Prevalence and factors associated with impaired left ventricular global longitudinal strain in patients with Chagas disease: SaMi-Trop cohort study.

Cardiomyopathy is a major cause of death in Chagas disease and early detection of cardiac involvement is essential. Myocardial strain is a reliable technique for assessment of subtle left ventricular (LV) contractility alterations. This study assessed LV global longitudinal strain (GLS) in a large Chagas disease population living in remote areas. Between 2015 and 2016, Chagas disease patients were selected in the northern of the Minas Gerais state. All patients underwent T. cruzi antibodies tests and those who had positive tests were included. A resting 12-lead ECG was recorded and classified using the Minnesota Code criteria. Echocardiography was performed at public health primary care units and speckle-tracking strain was analyzed offline. LV dysfunction was defined as ejection fraction (LVEF < 50%) and reduced GLS was defined as < 16% (absolute value). A total of 1387 patients were included, mean age of 60.0 ± 12.5 years, 68% were women, and 14% had LV dysfunction. Among patients with normal LVEF, 59% had impaired LV GLS. Overall, patients with impaired GLS were older, had more comorbidities and ECG abnormalities than those with normal GLS. The independent factors associated with reduced GLS were ST-T abnormalities (OR 1.954; 95% CI 1.027-3.718), QRS duration (OR 1.009; 95% CI 1.002-1.016), LVEF (OR 0.947; 95% CI 0.923-0.972), and E/e' ratio (OR 1.059; 95% CI 1.009-1.112). In a cohort of Chagas disease from endemic areas, impaired LV GLS was detected in a significant proportion of patients, despite normal ECG and preserved LVEF. The main determinants of reduced LV GLS were ST-T abnormalities, QRS duration, LVEF and E/e' ratio, adjusting for demographical and clinical data.

Treatment of Chronic Atrial Fibrillation During Surgery for Rheumatic Mitral Valve Disease.

Introduction: The result of surgical ablation of atrial fibrillation remains controversial, although prospective and randomized studies have shown significant differences in the return to sinus rhythm in patients treated with ablation versus control group. Surgery of the Labyrinth, proposed by Cox and colleagues, is complex and increases the morbidity rate. Therefore, studies are needed to confirm the impact on clinical outcomes and quality of life of these patients. Objective: To analyze the results obtained in the treatment of atrial fibrillation by surgical approach, by Gomes procedure, for mitral valve surgery in patients with rheumatic heart disease associated with chronic atrial fibrillation. Methods: We studied 20 patients with mitral valve dysfunction of rheumatic etiology, evolving with chronic atrial fibrillation, submitted to surgical treatment of valvular dysfunction and atrial fibrillation by Gomes procedure. Results: The mean duration of infusion ranged from 65.8±11.22 and aortic clamping of 40.8±7.87 minutes. Of 20 patients operated, 19 (95%) patients were discharged with normal atrial heart rhythm. One (5%) patient required permanent endocardial pacing. In the postoperative follow-up of six months, 18 (90%) patients continued with regular atrial rhythm, one (5%) patient returned to atrial fibrillation and one (5%) patient continued to require endocardial pacemaker to maintain regular rhythm. Conclusion: Gomes procedure associated with surgical correction of mitral dysfunction simplified the surgical ablation of atrial fibrillation in patients with rheumatic mitral valve disease and persistent atrial fibrillation. The results showed that it is a safe and effective procedure.

Treatment of chronic atrial fibrillation during surgery for rheumatic mitral valve disease

Abstract Introduction: The result of surgical ablation of atrial fibrillation remains controversial, although prospective and randomized studies have shown significant differences in the return to sinus rhythm in patients treated with ablation versus control group. Surgery of the Labyrinth, proposed by Cox and colleagues, is complex and increases the morbidity rate. Therefore, studies are needed to confirm the impact on clinical outcomes and quality of life of these patients. Objective: To analyze the results obtained in the treatment of atrial fibrillation by surgical approach, by Gomes procedure, for mitral valve surgery in patients with rheumatic heart disease associated with chronic atrial fibrillation. Methods: We studied 20 patients with mitral valve dysfunction of rheumatic etiology, evolving with chronic atrial fibrillation, submitted to surgical treatment of valvular dysfunction and atrial fibrillation by Gomes procedure. Results: The mean duration of infusion ranged from 65.8±11.22 and aortic clamping of 40.8±7.87 minutes. Of 20 patients operated, 19 (95%) patients were discharged with normal atrial heart rhythm. One (5%) patient required permanent endocardial pacing. In the postoperative follow-up of six months, 18 (90%) patients continued with regular atrial rhythm, one (5%) patient returned to atrial fibrillation and one (5%) patient continued to require endocardial pacemaker to maintain regular rhythm. Conclusion: Gomes procedure associated with surgical correction of mitral dysfunction simplified the surgical ablation of atrial fibrillation in patients with rheumatic mitral valve disease and persistent atrial fibrillation. The results showed that it is a safe and effective procedure.

Thoracic ectopia cordis with anatomically normal heart.

Ectopia cordis is a rare congenital malformation, which is commonly associated with other intracardiac defects. At two-day-old full-term baby girl was admitted to Santa Casade Misericórdia Hospital Montes Claros, NG, Brazil, with thoracic ectopia cordis. A transthoracic echocardiographic study did not identify any associated congenital heart diseases. The infant underwent surgical treatment using a rib graft to create a neo-sternum. She was discharged after presenting a good outcome on the 20th postoperative day.

Ectopia cordis torácica com coração anatomicamente normal / Thoracic ectopia cordis with anatomically normal heart

A ectopia cardíaca é uma má formação congênita rara, normalmente associada a outras más formações intracardíacas. Uma criança do sexo feminino com dois dias de vida, nascida a termo de uma primeira gestação sem intercorrências (G1P1A0), por parto cesariano, foi admitida na Santa Casa de Montes Claros, em Minas Gerais, apresentando ectopia cardíaca na forma torácica. O estudo ecocardiográfico transtorácico não evidenciou cardiopatia congênita associada. A paciente foi submetida a tratamento cirúrgico, utilizando enxerto de costela. Apresentou boa evolução, recebendo alta hospitalar no vigésimo dia de pós-operatório.

Ectopia cordis is a rare congenital malformation, which is commonly associated with other intracardiac defects. A two-day-old full-term baby girl was admitted to Santa Casa de Montes Claros Hospital, with thoracic ectopia cordis. A transthoracic echocardiographic study did not identify any associated congenital heart diseases. The infant underwent surgical treatment using a rib graft to create a neo-sternum. She was discharged after a good evolution on the 20th postoperative day.

Influence of tranexamic acid in postoperative bleeding of cardiac surgery with cardiopulmonary bypass

OBJETIVO: Analisar a influência do ácido tranexâmico no sangramento pós-operatório de cirurgia cardíaca com circulaçäo extracorpórea (CEC). MÉTODO: Foram randomizados, em 2 grupos, 51 pacientes submetidos a cirurgia cardíaca com auxílio de CEC. Grupos: Grupo I - controle, com 26 pacientes, sendo 12 com doença coronariana obstrutiva e 14 com lesöes valvulares; Grupo II - ácido tranexâmico, com 25 pacientes, sendo 14 com doença coronariana obstrutiva e 11 com lesöes valvulares. No grupo I foram infundidos 250ml de soluçäo fisiológica (SF) 0,9 porcento, após acesso venoso; o grupo II recebeu 100mg/kg de peso corpóreo de ácido tranexâmico diluído em 250ml de SF 0,9 porcento, após acesso venoso. Foram colhidas amostras de sangue para exames na admissäo ao CTI, após 12, 24 e 36 horas de pós-operatório. Os grupos foram comparados com relaçäo a fatores que pudessem influir no sangramento pós-operatório e na necessidade de hemotransfusäo: idade, sexo, creatinina, tempo de CEC, variaçäo no hematócrito, plaquetas, fibrinogênio, número de pontes safenas, uso da artéria torácica interna, troca ou reconstruçäo valvar. Foram avaliados o sangramento no pós-operatório da 1a a 4a horas e o total. O método estatístico empregado foi o teste t de Student, com correçäo de Welch, dependendo do caso, para os dados contínuos. Os dados categóricos (sexo, troca valvar, etc.) foram analisados pelo teste näo paramétrico do X2. Em algumas situações foi usado teste exato de Fisher. Em todos os casos foi utilizado índice de significância p < 0,05. RESULTADOS: Com relaçäo ao sangramento pós-operatório e a utilizaçäo de hemoderivados, houve reduçäo da média dos mesmos nos pacientes com lesöes valvulares no Grupo II, com diferença estatística. Com relaçäo às complicações tromboembólicas ou renais, näo houve diferença estatística entre os grupos. CONCLUSAO: Nos pacientes com lesöes valvulares, ocorreu reduçäo do sangramento e da necessidade de transfusäo de concentrado de hemácias, ambos com diferença estatística. Nos pacientes com doença coronariana obstrutiva, houve apenas tendência à reduçäo do sangramento. O uso do acido tranexâmico näo esteve relacionado a maior incidência de complicações tromboembólicas ou com insuficiência renal na casuística avaliada.