RESUMO

The autonomic nervous system is abnormal in patients with advanced Chagas'heart disease. Most researchers consider these autonomic abnormalities as primary, specific and irreversible. However, when and why do these abnormalities appear in the natural history of Chagas'disease, is still the subject of intense controversy. Recent morphological and functional studies strongly suggest that, the sympathetic and the parasympathetic abnormalities, are preceded by myocardial damage and left ventricular dysfunction. Consequently, the cardiac parasympathetic abnormalities and the activation of the sympathetic and of the renin-angiotensin-aldosterone systems of chagasic patients are very likely secondary and partially reversible. Therefore, neurohormonal activation, as postulated by the neurogenic theory could contribute to the progression of myocardial damage and left ventricular dysfunction. Additional clinical investigations are necessary to clarify this important issue.

Assuntos

RESUMO

The autonomic nervous system is abnormal in patients with advanced Chagas' heart disease. Most researchers consider these autonomic abnormalities as primary, specific and irreversible. However, when and why these abnormalities appear in the natural history of Chagas' disease, is still the subject of intense controversy. Recent morphological and functional studies strongly suggest that the sympathetic and the parasympathetic abnormalities are preceded by myocardial damage and left ventricular dysfunction. Moreover, chagasic patients with cardiac failure benefit from drugs which antagonize neurohumoral activation. Consequently, the abnormalities of the autonomic nervous system of chagasic patients are very likely secondary and partially reversible.

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Assuntos

RESUMO

PURPOSE: To compare balloon valvuloplasty and surgical valvulotomy in the management of pulmonary valvar stenosis. PATIENTS AND METHODS: Balloon pulmonary valvuloplasty was performed in 10 consecutive patients, 6 girls and 4 boys, age ranges 3 to 19 years (mean 11), between April 1987 to November 1988. RESULTS: Immediate hemodynamic and angiographic changes consisted in reduction of the peak transvalvular gradient from 93 +/- 42 mmHg to 39 +/- 26 (p less than 0.01), the right ventricular systolic pressure from 108 +/- 16 mmHg to 58 +/- 27 mmHg (p less than 0.01) and in increasing of the pulmonary valve diameter from 9.59 +/- 3.28 mm to 19.55 +/- 6.16 mm (p less than 0.01) and the systolic pulmonary artery pressure from 15.15 +/- 3.28 mmHg to 18.4 +/- 6 (NS). No relationship between right ventricular systolic pressure and transpulmonary valvular gradient could be found. We only observed one case of mild pulmonary insufficiency as a complication of the procedure. The intermediate follow up (7 to 14 months), in 4 of 10 patients showed maintenance of the initial finding. CONCLUSION: The results of the percutaneous pulmonary valve valvuloplasty are as good as those obtained by the surgical valvulotomy.

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Assuntos

RESUMO

In order to detect possible abnormalities in sinus node function and atrio-ventricular conduction, one hundred and fourty three chagasic patients were subjected to electrophysiologic and pharmacologic studies. These patients were placed in four categories based on the their clinical, hemodynamic and angiographic characteristics. The chagasic patient without cardiac involvement (group IA), had no detectable abnormalities. Ten percent of those patients with early myocardial damage (group IB), had impaired sinus node automaticity. In three percent, the autonomic innervation was also altered and four percent had abnormally prolonged atrio-ventricular conduction. Among chagasic patients with abnormal EKG'S without heart failure (Group II), 45% had impaired sinus node automaticity, autonomic innervation was altered in 12%, and atrio-ventricular conduction was prolonged in 37%. Sinus node automaticity was impaired in 22% of those patients with abnormal EKG'S and heart failure (Group III). Autonomic innervation was altered in 33%, and atrio-ventricular conduction was prolonged in 47%. We conclude that over half of our patients with abnormal EKG'S will eventually require permanent pacing. Therefore, in these chagasic patients sinus node function and atrioventricular conduction should be routinely studied.

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We studied 19 patients (13 women and 6 men), with pure mitral stenosis by cineangiocardiograms taken in the right anterior 30 degrees oblique projection. Seven patients were also studied by single element M mode echocardiography in monoplane projection. We observed a significative diminution in the wall thickness and mass of the left ventricle in those patients in which the mitral valvular area was less than 1 cm2/m2. These results were interpreted as due to a global diminution in the cardiac mass induced by a reduction in the wall thickness of the left ventricle in all segments. When the patients with diminished mass were grouped by age, no correlation between chronicity and diminished mass was observed. We concluded that the diminution of the left ventricular mass in pure, severe mitral stenosis has a multifactorial etiology; the prolonged immobility of some myocardial segments could play a role, but the fibrosis secondary to acute or chronic myocarditis could be more important.

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Se estudio la masa y el espesor ventriculares izquierdos por cineangiocardiograma en oblicua derecha anterior a 30 grados en 19 pacientes, 13 mujeres y 6 hombres portadores de estenosis mitral pura y por ecocardiograma monoplano, modo M, en 7 de estos pacientes.Se observo una disminucion estadisticamente significativa del espesor y masa ventriculares izquierdos en pacientes con area valvular mitral menor de 1 cm2/m2. Se interpreto el hecho como una disminucion universal de la masa cardiaca debida a una disminucion del espesor de la pared ventricular en todos sus segmentos. Al comparar los resultados obtenidos en los pacientes con masa disminuida, por grupos etarios, con el fin de ver la influencia de la cronicidad, no se observo diferencia significativa entre los grupos. Se sugiere que la disminucion de la masa ventricular izquierda en la estenosis mitral pura severa es un problema multifactorial, donde podria influir la inmovilidad del miocardio en algunos segmentos, pero quizas sea mas importante la presencia de miocarditis aguda o cronica que haya conducido a fibrosis

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RESUMO

We performed an echocardiographic and hemodynamic study in 10 patients with cath proven pulmonary arterial hypertension (PAH). The results show that the echocardiographic pattern of PTH such as flat diastolic pulmonary echo, premature closing, flutter, abscense of "A" wave, in creased opening velocity and changes in the right ventricular systolic time intervals, are equivocal. The most common echo finding in our study, was the increased opening velocity. Other echo data could be absent despite the true presence of pulmonary hypertension in a particular case. This report shows similar findings to a recent one published elsewhere (12) with no correlation between echo and hemodynamic data.

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