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Introducao O pseudoaneurisma (PA) do ventriculo esquerdo (VE) constitui uma complicacao mecânica rara do infarto agudo do miocardio (IAM). Resulta de ruptura miocardica, em que o processo hemorragico e contido pelo pericardio aderente. Ocorre mais comumente na parede ventricular inferior e posterior, uma vez que a ruptura da parede anterior do ventriculo conduz habitualmente ao tamponamento cardiaco e morte imediata, enquanto que a face infero-posterior do coracao se apoia sobre o diafragma, facilitando a contencao da cavidade ventricular pelo pericardio. [...]

Introduction and Objectives: The aim of this study was to assess the impact of a conservative strategy in non-ST-segment elevation myocardial infarction in patients in the Portuguese Registry of Acute Coronary Syndromes. Methods: The 3780 patients included in the study over a three-year period were divided into three groups: group 1, patients treated by a conservative strategy during hospitalization; group 2, patients who underwent coronary angiography without percutaneous coronary intervention (PCI); and group 3, patients who underwent PCI. Clinical and procedural data and in-hospital complications were compared. The primary endpoint was defined as in-hospital or one-year mortality and the secondary endpoint as the presence of at least one of the following in-hospital complications: major bleeding according to the GUSTO criteria, need for blood transfusion, invasive ventilation, heart failure or reinfarction. Results: Of the patients analyzed, 16.5% were treated by a conservative strategy. Patients in this group were older, more often women, and had more high-risk factors. A conservative strategy was associated with a higher rate of the primary endpoint – in-hospital mortality (10.6% vs. 1.1% vs. 0.6% in groups 1, 2 and 3, respectively, p

Resumo: Os autores apresentam um raro caso de miocardiopatia hipertrófica (MCH) associada a ventrículo esquerdo não compactado (VENC) e fístulas das artérias coronárias para o ventrículo esquerdo (VE) numa doente de 42 anos, que se apresenta com enfarte agudo do miocárdio sem elevação do segmento ST (EAMSEST). A coronariografia, a ecocardiografia transtorácica (ETT) e ressonância magnética cardíaca (RMC) revelaram as alterações estruturais do VE e da árvore coronária. Abstract: The authors present a rare case of hypertrophic cardiomyopathy associated with left ventricular noncompaction cardiomyopathy and coronary artery-left ventricular fistulae in a 42-year-old woman presenting with non-ST-elevation myocardial infarction. Coronary angiography, transthoracic echocardiography and cardiac magnetic resonance revealed the structural abnormalities of the left ventricle and the coronary tree. Palavras-chave: Miocardiopatia hipertrófica, Ventrículo esquerdo não compactado, Fístula coronário-ventricular, Enfarte do miocárdio embólico, Recesso intramiocárdico, Mutação genética, Keywords: Hypertrophic cardiomyopathy, Left ventricular noncompaction cardiomyopathy, Coronary artery-left ventricular fistulae, Embolic myocardial infarction, Intramyocardial recess, Genetic mutation

The authors present a rare case of hypertrophic cardiomyopathy associated with left ventricular noncompaction cardiomyopathy and coronary artery-left ventricular fistulae in a 42-year-old woman presenting with non-ST-elevation myocardial infarction. Coronary angiography, transthoracic echocardiography and cardiac magnetic resonance revealed the structural abnormalities of the left ventricle and the coronary tree. Resumo: Os autores apresentam um raro caso de miocardiopatia hipertrófica (MCH) associada a ventrículo esquerdo não compactado (VENC) e fístulas das artérias coronárias para o ventrículo esquerdo (VE) numa doente de 42 anos, que se apresenta com enfarte agudo do miocárdio sem elevação do segmento ST (EAMSEST). A coronariografia, a ecocardiografia transtorácica (ETT) e ressonância magnética cardíaca (RMC) revelaram as alterações estruturais do VE e da árvore coronária. Keywords: Hypertrophic cardiomyopathy, Left ventricular noncompaction cardiomyopathy, Coronary artery-left ventricular fistulae, Embolic myocardial infarction, Intramyocardial recess, Genetic mutation, Palavras-chave: Miocardiopatia hipertrófica, Ventrículo esquerdo não compactado, Fístula coronário-ventricular, Enfarte do miocárdio embólico, Recesso intramiocárdico, Mutação genética

Left ventricular noncompaction (LVNC) is now recognized as a distinct form of cardiomyopathy with a clinical presentation and natural history of its own. Common manifestations of LVNC include heart failure, ventricular arrhythmias and embolic events, but serious atrioventricular conduction disturbances are rarely reported in the literature. The authors describe the case of a 40-year-old woman who went to the emergency department due to syncope. The ECG revealed left bundle branch block (LBBB) and 2:1 atrioventricular block (AVB) and the patient was admitted for pacemaker implantation. During hospitalization she developed torsade de pointes and complete AVB with increased QTc. The echocardiogram showed images compatible with LVNC. This case provides additional evidence that LVNC may be complicated by 2:1 (or complete) AVB, intraventricular conduction disturbances (LBBB) and repolarization abnormalities (long QT). This combination of electrocardiographic changes has rarely been reported in the literature. We describe a series of affected patients, focusing on electrocardiographic characteristics. Resumo: O ventrículo esquerdo não compactado (VENC) tem sido reconhecido como uma forma distinta de miocardiopatia com uma apresentação clínica e história natural próprias. As manifestações comuns de VENC são insuficiência cardíaca, arritmias ventriculares e eventos embólicos. A presença de perturbações da condução auriculoventricular de maior gravidade encontra-se raramente descrita na literatura. Os autores descrevem o caso clínico de uma paciente com 40 anos de idade, que recorreu ao Serviço de Urgência por síncope. O ECG revelou bloqueio completo de ramo esquerdo do feixe de His e bloqueio auriculoventricular (BAV) 2:1, tendo sido internada para implantação de pacemaker. Durante o internamento, desenvolve fenómenos de torsade de pointes e de BAV completo com aumento do intervalo QTc. O ecocardiograma revelou imagens compatíveis com VENC. Com este caso, os autores fornecem evidência adicional de que a presença de VENC pode ser complicada por BAV 2:1 (ou completo), perturbações da condução intraventricular (BCRE) e da repolarização (QT longo), alterações eletrocardiográficas concomitantes pouco descritas na literatura. Descreve-se uma série de pacientes afetados, com foco nas características eletrocardiográficas. Keywords: Left ventricular noncompaction, Atrioventricular block, Torsade de pointes, Palavras-chave: Ventrículo esquerdo não compactado, Bloqueio auriculoventricular, Torsade de pointes

Resumo: O ventrículo esquerdo não compactado (VENC) tem sido reconhecido como uma forma distinta de miocardiopatia com uma apresentação clínica e história natural próprias. As manifestações comuns de VENC são insuficiência cardíaca, arritmias ventriculares e eventos embólicos. A presença de perturbações da condução auriculoventricular de maior gravidade encontra-se raramente descrita na literatura. Os autores descrevem o caso clínico de uma paciente com 40 anos de idade, que recorreu ao Serviço de Urgência por síncope. O ECG revelou bloqueio completo de ramo esquerdo do feixe de His e bloqueio auriculoventricular (BAV) 2:1, tendo sido internada para implantação de pacemaker. Durante o internamento, desenvolve fenómenos de torsade de pointes e de BAV completo com aumento do intervalo QTc. O ecocardiograma revelou imagens compatíveis com VENC. Com este caso, os autores fornecem evidência adicional de que a presença de VENC pode ser complicada por BAV 2:1 (ou completo), perturbações da condução intraventricular (BCRE) e da repolarização (QT longo), alterações eletrocardiográficas concomitantes pouco descritas na literatura. Descreve-se uma série de pacientes afetados, com foco nas características eletrocardiográficas. Abstract: Left ventricular noncompaction (LVNC) is now recognized as a distinct form of cardiomyopathy with a clinical presentation and natural history of its own. Common manifestations of LVNC include heart failure, ventricular arrhythmias and embolic events, but serious atrioventricular conduction disturbances are rarely reported in the literature. The authors describe the case of a 40-year-old woman who went to the emergency department due to syncope. The ECG revealed left bundle branch block (LBBB) and 2:1 atrioventricular block (AVB) and the patient was admitted for pacemaker implantation. During hospitalization she developed torsade de pointes and complete AVB with increased QTc. The echocardiogram showed images compatible with LVNC. This case provides additional evidence that LVNC may be complicated by 2:1 (or complete) AVB, intraventricular conduction disturbances (LBBB) and repolarization abnormalities (long QT). This combination of electrocardiographic changes has rarely been reported in the literature. We describe a series of affected patients, focusing on electrocardiographic characteristics. Palavras-chave: Ventrículo esquerdo não compactado, Bloqueio auriculoventricular, Torsade de pointes, Keywords: Left ventricular noncompactation, Atrioventricular block, Torsade de pointes

Background: Heart failure (HF) is a highly prevalent syndrome. Although the long-term prognostic factors have been identified in chronic HF, this information is scarcer with respect to patients with acute HF. despite available data in the literature on long-term prognostic factors in chronic HF, data on acute HF patients are more scarce. Objectives: To develop a predictor of unfavorable prognostic events in patients hospitalized for acute HF syndromes, and to characterize a group at higher risk regarding their clinical characteristics, treatment and outcomes. Methods: cohort study of 600 patients admitted for acute HF, defined according to the European Society of Cardiology criteria. Primary endpoint for score derivation was defined as all-cause mortality and / or rehospitalization for HF at 12 months. For score validation, the following endpoints were used: all-cause mortality and / or readmission for HF at 6, 12 and 24 months. The exclusion criteria were: high output HF; patients with acute myocardial infraction, acute myocarditis, infectious endocarditis, pulmonary infection, pulmonary artery hypertension and severe mitral stenosis. Results: 505 patients were included, and prognostic predicting factors at 12 months were identified. One or two points were assigned according to the odds ratio (OR) obtained (p < 0.05). After the total score value was determined, a 4-point cut-off was determined for each ROC curve at 12 months. Two groups were formed according to the number of points, group A < 4 points, and group B = 4 points. Group B was composed of older patients, with higher number of comorbidities and predictors of the combined endpoint at 6, 12 and 24 months, as linearly represented in the survival curves (Log rank). Conclusions: This risk score enabled the identification of a group with worse prognosis at 12 months. Resumo Fundamento: A insuficiência cardíaca (IC) é uma síndrome de elevada prevalência. Apesar de existir na literatura informação relativa aos fatores prognósticos a longo prazo na IC crônica, esta é mais escassa no que diz respeito aos pacientes com IC aguda. Objetivos: Desenvolver um score preditor de eventos prognósticos desfavoráveis em doentes admitidos com síndromes de IC aguda e caracterizar um grupo de maior risco quanto às suas características clínicas, terapêutica e resultados. Métodos: Estudo de coorte de 600 doentes internados com IC aguda, definida de acordo com os critérios da Sociedade Europeia de Cardiologia. O endpoint primário para a derivação do score foi definido como mortalidade de qualquer causa e/ou reinternação por IC aos 12 meses. Para a validação do score, foram utilizados como endpoints: mortalidade de qualquer causa e/ou reinternação por IC aos 6, 12 e 24 meses. Os critérios de exclusão foram: IC de alto débito, pacientes com infarto agudo do miocárdio, miocardite aguda, endocardite infeciosa, infeção pulmonar, hipertensão arterial pulmonar e estenose mitral grave. Resultados: Foram incluídos 505 doentes e identificados preditores prognósticos aos 12 meses. Atribuíram-se 1 ou 2 pontos (p.) de acordo com os odds ratio (OR) obtidos (p < 0,05). Após a determinação do valor de score total, foi estabelecido um cut-off de 4 pontos por curva ROC. Constituíram-se 2 grupos de acordo com a pontuação, grupo A < 4 p. versus grupo B = 4 p. O grupo B era constituído por idosos, com maior número de comorbidades e preditor de endpoint combinado aos 6, 12 e 24 meses traduzido linearmente nas curvas de sobrevida (Log rank). Conclusões: Este score de risco permitiu identificar um grupo com pior prognóstico aos 12 meses.

Introduction: Pulmonary angiography by computed tomography (CT) is the method of choice for the detection of acute pulmonary embolism (PE). Studies have shown that the severity of PE can be estimated by clot burden scores. Objective: To evaluate the correlation between an angiographic clot burden score (Qanadli score–QS) and parameters of right ventricular dysfunction (RVD) in patients admitted for PE. Methods: We performed a retrospective study of 107 patients (60% female) admitted to an intensive care unit for PE (intermediate/high risk) between January 1, 2007 and September 30, 2011. Images from 16-slice multidetector CT angiography were reviewed in 102 patients and the QS calculated. Based on a cut-off of 18 points established by ROC curve analysis, two groups were formed (A 18 was an independent predictor of RVD (RV/LV ratio >1) (OR: 10.85; p 18 points proved to be an independent predictor of RVD in PE, and correlated linearly with variables associated with higher morbidity and mortality. Resumo: Introdução: A angio-TC pulmonar é o método de escolha para o diagnóstico de tromboembolismo pulmonar (TEP). Estudos têm demonstrado que a gravidade do TEP poderá ser estimada com sistemas de quantificação de carga embólica. Objetivo: Avaliar a correlação entre um score de carga embólica angiográfica (Qanadli score – QS), com os parâmetros de disfunção ventricular direita (DVD), em pacientes com TEP. Métodos: Estudo retrospetivo de 107 pacientes (feminino – 60%), admitidos por TEP (intermédio/elevado risco) numa UCIC (1/1/2007-30/9/2011). Revistas as imagens de angio-TC de 102 pacientes (TCMD-16C) e quantificado o QS. Estabelecido cut-off de 18 pontos por curva ROC. Constituídos 2 grupos (G) (A 18 preditor independente de DVD (VD/VE> 1) (OR:10,85;p 18 pontos revelou-se preditor independente de DVD no TEP, correlacionando-se linearmente com multivariáveis associadas a morbi/mortalidade mais elevada. Keywords: Pulmonary embolism, Clot burden score, Right ventricular dysfunction, Palavras-chave: Tromboembolismo pulmonar, Score de carga embólica, Disfunção ventricular direita

Resumo: Introdução: A angio-TC pulmonar é o método de escolha para o diagnóstico de tromboembolismo pulmonar (TEP). Estudos têm demonstrado que a gravidade do TEP poderá ser estimada com sistemas de quantificação de carga embólica. Objetivo: Avaliar a correlação entre um score de carga embólica angiográfica (Qanadli score – QS), com os parâmetros de disfunção ventricular direita (DVD), em pacientes com TEP. Métodos: Estudo retrospetivo de 107 pacientes (feminino – 60%), admitidos por TEP (intermédio/elevado risco) numa UCIC (1/1/2007-30/9/2011). Revistas as imagens de angio-TC de 102 pacientes (TCMD-16C) e quantificado o QS. Estabelecido cut-off de 18 pontos por curva ROC. Constituídos 2 grupos (G) (A 18 preditor independente de DVD (VD/VE > 1) (OR:10,85; p 18 pontos revelou-se preditor independente de DVD no TEP, correlacionando-se linearmente com multivariáveis associadas a morbi/mortalidade mais elevada. Abstract: Introduction: Pulmonary angiography by computed tomography (CT) is the method of choice for the detection of acute pulmonary embolism (PE). Studies have shown that the severity of PE can be estimated by clot burden scores. Objective: To evaluate the correlation between an angiographic clot burden score (Qanadli score - QS) and parameters of right ventricular dysfunction (RVD) in patients admitted for PE. Methods: We performed a retrospective study of 107 patients (60% female) admitted to an intensive care unit for PE (intermediate/high risk) between January 1, 2007 and September 30, 2011. Images from 16-slice multidetector CT angiography were reviewed in 102 patients and the QS calculated. Based on a cut-off of 18 points established by ROC curve analysis, two groups were formed (A 18 was an independent predictor of RVD (RV/LV ratio > 1) (OR: 10.85; p 18 points proved to be an independent predictor of RVD in PE, and correlated linearly with variables associated with higher morbidity and mortality. Palavras-chave: Tromboembolismo pulmonar, Score de carga embólica, Disfunção ventricular direita, Keywords: Pulmonary embolism, Clot burden score, Right ventricular dysfunction

Adults with chronic immunosuppressive conditions are at an increased risk for Streptococcus agalactiae endocarditis, which is typically characterized by acute onset, presence of large vegetations, rapid valvular destruction and frequent complications. We report a rare case of a 74 years old man presenting with fever, renal infarction, ischemic stroke and uveitis. Infective endocarditis was diagnosed and Streptococcus agalactiae was isolated in blood cultures. A multiple myeloma Ig G-K was also diagnosed. The infective endocarditis was successfully treated with a course of benzylpenicillin and gentamicin. The authors highlight the severity of vascular embolic disease present in this case and the diagnostic challenge. They also intend to remind about the association between Streptococcus agalactiae endocarditis and chronic diseases, despite its low reported prevalence.Adultos com doenças imunossupressoras crónicas apresentam risco aumentado de endocardite a Streptococcus agalactiae, caracterizada por clínica de início súbito, vegetações de grandes dimensões, destruição valvular rápida e complicações frequentes. Relatamos o caso de um doente de 74 anos de idade, admitido por quadro febril associado a enfarte renal, acidente vascular cerebral e uveíte, com o diagnóstico subsequente de endocardite infeciosa, tendo-se objetivado bacteriemia a Streptococcus agalactiae. Simultaneamente foi diagnosticado mieloma múltiplo Ig G-K. A endocardite infeciosa foi tratada com sucesso recorrendo a antibioterapia com benzilpenicilina e gentamicina. Os autores destacam a gravidade da doença embólica vascular presente neste caso e o desafio diagnóstico. Pretendem ainda relembrar a associação entre endocardite a Streptococcus agalactiae e as doenças crónicas, apesar da sua baixa prevalência.

We report the case of a 54-year-old male with a history of chest trauma in 2011, complicated by bacteremia caused by methicillin-sensitive Staphylococcus aureus (MSSA). In 2012, the patient was diagnosed with spondylodiscitis, and in 2013, he was referred to cardiology for dyspnea. Transthoracic echocardiography (TTE) showed an aneurysm of the posterior leaflet of the mitral valve. Transesophageal echocardiography (TEE) confirmed the presence of the aneurysm, which caused severe valvular insufficiency. Although infective endocarditis was never confirmed, after reviewing his medical records, the authors concluded that this condition was probably associated with mitral valve aneurysm. Figure 1 Transthoracic echocardiography (TTE): apical 4-chamber view – image of the calcified nodule on the posterior leaflet (P1–P2 transition), under which lies an aneurysm of the mitral valve in diastole (A) and systole (B) – white arrow. ...

info:eu-repo/semantics/publishedVersion

Resumo: A miocardiopatia arritmogénica do ventrículo direito – também denominada de displasia arritmogénica do ventrículo direito – é uma patologia em que se verifica a substituição do miocárdio por tecido fibroso ou fibroadiposo predominantemente no ventrículo direito e que se caracteriza clinicamente por arritmias ventriculares potencialmente letais, sendo uma das causas mais relevantes de morte súbita cardíaca. A sua prevalência exata é desconhecida, no entanto, estima‐se que seja de cerca de 1: 5.000 na população adulta. O diagnóstico pode ser efetuado mediante a constatação de alterações estruturais e funcionais do ventrículo direito, alterações eletrocardiográficas – da condução em ECG basal, arritmias ventriculares – e da história familiar. A existência de critérios de diagnóstico facilita o reconhecimento e interpretação das características clínicas não específicas desta entidade.Apresenta‐se um caso clínico em que o diagnóstico de miocardiopatia arritmogénica do ventrículo direito foi desencadeado a partir da suspeita de patologia ventricular direita suscitada por ecocardiograma transtorácico. A análise do ECG serviu para o confirmar, tendo‐se detetado ondas épsilon que em geral passam despercebidas, mas que neste caso foram a chave para o diagnóstico tendo‐se também aferido a sua existência em técnicas de ECG não convencional como o ECG modificado de Fontaine.A evolução subsequente do quadro clínico culminou com a ocorrência de taquicardia ventricular o que motivou a implantação de cardiodesfibrilhador implantável (CDI). Abstract: Arrhythmogenic right ventricular cardiomyopathy, also known as arrhythmogenic right ventricular dysplasia, is a condition in which myocardium is replaced by fibrous or fibrofatty tissue, predominantly in the right ventricle. It is clinically characterized by potentially lethal ventricular arrhythmias, and is a leading cause of sudden cardiac death. Its prevalence is not known exactly but is estimated at approximately 1:5000 in the adult population. Diagnosis can be on the basis of structural and functional alterations of the right ventricle, electrocardiographic abnormalities (including depolarization and repolarization alterations and ventricular arrhythmias) and family history. Diagnostic criteria facilitate the recognition and interpretation of non‐specific clinical features of this disease.The authors present a case in which the diagnosis of arrhythmogenic right ventricular cardiomyopathy was prompted by the suspicion of right ventricular disease on transthoracic echocardiography. This was confirmed by detection of epsilon waves on analysis of the ECG, which generally go unnoticed but in this case were the key to the diagnosis. Their presence was also shown by non‐conventional ECG techniques such as modified Fontaine ECG.The course of the disease culminated in the occurrence of ventricular tachycardia, which prompted placement of an implantable cardioverter‐defibrillator. Palavras‐chave: Miocardiopatia arritmogénica do ventrículo direito, Eletrocardiograma modificado de Fontaine, Ondas épsilon, Keywords: Arrhythmogenic right ventricular cardiomyopathy, Modified Fontaine ECG, Epsilon waves

Cardiac hemangiomas are a rare benign primary tumor with an estimated incidence of no more than 10% of cases of primary cardiac tumors. They can arise in any location but most of them occur predominantly in the right ventricle. Heart hemangiomas are usually asymptomatic and accidentally diagnosed by imaging methods such as echocardiography or nuclear magnetic resonance; however they can cause symptoms resulting from obstruction of blood flow, interference with the heart valves, arrhythmias or embolization. Surgical resection is the treatment of choice and long-term prognosis is favorable after total resection of the tumor. The authors present a case of cardiac hemangioma whose clinical diagnosis was triggered by exertional dyspnea and culminating with complete resection of the tumor. In this context, a review of this entity is made with special emphasis on imaging modalities used for diagnosis.

Arrhythmogenic right ventricular cardiomyopathy, also known as arrhythmogenic right ventricular dysplasia, is a condition in which myocardium is replaced by fibrous or fibrofatty tissue, predominantly in the right ventricle. It is clinically characterized by potentially lethal ventricular arrhythmias, and is a leading cause of sudden cardiac death. Its prevalence is not known exactly but is estimated at approximately 1:5000 in the adult population. Diagnosis can be on the basis of structural and functional alterations of the right ventricle, electrocardiographic abnormalities (including depolarization and repolarization alterations and ventricular arrhythmias) and family history. Diagnostic criteria facilitate the recognition and interpretation of non-specific clinical features of this disease.The authors present a case in which the diagnosis of arrhythmogenic right ventricular cardiomyopathy was prompted by the suspicion of right ventricular disease on transthoracic echocardiography. This was confirmed by detection of epsilon waves on analysis of the ECG, which generally go unnoticed but in this case were the key to the diagnosis. Their presence was also shown by non-conventional ECG techniques such as modified Fontaine ECG.The course of the disease culminated in the occurrence of ventricular tachycardia, which prompted placement of an implantable cardioverter-defibrillator. Resumo: A miocardiopatia arritmogénica do ventrículo direito – também denominada de displasia arritmogénica do ventrículo direito – é uma patologia em que se verifica a substituição do miocárdio por tecido fibroso ou fibroadiposo predominantemente no ventrículo direito e que se caracteriza clinicamente por arritmias ventriculares potencialmente letais, sendo uma das causas mais relevantes de morte súbita cardíaca. A sua prevalência exata é desconhecida, no entanto, estima-se que seja de cerca de 1: 5.000 na população adulta. O diagnóstico pode ser efetuado mediante a constatação de alterações estruturais e funcionais do ventrículo direito, alterações eletrocardiográficas – da condução em ECG basal, arritmias ventriculares – e da história familiar. A existência de critérios de diagnóstico facilita o reconhecimento e interpretação das características clínicas não específicas desta entidade.Apresenta-se um caso clínico em que o diagnóstico de miocardiopatia arritmogénica do ventrículo direito foi desencadeado a partir da suspeita de patologia ventricular direita suscitada por ecocardiograma transtorácico. A análise do ECG serviu para o confirmar, tendo-se detetado ondas épsilon que em geral passam despercebidas, mas que neste caso foram a chave para o diagnóstico tendo-se também aferido a sua existência em técnicas de ECG não convencional como o ECG modificado de Fontaine.A evolução subsequente do quadro clínico culminou com a ocorrência de taquicardia ventricular o que motivou a implantação de cardiodesfibrilhador implantável (CDI). Keywords: Arrhythmogenic right ventricular cardiomyopathy, Modified Fontaine ECG, Epsilon waves, Palavras-chave: Miocardiopatia arritmogénica do ventrículo direito, Eletrocardiograma modificado de Fontaine, Ondas épsilon

Long term survival in patients with partial atrioventricular septal defect (PAVSD) without adequate surgical management is very rare. The authors present the case of a 60 year-old woman who was referred to our hospital with dyspnea and worsening of general condition. A heart defect was diagnosed at the age of 25 years, but at the time the patient declined surgery. The patient underwent echocardiographic and haemodynamic evaluation prior to corrective surgery. The present report highlights the complications of chronic volume overload due to a congenital cardiac defect characterized by left--to-right shunts and atrio-ventricular valvular regurgitation with its haemodynamic implications. Despite the haemodynamic burden, the patient underwent successful corrective surgery, demonstrating the resilience of human endurance facing various comorbidities.

International audience; A simple synthesis of polymer core-dendrimer shell nanoparticles (NPs) in the 15-20-nm-diameter range is presented. Amine-terminated polypropyleneimine (PPI) dendrimers DAB-dendri-(NH2)(4) and DAB-dendri-(NH2)(16) (DAB4 and DAB16) are covalently attached to the surface of primary polystyrene-based NPs bearing reactive chlorobenzyl groups produced by microemulsion polymerization in the presence of a cationic surfactant. The grafting readily proceeds under mild conditions and leads to translucent aqueous suspensions of core-shell-type NPs with a high density of peripheral amine groups that have been characterized relative to their size and chemical composition. The dendritic shell acts as a protective ionizable outer layer and provides an improvement of the colloidal stability in neutral and acidic media. The metal-binding capacity of the PPI dendrimers is retained, and spectrophotometric titrations show that the dendrimer-grafted NPs can trap a large number of Cu2+ ions (more than 900 Cu per NP-DAB16). These properties make them potentially valuable templates for the elaboration of hybrid nanomaterials. The reactivity of the external amine groups is used to link covalently azobenzene chromophores (disperse Red 1 residues) through aza-Michael addition in aqueous suspension. This simple method gives access to colored NPs with high dye contents in the outer layer (up to 1000-1500 dye molecules per NP), which indicates that dendrimer-functionalized NPs are valuable building blocks for the construction of multifunctional nanomaterials.