An elderly patient with non-dialysis renal failure and oxygendependent chronic obstructive pulmonary disease was admitted to the emergency room with lancinating abdominal pain. Angiotomography of the abdomen revealed the presence of a large aortic aneurysm with involvement of visceral arteries. Due to the high surgical risk, endovascular repair was proposed, using the chimney graft technique for the preservation of the visceral vessels. This technique is promising because it enables endovascular repair of aneurysms, be it in elective cases, emergencies, or rescue of a visceral artery accidentally covered by an aortic stent graft.

Anomalous coronary arteries are rare. The origin of the left main coronary artery from the right sinus of Valsalva is related to some events, such as syncope, arrhythmias, angina, among others. By and large, its diagnosis is incidentally made by coronary angiography. The presence of this type of anomaly may hinder percutaneous approach of the coronary lesions. The authors describe a case of left main coronary artery originating from the right sinus of Valsalva, associated to disease of multiple vessels. After discussing the case with the patient and family, the cath lab team performed a successful percutaneous coronary intervention.

INTRODUCTION: In Brazil and around the world, there is still an abundance of hospital services that restrict exercise in individuals undergoing percutaneous coronary interventions (PCI), in the immediate postoperative period, for fear of complications. It is important to demonstrate that cardiovascular physical therapy can be performed in this population. OBJECTIVE: To verify the adverse effects in the performance of early ambulation after PCI, with the use of a mechanical device of arterial closure in the femoral puncture. POPULATION AND METHODS: Two cases (68-years-old man and 57-years-old woman) submitted to a single-vessel coronary artery (right coronary artery and diagonal branch, respectively) that had their femoral puncture associated with the device Angio-Seal - St. Jude Medical©, who were discharged from the hospital six hours after the intervention. Before PCI, patients had stable angina and cardiovascular risk factors (dyslipidemia, hypertension, and others). After the PCI, the patients were evaluated by the Heart Team, who monitored intercurrences during hospitalization (chest pain, ventilatory discomfort, electrocardiogram, cardiac enzymes and others). The gait of the individuals was verified, in order to evaluate the tolerance of the individuals to the same, after five hours of the PCI. Individuals were advised to walk in a light rhythm (modified Borg 1-3) for five minutes in a corridor of approximately 15 meters, in round-trip movements, and were evaluated after ambulation for hematoma at the puncture site, pain or any complications that might arise. On the first postoperative day, a telephone call was made for a second complication check. RESULTS: Both patients tolerated the five-minute walk and were released from the hospital after six hours, wandering uneventfully. One of the patients reported low-intensity headache during hospitalization. The same patient reported low-intensity pain at the puncture site the next day. There were no clinically relevant changes in cardiovascular or ventilatory parameters during the six hours postoperative hospitalization or during ambulation. CONCLUSION: Early ambulation within six hours after PCI was well tolerated in the two cases studied, even with the femoral artery access site. The use of a mechanical device for arterial closure was important so that the ambulation could be carried out in this population.

Background: In Brazil, myocardial infarction affects approximately 300 thousand individuals per year, with mortality rate of 30%, and 80% of deaths occur in the first 24 hours. The telemedicine systems, such as Latin America Telemedicine Infarct Network, aim to optimize the stages from triage to treatment. Communication among the emergency care units and tertiary care services is known to be difficult, and the system aims to interconnect triage, physician and transport, facilitating transfer of patients to the cath lab. Therefore, implementing a telemedicine system for myocardial infarction and assessment of cardiovascular outcomes is justified. The objective of this study was to analyze the implementation of a telemedicine program, the characteristics of the population and the time intervals for treatment and transfer, in addition to in-hospital mortality. Methods: A cohort study with 110 individuals diagnosed as ST-segment elevation myocardial infarction in five emergency care units in the city of Aparecida de Goiânia, from November 2015 to August 2018. Results: In the period described, 110 patients were treated, mean age of 58±11 years, 72.2% were male, 53.6% hypertensive, 23.6% diabetic, 27.3% active smokers and 6.4% had a history of previous infarction. Of the patients admitted, 90.9% were submitted to primary percutaneous coronary intervention, and 8.2% of total number of patients died within the first 30 days. Conclusion: Implementing a telemedicine system resulted in reduced mortality as compared to the public health system. Despite better care, we observed longer transfer time, which justifies the need to implement fibrinolytic therapy in secondary care units. RESUMO -Introdução:No Brasil, o infarto agudo do miocárdio acomete aproximadamente 300 mil pessoas ao ano, com mortalidade de 30%, sendo 80% destas nas primeiras 24 horas. Os sistemas de telemedicina, a exemplo do Latin America Telemedicine Infarct Network, objetivam otimizar as etapas, desde a triagem ao tratamento. Sabendo da dificuldade de comunicação entre unidades de pronto atendimento e serviço terciário, o sistema busca interligar triagem, médico e transporte, facilitando a transferência do paciente à hemodinâmica. Desse modo, justifica-se a implementação de sistema de telemedicina voltado ao infarto agudo do miocárdio e à avaliação de desfechos cardiovasculares. O objetivo do presente trabalho foi analisar a implementação de um programa de telemedicina, bem como as características da população e os tempos envolvidos no tratamento e na transferência, além da mortalidade hospitalar. Métodos: Estudo de coorte com 110 indivíduos diagnosticados com infarto agudo do miocárdio com supradesnivelamento do segmento ST em cinco unidades de pronto atendimento do município de Aparecida de Goiânia, no período entre novembro de 2015 e agosto de 2018. Resultados: No período descrito, foram tratados 110 pacientes, com média de idade de 58±11 anos, sendo 72,2% do sexo masculino, 53,6% hipertensos, 23,6% diabéticos, 27,3% tabagistas ativos e 6,4% com história...

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