Influence of the tilt angle of Percutaneous Aortic Prosthesis on Velocity and Shear Stress Fields.

Background: Due to the nature of the percutaneous prosthesis deployment process, a variation in its final position is expected. Prosthetic valve placement will define the spatial location of its effective orifice in relation to the aortic annulus. The blood flow pattern in the ascending aorta is related to the aortic remodeling process, and depends on the spatial location of the effective orifice.

Analysis of the Economic Impact of Cardiovascular Diseases in the Last Five Years in Brazil.

Background: There is growing concern about the economic impact of cardiovascular diseases (CVD) in Brazil and worldwide.

Objective: To estimate the economic impact of CVD in Brazil in the last five years.

Methods: The information to estimate CVD costs was taken from national databases, adding the direct costs with hospitalizations, outpatient visits and benefits granted by social security.

Trimetazidine and inflammatory response in coronary artery bypass grafting.

Background: Organic inflammatory response is a pathophysiological mechanism present at every coronary artery bypass grafting with extracorporeal circulation (CABG-ECC), the release of inflammatory mediators being one of its defense mechanisms.

Objective: To assess, in a prospective double-blind randomized and placebo-controlled study, the effects of trimetazidine (Tmz) on the inflammatory response, by using the variation in interleukins 6 and 8, TNF-α, complements C3 and C5, and highly sensitive C-reactive protein (HS-CRP) levels in the pre- and post-operative periods.

Methods: This study assessed 30 patients undergoing CABG-ECC with intermittent hypothermic cardioplegia, and having, at most, mild ventricular dysfunction.

Trimetazidine on ischemic injury and reperfusion in coronary artery bypass grafting.

Background: The ischemia and reperfusion ischemia is a common physiopathological mechanisms, which has difficult control during Coronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass, the critical moment of which happening by the end of surgery, when there is declamping of aorta and release of hyperoxic radicals causing the injury.

Objective: Evaluate, in a randomized double-blind prospective study, controlled with placebo, the effects of Trimetazidine (Tmz) on ischemic injury and myocardial reperfusion, identifying the change in plasma markers of a myocardial aggression (troponin T and CPK-MB), and echocardiographic changes of ventricular function.

Methods: We studied 60 patients divided in two groups (placebo and Tmz) with mild ventricular dysfunction at the most, stratified by echocardiography and receiving medication/placebo at a dose of 20 mg/3 x/day, starting from 12 to 15 days after pre-operative period up to 5 to 8 days after post-operative period.

Case reports: hyperbaric oxygen therapy for the treatment of cerebral air embolism.

Cerebral air embolism is one of the most deleterious disorders that may affect divers, but it is also a possible complication of surgeries and medical procedures. We report our experience with iatrogenic cerebral air embolism and hyperbaric oxygen treatment.

[Regional left ventricular dysfunction and its association with complex ventricular arrhythmia, in chagasic patients with normal or borderline electrocardiogram].

Introduction: Sudden death is the major cause of death among chagasic patients. A significant number of fatal events in patients without apparent heart disease and borderline electrocardiogram, but with contractile ventricular dysfunction, have been documented. This work aimed to determine the association between regional dysfunction and the presence of ventricular arrhythmia in chagasic patients without apparent heart disease.

Evaluation of atherosclerosis in renal transplanted patients by non-invasive methods.

Background: Endothelial dysfunction can be considered an early atherogenic event.

Objective: To assess atherosclerosis in renal transplanted patients through the coronary calcium score, carotid duplex scan and brachial reactivity through ultrasonography.

Methods: We assessed 30 renal transplanted male patients with stable renal function, with a mean age of 41.

Complications related to carotid sinus massage in 502 ambulatory patients.

Background: The carotid sinus massage (CSM) is a simple and low-cost technique with many indications.

Objective: To determine the safety of CSM in outpatients with high prevalence of atherosclerotic disease and cardiopathy.

Methods: A transversal study.

Cardioinhibitory carotid sinus hypersensitivity: prevalence and predictors in 502 outpatients.

Background: Cardioinhibitory response (CIR) is defined as asystole >3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). Pacemaker implantation is indicated for patients with unexplained syncope episodes and CIR.

Objective: To determine the prevalence and predictors of CIR in patients with a high prevalence of cardiovascular disease, and assess the clinical significance of CIR in patients with a history of unexplained syncope or falls.

AIDS in childhood: cardiac involvement with and without triple combination antiretroviral therapy.

Objective: To describe the prevalence of cardiac abnormalities in the echocardiogram of children with AIDS followed up in a reference service at 18+/-6 months of AIDS confirmed diagnosis.

Methods: A cross-section study with a cohort after 18+/-6 months of AIDS diagnosis. The study included a total of 93 children with a confirmed diagnosis of AIDS with vertical transmission, with no malignancies and who underwent echocardiogram (echo) during cardiologic evaluation.

Comparison of the inoue and single balloon techniques during long term percutaneous balloon mitral valvoplasty follow-up. Analysis of risk factors for death and major events.

Objective: To analyze the long term evolution of patients undergoing percutaneous balloon mitral valvoplasty comparing the Inoue and Balt single balloon methods, and to identify predictors of death and major events (death, repeat balloon mitral valvoplasty or mitral valve surgery).

Methods: The follow-up for the single and Inoue balloon groups were 54 +/- 31 (1 to 126) months and 34 +/- 26 (2 to 105) months, respectively (p < 0.0001).

Using ambulatory blood pressure monitoring to assess blood pressure of firefighters with parental history of hypertension.

Objective: To evaluate the influence of family history of systemic arterial hypertension (FSAH) on the effect of stress from work in Uniformed Firefighters (BMCs) through Ambulatory Blood Pressure Monitoring (ABPM).

Methods: A prospective case-control study. Sixty-six healthy BMC underwent ABPM during 12 hours of work at the Communication Center (CC).

C-reactive protein diagnostic and prognostic value in patients presenting at the emergency room with chest pain.

Objective: To test immediate diagnostic and prognostic values of C-reactive protein (CRP) in patients admitted to the emergency room (ER) with chest pain (CP) without ST-segment elevation on the electrocardiogram (ECG).

Methods: From January 2002 to December 2003, 980 patients were consecutively seen in the ER with CP suggestive of acute coronary syndrome (ACS) (age = 64.9 +/- 14.

The effects of beta-blockers on dobutamine-atropine stress echocardiography: early protocol versus standard protocol.

Background: To study the effects of Beta-blockers during Dobutamine Stress Echocardiography (DSE) comparing the hemodynamic benefits of an early administration of atropine in patients taking or not Beta-blockers.

Methods: One hundred and twenty-one patients were submitted to dobutamine stress echocardiography for the investigation of myocardial ischemia. The administration of atropine was randomized into two groups: A or B (early protocol when atropine was administered at 10 and 20 mcg/kg/min of dobutamine, respectively) and C (standard protocol with atropine at 40 mcg/kg/min of dobutamine).

[Correlation between biochemical markers and coronary angiography in patients with non-ST elevation acute coronary syndromes].

Objective: Investigate the correlation between biochemical markers (TNI, CRP and fibrinogen) and anatomical coronary angiographic findings in patients with non-ST elevation acute coronary syndromes (NSTE-ACS).

Methods: One blood sample was obtained to test for markers, and coronary angiography was performed within the first 72 hours after hospitalization. Univariate analysis was used to search for correlations between the 3 markers and the angiographic findings in the group of patients with an identified ischemia-related artery (IRA), and multivariate analysis was performed to investigate the correlation between these markers and the presence of unstable atherosclerotic lesions solely in the group with a coronary obstruction > 50%.

The effects of early administration of atropine during dobutamine stress echocardiography: advantages and disadvantages of early dobutamine-atropine protocol.

Background: The conventional dobutamine protocol for the investigation of induced myocardial ischemia is well established. Our objective was to evaluate the effects of early administration of atropine during the dobutamine stress echocardiogram, as compared to its conventional use.

Methods: One hundred and twenty-one patients were referred to the dobutamine stress echocardiogram, for the investigation of myocardial ischemia and the administration of atropine was randomized into three groups (A, B, C at 10, 20 and 40 mcg/kg/min of dobutamine, respectively).

[Temporal tendency of in-hospital lethality due to acute myocardial infarction. 1994-2003].

Objective: To analyze the temporal tendency of lethality due to acute myocardial infarction (AMI) and if the change in behavior directly interfered in such lethality.

Methods: 1055 non-selected patients, who were hospitalized in coronary unit from 1994 to 2003, were assessed. Clinical and therapeutic profile-related variables were analyzed.

Prevalence and prognostic value of perfusion defects detected by stress technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography in asymptomatic patients with diabetes mellitus and no known coronary artery disease.

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in diabetics. Early diagnosis of CAD and identification of high-risk subgroups, followed by appropriate therapy, may therefore enhance survival. This study sought to determine the value of stress myocardial perfusion single-photon emission computed tomography (SPECT) with technetium-99m sestamibi to detect perfusion defects and predict cardiac events in asymptomatic diabetics.

Clinical determinants of increased QT dispersion in patients with diabetes mellitus.

Aims: To compare QT dispersion measurements in diabetic patients to control subjects and assess any associations between QT dispersion and diabetic clinical characteristics.

Methods: A total of 512 diabetics and 50 age and gender matched controls were studied. QT interval was measured manually in 12-lead conventional electrocardiograms, and QT dispersion (QTd), heart rate-corrected QT dispersion (QTcd), number of leads-adjusted QT dispersion (adjuQTd) and adjacent QT dispersion (adjaQTd) were calculated.

Congestive heart failure. Correlation between functional class and systolic and diastolic functions assessed by Doppler echocardiography.

Objective: To evaluate the influence of systolic or diastolic dysfunction, or both on congestive heart failure functional class.

Methods: Thirty-six consecutive patients with a clinical diagnosis of congestive heart failure with sinus rhythm, who were seen between September and November of 1998 answered an adapted questionnaire about tolerance to physical activity for the determination of NYHA functional class. The patients were studied with transthoracic Doppler echocardiography.

[Morpho-functional cardiac evaluation in young normotensive children of hypertensive patients. A prospective Doppler-echocardiographic study].

Purpose: Evaluate functional and/or structural cardiac changes in young normotensive subjects with a family history of hypertension.

Methods: Prospective study was performed with 62 normotensive persons, ages 15 to 30 years, divided in 32 children of hypertensive patients (group 1) and 30 children of normotensive persons (group 2) comparable in blood pressure, body surface area, heart rate, age and sex. After clinical examination, all underwent Doppler-echocardiogram to evaluate cardiac structure and left ventricular (LV) systolic and diastolic function.

M-mode and two-dimensional echocardiographic features in cardiac amyloidosis.

Twenty-eight patients with cardiac amyloidosis were studied by echocardiography -- 26 by M-mode and 13 by two-dimensional (2D) studies. All had heart failure and biopsy-proved amyloidosis, M-mode features included (1) normal left ventricular (LV) dimension in all; (2) thickened ventricular septum (88%), LV posterior wall (77%), and right ventricular (RV) anterior wall (79%); (3) decreased thickening of ventricular septum (96%) and of LV posterior wall (65%) and reduced LV global function (62%); (4) left atrial enlargement (50%); and (5) pericardial effusion (58%). Two-dimensional echocardiography provided additional features: (1) thickened papillary muscles (five of 13); (2) thickened valves (four of 13); (3) better appreciation of thickened RV wall; and (4) a characteristic "granular sparkling" appearance of thickened cardiac walls -- presumably secondary to the amyloid deposit -- which was noted in 12 of 13 patients.

Primary inferior vena cava thrombosis: report of nine cases.

All cases of inferior vena cava obstruction diagnosed at the Mayo Clinic between 1950 and 1973 were reviewed. Diagnosis was confirmed by surgery, phlebography, or postmortem examinations in 64 cases; the cause in 55 cases is described. Carcinoma of the kidney was the most common cause (31% pf cases).