Connective Tissue – ABC CARDIOL

IJCS

Case Report

A Challenging Case Of Pulmonary Arterial Hypertension: Never Judge By Appearances

Pedro Silvério António et al. Manuel Silvério António Catarina Lopes Resende Tatiana Guimarães … Daniel Cazeiro Yolanda Sá Pereira Fausto José Pinto Rui Plácido

Abstract

We report the case of a patient with symptomatic pulmonary hypertension (PH) associated with diffuse systemic sclerosis (SSc) whose initial assessment suggested a group 3 (clinical classification) PH. The patient had a history of drugs/toxins consumption, which contributed to the development of intrinsic pulmonary vascular disease. This changed the panorama towards the diagnosis of pulmonary arterial hypertension (PAH), with important therapeutic and prognostic implications. In fact, the excellent clinical, laboratory and hemodynamic response to therapy confirmed the hypothesis of a case of drug-associated PAH (DPAH) in a patient with diffuse SSc and lung disease. Considering the presence of DPAH, it was deemed necessary to assess acute vasoreactivity during right heart catheterization (RHC). If criteria were met, the clinical scenario may change towards a favorable and sustained clinical and hemodynamic response with oral calcium channel blockers. However, the response to inhaled nitric oxide was negative in our patient and the therapeutic strategy with dual oral combination therapy with tadalafil and ambrisentan was continued. After six-months of therapy the patient significantly improved, from a high to a low risk of one-year mortality.

Read Full Article

ABCIC

Original Article

Association between Anatomical Variation of the Great Saphenous Vein and Venous Failure in Patients Undergoing Vascular Ultrasound of the Lower Limbs

Ana Cristina Lopes Albricker et al. Ane Graziela Ferreira Andrade Danila Simões Almeida Gisely Simões Almeida … Jaider Matheus Monteiro de Andrade Paola Souza dos Santos Marcio Vinícius Lins Barros

Summary

Introduction

Venous anatomy may present significant variability, with a wide incidence of venous tributaries, duplicate or accessory veins related to saphenous veins. The recognition and identification of these variations are important in the therapeutic management of these patients, and vascular ultrasonography is the method of choice in the evaluation of the peripheral venous system.

Objectives

To evaluate the association between anatomic variance of the great saphenous vein (VSM) and venous insufficiency of the lower limbs in patients with primary varicose veins of the lower limbs.

Methods

Patients with varicose veins were consecutively evaluated in the period from 2014 to 2015, excluding patients with a history of previous surgery and deep venous thrombosis. Vascular ultrasound was performed to examine the superficial venous system, in particular to the VSM study, determining the different patterns of anatomical variation of this vessel and its association with the presence of venous insufficiency and CEAP classification.

Results

422 lower limbs of 211 patients, aged between 21 and 86 years, mean age of 45.7 years, 81% female, with a predominance of APC 1 (43.8%) and 2 (46.2% %). Reflux in the VSM was found in 35.1%. The presence of anatomical variation was found in 8.8% of the patients, being more frequent in the distal third of the thigh and proximal of the leg (27.3%). No association was found between the anatomical variation of MSV and CEAP (p = 0.25). There was a statistically significant association between no anatomic variation and the presence of VSM insufficiency (p = 0.03).

Conclusion

in the present study, anatomic variation of the great saphenous vein was observed in about 9% of the patients, with a significant association between insufficiency of the great saphenous vein and no anatomical variation. (Arq Bras Cardiol: Imagem cardiovasc. 2018;31(2):90-94)