1. Introduction There are currently a wide modalities of interventional strategies – both transcatheter and surgical – which can be indicated for patients with valvular heart diseases (VHD), with the objective of reducing the morbidity and mortality. The correct timing for indication and the type of interventional treatment are linked to the precise anatomical and functional diagnosis of the VHD, and comprehensive global evaluation of the patient. The 2020 Update of the Brazilian Guidelines for VHD, in addition to compiling [...] 1. Introduction There are currently a wide modalities of interventional strategies – both transcatheter and surgical – which can be indicated for patients with valvular heart diseases (VHD), with the objective of reducing the morbidity and mortality. The correct timing for indication and the type of interventional treatment are linked to the precise anatomical and functional diagnosis of the VHD, and comprehensive global evaluation of the patient. The 2020 Update of the Brazilian Guidelines for VHD, in addition to compiling

1. Introduction Scientific knowledge of hypertrophic cardiomyopathy (HCM) has significantly improved in the past decades. A better understanding of its pathogenesis, significant advances in the use of imaging methods, and the more common application of genetic analysis, in addition to a better characterization of the natural history of this myocardial disease, have profoundly reformulated its clinical and prognostic significance. Conversely, these processes were accompanied by the development of new medications addressing molecular mechanisms intrinsically linked to the pathophysiology and pathogenesis [...] 1. Introduction Scientific knowledge of hypertrophic cardiomyopathy (HCM) has significantly improved in the past decades. A better understanding of its pathogenesis, significant advances in the use of imaging methods, and the more common application of genetic analysis, in addition to a better characterization of the natural history of this myocardial disease, have profoundly reformulated its clinical and prognostic significance. Conversely, these processes were accompanied by the development of new medications addressing molecular mechanisms intrinsically linked to the pathophysiology and pathogenesis

1. Introdução O conhecimento médico científico sobre a cardiomiopatia hipertrófica (CMH) recebeu grande avanço nas últimas décadas. O melhor entendimento da sua patogênese, os avanços expressivos no emprego dos métodos de imagem e a aplicação mais corriqueira da análise genética, além da melhor caracterização da história natural dessa doença miocárdica, trouxeram uma profunda reformulação do seu significado clínico e prognóstico. Por outro lado, esses progressos foram acompanhados do desenvolvimento de novas drogas endereçando mecanismos moleculares intrinsecamente ligados à fisiopatogênese da [...] 1. Introdução O conhecimento médico científico sobre a cardiomiopatia hipertrófica (CMH) recebeu grande avanço nas últimas décadas. O melhor entendimento da sua patogênese, os avanços expressivos no emprego dos métodos de imagem e a aplicação mais corriqueira da análise genética, além da melhor caracterização da história natural dessa doença miocárdica, trouxeram uma profunda reformulação do seu significado clínico e prognóstico. Por outro lado, esses progressos foram acompanhados do desenvolvimento de novas drogas endereçando mecanismos moleculares intrinsecamente ligados à fisiopatogênese da

As fístulas da árvore traqueobrônquica, sejam elas broncopleurais ou traqueoesofágicas, apresentam etiologia multifatorial, com incidência variável na literatura. Em geral, apresentam alta morbidade e mortalidade, com indicação formal de correção cirúrgica. Entretanto, a condição clínica dos pacientes muitas vezes não permite uma reintervenção cirúrgica de grande porte. Além disso, as tentativas de fechamento endoscópico raramente têm sucesso, principalmente em fístulas de grande diâmetro. Relatamos os casos de três pacientes submetidos ao fechamento endoscópico de fístulas, sendo duas maiores que 10 mm, com a aplicação de dispositivos oclusores utilizados na cardiologia intervencionista, de forma minimamente invasiva e com resultados iniciais positivos. Esses dados sinalizam que essa pode ser uma técnica promissora na resolução de fístulas da árvore traqueobrônquica.

To evaluate the effectiveness and safety of pleurodesis carried out entirely on an outpatient basis in patients with recurrent malignant pleural effusions and Karnofsky Performance Status scores <70. This study was a prospective trial comprising patients with symptomatic recurrent malignant pleural effusion and Karnofsky Performance Status scores 30. All selected patients underwent pleural catheter placement (14 Fr) in an outpatient facility. When chest radiography revealed post-drainage lung expansion of >90%, pleurodesis (3 g of talc) was performed. Catheters were maintained until the daily output was ,100 mL/day. The patients were evaluated in the first month and every three months thereafter for fluid recurrence, the need for additional procedures, and complications. During the study period (January 2005 to July 2007), 64 patients (24 men, 40 women), with an average age of 61.4 years, underwent elective chest tube drainage. Primary sites of the underlying malignancy were breast (27), lung (22), and others (15). Sixty-six pleural catheters were placed (bilaterally in 2 patients), and 52 talc pleurodesis procedures were performed. Fourteen patients had a trapped lung and were excluded from the trial. No complications were observed during catheter placement or pleurodesis. Post-pleurodesis complications included catheter obstruction (4 patients) and empyema (1). The average drainage time was 9.9 days. The recurrence rate observed in patients that were alive 30 days after pleurodesis was 13.9% (5/36 patients). Six patients required additional procedures after the pleurodesis. The average survival time was 101 days. In this study, talc pleurodesis was safely performed in an outpatient setting with good efficacy and a reasonable complication rate, thereby avoiding hospital admission.

OBJECTIVES: Our goal was to analyse the initial results of the first 50 transapical transcatheter mitral valve-in-valve procedures performed in a single Latin American centre. METHODS: A prospective, single centre, database analysis was conducted to evaluate immediate, 30-day and 1-year postoperative results of 50 consecutive patients who had a transcatheter mitral valve-in-valve procedure from May 2015 to June 2018. All patients were operated on in a hybrid operating room and received a balloon-expandable valve via the transapical approach. Preoperative and postoperative characteristics were analysed and compared between the first 25 and the second 25 patients to evaluate the impact of the learning curve. Twenty patients had a follow-up examination at 1 year. RESULTS: There was a 98% device success rate. The patients had a mean age of 64.8 years; 72% were women; 80% were in New York Heart Association functional class ≥III preoperatively; and 36% of the procedures were urgent. The mean Society of Thoracic Surgeons scores and EuroSCORE II were 8.3% and 12.4%, respectively. Patients had a median of 2 previous operations; valve durability was 12.1 years; and 64% mitral valve disease of rheumatic fever aetiology. Echocardiography showed decreases in the maximum and mean mitral gradients from 23.5 to 14.6 and 11.5 to 6.4 mmHg postoperatively; the overall mean hospitalization period was 15 days. The overall mortality rate at 30 days was 14%, with 1 intraprocedural death. Further subanalyses between the first and the second half of the cases showed a drop in the mortality rate from 20% to 8% (P < 0.01). CONCLUSION: The transcatheter mitral valve-in-valve procedure was shown to be a safe and effective procedure to treat bioprosthetic dysfunction, with potential benefits in patients with rheumatic disease.