Kidney Neoplasms – ABC CARDIOL

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Extensive Renal Tumor Diagnosed from Echocardiography Findings

Morgahna Nathalie Wamser et al. James Alberton

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Anatomopathological Session

Case 2/2016 – 76-Year-Old Male with Hypertensive Heart Disease, Renal Tumor and Shock

Marcela Anhesini Benetti et al. Rafael Amorim Belo Nunes Luiz Alberto Benvenuti

Clinical aspects

The patient had multiple comorbidities, chest pain and dyspnea on exertion. During follow-up, cardiomyopathy installed with segmental impairment of left ventricular contractility and complex ventricular arrhythmia. Initially, he had arterial hypertension and sinus bradycardia, with no other significant changes. Later, the patient experienced clinical worsening and new comorbidities: hyperuricemia, smoking and obesity. The ECG showed a significant change over time, and RBBB appeared. The functional assessment of myocardial ischemia revealed no significant change during follow-up. The symptoms progressively worsened, and, at the age of 72 years, the patient was hospitalized due to sustained ventricular tachycardia with hemodynamic instability. He reported previous surgery to treat malignant urinary bladder neoplasm, and gastrectomy to treat peptic ulcer. In 2011, the patient received an ICD to prevent sudden death, the last assessment being in March 2012. In June 2012, he was hospitalized due to presumed septic shock and eventually died.

During follow-up, the patient developed progressive cardiomyopathy with segmental impairment of left ventricular contractility associated with complex ventricular arrhythmias, and no significant coronary artery disease.

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Case Report

Type 1 Brugada Pattern Unmasked During the Recovery Period of an Exercise Stress Test

Daniel García-Fuertes et al. Elena Villanueva-Fernández Manuel Crespín-Crespín Alberto Puchol … Marta Pachón Miguel Angel Arias

Introduction

Brugada syndrome (BrS) is an autosomal dominant channelopathy considered to be responsible for 4% to 12% of all sudden cardiac deaths and up to 20% of sudden cardiac deaths that occur in normal hearts. It is characterized by specific electrocardiographic findings in the right precordial leads. Although three patterns have been described, BrS is only diagnosed in patients with ST-segment elevation with type 1 morphology > 2 mm in at least 1 lead among the right precordial leads (V1, V2) occurring either spontaneously or after provocative drug test with intravenous administration of Class I antiarrhythmic drugs.

Symptoms often occur during rest or sleep, during febrile state, or in vagotonic conditions, as the recovery period of an exercise test could be considered. In fact, attenuation of ST-segment elevation at the peak of exercise stress test followed by its appearance during the recovery phase is considered not only supportive for the diagnosis of BrS, but also as a possible predictor of adverse outcomes. These data have been obtained from series of patients previously diagnosed because of a spontaneous or pharmacologically-induced type 1 pattern, but cases without previous evidence of this pattern where the diagnosis was unmasked by exercise testing are scarce.

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Artigo Original

Renal and adrenal tumors with cardiac invasion: immediate surgical results in 14 patients

Rafael Fagionato Locali et al. Priscila Katsumi Matsuoka Tiago Cherbo Edmo Atique Gabriel Enio Buffolo

BACKGROUND: The resection of tumor thrombus of the inferior vena cava (IVC) and right atrium (RA) increases the survival rate of patients with renal/adrenal cancer. OBJECTIVE: To evaluate the surgical procedure in cases of IVC and RA in the treatment of renal and adrenal tumors. METHODS: Fourteen patients undergoing surgical intervention (during the period) between January 1997 and June 2007, for resection of IVC and/or RA thrombus due to renal or adrenal tumors, were retrospectively evaluated. The patients (64.2% male) presented with Wilms’ tumor, clear cell carcinoma and adrenal adenocarcinoma, and had mean age of 4.5, 60.5 and 2.5 years, respectively. Epidemiological characteristics and intra- and postoperative parameters were evaluated. RESULTS: Suprahepatic IVC tumor thrombus were observed in all the patients, and in 62.4% of them the thrombus invaded the RA. Thrombectomy was performed with extracorporeal circulation with deep hypothermia and total circulatory arrest in 85.7%, with mild hypothermia in the remaining cases. The inferior vena cava was ligated in 7.1% of the cases, and reconstruction with suture was performed in 92.9% of the patients. The duration of orotracheal intubation and length of hospital stay were different, according to the tumor type. Two deaths, due to intraoperative cardiorespiratory arrest, were seen among patients with adrenal adenocarcinoma. CONCLUSION: IVC and RA tumor thrombi are more frequent in patients with Wilms’ tumor. More postoperative complications are seen in patients with adrenal adenocarcinoma, and the postoperative prognosis is better for patients with Wilms’ tumor.

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Extensive Renal Tumor Diagnosed from Echocardiography Findings

Case 2/2016 – 76-Year-Old Male with Hypertensive Heart Disease, Renal Tumor and Shock

Clinical aspects

Type 1 Brugada Pattern Unmasked During the Recovery Period of an Exercise Stress Test

Introduction

Renal and adrenal tumors with cardiac invasion: immediate surgical results in 14 patients

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