Biomedical subjects
Publications and source records attributed to L Branco.
Multiple coronary aneurysms are rare. We report a case of a 56 year-old patient and make a state of the art on this subject, discussing etiologic and pathogenic considerations versus clinical and therapeutic aspects.
STUDY OBJECTIVE: Characterization of the arrhythmic profile of idiopathic dilated cardiomyopathy (DMC); Evaluation of the relation of complex ventricular ectopy and cardiac dysfunction; Clinical outcome. PATIENTS: We studied 20 patients (P) with idiopathic DCM, 15 males P and 5 female P, mean age 51.3 +/- 17.4 years (between 17 and 75 years). MATERIAL AND METHODS: 24-hours Holter study and left cardiac catheterization with ventriculography were performed. Patients were followed at the consults. RESULTS: We detected in the Holter study the presence of ventricular ectopy in 19 P (95%). Nine P had complex ventricular arrhythmias (45%), 10 P had simple ventricular arrhythmias (50%) and 1 P had no ventricular arrhythmia (5%). The mean left ventricular ejection fraction was 28.6 +/- 14.1% (12 to 44%). Two groups were defined based on the severity of left ventricular dysfunction: Group I with 12 P and Group II with 8 P. In Group I, 8 P had complex ventricular ectopy and, in Group II, 1 P had complex ventricular ectopy (p < 0.05). Comparing mean left ventricular ejection fraction in the two groups of arrhythmias (simple and complex), 33.9 +/- 12.5% and 22.1 +/- 13.8%, we found out a statistically significant difference (p < 0.05). After an eight to thirty six months of follow-up, a greater number of cardiac events (mortality, transplant) were detected in the groups of complex arrhythmia and of more severe cardiac dysfunction. CONCLUSIONS: We conclude that there is a high frequency of ventricular arrhythmias in this group of patients with idiopathic DCM. Complex ventricular arrhythmias were more frequently associated to more severe left ventricular dysfunction. The number of cardiac events at follow-up was higher in patients with complex ventricular arrhythmias and in those with more depressed cardiac function.
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There is some controversy regarding the indications for transesophageal echocardiography in patients with suspected systemic embolism. The present case report refers to a 65 year old male admitted to the hospital for ischemic acute cerebrovascular accident, which was confirmed by cerebral computerized tomography. A transthoracic echocardiogram was performed showing right atrial and ventricular dilatation. A transesophageal echocardiogram was also performed to exclude thromboembolism and clarify dilatation of the right cavities. Mild spontaneous echocontrast was present in the left atrium without images of thrombus; an interatrial septal aneurysm with patent foramen ovale was found with right to left flow; an image compatible with a very mobile, large, proximal thrombus in the main pulmonary artery was observed. A venous duplex scan was performed, demonstrating venous thrombosis in the right popliteal and femoral veins. Pulmonary arteriography showed a large thrombus in the right pulmonary branch extending to the median lobe and a smaller thrombus in the left pulmonary branch. Apparently, the patient had no predisposing factors for thromboembolism. Full-dose heparin was started followed by oral anticoagulation. An inferior vena cava filter was implanted. At hospital discharge the pulmonary thrombus had disappeared and the right cardiac cavities had returned to normal size. The interatrial aneurysm had disappeared and foramen ovale was no longer patent. After 36 months of clinical follow up on oral anticoagulation, the patient remains asymptomatic without neurological sequelae nor respiratory distress.
The authors report a case of congestive heart failure as a consequence of traumatic postlumbar laminectomy arteriovenous fistula. A 49 years old female with the diagnosis of atrial septal defect was admitted at the hospital, complaining of dyspnea and peripheral edema. A hemodynamic study was performed and an arteriovenous fistula was detected between the iliac artery and vein, and arterial septal defect was excluded. Surgery for fistula closure was performed with great clinical improvement.
Myotonic dystrophy may have several cardiovascular abnormalities. We report a case in which the cardiac changes that can be found in this disease. Finally, we make a revision of the cardiac changes that can be found in this disease.