ISSN: 1678-9741 - Open Access

Volume 10 - Número 2


ORIGINAL ARTICLE
Manual debridement for repair in calcified aortic stenosis

Renato A. K KalilI; Guaracy F Teixeira FilhoI; João Ricardo M Sant' AnnaI; Paulo R PratesI; Fernando A LuccheseI; Carla R BrauchI; Edemar M. C PereiraI; Altamiro R. da CostaI; Marisa F SantosI; Ivo A NesrallaI

Braz J Cardiovasc Surg 10; Publish in: 8/2/2025
FULL TEXT
A series of 21 patients submitted to mechanical debridement for treatment of calcified stenotic aortic valves is presented. There were 8 congenital and 13 senile valves, in 10 male and 11 female patients. Mean age 63.8 ± 9.5 (44 to 78) years. Six had also coronary bypass grafts and 1 mitral comissurotomy. Total perfusion time was 53.8 ± 21.4 min and ischemic time 33.7 ± 12.1 min. All patients had been followedup from 1 month to 2 years. In 16 a late echocardiographic evaluation was performed. There have been no early and 1 late death. Surviving patients are in functional classes I or II. Maximum instantaneous gradient dropped from 90.7 ± 23.3 mmHg to 33.0 ±7.9 mmHg (p < 0.01) and mean aortic gradient from 50.3 ± 11.0 mmHg to 19.9 ± 3.5 mmHg (p < 0.05). Septal width reduced from 2.0 ± 0.5 cm to 1.2 ± 0.1 (p < 0.01). Aortic regurgitation, by echocardiography, was considered minimum in 5, mild in 9 and moderated in 2 cases. Mechanical debridement of calcified aortic valves, congenital or senile, provides good medium-term relief for aortic stenosis. This technical alternative may be considered in older patients, small aortic roots and higher risks of anticoagulation. Keywords: Aortic stenosis, surgery, debridement; Heart valves, sugery
Surgical treatment of chronic pulmonary embolism: analisys of initial experience

Fábio B JateneI; Paulo M Pêgo-FernandesI; Sérgio PovedaI; Rosangela MonteiroI; Alberto CukierI; Charles MadyI; Adib D JateneI

Braz J Cardiovasc Surg 10; Publish in: 8/2/2025
FULL TEXT
After the acute pulmonary embolism, in the majority of the cases lysis occurs with recanalization of the pulmonary branches. However, in a small but undetermined number of patients (pts) with chronic pulmonary embolism (PE) the incomplete resolution of the embolic material may result in a severe pulmonary hypertension. The pulmonary thromboendarterectomy is an option, specially when the obstruction is proximal and the patient presents failure of the clinical treatment. Many surgical techniques have been used, but the utilized sternotomy, extracorporeal circulation and hypothermic circulatory arrest presented best results. Until January 95,15 pts with PE were operated upon. The pulmonary angiography showed pulmonary embolism at both lungs in 66.7% of the cases. Sternotomy was realized in 73.3%. Endarterectomy by retrograde traction of thrombus was used in these pts. Extracorporeal circulation was utilized in all pts, with medium time of 124.8 min. In 66.7% of the cases hypothermic circulatory arrest was realized with medium time of 34.2 min. The pulmonary artery pressure was 91/32/55 mmHg in the pre and presented reduction by 52/15/ 27 mmHg in the postoperative period. One hospitalar death due to coagulopathy, and one later death due to complications not related to surgery were registered. Of the 13 survivors, 1 (7.7%) presented reobstruction and 12 (92.3%) had good evolution and now are free of symptoms, with oral anticoagulation in a period of until 165 months (47mo). In conclusion, the pulmonary thromboendarterectomy realized by sternotomy and with help of the hypothermic circulatory arrest is a safe procedure for resolution of pulmonary embolus and symptoms, and maintenance of the results at longterm follow-up. Keywords: Descriptors: Embolism, pulmonary, surgery; Thromboendarterectomy, pulmonary; Hypertension, pulmonary
Radial artery for coronary artery bypass grafting

Luís Alberto DallanI; Sérgio Almeida de OliveiraI; Ricardo C CorsoI; Ana N PereiraI; José Carlos R IglesiasI; Geraldo VerginelliI; Adib D JateneI

Braz J Cardiovasc Surg 10; Publish in: 8/2/2025
FULL TEXT
The radial artery (RA) was used as a conduit for coronary artery bypass many years ago. Some years later, the graft was abandoned due to of a high incidence of narrowing or occlusion. The advent of new antispastic drugs led us to reinvestigate the use of the RA for coronary artery bypass grafting. Since May 1994,30 patients underwent myocardial revascularization using 31 RA grafts (1 patient received 2 grafts) at our Service. The left internal thoracic artery (LITA) was concomitantly used in all (100%) patients, the right internal thoracic artery (RITA) in 9 (30%) patients and a saphenous vein graft in 24 (80%) cases. A mean of 3.5 graft per patient was performed. The RA was anastomosed to the diagonal (n=10/33,3%), circunflex (n=8/26.6%), right coronary (n=8/26.6%), diagonalis (n=4/13.3%) and anterior interventricular artery (n=1/3.3%). Two (6.6%) patients presented for redo coronary surgery and 14 (46%) had prior myocardial infarction. Two patients underwent associated ventricular aneurismectomy and 3 coronary endarterectomy. The left RA was used in 28 (93.4%) patients, and the right RA in the 2 (6.6%) remaining. The RA was used as a free graft. The proximal end of the RA was directly anastomosed to the ascending aorta using a 7-0 Polypropylene suture. After complete, the aortic clamp was removed and the blood flow throught the RA was tested. The distal anastomosis was then performed using a running 7-0 Polypropylene suture. All patientes received diltiazem started intraoperatively and continued at the follow-up period, when the AAS was associated. There was no mortality in this series. Angiographic controls were obtained in 7 (23.3%) patients before the Hospital discharge, with all patent grafts without any abnormality. We have not observed any ischemic symptoms of the hand in this series. We believe that the RA is a valuable alternative procedure to the myocardial revascularization, specially after the advent of new antispastic drugs. However, a larger study including late control angiograms is still required to establish definitive conclusions. Keywords: Radial artery, myocardial revascularization; Myocardial revascularization, surgery, radial artery
Brazilian permanent cardiac pacemaker implantation experience: results obtained from the Brazilian Pacemaker Register's data

Roberto CostaI; Maria Inês de Paula LeãoI

Braz J Cardiovasc Surg 10; Publish in: 8/2/2025
FULL TEXT
BACKGROUND: Brazilian Pacemaker Registry (RBM) is a nationwide database to collect informations about all permanent pacemaker procedures performed in Brazil. It is a task force composed by Medical Society, Health Ministeryand Pacemaker Companies. OBJECTIVE: To report the data obtained from June to December, 1994. METHODS: From June 1 st to December 31,1994,4696 surgical procedures for permanent cardiac pacing were informed. These procedures were 3403 (72,5%) initial implantations, 1053 (22.4%) re-operations and in 240 cases this information was non-available. RESULTS: From 3403 initial implantations informed, 52.8% were males and 73.7% Caucasians. Preoperative dizziness or syncopes were refered in 76.4% and congestive heart failure in 85.0% of the patients. EKG evaluation showed 3rd degree atrioventricular (AV) block in 57.7%, sick sinus syndrome in 13.9%, 2nd degree AV block in 13.8%, and high degree AV block and flutter or atrial fibrillation in 6.6% of patients. Chaga's disease was the prédominât ethiology (30.4%). Ventricular pacemakers were implanted in 83.6% of cases, atrioventricular in 16.1 % and atrial pacing in 0.3%. In the 1053 cases of re-operation, the interval between the initial implantation and the present procedure ranged from 1 month to 24 years (M=7.1 years). Pulse generator replacements were refered in 917 patients (87.0% of re-operation procedures), 65.7% of them at the end of life. Atrial lead replacement were performed in 21, and ventricular lead replacement in 203 patients. Keywords: Cardiac pacemakers, surgery, data collection; Cardiac stimulation, artificial, data collection; Cardiac arrithmias; Brazilian Pacemaker Registry - RBM
Heart autotransplantation: a new technique to complex intracardiac reppairs

Randas J. V BatistaI; Marcos FranzoniI; Dalton PrécomaI; Lise BochinoI; Paulo NeryI; Eduardo OliveiraI; Rosane CarvalhoI; Noriaki TakeshitaI; Murilo FurukawaI; Lisias ThomeI; Francisco J LinoII; José Luiz Verde dos SantosI; Marco A CunhaII

Braz J Cardiovasc Surg 10; Publish in: 8/2/2025
FULL TEXT
From January 1990 to May 1995,92 patients with complex cardiac problems and supraventricular arrhythmias were operated upon with the technique of heart autotransplantation. The arrhythmias were: atrial fibrillation (n=89); reentry (n=2); long QT syndrome (n=1). Females predominated (n=63). The age varied from 18 to 76 years (m=43). Concomittant defects were: giant left atrium (> 6 cm measured by echo) (n=65); giant right atrium (n=9); large left atrium (< 6 cm./>4 cm) (n=23); mitral stenosis (n=46); mitral insufficiency (n=28); mitral double lesion (n=16); aortic stenosis (n=12); aortic insufficiency (n=5); tricuspid insufficiency (n=75); atrial thrombosis (n=23); atrial calcification (n=12); pulmonnary hypertension (n=86); biventricular fibroelastose (n=3); atrioventricular rupture (n=1); aortic root aneurysm (n=1); partial ventriculectomy (n=8); 88 patients left the operating room and remained in sinus rhythm; 6 required inotropic drugs and 3 antiarrhythmic drugs. All patients with giant atria and atrial fibrillation had their atria reduced to normal sizes. There were no OR mortality and 6 patients died during hospitalization. Six months later the survivors were clinically well, in sinus rhythm. The technique of heart autotransplantation facilitates intracardiac reppairs, provides atrial reduction and returns patients with atrial fibrillation into sinus rhythm, and opens new frontiers. Keywords: Heart autotransplantation; Heart transplantation, human, autotransplantation

CASE REPORT
Surgical treatment of long QT syndrome: the cardiac autotransplantation technique with preservation of the conduction system

Miguel Barbero-MarcialI; Eduardo SosaI; Nana Miura IkariI; Arlindo A RisoI; Paulo R CamargoI; Fúlvio PileggiI; Adib D JateneI

Braz J Cardiovasc Surg 10; Publish in: 8/2/2025
FULL TEXT
The long QT syndrome is characterized by intermittent or permanent prolongation of the QT interval, ventricular tachyarrhythmias and frequent sudden death. There is three previous reports in the literature, two unsuccessful. In all these patients a postoperative pacemaker was implanted. In our Institute, in October 1993 to May 1994, three patients with this syndrome, one female and two male aged 10,11 and 13 years were submitted to total denervation of the heart through autotransplantation. Despite full dosis of propranolol these patients were severaly symptomatic, with recurrent ventricular tachycardia. The technique was orientated to avoid lesion of the conduction system. The superior and inferior vena cava, the aortic and the pulmonary trunk were transected. Only the posterior wall of the left atrium between the pulmonary veins was incised. After surgery the patients remained in sinus rhythm without episodes of ventricular tachycardia even during serial ergometric test. Considering these preliminary results we recommend the described technique for patients with the long QT syndrome refractarles to adequate medication. Keywords: Long QT syndrome, heart autotransplantation; QT, long, surgery; Heart autotransplantation; Heart transplantation, human, autotransplantation

CONSENSUS, RULES, STATUTES
Consensus. Working Group on Cardiac Pacing of the Brazilian Society of Cardiovascular Surgery - 1995

Décio S KormannI; Paulo R. A GauchI; Roberto T. TAKEDAI; José Carlos S AndradeI; Silas dos Santos Galvão FilhoI; Oswaldo Tadeu GrecoII; Cídio HALPERINII; Fernando A LuccheseI; Paulo de Tarso Jorge MEDEIROSI; José Carlos PachónI; Roberto CostaI

Braz J Cardiovasc Surg 10; Publish in: 8/2/2025
Keywords: Consensus, Brazilian Working Group on Cardiac Pacing; Consensus, cardiac pacemakers, implantation; Cardiac pacemakers, consensus for implantation