ABC | Volume 112, Nº2, February 2019

Anatomopathological Correlation Arq Bras Cardiol. 2019; 112(2):204-210 Favaratto & Aiello Heart failure after surgical correction of aortic dissection Figure 1 – ECG showing atrial and left ventricular overload, the latter with a strain pattern. Figure 2 – Chest x-ray: mediastinal enlargement, suggestive of aortic aneurysm and cardiomegaly. sound, mitral systolic murmur +++ / 6+, tricuspid systolic murmur +++ / 6+ and aortic systolic murmur ++ / 6+; abdominal assessment - liver palpable at 5 cm from the right costal border; palpable and symmetrical lower-limb pulses. He was started on intravenous dobutamine, vasodilator and diuretic drugs, in addition to the antibiotics vancomycin and meropenem. Laboratory tests (August 11, 2012) showed hemoglobin: 9.2 g/dL, hematocrit: 31%, leukocytes: 12,980/mm 3 (neutrophils 74%, eosinophils 1%, basophils 1%, lymphocytes 19%, monocytes 5%), platelets: 395,000/mm³, C-reactive protein: 79.58 mg/dL, urea: 55 mg/dL, creatinine: 1.26 mg/dL, sodium: 135 mEq/L, potassium: 5.1 mEq/L, prothrombin time: (INR) = 1.2, APTT:(rel) = 0.97, venous lactate: 55 mg/dL The chest x-ray showed pulmonary congestion and cardiomegaly. The echocardiogram (August 13, 2012) showed the following measurements: aorta, 41 mm; left atrium, 50 mm; right ventricle, 35 mm; septum, 9 mm; posterior wall, 10 mm; left ventricle, 86 mm; ejection fraction, 20%; hypertrophic left ventricle with diffuse hypokinesis; right ventricle with moderate hypokinesis; severe mitral regurgitation; normal aortic valve; pulmonary valve with indirect signs of pulmonary hypertension; estimated pressure of 43 mmHg and presence of Dacron tube in the aorta. The transesophageal echocardiogram (August 16, 2012) also showed the presence of marked tricuspid regurgitation and no images suggestive of thrombi or vegetations were observed. The laboratory tests performed on August 12 showed hemoglobin decrease to 7.7 g/dL and no evidence of bleeding and, therefore, an upper digestive endoscopy was requested, which did not show any alterations. 205