[Sickle cell trait: clinical presentation as acute liver failure]. / Traço falcêmico com apresentação clínica de insuficiência hepática aguda.

Acute liver insufficiency, followed by heart disease, pneumopathy and infectious syndrome is reported in a 36 year old brown alcoholic man in which the necropsy revealed anatomopathological changes suggesting sickle cell trait. Acute ischemic lesions were noted in the heart, kidneys, central nervous system and liver. In the absence of other causes explaining the ischemic lesions, they were attributed to circulatory changes related to sickle cell trait. Hepatic failure was consequent to functional disturbances derived from the occlusion of sinusoids and necrosis of hepatocytes. The factor responsible for sickling, which caused recent ischemic lesions, may have been the respiratory insufficiency secondary to lung disease. Chronic ischemic lesions have been seen in the heart and may be related to previous sickling episodes. Subsequent to necropsy findings, screening of family members revealed a daughter with sickle cell trait.

[Rheumatic heart disease and infective endocarditis in a patient with acquired immunodeficiency syndrome]. / Cardiopatia reumática e endocardite infecciosa em paciente com síndrome de imunodeficiência adquirida.

A 36-old-woman was admitted with an infectious syndrome, respiratory insufficiency and vasculitis. There was a history of chronic intravenous drug abuse, sexual promiscuity and rheumatic heart disease. She had HIV positive tests. The vasculitis and heart failure worsened and the patient died of stroke. At autopsy it was found histologic evidence of AIDS, rheumatic heart disease with Aschoff nodes, infective endocarditis with cerebral abscesses and thalamic infarction.

[Severe tricuspid valve insufficiency due to papillary anterior muscle infarction of the right ventricle secondary to neonatal hypoxia]. / Insuficiência tricúspide severa por infarto do músculo papilar anterior do ventrículo direito secundário à hipóxia neonatal.

A fatal case of a stressed newborn baby who developed tricuspid insufficiency due to an anterior papillary muscle infarction of the right ventricle, related to perinatal anoxia is reported. The baby needed resuscitation management and had a systolic murmur soon after birth. The echocardiographic examination showed a flail anterior leaflet of the tricuspid valve due to an avulsed anterior papillary muscle. There was rupture of chordae tendineae between anterior and posterior leaflet. Necrosis and calcium deposit were found in the area. The conclusion was that the anoxia in perinatal period, in most cases, causes transient lesions, but in few cases might be severe and fatal. It is important a complete cardiac evaluation in every case of prolonged perinatal stress.

Common arterial trunk arising exclusively from the right ventricle with hypoplastic left ventricle and intact ventricular septum.

A common arterial trunk is a rare congenital anomaly usually accompanied by other intracardiac malformations. The association with hearts with a univentricular atrioventricular connexion is particularly uncommon. We report a case of a common arterial trunk occurring in a heart with absent left atrioventricular connexion. The trunk arose exclusively from the right ventricle, the left ventricle was incomplete and the ventricular septum was intact. Other associated malformations were an interrupted aortic arch and an atrial septal defect.