Ventricular resynchronization through biventricular cardiac pacing for the treatment of refractory heart failure in dilated cardiomyopathy

OBJECTIVE: The biventricular pacing (BVP) approach has good results in the treatment of congestive heart failure (CHF) in patients (pts) with disorders of intraventricular conduction. METHODS: We have applied BVP to 28 pts, with left ventricular pacing using minitoracotomy in 3 pts and the transvenous aproach via coronary sinus in 25 pts. The mean duration of the QRS complexes was 187 ms, in the presence of the left branch block in 22 pts, and right branch block + divisional hemiblock in 6 pts. All pts had been considerated candidates to cardiac transplantation, and were under optimized drug therapy. Sixteen pts were in Functional Class (NYHA) IV, and 12 in class III. The ejection fraction varied from 22 to 46% (average = 34%). The pacing mode employed was biventricular triple-chamber in 22 pts, and bi-ventricular dual-chamber in 6 pts (one with ICD). RESULTS: The pts were followed up for a period that ranged from 10 days to 14 months (mean 5 months). All pts presented clinical improvement after implant, chaging the NYHA Functional Class at the end of follow-up to Class I (9pts), Class II (10 pts) and Class III (6 pts). The initial mean ejection fraction have-raised to 37%. Two pts died suddenly. One patient died due to a pulmonary fungal infection. CONCLUSION: Ventricular resynchronization through BVP, improved significantly the Functional Class and, therefore, the quality of life. Assessments of myocardial function acutely performed do not reflect the clinical improvement observed

The southern Araçuaí belt and the Dom Silvério Group: geologic architecture and tectonic significance

The Araçuaí belt corresponds to the external portion of the western half of the Araçuaí-West Congo Neopro-terozoic orogen. TheAraçuaí belt fringes the São Francisco craton to east and is separated from the crystalline core of the orogen by the Abre Campo geophysical discontinuity. The southern Araçuaí belt involves four major lithologic units: the Archean and Paleoproterozoic gneisses of the Mantiqueira Complex, the Pedra Dourada Charnockite, the Paleoproterozoic Borrachudos Granitoid, and the metavolcanosedimentary rocks of the Dom Silvério Group. The Dom Silvério Group occurs in a NNE-SSW striking belt and consists of a thick package of metapelitic rocks with intercalations of quartzites, amphibolites, meta-ultramafics, banded iron formations, gondites and marbles. All units of the southern Araçuaí belt underwent four syn-metamorphic phases of deformation in the course of the Brasiliano event. The first phase, synchronous to a regional amphibolite facies metamorphism, was associated to a general tectonic transport towards north along the left-lateral Dom Silvério shear zone and its low angle segment. The second and third phases represent progressive stages of a west directed shortening, which led to the development of local thrusts and pervasive folds in several scales. The fourth phase is extensional and reflects the collapse of the orogen.<br>A Faixa Araçuaí corresponde à porção ocidental externa do orógeno neoproterozóico Araçuaí-Congo Ocidental. Margeia a borda leste do Cráton do São Francisco e é separada do núcleo cristalino do orógeno pela descontinuidade geofísica de Abre Campo. A porção meridional da Faixa Araçuaí envolve quatro unidades litológicas principais: os ortognaisses arqueanos e paleoproterozóicos do Complexo Mantiqueira, os charnoquitos Pedra Dourada, os granitóides paleoproterozóicos da Suíte Borrachudos e as rochas metavulcanossedimentares do Grupo Dom Silvério. O Grupo Dom Silvério ocorre em uma faixa NNE-SSW e engloba um pacote de rochas metapelíticas com intercalações de quartzitos, anfibolitos, meta-ultramáficas, formações ferríferas, gonditos e mármores. Todas as unidades da porção meridional da Faixa Araçuaí foram envolvidas em quatro fases deformacionais sin-metamórficas no curso do Evento Brasiliano. A primeira fase, sincrônica a um metamorfismo regional de fácies anfibolito, associou-se a um transporte tectônico geral para norte ao longo da zona de cisalhamento sinistral de Dom Silvério e no segmento de baixo ângulo a ela conectado. A segunda e terceira fases representam estágios progressivos de um encurtamento com movimentação geral para oeste, com desenvolvimento de empurrões localizados e intenso dobramento em todas as escalas. A quarta fase é extensional e reflete o colapso do orógeno