Dengue viruses were shown to cause cardiac disease with clinical manifestations ranging from mild elevation of biomarkers to myocarditis and/or pericarditis.

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Activated matrix metalloproteinases (MMPs) cause cardiomyocyte injury during acute pulmonary thromboembolism (APT). However, the functional consequences of this alteration are not known. We examined whether doxycycline (a MMP inhibitor) improves right ventricle function and the cardiac responses to dobutamine during APT. APT was induced with autologous blood clots (350 mg/kg) in anaesthetized male lambs pre-treated with doxycycline (Doxy, 10 mg/kg/day, intravenously) or saline. Non-embolized control lambs received doxycycline pre-treatment or saline. The responses to intravenous dobutamine (Dob, 1, 5, 10 μg/kg/min.) or saline infusions at 30 and 120 min. after APT induction were evaluated by echocardiography. APT increased mean pulmonary artery pressure and pulmonary vascular resistance index by ∼185%. Doxycycline partially prevented APT-induced pulmonary hypertension (P < 0.05). RV diameter increased in the APT group (from 10.7 ± 0.8 to 18.3 ± 1.6 mm, P < 0.05), but not in the Doxy+APT group (from 13.3 ± 0.9 to 14.4 ± 1.0 mm, P > 0.05). RV dysfunction on stress echocardiography was observed in embolized lambs (APT+Dob group) but not in embolized animals pre-treated with doxycycline (Doxy+APT+Dob). APT increased MMP-9 activity, oxidative stress and gelatinolytic activity in the RV. Although doxycycline had no effects on RV MMP-9 activity, it prevented the increases in RV oxidative stress and gelatinolytic activity (P < 0.05). APT increased serum cardiac troponin I concentrations (P < 0.05), doxycycline partially prevented this alteration (P < 0.05). We found evidence to support that doxycycline prevents RV dysfunction and improves the cardiac responses to dobutamine during APT.

ObjectiveTo present a surgical variant technique to repair left ventricular aneurysms.MethodsAfter anesthesia, cardiopulmonary bypass, and myocardial protection with hyperkalemic tepic blood cardioplegia: 1) The left ventricle is opened through the infarct and an endocardial encircling suture is placed at the transitional zone between the scarred and normal tissue; 2) Next, the scar tissue is circumferentially plicated with deep stitches using the same suture thread, taking care to eliminate the entire septal scar; 3) Then, a second encircling suture is placed, completing the occlusion of the aneurysm, and; 4) Finally, the remaining scar tissue is oversewn with an invaginating suture, to ensure hemostasis. Myocardium revascularization is performed after correction of the left ventricle aneurysm. The same surgeon performed all the operations.ResultsRegarding the post-surgical outcome 4 patients (40%) had surgery 8 eight years ago, 2 patients (20%) were operated on over 6 years ago, and 1 patient (10%) was operated on more than 5 years ago. Three patients (30%) were in functional class I, class II in 2 patients (20%) and 2 patients (20%) with severe comorbidities remains in class III of the NYHA. There were three deaths (at four days, 15 days and eight months) in septuagenarians with acute myocardial infarction, diabetes and pulmonary emphysema.ConclusionThe technique is easy to perform, safe and it can be an option for the correction of left ventricle aneurysms.

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Endomyocardial fibrosis, which is a cause of restrictive cardiomyopathy, is characterized by the deposition of fibrous tissue in the apical region of 1 or both ventricles. The condition not only affects the diastolic dynamics of the ventricles, but also the function of the atrioventricular valves. The disease occurs predominantly in tropical regions worldwide and in sub-Saharan Africa. This condition is not well understood, with varied manifestations, from subclinical presentations to chronic and progressive edematous syndromes. Here, we present the challenging case of a patient with an indeterminate echocardiographic image, suggesting apical hypertrophy, plus severe aortic stenosis and fibrosis of the left ventricular outflow tract. An electrocardiogram revealed symmetrical T-wave inversion, which is a characteristic manifestation of apical hypertrophy. The importance of cardiac imaging examinations such as echocardiography and cardiac magnetic resonance for differentiating between endomyocardial fibrosis and apical hypertrophy is highlighted in this patient's case.

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A febre reumática aguda é uma complicação tardia da infecção de orofaringe causada pelo estreptococo beta hemolítico do grupo A. Os principais órgãos e sistemas acometidos são articulações, coração, pele, tecido subcutâneo e sistema nervoso central. A cardite reumática é a mais grave das apresentações e responsável pelas sequelas valvares crônicas. O diagnóstico é baseado na combinação de avaliação clínica e laboratorial usando os critérios de Jones modificados. Os pacientes muitas vezes são assintomáticos ou com sintomas atípicos, dificultando o diagnóstico na fase aguda, sendo necessário alta suspeição clínica