2018;31(4) – ABC CARDIOL

Paravalvular leaks are a common complication after valve replacement surgery. Quantification of the severity, location and morphology of paravalvular leaks can be obtained by three-dimensional transesophageal echocardiography.

Objective

To evaluate the correlation between the severity of paravalvular regurgitation by vena contracta measurement using bidimensional echocardiography, and measurements derived from three-dimensional transesophageal echocardiography (length, width and area). To evaluate the therapeutic success of three-dimensional transesophageal echocardiography-guided paravalvular leaks occlusion and the correlation between three-dimensional transesophageal echocardiography measurements and dimensions of devices for percutaneous occlusion.

Method

Retrospective study of 11 patients consecutively submitted to percutaneous paravalvular leaks treatment between 2014 and 2015, using transthoracic echocardiography and between three-dimensional transesophageal echocardiography in the preoperative and intraoperative periods.

Results

Out of a total of 20 paravalvular leaks, 18 showed immediate technical success. There was no correlation between the measurements of the bidimensional vena contracta and the measures derived from the three-dimensional transesophageal echocardiography. There was a strong correlation between the defect length measured by the three-dimensional transesophageal echocardiography and the device for percutaneous occlusion length (rho = 0.929; p < 0.001); and moderate between the defect area and the device for percutaneous occlusion area (rho = 0.682, p = 0.002). There was no correlation between the device for percutaneous occlusion width and the defect width measured by three-dimensional transesophageal echocardiography (rho = 0.440; p = 0.067).

Conclusion

There was no correlation between the measurement of the bidimensional vena contracta and the measures derived from the three-dimensional transesophageal echocardiography. The choice of devices for percutaneous occlusion based on three-dimensional transesophageal echocardiography measurements showed a high success rate, with an excellent correlation between defect length and devices for percutaneous occlusion length. The correlation between the areas was good, and there was no correlation between the widths. (Arq Bras Cardiol: Imagem cardiovasc. 2018;31(4):225-230)

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Original Article

Ligation of the Branches of the Anastomosed Internal Thoracic Artery in the Anterior Descending Coronary Artery and the Effect on Flow Velocities and Functional Status of the Graft

José Sebastião de Abreu et al. Tereza Cristina D Pinheiro José Acácio Feitosa Marilia Esther B Abreu … Ana Gardenia L. P Farias Marcia Maria Carneiro Sandra Nívea R Falcão

Summary

Introduction

Modification of internal thoracic artery flow occurs after its anastomosis in the left anterior descending coronary artery.

Objective

To evaluate the effect of ligation of the proximal branches of anastomosed internal thoracic artery flow on the left anterior descending in relation to velocities and coronary flow velocity reserve in patients with left ventricular ejection fraction preserved (> 50%).

Methods

Prospective study of patients with left ventricular ejection fraction > 50% and revascularized. Group I was composed of 25 patients with ligation of the major branches of the internal thoracic artery flow before its anastomosis in the left anterior descending coronary artery, and Group II was composed of 28 patients without ligation. Doppler was recorded at the proximal level of internal thoracic artery flow in the preoperative, early postoperative and 6 months later. The systolic peak velocity and diastolic, and systolic mean velocity and diastolic were measured. Coronary flow velocity reserve was obtained during dobutamine stress echocardiography in postoperative period 6 months later.

Results

In the postoperative, the systolic peak velocity and the systolic mean velocity decreased while increasing the diastolic peak velocity and the diastolic mean velocity in the groups (p < 0.05). From the postoperative to the postoperative period 6 months later, only the diastolic peak velocity modified, occurring its decrease in the groups (p < 0.05). During the dobutamine stress echocardiography, diastolic peak velocity and the diastolic mean velocity increased (p < 0.05) and groups did not differ, however, the systolic peak velocity and the systolic mean velocity increased only in Group II (p < 0.05). The coronary flow velocity reserve of the groups calculated by diastolic peak velocity (Group I = 2.17 ± 0.64 and Group II = 2.28 ± 0.63) and diastolic mean velocity (Group I = 2.27 ± 0.54 and Group II = 2.5 ± 0.79) did not differ.

Conclusion

In patients with preserved left ventricular ejection fraction, the ligation of the large branches of the anastomosed internal thoracic artery flow into the left anterior descending coronary artery does not compromise the coronary flow velocity reserve, but determines limitation in the increase of the systolic velocities. (Arq Bras Cardiol: Imagem cardiovasc. 2018;31(4):231-240)

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Case Report

Ruptured Right Sinus of Valsalva Aneurysm with Right Ventricular Fistula

Carolina Santana dos Reis Gonçalves et al. Rafael Rocha Silva Marta Fernandes Lima

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Case Report

Thrombus-in-transit and Paradoxical Embolism in Patient with ST-Segment Elevation Acute Coronary Syndrome

Daniel Lucena de Aguiar et al. Gisele Nogueira Bezerra Isabella Cabral Marinho Plens Lúcia de Sousa Belém Danielli Oliveira da Costa Lino

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Case Report

An Insignificant Flow That Intrigues Echocardiographers. Echocardiographic Pattern in 15 Cases of Coronary-Pulmonary Fistula and Literature Review

Carlos Eduardo Suaide Silva et al. Vera Demarchi Aiello Renata Rejane Linhares Luciana Braz Peixoto … Mariane Daltrini Trandafilov Pimentel Lucas Bercht Fernanda Storti Manuel Adán Gil Claudia Gianini Monaco

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Review Manuscript

Current Role of Cardiac Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy

Fábio Vieira Fernandes et al. Juliana Hiromi Silva Matsumoto Bello Afonso Akio Shiozaki Roberto Caldeira Cury

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Case Report

Acute Myocardial Infarction Following Blunt Chest Trauma

Rafael Castro da Silva et al. Ilan Gottlieb Gabriella Andrade de Sá Alex dos Santos Felix … Daniella Bastos Rawet Mariah Rodrigues Paulino Emanuelle Ferreira Adriano Milton Ricardo Poffo André Luiz da Fonseca Feijó

[…]

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Original Article

Systemic Hypertension and Right Ventricle: Preliminary Echocardiographic Data

Anderson José Argemiro et al. Ana Cristina Camarozano Daniela de Castro Carmo Jerônimo Antonio Fortunato … Rubens Zenóbio Darwich Liz Andréa Villela Baroncini

Summary

Background

Systemic arterial hypertension (SAH) has not yet been directly correlated with right ventricular hypertrophy (RV).

Objective

To assess the correlation between the presence of systemic arterial hypertension and right ventricular thickness, dimensions and function.

Methods

Cross-sectional and observational study. A total of 65 individuals were selected. They underwent echocardiogram with right ventricular evaluation in five aspects: free wall thickness; proximal diameter (RPD), mid diameter (RMD), basal diameter (RBD); tricuspid annular plane systolic excursion; and tissue doppler S’ wave. The subjects were divided into two groups: Control Group, without systemic arterial hypertension, with 24 subjects (17 women) and Study Group, with systemic arterial hypertension, with 41 subjects (29 women).

Results

Study Group presented older individuals in relation to Control Group (67 years ± 12 years and 47 ± 20 years; p < 0.001). In the Control Group, men presented higher values compared to women: proximal diameter (24.1 mm ± 1.3 mm vs. 20.1 mm ± 2.9 mm; p = 0.002), basal diameter (32.9 mm ± 2.7 mm vs. 26.5 mm ± 4.2 mm; p = 0.001), mid diameter (27 mm ± 2.1 mm vs. 21.2m ; p = 0.005); left ventricle diastolic diameter (49.6 mm ± 2.1 mm vs. 45.5 ± 4.3 mm; p = 0.028); left ventricle systolic diameter (30.1 mm ± 3.2 mm vs. 27.1 mm ± 2.9 mm; p = 0.034); and S’ wave (14.9 cm/s ± 2.4 cm/s vs. 13 cm/s ± 1.7 cm/s; p = 0.04). However, in the Study Group there were no significant differences between men and women in the same variables. These findings suggest greater impact of systemic hypertension in women.

Conclusion

The presence of systemic hypertension may cause different structural alterations in geometric ventricular patterns in men and women, possibly determining greater effects on the female sex. However, further studies are needed to confirm these findings. (Arq Bras Cardiol: Imagem cardiovasc. 2018;31(4):241-249)

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