RCAAP Repository
Prescribility of generic microemulsion Cyclosporine A in heart transplant patients
OBJECT: This paper aims to define the prescribility (therapeutic efficacy and bio-safety) of generic microemulsion Cyclosporin (Sigmasporin Microral®). METHOD: Casuistic: Twenty heart transplantation patients, 13 males and 7 females, with a mean age of 49.6 years, began immunosuppression treatment with generic microemulsion cyclosporin (Sigmasporin Microral®). They underwent clinical and laboratory evaluation during a minimum of three months. Procedures included clinic evaluation with electro and echocardiogram, endomyocardial biopsy, routine biochemical and hematological tests. RESULTS: The mean follow-up was 10 months with a maximum of 16 months. A total of 151 endomyocardial biopsies were evaluated: 31.7% were degree 0, 43.7% 1a and 23.1% 1b. We had only one case of acute clinical rejection confirmed by biopsy as IIIa, and one patient with mediastinitis, both of whom had a good evolution. The mean cyclosporin blood level was 303 Ng/mL. All other parameters also showed a good evolution. CONCLUSION: Generic microemulsion cyclosporin (Sigmasporin Microral®) shows therapeutic efficacy and an excellent bio-safety profile. Its Prescribility is confirmed.
2022-12-06T14:00:36Z
Manrique,Ricardo Magalhães,Hélio M. Dinkhuysen,Jarbas Correia,Edileide Lin-Wang,Hui Tsu Vasconcellos,Marcos Carvalho,Eliete Mejia,Juan A. C. Souza Neto,João D de
Risk factors of mortality in nine years of follow-up after dynamic cardiomyoplasty
PURPOSE: To retrospectively evaluate the survival rate of patients that underwent dynamic cardiomyoplasty, determining the influence of pre-, intra- and post-operative factors and the evolution of left ventricle ejection fraction according to the stimulation mode. METHOD: Forty-three patients that underwent dynamic cardiomyoplasty between May 1988 and September 1997 were analyzed. Functional class III was predominant (81.4%). The mean left ventricle ejection fraction was 19.37 ± 3.48%. Hospital death was 2.2% and 39 patients who completed the conditioning period had a mean follow up of 46 ± 26 months. Twenty-eight patients were predominantly maintained under stimulation mode 1:1 and 11 under 1:2 stimulation mode. RESULTS: Survival rate at nine years of follow up was 9%. The causes of death were progression of the heart failure and sudden cardiac death. Functional class, the pulmonary vascular-resistance index and stimulation mode were identified as risk factors. The maintenance of the increase of the left ventricle ejection fraction when compared to the preoperative values was more consistent during the studied period when the graft was stimulated in the 1:2 mode. CONCLUSION: Late results of dynamic cardiomyoplasty are limited by the high incidence of deaths by progression of the heart failure and sudden cardiac death. Survival rate is influenced by the preoperative clinical condition and by the stimulation mode. Muscle graft performance is higher at late follow up with the 1:2 stimulation mode.
2022-12-06T14:00:36Z
Benício,Anderson Moreira,Luiz Felipe P. Bacal,Fernando Stolf,Noedir A.G. Oliveira,Sérgio A.
Surgical treatment of active infectious endocarditis: a study of 361 surgical cases
OBJECTIVE: To report on the experience achieved with the surgical treatment of 361 patients with acute infectious endocarditis who were operated on in the Heart Institute of the University of São Paulo. METHOD: The ages of the patients ranged from 3 to 81 years, with an average age of 38 ± 8.3 years. There were 230 male patients. It was possible to identify the etiologic agent in 311 (86.20%) patients. The diagnosis of acute infectious endocarditis was obtained by clinical, echocardiographic and microbiological evaluations. Two hundred and five patients had lesions of heart valves and 156 patients had lesions of cardiac valvular prostheses. Ninety had annular abscesses and 11 had fistulae. Of the group of diseased native valves, 104 (50.73) were operated on because of severe heart failure and 87 (42.44%) because of progressive sepsis. All natural aortic valves (136) were replaced by artificial valves. There were 107 diseased native mitral valves. In this group partial resections of infected tissue (vegetations) were carried out in 13 patients while maintaining the valvar apparatus. Of the 16 infected tricuspid valves, 8 were replaced. All the prostheses were substituted. The abscesses were cleaned and closed when their diameter was less than 10 mm. The larger abscesses were cleaned and closed with a pericardial graft, which was the support for the artificial valve. RESULTS: There were 75 (20.78%) hospital deaths, most of which caused by heart problems and their complications. There were 15 cases of postoperative endocarditis, 10 of which were re-operated on. The late follow-up showed good functional and clinical results, with 222 (77.62%) patients as NYHA Class I. CONCLUSIONS: When indicated, the surgical treatment must be instituted as early as possible. All diseased and infected tissue must be removed to achieve good results.
2022-12-06T14:00:36Z
Dias,Altamiro Ribeiro Pomerantzeff,Pablo M. Brandão,Carlos Manoel A. Dias,Ricardo Ribeiro Grinberg,Max Lahoz,Eliecer Villamizer de Oliveira,Sérgio Almeida de
The transvalvar gradient after the aortic porcine stented valve replacement can be predicted?
OBJECTIVE: This work aimed at establishing scientific criteria using the valve size mismatch to predict the transvalvar gradient resultant of aortic valve replacement. METHOD: Thirty-one consecutive patients who survived aortic valve replacement surgeries using Labcor porcine stented prosthesis, in the period from March 1993 to June 2002 were studied. Each patient was submitted to an echocardiogram within three postoperative months at the same institution. The mean transvalvar gradient pressure was compared with the diameter of the prosthesis and the patient's body surface area. RESULTS: The p-value for the diameter of the prosthesis was 0.81 and 0.59 for the R Index. CONCLUSION: No relation at all was found to help to predict the postoperative pressure gradient, based on the prosthesis size and the body surface area of the patients.
2022-12-06T14:00:36Z
Rocha,Eduardo Augusto Victor Rabello,Renato Rocha Oliveira,Sérgio Caporali de Tito,Marcus Gustavo Cataldo,Pollyana Cardoso Freire Oliveira,Homero Geraldo de
The surgical treatment of traumatic rupture of aortic valve and atrial septum after blunt chest trauma: literature review and presentation of a rare case
The case of a 49-year-old man who suffered a car accident responsible for several chest injuries including fractures of the left ribs, large subcutaneous emphysema and left hemopneumothorax arrived in shock in the Emergency Room of the Real Hospital Português de Beneficência in Pernambuco (RHPBPE). He was hospitalized for 30 days including some time in the intensive care unit and but did not show signs of diastolic murmur or heart failure. He was submitted to an echocardiography examination that diagnosed slight aortic incompetence, good left ventricular function and was discharged after clinical improvement. Three months later he started to feel symptoms of heart failure and returned to cardiac Emergency Room of the same Hospital. He repeated transthoracic and transesophageal echocardiography examinations presenting severe aortic incompetence due to leaflet disruption, rupture of atrial septum with enlargement of the right cardiac chambers and poor left ventricular function. He underwent surgical treatment of these lesions, with direct approach of the atrial septum and the aortic valve was replaced with a mechanical prosthesis, with a good result.
2022-12-06T14:00:36Z
Arruda Filho,Mauro Barbosa Silva,Heraldo Maia e Santos,Flávia Arruda de Godoy Rayol,Sérgio da Costa Arruda,Ana Paola Morais Gusmão,Cláudia Arruda Buarque de Fontes Junior,Ednaldo Arruda,Mauro Barbosa
Coronary sinus iatrogenic lesion during repeated mitral valve replacement: case report of an immediate transmitral annulus repair
We report a case and evolution of a patient in whom the coronary sinus was damaged and reconstructed through the mitral annulus. The surgical accident happened during a degenerated biological valve prosthesis instrumentation. An almost complete left circumflex coronary artery division was our first hypothesis. A coronary probe introduced through the vascular injury was distally detected inside the right atrium confirming a coronary sinus lesion. The surgical correction was performed using running polypropylene 7-0 sutures through the mitral ring. After fourteen months, a coronary sinus angiographic image was taking observing the venous phase of selective left coronary arteriography. The image demonstrated an acceptable narrowing of the local venous repair. In our opinion the single coronary sinus division or its repair, in this iatrogenic situation, is a matter of speculation.
2022-12-06T14:00:36Z
Evora,Paulo R. B. Ribeiro,Paulo J. F. Menardi,Antonio C. Vicente,Walter V. A. Rodrigues,Alfredo J.
Extracardiac conduit in total cavopulmonary connection
OBJECTIVE: This study evaluates a new technique of an extracardiac conduit in total cavopulmonary connection in complex congenital heart disease. METHODS: Between May 2000 and October 2002, 18 extracardiac conduit surgeries were performed. The patients' weights ranged from 11 to 29 kilograms, the ages ranged from 1 to 12 years old and 10 patients were male. There were eight patients with tricuspid atresia, eight with univentricular heart, and two with unbalanced total atrioventricular septal defect. There were 17 patients who had been submitted to a previous palliative surgery. The surgery was performed at over 32º centigrade without aortic ischemia. Ten PTFE, 4 Hemashield and 4 bovine pericardium tubes were used with diameters ranging from 16 to 22 mm. RESULTS: There were four cases of tube thrombosis and these patients were a reoperation was performed with one death. In one patient a takedown was performed on the 69th postoperative day. There were three deaths, one due to tube thrombosis and two due to low cardiac output. CONCLUSION: Extracardiac conduit is already used for total cavopulmonary connection, but despite encouraging early results, a longer follow-up is necessary to prove its real advantages.
2022-12-06T14:00:36Z
Paulista,Paulo Paredes Souza,Luiz Carlos Bento de Chaccur,Paulo Issa,Mário Almeida,Antonio Flávio Sanches de Guerra,Ana Luiza Paulista Arnoni,Renato Tambellini Paulista,Paulo Henrique Dagola Santana,Maria Virginia Tavares
Prognostic implications of myocardial creatine kinase and cardiac troponin in coronary artery bypass surgery
OBJECTIVES: To evaluate the prognostic implications of myocardial creatine kinase and troponin I (cTn I) in blood samples from the coronary sinus of patients submitted to coronary artery bypass surgery both with and without ischemic preconditioning. METHODS: From October 1998 to May 1999, 35 patients with coronary artery disease who were submitted to coronary artery bypass surgery were studied. Samples containing creatine kinase and cTn I were obtained from the great cardiac vein during surgery at the onset of cardiopulmonary bypass, at the end of the first anastomosis, and at the end of cardiopulmonary bypass. In May 2002, 29 patients were evaluated in regards to the angina functional class, congestive heart failure, number of hospitalizations, myocardial infarction and death. There were 15 patients in the Preconditioned group and 14 in the Control group. Each group was subdivided into patients with and without cardiovascular symptoms. RESULTS: The Control and Preconditioned groups were not significantly different in relation to frequency of cardiovascular symptoms. There were progressive increases of the creatine kinase and cTn I levels at different Interval s of the study. The cTn I in the Preconditioned group was 1.21 ± 0.64 ng/mL and 3.19 ± 3.21 ng/mL in the Control group (p<0.05). The Control group with symptoms had the highest level for cTn I of 5.07 ± 3.69 ng/mL, significantly higher than all other groups (p<0.05). CONCLUSIONS: The Preconditioned group had the lowest level of cTn I. The cTn I may be a marker for late evolution in patients submitted to coronary artery bypass surgery.
2022-12-06T14:00:36Z
Taniguchi,Fábio P. Pêgo-Fernandes,Paulo M. Jatene,Fabio B. Kwasnicka,Karina L. Strumz,Célia M. C. Oliveira,Sérgio A.
Aortic valve replacement using bovine pericardial bioprostheses: 12 years of experience
OBJECTIVES: The present study is aimed at evaluating the long-term outcomes (up to 12 years of follow-up) of patients undergoing aortic valve replacement using bovine pericardial prostheses. METHOD: From March 1992 to January 2003, 287 patients underwent aortic valve replacement as a single procedure, using bovine pericardial prostheses. Of these, 189 (65.9%) were males. Ages ranged from 15 to 82 years with a mean and standard deviation of 53.6 ± 15.1 years and median of 56 years. The diameters of the bioprostheses ranged from 21 to 29 mm, of which 23 mm (105 cases, 36.6%) and 25 mm (105 cases, 36.6%) were the most prevalent sizes. Only in 1 patient was a 29-mm prosthesis implanted. The assessed variables were late overall survival, comparative survival of patients < 70 years and ³ 70 years of age and the percentage of patients free from reoperations due to primary valve failure. Statistical analysis was performed with the aid of actuarial curves (Kaplan-Meier). RESULTS: The overall actuarial survival at the end of 12 years was 91.7 ± 2.2%. Separate analysis of patients < 70 years (Group A= 252 patients) and ³ 70 years (Group B= 35 patients) showed the overall survival in Group A was 94.7 ± 1.7% and 58.1 ± 17.2% in Group B (Logrank test P= 0.0005; Hazard Ratio 0.20 95% CI 0.01 to 0.29). The rate free from reoperation due to primary valve failure was 96.1 ± 2.0% at the end of 12 years. The 4 patients with implantation failure were in Group A and had a mean age of 49.7 years. CONCLUSIONS: The use of bovine pericardial prostheses in patients with aortic valve disease provides an excellent survival rate over 12 years of follow-up. Patients with 70 years and over had a significantly lower survival, but dysfunctions were only observed in the younger group of patients.
2022-12-06T14:00:36Z
Braile,Domingo M. Leal,João Carlos Godoy,Moacir Fernandes Braile,Maria Christiane Valéria Paula Neto,Alfredo de
Cardiac muscle apoptosis: a comparison of myocardium revascularization with and without cardiopulmonary bypass
OBJECTIVE: Inflammatory response and metabolic disturbances in coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and without (OFF-PUMP) have been researched. Apoptosis in ischemic reperfusion and chronic disease models has been shown in recent studies. The objective of this study is to compare the apoptosis intensity detected in cardiac myocytes before and after CABG with and without cardiopulmonary bypass. METHOD: Eighteen patients undergoing elective CABG were divided in two groups: the first group underwent cardiopulmonary bypasses and the second group did not. Auricle myocardial samples were obtained at the beginning and at the end of the surgery. Specimens were examined for apoptosis using the TUNEL method. RESULTS: There was no significant difference between the two groups in the surgical, demographic and postoperative data. The number of grafts was statistically different. There was no significant difference between the numbers of cells undergoing apoptosis in the two groups at the beginning of the procedure. There was no significant difference in the number of cells undergoing apoptosis from the beginning to the end of CABG in the OFF-PUMP group. There was a significant difference between the number of cells undergoing apoptosis at the beginning and the end of the CABG in the CPB group (p<0.01). CONCLUSION: The smaller number of cells undergoing apoptosis in the OFF-PUMP group is in accordance with published data that suggest CPB is capable of promoting cell lesion. Having shown that, another favorable argument can be added to the indication of the CABG without CPB.
2022-12-06T14:00:36Z
Gaia,Diego Felipe Moreira,Rafael Saviolo Arrais,Magaly Vinhola,Nivia Cristina Tot Buffolo,Enio Smith,Ricardo Luiz
Cardioplegia using low volumic cardioplegic agents: morphological study in isolated rabbit hearts
INTRODUCTION: Pharmacological cardioplegic solution aims to eliminate the consequences of ischemic damage, which results from the misbalance between the offer and consumption of energy during the arrest of the heart beats during cardiac surgery with cardiopulmonary bypass. OBJECTIVES: This research experimentally evaluates the structural and ultrastructural changes in isolated rabbit hearts submitted to arrest protected by a Low Volumetric Cardioplegic Solution (LVCS). MATERIAL AND METHOD: The study counted with a control group and two experimental groups. In group I the cardiac arrest was obtained by infusion of the LVCS for 2 hours. In group II the experiment was conducted in the same way until the arrest protected by LVCS for 2 hours, and immediately after reperfusion was performed with the Ringer Locke (RL) oxygenated solution for 1 hour. In the control group the hearts were perfused with the RL oxygenated solution for 2 hours. After the experiments, 8 samples of the left ventricle were fixed in 10% formaldehyde and 2.5% glutaraldehyde for histological and ultrastructural analysis. RESULTS: The myocardial cells, the fibroblasts and the endothelial cells which were observed in the experimental groups I and II, presented with marginalization of the heterochromatin, compaction of the nucleolus, change in the morphology of the mitochondria and compaction of the cristae. Also there was an increase of the density of the mitochondrial matrix. This indicates that the nuclear structure as well as the structure of the cytoplasmic organelles were altered when compared to the cells of the control group. CONCLUSION: The structural modifications were due a physiological adaptation of the cell, and not an indication of oncosis or apoptosis, suggesting that the cardioplegic solution used was efficient for the preservation of the cells.
2022-12-06T14:00:36Z
Lima-Oliveira,Ana Paula Marques Azeredo-Oliveira,Maria Tercília Vilela Taboga,Sebastião Roberto Godoy,Moacir Fernandes de Braile,Domingo Marcolino
The behavior of Troponin I and CKMB mass in children who underwent surgical correction of congenital heart malformations
OBJECTIVE: To analyze the behavior of troponin (TROP I) and CKMB mass (CKMBm) in regards to the addition of magnesium in cardioplegic solutions; and also the influence of per-operative factors. METHOD: A total of 28 children with ages ranging from 3 to 108 months were studied. The mean weight was 11.8 kg. Eighteen were male. The patients were divided into two groups. Sixteen children in group I (GI) and 12 in group II (GII). The patients in GI received cold blood cardioplegic solution with magnesium (12 mEq/L) and potassium chloride (20 mEq/L) at 20 mL/kg. The patients in GII received the same solution without magnesium. Six blood samples were collected for serum analysis of the concentration of TROP I and CKMBm. The blood samples were collected before clamping the aorta and at 1, 6, 24, 48 and 72 hours after aorta clamping termination. RESULTS: There were no statistical differences in the TROP I and CKMBm levels between the two groups. Among the per-operative factors cyanosis influenced the TROP I and CKMBm levels. Additionally, the aorta clamping time influenced the TROP I levels. CONCLUSIONS: The addition of magnesium in the cardioplegic solution was not associated with different levels of TROP I and CKMBm. Cyanosis and aorta clamping time interfered with peak TROP I levels.
2022-12-06T14:00:36Z
Salerno,Pedro Rafael Jatene,Fabio Biscegli Figueiredo,Patrícia Elias Bosisio,Ieda Jatene Jatene,Marcelo Biscegli Santos,Magaly Arraes dos Souza,Luís Carlos Bento de Jatene,Adib Domingos
Surgical prophylaxis secundary to cryptogenic stroke or transient ischemic attack in patients with patent foramen ovale
INTRODUCTION: Prevention of recurrent cryptogenic strokes or transient ischemic attacks in adults with patent foramen ovale (PFO) represents a therapeutic challenge. Antithrombotic pharmacological treatment is widely used, but its indication is limited because of its significant complications. OBJECTIVE: To demonstrate the efficacy of the surgical closure of patent foramen ovale (PFO) as prophylaxis secondary to cryptogenic strokes or transient ischemic attacks of undetermined origin. METHOD: In this study, 31 men and 16 women with previous ischemic cerebral events underwent direct surgical closure of the PFO. Mean age was 40 years (from 27 to 59 years). No coexisting cause of the stroke was found after extensive investigation, including blood coagulation tests, transesophageal contrast echocardiography (TEE), extracranial and transcranial doppler ultrasonography, 24-hour electrocardiographic monitoring, brain magnetic resonance (BMR) and CT scan. Criteria for operation also included at least two of the following: atrial septal aneurysm, multiple cerebral infarcts, multiple cerebral events and a history of Valsalva strain before stroke. Before operation, only one patient had two shunts (1 PFO and 1 intrapulmonary shunt). RESULTS: No complications occurred during or after the operation, but a few hours after the operation transient arrhythmias developed in four patients without atrial fibrillation, hemodynamic instability nor embolism. All patients survived in class I (NYHA) and during a mean follow-up of 36 months, no patient had recurrence of the stroke or transient ischemic attacks. All patients prospectively underwent BMR and contrast TEE with simultaneous transcranial doppler ultrasonography. A residual right-to-left shunt, smaller than the preoperative one, was observed in only one patient, whereas no lesion was seen on the BMR. CONCLUSION: It is concluded that surgical closure of PFO in patients with presumed paradoxical embolism is safe and avoids recurrent stroke.
2022-12-06T14:00:36Z
Guffi,Michele E.A.
Computer dynamics to evaluate blood flow through the modified Blalock-Taussig shunt
OBJECTIVES: To study the influence of geometric factors upon the function of modified Blalock-Taussig anastomoses (mBT) using a computational dynamic code based upon the method of finite elements. METHODS: The mBT operation, performed in 10 patients, was graphically reconstructed to create a parametric 3-dimensional geometric model. Using Streamline Upwind/Petrov-Galerkin approximations, blood flow and distribution were evaluated in different diameters of subclavian arteries and polytetrafluoroethylene grafts (PTFE) and angles of proximal anastomoses. RESULTS: The percentage of blood flow derived through the PTFE grows as its diameter increases in relation to subclavian artery diameter. Variations in the PTFE diameter do not interfere with pulmonary artery flow distribution. An angle of 110º in proximal anastomoses results in a high percentage of blood derivation to the graft, while angles of 30º, 60ºand 90º present with almost similar flow rates. However, angles of 30º and 110º produce an excessive flow to one of the pulmonary arteries, in detriment of the other. Peak pressure in the PTFE is affected by the proximal angle of anastomosis, with 30º resulting in higher and 110º in lower values. As the angle increases, the region of higher pressure shifts from the PTFE to subclavian artery. CONCLUSION: In the experimental model, percentage of flow derived in the PTFE is directly related to the diameter of the graft. The ratio between the diameters of subclavian artery and graft is an important regulator of flow deviation to the anastomosis. Angles of the anastomosis between the subclavian artery and the PTFE of 60º to 90º result in favorable pulmonary artery flow distribution and the location of the peak pressure.
2022-12-06T14:00:36Z
Sant'Anna,João Ricardo M. Pereira,Dimitrius C. Kalil,Renato A. K. Prates,Paulo R. Horowitz,Estela Sant'Anna,Roberto T. Prates,Paulo R . L. Nesralla,Ivo A.
Surgical results of coronary artery bypass grafting without cardiopulmonary bypass: analysis of 3,410 patients
OBJECTIVES: Over the past few years, great strides have been made in off-pump coronary surgery. This progress is due to a combination of the advances in surgical techniques and the development of instruments that make it possible to perform this procedure in the most varied situations. This is a retrospective study, the purpose of which is to assess our experience with this procedure over the last eleven and a half years. The authors underscore the rapid progress of the method in recent years and report on its indications, contraindications and results. METHODS: In the period from August 1991 to December 2003, 3,410 consecutively patients suffering from angina pectoris were submitted to off-pump coronary surgery. Ages ranged from 13 to 93 years, with a mean of 63 ± 12.0 years. Males accounted for 58% of the cases. The angina was rated according to the criteria of the Canadian Cardiovascular Society, 6.1% of the patients being in Class I, 6.8% in Class II, 46.3% in Class III and 40.8% in Class IV. RESULTS: Intraoperative mortality was low (0.4%). Hospital mortality (30 postoperative days) was 2.5%. Mortality and morbidity among the octogenarian patients were extremely low compared with patients operated on with cardiopulmonary bypass (CPB) (2.2% versus 12.6%) (p<0.001). Postoperative complications regarded as nonfatal occurred in 7.6%. In the final year no difference was observed between the number of conduits in the patients operated on with and without CPB [with CPB 2.8 ± 1.2 and without 2.8 ± 0.8 (NS)]. Acute myocardial infarction was the most frequent complication, occurring in 2.7% of the patients. The mean time in the intensive care unit was 22.3 hours. CONCLUSIONS: Off-pump coronary surgery, employed as a revascularization technique in patients requiring multiple grafts, is a reproducible procedure, the results of which are similar to those obtained from conventional surgery with CPB. In the present series it was possible to perform coronary artery bypass grafting without CPB in 95% of the patients, thus making all patients with indication for grafting potential candidates for the procedure without CPB.
2022-12-06T14:00:36Z
Lima,Ricardo de Carvalho Escobar,Mozart Augusto Soares Lobo Filho,José Glauco Diniz,Roberto Saraiva,Antonio Césio,Antonio Gesteira,Mário Vasconcelos,Frederico
A rare association of total anomalous pulmonary venous connection and cor triatriatum
The association between total anomalous pulmonary venous connection and cor triatriatum is extremely rare. We emphasize the possibility of rupturing the membrane of cor triatriatum in the preoperative cineangiographic study, providing a significant improvement of the clinical features, as well as surgical correction and successful evolution.
2022-12-06T14:00:36Z
Croti,Ulisses Alexandre Braile,Domingo Marcolino Godoy,Moacir Fernandes de De Marchi,Carlos Alberto
Preparation of the saphenous vein for coronary artery bypass grafting: a new technique "no touch" that maintains the vein wall integral and provides high immediate patency
BACKGROUND: The technique of harvesting the saphenous vein (SV) for coronary artery bypass grafting (CABG) influences the fate of vein grafts. A new "no touch" (NT) technique of SV preparation was developed where the vein is harvested with a pedicle of surrounding tissue, which protects the vein from spasms therefore obviating the need for distension. METHOD: A prospective randomized study in 156 patients who underwent CABG was performed comparing three SV harvesting techniques. The techniques were conventional (c) (adventitial stripping of the vein, manual distention and storing in saline solution); Intermediate (I) (after adventitial stripping, the vein was left in situ, covered with a papaverine-soaked compress, and stored in heparinized blood); and "no touch" (SV dissected with its surrounding tissue was left in situ, covered with a saline-soaked compress and stored in heparinized blood). A morphological study of the endothelium was preformed using scanning electronic microscopy and an angiographic assessment of the vein graft patency was performed at 18 months mean follow-up time. Also an immunohistochemistry assessment was performed to identify the enzyme, nitric oxide synthase (NOS) in the vein wall. RESULTS: The preservation of the endothelial cell integrity was greater with the "no touch" technique than with the other procedures. At angiographic follow up, the patency for NT was 95.4%, 88.9% for grafts in group C and 86.2% for grafts in group I. The immunohistochemistry assessment revealed NOS in all three layers of the vein wall that was prepared by the "no touch" technique. However, a great reduction of this enzyme in veins treated by the conventional technique was observed. CONCLUSION: The endothelial integrity and NOS activity were better preserved when using the "no touch" technique for vein graft harvesting. The vasorelaxation and thrombo-resistant activities of nitric oxide (NO) may be responsible for the reduced of vasospasms and improved patency rate. Furthermore, the mechanical properties provided by the cushion of surrounding tissue in graft harvested by NT technique may contribute to the observed high patency rate.
2022-12-06T14:00:36Z
Souza,Domingos S. R. Dashwood,Michael R. Tonazi,Alan Johansson,Benny Buffolo,Enio Lima,Ricardo Filbey,Derek Bomfim,Vollmer
Surgical treatment of congenital mitral stenosis: medium-term results
OBJECTIVE: For a cohort of patients with congenital mitral stenosis (CMS), to determine: patient outcomes, predictors of valve repairability and predictors of durability of valve repair. METHODS: From 1989 and 2002, 23 patients underwent surgical treatment of CMS, excluding those with common atrioventricular canal, and univentricular forms. The median age at operation was 15.5 months (range 2-204), and the median body weight was 11 Kg (range 4.5-51.6). Seventeen patients (73.9%) had associated anomalies, including Shone's complex in nine (39.1%) and pulmonary hypertension in 14 (60.9%). Mitral stenosis was severe in 14 patients (60.9%) and moderate in the remaining (median trans-mitral gradient of 16 mmHg, range 8.5-32). Mitral valve repair was performed in 18 patients (78.3%), and valve replacement in five (21.7%). Repair techniques included papillary muscle splitting (n=10), excision of supravalvular ring (n=9) and commissurotomy (n=8). Twelve patients (52.2%) required associated procedures. RESULTS: There were no early and late deaths at a mean follow-up of 58.5 ± 46.7 months (range 1-156). Mean hospital stay was 12.7 ± 8.2 days. There were no significant factors associated with unsuccessful valve repair. Actuarial freedom from reoperation at five years was 67.1% (CI 95%: 56.8% to 77.4%). The mitral valve repair group required reoperation in eight patients (44.4%) (two early and six late), as opposed to one (20%) in the replacement group. The presence of preoperative pulmonary hypertension was significantly related (p<0.005) to higher reoperation rates. All but two the followed patients are presently in functional class I and the echocardiography has shown less than 2+ mitral stenosis and/or regurgitation. CONCLUSION: Reoperations were the most important cause of morbidity at the medium-term follow-up of CMS. Preoperative pulmonary hypertension may predict the need for reoperation after mitral valve repair, which is the procedure of choice in CMS.
2022-12-06T14:00:36Z
Atik,Fernando A. Duncan,Brian W. Rosenthal,Geoffrey L. Kawase,Isamu Joshi,Raja Mee,Roger B. B.
Myocardial revascularization in the elderly patient: with or without cardiopulmonary bypass?
OBJECTIVE: To verify if there is advantage in myocardial revascularization the elderly without cardiopulmonary bypass (CPB) in relation to the use of the same, being considered the viability of complete myocardial revascularization (MR) and the hospital morbidity and mortality. METHOD: We prospectively studied a hundred consecutive, no randomized patients, with age > or = 70 years, submitted to the primary and isolated myocardial revascularization between January and December of 2000. The patients were divided in two groups, G1 - 50 patients operated with CPB and G2 - 50 patients operated without CPB. Univariate testing of variables was performed with chi-squared analysis in the SPSS 10.0 Program and a p value less than 0.005 was considered significant. RESULTS: There was no renal failure or myocardial infarction (MI) in both groups; the incidence of respiratory failure was identical in the two groups (4%); two patient of G1 they had Strokes, and 12 presented low output syndrome, occurrences not registered in G2. The need of ventilatory support > 24 hs was not significant between groups. Medium time of hospital stay was 21.8 and 11.7 days respectively (NS) and the survival after 30 days were similar in the two groups. The patients' of G1 eighty percent had more than two approached arteries, against only 48% of G2 (p < 0.0001). CONCLUSION: Because the largest number of grafts in the patients of G1, we can affirm that the use of CPB can provide a larger probability of complete RM.
2022-12-06T14:00:36Z
Iglézias,José Carlos Rossini Lourenção Jr.,Artur Dallan,Luís Alberto de Oliveira Puig,Luiz Boro Oliveira,Sérgio Almeida de
Late results of pulmonary root translocation in the correction of transposition of the great arteries
OBJECTIVE: The purpose of this study was to evaluate the late follow-up of pulmonary root translocation, a technique that aims to avoid complications and the need of reoperations related to the Rastelli procedure, in the repair of ventriculo-arterial connection anomalies associated to pulmonary stenosis and ventricular septal defect. METHODS: Five patients, ranging from two months to three years of age, were submitted to anterior pulmonary root translocation, from April 1994 to July 1999. The surgical technique consisted of pulmonary root removal from the left ventricle and its connection to the right ventricle, after patch diversion of the blood flow from the left ventricle to the aorta, through the ventricular septal defect. The construction of the right ventricle outflow tract was completed with autologous pericardium. RESULTS: There were neither early nor late deaths. There was no need for re-intervention. The late clinical and echocardiographic follow-ups showed some growth of the pulmonary root, with no clinically significant transpulmonary valve gradient (zero to 41 mmHg) and all patients were asymptomatic. CONCLUSION: Pulmonary root translocation showed to be efficient in the repair of ventriculo-arterial connection anomalies, with ventricular septal defect and pulmonary stenosis, and it was employed even in small children, with good early and long-term results, without the need for late reoperations in this small group of patients.
2022-12-06T14:00:36Z
Fonseca,Luciana da Baumgratz,José Francisco Castro,Rodrigo Moreira de Franchi,Sônia Meiken Vila,José Henrique Andrade Lopes,Lílian Maria Silva,José Pedro da