Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
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Comparative Study
[Transesophageal echocardiography. Analysis of 15 months of activities].
At the Centre of Thoracic Surgery we have so far performed 235 exams of transesophageal echocardiography (TEE). The aim of our study was critical analysis of the exams and if possible the comparison of the information given by TEE, transthoracic echocardiography (TTE) and surgery. We used biplane 5 MHz probe. ⋯ TTE identified 4 false atrial defects. TEE maintained mitral regurgitation quantification in 4 patients and changed in 9. So, TEE is important to detect most cardiac diseases.
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Two-dimensional echocardiography (2D-ECO) evaluation as an alternative guidance technique during temporary pacing wire placement. ⋯ The 2D-ECO was an efficient alternative technique of guidance during temporary lead placement, ensuring satisfactory longterm pacing and sensing. Our results indicate that 2D-ECO may be the best alternative control for urgent lead implantation whenever fluoroscopic facilities are remote or logistically not convenient.
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Review Case Reports
[A case of incessant junctional tachycardia in a female patient with aneurysm of the interauricular septum].
A permanent supraventricular tachycardia (SVT) was diagnosed in a 54-year-old hypertensive but cardiologically asymptomatic female patient, admitted to a surgery department for biliary lithiasis and hepatic echinococcosis. Heart rate was about 130 bpm and ECGs showed negative P waves in leads I, II, III, aVF, and precordial leads V2 to V6, being the RP' interval longer than P'R interval. Pharmacological intervention during Holter monitoring (20 hours) was instituted: following i.v. propranolol (4 mg), heart rate progressively decreased (to 112 bpm), mainly due to an increase in SVT RP' interval, and brief, spontaneous SVT interruptions occurred, preceded by P'R interval prolongation; SVT stopped after P' recording, and resumed after 2 sinus beats, (showing enlarged P waves and slightly prolonged PR interval), induced by cycle length shortening; later on, under i.v. amiodarone infusion (100 mg/hour) and coincident with the sleeping period, SVT cycle length progressively increased (to 600 msec), due to equivalent increases in P'R and R'P intervals. ⋯ Abdominal surgery (cholecystectomy plus partial hepatic pericystectomy) was performed without any complications or SVT recurrences. During a 6-month follow-up period, maintaining amiodarone (200 mg/d) and propafenone (450 mg/d), the patient remained SVT-free, and Holter monitoring performed at 3 and 5 months showed permanent sinus rhythm and 1:1 AV conduction with slightly prolonged PR interval (less than 0.29 sec and shortening at faster heart rates). This case documents Holter monitoring capability for the evaluation of tachycardia mechanisms in patients with permanent SVT.
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In this article the author intends to make a review of the most important indications and aims of mechanical ventilation, and the repercussion of artificial ventilation over the different systems of the body. The main kinds of ventilators used for the management of the critically ill patient, connected to a ventilator are reviewed.
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The authors report a case of floating left atrial thrombus, detected by transthoracic echocardiography, in a 63 years old patient with moderate mitral stenosis and atrial fibrillation. He was admitted to hospital, with supraventricular tachyarrhythmia and pulmonary edema. There was no previous syncope or thromboembolism episodes. ⋯ The diagnosis of the free floating left atrial thrombus was made by two-dimensional echocardiography. Predisposing factors, clinical course and echocardiographic diagnosis are discussed. The risk of prolonged engagement of the thrombus in the mitral orifice, causing syncope or sudden death, justifies urgent surgery associating thrombectomy and treatment of mitral stenosis.