Case report
Anterolateral papillary muscle rupture after intervention of the right coronary artery
Rotura do músculo papilar anterolateral após intervenção na artéria coronária direita
Liam Morris
, Anand Desai, Nuri Ilker Akkus
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Division of Cardiology, LSU Health Sciences Center, Shreveport, LA, United States
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of the right coronary artery" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "693.e1" "paginaFinal" => "693.e3" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Liam Morris, Anand Desai, Nuri Ilker Akkus" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Liam" "apellidos" => "Morris" "email" => array:1 [ 0 => "lees07@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Anand" "apellidos" => "Desai" ] 2 => array:2 [ "nombre" => "Nuri Ilker" "apellidos" => "Akkus" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Division of Cardiology, LSU Health Sciences Center, Shreveport, LA, United States" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Rotura do músculo papilar anterolateral após intervenção na artéria coronária direita" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1215 "Ancho" => 2833 "Tamanyo" => 232463 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Subcostal transthoracic echocardiographic images showing anterolateral papillary muscle rupture and severe mitral regurgitation (white arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Papillary muscle rupture is a life-threatening complication of acute myocardial infarction (MI) that accounts for 5% of deaths in these patients.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> Rupture of the posteromedial papillary muscle is more frequent than of the anterolateral papillary muscle due to the dual blood supply to the latter (left anterior descending and left circumflex arteries).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> However, a right coronary artery (RCA) lesion causing an anterolateral papillary muscle rupture is extremely rare, with only two reported cases in the literature.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> An associated right ventricular infarction further complicates management and the literature on this complication is limited. Herein, we present a rare case of an isolated right coronary artery (RCA) lesion resulting in anterolateral papillary muscle rupture and concomitant right ventricular (RV) infarction.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 78-year-old white male with a history of hypertension, hyperlipidemia, cerebrovascular accident, right carotid endarterectomy (three years previously) and chronic stage 5 kidney disease, presented to the emergency department with retrosternal chest pressure starting two days prior to admission. The patient described the pain as dull in nature, radiating to the left arm. His history was positive for dyspnea on minimal exertion since the onset of symptoms; however there was no associated orthopnea or paroxysmal nocturnal dyspnea. His social history was negative for smoking, alcohol or illicit drug use. His home medications included aspirin, lisinopril, pravastatin, ferrous sulfate, calcium acetate, ergocalciferol and calcium carbonate.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On physical exam, heart rate was 102 beats/min and blood pressure was 103/87 mmHg. The rest of the clinical exam was unremarkable with normal S1, S2 and no murmur. The ECG revealed sinus rhythm, left axis deviation, non-specific intraventricular conduction block and ST-T wave abnormalities suggestive of inferior ischemia. Laboratory tests revealed an elevated troponin I level of 11.8 ng/ml. A two-dimensional (2D) echocardiogram showed severe inferior wall hypokinesis, with moderately reduced left ventricular systolic function and estimated ejection fraction of 35–40%, with no significant mitral regurgitation (MR). The patient was urgently taken to the cardiac catheterization laboratory and was found to have a 99% RCA lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>), with no significant lesions in the other vessels. Successful percutaneous coronary intervention with stenting of the RCA was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>); the patient was admitted to the telemetry floor for close monitoring, and continued on intravenous normal saline to prevent contrast-induced nephropathy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The next morning, the patient complained of diffuse weakness and lethargy. He was found to be hypotensive (systolic blood pressure 60 mmHg), tachycardic (136 beats/min) and tachypneic (24 cycles/min). Physical examination revealed elevated jugular venous pressure, a new 2/6 holosystolic murmur heard best over the apex, radiating to the axilla, and scattered bibasilar crackles on pulmonary auscultation. The ECG showed sinus tachycardia, with inferior ST elevations suggestive of injury. Postprocedural troponin was also elevated at 114.0 ng/ml. The chest X-ray revealed changes consistent with pulmonary edema. Repeat 2D echocardiography revealed anterolateral papillary muscle rupture with severe eccentric mitral regurgitation (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>), and evidence of right ventricular hypokinesis. He was started on norepinephrine and taken urgently to the catheterization laboratory, where the previously placed stent was found to be patent. Right heart catheterization revealed elevated right-sided pressures with pulmonary artery pressure of 55/25 mmHg, RV pressure of 47/21 mmHg and right atrial pressure of 20 mmHg, and an intra-aortic balloon pump was placed. He was started on a low-dose milrinone infusion due to RV dysfunction and low cardiac output, and the cardiothoracic surgery department was consulted for emergent surgery. Due to RV infarction and improved hemodynamic status with vasopressors and inotropes the surgery was delayed for 2–3 days by the surgical team. However the patient suffered cardiorespiratory failure on day 2, requiring intubation with mechanical ventilation, and expired after cardiac arrest on day 3.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">We present an unusual case of anterolateral papillary muscle rupture due to an isolated RCA lesion, complicated by a right ventricular infarction. Papillary muscle rupture usually occurs two to seven days after the infarction,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,4</span></a> and in our patient occurred on day 3 (he complained of symptoms lasting two days prior to admission). Furthermore, coronary angiography revealed a large RCA with an overwhelming right predominance. The left circumflex artery was small in comparison, and showed only mild disease, which could explain the anterolateral papillary muscle rupture, as its major blood supply was from the RCA. We believe a periprocedural MI also contributed to this catastrophe, as shown by a significant elevation in cardiac biomarkers post-procedure, coupled with findings of RV infarction on imaging studies. Although an early conservative approach was adopted, due to the presence of an RV infarction and a favorable response to vasopressors and inotropic agents, the severity of the MR and the acute nature of its onset contributed to the patient's demise.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, anterolateral papillary muscle rupture from an isolated right coronary artery lesion is extremely rare, and when associated with right ventricular infarction, can be fatal. Echocardiography remains the key to diagnosing this devastating mechanical complication of an acute MI.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Early surgery still remains the best possible management option,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></a> however data on right ventricular infarctions complicating the above is limited.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Ethical disclosure</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Protection of human and animal subjects</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Confidentiality of data</span><p id="par1035" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres577354" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec593957" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres577355" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec593958" "titulo" => "Palavras-chave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosure" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-01-19" "fechaAceptado" => "2015-03-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec593957" "palabras" => array:4 [ 0 => "Anterolateral papillary muscle rupture" 1 => "Mitral regurgitation" 2 => "Right ventricular infarction" 3 => "Periprocedural myocardial infarction" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec593958" "palabras" => array:4 [ 0 => "Rotura do músculo papilar ântero-lateral" 1 => "Regurgitação mitral" 2 => "Enfarte do ventrículo direito" 3 => "Enfarte do miocárdio periprocedimento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rupture of the anterolateral papillary muscle following a right coronary artery occlusion is extremely rare, and when complicated by a right ventricular infarction, can be fatal. The literature on optimal management of this complication is limited. We present an unusual case of anterolateral papillary muscle rupture following intervention of the right coronary artery.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A rotura do músculo papilar ântero-lateral, na sequência da oclusão da artéria coronária direita é extremamente rara e, quando complicada por um enfarte do ventrículo direito, pode ser fatal. Presentemente, a literatura do tratamento otimizado da mesma é escassa. Apresentamos um caso muito particular da rotura do músculo papilar ântero-lateral, na sequência de uma intervenção à artéria coronária direita.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 821 "Ancho" => 1500 "Tamanyo" => 125796 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Angiography of the right coronary artery, with images before and after percutaneous coronary intervention (white arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1215 "Ancho" => 2833 "Tamanyo" => 232463 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Subcostal transthoracic echocardiographic images showing anterolateral papillary muscle rupture and severe mitral regurgitation (white arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Papillary muscle rupture in fatal acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.Y. Wei" 1 => "G.M. Hutchins" 2 => "B.H. Bulkley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1979" "volumen" => "90" "paginaInicial" => "149" "paginaFinal" => "153" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/443647" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ischemic rupture of the anterolateral papillary muscle" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Catarina" 1 => "G. António" 2 => "P.M. Álvares" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2012.06.014" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "243" "paginaFinal" => "246" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23453536" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolated right coronary lesion and anterolateral papillary muscle rupture – case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Stefanovski" 1 => "A. Walfisch" 2 => "S. Kedev" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1749-8090-7-75" "Revista" => array:5 [ "tituloSerie" => "J Cardiothorac Surg" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22898299" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical complications of acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.S. Kutty" 1 => "N. Jones" 2 => "N. Moorjani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccl.2013.07.004" "Revista" => array:7 [ "tituloSerie" => "Cardiol Clin" "fecha" => "2013" "volumen" => "31" "numero" => "4" "paginaInicial" => "519" "paginaFinal" => "531" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24188218" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Double papillary muscle infarction related to right coronary artery occlusion – a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.U. Güllü" 1 => "U. İnce" 2 => "E.M. Ökten" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5606/tgkdc.dergisi.2013.6337" "Revista" => array:2 [ "tituloSerie" => "Türk Göğüs Kalp Damar Cerrahisi Dergisi" "fecha" => "2013" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003400000011/v1_201511060141/S0870255115002383/v1_201511060141/en/main.assets" "Apartado" => array:4 [ "identificador" => "362" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003400000011/v1_201511060141/S0870255115002383/v1_201511060141/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115002383?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 16 | 5 | 21 |
| 2024 Outubro | 83 | 38 | 121 |
| 2024 Setembro | 69 | 28 | 97 |
| 2024 Agosto | 53 | 30 | 83 |
| 2024 Julho | 67 | 32 | 99 |
| 2024 Junho | 53 | 24 | 77 |
| 2024 Maio | 66 | 28 | 94 |
| 2024 Abril | 66 | 35 | 101 |
| 2024 Maro | 47 | 24 | 71 |
| 2024 Fevereiro | 53 | 25 | 78 |
| 2024 Janeiro | 65 | 24 | 89 |
| 2023 Dezembro | 55 | 25 | 80 |
| 2023 Novembro | 61 | 24 | 85 |
| 2023 Outubro | 51 | 17 | 68 |
| 2023 Setembro | 43 | 16 | 59 |
| 2023 Agosto | 48 | 24 | 72 |
| 2023 Julho | 45 | 17 | 62 |
| 2023 Junho | 56 | 15 | 71 |
| 2023 Maio | 63 | 31 | 94 |
| 2023 Abril | 33 | 4 | 37 |
| 2023 Maro | 45 | 24 | 69 |
| 2023 Fevereiro | 37 | 18 | 55 |
| 2023 Janeiro | 52 | 15 | 67 |
| 2022 Dezembro | 69 | 17 | 86 |
| 2022 Novembro | 50 | 25 | 75 |
| 2022 Outubro | 55 | 29 | 84 |
| 2022 Setembro | 65 | 24 | 89 |
| 2022 Agosto | 85 | 30 | 115 |
| 2022 Julho | 54 | 36 | 90 |
| 2022 Junho | 39 | 26 | 65 |
| 2022 Maio | 55 | 34 | 89 |
| 2022 Abril | 99 | 30 | 129 |
| 2022 Maro | 90 | 37 | 127 |
| 2022 Fevereiro | 52 | 20 | 72 |
| 2022 Janeiro | 61 | 27 | 88 |
| 2021 Dezembro | 35 | 25 | 60 |
| 2021 Novembro | 48 | 40 | 88 |
| 2021 Outubro | 73 | 49 | 122 |
| 2021 Setembro | 43 | 27 | 70 |
| 2021 Agosto | 34 | 30 | 64 |
| 2021 Julho | 34 | 30 | 64 |
| 2021 Junho | 39 | 24 | 63 |
| 2021 Maio | 62 | 36 | 98 |
| 2021 Abril | 126 | 34 | 160 |
| 2021 Maro | 109 | 12 | 121 |
| 2021 Fevereiro | 120 | 17 | 137 |
| 2021 Janeiro | 54 | 7 | 61 |
| 2020 Dezembro | 57 | 13 | 70 |
| 2020 Novembro | 44 | 17 | 61 |
| 2020 Outubro | 29 | 15 | 44 |
| 2020 Setembro | 78 | 16 | 94 |
| 2020 Agosto | 52 | 7 | 59 |
| 2020 Julho | 69 | 15 | 84 |
| 2020 Junho | 54 | 19 | 73 |
| 2020 Maio | 56 | 8 | 64 |
| 2020 Abril | 64 | 16 | 80 |
| 2020 Maro | 42 | 10 | 52 |
| 2020 Fevereiro | 143 | 26 | 169 |
| 2020 Janeiro | 46 | 9 | 55 |
| 2019 Dezembro | 46 | 8 | 54 |
| 2019 Novembro | 55 | 6 | 61 |
| 2019 Outubro | 68 | 6 | 74 |
| 2019 Setembro | 41 | 9 | 50 |
| 2019 Agosto | 40 | 8 | 48 |
| 2019 Julho | 55 | 11 | 66 |
| 2019 Junho | 57 | 20 | 77 |
| 2019 Maio | 49 | 18 | 67 |
| 2019 Abril | 39 | 18 | 57 |
| 2019 Maro | 81 | 13 | 94 |
| 2019 Fevereiro | 65 | 13 | 78 |
| 2019 Janeiro | 106 | 7 | 113 |
| 2018 Dezembro | 95 | 12 | 107 |
| 2018 Novembro | 120 | 20 | 140 |
| 2018 Outubro | 174 | 11 | 185 |
| 2018 Setembro | 36 | 9 | 45 |
| 2018 Agosto | 40 | 13 | 53 |
| 2018 Julho | 41 | 10 | 51 |
| 2018 Junho | 62 | 9 | 71 |
| 2018 Maio | 77 | 9 | 86 |
| 2018 Abril | 58 | 11 | 69 |
| 2018 Maro | 99 | 9 | 108 |
| 2018 Fevereiro | 49 | 2 | 51 |
| 2018 Janeiro | 62 | 10 | 72 |
| 2017 Dezembro | 64 | 5 | 69 |
| 2017 Novembro | 35 | 11 | 46 |
| 2017 Outubro | 31 | 7 | 38 |
| 2017 Setembro | 26 | 7 | 33 |
| 2017 Agosto | 58 | 8 | 66 |
| 2017 Julho | 29 | 3 | 32 |
| 2017 Junho | 37 | 7 | 44 |
| 2017 Maio | 46 | 8 | 54 |
| 2017 Abril | 35 | 14 | 49 |
| 2017 Maro | 39 | 70 | 109 |
| 2017 Fevereiro | 36 | 18 | 54 |
| 2017 Janeiro | 27 | 9 | 36 |
| 2016 Dezembro | 39 | 6 | 45 |
| 2016 Novembro | 26 | 5 | 31 |
| 2016 Outubro | 21 | 7 | 28 |
| 2016 Setembro | 12 | 5 | 17 |
| 2016 Agosto | 11 | 2 | 13 |
| 2016 Julho | 7 | 5 | 12 |
| 2016 Junho | 13 | 7 | 20 |
| 2016 Maio | 10 | 7 | 17 |
| 2016 Abril | 28 | 4 | 32 |
| 2016 Maro | 39 | 9 | 48 |
| 2016 Fevereiro | 60 | 18 | 78 |
| 2016 Janeiro | 40 | 23 | 63 |
| 2015 Dezembro | 127 | 61 | 188 |
| 2015 Novembro | 116 | 87 | 203 |
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