Luiz Junya Kajita

Pulmonary vein stenosis complicating catheter ablation of focal atrial fibrillation.

Pulmonary Vein Stenosis. Introduction: A recently described focal origin of atrial fibrillation, mainly inside pulmonary veins, is creating new perspectives for radiofrequency catheter ablation. However, pulmonary venous stenosis may occur with uncertain clinical consequences. This report describes a veno‐occlusive syndrome secondary to left pulmonary vein stenosis after radiofrequency catheter ablation.

Extrinsic compression of the left main coronary artery by a dilated pulmonary artery: Clinical, angiographic, and hemodynamic determinants

Extrinsic compression of the left main coronary artery (LMC) by the pulmonary artery (PA) is a very unusual and poorly understood entity, usually associated with the presence of adult congenital heart disease. We identified 12 patients (age range, 6 months to 55 years) with LMC stenosis (≥ 50%) presumably secondary to compression by a dilated main PA and related to various forms of heart disease (11 congenital, 1 pulmonary hypertension). In all cases, the main PA was dilated with the main PA/aortic root diameter increased (mean, 2.0; normal value, ≤ 1.0), and in all but two, PA pressures were increased (> 30 mm Hg systolic). Left coronary trunk stenosis was usually visualized in only one angiographic view (best seen in 45° left anterior oblique, 30° cranial projection). The LMC also appeared to be inferiorly displaced and in close contact with the left aortic sinus (mean angle between sinus and LMC was 23° ± 13°, a control group was 70° ± 15°). In one patient, surgical correction of the dilated PA was associated with a reduction in LMC stenosis from 85% to < 50% and less inferior left main displacement (from 25° to 50°). Patients with a dilated main PA may exhibit extrinsic LMC compression leading to significant eccentric narrowing and downward displacement of the LMC. In the presence of significant dilatation of the main PA from any etiology, functional and/or anatomic studies should be performed to exclude significant LM obstruction. Cathet Cardiovasc Intervent 2001;52:49–54.

Residual aortic regurgitation is a major determinant of late mortality after transcatheter aortic valve implantation.

aortic valve implantation Pedro A. Lemos ⁎, Francesco Saia , Jose Mariani Jr., Cinzia Marrozzini , Antonio Esteves Filho , Luiz J. Kajita , Cristina Ciuca , Nevio Taglieri , Barbara Bordoni , Carolina Moretti , Tullio Palmerini , Marianna D.A. Dracoulakis , Fabio B. Jatene , Roberto Kalil-Filho , Antonio Marzocchi c a Sirio-Libanes Hospital, Sao Paulo, Brazil b Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil c Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy d Irmandade da Santa Casa de Misericordia, Sao Paulo, Brazil

Effects of Low Doses of Inhaled Nitric Oxide Combined with Oxygen for the Evaluation of Pulmonary Vascular Reactivity in Patients with Pulmonary Hypertension

The purpose of this study was to evaluate the hemodynamic effects of inhaled nitric oxide in oxygen (NO + O2) in patients with pulmonary hypertension. Eighteen patients (median age 31.5 months) with pulmonary hypertension inhaled through a mask 100% O2 and 20 parts per million NO + inspired O2 fraction (FiO2) at 0.4. Hemodynamic measurements were made at baseline and after O2 and NO + O2 administration. The pulmonary vascular resistance index decreased after inhalation of O2 and NO + O2 (p = 0.0018 and p = 0.0003, respectively), the decrease being significantly greater after NO + O2 (p = 0.0311). Concerning the transpulmonary pressure gradient, a reduction occurred in values after O2 and NO + O2 inhalation when compared with baseline values (p = 0.0014 and p = 0.0008). In patients with congenital heart disease, an increase occurred in pulmonary blood flow after O2 (p = 0.0089) and NO + O2 (p = 0.0019) compared with baseline values, and an increase also occurred in the pulmonary/systemic blood flow ratio after NO + O2 (p = 0.0017). The main side effect related to NO + O2 was pulmonary congestion in 3 patients. Low doses of NO combined with O2 demonstrated a selective pulmonary vasodilator response in patients with pulmonary hypertension. Despite its use for testing pulmonary reactivity, inhalation of NO + O2 should be carefully administered because of the potential risk of pulmonary congestion.

Essential thrombocythemia and acute myocardial infarction treated with rescue coronary angioplasty

A 48-year-old man with essential thrombocythemia suffered an extensive anterior acute myocardial infarction; this is a rare association. A pharmacological thrombolysis was performed, without success. He subsequently underwent successful rescue coronary angioplasty. To our knowledge, there is no other report in the literature relating the triad of essential thrombocythemia, acute myocardial infarction and rescue coronary angioplasty.

Agenesia isolada da artéria pulmonar direita ou esquerda: avaliação da evolução natural e a longo prazo, após intervenção corretiva

OBJECTIVE Unilateral pulmonary artery agenesis is an uncommon isolated anomaly and since 1978 only 119 cases have been reported. In general the condition presents as pulmonary hypertension (PH) in children and hemoptysis in adults. Interventions such as pulmonary artery reconstruction and lobectomies were performed in 17% of the cases. We analyzed four of these cases, two in natural evolution and two with late term PH regression after surgical correction. METHODS Three 22,10 and 35 month old male children and one 20 month old female child were included in the study. The 22 month old presented right-sided heart failure (RHF) and cyanosis; the 10 month old presented RHF and the other two presented exertion fatigue. All had PH symptoms, right ventricular strain on the EKG and cardiomegaly. Cardiac catheterization showed systemic pressures in the contralateral pulmonary artery, with right-sided agenesis in three of the children and left-sided agenesis in one child. RESULTS Surgical correction of pulmonary artery continuity was possible in the 22 month old and 10 month old using a 7 mm diameter Goretex conduit between the pulmonary arteries up to the hypoplastic contralateral pulmonary hilum. There was early and late regression of the PH signs and the children remained stable during follow-up to the ages of 7 and 2.5 years, respectively. The pressure ratio between the left and right ventricles was 30 and 40%, in both cases. Pulmonary perfusion increased from 8 to 44% and from 8 to 23%, in the two cases. The same procedure was scheduled for the other patients. CONCLUSION This technique has become the operation of choice for similar cases, that are rarely described in literature, even in the presence of severe PH and contralateral pulmonary artery hypoplasia.

Right internal thoracic artery remodeling 18 years after circumflex system grafting

A 64-year-old man with left main coronary artery disease underwent myocardial revascularization. The left internal thoracic artery (LITA) was sutured to the left anterior descending artery, and the right internal thoracic artery (RITA) was sutured to the obtuse marginal artery. Eighteen years later, angina reoccurred. Catheterization revealed that both the coronary and the left subclavian arteries were occluded and that a patent RITA graft was maintaining the cardiac blood supply. The RITA graft evaluation revealed increased lumen diameters, suggestive of remodeling. The LITA was subsequently disconnected and sutured to the aorta as a free graft in order to restore appropriate myocardial blood flow. This case emphasizes the benefits of using a live graft for left coronary system grafting, which include long-term patency and flow-dependent remodeling.

Implante transcateter de prótese valvular aórtica: perfil clínico e evolução de uma série consecutiva de 75 casos do registro conjunto Universidade de Bolonha/Hospital Sírio-Libanês

INTRODUCAO: O implante transcateter de protese valvular aortica (ITVA) tem sido utilizado em nosso meio e em diversos paises do mundo como alternativa ao tratamento conservador em pacientes com estenose aortica grave e elevado risco cirurgico. Objetivou-se descrever o perfil clinico basal e a mortalidade a curto e medio prazos de uma serie consecutiva de casos tratados com ITVA em dois centros localizados, respectivamente, na Italia e no Brasil. METODOS: A populacao de estudo foi composta pelos primeiros 75 pacientes consecutivos com estenose valvar aortica grave tratados com a protese Medtronic CoreValveTM Revalving System (MCV - Medtronic, Minneapolis, Estados Unidos). Tipicamente, a indicacao para o ITVA foi motivada pelo alto risco cirurgico. A media de idade era de 82 anos, 55% eram mulheres, um terco apresentava doenca pulmonar grave e 95% apresentavam insuficiencia cardiaca sintomatica. RESULTADOS: Apos o ITVA, houve reducao significativa do gradiente transvalvar aortico maximo (basal: 95,8 ± 32,3 mmHg; pos-procedimento: 18,5 ± 6,1 mmHg) e medio (basal: 45,9 ± 16,9 mmHg; pos-procedimento: 10,4 ± 5,2 mmHg) (P < 0,01 para ambos). Insuficiencia aortica moderada ou acentuada foi evidenciada em 7% dos casos apos ITVA. A taxa de sobrevida global aos 30 dias foi de 91,6% e aos 12 meses, de 79%. CONCLUSOES: O ITVA surge como um metodo terapeutico de grande relevância para portadores de estenose aortica de alto risco cirurgico. As taxas de sobrevida precoce e a medio prazo indicam o beneficio potencial do novo procedimento tambem para pacientes tratados no chamado mundo real.

Superdominant Right Coronary Artery with Absence of Left Circumflex and Anomalous Origin of the Left Anterior Descending Coronary from the Right Sinus: An Unheard Coronary Anomaly Circulation

Coronary artery anomalies are congenital changes in their origin, course, and/or structure. Most of them are discovered as incidental findings during coronary angiographic studies or at autopsies. We present herein the case of a 70-year-old man with symptomatic severe aortic valvar stenosis whose preoperative coronary angiogram revealed a so far unreported coronary anomaly circulation pattern.

Miocardiopatia preponderante de ventrículo direito por miocardite prévia ou por displasia arritmogênica

A clinical case of a 10-year-old male patient is reported. His dilated and prevailing right ventricular myocardiopathy shows diagnostic difficulties between previous myocarditis etiology and arrhythmogenic dysplasia. As the elements are not pathognomonic of one or other cause, the increase of cardiac enzymes in subacute stage maybe tends to the supposition of previous myocarditis. Hence, the questioning that many cases labeled as arrhythmogenic dysplasia can truly correspond to the possibility of evolutional myocarditis. The controversial clinic management is disputable.