RESUMO: Mulher de 19 anos, portadora de angiossarcoma de átrio direito que obstruía parcialmente a valva tricúspide, desenvolveu hipoxemia severa conseqüente a shunt direito-esquerdo através do forame oval pérvio, situação descrita pela primeira vez nesse tipo de tumor. Foi realizada ressecção tumoral ampla, embora incompleta, e reconstrução do átrio com fragmento de pericárdio bovino. No pós-operatório, tomografias de crânio, tórax, abdome e cintilografia óssea não mostraram metástases. Optouse por radioterapia local complementar, sem quimioterapia. A paciente faleceu em conseqüência de metástase generalizada, porém sem recidiva local do tumor, cinco meses após a operação. DESCRITORES: Hemangiossarcoma, cirurgia. Neoplasias cardíacas, cirurgia. Átrio, cirurgia.José Carlos R. IGLÉZIAS*, Luiz Guilherme Carneiro VELLOSO*, Luís Alberto DALLAN*, Luiz Alberto BENVENUTI*, Geraldo VERGINELLI*, Noedir A. G. STOLF* INTRODUÇÃOOs tumores primários do coração e pericárdio são extremamente raros, com uma incidência de 0,02% a 0,28%. Por outro lado, as neoplasias metastáticas, como as de mama ou de pulmão (as que mais enviam metástases para o coração, seguidas pelas leucemias e linfomas) são 10 a 40 vezes mais freqüentes do que os tumores primários (1)(2)(3) . Cerca de 10% dos pacientes que morrem com cân-cer de pulmão ou de mama e 25% com tumores de outros órgãos, apresentam, em suas necropsias, metástases cardíacas. Elas ocorrem ao redor da quinta e da sexta década, sem diferenças aparentes quanto ao sexo. Essas invasões metastáticas acentuam-se com a sobrevida dos pacientes com neoplasias sistêmicas, em virtude de tratamentos cada vez mais específicos. Desse modo, passarão a desempenhar um papel muito mais relevante na morbidade e mortalidade desses indivíduos (4) .As neoplasias cardíacas podem ser classificadas de acordo com a localização ou por seu tipo histológico. LAMMERS & BLOOR (2) classificam os tumores segundo a localização e ocorrência mais freqüente (Quadro 1). No pericárdio, os tumores primários benignos ou malignos ocorrem com a mesma freqüência. No coração, por outro lado, os tumores benignos geralmente são 3 vezes mais freqüen-tes, sendo representados em ordem decrescente de ocorrência pelos mixomas, rabdomiomas, lipomas, fibromas e teratomas (2,3) .Os mixomas, tumores cardíacos mais encontrados, correspondem a 40% de todos os tumores cardíacos benignos, 25% de todos os tumores e cistos do coração e cerca de 50% dos tumores benignos em adultos (4) . Ainda na população adulta, aproximadamente 25% dos tumores sólidos e císticos do coração e do pericárdio são malignos; destes 33% são angiossarcomas, 20% rabdomiossarcomas, 15% mesoteliomas e 10% fibrossarcomas (5) .Os tumores cardíacos primários pediátricos diferem daqueles dos adultos, quanto à sua incidên-cia, ao tipo histológico e à localização. Neoplasias malignas são raras na criança e não ultrapassam a 10% de todos os tumores nesta faixa etária (6) . Os

Endocarditis, bacterial; embolism; abdomen acute; abdominal pain.A 35-year-old patient was seen in an Emergency Department, with six hours of pain in the right iliac fossa and fever. The hypothesis diagnosis was acute appendicitis and an exploring laparotomy for appendectomy was carried out. The patient returned to the hospital three days after having been discharged, debilitated, feverish, having alterations in speech, reduction in the level of consciousness and complete hemiparesis to the left. The computed tomography scan of the skull and the liquor puncture were normal. Cerebral magnetic resonance image showed aspects compatible with vertebrobasilar ischemic stroke. The anatomopathological study of the cecal appendix disclosed erosions in the mucous, reactive lymphoid hyperplasia and superficial acute inflammatory infiltrate. There were no evidences of abscess in the appendix part analyzed.The patient received hospital discharge, returning to the emergency department three days later with signs and symptoms of prostration, high fever maintained, dizziness, speech disturbance and decrease in the conscience level. In the neurological exam, he presented somnolence, with multidirectional nystagmus and complete hemiparesis to the left. The liquoric puncture and biochemical analysis were normal. The skull's tomography had a normal result. The magnetic nuclear resonance of the encephalon showed compatible aspects with ischemic stroke vertebrobasilar. The transthoracic echocardiogram was normal and the transesophagic echocardiogram revealed vegetation in the aortic valve with aortic insufficiency of moderate degree in the dopplercardiogram. Blood cultures were positive for the Enterococcus bovis. Specific antibioticotherapy was initiated and colonoscopy with biopsy was carried out, which showed adenocarcinoma in situ.The patient evolved with regression of the symptoms, having discharge with left hemiparesis and dyslalia, thus, he was followed for neoplasia treatment. DiscussionThe infective endocarditis (IE) is many times difficult to be established, once it presents an ample clinical spectrum. The clinical presentation of IE can be acute or subacute and frequently includes cardiac and extracardiac manifestations, with fever as the most common symptom, besides anorexia, weight loss, physical indisposition and nightly perspiration. In 1994, echocardiographic criteria (Duke) were introduced for the IE diagnosis 1 .The systemic embolic manifestations are complications that require a high degree of diagnosis suspicion, given its direct implication in worsening the patients' prognosis.The systemic embolism is a frequent complication of the IE observed in approximately 50% of the cases and more frequently evolves the central nervous system, the spleen, kidneys, liver, iliac or mesenteric arteries 2 .The occurrence of acute abdomen as an embolism initial manifestation of IE is rare, with few cases described in literature 2 . The most predominant abdominal symptoms can confuse the clinical chart, retard the treatment of pri...

OBJECTIVE: To evaluate the efficacy of hypnosis for management of claustrophobia in patients submitted to magnetic resonance imaging. MATERIALS AND METHODS: Twenty claustrophobic patients referred for magnetic resonance imaging under sedation were submitted to hypnosis using the Braid technique. The patients susceptible to hypnosis were submitted to magnetic resonance imaging under hypnotic trance without using sedative drugs. RESULTS: Out of the sample, 18 (90%) patients were susceptible to the technique. Of the 16 hypnotizable subjects who were submitted to magnetic resonance imaging, 15 (93.8%) could complete the examination under hypnotic trance, with no sign of claustrophobia and without need of sedative drugs. CONCLUSION: Hypnosis is an alternative to anesthetic sedation for claustrophobic patients who must undergo magnetic resonance imaging. Keywords: Hypnosis; Claustrophobia; Magnetic resonance imaging.OBJETIVO: Testar a eficácia da hipnose para o controle de claustrofobia em pacientes submetidos a exames de ressonância magnética. MATERIAIS E MÉTODOS: Vinte pacientes claustrofóbicos, com indicação de sedação para ressonância magnética, foram submetidos a hipnose pela técnica de Braid. Os pacientes suscetíveis à hipnose foram encaminhados para realização do exame em estado de transe hipnótico, sem uso de medicamentos para sedação. RESULTADOS: Da amostra estudada, 18 casos (90%) foram suscetíveis à técnica. Dos 16 pacientes sensíveis à hipnose que compareceram para a ressonância magnética, 15 (93,8%) realizaram o exame em transe hipnótico, sem ocorrência de crise de claustrofobia e sem necessitar de medicamentos para sedação. CONCLUSÃO: Hipnose é uma alternativa para a sedação medicamentosa em pacientes claustrofóbicos que necessitam realizar ressonância magnética. Unitermos: Hipnose; Claustrofobia; Imagem por ressonância magnética. AbstractResumo

Freitas et al. Circulatory support after myocardial infarctionArq Bras Cardiol 2012;98(6):e96-e98

Perfusão cerebral retrógrada e anterógrada no tratamento cirúrgico de dissecção aguda da aorta ascendenteCerebral retrograde perfusion alternating with carotid artery anterograde perfusion in the surgical treatment of acute dissection of ascending aorta dissection AbstractThe authors report an original case using cerebral retrograde perfusion alternating with carotid artery anterograde perfusion, during the surgical treatment of acute ascending aorta dissection. The patient was discharged on the 32nd post-operative day in a clinically controlled condition. The Mini Mental State Examination was applied after 30 days and showed normal cerebral cognitive activity. The authors believe that this method can give a protective effect to the brain during procedures involving aortic dissection or aneurysms, after evaluating its use after a significant series of cases. [2,3]. The objective of this report is to inform about the alternate use of retrograde and anterograde cerebral perfusion at normothermia, as a method of cerebral protection in the surgical treatment of acute aortic dissection and the results of the late neurological evaluation. CASE REPORTA 46-year-old male patient with characteristics of Marfan's Syndrome was attended in the Hospital Emergency Department with acute aortic dissection. The disease was associated to acute myocardial infarction, acute aortic insufficiency, acute renal insufficiency, long-term symptoms and cardiogenic shock.An urgent surgery was performed. The operation was conducted in the routine manner with normothermic cardiopulmonary bypass (CPB), which was established and utilized according to Figure 1.Subsequently at normothermia, a number 32 valved tubular prosthesis with a number 27 St. Jude prosthesis were implanted, as the annulo-aortic ectasia was great and there was significant aortic insufficiency due to dilation of the valve annulus and collapse of the non-coronary cusp.Infusion of cold crystalloid cardioplegic solution was made at twenty-minute intervals to the ostia of the coronary arteries. The left coronary artery ostium was implanted in the tubular prosthesis, utilizing a continuous 6-0 prolene suture. An autogenic saphenous vein bridge was performed to the right coronary artery which was proximally ligated.At normothermia CPB was interrupted. Retrograde cerebral perfusion was made using Line D, with a flow that varied between (300-500 mL/min.) and the drainage through Line C was interrupted. The ascending aorta was opened lengthwise as far as the pericardial reflection, it was inspected and the right and left coronary arteries were located. Both carotids were cannulated and isolated using external tourniquets. The return flow of the retrograde perfusion was utilized to fill the perfusion cannulae of the carotids (Line F) which, after being filled of blood, were clamped, the air was removed and they were connected to the anterograde perfusion line (Line E), obtained with a 'Y2' connector.The anterograde flow at 11 mL/kg of body weight/min and interruption of the retrograde ...