Chagas disease in Virgem da Lapa, Minas Gerais, Brazil: left ventricle aneurysm and the risk of death in the 24-year interval

BACKGROUND Left ventricular aneurysm (LVA) is indicator of high morbidity in Chagas' disease. A cross-sectional study performed identified LVA in 18.8% of the chronic chagasic patients (CCP). OBJECTIVE Determine the risk of death of patients with chronic chagasic cardiopathy (CCC) and LVA in 24-year interval. MATERIAL AND METHODS In 1995 a cohort of 298 CCP was evaluated by anamnesis, physical examination, EKG and ECHO and classified in groups: G0 = 86 without cardiopathy; G1 = 156 with cardiopathy without LVA and G2 = 56 with cardiopathy and LVA. 38 patients of G0 and G1 used benznidazole. Information about the deaths was obtained in the notary, death certificates, hospital records and family members. FINDINGS Were registered 113 deaths (37.9%): 107 (35.9%) attributed to cardiopathy and 6 (2.0%) to other causes (p < 0.05). Amongst these 107 deaths, 10 (11.6%) occurred in G0; 49 (31.4%) occurred in G1 and 48 (85.7%) occurred in G2 (p < 0.05). The risk of death was 2.7 and 7.4 times significantly higher in G2, than in G1 and G0, respectively. CONCLUSION Chronic chagasic patients with LVA and ejection fraction < 45% have a higher risk of death than those without.

Ruptura miocárdica y formación de aneurisma después de un infarto agudo de miocardio silente: reporte de un caso / Myocardial rupture and aneurysm after an acute, silent myocardial infarction: a case report

Los aneurismas ventriculares y la ruptura del septum interventricular son complicaciones del infarto agudo del miocardio que pueden acompañarse de alta morbimortalidad. Se reporta el caso de un paciente con formación y ruptura de un aneurisma verdadero de la pared inferior y del septum interventricular inferior después de un infarto agudo de miocardio silente. Se discuten las características clínicas, diagnóstico y manejo de estas complicaciones potencialmente letales.

Ventricular aneurysms and interventricular septal rupture are complications of acute myocardial infarction and thesecomplications may have a high morbidity and mortality. We report the case of a patient with an aneurysm involving theinferior myocardium and the inferior interventricular septum following an acute silent myocardial infarction. The clinicalcharacteristics, diagnosis and management of these potentially lethal complications are discussed.

Divertículo congénito del ventrículo izquierdo en el niño: una experiencia africana / Congenital diverticulum of the left ventricle in children: an African experience

Se describe el caso de un escolar africano, de 7 años de edad, con un divertículo congénito del ventrículo izquierdo que fue exitosamente tratado mediante cirugía. Esta es una afección infrecuente, mal interpretada y potencialmente letal. Se ha descrito una amplia variedad de manifestaciones clínicas, y el diagnóstico se basa en el examen físico, los resultados radiográficos y electrocardiográficos. Estos últimos son indispensables, pues con el Doppler en color se puede observar el cortocircuito (shunt) desde el ventrículo hasta la cámara diverticular, alternativamente en sístole y diástole. La angiocardiografía, la tomografía axial y sobre todo la resonancia magnética son, sin duda, elementos que contribuyen a corroborar el diagnóstico. Diferentes técnicas quirúrgicas se han empleado con éxito en la reparación de este defecto

Authors describe the case of an African schoolboy aged 7, with a congenital diverticulum of left ventricle successfully treated by surgery. This is a uncommon affection, misinterpreted and potentially lethal. Many clinical manifestations have been described and the diagnosis is based on the physical examination, radiographic and electrocardiographic results. These latter are essential since with the use of color-Doppler it is possible to note the shunt from the ventricle up to the diverticulum camera in systole and in diastole. The angiocardiography, axial tomography (AT) and mainly the magnetic resonance (MR) are undoubtedly, elements contributing to corroborate the diagnosis. Different surgical techniques have been successfully used in repair of this defect

Combined coronary artery bypass grafting and other heart surgical procedures——Clinical Analysis of Consecutive 134 cases / 介入放射学杂志

Objective To retrospectively review clinical results of combined coronary artery bypass grafting (CABG) and other heart surgical procedures.Methods Combined CABG and other heart surgical procedures have been done in 134 consecutive cases (male 114, female 20), aged from 48 to 76 years with a mean of 61.7. Coronary angiograph showed that all patients have coronary stenosis with left main involved in 20 cases, and 41 cases have diffused coronary artery disease. 56 patients have post myocardial infarction left ventrical aneurysms, and 42 patients have valve dysfunction which need surgical correction. Left ventricular ejection fraction (EF) were equal to or lower than 45% in 63 patients and in 13 patients EF is less than 30%. All the patients received combined CABG under the support of cardiopulmonary bypass (CPB) and other heart surgical procedures (Transmyocardial laser revascularization in 36, valve procedures in 42, and left ventricle aneurysm resection or plasty in 56 patients simultaneously). Results The mean number of grafts was 2.46 per patient. Intra-aortic balloon pump was required in 6 cases for 11 to 54 hours Postoperative. 3 patients died postoperatively with mortality rate 2.2% (two from low cardiac output syndrome, and one from multiple organs failure). 131 patients recovered and discharged.Conclusion Combined CABG and other heart surgical procedures in more demanding than CABG along but can be done with acceptable morbidity and mortality if good surgical plan can be designed and all the heart abnormalities can be corrected simultaneously.

Técnica de Cooley modificada para a correçäo cirúrgica de aneurismas do ventrículo esquerdo / Modified Cooley technique for surgical repair of left ventricular aneurysms

Avaliar os resultados cirúrgicos imediatos da técnica de endoaneurismorrafia ventricular de Cooley modificada. Oito pacientes, sete homens, com idades de 38 a 67 (m = 51,2 ñ 11,4) anos, portadores de aneurisma do ventrículo esquerdo pós-infarto agudo do miocárdio, submetidos à correçäo do aneurisma pela técnica de endoaneurismorrafia ventricular de Cooley modificada. Todos os pacientes receberam alta hospitalar assintomáticos em período médio de 9,0 ñ 2,3 dias após a cirurgia, näo tendo ocorrido complicaçöes pós-operatórias. O índice cardíaco médio aumentou de 2,1 ñ 0,5 para 3,3 ñ 1,1l/min (p < 0,05), perfazendo aumento médio de 52,8%. Nenhum paciente necessitou de suporte circulatório mecânico e o suporte farmacológico pôde ser interrompido em todos os casos no pós-operatório imediato. A técnica de endoaneurismorrafia ventricular de Cooley modificada tem ostrado resultados iniciais animadores, buscando preservar a anatomia do ventrículo esquerdo o mais próximo do normal