Endomyocardial biopsy: a 21st century diagnostic tool.

The question of the utility of Endomyocardial Biopsy (EMB) often and recurrently raises. It is claimed that the image techniques provide identical results without the risks of an invasive procedure. It is a fact that the impressive technico-scientific development of cardiovascular imagological methodologies covers a broad spectrum of diagnosis.

Transcatheter aortic valve implantation (TAVI) in cardiogenic shock: TAVI-shock registry results.

Objectives: Aim of this study is to evaluate safety, feasibility, and mid-term outcome of transcatheter aortic valve implantation (TAVI) in cardiogenic shock (CS).

Background: Balloon aortic valvuloplasty in patients with severe aortic valve stenosis (SAS) complicated by CS is indicated but associated with a grim prognosis. TAVI might be a more reasonable treatment option in this setting but data are scant.

Autopsy in adults with congenital heart disease (ACHD).

The adult congenital heart diseases (ACHD) population is exceeding the pediatric congenital heart diseases (CHD) population and is progressively expanding each year, representing more than 90% of patients with CHD. Of these, about 75% have undergone surgical and/or percutaneous intervention for palliation or correction. Autopsy can be a very challenging procedure in ACHD patients.

Thrombus aspiration in patients with ST-elevation myocardial infarction: results of a national registry of interventional cardiology.

Background: We aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in 'real-world' settings.

Methods: We performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006-2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI).

Energy expenditure during an exercise training session for cardiac patients.

Increasing energy expenditure (EE) in cardiac patients remains a challenge. Exercise approaches in cardiac rehabilitation/secondary prevention programs (CR/SP) have consistently resulted in minimal weight loss, due in part to the low exercise-related EE. The purpose of this study was to measure the EE among patients participating in a routine exercise session of Phase III maintenance CR/SP, where a recreational activity was introduced.

Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology.

Although sudden cardiac death (SCD) is one of the most important modes of death in Western countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed and the accurate diagnosis of the causes of SCD is now of particular importance. Pathologists are responsible for determining the precise cause and mechanism of sudden death but there is still considerable variation in the way in which they approach this increasingly complex task.

Impact of Routine Fractional Flow Reserve on Management Decision and 1-Year Clinical Outcome of Patients With Acute Coronary Syndromes: PRIME-FFR (Insights From the POST-IT [Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease] and R3F [French FFR Registry] Integrated Multicenter Registries - Implementation of FFR [Fractional Flow Reserve] in Routine Practice).

Background: Fractional flow reserve (FFR) is not firmly established as a guide to treatment in patients with acute coronary syndromes (ACS). Primary goals were to evaluate the impact of integrating FFR on management decisions and on clinical outcome of patients with ACS undergoing coronary angiography, as compared with patients with stable coronary artery disease.

Methods And Results: R3F (French FFR Registry) and POST-IT (Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease), sharing a common design, were pooled as PRIME-FFR (Insights From the POST-IT and R3F Integrated Multicenter Registries - Implementation of FFR in Routine Practice).

Renal denervation for resistant hypertension.

There is a marked contrast between the high prevalence of hypertension and the low rates of adequate control. A subset of patients with suboptimal blood pressure control have drug-resistant hypertension, in the pathophysiology of which chronic sympathetic hyperactivation is significantly involved. Sympathetic renal denervation has recently emerged as a device-based treatment for resistant hypertension.

Late results (>10 years) of intracoronary beta brachytherapy for diffuse in-stent restenosis.

Introduction: Until the development of drug-eluting stents (DES), diffuse in-stent restenosis (ISR) was the main limitation of bare-metal stents in percutaneous coronary intervention (PCI). Among the different treatments available, intracoronary brachytherapy (BT) emerged as one of the most promising, although it was almost abandoned with the increasing use of DES.

Objective: To assess the Portuguese experience with 90Sr/90Y beta brachytherapy for the treatment of diffuse ISR regarding long-term (>10 years) major adverse cardiac events (MACE) and angiographic restenosis.

[Position statement on bioresorbable vascular scaffolds in Portugal].

Background: Bioresorbable vascular scaffolds (BVS) were recently approved for percutaneous coronary intervention in Europe. The aim of this position statement is to review the information and studies on available BVS, to stimulate discussion on their use and to propose guidelines for this treatment option in Portugal.

Methods And Results: A working group was set up to reach a consensus based on current evidence, discussion of clinical case models and individual experience.

[Upgrading to biventricular pacing for dilated cardiomyopathy following right ventricular pacing in a young patient].

A 2-day-old male infant required a conventional VVI pacemaker for congenital atrioventricular block. Three years later, he developed progressive heart failure due to left ventricular (LV) dysfunction and mitral regurgitation despite optimized medical treatment, and a cardiac resynchronization therapy (CRT) device was implanted. This is the first Portuguese report of CRT in a pediatric patient.

[Successful cardiac resynchronization therapy in a patient with heart failure and ischemic mitral regurgitation: importance of septal flash].

We describe the case of a 76-year-old man with a history of ischemic heart disease and functional mitral regurgitation who over the previous six months had experienced worsening of functional class (NYHA III/IV) under optimal medical therapy, without ischemic symptoms and with negative ischemic tests. Mitral valve annuloplasty was considered. As the patient presented left bundle branch block on the surface ECG, cardiac resynchronization therapy (CRT) was also considered.

Cardiac resynchronization therapy: can left ventricular lead position make the difference?

The authors report the case of an 82-year-old female patient with non-ischemic dilated cardiomyopathy who developed worsening heart failure functional class despite optimal medical therapy. As the patient met criteria for cardiac resynchronization, a CRT-P device was implanted, but due to technical difficulties, the left ventricular lead was implanted in the anterior coronary vein. In the absence of any benefit from the procedure, a new left ventricular lead was implanted in posterolateral position with good clinical and echocardiographic response.

Pediatric cardiology and telemedicine: seven years' experience of cooperation with remote hospitals.

Background: A telemedicine program was initiated in November 2000 between the Pediatric Cardiology Department of a tertiary care hospital in Lisbon and pediatricians and obstetricians from three remote Portuguese hospitals: two in mainland Portugal and one in the Azores. Images were transmitted by a telemedicine link over three integrated service digital network (ISDN) lines to a regional pediatric cardiology unit for interpretation by a consultant pediatric cardiologist.

Methods: We performed a retrospective review of all teleconsultations at our Department between November 2000 and December 2007.

Inferior and inferior-lateral location of left ventricular dyssynergy after myocardial infarction begets ischemic mitral regurgitation.

Introduction: Ischemic mitral regurgitation (IMR) after myocardial infarction (MI) results from changes in left ventricular geometry, which may involve the entire ventricular cavity (global remodeling) or predominantly affect the infarct zone (regional remodeling). The relative importance of these two distinct but not mutually exclusive mechanisms in generating IMR has been a matter of debate. The aim of our study was to assess the relative contribution of global versus inferior and inferior-lateral left ventricular dyssynergy in the development of significant IMR after MI.

Serum creatinine values underestimate surgical risk.

Introduction: Renal insufficiency is associated with increased mortality and morbidity from cardiac surgery. Serum creatinine (SCr) values are routinely used for the assessment of renal dysfunction. However, this parameter can overestimate renal function, especially in low-weight and elderly patients, who can have normal creatinine values despite impaired renal function.

C4d-the witness of humoral rejection.

Objective: Acute antibody-mediated (humoral) rejection is a major cause of morbidity, graft loss, and mortality among heart transplant patients. Herein we have presented our experience using C4d to characterize humoral rejection.

Materials And Methods: All nonformalin-fixed cardiac graft biopsies (protocol or emergency) received between May 2007 and May 2008 were examined by immunofluorescence for C4d.