Sudden Cardiac Death (SCD) and Sudden Cardiac Arrest (SCA) are uncommon in childhood. The etiology is broad vary by age and may have a familial or genetic component. Although, SCD/SCA can occur without warning, a prodrome may be present. The primary care physician should be able to recognize “red flags” as investigation is essential. Further, models of preventive strategies are limited. We provide an overview of the epidemiology, etiology, risk stratification and prevention of SCA/SCD.

Transesophageal Echocardiography (TEE) is extremely important for detecting intracardiac air. We present two cases of air embolism identified in the pulmonary artery and right ventricle, after valvular surgery associated with right atrial opening. We analyzed the high sensitivity of TEE for an early diagnosis and the need for continuous monitoring during the Cardiopulmonary Bypass (CPB), because intracardiac air rapidly changes its location and appearance. We evaluated the incidence and procedures for eliminating intracardiac air. We emphasize that not only the left side of the heart should be analyzed, also to look for achieving a complete deaeration in the right heart cavities, especially if the right atrium was opened.

Mitral stenosis still continuing to be a cause of morbidity and mortality in this part of the country. Restenosis rates after PTMC are 10-20%, and after CMV 20-40% in the coming 2 decades [1]. In REDO PTMC the valve is fibrotic and commmisural morphology which is split in the first procedure becomes fibrotic and calcified. The routine scores which analyze the valve does not take into consideration the commercial morphology so we aimed to study new Echocardiographic parameters and comparison with the existing scores in predicting immediate outcomes of REDO PTMC. Methods and Results: 42 symptomatic patients with mitral restenosis who have undergone REDO PTMC were enrolled and they were divided into 2 cohorts on the outcome as optimal (n=27) and suboptimal (n=15) groups Mean WILKINS SUTARIA and New REDO score were 7.89, 2.33, 8.96 in optimal group, 8.53, 1.60, 10.20 in suboptimal group with significant p value of 0.007 for new REDO score predicting its superior sensitivity over other 2 scores.

Background: Exercise training improves the survival and quality of life of coronary patients but the optimal way of combining exercise training modalities in coronary heart disease is still unknown. Methods: 74 coronary patients under pharmacological treatment were randomized into two groups: non-periodized training group (NPG, n=37) and periodized exercise training group (PG, n=37). The two groups were submitted to the same exercises during the 36 sessions making up the program, but prescribed in different ways. All the patients were submitted to an evaluation consisting of: medical admission consultancy, cardiopulmonary endurance testing, 1 maximum repetitions test (1RM) and a body composition evaluation. Results: The VO2 peak improved in both groups, although in a more effective way in the PG (4% vs 1.7%, p<0.001). In addition the functional capacity of this group improved by 13% and there was a significant reduction in the percent body fat (2.1%, p<0.005) and body weight (1.9 kg, p<0.005). The muscle strength of both groups improved and there was no significant difference between them (p<0.05). Conclusions: The present study showed that periodization of the treatment of coronary heart disease patients can improve their cardiopulmonary capacity and reduce the percent of body fat more effectively than the conventional one.

The ideal Coronary Artery Disease (CAD) treatment strategy should be defined based on the results from functional and anatomical examinations according to current guidelines [1]. However, this concept is apparently being overlooked by some centers, where percutaneous coronary intervention (PCI) is used to treat coronary lesions with =50% diameter stenosis, regardless of their functional repercussion [2-8]. Concern about the unnecessary revascularization of the myocardium motivated some cardiologists to develop the concept of functional PCI, where through the measurement of coronary fractional flow reserve (FFR) the therapeutic decision can be made [9].