Cardiac and Liver Fibrosis Assessed by Multiparametric MRI in Patients with Fontan Circulation.

The abnormal hemodynamics in Fontan circulation due to persistently increased systemic venous pressure results in hepatic venous congestion and Fontan-associated liver disease. Combined assessment of cardiac and liver fibrosis and cardiac remodeling using multiparametric MRI in this context have not been fully explored. To evaluate cardiac and liver fibrosis and cardiac remodeling using multiparametric MRI in patients who have undergone Fontan procedures. Thirty-eight patients and 23 controls underwent cardiac and liver MRI examinations in a 3.0-T scanner. Mann-Whitney, Fisher exact test, and Spearman's correlation were applied to evaluate myocardial volumes, function, native cardiac and liver T1 mapping, ECVs and liver stiffness. The mean native cardiac T1 value (p = 0.018), cardiac ECV (p < 0.001), liver native T1 (p < 0.001), liver ECV (p < 0.001), and liver stiffness (p < 0.001) were higher in patients than controls. The indexed end-diastolic volume (EDVi) correlated with the myocardial ECV (r = 0.356; p = 0.033), native liver T1 (r = 0.571; p < 0.001), and with liver stiffness (r = 0.391; p = 0.015). In addition, liver stiffness correlated with liver ECV (r = 0.361; p = 0.031) and native liver T1 (r = 0.458; p = 0.004). An association between cardiac remodeling and cardiac and liver fibrosis were found in this population. The usefulness of MRI to follow cardiac and liver involvement in these patients is critical to improve treatment strategies and to prevent the need for combined liver and heart transplantation.

EFFICACY OF CARPENTIER-EDWARDS PERICARDIAL PROSTHESES: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVES: The Carpentier-Edwards pericardial (CEP) prostheses are the type of bioprostheses most used worldwide. Although they were designed to minimize the rate of valve deterioration and reoperation, their clinical superiority over other prostheses models still lacks confirmation. The objective of this study was to evaluate its effectiveness. METHODS: We performed a systematic review and meta-analysis in the PubMed, Embase, Cochrane, and Lilacs databases. Operative mortality, overall mortality and reoperation rates after heart valve surgery were compared between the use of CEP and other cardiac prostheses. Two independent reviewers screened studies for inclusion and extracted the data. Disagreements were resolved by consensus. The GRADE criterion was used to assess the evidence quality. RESULTS: A total of twenty-eight studies were selected, including 19,615 individuals. The studies presented a high heterogeneity and low quality of evidence what limited the reliability of the results. The pooled data from the selected studies did not demonstrate significant differences between CEP and porcine, pericardial or stentless prostheses regarding operative mortality, overall mortality and reoperation rates. However, the pooled data from 3 observational trials pointed out a higher risk for reoperation after valve replacement using CEP prostheses against mechanical prostheses (OR 4.92 [95 percent confidence interval 2.43-9.96]). CONCLUSIONS: The current data present in the literature still does not support a clinical advantage for the use of CEP prostheses over other bioprostheses. The quality of the studies in the literature is limited and further studies are needed to address if CEP prostheses will have a clinical advantage over other prostheses.

Tiro de ar comprimido no coração: manejo conservador / Heart compressed air shot: conservative management

Objetivo: As modernas armas de ar comprimido são capazes de propelir projéteis em alta velocidade, provocando injúrias graves. O trauma cardíaco penetrante geralmente se apresenta com paciente instável, hemodinamicamente, necessitando de intervenções de emergência. O manejo desses pacientes, quando estáveis clinicamente, é controverso. Descrição: Descrevemos o caso de um pré-escolar, com 3 anos de idade, atingido no tórax por tiro de ar comprimido, a uma distância de 2 metros. O ecocardiograma mostrou pequena lâmina de derrame pleural à direita, função contrátil dos ventrículos preservada, imagem hiperrefringente no septo interventricular. O ecocardiograma tridimensional sugeriu não haver projeção do projétil para as cavidades ventriculares. Tomografia computadorizada de tórax demonstrou derrame pleural pequeno, à direita, e artefato metálico na projeção do septo interventricular, totalmente intramiocárdico. Comentários: O paciente permaneceu sem instabilidade clínica durante a internação. Conclusão: Optamos pelo manejo conservador e acompanhamento ambulatorial com medidas seriadas do nível sérico de chumbo e revisões ecocardiográficas.

Objective: Modern air guns are capable of propelling projectiles at high speed, causing severe injuries. Penetrating cardiac trauma usually presents with hemodynamically unstable patients, requiring emergency interventions. The management of these patients, when clinically stable, is controversial. Description: We’ll describe the case of a 3-year-old boy hit by a compressed air shot in the chest at a 2 meters distance. At admission, echocardiography showed a small slide of right pleural effusion, preserved cardiac function, and a hyperechoic image projected inside the interventricular septum. Three-dimensional echocardiography showed no projectile extension to the ventricular cavities. Chest CT showed a small right pleural effusion and a totally intramyocardial metallic artifact in the interventricular septum topography. Comments: The patient remained clinically stable during hospitalization. Conclusion: We chose conservative management and outpatient follow-up with serial measurements of serum lead and echocardiographic review.

Familial aggregation of end-stage kidney disease in Brazil.

BACKGROUND/AIMS: Familial aggregation of end-stage kidney disease (ESKD) has been reported in several studies, most of them carried out in USA. It is uncertain to what extent these findings can be generalized to other populations. The objective of this study was to assess whether familial aggregation of ESKD occurs in Brazil and whether it is influenced by race. METHODS: Case-control study including 555 ESKD patients and 595 controls without renal disease. Multivariate logistic regression models were used to assess the association between a history of ESKD in a first-degree relative (Fam-ESKD) and the risk of ESKD. Additionally, the association between Fam-ESKD and race among ESKD cases was analyzed. RESULTS: Twenty-seven cases (4.9%) and 5 controls (0.8%) reported Fam-ESKD (p < 0.001). Fam-ESKD was significantly more frequent among cases in a regression model adjusted for all studied covariates (OR = 5.71, 95% CI = 2.13-15.4; p < 0.001). The frequency of Fam-ESKD among dialysis patients belonging to the white, black and 'mixed' racial subgroups was 6.0, 4.3 and 4.0%, respectively (p = 0.62). There was no association between race and Fam-ESKD (p = 0.54) in adjusted regression analyses. CONCLUSION: Fam-ESKD occurs in Brazil but, as opposed to what has been suggested by American studies, it does not appear to be influenced by race.

Gordura epicárdica medida ao ecocardiograma correlaciona-se com ateromatose carotídea / Epicardial fat measured by echocardiography correlates to carotid atheromatosis

Fundamento: A presença de placas carotídeas é um marcador de doença cardiovascular já estabelecido. A medida da gordura epicárdica é um novo método de avaliação da gordura visceral. A relação entre o diâmetro da gordura epicárdica com o risco cardiovascular está sendo investigada, Objetivo: Avaliar a correlação entre a espessura da gordura epicárdica, medida pelo ecocardiograma, e ateromatose das artérias carótidas, Métodos: Foram avaliados 311 pacientes consecutivos, encaminhados para a realização de ecocardiograma ou ultrassonografia carotídea, com indicações clínicas comuns. A espessura da gordura epicárdica, na parede livre do ventrículo direito, foi avaliada com o ecocardiograma e o seu diâmetro, correlacionado com a presença ou não de ateromatose das artérias carótidas. Resultados: Os pacientes (45 por cento homens) tinham idade média de 56 +- 17 anos. A espessura média de gordura epicárdica foi de 5,4 +- 2,6mm. A espessura da gordura epicárdica foi, significativamente, maior nos pacientes com ateromatose das artérias carótidas (7,0 +- 2,2, n=141 vs. 4,7 +-2,5,n=166,p<0,001). A espessura da gordura epicárdica foi maior nos pacientes com hipertensão, diabetes mellitus, doença coronariana ou dislipidemia. Após regressão múltipla...