Gustavo Carvalho

Artéria coronária direita de origem anômala: diagnóstico e tratamento

We report the case of a rare anomaly of the right coronary artery (RCA) arising from the left aortic sinus, having a single ostium with the left coronary artery, associated with documented episodes of inferior ischemia, in which surgical treatment with a right internal thoracic artery to RCA bypass graft and the corresponding ligation provided greater stability to the coronary blood flow and good clinical progress.

Long-Term Survival in Truncus Arteriosus Communis Type A1 Associated with Ehlers-Danlos Syndrome A Case Report

Long-term survival is rare in patients with truncus arteriosus communis type A1 due to the early appearance of pulmonary artery obstructive changes. A 48-year-old woman with truncus arteriosus communis type A1 diagnosed with chest radiography, two-dimensional echocardio graphy, and cardiac catheterization is presented. The right ventricular pressure was 108 mm Hg , whereas the systolic pulmonary artery pressure was 98 mm Hg. A concomitant diagnosis of the Ehlers-Danlos syndrome was made with clinical findings. The association of Ehlers- Danlos syndrome, in which a collagen synthesis defect is observed in arterial vessels, might have interfered with pulmonary artery intimal proliferation, thus precluding the appearance of advanced pulmonary artery luminal obstructive changes and allowing long-term survival.

Infarto agudo do miocárdio e morte súbita documentada

Homem, sexagenario, deu entrada na emergencia com dor toracica duvidosa e lipotimia. Investigado e estratificado, teve eletrocardiogramas e marcadores sericos de injuria miocardica seriados negativos para isquemia miocardica, e teste ergometrico sem criterios para isquemia miocardica. Contudo, apresentou morte subita presenciada dentro do hospital enquanto fazia uso da monitorizacao eletrocardiografica continua com o holter, que evidenciou, em seus tracados, infarto agudo do miocardico complicado com arritmia ventricular complexa (taquicardia e fibrilacao ventricular), que culminou em morte refrataria as manobras de reanimacao cardio-respiratoria.

The Prognostic Value of CK-MB in Acute Myocardial Infarction in DevelopingCountries: A Descriptive Study

Background: Acute myocardial infarction is a common condition among developing countries with access-tocare issues. However, scarce information is available on the association between prognostic markers and patient outcomes in areas around the globe with scarcere sources. Aim: To evaluate the association between creatine phosphokinase myocardial band (CK-MB) and outcomes measured up to six months after the infarction. Methods: This is a longitudinal cohort study evaluating patients with a diagnosis of myocardial infarction up to six months after the ischemic event. Patients underwent catheterization up to 12 hours after the first symptoms. The primary predicting variable was CK-MB level, with outcome variables including re-infarction, death, and functional level status at 30 days and 6 months after infarction. Results: The average time of arrival was seven hours after the start of pain. When combining all adverse outcomes, 13.7% presented with either a myocardial re-infarction or death. When evaluating the association between serial CK-MB measurements and various outcomes of interest, there was usually no significant association with re-infarction, death or functional class at the 30-day and six-month follow-up evaluations. However, increased CK-MB measurements at admission, 18 and 72 hours continued to be significantly associated with increased length of hospital stay after adjusting for age and gender. CK-MB levels greater than 124 mg/dl after 18 hours after first symptoms were significant predictors of all combined adverse outcomes. Conclusion: CK-MB represents an alternative when it comes to prognostic predictors of combined outcomes including myocardial re-infarction, re-intervention or death.

Incidence of ventricular arrhythmias after stem cell therapy in patients with Chagas cardiomyopathy.

Background Treatment with stem cells in several cardiomyopathies may be related to the increase in arrhythmias. Objectives To determine whether intracoronary injection of stem cells in patients with Chagas cardiomyopathy is associated with increased incidence of ventricular arrhythmias, compared to the Control Group. Methods A retrospective cohort study that evaluated the medical records of 60 patients who participated in a previous cross-sectional study. The following data were collected: age, gender, drugs used and Holter variables that demonstrated the presence of arrhythmias. Holter was performed in four stages: randomization, 2, 6 and 12 months segments. The Control Group received medical treatment and intracoronary injection of placebo and the Study Group had drug treatment and autologous stem cell implant. Results There was no difference between Control Group and Study Group when analyzing the arrhythmia criteria. In the intra-group analysis, significant difference was found between the Holter tests of the Study Group for the variable total ventricular premature beats when compared with baseline, with p = 0.014 between Holter at randomization and Holter at 2 months, p = 0.004 between Holter at randomization and Holter at 6 months, and p = 0.014 between Holter at randomization and Holter at 12 months. The variable non-sustained ventricular tachycardia between Holter at randomization and Holter at 6 months showed p = 0.036. Conclusion The intracoronary injection of stem cells did not increase the incidence of ventricular arrhythmias in patients with Chagas cardiomyopathy compared to the Control Group.

Tratamento percutâneo da úlcera penetrante de aorta

Penetrating aortic ulcer is a variant of classic aortic dissection having distinct histopathological characteristics. If not appropriately treated, it evolves to combined morbidity and mortality rates as high as those of classic dissection. This condition, therefore, warrants special attention with accurate diagnosis and treatment. Percutaneous management using endoprosthesis is the method of choice, since the patients are usually elderly and have comorbidities that would increase the complication rates of traditional surgery. A 78-year-old woman complaining of thoracic pain was admitted to the hospital; her pain had been radiating to the interscapular and left lumbar regions for four months. Upon diagnostic investigation, a penetrating aortic ulcer was found, and after being successfully treated percutaneously with stent implantation, the patient became asymptomatic and is under outpatient follow-up.

Aorta-right ventricle fistula: an unexpected complication of bacterial endocarditis

BP = 160/90 mmHg in upper limbs, there were no palpable pulses in lower limbs. Systolic impulse verified in the 5th left paraesternal intercostal space, where a tremor irradiated until the 2nd right paraesternal intercostal space. A rude mesotelesystolic murmur audible in that region, irradiating to cervical, subclavicular and interscapular regions. The diagnostic hypothesis was infectious endocarditis, aortic valvar stenosis and coarctation of the aorta. At electrocardiogram, sinus rhythm and left ventricular overload; the thoracic radiography was normal. At blood count, anemia and leukocytosis were found. He was empirically treated with ceftriaxone 3g day.