Lurildo Ribeiro Saraiva

Origem anômala das artérias coronárias

The anomalous origin of the coronary arteries is a potentially lethal pathology, especially in neonates and young athletes. The understanding of the pathophysiological pattern of the disease has allowed the recognition of the different forms of clinical presentation. Despite being a cause of myocardial ischemia, functional tests can be normal. Coronary angiography used to be the gold standard for the diagnosis of this pathology, but non-invasive cardiovascular imaging tests have shown better definition of the origin and course of coronary arteries. Surgical treatment should be indicated for symptomatic patients, mainly in children with the anomalous origin of the left coronary artery from the pulmonary artery. The ideal management of asymptomatic patients remains undefined.

Treadmill stress test in children and adolescents: higher tolerance on exertion with ramp protocol

OBJECTIVE: Compare exercise tolerance by children and adolescents submitted to treadmill stress test (TST) following Bruce Protocol (BP) or Ramp Protocol (RP), as well as describe velocity and inclination reached with ramp protocol to help set protocol exercise standards. METHODS: Observational, case-based study, with history control of 1,006 children and adolescents in the 4 to 17-year-old range who were submitted to TST between October, 1986 and February, 2003, and who concluded one of the two protocols. Those who interrupted their ET for other reasons rather than physical exhaustion, those on medication that interfered in HR and those with physical constraints to exercise were excluded. Statistical analysis of data considered p<0.05 as significance level; with confidence interval at 95%. RESULTS: Exercise time close to 10 minutes in RP was significantly higher than in BP. HR max reached was higher than 180 bpm in both protocols. Inclination showed to be slightly higher in younger girls in Bruce Protocol. Velocity and VO2 max showed to be higher for all age ranges for those in the Ramp Protocol. CONCLUSION: Velocity and inclination reached with ramp protocol may be used as reference to help set ramp protocol exercise, which showed superior on exertion tolerance as compared to Bruce protocol.

Endomyocardial Fibrosis: Report of 6 Patients and Review of the Surgical Literature

Six patients with endomyocardial fibrosis were treated by endocardium decortication and atrioventricular valve replacement. There were 5 female patients and 1 male patient ranging from 14 to 48 years old (mean, 30 years). Four patients had involvement of the right ventricle, 1 patient had involvement of the left ventricle, and 1 patient had biventricular disease. There was 1 operative death due to low cardiac output state (the patient with biventricular endomyocardial fibrosis), and there was 1 late noncardiac death. The surgical literature, which describes 19 previously reported cases, was reviewed. On the basis of the results of this series and those of the reported cases, it is concluded that surgical treatment of endomyocardial fibrosis is feasible and provides good clinical improvement.

QT Dispersion predicting acute rheumatic carditis.

OBJECTIVE To investigate QT dispersion in the surface electrocardiogram of children with rheumatic carditis. METHODS QT dispersion was quantitatively evaluated in 33 children with acute rheumatic carditis. As a control group, we studied 33 healthy children free of any disease. The children were eligible for participation if the following criteria were met: diagnosis of acute rheumatic fever based on the revised Jones criteria and suffering from their first attack of carditis. The echo Doppler cardiogram was performed in all children, within 48-72 hours of hospitalisation. RESULTS Patients with carditis had a greater QT dispersion than the control group. When we analyse the QT dispersion according to the severity of the carditis, we observed that the dispersion tended to be greater in those with more severe valvar lesion. The sensitivity and specificity of the measurements of the QT dispersion in predicting acute carditis were estimated by using receiver operating characteristic curves. A QT dispersion greater than 40 milliseconds had a sensitivity of 63.6% and a specificity of 93.9% in predicting acute rheumatic carditis. CONCLUSION The lengthening of QT dispersion may reflect on cardiac involvement in rheumatic fever and be a new important parameter in the diagnosis and therapeutic decision for rheumatic carditis.

The prolongation of the QT interval in the acute rheumatic carditis: an enigma

Correspondencia: lurildo R. Saraiva • Avenida Prof. Moraes Rego, SN – Hospital das Clinicas – Cidade Universitaria – 50670-901 – Recife, PE E-mail: lurildocleano@hotmail.com Artigo recebido em 18/04/06; revisado recebido em 18/05/06; aceito em 18/05/06. Palavras-chave Febre reumatica, miocardite, sindrome do QT longo, doencas das valvas cardiacas. (PRi = 180 ms) e sinais de sobrecarga atrial esquerda, percebese o QTc alongado (valor medio em D2 = 0,441, maximo para a idade e sexo, 0,4201) e, mais que isso, a ampliacao desse alongamento apos extra-sistoles, com ondas T esmaecidas. Valores tao elevados para o limite superior de normalidade do QTc, como 0,450, admitidos por autores ingleses2, nao constituem, de modo algum, um fato consensual entre nos. Na sua tese de Catedra, “A sistole eletrica ventricular”, de 1949, o Professor Luiz V. Decourt1, no momento em que contemplou a apreciacao do intervalo QT na molestia reumatica, emitiu uma serie de conclusoes, apos minuciosa analise do eletrocardiograma (ECG) de 60 casos de individuos portadores de reumatismo ativo, entre eles, 35 com cardite reumatica “primitiva”. Utilizando a formula de Bazett no calculo do QT Sindrome caracterizada pelo historico de episodios de sincope e um intervalo QT longo, algumas vezes, levando a morte subita, devido a arritmia ventricular paroxistica corrigido para a frequencia cardiaca (QTc), verificou que:

Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state

OBJECTIVE: To identify the clinical and demographic predictors of in-hospital mortality in acute myocardial infarction with elevation of the ST segment in a public hospital, in the city of Fortaleza, Ceara state, Brazil. METHODS: A retrospective study of 373 patients experiencing their first episode of acute myocardial infarction was carried out. Of the study patients, 289 were discharged from the hospital (group A) and 84 died (group B). Both groups were analyzed regarding: sex; age; time elapsed from the beginning of the symptoms of myocardial infarction to assistance at the hospital; use of streptokinase; risk factors for atherosclerosis; electrocardiographic location of myocardial infarct; and Killip functional class. RESULTS: In a univariate analysis, group B had a greater proportion of the following parameters as compared with group A: non-Killip I functional class; diabetes; age >70 years; infarction of the inferior wall associated with right ventricular impairment; time between symptom onset and treatment at the hospital >12 h; anteroseptal or extensive anterior infarction; no use of streptokinase; and no tobacco use. In a multivariate logistic regression analysis, only non-Killip I functional class, diabetes, and age >70 years persisted as independent factors for death. CONCLUSION: Non-Killip I functional class, diabetes, and age >70 years were independent predictors of mortality in acute myocardial infarction with elevation of the ST segment.

Mitral valve disease with rheumatic appearance in the presence of left ventricular endomyocardial fibrosis

This is a report of a nine-year-old boy with both mitral stenosis and regurgitation and extensive endomyocardial fibrosis of the left ventricle. Focus is given to the singularity of the fibrotic process, with an emphasis on the etiopatho-genic aspects.

Progression of ventricular repolarization in left bundle branch block in non-compaction of the myocardium

Mailing Address: lurildo r. saraiva • Av. Prof. Moraes Rego, SN, Hospital das Clínicas UFPE, Disciplina de Cardiologia, Cidade Universitária 52070-420 Recife, PE, Brazil E-mail: lurildocleano@hotmail.com, lurildo@cardiol.br Manuscript received November 15, 2005; revised manuscript received November 21, 2005; accepted November 21, 2005. Male, 34-years-old, developed a rapidly progressive heart failure four years ago, resulting from a left ventricular (LV) noncompaction cardiomyopathy according to findings from magnetic resonance angiography. The initial electrocardiogram (Fig. 1) showed a first-degree AV block, left ventricular and left atrial overload and left bundle branch block, with SÂT at +30°, and biphasic T waves in D1 and V6. Recently, after a viral infection of the respiratory tract he presented with a severe exertional limitation. Doppler echocardiogram (Fig. 2) demonstrated diffuse hypokinesia and a significant decrease in LV ejection fraction (0.38) with mild mitral regurgitation, final LV diastolic diameter of 6.3cm and final systolic diameter of 5.1 cm, in addition to detecting the characteristic trabeculations in the internal face of the septal-apical myocardium with

Cardiac extension of primary mediastinal seminoma compressing the right ventricular outflow tract

We report the case of a 33-year-old male with primary seminoma of the anterior mediastinum with initial clinical manifestations suggestive of heart disease.

Phonomechanocardiographic Findings in Endomyocardial Fibrosis

Endomyocardial fibrosis (EMF) is a severe restrictive cardiomyopathy charac terized by the formation of fibrous tissue on the endocardium and to a lesser extent in the myocardium of one or both ventricles. The disease results in endocardial rigidity, atrioventricular valve dysfunction and progressive obliteration of the ventricular cavity. The clinical and pathological findings of EMF have been well established and definitive diagnosis can be made by selective cineangiocardiography.1-5 However, there are few reports concerning the phonomechanocardiographic (PMCG) patterns in this condition. In this paper we describe the PMCG findings in 12 patients with EMF which is now recognized with increasing frequency in the Northeast of Brazil.