[Cardiac performance and hemodynamic response under the effect of isoproterenol and D-isosorbitol in patients with dilated cardiomyopathy]. / Desempenho cardíaco e resposta hemodinâmica sob ação do isoproterenol e D-isosorbitol em portadores de miocardiopatia dilatada.

The authors studied cardiac performance of 36 patients with dilated cardiomiopathy through cardiac catheterization and left ventriculography in comparison with a control group. It has been verified that the end systolic volume (ESV) is more sensitive than ejection fraction (EF) as an indicator of the presence and degree of systolic dysfunction. Isoproterenol (IP) (18 patients) and D-isosorbitol (IS) (18 patients) have been used in the evaluation of hemodynamic response of DM. It has been verified equivalent responses such as: 1--decrease of ESV and end diastolic pressure (EDP); 2--increase of stroke volume and EF. The contractility indexes of left ventricle, however, showed different responses to the 2 substances: 1--with IP there was an increase of peak dp/dt and common peak isovolumetric pressure (CPIP 45 mmHg); 2--with IS there was no variation. The authors conclude that: 1--IP or similar drugs may be used during cardiac catheterization to evaluate the contractile reserve of the myocardium; 2--IS may be used in ambulatorial treatment of DM to improve ventricular function through a tendency to normalize intracardiac pressure-volume relation.

[Extensive partial agenesis of the left pericardium. An anatomo-clinical correlation. Report of 2 cases]. / Agenesia parcial extensa do pericárdio esquerdo. Correlação anatomoclínica. Relato de dois casos.

The authors report on two patients with large partial congenital defect of the left pericardium, as observed at post-mortem examination. In both cases, diagnosis was made during life thanks to the clinical syndrome described by Abbott, Sothworth and Stenvenson. In the first case diagnosis was confirmed by pneumothorax proposed by Ellis et al and the second case was recognized by the clinical-radiological syndrome. The first patient was followed until his death. Because of an abnormal echogram, he was submitted to exploratory cardiotomy and small ASD, aneurysmatic dilation of Valsalva sinus and mitral regurgitation by ruptured chordae tendineae were found. The autopsy, besides the findings at the operation, showed residual adhesive pericarditis with a cavity at the postero-superior region of the heart behind the left auricle and a redundant tricuspid cusp. The association of congenital pericardium defect to mitro-tricuspid redundant cusps and aneurysmatic dilatation of the sinus of Valsalva--suggesting myxomatous degeneration--plus atrial septal defect as in case 1, has not been found in the medical literature. In the second patient the defect was recognized in spite of congestive heart failure and severe tricuspid regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hemodynamic profile of patients with normal coronary cineangiography]. / Perfil hemodinâmico dos pacientes com cinecoronariografia normal.

The authors reviewed 1474 consecutive selective coronary arteriograms performed on patients with suspected coronary insufficiency for the diagnosis of obstructive coronary disease and found 281 (19.1%) cases of apparently normal coronary arteries. These patients presented mean age of 47 +/- 10 years; they were 135 (48%) males and 146 (52%) females. The objective of this study was to obtain the hemodynamic profile of these patients for the following parameters: a) aortic and left ventricular pressures; b) volumes, ejection fraction, segmentary contraction, wall thickness and mass of left ventricle; c) morphology, mobility and competence of the mitral valve. Eight groups of patients were selected: 1) without hemodynamic alterations - 18.9%; 2) with systemic arterial hypertension - 48.7%; 3) with abnormal myocardial contraction - 16.7%; 4) with idiopathic left ventricular hypertrophy - 6.4%; 5) with mitral valve prolapse - 2.5%; 7) with myocardial bridge of the left anterior descending coronary artery - 1.8%; 8) with coronary arterial microfistula of the left ventricle - 0.4%. It is desirable to determine before situations of cardiac emergencies, whether provoked ischemia, as detected by noninvasive stress testing, is present before the performing coronary arteriography in patients, specially females, with systemic arterial hypertension, left ventricular hypertrophy, disorders of ventricular contraction or mitral valve prolapse.

Improved visualization of aortopulmonary collateral arteries by abdominal aortic compression during angiography.

Increased filling of aortopulmonary collateral arteries occurs when the descending aorta is obstructed distal to their origin. We used this fact to develop a simple, safe technique for improving angiographic visualization of these arteries. The abdominal aorta is manually compressed against the spine during injection of contrast medium. A slight reflex bradycardia resulted, which probably also enhanced filling of the collateral arteries. In eight infants and children with either pulmonary atresia and a ventricular septal defect or truncus arteriosus communis, excellent visualization was consistently achieved without complication.

Aneurismas de artérias coronárias em crianças - coronarite por doença de Kawasaki / Coronary artery aneurysms in children - coronaritis caused by Kawasaki disease

Os autores relatam o caso de uma crianca de 9 anos de idade que apresentou a sindrome mucocutanea do nodulo linfatico (MLNS) ou doenca de Kawasaki aos 3 anos de idade. Foram realizados os exames clinico, eletrocardiografico, radiologico, ecocardiografico, cateterismo cardiaco e a cineangiocoronariografia. Esta mostrou aneurismas multiplos de arteria coronaria e disfuncao ventricular esquerda com diminuicao segmentar da contracao ventricular. Considerando este como o primeiro caso da MLNS com cineangiocoronariografia relatado no Brasil, descrevem os principais aspectos da doenca na fase precoce e tardia

Forma clínica isolada do "cor triatriatum". Novo sinal na radiologia convencional e aspectos particulares da ecocardiografia bidimensional / Isolated clinical form of cor triatriatum. New sign in conventional radiology and particular aspects of bidimensional echocardiography

E descrito um paciente com a forma do "cor-triatriatum" dando enfase aos achados da radiologia simples do torax e da ecocardiografia que ainda nao foram acentuados na literatura. No presente caso foi de fundamental importancia diagnostica uma forma inusitada de crescimento atrial esquerdo, vista na radiografia simples, que poderia ser um elemento utilissimo para o reconhecimento da anomalia

Verapamil como hipotensor. Estudo clinico, laboratorial, eletro e ecocardiografico. / Verapamil as hypotensive agent.Clinical, laboratorial, electro and echocardiographic study

Foram selecionados 65 pacientes com hipertensao leve e moderada. Instituiu-se tratamento incial com clortalidona (100mg/dia) durante 14 dias. Trinta e dois pacientes nao tiveram a pressao arterial normalizada e foram divididos em 2 grupos: 17 pacientes aos quais se acrescentou verapamil (240 a 360 mg/dia) e 15 pacientes aos quais se acrescentou metropolol (100 a 300 mg/dia). Foi feito controle com provas de funcao hepatica, eletrocardiograma e ecocardiograma antes e 15 dias apos o inicio do tratamento. Os 2 grupos mostraram resultados similares, com a normalizacao de PA em 16 de 17 pacientes tratados com verapamil e nos 15 com metoprolol. No grupo tratado com verapamil houve melhora na repolarizacao ventricular ao ECG em 4 de 11 pacientes com alteracoes previas, o que nao sucedeu em 4 dos tratados com metoprolol. As provas de funcao hepatica e os dados ecocardiograficos nao mostram alteracoes significativas. O verapamil, associado a clortalidona, mostrou-se util e eficiente por via oral no tratamento da hipertensao leve e moderada

Development of the ductus arteriosus in right ventricular outflow tract obstruction.

We studied the morphology of the ductus arteriosus in 14 infants, ages 2--90 days. Eight (group 1) had pulmonary atresia (structural and functional) with an intact interventricular septum; six (group 2) had pulmonary atresia with a ventricular septal defect. The inferior angle of the ductus arteriosus at the aortic junction was measured in each patient. In group 1, this angle was obtuse in all but one patient. In group 2, the angle was acute in all. Further study of intracardiac anatomy suggested that in group 1, the obtuse inferior angle of the ductus arteriosus was the result of a late and progressive obstructive phenomenon that allowed normal right-to-left flow through the ductus arteriosus during much of fetal life. In group 2, the direction of ductus arteriosus flow (normally from the pulmonary trunk to the aorta) was reversed, and flowed from the aorta to the pulmonary trunk. This reversal of flow was probably of early onset in the fetus, the aorta receiving the total combined ventricular output, and produced a small ductus arteriosus with an acute inferior angle. It is extremely important not to rule out pulmonary atresia with an intact interventricular septum when aortography in the newborn shows a normal-sized ductus arteriosus with an obtuse inferior angle. Despite existing pulmonary atresia, these patients have neither a hypoplastic right ventricle nor discontinuity of the right ventricle with the pulmonary artery.