Variações eletrocardiográficas em pacientes portador de cardiopatia hipertrófica em uso de CDI / Eletrocardiographic changes in patients with hypertrophic cardiomyopathy using ICD

A cardiomiopatia hipertrófica (CMH) é uma forma relativamente comum e complexa de doença cardíaca genética, sendo considerada a maior causa de morte súbita (MS) cardíaca em pessoas jovens, incluindo atletas, respondendo por 36% dos casos em jovens atletas nos Estados Unidos (EUA). O implante decardioversor-desfibrilador (CDI) tem demonstrado alta eficácia na prevenção desse evento. Para avaliação diagnóstica da CMH, o eletrocardiograma (ECG)representa ferramenta bastante útil, pois se encontra alterado em 75% a 95% dos casos clínicos. Após o implante do CDI, como demonstrado no caso relatado, são observadas variações no ECG que podem explicar a mudança benéfica na fisiopatologia obstrutiva da CMH.

Hypertrophic cardiomyopathy (HCM) is a relatively common and complex genetic heart disease, rated as main cause of sudden cardiac death (SCD) in young people, including athletes, accounting for 36% of these cases in young athletes in the United States(USA). IDC implants have proved highly effective for preventing such events. For diagnostic evaluations of CMH, the electrocardiogram (ECG) is a very useful tool, being altered in 75% to 95% of clinical cases. After an ICD implant, as demonstrated in this case report, variations in the ECG are noted that could explain the beneficial alteration in the pathophysiology of obstructive HCM.

Infarto agudo do miocárdio em adolescente secundário à trombose de aneurisma coronariano / Acute myocardial infarction in adolescent secondary to coronary aneurysm thrombosis

O aneurisma de artéria coronaria é uma doença geralmente descoberta de forma acidental já que a maioria dos pacientes permanece assintomática. Não obstante, raros pacientes podem apresentar complicações locais do aneurisma. Relata-se um caso de trombose de aneurisma de coronária seguido de infarto agudo do miocárdio em um adolescente. São revisadas, também, as modalidades diagnósticas na avaliação desta doença.

Coronary artery aneurysm is a disease usually diagnosed accidentally since most patients remain asymptomatic. Nonetheless, rare patients may havelocal aneurysm complications. We describe a case of coronary artery aneurysm thrombosis followed by acute myocardial infarction in an adolescent. We also review the imaging diagnosis of this disease.

Patent ductus arteriosus ligation is associated with impaired left ventricular systolic performance in premature infants weighing less than 1000 g.

OBJECTIVE: Patent ductus arteriosus ligation is often complicated by systemic hypotension and oxygenation failure. The ability of the immature myocardium to compensate for altered afterload is poorly understood. The aim of this study was to characterize the effects of patent ductus arteriosus ligation on myocardial performance in preterm infants. METHODS: Serial echocardiographic analysis was performed before and after patent ductus arteriosus ligation. Characteristics of the patent ductus arteriosus, myocardial performance (fractional shortening, mean velocity of circumferential fiber shortening, and left ventricular output) and left ventricular afterload (end-systolic wall stress) were assessed. The stress-velocity relationship was measured as a preload-independent, afterload-adjusted measure of myocardial contractility. RESULTS: Forty-six preterm infants were assessed at 28.5 +/- 11.3 days and a weight of 1058 +/- 272 g. Patent ductus arteriosus ligation was followed by increased left ventricular exposed vascular resistance temporally coinciding with reduced left ventricular preload, decreased left ventricular contractility, and low left ventricular output. Neonates weighing 1000 g or less had a higher rate of low fractional shortening (<25%) or low left ventricular output (<170 mL x kg(-1) x h(-1)) and increased need for cardiotropes and demonstrated a trend toward an impaired stress-velocity relationship. Neonates with impaired left ventricular systolic performance were more likely to require cardiotropes and have low systolic arterial pressure, increased heart rate, and abnormal base deficit. CONCLUSION: Patent ductus arteriosus ligation is sometimes associated with impaired left ventricular systolic performance, which is most likely attributable to altered loading conditions. Neonates weighing 1000 g or less are at increased risk of impaired left ventricular systolic performance, which might relate to maturational differences and decreased tolerance to altered loading conditions.

Technical option on tetralogy of Fallot with abnormal coronary artery: cases report.

Report on two children, one 11 year-male and another one year-six-month-female with tetralogy of Fallot associated with anomalous origin of coronary artery crossing the right ventricle outlet tract. Diagnosis was done by echocardiography and cardiac catheterization. On surgical correction we used an external composite tubular pericardium bovine graft and posterior wall of the pulmonary artery between the right ventricle and the pulmonary artery trunk. Patients had an uneventful post-operative period and were discharged asymptomatic. It is more an option on correction of tetralogy of fallot with anomalous coronary artery.

Opção técnica na tetralogia de Fallot com artéria coronária anômala: relato de casos / Technical option on tetralogy of Fallot with abnormal coronary artery: cases report

Relatamos dois casos um menino de 11 anos e uma menina de um ano e seis meses, portadores de tetralogia de Fallot com artéria coronária de origem anômala, cruzando a via de saída de ventrículo direito. O diagnóstico foi feito com ecocardiografia e cateterismo cardíaco. Utilizamos, na correção, um enxerto externo composto de pericárdio bovino e parede posterior da artéria pulmonar, entre o ventrículo direito e o tronco da artéria pulmonar. As crianças tiveram boa evolução pós-operatória, obtendo alta hospitalarassintomáticas. É mais uma opção técnica na correção da tetralogia de Fallot com artéria coronária anômala.

Report on two children, one 11 year-male and another one year-six-month-female with tetralogy of Fallot associated with anomalous origin of coronary artery crossing the right ventricle outlet tract. Diagnosis was done by echocardiography and cardiac catheterization. On surgical correction we used an external composite tubular pericardium bovine graft and posterior wall of the pulmonary artery between the right ventricle and the pulmonary artery trunk. Patients had an uneventful post-operative period and were discharged asymptomatic. It is more an option on correction of tetralogy of Fallot with anomalous coronary artery.