Eritrocitoferese pré-operatória em portador de hemoglobinopatia sc e estenose mitral / Preoperative Eritrocytopheresis in a Patient with Hemoglobinopathy SC and Mitral Stenosis

Hemoglobinopathies are associated with thrombotic complications, when exposed to cardiopulmonary bypass. A 54-year old, black woman with hemoglobinopathy SC and severe mitral stenosis was submitted to eritrocytopheresis 48 hours before mitral commissurotomy surgery. The therapeutic determined appearance of the percentual hemoglobin A of 68 with reduction the hemoglobin S of 48 to 15 and the hemoglobin C of 51 to 17. No complications occurred during postoperative period. To best of our knowledge, that is the first report about application the eritrocytopheresis in the pre operative extra corporeal circulation care in surgical treatment of patients with chronic rheumatic heart disease and hemoglobinopathy SC.

Relação entre função ventricular esquerda e desencadeamento de sintomas na insuficiência aórtica crônica severa / The relationship between left ventricular function and the precipitation of symptoms in severe chronic aortic insufficiency

PURPOSE--To study the relationship between symptoms and left ventricular function in 68 patients with severe chronic aortic regurgitation using echocardiogram and radionuclide left ventriculography at rest. METHODS--Three stages of natural history are assumed: the 1st, at the beginning of the study, when all patients were asymptomatic (clinical stage 0); the 2nd, at the end of 36 month persistence of asymptomatic (clinical stage 1), consisting of 45 patients (group AA); the 3rd, on occasion of manifestation of the symptoms during this period of time (clinical stage 2), consisting of 21 patients (group AS-PRE), with two fatalities not related to valvopathy. RESULTS--The comparison between the groups resulted in similarities in the mean ages, mean time of knowledge of the disease, predominance of males and rheumatic etiology. The profile analysis showed that the significant initial differences between the average of all echocardiographic variables (diastolic diameter, systolic diameter, shortening fraction, final systolic stress, volume-mass ratio, contractility index) and of the ejection fraction of the left ventricle obtained by the radionuclide ventriculography at rest, remained during the study. CONCLUSION--Development of symptoms grouped patients with more advanced excentric hypertrophy, did not coincide with any immediate change in the laboratory markers studied at rest and it was used as a referential for surgical therapy.

Evoluçäo do ciclo gravídico-puerperal em portadoras de estenose mitral / Course of pregnancy and puerperium in women with mitral valve stenosis

Objetivo. Estudar a evoluçäo do ciclo gravídico-pleural (CGP) e das características dos recém-nascidos, em portadoras de estenose mitral, que iniciaram a gravidez assintomáticas ou oligossintomáticas. Métodos. Sessenta e duas gestantes divididas em grupo GE 30 portadoras de estenose mitral GN - 32 sem cardiopatia. Resultados. No grupo GE, 16(53,3//) pacientes evoluíram para classe funcional (CF) III e 10(33//) para CF IV no decorrer da gestäo. No grupo GN, 18(56,2//) evoluíram para CF II. No grupo GE o parto foi vaginal em 70,0// e aplicado o bloqueio regional em 56,6// dos casos, sem diferença significativa (P > 0,1) entre os grupos. Prematuridade (20,0//) e recêm-nascidos pequenos para a idade gestacional (PIG) (36,7//) foram significativamente (p < 0,001) mais freqüentes no grupo GE. Näo houve mortalidade materno-fetal. Conclusäo. A maioria (86,7//) das gestantes do grupo GE evoluiu para CF III/CGP. Repouso, farmacoterapia e, em um caso, a valvoplastia por cateter-baläo contribuíram para que todas as pacients alcançassem a viabilidade fetal. Entretanto, freqüência expressiva de recém-nascidos prematuros (20,0// e PIG (36,7//) foi registrada