Noninvasive predictors of mortality for patients with Chagas' heart disease: a multivariate stepwise logistic regression study.

This prospective investigation was conducted in an attempt to identify noninvasive predictors of mortality for patients with Chagas' heart disease through a multivariate stepwise logistic regression study. Fifty-six patients with a positive complement fixation test for Chagas' disease were followed up at the Cardiomyopathy Clinic of our institution from April 1990 to April 1992. Patient age was 59 +/- 17 years; 28 (50%) were male. Upon admission, 19 patients (33%) were in the New York Heart Association (NYHA) class III and 8 (14%) in the NYHA class IV. Systolic blood pressure was 125 +/- 23 mm Hg, diastolic blood pressure 76 +/- 11 mm Hg and resting heart rate 77 +/- 11 beats/min. Forty patients (71%) were given digitalis and 39 (69%) angiotensin-converting enzyme inhibitors. Plasma Na+ was 140 +/- 4 mEq/l, K+ was 4.34 +/- 0.73 mEq/l and creatinine level 1.34 +/- 0.31 mg/100 ml. Cardiomegaly was observed in the chest X-ray of 41 of 51 (79%) available patients. Atrial fibrillation was observed in the resting ECG of 24 of 54 (44%) available patients, premature ventricular contractions in 23 (41%), right bundle branch block in 26 (46%) and left anterior hemiblock in 26 (46%) patients. Echocardiography revealed a left ventricular ejection fraction of 0.45 +/- 0.16, left ventricular systolic dimension of 51.23 +/- 13.53 mm and left ventricular diastolic dimension of 62.94 +/- 19 mm. Sixteen (28%) patients died during the 2-year study, 11 of them suddenly.(ABSTRACT TRUNCATED AT 250 WORDS)

Absence of Trypanosoma cruzi myocardial infection reactivation in Chagas' heart transplant.

The risk of Trypanosoma cruzi myocardial infection reactivation after immunosuppressive therapy has led to precluding heart transplantation as a therapeutic procedure for patients with end-stage Chagas' heart disease. We report a case of an orthotopic heart transplantation in a 43-year-old critically ill chagasic patient with an uneventful postoperative period. He was treated with azathioprine and cyclosporine to control graft rejection and showed no reactivation of the chagasic infection. One year following surgery, the patient is doing well. Nonsteroidal therapy appears not to reactivate T. cruzi infection in transplant chagasic patients.

Tricuspid endocarditis: a rare infectious complication of cardiac pacemaker in a patient with Chagas' disease--a case report.

Tricuspid endocarditis was diagnosed in a sixty-four-year-old patient with Chagas' disease who had a permanent cardiac pacemaker and whose generator had been replaced five months before an infection in the pocket. The pacing system was replaced by an epicardial one and the patient received antibiotics with good results.

Congenital circumflex coronary artery fistula with drainage into the left ventricle.

Congenital coronary fistula is a rare heart defect, which consists of a communication between a coronary artery and a cardiac chamber of coronary vessel. Most such fistulae drain into a right heart chamber or into the pulmonary artery. Congenital left coronary artery-left ventricle fistula is even more uncommon. In a search of the literature, we were able to find only 15 other cases of congenital left coronary artery-left ventricle fistula. We describe here the clinical picture of a patient with left circumflex coronary artery draining into the left ventricle, and the successful surgical repair of the lesion. As far as we know, such a case has never before been reported in detail.

[Coronary angioplasty in patients over 70. An analysis of 115 dilatations]. / Angioplastia coronária em pacientes acima de 70 anos. Análise de 115 dilatações.

PURPOSE: To verify the validity of transluminal coronary angioplasty (PTCA) in the population over 70 years old. METHODS: Retrospectively, were analysed 115 PTCA performed in 89 elderly patients (70 to 85 years old) from January 1988 to January 1991. Three groups were defined: A) single vessel-77 (86.5%) patients; B) double vessel-9 (10.1%) patients; C) three vessel-3 (3.4%) patients. RESULTS: Of the 89 treated patients, 81.8% in group A, 72.2% in group B and 75% in group C were successfully dilated. The learning curve had showed increase in success rate after the first 250 angioplasties (from 60.6% to 82.5%). Treatment of acute myocardial infarction by direct thrombolysis was made in 7 patients (6 S, 1 I). Major complications included: deaths (4.4%), ventricular fibrillation (1.08%), acute coronary occlusion (6.6%). Emergency coronary artery bypass grafting was required in 4.4% with one death. CONCLUSION: Coronary angioplasty is an effective treatment in elderly patients and may be performed with acceptable success and with low complications.

[Superior vena cava compression syndrome]. / Síndrome de compressão da veia cava superior.

The superior vena cava syndrome that causes difficulties on venous return to the heart is a uncommon clinical entity and actually, more than 90% of the cases are secondary to a malignant intrathoracic process, rather than the intrinsic diseases of the aorta that is a rare etiology of the compression. The present report documents an aortic ascending atherosclerotic aneurysm that developed a superior vena cava compression syndrome. The literature was reviewed, stressing some important aspects about the etiology, physiopathology, diagnostic procedures, prognostic and treatment of this syndrome.

Etomidato na induçäo em paciente submetido a cirurgia cardíaca / Anesthetic induction with etomidate in cardiac surgery

Foi utilizado o etomidato na induçäo da anestesia em 30 pacientes submetidos a cirurgia cardíaca, com média etária 50,4 ñ 11,6 anos e média ponderal 66,2 ñ 16,5 Kg. O etomidato foi administrado por via venosa na dose inicial de 0,3 mg.Kg-1, seguida, 5-6 minutos depois de uma segunda fase de 0,15 mg.Kg-1, imediatamente antes da intubaçäo traqueal. Entre ambas as doses foram administradas fentanil e pancurônio; após a intubaçäo, a anestesia foi mantida com isoflurano em concentraçöes de 1,0-2,0%, elevadas na medida do necessário para manter a PAM abaixo de 100 mmHg. Foram monitorizados: FC, PAM, PVC, Produto FC x PAS, ECG. A induçäo com etomidato näo se acompanhou de variaçöes significativas de FC, PAM, PC+VC e Produto FC x PAS nem de novas alteraçöes eletrocardiográficas, inclusive após a intubaçäo traqueal e a incisäo torácica. Os resultados sugerem que o etomidato, combinado ao fentanil, constitui alternativa válida para a induçäo da anestesia em cardiopatas submetidos a cirurgia cardíaca