Caso 2/2009: criança de 8 anos de idade com insuficiência valvar pulmonar e estenose da artéria pulmonar esquerda, como defeitos residuais após correção de tetralogia de Fallot

Abstract

Heart defects, congenital; pulmonary valve insufficiency; pulmonary valve stenosis; tetralogy of Fallot / complications. Clinical dataTiredness at moderate exertion, unaltered for 2 years, despite the use of digoxin and spironolactone. Patient underwent Tetralogy of Fallot repair at 8 months of age, with augmentation of the right ventricular outflow tract with bovine pericardium graft and monocusp placement.At physical examination, the patient was eupneic, had normal skin color and the peripheral pulses were normal. Weight: 32 kg; height: 130 cm; BP: 100/60 mm Hg; HR: 88 bpm. The aorta was not palpable at the sternal notch. There were slight precordial impulses at the left sternal border and the ictus cordis was palpable at the 4 th and 5 th left intercostal spaces, in the hemiclavicular line and limited by two digital pulps. The heart sounds were normal and the second heart sound was constant, with its two components of equal intensity. A mild proto-meso-diastolic murmur was identified through auscultation along the left sternal border, not accompanied by thrill. There was no systolic murmur. The liver was not palpable.The electrocardiogram showed signs of complete right bundle branch block with QRS complexes with a duration of 0.12 seconds. ÂP:+20 Radiographic imageshows slightly to moderately increased cardiac area, at the expense of the right cavities, corresponding mostly to a larger protusion of the right ventricular outflow tract between the mid arch and left lower arch, with slightly increased pulmonary vascular net on the right in contrast with the decreased aspect on the left (Figure 1). Diagnostic impression ConductAt the surgical intervention through the pulmonary trunk, the calcified monocusp was removed. The left pulmonary artery, obstructed at first, was enlarged with a bovine pericardium graft. Homograft number 21 was implanted between the RV and the pulmonary arteries in ECC of 100' and period of anoxia of 60'. The immediate post-surgical evolution was good, with the disappearance of the heart murmur, despite the remaining cardiomegaly.

Early echocardiographic predictors of increased left ventricular end-diastolic pressure three months after myocardial infarction in rats

“…Regardless of the complexity of the remodeling process, the term is frequently used as a synonym for ventricular dilation after myocardial infarction [24,25]. Consequently, our data, in concordance with the concept that remodeling is a powerful determinant of cardiac function following multiple injuries [24–26], indicated that systolic area larger than 0.33 cm 2 predicted increased LVEDP three months after myocardial infarction.…”

Rosemary supplementation (Rosmarinus oficinallis L.) attenuates cardiac remodeling after myocardial infarction in rats

“…Cardiac remodeling has significant clinical relevance as it can lead to complex changes in ventricular architecture, potentially evolving into chronic heart failure [7, 40]. For this reason, several strategies have been used to mitigate this process, including compounds found in rosemary leaves[17, 41].…”

“…Oxidative stress can also activate the production of inflammatory cytokines such as tumor necrosis factor-α (TNF-α), IL-1β and IL-6[6], triggering inflammatory pathways, fibrosis and cell death[5]. ROS and cytokines also contribute to the activation of matrix metalloproteinases (MMPs) and collagen deposition that might lead to structural changes in the heart [6, 7]. …”

“…Because oxidative stress can play a central pathophysiological role in cardiac remodeling after MI[4, 7], antioxidant supplements are beneficial after injury to the myocardium[8, 9]. In this context, the antioxidant properties of natural products have been examined[10].…”

Infarct Size as Predictor of Systolic Functional Recovery after Myocardial Infarction

“…Many factors determine the outcome of patients after an Acute Myocardial Infarction (AMI) 1,2 . Among these prognostic factors, heart failure is highlighted due to left ventricular dysfunction.…”