Clinical Profile and 30-Day Outcomes of Patients with Bicuspid Aortic Valve Undergoing Aortic Valve and/or Aorta Surgery. / Perfil Clínico e Desfechos em 30 Dias de Pacientes Portadores de Valva Aórtica Bicúspide Submetidos à Cirurgia em Valva Aórtica e/ou Aorta.

BACKGROUND: The bicuspid aortic valve (BAV) affects 0.5 to 2% of the population and is associated with valve and aortic alterations. There is a lack of studies on the profile of these patients in the Brazilian population. OBJECTIVE: To describe the profile of patients with BAV undergoing valve and/or aortic surgery in a tertiary cardiology center, in addition to the outcomes related to the intervention. METHODS: Retrospective cohort including 195 patients (mean age 54±14 years, 73.8% male) diagnosed with BAV who underwent surgical approach (valvular and/or aorta) from 2014 to 2019. Clinical data, echocardiographic and tomographic studies were evaluated, as well as characteristics of the intervention and events in 30 days. A value of p<0.05 was considered statistically significant. RESULTS: We found a high prevalence of aortic aneurysm (56.5%), with a mean diameter of 46.9±10.2 mm. Major aortic regurgitation was found in 25.1% and major aortic stenosis in 54.9%. Isolated aortic valve surgery was performed in 48.2%, isolated aortic surgery in 6.7% and combined surgery in 45.1%. The 30-day mortality was 8.2%. In the multivariate analysis, the predictors of the combined outcome at 30 days (death, atrial fibrillation and reoperation) were age (OR 1.044, 95% CI 1.009-1.081, p=0.014) and left ventricular mass index (OR 1.009, 95% CI 1.000-1.018, p=0.044). CONCLUSION: Patients with BAV approached in our service have a higher incidence of aortopathy, with the additional need to evaluate the aorta with computed tomography or magnetic resonance imaging.

FUNDAMENTO: A válvula aórtica bicúspide (VAB) atinge de 0,5 a 2% da população e está associada a alterações valvares e de aorta. Há carência de estudos sobre o perfil desses pacientes na população brasileira. OBJETIVO: Descrever o perfil de pacientes com VAB submetidos à cirurgia valvar e/ou de aorta em um centro cardiológico terciário, assim como os desfechos relacionados à intervenção. MÉTODOS: Coorte retrospectiva incluindo 195 pacientes (idade média 54±14 anos, 73,8% do sexo masculino) com diagnóstico de VAB submetidos à abordagem cirúrgica (valvar e/ou de aorta) no período de 2014 a 2019. Foram avaliados dados clínicos, ecocardiográficos e tomográficos, além das características da intervenção e eventos em 30 dias. O valor de p<0,05 foi considerado estatisticamente significante. RESULTADOS: Encontramos alta prevalência de aneurisma de aorta (56,5%), com diâmetro médio de 46,9±10,2 mm. Insuficiência aórtica importante foi encontrada em 25,1% e estenose aórtica importante em 54,9%. Cirurgia isolada em valva aórtica foi realizada em 48,2%, cirurgia isolada de aorta em 6,7% e cirurgia combinada em 45,1%. A mortalidade em 30 dias foi de 8,2%. Na análise multivariada, os fatores preditores de desfecho combinado em 30 dias (morte, fibrilação atrial e reoperação) foram idade (OR 1,044, IC 95% 1,009-1,081, p=0,014) e o índice de massa do ventrículo esquerdo (OR 1,009, IC 95% 1,000-1,018, p=0,044). CONCLUSÃO: Pacientes com VAB abordados no nosso serviço apresentam uma maior incidência de aortopatia, com a necessidade adicional de avaliação da aorta com tomografia computadorizada ou ressonância magnética.

COVID-19, congenital heart disease, and pregnancy: dramatic conjunction-case report.

BACKGROUND: Epidemiological data from the COVID-19 pandemic report that patients with pre-existing cardiovascular disease have worse outcomes and higher mortality, and that pregnant women should be considered at high risk. CASE SUMMARY: A 25-year-old pregnant woman on the waiting list for a heart transplant, with a history of complete atrioventricular canal surgery, mitral mechanical prosthetic implant (St Jude-27), and cardiac resynchronization therapy (Boston Scientific) was hospitalized at 30 weeks of gestation for treatment of heart failure. After 7 days of hospitalization, she had a positive RT-PCR test for severe acute respiratory syndrome coronavirus 2 with progressive worsening of her clinical condition and acute foetal distress. Hence emergency caesarean section was performed. After the birth, the patient required mechanical ventilation, progressing to multiple organ system failures. Conventional inotropic drugs, antibiotics, and mechanical ventilation for 30 days in the intensive care unit provided significant clinical, haemodynamic, and respiratory improvement. However, on the 37th day, she suddenly experienced respiratory failure, gastrointestinal and airway bleeding, culminating in death. DISCUSSION: Progressive physiological changes during pregnancy cause cardiovascular complications in women with severe heart disease and higher susceptibility to viral infection and severe pneumonia. COVID-19 is known to incite an intense inflammatory and prothrombotic response with clinical expression of severe acute respiratory syndrome, heart failure, and thromboembolic events. The overlap of these COVID-19 events with those of pregnancy in this woman with underlying heart disease contributed to an unfortunate outcome and maternal death.

Aneurisma do seio de valsava associado a fistula aortocavitária: relato de caso Kirschbaum, Marcelo / Valsava sinus aneurysm associated with aortocavitary fistula: case report

INTRODUÇÃO: Aneurisma do Seio de Valsalva é uma condição rara, geralmente congênita, primeiramente descrita em 1839 e tratada com sucesso pela primeira vez em 1950 por Morrow e col. Tem a incidência de 0,14% a 0,96% dos pacientes submetidos a cirurgia cardíaca de acordo com alguns estudos realizados em instituições de referência. De acordo com um estudo realizado por Takach et al., sua incidência em 50 anos de experiência foi de 0,14% dos casos submetidos a cirurgia cardíaca na instituição. Nesta casuística acometeu predominantemente homens, podendo ser assintomáticos ou oligossintomáticos, cursando com quadro de insuficiência cardíaca (IC), podendo cursar com piora súbita dos sintomas, decorrente geralmente de ruptura e formação de fístula com alguma cavidade cardíaca, sendo o ventrículo direito é a cavidade mais frequentemente acometida. O tratamento da condição é cirúrgico. DESCRIÇÃO DO CASO A.C.L., 37 anos, masculino, sem doenças crônicas, histórico de tromboembolismo pulmonar (TEP) em novembro/2017, o paciente foi admitido com quadro de insuficiência cardíaca e rápida piora da classe funcional. Realizou Angiotomografia de tórax não evidenciando novo evento tromboembólico, seguido de ecocardiograma transtorácico que revelou disfunção sistólica biventricular com achado de aneurisma roto de seio coronariano e refluxo aórtico importante, hipertensão pulmonar moderada e derrame pericárdico difuso. Procedida a realização de complementação transesofágica, que confirmou a rotura do anel com formação de fístula comunicando com ventrículo esquerdo medindo 22 por 11 mm, com refluxo de grau importante e forame oval patente (FOP) e trombo em apêndice atrial esquerdo. Ressonância cardíaca revelou aneurisma de seio coronariano esquerdo com fistulização para cavidade, achado também evidenciado em angiotomografia de aorta. Paciente submetido a cirurgia de troca de válvula aórtica por prótese biológica com reconstrução de raiz de aorta e fechamento do FOP, associado a remoção de trombo e exclusão de auriculeta esquerda, com boa evolução pós operatória e apresentando melhora importante da sintomatologia, recebendo alta para seguimento ambulatorial. CONCLUSÃO: Aneurisma de seio de Valsava é uma alteração congênita rara que pode cursar fistula aorto-cavitária levando a um quadro grave de IC que, se não identificado, pode evoluir de maneira desfavorável. (AU)

Characteristics of training and motivation of physicians working in emergency medicine.

INTRODUCTION:: Emergency medicine is an area in which correct decisions often need to be made fast, thus requiring a well-prepared medical team. There is little information regarding the profile of physicians working at emergency departments in Brazil. OBJECTIVE:: To describe general characteristics of training and motivation of physicians working in the emergency departments of medium and large hospitals in Salvador, Brazil. METHOD:: A cross-sectional study with standardized interviews applied to physicians who work in emergency units in 25 medium and large hospitals in Salvador. At least 75% of the professionals at each hospital were interviewed. One hospital refused to participate in the study. RESULTS:: A total of 659 physicians were interviewed, with a median age of 34 years (interquartile interval: 29-44 years), 329 (49.9%) were female and 96 (14.6%) were medical residents working at off hours. The percentage of physicians who had been trained with Basic Life Support, Advanced Cardiovascular Life Support and Advanced Trauma Life Support courses was 5.2, 18.4 and 11.0%, respectively, with a greater frequency of Advanced Cardiovascular Life Support training among younger individuals (23.6% versus 13.9%; p<0.001). Thirteen percent said they were completely satisfied with the activity, while 81.3% expressed a desire to stop working in emergency units in the next 15 years, mentioning stress levels as the main reason. CONCLUSION:: The physicians interviewed had taken few emergency immersion courses. A low motivational level was registered in physicians who work in the emergency departments of medium and large hospitals in Salvador.

Characteristics of training and motivation of physicians working in emergency medicine

Summary Introduction: Emergency medicine is an area in which correct decisions often need to be made fast, thus requiring a well-prepared medical team. There is little information regarding the profile of physicians working at emergency departments in Brazil. Objective: To describe general characteristics of training and motivation of physicians working in the emergency departments of medium and large hospitals in Salvador, Brazil. Method: A cross-sectional study with standardized interviews applied to physicians who work in emergency units in 25 medium and large hospitals in Salvador. At least 75% of the professionals at each hospital were interviewed. One hospital refused to participate in the study. Results: A total of 659 physicians were interviewed, with a median age of 34 years (interquartile interval: 29-44 years), 329 (49.9%) were female and 96 (14.6%) were medical residents working at off hours. The percentage of physicians who had been trained with Basic Life Support, Advanced Cardiovascular Life Support and Advanced Trauma Life Support courses was 5.2, 18.4 and 11.0%, respectively, with a greater frequency of Advanced Cardiovascular Life Support training among younger individuals (23.6% versus 13.9%; p<0.001). Thirteen percent said they were completely satisfied with the activity, while 81.3% expressed a desire to stop working in emergency units in the next 15 years, mentioning stress levels as the main reason. Conclusion: The physicians interviewed had taken few emergency immersion courses. A low motivational level was registered in physicians who work in the emergency departments of medium and large hospitals in Salvador.

Papel da reabilitação cardiovascular no tratamento da doença arterial coronariana estável / Role of cardiovascular rehabilitation in the treatment of stable coronary artery disease

As doenças cardiovasculares representam grande problema de saúde pública no Brasil e no mundo, visto que correspondem a maior causa de morbimortalidade, além de corresponder a altos custos em assistência médica. A doença arterial coronariana, entidade de caráter multifatorial, vem apresentando crescimento progressivo no último século, em virtude do aumento dos fatores de risco modificáveis e não modificáveis, principalmente no que concerne ao envelhecimento populacional...