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.

Superior vena cava syndrome as a complication of permanent cardiac pacemaker in a patient with Chagas' heart disease.

A 51-year-old man with Chagas' heart disease wearing a cardiac pacemaker developed a Superior Vena Cava Syndrome. Right-sided heart catheterization showed a Superior Vena Cava obstruction with extensive collateral flow via the azygous vein. The Superior Vena Cava Syndrome can be another complication of cardiac pacemaker implantation in patients with Chagas' heart disease.

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.

[Percutaneous transluminal coronary angioplasty in patients with prior surgical revascularization]. / Angioplastia coronária transluminal percutânea em pacientes com revascularização cirúrgica prévia.

PURPOSE: To show the author's experience with percutaneous transluminal coronary angioplasty (PTCA) in patients with prior coronary bypass surgery. METHODS: Between January 1989 and January 1991, 629 PTCA in 572 patients were performed. Forty-eight had previous revascularization surgery with interval range of 4 days to 10 years. The PTCA sites were divided in three groups: A) native arterial segments, not affected by surgery (26 patients); B) native arterial segments proximal (4 patients) and distal (2 patients) to graft anastomosis; C) in the coronary vein graft (16 patients). RESULTS: The overall primary success was 78%. In groups B and C, 16 procedures were successfully dilated (72%). All failures in group C were due to unstable problems in reaching (4 patients) or crossing (2 patients) the stenosis with the balloon. There was one death in group A and another in group C. CONCLUSION: Angioplasty is an effective alternative for treatment of recurrent ischemia in patients with prior myocardial revascularization surgery and in early results are comparable to the general angioplasty population.

[Percutaneous transluminal coronary angioplasty. Analysis of 305 dilatations]. / Angioplastia coronária transluminal percutânea. Análise de 305 dilatações.

PURPOSE: To show the initial experience of this service with the technique of percutaneous transluminal coronary angioplasty. PATIENTS AND METHODS: Between january 1988 and december 1989, 305 coronary angioplasties were performed in 280 patients with age range of 33 to 82 years (being 49% above 60 years old) and 71% male. Among those, 212 (75%) experienced clinical picture of stable angina and 68 (25%) of unstable angina or myocardial infarction. Patients were divided in three groups: group A--those with lesions of 70% or worse in more than one vessel or in the same vessel with or without any other vessel total occlusion (multiple lesions or multiple vessels: 36 patients; group B--those with lesions of 70% or worse in one vessel with at least one occluded vessel: 64 patients; group C--those with lesions of 70% or worse isolated in a single vessel: 180 patients. RESULTS: Of the 280 treated patients, 229 were considered successful (75%). There has been 22 complications (7%) and 9 deaths (3%). The late follow-up (from 1 to 24 months), displayed 28 new procedures based on clinical suspicion of restenosis. Obstruction or occlusion were present in 16 of the later, with 10 being selected to undergo new procedure, one of those twice. The remaining 12 patients received clinical or surgical treatment. CONCLUSION: Aside from the fact that early and midterm results indeed are promising, the procedure is not safe from immediate risks, and limiting late restenosis. Nevertheless, the lesions might be redilated by the same technique, with success rates comparable to the initial one.