Volume 21 - Número 3
EDITORIAL
Medicine accelerates growth of scientific research in Brazil
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Reutilization of medical equipment
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
SPECIAL ARTICLE
Vulnerability of atherosclerotic carotid disease: from laboratory to operating room - Part 2
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
ORIGINAL ARTICLE
Radial artery versus saphenous vein to myocardial revascularization: meta-analysis (there is no statistically significant difference)
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Objective: To compare the effectiveness of radial artery graft with saphenous vein graft to myocardial revascularization, in association with the internal thoracic artery.
Methods: We made a systematic review of literature, using a strategy to search articles applied to MEDLINE and LILACS databases. Two independent researchers have carried through the election of identified articles, evaluating carefully the methodology of articles considered excellent for the subject. Only the randomized controlled trials, with adjusted randomization system have been enclosed. All the situations where the researchers didn't agree there was a consensus meeting. It hasn't been stipulated restriction for postoperative period to graft angiographic evaluation, the vessel treated and enclosed patient's characteristics. The results have been expressed as Risk Relative (RR), with 95% of Confidence Interval (CI), to comparison the effectiveness between the radial artery and the saphenous vein.
Results: Based in these criteria three studies have been enclosed. We couldn't find statistic difference between grafts' patency studied (RR 0.53 [95% IC 0.13 - 2.18]).
Conclusion: Despite of the studies have good methodological quality, we have not observed a result significant statistically benefiting one of the grafts. The statistical power of the meta-analysis is low, therefore, it's necessary more randomized controlled trials, with adjusted sample size to detect possible differences between the considered treatments.
Keywords: radial artery, meta-analysis, myocardial revascularization, saphenous vein
Proportion among the segments of the normal tricuspid valve annulus: parameter for valve annuloplasty
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Objective: The purpose of this study was to determine the proportions among the segments of the human tricuspid valve annulus.
Methods: A descriptive autopsy study was made of 30 human hearts without fixation, within six hours of death, without congenital or acquired lesions and without tricuspid regurgitation. Tricuspid valve insufficiency was excluded by the infusion of pressurized water in the right ventricle with the pulmonary valve closed. Digital images of the tricuspid ring in its anatomical position and after flattening were analyzed by specific software. The mean measurements and ratios were compared in the two different situations.
Results: The mean measurements of the perimeter, septal and antero-posterior segments of the tricuspid ring in the anatomical position were: 105mm (±12.7), 30.6mm (±3.7) and 74mm (±9.4), respectively. When flattened, the mean measurement of the perimeter was 117.5mm (±13.3) and sizes of the septal, anterior and posterior segments were 32mm (±3.7), 46.3mm (±8.3) and 39.1mm (±8.5), respectively. The mean ratio between the antero-posterior and septal segments was 2.43 (±0.212) in the anatomical position and when flattened it was 2.67 (±0.304). Statistical differences were observed in the measurements of perimeter (p<0.0001), septal segment (p=0.003) and antero-posterior segment (p<0.0001) in both situations. Statistical differences also occurred in the ratios between the antero-posterior and septal segments (p=0.0005).
Conclusions: The proportion between the septal and antero-posterior segments of the normal human tricuspid valve is 1:2.43. Flattening the tricuspid ring to measure the segments, changes the values and the ratios between them.
Keywords: Anatomy; Heart; Tricuspid valve
Experimental assessment of a new electrode for fetal pacing
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Objective: The prognosis of congenital complete heart block (CHB) is very poor when manifested with fetal hydrops. Fetal pacing may improve the survival rate. This study aims to assess the electrophysiological characteristics of a new lead, as well as fetal hemodynamic and metabolism under different fetal heart rates.
Methods: The new lead (T-shaped) was deployed into the myocardium of five fetal goats. Fetal cardiac output was measured by a flow transducer. CHB was achieved by cryosurgical ablation of fetal AV node. Electrophysiological parameters, hemodynamic and metabolic behavior of the fetus under different fetal heart rates were evaluated.
Results: The acute stimulation thresholds were consistently low. The voltage strength-duration curve remained relatively constant at pulse widths > 0.5 msec. The stimulation resistance was 1050.4 ± 76.6 ohms, and the sensed fetal R wave was 8.6 ± 5.6 mV. Fetal heart rate bellow 60 bpm was associated to low cardiac output and low blood pressure (p<0.05). Fetal bradycardia also determined oxygen saturation drop parallel to low cardiac output, with severe hypoxia below 60 bpm.
Conclusions: The new lead allows for a less invasive procedure and stable fixation to the myocardium that may prevent lead dislodgement after fetal recovery. It seems to be compatible with safe chronic stimulation. This study suggests that a gradual increase in the fetal rate beginning on 80 bpm after implantation would be more adaptive and adequately augment fetal cardiac output.
Keywords: Fetal heart, surgery; Heart block, congenital; Heart block, surgery; Hydrops fetalis; Pacemaker, artificial
End stage cardiomyopathy and secondary mitral insufficiency: surgical alternative with prostesis implant and left ventricular remodeling
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Objective: To present a new surgical approach that consists of the implantation of a mitral prosthesis smaller than the annulus with traction of the papillary muscles to reduce the sphericalness of the left ventricle.
Method: Between December 1995 and September 2005, 116 heart disease patients were operated, all of whom were at end-stage despite of full medication. The patients were analysed according to clinical criteria, echocardiographic findings and morphology of the left ventricle.
Results: Hospital mortality was 16.3% (19/116) and mid-term follow-up (38 ± 16 months) showed evidence of improvement in the clinical status and some echocardiographic parameters, in particular reduction of the sphericalness of the left ventricle.
Conclusion: This technique, despite of the high mortality rate, offers a promising therapeutic alternative for the treatment of patients in refractory heart failure with cardiomyopathy associated to moderate or severe secondary mitral regurgitation.
Keywords: Congestive heart failure; Dilated cardiomyopathy; Mitral valve insufficiency
Evaluation of platelet aggregation and level of fibrinogen in patients with cardiovascular diseases and the correlation of taking aspirin with coronary risk factors
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Objective: To evaluate aspirin resistance in patients with cardiovascular diseases and to compare the amount of serum fibrinogen in patients taking aspirin with those who do not. To correlate the platelet aggregation and serum fibrinogen to cardiovascular risk parameters.
Method: Eighty-two patients were divided into two groups: Group 1 - 41 patients who took 100mg aspirin daily and Group 2 - 41 patients who did not utilized platelet antiaggregates. Epidemiological data were collected including age, gender and information on smoking and alcohol intake and serum fibrinogen and platelet aggregation were mesured.
Results: In the groups analyzed, advanced age (p=0.011), smoking (p=0.009) and alcoholism (p=0.007) were directly associated to the serum fibrinogenen level. There were no correlations between smoking, alcoholism, serum fibrinogen and platelet aggregation values (p>0.05). In Group 1, 29% of the patients presented with aspirin resistance. Of these, smokers (p=0.029) and the alcoholics (p=0.033) had higher serum fibrinogen levels.
Conclusion: Aspirin resistance was present in a high number of patients. Moreover, advanced age, smoking and alcoholism had a direct influence on the serum fibrinogen levels.
Keywords: Fibrinogen; Platelet aggregation; Aspirin, pharmacokinetics; Cardiovascular diseases
Analyses of the immediate effect of CO2 flow on vascular endothelium in goats
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Objective: The purpose of this study was to assess the effect of CO2 on the wall of the Left Internal Thoracic Artery (LITA) and Anterior Interventricular Artery (AIVA) in an experimental model using goats, comparing the immediate effects of the use of CO2 at flow rates of 5 L/min and 10 L/min during 20 minutes, with intermittent flow (every 30 seconds) with and without humidification, simultaneously to the LITA and AIVA.
Methods: Thirty-six male goats were submitted to a surgical procedure. Histological analysis was carried out using the immunoperoxidase reaction to mark the endothelium through the detection of VIII Coagulation Factor. Measurement was made by Quantimet following the Ip scale for vascular injury.
Results: Within control groups, with and without humidification, both for AIVA and LITA, there was no endothelial injury. The flow rate of 5 L/min provoked moderately significant endothelial injury of the AIVA without humidification, whereas with humidification the endothelial injury was seen but without statistical significance. The flow rate of 5 L/min, with or without humidification, provoked insignificant endothelial injury at LITA. With a flow rate of 10 L/min, there was highly significant endothelial injury, both for the LITA and AIVA and whether humidified or not.
Conclusions: In conclusion endothelial injury is flow-dependent with greater injury when using CO2 at a flow rate of 10 L/min and less at 5 L/min. The arteries involved in anastomosis (LITA and AIVA) are both affected, but there is a greater effect on the AIVA.
Keywords: Coronary disease, surgery; Carbon dioxide; Mammary arteries; Endothelium, injuries; Animal models
Use of ethanol in preventing calcification of porcine pulmonary heterograft: experimental study in sheep
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Objective: The objective of this work was to comparatively evaluate the use of ethanol (E) with glutaraldehyde (GDA) to inhibit the calcification of the porcine pulmonary valvar heterografts (PPVH) implanted in the right ventricle outflow tract of young sheep.
Method: Ten young sheep were used, divided into two similar groups: the GDA (control) Group and the Ethanol Group (in which the PPVH were pre-treated with ethanol-80). The surgery consisted of implanting the PPVH in the right ventricle outflow tract using a cardiopulmonary bypass. Echocardiography was performed to measure the transvalvar gradient and macroscopic analyses of the PPVH wall and microscopic analysis for calcification were performed. The amount of calcium was measured in the valve cusp at 210 days.
Results: The quantity of calcium in the PPVH of the GDA Group was 7.98 ± 6.82µg calcium/mg tissue and of the E Group it was 0.31± 0.33µg calcium/mg tissue. In respect to the maximum transvalvar gradient at 30 days, there was no significant difference between the groups. At 90, 180 and 210 days however, the GDA Group showed a greater transvalvar gradient than the E Group. The macroscopic analyses of the heterograft wall evidenced calcification in both groups but it was more pronounced in the GDA Group. The microscopic analysis of the cusp valve revealed the presence of calcification in all animals of the GDA Group, while in the E Group no calcification was seen.
Conclusion: In conclusion ethanol-80 inhibits calcification on the cusps during the period of the analysis but does not inhibit the calcification of the PPVH.
Keywords: Ethanol; Sheep; Calcinosis; Transplantation heterologous; Glutaral
Experiencing heart transplantation: the patients' perspective
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
bjective: For patients with heart failure, heart transplantation represents the possibility of survival and improvement in their quality of life. Thus, the awareness and participation of patients in the follow-up work by the healthcare team after transplantation are important. This study aimed at understanding the experience of heart transplantation based on the description of patients.
Methods:Twenty male and six females patients, whose ages ranged from 13 to 71 years old, were interviewed. The similarities of their accounts illustrated shared feelings which described their experiences.
Results: The patients re-experienced the transplantation phases and compared heart failure symptoms with the improvement achieved after transplantation. Some felt healthy whereas others reported the persistence of rejection and complications as well as the onset of other pathologies. However, all of them noted the improvement in their quality of life. Each one brought his own views concerning the experience itself, their relatives and the professionals who participated in their experience. They expressed their expectations regarding work and family achievements.
Conclusion: The contribution from this descriptive study lies in unveiling new perspectives of understanding such patients' needs, thus helping professionals who assist them to respond more effectively to their individuals necessities.
Keywords: Heart transplantation; Quality of life; Adaptation, psychological
A pulmonary ventricle system producing pulsatile pressure in single ventricle: experimental model
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Objective: Patients with functional single ventricle show bad survey, most of which result in cardiac failure even in the case that they are operated. The right heart bypass operations except for right atrium and right ventricle connections lack pulsatile pulmonary ventricle system besides the volume lack coming to the common ventricle. To solve the problem, we tried to create a pulmonary ventricle which produces pulsatile pressure experimentally.
Methods: We tried to form a right ventricle system which produces pulsatile pressure. The experimental model was carried on six sheep. The pressures of the created pulmonary ventricle, pulmonary artery and the left ventricle were measured after leaving the cardiopulmonary bypass.
Results: The mean of the systolic and diastolic pulmonary artery pressures were 15,6 ± 2.0 mmHg and 4.5 ± 1.5 mmHg. The mean of the left ventricular systolic pressure was mean 76.6 ± 4.4 mmHg.
Conclusion: A ventricle producing pulsatile pressure is necessary for regulating the pulmonary artery flow with high central venous pressure and low non-pulsatile pulmonary pressure in the anomalies with functional single ventricles.
Keywords: Heart ventricles, abnormalities; Heart defects, congenital; Heart bypass, right
Adverse events and reasons for discard related to the reuse of cardiac catheters in percutaneous transluminal coronary angioplasty
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Objective: To describe the adverse effects that occur during and after percutaneous transluminal coronary angioplasty (PTCA) possibly related to the reuse of medical equipment. An additional objective is to quantify and identify the reasons of discard in respect to the brand-new and reuse of medical equipment.
Method: Sixty patients were studied (48.3% with unstable angina, 45% with acute myocardial infarction and 6.7% with other diagnoses). During the procedure and stay in the Intensive Coronary Unit, the occurrence of fever, hypotension or hypertension, chills, sudoresis, bleeding, nausea and vomits were observed. Seven products were evaluated: catheter introducer, catheter guides (0.35 and 0.014), catheter balloons for angioplasty, indeflators and manifolds. In total, 76 brand-new and 410 reused apparatuses were studied to verify the occurrence of discard, whether this happened before or during the procedure and for what reasons. P-values 0.05 were considered signicant.
Results: Twenty-six patients presented adverse effects. Hypotension was the most common seen in 11(18.3%) cases. There was no significant association between this adverse effect and reuse or not of the equipment. Three brand-new products and 55 of the reused products were discarded as they were incomplete.
Conclusion: The adverse effects presented by patients submitted to coronary vessel angioplasty were not associated to the reuse of the medical equipment. The integrity and functionality were the main reasons of discard.
Keywords: Equipment reuse, risk factors; Equipment safety; Decontamination, methods; Sterilization, methods; Percutaneous coronary transluminal angioplasty
REVIEW ARTICLE
Reuse of cardiac catheters: a review
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Hemodynamic catheters are widely reused mainly in developing countries where the cost of new devices is very high. Scientific publications point to an absence of validated cleaning and sterilization processes and there is a consensus that reusing these devices causes physical, chemical and funcional damage. So what is the evidence related to the use of this kind of catheter? The objective of this study is to identify the scientific evidence related to the effects of reprocessing. A search for publications in English, Portuguese and Spanish was performed in Medline/Pubmed and LILACS using Medical Subject Headings (MeSH) terms and free terms without stipulating restraints on time. In total 21 papers were analized. It was found that there is commonly damage to the surface polymers as identified by eletronic microscopy. Failure in the cleaning and sterilization process was identified by the presence of debris and microrganisms at the end of the procedure. The results of this study are very important when choosing to reuse hemodynamic catheters.
Keywords: Balloon dilatation, instrumentation; Cross infection; Sterilization; Equipment reuse
EXPERIENCE THE OF SERVICE
Carotid artery inflow and anterograde cerebral perfusion in operations to correct aortic disease
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Objective: To evaluate the use of the right common carotid artery to establish cardiopulmonary bypass (CPB) and the use of anterograde cerebral perfusion as cerebral protection in patients scheduled for ascending aortic repair surgery.
Methods: Twenty-three patients were submitted to aortic repair because of different aortic diseases. In all of them a Gore-tex tube was anastomosed to the right common carotid artery to establish CPB and anterograde cerebral perfusion during distal anastomosis. Average CPB time was 195 minutes; average temperature was 24 degrees Celsius; average anterograde cerebral hypoperfusion time was 29 minutes; average hospital stay was 18 days.
Results: None of the 23 patients had any neurological dysfunction within the first 48 postoperative hours. Prior to discharge, all of them were submitted to the "Mini Mental State Examination (MMSE)" which did not identify any cognitive dysfunction or neurological injury. Two patients developed pulmonary infection, two patients needed dialysis and two patients died due to the high complexity of the cases. There were no perioperative deaths.
Conclusion: This is a practical, fast, efficient and reproducible way to establish CPB and anterograde cerebral protection, reducing the risk of cerebral ischemia and improving the natural postoperative outcome of these procedures.
Keywords: Aorta, surgery; Carotid artery, common; Extracorporeal circulation; Perfusion
CASE REPORT
Left sinus Valsalva aneurysm into anterior wall of right ventricle
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
The case of a 36-year-old male suffering from left sinus Valsalva aneurysm into anterior right ventricle and severe aortic valve regurgitation is presented. Diagnosis of this association was achieved before surgery by cardiac catheterization and Echocardiography. The patient was submitted to surgical repair by closing the orifice of the aneurysm using a bovine pericardium patch. The aortic valve regurgitation was repaired using Trusler's procedure.
Keywords: Aneurysm; Sinus of Valsalva; Aortic valve insufficiency, surgery
Ruptured thoracoabdominal aortic aneurysm in the right pleural space
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
CLINICAL-SURGICAL CORRELATION
Rastelli procedure with decellularized pulmonary homograft
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
Extended aortoplasty with bovine pericardium in the treatment of supravalvar aortic stenosis (Doty technique)
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025
LETTERS TO THE EDITOR
Letters to the Editor
Braz J Cardiovasc Surg 21;
Publish in: 8/2/2025