Volume 24 - Número 3
EDITORIAL
BJCVS globalization
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
The new Qualis, which has nothing to do with the science of Brazil. Open letter to the president of CAPES
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
The pediatric cardiac surgery as a philanthropic activity in the country and humanitarian mission abroad
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
ORIGINAL ARTICLE
Journal impact factor: this editorial, academic and scientific influence
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
In this report the authors present information on the bibliometric instruments and their importance in measuring the quality of scientific journals and researchers. They in particular the history and deployment of the impact factor of the existing Institute for Scientific Information since 1955. Are presented and discussed the criticism regarding the inadequacy of the impact factor for evaluation of scientific production, misuse and strategies editorial handling of the bibliometric index. It is presented to the new classification CAPES for the journals, based on various criteria and the impact factor and its influence on national scientific and academic life. The authors conclude that, despite all obstacles and discussions, the impact factor of the Institute for Scientific Information is still an useful tool and the only isolation available to assess the scientific and intellectual productivity.
Keywords: Impact factor; Citation index; Bibliometrics indicators
Prevalence and risk factors for acute renal failure in the postoperative of coronary artery bypass grafting
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
OBJECTIVE: To determine the prevalence, risk factors, and the clinical outcome of patients undergone coronary artery bypass grafting who progressed with Acute Renal Failure (ARF). METHODS: A retrospective cohort prospective study was performed from data of 186 patients undergone surgery from January 2003 through June 2006. The stored data were analyzed using the software STATA 9.0. RESULTS: The prevalence of ARF was of 30.6% (57/186). In 7.0% (4/57) dialysis therapy was needed. The mean age of patients with and without ARF progression was 62.8 (±9.4) years and 61.3 (±8.8) years respectively (P=NS). CPB time >115 min (p= 0.011) and cross-clamp time >85 min (p=0.044) were related to ARF by the univariate analysis. The need for intra-aortic balloon (P= 0.049), mechanical ventilation >24h (P = 0.006), Intensive Care Unit (ICU) stay > three days (P< 0.0001), bradycardia (P= 0.002), hypotension (P= 0.045), arrhythmia (P=0.005) and inotropic infusion (P= 0.0001) were higher in the ARF group. Only the ICU stay longer > 3 days showed statistical correlation with ARF by the multivariate analysis (P=0.018). The mortality rate with and without ARF was 8.8% (five cases) and 0.8% (one case) respectively (P=0.016), but it reached 50% (2/4) in dialytic patients. CONCLUSION: ARF was a frequent and severe postoperative complication associated with higher mortality and longer ICU stay, which presented as risk factors: longer CPB and cross-clamp times, mechanical ventilation > 24h and hemodynamic instability
Keywords: Myocardial revascularization; Risk Factors; Renal insufficiency, acute
Cystatin C and glomerular filtration rate in the cardiac surgery with cardiopulmonary bypass
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Objective: The aim of this study was to compare cystatin C versus creatinine as a marker for acute kidney injury in patients submitted to cardiac surgery with cardiopulmonary bypass. Methods: Fifty consecutive patients submitted to coronary artery bypass grafting were studied. Renal function was evaluated by serum cystatin C and creatinine. Blood samples were obtained from each patient at three time points: before operation, and on the first and fifth postoperative days. Glomerular filtration rate (GFR) was calculated by Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Larsson (Cys-GFR) formulas. Results: Creatinine and GFR by CG and MDRD formulas did not show statistical difference between study times. After renal injury from surgery, there was an increase in cystatin C on the 1st and 5th day after surgery, being significantly different on the 5th postoperative (P<0.01). The GFR by Larson formula was higher in the preoperative time (105.2 ± 41.0 ml/min) than in the 5th postoperative day (89.5± 31.5 ml/min; P<0.012). Conclusion: The cystatin C and the Cys-GFR showed significant changes after cardiac surgery when compared with the creatinine and respective GFR calculated by the Cockcroft-Gault and MDRD formulas.
Keywords: Cystatins; Extracorporeal circulation; Creatinine
Expression of apoptosis in human saphenous vein grafts in restoration of blood flow through coronary bypass surgery
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Objective: To investigate the possible role of apoptosis on brief distensions of human saphenous veins at different pressures. Methods: Fresh isolated grafts of human saphenous vein were assigned as control or distended (D) for fifteen seconds at 100, 200 and 300 mmHg. The degree of apoptotic caspases 3, 8, 9 and anti-apoptotic protein Bcl-2 expression were assessed by immunohistochemistry. Results: Fresh isolated segments of distended human saphenous veins presented similar apoptotic protein expression when compared with control veins. However, the Bcl-2 expression was significantly higher in the 300 mmHg distended segments compared with the control vein. Conclusion: These findings show that intact segments of human saphenous veins submitted to distensions at different pressures have similar apoptotic proteins expression when compared with non-distended control veins. Therefore, brief distensions commonly performed during surgical harvesting do not trigger apoptosis, and probably are not involved on the physiopathological mechanisms that lead to graft failure.
Keywords: Apoptosis; Cardiac surgical procedures; Saphenous vein
Video-assisted cardiac surgery: results from a pioneer project in Brazil
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
OBJECTIVE: To demonstrate the possibilities of the use of videothoracoscopy in cardiac surgery using cardiopulmonary bypass (CPB). METHODS: Between February 2006 and November 2008, 102 patients underwent consecutively minimally invasive video-assisted cardiac surgery. The cardiac pathologies approached were: mitral valvopathy (n=56), aortic (n=14), interatrial communication (IC) (n=32), six patients presented associated tricuspid insufficiency and 12 presented atrial fibrillation. The age ranged from 18 to 68 years and 57 were female. The surgical approach was: femoral arterial and venous cannulation, minithoracotomy ranging from four to six centimeters (cm) at the level of the 3º or 4º right intercostal space (RICS), depending on the pathology of the patient, between anterior axillary line and hemiclavicular line, submammary or right periareolar groove through the right breast and thoracoscopy. RESULTS: The surgical procedures were: plasty (n=20) or mitral valve replacement (n=36), aortic valve replacement (n=14), atrioseptoplasty using pericardial patch (n=32), tricuspid valve repair with rigid ring (n=6) and surgical correction of atrial fibrillation with radiofrequency (n=12). There were no complications during the procedures. There was no conversion to thoracotomy in neither case. Two patients developed atrial fibrillation in the postoperative period. There was an episode of stroke seven days after the hospital discharge and one death (0.9%) due to systemic inflammatory response syndrome (SIRS). CONCLUSION: This study demonstrates the coverage of pathologies that are possible to be approached by video-assisted cardiac surgery with cardiopulmonary bypass being a safe and effective procedure with low morbimortality. Minimally invasive video-assisted cardiac surgery is already a reality in Brazil, demonstrating excellent aesthetic and functional results
Keywords: Minimally invasive surgical procedures/methods; Thoracic surgery, video-assisted; Heart valves/surgery; Heart defects, congenital/surgery; Atrial fibrillation/therapy
Pulmonary artery banding: a simple procedure? A critical analysis at a tertiary center
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
OBJECTIVE: Although pulmonary artery banding (PAB) seems to be a technically simple procedure it presents several peculiarities and is related to a significant morbidity and mortality. The aim of this study is to analyze the experience of a tertiary hospital on the PAB by assessing and correlating many aspects related to the procedure. METHODS: Between January 2000 and December 2008, 61 patients undergone PAB due to congenital heart disease with increased pulmonary blood flow at Messejana Heart Hospital were assessed as for mortality, complications, stay in mechanical ventilation and need for intensive care unit (ICU), use of vasoactive drugs, difficulties in the adjustment on the banding and reoperations. Some statistical analyzes were performed to compare the subgroups. RESULTS: In 46.8% of the patients the intended pressoric adjustment was not achieved and in 6.5% it was necessary another surgery to readjust the banding. The mean time of mechanical ventilation was 14.1±49.6 days and ICU 14.16±10.92 days. In 82.6% of the patients vasoactives drugs were administrated for 10.3±12.79 days. Severe complications were noted in 49.15% of patients and cardiac insufficiency was the most common one with an incidence of 44%. The mortality rate was 8.2% and it was not influenced by weight or associated procedures with the PAB neither if univentricular or biventricular heart disease. CONCLUSION: The PAB can be performed with acceptable mortality rates compatible with the ones of the world literature. Nevertheless, the adjustment of the banding is difficult to be assessed during the surgery by making the procedure complex and justifying the high incidence of complications and long stay in ICU. It wasn't found any specific risk factor significant to mortality neither uni- or biventricular heart disease
Keywords: Cardiac surgical procedures; Pulmonary artery/surgery; Heart ventricles; Heart defects, congenital/surgery
Risk factors for hospital mortality in valve replacement with mechanical prosthesis
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Objective: Identification of risk factors for cardiac surgery can improve surgical results. Our aim is to identify factors related to increased hospital mortality for patients who underwent mechanical cardiac prosthesis implant. Methods: Prospective study with retrospective data acquirement study including 335 consecutive patients who underwent at least one implant of St. Jude Medical mechanical prosthesis between December 1994 and September 2005 at the Cardiology Institute of RS. Valve implants were 158 (47.1%) in aortic position, 146 (43.6%) in mitral and 31 (9.3%) in aortic and mitral. The following characteristics were analyzed in relation to hospital death: gender, age, body mass index, NYHA functional class, ejection fraction, type of valve lesion, hypertension, diabetes mellitus, serum creatinine, preoperative arrhythmias, prior heart surgery, CABG surgery, concomitant tricuspid valve surgery and operative priority (elective, urgent or emergent). Logistical regression was used to analyze data and odds-ratio was calculated for individual factors. Results: During the follow-up there were 13 (3.88%) deaths. In-hospital mortality risk was associated with serum creatinine (P<0.05), ejection fraction < 30% (P<0.001), mitral valve lesion (P<0.05), concomitant CABG surgery (P<0.01), prior cardiac surgery (P<0.01) and reoperation (P<0.01). Increased odd-ratio were related to previous cardiac surgery (5.36; IC95% 0.94-30.56), combined revascularization (5.28; IC95% 1.51-18.36), valvar reoperation (4.69; IC95% 0.93-23.57) and concomitant tricuspid annulosplasty (3.72; IC95% 0.75- 18.30). Conclusion: The mortality rate is within the parameters found in the literature, identifying recognized factors which neutralization by changes in surgical indication and medical management may enable risk reduction.
Keywords: Cardiac surgical procedures; Risk factors; Heart valve prosthesis; Mortality; Prostheses and implants
Topical use of antifibrinolytic agent to reduce postoperative bleeding after coronary artery bypass surgery
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Objective: Antifibrinolytic agents reduce bleeding after cardiac surgery, but there are adverse effects after their systemic use. These effects are avoided by topical application of antifibrinolytic agents in pericardial cavity. We compared the effects of topically applied epsilon-aminocaproic acid (EACA) and placebo on postoperative bleeding and transfusion requirements after coronary artery bypass surgery. Methods: In this single center prospective, randomized, double-blind trial, 53 patients were randomized into two groups to receive EACA (24 g in 250 ml of saline solution) or placebo (250 ml of saline solution) before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. Results: Postoperative bleeding within first 24 hours (h) period (EACA group 154.66±74.64 x Placebo group 220.21±136.42 ml; P=0.031) showed statistically significant inter-group difference, within 48 h (EACA group 259.14±420.07 x Placebo group 141.67±142.58 ml; P=0.614), as well as cumulative blood loss (EACA group 832.07±576.86 x Placebo group 827.50±434.12 ml; P=0.975), not showed statistically inter-group differences. Inter-group difference of blood product requirements was statistically significant (EACA group 185.90±342.07 x Placebo group 439.42±349.07 ml; P=0.016). Laboratory analyses showed no differences between the two groups postoperative (hematologic characteristics: hemoglobin (g/dl)- EACA group 9.18±0.92 x Placebo group 8.85±1.48 g/dL; P=0.11; hematocrit (%)-EACA group 28.15±3.35 x Placebo group 26.67±4.15%; P=0.06). Conclusion: Topical use of epsilon aminocaproic acid reduces postoperative bleeding in the first 24 hours and requirements of blood transfusion after coronary artery bypass graft surgery.
Keywords: Coronary artery bypass; Antifibrinolytic agents; Hemorrhage
Outcomes of aortic coarctation surgical treatment in adults
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
OBJECTIVE: The aim of this study is to describe our experience in aortic coarctation surgery in adult patients by assessing the immediate and mid-term outcomes. METHODS: From January 1987 to March 2000, 50 consecutive adult patients underwent surgery for correction of aortic coarctation, through left lateral thoracotomy. Of these, forty two (84%) patients presented high blood pressure, with mean systolic arterial pressure of 170.56 mmHg (125-220 mmHg). The mean of pressure gradient in the coarctation area was 51.4 mmHg (18-123 mmHg). Other associated surgical cardiovascular diseases were not treated in the same operative act, except in two cases of patent ductus arteriosus (PDA). Three different techniques were used: aortic coarctation resection with end-to-end anastomosis was performed in 20 (40%) patients, coarctation enlargement with bovine pericardial patch was performed in 22 (44%) patients and synthetic tube interposition was performed in eight (16%) patients. RESULTS: Operative morbidity was low; there was one case of bleeding who required reoperation. The most common immediate postoperative event was high blood pressure (98%), but it was easily controlled by intravenous drugs. There was no hospital death. Mean residual pressure gradient was 18.7 (8-33 mmHg). Patients were discharged in 9.5 days (5-30). Postoperative follow-up mean was 46.8 months (1-145 months) in 45 (91.8%) patients. Forty one (91.1%) of these followed-up patients had normal blood pressure, whereas 75.6% of them without drugs intake. 93.3% of these followed-up patients were asymptomatic. Four of them required further surgical operation, one needed a pacemaker implant, other two patients needed a cardiac valve replacement and one had endocarditis. There was one related death due to sepsis secondary to endocarditis. CONCLUSION: Surgical treatment of aortic coarctation, even in adult patients, is an efficient therapeutic choice, regardless of the applied surgical technique, with low morbidity and mortality. It reduces efficiently the arterial pressure levels in both immediate and mid-term follow-up
Keywords: Aortic coarctation/surgery; Aorta/surgery; Heart defects, congenital; Adult
Intermittent annular reduction with Alfieri's repair in the treatment of mitral insufficiency in children: initial results
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
OBJECTIVE: Mitral valve insufficiency must be treated by repair whenever as possible as it provides better results - especially within the pediatric population in order to avoid valve replacement inconvenients. The aim of this study is to describe mitral valve repair technique based on an anatomical and functional approach. METHODS: During a 13 months period, eight children (age ranged from 2 and 12 years old 6.37 ± 3.66) with mitral valve insufficiency underwent intermittent anterior and posterior annuloplasty associated with Alfieri's repair - performed by placing a stitch between the anterior and posterior leaflets in the point of maximal regurgitation thus creating a double orificial mitral valve. RESULTS: There were no surgical deaths. All patients underwent postoperative echocardiography. Three patients showed mild mitral valve insufficiency and five patients showed no insufficiency. The time in intensive care unit ranged from 2 to 4 days (2.5 ± 0.75), and the time of stay in hospital ranged from 5 to 8 days (6.37 ± 1.06). CONCLUSION: In spite of the little sample size, the proposed technique proved itself to be simple and effective in the treatment of single mitral valve insufficiency within the pediatric population. In addition, it also yielded satisfactory immediate results. Long-term follow-up is nevertheless necessary in order to evaluate long-term results
Keywords: Heart defects,congenital; Child; Mitral valve
Effects of physiotherapeutic instructions on anxiety of CABG patients
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
INTRODUCTION: The coronary artery bypass graft surgery is an option of treatment for cardiovascular diseases, and the patients who underwent such procedure can suffer from preoperative anxiety. OBJECTIVE: The aim of this study is to verify the effects of physiotherapeutic instructions at the anxiety level on patients undergone coronary artery bypass graft surgery. METHODS: Randomized clinical trial, with the sample composed by 51 individuals, 27 on the control group and 24 on the intervention; on which it was assessed the anxiety (Beck Scale for Anxiety) and pain (Visual Analog Scale) levels on the pre- and postoperative period and only the second group received instructions about the surgery procedures and ventilatory exercises. For statistical analysis the Wilcoxon, Mann-Whitney and Spearman tests were used. RESULTS: The lower anxiety levels were observed in patients that received the intervention on the period before surgery (9.6 ± 7.2 versus 13.4 ± 5.9, P=0.02). On the control group, the difference among the anxiety levels before and after the surgery was statistically significant (P= 0.003). The female individuals presented more anxious before the surgery compared to the male ones (P=0.058). It was also verified a relationship between lenght of stay at hospital and postoperative anxiety (P=0.05), where the more anxious individuals remained more time at the hospital. CONCLUSION: Patients oriented and instructed about physiotherapeutic ventilatory exercises and hospital routine, presented their levels of anxiety reduced on the preoperative compared to the control group. However, at the postoperative, both groups presented their anxiety levels reduced without significant difference between them
Keywords: Physical therapy (Specialty); Myocardial revascularization; Anxiety
Vehicle influence on potassium replacement effectiveness in hypokalemic rats
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Introduction: Patients who undergo cardiac surgery are commonly treated with diuretic therapy for the management of volume overload. The concern of hypokalemia important in the adult population submitted to cardiac surgery has been described. Intravenous potassium (K+) replacement dilution is only recommended with sodium chloride 0.9% solution (SF0.9%), likely due to the putative effects of glucose solution 5% (SG5%) on insulin secretion, which influence K+ replacement quality. However, it is not yet experimentally proved the influence of SF0.9% and SG5% on K+ replacement quality. Objectives: To evaluate the effects of different vehicles of K+ replacement on blood K+ levels in furosemide hypokalemic rats. Methods: Male Wistar rats divided into four groups: K+SF, K+SG, SF and SG. Jugular vein was cannulated for K+ replacement and femoral vein was cannulated for blood analysis. Furosemide (50mg/kg) was injected S.C. to induce hypokalemia. We prepared the following solutions: vehicle 1.6mL (SF0.9% or SG5%) + 0.4 mL de K+ (19.1%) and for control groups only vehicle 2 mL. Furosemide (50 mg/kg) was used to induce hypokalaemia, it was analyzed potassium plasmatic levels 24 hours before furosemide injection, 24 hours after furosemide injection and 30 minutes after post-replacement. Results: There was no significative difference in blood K+ levels before furosemide administration, after hypokalemic induction and after K+ replacement among all groups. Only SF+K presented blood Na+ levels increased after K+ replacement (P<0.05). Conclusion: K+ replacement in different vehicles did not affect blood K+ levels in rats.
Keywords: Hypokalemia; Potassium; Vehicles
Does aprotinin preserve platelets in children with acyanogenic congenital heart disease undergone surgery with cardiopulmonary bypass?
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
OBJECTIVE: Evaluation of the hemostatic and platelets effects in children with acyanogenic congenital heart disease undergone on-pump surgery who received aprotinin. METHODS: A prospective randomized study was performed on children aged 30 days to 4 years who had undergone correction of acyanogenic congenital heart disease using cardiopulmonary bypass (CPB) and were divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during CPB and the hemostatic dysfunction was analyzed by clinical and biochemical markers. Differences were considered to be significant when P<0.05. RESULTS: The groups were similar regarding demographic and intraoperative variables, except for a greater hemodilution in the Aprotinin Group. The drug presented no benefit regarding time of mechanical pulmonary ventilation, stay in the postoperative intensive care unit and hospital, or regarding the use of inotropic drugs and renal function. Platelet concentration was preserved with the use of Aprotinin, whereas thrombocytopenia occurred in the Control Group since the initiation of CPB. Blood loss was similar for both groups. There were no complications with the use of Aprotinin. CONCLUSION: Aprotinin quantitatively preserved the blood platelets in children with acyanogenic congenital heart disease
Keywords: Extracorporeal membrane oxygenation; Aprotinin; Hemostasis; Blood platelets; Cardiovascular surgical procedures
Identification of a statistical method as a quality tool: patient's length of stay in the operating room
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
OBJECTIVE: To identify a statistical method that may express the patient length of stay in the operating room and build a "matrix of relationship" for optimizing this time, the real and exact time of the operation. METHODS: The analysis of survival and the Kaplan-Meier estimator allowed to calculate the survival curves for different times and the "matrix of relationship" with 10 hypothesis to help in choosing the new operation. The study consisted of a simple random sample of 71 patients, from elective operations for adults in Cardiac Surgery/Clinics Hospital/Unicamp, with confidence level of 95% in 2008. RESULTS: On average, the times of the operations over at a range of 140 minutes to 200 minutes and excess from 5 minutes to 90 minutes. In general, on average, one operation was daily performed within 520 minutes, for a time of 720 minutes. CONCLUSION: 1) With the maximum available time of 720 minutes is not possible to perform surgery, unless using the "matrix of relationship", whereas the maximum time available varies between 660 minutes and 690 minutes, considering the range of cleaning of the room. 2) The time of the patient in the operating room is a time that includes the time of learning by the student in an university hospital school. 3) When optimizing the time, most patients will benefit, causing a decrease from the waiting list for new opeartions. 4) The "matrix of relationship" allows to view and express opinion on a better decision making in addition to decide upon several assumptions
Keywords: Cardiac surgical procedures; Survival analysis; Quality management
The role of electroanalgesia in patients undergoing coronary artery bypass surgery
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Objective: To assess the electroanalgesia as an effective method in the reduction of pain and consequent improvement in lung function in patients undergoing coronary artery bypass graft surgery. Methods: During the period of one year were studied 30 patients undergoing surgery for treatment of the ischemic coronary disease. After randomization, 15 patients were allocated in the study group (that received electroanalgesia) and 15 patients from the controlled group (placebo). From the 1st until the 5th postoperative day were realized two applications of eletroanalgesia or the placebo current, according the group where the patient was allocate. Results: There was a reduction in the levels of pain in the study group compared to the controlled group, evidenced by the value P<0.05; however, there isn't evidence of statistical difference of the spirometric variables between them. Conclusion: The group that did eletroanalgesia presented reduction in the intensity of postoperative pain, which however did not mean improvement in respiratory function of these patients.
Keywords: Myocardial revascularization/ methods; Pain, Postoperative; Spirometry; Transcutaneous electric nerve stimulation
SPECIAL ARTICLE
Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Objective: There is strong evidence that methylene blue (MB), an inhibitor of guanylate cyclase, is an excellent therapeutic option for vasoplegic syndrome (VS) treatment in heart surgery. The aim of this article is to review the MB's therapeutic function in the vasoplegic syndrome treatment. Methods: Fifteen years of literature review. Results: 1) Heparin and ACE inhibitors are risk factors; 2) In the recommended doses it is safe (the lethal dose is 40 mg/ kg); 3) The use of MB does not cause endothelial dysfunction; 4) The MB effect appears in cases of nitric oxide (NO) upregulation; 5) MB is not a vasoconstrictor, by blocking of the GMPc system it releases the AMPc system, facilitating the norepinephrine vasoconstrictor effect; 6) The most used dosage is 2 mg/kg as IV bolus followed by the same continuous infusion because plasmatic concentrations strongly decays in the first 40 minutes; 7) There is a possible "window of opportunity" for the MB's effectiveness. Conclusions: Although there are no definitive multicentric studies, the MB used to treat heart surgery VS, at the present time, is the best, safest and cheapest option, being a Brazilian contribution for the heart surgery.
Keywords: Methylene blue; Vascular diseases; Cardiovascular surgical procedures; Extracorporeal circulation; Vascular resistance/drug effects; Postoperative complications
Concepts of basic physics that every cardiovascular surgeon should know. Part I - Mechanics of fluids
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Background: Terminology and Lexicography have been especially addressed to the Allied Health Sciences regarding discussion of case reports or concerning publication of scientific articles. The knowledge of Human Anatomy enables the understanding of medical terms and the refinement of Medical Terminology makes possible a better anatomicomedical communication in a highly technical level. Most of the scientific publications in both Anatomy and Medicine are found only in English and most of dictionaries or search resources available do not have specificity enough to explain anatomicomedical, terminological, or lexicographical occurrences. Objective: To design and produce a multilingual terminological dictionary (Latim-English-Portuguese- Spanish) containing a list of English anatomicomedical terms in common usage in cardiology subspecialties addressed to medical students and professionals, to other allied health sciences professionals, and to translators working in this specific field. Methods: Terms, semantical and grammatical components were selected to compose an anatomicocardiological corpus. The adequacy to the thematic terminological research requests and the translation reliability level will be settled from the terminology specificity in contrast to the semantics, as well as from a peer survey of the main terms used by national and international experts in specialized journals, Internet sites, and from text-books on Anatomy and Cardiology. The inclusion criteria will be the terms included in the English, Portuguese, and Spanish Terminologia Anatomica - the official terminology of the anatomical sciences; nonofficial technical commonly used terms which lead to terminology or translation misunderstanding often being a source of confusion. Results: A table with a sample of the 508 most used anatomical cardiologic terms in English language peerreviewed journals of cardiology and (pediatric and adult) thoracic surgery is shown. Conclusions: The working up of a multilingual terminological dictionary reduces the risk of ambiguities, inconsistencies, inutilities, and repetitions concerning the Nomenclature addressed to the Allied Health Sciences by prioritizing the inclusion of official technical terms and a judicious selection of commonly used terms. Efforts to standardize lists of structures in Humana Anatomy lead to both opportunities of scientific update and conceptual enlightenment.
Keywords: Dictionary; Anatomy; Terminology; Cardiology; Translations
REVIEW ARTICLE
Importance of pre- and postoperative physiotherapy in pediatric cardiac surgery
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Lung complications during postoperative of pediatric heart surgery are frequently highlighting atelectasis and pneumonia. Physiotherapy has an important role in the treatment of these complications. We reviewed and update the physiotherapy performance in the preoperative and in the postoperative lung complication of pediatric cardiac surgery. We noted efficacy of physiotherapy treatment through different specific techniques and the need for development of new studies
Keywords: Thoracic Surgery; Atelectasis; Pneumonia; Physical Therapy (Specialty)
EVOLVING TECHNOLOGY / BASIC SCIENCE
Right coronary bypass grafting with coronary-coronary venous bypass graft
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
OBJECTIVE: The following report describes the experience of the Cardiovascular Surgery Team of the ABC Medical School with coronary-coronary bypass grafting. METHODS: Four patients undergone off-pump coronary artery bypass grafting, with coronary-coronary bypass of the right coronary artery, by using great saphenous vein graft. RESULTS: The follow-up period was 3 to 5 years without any intra- or postoperative recurrence. One patient presented anginal symptoms four years after the surgery and underwent cinecoronariography that revealed patent anastomosis. CONCLUSION: The coronary-coronary bypass is a good option for patients undergone coronary artery bypass grafting
Keywords: Myocardial revascularization/methods; Saphenous vein/transplantation; Aortic diseases/surgery; Coronary disease/surgery
HOW TO DO IT
Axillary artery in cardiopulmonary bypass: indications and results
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
OBJECTIVES: To determine indications and results of axillary artery cannulation for cardiopulmonary bypass. METHODS: From January 2005 through December 2008, axillary artery cannulation was used in 48 patients. Mean age was 62 ± 11 years and 33 (69%) patients were males. Axillary artery was approached by infraclavicular incision and the cannula introduced in a 8 millimeter Dacron side graft. RESULTS: Indications were calcified aorta (N=18, 38%), aortic dissection (N=15, 31%), ascending and/or aortic arch aneurysm (N=11, 23%) and prior to reoperative median sternotomy (N=4, 8%). Changes in intraoperative planning occurred most often in patients with calcified aorta (100% versus 10%, P<0.0001) than in patients with other indications, which follow their preoperative plan. Cardiopulmonary bypass (deep hypothermic circulatory arrest in 55% and conventional in the remaining) was uneventfully conducted in all patients but one (success rate 98%) due to undiagnosed inominate artery stenosis. Local complication was lymphatic drainage in three (6.2%) patients. CONCLUSIONS: Axillary artery is an alternative cannulation site in patients unsuitable to aortic cannulation. The type of indication may determine intraoperative changes in surgical planning
Keywords: Extracorporeal circulation; Axillary artery; Aorta
CASE REPORT
Heart transplantation in primary amyloidosis
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Cardiac amyloidosis is a disease with a gloom life expectance after the beginning of the symptomatic phase, usually with sudden death as the final event. The aggression to other organs, although, can make heart transplantation a disputable form of treatment taking into consideration the shortage of donor organs. The aim is to report the evolution with a survival of seven years after heart transplantation and in very fair condition of a patient with amyloidosis. One year after the heart transplantation, there was indication of renal transplantation also from the aggression from the disease. This patient compares' favorable with three other patients also from our service, who died early after de diagnosis. Even considering the multi systemic nature of amyloidosis, we can accept that in peculiar patients justified the heart transplantation, taking in the consideration the very bad prognosis of the disease
Keywords: Amyloidosis; Heart transplantation; Cardiomyopathies/surgery
Giant coronary artery dilatation in an asymptomatic patient
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Successful medical management of prosthetic-valve endocarditis complicated by perivalvular abscess
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
We present a case of a 44-year-old man with prosthetic aortic endocarditis complicated by a perivalvular abscess. He evolved with improvement of the infectious process only under clinical treatment. The patient presented a prior history of rheumatic fever and had previously been undergone three valve replacements due to prosthesis dysfunction and previous endocarditis. In this case report we discuss the main features of perivalvular abscess complicating infective endocarditis
Keywords: Endocarditis; Heart valve prosthesis; Cardiac surgical procedures
CLINICAL-SURGICAL CORRELATION
Total correction of tetralogy of Fallot in child with left pulmonary artery agenesis
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
Atrioventricular septal defect with tetralogy of Fallot in patient with Down's syndrome
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
MULTIMEDIA
Video-assisted minimally invasive mitral valve repair: periareolar approach
Braz J Cardiovasc Surg 24;
Publish in: 8/2/2025
LETTERS TO THE EDITOR
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