RESUMO
The hypertrophic cardiomyopathy may be associated with a variable degree of left ventricular outflow tract obstruction. There are several available therapeutic strategies for treatment: pharmacological, dual-chamber pacing, surgery and induced septal infarction. This last one is a novel technique with less experience in practice. We present the clinical case of a patient which showed persistent and severe obstruction in spite of the medications and dual-chamber pacing, and who underwent this novel technique. The results were optimal but new observations arise from this particular case.
Assuntos
Cardiomiopatia Hipertrófica/terapia , Embolização Terapêutica/métodos , Septos Cardíacos , Cateterismo Cardíaco , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Etanol/administração & dosagem , Seguimentos , Humanos , Infarto , Masculino , Pessoa de Meia-Idade , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/terapiaRESUMO
Coronary artery anomalies are not a frequent finding, and a single right coronary artery is extremely rare. This anomaly has been included among the potentially serious ones because its association with infarction and sudden death has been reported. We present the case of a female patient who complained of chest pain, showed a positive exercise treadmill test and had a single right coronary artery in the angiography with no stenotic lesions. The pathophysiology and the clinical implications are discussed.
Assuntos
Angina Pectoris/etiologia , Anomalias dos Vasos Coronários , Angina Pectoris/diagnóstico , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Ecocardiografia , Eletrocardiografia , Teste de Esforço , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
We have performed a retrospective analysis of the clinical, echocardiographic, surgical and necropsy data in 40 patients affected by infective endocarditis complicated by paravalvular abscess. The abscess developed on prosthetic valve in 13 cases, and on native valve in 27. Aortic valve was the most affected (85%). The clinical course was considered to be acute in 52% of the patients. Fever persisted despite of adequate antibiotic therapy in 57%. In 90%, overt heart failure were present. Staphylococcus were the most frequent causative microorganism (S. aureus, 22.5%; S. epidermidis, 20%). Bundle branch or atrioventricular block were detected in 18 patients (sensibility, 45%; specificity, 88%). Bidimensional echocardiography, along with Doppler techniques when necessary, detected an abscess in 81% of patients (sensibility, 80%; specificity, 84%). Thirty patients were operated. Eight of them (26%) died, two intraoperatively. Ten patients were not operated and nine died (90%). The difference was significant (p less than 0.001). Only age and surgical treatment were related to early survival. Over the follow-up of the operated patients, five presented prosthetic dehiscence, but only two required a new operation 3 months after the first intervention, and none died. In conclusion, the detection of a paravalvular abscess complicating an infective endocarditis is an indication for surgical treatment. Both surgical mortality and postoperative prosthetic dehiscence are acceptable. Bidimensional echocardiography is the most reliable tool for the diagnosis of this complication.