Strain bidimensional na cardiopatia de Takotsubo / Two-dimensional strain in Takotsubo cardiomyopathy

Este relato apresenta o seguimento tardio de um caso de cardiomiopatia de Takotsubo com boa evolução clínica e melhora da função sistólica global ventricular esquerda. Contudo, observou-se persistência de significativa disfunção sistólica regional longitudinal que foi avaliada por meio de nova técnica ecocardiográfica (speckle tracking), com as medidas do strain (S) e strain rate (SR) correspondentes. Ressaltamos a importância desse novo método para o acompanhamento dessa cardiopatia, pois permite identificar os pacientes que persistem com disfunção sistólica e que possivelmente serão beneficiados com a manutenção da terapêutica clínica.

This report presents the late follow-up of a case of Takotsubo cardiomyopathy with good clinical outcome and improved left ventricular global systolic function. However, there was persistence of significant regional longitudinal systolic dysfunction evaluated using a new echocardiographic technique (speckle tracking), with corresponding measures of strain (S) and strain rate (SR). We emphasize the importance of this new method to monitoring this cardiomyopathy, since it identifies patients with persistent systolic dysfunction who will possibly benefit from maintenance of clinical therapy.

Agenesia total do pericárdio do lado esquerdo / Total agenesis of the left pericardium

Descrevemos o caso de um paciente com 46 anos de idade e diagnóstico pré-operatório de comunicação interatial (CIA) do tipo ostium secundum. Após esternotomia constatou-se agenesia parcial do pericárdio do lado esquerdo. Acreditamos que diante de um quadro radiológico compatível com esta doença, mesmo que assintomática, pesquisa clínica na procura de anomalias cardiopulmonares deveria ser sistematizada, uma vez que a maioria desses achados quando presentes, são possíveis e necessitam de correção cirúrgica.

Revascularizaçäo cirúrgica das artérias posteriores do coraçäo sem circulaçäo extracorpórea / Surgical revascularization of posterior coronary arteries without cardiopulmonary bypass

Objective - To assess the results observed during the early prospective period in patients who had the posterior coronary arteries revascularized without cardiopulmonary bypass (CPB), in regard to the following parameters: age, sex, bypass grafts types, morbitidy and mortality. Methods - From January 1995 to June 1998, 673 patients underwent myocardial revascularization (MR). Of this total, 607 (90.20 per cent) MR procedures were performed without CPB. The posterior coronary arteries (PCA) were revascularized in 298 (44.27 per cent) patients, 280 (93.95 per cent) years (mean, 61 years). The male gender predominated, with 198 men (70.7 per cent). The revascularization of the posterior coronary arteries had the following distribution: diagonalis artery (31 patients, 10 per cent); marginal branches of the circumflex artery (243 patients, 78.7 per cent); posterior ventricular artery (4 patients, 1.3 per cent); and posterior descending artery (31 patients, 10 per cent). Results - Procedure-related complications without death occurred in 7 cases, giving a morbidity of 2.5 per cent. There were 11 deaths in the early posterative period (mortality of 3.9 per cent). Conclusion - Similarly to the anterior coronary arteries, the posterior coronary arteries may benefit from myocardial revascularization without CPB.