Volume 25 - Número 4
EDITORIAL
Continuing Medical Education: Essential
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Extracorporeal circulation
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Multidisciplinary approach to heart disease. The patient as a priority in medical decision
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Qualis 2011-2013 - The Three Rs
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Mechanical circulatory support: a great gap in Brazilian cardiac surgery
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
ORIGINAL ARTICLE
Ex vivo lung evaluation and reconditioning
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Objective: Only about 15% of the potential candidates for lung donation are considered suitable for transplantation. A new method for ex vivo lung perfusion (EVLP) has been developed and can be used for evaluation and reconditioning of "marginal" and unacceptable lungs. This is a report of functional evaluation experience with ex vivo perfusion of twelve donor lungs deemed unacceptable in São Paulo, Brazil. Methods: After harvesting, the lungs are perfused ex vivo with Steen Solution, an extra-cellular solution with high colloid osmotic pressure. A membrane oxygenator connected to the circuit receives gas from a mixture of nitrogen and carbon dioxide and maintains a normal mixed venous blood gas level in the perfusate. The lungs are gradually rewarmed, reperfused and ventilated. They are evaluated through analyses of oxygenation capacity, pulmonary vascular resistance (PVR), lung compliance (LC). Results: The arterial oxygen pressure (with inspired oxygen fractions of 100%) increased from a mean of 193.3 mmHg in the organ donor at the referring hospital to a mean of 495.3 mmHg during the ex vivo evaluation. After 1 hour of EVLP, mean PVR was 737.3 dynes/sec/cm5, and mean LC was 42.2 ml/cmH2O. Conclusions: The ex vivo evaluation model can improve oxygenation capacity of "marginal" lungs rejected for transplantation. It has a great potential to increase lung donor availability and, possibly, to reduce the waiting time on the list.
Keywords: Lung transplantation; Organ preservation; Lung injury
A score proposal to evaluate surgical risk in patients submitted to myocardial revascularization surgery
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Introduction: Scores to predict surgical risk in patients submitted to myocardial revascularization surgery are broadly used. Objective: To develop a score capable to predict mortality in patients submitted to myocardial revascularization surgery. Methods: From January 1996 to December 2007, data were collected from 2809 patients submitted to myocardial revascularization surgery at PUC-RS São Lucas Hospital. In 2/3 of the sample (n=1875), the score was developed, after uni and mutivariated analyses. In the remaining 1/3 (n =934) the score was validated. The final score was developed with the total sample, using the same variables (n=2809). The accuracy of the model was tested using the area under the ROC curve. Results: The mean age was 61.3 ±10.1 years and 34% were women. The risk factors identified as independent predictors of surgical mortality and used for score development (parentheses) were: age > 60 years (2), female (2), extracardiac vasculopathy (2), heart failure functional class III and IV (3), ejection fraction<45% (2), atrial fibrillation (2), chronic obstructive pulmonary disease (3), aortic stenosis (3), creatinine 1.5-2.4 (2), creatinine > 2.5 or dialysis (4), emergency/urgency surgery (16). The area obtained under the ROC curve was 0.86 (CI 0.81-0.9). Conclusion: The score developed, using clinical variables easy to obtain (age, sex, extracardiac vasculopathy, functional class, ejection fraction, atrial fibrillation, chronic obstructive pulmonary disease, aortic stenosis, creatinine and emergency/urgency surgery) showed capability to predict mortality in patients submitted to myocardial revascularization surgery in our Hospital.
Keywords: Myocardial revascularization; Risk factors; Risk Assessment/methods; Mortality
Oral anticoagulation in carriers of mechanical heart valve prostheses. Experience of ten years
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Background: Published data suggest that rates of thromboembolism and bleeding, in patients with mechanical heart valve prostheses, can be very small by optimizing current anticoagulant therapy. Objective: To evaluate the occurrence of complications in patients with mechanical heart valve prostheses undergoing anticoagulant therapy optimized through specialized clinics. Methods: We studied the occurrence of complications over 10 years in 261 anticoagulated patients with mechanical heart valve prostheses, followed in specialized clinics. These patients were divided into two groups according to percentage of queries with prothrombin time (INR) within the desired range: G1-0% to 50.00% and G2-50.01% to 100% of appointments. We evaluated the occurrence of thromboembolic and bleeding complications in their entirety or subdivided into major and minor, according to gravity. The results are presented in an actuarial study and frequency of occurrence of linear events. Results: The actuarial study showed that, over time, more G2 (with 50.01% to 100% of the consultations with INR in desired range) more patients were free of the occurrence of any event, of minor bleeding events or the marked increase of RNI. The linearized frequency of occurrence in all types events, were also lower in group G2. Conclusions: The period of time that patients that remain within the desired anticoagulation interval has directly relations with occurrence of complications. Even with careful follow-up at a specialized outpatient unit, only approximately one third of the patients showed an adequate anticoagulation level in more than half of the consultations.
Keywords: Anticoagulants; Embolism and thrombosis; Hemorrhage; Heart valve prosthesis
One and a half ventricular repair as an alternative for hypoplastic right ventricle
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Objective: Patients with complex congenital heart disease, characterized by right ventricle hypoplasia, had a palliative surgical option with one and a half ventricular repair. Methods: From July 2001 to March 2009, nine patients (mean age 5.2 years, range 3 to 9 years) with hypoplastic right ventricle, underwent correction with one and a half ventricle technique. Preoperative diagnoses included: pulmonary atresia with intact ventricular septum, in six and Ebstein's anomaly, in three cases. Six patients had bidirectional cavo-pulmonary shunt (Glenn operation) previously. The surgical approach was performed with cardiopulmonary bypass to correct intracardiac defects: atrial septal defect closure (nine cases); right ventricle outlet tract reconstruction with porcine pulmonary prosthesis (seven cases); tricuspid valvuloplasty (three cases). Results: There was one (11.1%) hospital death. All the patients left the hospital in good clinical conditions. One patient presented pulmonary stenosis at distal prosthesis anastomosis and needed surgical correction. There was one (12.5%) late deaths after reoperation. At mean follow-up of 39.8 months (range 16 months to 8.4 years) seven patients are alive in functional class I (NYHA). Conclusions: Surgical treatment of congenital cardiac anomalies in the presence of a hypoplastic right ventricle by means of one and a half ventricle repair has the advantages of reducing the surgical risk of biventricular repair compared to the Fontan circulation; it maintains a low right atrium pressure, a pulsatile pulmonary blood flow and improves the systemic oxygen saturation with short and medium-term promising results. Longer follow-up is needed to prove the efficacy of such a repair in the long term.
Keywords: Heart defects, congenital/surgery; Heart valve prosthesis implantation, methods; Child; Pulmonary atresia; Ebstein anomaly
EuroSCORE and mortality in coronary artery bypass graft surgery at Pernambuco Cardiologic Emergency Medical Services [Pronto Socorro Cardiológico de Pernambuco]
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Objective: The aim of this study is to evaluate the applicability of EuroSCORE in patients undergoing coronary artery bypass graft (CABG) surgery at the Division of Cardiovascular Surgery of Pernambuco Cardiologic Emergency Medical Services - PROCAPE. Methods: A retrospective study involving 500 patients operated between May 2007 and April 2010. The registers contained all the information used to calculate the EuroSCORE. The outcome of interest was death. Univariate analysis and multivariate analysis by backward logistic regression were applied to assess the association between each variable in the EuroSCORE and deaths. The following parameters were calculated: sensitivity, specificity, positive predictive value, and negative predictive value. The power of concordance between the predicted mortality by the EuroSCORE and the observed mortality was measured using the Kappa coefficient. The accuracy of the model was evaluated by the ROC (receiver operating characteristic) curve. Results: The incidence of death was 13%. In multivariate analysis, nine variables remained independent predictors of death: chronic obstructive pulmonary disease, creatinine >2,3mg/dL, active endocarditis, preoperative critical state, unstable angina, ejection fraction 30% to 50%, acute myocardial infarction < 90 days, emergency surgery and additional surgery. The score had a sensitivity of 88.4%, specificity of 79.3%, positive predictive value of 40.7%, negative predictive value of 97.7% and 80.6% concordance. The accuracy measured by the area under the ROC curve was 0.892 (95% CI 0.862-0.922). Conclusions: The EuroSCORE proved to be a simple and objective index, revealing a satisfactory discriminator of postoperative evolution in patients undergoing CABG surgery at our institution.
Keywords: Myocardial revascularization; Risk; Risk assessment/methods; Mortality
Respiratory muscle training in patients submitted to coronary arterial bypass graft
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Objectives: 1) To demonstrate the impaired ventilatory capacity during the post operatory period, in patients submitted to coronary arterial bypass graft surgery (CABG). 2) To test the hypothesis that the respiratory muscle training (RMT), performed after the surgery, may increase the ventilatory capacity in this population. Methods: Thirty-eight patients (age: 65±7 years, 29 male), whose underwent CABG with extra-corporeal circulation. Patients were randomized in two groups: 23 patients in the RMT group and 15 in the control group (CO). RMT group received conventional physiotherapy plus RMT. The CO group received the conventional physiotherapy. Evaluated parameters: maximum inspiratory and expiratory pressures (MIP) (MEP), dyspnea (Borg), peak expiratory flow (PEF), pain, tidal volume and hospitalization days. Measures were performed at pre, first post operatory day and also at the patients discharge from the hospital). Results: MIP and MEP in the RMT group were higher when compared with CO at the patients discharge (MIP: 90±26 vs. 55±38 cmH2O, P=0.01) (MEP: 99±30 vs. 53±26 cmH2O, P=0.02). The PEF was higher after hospitalization in the RMT group (237±93 vs. 157±102 lpm, P=0.02). Tidal volume was also higher in the RMT group at discharge (0.71±0.21 vs. 0.44±0.12 liters, P=0,00). No differences were observed among the groups in the aspects: admission days, dyspnea and pain. Conclusions: Patients submitted to CABG presents an impaired respiratory muscle strength in their post operatory. RMT performed in this phase was effective to restore the ventilatory capacity in the following parameters: MIP, MEP, PEF and tidal volume, in this group of patients.
Keywords: Myocardial revascularization; Breathing exercises; Treatment outcome
Analysis of aortic root surgery with composite mechanical aortic valve conduit and valve-sparing reconstruction
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Objective: Comparative analysis of early and late results of aortic root reconstruction with aortic valve sparing operations and the composite mechanical valve conduit replacement. Methods: From November 2002 to September 2009, 164 consecutive patients with mean age 54 ± 15 years, 115 male, underwent the aortic root reconstruction (125 mechanical valve conduit replacements and 39 valve sparing operations). Sixteen percent of patients had Marfan syndrome and 4.3% had bicuspid aortic valve. One hundred and forty-four patients (88%) were followed for a mean period of 41.1 ± 20.8 months. Results: The hospital mortality was 4.9%, 5.6% in operations with valved conduits and 2.6% in the valve sparing procedures (P < 0.05). There was no difference neither in survival (95% CI = 86% - 96%, P=0.1) nor in reoperation-free survival (95% CI = 85% - 90%, P=0.29). The survival free of complications such as bleeding, thromboembolism and endocarditis were favorable to the valve sparing operations, respectively (95% CI = 70% - 95%, P=0.001), (95% CI = 82% - 95% P=0.03) and (95% CI = 81% - 95%, P=0.03). Multivariate analysis showed that creatinine greater than 1.4 mg/dl, Cabrol operation and renal dialysis were predictors of mortality, respectively, with occurrence chance of 6 (95% CI = 1.8 - 19.5, P=0.003), 12 (95% CI = 3 - 49.7, P=0.0004) and 16 (95% CI = 3.6 - 71.3, P=0.0002). Conclusions: The aortic root reconstruction has a low early and late mortality, high survival free of complications and low need for reoperation. During the late follow-up, valve sparing aortic root reconstructions presented fewer incidences of bleeding, thromboembolic events and endocarditis.
Keywords: Aorta; Aortic aneurysm, thoracic; Aortic valve insufficiency; Aortic valve
Relation between respiratory muscle strength with respiratory complication on the heart surgery
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Objective: To check the respiratory muscle strength in cardiac surgery and the relationship with the postoperative pulmonary complications. Methods: Sixty-tree adult's patients undergoing elective cardiac surgery were enrolled in this study. In the day of the surgery all patients did the respiratory muscle strength test. In the postoperative a multidisciplinary team took care all patients and they receive physiotherapy treatment twice a day following the usual care of the hospital. In the fifth day after surgery, the patients repeat the respiratory muscle strength test and were examined postoperative pulmonary complications. Results: A significant lower inspiratory muscle strength (P=0.001) and expiratory muscle strength (P=0.0001) was found in the postoperative, however it wasn't statistics significantly the relationship between the inspiratory muscle strength (P=0.58) and expiratory muscle strength (P=0.4) preoperative with postoperative pulmonary complication. Conclusions: The respiratory strength preoperative couldn't be a predictor of postoperative pulmonary complication.
Keywords: Cardiac surgical procedures; Muscle strength; Postoperative Complications
The hypoplastic left heart syndrome is not a risk factor for Fontan operation
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Objective: To show the mortality rate of children undergoing to Fontan operation and determine whether the hypoplastic left heart syndrome (HLHS) is a risk factor for hospital mortality. Methods: From August 2001 to June 2008, 76 patients underwent Fontan operation and were divided into two groups: group A with 54 patients, 31 (40.7%) patients with tricuspid atresia and variants, six (7.8%) of double-inlet left ventricle, four (5.3%) and atrioventricular septal defect and total 13 (17.1%) of other complex congenital heart disease and group B all patients with HLHS a total of 22 (28.9%) patients. Results: Group A patients had a mean age of 6.47 years ± 4.83 and group B of 2.08 years ± 0.24 P <0.001, the average weight was 22.42 ± 11.04 against 12.99 ± 1.2 P = 0.016, the mean CPB time was 119.5 min versus 113.3 min P = 0.0, with a mean clamping time of 74.8 min and 73.5 min p = 0.75. The mean ICU stay was 4.1 days for group A versus 7.52 days for group B p = 0.0003. In total (group A + B) three patients died, with hospital mortality of 3.9%, and one patient with HLHS (4.54%) (P <0.001, 95% CI 0.001 to 0.228). Conclusion: Our study shows that despite higher morbidity in HLHS is not a risk factor for hospital mortality.
Keywords: Congenital heart defects/surgery; Hypothermia; Echocardiography
Epsilon-aminocaproic acid influence in postoperative bleeding and hemotransfusion in mitral valve surgery
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Introduction: The epsilon aminocaproic acid is an antifibrinolytic used in cardiovascular surgery to inhibit the fibrinolysis and to reduce the bleeding after CBP. Objective: To analyze the influence of the using of epsilon aminocaproic acid in the bleeding and in red-cell transfusion requirement in the first twenty-four hours postoperative of mitral valve surgery. Methods: Prospective studying, forty-two patients, randomized and divided in two equal groups: group #1 - control and group #2 - epsilon aminocaproic acid. In Group II were infused five grams of EACA in the induction of anesthesia, after full heparinization, CPB perfusate after reversal of heparin and one hour after the surgery, totaling 25 grams. In group I, saline solution was infused only in those moments. Results: Group #1 showed average bleeding volume of 633.57 ± 305,7 ml, and Group #2, an average of 308.81 ± 210.1 ml, with significant statistic difference (P=0.0003). Average volume of red-cell transfusion requirement in Groups 1 and 2 was, respectively, 942.86 ± 345.79 ml and 214.29 ± 330.58 ml, with significant difference (P<0.0001). Conclusion: The epsilon aminocaproic acid was able to reduce the bleeding volume and the red-cell transfusion requirement in the immediate postoperative of patients submitted to mitral valve surgery.
Keywords: Antifibrinolytic agents; Hemostasis; Blood transfusion
Pulmonary artery perfusion does not improve brain natriuretic peptide (BNP) levels in suine experimental research
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Objective: Assess if the main pulmonary artery controlled perfusion over cardiopulmonary bypass (CPB) modifies BNP levels expressed by the ventricular myocardium. Methods: Experimental research involving 32 pigs, divided into two groups according to CPB strategy - group I (cardioplegia) and group II (beating heart). Both groups were allocated into three subgroups according to lung perfusion strategy - subgroup A (control: no lung perfusion), subgroup B (lung perfusion with arterial blood) and subgroup C (lung perfusion with venous blood). In subgroups B and C, lung was perfused for 30 minutes, using preoperative mean pulmonary artery pressure (MPAP) as perfusion pressure, which was monitored through manometer. MPAP and pulmonary vascular resistance (PVR) were measured after coming off CPB using Swan-Ganz catheter. At preoperative time and 30 minutes after lung perfusion, specimens were taken from the right ventricular myocardium aiming to assess brain natriuretic peptide (BNP) and histologic pattern. Immunohistochemical and hematoxylin-eosin techniques were used to determine, respectively, BNP expression and inflammatory myocardial lesions. Results: In animals submitted to controlled lung perfusion, there was a postoperative reduction of MPAP (P=0.03) and PVR (P=0.005).There was no differences among subgroups within the group, I (P=0.228) and subgroups within group II (P=0.325) as to postoperative BNP expression. There were no differences among subgroups with and without lung perfusion as to postoperative inflammatory lesions (P>0.05). Conclusion: Main pulmonary artery controlled perfusion for 30 minutes did not yield substantial modifications in BNP expression and histologic pattern of the right ventricular myocardium.
Keywords: Cardiopulmonary bypass; Perfusion; Pulmonary artery
Cardiovascular behavior during rehabilitation after coronary artery bypass grafting
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Objective: The aim of the present study was to assess the behavior of cardiovascular variables during an in-hospital cardiovascular rehabilitation program in patients following myocardial revascularization surgery. Methods: A total of 14 patients (mean age: 55.4 ± 6.4 years, 78.6% male) participated in the study, all of whom had a previous diagnosis of coronary insufficiency and indication for elective surgery. The protocol consisted of a group of low-impact (2-3 METs) upper/lower extremity and walking exercises performed both pre and post-operatively (3rd and 4th days). The following variables were evaluated at rest and following the exercise program: heart rate (HR, bpm); systolic arterial pressure (SAP, mmHg); diastolic arterial pressure (DAP, mmHg); mean arterial pressure (MAP, mmHg); double product (DPr, bpm/mmHg); and the Rating of Perceived Exertion (RPE) scale. Results: There was a significant increase in HR and DPr in the individual analysis (P<0.001) as well as in between days (P<0.001 for HR and P<0.05 for DPr), but only attaining maximal values that were < 30% of predicted. Moreover, a negative correlation was found between the RPE scale and both SAP and MAP. Conclusion: The exercises proposed proved to be safe with the change in key physiologic variables throughout the experiment below recommended values for the hospitalization phase. Furthermore, the RPE scale appears to have a correlation with some hemodynamic variables and thus may be a useful tool for this group of patients.
Keywords: Exercise; Cardiovascular surgical procedures; Cardiovascular deconditioning
Mitral valve repair by Double Teflon technique: cardiac remodeling analysis by tridimensional echocardiography
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Introduction: Mitral valve repair is the treatment of choice to correct mitral insufficiency. Although the literature related to left atrial and ventricular behavior after mitral repair without use of prosthetic rings is scarce. Objective: To analyze cardiac morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique. Methods: Were included 14 patients with mixomatous mitral valve insufficiency that were submitted to mitral valve repair with the Double Teflon technique. Of them, 13 patients were in class III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistic analysis was made by repeated measures ANOVA test and was considered statistically significant P < 0.05. Results: The analysis of systolic volumes, atrial and ventricular, demonstrated a significant volumetric reduction between immediate postoperative period and 1 year (P=0.028 and P=0.020, respectively). Between preoperative period and 1 year, there was a mean reduction in atrial and ventricle volumes of 19.9% and 15.4%, respectively. Atrial and ventricle diastolic volumes presented a significant reduction in immediate postoperative period (P <0.001 and P =0.024, respectively), remaining stable during the study. There was an increase in left atrial ejection fraction after 6 months (P<0.001), although there was no significant variation in left ventricle ejection fraction. Conclusions: Patients submitted to mitral valve repair by the Double Teflon technique demonstrated a left atrial and ventricle reverse remodeling. These reductions were associated with an improvement in left atrial function during the study.
Keywords: Mitral valve; Mitral valve insufficiency; Reconstructive surgical procedures; Echocardiography, three-dimensional; Mitral valve prolapse
Analysis of hemodynamic performance of the bovine pericardium valved conduit, implanted in the aortic position in ovines
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Objective: The necessity for replacement of the valve, ascending aorta and aortic with coronary reimplantation in patients where anti-coagulation is undesirable, is increasing. We evaluated the hemodynamic performance of an aortic valved conduit made with glutaraldehyde treated bovine pericardium (AVCP) in animals. Methods: Therefore, AVCPs were implanted in eight young ovine and explanted after 150 days. Angiographic and hemodynamic study was performed at pre-operative and prior the explant. EchoDopplercardiograms were performed at day 30 and 150 of post-operative (test) and also in five nonoperated ovines. After explanted, AVCPs were submitted to a macroscopical, radiological and histological evaluation by optic microscopy. Results: In the hemodynamic analysis the arterial and pulmonary capillary pressure increased (P<0.05) between day 0 and 150. In the echoDoppercardiographic analysis, the test group presented higher values in the diastolic and systolic diameters of the left ventricle (P<0.05). In the test group, between day 30 and 150, occurred an increase of weight, thickness of the left ventricle walls, maximum transvalvar gradient, medium transvalvar gradient, left ventricle diastolic diameter and a decrease in the ejection function (P<0.05). Two animals with endocarditis explain those differences, how we can see with the statistycal analysis without this sample. Macroscopy showed calcification in variable degrees. Optic microscopy revealed data similar to literature with the use of glutaraldehyde treated bovine pericadium. Conclusions: These data indicate that the AVCPs allows the performance of this kind of experiment in the proposed model and that the hemodynamic outcomes found are similar to physiological parameters.
Keywords: Aortic valve; Heart valve prosthesis; Models, animal; Sheep
Cardiothoracic Surgery League from University of São Paulo Medical School: twelve years in medical education experience
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Introduction: Academic Leagues (Academic Interest Group) are entities that belong to medical schools and their hospitals. Their goals are research, medical education and health care. The cardiothoracic Surgery League (Liga de Cirurgia Cardiotorácica - LCCT), University of São Paulo Medical School, was founded 12 years ago, aimed at providing undergraduate medical students an opportunity to expand knowledge in cardiothoracic surgery and to take part in scientific studies in the field. Objective: To evaluate the experience gained through LCCT implementation. Methods: Current students and former members of LCCT were submitted to a specific evaluation form, delivered personally or by email, which provided data on the general opinion regarding LCCT's activities, the reasons for answers provided and choice of medical specialties. Furthermore, LCCT's total scientific production was evaluated. Results: Most undergraduate medical students 51/65 (78.5%) and former members 94/121 (77.7%) completed the form. The interest in Cardiothoracic Surgery was the most common reason for joining LCCT 44/161 (27.3%). Most students - 32/51 (62.7%) - reported their initial expectations were partially met. Almost every member would recommend a fellow medical student to join LCCT 50/51 (98%) and 25/51 (49%) of them participated in a scientific project linked to LCCT. In total, 47 scientific papers were published having LCCT's medical students as authors or co-authors during the existence of the league. Of the former members who chose a surgical career, 7/52 (13.4%) chose thoracic or cardiovascular surgery. Conclusion: LCCT has met its goals, since most current and former members recognized its role in their medical training, besides it is a good way to produce scientific initiation.
Keywords: Education, medical, undergraduate; Thoracic surgery; Education, medical
SPECIAL ARTICLE
Authorship for scientific papers: the new challenges
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
The dissemination of the practice of collaborative authorship (coauthorship) in Brazil and in the international scientific community has been accompanied by an increasing occurrence of frauds, manipulations and other deviations in the assignment of responsibility for a scientific paper. This article discusses the criteria for authorship attribution, the reasons for the growing indices of coauthorship and the challenges to determine authorship in electronic journals. Through literature review and case study (bibliographic search in scientific database), it shows ways to avoid that "misbehaviors" related to the authorship attribution affect the credibility of science.
Keywords: Authorship; Periodicals; Scientific communication; Scientific production
Focus on quality of life
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
REVIEW ARTICLE
Leukocytes and the inflammatory response in ischemia-reperfusion injury
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
The events of ischemia-reperfusion injury triggers a systemic inflammatory response and can lead to cellular injury and organ failure. Such effects are noted in the post-operative recovery, especially with the use of cardiopulmonary bypass. Nowadays, it is known that leukocytes play an important role in this process. Therefore, this study addresses the role of leukocytes in the physiopathology of ischemia-reperfusion injuries and activation of inflammatory cascades through this process and seek to help in the understanding of these mechanisms as well as to bring contributions on the therapeutic approaches that can mitigate them. This retrospective review was performed from indexed scientific papers published over the last ten years in Portuguese and English in international databases MEDLINE and SciELO and related classic texts. The descriptors investigated were: ischemia-reperfusion, leukocytes, inflammatory response, cardiopulmonary bypass, adverse effects and apoptosis.
Keywords: Extracorporeal circulation; Leukocytes; Ischemia; Reperfusion injury
CASE REPORT
Surgical repair of D-TGA with an aortopulmonary window and ventricular septal defects
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
D-Transposition of great arteries with an aortopulmonary window is a rare congenital anomaly. We describe a case of D-Transposition of great arteries with an aortopulmonary window and multiple ventricular septal defects in a 5-month boy who underwent successful surgical repair.
Keywords: Congenital heart defects/surgery; Transposition of great vessels; Transposition of great vessels/ surgery
Surgical treatment of pulmonary venous baffle obstruction after modified Senning procedure
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
A 13-year-old male was admitted to undergoing correction of a pulmonary venous baffle stenosis (PVBS) after a modified Senning procedure was performed by the age of five months. Recurrent Pulmonary congestion and pneumonia episodes were followed by echocardiography and cardiac catheterization that confirmed PVBS. Previous catheter balloon angioplasty was attempted, and a surgical revision was done under cardiopulmonary bypass. The bovine pericardial patch used for augmentation of the right atrium, retracted and calcified producing PVBS. Stenotic area was excised and enlargement was done with polytetrafluoroethylene membrane. Intraoperative transesophageal echocardiogram showed relief of stenosis.
Keywords: Reoperation; Pulmonary veins; Pericardium
Lipoma resection of the interventricular septum
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
We report the case of an asymptomatic 43-year-old-man with a lipoma of the interventricular septum. Diagnosis was established during routine medical examination by 2-dimensional echocardiography and confirmed by computed tomography and magnetic resonance imaging. The patient underwent successful resection of the tumor.
Keywords: Lipoma; Heart neoplasms; Ventricular septum
MULTIMEDIA
Correction of coarctation of the aorta with end anastomosis in premature newborn
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
CLINICAL-SURGICAL CORRELATION
Correction of aortic coarctation with interposition of a tube in a 12 years-old child
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
ACKNOWLEDGMENT
Acknowledgment
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
LETTERS TO THE EDITOR
Letters to the Editor
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Comment on the small skin bridges saphenectomy technique for coronary artery bypass grafting-A Letter to the Editor
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025
Surgery Study receives the VI ABC Award of Scientific Publication
Braz J Cardiovasc Surg 25;
Publish in: 8/2/2025