RESUMO
Fourteen cases of coronary arteriovenous fistulae observed at the Instituto Nacional de Cardiología Ignacio Chávez were analyzed. The fistula originated from the right coronary artery in 57.1% of the cases, from the left coronary artery in 35.7% and from both coronary arteries in 7.2%. Drainage occurred into the right ventricle in 71.4% of the cases, into the right atrium in 7.2% and into the main pulmonary artery in 21.4%. The physical, roentgenological and electrocardiographic findings are undistinguishable from those usually obtained in malformations with a shunt between the aorta and the right heart or the pulmonary artery. Definite diagnosis is made at angiography. 2D and Doppler echocardiography may also be very useful. Natural history depends on the age of the patient, the size of the arteriovenous shunt, the presence of pulmonary hypertension and the development of complications. Even though malformations with small shunts may be well tolerated, serious complications are frequent and, thus, 14.3% of the patients developed infective endocarditis, 42.9% were in heart failure, 14.3% complained of angina pectoris and 54.5% had pulmonary hypertension. Mortality in this series was 28.6%. Early elective ligation seems to be the optimal treatment of coronary arteriovenous fistulae. The surgical procedure, however, is not devoid of risk. Thus, two of the three patients in this series who were operated upon after 1967 developed perioperative myocardial infarctions. Improvement in surgical technique should prevent this complication.
Assuntos
Fístula Arteriovenosa/diagnóstico , Malformações Arteriovenosas/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários , Adolescente , Adulto , Fatores Etários , Idoso , Angina Pectoris/etiologia , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/fisiopatologia , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/fisiopatologia , Pré-Escolar , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Endocardite Bacteriana/etiologia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-IdadeRESUMO
Cardiovascular manifestations of Systemic Lupus Erythematosus (SLE) in 32 unselected patients, with active disease were reviewed. Primary cardiac disease manifested as pericarditis (22%), myocarditis (16%), and valvular disease (9%), was recognized along with secondary disease as heart failure with or without systemic hypertension. Comparison with previous work by others, suggest that our cases are more representative of actual clinical picture of cardiac SLE. It is interesting to notice tht 9% of our patients had valvular disease, and this alteration is only occasionally found in other Hospitals. Valvular disease is rarely noticed during life, although is highly prevalent in autopsy series. We stress the diagnosis and management of the cardiac manifestations of SLE, in order to lower the morbidity and mortality of this condition.
Assuntos
Doenças das Valvas Cardíacas/etiologia , Lúpus Eritematoso Sistêmico/complicações , Miocardite/etiologia , Pericardite/etiologia , Adolescente , Adulto , Idoso , Cardiomegalia/etiologia , Eletrocardiografia , Feminino , Bloqueio Cardíaco/etiologia , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão/etiologia , Masculino , Pessoa de Meia-IdadeAssuntos
Endocardite Bacteriana/etiologia , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias , Adolescente , Adulto , Valva Aórtica , Criança , Ecocardiografia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Complicações Pós-Operatórias/diagnóstico , Infecções Estafilocócicas/etiologia , Staphylococcus/isolamento & purificação , Fatores de TempoRESUMO
Following a brief historical introduction, we review the currently accepted clinical, etiological and hemodynamic classifications of the cardiomyopathies. The typical clinical and hemodynamic pattern of each variety, as well as a description of the echocardiographic data which raises the suspicion or supports the diagnosis of the particular cardiomyopathy are discussed. We attempt to demonstrate the usefulness of echocardiography as a non-invasive procedure in the doubtful cases of cardiomyopathy, without exposing the patient to the risks of the invasive procedures. The echocardiographic data of hypertrophic abnormalities of the intraventricular septum, mitral valve, aortic valve, free wall of the left ventricle and cardiac function are presented. The association of valvular heart disease an cardiomyopathy is considered. The differential diagnosis of valvular heart disease which present with echocardiographic abnormalities similar to those of the cardiomyopathies is discussed. We have reviewed the most important literature and have illustrated some of our cases. The future of the procedure in the early diagnosis during the asymptomatic period of the disease in the evaluation of the natural evolution of the illness and the patient's response to therapy is presented.
Assuntos
Cardiomiopatia Hipertrófica/diagnóstico , Ecocardiografia , Estudos de Avaliação como Assunto , Insuficiência Cardíaca/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Hemodinâmica , Humanos , UltrassonografiaAssuntos
Transtornos Cerebrovasculares/complicações , Cisticercose/cirurgia , Hipertensão Pulmonar/etiologia , Pressão Intracraniana , Complicações Pós-Operatórias/diagnóstico por imagem , Doença Cardiopulmonar/etiologia , Adulto , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Edema Encefálico/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/cirurgia , Humanos , Masculino , RadiografiaRESUMO
Following the historical introduction concerning the evolution of our present knowledge of the W-P-W syndrome, we discuss a unique case of complete transposition of the great vessels with an unusual type of pre-excitation. We attributed this excitation to an uncommonly placed bundle of Kent, which, to our knowledge, has not been previously reported as coexisting with the aforementioned congenital heart malformation. A review of the literature, a discussion of other congenital heart diseases associated with disturbances of A-V conduction, as well as the clinical and para-clinical data upon which we base our diagnosis are presented.