Volume 8 - Número 4

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From April 1983 to November 1993,185 patients were submitted to myocardial revascularization using bilateral thoracic internal artery. The left internal thoracic artery was used to left anterior descending artery and the right internal thoracic artery was used through transversus sinus to circunflex artery and his branches. We performed 38 angiographic studies during the late follow-up and demonstrated that the right internal thoracic artery was patent in 29 patients (92.7%) and the left internal thoracic artery in 30 (97%). We conclude that myocardial revascularyzation should be performed using bilateral internal thoracic artery routinely. Keywords: thoracic artery, surgery; circunflex artery, surgery; myocardial revascularization, surgery

The surgical treatment of LVA by geometric reconstruction has been increasing the results and the use of TEE is an important method to evaluate the results. From July 91 to January 92,22 consecutive patients (pts) with LVA were operated on, 20 were male and the ages ranged from 35 to 72 y (57.1 y). All pts were operated on with extracorporeal circulation (ECC), moderate hypothermia and intermitent aortic crossclamping. The surgical technique consisted by plicatures of septal and antero-apical wall to reconstruct the LV cavity and 19 pts received bypass grafts. No deaths were observed and in 4 pts was used IABP with good evolution. The TE evaluation was performed before and after the ECC in hemodinamic estability. Some parameters were evaluated as: inferior wall thickning (WT) that was 30% pre ECC and 61 % post ECC (p<0.05). The ejection fraction varied from 25% pre ECC to 52% post ECC (p<0.05). The diastolic diameter came from 65 mm pre ECC to 53 mm post ECC (p<0.05). In conclusion, the geometric reconstruction of LVA showed good results, confirmed by hemodynamic and ECHO parameters in intraoperative period. Keywords: left ventricle, geometric reconstruction

PURPOSE: Analise the incidence of cardiac rupture within the patients received in our hospital with the diagnosis of AMI in a period of 10 years and try to identify cases when the cardiac rupture can be submitted to a successful approach. METHODS: 9162 patients were received by INCOR with the diagnosis of AMI in the period from January 1983 to december 1993. From these patients 1.05% had cardiac rupture as an ischaemic complication of the myocardium infarction. The average of age was 69.5 years and showing a predominance of white people (93.75%) and female sex (55.3%). Data from patients include clinical history, complementary investigations, drugs used in the treatment and surgical or anatomopathological findings. The cardiac ruptures were classified as acute and sub-acute, according to literature. RESULTS: We found 72 cases of acute myocardial rupture with a mortality rate of 98.6% and 24 cases of sub-acute myocardial rupture with 41.6% of deaths. Four patients were operated on acute rupture and 15 patients were operated on subacute rupture. The post surgery survival was 78.9%. The patients who had a successful thrombolitic therapy, 76.4% died while the others who received routine therapy, 86.1 % passed away. Once the thrombolitic therapy was given until an hour the mortality was 33.3%; from 3 to 6 hours it was 60% and after 6 hours it was 100%. When it turns to the lenght of time of the onset of the cardiac rupture after I AM treatment, it happend after 5 days just in 5.9% of the patients who received trombolitic agents but in 40.5% of the patients with the routine therapy. CONCLUSIONS: We recognized the importance and the necessity of a immediate action for the patient with cardiac rupture even in sub-acute cases when 30% of the patients with an echographic probability of having a progression of the transmural ischaemic area die. In acute ruptures the situation is dramatic and survical depends on logistic factors. In sub-acute conditions however, new sutureless techniques without using extra-corporeal circulation are now available and they will have a huge importance in the treatment of this extremely serious complication of AMI. Keywords: myocardial infarction, surgery; thrombolitic agents

The purpose of our study was to analyse the results obtained in 18 neonate premature patients who underwent surgical closure of the patent ductus arteriosus, between July 1990 and December 1993 (42 months). Twelve (66.6%) patients were female, with age between 10 and 44 (20.8±8.3) days, gestacional age ranged from 26 to 28 (27.2±0.9) weeks. In the surgery day the birth weight was between 700 and 1380 (985.8 ±181.6) grams. Acute respiratory insufficiency was present in all patients, as the principal surgical indication. In six (33.3%) patients congestive cardiac insufficiency was present. The pharmacological treatment with indometacin, before the operation, was used in nine (50%) patients without success, and although have had no influence in the postoperative results, was associated with a significant reduction of the urine debit (p<0.001). The operative procedure to perform the ligation of the ductus arteriosus, was the fixation of three to four metallic clips, and it has proved to be easily praticable. The preoperative ecocardiography investigation was realized in 15 (83.2%) patients, showing an increase in the relationship between the left atrium and the aortic diameter in all the patients. This relationship was increased in only four (22.2%) patients 30 days after the operation, and only in one (5.5%) patient four months after the operation, showing a tendency of normalization of the cardiac function. In one (5.5%) patient there was a reopening of the ductus in immediate postoperative period, beeing submitted to a reoperation for the ligation of the ductus arteriosus. There was no significant difference in the period of orotraqueal intubation (p=0.586) as well as in the period with oxigen inspiratory fraction < 40% and > 40% < 60% in the pre and postoperative time, (p=0.841 and p=0.692, concerning), but with significant reduction in the period with oxigen inspiratory fraction > 60% (p=0.033). The period of hospitalization was comprehended between 43 and 157 (96.0±24.8) days. The causes of the mortality in the postoperative period have not been related to the surgical treatment. We conclude that the surgical ligation of the patent ductus arteriosus in neonate premature patients is an effective and safe method that can be performed with low morbidity and mortality. Keywords: patent ductus arteriosus, surgery

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Valve replacement and excision without using a prosthesis are the two mostfrequently used surgical techniques for the treatment of infective endocarditis of the tricuspid valve. Conservative operation with preservation of the native valve and resection of the infected tissue is a more recent approach, which is becoming the procedure of choice whenever feasible, specialy in intravenous drug abusers. Two cases of tricuspid valve reconstruction with good results are reported. One of the patients has also been aorto coronary bypassed at the same operation time. Keywords: heart valves, tricuspid, surgery; endocarditis, infective, surgery