RCAAP Repository
Unusual Presentation of Patent Ductus Arteriosus in Elderly Patient
Abstract We presented a case of a 56-year-old man with giant pulmonary artery aneurysm caused by a misdiagnosed patent ductus arteriosus, severe multivalvular disease and active aortic valve endocarditis successfully treated by surgery. The correct diagnosis was missed despite preoperative diagnostics because the small patent ductus arteriosus was located at the distal part of common pulmonary trunk and a huge regurgitant signal overlapped its Doppler signal. Thorough evaluation of every patient, regardless of age, is necessary to recognize and treat this congenital anomaly.
2022-12-06T14:01:12Z
Micovic,Slobodan V. Nesic,Ivan M. Milicic,Miroslav D. Vukovic,Petar M.
Late Cardiac Tamponade in a Patient Victim of Penetrating Trauma – Case Report
Abstract Case Presentation: A case of a 49-year-old patient, male, victim of stab wound, developing belatedly cardiac tamponade and hemodynamic stability was reported. The patient underwent a pericardial window with drainage of pericardial effusion of blackened aspect; however, without visualization of the cardiac lesion, enlargement of the incision by median sternotomy was opted for. A hematoma was spotted at the left ventricle with epicardial lesion and a patch of pericardium was made with 3-0 polypropylene. The patient developed acute pulmonary edema and atrial fibrillation, which improved after the intensive care unit clinical management, with hospital discharge in the 7th postoperative day.
2022-12-06T14:01:12Z
Maia,Adnaldo da Silveira Cunha,Alexandre Bichara da Pereira,Magnum Adriel Santos Chaves,Natalia Pompeu Morais,Ricardo Silva de Almeida,Lázaro Araújo de
Thoracoscopic Pulmonary Vein and Left Atrial Posterior Wall Isolation Combined with Left Atrial Appendage Resection in Patients with Long-Standing Persistent Atrial Fibrillation
Abstract Objective: To evaluate the efficacy and safety of a modified technique for totally thoracoscopic left atrial posterior wall and pulmonary vein isolation in patients with long-standing persistent atrial fibrillation. Methods: From April 2017 to December 2018, we included in this study 28 consecutive patients who underwent thoracoscopic left atrial posterior wall and pulmonary vein radiofrequency isolation combined with left atrial appendage resection. We used a device with irrigated electrodes (Medtronic Cardioblate Gemini-s). The original surgical technique “GALAXY” proposed by Doty in 2012 was modified. The number of ablations was significantly increased, and frequent position changing of the ablation device and change of device angulation were added. Results: Sinus rhythm was restored in all patients. There was no operative mortality, no myocardial infarction, and no stroke or transient ischemic attack. One patient required sternotomy and another survived left anterolateral thoracotomy due to bleeding. A 180-day follow-up (24-hour Holter monitoring) revealed no sign of recurrence of atrial fibrillation or other supraventricular arrhythmia in any patient. Mean follow-up was nine months (range: 6-16 months). At the last follow-up, 26 patients (92,9%) were in sinus rhythm (24-hour Holter monitoring). Conclusion: A frequent ablation device position changing during the surgery makes it possible to achieve complete left atrial posterior wall and pulmonary veins isolation. An increased number of applications allows to avoid a false positive transmural damage assessment showed by impedance drop. Also, frequent position changing of the ablation device and increased number of applications do not affect the number of postoperative complications.
2022-12-06T14:01:12Z
Zotov,Aleksandr Vachev,Sergei Borisov,Daniil Troitskiy,Aleksandr Khabazov,Robert
Simultaneous Thoracoscopic Approach in a Patient with Long-Standing Persistent Atrial Fibrillation and Primary Lung Cancer: the First Described Case
Abstract Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.
2022-12-06T14:01:12Z
Zotov,Aleksandr Vachev,Sergei Borisov,Daniil Troitskiy,Aleksandr Khabazov,Robert
The Largest Reported Giant Ascending Aortic Aneurysm Presented with Superior Vena Cava Syndrome
Abstract Giant ascending aortic aneurysm is a rare condition. In this paper, we present an uncommon case of giant ascending aortic aneurysm with a maximal diameter of 14 cm in a 77-year-old woman presenting with unusual symptoms. The patient underwent a successful surgery involving ascending aortic replacement, and was discharged without any complication. After discharge, she was followed regularly and no major problem was observed in her control visits. To the best of our knowledge, our case is the largest ascending aortic aneurysm reported to date in the existing literature.
2022-12-06T14:01:12Z
Bicer,Murat Yuksel,Ahmet Kan,Iris Irem
Bioelectrical Impedance Analysis for Monitoring Fluid and Body Cell Mass Changes in Patients Undergoing Cardiopulmonary Bypass
Abstract Objective: To evaluate preoperative and postoperative body fluid distribution with a bioelectrical impedance analyzer in patients undergoing cardiopulmonary bypass. Methods: Fifteen adult patients undergoing cardiopulmonary bypass were included in this study. Total body fluid changes, basal metabolism rates, body fat masses, lean body masses, and total cell masses were recorded. The patients’ values were measured before anesthesia, after anesthesia, after sternotomy, at the 5th, 30th, and 60th minutes of cardiopulmonary bypass, and on the 1st, 3rd, and 5th postoperative days. All values were compared with preoperative values. Results: Total body fluid changed significantly after cardiopulmonary bypass (P<0.01). Metabolic velocity significantly changed compared to preoperative measurements (P<0.05). Fat mass and lean body mass also changed significantly. Body mass index and phase angle did not change significantly (P>0.05). Conclusion: Changes in body fluids during and after cardiopulmonary bypass are inevitable. The increase in total body weight shows that this fluid load shifts to the extracellular space during bypass and the fluid load in this area passes into the intravascular area in the early postoperative period. This may cause edema and dysfunction in the major organs. Therefore, the fluid balance should be adjusted very carefully, especially during the bypass phase and the early postoperative period.
2022-12-06T14:01:12Z
Göz,Mustafa Sert,Cemil Hazar,Abdussamet Aydın,Mehmet Salih Kankılıç,Nazim
Update on Management of Postoperative Atrial Fibrillation After Cardiac Surgery
Abstract Postoperative atrial fibrillation (POAF) after cardiac surgery remarkably remains the most prevalent event in perioperative cardiac surgery, having great clinical and economic implications. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of POAF. This update is based on the latest current literature derived from articles and guidelines regarding atrial fibrillation.
2022-12-06T14:01:12Z
Ronsoni,Rafael de March Souza,Arthur Zanfrilli Marques Leiria,Tiago Luiz Luz Lima,Gustavo Glotz de
A Sufentanil-Based Rapid Cardiac Anesthesia Regimen in Children Undergoing Percutaneous Minimally-Invasive Intraoperative Device Closure of Ventricular Septal Defect
Abstract Objective: To assess the effectiveness and safety of fast-track cardiac anesthesia using the short-acting opioid sufentanil in children undergoing intraoperative device closure of ventricular septal defect (VSD). Methods: This retrospective clinical study included 65 children who underwent intraoperative device closure of VSD between January 2017 and June 2017. Patients were diagnosed with isolated perimembranous VSD by transthoracic echocardiography. Then, they were divided into two groups, group F (n=30), whose patients were given sufentanil-based fast-track cardiac anesthesia, and group C (n=35), whose patients were given conventional cardiac anesthesia. Perioperative clinical data were analyzed. Results: No significant differences were found between the preoperative clinical parameters and intraoperative hemodynamic indices between the two groups. In group C, compared with group F, the postoperative duration of mechanical ventilation, the length of stay in the intensive care unit, the length of hospital stay, and the hospital costs were significantly increased. Conclusion: In this retrospective study at a single center, sufentanil-based fast-track cardiac anesthesia was shown to be a safe and effective technique for minimally-invasive intraoperative device closure of VSD in children, which was performed with reduced in-hospital costs.
2022-12-06T14:01:12Z
Wang,Zeng-Chun Chen,Qiang Yu,Ling-Shan Chen,Liang-Wan Zhang,Gui-Can
Type 2 Myocardial Infarction Resulted from the Left Thoracic Stomach
Abstract The universal definition of myocardial infarction (MI) provides five subtypes of acute myocardial infarction (AMI). We present an interesting case of a type 2 myocardial infarction caused by the dilation of the left thoracic stomach.
2022-12-06T14:01:12Z
Shi,Yaming Zong,Yongzhong
Which is the Optimal Frozen Elephant Trunk? A Systematic Review and Meta-Analysis of Outcomes in 2161 Patients Undergoing Thoracic Aortic Aneurysm Surgery Using E-vita OPEN PLUS Hybrid Stent Graft versus Thoraflex™ Hybrid Prosthesis
Abstract Objective: To systematically review the rate of morbidity and mortality associated with the use of E-vita hybrid stent graft and ThoraflexTM in patients undergoing complex aortic surgery. Methods: A comprehensive search was undertaken among the four major databases to identify published data about E-vita or Thoraflex™ in patients undergoing repair of thoracic aortic aneurysms. Results: In total, 28 papers were included in the study, encompassing a total of 2,161 patients (1,919 E-vita and 242 Thoraflex™). Patients undergoing surgery with E-vita or Thoraflex™ were of similar age and sex. The number of patients undergoing non-elective repair with Thoraflex™ was higher than with E-vita (35.2% vs. 28.7%, respectively). Cardiopulmonary bypass time was associated with increasing mortality in E-vita patients, however a meta-analysis of proportions showed higher 30-day mortality, permanent neurological deficit, and one-year mortality for Thoraflex™ patients. Direct statistical comparisons between E-vita and Thoraflex™ was not possible due to heterogeneity of studies. Conclusion: Although there are limited studies available, the available data suggests that mortality and morbidity are lower for the E-vita device in thoracic aortic aneurysm surgery than for Thoraflex™. Long-term data of comparative studies do not yet exist to assess viability of these procedures.
2022-12-06T14:01:12Z
Harky,Amer Fok,Matthew Bashir,Mohamad
Constrictive Pericarditis with Extensive Calcification and Caseous Necrosis
Abstract Constrictive pericarditis is a disease where loss of pericardial elasticity and restriction of filling of the cardiac chambers occurs. It is most often seen as an associated symptom of heart failure. Pericardiectomy provides effective treatment for patients with symptomatic constrictive pericarditis, although high rates of morbidity and mortality are related to the procedure. We present a case with extensive calcification, massive caseous necrosis and an important impairment of right ventricular function successfully operated in our institution.
2022-12-06T14:01:12Z
Volpe,Marco Antônio Paredes,Jorge Edwin Morocho Maron,Emerson Sanchez,Isaac Samuel Moscoso Oliveira,João Alberto Pastor de Silveira,Luiza Zita D’Albuquerque
Concurrent Validity of the Static and Dynamic Measures of Inspiratory Muscle Strength: Comparison between Maximal Inspiratory Pressure and S-Index
Abstract Objective: To verify the concurrent validity between the inspiratory muscle strength (IMS) values obtained in static (maximal inspiratory pressure [MIP]) and dynamic (S-Index) assessments. Methods: Healthy individuals were submitted to two periods of evaluation: i) MIP, static maneuver to obtain IMS, determined by the Mueller’s maneuver from residual volume (RV) until total lung capacity (TLC); ii) and S-Index, inspiration against open airway starting from RV until TLC. Both measures were performed by the same evaluator and the subjects received the same instructions. Isolated maneuvers with differences < 10% were considered as reproducible measures. Results: Data from 45 subjects (21 males) were analyzed and that showed statistical difference between MIP and S-Index values (133.5 ± 33.3 and 125.6 ± 32.2 in cmH2O, respectively), with P=0.014. Linear regression showed r2=0.54 and S-Index prediction formula = 39.8+(0.75×MIP). Pearson’s correlation demonstrated a strong and significant association between the measures with r=0.74. The measurements showed good concordance evidenced by the Bland-Altman test. Conclusion: S-Index and MIP do not present similar values since they are evaluations of different events of the muscular contraction. However, they have a strong correlation and good agreement, which indicate that both are able to evaluate the IMS of healthy individuals.
2022-12-06T14:01:12Z
Areias,Guilherme de Souza Santiago,Luan Rodrigues Teixeira,Daniel Sobral Reis,Michel Silva
Left Ventricular Assist Device Implantation and Concomitant Dor Procedure: a Single Center Experience
Abstract Objective: Left ventricular assist device (LVAD) implantation with concomitant Dor plasty is only reported anecdotally. We herein aimed to describe our experience with LVAD and concomitant Dor procedures and describe long-term outcomes of this special subset of heart failure patients. Methods: Between January/2010 and December/2018, 144 patients received LVAD therapy at our institution. Of those, five patients (80% male, 60.4±7.2 years) presented with an apical aneurysm and received concomitant Dor plasty. Apical aneurysms presented diameter between 75 and 98 mm, with one impending rupture. Results: Procedural success was achieved in all patients. No unplanned right ventricular assist device implantation occurred. Furthermore, no acute 30-day mortality was seen. In follow-up, one patient was lost due to intentional disconnection of the driveline. One patient underwent heart transplantation on postoperative day 630. The remaining three patients are still on device with sufficient flow; pump thromboses were successfully managed by lysis therapy in one patient. Conclusion: LVAD implantation with concomitant Dor procedure is feasible, safe, and occasionally performed in patients with ischemic cardiomyopathy. Major advantages are prevention of thromboembolism and facilitation of LVAD placement by improving pump stability and warranting midventricular, coaxial alignment of the inflow cannula. In long-term follow-up, no adverse event associated with Dor plasty was observed.
2022-12-06T14:01:12Z
Schaefer,Andreas Schneeberger,Yvonne Castro,Liesa Sill,Bjoern Alassar,Yousuf Rybczynski,Meike Barten,Markus J Grahn,Hanno Reichenspurner,Hermann Philipp,Sebastian A Bernhardt,Alexander M
Caso 6/2013: mulher de 56 anos com anomalia de Ebstein em insuficiência cardíaca
No summary/description provided
2022-12-06T14:01:12Z
Atik,Edmar
I Diretriz de Ressuscitação Cardiopulmonar e Cuidados Cardiovasculares de Emergência da Sociedade Brasileira de Cardiologia
No summary/description provided
2022-12-06T14:01:12Z
Gonzalez,MM Timerman,S Gianotto-Oliveira,R Polastri,TF Canesin,MF Schimidt,A Siqueira,AW Pispico,A Longo,A Pieri,A Reis,A Tanaka,ACS Santos,AM Quilici,AP Ribeiro,ACL Barreto,ACP Pazin-Filho,A Timerman,A Machado,CA Franchin Neto,C Miranda,CH Medeiros,CR Malaque,CMS Bernoche,C Gonçalves,DM Sant'Ana,DG Osawa,EA Peixoto,E Arfelli,E Evaristo,EF Azeka,E Gomes,EP Wen,FH Ferreira,FG Lima,FG Mattos,FR Galas,FG Marques,FRB Tarasoutchi,F Mancuso,FJN Freitas,GR Feitosa-Filho,GS Barbosa,GC Giovanini,GR Miotto,HC Guimarães,HP Andrade,JP Oliveira-Filho,J Fernandes,JG Moraes Junior,JBMX Carvalho,JJF Ramires,JAF Cavalini,JF Teles,JMM Lopes,JL Lopes,LNGD Piegas,LS Hajjar,LA Brunório,L Dallan,LAP Cardoso,LF Rabelo,MMN Almeida,MFB Souza,MFS Favarato,MH Pavão,MLRC Shimoda,MS Oliveira Junior,MT Miura,N Filgueiras Filho,NM Pontes-Neto,OM Pinheiro,PAPC Farsky,OS Lopes,RD Silva,RCG Kalil Filho,R Gonçalves,RM Gagliardi,RJ Guinsburg,R Lisak,S Araújo,S Martins,SCO Lage,SG Franchi,SM Shimoda,T Accorsi,TD Barral,TCN Machado,TAO Scudeler,TL Lima,VC Guimarães,VA Sallai,VS Xavier,WS Nazima,W Sako,YK
Diretrizes brasileiras de antiagregantes plaquetários e anticoagulantes em cardiologia
No summary/description provided
2022-12-06T14:01:12Z
Lorga Filho,A M Azmus,AD Soeiro,AM Quadros,AS Avezum Junior,A Marques,AC Franci,A Manica,ALL Volschan,A De Paola,AAV Greco,AIL Ferreira,ACN Sousa,ACS Pesaro,AEP Simão,AF Lopes,ASSA Timerman,A Ramos,AIO Alves,BR Caramelli,B Mendes,BA Polanczyk,CA Montenegro,CEL Barbosa,CJDG Serrano Junior,CV Melo,CCL Pinho,C Moreira,DAR Calderaro,D Gualandro,DM Armaganijan,D Machado Neto,EA Bocchi,EA Paiva,EF Stefanini,E D'Amico,E Evaristo,EF Silva,EER Fernandes,F Brito Junior,FS Bacal,F Ganem,F Gomes,FLT Mattos,FR Moraes Neto,FR Tarasoutchi,F Darrieux,FCC Feitosa,GS Fenelon,G Morais,GR Correa Filho,H Castro,I Gonçalves Junior,I Atié,J Souza Neto,JD Ferreira,JFM Nicolau,JC Faria Neto,JR Annichino-Bizzacchi,JM Zimerman,LI Piegas,LS Pires,LJT Baracioli,LM Silva,LB Mattos,LAP Lisboa,LAF Magalhães,LPM Lopes,MACQ Montera,MW Figueiredo,MJO Malachias,MVB Gaz,MVB Andrade,MD Bacellar,MSC Barbosa,MR Clausell,NO Dutra,OP Coelho,OR Yu,PC Lavítola,PL Lemos Neto,PA Andrade,PB Farsky,PS Franco,RA Kalil,RAK Lopes,RD Esporcatte,R Heinisch,RH Kalil Filho,R Giraldez,RRCV Alves,RC Leite,REGS Gagliardi,RJ Ramos,RF Montenegro,ST Accorsi,TAD Jardim,TSV Scudeler,TL Moisés,VA Portal,VL
V Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose
No summary/description provided
2022-12-06T14:01:12Z
Xavier,H. T. Izar,M. C. Faria Neto,J. R. Assad,M. H. Rocha,V. Z. Sposito,A. C. Fonseca,F. A. dos Santos,J. E. Santos,R. D. Bertolami,M. C. Faludi,A. A. Martinez,T. L. R. Diament,J. Guimarães,A. Forti,N. A. Moriguchi,E. Chagas,A. C. P. Coelho,O. R. Ramires,J. A. F.
Atualização e enfoque em operações vasculares arteriais da II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia
No summary/description provided
2022-12-06T14:01:12Z
Marques,AC Bellen,BV Caramelli,B Presti,C Pinho,C Calderaro,D Gualandro,DM Carvalho,FC Carmo,GAL Correa Filho,H Casella,IB Fornari,LS Vacanti,LJ Vieira,MLC Monachini,MC De Luccia,N Yu,PC Farsky,PS Heinisch,RH Gualandro,SFM Mathias Jr,W
I Diretriz Brasileira de Prevenção Cardiovascular
No summary/description provided
2022-12-06T14:01:12Z
Simão,AF Precoma,DB Andrade,JP Correa Filho,H Saraiva,JFK Oliveira,GMM Murro,ALB Campos,A Alessi,A Avezum Junior,A Achutti,AC Miguel,ACMG Sousa,ACS Lotemberg,AMP Lins,AP Falud,AA Brandão,AA Sanjuliani,AF Sbissa,AS Alencar Filho,AC Herdy,AH Polanczyk,CA Lantieri,CJ Machado,CA Scherr,C Stoll,C Amodeo,C Araújo,CGS Saraiva,D Moriguchi,EH Mesquita,ET Cesena,FHY Fonseca,FAH Campos,GP Soares,GP Feitosa,GS Xavier,HT Castro,I Giuliano,ICB Rivera,IV Guimaraes,ICB Issa,JS Souza,JRM Faria Neto,JR Cunha,LBN Pellanda,LC Bortolotto,LA Bertolami,MC Miname,MH Gomes,MAM Tambascia,M Malachias,MVB Silva,MAM Izar,MC Magalhães,MEC Bacellar,MSC Milani,M Wajngarten,M Ghorayeb,N Coelho,OR Villela,PB Jardim,PCBV Santos Filho,RD Stein,R Cassani,RSL D'Avila,RL Ferreira,RM Barbosa,RB Povoa,RMS Kaiser,SE Ismael,SC Carvalho,T Giraldez,VZR Coutinho,W Souza,WKSB
Ecocardiografia de pacientes talassêmicos sem insuficiência cardíaca em tratamento com transfusões sanguíneas e quelação
FUNDAMENTO: Pacientes com talassemia major (TM) apresentam hemólise crônica e necessitam de transfusões sanguíneas egularmente que podem causar cardiomiopatia por sobrecarga de ferro e insuficiência cardíaca crônica. A hemocromatose é caracterizada por acúmulo excessivo de ferro nos tecidos; acometimento do coração é a principal causa de óbito em pacientes com talassemia. OBJETIVO: Avaliar as estruturas e a função cardíaca por meio de ecocardiografia com Doppler convencional e Doppler tecidual em pacientes com TM, sem evidência clínica de insuficiência cardíaca. MÉTODOS: Trata-se de estudo observacional prospectivo de 18 pacientes com TM que recebem transfusão sanguínea regularmente. Para avaliar, separadamente, os efeitos da anemia e da transfusão sanguínea, dois grupos controles pareados por gênero, idade, peso e altura foram incluídos: um com indivíduos saudáveis (Saudável, n = 18) e outro com pacientes com anemia por deficiência de ferro (Anemia, n = 18). Análise estatística foi realizada utilizando ANOVA seguida pelo teste de Tukey ou Kruskal-Wallis e teste de Dunn. RESULTADOS: As seguintes variáveis ecocardiográficas apresentaram valores significativamente mais elevados no grupo TM do que nos grupos Anemia e Saudável: índice de volume do átrio esquerdo (Saudável: 16,4 ± 6,08; Anemia: 17,9 ± 7,02; TM: 24,1 ± 8,30 cm/m); razão E/Em septal mitral (Saudável: 6,55 ± 1,60; Anemia: 6,74 ± 0,74; TM: 8,10 ± 1,31) e duração do fluxo reverso em veias pulmonares [Saudável: 74,0 (59,0-74,0); Anemia: 70,5 (67,0-74,0); TM: 111 (87,0-120) ms]. Arazão E/A mitral foi maior no grupo TM do que no grupo Anemia (Saudável: 1,80 ± 0,40; Anemia: 1,80 ± 0,24; TM: 2,03 ± 0,34). Não foram encontradas diferenças entre os grupos em variáveis estruturais do ventrículo esquerdo e em índices de função sistólica. CONCLUSÃO: A ecocardiografia com Doppler convencional e o Doppler tecidual permite que alterações na função diastólica do ventrículo esquerdo sejam identificadas em pacientes assintomáticos com talassemia major.
2022-12-06T14:01:12Z
Rodrigues,Alexandre Guimarães-Filho,Fábio Villaça Braga,João Carlos Ferreira Rodrigues,Cássia Spínola Custódio Waib,Paulo Fabron-Junior,Antonio Tan,Doralice Marvulle França,Ana Cristina C. V. Okoshi,Marina Politi Okoshi,Katashi