Valvoplastia sem suporte em crianças com anomalias congênitas da valva mitral: resultados clínicos tardios / Unsupported valvuloplasty in children with congenital mitral valve anomalies: late clinical results

OBJECTIVE: To analyze late clinical evolution after surgical treatment of children, with reparative and reconstructive techniques without annular support. METHODS: We evaluated 21 patients operated upon between 1975 and 1998. Age 4.67 + or - 3.44 years; 47.6 percent girls; mitral insufficiency 57.1 percent (12 cases), stenosis 28.6 percent (6 cases), and double lesion 14.3 percent (3 cases). The perfusion 43.10 + or - 9.50min, and ischemia time were 29.40 + or - 10.50min. The average clinical follow-up in mitral insufficiency was 41.52 + or - 53.61 months. In the stenosis group (4 patients) was 46.39 + or - 32.02 months, and in the double lesion group (3 patients), 39.41 + or - 37.5 months. The echocardiographic follow-up was in mitral insufficiency 37.17 + or - 39.51 months, stenosis 42.61 + or - 30.59 months, and in the double lesion 39.41 + or - 37.51 months. RESULTS: Operative mortality was 9.5 percent (2 cases). No late deaths occurred. In the group with mitral insufficiency, 10 (83.3 percent) patients were asymptomatic (p=0.04). The majorit y with mild reflux (p=0.002). In the follow-up of the stenosis group, all were in functional class I (NYHA); and the mean transvalve gradient varied between 8 and 12mmHg, average of 10.7mmHg. In the double lesion group, 1 patient was reoperated at 43 months. No endocarditis or thromboembolism were reported. CONCLUSION: Mitral stenosis repair has worse late results, related to the valve abnormalities and associated lesions. The correction of mitral insufficiency without annular support showed good long-term results

Endomiocardiofibrose / Endomyocardiofibrosis

Relata-se o caso de uma paciente feminina, branca, 67 anos, que apresentou sinais e sintomas de insuficiência cardíaca severa que, após investigaçäo, mostrou tratar-se de miocardiopatia restritiva por endomiocardiofibrose. Os autores fazem uma breve revisäo bibliográfica, destacando os aspectos diagnósticos e terapêuticos desta patologia

Correçäo da pressäo arterial pela circunferência do braço / Correction of blood pressure readings to patient's forearm circumference

Avaliou-se neste estudo a importância da correçäo da pressäo arterial pela circumferência do braço do paciente. Estudou-se 693 indivíduos (201masc., 492 fem.) com idade média de 48,85 (8 a 83 anos). Os valores mensurados foram corrigidos de acordo com a circunferência do braço do paciente, utilizando-se tabela específica. Observou-se uma prevalência de normotensos, hipertensos e hipertensos sistólicos isolados em índices de 57 por cento, 41 por cento e 1,15 por cento, respectivamente; e, após a correçäo, de 66,37 por cento, 31,19 por cento e 1,73 por cento, respectivamente. Conclui-se que a correçäo da PA pela circunferência do braço diminui número de hipertensos e aumenta o número de pacientes com hipertensäo arterial sistólica isolada