RESUMO
A patient was admitted because of an acute myocardial infarction which evolved with heart failure and postinfarction angina. A pattern consistent with dynamic left ventricular outflow obstruction was found. It disappeared after coronary angioplasty was performed on the vessel responsible for the ischemia.
Assuntos
Angina Pectoris/terapia , Angioplastia Coronária com Balão , Ecocardiografia , Infarto do Miocárdio/terapia , Obstrução do Fluxo Ventricular Externo/terapia , Angina Pectoris/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo/fisiologia , Circulação Coronária/fisiologia , Ecocardiografia Doppler , Eletrocardiografia , Feminino , Seguimentos , Hemodinâmica/fisiologia , Humanos , Pessoa de Meia-Idade , Contração Miocárdica/fisiologia , Infarto do Miocárdio/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagemRESUMO
One hundred and twenty stable patients with pure and severe aortic valve disease and without coronary lesions (aortic stenosis, 43 patients; aortic regurgitation, 45 patients; combined aortic stenosis and regurgitation, 32 patients) who had been submitted to haemodynamic studies were prospectively studied with standard electrocardiograms, M-mode echocardiograms, and 24-hour ambulatory electrocardiography (Holter recording). The frequency and complexity of ventricular arrhythmias were related to clinical parameters such as functional class, type of lesion and presence of syncope, and to parameters of left ventricular hypertrophy and function. Ventricular arrhythmias were present in 92% of patients. A high number of ventricular premature beats was directly correlated with parameters of complexity of the arrhythmia. A significant relation was found between electrocardiographic left ventricular hypertrophy and Ryan class (P less than 0.05), and an inverse relation between maximal number of ventricular premature beats in any hour and left ventricular ejection fraction (P less than 0.05). The group of patients with aortic regurgitation showed a higher total number of ventricular premature beats per 24 hours (P less than 0.001), a higher maximal number of these in any hour (P less than 0.01), a higher number of patients with pairs (P less than 0.001), and a higher number of patients in Ryan classes 3, 4A, 4B (P less than 0.01). This study shows a high incidence of ventricular arrhythmias in aortic valve disease, and especially in aortic regurgitation, with a significant relation between left ventricular hypertrophy and function, and number and complexity of arrhythmias.
Assuntos
Insuficiência da Valva Aórtica/complicações , Estenose da Valva Aórtica/complicações , Complexos Cardíacos Prematuros/epidemiologia , Cardiomegalia/complicações , Ventrículos do Coração , Função Ventricular Esquerda , Adulto , Idoso , Insuficiência da Valva Aórtica/classificação , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/classificação , Estenose da Valva Aórtica/fisiopatologia , Biomarcadores , Cateterismo Cardíaco , Complexos Cardíacos Prematuros/diagnóstico , Complexos Cardíacos Prematuros/etiologia , Cardiomegalia/patologia , Cardiomegalia/fisiopatologia , Ecocardiografia , Eletrocardiografia , Eletrocardiografia Ambulatorial , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Volume SistólicoRESUMO
Tricuspid insufficiency caused by blunt chest trauma is rare and usually unsuspected clinically, early after trauma. Cross-sectional Echocardiography and Cardiac Catheterization are essential to establish the diagnosis. Therapy applied varies from repair to valvular replacement. We describe an 18-year-old boy with traumatic tricuspid regurgitation treated by reconstruction of the attachments of the anterosuperior leaflet and annuloplasty with a Puig-Massana ring. Six month after surgery he is fully recovered, although persist a moderate degree of tricuspid insufficiency.
Assuntos
Traumatismos Cardíacos/cirurgia , Valva Tricúspide/lesões , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito , Adolescente , Emergências , Humanos , Masculino , Traumatismo Múltiplo/cirurgia , Técnicas de Sutura , Valva Tricúspide/cirurgiaRESUMO
INTRODUCTION AND AIMS: The influence of the type of health care funding and management of hospital centres on hospital mortality in coronary artery bypass surgery (CABG) has not been analyzed in detail. We therefore assessed clinical and quality of life preoperative profiles and in-hospital mortality in public and private patients undergoing coronary bypass surgery in Catalonia. METHODS: Clinical questionnaires, Duke Activity Status Index (DASI) and SF-36 were preoperatively administered to all patients undergoing first coronary bypass surgery without associated procedures in Catalonia between November 1996-June 1997. In-hospital morbidity and mortality were recorded. RESULTS: Predictors of in-hospital death, including DASI, SF-36 and comorbidity scores, were significantly worse in public than in private patients. In-hospital mortality rate was more than ten times greater in public than in private patients (8.2% vs 0.7%; p < 0.001). Multivariate analysis identified private funding of health care, among others, as an independent predictor of in-hospital survival. Non evidence-based indications for surgery were significantly more common in private than in public patients (6% vs 0.7%, p < 0.001). CONCLUSIONS: a) In catalonia, the risk profile of public patients undergoing coronary bypass surgery was significantly higher than that of private patients, accounting, at least in part, for a remarkable mortality difference; b) non evidence-based indications for surgery were more common in private than in public patients; c) these unequal patterns raise questions about the adequacy of care and referral patterns in both private and public sectors.