Volume 20 - Número 2
EDITORIAL
Words of Prof. Dr. Domingo M. Braile
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Opening speech of the 32nd Congress of the Brazilian Society of Cardiovascular Surgery in Vitória, Brazil
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
ORIGINAL ARTICLE
Inhibitory action of the Interleukin 1ß over the cellular proliferation of smooth muscle cells cultivated from human saphenous veins
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Objective: The saphenous vein (SV) is an effective graft used in coronary artery bypass grafting, although, its patency can be affected by the development of atherosclerosis. We have developed an experimental study demonstrating the development of apoptosis in SV grafts cultivated under arterial hemodynamic conditions (AHC). The interleukin-1â expression was also elevated in these veins slices. The aim of this study is to evaluate the influence of interleukin-1â in the precocious proliferation of the cultures of primary smooth muscle cells (PSMC).
Methods: PSMC of 6 different human SVs were cultivated in Dulbecco’s Modified Eagle Medium associated with bovine fetal serum. The control group was not treated with Interleukin-1â but treated groups were. Cellular proliferation (CP) was evaluated by measuring triple thymidine (3H), incorporated into the proliferated cells.
Results: The treatment with Interleukin-1â decreases cellular proliferation. The control group presented 100 ± 4.5% of CP. In the treated groups the quantity of Interleukin1 administered and the respective levels of CP observed were: 0.1 ng/mL – 112 ± 0.7%; 1 ng/mL – 83 ± 4.7%; 10 ng/mL – 69.1 ± 3.8% and 100 ng/mL – 76.3 ± 10.9% (p < 0.01).
Conclusion: We can conclude that the administration of increasing quantities of Interleukin-1â inhibits the proliferation of PSMC cultivated from human SVs. This suggests that the precocious process of apoptosis observed in the SV grafts exposed to AHC can be related to the action of this Interleukin.
Keywords: Cell culture; Saphenous vein; Myocardial revascularization; Gene Expression; Interleukin - 1
The beneficial effect of revascularization on patients with severe left ventricular dysfunction and viable myocardium: reverse remodeling and prognosis
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Objectives: To evaluate the integration of both viability and clinical parameters on the improvement in systolic performance, symptoms and prognosis, with post-revascularization reverse remodeling.
Method: One hundred and fifteen patients underwent thallium-201 imaging before myocardial revascularization. Left ventricular ejection fraction, left ventricular end-systolic volume index and left ventricular end-diastolic volume index were determined before and at each 6 months post-revascularization for 3 years.
Results: Patients with ³ 4 viable segments on thallium-201 imaging demonstrated an improvement in left ventricular ejection fraction from 34±6 to 44±4%, p<0.001), left ventricular end-systolic volume decreased from 78.3±11 to 57±17 mL/m2, p<0.001; left end-diastolic volume decreased from 113±31 to 91±22 ml/m2, p<0.001). Patients with < 4 viable segments failed to demonstrate an improvement of the left ventricle ejection fraction, 33.4±4 vs. 35.1±5% (p=0.19), and exhibited ongoing left ventricle end-systolic remodeling, 72±23 vs. 73±12 mL/m2 (p= 0.81), and the left ventricle end-diastolic volume increased from 112±24 to 118±16 mL/m2 (p=0.34), without improvement in NYHA class, and worse long-term prognosis (event; log rank test, p=0.0053). The multivariable analysis demonstrated clinical variables related to the unfavorable evolution showed diabetes, more than one myocardial infarction, and time interval between myocardial infarction and surgery were associated with worse prognosis.
Conclusion: The benefits of myocardium revascularization in patients with viable muscle, as well as an improvement in the left ventricular ejection fraction, provide reverse remodeling, improvement in functional class and favorable long-term prognosis.
Keywords: Myocardial revascularization; Ventricular remodeling; Heart failure, congestive
Risk factors analysis in transvenous pediatric pacing through femoral access: long-term experience
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Objective: Permanent cardiac pacing improves survival of children with congenital or acquired bradycardia, although mortality after pacing remains relatively high. The aim of this study was to evaluate the long-term outcomes of children who undergo permanent endocardial cardiac pacing via the femoral vein, including the identification of associated risk factors for mortality.
Method: From 1981 to 2000, 99 patients ranging in ages from one day to 13 years (4.1 ± 3.6 and median = 3 years) underwent permanent transfemoral pacemaker implantation due to congenital (39.4%), postsurgical (54.5%), or non-surgically acquired bradycardia (6.1%).
Results: By the end of 7.1 ± 5.3 years (708.3 patient-years) of prospective follow-up, 18 (18.2%) patients had died. The actuarial survival rates were 85%, 79.5%, and 74.2%, at 5, 10, and 15 years, respectively. Independent predictors of mortality identified by Cox proportional hazards analysis were younger age at implantation (p = 0.028), the presence of untreated cardiac anomalies or intracardiac prostheses (p = 0.0001), and radiographic evidence of cardiomegaly (p = 0.035).
Conclusions: Permanent endocardial pacing via the femoral vein presented survival expectance comparable to other techniques with a low rate of pacing complications. Long-term survival was limited by lower ages and cardiac dilatation at the time of implantation as well as by the presence of untreated cardiac defects or valve prostheses.
Keywords: Cardiac pacing, artificial; Pediatrics; Heart block, mortality; Risk factors
Mitral valve repair using the double Teflon technique in patients with severely calcified annuli and myxomatous disease
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Objective: The purpose of this study is to present the immediate and long-term results of mitral valve repair using the double Teflon technique in patients with mitral insufficiency due to myxomatous disease and severely calcified annuli.
Method: Between 1985 and 2002, 162 patients with mitral insufficiency due to myxomatous degeneration were submitted to mitral valve repair in the Heart Institute of University of São Paulo Medical School. From these, 13 presented severely calcified annuli and underwent mitral valve repair with quadrangular resection and annuloplasty using the double Teflon technique. The mean patient age was 65.4 +/- 12.9 year with 69.2% of the patients being male. One (7.7%) patient had associated coronary artery disease and was submitted to coronary artery bypass grafting. In the preoperative period, 15.4% of the patients were in functional class IV of the New York Heart Association, 69.2% in class III and 15.4% in class II.
Results: There was no operative death.In late postoperative period, 90.9% of the surviving patients were in functional class I. There were no episodes of hemolysis or endocarditis. One patient was reoperated on the second postoperative month and was submitted to mitral valve replacement. The actuarial survival at 14 years was 71.4% +/- 17.1%.
Conclusions: Mitral valve repair using the double Teflon technique in patients with myxomatous disease and severely calcified annuli presented satisfactory survival rates and good clinical evolution and proved to be a better alternative than mitral valve replacement.
Keywords: Mitral valve insufficiency, surgery; Mitral valve, surgery; Heart valves, surgery; Calcinosis
Effetiveness of a preoperative physiotherapeutic approach in myocardial revascularization
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Introduction: Postoperative pulmonary complications are a major source of mortality and morbility. Respiratory physiotherapy, which is often used to prevent and treat these complications, can be started preoperatively, in order to assess and guide the patients.
Objective: To establish the effectiveness of a preoperative physiotherapy program for patients submitted to elective coronary artery bypass surgery as regards to the reduction of the hospital stay and prevention of pulmonary complications, changes in pulmonary volumes and inspiratory muscle force.
Method: This was a randomized clinical trial. The study group consisted of 86 patients submitted to elective coronary artery bypass surgery at the Instituto de Cardiologia do Rio Grande do Sul. The intervention group (44 patients) was assessed and received physiotherapeutic guidance with written manuals at least 15 days before surgery. The control group (42 patients), on the other hand, received routine guidance on the day of hospital entry.
Results: A significant reduction in the hospital stay (p<0.05) was observed in the intervention group. No difference were found between the groups in respect to the change of lung volumes, inspiratory muscle force and occurrence of pulmonary complications as seen by X-ray.
Conclusion: Patients who have had preoperative instruction are better prepared to cooperate with postoperative treatment. As these patients understand the purpose of pre- and post-operative physiotherapy, the limitations resulting from the surgical process and the physiotherapeutic technique proposed, they may ultimately have a shorter stay in hospital.
Keywords: Physical therapy; Preoperative care; Myocardial revascularization
Myocardial revascularization: comparative cost study between conventional coronary bypass and percutaneous transluminal coronary angioplasty
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Objective: To compare the cost of coronary bypass surgery (CBS) and percutaneous transluminal coronary angioplasty (PTCA) for a one year follow-up.
Method: Eight-six patients were submitted to 87 CBS and 240 patients to 267 PTCA, between October 2003 and April 2004. The mean age of the two groups was 62 years. The CBS group was submitted to a mean of 3.7 bypass/ patient, using 96.5% of arterial conduits. In the PTCA group, a mean of 1.1 angioplasties/procedure were performed. Twenty-one (24.4%) patients had an angioplasty performed before the CBS. Each group was subdivided in, group A and B, in respect to the manner of payment.
Results: The mean cost for CBS was R$ 7.759,78, per procedure; in the PTCA group the cost/angioplasty was R$ 6.307,79. At the end of a year, the end values were R$ 7.875,73 for the CBS and R$ 8.234,96 for the PTCA group. In group B the CBS patients had a mean hospital cost of R$ 11.061,63 and R$ 11.087,29 at the end of a year; in the PTCA group the hospital costs were R$ 11.110,83, and at the end of a year R$ 13.414,59.
Conclusions: The author concludes that: 1) only 26.4% of the 326 patients were submitted to CBS; 2) PTCA group presented 26.7% re-interventions/patient and CBS group only 3.5%; 3) CBS costs were 17.4% less than those of the PTCA after one year, in group B.
Keywords: Myocardial revascularization; Costs and cost analysis; Coronary artery bypass; Angioplasty, transluminal, percutaneous coronary
Anatomy of the lateral, diagonal and anterosuperior arterial branches of the left ventricle of the human heart
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Objective: The objective of the present report was to describe the lateral, diagonal and anterosuperior arterial branches in the epicardial adipose tissue of the left ventricle and to analyze their frequency and diameters according to the type of coronary circulation. The precious knowledge of these branches has surgical application in their revascularization or during the injection of the cardioplegic substances into these branches.
Method: Fifty hearts obtained at autopsy from adult cadavers were dissected and fixed in formalin and the left ventricle was divided into three thirds: superior, middle and inferior. The lateral branch originated from the circumflex branch, the diagonal branch from the division of the left coronary artery and the anterosuperior branch from the anterior interventricular branch in the superior third of the left ventricle. The length in the epicardium and the diameter of each branch were measured and the blood flow was correlated to the type of coronary circulation.
Results: The diameter of the lateral branch, present in 88% of the cases, ranged from 0.6 to 4.5 mm (mean: 2.1 ± 0.7 mm). The diameter of the diagonal branch, present in 50% of cases, ranged from 1.0 to 3.8 mm (mean: 2.2 ± 0.7 mm). The diameter of the anterosuperior branch, present in 84% of cases, ranged from 1.0 to 4.1 mm (mean: 2.5 ± 0.8 mm). We detected 30/50 (60%) cases of dominance of the right coronary artery, 14/50 (28%) cases of the balanced type, and 6/12 (12%) cases of dominance of the left coronary artery. Mean blood flow in the anterosuperior branch presented a decreasing value in the following order: dominance of the right coronary artery, balanced and dominance of the left coronary artery. Inversely, the lateral branch presented with increasing values, while the diagonal branch presented a greater flow in the balanced type.
Conclusion: The results demonstrated the complementarity of the lateral, diagonal and anterosuperior arterial branches, as well as the correlation among these branches with the different types of coronary circulation: right dominance, balanced and left dominance.
Keywords: Heart, anatomy & histology; Coronary circulation
REVIEW ARTICLE
Reconstrutive surgery of regurgitating mitral valve in children
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Surgical treatment of atrial fibrilation
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
EXPERIMENTAL WORK
Experimental heterotopic cardiac and cutaneous transplantation in mice
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Objective: This is an experimental study which aims at developing and evaluating the feasibility of experimental techniques of vascularized and cutaneous abdominal heterotopic heart transplant in mice, creating an instrument of investigation for the effectiveness of prservation solutions, new immunosuppressive drugs, biological agents, genetic therapy and induction of immunological tolerance.
Method: The techniques used in this work were previously described by Corry et al. and Billingham et al.
Results: The total surgical time to perform the cardiac transplants (n=20) was on average 60.3+6.3 minutes and the time of cutaneous transplants (n= 20) 17.75+0.71 minutes. The average survival of the cutaneous allografts (n=34) and cardiac (n=24) allografts was 7 and 11 days, respectively, while the syngeneic grafts survived more than 100 days.
Conclusions: Both techniques are characterized by the easy reproducibility of the experimental models. The differences between the techniques were not limited either by the methodological peculiarities or by the length of survival and vascularization, but mainly by the immunogenicity and susceptibility of rejection.
Keywords: Heart transplantation; Skin transplantation; Transplantation immunology; Mice, inbred strains
CASE REPORT
Surgical repair of left ventricular rupture after the use of tenecteplase in the treatment of acute myocardium infarction
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
The use of thrombolytic agents in the treatment of acute myocardium infaction represented an important impact in the reduction of overall mortality. But this did not alter the cardiac rupture rate. This complication must be recognized and treated quickly.The authors report on a case of surgical repair of an early left ventricle rupture, after the use of tenecteplase in association with non-fractioned heparin for the treatment of acute myocardium infarction.
Keywords: Myocardial infarction; Thrombolytic therapy, adverse effects; Heart rupture, post infarction
Cerebral retrograde perfusion alternating with carotid artery anterograde perfusion in the surgical treatment of acute dissection of ascending aorta dissection
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
The authors report an original case using cerebral retrograde perfusion alternating with carotid artery anterograde perfusion, during the surgical treatment of acute ascending aorta dissection. The patient was discharged on 32nd post-operative day in a clinically controlled condition. The Mini Mental State Examination test was applied after 30 days and showed normal cerebral cognitive activity. The authors believe that this method can give a protective effect to the brain during procedures involving aortic dissection or aneurysms, after evaluating its use after a significant series of cases.
Keywords: Aortic aneurysm; Brain injuries; Cardiac surgical procedures; Perfusion, methods; Cerebrovascular circulation; Aortic diseases, surgery
Middle mediastinal thymoma: case report
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
We report on a case of a 55-year-old female patient, who presented with clinical signs suggestive of myasthenia gravis over a period of approximately 3 months. The therapeutic option using neostigmine gave an improvement of the dysphagia and palpebral ptosis. A chest radiograph demonstrated a mass occupying the medium mediastinum with projection to the right. Computed tomography of the thorax revealed the presence of a mass in the medium mediastinum and thus surgery was indicated. During the operation the mass was observed in the medium mediastinum suggesting thymoma. What caught our attention was the unusual location of the tumor, as normally thymomas are found in the upper and anterior mediastinum.
Keywords: Thymoma, surgery; Thymus neoplasms; Mediastinal neoplasms
CLINICAL-SURGICAL CORRELATION
Case 3/2005 - Valvar treatment in a child suffering from rheumatic disease
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
Case 4/2005 - Obstruction of the systemic-pulmonary shunt in Fallot tetralogy
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025
LETTERS TO THE EDITOR
Letters to the Editor
Braz J Cardiovasc Surg 20;
Publish in: 8/2/2025