Volume 23 - Número 4
EDITORIAL
BJCVS on track to complete digitalization
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
SYNTAX Trial: analysis and clinical implications
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
ORIGINAL ARTICLE
In vitro formation of capillary tubules from human umbilical cord blood cells with perspectives for therapeutic application
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: Endothelial progenitor cells (EPC) caracterized by the CD133+ marker, contribute to the neovascularization. Increasing EPC number in vitro could be a promising therapeutic tool. Human umbilical cord blood maintains a significant number of EPC, suggesting the possibility to use these cells to induce the revascularization of ischemic tissues. The aim of this study was to analize the in vitro function of differentiated CD133+ cells. Methods: Cells were characterized by flow cytometry, VEGF mRNA expression was evaluated by the RT-PCR analysis and the functionally by essays of capillary tubes formation. Results: Differentiated cells lost EPC markers, maintained low levels of markers for hematopoietic and monocytic cell lines and increased the expression of adult endothelial cell markers. Differentiated cells expressed VEGF mRNA and were capable to induce in vitro capillary tubules formation. Conclusion: CD133+ cells differentiated into endothelial cells in vitro are functionally active initiating the possibility of their use in future therapeutic applications.
Keywords: Endothelial cells; Cell proliferation; Cord blood stem cell transplantation; Neovascularization, physiologic
Chronotropic response to exercise after pulmonary veins isolation or Cox-maze operation
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To evaluate the chronotropic response to exercise during immediate and late postoperative period after atrial fibrillation and mitral valve surgical treatment by different techniques. Methods: Prospective controlled clinical study of 42 patients presenting chronic AF associated mitral valve disease, who underwent surgery by the techniques of pulmonary veins isolation (n=16), Modified Cox-maze procedure, without crioablation (n=13), both with isolated mitral valve repair (n=13). The preoperative clinical characteristics, surgical indications, kind and aetiology of valve lesion were similar between groups. The patients were outpatient followed-up and underwent series of ergometric tests. Results: In the immediate postoperative period, chronotropic response was similar in the 3 groups with mean of 73.6 ± 12.3% of maximal calculated heart rate. In the surgical pulmonary veins isolation group, there was an increment of heart rate, from 64.4 ± 12.4% of maximal heart rate in the immediate postoperative period to 78.9 ± 10.5% in the 12th month (P=0.012) of postoperative. In the Cox-maze group, heart rate varied, respectively, from 73.9 ± 11.14% to 78.8 ± 15.2% (P=1.000) and in the control group (only mitral valve surgery), from 67.2 ± 14.3% to 71.9 ± 12.9% (P=0.889). Conclusion: An attenuation of immediate postoperative chronotropic response to exercise was similar in the postoperative in the three different surgical techniques. There was a significant improvement in this response concerning to postoperative outcome in the pulmonary veins isolation group. These results suggest that simple surgical pulmonary veins isolation may be related to a better preservation of atrial chronotropism.
Keywords: Atrial fibrillation; Cardiac surgical procedures; Mitral valve; Heart rate
Prevention of postoperative pericardial adhesions using thermal sterile carboxymethyl chitosan
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: The aim of this study is to evaluate CMC physical-chemical alterations after thermal sterilization and its efficacy in preventing poststernotomy pericardial adhesions. Methods: After autoclaving thermal sterilization, thermal sterile Carboxymethyl Chitosan (CMCts) was submitted to physical-chemical analysis. Twelve animals were divided into two groups and underwent pericardiotomy and adhesion induction protocol. Afterward, topic CMCts or saline solution was administered. After 8 weeks, a sternotomy was performed for adhesion score macroscopic evaluation, dissection time and the amount of recalcitrant dissection, and microscopic evaluation. Results: Physical-chemical analysis showed no difference between CMC and CMCts. A macroscopic analysis showed that the intensity of adhesions was significantly lower in the CMCts group (P=0.007). Dissection time and use of recalcitrant dissection also decreased significantly (P=0.007, P=0.008; respectively). Microscopic results indicated a significant reduction in the epicardium collagen area and in the total epicardium area (P=0.05) and (P=0.03). Conclusion: The sterilization method did not change Carboxymethyl Chitosan physical-chemical properties. Using barrier bipolymer, such as CMCts, can decrease the intensity of pericardium postoperative adhesions, reducing sternotomy complications in cardiovascular reoperations.
Keywords: Adhesions/prevention & control; Pericardium; Chitosan; Sterilization/methods; Cardiac surgical procedures; Swine
Central venous pressure in femoral catheter: correlation with superior approach after heart surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: It is common to obtain femoral venous approach in patients undergoing combined heart surgery or as an alternative to superior approach (internal jugular vein or subclavian vein). The aim of this study was to compare the measures of central venous pressure (CVP) at two different sites (superior versus femoral). Methods: We prospectively and openly allocated 60 patients who underwent heart surgery between July from November 2006. Three measures were obtained from each patient at each site (admission, 6 and 12 hours after surgery) in two different inclinations of the headboard (zero and 30 degrees) totaling 720 measures. Results: Fifty five percent of patients who underwent coronary artery bypass grafting, 38% heart valve surgery and 7% other surgeries. The mean of CVP ± standard deviation (SD) measured in superior approach was 13.0 ± 5.5 mmHg (zero degree) and 13.3 ± 6.1 mmHg (30 degrees) while the measures in inferior approach were 11.1 ± 4.9 mmHg (zero degree) and 13.7 ± 4.6 mmHg (30 degrees). The linear correlation (r) between the measures in both sites was 0.66 (zero degree) and 0.53 (30 degrees), both with p value<0.0001. Conclusion: The CVP can be measured with accuracy in the femoral venous approach in the immediate postoperative period of heart surgery with better linear correlation obtained with the measures made with the headboard positioned at zero degree.
Keywords: Central venous pressure; Femoral vein; Thoracic surgery; Cardiovascular surgical procedures
Long-term follow-up of patients undergone coronary artery bypass grafting with exclusive use of arterial grafts
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To evaluate the long-term results of the coronary artery bypass grafting with exclusive use of arterial grafts for patients with triple vessel disease. Methods: We evaluated 136 patients who underwent isolated coronary artery bypass grafting between January 1995 and December 1997. 353 grafts were used for revascularization of 449 arteries (mean: 3.30 per patient). Grafts used were left internal thoracic artery (99.2%), right internal thoracic artery (56.6%), radial artery (87.5%), right gastroepiploic artery (20.5%) and one inferior epigastric artery. 76 (55.8%) patients received composite grafts ("Y" shape) and 66 (48.5%) patients received sequential anastomoses. Results: Hospital mortality was 4.4%. In the long-term follow-up (9.5 to 12.8 years), 82.1% of the patients were free of cardiac events. 20 (17.9%) patients had hospital readmission due to cardiac events: 15 presented angina and five presented acute myocardial infarction, and three of them presented associated heart failure. Eigth (7.1%) patients needed coronary reintervention: one of them underwent coronary bypass reoperation and the others underwent coronary angioplasty with stent. Estimated probability of cardiac event-free was 98.2%, 95.4% e 84.2% at 1, 5 and 10 years follow-up respectively. There were 16 (14.2%) late deaths and four of them (3.6%) were cardiac-related. Actuarial 12.8-year-survival of all deaths was 85% in this group. Conclusion: Coronary artery bypass grafting with exclusive use of arterial grafts is a safe procedure for patients with triple vessel coronary disease with good long-term results.
Keywords: Myocardial revascularization; Arteriosclerosis/surgery; Mammary arteries; Radial artery
Factors associated with failure in ventilatory weaning of children undergone pediatric cardiac surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To assess factors associated with failure in ventilatory weaning of children undergone surgical correction of congenital heart diseases. Methods: Cohort study with 29 children. The heart diseases were divided into cyanotic (nine children) and acyanotic (20 children). We studied children from 0 to 5 years who underwent heart surgery with invasive mechanical ventilation. Results: The failure group presented smaller value in SpO2 and higher values during days of stay in IMV and FiO2 when compared to the success group (P<0.05). It was observed that 4 children (14%) had failed in weaning, being necessary to return the ventilatory prosthesis before 48 hours after extubation. Conclusion: The days of IMV, SpO2 and FiO2 were the main factors associated with failed extubation in this group of patients.
Keywords: Cardiac surgical procedures; Heart defects, congenital/surgery; Respiration, artificial; Ventilator weaning/adverse effects
Reconstruction of the chest wall with external metal brace: alternative technique in poststernotomy mediastinitis
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To demonstrate the experience with the reconstruction of the chest wall utilizing metal brace to reduce the tension in the suture lines of myocutaneous flap in cases of mediastinitis. Methods: From July 2001 to February 2006, 1389 heart surgeries were performed in our institution of which eight (0.6%) developed mediastinitis. Seven were male and the mean age was 56.7 years. The risk factors for infection were diabetes and obesity in seven and malnutrition in one case. Seven patients had been undergone CABG and one repair of a congenital heart disease. The chest wall reconstruction consisted of percutaneous insertion of Kirshner wires parallel to the edges of the wound for anchoring of sutures to the muscular plane in order to allow the reduction of tension in the free edges of the wound and subsequent closure of the subcutaneous tissue and skin. Results: There was one death in the immediate postoperative due to arrhythmia and one late death secondary to sepsis. The remaining patients presented satisfactory postoperative course with good healing of the wound after the removal of the metal braces on the 21th postoperative day and in the follow-up of 6 to 54 months. Conclusion: The reconstruction of the chest wall utilizing temporary metal braces showed to be a safe and effective procedure with good aesthetic and functional outcomes in this group of patients.
Keywords: Mediastinitis; Cardiac surgical procedures, adverse effects; Sternum, surgery; Osteomyelitis
First inflammatory risk score for aortic endoprostheses
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To purpose an inflammatory risk score for aortic aneurysm endovascular treatment. Methods: Twenty-five patients were followed-up from preoperative period to third month postoperatively (1-hour, 6-hour, 24-hour, 48-hour, 7-day, 1-month, 2- month and 3-month). Inflammatory variables were C-reactive protein, hemosedimentation velocity, interleukins (IL-6, IL-8), tumor necrosis factor-Alpha, L-selectin, intercellular adhesion molecule (ICAM-1), red blood cells transfusion, volume of crystalloid, volume of contrast, type of endoprosthesis, number of endoprostheses, total count of leukocytes and lymphocytes. Spearman test defined the variables considered as candidates to higher inflammatory risk based on P < 20%. Logistic regression defined the variables considered as selected for final score based on P < 10%. ROC curve analysis revealed the cut-off values for variables selected by logistic regression. Results: Variables defined by Spearman test were: volume of crystalloid (P=0.04), type of endoprosthesis (P=0.04), volume of contrast (P=0.02), preoperative IL-8 (P = 0.10), 1-month ICAM-1 (P=0.03) and 1-month L-selectin (P=0.06). Logistic regression revealed that volume of crystalloid and preoperative IL-8 values are relevant for composition of inflammatory risk score for aortic aneurysm endovascular treatment. Risk score would be divided into three categories (mild, moderate and severe) based on numeric intervals of these two variables and the categories would be correlated to clinical findings. Conclusion: Volume of crystalloid and preoperative IL-8 are variables that might contribute to categorize inflammatory risk and thereby might play a prognostic role for aortic aneurysm endovascular treatment.
Keywords: Prostheses and implants; Aorta/surgery; Risk; Risk assessment; Inflammation
Aortic valve preservation surgery in elderly patients with aortic stenosis
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: The aim of the present study was to investigate early and late results of the aortic valve preservation surgery (AVPS) through rough-hewing, demineralization and commissurotomy of the aortic valve (AV) in aortic stenosis (AS) at elderly people. Methods: Thirty-two patients operated for pure AS, older than 65 years-old were studied at InCor FMUSP. Early and late results, clinical (ambulatory and phone interview) and echocardiographic follow-up were investigated. Actuarial and event-free survival analysis was done using the Kaplan-Meier method. Results: Four patients (15.4%) had presented de novo AV stenosis. Five patients had progressed to moderate and two to serious aortic regurgitation. Demineralization, commissurotomy and rough-hewing were realized in 28, 20 and 16 patients, respectively. Nine patients had presented serious postoperative complications (28.1%). Two hospital-acquired pneumonia sepsis and five late deaths had occurred. Postoperative NYHA functional status were 70.5%, 17.6%, 5.8% and 5.8% for functional classes I, II, III and IV, respectively. Actuarial eight-year survival rate was 66.9 ± 12.1%. Eight-year free thromboembolism and endocarditis rate were 90.9 ± 8.7% and 100%, respectively. Conclusion: Aortic valve preservation surgery at the aged with AS was revealed a low morbidity and mortality procedure and presented an eight-year acceptable survival rate and functional status improvement among the studied series of patients.
Keywords: Aortic valve stenosis; Aortic valve/surgery; Heart valve diseases/surgery; Aged; Treatment outcome
The effect of the body mass index on postoperative complications of coronary artery bypass grafting in elderly
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objectives: To evaluate the effect of BMI (body mass index) in the postoperative period of elderly patients undergoing CABG. Methods: Cross-sectional retrospective study, carried out in academic hospital, with all patients (n=290), aged or above 60 years, undergone CABG, from August 2006 to July 2007. The patients were divided into tertiles of BMI (<22, 22-27,> 27kg/m²). The variables included in the study were collected from medical records of patients and analyzed by logistic regression in association with the categories of BMI. Results: In the group with malnutrition were found larger percentage of impaired lung, kidney, hospital stay and immediate surgical mortality; but without statistical significance. Among female patients, the group malnutrition and eutrophy, 61.5% had hospital stay for a period longer than seven postoperative days compared to 42.5% male patients (P=0.003). In the group with malnutrition was found association between the CPB time and renal dysfunction with P<0.001 and, in eutrophic group with P=0.04. Obesity obtained protective association for lung dysfunction (RR=0.99), readmissions (RR=0.45) and mortality (RR = 0.77), and risk factor for renal dysfunction (RR=1.12). Conclusions: In short-term, elderly with lower BMI may have increased the risk for complications. In contrast, obesity can have a protective effect, except for renal dysfunction.
Keywords: Body mass index; Myocardial revascularization; Aged; Postoperative complications
Cold stress effects on cardiomyocytes nuclear size in rats: light microscopic evaluation
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Introduction: Total body induced hypothermia and myocardial cooling are effective methods regarding myocardial protection during heart surgery and ischemia. It is described in previous studies that extreme low temperature exposure causes mitochondrial cristae and myofilament disarrangement in cardiomyocytes, however, no investigation has analyzed the effects of cold stress on nuclear size of cardiomyocytes. Objectives: To evaluate the effects of acute cold stress exposure on the nuclear size of cardiomyocytes in rats. Methods: The experimental study procedures were performed on 300-310g adult male Wistar rats. Rats (n=20) were divided into two groups: 1) Control (CON) and; 2) Induced hypothermic (IH) group. Animals of IH group were exposed during 4 hours once at a controlled temperature of - 8ºC. It was performed histological analysis of liver and adrenal gland to examine the stress condition of animals. Cardiomyocytes nucleus size were examined by three independent investigators with the same and standardized criteria and analyzed by Bartko's intra-class correlation coefficient (R>0.75 = positive concordance). Student's t test was applied. The significance level was set at P<0.05. Results: The induced hypothermic group presented higher lipid depletion in adrenal gland cells (P<0.05) and higher glycogen depletion in liver glycogen (P<0.05). The experimental group showed lower cardiomyocytes nuclear volume (108 + 1.7 µm3; P<0.05), it decreased in 76% compared to the control group (142 + 2.3 µm3). Bartko's correlation: CON=0.44; IH=0.96, variation analysis between group's means differences was significant. Conclusion: These data suggest that acute cold stress exposure induces cardiomyocytes nucleus size reduction in rats.
Keywords: Myocytes, cardiac; Cell nucleus structures; Cold; Stress
Aortic valve replacement with different types of prosthesis. Are there differences in the outcomes during hospital phase?
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To analyze intraoperative data and possible differences in clinical evolution during postoperative hospital phase for aortic valve replacement surgery using different types of prosthesis. Methods: Analysis of 60 patients divided into three groups. Valve replacement with bioprosthesis (20), mechanical prosthesis (20) and homologous valve (20). The mean age was 51.1, 60% were male and 40% female patients; 86.7 % were in NYHA II or III; 63.3% presented arterial hypertension and 18.3% had diabetes. Aetiology of valve disease was degenerative for 39%, rheumatic for 36% and endocardits for 15%. Results: The hospital mortality was 5%; there were no differences in the incidence of septical or cardiogenic shock, acute renal failure, rhythms disorders during surgery or intensive care, neither for total time in intensive care and mechanical ventilation. However, there was statistical differences as regards the cardiopulmonary bypass total time (P=0.02) and the aortic clamping time (P<0.0001) unfavorable to homograft valve group. The ward admission time was greater for mechanical valve group (P=0.05) as well as for total admission time, but without statistical significance. It was observed that patients with preoperative hematocrit smaller than 38.1% used 2.73 units of blood components, and with postoperative hematocrit smaller than 32% used 1,79 units of blood components. Echocardiography control showed minimal evolutional differences. Conclusion: The use of different types of prosthesis for this study does not cause differences in the results of postoperative hospital phase. The use of homograft valve is a feasible option with good clinical applicability.
Keywords: Heart valve diseases; Aortic valve/surgery; Transplantation, homologous; Cardiac surgical procedures
Warfarin prevents venous obstruction after cardiac devices implantation in high-risk patients: partial analysis
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objectives: To evaluate the efficacy of prophylactic use of warfarin in patients with high risk of lead-associated thrombosis. Methods: Clinical, prospective, randomized and blinded study, in patients submitted to first transvenous leads implantation with LVEF <0.40 and/or previous ipsilateral temporary pacing. After device implantation, patients were randomly assigned to placebo or warfarin. Periodical clinical and laboratorial evaluations were performed to anticoagulant management. After a six-month period, every patient was submitted to a digital subtraction venography. From February 2004 to November 2006, 101 patients underwent randomization. Baseline characteristics were similar in both groups (P=NS). Results: Venographic analysis showed 31.4% of venous obstructions in patients assigned to warfarin as compared with 57.1% in patients assigned to placebo (RR= 0.57 [95% CI, 0.33 to 0.98]; P=0.015). In the warfarin group, 72% of the PT/INR tests were in therapeutic INR range. Only one patient required warfarin discontinuation and cross-over to placebo group due to gastrointestinal bleeding. Conclusions: These preliminary results showed that the anticoagulation therapy has been safe and reduced the frequency of venous thrombosis after transvenous cardiac devices implantation in high risk patients.
Keywords: Cardiac pacing, artificial; Postoperative complications; Venous thrombosis; Anticoagulants; Clinical trial
Risk factors in septuagenarians or elderly patients undergone coronary artery bypass grafting and or valves operations
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objectives: Septuagenarians or older patients needing heart surgery has increased in whole world. The objective of study is to know the characteristics of this group of patients and determine the risk factors for operative morbidity. Methods: We revised the medical records of 783 patients undergone heart valve surgery, myocardial revascularization or both between 2002 and 2007. The patients were divided in "control group" (<70 years) "septuagenarian group" (70 years old or more). Results: One hundred ninety seven patients were at least 70 years old (mean age 74.1±3.9) and 61% were male. In the control group the mean age was 52.1±11.7 and 54% were male. In the septuagenarians group it was significantly higher the proportion of patients suffering from peripheral vascular disease (9% versus 5%, P=0.019), carotid artery obstruction (5% versus 2%, P=0.026), unstable angina (17% versus 9%, P=0.018). In both groups coronary artery bypass surgery prevailed. In the septuagenarian group 41% of the patients had a least one morbid event, versus 22% of the patients in the control group (P<0.001). Postoperative bleeding, pulmonary complications, mediastinitis, need of vasopressors, renal dysfunction and strokes were significantly higher in the septuagenarian group. The mortality was higher in the septuagenarian (19% versus 8.5%, P<0.001). The logistic regression revealed that COPD (OR: 8.6), EF < 35% (OR: 7,1), non-elective operation (OR: 17,2) and cardiopulmonary bypass time >120 min (OR: 3,4) were predictive of hospital mortality in septuagenarian or older patients. Conclusions: The hospital mortality of septuagenarians or elderly is significantly higher than younger patients.
Keywords: Aged; Cardiac surgical procedures; Myocardial revascularization; Heart valves/surgery; Risk factors
New technology: valve repair using biodegradable rings
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To introduce a new concept in the annuloplasty technology. Although rigid and flexible rings meet the basic needs of adults, they do not preserve the changes in shape and size occurring during the cardiac cycle. If implanted in children, such materials do not allow growth of the native annulus. Methods: From March 2003 to March 2007, 207 patients underwent mitral and/or tricuspid valve repair implanting polidioxanone biodegradable rings - Bioring®. Patients were divided into two groups: Group 1, Adults: n=121. Mean age: 48 years (± 19.2). Oldest 85 years. Group 2, Pediatric: n=86. Mean age: 9.6 years (± 4.4). Youngest 0.5 years. Results: Group 1, Hospital mortality: 3.3%. Mean follow-up: 26.4 months ± 15.4. Four patients underwent mitral valve replacement 1, 2, 2 and 4 months post repair. Group 2, Hospital mortality: 1.2%. Mean follow-up: 26.7 months ± 13.4. Seven mitral reoperations within 1 to 24 months, two for valve re-repair, five for valve replacement. Conclusions: Biodegradable rings remodel the shape, reinforce the repair, restore the function of the atrioventricular valves and maintain the three dimensional dynamic motion and geometry of the mitral and tricuspid valves annulus. Growth potential is preserved in children. Although the biodegradable annuloplasty ring was first designed and developed for a pediatric population, it is currently applied to adult cases. Children with single ventricle and AV valve incompetence are an additional indication. The mid-term results showed that degradation of the device occurred without negative observable consequences. Long-term results should confirm these findings.
Keywords: Heart valves; Absorbable implants; Heart valve prosthesis; Mitral valve/surgery; Tricuspid valve/surgery
REVIEW ARTICLE
Respiratory physiotherapy in the pulmonary dysfunction after cardiac surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
The aim of this work is to make a critical review about the different techniques of respiratory physiotherapy used following cardiac surgery and this effectiveness in reverting pulmonary dysfunction. It has been used as reference publications in English and Portuguese using as key words thoracic surgery, respiratory exercises, physical therapy modalities, postoperative complications and myocardial revascularization, contained in the following databases - BIREME, SciELO Brazil, LILACS, PUBMED, from 1997 to 2007. A secondary search of the reference list of identified articles also was made. It has been selected eleven randomized trials (997 patients). For the articles included incentive spirometry was used in three; deep breathing exercises in six; deep breathing exercises added to positive expiratory pressure in four and positive airway pressure added to inspiratory resistance in two. Three trials used intermittent positive pressure breathing. Continuous positive airway pressure and bi-level positive airway pressure has been used in three and two trials. The protocols used in the studies were varied and the co interventions were present in a big part of these. The different analyzed varieties and the time of postoperatory follow up make a comparative analysis difficult. Pulmonary dysfunction is evident in the postoperatory period of cardiac surgery. The use of non-invasive ventilation has been associated with good results in the first postoperatory days. Despite the known importance of postoperatory respiratory physiotherapy, until now, there is no literary consensus about the superiority of one technique over the others.
Keywords: Thoracic surgery; Breathing exercises; Physical therapy modalities; Postoperative complications; Myocardial revascularization
SPECIAL ARTICLE
Specialty Outpatient Clinics: agility and resolution
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
CASE REPORT
Involution of aneurysmal collateral arteries after correction of aortic coarctation
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
A 47 year-old man with aortic coarctation had undergone extra-anatomic bypass through a left thoracotomy. He presented 10 years later with uncontrolled arterial hypertension due to residual aortic coarctation, graft obstruction and multiple collateral artery aneurysms between the subclavian artery and the aorta. He underwent extra-anatomic correction between the ascending aorta to descending aorta through a median sternotomy with the aid of conventional cardiopulmonary bypass. His postoperative recovery was unremarkable, and there was complete involution of all aneurysmal collateral arteries after the operation.
Keywords: Aortic coarctation/surgery; Heart defects, congenital; Collateral circulation
Thymic cyst as a differencial diagnosis of acute thoracic aortic disease
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Patient was referred to our Service with acute thoracic pain and diagnosis of intramural hematoma of the ascending aorta for surgical correction. The diagnostic investigation showed a cystic tumor involving the ascending aorta causing restriction of the right ventricular inflow. After resection, the histologic analysis disclosed the diagnosis of thymic cyst. The aim of this study is to describe a rare mediastinal tumor that may simulate a radiologic feature with characteristics of intramural hematoma and may result in a wrong therapeutic approach.
Keywords: Mediastinal cyst; Thymus neoplasms; Diagnosis, differential
Resection of left ventricular myxoma after embolic stroke
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Cardiac myxoma is the most common primary tumor of the heart. The tumor is located mainly in the left atrium but can arise from any heart chamber. Clinical symptoms are variable but dyspnea and embolism are the most frequent. We report a case of a young man that had embolic ischemic stroke caused by a large left ventricular myxoma. The patient underwent surgery three weeks after the stroke. The tumor was carefully resected without fragmentation. Surgical treatment was effective. We emphasize the rarity of this location together with a review of the current literature.
Keywords: Heart neoplasms; Myxoma; Stroke; Heart ventricles/pathology; Cardiac surgical procedures; Extracorporeal circulation
CLINICAL-SURGICAL CORRELATION
Ostium Secundum-type interatrial communication: few clinical symptoms and great hemodynamic repercussion
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Enlargement of the right ventricular outflow tract using autologous pediculated pericardium in the tetralogy of fallot treatment
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Acute aortic dissection associated with hypertensive emergency
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
MULTIMEDIA
Closure of the interventricular communication of right ventricular inflow tract
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
LETTERS TO THE EDITOR
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ACKNOWLEDGMENT
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