Ruptura de parede septal e corda tendínea de valva tricúspide após infarto audo do miocárdio / Ventricular septal perforation and rupture of the chordae tendineae of the tricuspid valve after acute myocardial infarction

Ruptura de parede septal (RPS) no infarto agudo do miocárdio (IAM) é uma complicação com alta mortalidade, com incidência de 0,2% na era de reperfusão miocárdica. Relata-se um caso de paciente com IAM associado à RPS, e possível rotura de cordas tendinosas da valva tricúspide.

Postinfarction ventricular septal perforation (VSP) is high-mortality complication with an incedence of 0,2%. This paper presents a case report on a patient presenting VSP in association with a possible rupture of the chordae tendineae of the tricuspide valve.

Anesthetic management for reentry sternotomy in a patient with a full stomach and pericardial tamponade from left ventricular rupture.

A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.

Desenvolvimento tardio de insuficiência cardíaca congestiva em comunicaçäo interventricular por ferimento penetrante, com resoluçäo da hipertensäo pulmonar após correçäo cirúrgica / Late Development of Congestive Heart Failure After a Stab Wound Ventricular Septal Defect with Regression of Wound Ventricular Septal Defect with Regression of Pulmonary Hypertension After Surgical Intervention

Male, 33 years-old, with onset of heart failure and edema; he used to be completely asymptomatic but mentioned he underwent previously a pleural drainage, after a hemothorax provoked by a stab wound. His physical examination confirmed he was in heart failure and showed a harsh holosystolic murmur between mitral and tricuspid areas. Cardiac catheterization demonstrated a large apical ventricular septal defect (VSD) and systemic pulmonary arterial pressures. With oxygen there was an increase in the left to right shunt and normal pulmonary vascular resistance. The clinical diagnosis was that of a traumatic VSD provoking pulmonary hypertension although a congenital etiology could not be completely ruled out. At surgery there was a sharp cut at the pericardium and an apical epicardial lesion; the VSD was patch sutured and the patient did well with control of his heart failure. A control hemodynamic study performed within the first postoperative month showed no residual shunt and complete normalization of the pulmonary pressures and resistance