Results from a liver transplant center in northeastern Brazil that performed more than 100 transplants in 2011.

BACKGROUND: Orthotopic liver transplantation is an essential approach performed in several centers around the world. Our center lies in northeastern Brazil and has performed this procedure since 2002. In 2011, 126 liver transplants were performed at our institution. METHODS: This study is a retrospective and descriptive analysis of the data collected from the medical records of those transplants. Epidemiological and clinical aspects were considered in this evaluation. The outcome analysis considered overall survival rates within 30 days and 1 year after transplantation. RESULTS: The sample of 124 patients showed 60% of all patients came from other regions, particularly the North and Midwest regions of Brazil, which had a combined population of >30 million in 2011. The most frequent etiologies for end-stage liver disease were hepatitis C and alcoholism. The average calculated MELD (Model for end-stage liver disease) was 21.0. Patient survival curves were 88.4% after 30 days and 81.5% after 1 year. CONCLUSION: The development of effective perioperative management for this procedure resulted in improved outcomes. Our center's performance is based on a multidisciplinary approach performed by qualified personnel, careful pre- and postoperative follow-up and continuous improvement of services.

Assessment of right ventricular function with Doppler echocardiographic indices derived from tricuspid annular motion: comparison with radionuclide angiography.

OBJECTIVE: To assess right ventricular systolic function using indices derived from tricuspid annular motion, and to compare the results with right ventricular ejection fraction (RVEF) calculated from radionuclide angiography. DESIGN: Pulsed Doppler echocardiography indices were obtained from 10 patients with a normal RVEF (group 1) and from 20 patients whose RVEF was less than 45% (group 2). RESULTS: The patients in the two groups were similar in age, systolic blood pressure, and heart rate. There was a close correlation between the tricuspid annular motion derived indices (D wave integral (DWI), peak velocity of D wave (PVDW), and tricuspid plane systolic excursion (TPSE)) and RVEF (r = 0.72, 0.82, and 0.79, respectively). DWI was significantly higher in group 1 than in group 2. PVDW discriminated adequately between individuals with abnormal and normal right ventricular ejection fraction. The sensitivity and specificity of tricuspid annular motion derived indices were very good. CONCLUSIONS: Indices derived from tricuspid annular motion appear to be important tools for assessing right ventricular systolic function.

[High output heart failure due to coronary fistula]. / Insuficiência cardíaca de alto débito devida a fístula coronária.

A 45 year-old woman complaining of heart failure symptoms (New York Heart Association--class III) and a non typical thoracic pain was submitted to a transthoracic echocardiogram which showed a very dilated coronary artery and a fistula to the right atrium. The angiograms confirmed the same findings. She underwent open heart surgery which confirmed the diagnosis. Fistula ligation was then undertaken. She remains symptom-free three years after the operation.

Um método para análise de movimentaçäo segmentar do ventrículo esquerdo em cineangiocardiografia com correçäo da obliteraçäo apical / Method for left ventricular wall motion analysis in cineangiocardiography with correction of the apical obliteration

Apresentamos um método para análise de movimentação segmentar do ventrículo esquerdo em cineangiografia que corrige a obliteração apical (OA) observada durante a sístole. A análise de movimentação é efetuada nas direções transversal e longitudinal segundo um sistema de referência baseado nos pontos de referência simétricos da silhueta diastólica final. A correção da OA mostrou ser necesssária especialmente para pacientes hipertróficos, caso contrário, levaria a uma avaliação incorreta da movimentação da região próxima ao ápice.

The apical ventricular lesion in Chagas' heart disease.

Apical lesions of the left ventricle, ranging from endocardial thickening to aneurysms, are commonly found in Chagas' heart disease. These abnormalities can be identified by ventriculography, two-dimensional echocardiography and radioisotopic studies. Generally, clinical manifestations are limited to arrhythmias and thromboembolic. The lesions are usually small and apparently do not play a role in ventricular dysfunction.

[Significance of intramural vascular injuries in myocardial revascularization. A case report]. / Significado das lesões vasculares intramurais em revascularização miocárdica. Relato de caso.

The authors report the case of 59 year-old hypertensive woman, suffering from angina pectoris, who died 24 hours after coronary by pass surgery due to cardiogenic shock. Autopsy revealed a small recent postero-lateral infarction. The venous by pass, however, were inconspicuous. Histologic examination showed extensive microarteriopathy with stenosing intimal fibro-elastosis and hyperplasia of the media, affecting 73% of the vessels with a diameter greater than 150 micra. The authors believe that the diffuse microangiopathy could have affected the myocardial reperfusion, and participated of the mechanical dysfunction.

Analysis of the position of the left ventricular apex and base during systole.

The relative positions of the left ventricular apex and base in end-diastole (ED) and end-systole (ES) were determined in a group of normal individuals using cross-sectional echocardiography (group A) and in a group of patients with normal hemodynamics and angiographic parameters using cine-computed tomography (group B). In both groups no change was detected in the position of the epicardial aspect of the apex from ED to ES. The base moved in direction of the apex by 10.2% +/- 1.9% (mean +/- standard deviation) of the longitudinal dimension of the chamber in group A and by 12.9% +/- 5.1% in group B. In both groups the apical cavity was obliterated by the peri-apical walls. Apical obliteration is responsible for the apparent movement of the apical segment seen in cineventriculography.

Sequence of shortening of the normal human left ventricle.

Left ventricular sequence of shortening was studied through the analysis of cineventriculograms in 30 degree right anterior oblique projection of 11 normal patients. In all patients transverse shortening progressed in base to apex direction, in a concentric fashion. Base descent started simultaneously with the first transverse inward motion and continued throughout systole. There was a slight protrusion of the apex in the beginning of systole, lasting a mean of 115 ms.