Nuno Moreno

Detection of Wolbachia bacteria in multiple organs and feces of the triatomine insect Rhodnius pallescens (Hemiptera, Reduviidae).

ABSTRACT At least two types of Wolbachia bacteria were detected in wild and insectarium-raised Rhodnius pallescens, a natural vector of Trypanosoma cruzi and Trypanosoma rangeli. Wolbachia was detected in all the organs and tissues studied and in the feces, and this provided a methodological advantage for determining the presence of this endosymbiont in this host, obviating the need to kill the specimens. The occurrence of trypanosomatids in wild individuals was also studied.

Levosimendan: The current situation and new prospects

Levosimendan is a pyridazinone-dinitrile derivative with positive inotropic and vasodilatory effects that has beneficial effects on myocardial performance. In previous randomized studies levosimendan improved hemodynamics and clinical course, but its effect on prognosis is still unclear. This important issue has limited its use. Although primarily used in the management of acute heart failure syndromes, this new inotropic agent may play a role in other clinical conditions. This review aims to summarize current knowledge on levosimendan and to present future prospects for the use of this drug.

Incessant slow bundle branch reentrant ventricular tachycardia in a young patient with left ventricular noncompaction

A 15-year-old girl was admitted to the cardiology outpatient clinic due to mild palpitations and documented incessant slow ventricular tachycardia (VT) with left bundle branch block (LBBB) pattern. The baseline electrocardiogram revealed first-degree atrioventricular block and intraventricular conduction defect. Transthoracic echocardiography showed prominent trabeculae and intertrabecular recesses suggesting left ventricular noncompaction (LVNC), which was confirmed by cardiac magnetic resonance imaging. During electrophysiological study, a sustained bundle branch reentrant VT with LBBB pattern and cycle length of 480 ms, similar to the clinical tachycardia, was easily and reproducibly inducible. As there was considerable risk of need for chronic ventricular pacing following right bundle ablation, no ablation was attempted and a cardioverter-defibrillator was implanted. To the best of our knowledge, no case reports of BBR-VT as the first manifestation of LVNC have been published. Furthermore, this is an extremely rare presentation of BBR-VT, which is usually a highly malignant arrhythmia.

Cardiac thrombus and conduction disorder in takotsubo cardiomyopathy

Takotsubo cardiomyopathy is a reversible form of left ventricular dysfunction with an apparently benign natural history after left ventricular recovery. Rarely there are complications such as arrhythmias and apical thrombus. We describe a case of takotsubo cardiomyopathy complicated with apical thrombus and persistent complete atrioventricular block after improvement of left ventricular wall motion.

Anomalous pulmonary venous connection: An underestimated entity

Anomalous pulmonary venous connection is an uncommon congenital anomaly in which all (total form) or some (partial form) pulmonary veins drain into a systemic vein or into the right atrium rather than into the left atrium. The authors present one case of total anomalous pulmonary venous connection and two cases of partial anomalous pulmonary venous connection, one of supracardiac drainage into the brachiocephalic vein, and the other of infracardiac anomalous venous drainage (scimitar syndrome). Through the presentation of these cases, this article aims to review the main pulmonary venous developmental defects, highlighting the role of imaging techniques in the assessment of these anomalies.

Aortic regurgitation in rheumatoid arthritis: an uncommon presentation

A 46-year-old woman with treated rheumatoid arthritis (RA) was referred to Cardiology Department due to symptomatic, non-syncopal, ventricular tachycardia episodes. On physical examination, a diastolic heart murmur on left sternal border, compatible with aortic regurgitation (AR), was described, without signs of heart failure or joint damage. Basal electrocardiogram showed sinus rhythm and right bundle branch block (BBB) and during tachycardia wide QRS complexes, with left BBB morphology and inferior axis. Transthoracic and transesophageal echocardiograms showed a tricuspid aortic valve (AV) with a large, non-mobile sub-AV mass, adherent to right coronary cusp (RCC) and membranous interventricular septum, leading to leaflet immobilization on diastole, causing eccentric, severe AR jet, impinging on anterior mitral valve leaflet (Fig. 1A–D; Videos 1–5); the left ventricle had normal dimensions and ejection fraction. Cardiac magnetic resonance findings were consistent with a non-fatty, fibrous, non-vascularized mass (Fig. 1E, F; Videos 6, 7). At surgery, RCC was thickened and immobilized by a 20 mm mass (Fig. 1G); non-coronary cusp was also involved and AV replacement with a mechanical valve performed. On histopathology, the valve and fibrous mass showed an inflammatory infiltrate, with a granuloma being found (Fig. 1H), without signs of neoplasm or microorganisms, a lesion characteristic of rheumatoid nodule. The clinical and imaging presentation turns this into a unique case: in most reports, leaflet retraction is the mechanism for valvular insufficiency in RA; here, a large inflammatory mass leads to cusp immobilization. This underscores the need to recognize RA as an etiology of heart valve disease, even when mechanism seems unusual.

Um caso complexo de endocardite de sondas de pacemaker

Pacemaker lead endocarditis is an uncommon complication after pacemaker implantation, but is associated with high rates of morbidity and mortality. The authors describe the case of a 68-year-old woman with a double-chamber pacemaker since 2007, admitted to an internal medicine department for spondylodiscitis and Staphylococcus aureus bacteremia. During hospitalization, she had an episode of syncope; the 12-lead electrocardiogram showed pacemaker malfunction with ventricular undersensing and loss of capture. A transesophageal echocardiogram showed images compatible with vegetations on the pacemaker leads. After antimicrobial therapy, the patient developed acute renal failure with subsequent multiple organ failure and death. A high index of clinical suspicion is required for early diagnosis and appropriate treatment of cardiac device-related infective endocarditis.

Mid-aortic syndrome in a patient with neurofibromatosis type 1

Mid-aortic syndrome is an uncommon condition characterized by constriction of the distal thoracic and/or abdominal aorta and its branches. A 43-year-old male patient with a history of neurofibromatosis type 1 (NF-1) was referred to our hospital for resistant arterial hypertension. At physical examination he presented asymmetric elevated blood pressure in the extremities, higher in the upper limbs. An echocardiogram was performed and showed moderate left ventricular hypertrophy, without signs of coarctation of the aorta. As a part of workup for hypertension, computed tomography (CT) was performed, which showed an abnormal aorta with severe narrowing and a saccular aneurysm at the level of the renal arteries (Figures 1 and 2). There was extensive collateral blood flow through hypertrophic lumbar, epigastric and mesenteric arteries and the left renal artery showed subtotal stenosis at its origin, causing atrophy of the left kidney (Figure 3). Additional angiographic study enabled a final diagnosis. There were also subcutaneous and retroperitoneal neurofibromas. Mid-aortic syndrome usually presents with arterial hypertension and is commonly diagnosed in children or young adults. It can be associated with Williams syndrome,

Case reportIncessant slow bundle branch reentrant ventricular tachycardia in a young patient with left ventricular noncompactionTaquicardia ventricular por reentrada de ramo lenta e incessante em adolescente com ventrículo esquerdo não-compactado

A 15-year-old girl was admitted to the cardiology outpatient clinic due to mild palpitations and documented incessant slow ventricular tachycardia (VT) with left bundle branch block (LBBB) pattern. The baseline electrocardiogram revealed first-degree atrioventricular block and intraventricular conduction defect. Transthoracic echocardiography showed prominent trabeculae and intertrabecular recesses suggesting left ventricular noncompaction (LVNC), which was confirmed by cardiac magnetic resonance imaging. During electrophysiological study, a sustained bundle branch reentrant VT with LBBB pattern and cycle length of 480 ms, similar to the clinical tachycardia, was easily and reproducibly inducible. As there was considerable risk of need for chronic ventricular pacing following right bundle ablation, no ablation was attempted and a cardioverter-defibrillator was implanted. To the best of our knowledge, no case reports of BBR-VT as the first manifestation of LVNC have been published. Furthermore, this is an extremely rare presentation of BBR-VT, which is usually a highly malignant arrhythmia.

Case reportCardiac thrombus and conduction disorder in takotsubo cardiomyopathyMiocardiopatia de takotsubo complicada com trombo apical e alterações da condução

Takotsubo cardiomyopathy is a reversible form of left ventricular dysfunction with an apparently benign natural history after left ventricular recovery. Rarely there are complications such as arrhythmias and apical thrombus. We describe a case of takotsubo cardiomyopathy complicated with apical thrombus and persistent complete atrioventricular block after improvement of left ventricular wall motion.