[Bedside cardiac catheterization. Advantages and disadvantages]. / Cateterismo cardíaco à beira do leito. Vantagens e desvantagens.

Three hundred patients submitted to bedside heart catheterization (BHC) from 1973 to 1985 were studied, in order to assess advantages and risks of the procedure. Two-hundred and sixty seven patients (89%) suffered a myocardial infarction (MI) and 146 of them were in functional class (Killip) II, 36 in FC III and 71 in FC IV. Thirty cases were submitted to BHC due to congestive heart failure. BHC was successful in 288 patients (96%) and the wedge pressure (WP) could be measured in 236 cases (78.7%). The WP was less than 18 mmHg in 47.2% of the patients in FC II, in 44.9% of the patients in FC III and in 35.3% of those in FC IV. Minor complications occurred in 33 cases (11.0%); balloon rupture in 12 (4.0%), transient arrhythmias in 11 (3.7%) and lumen obstruction in another 10 cases (3.3%). Forty five patients (15.0%) presented major complications related to the procedure: pulmonary infarction (PI) in 18 cases (6%), phlebitis in 15 cases (5%), sustained arrhythmias in 10 cases (3.3%), pulmonary artery rupture and endocarditis each in 1 case. The mean age between the group of patients with and without complications was similar the maintenance time as greater in the group of patients with complications: 3.4 +/- 0.2 vs 2.7 +/- 0.1 days (p less than 0.05). We concluded that many patients with clinical evidence of heart failure had WP smaller than 18 mmHg, emphasizing the value of the procedure in patients with complicated MI. The maintenance time was associated with the occurrence of complications, mainly PI and phlebitis.

[Changes in the ST segment in unstable angina pectoris. Its prognostic value]. / Alteraciones del segmento ST en la angina pectoris inestable. Su valor pronóstico.

Out of 145 patients with unstable angina hospitalized at CCU of the Instituto de Cardiologia do Rio Grande do Sul (Brazil) in 1981, 69 were studied: group I = 23 case (33.3%) with transient ST segment depression, group II = 13 cases (18.8%) with transient ST segment elevation, group III (control) = 33 cases (47.8%) without acute EKG changes. Group I showed a higher incidence of double-triple coronary artery involvement: 71.4% VS 53.8 and 63.3% respectively (non significant). This group also showed a higher number of patients with severe angina and who suffered acute myocardial infarction during follow-up, although without statistical significance. There were 8 deaths (34.8%) in group I, 3 (23.1%) in group II and 4 (12.1%) in group III (chi 2 = 4.11, p greater than 0.05). The 36 months survival rate was lower in group I than in groups II and III: 52.9% VS. 75.2% (NS) and 89.7% (P less than 0.02) respectively. We conclude that acute EKG changes, mainly transient ST segment depression, in unstable angina, are markers of high risk patients.

[Atrio-septostomy using a Rashkind catheter in complete transposition of the great arteries. Immediate and late results]. / Atrioseptostomía con catéter de Rashkind en la transposición completa de las grandes arterias. Resultados inmediatos y tardíos.

Seventy one patients with complete transposition of the great arteries (TGA) who underwent balloon atrial septostomy (BAS) were studied, with the purpose to evaluate its early and late results within the first year of life. Fifty four patients were male (76,1%) and 17 female (23,9%), aged 2 days to 11 months (mean = 2,3 +/- 0,3%), being 46,5% less than 1 month old. Increase in mean aortic oxygen saturation (Ox. Sat.) after BAS was highly significant (p less than 0,001), irrespective of age and morphological features of TGA. Analysis of the group of 55 patients who underwent only BAS during the first year of life showed: mean age in the 13 non-survivors was 3,3 +/- 0,2 months; increase in Ox.Sat. was highly significant in the 42 survivors and not significant in the 13 patients who died; mortality in children with and without patent ductus arteriosus was 23,1% and 23,8%, respectively. Death directly related do BAS occurred in 2 patients (2,8%), without other complications being observed. We conclude that BAS is an effective and low-risk procedure, even in neonates with poor clinical condition. Early response to BAS is predictive of survival in the first year of life.

Doenca de Kawasaki: uma abordagem cardiologica. / Kawasaki's disease: a cardiac approach

Os autores revisam os aspectos etiopatogenicos, clinicos, de investigacao e de terapeutica da doenca de Kawasaki, com enfase especial no envolvimento cardiovascular e na sua abordagem cardiologica

Avaliacao radiologica convencional da dupla via de saida do ventriculo direito, da conexao atrio-ventricular univentricular e da drenagem venosa pulmonar anomala total. / Conventional radiologic evaluation of double outlet right ventricule, univentricular atrioventricular conexion and total anomalous pulmonary venous drainage

Os autores apresentam revisao dos sinais radiologicos convencionais mais frequentes na dupla via de saida do ventriculo direito, na conexao atrio-ventricular e na drenagem venosa pulmonar anomala total, enfatizando as diferencas observadas nos diversos subgrupos morfo-funcionais de cada uma dessas cardiopatias