Ricardo Wang

Reduced Progression of Cardiac Allograft Vasculopathy with Routine Use of Induction Therapy with Basiliximab

Background Cardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV. Objectives The primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group. Methods Thirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel. Results Thirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120–185.43 mm3 vs. 127.77–131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30–49.15 mm3 [∆80%] vs. 20.23–26.69 mm3 [∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001). Conclusion Routine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT.

Síndrome do balonamento apical secundário ao uso abusivo de descongestionante nasal

We describe a typical case of apical ballooning syndrome in an octogenarian female patient with left ventricular wall motion abnormality on electrocardiography, whose ventricular function returned to normal. The patient has allergic rhinitis and had used nasal decongestant excessively a few hours prior to the episode of pain.

Use of Evidence-Based Interventions in Acute Coronary Syndrome - Subanalysis of the ACCEPT Registry

Background The recommendations in guidelines are based on evidence; however, there is a gap between recommendations and clinical practice. Objective To describe the practice of prescribing evidence-based treatments for patients with acute coronary syndrome in Brazil. Methods This study carried out a subanalysis of the ACCEPT registry, assessing epidemiological data and the prescription rate of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (IAT1RB), and statins. In addition, the quality of myocardial reperfusion in ST-segment elevation myocardial infarction was evaluated. Results This study assessed 2,453 patients. The prescription rates of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/IAT1RB, and statins were as follows: in 24 hours - 97.6%, 89.5%, 89.1%, 80.2%, 67.9% and 90.6%; and at six months - 89.3%, 53.6%, 0%, 74.4%, 57.6% and 85.4%, respectively. Regarding ST-segment elevation myocardial infarction, only 35.9% and 25.3% of the patients underwent primary angioplasty and thrombolysis, respectively, within the recommended times. Conclusion This registry showed high initial prescription rates of antiplatelet drugs, antithrombotic drugs, and statins, and lower prescription rates of beta-blockers and angiotensin-converting enzyme inhibitors/IAT1RB. Independently of the class, the use of all drugs decreased by six months. Most patients with ST-segment elevation myocardial infarction did not undergo myocardial reperfusion within the time recommended.

Tronco de coronária esquerda ocluso secundário a Lues terciária

A 27-year-old patient with tertiary syphilis, manifested as myocardial ischemia, presenting unstable angina, secondary to left coronary trunk occlusion. The diagnosis was confirmed by the serological findings and the pathological assessment of the aorta fragment.

Transseptal coronary angioplasty in patients with severe peripheral vascular disease

It is estimated that six thousand diagnostic cardiac catheterizations and two thousand coronary angioplasties are performed per million inhabitants per year1, all by retrograde approach. Roughly, for every six thousand procedures, one patient has diffuse injury of the arterial system, with involvement of the four extremities2. Despite the difficulty of arterial access, the anatomical diagnosis of coronary artery disease today is no longer a barrier. It is currently possible to conduct anatomical studies without the need for invasive study, especially due to the improved image quality of coronary CT angiography. However, coronary intervention is still a barrier, as larger profile catheters are used and anticoagulation is needed.

Assessment of cardiac allograft vasculopathy in cardiac transplantation: experience of a Brazilian center

BACKGROUND Cardiac transplantation continues to be the treatment of choice for heart failure refractory to optimized treatment. Two methods have high sensitivity for diagnosing allograft rejection episodes and cardiac allograft vasculopathy (CAV), important causes of mortality after transplantation. OBJECTIVE To assess the relationship between intravascular ultrasound (IVUS) results and endomyocardial biopsy (BX) reports in the follow-up of patients undergoing cardiac transplantation in a Brazilian reference service. METHODS A retrospective epidemiological observational study was carried out with patients undergoing orthotopic cardiac transplantation from 2000 to 2009. The study assessed the medical records of those patients and the results of the IVUS and BX routinely performed in the clinical post-transplant follow-up, as well as the therapy used. RESULTS Of the 77 patients assessed, 63.63% were males, their ages ranging from 22 to 69 years. Regarding the IVUS results, 33.96% of the patients were classified as Stanford class I, and 32.08%, as Stanford class IV. Of the 143 BX reports, 51.08% were 1R, and 0.69%, 3R. The Quilty effect was described in 14.48% of the BX reports. All patients used antiproliferative agents, 80.51% used calcineurin inhibitors, and 19.48% used proliferation signal inhibitors. CONCLUSION The assessment of cardiac transplant patients by use of IVUS provides detailed information for the early and sensitive diagnosis of CAV, which is complemented by histological data derived from BX, establishing a possible causal relationship between CAV and humoral rejection episodes.

Infarto agudo do miocárdio de parede inferior sem lesão obstrutiva coronária

ABSTRACT Inferior Acute Myocardial Infarctionwithout Coronary Lesions We describe the case of a 70-year-old patient admittedwith acute myocardial infarction, with clinical, electrocar-diographic, enzymatic and left ventricular regional wallmotion abnormalities. Coronary angiography showed noobstructive lesions, which was confirmed by intravascularultrasound (IVUS). Different hypothesis are raised to explainmyocardial infarction with normal coronary arteries inthis patient. DESCRIPTORS: Myocardial infarction. Coronary disease.Coronary angiography. Ultrasonography, interventional. O infarto agudo do miocardio e a principal causade morbidade e mortalidade em todo o mun-do 1 . A maioria dos casos decorre da instabili-zacao de uma placa aterosclerotica com trombosesobrejacente. Varios outros mecanismos foram identi-ficados como causa de sindrome coronaria aguda,como obstrucao dinâmica, inflamacao, obstrucao me-cânica e aumento de consumo miocardico de oxige-nio. Descrevemos a seguir um caso de infarto agudodo miocardio com coronarias normais.

Fístula da artéria descendente anterior para ventrículo direito pós-implante de stent

aciente do sexo masculino, 73 anos de idade, na-tural de Curitiba, admitido na Unidade de Dor To-racica da Santa Casa de Curitiba com quadro dedor toracica tipica em repouso, de inicio recente. Eletro-cardiograma mostrava infradesnivelamento do segmentoST, em parede anterior. Exames laboratoriais sem anor-malidades. Submetido a cineangiocoronariografia, quemostrou lesao moderada no terco medio da arteriadescendente anterior – DA – (Figura 1). Em analiseretrospectiva, nota-se discreta constricao no terco medio,sugestivo de trajeto intramiocardico da DA. A ultra-sonografia intracoronaria mostra area de 2,8mm

Terapia trombolítica no tratamento da embolia pulmonar maciça

aciente de 44 anos, sexo feminino, admitida naUnidade de Dor Toracica da Santa Casa de Mise-ricordia de Curitiba, com quadro de dispneia deinicio subito, com piora progressiva nos ultimos 5 dias,associada a dor ventilatoria-dependente. Relatode empastamento do membro inferior esquerdo e usode contraceptivo oral, nega outros fatores de risco paraembolia pulmonar. A admissao, encontrava-se taquip-neica, hipoxemica (Sat O