Relatamos caso de paciente portador de cardiomiopatia hipertrófica septal submetido a correção cirúrgica em que o emprego da ecocardiografia transesofágica intraoperatória proporcionou o planejamento da abordagem cirúrgica e o reconhecimento imediato do resultado operatório.

We report the case of a patient with septal hypertrophic cardiomyopathy undergoing surgical correction in which the use of intraoperative transesophageal echocardiography permitted the planning of the surgical approach and an immediate knowledge of the surgical outcome.

Relatamos caso de paciente portador de cardiomiopatia hipertrófica septal submetido a correção cirúrgica em que o emprego da ecocardiografia transesofágica intraoperatória proporcionou o planejamento da abordagem cirúrgica e o reconhecimento imediato do resultado operatório.

FUNDAMENTO: O acoplamento eletromecânico (sincronia) do ventrículo esquerdo (VE) tem importância na análise da performance sistólica, especialmente para a indicação da terapia de ressincronização cardíaca em pacientes com ICC avançada. OBJETIVO: Comparar a sincronia do VE analisada com ecocardiograma (eco) tridimensional (3D) em tempo real com medidas de FEVE obtidas com ECO 2D e 3D. MÉTODOS: Estudo prospectivo de 92 indivíduos (56 homens, 47±10 anos), 60 com anatomia cardíaca (eco) e ECG normais (Grupo N), 32 com cardiomiopatia dilatada (Grupo CMD). Com o emprego do ECO 3D foram aferidos FEVE, volumes e índice de dissincronia (ID)% para 16 segmentos do VE; com o ECO 2D foram medidos FEVE (método de Simpson) e volumes sistólico e diastólico do VE. Análise estatística: coeficiente de correlação (Pearson), 95% IC, teste de regressão linear, teste de Bland & Altman, p<0,05. RESULTADOS: O ID% variou de 0,2900 a 28,1000 (5,2014±6,3281), a FEVE 3D variou de 0,17 a 0,81 (0,52±0,17); a FEVE 2D variou de 0,3 a 0,69 (0,49±0,11). A correlação entre ID e FEVE 3D foi (r): -0,7432, p<0,0001, IC: -0,8227 a -0,6350, a relação linear entre ID (x) e FEVE 3D (y) foi y = 19,8124 + (-27,9578) x , p<0,0001. A correlação entre ID e FEVE 2D foi (r): -0,7012, p<0,0001, IC: -0,7923 a -0,5797. CONCLUSÃO: Nesta casuística foi observada boa correlação negativa entre o acoplamento sistólico tridimensional eletromecânico do VE e a FEVE medida ao ecocardiograma (3D e 2D).

BACKGORUND: Left ventricular (LV) electromechanical coupling (synchrony) is important in the analysis of the systolic performance, especially for the indication of cardiac resynchronization therapy in patients with advanced CHF. OBJECTIVE: To compare LV synchrony as analyzed by real-time three-dimensional (3D) echocardiography (ECHO) with LVEF measurements as obtained with 2D and 3D ECHO. METHODS: Prospective study of 92 individuals (56 men, 47 ± 10 years of age), of which 60 had normal heart structure (ECHO) and ECG (N group), and 32 had dilated cardiomyopathy (DCM group). Using 3D ECHO, LVEF, volumes and dyssynchrony index (%DI) for 16 LV segments were measured. Using 2D ECHO, LVEF (Simpson's method), and LV systolic and diastolic volumes were measured. Statistical analysis: Pearson's correlation coefficient, 95% CI, linear regression model, Bland & Altman analysis, p<0.05. RESULTS: %DI ranged from 0.2900 to 28.1000 (5.2014±6.3281), 3D LVEF ranged from 0.17 to 0.81 (0.52±0.17); and 2D LVEF ranged from 0.3 to 0.69 (0.49±0.11). The correlation between DI and 3D LVEF was (r): -0.7432, p<0.0001, CI: -0.8227 to -0.6350, the linear relation between DI (x) and 3D LVEF (y) was y = 19.8124 + (-27.9578) x, p<0.0001. The correlation between DI and 2D LVEF was (r): -0.7012, p<0.0001, CI: -0.7923 to -0.5797. CONCLUSION: In this case series, a good negative correlation was observed between LV electromechanical three-dimensional systolic coupling and LVEF as measured by echocardiography (3D and 2D).

OBJETIVO: Estudar bioprótese com descontinuidade do anel de sustentação, a bioprótese "Less Stented ®". O objetivo da fase 1 do trabalho foi o seu estudo "in vitro", onde foram avaliadas as características hemodinâmicas. O objetivo da fase 2 é relatar a experiência clínica inicial. MÉTODO: As biopróteses foram confeccionadas e avaliadas laboratorialmente na Braile Biomédica, em São José do Rio Preto, São Paulo. São próteses de pericárdio bovino, tratadas com glutaraldeído, segundo os mesmos padrões das próteses "stented". As próteses foram testadas no simulador de pulso e analisadas em simulador cardíaco. Foi realizada análise clínica e laboratorial (ecoDopplercardiografia e ressonância magnética) dos pacientes. RESULTADOS: A análise do gradiente pressórico transvalvar mostrou que ao longo do fluxo médio, equivalente ao débito cardíaco e que variou de 4,39 a 7,96 l/min, o gradiente transvalvar se manteve dentro de níveis clinicamente aceitáveis (6,37 a 11,62 mmHg). A curva de regressão mostrou boa correlação com o aumento de débito cardíaco com R² = 0,8291. A fração regurgitante variou de 10,95 a 17,94%, sendo que a fração de vazamento variou de 4,49 a 7,87%. Quanto ao coeficiente de descarga, ao índice de performance e ao de eficiência, verificou-se que esses parâmetros mostraram comportamento favorável com aumento progressivo do débito cardíaco, com excelente correlação tanto para o coeficiente de descarga, quanto para o índice de performance e o índice de eficiência (R² respectivamente, 0,9385; 0,9332; 0,9024). Os dois pacientes submetidos ao implante da bioprótese "Less- Stented®" apresentaram evolução clínica satisfatória. CONCLUSÃO: A bioprótese "Less-Stented®"poderá representar uma nova alternativa de substituto valvar.

OBJECTIVE: To study a bioprosthesis with discontinuation of the annular support, named the "Less Stented®" bioprosthesis. The Phase 1 objective was the "in vitro" study, during which the hemodynamic characteristics were analyzed. Phase 2 of this study consisted of an initial clinical implant protocol. METHOD: The "Less Stented" bioprosthesis consists in a glutaraldehyde treated bovine pericardium prosthesis manufactured by Braile Biomedica Ltda, São José do Rio Preto, São Paulo, Brazil, using the same manufacturing protocols as the stented bioprosthesis but with discontinuation of the annular suport. Bioprostheses were tested in a pulse simulator system and analyzed in cardiac simulator. with respect to the transvalvular gradient, regurgitant fraction and leakage volume, discharge coefficient, performance and efficiency index. The two patients of clinical protocol were analyzed according to the functional class (NYHA), an echocardiographic study and magnetic resonance, in both pre and postoperative periods. RESULTS: The transvalvular gradients ranged between 6.37 and 11.62 mmHg with a mean flow between 4.39 and 7.96 L/min, giving a good correlation (0.8291) on the regression curve with the increase in flow. The regurgitant fraction ranged between 10.95% and 17.94% and leakage volume between 4.49% and 7.87%. The discharge coefficient, performance and efficiency index showed favorable behavior with the flow increase, with good coefficient correlations for all three variables (0.9385, 0.9332 and 0.9024, respectively). The two patients submitted to "Less Stented®" bioprostheses implant presented good clinical evolutions. CONCLUSION: "Less Stented®" bioprostheses may represent a new alternative to aortic valve replacement.

PURPOSE:To determine the indication for and incidence and evolution of temporary and permanent pacemaker implantation in cardiac transplant recipients. METHODS: A retrospective review of 114 patients who underwent orthotopic heart transplantation InCor (Heart Institute USP BR) between March 1985 and May 1993. We studied the incidence of and indication for temporary pacing, the relationship between pacing and rejection, the need for pemanent pacing and the clinical follow-up. RESULTS: Fourteen of 114 (12%)heart transplant recipients required temporary pacing and 4 of 114 (3.5%) patients required permanent pacing. The indication for temporary pacing was sinus node dysfunction in 11 patients (78.5%) and atrioventricular (AV) block in 3 patients (21.4%). The indication for permanent pacemaker implantation was sinus node dysfunction in 3 patients (75%) and atrioventricular (AV) block in 1 patient (25%). We observed rejection in 3 patients (21.4%) who required temporary pacing and in 2 patients (50%) who required permanent pacing. The previous use of amiodarone was observed in 10 patients (71.4%) with temporary pacing. Seven of the 14 patients (50%) died during follow-up. CONCLUSION: Sinus node dysfunction was the principal indication for temporary and permanent pacemaker implantation in cardiac transplant recipients. The need for pacing was related to worse prognosis after cardiac transplantation.