Persistência de via cava superior esquerda e implante de marca-passo bicameral: resumo / Persistence of left superior vena cava and bicameral pacemaker implantation

Resumo 57028: trabalho apresentado no 37º Congresso de Cardiologia da SOCERJ

Cardiac surgery in infective endocarditis and predictors of in-hospital mortality. / Cirurgia cardíaca na endocardite infeciosa e preditores da mortalidade intra­hospitalar.

INTRODUCTION: Infective endocarditis (IE) is a serious disease with significant in-hospital mortality (15-30%) despite advances in medical and surgical therapy. AIMS: To perform a clinical characterization of patients undergoing cardiac surgery for IE and to identify factors that predict in-hospital mortality. METHODS: We retrospectively analyzed 145 patients with IE admitted between January 2006 and October 2017. RESULTS: The median age was 72 years. IE was acquired mainly in the community (69%), and involved the native aortic valve in 54% of patients, biological prosthetic valves in 22.1% and mechanical valves in 10.3%. Staphylococcus spp. (31.0%) were the most frequent etiological agents. Cardiac surgery was emergent in 29 patients, urgent in 108, and elective in eight. The main indications were heart failure (57.9%), large vegetations (20%), systemic embolism (17.2%) and valve dysfunction (15.2%). Overall, biological valves were implanted in 62.1% of patients and mechanical valves in 37.2%. A total of 19 patients (13.1%) died. Predictors of mortality were preoperative atrial fibrillation and lower left ventricular ejection fraction, postoperative severe valve regurgitation associated with cardiogenic shock, sepsis, septic shock associated with cardiogenic shock, cardiac tamponade, need for renal replacement therapy and, although without statistical significance, emergent surgery. CONCLUSIONS: There is a need for better indicators to enable early identification of surgical candidates for IE, implementation of a heart team, and better surgical strategies, including more rapid intervention, more specific postoperative care, and optimal antibiotic therapy.

Insuficiência tricúspide e fibrilação atrial associadas à contusio cordis: uma apresentação atípica / Tricuspid insufficiency and atrial fibrillation associated with contusio cordis: an atypical presentation

As lesões da valva tricúspide decorrentes de trauma torácico fechado são raras e frequentemente subdiagnosticadas. Relata-se o caso de paciente do sexo masculino de 42 anos de idade com sinais e sintomas de insuficiência cardíaca direita e fibrilação atrial (FA) persistente em anticoagulação oral com Varfarina. A história revelou trauma torácico há aproximadamente 11 anos, evoluiu com insuficiência tricúspide importante, disfunção biventricular e taquicardiomiopatia secundária à FA. Realizou-se efetivamente cirurgia cardíaca de troca valvar tricúspide com prótese biológica, sem intercorrências no pós-operatório imediato. O momento ideal para intervenção cirúrgica na insuficiência tricúspide traumática ainda é controverso e motivo de debate. A indicação tradicional de abordagem cirúrgica é a insuficiência cardíaca sintomática, e a realização precoce quando da identificação dos sintomas poderia prevenir remodelamento cardíaco adicional e preservar ou recuperar a função miocárdica...(AU)

Interrupted Aortic Arch in an Adult.

Interrupted aortic arch (IAA) is a rare congenital abnormality with only a few cases reported in adults. It is defined as complete loss of continuity between the ascending and descending portions of the aorta, and is usually associated with other cardiac defects. The diagnosis in adults should be suspected in the presence of refractory hypertension, a careful physical examination being crucial to early diagnosis. Magnetic resonance angiography (MRA) techniques can accurately characterize cardiovascular anatomy, and also provide information regarding heart chamber and valve function. LEARNING POINTS: Although rare, interrupted aortic arch (IAA) must be considered in the differential diagnosis of adults with refractory hypertension. A careful physical examination, with evaluation of femoral pulses and blood pressure in the four limbs, is essential for the diagnosis and for ensuring that the correct diagnosis is made promptly.This case highlights the value of magnetic resonance angiography (MRA) in radiation-free non-invasive evaluation of adults with congenital aortic abnormalities, as it may provide clinically important haemodynamic information.Only a few cases have been reported in adults. We present an unusual case in which the diagnosis was not made until adulthood.