Transposition of the great arteries with posterior aorta and subaortic conus: anatomical and surgical correlation.

Three hearts studied at autopsy with transposition of the great arteries and posterior aorta with isolated or predominantly subaortic conus are described. In all cases the aorta was posterior and to the right of the pulmonary trunk. In two cases it was significantly distant from the pulmonary trunk and in one it was very close. The caliber of the pulmonary trunk was larger than that of the aorta: greater than 2:1 in two cases and less than 2:1 in one case. A well developed subaortic conus was seen in all cases and a small subpulmonary conus in one case. In the other two cases, the pulmonary valve was in fibrous continuity with the mitral valve. In all cases the aortic valve was higher than the pulmonary valve, the relative heights above the ventricles being 25/20, 25/30 and 40/60 mm, respectively. The left coronary artery ran posteriorly and to the left of the pulmonary trunk in all the cases. The length of the main stem of the left coronary artery was 11, 11 and 30 mm, respectively. We discuss the significance of this type of transposition of the great arteries for techniques currently used for surgical correction.

[Evaluation of the effects of macerated oral dipyridamole on the ergometric test]. / Avaliação dos efeitos do dipiridamol oral macerado no teste ergométrico.

Eighteen male patients with ages varying from 42 to 72 years (average 60.6), with coronary heart disease confirmed by angiography, on regular rehabilitation program and on regular use of dipyridamole were submitted to three exercise stress tests: a control test (TE1) and forty minutes after oral administration of macerated dipyridamole in doses of 150 mg (TE2) and 300 mg (TE3), respectively. The comparison between the data of TE2 and TE1 demonstrated that in TE2 the ST depression was more accentuated in the smallest maximal load attained and in the effort peak as well. The comparison between the data of TE3 and TE1 showed that in TE3: 1) the ST depression was more evident in the effort peak and in the smallest attained load; 2) the heart rate and the product heart rate x blood pressure were smaller in the effort peak; 3) the total time of angina and the time for its relief after effort, were longer. The other exercise stress test parameters did not show any significant changes. These data, suggest that the physical effort overload, after dipyridamole administration, produced a more marked myocardial ischemia, whose degree was proportional to the dose.

Princípios gerais e aplicaçöes de reabilitaçäo / Rehabilitation: principles and applications

A reabilitaçäo cardíaca é o processo de desenvolvimento e manutençäo de nível desejável de atividade física, social e psicológica após o início da doença coronária sintomática. Trata-se de terapêutica multidisciplinar para patologia multifatorial. Os maiores objetivos säo: melhora da capacidade funcional e da qualidade de vida, mudança de hábitos após evento coronário, com modificaçäo dos fatores de risco e reduçäo dos índices de mortalidade. Säo discutidos os vários efeitos do treinamento físico, clusive sobre a qualidade de vida de homens e mulheres, os tipos de exercício apropriados, conforme o tipo de doença cardiovascular, bem como a estratificaçäo quanto ao risco para atividade física após evento coronário. finalmente, säo apresentadas as indicaçöes e contra-indicaçöes atuais da reabilitaçäo cardíaca.