Volume 2 - Número 3
ORIGINAL ARTICLE
Surgical treatment of left ventricular aneuysm: early and late results
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
The authors report on 112 patients with ventricular aneurysms operated opon between January 1984 and March 1986. The late results were evaluated from a period of 8 months to 3 years of follow-up. The age ranged from 33 to 75 years, with 42% of patients between 51 and 60 years old; 87% were males. The most common pre-operative symptoms were: angina, congestive heart failure, and arrhythmias. The location of the left aneurysm was anteroapical in all patients. The number of arteries involved was as follows: 1 (22.3%) 25 cases; 2 (44.6%) 50 cases; 3 (27.6%) 31 cases, and 4 or more (5.3%) 6 cases. According to the regional ejection fraction, the patients were classified in 3 groups: good, 37 cases (33.0%); regular, 60 cases (53.5%) and bad, 15 cases (13.5%). The aneurysm was corrected basead on the modern concept of LV geometric reconstructing. In only 22 cases, isolated aneurysmectomy was performed and in the remaining 88 cases, additional procedures were performed. The hospital mortality rate was 7.1% (8 cases) corresponding to the following groups: good (2.7%) 1 case; regular (3.3%) 2 cases, and bad (33.3%) 5 cases. The late mortality rate was 8.6% (9 cases). The late follow-up of the surviving 95 patients showed that 50 were symptomatic, while 45 had no symptoms. The authors conclude that in the good and regular groups, the results were satisfactory; however, in the bad groups, the total mortality rate was high (40.0%).
Keywords: aneurysms, left ventricle, surgery
Direct myocardial revascularization with left gastroepiploic artery: anatomic and histologic study and case report
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
The most used grafts for myocardial revascularization are saphenous vein and the internal mammary artery (IMA); long term patency studies have shown good results with IMA. The use of the gastroepiploic artery (GEA) as a graft for direct myocardial revascularization was tested in 25 cadavers, with ages varying from 23 to 84 years obtained from the Anatomy Department at the Escola Paulista de Medicina. The surgical technique consisted in cutting down the left GEA, sectioning its collaterals and cutting it off from the right GEA at the piloric zone. The diameter and length of the artery were studied. The placement of the artery in the pericardial sac was done through rotation of the pedicle in front of the diaphragm. It was possible to anastomose it to the right coronary artery or circunflex marginal. Histological studies performed on the GEA demonstrated a medial layer of the type elastic-muscular with low incidence of atherosclerosis. The clinical application of this technique was performed in a 58 years old female who had both saphenous veins completely fibrosed. The patient received three grafts: left IMA, right IMA and GEA for the left anterior descending, right coronary artery and circunflex artery, respectively. The immediate postoperative period was uneventful and she was discharged 12 days after surgery. Digital angiography was selectively performed in each of the three grafts demonstrating good patency in all of them. This is a new possibility of direct myocardial revascularization to be utilized when the usual venous grafts cannot bem employed.
Keywords: myocardial revascularization, surgery
Second surgery for myocardial revascularization
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
A second surgery for myocardial revascularization may be needed in some patients. One still discussed the reasons and the risk of such procedure. A group of 162 patients who underwent a second coronary by-pass graft surgery was analized. There was a significant number of patients with high blood pressure and with previous myocardial infarction. The reason for reoperation was either lesion within the by-pass lumen or a lesion within the lumen of a native artery non-previously treated. Most patients underwent the second coronary by-pass graft surgery after an interval of, at least, 6 years after the previous surgery. In-hospital mortality was 9% (23 patients). Authors discuss the possivle causal relationship between these findings and reoperation, as well as the causes of the high mortality.
Keywords: myocardial revascularization, surgery
Evaluation of the activity mode rate variable pulse generator
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
To evaluate the physiologic benefits of the rate response estimulation, 48 patients were submited to a 24 hours Holter recording and paired tolerance treadmill test (AAI VVI and AAI-R/VVI-R modes, selected in random order) one month after implantation of an activity sensing pacemaker Activitrax 8400. Mean age of the patients was 46 years and indications for pacing included atrial arrhythmias (16 patients) or A-V conduction disturbances (32 patients, including 25 with complete A-V block). The underlying disease was Chagas cardiomiopathy, in 32 patients. Initial pacemaker setting was: basic rate: 60 or 70 ppm; maximum activity rate: 125 ppm; activity threshold: medium, rate response: 5. The 24 hours Holter recording documented appropriate changes in heart during daily activities. Oversensing, which resulted in pacing interval fluctuations, was diagnosed in two patients and required pacemaker reprograming. Treadmill test showed a significant increase in heart rate during exercise: mean control value: 66.9 ppm; 4 min.: 84.6 ppm; 6 min.: 90.5 ppm (P < 0.05). In the paired test, the AAI/VVI-Activity mode enabled the patients to increase heart rate (12.5%) and exercise time (20.2%; P < 0.05). None of the patients presented exercise induced ventricular arrhythmias in mode AAI/VVI-Activity; on the other hand, 12 patients showed ventricular arrhythmia during exercise in mode AAI/VVI. Clinical improvement and more active life was referred by all patients in this short follow-up period. The Activitrax 8400 was effective in improving patients exercise capacity.
Keywords: pacemakers, cardiac, rate responsive
Replacement of heart valves prostheses
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
Replacement of valvular prosthesis is an increasingly frequent procedure in heart surgery. Better results are attained with the observation of correct indication and improved surgical technique. In the period of January 1984 to June 1986, 145 patients were submitted to prosthesis replacement, at our Institution. These patients received a total of 157 prostheses and 4 had their Starr-Edwards valve ball replaced due to ball variance. Six patients were submitted to a third valvular replacement in the mitral position, withouth deaths. Nine patients had a third valvular replacement in the aortic position with 1 death in the immediate postoperative period. Rupture or calcification of the dura mater leaflets were the main reason for the indication of prosthetic replacement. In the mitral position 41 patients presented rupture of the leaflets and 19 showed calcification. In the aortic position 32 bioprostheses underwent rupture and 12, calcification. Bio-prostheses were utilized in the majority of cases of replace the dysfunctioning prostheses. Porcine bioprostheses were implanted in 63 cases and bovine pericardial bioprostheses, in 35. Immediate mortality was 8.3% (12 patients); low cardiac output was the main cause of death. The most frequent immediate complications were low cardiac output, arrhythmias and bleeding. In the preoperative period 90% of the patients were in functional classes III and IV (NYHA). After the replacement, 89% of the aortics and 82% of the mitral were in functional classes I an II.
Keywords: heart valves, prostheses, replacement
Nine year follow-up of the bovine pericardial prosthetic valve IMC-Biomedica: a multicenter study
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
A mitral pericardial bioprosthetic valve IMC-Biomedica was implanted in a consecutive series of 798 patients with mean age of 52 years, from December 1977 to November 1978. The 722 patients who survived operation were observed during a period of 9 years (mean 27036 months or 2253 years). Actuarial studies indicated an expected survived rate at 9 years of 66% for adult patients and 68% for younger patients. The probability of complications were the following: rupture 0.4; perivalvar leak 0.4%; thromboembolysm 2.7%; endocarditis 3.2%; calcification 4.4%. The actuarial freedom from calcification between 1977 to 1982 (Group I) was 94.0% to adults and 12.0% to younger patients. On the other hand, between 1982 to 1986 (Group II) the actuarial analysis of calcification showed that 99.0% adults and 92.0% younger patients were free from this complication. Hence we believe that our option for the pericardial bioprosthetic valve was appropriate because 96.0% patients were free of complications deaths with the valve; this means that in 9 years the bioprosthetic lethal potential was only 4.0%.
Keywords: heart valves, biologic; heart valves, surgery
The cardioplegic action in the myocardial protection: experimental study through freeze fraction replictions
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
Evaluation of myocardial protection by cardioplegic solutions and hipothermia in anoxic hearts. An experimental study. This investigation was performed in a group of 20 dogs submitted to myocardial anoxia by cross-clamping of the ascending aorta for sixty minutes under extracorporeal circulation, followed by reperfusion for 360 minutes. Ultrastructural changes of the myocardium were studied. The animals were divided into 4 groups of 5 dogs each. In the first group (control), myocardial anoxia was induced in normothermia and no cardioplegic solution was administered. In the second group, the body temperature was reduced to 28ºC before the onset of myocardial anoxia, and no cardioplegic solution was used. In the third and fourth groups, in addition to 28ºC systemic hypothermia, coronary infusion of 4ºC cardioplegic solutions were performed immediately and after 30 minutes of clamping of the aorta. The cardioplegic solutions utilized have NaCl, KCl, CaCl2, Lidocaine, Verapamil, NaHCO3, MgSO4 and the infusion vehicle was 5% glucose solution in Group III, and blood in Group IV. Biopsies for freeze-fracture replication were obtained from the anterior wall of the left ventricle, before and after 60 minutes of myocardial anoxia, and 360 minutes after reperfusion. The alterations in sarcolemma and celular organeles due to anoxia or myocardial reperfusion was observed, specially through the diminution and aggregation of intramembranous particles in its P surface. We may conclude that both cardioplegic solutions used, associated to hipothermia, protect efficiently the myocardial cells against anoxia. It was not possible, however, to demonstrate any superiority of the blood solution over an acellular solution. Systemic hypothermia as a single method was not sufficient to offer good protection to the anoxic myocardium. The animals of Group I (control) showed severe compromise of the structure and function of the myocardium.
Keywords: myocardial protection, cardioplegia; myocardial protection, experimental
WORK NOT PRESENTED AT THE 14TH NATIONAL CONGRESS OF CARDIAC SURGERY
Double lung transplantation: technical aspects and clinical application
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
The re-introduction of single lung transplantation as a clinical reality and the experience of heart-lung transplantation prompted the development of double lung transplantation for end stage pulmonary disease. Although this procedure is still in its infancy, preliminary results are encouraging. The hazard of tracheal anastomosis dehiscence can be significantly reduced with an omental wrap. The advantage of double lung transplantation includes the extirpation of all diseased pulmonary tissue whilst retaining an inervated heart. In addition, the long term risk of accelerated cardiac atherosclerosis is avoided. Progress in the area of lung preservation and more precise diagnosis of rejection should influence the long term results. Double lung transplantation offers great potential in the management of lung disease and may help to optimise the availability of scarce donor organs.
Keywords: lung transplantation, double