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.

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% - p<0,001). Houve concordância em 342/375 territórios (91,2% - p<0,001). Para o território de DA a concordância foi de 87,2%, para CD 93,6% e para CX 92,8% (p<0,001). CONCLUSÃO: 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.

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.

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% mulheres) e GV: 44 pacientes (32,9 ± 9,5 anos e 90,9% 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. CONCLUSÃO: Ambos os métodos obtiveram 100% 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.

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.

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 µg/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.

OBJECTIVE: To evaluate elastic properties of conduit arteries in asymptomatic patients who have severe chronic aortic regurgitation. METHODS: Twelve healthy volunteers aged 30±1 years (control group) and 14 asymptomatic patients with severe aortic regurgitation aged 29±2 years and left ventricular ejection fraction of 0.61±0.02 (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 (78±3 versus 48±1mmHg, P<0.01). Arterial compliance and distensibility were significantly greater in the aortic regurgitation group compared with that in the control group (11.0±0.8 versus 8.1±0.7 10-10 N-1 m4, P=0.01 e and 39.3±2.6 versus 31.1±2.0 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.

OBJETIVO: Comparar resultados imediatos e após 12 meses de seguimento entre valvoplastia por balão e comissurotomia na estenose mitral. MÉTODOS: Oitenta e oito portadores de estenose mitral sintomáticos com anatomia favorável foram randomizados nos dois grupos. Todos os pacientes submeteram-se a avaliação clínica e Doppler ecocardiográfica antes, imediatamente após e 12 meses depois do procedimento. RESULTADOS: Gradiente médio mitral (mmHg) diminuiu (p<0,001) de 12,18±5,84 para 5,80±2,66 no grupo comissurotomia (GC) e de 11,66±6,13 para 4,98±2,40 (p<0,001) no grupo valvuloplastia (GV). Área valvar mitral (cm²) aumentou de 0,98±0,21 para 2,52±0,46 no GC e de 1,05±0,25 para 2,18±0,40 no GV (p<0,001). Em ambos os grupos ocorreu uma diminuição discreta na área valvar mitral ao final do acompanhamento. Não ocorreram óbitos. Um paciente do GV apresentou insuficiência mitral significativa e necessitou tratamento cirúrgico. Aos 12 meses de acompanhamento todos os pacientes do GC e 97,7% dos pacientes do GV estavam em classe funcional I ou II (NYHA). CONCLUSÃO: Os procedimentos foram seguros e mostraram melhora semelhante no gradiente mitral e classe funcional. A área valvar mitral aumentou expressivamente mais no GC, e apresentou, também, uma redução mais significativa após 12 meses. A maioria dos pacientes não alterou a classe funcional no acompanhamento.

PURPOSE: To compare immediate and late (12 months) follow up of clinical and Doppler echocardiographic results between percutaneous mitral balloon valvuloplasty and open commissurotomy in a prospective and randomized trial. METHODS: Eighty eight symptomatic patients with severe mitral stenosis and favorable anatomy were randomized in a prospective trial comparing the two procedures. All patients were submitted to clinical and Doppler echocardiographic evaluation before the procedures and immediate and twelve months thereafter. RESULTS: Mean mitral gradient (mmHg) decreased from 12.2±5.8 to 5.80±2.7 (p<0.001) in commissurotomy group (CG) and from 11.7±6.1 to 5.0±2.4 (p<0.001) in the balloon valvuloplasty group (VG). Mitral valve area (cm²) increased from 0.98±0.21 to 2.52±0.46 in CG and from 1.05±0.25 to 2.18±0.40 in VG (p<0.001). In both groups there was a slight decrease in mitral valve area at 12 month follow-up. There was no death in either group. One patient in the VG had moderate mitral regurgitation and underwent surgery. At the 12 month follow-up, all patients in CG and 97.7% of patients in VG were in New York Heart Association functional class I or II. CONCLUSION: Both procedures were safe and showed similar immediate improvement in mitral gradient and functional class. Mitral valve area had a greater increase immediately after commissurotomy, however there was a significantly greater reduction in the CG after 12 months of follow-up, when compared to balloon valvuloplasty. In both groups, mitral gradient remained reduced and most patients did not change functional class during the follow-up.

O tratamento cirúrgico do aneurisma do VE teve seus resultados incrementados com a aplicação do princípio da reconstrução da geometria da cavidade do VE através da aplicação de diferentes técnicas cirúrgicas. No auxílio da avaliação imediata dos resultados da cirurgia, além dos parâmetros hemodinâmicos, a ecocardiografia transesofágica vem se mostrando um método útil e eficiente. No período de julho/91 a janeiro/92, 22 pacientes consecutivos portadores de aneurisma de VE foram operados, sendo 20 masculinos com idade variando de 35 a 72 anos (57,1a). Dois grupos foram individualizados, sendo o grupo 1 (GI) composto por 11 pacientes que, além do tratamento do aneurisma de VE, receberam revascularização para outro território coronariano além da descendente anterior (DA) e GII com 11 pacientes que corrigiram o aneurisma de VE e não revascularizaram outras coronárias, além da DA.. Todos os pacientes apresentavam ICC prévia á operação e 8 pacientes sintomas anginosos no GI e 3 no GII. Os dois grupos eram similares quanto a idade, sexo e presença de ICC. Todos os pacientes foram operados com auxílio de circulação extracorpórea (CEC) em hipotermia moderada e pinçamento intermitente de aorta, pelo mesmo cirurgião. A técnica cirúrgica empregada constou da reconstrução da geometria da cavidade do VE com aplicação de sucessivas plicaturas da região septal e ântero-apical, além da RM nos casos já citados. Não houve óbitos e, além de suporte hemodinâmico com drogas inotrópicas, 4 pacientes fizeram uso de balão intra-órtico, com boa evolução posterior. A avaliação ecocardiográfica foi realizada antes do início da CEC e após saída de CEC em quadro de estabilidade hemodinâmica. Vários parâmetros foram avaliados como: espessamento da parede inferior que no pré-CEC era 31 % no Gl e 28% no G11 e no pós-CEC mudou para 62% e 60% no G1 e G11 (p,05). A fração de ejeção variou de 24% e 26% em G1 e G11 no pré-CEC para 51 % e 53% em G1 e G11 no pós-CEC (p,05). O diâmetro diastólico variou de 66 e 64 mm em G1 e G11 no pré-CEC para 54 e 52 mm após a correção em G1 e G11 (p,05). Em conclusão, a técnica de reconstrução da geometria do VE se mostrou eficiente, confirmada por parâmetros hemodinâmicos e ecocardiográficos durante o intraoperatório.

The surgical treatment of LVA by geometric reconstruction has been increasing the results and the use of TEE is an important method to evaluate the results. From July 91 to January 92,22 consecutive patients (pts) with LVA were operated on, 20 were male and the ages ranged from 35 to 72 y (57.1 y). All pts were operated on with extracorporeal circulation (ECC), moderate hypothermia and intermitent aortic crossclamping. The surgical technique consisted by plicatures of septal and antero-apical wall to reconstruct the LV cavity and 19 pts received bypass grafts. No deaths were observed and in 4 pts was used IABP with good evolution. The TE evaluation was performed before and after the ECC in hemodinamic estability. Some parameters were evaluated as: inferior wall thickning (WT) that was 30% pre ECC and 61 % post ECC (p<0.05). The ejection fraction varied from 25% pre ECC to 52% post ECC (p<0.05). The diastolic diameter came from 65 mm pre ECC to 53 mm post ECC (p<0.05). In conclusion, the geometric reconstruction of LVA showed good results, confirmed by hemodynamic and ECHO parameters in intraoperative period.

A ecodopplercardiografia ocupa posição de destaque no diagnóstico das valvopatias, pois fornece dados sobre a anatomia valvar, a área estenótica, os gradientes pressóricos e o grau da regurgitação. Seu uso na cirurgia cardíaca, com a abordagem epicárdica, é bastante conhecido. O advento da abordagem transesofágica, por não interferir no campo operatório, facilitou a sua utilização. O objetivo deste trabalho foi estudar a utilidade da ETE nacirurgiada valva mitral. De julho de 1991 a janeiro de 1992, aecodopplercardiografia transesofágica (ETE) monitorizou 198 cirurgias, das quais 65 foram sobre a valva mitral (VM). A idade variou de 8 a 62 anos e 42 pacientes eram do sexo feminino. A comissurotomia e papilarotomia (CP) foi o procedimento mais freqüente em 28 pacientes (pts), seguido do implante de bioprótese (BP) em 24 e da plastia (PL) em 19. A ETE pré-operatória confirmou o diagnóstico da lesão mitral em todos os pts, tendo acrescentado informações quanto ao grau e direção da insuficiência mitral (IM) em 8 dos 28 pts submetidos a CP. Modificou a orientação da abordagem da valva tricúspide em 9 oportunidades (3 por diagnosticar lesões não detectadas e 6 por evitar a abordagem desnecessária por melhor avaliação da lesão. Quanto aos pts submetidos a implante de BP, 6 já tinham próteses disfuncionantes, em 12 pts a BP foi implantada de imediato por decisão do cirurgião e, em 6 pts, a BP foi implantada após a detecção da presença de IM importante pós-correção. Quanto ao pts submetidos a PL, 12 tinham prolapso, 6 tinham insuficiência coronária e 1 era pós-operatório tardio de correção de defeito do septo atrioventricular. Em apenas 1 pt foi necessária nova CEC para nova plastia. A avaliação da tM pós CEC evidenciou 7 pts (10%) com IM importante, sendo necessária nova CEC, e mostrou IM leve em 15 pts, moderada em 8 e importante em 1 onde não foi realizada nova CEC. A ETE é um método de grande valor no auxílio do planejamento cirúrgico nas doenças da VM, bem como na avaliação imediaata dos resultados operatórios possibilitando ao cirurgião uma adequada análise anatômica e funcional da estrutura abordada.

The usefulness of routine intraoperative transesophageal echocardiography (TEE) for mitral valve (MV) surgery was studied in 65 patients (pts) with MV disease (mean age = 31 ± 14.8 to 62 yrs): 1 - Mitral regurgitation (MR): 19 pts-MV prolapse in 12 pts; Ischemic in 6 pts and post repair of ASD: 1 pt; 2 - Mitral stenosis (MS): 23 pts (4 of them with previous surgery); 3 - MS+MR and/or tricuspid valve (TV) lesions: 16 pts; 4 - Bioprosthetic valve (BV) dysfunction: 6 pts and 5 - Left atrial myxoma: 1 pt. Initial precardiopulmonary bypass TEE was used to confirm MV dysfunction, TV involvement and to assess LV function. On the 1 st run bypass (RBP), the MV commissurotomy was performed in 27 pts (23 with MS and 4 with MS+MR); the MV was replaced with BV (pericardial #21 to #29) in 18 pts (6 with BV dysfunction and 12 with MS+MR) and the MV repair was performed in all of 19 pts with MR). The 2nd RBP was required in 7 pts (11%): 1 pt with MR; 4 pts with MS+MR and 2 pts with MS. TEE caused changes in pre pump plans in 9 pts with TV lesions and in 10 pts with MS or MS+MR - preservation of native in 6 pts in which replacement was planned. Thus intraoperative TEE provides helpful information in MV surgery and can help avoid a mitral replacement in pts with MS or MS+MR.

O objetivo deste trabalho é apresentar os resultados pós-operatórios preliminares de 16 pacientes submetidos a implante de bioprótese valvular de pericárdio bovino com preservação de suas valvas naturais, operados seqüencialmente no período de março a setembro de 1989. As cúspides insuficientes foram pregueadas no anel mitral com pontos em U passados nas bordas livres e no anel mitral, sem quaisquer ressecções. Foram feitos estudos comparativos no pré e no pós-operatório das seguintes grandezas: diâmetro do átrio esquerdo, diâmetro do ventrículo esquerdo (VE), fração de ejeção e gradiente transvalvares mitrais (pico e médio). A avaliação estatística foi feita através do teste T de Student. O valor médio do diâmetro do VE no pré-operatório era de 67,31 mm, caindo para 60,50 mm no pós-operatório. O valor crítico de T foi 2,131, sendo o valor observado para a variação do diâmetro de VE igual a 3,18. O diâmetro de átrio esquerdo (AE) variou de 60,25 mm para 49,31 mm com T igual a 6,72. O valor médio da fração de ejeção no pré-operatório foi de 0,72, variando para 0,65 com T igual a 2,68. Os gradientes (valores médios) transvalvares variaram de 23,7 mm de Hg de pico e 12,5 de média, respectivamente, para 9,10 e 5,125. Estes valores residuais são perfeitamente aceitáveis de acordo com a literatura e a própria experiência do Serviço. Não houve complicações ou óbitos na série. Em nenhum paciente ocorreu gradiente na via de saída de VE que pudesse sugerir obstrução pela cúspide anterior. Os autores concluem pela eficácia da técnica a qual é de fácil e rápida execução, afasta desinserções atrioventrículares, não gera gradientes, favorece ótimo desempenho ventricular com rápida e acentuada regressão dos diâmetros de AE e VE.

The preliminary postoperative results in 16 patients submitted to valvular replacement utilising bovine pericardial valvular bioprostheses, without resection of their natural cusps, are presented. These patients were operated on sequentially from March to September 1989. The incompetent cusps were sutured to the mitral annulus with U stitches placed at their free edges. Pre and postoperative evaluation of the following parameters were obtained: left atrial diameters, left ventricular diameters, ejection fraction and mitral transvalvular gradients (peak and mean). Statistical evaluation utilising the Student's T test was performed. Preoperative mean value of the left ventricular diameter was 67.31 mm, decreasing to 60.50 mm in the postoperative evaluation. Critical value of T was 2.131, the value observed for the left ventricle variation being 3.18. The left atrial diameter varied from 60.25 mm to 49.31 mm (T equal to 6.72). Preoperative ejection fraction mean value was 0.72 and in the postoperative was 0.65 (T = 2.68). Mean transvalvular gradients varied from 23.7 mm (peak) and 12.5 mm (mean) to 9.10 and 5.125 respectively. These residual values are acceptable according to the current literature and the experience of our Institution. There were no complications or deaths in the present series. In no patient gradients in the left ventricular out flow tract suggesting obstruction by the anterior cusp were observed. The authors consider it an efficient technique, easily and rapidly performed, without danger of atrioventricular desinsertions and without significant gradients. Ventricular performance is enhanced and the left atrial and left ventricular diameters decrease considerably.