[Analysis of the composition and spatial disposition of atherosclerotic plaques localized in epicardial coronary artery bifurcations in adults]. / Análise da composição e disposição espacial de placas ateroscleróticas localizadas em bifurcações das artérias coronárias epicárdicas de adultos.

PURPOSE: To analyze macro and microscopic features of atherosclerotic plaques located in bifurcation of coronary arteries, defining their spatial disposition in those sites. METHODS: We studied 38 bifurcations of coronary arteries of patients whose cause of death was related to coronary artery disease. Histologic sections of 0.5mm were sequentially made from the main artery to the secondary branches. They were stained with hematoxilin-eosin technique. Histological analysis evaluated: a) morphologic composition of the plaques, b) degree of obstruction and c) plaque's disposition. RESULTS: a) Plaque's composition: fibrolipid plaques constituted 80% of the cases and mingled focal atrophy of the media at the base of the plaque in 61% with spots of total destruction and rupture of the elastic layers in 30%; b) degree of obstruction: ranged from 20% to 95%, with average 60 +/- 28%; c) disposition of plaques: we verified morphologic variation along the plaque, most of them (71%) being eccentric at bifurcation and not reaching the beginning of flow divider walls. CONCLUSION: Atherosclerotic plaques located in bifurcation of coronary arteries of adults are often fibrolipid plaques, eccentric, and their spatial disposition on those sites spare the beginning of the inner walls, reaching the outer walls.

[Efficacy and tolerance of a new calcium-channel blocking agent (nitrendipine) in the treatment of arterial hypertension]. / Eficácia e tolerabilidade de um novo bloqueador dos canais de cálcio (nitrendipina) no tratamento da hipertensão arterial.

PURPOSE: Assess the efficacy and tolerability of nitrendipine, 20 mg/day, in mild to moderate essential hypertension (diastolic blood pressure 95 to 114 mmHg). MATERIAL AND METHODS: Twenty patients in an open comparative trial (drug x placebo) during six weeks. Blood pressure and heart rate were measured in orthostatic and supine position and after hand-grip maneuver every two weeks. RESULTS: Systolic and diastolic blood pressure fell significatively in the treated group by the end of the study-supine (161 mmHg +/- 11 to 138 mmHg +/- 13 and 105 +/- 5 to 81 mmHg +/- 7 p less than 0.05) and orthostatic position (153 mmHg +/- 13 to 132 mmHg +/- 13 and 104 mmHg +/- 15 to 81 mmHg +/- 7, p less than 0.05) and after hand grip maneuver (170 mmHg +/- 21 to 148 mmHg +/- 22 and 108 mmHg +/- 5 to 85 mmHg +/- 7 p less than 0.05). Significant modifications were not observed in systolic and diastolic blood pressure in placebo group under the following conditions: supine (168 mmHg +/- 8 to 168 mmHg +/- 17 and 107 mmHg +/- 5 to 107 mmHg +/- 3) and orthostatic positions (167 mmHg +/- 9 to 163 mmHg +/- 14 and 107 mmHg +/- 5 to 107 mmHg +/- 4) and after hand grip maneuver (178 mmHg +/- 17 to 173 mmHg +/- 16 and 107 mmHg +/- 4 to 108 mmHg +/- 6). Significant changes in heart rate did not occur in both groups after treatment. Heart rate elevation observed after hand grip maneuver did not change. Adverse effects like headache, palpitation and dizziness occurred in both groups. Electrocardiogram, x-ray and blood chemistries were not modified during the trial.

[Mitral valvuloplasty with balloon catheterization in pregnant patients. Report of 3 cases]. / Valvoplastia mitral por cateter balão em pacientes grávidas. Relato de três casos.

The authors report on three pregnant patients with mitral stenosis with heart failure in functional class IV (NYHA) unresponsive to clinical treatment. They were submitted to mitral valvuloplasty, with significant clinical improvement, and were, hence, asymptomatic. Despite the small number of cases, it may be concluded that the procedure is simple and safe, which can be attested by the successful results.

Acquired ventricular septal defect and tricuspid valve disruption as a complication of infective endocarditis of the aortic valve.

Ventricular septal defect is a rare complication of infective endocarditis. This is a case report of a 48-year-old man with chronic alcoholism without known previous heart disease who developed a ventricular septal defect and a tricuspid valve disruption in the course of a fatal infective endocarditis of the aortic valve.

The De Vega annuloplasty as surgical treatment for tricuspid incompetence.

Seventy-six patients with tricuspid insufficiency associated with other valvular lesions underwent De Vega annuloplasty. There were mitral lesions in 74 patients, aortic valve lesions in eight and atrial septal defects (ASD) in four. The radiographic and electrocardiographic findings and hemodynamic data are reported for 66 patients. Replacement of one or two valves was performed in 56 patients, one or two valves commissurotomy in 21 and closure of the ASD in four. The immediate postoperative mortality was 19.7%. Forty-four patients were followed from six to 59 months. There were three late deaths and clinical conditions were improved in all the survivors except one who presented mitral restenosis. Discrete residual tricuspid incompetence occurred in 11 patients (25%). We conclude that the De Vega annuloplasty is the treatment of choice for functional tricuspid incompetence.

Clinical results of valve replacement by the Starr-Edwards prosthesis.

Heart valve replacement has initiated special research efforts and has led to debate among surgeons from different surgical services. It is in this area of cardiac surgery that complications are frequent. This paper is a summarized review of the problems related to valve replacement by the Starr-Edwards prosthesis at the University of Sao Paulo Medical School Heart Institute. It describes the difficulties which led the authors to abandon its use in 1971. Clinical experience is from July 1958 to January 1974.