Volume 3 - Número 2
ORIGINAL ARTICLE
The operation of Fontan-Kreutzer in complex congenital anomalies other than lb isolated tricuspid atresia, single ventricle and pulmonary atresia with intact septum
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
Between 1979 and 1989, 84 patients underwent a Fontan operation or one of its modifications; the ages ranged from 5 months to 31 years. Patients were placed into five anatomic groups: 1) tricuspid atresia la (3 cases, 1 death, 33.3%); 2) tricuspid atresia lb (48 cases, 5 deaths, 10.4%); 3) single ventricle (18 cases, 2 deaths, 11.1%); 4) pulmonary atresia, intact ventricular septum (5 cases, 1 death, 20.0%); 5) complex anomalies (10 cases, no deaths). The subgroup of complex anomalies was divided in: with situs inversus and with situs solitus. In the majority of these patients, additional procedures were performed; in 5, one A-V valve was closed; in 2, complex atrial septation was done; in 1, a mitral valvuloplasty and the septation of the single atrium were performed; in 1, the section of an anomalous pathway (Kent bundle) was carried out.
Keywords: Fontan operation; Fontan-Kreutzer operation
Rastelli operation with bovine pericardium valved conduit: early experience
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
The present report describes the initial experience with the Rastelli operation utilizing a composite graft of glutaraldehyde preserved bovine pericardium. The graft is made up of a tube which serves to reconstruct the outflow tract of the right ventricle and the pulmonary artery, and an inner tricuspid valve, without a supporting ring, which provides the tube with a one-way flow mechanism. From May, 1986 to October, 1987, five children were submitted to Rastelli operation utilizing this valved tube. Three were female and two male, ranging in age from 1 e to 8 years (mean 5 years). Three had transposition of the great arteries, VSD and subpulmonic stenosis, one had pulmonary atresia, VSD and a previous Waterston shunt, and one had a type II truncus arteriosus. Two patients died of causes unrelated to the type of the conduit used. The valved conduit of preserved bovine pericardium is easy to handle due to its excellent flexibility, allowing perfect adaptability inside the pericardial sac. The absence of a supporting ring abolish gradient across the conduit and turbulence which are recognized causes of calcification.
Keywords: valved conduits, bovine pericardium, surgery; Rastelli operation
Re-operations following Bentall-De Bono operation for anulo-aortic ectasia
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
A major surgical problem is imposed when late complications occur in patients submitted previously to aortic root replacement by the Bentall-De Bono technique. During an 11 years period, from January 1976 to December 1986, 37 patients had aortic root replacement with valved conduits and 5 presented late complications (13.5%) requiring a new operation. The lesions were: biological valve degeneration, infective endocarditis and suture leaks leading to pseudo aneurysm, peritubular leakage and hemolysis. There was 1 systemic embolization with an infected vegetation. The 5 patients were re-operated, with 1 surgical death (20%), in a case presenting fungal endocarditis (Aspergillus), due to uncontroled bleeding. The remaining 4 had an uneventful hospital course. There was 1 late death during a surgical exploratory thoracic procedure. The remaining 3 patients enjoy a normal active life. One of these still has a small peritubular leakage causing mild aortic regurgitation and hemolysis. The surgical procedure consisted of Dacron tube replacement preserving the implanted valve prostheses in the 2 cases with infective endocarditis. Two ruptures biological valves were replaced by methalic disc valves. In this situation, the Dacron tubes were preserved and the valves approached through a longitudinal incision in the tube. The suture leaks were corrected with direct isolated mattress sutures. Late re-operations may be required after aortic root replacement with composite valve-tube grafts. They can be performed at an acceptable surgical risk. The technique should be as conservative as possible and directed to the causing lesions, preserving the remaining structures. A methalic prosthesis should be the first choice for the primary procedure, in order to avoid late tissue degeneration.
Keywords: Bentall-De Bono operation, re-operation
The use of homograph and heterograph valves in extracardiac conduits
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
The concept of using extracardiac conduits, to establish an outflow tract between the right ventricle and the pulmonary artery was developed on the sixties. Between 1971 and 1986, 335 patients received extracardiac conduits for the right heart, at The Hospital for Sick Children, London; 176 were antibiotic preserved aortic homografts (Hancock, Ross, Carpentier-Edwards, lonescu-Shiley) and 19 non-valved tubes. These conduits were used for the repair of complex congenital heart defects. The mean age of these groups was 6.34 ± 4.6 years and the mean weight 17.8 ± 10.8 kg. The internal diameter of the conduits varied from 8 to 30 mm. The hospital mortality was 29.2% and long-term follow-up of the survivals had a maximum period of 14,39 years. Sixty patients (17.9%) were submited to 60 reoperations, being only 40% conduit related. The actuarial survival cun/e of freedom from obstruction was significant when analyzed the homografts, without Dacron, versus each group of heterografts (p < 0.005). The more important risk factors were the number of postoperative complications, for late deaths; the severity of associated lesions for reoperation, the date of surgery for the replacement of the extracardiac conduit, and the date of surgery and severity of associated lesions for the obstruction of the extracardiac conduits. We conclude that on long-term the use of extracardiac valved conduits has good results specially when using antibiotic preserved aortic homografts and therefore they are our first choice in the reconstruction of the pulmonary ventricle outflow tract.
Keywords: extracardiac conduits, surgery; heart valves, surgery; heart valves prostheses, surgery
New technique for transference of chordae tendinae following mitral commissurotomy
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
Since 1983, 40 consecutive patients with mitral stenosis and significant disease of the subvalvular apparatus underwent open heart mitral commissurotomy. The aim of the study was to evaluate the effects of an unrestricted dilatation of the two commissures followed by repair of the subsequent mitral regurgitation. The mitral regurgitation created by this procedure in 24 cases was corrected by transferring 2 to 6 chordae tendinae to the free border of the anterior and/or posterior leaflet in the commissural region. A central regurgitant lesion due to lack of coaptation of the valvular surfaces was treated by annuloplasty with a Carpentier prosthesis in 12 cases. The subvalvular abnormalities were treated by the conventional techniques of fenestration, resection and division of the papillary muscles. Thirty two of the 38 survivors had no residual murmur, and 6 had a short low intensity systolic murmur. The 2D echocardiographic study showed no residual stenosis. The residual systolic murmurs were evaluated by pulsed Doppler and corresponded to well localized regurgitation. This extensive operative technique gives very good immediate valvular results, which, associated with an adequate subvalvular procedure, are considered to be an important prognostic factor.
Keywords: heart valves, surgery
Heart transplantation at the University of Minnesota
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
Between January 1984 and December 1987, 117 heart transplants have been performed at the University of Minnesota. The indication for transplantation were end-stage heart failure due to ischemic heart disease (42%) and idiopathic cardiomiopathy (41%). The mean age of recipients was 45.2 years (mean 6 m-64 y). Immunosuppression with cyclospohne-A, azathioprine and prednisone was used in all cases. Actuarial survival was 95% at 1 year and 94% at 5 years. There were 7 deaths. Thirteen patients suffered one or more episodes of acute rejection diagnosed by endocardial biopsies. Graft atherosclerosis was assessed by annual coronary angiography. Abnormalities were demonstrated in 5 patients (7%) at 1 year, 5 patients (19%) at 2 years and a further 5 patients (38%) at 3 years. These results demonstrate that cardiac transplantation is a highly satisfactory therapy for end stage disease. The success of this program is attributed to careful donor/recipient selection, triple drug immunosupression and meticulous aftercare. The incidence of graft atherosclerosis is a major concern affecting late results of cardiac transplantation.
Keywords: heart transplantation, human
CASE REPORT
Anomalous drainage of the right inferior pulmonary vein into the inferior vena cava associated to intrathoracic hepatic appendix
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
The authors present a case of a 61-year-old woman with anomalous drainage of the right inferior pulmonary vein into the inferior vena cava associated to an intrathoracic hepatic appendix herniated through a diaphragmatic defect. Surgical correction was obtained by direct anastomosis of the anomalous vein to the left atrium, reduction of the hepatic appendix to the abdominal cavity and closure of the diphragmatic defect. The postoperative course was unevenftul. The rarity of this condition is stressed.
Keywords: pulmonary veins, anomalous drainage; hepatic appendix, intrathoracic
Conservative operation for bacterial endocardites of the tricuspide valve
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
One case of acute bacterial endocarditis of the tricuspid valve caused by S. aureus and following a septic abortion is presented. Surgical treatment was indicated after failure of antibiotics. Operation consisted of excision of a large vegetation adherent to the anterior and posterior cusps at the commisure and of the affected valvar tissue. Annular plicature at the segment corresponding to the posterior cuspid was employed to maintain competence. Clinical result was very satisfactory with resolution of sepsis. Dopplerecocardiography revealed the presence of the vegetation before the operation and showed a small regurgitation after valvoplasty. Conservative operation upon the atrioventricular valves must be kept in mind as an alternative in the treatment of acute bacterial endocarditis.
Keywords: bacterial endocarditis, surgery; heart valves, surgery
PREVIUS NOTE
Reparative operation for aortic valve incompetence by leaflet advancement with bovine pericardial: preliminary report
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
A new technique for correction of aortic incompetence by the advancement of one more valve leaflets with bovine pericardial is presented. After experimental studies in isolated animal hearts this technique was used with success in one patient.
Keywords: heart valves, surgery; heart valves, biologic