Papillary fibroelastoma of the mitral valve in a 3-year-old child: case report.

A 3.5-year-old boy with stroke secondary to embolization of a primary cardiac tumor is presented. The diagnosis was made by two-dimensional echocardiography and confirmed intraoperatively. A papillary fibroelastoma was identified histologically. It is a rare condition and a diagnostic challenge, as patients are asymptomatic before embolization. In view of the severe consequences, prompt surgery is recommended.

[Percutaneous closure of patent ductus arteriosus with the Rashkind device]. / Encerramento do canal arterial por via percutânea com o dispositivo de Rashkind.

PURPOSE: To assess the efficacy and safety of the percutaneous closure of the persistent ductus arteriosus with the Rashkind device. DESIGN: Clinical, angiographic and echocardiographic assessment of the patency of the ductus arteriosus at the time of the implantation of the first or second Rashkind device, followed by clinical and echocardiographic control at one, three and six months and yearly thereafter. PATIENTS: Thirty two patients with patent ductus arteriosus. Twenty seven were female and five male. Their ages ranged between 10 months and 33 years (6.8 +/- 7.7 years) and their weights between 7.3 and 52 (20.1 +/- 12.4) kg. Two patients were excluded due to a ductal diameter greater than 8 mm. Thirty patients had successful device implantation. METHODS: Implantation at cardiac catheterization of the Rashkind double umbrella occluder device in the narrowest portion of the patent ductus arteriosus. Twenty one patients had one device implanted and five had the implantation of a second device four to 12 months later, due to persistent patency of the ductus. RESULTS: Total closure was achieved in 26 out of 30 patients. In 21 patients the occlusion was obtained with a single device and in five patients with two devices. Among the remaining four patients, one is awaiting the implantation of a second device and the other three are under follow-up as their first devices were implanted recently. There were no complications. CONCLUSIONS: Percutaneous closure of the ductus arteriosus with the Rashkind device represents an efficient and safe alternative to surgery in most patients.

[Lymphangioma of the mediastinum as a cause of chylopericardium]. / Linfangioma mediastínico como causa de quilopericárdio.

Chylopericardium is a rare from of pericardial effusion. A case of a ten-year-old female patient with a chylopericardium incidentally detected during a mild respiratory infection through cardiac enlargement at the chest X ray is reported. The techniques used to achieve this diagnosis are described, a special emphasis being put on the CT-scan and lymphangiography, which have not been used in such cases so far. These techniques provided very useful data which were determinant for the success of the proposed therapy. This and other cases reported in the paper indicate that the most common cause of primary chylopericardium is a mediastinal lymphangioma.

[Aortic valve stenosis without apparent "gradient". Demonstration and treatment in heart catheterization]. / Estenose valvular aórtica sem "gradiente" aparente. Demonstração e tratamento no cateterismo cardíaco.

The case of a six years-old girl with Ductus Arterious, Pulmonary Hypertension, Aortic Stenosis and poor left ventricular function is presented. No aortic valvular gradient could be found on a simple aortic and left ventricular pressure measurement, but it could be recorded when transvalvular aortic flow was increased while the Ductus Arteriosus was occluded with a balloon. This manoeuver forced an increase in pulmonary blood flow by avoiding right-to-left ductal shunting, thus increasing the venous return to the left heart and across the aortic valve. The aortic valve stenosis was subsequently relieved by percutaneous balloon valvuloplasty performed in two separate instances. This was thought to be particularly indicated in this case, considering the high risks of open-heart surgery.