2017;30(2) – ABC CARDIOL

Case Report

Progression of Left Valve Disease during Use of Dopaminergic Drugs

Lívia Santana Barbosa et al. Ana Clara Tude Rodrigues Shirlei Novillo Pereira Hugo Leonardo Medeiros Vieira … Kamila Fernanda Staszko José Lázaro Andrade

Abstract

Cabergoline and bromocriptine are dopaminergic drugs deriving from ergot and used for treating hyperprolactinemic idiopathic disorders or pituitary adenomas, whose mechanism of action results from the reduction of prolactin secretion. Some reports in the literature show that cabergoline can cause valvular heart disease after long-term administration. We report the case of a patient diagnosed with macroprolactinoma who did interleaved use of cabergoline and bromocriptine and developed valvular abnormalities that did not exist before.

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Original Article

Echocardiography: The Examination Request by the Pediatriciant Achieving the Pediatric Cardiologist

Lene Garcia Barbosa et al. Amanda Bentes Rios de Freitas Mariana Aparecida Brunossi Moura Proença Célia Maria Camelo Silva

Summary

Background

Echocardiography is a diagnostic tool used to evaluate cardiac anomalies and clarify doubts about the benign nature of certain findings of cardiovascular clinical examination.

Objectives

To identify the main reasons for the request of echocardiography by pediatrician and evaluate the degree of anxiety of the family generated by this conduct.

Methods

We included patients younger than 18 years without previous diagnosis of heart disease and referred for the first echocardiogram. Family members responsible for the patients answered a questionnaire to assess the degree of their anxiety from order to the performance of the echocardiogram, with scores between 0 and 19. Data were analyzed using percentages, standard deviation and Student’s t test.

Results

Studied 30 patients with a mean age of 4.45 years. The most prevalent reason for referral was heart murmur (23 cases), of which 70% patients had no congenital heart disease hypothesis confirmed, after echocardiography. The average score on the anxiety questionnaire was 11 ± 6 significantly associated with the presence of heart disease, with a mean of 13.0 ± 5.3 vs. 9.3 ± 5.2 in the group without the possibility of it (p = 0.007).

Conclusion

The murmurs findings was the main reason for echocardiography request by the pediatrician. Confirmation of heart disease was higher in children under 1 year and with murmurs findings. Despite the anxiety level was higher in the group of patients who were diagnosed with congenital heart disease, this was not negligible in the family in the group of patients without heart disease. (Arq Bras Cardiol: Imagem cardiovasc. 2017;30(2):39-45)

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Image

Intrathoracic Mesothelial Cyst in Pediatric Patient

João Carlos Geber Júnior et al. Cláudia Regina Zaramello Ana Maria Silveira Rosendo Pedreira

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Case Report

Quadricuspid Aortic Valve Replaced via Minithoracotomy: A Short Case Report

Cássio Carvalho Soeiro Machado et al. Márcio Silva Miguel Lima Carlos Manuel de Almeida Brandão Elinthon Tavares Veronese … Jeane Mike Tsutsui Wilson Mathias Júnior

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Case Report

LV Pseudoaneurysm after Acute Myocardial Infarction

Eduardo Cavalcanti Lapa Santos et al. Aluísio Roberto Andrade Macedo Júnior André Gustavo Santos Lima Paloma Peter Travassos … Leonardo Godoy de Mello Motta Fernando Augusto Marinho dos Santos Figueira

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Original Article

Diastolic Function Assessment with Doppler Echocardiography and Two-Dimensional Strain

José Maria Del Castillo et al. Eugenio Soares de Albuquerque Carlos Antônio da Mota Silveira Diana Patrícia Lamprea Antonia Dulcineide Medeiros Sena

Summary

Background

The evaluation of left ventricular (LV) diastolic dysfunction presents a significant number of indeterminate dysfunctions, especially when ejection fraction (EF) is preserved. Global longitudinal strain (GLS) and systolic strain rate (SSR) and early diastolic strain rate (EDSR) may be useful for reclassifying diagnosed patients.

Objective

To evaluate, using GLS, SSR and EDSR, patients with diastolic dysfunction, compare with healthy individuals, and determine the additive value of the method.

Methods

The study included 149 patients (age 62.2 ± 10.6) with diastolic dysfunction (49.7% grade 1; 15.4% grade 2; 18.1% grade 3 and 16.8% unspecified) and 189 healthy individuals (age 44.5 ± 13.3). Left ventricular (LV) and left atrial (LA) dimensions and function, mitral and tissue Doppler velocities and their ratios, GLS, SSR and EDSR have been determined. Data evaluation using the Kolmogorov-Smirnoff, Kruskal-Wallis tests, multiple regression analysis and area under the ROC curve. Data were considered significant when p < 0.05.

Results

In diastolic dysfunction, LV dimensions and thickness were increased and EF was lower. Mitral and tissue Doppler revealed abnormalities and LA volume and tricuspid regurgitation velocity were increased. GLS and EDSR were decreased in dysfunction grade 2 and 3 and EDSR was decreased in dysfunction grade 1, correlating better with diastolic dysfunction. The ROC cutoff value for the EDSR was 1.0 s^-1.

Conclusion

Diastolic dysfunction supplemented with myocardial strain rate seems to add sensitivity and specificity where the diastolic function is indeterminate and may be used for reclassifying these patients. (Arq Bras Cardiol: Imagem cardiovasc. 2017;30(2):46-53)

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Review Article

Applicability of Myocardial Perfusion Scintigraphy in the Evaluation of Cardiac Synchronization

Christiane Cigagna Wiefels Reis et al. Erivelton Alessandro do Nascimento Fernanda Baptista Ribeiro Dias Mario Luiz Ribeiro … Annelise Passos Bispo Wanderley Layanara Albino Batista Thais Helena Peixoto Nunes Claudio Tinoco Mesquita

Abstract

To systematically assess the literature on the applicability of myocardial perfusion scintigraphy with phase analysis in the investigation of cardiac dyssynchrony and in the selection of patients for cardiac resynchronization therapy (CRT), manuscripts published on the PubMed database over the past five years have been reviewed. The following MeSH terms were used: heart failure, left ventricular, dyssynchrony, gated-spect, phase analysis and resynchronization therapy. Altogether, 99 manuscripts were included for discussion. Speckle-tracking echocardiography is still widely used in the evaluation of dyssynchrony, but the advent of myocardial perfusion scintigraphy with the phase analysis technique has been gaining ground, as besides being operator-independent, it can evaluate myocardial viability in the same test. Its use became more widespread in patients with left bundle branch block, with recommendation of CRT. Phase analysis also allows evaluating, in a highly reproducible way, the last ventricular segment to contract, hence allowing the best positioning of the CRT electrode. Knowing that the presence, location and extent of fibrosis in the left ventricle, associated with dyssynchrony are determinants of response to resynchronization therapy, gated-SPECT can provide this information in a single test and in a reproducible and accurate way. Phase histogram offers several parameters that provide greater sensitivity and specificity to the method. It seems that the technique is able to add value both in the selection and in the evaluation of response of patients eligible to CRT. Further studies are being conducted to demonstrate its clinical applicability.

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Case Report

Cardiac Angiosarcoma – Importance of Imaging in Early Diagnosis

Heron Rhydan Saad Rached et al. Alice de Almeida Soares Rony Aitta Roberto Nery Junior … José Ernesto Succi Letícia Engber Odilon Villiger

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