Uso de rTPA e aspirina no tratamento de trombose intracardíaca em recém-nascido / Combined rTPA and aspirin therapy for intracardiac thrombosis in neonates

Descreve-se o caso de um recém-nascido prematuro de peso muito baixo, gemelar, com trombose intracardíaca. O recém-nascido apresentou quadro compatível com sepse neonatal, sendo submetido a suporte avançado de vida, terapia com antibióticos, nutrição parenteral, uso de hemoderivados e cateterismo venoso profundo. Evoluiu com suspeita de endocardite infecciosa, sendo realizada ecocardiografia bidimensional com Doppler, quando foi evidenciado volumoso trombo intracavitário. Pela alta letalidade e pela dificuldade técnica da cirurgia, que, em alguns casos, é contra-indicada, optou-se pelo uso do trombolítico ativador de plasminogênio tecidual recombinante humano (rTPA) associado a aspirina, obtendo-se dissolução total do trombo sem efeitos adversos.

We describe a case of a very low birth weight premature female twin with intracardiac thrombosis. Her condition was consistent with neonatal sepsis, and she was treated with advanced life support, antibiotic therapy, parenteral nutrition, blood transfusion, and central venous catheterization. Infective endocarditis was suspected, and a large intracavitary thrombus was detected by two-dimensional Doppler echocardiography. Surgical procedure was not only technically difficult but also highly lethal, being contraindicated in some cases. Consequently, the use of the thrombolytic recombinant tissue-plasminogen activator (rTPA) associated with aspirin was the treatment of choice, and complete dissolution of the thrombus was achieved without adverse effects.

Influência do sistema renina angiotensina na redução da hipertrofia de ventrículo esquerdo em indivíduos hiperreatores / Influence of the renin-angiotensin system in left ventricular hypertrophy reduction in subjects with blood pressure hyperreactivity

Para avaliar a influência do sistema neurohumoral na redução da hipertrofia de ventrículo esquerdo em indivíduos hiperreatores foram realizados tratamento com exercício físico e drogas que bloqueiam o sistema nervoso simpático ou sistema renina angiotensina em 195 indivíduos sedentários e sadios durante período de 12 meses. Após realização de teste de esforço e ecocardiograma verificou-se que as drogas que bloqueiam o sistema renina angiotensina foram mais eficazes na redução da hipertrofia desses indivíduos que o exercício físico e drogas que bloqueiam o sistema nervoso simpático sendo que essa redução foi independente da redução da pressão arterial no repouso e esforço máximo / In order to evaluate the influence of the neurohumoral system in the left ventricular hypertrophy reduction in subjects with blood pressure hyperreactivity, 195 healthy, sedentary subjects were randomized to undergo treatment with physical training, drugs that block the sympathetic nervous system or the renin-angiotensin system over a period of 12 months. After treadmill exercise test and echocardiographic measurements, we concluded that drugs that block the renin-angiotensin system were more effective in left ventricular hypertrophy regression in these subjects than physical training and drugs that block the sympathetic nervous system and this regression took place regardless of blood pressure reduction at rest or peak effort...

Reduçäo da hipertrofia ventricular esquerda em pacientes com hipertensäo arterial com uso de inalapril, losartan ou a associaçäo enalapril + losartan / Reduction in left ventricualr hypertrophy in hypertensive patients treated with enalapril, losartan or the combination of enapril and losartan

OBJECTIVE : To compare the regression of left ventricular hypertrophy in patients with moderate hypertension treated with enalapril, losartan or a combination of the two drugs at lower doses. METHODS : Patients of both sexes with moderate hypertension confirmed by ambulatory monitoring of arte-rial blood pressure and with left ventricular hypertrophy on echocardiogram were assigned to three groups: enalapril 35 mg/day, n=15), losartan (175 mg/day, n=1 effective in reducing blood pressure and left ventricular mass index (LVMI, g/m2): 141ñ3.9 to 123ñ3.6 in the enalapril group (p<0.05), from 147ñ3.8 to 133ñ2.8 in the losartan group (p<0.05), and from 146ñ3.0 to5) and enalapril+losartan (15 mg+100 mg/day, n=16). The patients received the drugs for 10 months. RESULTS : The three therapeutic regimens were equally 116ñ4.0 in the enalapril+losartan group (p<0.05). However, the percent reduction of LVMI was significantly greater (p<0.01) in the enalapril+losartan group (20.5ñ5.0 per cent) than in enalapril (12.4ñ3.2 per cent) and the losartan (9.1ñ2.1 per cent) groups. Normalization of LVMI was obtained in 10 out of the 16 patients who reinhibitor and an angiotensin II receptor antagonist (AT1 receptor antagonist) in patients produced an additional effect on the reduction of left ventricular hypertrophy. This finding may depend on a more complete inhibition of the cardiac renin-angiotensin. (Au)ceived enalapril+ losartan, in 6 out of the 15 patients who received only enalapril and in 4 out of the 15patients treated with losartan. CONCLUSION : The combination of an angiotensin-converting enzyme inhibitor and an angiotensin II receptor antagonist (AT1 receptor antagonist) in patients produced an additional effect on the reduction of left ventricular hypertrophy. This finding may depend on a more complete inhibition of the cardiac renin-angiotensin.