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Background. Dengue is a disease whose clinical manifestations range from asymptomatic infections to a severe disease. There have been some previous reports of myocardial involvement in dengue, but this association has not been completely established. Methods. From January to July of 2011, patients hospitalized with dengue, confirmed through dengue nonstructural protein 1 and/or immunoglobulin M detection, were included in this study and troponin I and N terminal fragment of B-type natriuretic peptide levels were determined. Patients with abnormal biomarkers underwent echocardiography and when any abnormality wa detected, they underwent cardiac magnetic resonance imaging. Results. Eighty-one patients were evaluated and 12 patients (15%) presented with elevated biomarker levels. Compared to controls, they had higher leukocyte (P < .001) and platelet counts (P = .005); higher C-reactive protein (P = .02), and a lower viral load (P = .03). There was no difference according to clinical dengue classification; dengue hemorrhagic fever/dengue shock syndrome severity; duration of symptoms; or prevalence of secondary infection between the 2 groups. Two patients died secondary to cardiogenic shock before imaging studies. Necroscopic findings were compatible to myocarditis in both, and immunohistochemistry for dengue virus showed increased staining on mononuclear cells located in the myocardial tissue. Of the 10 patients who underwent echocardiography, depressed left ventricular ejection fraction (LVEF) was identified in 1, left ventricular segmental abnormalities with preserved LVEF in 2, and an important pericardial effusion with tamponade in another. Cardiac involvement was confirmed by CMR in these 4 patients. Conclusions. Dengue viruses were shown to cause cardiac disease with clinical manifestations ranging from mild elevation of biomarkers to myocarditis and/or pericarditis.

Ventricular constraint therapy has been used to prevent and reverse the progression of heart failure in ischemic and nonischemic cardiomyopathies. We hypothesized that ventricular restraint should be tried by closing the pericardium that was previously opened following left ventricle topographical projection. The surgical technique presentation is illustrated by a remarkable 13-year outcome of one patient with dilated cardiomyopathy treated surgically by mitral prosthesis, Cox/Maze III surgery to treat atrial fibrillation, and associated to the ventricular constraint using the patient's own pericardium. The ventricular pericardial restraint role is unclear, since the patient had multiple corrections that could be responsible for the good outcome; however it is viable deserving investigations.

Objective: To present a surgical variant technique to repair left ventricular aneurysms. Methods: After anesthesia, cardiopulmonary bypass, and myocardial protection with hyperkalemic tepic blood cardioplegia: 1) The left ventricle is opened through the infarct and an endocardial encircling suture is placed at the transitional zone between the scarred and normal tissue; 2) Next, the scar tissue is circumferentially plicated with deep stitches using the same suture thread, taking care to eliminate the entire septal scar; 3) Then, a second encircling suture is placed, completing the occlusion of the aneurysm, and; 4) Finally, the remaining scar tissue is oversewn with an invaginating suture, to ensure hemostasis. Myocardium revascularization is performed after correction of the left ventricle aneurysm. The same surgeon performed all the operations. Results: Regarding the post-surgical outcome 4 patients (40%) had surgery 8 eight years ago, 2 patients (20%) were operated on over 6 years ago, and 1 patient (10%) was operated on more than 5 years ago. Three patients (30%) were in functional class I, class II in 2 patients (20%) and 2 patients (20%) with severe comorbidities remains in class III of the NYHA. There were three deaths (at four days, 15 days and eight months) in septuagenarians with acute myocardial infarction, diabetes and pulmonary emphysema. Conclusion: The technique is easy to perform, safe and it can be an option for the correction of left ventricle aneurysms.

Patient YB, 50 years old, female, with hypothyroidism, severe left ventricular dysfunction, uncompressed left ventricle and poorly tolerated ventricular tachycardia, submitted to implantation of a dual chamber implantable cardioverter-defibrillator (ICD) in February 2012 (generator Secura DR Medtronic, 4076 Medtronic atrial electrode, and Sprint Quattro 6947 Medtronic ventricular electrode). Returns asymptomatic nine months after the implant for routine evaluation.

Patient T.D., 23 years old, female, with corrected transposition of the great arteries, complete atrioventricular block with narrow QRS, submitted to bicameral pacemaker implantation at 13 years of age, with generator replacement three years ago. She has a good functional capacity, but complains of fatigue in the face of intense effort.

Patient T.D., 23 years old, female, with corrected transposition of the great arteries, complete atrioventricular block with narrow QRS, submitted to bicameral pacemaker implantation at 13 years of age, with generator replacement three years ago. She has a good functional capacity, but complains of fatigue in the face of intense effort.

Patient T.D., 23 years old, female, with corrected transposition of the great arteries, complete atrioventricular block with narrow QRS, submitted to bicameral pacemaker implantation at 13 years of age, with generator replacement three years ago. She has a good functional capacity, but complains of fatigue in the face of intense effort.

Patient OG, 62 years, with arrhythmogenic cardiomyopathy in the right ventricle and low-tolerated sustained tachycardia, user of an implantable ventricular single-chamber cardiovascular defibrillator (ICD), returned asymptomatic for routine evaluation. Th ere was no registry of sustained arrhythmia, and the limits of stimulation and sensitivity were checked and were appropriate. However, facing the device’s telemetry, it was detected lack of sensitivity in a ventricular extra-systole.

Patient T.D., 23 years old, female, with corrected transposition of the great arteries, complete atrioventricular block with narrow QRS, submitted to bicameral pacemaker implantation at 13 years of age, with generator replacement three years ago. She has a good functional capacity, but complains of fatigue in the face of intense effort.

Paciente OG, 62 anos, com cardiomiopatia arritmogênica do ventrículo direito e taquicardia ventricular sustentada mal tolerada, portador de cardioversor desfibrilador implantável (CDI) de câmara única ventricular, retornou assintomático para avaliação de rotina. Não havia registro de arritmias sustentadas, e os limiares de estimulação e sensibilidade foram checados e estavam adequados. No entanto, diante da telemetria do dispositivo, foi identificada uma falha de sensibilidade de uma extra-sístole ventricular.