[Radiological findings in endomyocardial fibrosis]. / Aspectos radiológicos da endomiocardiofibrose.

PURPOSE: To determine through conventional radiology the type of ventricular involvement in endomyocardial fibrosis (EMF). METHODS: We analyzed 56 cases with EMF confirmed by angiocardiography and 9 by postmortem study, aged between 16 and 56 years (mean 32); there were 42 females. Only one radiologist analyzed X-rays without any knowledge of the cineangiography findings. RESULTS: The right side of the heart was primarily involved in 9 patients and the cardiac silhouette was characteristically globular and had oligemic pulmonary fields (66.66%). The cardiothoracic ratio was 0.62 +/- 0.11. Out of 9 patients, 8 were female. The left side of the heart was established as being primarily involved in 11 cases and simulated rheumatic mitral disease. The cardiothoracic ratio was 0.51 +/- 0.09 and there were increased pulmonary fields in 63.6%. The biventricular disease occurred in 36 cases. There were radiologic findings of right and left side. The cardiothoracic ratio was 0.63 +/- 0.06 and there was oligemic pulmonary fields in 38.8%, increased pulmonary fields in 33.3% and was normal in 27.7%. There were 4:1 females. CONCLUSION: The radiological study is fundamental in the initial diagnosis of EMF. The type of involvement could be done in 66.07% of all cases by chest X-ray.

[Acute aortic dissections. Hospital outcome of 186 cases]. / Dissecções agudas da aorta. Evolução hospitalar de 186 casos.

PURPOSE: To determine in hospital outcome acute aortic dissection patients. METHODS: We revised 186 consecutive cases (up to 14 days of dissection), in a period of 6 years. The patients were divided according to Daily's classification (types A and B). RESULTS: Type A--127 cases: a) 75 were surgically treated (37 died); b) 2 were medically treated (both died); c) 39 died before the definitive treatment could be initiated; d) 11 died misdiagnosed or undiagnosed. The total mortality was 70.0%. Type B--59 cases: a) 11 complicated cases were surgically treated (6 died); b) 40 were medically treated (8 died); c) 7 died before the definitive treatment could be initiated; d) one died misdiagnosed. The total mortality was 37.25%. In summary, 41.4% of the patients survived. 28.4% died despite the definitive treatment, 24.7% died before the definitive treatment could be initiated and 6.4% died without the correct diagnosis. CONCLUSION: The acute aortic dissection is a dramatic situation, mainly type A. In this type of dissection many patients (41%) died misdiagnosed, undiagnosed or without enough time to surgical therapy. So, an earlier diagnosis and treatment are imperative.

[Cardiac thrombosis and embolism in patients having died of chronic Chagas cardiopathy]. / Trombose cardíaca e embolia em pacientes falecidos de cardiopatia chagásica crônica.

The authors studied the files of 111 patients (mean age 47.5 years) with chronic Chagas' disease and severe heart failure who had died between 1978 and 1984; they were 72 men and 39 women. Eighty-one patients (73%) had cardiac thrombosis, 65 times (53%) in right chambers and 56 times (46%) in left ones. Sixty-seven patients (60%) had thromboembolic episodes, 41 (65%) to the lungs, 23 (38%) to other organs (target organs: the kidneys in 21 cases, spleen in four, brain in two, abdominal aorta in one, mesenteric artery in one and iliac artery in one). Right chamber thrombosis occurred 65 times, 35 (53%) with pulmonary thromboembolism. Left chamber thrombosis occurred 56 times, 24 (42%) with systemic thromboembolism. A total of 41 patients had pulmonary thromboembolism, only six (14%) without right chamber thrombosis; of 26 patients with systemic thromboembolism, only two (7%) did not have left chamber thrombosis. The authors concluded that the incidence of thrombosis and thromboembolism was high in the group studied, and that there was a relationship between chamber thrombosis and systemic or pulmonary thromboembolism.