oxidase activity and predominance of pro-oxidizing agents, surpassing the anti-oxidant capacity of the organism self-defense. Besides this, such enzyme hyperactivity reduces the bioavailability of nitric oxide, capital for vasodilation and maintenance of normal vascular function. In spite of NADPH oxidase being directly connected to the endothelial dysfunction, it was firstly described as for its expression in phagocytes, where its activity determines efficiency of organism defense mechanisms against pathogens. Slight differences between structural units of NADPH oxidases, depending on the type of cell which expresses it, may create therapeutic implications, allowing to selectively inhibiting redox unbalance triggered by NADPH oxidase, without compromising, however, its participation in physiological cellular signaling which make sure protection against micro-organisms.

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Letter to the Editor

Quality of life in chronic diseases

Karine Zortéa

LETTER TO THE EDITOR

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