ABC | Volume 114, Nº4, Suplement, April 2020

Anatomopathological Correlation Favarato & Benvenuti Heart failure after myocardial infarction an rupture of chordae tendineae Arq Bras Cardiol 2020; 114(4Suppl.1):47-56 atrial septal defect was observed in the oval fossa, measuring 15 mm. It is noteworthy that the association between mitral valve prolapse and atrial septal defect is not common, having been reported many years ago in a study published in this same journal. 12 After surgery, the patient developed residual mitral regurgitation, classified as moderate on imaging exams. At the autopsy, a marked retraction of the posterior cusp in the repair region was observed, which prevented the adequate coaptation of the cusps and justified the residual regurgitation. There was no infectious endocarditis, which was clinically considered and consists of one of the complications of valve prolapse. 13 The closure of the atrial septal defect and CABG did not have any complications. It should be noted that coronary artery disease was of atherosclerotic origin and did not have any major myocardial consequences, with only mild left ventricular myocardiosclerosis. The patient had soft tissue infection in the saphenectomy region and septicemia with positive blood culture for staphylococci, with progressive worsening of the clinical picture until death. At autopsy, we confirmed the acute purulent infection at the saphenectomy site, with areas of necrosis.It was not possible to safely identify the presence of bacteria, which is certainly due to prolonged antibiotic therapy, a probable cause of the acute pseudomembranous colitis. There was no detailed examination of the lower-limb venous system, which could have identified septic thrombophlebitis, probable origin of the emboli that caused pulmonary infarctions, considered the final cause of death. In a recently published review, deep vein thrombosis and pulmonary thromboembolism were detected in 1.62% and 0.38% of 3 million patients undergoing cardiac surgery and were associated with higher mortality. 14 Pancreatitis caused by cytomegalovirus was found at the autopsy, which, however, did not have significant clinical consequences. It is important to note that this was not a generalized cytomegalovirus infection, which was identified only in the pancreatic parenchyma. Pancreatic infection by cytomegalovirus is rare, and very few cases have been reported so far, both in immunocompromised and immunocompetent patients. 14 (Dr. Luiz Alberto Benvenuti) 1. Thygensen K, Alpert JS, Jaffe AS, Chaitman Br, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019; 40(3):237-69. 2. Kang J, Das B. Emergent Presentation of Decompensate Mitral Valve Prolapse and Atrial Septal Defect. West J Emerg Med. 2015; 16(3):432-4. 3. Avierinos JF, Gersh BJ, Melton III LJ, Bailey KR, Shub C, Nishimura RA, et al. Natural history of asymptomatic mitral valve prolapse in the community. Circulation. 2002;106(11):1355-61. 4. Delling FN, Rong J, Larson MG, Lehman B, Fuller D, Osypiuk E, et al. The evolution of mitral valve prolapse: insights from The Framingham Heart Study. Circulation. 2016; 133(17):1688-95. 5. Gabbay U, Yosefy C. The underlying causes of chordae tendinae rupture: a systematic review. Int J Cardiol. 2010; 143(2):113-8. 6. Shiraishi I, Nishimura K, Sakaguchi H, Abe T, Kitano M, Kurosaki K, et al. Acute rupture of chordae tendineae of the mitral valve in infants: a nationwide survey in Japan exploring a new syndrome. Circulation. 2014; 130(13):1053-61. 7. Habib G, Lancellotti P, Antunes MJ , Bongiorni MG, Casalta JP, Del Zotti F, et al. Task Force for the Management of infective endocarditis of the European Society of Cardiology Members. 2015 ESC Guidelines for management of infective endocarditis. Eur Heart J. 2015;36(44):3075-123. 8. ChavezLO,LeonM,EinavS,VaronJ.Beyondmuscledestruction:asystematic reviewofrhabdomyolysisforclinicalpractice.CriticalCare.2016;20(1):135. 9. TaylorRM,TujiosS, JinjuvadiaK,DavernT,ShaikhOS,HanS,etail.Shortand Long-Term Outcomes in Patients with Acute Liver Failure Due to Ischemic Hepatitis. Dig Dis Sci. 2012; 57(3):777-85. 10. Burke KE, Lamont JT. Clostridium difficile infection: A Worldwide Disease (Review). Gut and Liver. 2014; 8(1):1-6. 11. Hayek E, Gring CN, Griffin BP. Mitral valve prolapse. Lancet. 2005; 365(9458)507-18. 12. Frem AS, Bittencourt LA, Carvalhal-Filho SS et al. Association of mitral valve prolapseand interatrialcom munication:Reportofthecase.ArqBrasCardiol . 1979;32(2):113-6. 13. Khoury H, Lyons R, Sanaiha Y, Rudasill S, Shemin RJ, BenharASh P. Deep venous thrombosis and pulmonar embolism in cardiac surgical patients. Ann Thorac Surg. 2019 Nov 7; piiS0003-4975(19)31629-7. 14. Chan A, Bazerbachi F, Hanson B, Alraies MC, Duran-Nelson A. Cytomegalovirus hepatitis and pancreatitis in the immunocompetent. Ochsner J. 2014;14(2):295-9. References Este é um artigo de acesso aberto distribuído sob os termos da licença de atribuição pelo Creative Commons 56