Central American and Caribbean Consensus Document for the Optimal Management of Oral Anticoagulation in Patients with Non-Valvular Atrial Fibrillation Endorsed by the Central American and Caribbean Society of Arterial Hypertension and Cardiovascular Prevention.

Atrial fibrillation (AF) is the most common arrhythmia in adults. Prevention of the ischaemic risk with oral anticoagulants (OACs) is widely recommended, and current clinical guidelines recommend direct oral anticoagulants (DOACs) as preference therapy for stroke prevention. However, there are currently no clinical practice guidelines or recommendation documents on the optimal management of OACs in patients with AF that specifically address and adapt to the Central American and Caribbean context. The aim of this Delphi-like study is to respond to doubts that may arise in the management of OACs in patients with non-valvular AF in this geographical area. A consensus project was performed on the basis of a systematic review of the literature, a recommended ADOLOPMENT-like approach, and the application of a two-round Delphi survey. In the first round, 31 recommendations were evaluated and 30 reached consensus, of which, 10 unanimously agreed. The study assessed expert opinions in a wide variety of contextualized recommendations for the optimal management of DOACs in patients with non-valvular atrial fibrillation (NVAF). There is a broad consensus on the clinical practice guideline (CPG) statements used related to anticoagulation indication, patient follow-up, anticoagulation therapy complications, COVID-19 management and prevention, and cardiac interventions.

Cirurgia livre de retalho com função imediata associada ao planejamento computadorizado: relato de caso clínico / Flapless surgery with immediate loading associated to computerized planning: a case report

A cirurgia livre de retalho associada a um planejamento computadorizado proporciona grande precisão no tratamento, permitindo a confecção de próteses para serem instaladas no momento da cirurgia. As suas principais vantagens incluem menor sangramento, maior conforto, menor edema e recuperação mais acelerada no pós-operatório. Este artigo tem o objetivo de discutir, através de um caso clínico, os passos para a elaboração deste tipo de reabilitação.

The flapless surgery associated to computerized planning provides great precision in the treatment, allowing the confection of the prosthesis to be installed in the moment of the surgery. It's main advantages includes minor bleed, greater comfort, smaller swelling and sped up recovery in the postoperative. The aim of this article is to discuss, through a clinical case, the steps related to the confection of this rehabilitation.

Myocardial contrast echocardiography in assessing microcirculation in baboons with chagas disease.

OBJECTIVE: Microvascular abnormalities have been postulated in the pathogenesis of chagasic cardiomyopathy. The objective of this study was to evaluate the relationship between coronary microcirculation and systolic function impairment in baboons with Chagas disease using myocardial contrast echocardiography (MCE). METHODS: Seventeen seropositive (5 males, 12 females; mean age 20 years) and 13 age- and gender-matched seronegative baboons underwent MCE using intravenous octafluoropropane human albumin microspheres. Color-coding was used to enhance tissue contrast in assessing regional myocardium uniformity and texture. Dipyridamole (0.54 mg/kg) was given to a subset of 4 animals to challenge coronary flow reserve. Systolic indices included left ventricular fractional shortening, velocity of circumferential fiber shortening, and left and right ventricular ejection fractions. RESULTS: Four of the 17 (24%) seropositive primates had decreased fractional shortening (25 +/- 8% vs. 40 +/-5%, p <.005), velocity of circumferential fiber shortening (1.05 +/- 0.36 circ/s vs. 1.84 +/- 0.23 circ/s, p <.0001), and reduced right ventricular ejection fraction (44 +/- 9% vs. 54 +/- 4%, p <.05) compared to other seropositive animals. Seropositive and seronegative groups showed no significant differences on the coronary microcirculation pattern as evaluated by MCE, including the 4 baboons with systolic function impairment. Moreover, coronary flow vasoreactivity resulted in a significant increase in myocardial flow as detected by color-coding masking. CONCLUSIONS: Chagasic heart disease is present in 24% of seropositive baboons spontaneously infected with Trypanosoma cruzi. MCE reveals a discrepancy between coronary microcirculation at rest and alterations in myocardial contractility, suggesting preservation of the microvascular integrity in this unique animal model.

Electrocardiographic findings in naturally acquired chagasic heart disease in nonhuman primates.

The significance of electrocardiographic (ECG) changes described in animals with Chagas' disease is questionable in view that other non-invasive comparisons have been lacking. 12-lead ECG and two-dimensional echocardiography (echo) was performed in 17 seropositive and 13 seronegative baboons. Similar to humans, a wide variety of ECG outcomes were observed in the infected animals. Standard ECG measurements were not different between groups. Five seropositive (29%) and 3 seronegative (23%) animals had low voltage; 4 seropositives (24%) and 2 (15%) seronegatives had tall P-waves. Precordial Q waves were seen in 10 seropositives (59%) and in 7 (54%) seronegatives without septal abnormalities on two-dimensional echo. One seropositive animal had a 2(nd) degree (Wenckebach) AV block and left anterior fascicular block. Most animals in both groups had diffuse T-wave abnormalities. Echo evidence of systolic dysfunction was found in 4 seropositives and in none of the controls; thus, chagasic heart disease was present in 24% of naturally infected baboons. Since most non-human primates, irrespective of their serology, have diffuse, nonspecific ECG changes not necessarily diagnostic of myocardial disease, two-dimensional echo should be added to their non-invasive assessment.

Morphologic and functional characterization of Chagasic heart disease in non-human primates.

Chagasic heart disease has been documented in non-human primates, but noninvasive characterization of systolic and diastolic function has not been previously reported. Seventeen seropositive (12 females; mean age, 20) and 13 age- and gender-matched seronegative baboons underwent Doppler echocardiography. Systolic function indices included left ventricular (LV) fractional shortening (FS %), velocity of circumferential fiber shortening (VCF, circ/sec), LV mass index, and left and right ventricular ejection fractions (RVEF %). Diastolic function indices included transmitral E-wave, A-wave, E/A ratio, E-deceleration time, and isovolumic relaxation time. Twelve-lead electrocardiographic (ECG) recordings were obtained. There were no significant differences between groups for body size or blood pressure. Seropositive and seronegative groups revealed diffuse non-specific T wave changes precluding differentiation; however, tall "P" waves were seen in four seropositive and two seronegative baboons. Four of the 17 (24%) seropositive baboons had decreased FS (25 +/- 8% versus 40 +/- 5%, P < 0.005) and VCF (1.05 +/- 0.36 circ/sec versus 1.84 +/- 0.23 circ/sec, P < 0.0001), prolonged isovolumic relaxation time (71 +/- 16 msec versus 55 +/- 9 msec, P < 0.02), and reduced RVEF (44 +/- 9% versus 54 +/- 4%, P < 0.05), as compared with the other seropositive baboons. We conclude that chagasic heart disease is present in 24% of the naturally infected baboons in this study. ECG evidence of right atrial enlargement was more common in the seropositive animals. There were systolic and diastolic abnormalities of both ventricles. The LV systolic dysfunction may be segmental or diffuse.