Volume 1 - Número 2
EDITORIAL
Operação de Jatene: 1975-1987
Braz J Cardiovasc Surg 1;
Publish in: 8/1/2025
Keywords:
ORIGINAL ARTICLE
Questions regarding surgical indications in pulmonary artery banding
Braz J Cardiovasc Surg 1;
Publish in: 8/1/2025
From February 1979 to March 1986, 50 patients were submitted to pulmonary artery banding in order to control congestive heart failure and to prevent pulmonary vascular disease. Twenty-three patients were male and 17 were female. The mean age was 6 months (20 days to 17 months). The preoperative diagnosis were: ventricular septal defect (22), atrioventricular canal (6), double outlet right ventricle (2), tricuspid atresia (2), transposition of the great arteries (3), truncus arteriosus (2), single ventricle (1) and complexes pathologies (2). The pulmonary banding was carried out under control of the pulmonary artery pressure. Two patients (5 per cent) died on the immediate postoperative period: one patient in atrioventricular block and another in sepsis. One patient died of pneumonia on the late postoperative period. The remaining patients had a satisfactory evolution, increasing 400g of weight monthly. Thirteen patients were submitted to hemodynamic studies on the postoperative period (mean 21 months). Important reduction in pulmonary pressures and flows were then observed, including in five cases with A-V canal. Thirteen patients were reoperated on to correct their underlying defects one year after the banding. Then, one patient died in the immediate postoperative phase and another on the late phase. One of the six patients with A-V canal died on the immediate postoperative period and the others were reoperated for correction of the defects, with good results.
Keywords: pulmonary artery banding
Comparative analysis of universal atrio-ventricular (DDD) vs ventricular (VVI) artificial cardiac stimultion: a multicenter study
Braz J Cardiovasc Surg 1;
Publish in: 8/1/2025
This paper documents, through radiological, stress test, echocardiography and Holter monitor, the effect of DDD and VVI stimulation. Seven Centers with large experience in pacemakers contributed cases. We didn't notice significant differences between DDD and VVI stimulation in the patients studied and in Chagas or non-Chagas disease.
Keywords: cardiac stimulation, artificial; cardiac stimulation, techniques; pacemakers, cardiac
Permanent endocardial pacemaker in the first decade of life
Braz J Cardiovasc Surg 1;
Publish in: 8/1/2025
Pacemaker implantation in children represents a challenge due to the lack of flexibility of the existing system in relation to the growth of the patients to difficulties in choosing the best place to insert the pulse generator and to technical and social problems as well. Even in Services where the first option should have been the endocardial via, the epicardial implantation has been employed in low weight children. At the INCOR - USP, from November 1980 to October 1985, there were 21 endocardial pacemaker implantations in children at the first decade of their lives. The implantation technique consists of lead insertion through the femoral vein, leaving a loop in the right atrium and placing of the pulse generator in the illiac region. After few years, when the growth of the patient has stretched the lead, the child is reoperated to liberate more leak and to form a new loop, thus allowing the use of the same system for a very long period. The age of the patients varied from 2 months to 10 years. Thirteen of the 21 children were less than 5 years old, and 5 were in their first year of life. The predominant indication was 3rd. degree A-V block (90%), which in 75% of the cases was postoperative. In the follow-up period - three to 63 months and mean of 26 months - 3 patients died from causes unrelated to the pacemaker; the remaining patientsare well. Five children have been reoperated on to liberate the lead from the pulse generator pocket and to form a new loop in the atrium. The advantages of this technique were observed in the follow-up, as compared to epicardial and conventional endocardial implantation. They include: 1) easiness of the technique, with minimal surgical trauma and virtually uneventfull postoperative course; 2) no need of other kind of prosthesis to house the lead; 3) safe follow-up the child with a single radiographic study; 4) preservation of the superior cava system to be imployed in adult life; 5) adequate social integration of the child, who can engage in sports and enjoy a normal childhood without the pacemaker being noticed by others.
Keywords: pacemakers, permanent, endocardial; pacemakers, cardiac
Valve replacement with aortic glutaraldehyde preserved homografts: a multicenter study
Braz J Cardiovasc Surg 1;
Publish in: 8/1/2025
Due to good results obtained with glutaraldehyde preserved heterologous biological valves, the authors are performing a multicentric trial for the purpose of analysing the results of industrialized stentmounted glutaraldehyde preserved aortic homologous valves. We studied 63 patients, operated on from February 1984 to February 1986, with ages varying from 7 to 64 years (28 of them 44.5% less than 15 years old). Hospital mortality was 1.6% and was not related to the prosthesis. In the 62 remaining patients follow-up has ranged from 1 to 17 months in a total of 454 mo/patients. The only observed complication was one case of acute endocarditis. (Candida albicans) on the second postoperative month in a patient who had vaginal candidiasis and in whom a replacement was done. The other patients are doing well, all NYHA class II. The authors expect that homologous valves will be better on a long term basis than its heterologous counterparts.
Keywords: aortic valve, homologous; aortic valve, surgery; aortic valve, prosthesis
Valvular surgery in children: experience with 135 cases
Braz J Cardiovasc Surg 1;
Publish in: 8/1/2025
Valvular surgery was performed in 135 patients under the age of 15 years during the period between February 1975 and February 1986. They are devided in two groups: group I) plastic repair, 60 patients; group II) prosthetic surgery, 75 patients. In group I hospital mortality was 7%. Were lost to follow-up 34% of the survivors. Among the patients under control, 72% have no symptoms. 5% died and 22% have had another surgery for prosthesis placement. In group II hospital mortality was 12% and 20% of survivors were lost to follow-up. Of the remaining patients, 71 % have no, or few symptoms, 4% are symptomatic and not doing well; 13% have died and 23% have had a second operation. In conclusion, we think that every effort should be made to preserve native valves in this young group of patients.
Keywords: heart valve, surgery, children; heart valve, prosthesis
Intra-operative, post-extracorporeal aortic counterpulsation: presentation of the method
Braz J Cardiovasc Surg 1;
Publish in: 8/1/2025
The authors present on a system to obtain the aortic counterpulsation-effect in the immediate period after cardiopulmonary bypass for cardiac surgery.
Keywords: aortic counterpulsation, intraoperative; aortic counterpulsation; extracorporeal circulation
Human cardiac transplant: initial experience
Braz J Cardiovasc Surg 1;
Publish in: 8/1/2025
At the Instituto do Coração, University of São Paulo Medical School, 11 patients were submitted to heart transplantation from march 1985 up to february 1986. All were male, with ages of 39-59 years, 6 with coronary heart disease, 4 with dilated cardiomyopathy and 1 with Chagas cardiomyopathy. The patients were studied hemodynamically with a Swan-Ganz catheter pre-operatively, at the arrival in the intensive care unit, in the first postoperative day and 30 or more days after the transplant. The data showed that there was a progressive increase of cardiac index and decreases of pulmonary artery pressure, capilary pulmonary wedge pressure, pulmonary vascular resistance and systemic vascular resistance. Three of the 11 patients had immediate renal dysfunction that returned to normal by the 15th day. Late postoperatively 2 patients had increase of creatinine levels. Only 3 patients had no rejection episodes; among the others these episodes were represented by hystological alterations with no clinical manifestations. Infections complications occurred in 9 patients and were easily clinically treated. Late postoperatively, hypertension was present in 8 patients; in 2 of them it was moderate. There was no death in these 11 patients; all are symptom free and the first 6 are working.
Keywords: heart transplantation, human
Non-cardiogenic pulmonary edema after cardiopulmonary bypass
Braz J Cardiovasc Surg 1;
Publish in: 8/1/2025
Non-cardiogenic pulmonary edema is a recently described serious complication which follows heart surgery under cardiopulmonary bypass. The onset of symptoms is rapid, with bronchospasm, sero-hemorrhagic secretion through the airways, and arterial hypotension. Differential diagnosis with left ventricular failure is obtained from the normal or low pressures in the pulmonary circulation. This points out to an increased vascular permeability as the main ethiological agent. The authors report the occurrence of this syndrome in six patients submitted to heart operations under cardiopulmonary bypass and discuss physiopathology, diagnosis, therapy and histopathological findings in patients with lethal evolution.
Keywords: pulmonary edema, non-cardiogenic; extracorporeal circulation
Heterotopic heart transplant without extra-corporeal circulation: an experimental study in dogs
Braz J Cardiovasc Surg 1;
Publish in: 8/1/2025
The authors describe a new heterotopic heart transplantation technique. Fourteen adult mongrel dogs were operated on via left lateral thoracotomy. Only two vascular anastomosis were performed, without extra-corporeal circulation. The dogs tolerated well the procedure. Cardiac catheterization demonstrated the method to be efficient. There is the possibility of applying this technique in humans.
Keywords: heart transplant, heterotopic, experimental