Endovascular treatment of pseudoaneurysm of the thoracic aorta from a firearm injury

A 24-year-old male patient was the victim of a firearm wound that penetrated the thorax. He arrived at another hospital hemodynamically unstable and was submitted to exploratory surgery by means of bithoracotomy. A lesion of the left branch of the pulmonary artery was detected and successfully repaired. He was submitted for computer-aided tomography on the fifth postoperative day, and a lesion of the mid-thoracic aorta was detected, which formed a saccular image. Considering that the patient had already been submitted to a bithoracotomy and that a direct approach to repair would involve another thoracotomy within a short period of time, endovascular treatment was chosen in our hospital. The procedure was performed under fluoroscopy. A second computer-aided tomography indicated adequate treatment of the lesion, with no indication of an endoleak. He has undergone ambulatory follow-up for 36 months without any problem related to the procedure. While endovascular treatment of the aorta has developed enormously, multicenter studies are needed to better define the long-term results of this approach. © 2008 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

Razão triglicérides/HDL-C e proteína C reativa de alta sensibilidade na avaliação do risco cardiovascular

Introduction: Calculated indexes from laboratory measurements and the determination of plasma markers are commonly used in cardiovascular risk assessment. Objective: To use triglycerides/high-density lipoprotein cholesterol (HDL-C) ratio, estimate of low-density lipoprotein (LDL) particle size and high sensitive C-reactive protein (hs-CRP) levels to the clinical and laboratorial assessment of coronary risk among patients with coronary disease. Material and methods: Sixty patients were chosen accordingly, 36 female (F) (65 ± 9 years of age) and 24 male (M) (55 ± 10 years of age) diagnosed with stable ischemic cardiopathy at Ana Neri Hospital, Salvador, Bahia, Brazil. The investigation was carried out at the Clinical Biochemistry Laboratory of the College of Pharmacy at Federal University of Bahia (UFBA). Blood samples were collected after a 12-hour fast to determine hs-CRP, lipid profile and risk indicators. All data were assessed through Syncron LX®20 Beckman Coulter. The inferential analysis results were considered significant when p ≤ 5%. Data analysis was carried out with GraphPad Prism® (4.03 version) software. Results: Data analysis showed a positive correlation between hs-CRP and triglycerides/HDL-C ratio only among women (r = 0.4; p = 0.0442), n = 36. The analysis of other parameters did not show any significance. Conclusion: The triglycerides/HDL-C ratio and hs-CRP may be used as indicators of increase in cardiovascular risk among women with coronary artery disease (CAD).

Ausência de arteriosclerose na porção intramiocárdica das artérias coronárias: Um mistério a ser resolvido?

Several studies show that portions of intramyocardial coronary arteries are spared of arteriosclerosis, involving morphological, embryological, biochemical and pathophysiological aspects. Endothelial function is significantly affected in the segment of transition, as estimated by the vasoactive response to Ach. These findings suggest that myocardial bridge can provide protection against arteriosclerosis by counteracting the negative effects of endothelial dysfunction. The intramyocardial portion's protection phenomenon deserves further scientific research on all research fronts. Improved morphological, biomechanical and especially physiological and embryological knowledge may be the key to a future window of opportunity for chronic arterial disease therapy and prevention. In addition, this review discusses possible therapeutic approaches for symptomatic coronary ischemia caused by myocardial bridges.

Involvement of the atrial natriuretic peptide in cardiovascular pathophysiology and its relationship with exercise

In this minireview we describe the involvement of the atrial natriuretic peptide (ANP) in cardiovascular pathophysiology and exercise. The ANP has a broad homeostatic role and exerts complex effects on the cardio-circulatory hemodynamics, it is produced by the left atrium and has a key role in regulating sodium and water balance in mammals and humans. The dominant stimulus for its release is atrial wall tension, commonly caused by exercise. The ANP is involved in the process of lipolysis through a cGMP signaling pathway and, as a consequence, reducing blood pressure by decreasing the sensitivity of vascular smooth muscle to the action of vasoconstrictors and regulate fluid balance. The increase of this hormone is associated with better survival in patients with chronic heart failure (CHF). This minireview provides new evidence based on recent studies related to the beneficial effects of exercise in patients with cardiovascular disease, focusing on the ANP. © 2012 de Almeida et al; licensee BioMed Central Ltd.

Sensitivity, specificity and predictive values of linear and nonlinear indices of heart rate variability in stable angina patients

Background: Decreased heart rate variability (HRV) is related to higher morbidity and mortality. In this study we evaluated the linear and nonlinear indices of the HRV in stable angina patients submitted to coronary angiography. Methods. We studied 77 unselected patients for elective coronary angiography, which were divided into two groups: coronary artery disease (CAD) and non-CAD groups. For analysis of HRV indices, HRV was recorded beat by beat with the volunteers in the supine position for 40 minutes. We analyzed the linear indices in the time (SDNN [standard deviation of normal to normal], NN50 [total number of adjacent RR intervals with a difference of duration greater than 50ms] and RMSSD [root-mean square of differences]) and frequency domains ultra-low frequency (ULF) ≤ 0,003 Hz, very low frequency (VLF) 0,003 - 0,04 Hz, low frequency (LF) (0.04-0.15 Hz), and high frequency (HF) (0.15-0.40 Hz) as well as the ratio between LF and HF components (LF/HF). In relation to the nonlinear indices we evaluated SD1, SD2, SD1/SD2, approximate entropy (-ApEn), α1, α2, Lyapunov Exponent, Hurst Exponent, autocorrelation and dimension correlation. The definition of the cutoff point of the variables for predictive tests was obtained by the Receiver Operating Characteristic curve (ROC). The area under the ROC curve was calculated by the extended trapezoidal rule, assuming as relevant areas under the curve ≥ 0.650. Results: Coronary arterial disease patients presented reduced values of SDNN, RMSSD, NN50, HF, SD1, SD2 and -ApEn. HF ≤ 66 ms§ssup§2§esup§, RMSSD ≤ 23.9 ms, ApEn ≤-0.296 and NN50 ≤ 16 presented the best discriminatory power for the presence of significant coronary obstruction. Conclusion: We suggest the use of Heart Rate Variability Analysis in linear and nonlinear domains, for prognostic purposes in patients with stable angina pectoris, in view of their overall impairment. © 2012 Pivatelli et al.; licensee BioMed Central Ltd.

Poincaré plot indexes of heart rate variability: Relationships with other nonlinear variables

The Poincaré plot for heart rate variability analysis is a technique considered geometrical and non-linear, that can be used to assess the dynamics of heart rate variability by a representation of the values of each pair of R-R intervals into a simplified phase space that describes the system's evolution. The aim of the present study was to verify if there is some correlation between SD1, SD2 and SD1/SD2 ratio and heart rate variability nonlinear indexes either in disease or healthy conditions. 114 patients with arterial coronary disease and 65 healthy subjects underwent 30. minute heart rate registration, in supine position and the analyzed indexes were as follows: SD1, SD2, SD1/SD2, Sample Entropy, Lyapunov Exponent, Hurst Exponent, Correlation Dimension, Detrended Fluctuation Analysis, SDNN, RMSSD, LF, HF and LF/HF ratio. Correlation coefficients between SD1, SD2 and SD1/SD2 indexes and the other variables were tested by the Spearman rank correlation test and a regression analysis. We verified high correlation between SD1/SD2 index and HE and DFA (α1) in both groups, suggesting that this ratio can be used as a surrogate variable. © 2013 Elsevier B.V.

Avaliação da qualidade de vida e funcionalidade em pacientes com doença arterial coronariana submetidos à revascularização cirúrgica ou angioplastia

Pós-graduação em Bases Gerais da Cirurgia - FMB

Estudo eletrocardiográfico e ecocardiográfico de pacientes com doença pulmonar obstrutiva crônica (DPOC)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Polimorfismo da haptoglobina correlacionado com doença arterial coronariana

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Complicações intra-operatórias das anestesias do neuroeixo realizadas de maio de 1990 a maio de 2008 na FMB-UNESP: análise retrospectiva

Pós-graduação em Anestesiologia - FMB

Efeitos da suplementação vitamínica de ácido fólico sobre a concentração de homocisteína e marcadores de inflamação em indivíduos portadores de doença arterial periférica

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Frequência de doença arterial coronariana assintomática em pacientes portadores de estenose de artéria renal

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeito da fibra solúvel sobre a hipertrigliceridemia e perfil imunológico de indivíduos HIV positivo em uso de terapia anti-retroviral de alta atividade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo da remodelação cardíaca em pacientes com doença pulmonar obstrutiva crônica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Associação da mutação G1691A (fator V de Leiden) no gene do fator V da coagulação, da mutação G20210A no gene da protrombina e das mutações C677T e G1793A no gene da metilenotetrahidrofolato redutase com a doença arterial coronariana

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR