Ecocardiografia Tridimensional na avaliação de endocardite de válvula nativa: um relato de caso e semelhança entre achados ecocardiográficos e cirúrgicos / Three-Dimensional transesophageal echocardiography in native valve endocarditis: a case report and similarities between echocardiography and surgical findings

A endocardite de valva nativa é uma doença incomum, complexa, e de alta morbimortalidade. Requer tratamento clínico prolongado, com várias complicações possíveis, e o seu tratamento cirúrgico é complexo e tecnicamente difícil. O ecocardiograma transtorácico e transesofágico são fundamentais na avaliação da doença, inclusive seus achados são parte dos critérios diagnósticos de endocardite. Adicionalmente, o ecocardiograma tridimensional (3D) contribui com detalhamento anatômico na avaliação das estruturas cardíacas acometidas pela doença. Mostramos um caso em que é ilustrado o papel da ecocardiografia no diagnóstico e avaliação de complicações da endocardite, comparando as imagens do ecocardiograma 3D pré-operatórias, com os achados durante o ato cirúrgico. (AU)

Native valve bacterial endocarditis is an uncommon, complex, and highly morbid disease that requires prolonged clinical treatment and challenging surgical interventions. Transthoracic and transesophageal echocardiography are paramount assessment tools whose findings are included in the diagnostic criteria. Three-dimensional echocardiography shows further realistic imaging details. Here we present a case demonstrating the role of echocardiography in the diagnosis of endocarditis and the identification of its complications to show how advanced imaging techniques may have a remarkable resemblance with in vivo surgical findings. (AU)

Coartación de aorta y su asociación con la patología mitral / Aortic Coartaction and its association with the mitral pathology

Coartaction of the aorta is characterized by a localized deformity narrowing the aortic lumen. The zone of coartaction is characteristically located beyond the origin of the left subclavian artery. Most of them are located in the zone of the posterior wall of the oposit aorta of the invertion of the ductus. The coartaction of the aorta amounts up to 5.1% of the congenital cardiac malformations and constitutes the eigth cardiac malformation in frequency; Is a malformation tipically associated with the Turner syndrome. The aims of this report were to describe and to analyze the mitral pathology and the clinicosonographic experience in patients with coarctation of the aorta associated to congenital mistral pathology during the last 10 years. An observtiona, descriptive and retrospective study was performed. The history of 103 patients with a diagnosis of coartaction of the aorta assisted in our Hospital were studied. All the patients were confirmed by color Doppler echocardiography. Assuming that the mitral pathology is a frequent association that affects strongly the morbi-mortality and the prognosis of such patients is an indisensable condition to investigate its presence in, front of a diagnosis of coartaction of the aorta (AU)

Occult metastatic melanoma presenting as an acute coronary syndrome

Abstract Melanoma is a tumor that virtually involves any tissue and commonly metastasizes to the heart. It is usually not diagnosed because of the absent/nonspecific cardiac signs and symptoms. Herein, we present a case of a 41-year-old man without any cardiovascular risk factor, admitted to the emergency room with chest pain, diagnosed with a myocardial infarction. Due to the presence of a mass adjacent to the mitral valve on the cardiac ultrasound examination, causing mitral regurgitation, the patient was referred to surgery. Pathological analysis of the excised specimens diagnosed the melanoma. The chemotherapy was started and achieved a partial response. Cardiac metastases usually affect the myocardium, leaving the valves unaffected. In this case, the acute coronary syndrome was the first manifestation of the malignant melanoma. We highlight the high level of suspicion needed in these cases.

A new experimental device for transapical access of the aortic and mitral valves as well as the aorta in its various segments

Abstract Objective: To present the results of a new experimental device developed to facilitate the transapical access in endovascular treatment of structural heart diseases. It aims to reduce the risk of bleeding and complications in this type of access and demonstrate the device as a safe, fast and effective alternative. Methods: CorPoint is composed of three parts: introducer, base with coiled spring, and closing capsule. By rotating movements, the spring is introduced into the myocardium and progressively approaches the base to the surface of the heart. Guidewires and catheters are inserted through the hollow central part and, at the end of the procedure, the capsule is screwed over the base, therefore stopping any bleeding. Results: The device was implanted in 15 pigs, weighing 60 kg each, through an anterolateral thoracotomy, while catheters were introduced and guided by fluoroscopy. All animals had minimal bleeding; introducers with diameter up to 22 Fr were used and various catheters and guidewires were easily handled. After finishing the procedure, the closing capsule was attached and no bleeding was observed at the site. Conclusion: This new device has proved effective, fast and secure for the transapical access. This shows great potential for use, especially by ensuring an easier and direct access to the mitral and aortic valves; the shortest distance to be traveled by catheters; access to the ascending and descending aorta; decreased bleeding complications; decreased surgical time; and the possibility of allowing the technique to evolve and become totally percutaneous.

Emergent management of a case with acute sub-dural hematoma post mechanical mitral valve replacement on warfarin therapy

The use of anticoagulants to prevent thromboembolic complications post mechanical valve replacement is associated with intracranial or subdural hemorrhage. In such cases, the scale has to be balanced to have a good anticoagulation in order to prevent thromboembolism and to have a target INR [International normalized ration] in order to avoid hemorrhages specifically intracranial hemorrhages. A controversy exists on reversal of anticoagulation for emergency surgery and management may differ from case to case. Here, we report a case with massive subdural hematoma on warfarin post mechanical mitral valve replacement for emergency craniotomy and evacuation. Effective optimization and correction of INR by reversing anticoagulation lead to an improved outcome without further increase in thromboembolic complications

Hemangiosarcoma at the base of the left atrium of a dog with mitral and tricuspid valve degeneration ­ case report / Hemangiossarcoma na base do átrio esquerdo de um cão com degeneração da válvula mitral e tricúspide ­ relato de caso

Hemangiosarcoma (HSA) is a malignant neoplasm originating from the vascular endothelium, with high metastatic power and commonly described in the spleen, liver, and right atrium. Thus, the objective of the present study is to report the occurrence of HSA at the base of the left atrium of a male, elderly, Lhasa Apso dog, treated with cyanosis, orthopedic position, cough. In the physical examination, the presence of crackling was observed in pulmonary lobes, murmur in focus of mitral and tricuspid grade IV\VI. The recommended emergency therapy was performed until the clinical improvement of the animal. After echocardiography, mitral and tricuspid valvular degeneration was confirmed, as well as the presence of an irregular, mixed echocardiogram, extra-cardiac, immobile at the base of the left atrium, measuring 2.9 x 1.44 cm in diameter. The clinical therapy established stabilized the clinical picture for 128 days, with recurrence of pulmonary edema and severe hemorrhagic pleural effusion, with the owners opting for euthanasia of the animal and necropsy confirming the definitive diagnosis of extrahepatic SAH at the base of the left atrium.(AU)

O hemangiossarcoma (HSA) é uma neoplasia maligna originada no endotélio vascular, com alto poder metastático e comumente descrito no baço, fígado e átrio direito. Assim, o objetivo deste trabalho é relatar a ocorrência do HSA na base do átrio esquerdo de um cão, macho, idoso, da raça Lhasa Apso, atendido apresentando cianose, posição ortopneica e tosse. No exame físico foi observado presença de crepitação em lobos pulmonares e sopro em foco de mitral e tricúspide grau IV\VI. Foi realizada terapia emergencial preconizada até a melhora clínica do animal, e após a ecocardiografia confirmou-se a degeneração valvular mitral e tricúspide, bem como a presença de uma imagem irregular, de ecogenicidade mista, extracardíaca e imóvel na base do átrio esquerdo, medindo 2,9 x 1,44 cm de diâmetro. A terapia clínica instituída estabilizou o quadro clínico por 128 dias, havendo recidiva do edema pulmonar e efusão pleural hemorrágica grave, com os proprietários optando pela eutanásia do animal e a necropsia, confirmando o diagnóstico definitivo do HSA extracardíaco na base do átrio esquerdo.(AU)

The mid-term results of patients who underwent radiofrequency atrial fibrillation ablation together with mitral valve surgery

Abstract Objetive: Saline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed. Methods: Forty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74) underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90%) were in NYHA class III; 34 (85%) patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months. Results: While the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination. Conclusion: Radiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.

Arcada mitral: causa silente de sibilancias recurrentes en la infancia. Caso clínico / Anomalous mitral arcade: a disguised and silent lesion leading to a recurrent wheezing in children. A case report

El síndrome bronquial obstructivo recurrente o sibilante recurrente constituye uno de los motivos de consulta más frecuentes en pediatría. Entre los diagnósticos etiológicos diferenciales, se encuentran las cardiopatías congénitas. En esta presentación, se describe el caso de un niño de 4 años derivado a nuestra Institución para valoración cardiológica por presentar sibilancias recurrentes. Se trató de un caso de estenosis mitral congénita grave secundaria a arcada mitral. La arcada mitral es una cardiopatía congénita infrecuente. Constituye una variante de obstrucción al tracto de entrada del ventrículo izquierdo, que afecta el aparato subvalvular mitral y genera hipertensión pulmonar retrograda poscapilar y edema intersticial. El diagnóstico se realizó mediante la evaluación clínica, electrocardiográfica, radiológica y, fundamentalmente, ecocardiográfica. Se efectuó una corrección quirúrgica exitosa con remoción completa de la obstrucción mitral.

Recurrent wheezing is a very common clinical ailment throughout infancy and childhood. The most common diagnosis in children with wheezing is asthma. However, some other causes should be considered in the differential diagnosis such as a congenital cardiac defect. We present a case of a four year old boy presenting with recurrent wheezing who was referred to our institution for cardiac evaluation. Severe mitral stenosis secondary to an anomalous mitral arcade was diagnosed by physical examination, chest X-ray, electrocardiogram and mainly transthoracic and transesophageal echocardiography. Anomalous mitral arcade is a rare congenital malformation of the mitral tensor apparatus which comprises the chordae tendineae and papillary muscles. This abnormal anatomy leads to increased filling pressure of the left ventricle, a retrograde post capillary pulmonary hypertension and interstitial aedema. The patient was referred to cardiac surgery and underwent a successful procedure with complete removal of the obstructive mitral lesion.

Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair / Análise morfológica e funcional do anel mitral com o uso da ecocardiografia tridimensional em tempo real em indivíduos submetidos à plástica mitral sem o uso de anéis protéticos

AbstractIntroduction:Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce.Objective:To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique.Methods:Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05.Results:There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study.Conclusion:Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study.

ResumoIntrodução:A plastia valvar mitral é o tratamento de escolha para a insuficiência mitral, porém, a literatura é escassa em relação ao comportamento do anel mitral após a plástica mitral sem utilização de anéis protéticos.Objetivo:Realizar a análise morfofuncional do anel mitral de indivíduos submetidos à plastia valvar mitral pela Técnica de Duplo Teflon, sem utilização de anel protético, por meio da ecocardiografia tridimensional em tempo real.Métodos:Foram incluídos 14 pacientes com insuficiência mitral mixomatosa submetidos à plástica mitral pela técnica de Duplo Teflon. Treze pacientes encontravam-se em classe III/IV. Os pacientes foram avaliados nos períodos pré-operatório, pós-operatório imediato, 6 meses e 1 ano. Foi utilizado teste de análise de variância de medidas repetidas para o estudo estatístico, sendo considerado estatisticamente significante P<0,05.Resultados:Não houve óbito, reoperação por disfunção valvar, tromboembolismo ou endocardite durante o estudo. A planimetria posterior do anel mitral demostrou uma redução significativa (P<0,001) no pós-operatório imediato, que se manteve estável durante o estudo, apresentando redução média de 25,8% com 1 ano em relação ao pré-operatório. Houve uma redução significativa dos diâmetros ântero-posterior e médio-lateral no pós-operatório imediato (P<0,001), porém, houve um aumento significativo no diâmetro médio-lateral entre pós-operatório imediato e 1 ano. Não houve diferença na variação da área interna mitral ao longo do estudo.Conclusão:A anuloplastia segmentar reduziu significativamente o componente posterior do anel mitral, permanecendo estável no período de um ano. A variação da área valvar durante o ciclo cardíaco permaneceu estável durante o estudo.

Association of diffuse idiopathic skeletal hyperostosis and aortic valve sclerosis / Asociación de hiperostosis esquelética idiopática difusa y esclerosis valvular aórtica

The principal objective of this investigation was to analyze the association between diffuse idiopathic skeletal hyperostosis (DISH) and the presence of aortic valve sclerosis (AVS). For this study we used results from 1000 consecutive outpatients (473 males), older than 50 years of age (average 67.6 years), that had been examined with Doppler echocardiogram and anterior and lateral chest radiographs. Overall, 195 patients (19.5%) were diagnosed with DISH and 283 (28.3%) with AVS. DISH was more prevalent than AVS in males (66.7% vs. 42.6%, p< 0.0001) and in older patients (73.6 ± 9 years vs. 66.1 ± 9 years, p < 0.0001). Furthermore, 55.4% of patients with dorsal DISH presented aortic sclerosis calcification vs. 21.7% of patients free of DISH (OR = 4.47; 95% CI = 3.22-6.21). The adjusted odds ratio (OR) was calculated by sex and age resulting in 3.04 (95% CI = 2.12-4.36; p < .0001). A statistically significant association was found between DISH and AVS in accordance to age and sex. The biological plausibility of this association is based on similar risk factors, pathogenic mechanisms and vascular complications.

El objetivo principal fue analizar la asociación entre la hiperostosis esquelética idiopática difusa (DISH) y la presencia de esclerosis valvular aórtica (AVS). Se evaluaron los resultados de 1000 pacientes ambulatorios consecutivos (473 varones), mayores de 50 años (promedio, 67.6 años), que habían sido examinados con un ecocardiograma Doppler y radiología torácica anterior y lateral. Globalmente, 195 pacientes (19.5%) tuvieron diagnóstico de DISH y 283 (28.3%) de AVS. DISH fue más prevalente que AVS en varones (66.7% vs. 42.6%, p < 0.0001) y en pacientes de mayor edad (73.6 ± 9 años vs. 66.1 ± 9 años, p < 0.0001). Además, 55.4% de los pacientes con DISH dorsal presentaron AVS vs. 21.7% de los pacientes sin DISH (OR = 4.47; 95% CI = 3.22-6.21). El odds ratio (OR) ajustado por sexo y edad fue 3.04 (95% CI = 2.12-4.36; p < 0.0001). Se encontró una asociación estadísticamente significativa entre DISH y AVS, que se mantuvo después de ajustar por sexo y edad. La plausibilidad biológica de esta asociación se basa en los factores de riesgo, mecanismos patogénicos y complicaciones vasculares compartidos.

Geometria da valva mitral derivada da ressonância magnética cardiovascular na avaliação da gravidade da regurgitação mitral / Cardiovascular magnetic resonance imaging-derived mitral valve geometry in determining mitral regurgitation severity

FUNDAMENTO: A regurgitação mitral é a doença valvar cardíaca mais comum em todo o mundo. A ressonância magnética pode ser uma ferramenta útil para analisar os parâmetros da valva mitral. OBJETIVO: diferenciar padrões geométricos da valva mitral em pacientes com diferentes gravidades por regurgitação mitral (RM) com base na ressonância magnética cardiovascular. MÉTODOS: Sessenta e três pacientes foram submetidos à ressonância magnética cardiovascular. Os parâmetros da valva mitral analisados foram: área (mm2) e ângulo (graus) de tenting, altura do ventrículo (mm), altura do tenting (mm), folheto anterior, comprimento posterior do folheto (leaflet) e diâmetro do anulo (mm). Os pacientes foram divididos em dois grupos, um incluindo pacientes que necessitaram de cirurgia da valva mitral e o outro os que não. RESULTADOS: Trinta e seis pacientes apresentaram de RM discreta a leve (1-2+) e 27 RM de moderada a grave (3-4+). Dez (15,9%) dos 63 pacientes foram submetidos à cirurgia. Pacientes com RM mais grave tiveram maior diâmetro sistólico final do ventrículo esquerdo (38,6 ± 10,2 vs. 45,4 ± 16,8, p < 0,05) e diâmetro diastólico final esquerdo (52,9 ± 6,8 vs. 60,1 ± 12,3, p = 0,005). Na análise multivariada, a área de tenting foi a determinante mais forte de gravidade de RM (r = 0,62, p = 0,035). Comprimento do anulo (36,1 ± 4,7 vs. 41 ± 6,7, p< 0,001), área de tenting (190,7 ± 149,7 vs. 130 ± 71,3, p= 0,048) e comprimento do folheto posterior (15,1 ± 4,1 vs. 12,2 ± 3,5, p= 0,023) foram maiores em pacientes que precisaram de cirurgia da valva mitral. CONCLUSÕES: Área de tenting, anulo e comprimento do folheto posterior são possíveis determinantes da gravidade da RM. Estes parâmetros geométricos podem ser usados para individualizar a gravidade e, provavelmente, no futuro, orientar o tratamento do paciente com base na anatomia individual do aparelho mitral.

BACKGROUND: Mitral regurgitation is the most common valvular heart disease worldwide. Magnetic resonance may be a useful tool to analyze mitral valve parameters. OBJECTIVE: To distinguish mitral valve geometric patterns in patients with different severities of mitral regurgitation (MR) based on cardiovascular magnetic resonance imaging. METHODS: Sixty-three patients underwent cardiovascular magnetic resonance imaging. Mitral valve parameters analyzed were: tenting area (mm2) and angle (degrees), ventricle height (mm), tenting height (mm), anterior leaflet, posterior leaflet length and annulus diameter (mm). Patients were divided into two groups, one including patients who required mitral valve surgery and another which did not. RESULTS: Thirty-six patients had trace to mild (1-2+) MR and 27 had moderate to severe MR (3-4+). Ten (15.9%) out of 63 patients underwent surgery. Patients with more severe MR had a larger left ventricle end systolic diameter (38.6 ± 10.2 vs 45.4 ± 16.8, p<0.05) and left end diastolic diameter (52.9 ± 6.8 vs 60.1 ± 12.3, p= 0.005). On multivariate analysis, the tenting area was the strongest determinant of MR severity (r= 0.62, p=0.035). Annulus length (36.1 ± 4.7 vs 41 ± 6.7, p< 0.001), tenting area (190.7 ± 149.7 vs 130 ± 71.3, p= 0.048) and posterior leaflet length (15.1 ± 4.1 vs 12.2 ± 3.5, p= 0.023) were larger on patients requiring mitral valve surgery. CONCLUSIONS: Tenting area, annulus and posterior leaflet length are possible determinants of MR severity. These geometric parameters could be used to determine severity and could, in the future, direct specific patient care based on individual mitral apparatus anatomy.

Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgery / Estudo randomizado clínico e ultramicroscópico na cirurgia valvar mitral com o coração com atividade elétrica versus sem atividade elétrica

INTRODUCTION: Beating heart surgery on normothermic bypass simulates physiologic cardiac status. OBJECTIVES: This study compared clinical and transmission electron microscopic aspects of myocardial protection during mitral valve replacement using warm retrograde perfusion in empty beating versus arrested heart with cold blood anterograde cardioplegia. METHODS: Randomized study to evaluate myocardial cellular ischemia-reperfusion of both techniques to replace the mitral valve. Thirty-four patients were randomly assigned into group A (beating heart) and group B (arrested heart). The following parameters were assessed: echocardiography, blood chemistry, hemoglobin, lactate. During the surgical procedure a total of 102 myocardial biopsies were performed for ultrastructural analysis from anterior left ventricular wall: before cardiopulmonary bypass, before aortic desclamping and 10 minutes after reperfusion. RESULTS: Elevation of lactate at 3 hours during the procedure was higher in group A, but similar at the end of surgery (P=0.06). Cardioversion was necessary in 5/17 (A) vs. 13/17 (B) P=0.07. Median intraoperative systemic temperature was significantly lower in the group B compared to A (32oC vs. 36oC), P<0.001. There was no significant difference of the ultramicroscopic aspects of the heart biopsies before, during and after surgery in both groups. Cellular and mitochondrial transient abnormalities such as mitochondrial swelling, glycogen loss and cytosol swelling were detected independently of the moment of the biopsies. CONCLUSION: Myocardial protection and ultrastructural abnormalities were similar for both types of mitral valve replacement beating or arrested heart techniques.

INTRODUÇÃO: A cirurgia valvar mitral pode ser realizada com o coração com atividade elétrica, vazio e normotérmico com pinçamento aórtico, perfusão sanguínea no seio coronário, simulando um estado fisiológico. OBJETIVOS: Comparar as manifestações clínicas e ultramicroscópicas do miocárdio, na cirurgia valvar mitral, com o coração com atividade elétrica versus sem atividade elétrica. MÉTODOS: Estudo randomizado constituído de 34 pacientes: grupo A (batendo) e grupo B (parado). Os parâmetros foram: hematológico, bioquímico, ecocardiográfico, lactato. Foram realizadas 102 biopsias da parede anterior do ventrículo esquerdo preparadas para análise ultraestrutural: antes da circulação extracorpórea, antes do despinçamento aórtico e 10 minutos após a interrupção da circulação extracorpórea. RESULTADOS: Verificou-se elevação do lactato 3 horas após o início do procedimento, que foi maior no grupo A (P=0,06), todavia semelhantes no final da cirurgia. A cardioversão foi necessária em (A) 5/17 vs. (B) 13/17, P=0,07. A temperatura intraoperatória média foi significativamente menor no grupo B em relação ao grupo A (32oC vs. 36oC), P<0,001. A análise ultramicroscópica das amostras das biopsias do coração antes da circulação extracorpórea, ao término do pinçamento aórtico e após a saída da circulação extracorpórea, revelou anormalidades transitórias semelhantes no citoplasma, núcleos e mitocôndrias em ambos os grupos, independentemente do momento das biopsias. CONCLUSÃO: A proteção miocárdica na cirurgia valvar mitral apresentou aspectos semelhantes na preservação da integridade ultraestrutural dos cardiomiócitos quando realizada com o coração com ou sem atividade elétrica.

Impressive echocardiographic images of a rare pathology: aneurysm of the mitral valve - report of two cases and review of the literature

Aneurysm of the mitral valve [AMV] is rarely reported. The etiology of this unusual pathology is commonly attributed to aortic valve endocarditis [AVE] with aortic regurgitation [AR] or connective tissue disease. We present two recent cases of AMV with good correlation between pre-operative trans-esophageal echocardiography [TEE], intra-operative real-time 3-dimensional echocardiography [RT-3D-Echo] and surgical findings. The importance of diligent surveillance by TEE in patients with AVE for occurrence of AMV is emphasized. The literature on this topic is briefly reviewed

Dominância coronariana na síndrome da hipoplasia do coração esquerdo / Coronary dominance patterns in hypoplastic left heart syndrome

INTRODUÇÃO: Apesar de a síndrome do coração esquerdo hipoplásico (SCEH) ser extensamente estudada, esta doença ainda apresenta mortalidade elevada se comparada a outras doenças tratadas como fisiologia univentricular. Assim, diferenças morfológicas entre fenótipos dentro do espectro da SCEH podem ser fatores de risco e sua identificação pode auxiliar na escolha terapêutica entre os subgrupos anatômicos. OBJETIVOS: Determinar a forma mais frequente de dominância coronariana em corações com SCEH nos subgrupos com atresia (AM) e estenose mitral (EM). MÉTODOS: Análise da anatomia coronariana de acordo com a distribuição dos ramos epicárdicos e o padrão de dominância, classificadas em direita, esquerda ou balanceada. O grupo controle foi composto por nove peças de corações morfologicamente normais. O grupo SCEH constituiu-se de nove peças com AM e 24 peças com EM. Para análise estatística foi utilizado o teste do qui-quadrado. RESULTADOS: Houve diferença significativa entre os dois grupos em relação à dominância coronariana (x²= 9,298; P=0,01). A dominância esquerda esteve presente em 75 por cento dos casos de EM, e a balanceada só foi observada na EM. No grupo controle, observou-se dominância direita em todos os casos (P<0,01). CONCLUSÕES: A dominância esquerda é mais frequente na SCEH que no grupo controle de corações normais e, na SCEH, a dominância coronariana esquerda é mais frequente no subgrupo com EM.

INTRODUCTION: Although hypoplastic left heart syndrome (HLHS) be extensively studied, this disease still has a high mortality rate compared to other diseases treated as univentricular physiology. In this way, morphological differences between phenotypes within the spectrum of HLHS may be risk factors and their identification can assist in choosing treatment between subgroups. OBJECTIVE: To identify the most prevalent form of coronary artery dominance in hearts with HLHS groups with mitral atresia (MA) and mitral stenosis (MS). METHODS: Analysis of coronary anatomy according to the distribution of epicardial branches and the pattern of dominance, classified as right, left or balanced. The control group was composed of nine pieces of morphologically normal hearts, the HLHS group consisted of 9 pieces with MA and 24 pieces with MS. For statistical analysis we used the x² test. RESULTS: There were significant differences between the two groups in relation to coronary artery dominance (x² = 9.298, P = 0.01). Left dominance was present in 75 percent of cases of MS, and balanced one was only observed in pieces with MS. The control group had right dominance in all cases (P <0.01). CONCLUSIONS:Left dominance is more common in HLHS than in the control group of normal hearts and in HLHS. The left coronary dominance is more frequent in the subgroup with mitral stenosis.