Volume 18 - Número 1
EDITORIAL
Words from Professor Dr. Domingo M Braile
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
WORDS FROM THE PRESIDENT
President's words
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
SPECIAL
General guidance to writing scientific works
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
ORIGINAL ARTICLE
Mortality after partial left ventriculectomy in relation to contraindications for heart transplantation
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
OBJECTIVE:To analyze the impact of the contraindications for heart transplantation in mortality and survival time after partial left ventriculectomy.
METHOD: A prospective clinical study of a cohort of 43 patients submitted to partial left ventriculectomy, in whom there were contraindications for heart transplantation was performed. The following contraindications were analyzed: psychological, sociocultural, age of 65 years of age and older, elevated pulmonary arteriolar resistance and pulmonary arterial hypertension and the refusal or not for transplantation. These variables were tested for association with postoperative mortality and survival time after partial left ventriculectomy. Statistical analysis included the Chi-square test, Kaplan-Meier survival analysis, non-parametric log-rank test, Cox regression model, 95% confidence intervals and p values (significant if less than 0.05).
RESULTS: Higher postoperative mortality rates for partial left ventriculectomy were found when the following contraindications of heart transplantation were present preoperatively: poor sociocultural conditions (p = 0.037), psychological disturbances (p = 0.037) and in patients who accepted heart transplantation even when counseled against this procedure (p = 0.017). Survival time was significantly shortened in the presence of psychological disturbances (p = 0.0466), in patients older than 65 years (p = 0.0397) and in those who did not accept heart transplantation (p = 0.0306). Elevated pulmonary arteriolar resistance and pulmonary arterial hypertension were not associated with higher mortality rates or shortened survival time.
CONCLUSION: Some of the contraindications for heart transplantation adversely affected the mortality and survival time after partial left ventriculectomy, thus revealing the ineffectiveness of this alternative procedure in this subset of patients.
Keywords: Cardiomyopathy, congestive; Heart failure, congestive; Heart ventricle, surgery; Cardiac surgical procedures, mortality
Aortic reconstruction with bovine pericardial grafts
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
INTRODUCTION: Glutaraldehyde-treated crimped bovine pericardial grafts are currently used in aortic graft surgery. These conduits have become good options for these operations, available in different sizes and shapes and at a low cost.
OBJECTIVE:To evaluate the results obtained with bovine pericardial grafts for aortic reconstruction, specially concerning late complications.
METHOD: Between January 1995 and January 2002, 57 patients underwent different types of aortic reconstruction operations using bovine pericardial grafts. A total of 29 (50.8%) were operated on an urgent basis (mostly acute Stanford A dissection) and 28 electively. Thoracotomy was performed in three patients for descending aortic replacement (two patients) and aortoplasty with a patch in one. All remaining 54 underwent sternotomy, cardiopulmonary bypass and aortic resection. Deep hypothermia and total circulatory arrest was used in acute dissections and arch operations.
RESULTS: Hospital mortality was 17.5%. Follow-up was 24.09 months (18.5 to 29.8 months confidence interval) and complication-free actuarial survival curve was 92.3% (standard deviation ± 10.6). Two patients lately developed thoracoabdominal aneurysms following previous DeBakey II dissection and one died from endocarditis. One "patch" aortoplasty patient developed local descending aortic pseudoaneurysm 42 months after surgery. All other patients are asymptomatic and currently clinically evaluated with echocardiography and CT scans, showing no complications.
CONCLUSION: Use of bovine pericardial grafts in aortic reconstruction surgery is adequate and safe, with few complications related to the conduits
Keywords: Aorta, surgery; Aneurysm dissecting, surgery; Pericardium; Bioprosthesis
Vineberg Procedure by "Vineberg Technique modified by Lobo Filho": morbidity and mortality in the imediate post operative period, angiography results and flow analyze of the left internal thoracic artery implanted
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
BACKGROUND: The Vineberg procedure consists in inserting the internal thoracic artery in the ischemic left ventricle muscle. The main question is the ability of this artery to supply adequate flow for the isquemic miocardium.
OBJECTIVES: To evaluate angiographic results of Vineberg procedure by the Vineberg technique modified by Lobo Filho, the morbidity and mortality in the imediate post operative period (POP) and analysis of the flow of the implanted left internal thoracic artery (LITA) at rest and under stress.
METHOD: Between September 1999 and April 2002, in our service, eight patients were operated by the above describe technique, in which the implant of the internal thoracic artery in the intimacy of the left ventricle muscle is achieved using a kit used for the introduction of the endocardial leads of pacemakers through the subclavian vein. After six months, they went to angiographic and doppler evaluation. For the LITA study with the doppler we divided the sample into two groups: "Vineberg group", formed by the eigth patients mentioned above; and "control group" formed by 20 patients in whom the LITA recascularize directly the anterior interventricular artery. The angiographic study demonstrade patency of all the grafts in both groups. With the doppler, it was measured the output and flow velocity in the grafts. The analysis of data obtained was taken with T-test for paired and unpaired samples.
RESULTS: There were no deaths or complications in imediate POP. The angiographic study showed 100% patency. The total output of Vineberg group was 55% of the ones in the Control group. In both groups, the total output increased with the stress.
CONCLUSIONS: The Vineberg technique modified by Lobo Filho can be used with low rates of morbidity and mortality, high index of patency providing a significant blood flow at rest and under stress.
Keywords: Myocardial revascularization, methods; Left internal thoracic artery, surgery
The pulmonary vascular blood supply in the pulmonary atresia with ventricular septal defect and its implications in surgical treatment
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
OBJECTIVE: With base in the studies cineangiocardiography of pacients with pulmonary atresia (PA) with ventricular septal defect (VSD), to identify in the groups proposed by BARBERO MARCIAL, subgroups with similar morphological characteristics, to measure their central pulmonary arteries (CPA) and major aortopulmonary collateral arteries (MAPCA), thereby establishing their implications in surgical treatment.
METHOD: Sixty three patients were classified in groups A (15), B (40) and C (8) between january 1990 and june 2001. Patients with complete cineangiocardiograms prior to the first surgical intervention were included in this study, being calculated the pulmonary arterial index (PAI), the major aortopulmonary collateral arterial index (MAPCAI) and the total neopulmonary arterial index (TNPAI = PAI + MAPCAI). Surgical treatment was considered palliative (PT), definitively palliative (DPT) and definitive (DT).
RESULTS: Nine subgroups were identified, A (A1 and A2), B (B1, B2, B3, B4 and B5) and C (C1 and C2). In group A, the PAI of patients for DT was higher than for PT patients (p=0,0092). In group B, the TNPAI of DT patients was greater than for PT patients (p=0,0959). In group C, the MAPCAI in DPT patients was lower than in PT and DT patients. In the group A was not mortality, in the group B was of 17,5% and in the group C was of 12,5%.
CONCLUSIONS:Among the groups A, B e C was possible to identifiy nine subgroups, the morphologic and morphometric characteristics allowed to suggest the surgical treatment in the patients of the group A had larger chance of TD, the group B of TP and the group C of TPD. The mortality presented larger correlation with the morphologic characteristics that with the morphometric.
Keywords: Pulmonary atresia, surgery; Pulmonary atresia, physiopathology; Heart septal defects, ventricular, surgery; Heart defects, congenital, surgery
Late angiographic evaluation of radial artery grafts used in surgical myocardial revascularization
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
OBJECTIVE: To evaluate the late patency of the radial artery used as a conduit in coronary artery bypass grafting through a selective catheterization.
METHOD:A group of 109 patients operated on for coronary artery bypass grafting used radial artery as grafts, from September 1995 to October 1996, were re-studied in the immediate post-operative period. Among these patients, 91 (83.5%) were contacted either by phone or through outpatient follow-ups, and 34 underwent a late angiographic study. Twenty-two patients were male (65%). The average age of the patients was 57.4 years old (37-70). The average time of the restudy was of 51.2 months (41-63). Thirty-eight distal anastomoses were performed using the radial artery, with an average of 1.12 distal anastomoses per patient. The analysis of these data is the basis for the present study.
RESULTS: The radial artery was patent in 30 patients (34 distal anastomoses - 89.5%), and had a lesion in only one patient along with the proximal anastomosis in the aorta. Out of the four patients who presented total graft obstruction, two were male. We observed inadequate indications in two patients, and no justifiable occlusions in the others. From the 91 re-studied patients in the immediate post-operative period, there was late mortality in 6 patients (6.6%), one adenocarcinoma of the lung, and the others by cardiac causes. The only patient who presented a lesion at the radial artery underwent angioplasty with a stent implantation and had a satisfactory outcome.
CONCLUSIONS: The radial artery, used as a conduit for coronary artery bypass grafting, shows satisfactory angiographic aspects and also a satisfactory patency, similar to those of the left internal thoracic artery, when evaluated in this time of follow-up.
Keywords: Radial artery, surgery; Radial artery, anatomy and histology; Myocardial revascularization
New electrode for pacing fetuses with complete heart block
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
OBJECTIVE: As fetal complete heart block with hydrops carries a poor prognosis, intrauterine pacing appears the most logical treatment. However, premature labor following hysterotomy remains a major obstacle to open procedures. Therefore, we developed a new lead for fetal pacing that avoids the need for intrauterine open surgical procedures.
METHODS We successfully implanted a new T-bar-shaped lead into the myocardium of a fetus at 25 weeks gestation presenting with complete heart block (heart rate = 47 beats per minute), hydrops, and structural heart defects. The procedure was performed under ultrasound guidance, and the lead was introduced through the tip of a specially designed, 18G needle. The new lead was then connected to a Biotronik Actros pulse generator, which was implanted subcutaneously in the maternal abdominal wall.
RESULTS: The stimulation resistance was 357 W, and the sensed fetal R wave was 6.4 mV. The voltage strength-duration curve remained relatively constant at pulse widths > 0.6 msec. An echocardiogram on the first postoperative day revealed a mild pericardial effusion. The fetal heart rate was sTable , with low stimulation thresholds and no stimulation failures. No uterine contractions were observed during the postoperative period. However, the fetus died 36 hours after the procedure, probably due to cardiac tamponade.
CONCLUSION: To our knowledge, this is the first documentation of voltage strength-duration curves for the acute myocardial stimulation threshold of a human fetus that survived 36 hours after intrauterine pacemaker implantation. This case emphasizes that percutaneous fetal pacing with the new lead is feasible and may minimize the chances of premature labor.
Keywords: Cardiac surgical procedures; Heart block, surgery; Pacemaker artificial; Hydrops fetalis
Coronary endarterectomy: technique and results in a case-control study
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
OBJECTIVE: Early reports showed a high incidence of postoperative morbidity and mortality after coronary endarterectomy, and its value is still controversial. With technical improvement the role of coronary endarterectomy has been reviewed. In this study we evaluate our results of coronary endarterectomy, and show our strategy for patients with diffuse coronary artery disease.
METHOD: We retrospectively reviewed 278 patients who underwent coronary artery bypass grafting, between January 2000 and December 2001, separated in two groups. The endarterectomy group - 32 patients (11.5%) who underwent coronary endarterectomy and the control group of patients characteristics similar to the first group.
RESULTS: The mean follow-up time was 9.9 months. Both groups only demonstrated a statistical difference in the number of previous myocardial infarctions. The coronary endarterectomy was performed on 38 vessels, 78.75% in the left coronary system, and 21.05% in the right system. In the postoperative follow-up no significant differences were detected, but in the coronary endarterectomy group the incidence of intra-aortic balloon pump insertion was higher.
CONCLUSIONS: We demonstrated that coronary endarterectomy should be used to achieve complete revascularization in patients with diffuse coronary disease, and the results are similar to conventional surgical treatment. A long-term follow up is necessary to demonstrate the future performance of these vessels and grafts.
Keywords: Coronary disease, surgery; Myocardial revascularization, methods; Endarterectomy
Immediate extubation in cardiac surgery: evaluation using electroencephalogram
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
BACKGROUND AND OBJECTIVES:The current techniques of anesthesia employed in cardiac surgery leading to immediate extubation depend on adequate analgesia and titration of anesthetic drugs. We sought to determine the best possible moment of extubation, using the bispectral index of the electroencephalogram.
METHOD: Twelve ASA III patients were analyzed. Seven (58.4%) were children (Group I), submitted to correction of congenital cardiac defects with ages ranging from 0 to 7 years. Five adults (Group II), with ages ranging from 30 to 75 years, underwent coronary artery bypass grafts. In Group I spinal anesthesia (L5-S1) using hyperbaric 0.5% bupivacaine (0.5mg/kg) and morphine (5µg/kg) was chosen. In Group II epidural anesthesia (T3-T4) with catheter placement plus ropivacaine (60mg) and morphine (2mg) were employed. For the induction of anesthesia fentanila (4µg/kg), muscle relaxant and propofol (to bring the bispectral index value down to 30) were utilized. General anesthesia was maintained with sevofluorane, maintaining the bispectral index value between 40 and 60. Extubation was programmed at a bispectral index value of 90.
RESULTS: All patients were extubated up to one hour after the end of the surgical procedure, 91.6% of them in the operating room. All had the cognitive functions preserved without history of explicit memory or pain (adults and children who were able to speak), nor facial expression of pain (small children). Four (57%) patients in Group I and one (20%) in Group II had post-operative pruritus. Two patients (28%) in Group II had emesis.
CONCLUSIONS: The results suggest that the technique employed is safe and effective, as long as the criteria for its use are strictly observed.
Keywords: Electro-encephalography; Cardiovascular surgical procedures; Anesthesia
CLINICAL RESEARCH PAPER
Cardiac tumours: clinical, echocardiographic and pathological features
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
OBJECTIVE: The purpose of our paper was clinical and echocardiographic characterisation of patients with cardiac tumours and the evaluation of the surgery and tumour recurrence.
METHOD: The first part of research was a retrospective investigation to identify cardiac tumours identification and to collect data from patients' records of the Messejana Hospital and Walter Cantídio University Hospital, from 1981 to 2001. In this period, 19 cases of cardiac tumours were discovered. The patients were submitted to clinical, electrocardiographic and echocardiographic re-evaluation from March to July 2002.
RESULTS: Congestive symptoms and thoracic pain were the most frequent symptoms. The location in which most of the tumours were identified was left atrium. Among patients submitted to surgery, all of them had the tumour extracted from atrium. The most common histopathologic type was myxoma (78%). Surgical mortality was 14%. Tumour recurrence occurred in one patient.
CONCLUSION: Cardiac tumours were more frequent in left atrium, benign tumours were more frequent than malignant tumours, and the most frequent histopathologic type was myxoma.
Keywords: Heart neoplasms, surgery; Myxoma
CASE REPORT
Partial left ventriculectomy in a child: 70-month clinical follow up
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
We describe the 70- month follow up of a child with idiopathic dilated cardiomyopathy and end-stage congestive heart failure (NYHA III/IV) who underwent partial left ventriculectomy - the Batista operation when he was two and half years old. The clinical follow up was performed in the outpatient clinic by electrocardiography, echocardiography and radionuclide ventriculography to better analyse the left ventricular ejection fraction. The left ventricular diameter increased. Echocardiograms showed enlargement mainly in the systolic left ventricular diameter and slow decrease in fractional shortening (delta D). The child was in class I (NYHA) during the follow-up. His exercise endurance was better than before surgery and hospitalization was not necessary. For these reasons, we believe that this procedure can be considered as a therapeutic option in children with severe dilated cardiomiopathy who are waiting for heart transplantation, as the shortage of donors is a fact.
Keywords: Cardiomyopathy, congestive, surgery; Cardiac surgical procedures, methods; Heart ventricle, surgery
Surgical treatment of isolated fistulae of coronary arteries
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
OBJECTIVE:To report the surgical results obtained with the surgical correction of fistulae of coronary arteries in the pulmonary artery branch.
METHOD: From 1995 to 1999, three female patients with diagnoses of isolated fistulae of coronary arteries confirmed by cinecoronariography underwent surgery.
RESULTS: No other associated heart diseases were observed in the patients. The main symptom of all patients was angina pectoris. After closing the coronary fistulae the patients progressed with event-free post-operative periods and with total recovery from the angina.
CONCLUSION: Surgical treatment should be considered for all patients diagnosed as having isolated fistulae, due to the low morbid-mortality rate in addition to the technical simplicity of closing and performing the ligature of fistulae.
Keywords: Arterio-arterial fistula, surgery; Arterio-arterial fistula, congenital; Coronary circulation; Pulmonary artery, surgery
Surgical treatment of a floating non-occlusive thrombus in the ascending aorta. Case report.
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025
We report the case of a 44-year-old diabetic woman who was a smoker using synthetic progestagen, with previous history of suspected thrombotic cerebral ischemia. She was admitted with clinical evidence of acute myocardial infarction. A coronary angiogram showed normal coronary arteries and distal occlusion of the left circumflex coronary artery. An ascending aorta angiogram and transesophageal echocardiography revealed a free floating mass attached to the aortic wall. The pedunculated thrombotic mass was surgically removed. Histological examination of the resected structure confirmed the macroscopic findings and revealed a recent thrombus. The patient was prescribed oral anticoagulant and released from hospital.
Keywords: Aorta; Aortic disease, thrombosis; Thrombectomy
Statistical Methods
Braz J Cardiovasc Surg 18;
Publish in: 8/1/2025