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- Bicaval Transcatheter Prosthesis Implantation for Treatment of Tricuspid RegurgitationPublication . Custódio, Pedro; Carvalho, António; Bico, PedroThe transcatheter bicaval valve system is an emerging therapeutic option for tricuspid regurgitation, consisting of 2 biological valves to prevent caval reflux. The experience with this device is still scarce, and to the best of our knowledge, this is the first case of thrombosis ever reported. (Level of Difficulty: Advanced.) (J Am Coll Cardiol Case Rep 2023;6:101609) © 2023 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- A large outbreak of Legionnaires’ Disease in an industrial town in PortugalPublication . George, F; Shivaji, T; Pinto, CS; Serra, LA; Valente, J; Albuquerque, MJ; Vicêncio, PC; San-Bento, A; Diegues, P; Nogueira, PJ; Marques, T; Rebelo, H; Costa, F; Rodrigues, R; Nunes, A; Borges, V; Gomes, JP; Sampaio, D; Barreiro, P; Duarte, S; Carpinteiro, D; Mendonça, J; Silva, C; Vieira, L; Simões, MJ; Gonçalves, P; Nunes, B; Dias, C; Machado, J; Almeida, F; Goncalves, EA; Carvalho, L; Viterbo, P; Jardim, D; Lacasta, N; Boavida, F; Perez, A; Santana, I; Matias, P; Banza, N; Rabacal, CBackground We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure to the affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10 km buffer centered on each cooling tower system. We compared the number of cases with expected numbers, calculated from the outbreak's attack rates applied to 2011 census population. Using Stones’ Test, we tested observed to expected ratios for decline in risk, with distance up to 10 km four directions. Isolates of Legionella pneumophila were compared using molecular methods. Results We identified 403 cases, 377 of which were confirmed, 14 patients died. Patients became ill between 14 October and 2 December. A NE wind and thermal inversion were recorded during the estimated period of exposure. Disease risk was highest in people living south west from all of the industries identified and decreased with distance (p < 0.001). 71 clinical isolates demonstrated an identical SBT profile to an isolate from a cooling tower. Whole genome sequencing identified an unusual L. pneumophila subsp. fraseri serogroup 1 as the outbreak causative strain, and confirmed isolates’ relatedness. Conclusions Industrial wet cooling systems, bacteria with enhanced survival characteristics and a combination of climatic conditions contributed to the second largest outbreak of Legionnaires’ disease recorded internationally.
- O efeito de um programa de exercício físico na qualidade de vida em doentes cardíacosPublication . Tavares, N; Madeira, R; Henriques, A; Almeida, A; Nuno, LAs políticas públicas de saúde e os programas de reabilitac¸ão cardíaca, com exercício físico, são reconhecidos como uma componente essencial nos cuidados fornecidos aos cidadãos, permitindo preservar ou readquirir o seu lugar na comunidade, bem como aumentar a sua qualidade de vida. Objetivo: Aplicar o exercício físico supervisionado (grupo ES), em fase de ambulatório precoce, realizado na comunidade, com vista a analisar e comparar os resultados desta aplicac¸ão com os dados obtidos pelos doentes sujeitos apenas ao tratamento convencional (grupo TC). Método: O estudo teve uma durac¸ão superior a 3 meses, dividindo os doentes cardíacos em 2 grupos (grupo ES vs. grupo TC), tendo sido esclarecidos, através de consentimento informado, do propósito e procedimentos do estudo. Após a divisão, os doentes sujeitos ao exercício físico supervisionado (grupo ES) foram submetidos a um plano de intervenc¸ão estruturado em 3 fases, segundo a frequência, intensidade, tempo e tipo de exercício físico, conforme a devida estratificac¸ão do risco e recomendac¸ões da American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). Os doentes realizaram 2 avaliac¸ões no Hospital de Vila Franca de Xira, recorrendo ao questionário MacNew para avaliar a qualidade de vida relacionada com a saúde na doenc¸a cardíaca. Avaliou-se a média e o desvio padrão para todas as variáveis em estudo, recorrendo-se aos testes não paramétricos e paramétricos para um nível de significância de alfa = 0,05. Resultados: Foram observadas diferenc¸as estatisticamente significativas ao nível da qualidade de vida geral (p < 0,01), bem como uma variac¸ão percentual crescente (+ 53,86%) no grupo ES. Conclusão: O exercício físico supervisionado, realizado na comunidade logo após alta hospitalar, com uma intensidade pelo menos moderada, potencia a qualidade de vida em doentes cardíacos.
- Síndrome de Brugada Complicado de Morte SúbitaPublication . Rabaçal, C; Mendonça, C; Nuno, L; Almeida, A; Afonso, SBrugada syndrome is an electrocardiographic diagnosis that is increasingly recognized as a cause of sudden cardiac death. The authors present a clinical case of a patient with a family history of sudden death, in whom a diagnosis of Brugada syndrome had been established, and who died suddenly. They also present a brief review of the main findings of this entity, particularly the diagnostic criteria and treatment of choice, since it is recognized that its prevalence will rise in the coming years.
- The Manchester Triage System in acute coronary syndromesPublication . Matias, C; Oliveira, R; Duarte, R; Bico, P; Mendonça, C; Nuno, L; Almeida, A; Rabaçal, C; Afonso, SINTRODUCTION: A growing number of hospitals have implemented the Manchester Triage System (MTS) in their Emergency Department (ED), so as to better prioritize the evaluation of those attending these departments. OBJECTIVES: To assess whether the MTS was used effectively in patients admitted to the hospital with a diagnosis of acute coronary syndrome (ACS). METHODS: We evaluated 114 consecutive patients admitted to the Cardiology Department with a diagnosis of ACS. We recorded the color assigned in the MTS, mean time from arrival in the ED to MTS, mean time from MTS to first medical assessment (1-MA) and mean time from 1-MA to admission. We also analyzed the correlation between the type of ACS and clinical presentation and its relation with MTS. RESULTS: Of the 114 patients, one was coded red (0.9%), 71 orange (62.3%), 12 green (11%), and two were not assigned a color code according to MTS because they were admitted via a Medical Emergency and Resuscitation Vehicle. Mean time from arrival in the ED to MTS was 5.2 +/- 0.6 min and from MTS to MA was 20 +/- 2.5 min. In patients triaged as orange the time from MTS to MA was 15.1 +/- 1.5 min, as yellow 36.2 +/- 7 min, and as green 35.2 +/- 20.6 min (p = 0.003). Mean time from 1-MA to admission was 144.4 +/- 17 min, with no differences according to triage code or ACS type. Clinical presentation influenced triage and the speed of 1-MA and admission, patients with typical presentation being evaluated and admitted more quickly. CONCLUSIONS: Most patients admitted for ACS are initially triaged as orange or yellow, an indication for prompt assessment in the ED; this has a positive effect on time to first medical assessment, but has no effect on time to hospital admission.
- Iatrogenic aortic pseudoaneurysm: A forgotten complicationPublication . Almeida, S; Bico, P; Almeida, AR; Laranjeira Santos, A; Banazol, N; Fragata, J; Rabaçal, CPseudoaneurysms of the ascending aorta are a rare complication of cardiac surgery. However, the poor prognosis associated with this condition if untreated makes early diagnosis and treatment important. We present the case of a 66-year-old woman who had undergone mitral valvuloplasty 12 days previously, who was admitted with a diagnosis of new-onset atrial fibrillation. The transthoracic echocardiogram showed a clot in the right atrium and anticoagulation was initiated, followed by antibiotic therapy. After further investigation, the patient was diagnosed with a pseudoaneurysm of the ascending aorta and underwent surgical repair, followed by six weeks of antibiotic therapy. She was readmitted six months later for an abscess of the lower sternum and mediastinum. After a conservative approach with antibiotics and local drainage failed, recurrence of a large pseudoaneurysm compressing the superior vena cava was documented. A third operation was performed to debride the infected tissue and to place an aortic allograft. There were no postoperative complications.
- Assimetria pulmonar na telerradiografia do tóraxPublication . Oliveira, R; Martins, JD; Marques, H; Santos, O; Freitas, I; Pinto, FFThe unilateral absence of one pulmonary artery is a rare congenital abnormality. The authors report a clinical case of a two-year-old boy with no previous medical history who was referred for evaluation after the detection of pulmonary asymmetry on the chest X-ray with a right mediastinal shift. The CT scan and pulmonary perfusion scintigraphy pointed to an absent right pulmonary artery, which was confirmed by right heart catheterization and cardiac magnetic resonance imaging. This is an important pathology because early diagnosis and timely correction can prevent future complications. Since at this time the patient is asymptomatic, the authors opted for careful clinical vigilance.