RESUMO
Evaluamos los efectos de la hipertrofia ventricular izquierda sobre la función diastólica del ventrículo izquierdo y derecho, usando mediciones del tiempo de relajación isovolumétrica con ecocardiografía Doppler. Estudiamos 28 pacientes, 14 con hipertrofia ventricular izquierda secundaria a hipertensión arterial (Grupo 1), y 14 con cardiomiopatía hipertrófica idiopática (Grupo 2). Calculamos el tiempo de relajación isovolumétrica izquierdo y derecho a partir de intervalos medidos por ecocardiografía Doppler, también realizamos estudios hemodinámicos y de angiografía coronaria. El tiempo de relajación isovolumétrica izquierdo estuvo prolongado en 13 pacientes del Grupo 1 y 12 pacientes del Grupo 2. En el Grupo 1, la prolongación del mismo tiempo estuvo asociado a hipertensión pulmonar y/o la presencia de estenosis en la arteria coronaria derecha. En el Grupo 2, la prolongación del tiempo de relajación isovolumétrica derecho no correlacionó con hipertensión púlmonar, estenosis de la arteria coronaria derecha, o grosor del septum interventricular. Concluímos que el tiempo de relajación isovolumétrica izquierdo y derecho puede estar prolongado en presencia de hipertrofia ventricular izquierda. Aunque el tiempo de relajación isovolumétrica derecho puede estar prolongado en hipertrofia ventricular izquierda secundaria a hipertensión, el tiempo está afectado por factores hemodinámicos o asociados a estenosis de la arteria coronaria derecha. En cardiomiopatía hipertrófica, otros mecanismos como función miocárdica dañada o alteración en la geometría ventricular derecha, parecen ser los responsables.
Assuntos
Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Pacientes , Hipertrofia , Relaxamento/métodos , Ventrículos do Coração , Cardiomiopatia Hipertrófica , Ecocardiografia , HipertensãoRESUMO
Two cases of coronary arteriovenous fistulae are reported. In the first case, the right coronary artery (RCA) drained into the right ventricular outflow tract, and the distal RCA filled through a branch of the left anterior descending coronary artery. In the second case, the RCA drained into the right atrium and filled through a branch of the left circumflex artery. The fistulae were closed with subcoronary mattress sutures that preserved the continuity of the native circulation.
RESUMO
We offer a comprehensive classification of coronary artery anomalies, together with angiographic examples of each entity. Minimal requirements for normality include the following criteria: (1) the dual aortic origin is from right and left coronary ostia; (2) the course of the right coronary artery follows the right atrioventricular groove; (3) the course of the left coronary artery follows the left atrioventricular groove and anterior interventricular groove; (4) the posterior descending branch originates from either the right or left coronary artery; (5) the major coronary branches flow epicardially; and (6) the coronary arteries terminate at the myocardial capillary level. This conception of "normal" coronary arteries has determined the classification of abnormalities presented here. Early and correct diagnosis of anomalies that may compromise the myocardial blood supply is stressed, and possible surgical solutions are offered. Selective coronary angiography is the technique of choice for precise visualization of the coronary artery system.
RESUMO
A patient with aortic regurgitation, stenosis, and calcification of the septum is reported. Results of echocardiography revealed asymmetrical septal hypertrophy without other features of idiopathic hypertrophic subaortic stenosis. There was no subaortic obstruction evident on cardiac catheterization and angiography. This case serves to emphasize that calcification of the interventricular septum is another possible cause of asymmetrical septal hypertrophy.
RESUMO
A 55-year-old man was referred for the evaluation of frequent chest pain and syncope. While in the hospital, he experienced severe chest pain accompanied by transient ST segment elevation and a slight elevation of cardiac enzyme levels. Multiple coronary arteriograms were recorded at various times during an interval of 2 months. On one occasion, the results were normal; on another occasion, they showed total occlusion of the left anterior descending, diagonal, and circumflex coronary arteries. The occlusion was completely relieved with sublingual nitroglycerin. Because the patient's clinical condition deteriorated rapidly, double aortocoronary saphenous vein bypass was performed to the left anterior descending and circumflex coronary arteries. During the induction of anesthesia, ventricular fibrillation occurred, and the patient died from refractory recurrent fibrillation 4 hours after surgery. Postmortem examination revealed normal coronary arteries, patent vein grafts, and multiple focal areas of recent and old myocardial fibrosis. Thus, it appears that coronary spasm, in the presence of otherwise normal coronary arteries, can produce myocardial infarction with necrosis, and that medical management may provide a more successful method of treating such patients.
RESUMO
In an attempt to clarify some of the controversy regarding the concepts of myocardial ischemia, various cardiac pathologies are presented to demonstrate several of the unusual mechanisms involved in the causes of transient ischemic events of the myocardium. A review of the literature is presented, with a discussion of the current approach to managing these unusual clinical conditions.
RESUMO
An unusual case of a middle-aged male with segmental aortitis and aortic incompetence is described. To our knowledge, only 13 cases have been previously described in the literature, but only two have had anatomopathological confirmation. Aortic incompetence is a rare manifestation of segmental aortitis. Although intrinsic abnormalities of the aortic valve have been proposed, the finding of a normal aortic valve at postmortem examination in 2 of the 3 cases in which the aortic valve was examined, supports the premise that the incompetence is probably secondary to disproportionate dilatation of the aortic root.
