ISSN: 1678-9741 - Open Access

Volume 25 - Número 3


EDITORIAL
BJCVS goes 100% digital

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Research Ethics Committee. Mandatory necessity. Requirement needed

Michel Pompeu Barros de Oliveira SáI; Ricardo de Carvalho LimaII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
The pump

Paulo Roberto PratesI

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025

ORIGINAL ARTICLE
Transapical aortic valve implantation: results of a Brazilian prosthesis

Diego Felipe GaiaI; José Honório PalmaII; Carolina Baeta Neves Duarte FerreiraIII; José Augusto Marcondes de SouzaIV; Guilherme AgreliV; José Cícero Stocco GuilhenVI; André TelisVII; Enio BuffoloVIII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Objective: The aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such a risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for the aortic position implant. Methods: After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median Logistic EuroSCORE was 43.7%. Four patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. All patients presented symptoms. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis was implanted through the ventricular apex under ventricular pacing or hemorrhagic shock, after aortic valvoplasty. Echocardiograph and angiograph controls were performed, and the patients were referred to ICU. Results: Implant was feasible in 13 cases. There were no intra-operative deaths. Median peak transvalvular aortic gradient reduced to 25.0 mmHg, and left ventricular function improved in the first seven post-operative days. Paravalvular aortic regurgitation was mild and present in 71%. No definitive pacemaker was needed. There was no peripheral vascular complication. Overall mortality was 42%. Conclusion: The transapical implantation of catheter-mounted bioprosthesis was a feasible procedure. Long term follow-up is mandatory in order to access efficacy and indications. Keywords: Aortic valve stenosis; Heart catheterization; Extracorporeal circulation
Hybrid procedures for complex thoracic aortic diseases

José Carlos IngrundI; Felipe NasserII; Seleno Glauber de Jesus-SilvaIII; Renán Prado LimacoIV; Francisco Leonardo GalastriV; Marcelo Calil BurihanVI; Carlos Edson Campos Cunha FilhoVII; Adnan NeserVIII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Background: Hybrid procedures for the treatment of complex thoracic aortic diseases (CTAD) require the revascularization of one or more supra-aortic arteries, followed by the deployment of one or more aortic endoprosthesis, with lower morbidity and mortality compared to conventional surgery. Objectives: To evaluate the technique and results of hybrid procedures for CTAD. Methods: During two years, 12 patients with CTAD underwent hybrid procedures, including aortic arch aneurysms and acute Stanford A and B aortic dissections. All patients had formal indications to invasive treatment, and inadequate proximal landing zone (less than 20mm). Half were male and the mean age was 55.5 years (42 to 78). At least three cardiovascular risk factors were present in 75% of patients. The average follow-up was 10.9 months (2 to 25), with periodic consultations and CT scans. Results: The initial technical success was achieved in 10 patients. Bypasses of supra-aortic vessels were performed in a surgical environment and endovascular procedures in an interventional radiology facility. "Through-and-through" technique was used in six patients. Two deaths occurred in the first 30 days after the procedure. No endoprosthesis migration was observed. No patient had paraplegia, stroke, renal failure, bleeding or coagulopathy, elective or emergency surgical conversion. Conclusion: Hybrid treatment of CTAD is feasible, especially in high risk patients. Proper integration of surgical and endovascular techniques, in addition to clinical and radiological surveillance, makes this technique a great alternative to conventional surgery. Keywords: Aortic aneurysm, thoracic; Aneurysm, dissecting; Aorta, thoracic; Ultrasonography, interventional; Blood vessel prosthesis implantation
VEGF gene therapy for angiogenesis in refractory angina: Phase I/II clinical trial

Renato A. K KalilI; Felipe Borsu de SallesII; Imarilde Inês GiustiIII; Clarissa Garcia RodriguesIV; Sang Won HanV; Roberto Tofani Sant'annaVI; Eduardo LudwigVII; Gabriel GrossmanVIII; Paulo Roberto Lunardi PratesIX; João Ricardo Michelin Sant'AnnaX; Guaracy Fernandes Teixeira FilhoXI; Nance Beyer NardiXII; Ivo Abrahão NesrallaXIII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Objective: Safety, feasibility and early myocardial angiogenic effects evaluation of transthoracic intramyocardial phVEGF165 administration for refractory angina in no option patients. Methods: Cohort study, in which 13 patients with refractory angina under optimized clinical treatment where included, after cineangiograms had been evaluated and found unfeasible by surgeon and interventional cardiologist. Intramyocardial injections of 5mL solution containing plasmidial VEGF165 where done over the ischemic area of myocardium identified by previous SPECT/Sestamibi scan. Evaluations included a SPECT scan, stress test, Minnesotta QOL questionnaire and NYHA functional class and CCS angina class determinations. Results: There were no deaths or new interventions during the study period. There were no significant variations in SPECT scans, QOL scores and stress tests results during medical treatment in the included patients. After the 3rd post operative month, there was improvement in SPECT segmental scores, SSS (18.38±7.51 vs. 15.31±7.29, P=0.003) and SRS (11.92±7.49 vs. 8.53±6.68, P=0.002). The ischemic area extension, however, had non-significant variation (23.38±13.12% vs. 20.08±13.88%, P=0.1). Stress tests METs varied from 7.66±4.47 pre to 10.29±4.36 METs post-op (P=0.08). QOL score improved from 48.23±18.35 pre to 30.15±20.13 post-op points (P=0.02). NYHA class was 3.15±0.38 pre vs. 1.77±0.83 post-op (P=0.001) and angina CCS class, 3.08±0.64 vs. 1.77±0.83 (P=0.001). Conclusions: Intramyocardial VEGF165 therapy for refractory angina, in this small trial of no option patients, resulted feasible and safe. Early clinical and scintilographic data showed improvements in symptoms and myocardial perfusion, with regression of ischemia severity in treated areas. Keywords: Gene therapy; Angiogenesis inducing agents; Myocardial ischemia; Angina pectoris
Mitral valve surgery using right anterolateral thoracotomy: is the aortic cannulation a safety procedure?

Marco Antonio Vieira GuedesI; Pablo Maria Alberto PomerantzeffII; Carlos Manuel de Almeida BrandãoIII; Marcelo Luiz Campos VieiraIV; Max GrinbergV; Noedir Antonio Groppo Stolf

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Introduction: The right anterolateral thoracotomy is an alternative technique for surgical approach of mitral valve. In these cases, femoral-femoral bypass still has been used, rising occurrence of complications related to femoral cannulation. Objective: Describe the technique and results of mitral valve treatment by right anterolateral thoracotomy using aortic cannulation for cardiac pulmonary bypass (CPB). Methods: From 1983 e 2008, 100 consecutive female patients, with average age 35 ±13 years, 96 (96%) underwent mitral valve surgical treatment in the Heart Institute of São Paulo. A right anterolateral thoracotomy approach associated with aortic cannulation was used for CPB. Eighty (80%) patients had rheumatic disease and 84 (84%) patients presented functional class III or IV. Results: Were performed 45 (45%) comissurotomies, 38 (38%) valve repairs, 7(7%) mitral valve replacements, seven (7%) recomissurotomies and three (3%) prosthesis replacement. Sparing surgery was performed in 90 (90%) patients. The average CPB and clamp time were 57±27 min e 39±19 min, respectively. There were no in-hospital death, reoperation due to bleeding and convertion to sternotomy. Introperative complications were related to heart harvest (5%), especially in reoperations (3%). The most important complications in postoperative period were related to pulmonary system (11%), followed by atrial fibrilation (10%) but without major systemic repercussions. The mean in-hospital length of stay was 8±3 days. Follow-up was 6.038 patients/month. Actuarial survival was 98.0±1.9% and freedom from reoperation was 81.4±7.8% in 180 months. Conclusion: The right anterolateral thoracotomy associated with aortic cannulation in mitral valve surgery is a simple technique, reproducible and safety. Keywords: Mitral valve; Surgical procedures, minimally invasive; Extracorporeal circulation; Thoracic surgery; Heart valves
Tratamento da fibrilação atrial com ablação por ultrassom, durante correção cirúrgica de doença valvar cardíaca

Rosaly Moraes Marques LinsI; Ricardo de Carvalho LimaII; Frederico Pires Vasconcelos SilvaIII; Alexandre Motta de MenezesIV; Pedro Rafael SalernoV; Emmanuel Caou ThéVI; Diana SepúlvedaVII; Eugênio AlbuquerqueVIII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Objective: This study aims to evaluate the surgical treatment of atrial fibrillation with ultrasound ablation concomitant to mitral surgery in PROCAPE's patients with permanent atrial fibrillation. Methods: From March 2008 through January 2009 a prospective study was performed at the Pernambuco Cardiology Emergency Facility on 44 consecutive patients with a permanent atrial fibrillation and concomitant cardiac valvular surgery indication, from March 2008 through January 2009 at Pernambuco Cardiology Emergency Facility Twenty two patients underwent epicardial ultrasonic ablation on the right atrium and had ultrasonic ablation performed in the left atrium endocardial concomitant with the valve procedure. The other 22 patients, the concurrent controls were submitted to valve procedure without ultrasonic ablation. Patients with serious diseases such as coronary and others were excluded of the research. Results: It was observed 90% restoration to sinus rhythm immediately after surgery in patients submitted to treatment of atrial fibrillation with ultrasound ablation simultaneous a mitral surgery. The evolution in late post operation showed that the maintenance of sinus rhythm drops although it was still 27% higher in the group which received ablation compared with the control group. 86.40% of the patients who received ablation had improved in functional class; they also have fewer complications than patients in the control group. Conclusion: The results showed that the patients who received treatment for atrial fibrillation simultaneously with valvar surgery had advantages related to the control group. Keywords: Atrial fibrillation; Arrhythmias, cardiac; Ablation techniques; Mitral valve
Assessment and medium-term follow up of heart transplant candidates undergoing low-intensity exercise

Darlene Yuri YoshimoriI; Gerson Cipriano JrII; Vanessa MairI; João Nelson Rodrigues BrancoIII; Enio BuffoloIV

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Objectives: To study cardiovascular behavior and safety regarding a low-intensity exercise program for heart transplant candidates with severe heart failure. Methods: Twenty-one patients with severe heart failure on the transplant list of the UNIFESP university hospital (Brazil) were studied. Following evaluation, the patients were monitored during an exercise program with six progressive phases (1 - upper limbs; 2 - lower limbs; 3 - walking; 4 - ½ flight of stairs; 5 - walking 200 m; and 6 - whole flight of stairs), with the intensity estimated at two to six metabolic equivalents (1 MET = 3.5 ml of O2/kg/min.). The patients were prospectively followed up for approximately 17 months for the occurrence of clinical complications and death. Results: Three patients were unable to perform the complete program; BMI, maximal respiratory pressure (Pimax and Pemax, cmH2O) and number of previous hospitalizations were considered predictors for this subgroup. Heart rate (HR, bpm), double product (DP, bpm x mmHg) and Borg perceived exertion scale (PE) underwent the greatest oscillation during exercise, especially in phase 5 (H"METS), and are considered the best markers related to exertion. Blood pressure (BP, mmHg) oscillated little. There was no increase in the incidence of arrhythmia (Kappa=0.552) during exercise. There was a moderate positive correlation between PE and BP (r=0.4; P=0.02) in phase 5 (walking 200 m). The patients who died had low Pimax values upon the initial evaluation. During the exercise program, there was a reduction in BP response and an increase in HR response. Conclusion: Regarding cardiovascular behavior, the exercise program proved safe and well tolerated, but there is a need for monitoring. Information obtained upon the initial evaluation and during exercise program is associated to decompensation and death. Such information could assist in determining the stage of the disease. Keywords: Exercise; Rehabilitation; Heart failure; Heart transplantation
Clinical and surgical profile of patients operated for postinfarction interventricular septal rupture

Michel Pompeu Barros de Oliveira SáI; Marcus Villander Barros de Oliveira SáII; Caio Henrique BarbosaII; Niedjon Peixoto de Carvalho SilvaIII; Rodrigo Renda de EscobarIV; Fábio Gonçalves de RuedaV; Frederico Pires Vasconcelos SilvaVI; Ricardo de Carvalho LimaVII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Objectives: To study clinical features, complications and in-hospital outcomes of patients operated for postinfarction ventricular septal rupture. Methods: A retrospective study involving 21 patients between January/1996 and June/2009. All operations were performed at the Division of Cardiovascular Surgery of Complexo Hospitalar HUOC/PROCAPE. Results: Mean age of patients was 62.81 years (±8.21), 61.9% (n=13) were male. Rupture occurred on average 4.8 days after infarction. Cardiogenic shock was observed in 57.1% (n=12), being risk factor for death (100% with shock vs. 22.2% without shock; P<0.001). Survivors had a higher mean ejection fraction compared to deaths (66.29%±4.61% versus 42.71%±4.79%, P <0.001). All were classified as high risk by the EuroSCORE, and the survivors had lower average score compared to deaths (6.57±0.53 versus 10.93±2.23; P<0.001). The majority (76.2%, n=16) of the patients needed to use vasoactive drugs and 57.1% (n=12) considered hemodynamically unstable. Need for vasoactive drugs was a risk factor for death (81.3% with vasoactive drugs versus 20% without vasoactive drugs, P=0.025). Hemodynamic instability was also a risk factor for death (100% in the unstable group versus 22.2% in the stable group; P<0.001). The rate of in-hospital mortality was 66.7% (n=14). Conclusions: The need for vasoactive drugs, hemodynamic instability and cardiogenic shock were associated with higher rates of mortality. Patients who had adverse outcomes had less ventricular function and higher score in the EuroSCORE. Mortality remains high. Keywords: Heart septal defects, ventricular; Heart rupture, post-infarction; Myocardial infarction
Serum lactate as mortality and morbidity marker in infants after Jatene´s operation

Taís Sica da RochaI; Alan Soares da SilveiraII; Aline Medeiros BottaIII; Cláudia Pires RicachinevskyIV; Lisiane Dalle MulleV; Aldemir NogueiraVI

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Objective: To assess the morbidity and mortality after Jatene's operation using lactate as the main marker. Methods: We performed a historical cohort with infants admitted in a pediatric intensive care unit during 1995 to 2005 who underwent this surgery. We assessed the preoperative, immediate (IPD), third hour (3h), six hour (6h) and first day (POD1) serum lactate as well as other factors such as sepsis, increased bleeding, low cardiac output syndrome, renal insufficiency, pulmonary hypertension, cardiac arrythmias, chylothorax, myocardial ischemia, seizures, presence of other complication, and also information about length of PICU stay and death. Results: The mean age of 76 patients was 14.59± 19.09 days, birth weight 3.128± 0.48 kg Forty-four patients had the diagnosis of simple transposition of great arteries. The circulatory bypass time was 143.78± 28.77 minutes and aortic clamping time of 87.68± 22.3 minutes and LOS of 20.28±15.62 days. Twenty four (31.58%) died during hospital stay. Lactate increased in IPD, returning to baseline at 24 hours. Patients who died raised and maintained IPD lactate higher. The 3h lactate best discriminated mortality with area under the curve of 0.68 (CI 0.54 to 0.83) P = 0.035. However, considering a cutoff point for lactate greater or equal to 5.8 mmol/dl in the 3-h PO, we obtained only 67% sensitivity and specificity of 64% for mortality. There is positive correlation between number of complications and lactate. The low cardiac output syndrome with an odds ratio (OR) of 7.67 (2.38-24), increased bleeding with OR 2.91 (1.07-7.94) and respiratory complication with OR 1.67 (1.35-2.05) are risk factors when combined. Conclusion: After Jatene's operation, morbidity and mortality can be assessed with the serum lactate levels, suggesting increased values in the third hour is suggestive of a worse prognosis. Keywords: Lactic acid; Morbidity; Transposition of great vessels; Mortality
Influence of physical activity during leisure time in patients in the follow-up two years after CABG

Marcio Roberto MartiniI; Juarez Neuhaus BarbisanII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Objective: To investigate the effect of physical activity in leisure time (LTPA) on the prognosis of patients two years after coronary artery bypass grafting (CABG). Methods: Cohort study with 202 elective CABG patients, mean age of patients was 62 ± 10 years, 134 (66%) men divided into sedentary and active according their LTPA. Followed for two years after CAGB where the occurrence of major adverse cardiac events (MACES) were found, and changes in physical activity. Results: Thirty-eight had MACES. Twenty-nine were sedentary, nine active (P=0.18). Active: three (4.5%) readmissions, three (4.5%) deaths and two (3%) stroke. Sedentary: seven (5.1%) acute myocardial infarction (AMI), seven (5.1%) readmissions, 16 (11.6%) deaths and one (0.7%) stroke. LTPA decreased from preoperative to the postoperative period. Sedentary: 2.09 (±0.58) and 2.08 (±0.57); active: 2.53 (±0.73) and 2.33 (±0.71). The leisure and locomotion activities in the preoperative and postoperative: Sedentary increased 2.08 (±1.09) and 2.13 (±0.78); active reduction 2.53 (±0.73) and 2.27 (±1.12). The 6-minute walk test increased pre and postoperative. Sedentary: 255m (±167.06m) and 377m (±190.63m); active: 337m (±172.42m) and 405m (±148.93 m). The veterans specific activity questionnaire increased the pre and postoperative. Sedentary: 4.39 (±1.80) and 6.99 (±3.08); active: 4.44 (±1.82) and 8.50 (±3.16). Conclusion: The results indicate that LTPA does not modify the late prognostic of CABG patients, but CABG itself promotes physical activity and improves long-term functional capacity. Keywords: Exercise; Physical education and training; Myocardial revascularization
Pericardium closure after heart operations: a safety option?

Carlos Eduardo Pereira DantasI; Mauro Paes Leme de SáII; Eduardo Sergio BastosIII; Monica M. F MagnaniniIV

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Objectives: Primary pericardium closure may reduce the risk of cardiac injury during chest re opening, especially the right ventricle, aorta and coronary bypass grafts. Nevertheless, concern about adverse hemodynamic effects prevents most heart surgeons of closuring the pericardium. Methods: We evaluated 48 patients undergoing open heart surgery consecutively which the pericardium was closed in 30 patients (group A) and 18 patients, as a control group (group B) in which the pericardium was left open. All patients underwent posteroanterior and lateral chest roentgenograms before surgery and one week postoperatively. Postoperative evaluation also included echocardiograms, ECG and postoperative enzyme analysis. Results: There were no deaths or any complications in both groups (acute myocardial infarction, stroke, bleeding or cardiac tamponate). It was observed statistically differences between both groups especially in echocardiogram parameters and cardiothoracic ratio without clinical impact. Conclusion: Pericardium closure is a simple method to facilitate resternotomy during subsequent re operative procedures. However, cardiac surgeons should be aware of the transient deterioration in hemodynamics associated with it, even thought there was no clinical significance in this study. Keywords: Pericardium; General surgery; Cardiac surgical procedures
Farmacologic test pre-implants in hypertension pulmonary elevated and still in candidates to heterotopic transplantation

Jarbas Jakson DinkhuysenI; Reginaldo CipulloII; Carlos ContrerasIII; Marco Aurélio FingerII; Ricardo ManriqueIV; Helio M MagalhãesV; Paulo ChaccurVI; João RossiVII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Background: Evaluation of pulmonary artery pressure just before transplanting with sodium nitroprusside may allow conversion to orthotopic technique. Methods: Between 1992 and 2007, 228 transplants were performed systematically and this was used in seven patients with preoperative hemodynamic evaluation: Pre NP (mmHg) Post NP (mmHg) Systolic systemic blood pressure (PSAS) 108-78 (101.7±10.9) 90-74 (79.5±15.2) pulmonary arterial systolic pressure (PASP) 88-51 (69.8±13.2) 70-40 (57.8±9.9) Gradient transpulmonary (GTP) 16-11 (14.2±1.7) 14-11 (12.4±1.2) pulmonary vascular resistance (PVR/w) 7.9 to 4.8 (6.2±1 0) 5.9-4.1 (5.0±0.8). Results: The intraoperative findings were: Pre NP (mmHg) e Post NP (mmHg), respectively, PSAS 91-78 (8.5±5.2) and 65-59 (4.2±63.8)(P=0.017), decrease 19.9%, decrease 29.3%; PSAP 71-52 (61.8±6.1) and 43-32 (37.5±3.3)(P=0.018), decrease 28%, decrease 41%. In light of these data, patients were transplanted by orthotopic technique not being observed mortality in the short and long-term evolution from 5 months to 6 years. Conclusion: This methodology allowed the conversion of the technique for heterotopic orthotopically, with good early and late otcomes. Keywords: Hypertension, pulmonary; Heart transplantation; Pulmonary artery
Evaluation of the biological behavior of decellularized pulmonary homografts: an experimental sheep model

Fábio Binhara NavarroI; Francisco Diniz Affonso da CostaII; Leonardo Andrade MulinariIII; Gustavo Klug PimentelIV; João Gabriel RoderjanV; Eduardo Discher VieiraVI; Lúcia de NoronhaVII; Nelson Itiro MiyagueVIII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Introduction: The cryopreserved homograft is a good valve substitute due attributes like excellent hemodynamics, low incidence of thromboembolic events, infection resistance and good mid-term durability. However, progressive homograft degeneration and fibrocalcification may occur, particularly in the childhood and young adults. Their antigenicity triggers an immunological reaction that plays an important role in their degeneration and failure. The decellularization process was proposed to decrease this antigenicity. By the action of detergents and enzymes, this process removes all cellular components from the homograft matrix, diminishing immunogenicity and probably delaying its degeneration. Objective: The objective of this experimental and descriptive study is to evaluate the biological and functional behavior of decellularized pulmonary homografts (Decell-H), treated by a sodium dodecil sulfate solution (0.1%), developed in our University (Pontifícia Universidade Católica do Paraná). For the characterization of Decell-H performance, parameters like recellularization, calcification, and echocardiographic data will be analyzed. Methods: Eight juvenile sheep were submitted to the implantation of the Decell-H sutured into orthotopic position, through a left thoracotomy and with cardiopulmonary bypass support. They were followed-up clinically and by periodical echocardiograms until the explantation, which were performed in different time for every two sheep: seven, 30, 90 and 180 postoperative days. For histological analysis we used Hematoxilin-eosin, Movat and Alizarin-Red staining. Results: The sheep reached their follow-up period in a good clinical state. There was no valve regurgitation or stenonis by the echocardiogram. The animals submitted to the explantation in 90 and 180 days had a significant somatic growth and these Decell-H(s) had a diameter increase, without central valve insufficiency. Histologically, all homografts preserved their extra-cellular matrix organization and were progressively recellularized, without calcification. Conclusion: In this experimental model, the Decell-H behaved as an excellent valve substitute. Keywords: Transplantation, Homologous, Host vs Graft Reaction; Heart Valve Diseases
Myocardium functional recovery protection by omeprazole after ischemia-reperfusion in isolated rat hearts

Otoni Moreira GomesI; Mônica de Mônico MagalhãesII; Rafael Diniz AbrantesIII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Objective: To evaluate the myocardium contractility alterations of isolated hearts of rats, submitted to ischemia and reperfusion with and without administration of the omeprazole. Methods: Twelve Wistar breed rats with 270g mean body weight was studied. After anesthesia by intraperitoneal injection of ketamine 10mg and xylazine 2mg, their hearts were removed and perfused with Krebs-Henseleit solution (95% of O2 and 5% of CO2, 37oC, 110-120mmHg perfusion pressure, 8 mmHg ventricular diastolic pressure) in the São Francisco de Assis disposable Langendorff system model Comex Ltda, MG. The six hearts of Group I (GI) and of the Group II (GII) were submitted to 20 min ischemia and 30 min reperfusion. In GII hearts, intracoronary injection of omeprazole 200 mcg was done immediately before the ischemia period induction. The following parameters were registered after the stabilization period (t0), and after the reperfusion period (t30): heart rate (HR), coronary flow (CoF), systolic pressure (SP), +dP/dt and -dP/dt. The Kruskal-Wallis test (P<0.05) was applied to statistical analysis. Results: There were no significant differences (P>0.05) between groups among HR and CoF values. Differences (P<0.05) occurred between groups, I e II after the reperfusion period (t30) regarding systolic pressure reduced for 28.0±3.6% in the control group GI and for 79.0±5.9% in GII; The +dP/dtmax declined to be only 31.0±5.6% in GI, preserving 99.4±11.2% values in GII (P<0.05). The t30 -dP/dtmax values were GI 26.0±7.3% and GII 82.0±2.2% (P<0.05). Conclusion: The omeprazole administration before ischemia induction significantly protected the myocardium function recovery. Keywords: Myocardial infarction; Ischemic preconditioning, myocardial; Omeprazole

REVIEW ARTICLE
Is it time to adopt beating-heart coronary artery bypass grafting? A review of literature

Emad Mohamed HijaziI

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Avoiding the morbidity of cardiopulmonary bypass should theoretically reduce the incidence of organ dysfunction and lead to improved patient outcomes. Recently, cardiac mechanical stabilization techniques were developed, facilitating on-pump CABG (OPCAB). The use of CPB may influence the economic outcome, while maintaining quality of care and patient satisfaction. MEDLINE, EMBASE, Cochrane Controlled Trials Register (CCTR), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), Science Citation Index (SCI), Current Contents, NHS Economic Evaluation Database (NEED), and International Network of Agencies for Health Technology Assessment (INAHTA) databases were searched from the date of their inception to the end of March 2008, using the search terms off-pump, minimally invasive, beating heart, coronary artery bypass, and their variants. Off-pump revascularization offers a safe, cost-effective alternative to conventional coronary revascularization with cardiopulmonary bypass (CABG) and cardioplegic arrest. Keywords: Extracorporeal circulation; Cardiac surgical procedures; Coronary artery bypass; Myocardial revascularization; Coronary artery bypass, off-pump

CASE REPORT
Implantable cardioverter-defibrillator in pregnant women with hypertrophic cardiomyopathy

João Carlos LealI; Victor Rodrigues Ribeiro FerreiraII; Luis Ernesto AvanciIII; Domingo M BraileIV

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Surgical treatment of aortic dissection is a challenge for the cardiac surgeon, especially in patients undergoing cardiac operations. Our objective in this case report is to demonstrate how we treat the chronic type A aortic dissection in patients revascularized using percutaneous arterial and venous cannulae. Keywords: Extracorporeal circulation; Myocardial revascularization; Systemic inflammatory response syndrome; Aortic aneurysm/surgery
Implantable cardioverter-defibrillator in pregnant women with hypertrophic cardiomyopathy

Leonardo Jorge Cordeiro de PaulaI; Henrique Barbosa RibeiroII; Roberto Márcio de Oliveira JúniorIII; Kátia Regina da SilvaIV

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
We describe the successful implantation of a cardioverter-defibrillator (ICD) in two pregnant women with hypertrophic cardiomyopathy at high risk. The indication of ICD and the necessary care for ICD implantation during pregnancy are discussed and were the main objectives of this case report. Keywords: Defibrillators, implantable; Cardiomyopathy, hypertrophic; Pregnancy; Death, sudden, cardiac
Coronary-artery spasm after coronary artery bypass graft surgery without extracorporeal circulation. Diagnostic and management

Joaquim David Carneiro NetoI; José Antonio de Lima NetoII; Rosa Maria da Costa SimõesIII; Noedir Antonio Groppo StolfIV

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Coronary artery spasm in perioperative of coronary artery bypass graft surgery is a serious complication, with high rate mortality. Patient 51 years-old submitted to coronary artery bypass graft surgery without Extracorporeal Circulation. The patient evolved in 1st post operative (PO) day with enzymatic alteration and ST-elevation, developing soon afterwards in ventricular fibrillation, defibrillation with success. Cardiac catheterization showed important spasm of all coronary arteries and anastomosis between the left internal thoracic artery and the left anterior interventricular artery. Intracoronary Vasodilators and intra-graft, with re-establishment of their usual and immediate calibers to improve clinic and Hemodynamic stability was used. Satisfactory evolution, discharged at 13rd PO day. Keywords: Myocardial revascularization; Coronary artery bypass; Coronary vasospasm; Heart catheterization
Syphilitic aortitis: diagnosis and treatment. Case report

Roberto Santos SaraivaI; Claudio Albernaz CésarII; Marco Antonio Araújo de MelloII

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Aortitis is one of the many possibilities of lesion caused by tertiary syphilis. Between all the cardiovascular lesions, the aorta's injury is the most common. We report a case of a 48-year-old patient diagnosed with syphilitic aortitis who had undergone surgery for the replacement of the aortic root and aortic valve. The diagnosis hypothesis was pondered because of the in situ aspect of the arterial damage. Although the rarity of the disease, it persists. Keywords: Syphilis, Cardiovascular; Aorta

CLINICAL-SURGICAL CORRELATION
Enlargement of the neopulmonary after Jatene's operation

Ulisses Alexandre CrotiI; Domingo M BraileI; Marcelo Felipe KozakI; Lilian BeaniI

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025

MULTIMEDIA
Surgical correction of the anomalous origin of right pulmonary artery of aorta

Ulisses Alexandre CrotiI; Domingo M Braile; Marcos Aurélio Barbosa de Oliveira; Carlos Henrique De MarchiI

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025

TRIBUTE
To the master, with love (1943-2010)

Rui M. S AlmeidaI

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025

SCIENCE & TECHNOLOGY

LETTERS TO THE EDITOR
Letters to the Editor

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025
Radius of the vessel, resistance and coronary flow Part II

Braz J Cardiovasc Surg 25; Publish in: 8/2/2025