An elevated CRP level at hospital admission and vegetation length at diagnosis were strong predictors of in-hospital mortality in IE, independent of other prognostic parameters, specifically taking into account patient characteristics and complications during therapy.

IntroductionPrimary graft dysfunction is a major cause of mortality after heart transplantation.ObjectiveTo evaluate correlations between donor-related clinical/biochemical markers and the occurrence of primary graft dysfunction/clinical outcomes of recipients within 30 days of transplant.MethodsThe prospective study involved 43 donor/recipient pairs. Data collected from donors included demographic and echocardiographic information, noradrenaline administration rates and concentrations of soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2), interleukins (IL-6 and IL-10), monocyte chemoattractant protein-1, C-reactive protein and cardiac troponin I. Data collected from recipients included operating, cardiopulmonary bypass, intensive care unit and hospitalization times, inotrope administration and left/right ventricular function through echocardiography.ResultsRecipients who developed moderate/severe left ventricular dysfunction had received organs from significantly older donors (P =0.020). Recipients from donors who required moderate/high doses of noradrenaline (>0.23 µg/kg/min) around harvesting time exhibited lower post-transplant ventricular ejection fractions (P =0.002) and required longer CPB times (P =0.039). Significantly higher concentrations of sTNFR1 (P =0.014) and sTNFR2 (P =0.030) in donors were associated with reduced intensive care unit times (≤5 days) in recipients, while higher donor IL-6 (P =0.029) and IL-10 (P =0.037) levels were correlated with reduced hospitalization times (≤25 days) in recipients. Recipients who required moderate/high levels of noradrenaline for weaning off cardiopulmonary bypass were associated with lower donor concentrations of sTNFR2 (P =0.028) and IL-6 (P =0.001).ConclusionHigh levels of sTNFR1, sTNFR2, IL-6 and IL-10 in donors were associated with enhanced evolution in recipients. Allografts from older donors, or from those treated with noradrenaline doses >0.23 µg/kg/min, were more frequently affected by primary graft dysfunction within 30 days of surgery.

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Cardiomiopatia isquêmica terminal associada à complicação do uso de stent no tratamento de infarto agudo do miocárdioTerminal ischemic cardiomyopathy associated with complication of stenting in the treatment of acute myocardial infarction A serious complication such as dissection of the left main coronary artery, with significant reduction in coronary blood flow by the true light, requires quick action. Therefore, the immediate choice of stent with appropriate length and size to treat the complication is necessary.Descriptors: Stents. Heart Transplantation. Myocardial Ischemia.

On February 2008, a 23-year-old man with no significant past medical history was newly diagnosed with acute myelocytic leukaemia and was admitted to the University Hospital, Federal University of Minas Gerais, Belo Horizontal, Brazil for induction chemotherapy. On physical examination, he was febrile (38.6°C), pale, and had cervical lymphadenomegaly. The cardiovascular examination was normal. Initial laboratory findings included a haemoglobin level of 10.0 g dl )1 ; white blood cell count of 53.300 mm )3 with 54% blasts; platelet count of 48 000 mm )3 ; and C-reactive protein of 68 mg dl )1 . Blood chemistry showed no abnormalities and blood and urine cultures were negative.On hospital day 2, after three sets of blood samples had been obtained for culture, the patient was empirically treated with intravenous ceftazidime and amikacin. Four days later, a chest computed tomography (CT) showed bilateral basilar nodules surrounded by a ground-glass appearance suggestive of invasive pulmonary aspergillosis. Amphotericin B was started. On the next day, the patient received the first cycle of chemotherapy (cytarabine and daunorubicin). The fever subsided in 3 days, but he started complaining of a pleuritic chest pain. Low breathing sounds with basal crackles were noticed on physical examination. Arterial blood gas revealed hypoxemia. Because of the suspicion of invasive aspergillosis, voriconazole was added to the antibiotic regimen.In a few days, the patient developed heart failure with S 3 gallop. A transthoracic echocardiography (TTE) showed left ventricular systolic dysfunction and a mild pericardial effusion. No cardiac vegetations were noticed. On the following days, because of the reappearance of fever associated with severe myalgia and hypotension, he was put also on vancomycin. Erythematous painful nodules appeared in his extremities, including one with a necrotic centre in his left foot. The biopsy of this lesion showed several septate hyphal elements, which were later identified as Fusarium solani. This fungus was also recovered from the blood cultures. At this time, a new TTE disclosed mobile masses of echoes attached to the endocardial surface of the right ventricle. The tricuspid valve was morphologically normal. A transesophageal echocardiography (TEE) confirmed the presence of two round masses attached to the endocardial surface of the apex of the right ventricle and one in the right atrium. They were mobile and presented echo-free spaces in their central areas. The largest mass measured 13 · 8 mm in the longest axis (Fig. 1).The patient was treated with a combination of amphotericin B and voriconazole, along with surgical procedure. A median sternotomy and a standard cardiopulmonary bypass were performed. The heart was stopped using the routine procedures of cardioplegic arrest -the aortic cross was clamped and cold blood cardioplegic solution was administered into the aortic root. The right atrium was opened and the atrial vegetation was seen and easily removed. Through the tricuspid valve, it was po...

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