RESUMO
OBJECTIVE: To assess the changes in ventricular evoked responses (VER) produced by the decrease in left ventricular outflow tract gradient (LVOTG) in patients with hypertrophic obstructive cardiomyopathy (HOCM) treated with dual-chamber (DDD) pacing. METHODS: A pulse generator Physios CTM (Biotronik, Germany) was implanted in 9 patients with severe drug-refractory HOCM. After implantation, the following conditions were assessed: 1) Baseline evaluation: different AV delay (ranging from 150 ms to 50 ms) were sequentially programmed during 5 to 10 minutes, and the LVOTG (as determined by Doppler echocardiography) and VER recorded; 2) standard evaluation, when the best AV delay (resulting in the lowest LVOTG) programmed at the initial evaluation was maintained so that its effect on VER and LVOTG could be assessed during each chronic pacing evaluation. RESULTS: LVOTG decreased after DDD pacing, with a mean value of 59 +/- 24 mmHg after dual chamber pacemaker, which was significantly less than the gradient before pacing (98 + 22 mmHg). An AV delay > 100 ms produced a significantly lower decrease in VER depolarization duration (VERDD) when compared to an AV delay < or = 100 ms. Linear regression analyses showed a significant correlation between the LVOTG values and the magnitude of VER (r = 0.69; p < 0.05) in the 9 studied patients. CONCLUSION: The telemetry obtained intramyocardial electrogram is a sensitive means to assess left ventricular dynamics in patients with HOCM treated with DDD pacing.
Assuntos
Cardiomiopatia Hipertrófica/fisiopatologia , Marca-Passo Artificial , Adolescente , Adulto , Cardiomiopatia Hipertrófica/terapia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-IdadeRESUMO
A 17 year old girl was asymptomatic until 3 months ago, when she noticed palpitations and chest pain. Physical examination revealed a systolic murmur + + +/6 in the pulmonary area. Chest X-ray showed discrete dilatation of the pulmonary trunk and the electrocardiogram a first degree heart block. The diagnosis of myxoma was established after echocardiogram and cardiac catheterization when a mobile cardiac mass was identified in the right ventricular outflow tract. The tumor was removed using extracorporeal circulation and the ventricular access through the right atrium. After a 16 month follow-up the patient is dealing a normal life and there are no signs of recurrence.
Assuntos
Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Adolescente , Diagnóstico Diferencial , Ecocardiografia , Feminino , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Humanos , Mixoma/cirurgia , Estenose da Valva Pulmonar/diagnósticoRESUMO
Three cases of gunshot wounds of the chest are reported, in each of which a bullet was retained within the heart. Although it is rare, the surgeon should consider this possibility if the missile overlies the cardiac silhouette on the plain chest radiograph. Fluoroscopy played an important part in confirming the diagnosis. Cardiopulmonary bypass was used in all cases and provides operating circumstances that improve the prospects of success.
Assuntos
Traumatismos Cardíacos/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Feminino , Coração/diagnóstico por imagem , Traumatismos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Radiografia , Ferimentos por Arma de Fogo/diagnóstico por imagemRESUMO
Os autores apresentam sua experiencia inicial em 100 pacientes com traumatismo toracico, admitidos no Hospital Sao Vicente de Paula no periodo de agosto de 1979 a janeiro de 1981. Discutem os principios gerais no atendimento a estes pacientes,as situacoes especificas e enfatizam a necessidade de drenagem pleural adequada, da toracotomia imediata na persistencia de hemorragia e choque apesar do tratamento inicial, e que especial atencao deve ser dada as lesoes associadas, pois aqui contribuiram com 45% dos obitos de um total de 11 pacientes
Assuntos
Humanos , Traumatismos Torácicos , Drenagem , Cirurgia TorácicaRESUMO
Sao apresentados dois casos de fistula arterio-venosa apos ferimento penetrante na regiao cervico-toracica. A necessidade do diagnostico preciso e precoce, bem como a correta abordagem cirurgica nesta situacao sao discutidos