RESUMO
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.
Assuntos
Endocardite Bacteriana/complicações , Ruptura Cardíaca/etiologia , Septos Cardíacos , Valva Aórtica , Doenças das Valvas Cardíacas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva TricúspideRESUMO
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.
Assuntos
Insuficiência da Valva Tricúspide/cirurgia , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/mortalidadeRESUMO
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.
Assuntos
Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Nitrendipino/uso terapêutico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitrendipino/administração & dosagemRESUMO
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.
Assuntos
Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Adulto , Idoso , Angioplastia Coronária com Balão , Biópsia , Doença da Artéria Coronariana/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Cateterismo , Estenose da Valva Mitral/terapia , Complicações Cardiovasculares na Gravidez/terapia , Adulto , Ecocardiografia , Feminino , Hemodinâmica , Humanos , GravidezAssuntos
Valva Aórtica/transplante , Valva Mitral/cirurgia , Transplante Heterólogo , Adolescente , Adulto , Animais , Criança , Eletrocardiografia , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Fonocardiografia , SuínosAssuntos
Fibrose Endomiocárdica/cirurgia , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Valva Tricúspide/cirurgia , Adulto , Bioprótese , Cineangiografia , Dura-Máter , Eletrocardiografia , Fibrose Endomiocárdica/complicações , Fibrose Endomiocárdica/diagnóstico por imagem , Fibrose Endomiocárdica/fisiopatologia , Feminino , Insuficiência Cardíaca/complicações , Humanos , Derrame Pericárdico/complicações , Complicações Pós-OperatóriasAssuntos
Clortalidona/farmacologia , Hipertensão/tratamento farmacológico , Resistência Vascular/efeitos dos fármacos , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Clortalidona/uso terapêutico , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-IdadeAssuntos
Etanolaminas/uso terapêutico , Hipertensão/tratamento farmacológico , Labetalol/uso terapêutico , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Ensaios Clínicos como Assunto , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Humanos , Labetalol/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nifedipino/uso terapêuticoRESUMO
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.