Aneurisma volumoso da artéria pulmonar em paciente portador de doença de Behçet: relato de caso / Huge aneurism of the pulmonary artery in patient with Behçet's disease: case report

JUSTIFICATIVA E OBJETIVOS: A doença de Behçet caracteriza-se pela presença de lesões cutâneas, história de ulcerações orais, observação de patergia, envolvimento ocular do tipo uveíte e alterações vasculares. Constitui-se em afecção rara no nosso meio, inscrevendo-se no capítulo das vasculites sistêmicas primárias. RELATO DO CASO: Descrição de manifestação vascular pulmonar incomum, caracterizada pelo desenvolvimento de volumoso aneurisma na circulação arterial pulmonar em paciente com doença de Behçet. CONCLUSÃO: A presença de aneurisma da artéria pulmonar é manifestação rara, porém observada na doença em questão.(AU)

BACKGROUND AND OBJECTIVES: Behçet `s disease is a rare affection characterized by skin lesions, history of aftous ulcers, pathergy, ocular involvement like uveitis, as well as venous and arterial compromise. CASE REPORT: A patient with various systemic manifestations of Behçet’s disease, including a huge aneurysm in the left pulmonary artery. CONCLUSION: The appearance of this unusual vascular alteration is considered a rare manifestation of Behçet’s disease.(AU)

Cine magnetic resonance imaging for evaluation of congenital heart disease: role in pediatric cardiology compared with echocardiography and angiography.

Cine magnetic resonance imaging was used for preoperative and postoperative evaluation of 91 patients with congenital heart disease. Their ages ranged from 6 weeks to 14 years. The quality of study was excellent in 81% of the cases, in which it provided complete documentation of diagnostic features; substantial diagnostic information was provided in another 14%, and the study was nondiagnostic in only 5%. This technique was most useful for evaluating areas of the right ventricle (95%), great arteries (95%), vena cava (94%), and pulmonary venous system (91%). The anatomic delineation of these areas was comparable to that obtained by cineangiography and was superior to echocardiography, especially in postoperative patients. For complex venous anomalies, magnetic resonance imaging provided better anatomic details than did angiography or echocardiography. The capability of multiplanar imaging allows complex angled views through the desired planes of the heart and great vessels. Proper sedation is essential to obtain maximum diagnostic information. Our preliminary experience suggests that this new modality provides excellent anatomic information in infants and children with congenital cardiac defects and will play an increasing role in pediatric cardiac diagnosis.

[10 years of nuclear cardiology. (I). Clinical development and technological progress in nuclear medicine at the Ignacio Chávez National Cardiological Institute]. / Diez años de cardiología nuclear. (I). Evolución asistencial y progreso tecnológico de la medicina nuclear en el Instituto Nacional de Cardiología "Ignacio Chávez".

The department of nuclear medicine of the Instituto Nacional de Cardiología started at the right moment (June 2, 1977), when the first cardiological procedures were developed. Unfortunately, it coincided in time with the beginning of the financial crisis. The higher costs of nuclear medicine instruments and operationsdid not allow the evolution of the department according to the original project, as nuclear cardiology demands special tracers and instrumentation, which are expensive and only available abroad. To solve these problems, we planned the creation of our own technology. We created a laboratory for radiopharmacy to elaborate lyophylized ingredients for the "cold" kits for instant labeling with 99Tcm of several tracers. With this, we achieved a substantial decrease in the operating costs, with total independence of commercial firms, and the future of the department was assured. In the field of instrumentation, a new system for tomodensitometric imaging of the thorax has been created by using two external gamma sources 99Tcm, and a digital system for image display and analysis was designed, built and programmed. This system, allowed the development of the quantitative technique of nuclear cardiology. We expect the software menu to be finished within this year. The transit from general nuclear medicine to nuclear cardiology has been slow in this Institute. During the first 8 years, the cardiological studies represented 10.8% of all in vivo studies; this figure increased to 37.8% in 1986. However, the increasing demand of cardiological studies tends to displace other in vivo studies due to oversaturation of the gamma-camera and the digital system. It can be concluded that the evolution of nuclear cardiology has been slow in this Institute, but represents a factual progress based on the creation of a technological substructure with internal resources.

[Digital radiocardioangiography as an auxiliary method for the precise localization of zones of myocardial concentration of 99mTc-Sn(II)-pyrophosphate. Preliminary report]. / La radiocardioangiografía digital como auxiliar para la localización precisa de las zonas de concentración miocardica del 99mTc-Sn(II)-pirofosfato. Informe preliminar.

A new method is introduced for the superposition of 99mTc-pyrophosphate (PiF) myocardial images on the isolated images of the radioangiocardiographic dextrophase and levophase, in order to include cardiac anatomical references for the accurate topographic localization of the PiF concentration areas. Results in two different patients are presented. In one of them, the PiF concentration was evident at the inferoseptal, inferoapical and posterolateral regions of the left ventricle. In the other, the PiF concentration was evident at the same areas than in the former plus the inferoanterior region of the right ventricle. Our project is to validate this procedure by correlating its results with those obtained through other clinical methods that detect right ventricular infarction.

[Axial angiography in tetralogy of Fallot]. / Angiografia axial en la tetralogia de Fallot.

We studied 15 patients with the diagnosis of tetralogy of Fallot by means of conventional and axial angiocardiography. Axial studies were performed in the four chamber view (vertical and horizontal X-ray beams) and in the sitting-up view (vertical X-ray beam). With the right ventriculogram we analyzed the anatomic characteristics of this chamber, infundibular stenosis and the pulmonary branches. Left ventriculograms were performed in order to rule out other less common associated defects. In the sitting-up view we analyzed the characteristics of the right ventricular infundibulum and the pulmonary valve, artery and branches. None of our patients underwent aortography or coronary artery angiography. We conclude that utilization of axial angiocardiography is useful in tetralogy of Fallot because it permits a better appreciation of the anatomy of this malformation, the presence or absence of stenosis of the pulmonary branches and other less frequent associated defects. Aortography or coronary artery angiography must be performed in children in which the anatomy of the coronary arteries cannot be determined by either left or right ventriculograms.

[Comparative study of coronariography and radiocoronariography in ischemic cardiopathy. Preliminary report]. / Estudio comparativo entre la coronariografiá y la radiocoronariografía en la cardiopatía isquémica. Comunicación preliminar.

25 patients with ischemic heart disease were studied by selective coronariography and radiocoronariograpy with 3mCi of human albumin macroaggregates labeled with 99mTc, injected selectively into each coronary artery. Gammagraphic images were then obtained. 17 cases (68%), had coronary obstructions and 8 patients (32%), had a normal coronary angiogram. Of all patients studied, 23 (92%), had areas of hypoperfusion. Patients with coronary obstructions had corresponding image defects. 6 cases with normal coronary angiography had areas of hypoperfusion and finally 2 cases had normal images in both studies. All patients wit EC6 necrosis had abnormal radiocoronariography. The macrocirculation is studied by coronary angiography, while the microcirculation is visualized by radiocoronariography. Both technique are complementary. We conclude that radiocoronariography should be performed routinely after coronary angiography in the study of ischemic heart disease, with special emphasis in cases with normal angiograms.

[Quantification of ventricular volume. Comparative study of 2 angiographic methods]. / "Cuantificación de los volúmenes ventriculares: estudio comparativo de 2 métodos angiográficos".

The left ventricular volumes and the ejection fraction were measured in 78 patients who had different cardiopathies, in more than 50% the diagnosis of ischaemic heart disease of coronary origin was made. Every cineangiocardiogram was carefully observed to find those who had normal and abnormal ventricular contraction. The ventricular volumes were calculated by the Green method and afterwards the results were compared with the values obtained by the Sandler and Dodge method. A very good correlation was found between the two methods and we got the conclusion that although it is preferable to calculate ventricular volumes and the ejection fraction with biplane method or with Saudler and Dodge's monoplane, the results of the present work permit the use of Green's method in calculating ventricular volumes and obtaining confident results, independently of the ventricular contraction type with the exception of those who have large ventricular aneurisms.

[Levogram in congenital cardiopathies. Its practical usefulness in newborn infants and small children given its low risk]. / El levograma en las cardiopatías congénitas. Su utilidad práctica en recién nacidos y niños pequeños por su bajo riesgo.

Four hundred and fifty six angiocardiograms were studied to evaluate the validity of levogram for diagnosis. They were separated in three groups: 1. Right angiocardiogram with a levogram. 2. Right angiocardiogram and left angiocardiogram. 3. Left angiocardiogram only. The distribution according to age, and type of heart disease is shown. The correlation between levogram and left angiocardiogram was looked for. The findings at survey were correlated with the angiocardiographic diagnosis and a high correlation was established. The usefulness of this procedure to diagnose specific type of heart disease in the small child is emphasized.

[Determination of the real value of the ventricular volume using angiographic methods]. / Determinación del valor real del volumen ventricular por metodos angiográficos

The developing of cuantitative angiographic procedures for evaluating the left ventricular efficiency have displaced most of the simple hemodynamic methods. The calculation of the left ventricular volume by usual ventriculography yields, as a rule, magnified values. The purpose of this paper is to determine the equation of the regression line means of which the real left ventricular volume can be calculated. A series of 12 normal hearts obtained from accidentaly deceased adult individuals (this necropsy material was afforded by the Forensic Medicine Department of México City). Previously measured amounts of a contrast substance were injected into the left ventricular cavity. The heart was filmed in a position equivalent to the chest RAO. The volume of the left ventricle was calculated using monoplane Sandler and Dodge cineventriculographic method. The results were submitted to statistic analysis. Confrontation of calculated and real values rendered a significative "r" (0.7374) and a non-significant "p" (0.001) the regression equation obteined was: y=36.97 + (0.39 x) in which: y=real left ventricular volume. x=calculated left ventricular volume.

[Comparison of 2 angiographic methods to determine the expulsion fraction of the left ventricle]. / Estudio comparativo de dos métodos angiográficos para determinar la fracción de expulsión ventricular izquierda

Left ventricular volume and ejection fraction were determined by two methods of one plane angiography in 50 cases of ischemic heart disease. Statistical analysis of the results obtained by both methods showed no significant differences.