ObjectiveTo analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch.MethodsOne hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%).ResultsA carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%).ConclusionCarotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates.

BackgroundFew reports exist on the relationship of the left ventricular diastolic dysfunction (LVDD) with its most important features including enlargement of the left atrium and left ventricular hypertrophy (LVH), and with the right ventricular (RV) function.ObjectiveTo determine the correlation between the left atrial size and the RV function and dimensions in patients with and without LVDD and LVH.MethodsFifty patients were included, 25 (40% men) of them with LVDD, aged 67.1 ± 10.6 years (study group) and 25 without LVDD (52% men) aged 49.9 ± 16.3 years (control group). Patients underwent transthoracic echocardiography with evaluation of the left atrial size and volume (LAV), LVDD, LVH, and RV function and dimensions. P-values < 0.05 were considered statistically significant.ResultsLAV > 34 mL/m2 and left atrial size > 40 mm were associated with lower absolute values of tricuspid annular plane systolic excursion (TAPSE) and RV lateral S' (p ≤ 0.001, Pearson's correlation coefficient -0.4 and -0.38, respectively) in the study group. Patients in the study group showed higher incidence of LVH (p = 0.02) and greater left atrial diameter (p = 0.03) compared with the control group. In addition, greater left atrial diameter (p = 0.02) and LAV (p = 0.01) values were found in patients with LVDD grade II compared with LVDD grade I.ConclusionsThe present study determined, for the first time, the correlation of left atrial enlargement with progressive RV dysfunction in patients with LVDD.

Introdução: Por muitos anos, o ventrículo direito (VD) foi muito pouco estudado e, às vezes, considerado semelhante ao ventrículo esquerdo (VE). Porém, diferentemente do VE, o VD apresenta diferença desde a sua forma mais hemielipsoide como também na contratilidade que está mais associada ao acoplamento ventrículo-atrial relacionado à elasticidade, demonstrando, assim, a importância da complacência do VD tanto para a função sistólica como também para a função diastólica. Essas diferenças começam a ser mais valorizadas e estudadas nos últimos anos devido à maior necessidade de seu entendimento após a introdução dos corações artificiais que não se acoplavam adequadamente. Objetivo: Avaliar a correlação das alterações ecocardiográficas da função diastólica do VD com a progressão da idade e com o sexo em indivíduos com função sistólica biventricular preservada. Métodos: Estudo de coorte, observacional e retrospectivo. Foram selecionados 110 pacientes, 66 (60%) mulheres (62,6±13,7 anos) e 44 (40%) homens (60,6±10,8 anos). Os dados avaliados ao ecocardiograma transtorácico (ETT) foram (i) ao Doppler espectral do influxo tricúspide onda E, onda A, relação E/A e tempo de desaceleração da onda E; e (ii) ao Doppler tecidual do anel tricúspide, onda e’ lateral, onda a’ e relação E/e’. As correlações foram realizadas através dos coeficientes de Pearson e Spearman. Resultados: Na população estudada, apenas 35,2% dos indivíduos apresentaram disfunção diastólica do VD após a aplicação dos critérios de disfunção diastólica utilizados para o VE. Das variáveis ecocardiográficas avaliadas do VD, a onda E apresentou correlação negativa com a idade nas mulheres (r -0,473, p < 0,001) e nos homens (r -0,37, p = 0,015). A relação E/A apresentou uma correlação negativa com a idade apenas no sexo feminino (r -0,32; p = 0,001), e a desaceleração da onda E apresentou uma correlação positiva com a idade apenas no sexo feminino (r 0,31, p = 0,014). As demais variáveis não tiveram significância estatística de correlação com a idade tanto em homens quanto em mulheres. Conclusões: O presente estudo mostrou correlação dos parâmetros ecocardiográficos para disfunção diastólica do VD com a idade, mais evidentes no sexo feminino.

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ResumoIntroduction: Valvular deposits of calcium quantified by transthoracic echocardiography are associated with the occurrence of systemic atherosclerotic disease, but its prognostic value and influence of associated cardiovascular risk factors have not been defined yet.Objectives: To correlate the valvular cardiac calcium index by transthoracic echocardiography with cardiovascular risk factors and presence of coronary artery disease (CAD). Methods:We selected 203 patients (61.2 ± 14.3 years; 57.6% females) who underwent transthoracic echocardiography with cardiac calcium index quantification. The presence or absence of CAD, hypertension, diabetes mellitus (DM), dyslipidemia, and smoking was assessed.Results: Age above 65 years (p < 0.001) and the presence of hypertension (p < 0.001) showed a significant correlation with the presence of cardiac calcification, whereas DM (p = 0.056) and CAD (p = 0.08) showed only a trend toward a correlation with calcification. Mitral valve calcification alone correlated significantly with age above 65 years (p < 0.001), presence of CAD (p = 0.004), hypertension (p = 0.054), and DM (p = 0.07). On multivariate analysis, CAD (odds ratio [OR] 3.39, 95% confidence interval [95%CI] 1.58-7.29, p = 0.002) and age > 65 years (OR 1.05, 95%CI 1.02-1.08, p = 0.003) correlated significantly and independently with mitral valve calcification. Aortic valve calcification alone showed no correlation with the presence of CAD (p = 0.435), but correlated significantly with age above 65 years (p < 0.001) and hypertension (p < 0.001). On multivariate analysis, only age (OR 1.1, 95%CI 1.06-1.14, p < 0.001) remained independently and significantly correlated with aortic calcification. Conclusion:Age above 65 years and hypertension were independent risk factors for the presence of valvular cardiac calcification, with mitral valve calcification alone emerging as significantly and independently associated with the presence of CAD. (Int J Cardiovasc Sci. 2017;30(2):136-144)