Intra-pericardial thrombin injection in iatrogenic cardiac tamponade: a case report.

BACKGROUND: Nowadays, percutaneous procedures are expanding in use, and this comes with complications associated with the procedure itself. Cardiac tamponade is rare but may be life threatening since it can involve hemodynamic instability. It is known that after pleural effusion during a percutaneous procedure, pericardiocentesis should be used as drainage of the cavity. However, that does not achieve hemostasis in some cases, and in those patients who are hemodynamically unstable, a sealing agent to promote hemostasis might be useful, like thrombin. CASE PRESENTATION: We present a case report of 89-year-old patient with history of melanoma undergoing treatment with pembrolizumab, who attended the emergency department referring chest pain (intensity 5/10) and palpitations that have lasted hours. He had TnTUs 554/566 ng/L and an echocardiogram that showed dilated right chambers, hypertrophy and global hypokinesia of the left ventricle, increased filling pressures of the left ventricle and pulmonary hypertension. Myocarditis associated with pembrolizumab was suspected, so high dose steroids were initiated and endomyocardial biopsy was conducted, resulting in iatrogenic cardiac tamponade. To determine the etiology of the suspected myocarditis, an endomyocardial biopsy was performed. Unfortunately, an intraprocedural complication arose: pleural effusion resulting in iatrogenic cardiac tamponade, leading to hemodynamic instability. It required immediate pericardial drainage via subxiphoid puncture, obtaining a 550 mL hematic debit. Clinical manifestations raised suspicion of tamponade, prompting a bedside echocardiogram for a definitive diagnosis. Despite these efforts, the patient remained hemodynamically unstable, and due to the elevated surgical risk, intrapericardial thrombin was employed to achieve successful hemostasis. CONCLUSIONS: Cardiac tamponade is a life-threatening condition that can sometimes be induced iatrogenically, resulting from percutaneous interventions. Despite limited evidence regarding this therapeutic strategy, in patients experiencing iatrogenic cardiac tamponade with hemodynamic instability and high surgical risk, the administration of intra-pericardial thrombin could be contemplated.

Acute Cellular Rejection in Heart Transplant Patients: Insights of Global Longitudinal Strain, Myocardial Work, and an Exclusive Group of Chagas Disease.

Background: Echocardiographic markers associated with asymptomatic acute cellular rejection (ACR) in patients with orthotopic heart transplant (HT) are still under investigation. The aim of our study was to determine clinical and myocardial strain imaging (MSI) variables evaluated by echocardiography associated with ACR in the first year of HT. A separate analysis was performed to compare variables during the first 6 months of HT, when ACR has a prevalence in 60% of patients. Another analysis evaluated an exclusive population with Chagas disease as the cause of HT. Methods: We prospectively studied 67 patients with less than 1 year of HT, 36 patients without ACR (41% men, age 49 ± 12 years, 52% Chagas disease as the cause of heart failure), and 31 patients with ACR (59% men, age 55 ± 8 years, 74% Chagas disease as the cause of heart failure). Conventional echocardiographic measurements and MSI by global longitudinal strain (GLS) from the left ventricle (LV) and right ventricle free wall (RV-FWLS) and myocardial work (MW) from the left ventricle were obtained by experienced echocardiologists. Clinical variables, such as the presence of diabetes, hypertension, and immunosuppressant drugs, were compared between groups. Results: HT patients with ACR were older and used more cyclosporine for immunosuppression. The positive ACR group had an increased relative wall thickness and LV mass index and similar LVGLS and RV-FWLS compared to the negative ACR group. Nevertheless, MW analysis observed increased global work efficiency (GWE) in positive ACR. Multivariate analysis identified older age, cyclosporine use, LV mass index, and GWE as independent predictors for detecting rejection. A separate analysis was performed for patients with less than 6 months of HT. Similar MSI was observed in both groups, with a trend for increased GWE in patients with ACR and significantly increased LV mass index in the ACR group. An exclusive group of Chagas patients as the primary cause of HT was analyzed, and similar MSI results for LVGLS, RV-FWLS, and MW were observed for both ACR and the no rejection groups. Additionally, the survival rates at 2 years were similar between the Chagas disease groups. Conclusion: LVGLS and RV-FWLS were similar between patients with or without ACR in the first year after HT. Conversely, GWE, a derivative of LVGLS, and LV mass index were increased in positive ACR and could be markers for rejection. Increased LV mass index was also found in a subgroup analysis of patients less than 6 months after HT; however, MSI was similar regardless of ACR. For chagasic patients, rejection in the first year did not increase mortality at the 2-year follow-up, and MSI parameters were similar between patients with or without ACR. In a multivariate analysis to predict ACR, the independent parameters in this study were older age, cyclosporine use, LV mass index, and GWE.

Viral Cardiomyopathies Associated With SARS-CoV-2 Infection.

Context: Since the end of 2019 with the identification of the new coronavirus SARS-CoV-2 and the disease it produces, named COVID-19, various manifestations have been described, initially pulmonary due to acute and severe respiratory syndromes, now systemic manifestations have been described. Case Report: We report 3 cases of patients with cardiovascular manifestations associated with SARS-CoV-2 infection, highlighting the diagnostic approach and variety of presentation, from acute myocardial infarction, myocarditis, heart failure, shock, arrhythmias to sudden death. Conclusions: Every day is more frequent to find reports of patients with cardiovascular compromise during COVID-19 affecting the development and prognosis of this disease.

Usefulness of PCR for Trypanosoma cruzi DNA in blood and endomyocardial biopsies for detection of Chagas disease reactivation after heart transplantation: A comparative study.

BACKGROUND: Chagas disease reactivation (CDR) after heart transplantation is characterized by relapse of the infectious disease with proliferation and dissemination of Trypanosoma cruzi parasites. Serial blood PCR testing is consensually recommended for CDR monitoring, but there is uncertainty about the incremental value in performing the molecular tests in endomyocardial biopsies (EMB). METHODS: We compared qualitative and quantitative results of PCR for T cruzi DNA in 62 pairs of blood and EMB collected with a maximum time interval of 7 days, from 34 heart-transplanted, chagasic patients. RESULTS: Blood PCR resulted positive in 39/62 (62.9%) samples, with PL ranging from 0.14 to 1610.73 (median: 3.31). PCR resulted positive in 8/60 (13.3%) EMB, with PL ranging from 2.82 to 1670.55 (median: 65.63). All blood samples which tested negative presented a paired EMB which also tested negative. However, 31/39 (79.5%) blood samples which tested positive presented a paired EMB which tested negative. There was poor agreement between blood and EMB PCR (kappa = 0.153). CDR affecting the myocardium (myo-CDR) was diagnosed in three occasions. PCR resulted positive in both blood and EMB at the time of myo-CDR, with PL ranging from 0.61 to 1610.73 in blood and 13.8 to 1670.55 in EMB. CONCLUSIONS: Negative PCR for T cruzi in blood rules out myo-CDR, with no value of testing EMB. Positive PCR in blood with high PL is diagnostic for myo-CDR. If PCR in blood results positive with low PL, testing EMB is useful: negative PCR turns unlikely, and positive PCR reinforces greatly the possibility of myo-CDR.

Sequential measurement of Trypanosoma cruzi parasitic load in endomyocardial biopsies for early detection and follow-up of Chagas disease reactivation after heart transplantation.

BACKGROUND: Reactivation of Chagas disease after heart transplantation is characterized by proliferation and dissemination of Trypanosoma cruzi parasites to several organs. Reactivation affecting the allograft can simulate acute cellular rejection, from which it should be distinguished through the analysis of endomyocardial biopsies (EMB). METHODS: We evaluated retrospectively 100 EMB collected in the first year of follow-up from 13 heart-transplanted, chagasic patients who presented reactivation and were successfully treated. Additionally, 37 EMB from 8 patients who did not present reactivation constituted the control group. We reviewed histopathology and performed a real-time PCR-based assay in order to evaluate the T cruzi parasitic load of each EMB. RESULTS: The parasitic load of the EMB at the time of reactivation ranged from 22.80 to 190 000/106 cells (median: 1555). In 6 patients, none of the EMB obtained prior to reactivation amplified T cruzi DNA. On the other hand, 10 EMB from 7 patients, obtained 9-105 days before reactivation (median: 26 days), showed parasitic load ranging from 8.25 to 625/106 cells (median: 167.55). In all patients, the parasitic load increased at the time of reactivation, usually sharply. After initiation of treatment, all patients showed negative PCR or a dramatic reduction of the parasitic load in the following EMB. None of the EMB from the control group amplified T cruzi DNA. CONCLUSIONS: Sequential measurement of T cruzi parasitic load in EMB is useful for monitoring Chagas disease reactivation after heart transplantation. Its increase suggests imminent reactivation and its decrease after treatment indicates favorable evolution for cure of the episode of reactivation.

European Association of Cardiovascular Imaging/Cardiovascular Imaging Department of the Brazilian Society of Cardiology recommendations for the use of cardiac imaging to assess and follow patients after heart transplantation.

The cohort of long-term survivors of heart transplant is expanding, and the assessment of these patients requires specific knowledge of the surgical techniques employed to implant the donor heart, the physiology of the transplanted heart, complications of invasive tests routinely performed to detect graft rejection (GR), and the specific pathologies that may affect the transplanted heart. A joint EACVI/Brazilian cardiovascular imaging writing group committee has prepared these recommendations to provide a practical guide to echocardiographers involved in the follow-up of heart transplant patients and a framework for standardized and efficient use of cardiovascular imaging after heart transplant. Since the transplanted heart is smaller than the recipient's dilated heart, the former is usually located more medially in the mediastinum and tends to be rotated clockwise. Therefore, standard views with conventional two-dimensional (2D) echocardiography are often difficult to obtain generating a large variability from patient to patient. Therefore, in echocardiography laboratories equipped with three-dimensional echocardiography (3DE) scanners and specific expertise with the technique, 3DE may be a suitable alternative to conventional 2D echocardiography to assess the size and the function of cardiac chambers. 3DE measurement of left (LV) and right ventricular (RV) size and function are more accurate and reproducible than conventional 2D calculations. However, clinicians should be aware that cardiac chamber volumes obtained with 3DE cannot be compared with those obtained with 2D echocardiography. To assess cardiac chamber morphology and function during follow-up studies, it is recommended to obtain a comprehensive echocardiographic study at 6 months from the cardiac transplantation as a baseline and make a careful quantitation of cardiac chamber size, RV systolic function, both systolic and diastolic parameters of LV function, and pulmonary artery pressure. Subsequent echocardiographic studies should be interpreted in comparison with the data obtained from the 6-month study. An echocardiographic study, which shows no change from the baseline study, has a high negative predictive value for GR. There is no single systolic or diastolic parameter that can be reliably used to diagnose GR. However, in case several parameters are abnormal, the likelihood of GR increases. When an abnormality is detected, careful revision of images of the present and baseline study (side-by-side) is highly recommended. Global longitudinal strain (GLS) is a suitable parameter to diagnose subclinical allograft dysfunction, regardless of aetiology, by comparing the changes occurring during serial evaluations. Evaluation of GLS could be used in association with endomyocardial biopsy (EMB) to characterize and monitor an acute GR or global dysfunction episode. RV size and function at baseline should be assessed using several parameters, which do not exclusively evaluate longitudinal function. At follow-up echocardiogram, all these parameters should be compared with the baseline values. 3DE may provide a more accurate and comprehensive assessment of RV size and function. Moreover, due to the unpredictable shape of the atria in transplanted patients, atrial volume should be measured using the discs' summation algorithm (biplane algorithm for the left atrium) or 3DE. Tricuspid regurgitation should be looked for and properly assessed in all echocardiographic studies. In case of significant changes in severity of tricuspid regurgitation during follow-up, a 2D/3D and colour Doppler assessment of its severity and mechanisms should be performed. Aortic and mitral valves should be evaluated according to current recommendations. Pericardial effusion should be serially evaluated regarding extent, location, and haemodynamic impact. In case of newly detected pericardial effusion, GR should be considered taking into account the overall echocardiographic assessment and patient evaluation. Dobutamine stress echocardiography might be a suitable alternative to routine coronary angiography to assess cardiac allograft vasculopathy (CAV) at centres with adequate experience with the methodology. Coronary flow reserve and/or contrast infusion to assess myocardial perfusion might be combined with stress echocardiography to improve the accuracy of the test. In addition to its role in monitoring cardiac chamber function and in diagnosis the occurrence of GR and/or CAV, in experienced centres, echocardiography might be an alternative to fluoroscopy to guide EMB, particularly in children and young women, since echocardiography avoids repeated X-ray exposure, permits visualization of soft tissues and safer performance of biopsies of different RV regions. Finally, in addition to the indications about when and how to use echocardiography, the document also addresses the role of the other cardiovascular imaging modalities during follow-up of heart transplant patients. In patients with inadequate acoustic window and contraindication to contrast agents, pharmacological SPECT is an alternative imaging modality to detect CAV in heart transplant patients. However, in centres with adequate expertise, intravascular ultrasound (IVUS) in conjunction with coronary angiography with a baseline study at 4-6 weeks and at 1 year after heart transplant should be performed to exclude donor coronary artery disease, to detect rapidly progressive CAV, and to provide prognostic information. Despite the fact that coronary angiography is the current gold-standard method for the detection of CAV, the use of IVUS should also be considered when there is a discrepancy between non-invasive imaging tests and coronary angiography concerning the presence of CAV. In experienced centres, computerized tomography coronary angiography is a good alternative to coronary angiography to detect CAV. In patients with a persistently high heart rate, scanners that provide high temporal resolution, such as dual-source systems, provide better image quality. Finally, in patients with insufficient acoustic window, cardiac magnetic resonance is an alternative to echocardiography to assess cardiac chamber volumes and function and to exclude acute GR and CAV in a surveillance protocol.

Amiloidosis cardíaca con obstrucción dinámica subaórtica / Cardiac Amyloidosis with Dynamic Subaortic Obstruction

La amiloidosis es una enfermedad infiltrativa sistémica que compromete el corazón y representa una causa importante de miocardiopatía restrictiva. En esta presentación se describe el caso de una paciente con insuficiencia cardíaca (IC) secundaria a miocardiopatía infiltrativa por depósito amiloide y obstrucción dinámica del tracto de salida del ventrículo izquierdo. El diagnóstico hematológico fue de mieloma múltiple por cadenas livianas y se demostró amiloidosis en dos tejidos extracardíacos. El ecocardiograma reveló aumento de los espesores parietales con obstrucción dinámica subaórtica significativa y la resonancia cardíaca mostró un patrón compatible con infiltración amiloide. La biopsia endomiocárdica confirmó la amiloidosis cardíaca. La publicación de este caso constituye la primera comunicación en nuestro país de esta forma de presentación atípica de amiloidosis cardíaca.

Primary amyloidosis is a systemic infiltrative disease that compromises the heart and represents an important cause of restrictive cardiomyopathy. We describe the case of a patient with heart failure secondary to an infiltrative cardiomyopathy with amyloid deposition and dynamic left ventricular outflow tract obstruction. The hematological diagnosis was light chain multiple myeloma with presence of amyloidosis in two extracardiac tissues. The echocardiogram revealed substantial wall thickening with significant dynamic subaortic obstruction; the magnetic resonance imaging showed a pattern suggestive of amyloid infiltration. An endomyocardial biopsy confirmed the diagnosis of cardiac amyloidosis. This is the first case of this atypical presentation of cardiac amyloidosis reported in our country.

Arritmia como única forma de presentación de la miocarditis / Arrhythmia as the only presentation form of myocarditis / Arritmia como a única forma de apresentação de miocardite

Introducción. Las arritmias ventriculares se presentan, en algunos pacientes, como único signo clínico de miocarditis, siendo ésta no incluida como probabilidad etiológica. La dificultad de la caracterización clínica de esta forma de presentación en esta patología no permite iniciar el tratamiento oportuno. Objetivo. Analizar la evolución clínica y el tratamiento de pacientes con arritmias, como única manifestación clínica de miocarditis. Materiales y método. Estudio descriptivo, observacional, transversal, retrospectivo de diecinueve pacientes con diagnóstico de miocarditis, asistidos en nuestra institución, entre los años 2000 y 2009. Se seleccionaron siete pacientes (35%), que presentaron arritmias ventriculares como única forma de manifestación clínica. La edad media de estos pacientes fue de 18 ± 7 años, cinco hombres y dos mujeres. Todos tuvieron biopsia endomiocárdica positiva para miocarditis. Se examinaron las historias clínicas a fin de observar el tipo de arritmia, la función ventricular, la respuesta al tratamiento recibido y la evolución clínica a corto y largo plazo. Para el análisis estadístico, se empleó el programa estadístico InfoStat/Profesional versión 2009p. Resultados. Todos los pacientes presentaron extrasístoles ventriculares frecuentes, 3 (43%) taquicardia ventricular no sostenida y 4 (57%) taquicardia ventricular sostenida, de éstos, 1 paciente padeció además fibrilación ventricular. La función ventricular fue normal en todos los pacientes (fracción de eyección: 62 ± 8,08%). Seis pacientes (86%) fueron tratados con inmunosupresores (corticoides y azatioprina), de los cuales 5 (72%) evolucionaron con extrasístoles ventriculares aisladas. Sólo un paciente continuó con taquicardia ventricular sostenida, que requirió implante de cardiodesfibrilador y ablación por radiofrecuencia. No hubo óbitos, en un seguimiento de 6 ± 3 años. Conclusiones. De los pacientes tratados con inmunosupresores se logró reducir la inflamación y controlar las arritmias. Se evidenció una buena evolución de los pacientes a corto y largo plazo.

Background. Ventricular arrhythmias occur in some patients as the only clinical sign of myocarditis; still it is not included as an etiological probability. The complexity of its clinical characterization does not allow an appropriate treatment. Aim.To analyze clinical evolution and treatment in those patients with arrhythmia as the only clinical manifestation of myocarditis. Materials and method. Descriptive, observational, transversal, retrospective study, enrolling nineteen patients diagnosed with myocarditis, attended in our institution within the period 2000-2009. Seven patients (35%) who presented ventricular arrhythmia as the only clinical manifestation were selected. Their mean age was 18 ± 7 years old, five men and two women. All of them underwent endomyocardial biopsy, resulting positive for myocarditis. Clinical histories were analyzed in order to examine arrhythmia type, ventricular function, response to received treatment, and clinical long and short-term evolution. Statistical analysis was performed with statistical program InfoStat/Profesional version 2009p. Results. All patients presented frequent ventricular extrasystoles; 3 (43%) non sustained ventricular tachycardia; 4 (57%) sustained ventricular tachycardia, and 1 of these patients had ventricular fibrillation. Ventricular function was normal in all patients (ejection fraction 62 ± 8,08%). Six patients (86%) received immunosupressors (corticoids y azatioprin), of which 5 (72%) evolved with isolated ventricular extrasystoles. Only one patient continued with sustained ventricular tachycardia, requiring defibrillator implantation and radiofrequency ablation. There were no deaths in a follow up of 6 ± 3 years. Conclusions. Immunosuppressive therapy allowed reducing inflammation and controlling arrhythmias. Patients showed a good short and long term evolution.

Introdução. As arritmias ventriculares ocorrem em alguns pacientes, como o único sinal clínico de miocardite, ainda não incluída como de probabilidade de diagnóstico. A dificuldade da caracterização clínica da doença não permite o tratamento adequado para controlá-lo. Objetivo. Analisar a evolução clínica e tratamento de pacientes com arritmias, como a única manifestação clínica da miocardite. Materiais e métodos. Estúdio descritivo, observacional, transversal, retrospectivo, com dezenove pacientes com diagnóstico de miocardite, atendidos em nossa instituição entre os anos 2000 e 2009. Foram selecionados sete pacientes (35%) com arritmia ventricular como única forma de manifestação clínica. A idade média desses pacientes foi de 18± 7 anos, cinco homens e duas mulheres. Todos foram submetidos à biópsia endomiocárdica, resultando positivo para miocardite. As histórias clínicas foram analisadas a fim de avaliar o tipo de arritmia, função ventricular, a resposta ao tratamento recebido e evolução clínica a longo e curto prazo. A análise estatística foi realizada com o programa estatístico InfoStat/Profesional versão 2009p. Resultados. Todos os pacientes apresentaram extra-sístoles ventriculares freqüentes, 3 (43%) taquicardia ventricular não sustentada; 4 (57%) taquicardia ventricular sustentada, e um destes pacientes também sofreu fibrilação ventricular. A função ventricular era normal em todos os pacientes (fração de ejeção de 62 ± 8,08%). Seis pacientes (86%) receberam imunossupressores (corticóides e azatioprina), dos quais 5 (72%) evoluíram com extra-sístoles ventriculares isoladas. Apenas um paciente continuou com taquicardia ventricular sustentada, necessitando de implante de desfibrilador e ablação por radiofreqüência. Não houve mortes em um seguimento de 6 ± 3 anos. Conclusões. A terapia imunossupressora permitiu reduzir a inflamação e controlar arritmias. Os pacientes apresentaram boa evolução a curto e longo prazo.

Propuesta de protocolo de biopsia cardíaca. Servicio de Anatomía Patológica y Departamento de Cardiología / Proposal of cardiac biopsy protocol. Service of Pathology and Department of Cardiology / Proposta de protocolo de biópsia cardíaca. Serviços de anatomia patológica e departamento de cardiologia

Introducción: Las biopsias endomiocárdicas se utilizan habitualmente para el diagnóstico de muchas patologías que han sido agrupadas por Billigham y Tazelaar en inflamatorias, metabólicas, endocrinas, neuromusculares, tóxicas, procesos linfoproliferativos y el diagnóstico de rechazo a trasplante cardíaco para evaluar la cardiotoxicidad por drogas (antraciclinas, dexoxirubina, cocaína, alcohol, entre otras); también como análisis de miocardio isquémico y su zona limítrofe. Objetivo: Trataremos de evaluar desde un punto de vista cuantitativo, la amplitud de observaciones que se han hecho de la biopsia cardíaca, en un innumerable listado de patologías, desde la MO a la ME (Microscopía óptica a microscopía electrónica). Se intentará graduar los hallazgos morfológicos de la misma, enlazándolos con la topografía y función, teniendo en cuenta, además, los factores bioquímicos y genéticos, organismos vivos, drogas, agentes físicos y procedimientos diagnósticos. Material y Métodos: Para el presente estudio se realizó una recopilación bibliográfica teniendo en cuenta los siguientes criterios: 1) cambios morfológicos sub-celulares-matriz tisular; 2) score de necrosis; 3) score inflamatorio, 4) score de fibrosis; 5) depósitos intracelulares y de pigmentos. Procesamiento de las muestran fijadas en formol buffer (tiempo 2-12 hs.) con coloración de rutina: H/E, Pas, Masson, Zihel Neelsen prolongada, Perls, Azul de Toluidina, Rojo Congo, Orceina. Panel con técnicas de I.H.Q.(BIO SB®).Conclusión: Creemos importante establecer un método que permita hacer una adecuada correlación clínico patológica aplicable a mejorar la interpretación de la injuria tisular, celular y facilitar de este modo, una correcta elección terapéutica.

Introdução: As biópsias endomiocárdicas são utilizadas habitualmente para o diagnóstico de muitas patologias, que foram agrupadas por Billigham e Tazelaar em inflamatórias, metabólicas, endócrinas, neuromusculares, tóxicas, processos linfoproliferativos e o diagnóstico de rejeição a trasplante cardíaco, para avaliar a cardiotoxicidade por drogas (antraciclinas, doxorrubicina, cocaína, álcool, entre outras). Também como análise de miocárdio isquêmico e sua zona limítrofe. Objetivo: Trataremos de avaliar sob o ponto de vista quantitativo, a amplidão de observações feitas da biópsia cardíaca, em uma inumerável lista de patologias, de MO a ME.Tentaremos graduar os descobrimentos morfológicos da mesma, enlaçando-os com a topografia e função, levando em consideração também os fatores bioquímicos e genéticos, organismos vivos, drogas, agentes físicos, procedimentos e diagnósticos.Material e Métodos: para o presente estudo realizou-se uma recopilação bibliográfica considerando os seguintes critérios, 1) alterações morfológicas subcelulares-matriz tissular; 2) escore de necrose; 3) escore inflamatório, 4) escore de fibrose; 5) depósitos intracelulares e de pigmentos. Processamento das amostras fixadas em formol buffer (tempo 2 -12 h.) com coloração de rotina: H/E, Pas, Masson, Zihel Neelsen prolongada, Perls, Azul de Toluidina, Vermelho Congo, Orceína. Painel com técnicas de I.H.Q. (BIO SB®). Conclusão: Achamos importante estabelecer um método que permita fazer uma adequada correlação clínico patológica aplicável a melhorar a interpretação da injúria tisular celular e, deste modo, facilitar uma correta decisão terapêutica.

Introduction: The endomiocárdica biopsies is habitually used for the diagnosis of many pathologies, grouped by Billigham and Tazelaar in inflammatory, metabolic, endocrine, neuromuscular, toxic, processes linfoproliferative and in diagnosis of rejection to heart transplant or to evaluate the cardiotoxicity for drugs (antracicline, dexoxirubine, cocaine, alcohol among other). Also as analysis of cardiac ischemia and their bordering area. Objective: We will try to evaluate from a quantitative point of view, the width of observations that you/they have been made of the heart biopsy in a countless listing of pathologies, from the MO to ME. We will try to graduate the morphologic discoveries of the same one, connecting them with the topography and function, also keeping in mind the biochemical and genetic factors, alive organisms, you drug, physical agents, procedures diagnoses. (Sherman Bloom, pag 329, I Diagnose of Cardiovasc. Pathology).Material and Methods: for the present study was carried out a bibliographical summary keeping in mind the following approaches, 1) changes morphologic subcellular-main tissue; 2) necrosis score; 3) inflammatory score 4) fibrosis score; 5) deposits intracellular and of pigments. Prosecution of they show them fixed in formol buffer (time 2 -12 hs.) with routine coloration: H/E, Pas, Masson, Zihel lingering Neelsen, Perls, Blue of Toluidine, Red Congo, Orceine. Panel with technical of I.H.Q. (BIO SB®). Conclusion: We believe as very important to establish a methodology eich allow an applicable pathological clinical appropriate correlation to improve the interpretation of the tissue insult and to facilitate in this way a correct therapeutic election.

Miocarditis viral en el adulto / Viral myocarditis in the adult

La miocarditis viral es resultado de una inflamación del miocardio provocada por diferentes virus. Esta enfermedad cardíaca constituye sin duda una urgencia cardiovascular en el adulto por las complicaciones que ocasiona. El cuadro clínico se caracteriza por arritmias e insuficiencia cardíaca que pueden conducir a la muerte. La secuela más frecuente de la miocarditis viral a largo plazo es la miocardiopatía dilatada. En el presente trabajo se revisa etiología, fisiopatología, sintomatología, diagnóstico y tratamiento de la miocarditis viral en el adulto(AU)

Viral myocarditis is the result of a myocardial inflammation provoked by different viruses. This cardiac disease is doubtless a cardiovascular urgency in the adult due to its complications. The clinical picture is characterized by arrhythmias and cardiac failure that may to lead to death. The more frequent long-term myocarditis sequela is the dilated myocardiopathy. In present paper etiology, pathophysiology, symptomatology, diagnosis and treatment of viral myocarditis in the adult are reviewed(AU)

Miocarditis viral en el adulto / Viral myocarditis in the adult

La miocarditis viral es resultado de una inflamación del miocardio provocada por diferentes virus. Esta enfermedad cardíaca constituye sin duda una urgencia cardiovascular en el adulto por las complicaciones que ocasiona. El cuadro clínico se caracteriza por arritmias e insuficiencia cardíaca que pueden conducir a la muerte. La secuela más frecuente de la miocarditis viral a largo plazo es la miocardiopatía dilatada. En el presente trabajo se revisa etiología, fisiopatología, sintomatología, diagnóstico y tratamiento de la miocarditis viral en el adulto

Viral myocarditis is the result of a myocardial inflammation provoked by different viruses. This cardiac disease is doubtless a cardiovascular urgency in the adult due to its complications. The clinical picture is characterized by arrhythmias and cardiac failure that may to lead to death. The more frequent long-term myocarditis sequela is the dilated myocardiopathy. In present paper etiology, pathophysiology, symptomatology, diagnosis and treatment of viral myocarditis in the adult are reviewed

Miocardiopatías en población infantil y adolescente: estudio en autopsias y biopsias endomiocárdicas / Diseases of the myocardium in a infantile and adolescent population: study en autopsy and endomyocardial biopsy

El principal objetivo de este trabajo es contribuir al conocimiento de la anatomía patológica especialmente del aspecto histopatológico de las enfermedades del miocardio en menores o igual de 18 años de edad en Venezuela. Se estudiaron desde el punto anatomopatológico 19 casos de enfermedades del miocardio en una población infantil y adolescente de ambos sexos, (8 autopsias y 11 biopsias endomiocárdicas), según los criterios de la OMS. En 7 casos se hizo el estudio del miocardio mediante microscopio electrónico. Para el diagnóstico de las miocarditis se aplicaron los criterios de Dallas. Las miocardiopatías fueron más frecuentes que las miocardiopatías específicas(11/9), siendo las miocardiopatías dilatadas y las miocardiopatías inflamatorias las que ocuparon el primer lugar en ambos grupos respectivamente. Las alteraciones histológicas y ultraestructurales fueron inespecíficas caracterizadas por hipertrofia celular y degeneración celular, fibrosis en las miocardiopatías dilatadas y proceso inflamatorio en las miocarditis. Se señalaron algunos aspectos característicos histopatológicos de la biopsia endomiocárdica en la fibrosis endomiocárdica, (dos casos), de la distrofia muscular (un caso de autopsia)y de la miocardiopatía hipertrófica (un caso de autopsia). No se encontró un solo caso de miocarditis chagásica ni de displasia arritmogénica del ventrículo derecho. Se concluyó que el perfil de las miocardiopatías en las dos primeras décadas de la vida es el mismo que en el adulto. Igualmente, las miocarditis ocuparon el primer lugar de las miocardiopatías inflamatorias.

The main objective of this work is to contribute specially to the knowledge of the pathological anatomy of the histopathologic aspect of the disease of the myocardium of young in or smaller of 18 years of age in Venezuela. 19 cases of disease of the myocardium in an infantile and adolescent population of both sexes studied (8 endomyocardial biopsy and 11 autopsy), according to the criteria of the WHO. In 7 cases the study became of the myocardium by means of electron microscope. For the identification of the myocardditis the criteria of Dallas were applied. The cardiomyopathies were more frequent than the specific cardiomyopathy (11/9), and the inflammatory cardiomyopathy those that respectively occupied the first place in both groups. The histological and ultrastructural alterations were unspecific characterized by hypertrophied cellular and callular degeneration, fibrosis in the cardiomyopathy and inflammatory process in the myocarditis. Some histopathologic aspects were indicated characteristic of the endomyocardial biopsy in the endomyocardial fibrosis. (two cases), of the muscular dystrophy (a case of autopsy) and of the hypertrophic cardiomyopathy (a case of autopsy). Was not a single case of cardiomyopathy arritmogenic of the right ventricle and chagastic myocarditis. One concluded that the profile of the cardiomyopathies in the two first decades of the life, is he himself who in the adult. Also, the myocarditis occupied the first place of the inflammatory cardiomyopathy.

Resposta histológica do miocárdio a diferentes esquemas imunossupressores em pacientes com cardiomiopatia dilatada e diagnóstico de miocardite à biópsia endomiocárdica / Histological response of the myocardium to different immunosuppressor schedule in patients with dilated cardiomyopathy and diagnosis of myocarditis at endomyocardial biopsy

Verificar a evoluçäo histológica do miocárdio em crianças portadoras de miocardite ativa submetidas ou näo à imunossupressäo, através de biópsias antes e depois de tratamento. Quatro grupos submetidos a diferentes esquemas de imunossupressäo e um grupo controle que recebeu somente drogas anticongestivas: grupo I - controle (4 pacientes), grupo II - prednisona (5 pacientes), grupo III - prednisona e azatioprina (9 pacientes), grupo IV - prednisona e ciclosporina (5 pacientes). Nenhum paciente do grupo I apresentou melhora histológica em período médio de 9 meses, enquanto que a melhora histológica ocorreu em 20% dos pacientes do grupo II, 67% do grupo III e 80% do grupo IV. Apenas pacientes do grupo III e IV apresentaram aspecto de miocardite em resoluçäo, após tratamento. A terapêutica imunossupressora com azatioprina ou ciclosporina, associada à prednisona, propiciou diminuiçäo da atividade da miocardite em maior proporçäo de casos do que o verificado nos tratados só com corticóide ou ainda sem imunossupressäo

PurposeTo analyse the histological evolution of endomyocardial biopsies from children with active myocarditis, submitted or not to immunosuppressive therapy. Patients and MethodsFour groups of patients were compared, clinically treated as follows: group Ianticongestive drugs (4 patients); group IIprednisone (5 patients); group III prednisone plus azathioprine (9 patients); group IVprednisone and cyclosporine (5 patients). ResultsNo patient from group I presented any histological improvement during a mean period of 9 months, while evident histological improvement occurred in 25% of patients from group I, 67% from group III and 80% from group IV. The microscopical aspect of resolving myocarditis was only observed in patients from groups III and IV, after treatment. Conclusion The immunosuppressive therapy with azathioprine or cyclosporine plus prednisone leads to decrease of active myocarditis intensity in a higher proportion of cases than the treatment with only prednisone or no immunosuppressive drugs.