ABSTRACT
A 17 year old male adolescent was admitted to the hospital due to dyspnea and cyanosis, since the age of 6 years. On physical examination, it was found a continuous murmur over the left esternal border at the 4th and 5th intercostal spaces suggesting a coronary fistula. A color-echocardiogram associated with an angiography confirmed the diagnosis of coronary fistula and severe pulmonary stenosis. The functional consequence was a right to left shunt with cyanosis. A surgical repair was performed with closure of the fistula at the point where it drained into the right ventricle plus a pulmonary commissurotomy. The patient had an uneventful recovery.
Subject(s)
Coronary Disease/complications , Cyanosis/complications , Fistula/complications , Pulmonary Valve Stenosis/complications , Adolescent , Aortography , Coronary Disease/diagnostic imaging , Coronary Disease/surgery , Cyanosis/diagnostic imaging , Cyanosis/surgery , Echocardiography , Electrocardiography , Fistula/diagnostic imaging , Fistula/surgery , Humans , Male , Prognosis , Pulmonary Valve Stenosis/diagnostic imaging , Pulmonary Valve Stenosis/surgeryABSTRACT
Adolescente do sexo masculino, 17 anos, com queixa de dispnéia e cianose desde os 6 anos, apresentava ao exame fisíco sopro contínuo nos quarto e quinto espaços intercostais esquerdos, sugestivo de fístula coronariana. O eco-color e a angiografia confirmaram a hipótese de fístula coronariana associada a estenose pulmonar valvar grave e shunt direito-esquerdo, o que provocava a cianose. Foi submetido a correçäo cirúrgica para fechamento da fístula ao nível do seu sítio de drenagem e realizaçäo de cosurotomia pulmonar, permanecendo assintomático até o momento.
Subject(s)
Pulmonary Valve Stenosis , Cyanosis , Arterio-Arterial FistulaABSTRACT
A 15 year-old male adolescent was hospitalized in a severe septic condition, due to infectious endocarditis which abided for 20 days. The admittance echocardiogram displayed a mitral valve vegetation in conjunction to a hypertrophic cardiomyopathy. In spite of applied antibiotics the patient expired. The authors emphasize the diagnostic difficulties of this compound entity and stress the need of antibiotic prophylaxis for patients who bear a hypertrophic cardiomyopathy, even in those with a non-obstructive disposition.
Subject(s)
Cardiomyopathy, Hypertrophic/complications , Endocarditis, Bacterial/complications , Streptococcal Infections/complications , Adolescent , Cardiomyopathy, Hypertrophic/diagnostic imaging , Echocardiography , Endocarditis, Bacterial/diagnostic imaging , Humans , Male , Streptococcal Infections/diagnostic imagingABSTRACT
Thirty-two insulin-dependent (type I) diabetic patients were studied to detect cardiovascular autonomic nervous system involvement. Half percent (16 cases) were men. Their ages ranged from 6 to 64 years (29.03 years). The average time of diagnosed diabetes was 6.5 years. The group was submitted to several clinical (respiratory, arrhythmia, Valsalva, isometric, orthostatic) and pharmacological tests (propranolol and atropine). The physiological responses were measured as heart beat frequency and blood pressure. Results were analyzed by various statistical methods. Evaluation through a diabetic complication scale showed that ten (31.25%) were uncomplicated), 14 (43.75%) at grade 1, four (12.50%) at grade 2, two (6.25%) at grade 3 and two (6.25%) at grade 4. This scale only correlated to the term of diabetes (p less than 0.01). Results from the autonomic test battery indicated that 12 (37.50%) had isolated parasympathetic damage, five (15.62%) sympathetic lesions, and two (6.25%) had mixed type involvement. We observed, as to cardiovascular autonomic involvement, 13 (40.62%) had no involvement and 19 (59.38%) had some degree of damage; in the latter group, 15 (46.78%) had early lesions and four (12.50%) definite.
