Volume 10 - Número 4

From 4/8/94 thru 2/28/95, 32 patients were submitted to myocardial revascularization utilizing the radial artery graft (RA) as part of the procedure. This represented 17.3% of our coronary bypass surgery experience during that period. Twenty three patients were male and mean age was 56.8 years (41-74). The RA was used to graft the anterior interventricular area in 7 cases, right coronary artery in 7 cases and circunflex in 18 cases. Two patients died, for a hospital mortality of 6%, being of non-cardiac causes in both. Angiographyc control was done in all hospital survivors before discharge, revealing 96% of graft patency rate (46/48). However, there were two cases of moderate spasm related to catheter tip, one case of severe spasm and two grafts exibit string sign. Eight patients with follow-up time greater than 6 months (mean 7.4) were submitted to sequential angiographyc control, showing 100% patency rate, with no detectable visual abnormalities. One patient which showed "string sign" at her first angiographyc study was restudied at 4 months. Her graft actually showed progression of the abnormality, being, however, still patent. The results herein obtained allow us to conclude that the RA might be an excelent option for patients with varicose or absent saphenous vein. Longer follow-up studies will determine the real value of the RA as aortocoronary grafts. Keywords: Myocardial revascularization with radial artery, clinical study; Myocardial revascularization with radial artery, angiographic study; Myocardial revascularization, surgery

The indication, surgical pathology and the results of surgical treatment of 28 patients operated on for infectious endocarditis between 1983 and 1994 are here evaluated. The clinical diagnosis was confirmed by echocardiography and cineangiography. Seventy-five percent of the patients were male and 25% female, with the mean age of 35.2 (14 to 67) years old. Ninety three percent were in functional class III or IV (N Y H A). Elapsed time between diagnosis and surgery was around 4 weeks (1-363 days). A positive hemoculture was present in 25% of the cases and the commonest bacteria found were streptococcus and staphilococcus. The aortic valve was the one usualy affected and vegetations was the usual finding. Surgical treatment consisted of valvuloplasty in 2 cases and valve replacement in 26. Complications were present in 39.28% of the cases, which resulted in the death of five of them (18%). We conclude that, although rare, the infectious endocarditis is a serious disease; if not prevented with adequate antibiotic prophilaxis or treated in due time, serious complications or even death might occur. Keywords: Endocarditis, infeccious, surgery

INTRODUCTION: a hybrid valve was developed for improving a durable mechanic disc valve with good biocompatibility, by promoting easy healing around the ring valve and making the maximum isolation of the synthetic material in the blood stream. Lining the mechanical valve with porcine biologic tissue (pericardium and vein) is a tentative to reduce the morbidity and mortality on respect of thrombosis, thromboembolism, reoperations and minor use of anticoagulants to reduce the hemorrhagic events. Some principles were established on hybrid valve: durable mechanical system, points of contact without biologic material, use of biological material with minor organic reaction, movable parts without biologic material outside its perimeter, preferential closing system with superposition on a track seat and loose joints for accept biologic material limited growth. MATERIAL AND METHOD: the valve is the type of perforated tilting disc and all made of Carbolite (hardened polymeric carbon). The prosthesis is all covered except the central pivot, the disc and the internal part of the minor orifice, with 65% amount of surface recovered. The disc extends over thetnajor orifice with a track seat. The valve is processed in glycerol and sterilized in ETO and preserved in glycerol preferentially. There are seven mitral patients in observation with a mean time of 7,8 months (4 to 13 months) with oral anticoagulation. INITIAL RESULTS: in the first three months the mean Prothrombin Value (PV) was 60% and a case of valvular thrombosis occurred after two months with a PV of 70%, history of tachycardia and dyspnea. The patient was reoperated and was seen a good healing on Polyester ring and diffuse fibrin deposit. The fibrin was removed and the valve is going well after ten months. Two majors of hemorrhagic episodes occurred in two patients with a PV of 10% and 20% with good evolution. After three months the group has the mean PV of 51 % with no cases of hemolysis, thromboembolism, dysfunction or hemorrhagic events. CONCLUSIONS: the mechanical tests of the valve and the initial clinical aspects are favorables. It is necessary to augment the number of cases with more effective and uniform anticoagulant protection in the first three months to avoid thrombosis and hemorrhagic events. After three months the biolization of the valve with low anticoagulant doses seems to be efficient. Keywords: Heart valves prostheses, biologic

The purpose of this study was to evaluate the intra-aortic balloon pump as a method of mechanical support for the management of patients with low output syndrome, following cardiac surgery with cardiopulmonary bypass. The results with early (intra-operative) and late (post-operative) support were compared, as well as the relationship among cardiopulmonary bypass time, aortic clamp time and mortality. Pre-operative left ventricle ejection fraction, as a prognosis index, and complications rates were also analysed. One hundred and thirty patients from Texas Heart Institute, during the period of January to December 1987, were studied retrospectively; there were 103 men and 27 women, with a mean age of 61.5 ± 10.7 (14 to 84) years. The mean weight body and body surface area were 75.5 ± 16.6 (42 to 134) kilograms and 1.87 ± 0.24 (1.08 to 2.60) square meters respectively. The mean time of cardiopulmonary bypass was 98 (33 to 299) minutes and the mean time of aortic clamp was 49 (10 to 122) minutes. All the patients had low cardiac output, associated with refractary arrythmias in 4 and after cardiac arrest in the intensive care unit in 2 patients. The intra-aortic balloon pump was left for variable periods of time from 15 minutes to 256 hours. The all cohort was divided in six groups, according to the early (intra-operative) insertion of the balloon pump (Group I), the late (post-operative) insertion (Group II), patient's age equal or inferior to 65 years Group III and Group IV age superior to 65 years, Group V and VI according cardiopulmonary bypass time up to 120 or superior to 120 minutes, and both were divided according to aortic clamp time (subgroup 1, up to 60 minutes and subgroup 2, superior to 60 minutes). The outcome was successful in 81 (62.3%) and 49 (37.7%) died (36.2% from Group I and 44% from Group II). The survival rate was greater in Group III (68.6%) than in Group IV (51 %) with p<0.05 showing statistical relevance of mortality in the older group. There were no significant associations between ejection fraction, aortic clamp time versus mortality but cardiopulmonary bypass had high statistical significance with p<0.01 for times over 120 minutes. Complications were found in 6 patients (4.6%). These data suggest that intra-aortic balloon pump is an effective mechanical support for the management of patients with low cardiac output following cardiac surgery with cardiopulmonary bypass, showing a tendency of best results when earliest applied, there is an influence of age and time of cardiopulmonary bypass over the mortality rates, suggesting that in these patients should be used more aggressive and effective circulatory support device. Keywords: Assisted circulation, intra-aortic balloon pump; Intra-aortic balloon pump

Cardiac rate, myocardial tension, coronary flow and myocardial contractility (dT/dt) variantions were registered in a population of fourty Wistar rats. In all animals, after ether anesthesia, the hearts were removed and perfused with 95% O2 and 5% CO2 enriched Krebs-Henseleit (K-H) solution, under 90 cm H2O constant pressure and temperature of 37,0 ± 0.5ºC, until complete stabilization, for control values registration. The hearts were distributed into four groups: Group I were perfused with K-H solution, gathering the data of cardiac performance after 1, 3, 5,10,15, 20, 25, and 30 minutes. In the other three groups, these data were also registered in the same times, after they were treated with 50 mcg of diazepam (Group II), 25 mcg of midazolam (Group III) and 25 mcg followed by 50 mcg of propofol (Group IV25 and IV50). The cardiac rate underwent significant variation in the groups estudied except Group II. Myocardial tension varied to a negative degree in the groups, except for Groups I and IV (propofol 50 mcg). In relation to myocardial contractility (dT/dt), except Group I, all groups underwent decreases. The coronary flow exhibited decreases in all groups studied. The observed variations were statistically significant (p<0.05). It is concluded that the drugs tested (diazepam, midazolama and propofol) determine statistically significant decrease of the myocardial contractility, without difference concerning the intensity of depression degree among all studied groups. Keywords: Diazepan in myocardial contractility; Midazolam in myocardial contractility; Propofol in myocardial contractility; Myocardial contractility

From March to August 1993, parents of 57 children between 0 and 7 years old, with congenital cardiopathies, hospitalized for surgical treatment were studied; 94.5% came from the urban zone and 86% from familiar groups who not exceeded 5 people. In the familiar group, 56.5% of the fathers and 58% of the mothers had elementary school; 41 % of the fathers had technical occupation and 72% of the mothers had no professional qualification (housewives). The following subjects were studied: a) professional changes of parents; b) modifying in interpersonal relationship; c) difficulties fo face the surgery moment; d) future hopes related to the surgical child. The results showed that, for young couples of low medium social class, concerning the stage of familiar structuring, a sick member and the fact of the cardiac surgery, present stress and some avoid to speak about the future. Keywords: Family and surgical treated children; Family and hospitalized children

The authors describe the surgical cure of a case of Pentalogy of Cantrell, a rare anomaly characterized by congenital lesions involving the abdominal wall, the inferior third of the sternum, the ventral diaphragm, the pericardium and the heart. Keywords: Cantrell, pentalogy of, surgery