An elderly patient with non-dialysis renal failure and oxygendependent chronic obstructive pulmonary disease was admitted to the emergency room with lancinating abdominal pain. Angiotomography of the abdomen revealed the presence of a large aortic aneurysm with involvement of visceral arteries. Due to the high surgical risk, endovascular repair was proposed, using the chimney graft technique for the preservation of the visceral vessels. This technique is promising because it enables endovascular repair of aneurysms, be it in elective cases, emergencies, or rescue of a visceral artery accidentally covered by an aortic stent graft.

Aim To determine the tolerance and acceptance of hepatic venous pressure gradient (HVPG) measurements in patients with liver cirrhosis. Methods This prospective international multicenter study included 271 patients with cirrhosis who were scheduled to undergo HVPG measurement between October 2019 and June 2020. Data related to the tolerance and acceptance of HVPG measurements were collected using descriptive questionnaires. Results HVPG measurements were technically successful in all 271 patients, with 141 (52.0%) undergoing HVPG measurement alone. The complication rate was 0.4%. Postoperative pain was significantly lower than preoperative expected pain (p < 0.001) and intraoperative pain (p < 0.001), and intraoperative pain was also significantly lower than preoperative expected pain (p = 0.036). No, mild, moderate, severe, and intolerable discomfort scores were reported by 36.9%, 44.6%, 11.1%, 6.3%, and 0.4% of these patients, respectively, during HVPG measurement and by 54.6% 32.5%, 11.4%, 1.5%, and 0%, respectively, after HVPG measurement. Of these patients, 39.5% had little understanding and 10% had no understanding of the value of HVPG measurement, with 35.1% and 4.1% regarding HVPG measurements as being of little or no help, respectively. Most patients reported that they would definitely (15.5%), probably (46.9%), or possibly (29.9%) choose to undergo additional HVPG measurements again, and 62.7% regarded the cost of the procedure as acceptable. Conclusion HVPG measurement was safe and well‐tolerated in patients with cirrhosis, but patient education and communication are warranted to improve the acceptance of this procedure.

Anomalous coronary arteries are rare conditions, especially when the origin of the right coronary artery comes from the trunk of the pulmonary artery. The manifestations of the disease can occur at an early stage, leading to sudden death, myocardial infarction or ischemic cardiomyopathy. Many reported cases have been asymptomatic for long periods. Surgery is always indicated as seen in most of the literature. We describe an angiographic case of an oligosymptomatic 76-year old patient referred for elective coronary angiography for preoperative evaluation of prostate surgery. Although surgical treatment is the first choice, especially in early diagnosis, this patient was referred for a conservative treatment.

Anomalous coronary arteries are rare. The origin of the left main coronary artery from the right sinus of Valsalva is related to some events, such as syncope, arrhythmias, angina, among others. By and large, its diagnosis is incidentally made by coronary angiography. The presence of this type of anomaly may hinder percutaneous approach of the coronary lesions. The authors describe a case of left main coronary artery originating from the right sinus of Valsalva, associated to disease of multiple vessels. After discussing the case with the patient and family, the cath lab team performed a successful percutaneous coronary intervention.

Background: In Brazil, myocardial infarction affects approximately 300 thousand individuals per year, with mortality rate of 30%, and 80% of deaths occur in the first 24 hours. The telemedicine systems, such as Latin America Telemedicine Infarct Network, aim to optimize the stages from triage to treatment. Communication among the emergency care units and tertiary care services is known to be difficult, and the system aims to interconnect triage, physician and transport, facilitating transfer of patients to the cath lab. Therefore, implementing a telemedicine system for myocardial infarction and assessment of cardiovascular outcomes is justified. The objective of this study was to analyze the implementation of a telemedicine program, the characteristics of the population and the time intervals for treatment and transfer, in addition to in-hospital mortality. Methods: A cohort study with 110 individuals diagnosed as ST-segment elevation myocardial infarction in five emergency care units in the city of Aparecida de Goiânia, from November 2015 to August 2018. Results: In the period described, 110 patients were treated, mean age of 58±11 years, 72.2% were male, 53.6% hypertensive, 23.6% diabetic, 27.3% active smokers and 6.4% had a history of previous infarction. Of the patients admitted, 90.9% were submitted to primary percutaneous coronary intervention, and 8.2% of total number of patients died within the first 30 days. Conclusion: Implementing a telemedicine system resulted in reduced mortality as compared to the public health system. Despite better care, we observed longer transfer time, which justifies the need to implement fibrinolytic therapy in secondary care units. RESUMO -Introdução:No Brasil, o infarto agudo do miocárdio acomete aproximadamente 300 mil pessoas ao ano, com mortalidade de 30%, sendo 80% destas nas primeiras 24 horas. Os sistemas de telemedicina, a exemplo do Latin America Telemedicine Infarct Network, objetivam otimizar as etapas, desde a triagem ao tratamento. Sabendo da dificuldade de comunicação entre unidades de pronto atendimento e serviço terciário, o sistema busca interligar triagem, médico e transporte, facilitando a transferência do paciente à hemodinâmica. Desse modo, justifica-se a implementação de sistema de telemedicina voltado ao infarto agudo do miocárdio e à avaliação de desfechos cardiovasculares. O objetivo do presente trabalho foi analisar a implementação de um programa de telemedicina, bem como as características da população e os tempos envolvidos no tratamento e na transferência, além da mortalidade hospitalar. Métodos: Estudo de coorte com 110 indivíduos diagnosticados com infarto agudo do miocárdio com supradesnivelamento do segmento ST em cinco unidades de pronto atendimento do município de Aparecida de Goiânia, no período entre novembro de 2015 e agosto de 2018. Resultados: No período descrito, foram tratados 110 pacientes, com média de idade de 58±11 anos, sendo 72,2% do sexo masculino, 53,6% hipertensos, 23,6% diabéticos, 27,3% tabagistas ativos e 6,4% com história...