Browsing by Author "Freitas, A"
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- Acute coronary syndrome of paradoxical originPublication . Ferreira, AR; Freitas, A; Magno, P; Soares, A; Abreu, PF; Neves, JP; Gil, VMWe describe a rare case of acute myocardial infarction secondary to paradoxical embolism complicating acute pulmonary embolism. A 44-year-old woman presented to the emergency department with chest pain. The physical examination was unremarkable except for oxygen saturation of 75%, and the electrocardiogram showed ST-segment elevation in the inferior leads. Urgent coronary angiography showed a distal occlusion of the right coronary artery and multiple thrombi were aspirated. Despite relief of chest pain and electrocardiogram normalization, her oxygen saturation remained low (90%) with high-flow oxygen by mask. The transthoracic echocardiogram showed a mass in the left atrium and dilatation of the right chambers, while the transesophageal echocardiogram showed a thrombus attached to the interatrial septum in the region of the foramen ovale. Color flow imaging was consistent with a patent foramen ovale. Thoracic computed tomography angiography documented thrombi in both branches of the pulmonary trunk. After five days on anticoagulation, the patient underwent surgical foramen ovale closure.
- Cardiopatia congénita do adulto: substrato para endocardite infecciosaPublication . Faustino, M; Freitas, A; Soares, A; Fragata, J; Gil, VM; Morais, C
- Double orifice mitral valve in an asymptomatic adult with an unusual combination of congenital malformations: a case reportPublication . Proença, G; Freitas, A; Baptista, SB; Thomas, B; Fragata, J; Ferreira, RWe report a case of an asymptomatic adult patient, with several congenital malformations including an infrequent variant of double orifice mitral valve, postductal aortic coarctation, bicuspid aortic valve and an aneurysm of the right Valsalva sinus. The loss of support of the right coronary cusp of the aortic valve caused major aortic regurgitation. With the exception of the mitral valve, which was left untouched because it was neither stenotic nor regurgitant, all the other abnormalities were successfully corrected, in a two-step surgical approach.
- Endocardite da valvula tricuspide e embolias pulmonares tipo pneumatoceloPublication . Galrinho, A; Antunes, I; Freitas, A; Ferreira, R
- Endocardite das válvulas das cavidades direitas: a importância da ecocardiografia na identificação da(s) estrutura(s) afectada(s)Publication . Ricardo, J; Garcia, A; Leite, A; Serra, I; Revés, L; Miranda, C; Freitas, A; Freitas, PTA endocardite das válvulas das cavidades direitas do coração é rara. Ocorre geralmente em doentes com toxicofilia endovenosa, portadores de pacemaker (PMD), portadores de próteses valvulares ou cateter venoso central e ainda em doentes com cardiopatias congénitas. A Ecocardiografia constitui o gold standard na identificação da(s) estrutura(s) afetada (s) e permite a orientação terapêutica. Apesar de ser rara, a endocardite das cavidades direitas deve ser tida em conta durante a realização de ecocardiografia transtorácica e/ou transesofágica que vise o diagnóstico de endocardite. A profilaxia antibiótica deve ser sempre aplicada antes da realização de qualquer procedimento invasivo de acordo com as recomendações publicadas. Acentua-se a necessidade de educar a população, prevenindo-se assim complicações graves resultantes de procedimentos simples cada vez mais vulgares nas populações mais jovens, como a colocação de piercing. Os autores apresentam dois casos clínicos dessa patologia.
- From hypertrophic cardiomyopathy centers to inherited cardiovascular disease centers in Europe. A small or a major step? A position paper from the Nucleus of the Working Group on Myocardial and Pericardial Diseases of the Portuguese Society of Cardiology.Publication . Cardim, N; Freitas, A; Brito, DThe prevalence, complexity, clinical importance, heterogeneity and unpredictability of inherited cardiovascular diseases make the development of inherited cardiovascular disease centers an inevitability, with the ultimate goal of reducing the morbidity and mortality associated with these conditions. An inherited cardiovascular disease center may be seen as a subunit of a cardiology department, with health professionals specializing in these types of disorders, organized to provide excellence in all related areas, including diagnosis, treatment, followup, prevention, risk stratification and prognosis. Among its objectives are the development of action protocols and the creation of databases that enable patients to be included in national and international research networks. To achieve these objectives these centers should include functional units of clinical and basic sciences, research, training and education, acting in harmony in a holistic approach to patients and their families. As most experience on inherited cardiovascular diseases is based on hypertrophic cardiomyopathy and on "hypertrophic cardiomyopathy centers", these centers represent an excellent opportunity to learn how to set up inherited cardiovascular disease centers. European centers will differ from country to country, reflecting the heterogeneity of national health systems, but will share a common core, presented in this document. Though we are aware that this ambitious project is not at all easy and may be difficult to implement in its entirety--in fact we consider it a major step--our position is that all the efforts to achieve it are worthwhile, considering that the main goal will always be the well-being of those affected by these particular disorders.
- Importância da ecocardiografia transesofágica multiplanar no diagnóstico de tromboembolismo pulmonarPublication . Galrinho, A; Abreu, A; Freitas, A; Loureiro, J; Sá, E; Ferreira, R; Santos, TPulmonary thromboembolism (PTE) is a clinical entity difficult to diagnose, its setting is often confused with other pathological entities. The inexistence of isotopic techniques in most centres and the difficulty and delay in performing a pulmonary angiography leads transesophageal echocardiography (TEE) to be, a method of increasing importance for its diagnosis. From January 1996 to November 1997, echocardiographic evaluation was requested for 33 patients due to clinical suspicion of pulmonary thromboembolism. A transthoracic assessment was made previously in 21 patients (average ages 58.3 years, 52% males) which had signs of right overload (dilatation of the right cavities, anomalous movement of the intraventricular septum and pulmonary hypertension) a TEE was performed. The TEE was negative in 10 patients (TEEn) without evidence of thrombi in the trunk and main branches of the pulmonary artery (PA); there was one death on this group for repeated pulmonary microembolisms confirmed by necropsy. The TEE was positive in 11 patients (TEEp) with evidence of thrombi in the PA trunk in 3 patients, bilaterally in both branches in 3 patients and in the right branch in 5 patients. There were dilatations of the right cavities in all patients, paradoxal movement of the interventricular septum and bulging of the intra-auricular septum to the left atria. Foramen ovale was detected in 2 patients. The best visualisation of the PA was achieved in the intermediate planes between 30-70 degrees and between 90-130 degrees (plane for transverse slice of the right branch of the pulmonary artery). In 7 patients with TEEp, PTE was confirmed by CT-scan (visualisation of the thrombi in the trunk and main branches of the PA) and/or ventilation-perfusion scintigraphy and/or pulmonary angiography. In three cases of massive pulmonary embolism in young patients, with severe pulmonary hypertension, thrombolysis was performed with rTPA, under TEE control before and after rTPA in one of the cases. In conclusion, transesophageal echocardiography is an easy technique to be performed in the case of clinical suspicion of PTE. The existence of a negative examination does not invalidate the existence of PTE since only the trunk and the main branches of the PA are accessible by this technique. The detection of thrombi at this level in patients with clinical suspicion of massive pulmonary embolism confirms the diagnosis and supports the indication of thrombolysis.
- Left ventricular pseudoaneurysm: a challenging diagnosis.Publication . Faustino, M; Ranchordás, S; Abecasis, J; Freitas, A; Ferreira, M; Gil, V; Morais, C; Neves, JPLeft ventricular pseudoaneurysm is a rare complication of acute myocardial infarction, associated with high mortality. However, it can present in a non-specific manner, complicating and delaying the diagnosis. The authors present the case of a 65-year-old patient, hypertensive, with no other known relevant medical history, who presented with chest pain, cough and left pleural effusion, initially attributed to a pulmonary process. However, these were in fact the result of a left ventricular pseudoaneurysm following silent acute myocardial infarction. The diagnosis was suspected on echocardiography and confirmed by cardiac magnetic resonance imaging, and the patient underwent successful surgical pseudoaneurysm repair. This case illustrates an atypical presentation of a left ventricular pseudoaneurysm, in which the manifestations resulted from pericardial and pleural extension of the inflammatory process associated with contained myocardial rupture. The case demonstrates the need for a high index of suspicion, and the value of imaging techniques to confirm it, in order to proceed with appropriate surgical treatment, and thus modify the course of the disease.
- Não compactação do Ventrículo Esquerdo. Revisão da Literatura a Propósito de um Caso ClínicoPublication . Magno, P; Freitas, A; Gil, VMA não compactação isolada do ventrículo esquerdo (NCIVE) constitui uma etiologia rara de miocardiopatia dilatada, caracterizando-se do ponto de vista morfológico por apresentar dilatação do ventrículo esquerdo, com exuberante padrão trabecular. Embora não esteja claramente demonstrado, é geralmente aceite que a NCIVE resulta da paragem do processo de compactação miocárdica durante a embriogénese. Têm sido descritas formas familiares, estando identificadas alterações de genes que codificam proteínas de ligação entre a matriz extra-celular e o citoesqueleto. O quadro clínico é frequentemente dominado por sintomas e manifestações de insuficiência cardíaca, sendo as complicações cardio-embólicas e disrítmicas, causa frequente de morbilidade e mortalidade. O diagnóstico tem por base critérios clínicos e ecocardiográficos, e a estratégia terapêutica assenta nas recomendações estabelecidas para o tratamento da insuficiência cardíaca, destacando-se a importância da hipocoagulação e prevenção de disrtimias malignas. Os autores descrevem o caso clínico de um homem de 29 anos, internado por um quadro de insuficiência cardíaca congestiva em classe IV da NYHA, com dilatação do ventrículo esquerdo, acompanhada de exuberante trabeculação das paredes, disfunção sistólica grave e volumoso trombo apical. A evolução clínica foi favorável após terapêutica farmacológica convencional e perfusão de levosimendan, tendo tido alta melhorado, em classe I-II da NYHA. Cerca de 18 meses após alta hospitalar, faleceu subitamente no domicílio. A propósito do caso, foi feita uma revisão da literatura actual sobre a NCIVE, no que se refere à etiopatogenia, critérios de diagnóstico e orientação terapêutica.
- Persistência da Veia Cava Superior Esquerda. Diagnóstico EcocardiográficoPublication . Cunha, P; Freitas, A; Magno, P; Gil, VM
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