RESUMO
We report the case of a patient presenting a sarcoma of interatrial septum with an accelerated growth and a fulminate clinical course documented by non-invasive image diagnostic techniques, habitual in the cardiologic practice. The natural history of some cardiac malignant tumours, as aggressive as in this case, explains the diagnostic delay, the difficulty to establish a curative treatment such as surgery and/or chemotherapy/radiotherapy and the awful short-term prognosis.
Assuntos
Neoplasias Cardíacas/patologia , Sarcoma/patologia , Adulto , Divisão Celular , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Sarcoma/diagnóstico por imagem , Fatores de Tempo , UltrassonografiaRESUMO
Wegener's granulomatosis (WG) is a necrotizing and granulomatous vasculitis that usually affects the upper and lower respiratory tract and the kidneys. Cardiac involvement is rare although pericarditis, coronary arteritis, myocarditis, valvulitis and arrhythmias have been described. Acute myocardial infarction with clinical expression is an exceptional complication of Wegener's granulomatosis. We report a case of a 30-year-old man with Wegener's granulomatosis who suffered an acute myocardial infarction during the initial phase of the disease, following seven days of treatment with glucocorticoids and cyclophosphamide. Transthoracic echocardiography showed abnormal regional wall motion with septal hypokinesia and apical akinesia. Cardiac catheterization revealed an ectasic segment in the proximal left anterior descending coronary artery and total occlusion in the mid-segment. Medical therapy with prednisone and cyclophosphamide was continued. No complications and initial remission were achieved.
Assuntos
Granulomatose com Poliangiite/complicações , Infarto do Miocárdio/etiologia , Adulto , Anti-Inflamatórios/uso terapêutico , Angiografia Coronária , Ciclofosfamida/uso terapêutico , Eletrocardiografia , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Masculino , Infarto do Miocárdio/diagnóstico , Prednisona/uso terapêuticoRESUMO
A patient with a complex congenital abnormality required the implantation of an interatrial septum patch through a right lateral atriotomy. Nine years later he developed two different morphologies of an incessant uncommon atrial flutter refractory to antiarrhythmic drug treatment. The electrophysiological study localized a site on the right atrium lateral wall where local activation time was 75 ms earlier than the onset of the P wave, transient entrainment with concealed fusion was obtained, the first postpacing interval after transient entrainment was 5 ms longer than tachycardia cycle length and the stimulus to P wave interval was 50 ms. At this site, radiofrequency delivery terminated the atrial flutter in less than 1 second. No further induction or recurrences of any morphology of the atrial flutter were observed after a four month follow up. These findings suggest the existence of a narrow conduction isthmus amenable to interruption by focal delivery of radiofrequency. The isthmus was most probably located between the atriotomy and the crista terminalis, posterior to the former and anterior to the latter.
Assuntos
Flutter Atrial/etiologia , Flutter Atrial/terapia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ablação por Cateter , Cicatriz/complicações , Cicatriz/etiologia , Complicações Pós-Operatórias/terapia , Adulto , Flutter Atrial/fisiopatologia , Cicatriz/fisiopatologia , Eletrocardiografia , Átrios do Coração/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/fisiopatologiaRESUMO
We report a case of a 58-year-old woman with rheumatic mitral stenosis scheduled for percutaneous valvuloplasty. Prior left and right ventricular angiograms showed multiple diverticula at left ventricular apical and diaphragmatic walls and right ventricular diaphragmatic wall. Chest x-ray and echocardiogram were normal. Magnetic resonance imaging was concordant with catheterization findings and ruled out other cardiac malformations. The risk of ventricular perforation changed our indication of percutaneous valvuloplasty in favor of open heart commissurotomy.