[Coronary arteriography in severe aortic valve disease]

Three hundred and twelve patients with severe aortic valve disease underwent a pre-operative haemodynamic study including coronary arteriography either as routine [age more than 50 years] or because of chest pains, previous myocardial infarction or for patients with risk factors of coronary ath‚rosclerosis. Significant coronary artery disease was present in 9% of all cases. Coronary artery disease was more frequent in patients with angina and in patients with previous myocardial infarction but none of these factors was specific. We conclude that except young patients <40 years old, with no chest pain and no coronary risk factors, coronary arteriography is recommended in patients with severe aortic valve disease before aortic valve replacement

[Anatomic repair of transposition of the great areries or arterial switch operation]

Between January 1990 and September 2003, 62 patients underwent anatomic repair of a transposition of the great arteries. Mean operative age is 40 days. Transposition of the great arteries was simple in 38 cases and associated to a large ventricular septal defect in 24 cases. 44 patients have had an atrial septostomy of Rashkind and 45 an infusion of prostaglandin E 1.5 patients with simple transposition of the great arteries have had left ventricular retraining before arteriel switch. In association to arterial switch, were performed closure of ventricular septa] defect in 24 cases, cure of coarctation of the aorta in 4 cases and cure of an abnormal partial pulmonary venous return in 1 case. Early mortality was 6,45 %. After a mean follow up of 3 years, one patient died suddenly [late mortality is 1,72 %] and one patient had to have 2 reoperations. Results of anatomic repair are now excellent. Late mortality is essentially related to coronary complications so that a careful follow-up is mandatory

[Percutaneous mitral commissurotomy and left ventricular function in severe mitral stenosis]

The purpose of this study was to determine the immediate effect of percutaneous mitral commissurotomy [PMC] on left ventricular [LV] performance. We studied 30 patients with severe mitral stenosis undergoing successful PMC by cardiac catheterization and angiography before and 5 minutes after PMC. All patients were in sinus rhythm and no patient had hypertention or clinical coronary artery desease. We conclude that the left ventricular end-diastolic volume and the stroke volume increased significatively immediately after PMC because of and increase in LV filling after relieving the mitral mechanical obstruction

[Pulmonary hypertension in heterozygous sickle hemoglobinopathy about one case]

We report the case of a 33- years-girl with SCA and severe PH. She developed six month before admission, non productive couph and dyspnea. Physical examination at admission revealed shortness of breath and right heart ventricular failure. Electrocardiography showed sinus rhythm and an incomplete left bundle branch block. Chest roentgenography revealed cardiomegaly with cardiothoracic index at 0.66 and pulmonary infiltrates. Laboratory tests revealed an anemia with hemoglobin of 7,1 g/dl, white blood cell count of 12500/mm, moderate renal failure [cretininemia=178 micromol/l] and hypoxemia with oxygen pressure of 60 mmHg. Hemoglobin electrophoresis revealed an heterozygous SCA. Echocardiography revealed dilatation of right heart cavities and a systolic pulmonary artery pressure of 60 mmHg. A perfusion lung scintigraphy demonstrated multiple subsegmental perfusion defects. PH is a common complication of adult patients with SCA. Appropriate therapies and strategies for prevention of PH in SCA are unkown. Further research exploring therapies such as oxygen, nitric oxide, prostacyclin and hydroxyurea are indicated

Valvuloplastia percutânea mitral por baläo: resultados imediatos de 80 casos / Percutaneous mitral valvuloplasty by ballon catheterization: immediate results of 80 cases

Setenta e sete valvotomias foram realizadas nas primeiras 80 tentativas de tratamento da estenose mitral por valvuloplastia percutânea por duplo baläo (BMV). No grupo de 80 pacientes, 16 eram homens, a média de idade era de 44 ñ 17 anos, 12 tinham sido submetidos anteriormente a comissurotomia mitral cirúrgica, 26 apresentavam pequena insuficiência mitral. Havia importante alteraçäo valvar (imobilidade, espessamento ou calcificaçäo) ou do aparelho subvalvar em 29 pacientes. A média da pressäo "capilar" pulmonar variou de 22 ñ 6 a 12 ñ 5 mmHg (p < 0,001), o gradiente transvalvar mitral médio de 15 ñ 6 a 5 ñ 4 mmHg (p < 0,001). O índice cardíaco näo variou, a área valvar mitral (Gorlin) aumentou de 1,09 ñ 0,29 a 2,19 ñ 0,72 cm**2 (p < 0,001). Variaçöes similares foram medidas pela ecodopplercardiografia. Houve 3 tamponamentos: o primeiro num paciente no qual a BMV näo foi concluída; nos outros casos, as pressöes intracavitárias foram medidas depois da drenagem cirúrgica do pericárdio. A BMV näo foi eficaz num dos pacientes, que faleceu 3 dias após a toracotomia. Os três tamponamentos ocorreram por perfuraçäo do ventrículo esquerdo por baläo terminando em ponta. Näo houve mais tamponamento depois que foram adotados balöes terminando em "pigtail". Näo houve aumento de insuficiência mitral de mais de 1 +. Foi constatada comunicaçäo interatrial com relaçäo de fluxos pulmonar/sistêmico >= 1,5 e < 2 em 5 pacientes, e nenhum deles necessitou correçäo cirúrgica. A BMV é alternativa ao...