RESUMO
BACKGROUND: Acute aortic syndrome is the modern term that includes aortic dissection, intramural hematoma, and symptomatic aortic ulcer. Iatrogenic coronary artery dissection extending to the aorta during percutaneous coronary intervention is a very rare but life-threatening complication. Despite some reports of spontaneous recovery, most of these patients are treated surgically as a spontaneous aortic dissection, especially if there is a complication of the aortic lesion. CASE REPORT: A 52-year-old white female was submitted to an angioplasty in the right coronary without success and the procedure was complicated by a dissection in aortic root with progressive extension to the ascending aorta. This lesion deformed the aortic valve, leaving it with an acute moderate regurgitation. Because of current use of clopidogrel and clinical stability of the patient, the local Heart Team decided to withdrawn this antiplatelet for 5 days before surgery despite the risk related to the aortic syndrome. A new echocardiogram 3 days later showed that the hematoma was reabsorbed with improvement of the aortic insufficiency. An angiotomography confirmed the reabsorption of the hematoma. The surgery was canceled and the patient was maintained in a conservative treatment and discharged. Seventeen months later, she was re-evaluated and was still asymptomatic without aortic regurgitation in the echocardiogram and showing progressive regression of the aortic hematoma in the tomography. CONCLUSIONS: Despite the conservative treatment, this case of iatrogenic aortic dissection complicated by an acute aortic regurgitation had a good evolution in a follow-up of 17 months.
Assuntos
Síndrome Coronariana Aguda/cirurgia , Aneurisma da Aorta Torácica/etiologia , Dissecção Aórtica/etiologia , Insuficiência da Valva Aórtica/complicações , Intervenção Coronária Percutânea/efeitos adversos , Doença Aguda , Dissecção Aórtica/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Insuficiência da Valva Aórtica/diagnóstico , Angiografia Coronária , Ecocardiografia Transesofagiana , Feminino , Humanos , Pessoa de Meia-Idade , Remissão Espontânea , Síndrome , Tomografia Computadorizada por Raios XRESUMO
When food is available recurrently at a particular time of day, several species increase their locomotion in the hours that precede food delivery, a phenomenon called food anticipatory activity (FAA). In mammals, many studies have shown that FAA is driven by a food-entrained circadian oscillator (FEO) that is distinct from the light-entrained pacemaker in the suprachiasmatic nucleus of the hypothalamus. Few studies have investigated the effect of sugar ingestion on food anticipatory rhythms and the FEO. We aimed to extend the understanding of the role of glucose on the emergence of food anticipatory rhythms by investigating whether glucose ingestion is sufficient to produce daily food anticipation, reflected by motor activity and core body temperature rhythms. Under a 12 h/12 h light/dark cycle, chow-deprived rats had glucose solution available between Zeitgeber Time (ZT) 6 and ZT 9 for 10 days (glucose restriction group), whereas control animals had chow available within the same time window (chow restriction group). Animals in both groups exhibited anticipatory motor activity and body temperature around the fourth day of the scheduled food restriction. Glucose-fed rats ingested ~15 kcal on the days immediately before FAA emergence and reached an intake of ~20 kcal/day, whereas chow-fed rats ingested ~40 kcal/day. The glucose restriction group exhibited a pattern of food anticipation (activity and temperature) that was extremely similar to that observed in the chow restriction group. We conclude that glucose ingestion is a sufficient temporal cue to produce recurrent food anticipation, reflected by activity and temperature rhythms, in rats.
Assuntos
Animais , Ratos , Fenômenos Fisiológicos da Nutrição Animal , Comportamento Animal , Temperatura Corporal , Ritmo Circadiano , GlucoseRESUMO
When food is available recurrently at a particular time of day, several species increase their locomotion in the hours that precede food delivery, a phenomenon called food anticipatory activity (FAA). In mammals, many studies have shown that FAA is driven by a food-entrained circadian oscillator (FEO) that is distinct from the light-entrained pacemaker in the suprachiasmatic nucleus of the hypothalamus. Few studies have investigated the effect of sugar ingestion on food anticipatory rhythms and the FEO. We aimed to extend the understanding of the role of glucose on the emergence of food anticipatory rhythms by investigating whether glucose ingestion is sufficient to produce daily food anticipation, reflected by motor activity and core body temperature rhythms. Under a 12 h/12 h light/dark cycle, chow-deprived rats had glucose solution available between Zeitgeber Time (ZT) 6 and ZT 9 for 10 days (glucose restriction group), whereas control animals had chow available within the same time window (chow restriction group). Animals in both groups exhibited anticipatory motor activity and body temperature around the fourth day of the scheduled food restriction. Glucose-fed rats ingested ~15 kcal on the days immediately before FAA emergence and reached an intake of ~20 kcal/day, whereas chow-fed rats ingested ~40 kcal/day. The glucose restriction group exhibited a pattern of food anticipation (activity and temperature) that was extremely similar to that observed in the chow restriction group. We conclude that glucose ingestion is a sufficient temporal cue to produce recurrent food anticipation, reflected by activity and temperature rhythms, in rats.(AU)
Assuntos
Animais , Ratos , Ritmo Circadiano , Fenômenos Fisiológicos da Nutrição Animal , Comportamento Animal , Temperatura Corporal , GlucoseRESUMO
The effect of dobutamine on carotid and brachial arteries compliance and the association of L-arginine as a potential nitric oxide pathway restorer were evaluated in patients with heart failure. Twenty-seven outpatients participated. Drugs used for the treatment of heart failure were withheld at least 24 hours before the study. The carotid and brachial artery diameters and hemodynamic variables were evaluated by ultrasonography and Doppler in baseline conditions, with dobutamine, with flow-mediated dilatation (FMD), and with placebo or L-arginine alone and associated with dobutamine. There was a significant increase in carotid peak blood flow with dobutamine when compared with that at baseline (P = 0.0001) or with L-arginine or placebo (P = 0.0001 and P = 0.0001, respectively), with increase of the cardiac index (P = 0.0001). Dobutamine did not increase carotid arterial compliance. FMD significantly increased the brachial peak blood flow (P = 0.0022) and the artery diameter (P = 0.0001). Dobutamine did not change the brachial artery diameter. Brachial peak blood flow was increased with dobutamine alone or associated with placebo or L-arginine comparing with L-arginine or placebo alone (P = 0.0168 and P = 0.0140, respectively), but was not increased compared with that at baseline. L-arginine infusion was not associated with changes in carotid, brachial, or in the cardiac index. We concluded that dobutamine increased carotid peak blood flow in patients with heart failure, although without changing the arterial compliance. The FMD of brachial artery was maintained, while brachial artery response to dobutamine infusion was less reliable. The carotid artery may be under the direct influence of the heart, while the brachial artery may be under predominant local control.
Assuntos
Arginina/administração & dosagem , Artéria Braquial/efeitos dos fármacos , Artéria Braquial/fisiopatologia , Dobutamina/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Braquial/diagnóstico por imagem , Quimioterapia Combinada , Módulo de Elasticidade/efeitos dos fármacos , Técnicas de Imagem por Elasticidade/métodos , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Resistência Vascular/efeitos dos fármacos , Vasodilatadores/administração & dosagemRESUMO
O presente caso relata uma anomalia congênita (1:14.000 necropsias) e de difícil diagnóstico, visto que os portadores dessa anomalia, geralmente são assintomaticos: a agenesia do pericárdio. O diagnóstico baseado no tripé: radiografia de tórax, ecodopplercardiograma e tomografia computadorizada ou ressonância magnética de tórax deve ser sempre lembrando, uma vez que a patologia oferece risco de evolução para evento cardíaco agudo potencialmente letal, quando de sua apresentação parcial.
Assuntos
Humanos , Masculino , Criança , Cardiopatias Congênitas/genética , Ecocardiografia/métodos , Ecocardiografia , Espectroscopia de Ressonância Magnética , Pericárdio/anormalidades , Radiografia Torácica , TomografiaRESUMO
Objetivo: Avaliar a correlação entre insuficiência mitral (IM)e alterções na resposta eletrocardiográfica do teste egométrico, em portadores de prolapso valvar mitral. Método: Estudou-se 189 portadores de prolapso mitral através de ecocardiograma e teste de esforço. 57 por cento do sexo feminino, idade média de 39,1(+ 12 anos), com função ventricular normal, ausência de quaisquer outras valvopatias ou de miocardiopatias e sem histórico prévio de doença arterial coronária. A presença de infradesnível do segmento ST(morfologia horizontal e descendente) e arritmias supraventriculares, definiram um desfecho primário composto. Alterações morfológicas do segmento ST e arritmias (supraventriculares ou ventriculares) foram considerados desfechos secundários, quando avaliados de forma independente. Resultados: 36 pacientes (19 por cento) apresentaram o desfecho composto, sendo 21 com IM(P=0,06). 84 pacientes (44,4 por cento) apresentaram IM. 11 pacientes apresentaram alterações morfológicas do segmento ST, destes, 8 apresentaram IM(P=0,05). Dos 107 pacientes (56,6 por cento) com degenerção mixomatosa, 21 apresentaram o desfecho composto (P=0,81). 31 pacientes (16,4 por cento) apresentaram arritmias supraventriculares ou ventriculares isoladas e raras durante o teste ergométrico, sendo 18 com IM(P=0,95). Conclusão: A presença de insuficiência mitral, no portador de prolapso valvar mitral, foi predictiva de alterações morfológicas do eletrocardiograma no teste ergométrico.
Assuntos
Humanos , Masculino , Feminino , Adulto , Insuficiência da Valva Mitral/diagnóstico , Prolapso da Valva Mitral/diagnóstico , Teste de Esforço/métodosRESUMO
BACKGROUND: Noninvasive detection of coronary allograft vasculopathy is still challenging. To determine the accuracy of myocardial contrast echocardiography (MCE) in detecting coronary allograft vasculopathy after heart transplantation, we studied 35 asymptomatic patients (30 men, aged 46 +/- 12.7 years) with normal left ventricular function. METHODS: Patients underwent MCE with continuous contrast (perfluorocarbon-exposed sonicated dextrose albumin) administration. Images were obtained at baseline and during peak dobutamine (up to 40 mg/kg/min) with intermittent harmonic imaging. Areas failing to increase contrast enhancement during peak stress were regarded as abnormal. Coronary artery obstructions greater than 50% at angiography were considered significant. RESULTS: Seven out of 10 patients with coronary artery disease had a positive MCE and one patient with a positive MCE had no angiographically detected disease (sensitivity = 70%, specificity = 96%, accuracy = 88.6%). Agreement between the vascular territory and perfusion defects was good for the left anterior descending coronary artery (kappa = 0.56), but not for other arteries. Although 5 patients had multivessel disease, multiple perfusion defects were detected in only one patient. CONCLUSION: MCE showed good accuracy in detecting the presence of coronary allograft vasculopathy after heart transplantation; however, it failed to identify the extent of the disease.
Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Ecocardiografia , Transplante de Coração , Adolescente , Adulto , Idoso , Pressão Sanguínea , Cardiomiopatias/cirurgia , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/cirurgia , Sensibilidade e Especificidade , Transplante Homólogo , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
OBJECTIVE: To compare myocardial contrast echocardiography (MCE) using PESDA and adenosine in bolus (ADN) with myocardial nuclear scintigraphy (NS) in patients (pts) undergoing routine investigation with a high probability of having coronary artery disease. METHODS: This study comprised 125 pts (85 men) with 58.4 +/- 10.6 years, who underwent MCE and NS within 4 weeks. MCE was performed with PESDA in a continuous infusion at rest and after administration of an adenosine bolus. The LV walls was divided into 3 territories related to the coronary arteries, in a total of 375 territories. MCE was normal when an increase in contrast intensity occurred after ADN. The reduction in contrast intensity at rest or after ADN was defined as an abnormal MCE result. NS was performed according to classical protocols. When compared per patient, both examinations were considered concordant when they were normal or abnormal, independent of its location. The comparison by territory was considered concordant when perfusion defects existed or not in the same territory. The chi-square test was used to determine the significance of concordance. RESULTS: In 106/125 pts, MCE and NS were concordant (84.8% - P < 0.001). Concordance occurred in 342/375 territories (91.2% - P < 0.001). For the LAD territory, concordance was 87.2%; for the RCA, 93.6%; and for the CX, 92.8% (P < 0.001). CONCLUSION: An excellent concordance exists between MCE and NS in assessing pts for coronary artery disease; therefore, MCE may represent a good alternative for assessing myocardial perfusion.
Assuntos
Meios de Contraste , Doença da Artéria Coronariana/diagnóstico por imagem , Tecnécio Tc 99m Sestamibi , Adenosina , Albuminas , Ecocardiografia/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , CintilografiaRESUMO
OBJETIVO: Comparar a ecocardiografia de contraste miocárdico (ECM) usando PESDA e adenosina em bolus (ADN) com a cintilografia miocárdica com radioisótopos (CM) em pacientes (pts) submetidos a investigação e alta probabilidade de doença arterial coronariana. MÉTODOS: Foram estudados 125 pts, 58,4 ± 10,6 anos, 85 homens, com ECM e CM, realizados com intervalo máximo de 4 semanas. ECM foi realizada com PESDA em infusão contínua em repouso e após ADN. As paredes do VE foram divididas em 3 territórios relacionados às artérias coronarianas, totalizando 375 territórios. ECM foi normal quando houve aumento da intensidade do contraste após ADN. Diminuição da intensidade do contraste em repouso ou após ADN foi definida como ECM anormal. CM foi realizada usando protocolos clássicos. Comparados por pacientes, foram considerados concordantes quando ambos exames eram normais ou anormais independente de localização. A comparação por território foi considerada concordante quando havia ou não déficit perfusional num mesmo território. A significância da concordância foi feita pelo teste do qui-quadrado. RESULTADOS: Em 106/125 pts ECM e CM foram concordantes (84,8 por cento - p<0,001). Houve concordância em 342/375 territórios (91,2 por cento - p<0,001). Para o território de DA a concordância foi de 87,2 por cento, para CD 93,6 por cento e para CX 92,8 por cento (p<0,001). CONCLUSAO: Existe uma ótima concordância entre ECM e CM nos pts em investigação para doença arterial coronariana, podendo a ECM representar uma alternativa à avaliação da perfusão miocárdica.
Assuntos
Humanos , Masculino , Feminino , Meios de Contraste , Doença da Artéria Coronariana , Doença da Artéria Coronariana , Ecocardiografia/métodos , Adenosina , Albuminas , Estudos Longitudinais , Estudos ProspectivosRESUMO
OBJECTIVE: To compare clinical and laboratory data in patients with mitral stenosis undergoing open commissurotomy or balloon valvuloplasty, who were followed up for 5 years. METHODS: Eighty-one patients were prospectively assessed prior to the procedure (PRE) and immediately after the procedure, in the immediate postoperative period (IPO), and followed up yearly for 5 years (PO12M, PO24M, PO36M, PO48M, and PO60M). They were randomized into the following 2 groups: GC (group undergoing open commissurotomy): 37 patients (32.4 +/- 7.2 years; 89.2% females); and GV (group undergoing balloon valvuloplasty): 44 patients (32.9 +/- 9.5 years; 90.9% females). The patients' assessment comprised the following items: functional class, occurrence of events, electrocardiography, and Doppler echocardiography. RESULTS: A significant improvement in functional class occurred in most patients. Three patients in GC and in GV were in functional class III in PO60M. No difference in the mitral gradient was observed between the groups. A difference in the mean mitral valve areas was observed between the groups during the entire evaluation. No patients died. In regard to the IPO of GC, 3 patients had moderate mitral insufficiency (MI), and 3 had bleeding (1 was reoperated upon). In the IPO of GV, 4 patients had moderate MI, 1 had severe MI, 2 had cardiac tamponade, and 1 patient required surgery due to severe MI. Over 60 months, 9 GV patients evolved to moderate or severe MI, while 6 GC patients evolved to moderate or severe MI, and 2 other GC patients required surgery due to double mitral dysfunction. CONCLUSION: The rate of success in open mitral commissurotomy and balloon mitral valvuloplasty was 100%, and the rate of complications was low. During follow-up, a mild elevation in mitral gradient and a drop in mitral valve area were observed in both groups.
Assuntos
Oclusão com Balão , Cateterismo , Estenose da Valva Mitral/terapia , Adulto , Distribuição de Qui-Quadrado , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/cirurgia , Estudos ProspectivosRESUMO
OBJETIVO: Comparar dados clínicos-laboratoriais em portadores de estenose mitral submetidos à comissurotomia ou valvoplastia por cateter-balão, obtidos ao longo de 5 anos de acompanhamento. MÉTODOS: Foram acompanhados, prospectivamente, 81 pacientes no pré (PRÉ), imediatamente após o procedimento (POI), e ao longo de cinco anos (PO12M, PO24M,..., PO60M) e randomizados em dois grupos: GC: 37 pacientes (32,4 ± 7,2 anos e 89,2 por cento mulheres) e GV: 44 pacientes (32,9 ± 9,5 anos e 90,9 por cento mulheres). A avaliação compreendeu: classe funcional, ocorrência de eventos, eletrocardiograma e ecodopplercardiograma. RESULTADOS: Houve melhora expressiva da classe funcional na maioria dos pacientes, três casos do GC e do GV estavam em classe funcional III no PO60M. Não houve diferença em relação ao gradiente mitral entre os grupos. Houve diferença das médias de área valvar mitral entre os grupos durante toda avaliação. Não ocorreram óbitos. No POI do GC observamos 3 casos com insuficiência mitral (IM) moderada, 3 com sangramento (1 reoperado) e, no GV, 4 casos com IM moderada, 1 com IM importante, 2 com tamponamento cardíaco, 1 caso necessitou cirurgia por IM importante. Ao longo de 60 meses, no GV, 9 casos evoluiram com IM moderada ou importante e no GC, 6 casos evoluiram com IM moderada ou importante e outros dois necessitaram cirurgia por dupla disfunção mitral. CONCLUSAO: Ambos os métodos obtiveram 100 por cento de sucesso com baixa taxa de complicações. No seguimento, houve elevação discreta do gradiente mitral e queda de área valvar mitral em ambos os grupos.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estenose da Valva Mitral/terapia , Distribuição de Qui-Quadrado , Ecocardiografia Doppler , Seguimentos , Estenose da Valva Mitral/cirurgia , Estenose da Valva Mitral , Estudos ProspectivosRESUMO
BACKGROUND: Exercise-induced dyspnea is a frequent feature in patients with hyperthyroidism. HYPOTHESIS: Data from clinical studies to elucidate the origin of this symptom are lacking. In the current study, we examined the hemodynamic and oxygenation responses to exercise and beta-adrenergic blockade in patients with hyperthyroidism and their relationship with dyspnea. METHODS: Hemodynamic studies were performed under resting conditions and after isotonic exercise in 15 patients with hyperthyroidism and 11 control subjects. Exercise was applied using a bicycle ergometer, with progressive loads. In the hyperthyroid group, measurements were repeated at rest and during supine exercise after administering 15 mg of intravenous metoprolol. RESULTS: End-diastolic pulmonary artery pressure and cardiac index were higher in the hyperthyroid group than in controls (18.6 +/- 5.3 vs. 11.2 +/- 4.9 mmHg; p = 0.02, and 6.0 +/- 1.7 vs. 2.8 +/- 0.5 l/min/m2; p = 0.0001, respectively). After exercise, there was an increase in end-diastolic pulmonary artery pressure in the hyperthyroid group (18.6 +/- 5.3 to 25.5 +/- 9.9 mmHg; p = 0.02), revealing impaired cardiocirculatory reserve. Pulmonary arteriolar resistance increased significantly in parallel with end-diastolic pulmonary artery pressure after drug administration, suggesting an inadequate cardiovascular response after beta blockade in patients with hyperthyroidism. CONCLUSION: We observed that functional left ventricular reserve is impaired in patients with hyperthyroidism, suggesting an explanation for the frequent symptom of dyspnea and impaired exercise tolerance. Moreover, we also suggest that beta-adrenergic blockade may adversely affect cardiovascular function in patients with hyperthyroidism.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Exercício Físico/fisiologia , Hipertireoidismo/tratamento farmacológico , Hipertireoidismo/fisiopatologia , Consumo de Oxigênio/efeitos dos fármacos , Adulto , Diástole/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Metoprolol/uso terapêutico , Pessoa de Meia-Idade , Pressão Propulsora Pulmonar/efeitos dos fármacos , Estatística como Assunto , Volume Sistólico/efeitos dos fármacos , Resultado do Tratamento , Resistência Vascular/efeitos dos fármacosRESUMO
Arterial compliance is determined by structural factors, such as collagen and elastin, and functional factors, such as vasoactive neurohormones. To determine whether angiotensin II contributes to decreased arterial compliance in patients with heart failure, this study tested the hypothesis that administration of an angiotensin-converting enzyme inhibitor improves arterial compliance. Arterial compliance and stiffness were determined by measuring carotid artery diameter, using high-resolution duplex ultrasonography, and blood pressure in 23 patients with heart failure secondary to idiopathic dilated cardiomyopathy. Measurements were made before and after intravenous administration of enalaprilat (1 mg) or vehicle. Arterial compliance was inversely related to both baseline plasma angiotensin II (r = -0.52; P = 0.015) and angiotensin-converting enzyme concentrations (r = -0.45; P = 0.041). During isobaric conditions, enalaprilat increased carotid artery compliance from 3.0 +/- 0.4 to 5.0 +/- 0.4 x 10(-10) N(-1). m(4) (P = 0.001) and decreased the carotid artery stiffness index from 17.5 +/- 1.8 to 10.1 +/- 0.6 units (P = 0.001), whereas the vehicle had no effect. Thus angiotensin II is associated with reduced carotid arterial compliance in patients with congestive heart failure, and angiotensin-converting enzyme inhibition improves arterial elastic properties. This favorable effect on the pulsatile component of afterload may contribute to the improvement in left ventricular performance that occurs in patients with heart failure treated with angiotensin-converting enzyme inhibitors.
Assuntos
Angiotensina II/metabolismo , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Enalaprilato/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Adulto , Artéria Braquial/efeitos dos fármacos , Artéria Braquial/fisiologia , Artérias Carótidas/efeitos dos fármacos , Artérias Carótidas/fisiologia , Complacência (Medida de Distensibilidade)/efeitos dos fármacos , Elasticidade/efeitos dos fármacos , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To evaluate the Coronary Flow Reserve in the Coronary Sinus through transesophageal Doppler echocardiography in normal subjects. METHODS: We obtained technically adequate flow samples for analysis in 10 healthy volunteers (37+/-8 years, 5 men) with no history of heart or systemic disease and with mean left ventricular mass index by transthoracic echocardiography of 87+/-18 g/m2. Coronary sinus flow velocity was recorded within the coronary sinus with the patient in a resting condition and during intravenous adenosine infusion at a dose of 140 micro g/kg/min for 4 minutes. Recording of coronary sinus blood flow was possible in all cases with measurement of peak systolic, diastolic, and retrograde velocities (PSV, PDV, and PRV, cm/sec), mean systolic and diastolic velocities (MSV and MDV, cm/sec), and systolic and diastolic velocity time integral (VTI S and VTI D, cm/sec). RESULTS: The coronary flow reserve was calculated as the ratio between the blood flow in the basal state and the maximum measured hyperemic blood flow with adenosine infusion. Results are shown as mean and standard deviations. (CFR = PSV + PDV - PRV/basal PSV): 1st min = 2.2+/-0.21; 2nd min = 3+/-0.3; 3rd min = 3.4+/-0.37; 4th min = 3.6 +/- 0.33. CONCLUSION: Although coronary sinus flow had significantly increased in the first minute, higher velocities were seen at third and fourth minutes, indicating that these should be the best times to study coronary sinus flow with intravenous adenosine in continuous infusion.
Assuntos
Circulação Coronária/fisiologia , Vasos Coronários/fisiologia , Ecocardiografia Doppler/métodos , Adenosina/farmacologia , Adulto , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Circulação Coronária/efeitos dos fármacos , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Masculino , Vasodilatadores/farmacologiaRESUMO
OBJECTIVE - To evaluate the Coronary Flow Reserve in the Coronary Sinus through transesophageal Doppler echocardiography in normal subjects. METHODS - We obtained technically adequate flow samples for analysis in 10 healthy volunteers (37±8 years, 5 men) with no history of heart or systemic disease and with mean left ventricular mass index by transthoracic echocardiography of 87±18 g/m². Coronary sinus flow velocity was recorded within the coronary sinus with the patient in a resting condition and during intravenous adenosine infusion at a dose of 140 æg/kg/min for 4 minutes. Recording of coronary sinus blood flow was possible in all cases with measurement of peak systolic, diastolic, and retrograde velocities (PSV, PDV, and PRV, cm/sec), mean systolic and diastolic velocities (MSV and MDV, cm/sec), and systolic and diastolic velocity time integral (VTI S and VTI D, cm/sec). RESULTS - The coronary flow reserve was calculated as the ratio between the blood flow in the basal state and the maximum measured hyperemic blood flow with adenosine infusion. Results are shown as mean and standard deviations. (CFR = PSV + PDV -- PRV/basal PSV): 1st min = 2.2±0.21; 2nd min = 3±0.3; 3rd min = 3.4±0.37; 4th min = 3.6 ± 0.33. CONCLUSION - Although coronary sinus flow had significantly increased in the first minute, higher velocities were seen at third and fourth minutes, indicating that these should be the best times to study coronary sinus flow with intravenous adenosine in continuous infusion
Assuntos
Humanos , Masculino , Feminino , Adulto , Circulação Coronária , Vasos Coronários , Ecocardiografia Doppler , Adenosina , Velocidade do Fluxo Sanguíneo , Vasos Coronários , VasodilatadoresRESUMO
BACKGROUND: The aim of this study was to examine prospectively the impact of renal transplantation on the morphological and functional characteristics of the carotid arteries and heart in a group of end-stage renal failure patients without overt cardiovascular disease, followed up for >3 years. METHODS: Twenty-two patients were evaluated 2-3 weeks after renal transplantation, and again 12 and 40 months post-transplant, using high resolution ultrasound imaging and echocardiography. RESULTS: Kidney and patient survival were 100% at the end of follow-up without any major cardiovascular events. After 40+/-1.2 months, carotid morphological parameters were normalized: carotid intima-media thickness fell from 788+/-24 to 676+/-32 microm (P<0.01) and the carotid wall/lumen ratio fell from 118+/-3 to 103+/-3 microm (P<0.01). Significant reduction of left ventricular (LV) posterior wall thickness (11.5+/-0.2 to 11.3+/-0.2 mm, P<0.05) and LV mass index (172+/-9 to 158+/-8 g/m(2), P<0.01) was already observed after 12+/-0.2 months. Further reduction of LV posterior wall thickness (10.4+/-0.3 mm, P<0.01) and of LV mass index (136+/-7 g/m(2), P<0.01) also occurred after 40+/-1.2 months. However, carotid distensibility (19.5+/-2.1 vs 22+/-2.4, not significant (NS)) and LV compliance (early to atrial flow ratio: 1.2+/-0.1 vs 1.3+/-0.1, NS) remained abnormal, and normalization of the LV mass was attained by only 25% of the patients with LV hypertrophy on baseline. Multiple stepwise regression analysis showed that the rate of change of reduction of the intima-media thickness was influenced by age (negative association, P<0.001) and was positively related to white race (P<0.05), female sex (P<0.01) and to the parallel reduction of maximum carotid diameter (P<0.001). Reduction of LV mass index over time was negatively related to the duration of dialysis treatment and to the parallel increase observed in body mass index and haematocrit, and was positively related to the simultaneous reduction of diastolic blood pressure (P<0.01 for all variables). CONCLUSIONS: Successful renal transplantation improves but does not cause complete regression of the cardiovascular alterations of end-stage renal disease. Only intima-media thickness was normalized by transplantation, whereas LVMI and carotid and ventricular distensibility remained abnormal. The results suggest that extended duration of dialysis, weight gain, high blood pressure and high haematocrit may adversely affect the rate of change of post-transplant cardiovascular hypertrophy.
Assuntos
Artérias Carótidas/fisiopatologia , Hipertrofia Ventricular Esquerda/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Adulto , Artérias Carótidas/patologia , Ecocardiografia , Feminino , Humanos , Falência Renal Crônica/patologia , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos ProspectivosRESUMO
Eighty patients with tight and pliable mitral stenosis were randomized in a prospective trial comparing percutaneous balloon valvuloplasty and open commissurotomy. Mitral valve area increased significantly in both groups immediately after the procedures. However, a decrease in mitral valve area occurred in both groups at 6, 12 and 24 months during the follow-up. There was no death in either group. Two patients had significant mitral regurgitation after percutaneous balloon valvuloplasty. After 24 months, all patients in the commissurotomy group and 97.4% of the patients in the balloon valvuloplasty group were in New York Heart Association functional class I or II.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Cateterismo , Estenose da Valva Mitral/cirurgia , Adolescente , Adulto , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
OBJECTIVE: To evaluate elastic properties of conduit arteries in asymptomatic patients who have severe chronic aortic regurgitation. METHODS: Twelve healthy volunteers aged 30Ý1 years (control group) and 14 asymptomatic patients with severe aortic regurgitation aged 29Ý2 years and left ventricular ejection fraction of 0.61Ý0.02 (radioisotope ventriculography) were studied. High-resolution ultrasonography was performed to measure the systolic and diastolic diameters of the common carotid artery. Simultaneous measurement of blood pressure enabled the calculation of arterial compliance and distensibility. RESULTS: No differences were observed between patients with aortic regurgitation and the control group concerning age, sex, body surface, and mean blood pressure. Pulse pressure was significantly higher in the aortic regurgitation group compared with that in the control group (78Ý3 versus 48Ý1mmHg, P<0.01). Arterial compliance and distensibility were significantly greater in the aortic regurgitation group compared with that in the control group (11.0Ý0.8 versus 8.1Ý0.7 10-10 N-1 m4, P=0.01 e and 39.3Ý2.6 versus 31.1Ý2.0 10-6 N-1 m², P=0.02, respectively). CONCLUSION: Patients with chronic aortic regurgitation have increased arterial distensibility. Greater vascular compliance, to lessen the impact of systolic volume ejected into conduit arteries, represents a compensatory mechanism in left ventricular and arterial system coupling