ABC | Volume 113, Nº3, September 2019

Case Report Cilsal Single-ventricle atrioventricular connection in elderly individual Arq Bras Cardiol. 2019; 113(3):438-443 peptide assay is highly sensitive and specific in the diagnosis of heart failure. In our patient, brain natriuretic peptide levels were markedly elevated. Conventional standard echocardiography exhibits pathologic findings at advanced stages of cardiac involvement. The assessment of the ventricular function involves two different phenotypes. The first one is ‘dilated cardiomyopathy’ phenotype revealed by with left-right ventricular dilatation and reduced contractility, which cause congestive heart failure. The second one is ‘restrictive cardiomyopathy’ phenotype revealed by restrictive left-right ventricular filling resulting in pulmonary hypertension, right ventricular dilatation, and heart failure. 7 In this report, our patient had impaired cardiac functions similar to both dilated and restrictive patterns of cardiomyopathy. Right, and left ventricle contractility was reduced which led to congestive heart failure. Both ventricle diastolic dimensions were increased. Assessment with pulsed and pulsed tissue Doppler demonstrated left and right ventricle diastolic dysfunction. Factors that may cause pulmonary hypertension in patients with thalassemia include elevated pulmonary resistance due to high volume of blood flow, elevated shear forces, hypercoagulable state secondary to splenectomy and nitric oxide formation after chronic hemolysis. Although right heart failure may develop secondary to pulmonary hypertension, in thalassemic patients, it may also develop in the absence of elevated pulmonary hypertension. 8 Video 2 – Transthoracic echocardiography from the apical four-chamber by color Doppler view showed immobile leaflets of tricuspid valve in a fixed open position. To view the video click on the link: https://bit.ly/2lTc6iX Video 3 – Transthoracic echocardiography from the parasternal long axis view with color Doppler showing mild mitral regurgitation. To view the video click on the link: https://bit.ly/2lTc6iX 441