Search

Fernando A Atik,1 Vanessa G Campos,2 Claudio R da Cunha,1 Felipe Bezerra Martins de Oliveira,1 Maria Estefânia Bosco Otto,2 Guilherme U Monte,2 1Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Fundação Universitária de Cardiologia, Brasília, Distrito Federal, Brazil; 2Department of Cardiovascular Medicine, Instituto de Cardiologia do Distrito Federal, Fundação Universitária de Cardiologia, Brasília, Distrito Federal, Brazil Abstract: A 46-year-old man with bicuspid aortic valve and severe calcific aortic stenosis was submitted to aortic valve replacement with a stented bioprosthesis. He developed Staphylococcus epidermidis prosthetic valve endocarditis a month later, presenting in the emergency room with acute myocardial infarction. The mechanism of myocardial ischemia was a large aortic root abscess causing left main extrinsic compression. He was urgently taken to the operating room, and an aortic root replacement with cryopreserved homograft was performed, associated with autologous pericardium patch closure of aortic to right atrium fistula and coronary artery bypass grafting of the left anterior descending. After a difficult postoperative period with multiple problems, he was eventually discharged home. At 36-month follow-up, he is asymptomatic with no recurrent infection, and the left main coronary artery is widely patent on control chest computed tomography. Keywords: aortic root, endocarditis, aortic valve replacement, heart valve, allograft

Objective: To measure the transit times (TTs) of contrast agents among the injection site (antecubital vein), superior vena cava, pulmonary trunk, and ascending aorta, in coronary computed tomography angiography (CTA) examinations of outpatients with no history of cardiovascular or lung disease, thus defining reference values for those TTs., Materials and Methods: The contrast TTs from the injection site (antecubital vein) to the superior vena cava, from the superior vena cava to the pulmonary trunk, and from the pulmonary trunk to the ascending aorta were measured by monitoring contrast enhancement in real time (bolus tracking). Cardiac output was measured by the geometric method during the CTA examination and was correlated with the contrast TT., Results: Forty-three individuals were analyzed. The mean contrast TT was 13.1 s overall (from the antecubital vein to the ascending aorta), 3.0 s from the superior vena cava to the pulmonary trunk, and 7.2 s from the pulmonary trunk to the ascending aorta. There was a tendency toward a correlation between contrast TT and cardiac output ( p = 0.055)., Conclusion: The reference values established here for contrast TTs among the superior vena cava, pulmonary trunk, and ascending aorta will serve as a basis for clinical evaluation.

Current risk stratification strategies for coronary artery disease (CAD) have low predictive value in asymptomatic subjects classified as intermediate cardiovascular risk. This is relevant because not all coronary events occur in individuals with traditional multiple risk factors. Most importantly, the first manifestation of the disease may be either sudden cardiac death or acute coronary syndrome, after rupture and thrombosis of an unstable non-obstructive atherosclerotic plaque, which was previously silent. The inaccurate stratification using the current models may ultimately subject the individual to excessive or insufficient preventive therapies. A breakthrough in the comprehension of the molecular mechanisms governing the atherosclerosis pathology has driven many researches toward the necessity for a better risk stratification. In this Review, we discuss how metabolomics screening integrated with traditional risk assessments becomes a powerful approach to improve non-invasive CAD subclinical diagnostics. In addition, this Review highlights the findings of metabolomics studies performed by two relevant analytical platforms in current use-mass spectrometry (MS) hyphenated to separation techniques and nuclear magnetic resonance spectroscopy (NMR) -and evaluates critically the challenges for further clinical implementation of metabolomics data. We also discuss the modern understanding of the pathophysiology of atherosclerosis and the limitations of traditional analytical methods. Our aim is to show how discriminant metabolites originated from metabolomics approaches may become promising candidate molecules to aid intermediate risk patient stratification for cardiovascular events and how these tools could successfully meet the demands to translate cardiovascular metabolic biomarkers into clinical settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Martins, Paiva, Paiva, de Oliveira, Machado, Alves, Picossi, Faccio, Tavares, Barbas, Giraldez, Santos, Monte and Atik.)

Background: Infection after cardiovascular surgery is multifactorial. We sought to determine whether the anthropometric profile influences the occurrence of infection after isolated coronary artery bypass grafting (CABG)., Methods: Between January 2011 and June 2016, 1777 consecutive adult patients were submitted to isolated coronary artery bypass grafting. Mean age was 61.7 ± 9.8 years and 1193 (67.1%) were males. Patients were divided into four groups according to the body mass index (BMI) classification: underweight (BMI < 18.5 kg/m 2 ; N = 17, 0.9%), normal range (BMI: 18.5-24.99 kg/m 2 ; N = 522, 29.4%), overweight (BMI: 25-29.99 kg/m 2 ; N = 796, 44.8%), and obese (BMI > 30 kg/m 2 ; N = 430, 24.2%). In-hospital outcomes were compared and independent predictors of infection were obtained through multiple Poisson regression with a robust variation., Results: Independent predictors of any infection morbidity were female sex (relative ratio [RR], 1.47; p = .002), age > 60 years (RR, 1.85; p < .0001), cardiopulmonary bypass > 120 min (RR, 1.89; p = .0007), preoperative myocardial infarction < 30 days (RR, 1.37; p = .01), diabetes mellitus (RR, 1.59; p = .0003), ejection fraction < 48% (RR, 2.12; p < .0001), and blood transfusion (RR, 1.55; p = .0008). Among other variables, obesity, as well as diabetes mellitus, were independent predictors of superficial and deep sternal wound infection., Conclusions: Other factors rather than the anthropometric profile are more important in determining the occurrence of any infection after CABG. However, surgical site infection has occurred more frequently in obese patients. Appropriate patient selection, control of modifiable factors, and application of surgical bundles would minimize this important complication., (© 2021 Wiley Periodicals LLC.)

Background and Aim: Complications of inferior vena cava filters are relatively common, and they vary according to different filter types and designs. We aim to present a case of penetrated inferior vena cava filter into the liver., Methods: Case report., Results: A 42-year old man with thrombophilia (prothrombin gene mutation) required the insertion of an inferior vena cava filter because of recurrent gastrointestinal bleeding associated with oral anticoagulation. However, it penetrated through the retro-hepatic vena cava into the liver, being manifested by constant, blunt abdominal pain. Endovascular retrieval was considered of extreme risk, though a surgical approach was performed under cardiopulmonary bypass with deep hypothermic circulatory arrest. The patient has recovered uneventfully with complete symptom relief., Conclusions: In symptomatic penetrated vena cava filters in which endovascular retrieval is not feasible, a surgical approach with appropriate planning is a safe and effective treatment., (© 2020 Wiley Periodicals LLC.)

This case report describes a patient with persistent atrial fibrillation (AF) submitted to radiofrequency catheter ablation of AF through the pulmonary vein antrum isolation technique, who developed a severe stenosis of the left superior pulmonary vein (LSPV), without presenting any symptoms. The diagnosis of the PV stenosis was made by a routine postprocedure computed tomography scan of the left atrium, and the patient was subsequently submitted to angioplasty with stenting of the LSPV, resulting in the normalization of pulmonary perfusion, as seen by ventilation/perfusion scan made three months after the LSPV angioplasty.

Background: Perioperative myocardial infarction (POMI) is a complication of coronary artery bypass grafting (CABG) with a potential prognostic impact. Technetium-99m pyrophosphate myocardial scintigraphy (MS) is used in the diagnosis of POMI; however it shows a limited sensitivity for subendocardial lesions. Cardiovascular magnetic resonance imaging (CMRI), in turn, has a high accuracy in the detection of myocardial necrosis., Objective: To compare CMRI and MS for the detection of POMI after CABG., Methods: A total of 24 patients with chronic coronary artery disease were studied using the delayed contrast enhanced CMRI and MS before and after CABG by analyzing the development of areas of perioperative myocardial necrosis (POMI). Biochemical markers of myocardial injury (CKMB and troponin I) were also determined before and after surgery., Results: Nineteen patients completed the study. Of these, 6 (32%) presented POMI on CMRI and 4 (21%) on MS (p = NS). Of the 323 left ventricular segments assessed, 17 (5.3%) showed perioperative necrosis on CMRI and 7 (2.2%) on MS (p = 0.013). Moderate agreement was observed between the methods (kappa = 0.46). There was disagreement regarding the diagnosis of POMI in 4 (21%) cases, most of them with small areas of perioperative necrosis on CMRI which were not visualized on MS. In all cases with POMI on CMRI, significant CKMB and troponin I elevations were observed., Conclusion: Moderate diagnostic agreement was observed between the methods for the detection of POMI, but CMRI enabled visualization of small areas of perioperative myocardial necrosis which were not identified on MS and were associated with elevation of biochemical markers of myocardial injury.