RESUMO
We report a case of isolated aortic regurgitation complicated by active infective endocarditis with streptococcus viridans as causative organism. The affected structure was a previous normal mitral valve.
Assuntos
Insuficiência da Valva Aórtica/complicações , Endocardite Bacteriana/etiologia , Valva Mitral , Infecções Estreptocócicas/etiologia , Adulto , Insuficiência da Valva Aórtica/fisiopatologia , Humanos , Masculino , Sepse/etiologia , Extração Dentária/efeitos adversosRESUMO
The purpose of this study is to determine the sensitivity and specificity of two dimensional echocardiography in the diagnosis of thrombosis of the left atrial appendage. Sixty patients with mitral rheumatic heart disease were examined prospectively 24 to 72 hours prior to cardiac surgery. Two images were used to identify thrombosis in the appendage: parasternal short axis at the level of the aortic valve with a lateral and superior inclination of the transducer and a modified apical five chamber view with counter clockwise rotation of the transducer between the apical long axis and the five chamber view. Diagnosis was corroborated during surgery and by histopathological analysis. In all cases the presence and predominance of mitral lesion (stenosis or regurgitation) were established by clinical history, electrocardiogram, chest roentgenogram and two dimensional echocardiogram. In 58 patients the lesions were also confirmed by cardiac catheterization. Of the 60 patients (46 females and 14 males between 16 and 61 years of age), eleven cases (18.3%) of left atrial thrombosis were detected, of which seven had formed in the left atrial appendage. All were confirmed during surgical intervention and pathological analysis. One thrombus in the left atrial appendage not diagnosed by echocardiography was found during surgery (Sensitivity:90.9%). In this case pathology studies demonstrated recently formed thrombi. In all cases in which two dimensional echocardiography did not show signs suggesting thrombosis, surgery confirmed that atrial thrombosis did not exist (Specificity: 100%). This study demonstrates the utility of two dimensional echocardiography in the diagnosis of thrombosis of the left atrial appendage, thus making it possible to schedule corrective surgery and the use of anticoagulants.
Assuntos
Ecocardiografia , Cardiopatias/diagnóstico , Trombose/diagnóstico , Adolescente , Adulto , Feminino , Átrios do Coração , Cardiopatias/complicações , Doenças das Valvas Cardíacas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Trombose/complicaçõesRESUMO
With the purpose of learning the usefulness of radiologic and angiographic procedures for the evaluation of Takayasu's arteritis (TA), we studied 64 patients (ratio women: 8.1, average age: 23.5 years, range: 13-52 years) in which we performed arteriographic studies in the clinically affected area. All cases had chest films: 53 had thoracic aortogram, 60 abdominal aortogram, 16 pulmonary arteriography. According to the topography of the lesions we found 8% of the cases with damage exclusive to the supra-aortic trunk, 6% with isolated alteration of the intermediate thoraco-abdominal aorta, 62% with mixed pathology of the two categories above, and 21% with lesions in the pulmonary artery besides systemic arteriopathy. The results were as follows: 1) radiology of the chest: cardiomegaly (48%), irregularities in the ascending aorta (31%), calcification in the aortic wall (29%), calcified granulomas (25%) and signs of pulmonary venous hypertension (21%); 2) thoracic aortogram: irregularities in the descending aorta (56.6%), thickening of the wall of descending aorta (39.6%), dilatation of the ascending aorta (26.4%), of the descending aorta (26.4%); occlusions: of the left subclavian (24 cases), left mammary (16 cases), left carotid (8 cases) and left vertebral (8 cases); 3) abdominal aortogram: irregularities of the outline, stenosis, prominent "supplementary" arteries and aneurysms in 53%, 43.3%, 38% and 13.3 of the studies performed. The arteries most commonly affected were: renal (74.7%), both (31.6%), right (28.2%) and left (14.9%), superior mesenteric (26.6%) and hepatic (21.6%); 4) pulmonary arteriography: arterial occlusions: right superior lobar branch (37.5%), right medial (6.2%), right inferior (12.5%), without predilection by any lobe; 5) coronary arteriography: one case with occlusion of anterior descending artery and circumflex coronary artery (the other 8 cases without significant lesions). We concluded that TA affects independently the arteries of different areas, hence it is necessary to perform multiple angiographic studies for adequate evaluation of the extension of vascular damage.
Assuntos
Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Síndromes do Arco Aórtico/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Radiografia Torácica , Arterite de Takayasu/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Se analizaron los datos fonomecanocardiográficos en 27 casos de cardiomiopatía dilatada (CMD), diagnosticada en todos ellos por historia clínica, laboratorio, ecocardiograma, estudio hemodinámico y cinecoronariográfico. Los pacientes que presentaban bloqueo completo de rama izquierda fueron excluidos. Se estudió además un grupo control normal de 24 casos, con edad promedio y sexo similar al grupo CMD. Los trazados fueron realizados con un equipo Siemens-Elema (Mingograph-34) con inscripción directa a chorro de tinta, en cuatro canales, con electrocardiograma en derivación DII, fono en foco mitral y pulso carotideo o apicocardiograma en forma simultánea. Los datos analizados fueron los siguientes: frecuencia cardíaca (FC), sístole electromecánica corregida (SEMc) período pre-expulsivo corregido (PPEc), período expulsivo corregido (PEc), índice de Weissler (IW), distancia IIAo-OM (IIAo-OM), tiempo de ascenso del apicocardiograma (TAACG), amplitud de la onda "a"-del apicocardiograma (onda "a"), intensidad del primer ruido cardíaco (IRC) y presencia de tercer o cuarto ruido (IIIRC-IVRC). Los valores promedio y su desvío estandar para normales y grupo CMD, respectivamente fueron: FC = 67.08 + ou - 7.67 lat/min y 88.84 + ou - 15.31 lat/min; SEMc = 554.23 + ou - 28.37 mseg y 561.35 + ou - 30.99 mseg.; PEc = 409.38 + ou - 27.28 mseg y 375.54 + ou - 28.21 mseg; PPEc = 145.13 + ou - 17.64 mseg y 194.11 + ou - 22.09 mseg; PER = 102 + ou - 9.27% y 84.78 + ou - 8.61%; IW = 0.39 + ou - 0.07 y 0.72 + ou - 0.11; onda "a": 7.37 + ou - 2.15% y 19.47 + ou - 6.76%; IIAo-OM = 0.094 + ou - 0.0012 seg y 0.105 + ou - 0.018 seg; TAACG = 0.093 + ou - 0.0015 seg y 0.143 + ou - 0.067 seg. El análisis estadístico comparativo demostró diferencia muy significativa (p<0.001) en: FC, PEc, PPEc, PER, IW, onda "a" y TAACG; significativa (p<0.05) en el IIAo-OM y no significativa en la SEMc. En los casos con CMD hubo disminución de IRC en el 74%, presencia de IIIRC en el 100% y de IVRC en el 83% de los pacientes con ritmo sinusal. Se concluye que el estudio fonomecanocardiográfico, a través del hallazgo de IIIRC, IVRC, disminución del IRC, aumento del PEEc, TAACG, IW, disminución del PEC, PER y el aumento de la amplitud de la onda "a" en el ACG, permite sugerir la presencia de CMD
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Cardiomiopatia Dilatada/diagnóstico , FonocardiografiaRESUMO
Twenty seven patients with dilated cardiomyopathy (DCM) were studied by phonocardiography and mechanocardiography. The diagnosis was made in each case by history, laboratory, echocardiogram, hemodynamic study and coronary arteriography. Patients with left complete bundle branch block were excluded. As controls we studied 24 subjects with comparable age an sex. The phonomecanocardiographic records were performed with a Siemens-Elema machine (Mingograph-34) with direct ink recording with electrocardiogram in lead DII, phonocardiogram in mitral focus, and carotid pulse or apexcardiogram (ACG) simultaneously. The following data were assessed: heart rate (HR) electromechanical interval (Q-S2), preejection period of left ventricular contraction (PEP), left ventricular ejection time (LVET), relative ejection period (REP), ratio PEP/LVET (IW), "a" wave of the ACG ("a" wave), rising period of the apex-cardiogram (RPACG), isovolumic relaxation time (IRT), first heart sound intensity (S1I), third and fourth heart sound presence (S3 and S4) respectively. The average values (mean) and their standard deviation for the groups (N) and DCM respectively were: HR (b/m): 67.08 +/- 7.67 and 88.84 +/- 15.31; Q - S2 (msec.): 554.23 +/- 28.37 and 561.35 +/- 30.99; PEP (msec.): 145.13 +/- 17.64 and 194.11 +/- 22.09; LVET (msec): 409.38 +/- 27.68 and 375.54 +/- 28.21; REP (%): 102 +/- 9.27 and 84.78 +/- 8.61; IW: 0.395 +/- 0.078 and 0.72 +/- 0.11; "a" wave (%): 7.37 +/- 2.15 and 19.47 +/- 6.76; RPACG (sec.): 0.093 +/- 0.0015 and 0.143 +/- 0.067; IRT (sec.): 0.094 +/- 0.0012 and 0.105 +/- 0.018.(ABSTRACT TRUNCATED AT 250 WORDS)