Compromiso cardiovascular en pacientes con síndrome inflamatorio pediátrico multisistémico, asociado a infección por SARS-CoV-2 / Cardiovascular involvement in pediatric patients with SARS-CoV-2 associated to multisystemic inflammatory syndrome

INTRODUCCION: El Síndrome Inflamatorio Pediátrico Multisistémico (PIMS) ha emergido como una nueva enfermedad en niños, secundaria a infección por SARSCoV-2. Se caracteriza por presentar compromiso multiorgánico con parámetros inflamatorios elevados y manifestaciones clínicas graves, siendo el corazón el órgano más severamente comprometido. OBJETIVO: Describir las características clínicas y de laboratorio de 23 pacientes con diagnóstico de PIMS con compromiso cardiovascular hospitalizados en un centro único. MÉTODO: Se efectuó un estudio retrospectivo analizando los hallazgos clínicos y de laboratorio junto a las manifestaciones cardiovasculares que presentaron estos pacientes. RESULTADOS: 23/29 pacientes con PIMS (78%) presentaron manifestaciones digestivas y mucocutáneas. Las manifestaciones cardiovasculares fueron: Síndrome Kawasaki y "Kawasaki like" sin compromiso coronario en 15/23 (65%) y con compromiso coronario en 3 (13%). Shock en 9 pacientes (39%), injuria miocárdica- miocarditis en 8 (35%) y derrame pericárdico en 13 (56%). Trastornos del ritmo cardíaco se observaron en 6 pacientes (26%). La terapia más utilizada fue inmunoglobulina y corticoides. 18 /23 requirieron manejo en unidades de intermedio y/o intensivo. Un 70% de los pacientes se recuperó del compromiso cardiovascular antes del alta. CONCLUSIÓN: El compromiso cardiovascular en PIMS es la complicación más frecuente de esta enfermedad, que se acompaña de manifestaciones inmunológicas y hematológicas graves lo que hace necesario un tratamiento multidisciplinario para un mejor manejo de estos pacientes.

INTRODUCTION: Pediatric Multisystemic Inflammatory Syndrome (PIMS) has emerged as a new disease in children, secondary to SARSCoV-2 infection. It is characterized by multi-organ involvement with elevated inflammatory parameters and severe clinical manifestations, the heart being the organ most severely involved. OBJETIVE: to describe the clinical and laboratory characteristics of 23 patients diagnosed with PIMS with cardiovascular involvement hospitalized in a single center. METHOD: We conducted a retrospective study in which we analyzed the clinical and laboratory findings along with the cardiovascular manifestations presented by these patients. Results: 23/29 patients with PIMS and cardiovascular involvement were selected, 78% had digestive and mucocutaneous manifestations. Cardiovascular manifestations consisted of KawasakiKawasaki like syndrome without coronary involvement in 15/23 (65%) and coronary involvement in 3 (13%). Nine patients developed shock (39%), 8 (35%) myocardial injury in and 13 (56%) pericardial effusion.. Heart rhythm disorders were observed in 6 patients (26%). The main therapy was immunoglobulin and corticosteroids. 18 /23 required management in intermediate and/or intensive care unit. 70% of patients recovered from cardiovascular involvement before discharge. CONCLUSION: Cardiovascular involvement in PIMS is the most frequent complication of this disease, but it is associated with severe immunological and hematological manifestations, which makes necessary a multidisciplinary treatment for a better management

Ruptura traumática de músculo papilar da valva tricúspide com forame oval patente adquirido e ruptura atrial direita oculta / Traumatic tricuspid valve papillary muscle case with concomitant acquired patent foramen ovale and covert right atrial rupture

RESUMO O traumatismo cardíaco é comum em acidentes com veículos automotores. Uma mulher com 50 anos de idade foi transportada para nosso hospital após sofrer múltiplos traumatismos em um acidente de automóvel quando dirigia em alta velocidade. Após admissão à unidade de terapia intensiva, uma ultrassonografia cardíaca revelou ruptura traumática de músculo papilar da valva tricúspide e forame oval patente, enquanto se observou, no exame físico, o sinal de Lancisi. Foi realizado tratamento cirúrgico com anuloplastia da valva e fechamento do forame oval patente; durante o ato cirúrgico, diagnosticou-se ruptura oculta do átrio direito.

ABSTRACT Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.

Injuria miocárdica postcirugía no cardiaca (MINS) en pacientes sometidos a cirugía vascular: artículo de revisión / Myocardial injury after noncardiac surgery (MINS) in major vascular surgery, a review

Vascular surgery is considered high risk, due to the characteristics of patients and surgical procedures. Recently, the diagnosis of myocardial injury after non-cardiac surgery (MINS) was introduced to focus attention on the prognostic relevance of elevated ischemic troponin after non-cardiac surgery. In the study Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION), that included more than 15,000 patients who underwent non-cardiac surgery, MINS was independently associated with mortality 3 to 4 times greater than 30 days after surgery. Biccard et al published a study derived from the study VISION in which 502 patients underwent vascular surgery, resulting in significantly higher mortality (12.5% vs 1.5%, p < 0.001) in patients who developed MINS compared to those who did not develop MINS (OR 9.48, 95% CI, 3.46-25.96). The 2014 guidelines for preoperative cardiovascular evaluation of the American College of Cardiology/American Heart Association (ACC/AHA) do not recommend the postoperative surveillance of troponin in patients without symptoms or signs of myocardial ischemia, nor in patients at high risk of coronary disease (as patients undergoing vascular surgery). On the other hand, the 2017 guidelines of the Canadian Cardiovascular Society on Perioperative Cardiac Risk, evaluation and treatment for non-cardiac surgery patients, recommend obtaining daily measurements of troponin for 48 to 72 hours after of non-cardiac surgery, in patients with a baseline risk of more than 5% of cardiovascular death or acute non-fatal myocardial infarction at 30 days after surgery. MINS is a potentially useful marker of adverse postoperative outcomes and its detection could provide opportunities to improve clinical outcomes in affected patients.

La cirugía vascular es considerada de alto riesgo, debido a características propias de los pacientes y de los procedimientos quirúrgicos. Recientemente, se introdujo el diagnóstico de injuria miocárdica postcirugía no cardiaca (MINS) para centrar la atención en la relevancia pronóstica de la elevación de la troponina isquémica después de una cirugía no cardíaca. Dos grandes estudios han demostrado que la mortalidad es significativamente mayor en pacientes que desarrollaron MINS. Las guías 2014 de evaluación cardiovascular preoperatoria de American College of Cardiology/American Heart Association (ACC/AHA), no recomiendan la vigilancia postoperatoria de troponina en pacientes sin síntomas ni signos de isquemia miocárdica ni tampoco en pacientes con alto riesgo de infarto al miocardio (como pacientes sometidos a cirugía vascular). Sin embargo, las guías de sociedad cardiovascular canadiense (publicadas en 2017) sobre riesgo cardíaco perioperatorio, evaluación y tratamiento para pacientes de cirugía no cardíaca] recomiendan obtener mediciones diarias de troponina durante 48 a 72 horas después de cirugía no cardíaca, en pacientes con un riesgo basal superior al 5% de muerte cardiovascular o infarto agudo al miocardio no fatal a 30 días después de una cirugía. MINS se debe considerar como un marcador potencialmente útil de resultados postoperatorios adversos y su detección podría brindar oportunidades para mejorar los resultados clínicos en los pacientes afectados.

Perforación miocárdica subaguda relacionada a electrodo de marcapasos. Reporte de caso y revisión de la literatura / Subacute myocardial perforation related to a pacemaker lead. Case report and literature review

Resumen La perforación miocárdica relacionada a electrodos de estimulación cardiaca es una complicación poco frecuente, pero desafortunada, ya que sus implicaciones clínicas son potencialmente letales. Nosotros describimos la evolución fluoroscópica de un caso de perforación subaguda del ventrículo derecho, así como el análisis en función de la revisión de la literatura. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract Myocardial perforation related to cardiac electronic devices leads is a rare, but unfortunate complication, since its clinical implications are potentially lethal. The fluoroscopic outcome of case of subacute right ventricular perforation is presented, together with an analysis based on a literature review. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

The role of heart team approach in penetrating cardiac trauma: case report and review of the literature

Abstract Penetrating cardiac trauma has been increasing in clinical experience and is joined to important morbidity and mortality. A case of a 38-year-old female with history of postpartum depression was reported, admitted to our department for cardiac tamponade due to penetrating self-inflicted multiple stab wound of the chest complicated by rupture of anterior left ventricular wall and traumatic ventricular septal defect. Following the unstable hemodynamic instability, a combined therapeutic strategy was chosen: surgery and transcatheter implantation to correct free wall ventricle damage and traumatic ventricular septal defect, respectively.

Trauma cardíaco fatal na cidade de Manaus/AM, Brasil / Fatal cardiac trauma in the city of Manaus, Amazonas state, Brazil

RESUMO Objetivo: determinar o índice de trauma cardíaco fatal na cidade de Manaus e esclarecer os mecanismos de trauma e de morte, o tratamento hospitalar prévio, assim como as lesões associadas ao trauma cardíaco. Métodos: estudo retrospectivo, observacional, transversal, que revisou os laudos de necropsias do Instituto Médico Legal de Manaus entre novembro de 2015 e outubro de 2016, cuja causa mortis foi lesão cardíaca. Resultados: o índice de trauma cardíaco foi de 5,98% (138 casos) dentre 2306 necropsias realizadas no período do estudo. Homens foram afetados em 92%. A mediana de idade foi de 27 anos (14 a 83). A arma de fogo foi o mecanismo de trauma em 62,3% e a arma branca em 29,7%. A exsanguinação foi responsável pela maioria das mortes e o tamponamento cardíaco esteve presente em segundo lugar. Óbito no local ocorreu em 86,2%. Os ventrículos foram as câmaras mais lesionadas. O hemotórax foi descrito em 90,6%. Apenas 23 (16,7%) doentes foram removidos até o pronto socorro, porém seis deles (26,2%) não foram submetidos à toracotomia, apenas à drenagem de tórax. O pulmão foi acometido em 57% unilateralmente e 43% bilateralmente. Conclusão: o trauma cardíaco fatal representou um índice de 5,98% na cidade de Manaus. A maioria dos doentes morre na cena do trauma, geralmente devido à exsanguinação causada por ferimento de arma de fogo. Cerca de um quarto dos pacientes que chegaram ao pronto socorro e morreram, não foram diagnosticados com trauma cardíaco em tempo hábil.

ABSTRACT Objective: to determine the frequency of fatal cardiac trauma in the city of Manaus, Brazil, between November 2015 and October 2016, and to clarify the mechanisms of trauma and death, previous hospital treatment, as well as the injuries associated with cardiac trauma. Methods: retrospective, observational, and cross-sectional study, which reviewed the necropsy reports of individuals whose cause of death was cardiac injury. Results: the cardiac trauma rate was of 5.98% (138 cases) out of 2,306 necropsies performed in the study period by Instituto Médico Legal (IML) de Manaus (IML is a Brazilian institute responsible for necropsies and cadaveric reports). Males accounted for 92% of the cases. The median age was 27 years (14-83). Gunshot wounds (GSW) was the trauma mechanism in 62.3% and stab wound (SW) in 29.7%. Exsanguination was responsible for most of the deaths and cardiac tamponade was present in second place. On-site death occurred in 86.2% of the cases. The ventricles were the most common site of cardiac injury. Hemothorax was identified in 90.6% of the individuals. Only 23 patients (16.7%) were taken to the hospital (Emergency Room), but six (26.2%) were submitted only to chest drainage, not to thoracotomy. The lung was unilaterally affected in 57% of the cases and bilaterally in 43%. Conclusion: fatal cardiac trauma represented an index of 5.98% in the city of Manaus. Most patients die at the scene of the trauma, usually due to exsanguination caused by gunshot wound. About a quarter of patients who reached the hospital and died were not diagnosed with cardiac trauma in time.

Traslado aéreo con balón de contrapulsación aórtico de paciente con ruptura del septum interventricular post infarto al miocardio / Air transfer with an aortic balloon counterpulsation of a patient with interventricular septal rupture after myocardial infarction

Introducción: El balón intraaórtico de contrapulsación (BIAC) puede utilizarse como soporte circulatorio en pacientes cuyo tratamiento definitivo no está en el hospital de ingreso y es necesario hacer un traslado pensando en el mejor resultado final para el paciente. No existen reportes nacionales de este tipo de traslado Presentación del caso: Paciente mujer de 62 años con múltiples antecedentes mórbidos fue trasladada desde Tocopilla al Hospital Regional de Antofagasta (HRA), consultando por cuadro de disnea progresiva y dolor en hemiabdomen superior de 72 horas de evolución. Se planteó un síndrome coronario agudo y se solicitó co-ronariografía que reveló una estenosis de la arteria descendente anterior en su 1/3 medio en un 80%. Se realizó una angioplastía con Stent DES. Al llegar a UCI destaca soplo pansistólico en foco mitral solicitándose ecocar-diograma Doppler Color que mostró una comunicación interventricular (CIV) (Figura 1). Se instaló un balón de contrapulsación intra aórtico (Figura 2) y se planificó el traslado aéreo al Hospital Gustavo Fricke (HGF) que se efectuó sin incidentes (Figura 3). Tres días después se cerró la CIV manteniendo el balón de contrapulsación intra aórtico. Un ecocardiograma de control mostró una CIV residual de 0,7 mm y la evolución clínica posterior fue satisfactoria. Al 13er día post operación se constató una infección de la herida operatoria. Se trató con an-tibióticoterapia y aseo quirúrgico en 4 oportunidades, evolucionando satisfactoriamente. Se trasladó de regreso al Hospital de Antofagasta sin complicaciones y finalmente se dio de alta.

Introduction: Intra-aortic balloon counterpulsation (IABC) has been used for many years. IABC serves as circulatory support in patients where definitive care is not in the admission hospital. There are not reports of air transport with IABC in our national reality. Case report: A 62 year old patient with multiple morbid history was derived from Tocopilla to Antofagasta's Regional Hospital (ARH), she consulted for progressive dyspnea and abdominal pain 72 hours ago. We diagnosed acute coronary syndrome and the coronariography informs coronary stenosis of the anterior descending artery in the middle third about 80%. Angioplasty with stent is performed. The patient arrived to UCI, in the physical examination stands mitral pansystolic murmur. Color doppler echocardiography was requested: highlight interventricular comunication (IVC). Counterpulsation balloon is positioned and we planned the air transport to Gustavo Fricke Hospital (HGF). Transfer HRA-HGF was performed uneventfully with stable patient. 3 days after, IVC is closed and maintains IABC. Control echocardiography reports 0.7 mm residual IVC with satisfactory clinical course. At the 13th post-surgical day, the wound becomes infected and she is treated with antibiotic therapy and surgical toilet in 4 opportunities to evolve successfully. The HGF-HRA transfer is done without complications, his recuperation is satisfactory and she is discharged from the ARH. Discussion: There is evidence that the air tranfers with BIAC are safe, always considering factors such as the expansion of gases and electronic failures.

A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg−1·day−1), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

Paradoxo do cálcio - o que temos a temer? / The calcium paradox - What should we have to fear?

O paradoxo do cálcio foi pela primeira vez citado em 1966 por Zimmerman et al. A partir daí, ganhou grande interesse por parte da comunidade científica internacional devido ao fato da ausência do íon cálcio produzir na célula muscular cardíaca dano semelhante à lesão de isquemia-reperfusão. Apesar de não serem conhecidos todos os mecanismos envolvidos no processo da lesão celular no paradoxo do cálcio, a conexão intercelular mantida somente pelo nexus parece ter papel chave na fragmentação celular. A adição de pequenas concentrações de cálcio, bloqueadores de canal de cálcio, hiponatremia ou hipotermia são importantes para evitar que haja lesão celular no momento da reperfusão com soluções com concentração fisiológica de cálcio.

The calcium paradox was first mentioned in 1966 by Zimmerman et al. Thereafter gained great interest from the scientific community due to the fact of the absence of calcium ions in heart muscle cells produce damage similar to ischemia-reperfusion. Although not all known mechanisms involved in cellular injury in the calcium paradox intercellular connection maintained only by nexus seems to have a key role in cellular fragmentation. The addition of small concentrations of calcium, calcium channel blockers, and hyponatraemia hypothermia are important to prevent any cellular damage during reperfusion solutions with physiological concentration of calcium.

Intracardiac embolization of inferior vena cava filter associated with right atrium perforation and cardiac tamponade / Embolização de filtro de veia cava associado à perfuração de átrio direito e tamponamento cardíaco

Insertion of inferior vena cava filters has been well established in literature, reducing occurrence of pulmonary embolism after an episode of deep venous thrombosis in patients with contraindication to anticoagulation. There are a small number of complications related to procedure and embolization is rare. In this context, we described a case of intracardiac embolization associated with cardiac tamponade.

A colocação percutânea de filtro de veia cava inferior é bem estabelecida em literatura, reduzindo a chance de ocorrência de tromboembolismo pulmonar após um episódio de trombose venosa profunda em pacientes com contraindicações à anticoagulação. O índice de complicações relacionadas ao procedimento é pequeno, sendo embolização evento extremamente raro. Nesse contexto, descrevemos um caso de embolização intracardíaca de filtro de veia cava inferior associada ao tamponamento cardíaco.

Understanding traumatic blunt cardiac injury.

Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI) are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word "Blunt Cardiac Injury," we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory.

Ferimento cardíaco transfixante por projétil de arma de fogo: relato de caso / Transfixing gunshot wound to the heart: case report

O trauma cardíaco penetrante apresenta altas taxas de mortalidade. É comumente associado a lesões por armas brancas, porém crescentes índices na violência urbana têm contribuído para o aumento no número de ferimentos cardíacos por projéteis de armas de fogo. Estas possuem as maiores taxas de mortalidade dentre os ferimentos cardíacos penetrantes e podem acometer múltiplas câmaras cardíacas, com índices de mortalidade ainda mais elevados. Apresentamos um caso de um paciente, vítima de tentativa de roubo, que sofreu ferimento cardíaco transfixante por projétil de arma de fogo, operado com sucesso em nossa instituição.

Penetrating cardiac trauma carries high mortality rates. It has been commonly associated with stabbing, but increasing urban violence has led to growing numbers of gunshot heart wounds. The latter have higher mortality rates among penetrating cardiac injuries and may affect multiple heart chambers, with mortality rates even higher. We report a patient, victim of an attempted armed robbery, who had a transfixing gunshot wound to the heart, successfully operated at our institution.

A Randomized Study Assessing the Effects of Pretreatment with Cilostazol on Periprocedural Myonecrosis after Percutaneous Coronary Intervention

PURPOSE: It is unknown whether cilostazol pretreatment reduces postprocedural myonecrosis (PPMN). Cilostazol pretreatment reduces PPMN after percutaneous coronary intervention (PCI). MATERIALS AND METHODS: A total of 120 patients with stable angina scheduled for elective PCI were randomly assigned to a 7-day pretreatment with Cilostazol (200 mg/day) or to a control group. Creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) levels were measured at baseline and at 6 and 24 hours after PCI. The primary end-point was the occurrence of PPMN, defined as any CK-MB elevation above the upper normal limit (UNL). Aspirin and clopidogrel were co-administered for 7 days before PCI, and resistance to these agents was then assayed using the VerifyNow System. RESULTS: There was no difference in baseline characteristics between the final analyzable cilostazol (n=54) and the control group (n=56). Despite a significantly greater % inhibition of clopidogrel in the cilostazol group (39+/-23% versus 25+/-22%, p=0.003), the incidence of PPMN was similar between the cilostazol group (24%) and the control group (25%, p=1.000). The rate of CK-MB elevation at > or =3 times UNL was also similar between the two groups (6% versus 5%, p=0.583). The incidence of cTnI increase over the UNL or to 3 times the UNL was not different between the two groups. There was no significant difference in terms of the rate of adverse events during follow-up, although the cilostazol group showed a tendency to have a slightly higher incidence of entry site hematoma. CONCLUSION: This trial demonstrated that adjunctive cilostazol pretreatment might not significantly reduce PPMN after elective PCI in patients with stable angina.

Perfuração tardia de ventrículo direito em portador de cardioversor desfibrilador implantável / Delayed right ventricular perforation in patient with implantable cardioverter - defibrillator / Perforación tardía de VD en portador de DCI

Descrevemos o caso de uma paciente de 62 anos que retornou para avaliação nove meses após implante de cardioversor desfibrilador implantável (CDI) com sinais de perfuração tardia do ventrículo direito. São discutidos os sinais clínicos que permitem o diagnóstico dessa apresentação tardia, assim como as condutas e a frequência dessa complicação na literatura.

We describe the case of a 62-year-old patient who returned for evaluation nine months after receiving an implantable cardioverter-defibrillator (ICD) with signs of delayed right ventricular (RV) perforation. The clinical signs that allowed the diagnosis of this late presentation to be achieved are discussed herein, as well as the conduct and the frequency of this complication in the literature.

Describimos un caso de una mujer de 62 años que regresó para evaluación nueve meses después de implantación de un desfibrilador cardiaco implantable (DCI) con signos de perforación tardía del ventrículo derecho. Se discuten los signos clínicos que permitan el diagnóstico de esta presentación tardía, así como el comportamiento y la frecuencia de esta complicación en la literatura.

Perfuração de ventrículo esquerdo durante cateterismo cardíaco diagnóstico / Perforation of the left ventricle during cardiac catheterization

Perfuração de uma câmara cardíaca é uma complicação maior do cateterismo cardíaco, condição extremamente rara, porém de gravidade bem documentada. Relatamos um caso de perfuração de ventrículo esquedo ocorrido após a realização de ventriculografia esquerda com cateter pig tail, seguido de colapso cardiovascular em decorrência de tamponamento cardíaco. O quadro foi manejado com pronta realização de pericardiocentese, a qual foi suficiente para estabilização clínica e resolução do caso.

Perforation of a heart chamber is a major complication ofcardiac catheterization, an extremely rare condition, although its potential severity is well documented. We describe a case of perforation of the left ventricle occurred after a left ventriculography with a pig tail catheter, followed by cardiovascular collapse due to cardiac tamponade. This situation was handled with prompt pericardiocentesis, which led to clinical stabilization and case resolution.

Tratamiento quirúrgico de las heridas cardíacas: experiencia en 23 pacientes en el Hospital Universitario de Maracaibo / Surgical treatment of hearth injuries: experience in 23 patients at the Hospital Universitario de Maracaibo

Evaluar el diagnóstico y tratamiento de las heridas cardíacas en el Hospital Universitario de Maracaibo. Se evaluaron un total de 23 pacientes quienes presentaron traumatismos cardíacos penetrantes en el período comprendido entre enero de 1991 y enero de 2007, los signos y síntomas presentes, localización de la lesión, estudios diagnósticos, intervenciones quirúrgicas realizadas y evolución postoperatoria. De los 23 traumatismos cardiovasculares penetrantes, 11 (47.82 por ciento) correspondieron a arma de fuego, 9 (39.13 por ciento) a heridas por arma blanca y 3 (13.045 por ciento) por pico de botella. Las lesiones cardíacas más frecuentes fueron: 11 heridas en ventrículo izquierdo (47.82 por ciento), 10 en ventrículo derecho (43.47 por ciento) 2 en aurícula derecha (8.69 por ciento). 2 pacientes (8,69 por ciento) presentaron choque hipovolémico durante el acto operatorio. 3 pacientes (13.04 por ciento) fallecieron en el postoperatorio inmediato y 2 (8,69 por ciento) en el postoperatorio tardío por sepsis. Las heridas del corazón se acompañan de una elevada morbi-mortalidad y los pacientes en que se sospechen estas lesiones ameritan una atención inmediata. Se hace referencia a las medidas a seguir en los pacientes con traumatismos cardiovasculares, criterios diagnósticos y diferentes formas de tratamiento quirúrgico.

Pericardial window used in the diagnosis of cardiac injury

PURPOSE: The purpose of the present study is to analyze the results of subxiphoid pericardial window (SPW) and transdiaphragmatic pericardial window (TDP) procedures comparing the two techniques. METHODS: During the period of January, 1994 to December, 2004, at UNICAMP, 245 patients underwent a pericardial window (PW) procedure to evaluate the possibility of cardiac injury. We reviewed the medical records of those patients in order to compare both procedures. RESULTS: Two hundred and seven patients (84.5 percent) underwent the SPW procedure, and 38 (15.5 percent) underwent the TDP procedure. Of the patients who underwent a SPW procedure, 151 (72.9 percent) had gunshots injuries, and 56 (27.1 percent) had stab wounds. In the group of patients submitted to TDP procedure, the wound was caused by gunshot in 26 (68.4 percent). The SPW method has shown a sensitivity of 97.5 percent, specificity of 95.8 percent, and an accuracy of 96.1 percent. The TDP method demonstrated a sensitivity of 100 percent, specificity of 97 percent and a 97.4 percent of accuracy rate. This review showed 8 (3.3 percent) false positive results. There was a single case (2.6 percent) of complications directly associated to the TDP, and this patient developed pericarditis. CONCLUSIONS: Both techniques presented an equally great result, with high sensitivity and specificity. Both surgical techniques must be carefully done to avoid false positive results.

OBJETIVO: Analisar os resultados da janela pericárdica subxifóidea (JPSX) e da janela pericárdica transdiafragmática (JPTD), comparando as duas técnicas. MÉTODOS: Durante o período entre Janeiro de 1994 a Dezembro de 2004, 245 pacientes foram submetidos à janela pericárdica (JP) na Unicamp, a fim de avaliar a presença de lesão cardíaca. Foram revisadas as informações destes pacientes a fim de comparar as técnicas de JP. RESULTADOS: Duzentos e sete (84,5 por cento) pacientes foram submetidos à JPSX, e 38 (15,5 por cento) à JPTD. Dos pacientes que realizaram a JPSX, 151 (72,9 por cento) foram vítimas de lesões provocadas por projétil de arma de fogo (FPAF), e 56 (27,1 por cento) por arma branca (FAB). Em relação aos pacientes submetidos à JPTD, o ferimento foi causado por FPAF em 26 (68,4 por cento). O método JPSX teve uma sensibilidade de 97,5 por cento, especificidade de 95,8 por cento, e uma acurácia de 96,1 por cento. A JPTD resultou numa sensibilidade de 100 por cento, especificidade de 97 por cento e 97,4 por cento de acurácia. Em 8 pacientes (3,3 por cento) o resultado foi falso-positivo. Houve um único caso (2,6 por cento) de complicação diretamente relacionada à JPTD. CONCLUSÕES: Ambas as técnicas apresentaram um bom resultado, com alta sensibilidade e especificidade. Entretanto, estes procedimentos cirúrgicos devem ser efetuados com cuidado, a fim de evitar resultados falso-positivos.