Clinical, electrocardiographic and echocardiographic evolution of chronic Chagas disease treated with nifurtimox on prolonged follow-up in Chile: observational study.

OBJECTIVES: This study aimed to describe the electrocardiographic and echocardiographic status of chronic Chagas disease (cChD) patients treated with nifurtimox. METHODS: An observational study was performed in 146 cChD patients followed over a mean of 7.9 years. RESULTS: Of the 146 patients, 41 (28.1%) with normal electrocardiogram (ECG) at baseline maintained this condition, 34 (23.3%) with altered ECG at baseline normalised the alterations, and 46 (31.5%) with ECG abnormalities at baseline maintained this condition [23 (15.8%) with small alterations]. Finally, 25 cases (17.1%) in indeterminate phase altered the ECG. Differences before and after follow-up (P < 0.001) were found. The percentage of beneficial treatment was different than expected by chance (Z = 4.8; P < 0.001) and the annual percentage of cases that developed ECG alterations was lower than that of a historical cohort of untreated patients (P < 0.001). An echocardiogram was performed in 68 patients with baseline ECG alterations. The ejection fraction (EF) was normal in 57 (83.8%) and abnormal in 11 (16.2%). In 38 patients with ECG abnormalities that did not progress after treatment, EF and segmental motility (SM) were normal in 31 (81.6%) and 26 (68.4%), respectively. In 17 patients with ECG abnormalities, EF and SM were normal in 15 (88.2%) and 14 (82.4%) cases, respectively. CONCLUSION: Less progression to cardiomyopathy compared with a historical untreated cohort as well as the EF/SM results in patients with abnormal ECG that did not progress and in indeterminate cChD that altered the ECG suggests a beneficial effect of nifurtimox.

Mass attached to mechanical mitral valve mimicking a thrombus.

Mitral valve replacement with preservation of chordae tendineae and papillary muscles is a well-known technique which has proved beneficial by reducing postoperative left ventricular remodeling and preserving left ventricular function. This advantage has been demonstrated in functional mitral valve regurgitation as well as mitral valve regurgitation due to rheumatic disease. Regarding complications of this technique, several of them have been reported, papillary muscle rupture being one of them. We describe a clinical case of this weird but possible kind of complication.

Correlaçäo entre a clínica, a ecocardiografia transtorácica e a ecocardiografia transesofágica no diagnóstico diferencial dos defeitos do septo interatrial e hipertensäo pulmonar em adultos / Correlation among clinical, transthoracic and transesophageal features for differential diagnosis of atrial septal defects and pulmonary hypertension in adults

Resumo: Este estudo visa fazer a correlaçäo entre a clínica, a ecocardiografia transtorácica (ETT) e a ecocardiografia transesofgica (ETE) no diagnóstico diferencial dos defeitos do septo interatrial (DSIA) e hipertensäo pulmonar (HP) em adultos. Realizamos ETT a ETE em 30 pacientes com diagnóstico de DSIA baseado em critérios de ausculta cardíaca, radiológicos e eletrocardiográficos. Três critérios, em 16 pacientes (grupo B). Foram determinados a sensibilidade, a especificidade, a acurácia e os valores preditivos positivo e negativo para a ETT, admitindo-se os resultados da ETE como ''gold standard''. A sensibilidade da ETT para o diagnóstico de DSIA é baixa 50 (por cento), a especificidade é de 75-90 (por cento), a acurária de 60-66 (por cento), o valor preditivo positivo de 75-83 (por cento), e o valor preditivo negativo de 37-75 (por cento), näo sendo capaz de diagnosticar os DSIAs tipo seio venoso. Catorze pacientes 46,6 (por cento) apresentaram diagnóstico final de HP, näo estando relacionada a DSIA