Volume 9 - Número 2
ORIGINAL ARTICLE
Incidence of coronariopathy after orthotopic heart transplantation
Braz J Cardiovasc Surg 9;
Publish in: 8/1/2025
The purpose of this study was to analise late anatomical status of coronary arteries in patients (pts) in whom orthotopic heart transplantation(OHT) was perfomed. We studied 22 pts submitted to OHT with post-operative follow-up longer than 36 months. They were evaluated by cinecoronariography every year in a 5 years follow-up. Ventriculography analisis showed stability (in normal values) of the left ventricular ejection fraction (p= 0,99) during the follow-up period. The sequential coronary studies showed a progressive increase on incidence of abnormalities in coronary arteries with disorders of contratile function. The obstructive abnormalities were present in all segments but more in distal territories. The acute rejection episodes and cardiomiopathy etiologies didn't change the natural evolution of coronary atherosclerosis.
Keywords: heart transplantation, follow-up, coronary arteries; heart transplatation, coronary atherosclerosis; heart transplantation, orthotopic
Replacement of the ascending aorta and aortic arch by bovine pericardial grafts
Braz J Cardiovasc Surg 9;
Publish in: 8/1/2025
Bovine pericardial (P.B.) grafts are in clinical use at Biocor Institute since 1989 for replacement or repair of the ascending aorta (AsAo) and the initial segment of the aortic arch (AoAr); the main advantages of B.F. grafts that justified its clinical application are: easiness to handle, fully hemostatic and low cost. This study was conducted to analyse the fate of the heterograft after a minimum of 2 years of implantation. From February 1989 to Frebruary 1994, 84 patients had a B.P. graft implanted in the AsAo or AoAr. The total hospital mortality was 18%. Thirty-one patients who had two years of follow-up were selected for analysis of the B.P. graft (mean follow-up = 40.9 months). They underwent either an echocardiographic examination or an aortographic study (n=15) in order to determine the presence of dilatation, calcification, thrombus and pseudoaneurysm. In all patients the graft was functioning perfectly and no abnormalities were recorded. The current follow-up is short and complications such as calcification and pseudoaneurysm may still develop, therefore a longer time is required. The present study has shown superior handling and hemostatic properties over the classical Dacron grafts and no adverse behavior was noted during this 4 years of study.
Keywords: ascending aorta, surgery; aortic arch, surgery; pericardial grafts, surgery
Intra-aortic balloon pumping: incidence of complications related to its insertion
Braz J Cardiovasc Surg 9;
Publish in: 8/1/2025
The technological advances of recent years have permitted a wide range of uses for intraaort balloon pumping (IABP) to support acute cardiac failure in many clinical condition. In spite of this, some complications related to its insertion, duration of use and location have been described. The aim of his study was to investigate the incidence of infections in severely compromised postoperative cardiac patients undergoing IABP therapy. Between January 1990 and July 1992, the records of 97 patients that required IABP support after cardiac surgery were reviewed, but only 55 met the criteria to be included. The analysis consited of: incidence of infections, culture results, type and duration of by-pass and surgery duration of intravascular catheterization and clinical outcome. The following sites of infection were considered: lung, urine, blood, surgical incision and IABP catheter insertion. The mean time of procedures were: IABP= 3.9 ± 2.01 days surgery an by-pass equal to 8.0 and 2.5 hours respectively. We observed a high incidence of infection in these patients, mainly pneumonia (63.6%). The IABP insertion infection rate was 7.0% higher than our general postoperative wound infection rate (3.0%). Although this relatively higher incidence of infection may not directly relate to the martality rate, we suggest that these patients must have extremely careful surveillance for ocurrence of infections and possible prophylactic measures regarding pulmonary infections.
Keywords: intra-aortic balloon pump, complications, infectious; counterpulsation in heart surgery
Assessment of late results of bidirecional cavopulmonary shunt on paliative treatment of congenital heart disease with functional isolated ventricular chamber
Braz J Cardiovasc Surg 9;
Publish in: 8/1/2025
From March 1990 to January 1994, 17 patients 1 to 13 years old (mean 7 years), who had congenital heart disease with functional isolated ventricular chamber, were submitted to bidirectional cavopulmonary shunts. Nine cases had Tricuspid Atresia (TA) (7 type Ib, 1 type Ic and 1 type IIb). Five cases had Double Inlet Right ventricle (Dl RV); two cases had multiple Ventricular Septal Defects (VSD) plus RV hypoplasia. One case had pulmonary atresia with Intact Ventricular septum (PA/IVS). Nine (52,9%) patients had been submitted, to previous paliative operations. The operations in 12 (70,5%) cases were with extracorporeal circulation (ECC) and in 5 (29,4%) cases with superior vena cava (SVC) to right atrio (RA) temporary shunt. In all cases the SVC was anastomosed to right pulmonary artery (RPA) closing the pulmonary valve (PV) or linking the Blalock-Taussig shunt to interrupt the pulmonary flow. There are three (17,6%) deaths in the immediate postoperative period and 2 (14,2%) late deaths. Twelve (70,5%) patients were followed-up for 2 to 46 months. One patient was submitted to the 2 nd operation, tunnelating the inferior vena cava (IVC) to RPA, with success. The assessment of bidirectional cavopulmonary flow was made with Doppler echocardiography and magnetic resonance and the pulmonary perfusion was made with radioisotopic cintilography. The indication tor the 2 nd, operation depended on the clinical evolution and assessment of arterial saturation during the cicloergometric test. The bidirectional cavo pulmonary shunt allows the progressive adaptation of the venous flow to lung and reduced ventricular volume load, preparing the patient to total venous shunt.
Keywords: cavopulmonary shunt, surgery
Spinal protection during descending aortic surgery
Braz J Cardiovasc Surg 9;
Publish in: 8/1/2025
The authors have used for spinal cord protection during descending aortic surgery, partial extracorporeal circulation from left atrium to left femoral artery, low dose of heparin (1 mg/kg), centrifugal pump (bio-pump) and controlled exsanguination. They have operated upon with this methodology 4 patients without mortality, paraplegia or excessive bleeding.
Keywords: spinal protection in aortic surgery; extracorporeal circulation; exsanguination
Reoperations for valvopathies: analyzis of 697 patients
Braz J Cardiovasc Surg 9;
Publish in: 8/1/2025
The aim of this study was to analyze the early and late results of the reoperation for valvar disease with the focus on the patient not on the prosthesis. A retrospective analysis of 697 patients (419 female, 278 male) was done between 1970 and 1990. The mean age was 43.4+17.9 years old. Pre-operative diagnosis were 281 (40.3%) prosthesis dysfunction, (2/2) 30.5% restenosis pos-comissurotomy, (103) 4,7% prosthesis rupture, 101 (14.5%) prosthesis thrombosis. Reoperations for valvopathy were 7.38% of the total surgical procedures in our Service, and in the last 2 years 26.7% of the total valvar surgery procedures. The hospital mortality was 9.89%, and the mean interval between the first and second procedure was 77+37 months. A third operation was carry on 110 patients with the mean interval of 81+28 and 10 had a fourth intervention. The late mortality was 16.6% and the mean follow up is 14 years with 18.7% lost of segment. Different from others studies where the prosthesis have been followed, our main goal was followthe patient's clinical evolution. The results shown that reoperations for valvopathy have increased in our Institution. The procedure can be done with an acceptable risk even though the long term results are not excellent the patients can have a reasonable survival and a chance of a new operation.
Keywords: heart valves, surgery; heart valves, reoperation; valvopathies, follow-up of patients
Valvopathies: surgical treatment. Part 1
Braz J Cardiovasc Surg 9;
Publish in: 8/1/2025
This subject is extensive, and will be divided in three parts. The present paper is related to historic aspects, surgical indication, preoperative approaches and heart valves prostheses. The following two chapters will discuss surgical techniques, reoperations and special condicions like surgical treatment of endocarditis, and bovine pericardial valves.
Keywords: heart valves, surgery; valvopathies, history; valvopathies, surgical indications; valvopathies, clinical approach; heart valves prostheses
Evaluation of the levels of anxiety on patients assisted by the Service of Cardiovascular Rehabilitation from the Diagnosis and Therapeutic Division of Instituto Dante Pazzanese de Cardiologia
Braz J Cardiovasc Surg 9;
Publish in: 8/1/2025
Anxiety has been mentioned as one of the relevant agents for the development and maintenance of coronary artery disease. In this study were evaluated the levels of State - Trait Anxiety of 100 patients assisted by the Service of Cardiovascular Rehabilitation of Instituto Dante Pazzanese de Cardiologia, São Paulo, Brasil. Patients were submited to the State-Trait Anxiety Inventory - STAI before physical activities, those who showed State Anxiety above the average were revaluated after the activities, to verify if the activities helped to diminish the levels of State Anxiety. The conclusion given from the results was that the patients benefited from this procedure, considering the decrease of anxiety levels studied. Hostility and sociability also stood out as ways of interrelations. Psychologicaly speaking, the authors suggest that the use of relaxing technics, group dynamics and psychological guidance as means to change the behavior and the life style of an individual, help to establish a better psychism functioning as well as a homeostasis balance.
Keywords: coronary diseases, psicological profile of patients; coronary diseases, rehabilitation