Volume 6 - Número 1
EDITORIAL
ORIGINAL ARTICLE
Endomyocardial fibrosis: results of the surgical treatment with atrioventricular valve preservation
Braz J Cardiovasc Surg 6;
Publish in: 8/1/2025
Between April 1988 and January 1991 we operated on 25 consecutive patients with endomyocardial fibrosis (EMF) with an approach to preserve the atrioventricular valves. Nineteen patients were females and six males. Their ages ranged from 11 to 5 years, with an average of 40.6 years. Seventeen patients had biventricular involvement, six had involvement of the left ventricle and only two patients had an isolated lesion of the right ventricle. All of them were in advanced stage of heart failure, 19 of which were in class IV of the NYHA, and six were in class III. Prior to the operation, tricuspid insufficiency was present in 24 patients and mitrai insufficiency was present in 22 patients. All the patients were operated on with the support of extracorporeal circulation and systemic hipothermia of 28ºC. Intermitent aortic cross-clamping was used so as to permit better exposition of the ventricular cavities. The fibrosis of the right ventricle was always removed through the tricuspid valve, while the fibrosis of the left ventricle was removed through a small apical left ventriculotomy in all the patients. An DeVega's annuloplasty of the tricuspid valve was necessary in all the patients with tricuspid insuffiency. On the other hand, seven patients had spontaneous correction of the ventricle insufficiency after the removal of the fibrosis of the left ventricle, while fifteen needed an annuloplasty. There was one (4.0%) in-hospital death and no late deaths. All patients experienced clinical improvement and are in NYHA functional class I or II.
Keywords: endomyocardial fibrosis, surgery; heart valves, atrioventricular; cardiomyopathies, surgery
Surgical treatment of thoracic aortic lesions with deep hypothermia and circulatory arrest
Braz J Cardiovasc Surg 6;
Publish in: 8/1/2025
The authors report 14 cases of aneurysms and/or dissections of the thoracic aorta, treated with deep hypothermia and circulatory arrest. There were 6 aneurysms of the aorta (1 of the ascending aorta, 3 of the aortic arch, 1 of the ascending aorta and aortic arch, 1 of the descending aorta) and 8 cases of aortic dissections. The patients were gradually colled down to 18ºC of nasopharingeal temperature. The mean circulatory arrest time was 35 minutes. There were 4 hospital deaths; 1 patient died in the operating room, from persistent surgical bleeding; 1 patient died from acute renal failure, which was already present in the pre-operative period; 1 patient died after an acute myocardial infarction followed by ventricular fibrillation; 1 patient died from pulmonary infection following a carebro-vascular accident. This was the only death directly related to the circulatory arrest technique. Among the 10 survivors, there were 2 patients who required prolonged ventilatory support and 4 minor neurological abnormalities with complete recovery. The technique of deep hypothermia and circulatory arrest proved to be a good alternative in the treatment of difficult aortic lesions.
Keywords: thoracic aorta, surgery with deep hypothermia and circulatory arrest
Surgical treatment of thoracoabdominal aortic aneurysms
Braz J Cardiovasc Surg 6;
Publish in: 8/1/2025
Five patients have been operated on of thoracoabdominal aortic aneurysms. The mean age was 53 years (range 31-71) and three were women. All the patients were symptomatic, three of them had arteriosclerotic aneurysms, and the other two had dissecting aneurysms. Three patients had been operated on previously. The exposure of aneurysm was made through a thoracoabdominal incision, in four patients clamps were placed above and below the aneurysm and it was incised longitudinally. Bypass between left atrium and left femoral artery with hypothermia and circulatory arrest was used in the other patients, since the proximal thoracic aortic clamping was impossible. A woven Dacron graft of adequate size was used to substitute the aorta, intercostals and visceral arteries were reimplanted. Paraplegia occurred in one patient. There was no intraoperative death. Two patients died in the immediate postoperative period, one of them on the 3rd day, by neurologic coma caused by cardiac arrest during the operation, and the other patient on the 12th postoperative day, suddenlly. Three patients were followed up. Two patients are doing well, 13 and 72 months after operation, and the other one has the limitation of the paraplegia.
Keywords: aneurysms, thoracoabdominal, surgery
Ten years of operation for aneurysms or chronic dissections of ascending aorta, in the Instituto do Coração - FMUSP
Braz J Cardiovasc Surg 6;
Publish in: 8/1/2025
From January 1980 to Dezember 1990, 109 patients, 86 males and 16 females, ranging in age from 12 to 70 years, were operatated on for aneurysms or chronic dissections of the ascending aorta, associated or not to aortic valve insufficiency. Thirty-four patients were in New York Heart Association class IV, 51 in class III, 18 in class II and six in class I. Fifty-two patients had chronic aortic dissection, 29 annulo-aortic ectasia, 10 saaular aneurysm, remaining 8 ethiologics. The early mortality was 12.8% (14 deaths). Twenthy-seven patients were lost for follow-up during a period ranging from three months to 10 years (average 82 months). The late mortality was 13.4% (11/82). Among the 72 patients survivors, clinicai improvement was observed in the majority of patients (90.5% are in class I or II). Among the several operative techniques, the Bentatt and De Bono showed better early survival and is preferable option when indicated. The actuarial curve showed a 70% survival for the whole group, after 120 months. The results observed in terms of survival and clinical improvement suggest that surgery is the treatment of choice for aneurysms and chronic dissections of ascending aorta.
Keywords: aneurysms of ascending aorta, surgery; dissections of ascending aorta, surgery
Surgical repair of ectopia cordis: report of three cases and a review of the literature
Braz J Cardiovasc Surg 6;
Publish in: 8/1/2025
Between 1985 and 1990, three neonates with ectopia cordis (EC) were admitted to the InCor - FMUSP; two had thoracoabdominal type and one thoracic type. All patients had associated cardiac anomalies: tricuspid atresia type I-A, abscence of central pulmonary arteries and systemic-pulmonary collaterals (one patient); ventricular septal defect (VSD) and atrial septal defect (ASD) (one patient); ASD (one patient). One child was not operated upon, due to infection in pulmonary artery laceration, with death caused by bleeding. The others were operated upon in order to provide a skin coverage; one died in low cardiac output on the early postoperative period; the other died on the 141 st day of postoperative period, caused by respiratory failure. This long evolution was possibly due to a cardiac defect with no significant repercussion (ASD) and to a contribution of a plastic surgeon. This paper describes these three cases and makes a brief review of the literature.
Keywords: ectopia cordis, surgery
Fetal cardiac surgery: hemodynamic characteristics of placenta during extracorporeal circulation
Braz J Cardiovasc Surg 6;
Publish in: 8/1/2025
Decreased placental perfusion and respiratory gas exchange have been observed following experimental fetal cardiopulmonary bypass (CPB). To better characterize placental hemodynamics during CPB, 7 isolated in-situ lamb placentas were placed on a CPB circuit, using umbilical arterial and venous cannulation. Measures were taken to simulate normal placental hemodynamics. Perfusion flow rates were varied randomly from 15 to 300 ml/min/kg fetal wt. during both normothermia and hypothermia. Placental vascular resistance (PVR) remained constant when perfusion pressure and flow were varied above 40 mmHg and 150 ml/min/kg respectively. Below these values, PVR varied inversely. This increase in PVR was more marked when CPB was performed with hypothermia as compared to normothermia. The clinical implications is that decreased placental flow and pressure on CPB may lead to a vicious cycle resulting in further impariment of placental perfusion and respiratory gas exchange. Hypothermia promotes this impairment.
Keywords: heart surgery, fetal; placenta, hemodynamic during extracorporeal circulation
Aneurysm of the sinus of Valsalva: analysis of seven cases
Braz J Cardiovasc Surg 6;
Publish in: 8/1/2025
The authors present their experience on seven cases of Valsalva-sinus aneurysm (VSA) at the Instituto de Moléstias Cardiovasculares (IMC), from January 1984 to July 1990, treated surgically using bovine pericardium patch (PB-IMC) or valve replacement when indicated. Five cases were congenital and two were related to rheumatic disease. In two of the congenital cases the aneurysms were leaking into the right atrium, two were leaking into the right ventricle. And the remaining one was not leaking but was projected into the left ventricle. One of the congenital cases was leaking into the right ventricle and the other presented protrusion of the aneurysmatic sac into the left ventricle and eversion of the corresponding aortic leaflets. A bovine pericardium patch was used to give support for he sutures inxthe congenital ASV cases; for the cases related to rheumatic disease a valve replacement was performed using an IMC-PB biologic valve. From the congenital VSA patients, one had deiscence of suture at seven months and at six years, and was submitted to reoperation in both occasions. In the related to rheumatic disease group one died due to stroke on the 15 th postoperative day. The use of PB patch proved satisfactory in this treatment, providing good support for the suture.
Keywords: aneurysms of the sinus of Valsalva, surgery
CASE REPORT
Surgical correction for atrial inversion in Senning operation in case of right ventricular dysfunction
Braz J Cardiovasc Surg 6;
Publish in: 8/1/2025
A new proposal for the treatment of right ventricular dysfunction in late postoperative period of patients submitted to Senning operation is presented. The technique could be used in cases originally with transposition of the great arteries associated with pulmonary stenosis and a large VSD. A 12-year-old patient, who had been submitted, 8 years before, to an atrial inversion associated with closure of a large VSD and relieve of a pulmonary stonosis was submitted to this new operation. Senning operation was undone thus reestablishing atrio-ventricular concordance; the patch used for closure of VSD was removed, and the aorta was connected to the left-ventricle. Pulmonary artery was cut transversally, adjacent to the valvar horizontal plane. The proximal extremity was sutured and the distal was connected to the right ventricle through a valvar tube graft of bovine pericardium. The clinical course was uneventful and the patient improved from functional class IV to I/II.
Keywords: Senning operation, reversion; Senning operation, late complications; ventricular dysfunction, surgery
Alternative treatment for adult respiratory distress syndrome: case report
Braz J Cardiovasc Surg 6;
Publish in: 8/1/2025
This is a case report of a 33-year-old patient, female, with adult respiratory distress syndrome following coronary by-pass graft surgery. Innitially the patient was supported with mechanical ventilation and PEEP (end expiratory positive pressure) and negative fluid balance. After seven days the FIO2 was 100% and PaO2 under 50 mmHg. A membrane oxygenator device (ECCO2R) was installed to improve arterial oxygenation and CO2 remotion, according to the following protocol: curarization, low tidal volume, and respiratory frequency at the minimal values (under 5). After 8 days there was an improvement in arterial oxygenation; the device was removed. The mechanical ventilation was maintained until the 57 th post operative day. After 4 months of follow-up the patient was in good conditions.
Keywords: syndrome of respiratory distress, surgery, adults