Edmundo Clarindo Oliveira

Pulmonary hypertension in schistosomiasis mansoni

To evaluate cardiopulmonary involvement in schistosomiasis mansoni, 246 patients from an endemic area of Brazil were examined; 152 had been previously treated for schistosomiasis. Based on stool examination and/or abdominal ultrasonography, the patients were divided into those with schistosomiasis (69%) and those in whom the disease was not present (31%). M mode measurements were similar in the 2 groups. Pulmonary pressure was measured by Doppler echocardiography; 25% of the subjects had pulmonary hypertension. Those with pulmonary hypertension had a higher prevalence of schistosomiasis (80%) than those without (64%; P = 0.03). No case of cor pulmonale was diagnosed by electrocardiography or Doppler echocardiography. The prevalence of pulmonary hypertension correlated neither with periportal fibrosis nor with prior treatment for schistosomiasis.

Doppler Echocardiographic Features of Coronary Artery Fistula: Report of 8 Cases

Coronary artery fistula is a rare congenital anomaly in which the involved coronary artery empties into a cardiac chamber, pulmonary artery, or other structure. Its diagnosis can be made noninvasively by finding a dilated coronary artery by 2-dimensional (2D) echocardiography, and its drainage can be detected by color flow mapping. We describe features of coronary artery fistulas in 8 patients whose condition was prospectively diagnosed by Doppler echocardiography with color flow mapping. The right coronary artery was involved in 4 cases and the left coronary artery in 4. Four fistulas drained to the right ventricle, 2 to the right atrium, and 2 to the pulmonary artery. In 1 patient who had left and right coronary fistulas to the pulmonary artery, only the first was diagnosed noninvasively. The diagnosis of coronary fistulas can usually be made by 2D echocardiography with color flow mapping. However, fistulas to the pulmonary artery may be more difficult to detect by 2D echocardiography because the coronary artery may be of normal size and the shunt small.

Adenosine for vasoreactivity testing in pulmonary hypertension: a head-to-head comparison with inhaled nitric oxide.

BACKGROUND APVT is an invasive method recommended for symptomatic patients with PAH that permits the identification of the minority of patients (<20%) that may benefit from long-term calcium channel blockers. Adenosine has been indicated in guidelines as a vasodilator agent of choice for APVT, although it has not been directly compared with iNO, the gold standard for this test. The objective of the study was to compare adenosine with inhaled nitric oxide (iNO) for acute pulmonary vasoreactivity testing (APVT) in pulmonary arterial hypertension (PAH), in order to determine the efficacy and safety of the first in the clinical setting. METHODS The measurements of cardiac output, pulmonary and systemic resistance were done in the basal state and with a stepwise increase of the dose of each drug until either maximum dosage (adenosine: 500 microg/kg/min or iNO: 80 ppm) or side effects observed or a positive response were reached, according to current guidelines. The order of drugs used in each test was consecutively alternated during the study. RESULTS Six of the 39 studied patients (15%) presented a positive response to iNO; none to adenosine (p = 0.047, McNemars test). Twenty-three patients (59%) did not reach the maximum dose of adenosine due to side effects, including bronchospasm, thoracic pain and bradycardia. CONCLUSIONS APVT testing with adenosine was not able to detect PAH patients responsive to iNo and provoked frequent adverse effects. Adenosine should not be used as a vasodilator drug in APVT.

Sildenafil no tratamento da hipertensão arterial pulmonar idiopática em crianças e adolescentes

OBJECTIVE This study aims to provide data on the use of oral sildenafil in patients in New York Heart Association functional class III or IV with severe idiopathic pulmonary arterial hypertension unresponsive to conventional therapy. METHOD In this series, six patients with idiopathic pulmonary arterial hypertension were prospectively treated with 2 to 8 mg of oral sildenafil in four to six doses a day. All patients were submitted to physical examination, electrocardiogram and echocardiogram, chest computed tomography, ventilation and pulmonary perfusion scintigraphy, coagulation studies, and tests for collagen vascular disease, acquired immune deficiency syndrome and schistosomiasis in order to rule out secondary causes of pulmonary arterial hypertension. All patients underwent cardiac catheterization for vasoreactivity tests using nitric oxide, O2 at 100% and oral nifedipine, and a 6 minute walking test was performed in those patients who were considered able to exercise. RESULTS All patients achieved a good therapeutic response, with improvement by at least one functional class, and presented an increase in systemic arterial oxygen saturation. Five patients showed a decrease in the pulmonary systolic pressure to systemic systolic pressure ratio and improvement in the six-minute walking test. No major side effects were observed at 4 to 36 months of follow-up. One patient had sudden death after sildenafil had been withdrawn by mistake. CONCLUSIONS These data suggest that sildenafil may be useful in the management of idiopathic pulmonary arterial hypertension. Patients should be advised against the withdrawal of sildenafil without medical supervision.

Teste de vasorreatividade pulmonar

Pulmonary arterial hypertension is classified as idiopathic or secondary (associated with collagenoses, heart disease, portal hypertension, pulmonary thromboembolism, and pulmonary vascular diseases). Pulmonary vasoreactivity should be tested in order to define the best treatment option. Of the many drugs that have been used to test pulmonary vasoreactivity, inhaled nitric oxide is the best choice, due its specific pulmonary effect and very short half-life (5-10 s). The results of this test identify candidates for heart surgery among patients with congenital heart disease and candidates for the use of calcium antagonists among patients with other forms of pulmonary hypertension. Performing and interpreting the results of such tests are a great responsibility, since mistakes can lead to incorrect treatment decisions, resulting in the death of patients.

Fechamento percutâneo de comunicação interatrial por punção trans-hepática

O fechamento percutâneo da comunicacao interatrial (CIA) ostium secundum (OS) e procedimento bem estabelecido, sendo atualmente considerado o tratamento de escolha por seus bons resultados e sua baixa morbidade e mortalidade. O procedimento e realizado rotineiramente pela veia cava inferior (VCI). Ocasionalmente, entretanto, essa via de acesso nao e possivel por causa da obstrucao ou da ausencia congenita da VCI. Apresentaremos um caso de fechamento de CIA por puncao trans-hepatica decorrente de impossibilidade de uso da VCI.

Anomalous Origin of Left Coronary Artery From the Left Ventricle

A 54-year-old asymptomatic woman (M.H.S.), was referred to the Hospital das Clinicas da Universidade Federal de Minas Gerais (HC/UFMG) cardiology service for routine cardiological evaluation in 2006. The physical examination and basal ECG were normal. Exercise stress testing showed unspecific ST segment alteration, and technetium scintigraphy was normal. One year later, repeat examination showed normal basal ECG, discrete displacement of ST segment by exercise stress testing, and transient ischemic alteration in apical area by technetium perfusion imaging. …

Portal cholangiopathy: case report

The present report describes the case of a child that after blunt abdominal trauma presented with portal thrombosis followed by progressive splenomegaly and jaundice. Ultrasonography and percutaneous cholangiography revealed biliary dilatation secondary to choledochal stenosis caused by dilated peribiliary veins, characterizing a case of portal biliopathy. The present case report is aimed at presenting an uncommon cause of this condition.

Implante transcateter de bioprótese valvular pulmonar: revisão sistemática da literatura

Surgical repair of some complex congenital heart diseases involves reconstruction of the right ventricular outflow tract using homografts, bioprostheses, bovine jugular grafts or other valved conduits between the right ventricle and the main pulmonary artery. Although these surgical procedures may be performed with low mortality rates, the life span of these implanted valves or conduits is usually short (< 10 years) due to either degeneration and/or calcification. Variable degrees of pulmonary stenosis, often associated with pulmonary insufficiency, are consequences of conduit degeneration. In 2000, Bonhoeffer et al. were the first to report the transcatheter pulmonary valve implantation (TPVI) of a bioprosthetic pulmonary valve later named Melody® valve (Medtronic, Minneapolis, USA). The technique was initially developed to limit the need for multiple surgical procedures, and, ultimately, to work as a surrogate of a new surgical valve replacement. Subsequent clinical studies in Europe and the United States confirmed the safety and efficacy of this technique in a larger number of patients. Since the National Sanitary Surveillance Agency (Agencia Nacional de Vigilância Sanitaria - Anvisa) granted approval for clinical use of the Melody® transcatheter pulmonary biological valve in February 2103, we deemed that a judicious assessment of this new technology was timely and necessary before the widespread use in our country. The objective of this study was to perform a systematic literature review on the use of TPVI in patients with dysfunctional homografts, valved conduits and bioprostheses implanted surgically in the right ventricular outflow tract.

Transcatheter pulmonary valve implantation: systematic literature review

ABSTRACT Surgical repair of some complex congenital heart diseases involves reconstruction of the right ventricular outflow tract using homografts, bioprostheses, bovine jugular grafts or other valved conduits between the right ventricle and the main pulmonary artery. Although these surgical procedures may be performed with low mortality rates, the life span of these implanted valves or conduits is usually short (