A embolização percutânea transcateter tornou-se o tratamento de escolha para fístulas arteriovenosas pulmonares (FAVPs), na maioria dos casos em substituição à intervenção cirúrgica. Os dispositivos clássicos, tais como coils intravasculares e balões destacáveis, provaram ser um sucesso para oclusões percutâneas de FAVPs pequenas ou médias; porém, não são ideais nas fístulas maiores e de alto fluxo pelo risco de embolização para a circulação sistêmica. Relatamos o caso de uma mulher de 49 anos de idade com FAVP de alto fluxo e manifestações neurológicas isquêmicas prévias, submetida com sucesso a fechamento percutâneo com AmplatzerTM Vascular Plug II, um dispositivo projetado para oclusão de anormalidades vasculares.

Percutaneous transcatheter embolization has become the treatment of choice for pulmonary arteriovenous fistulae (PAVFs), replacing surgical intervention in most cases. Classical devices, such as intravascular coils and detachable balloons, have proven to be successful for percutaneous occlusions of small or medium-sized PAVFs; however, they are not ideal for larger and high flow fistulae due to the risk of embolization to systemic circulation. The case of a 49-year-old woman with high flow pulmonary fistula and previous neurological ischemic manifestations undergoing successful transcatheter closure with an AmplatzerTM Vascular Plug II, a device designed for occlusion of vascular abnormalities, is reported.

O transplante de células-tronco é uma nova terapia com objetivo de produzir regeneração cardíaca pela diferenciação ou aumento dos miócitos cardíacos ou proliferação neovascular em pacientes no estágio final de insuficiência cardíaca congestiva secundária a cardiomiopatia dilatada¹, mas os resultados são desconhecidos2,3.

Stem cell transplantation is a new therapy applied to produce cardiac regeneration through differentiation or increase of heart myocytes or neovascular proliferation in patients in the end stage of congestive heart failure secondary to dilated cardiomyopathy¹, but the results are still unknown2,3.

A ruptura da parede livre do ventrículo esquerdo é uma dramática, porém nem sempre fatal complicação do infarto agudo do miocárdio. No entanto, se o diagnóstico correto for retardado, o tratamento cirúrgico pode ser comprometido. Os autores relatam um caso de volumoso pseudo-aneurisma de parede inferior de ventrículo esquerdo diagnosticado ao estudo angiográfico.

Left ventricular free wall rupture is a dramatic but not always fatal complication from myocardial acute infarction. However, if proper diagnosis is delayed, surgical treatment may be compromised. The authors report a case of large pseudoaneurysm in left ventricular inferior wall diagnosed on angiography study.

OBJETIVO: Avaliar o implante de stents sem dilatação prévia com cateter balão convencional para o tratamento das obstruções coronarianas, utilizando-se cateteres guias de baixo perfil através da técnica radial. MÉTODOS: A técnica radial é atraente pela possibilidade de se evitar o trauma provocado pelo balão, menor tempo para sua realização, exposição reduzida à radiação e consumo de contraste em quantidades inferiores às habitualmente usadas neste tipo de procedimento. RESULTADOS: Analisada a experiência inicial de implante direto de stents, através de cateteres de baixo perfil por via radial, em 45 pacientes, com idade média de 65 anos. Em todos os casos houve sucesso no procedimento sem complicações maiores na fase hospitalar. CONCLUSÃO: Os resultados com a população estudada demonstraram ser a técnica radial segura, eficaz e com muito baixo risco de complicações.

OBJECTIVE: To assess stent implantation without previous dilation with a conventional balloon catheter to treat coronary artery obstructions, by using low profile guiding catheters and the transradial approach. METHODS: The transradial approach is attractive due to the possibility of avoiding the trauma caused by the balloon, its shorter time of performance, reduced exposure to radiation, and the use of lower quantities of contrast medium than those usually required in this type of procedure. RESULTS: The initial experience of direct stent implantation with low profile guiding catheters and the transradial approach was analyzed in 45 patients, whose mean age was 65 years. All procedures were successful, with no major complications in the in-hospital phase. CONCLUSION: The results obtained with the population studied proved that the transradial approach is safe, effective, and has very few risks of complications.

OBJETIVO: Descrever os achados clínicos e ecocardiográficos de trombose em prótese biológica mitral e o valor do ecocardiograma transesofágico (ETE) no diagnóstico e monitoração da lise do trombo. MÉTODOS: Foram estudados ao ETE 111 pacientes com prótese biológica mitral, e incluídos 4 de 7 com suspeita de trombo nestas próteses (idade média = 60,2±10,2 anos; 2 homens). O diagnóstico pôde ser confirmado pela realização seriada do ETE e pela evolução clínica. Investigaram-se os aspectos morfológicos dos folhetos da prótese, e presença e característica das massas ecogênicas anexas. Foram obtidos o gradiente médio pela prótese e a área valvar. RESULTADOS: O diagnóstico de trombo em prótese biológica mitral foi realizado 48,7±55,2 meses após a cirurgia. Dois pacientes apresentaram acidente vascular encefálico isquêmico no pós-operatório imediato. O gradiente médio global estava elevado (11,4±3 mmHg) e a área valvar reduzida (1,24±0,3cm²). Ao ETE, em todos foram evidenciadas massas ecogênicas em face ventricular esquerda da prótese biológica mitral, sugestivas de trombo. No ETE seriado (136±233 dias), houve desaparecimento do trombo em dois casos e redução do trombo nos outros dois, após tratamento. O gradiente médio reduziu para 6,2±3 mmHg (p=0,004; IC 95%), e a área valvar aumentou para 2,07±0,4 (p=ns). CONCLUSÃO: O ETE mostrou-se útil na detecção de trombo em prótese biológica mitral e eficaz na monitoração do tratamento, em todos casos.

OBJECTIVE: To report the clinical and echocardiographic findings of bioprosthetic mitral valve thrombosis and the value of transesophageal echocardiography (TEE) in its diagnosis and monitoring of thrombolysis. METHODS: One hundred and eleven patients with mitral bioprostheses underwent TEE, and 4 out of 7 suspected of having a thrombus on these prostheses were included in the study (mean age = 60.2±10.2 years; 2 men). The diagnosis was confirmed with serial TEE and clinical evolution. The morphologic features of the prosthetic leaflets, as well as the presence and characteristics of attached echogenic masses were investigated. The mean gradient through the prosthesis and the valvular area were obtained. RESULTS: The diagnosis of bioprosthetic mitral valve thrombosis was established 48.7±55.2 months after surgery. Two patients had ischemic stroke in the early postoperative period. The mean overall gradient was high (11.4±3 mmHg) and the valvular area reduced (1.24±0.3 cm²). On TEE, echogenic masses on the left ventricular face of the mitral bioprosthesis suggestive of thrombus were evidenced in all patients. On serial TEE (136±233 days), in 2 patients the thrombus had disappeared and in 2 others it was smaller after treatment, the mean gradient dropped to 6.2±3 mmHg (P = 0.004; 95% CI), and the valvular area increased to 2.07±0.4 (P = NS). CONCLUSION: TEE proved to be useful for detecting bioprosthetic mitral valve thrombosis and was effective in monitoring the treatment in all patients.

We report a rare case of anomalous origin of the left coronary artery from the pulmonary trunk in a 45-year-old woman. The approach and technique used for selective catheterization of an anomalous left coronary artery arising from the pulmonary trunk are described. Six years after diagnosis, echocardiography showed left ventricular disfunction, and surgical treatment was indicated again. The origin of the left coronary artery from the pulmonary trunk was closed, and the postoperative period was uneventful, with recovery of left ventricular function and disappearance of ischemic features on stress myocardial perfusion imaging with 99m Tc-sestamibi, performed 4 weeks after surgery.

Few patients with corrected transposition of the great arteries survive past 50 years of age because of the association with congenital defects, development of total atrioventricular block, and right ventricular dysfunction. We report the case of a male patient with dextrocardia in situs solitus and corrected transposition of the great arteries associated with a wide atrial septal defect and severe pulmonary valvar and subvalvar stenoses. The patient also developed a large aneurysm on the pulmonary artery, total atrioventricular block diagnosed 8 years earlier, symptoms of dysfunction of the systemic ventricle in the previous 2 years, insufficiency of the left atrioventricular valve, and aortic regurgitation. Despite all these associated anomalies, the patient developed class III cardiac decompensation only at the age of 68 years, which makes this case a rarity. The patient was clinically treated, and was discharged from the hospital in good condition.

This is the report of a five-month-old child presenting clinical evidence of Pompe's disease: severe hypotonicity, hyporeflexia and congestive heart failure. The ECG showed a short PR interval, the chest radiography disclosed marked cardiomegaly, and the echocardiogram revealed marked left ventricular hypertrophy - the most typical finding of this disease. A skeletal muscle biopsy led to final diagnosis, because in the histopathologic study marked increased glycogen accumulation was evident. Death occurred two months after symptom onset.