Modificações eletrovetorcardiográficas após ablaçäo septal percutânea na cardiomiopatia hipertrófica obstrutiva e possíveis causas anatômicas / Vector electrocardiographic alterations after percutaneous septal ablation in obstructive hypertrophic cardiomyopathy. Possible anatomic causes

OBJECTIVE - Analyze the dromotropic disturbances (vector-electrocardiographic), and the possible anatomic causes, provoked by selective alcohol injection in the septal branch, for percutaneous treatment, of obstructive hypertrophic cardiomyopathy. METHODS - Ten patients with a mean age of 52.7 years underwent percutaneous septal ablation (PTSA) from october 1998; all in functional class III/IV). Twelve-lead electrocardiogram was performed prior to and during PTSA, and later electrocardiogram and vectorcardiogram according to Frank's method. The patients were followed up for 32 months. RESULTS - On electrocardiogram (ECG) prior to PTSA all patients had sinus rhythm and left atrial enlargement, 8 left ventricular hypertrophy of systolic pattern. On ECG immediately after PTSA, 8 had complete right bundle-branch block; 1 transient total atrioventricular block; 1 alternating transient bundle-branch block either right or hemiblock. On late ECG 8 had complete right bundle-branch block confirmed by vectorcardiogram, type 1 or Grishman. CONCLUSION - Septal fibrosis following alcohol injection caused a predominance of complete right bundle-branch block, different from surgery of myotomy/myectomy

Endocardite infecciosa: estudo Doppler-ecocardiografico prospectivo / Infective endocarditis. Prospective Doppler-echocardiographic study

Estudo de aspectos Doppler-ecocardiográficos em portadores de endocardite infecciosa (EI) e sua correlaçäo com prognóstico e evoluçäo. Cento e oito pacientes com suspeita de EI a fim de determinar se a presença de vegetaçäo (veg), tamanho, moblidade e local e acometimento identificam, por si só, grupos de alto risco. O diagnóstico se fez presente em 93,9% dos pacientes com EI do lado direito do coraçäo e em 77,3% daqueles com EI do lado esquerdo. Pacientes com (84,2%) e sem (15,8%) veg näo apresentaram diferença significativa na incidência de complicaçöes (embolias, ICC e óbito), o mesmo acontecendo em relaçäo ao tamanho. Pacientes com veg aórtica (Ao) apresentaram maior incidência de ICC (Ao 53,8 x Mitral (MI) 31,0% x Tricúspide (Tric0 3,7%), necessidade de cirurgia (Ao 69,2%) x Mi 34,5% x Tric 3,7%) e óbito (Ao 30,7% x Mi 13,7% x Tric 7,4%). Fenômenos embólicos foram observados em 81,4% dos pacientes com veg em Tric. Oito pacientes apresentaram EI em prótese Ao, com tratamento cirúrgico em 5 (62,5%) e óbito em 2 (25%) enquanto dentre os 12 com EI em prótese Mi, 7 (58,3%) necessitaram de cirurgia e 3 (25%) foram a óbito. Derrame pericárdico foi constatado em 51 pacientes (47,2%), ruptura de cordoalha em 14 (12,9%) e abcesso para-valvar em 6 (5,5%), os portadores deste encaminhados á cirurgia. A Doppler-ecocardiografia constitui-se método de excelência na confirmaçäo diagnóstica da EI e os aspectos por ela determinados relacionam-se, por vezes, com o prognóstico e a evoluçäo

Purpose: To study of the Doppler-echocardiographic aspects in patients with IE and its correlation with the prognosis and evolution. Patients and Methods: One hundred and eight patients with clinical of IE were prospectively studied by Doppler-echocardiography (D-E) in order to determine whether the simple presence of vegetation, its size, mobility and place of attachment could identify high risk groups. Vegetations were classified according to its size (longest axis) into small (veg < 5 mm), medium (5 mm < veg < 10 mm) and large (veg < 10 mm); according to its kind into sessible or mobile and according to its appearance into cotton like or calcifzed. Results:Patients with (84.2%) and without (15.8%) vegetations didn’t show any significant difference in the complications incidence (emboli, heart failure or death) and the same happened with its size. However, patients with aortic positioned vegetations showed ligher incidence of HF (Aortic 53.8 x Mitral 31.0% x Tricuspid 3.7%) need for surgery (Aortic 69.2% x Mitral 34.5% x Tricuspid 3.7%) and death (Aortic 30.7% x Mitral 13.7% x Tricuspid 7.4%). Emboli were observed in 81.4% of the patients with tricuspid valve vegetations. Eight patients showed IE on aortic prothesis. Five of them needed surgical treatment and 2 of them died. Among 12 patients with IE on mitral prothesis, 7 needed surgery and 3 died. Pericardial effusion were verified in 51 patients (47.2%), chordal rupture in 14 (12.8%) and valve abcess in 6 (5.5%). All patients with valve abcess were submitted to surgery. Conclusion: Doppler-echocardiography is an excellent method in the diagnosis of IE and its aspects may have, sometimes, a positive correlation with the prognosis and patient’s evolution.