Volume 26 - Número 2
BJCVS has impact factor of 0.963
The Einstein's frog
The importance of the internet for medical societies
Fractal dimension in quantifying the degree of myocardial cellular rejection after cardiac transplantation
OBJECTIVE: The aim of the present study was to try to establish the contribution of FD in the quantification of myocardial cellular rejection after cardiac transplantation.
METHODS: Microscopic digital images were captured at 800x600 resolution (magnification 100x). FD was calculated with the aid of "ImageJ software" with adaptations. The classification of the degrees of rejection was in agreement with the "International Society for Heart and Lung Transplantation" (ISHLT 2004). The final report of the degree of rejection was confirmed and redefined after an exhaustive review of the slides by an external experienced pathologist. 658 slides were evaluated with the following distribution among the degrees of rejection (R): 335 (0R); 214 (1R); 70 (2R); 39 (3R). The data were statistically analyzed with Kruskal-Wallis tests and ROC curves being considered significant values of P < 0.05.
RESULTS: There was significant statistical difference between the various degrees of rejection with the exception of R3 versus R2. The same trend was observed in applying the ROC curve.
CONCLUSION: FD may contribute to the assessment of myocardial cellular rejection. Higher values are directly associated with progressively higher degrees of rejection. This may help in decision making of doubtful cases and those which contemplate the intensification of immunosuppressive medication. Keywords: Heart transplantation; Biopsy; Graft rejection; Cardiac surgical procedures
Predictors of infection in post-coronary artery bypass graft surgery
BACKGROUND: Although coronary artery bypass grafting (CABG) is
a good alternative therapy in severe arterial disease, it may evolve with
complications, especially infections.
OBJECTIVES: To determine the incidence of infection in post-CABG and its
clinical predictors in a cardiology reference center in Brazil.
METHODS: Cohort study. Data were collected from all patients undergoing
CABG between January/2004 and February/2006, excluding emergency surgery,
absent record of glucose blood levels preoperatively and infection prior to
surgery. Statistical analysis: Student's t test, chi square, logistic
regression.
RESULTS: We evaluated 717 patients, 61.9 ± 11 years old, 67.1% were men,
29.6% with diabetes, of whom 137 (19.1%) developed infection (62% respiratory,
25% superficial wound, 9.5% urinary, 3.6% deep wound). Diabetes was more
prevalent in those who developed infection, as well as prolonged time of
indwelling central venous catheter (79.3 ± 40.5 vs. 61.0 ± 19.3 hours, P<0.001).
After multivariate analysis (model adjusted for dyslipidemia, hypertension,
smoking and leukocytes), both diabetes (OR 4.18 [2.60-6.74]),
prolonged central venous line (OR 1.019 [1.00-1.02] and
cardiac catheterism (OR 2.03 [1.14-3.60] remained predictors
of infection. While diabetes is associated with a higher percentage of
infections (P <0.001), preoperative serum glucose was not associated
with increased risk of infection.
CONCLUSIONS: Diabetes and permanence of central venous catheters were
associated with development of infection in post-CABG. The preoperative blood
glucose was not a predictor of risk of infection. It is probably necessary to
study with greater detail glycemic control trans- and post-operatively.
Design conception and experimental setup for in vitro evaluation of mitral prosthetic valves
BACKGROUND: Since most complications related to the operation of
prosthetic heart valves is due to disturbances of flow, its hydrodynamic
characterization is a useful aid in the design of new prostheses. Simulations
of pulsatile flow in cardiac prostheses began nearly 40 years ago, through the
development of different mock human circulatory systems, improving the clinical
results interpretation. A new design of a pulse duplicator system was developed
at Polytechnic School of USP to study prosthetic heart valves.
OBJECTIVE: To present the conception of a new mock circulatory system
for hydrodynamic simulations of cardiac prosthetic valves and the assembly plan
of an experiment whose focus is the test of mitral prosthesis.
METHODS: Its conception is based on the state-of-art's review of these
studies and the experience got with the previous mock circulatory systems,
particularly the one used in the Instituto Dante Pazzanese de Cardiologia,
São Paulo, SP, Brazil.
RESULTS: In this design, an electric servomotor controlled by computer
emits, through a hydraulic piston, a pulse to the left ventricular chamber
model, where the heart valves are accomodated. To characterize, in the future,
the dynamic operation of mitral prosthetic valves, an experimental setup was
mounted to provide measurements of volumetric flow, instantaneous pressure and
velocity fields on these valves. Optical access is conveniently provided on the
design, making possible the use, in the future, of a LDA system.
CONCLUSIONS: In order to improve the analysis of hydrodynamic shear
stress and prediction of haemolysis, the experimental results may be used to
regulate a numerical model using 'Computational Fluid Dynamics' (CFD).
Brazilian perfusionists and arterial roller pump adjustment: comparison between static and dynamic calibration method
INTRODUCTION: Roller pumps play an important role in
extracorporeal circulation. However, occlusion of the rollers should be
adequately performed and this can be adjusted mainly by two methods: static and
dynamic.
OBJECTIVE: To investigate how the Brazilian perfusionists adjust
arterial roller pumps in their services and evaluate the application of a
Device to Assist Calibration (DAC) that facilitates roller adjustment by the
dynamic calibration method.
METHODS: We installed a roller pump with accessories to perform
adjustment by drop rate (static calibration) and dynamic calibration methods
during the XXVIII Brazilian Congress of Extracorporeal Circulation.
Perfusionists were asked to adjust the roller pump according to the procedure
they usually do in their service. After each adjustment pressure was measured
by dynamic calibration method with DAC. The research was approved by the
Research Ethics Committee of UNICAMP, Nº 1144/2010.
RESULTS: There were 56 perfusionists in this study. Pressure average of
56 measurements of dynamic calibration was 434 ± 214 mmHg; 76% of measurements
were within the recommended range for the use of the dynamic calibration method
(between 150 and 500 mmHg).
CONCLUSION: Brazilian perfusionists tend to adjust roller pumps with
less occlusive settings. The amplitudes of the dynamic calibration pressure
tend to be smaller for more experienced perfusionists because their skills
increase with time. The device can be used by the perfusionist to adjust roller
pumps with greater accuracy and mainly repeatability in few minutes.
Effects of the use of mechanical ventilation weaning protocol in the Coronary Care Unit: randomized study
OBJECTIVE: To compare mechanical ventilation weaning based on
a protocol using the spontaneous breathing trial against mechanical ventilation
weaning without a standardized protocol in heart patients.
METHODS: Prospective, open, randomized study. In 2006, 36 patients
undergoing mechanical ventilation for over 24 hours were randomized into two
groups: control group - eighteen patients whose mechanical ventilation weaning
was performed according to the different procedures adopted by the
multidisciplinary team; and experimental group - eighteen patients weaned
according to previously established protocol.
RESULTS: Control group patients started the weaning process sooner than
experimental group patients (74.7 ± 14.7 hours vs. 185.7 ± 22.9 hours, P=0.0004).
However, after the experimental group patients were ready for weaning, the
extubation was carried out more rapidly than in the control group (149.1 ± 3.6
min vs. 4179.1 ± 927.8 min, P < 0.0001) with significantly lower
reintubation rates (16.7% vs. 66.7%, P = 0.005).
CONCLUSION: The use of a specific protocol based on the spontaneous
breathing trial for mechanical ventilation weaning in heart patients had better
outcomes than weaning carried out without a standardized protocol, with shorter
weaning times and lower reintubation rates.
The impact of blood transfusion on morbidity and mortality after cardiac surgery
OBJECTIVES: To analyze the impact of blood transfusion on the
incidence of clinical outcomes postoperatively (PO) from cardiac surgery.
METHODS: Retrospective cohort study. We analyzed 4028 patients
undergoing coronary artery bypass grafting (CABG), valve (TV), or both, in
Brazilian tertiary university hospital between 1996 and 2009. We compared the
postoperative complications between patients with blood transfusion (n = 916)
and non-blood transfusion (n = 3112). Univariate analysis was performed using
the Student t test, and multivariate logistic regression bivariate (stepwise
forward). Were considered significant variables with P <0.05.
RESULTS: Patients who received blood transfusions had more infectious
episodes as mediastinitis (4.9% vs. 2.2%, P <0.001), respiratory
infection (27.8% vs 17.1%, P <0.001) and sepsis (6.2% vs. 2.5%, P
<0.001). There were more episodes of atrial fibrillation (AF) (27% vs.
20.4%, P <0.001), acute renal failure (ARF) (14.5% vs 7.3%, P
<0.001) and stroke (4.8% vs. 2.6%, P = 0.001). The length of PO
hospital stay was higher in transfused (13 ± 12.07 days vs. 9.72 ± 7.66 days, P
<0.001). However, mortality didn't differ between groups (10.9% vs. 9.1%, P
= 0.112). The transfusion was shown to be a risk factor for: respiratory
infection (OR: 1.91, 95% CI 1.59-2.29, P <0.001), AF (OR: 1.35, 95%
CI 1.13-1.61, P = 0.01), sepsis (OR: 2.08, 95% CI 1.4-3.07, P
<0.001), mediastinitis (OR: 2.14, 95% CI: 1.43-3.21, P <0.001),
stroke (OR: 1.63, 95% CI 1.1-2.41, P = 0.014) and ARF (OR 1.8, 95% CI:
1.39-2.33, P <0.001).
CONCLUSION: The blood transfusion is associated with increased risk of
infectious events, episodes of AF, ARF and stroke, as well as the increased
length of hospital stay but not mortality.
Quality of life of patients with implantable cardioversor-defibrillator: the usage of SF-36 questionnaire
OBJECTIVE: To observe the quality of life of patients with
implantable cardioversor defibrillator (ICD).
METHODS: Descriptive research with quantitative approach by means of an
interview and the analysis of the Questionnaire SF-36 in a cardiovascular
outpatient service. Fifty patients users of this device participated in this
study during their medical follow-up in the period from January to December.
RESULTS: Out of the subjects, 19 (38%) were female and 31 (62%) male.
The average age was 58.4 years, ranging from 21 to 75 years. Two domains
regarding limitations by physical and emotional aspects below score 50 were observed
The social aspects domain presented the higher score; 80,5. Most of the users
reported that their health is a little better compared with a year ago.
CONCLUSION: The results showed that individuals' quality of life is
impaired, with lower scores for physical and emotional aspects. There was not a
correlation between quality of life and age, gender, marital status and
educational level. However, they feel comfortable and safe with ICD benefits
since it provides their maintenance in being alive protecting them of sudden
death.
Physical therapy in postoperative cardiac surgery: the patient's perception
INTRODUCTION: Many strategies to improve services provided by
for physiotherapy are based on patients satisfaction. Listen and observe the behavior
of patients in a hospital is crucial to understanding and improvement of
service and the hospital.
OBJECTIVE: This study aimed to identify the patient's perception
undergoing cardiac surgery on the physiotherapy service provided to wards of
hospitals for heart surgery reference in the city of Maceió, AL, Brazil, and
from that information detect what actions are perceived as priorities for which
are noteworthy plans for improvements in quality of care.
METHODS: Cross-sectional study, conducted in quality and quantity of
reference hospitals in cardiac surgery in the city of Maceio, AL, Brazil, in
the period from September to November 2008. The study included 30 users of the
Sistema Único de Saúde, of which 12 (40%) female and 18 (60%) males. The average
age of this sample was 49.2 ± 11.9 years and most belonged to socioeconomic
class D (36.7%).
RESULTS: It was found that only 16.7% had contact with the
physiotherapist before surgery. Regarding educational guidelines about
postoperative period, only 2.9% patients reported having received them.
However, 56.8% rated the care as good and 100% of patients reported believing
that physiotherapy could improve their health status.
CONCLUSION: We suggest the implementation of preoperative physical
therapy protocols with preventive measures and educational as well as new
researchs that may characterize the population of users of health
plans/private.
A bovine pericardium rigid prosthesis for left ventricle restoration: 12 years of follow-up
BACKGROUND: Myocardial infarction might result in dilated left
ventricle and numerous techniques have been described to restore the original
left ventricle shape and identify tools for late survival assessment. The aim
of this study is to compare our experience with a modified Dor procedure using
a rigid prosthesis to the septal anterior ventricular exclusion procedure
(SAVE) for left ventricle restoration. The EuroScore index for prediction of
late follow up survival was evaluated.
METHODS: We evaluated 80 patients who underwent left ventricle
restoration between 1999 to 2007 and eight patients were excluded with
incomplete data. A modified Dor procedure with rigid prosthesis (MD group) was
performed on 53 patients and 19 underwent the septal anterior ventricular
exclusion procedure (SAVE group). The patients were classified according their
left ventricle shape as type I, II or III. Kaplan-Meier and Cox proportional
hazard ratio regressions analysis were performed to assess survival after both
techniques and expected surgical mortality using EuroScore index ranking after
12 years of follow up.
RESULTS: The operative mortality was comparable in both groups ranked by
EuroScore index. The groups were comparable for all clinical data, except the
MD group had more patients using intra-aortic balloon pumps before surgery,
(5.7% vs. 0; P<0.01). Kaplan Meier analysis by left ventricle shape
showed comparable survival for all patients, with slightly higher survival for
type I. Kaplan Meier analysis of all death showed equivalent survival curves
for both techniques after 12 years of follow up (71.5 ± 12.3 vs. 46.6 ±20.5
years; P=0.08). Kaplan Meier analysis of EuroScore index for all
patients showed a difference between the three ranked categories, i.e., 0 to
10%, 11 to 49% and higher than 50% expected surgical mortality after 12 years
of follow up (70.9 ± 16.2 vs. 67.5 ± 12.7 vs. 53.0 ± 15.5; P=0.003).
CONCLUSION: The MD procedure showed consistent ejection fraction
improvements after long term follow up. Survival was comparable for all
ventricular types and for the MD and SAVE procedures. The EuroScore index is a
useful index for late survival assessment of ventricular restoration
techniques.
Osteopontin expression and its possible functions in the aortic disorders and coronary artery
BACKGROUND: Osteopontin (OPN) has been verified to be closely
associated with oncogenesis and remodeling processes. But this cytokine was
rarely assessed in the presence of aortopathies, especially acute aortic
dissection. The aim of the present study was to evaluate the expressions of OPN
by way of molecular biological approaches so as to offer a better understanding
of the possible mechanisms of the aortopathies.
METHODS: Consecutive patients with type A acute aortic dissection (20
patients), aortic aneurysm (nine patients) or coronary artery disease (21
patients) referred to this hospital for surgical operations were enrolled into
this study. Blood samples of the surgical patients after systematic
heparinization, and control fast morning blood samples drawn from 21 young
healthy volunteers who had no evidence of any healthy problems were
investigated for enzyme linked immunosorbent assay (ELISA). The surgical
specimens of the aortic tissues collected from the surgical patients during the
operations were obtained for quantitative realtime reverse transcription
polymerase chain reaction (RT-PCR) for OPN mRNA, western blot assay for OPN
protein, and for immunohistochemical staining of OPN. Ascending aortic tissues
from the autopsies of the healthy individuals dying of accident were obtained
as controls of immunohistochemistry.
RESULTS: By quantitative RT-PCR, the expressions of OPN mRNA were all
upregulated in all three surgical groups. The quantitative results did not
reveal any intergroup differences. Western blot assay revealed that OPN was
positive with similar intensities of expressions in all three surgical groups.
Quantitative western blot analyses of OPN expressions did not show any
significance between groups. The OPN expressions by ELISA in the aortic tissue
were 3.09311 ± 1.65737, 3.40414 ± 1.15095, and 1.68243 ± 0.31119 pg/mg protein
in the aortic dissection, aortic aneurysm, and coronary artery disease groups,
respectively. The OPN level of the patients with coronary artery disease was
much lower than those with aortic dissection (P = 0.033) or with aortic
aneurysm (P = 0.019). By unparametric tests, there were significant
differences in the aortic OPN contents among aortic dissection, aortic aneurysm
and coronary artery disease groups (P < 0.01). A significant direct
correlation was present between plasma OPN concentration and the time interval
from the onset to surgery of aortic dissection (Y = 0.1420X + 2.4838, r2
= 0.5623, r = 0.750, P = 0.032). By immunohistochemistry, OPN was
expressed in the aortic cells: in the intima, it was weaker in all three
surgical groups in comparison with the healthy control; in the media, it was
weak in the aortic dissection, intense positive in aortic aneurysm, focal
positive in the coronary artery disease, but evenly positive in the healthy
control groups; and in the adventitia, it was positive in the aortic
dissection, coronary artery disease and healthy control groups, but weak positive
in the aortic aneurysm group.
CONCLUSION: These data may provide evidences that OPN may play a role in
the pathogenesis of aortopathies including aortic dissection, aortic aneurysm,
and coronary artery disease. OPN might be of potential perspective as a
clinically diagnostic tool in the evaluations of the complex remodeling process
incorporating vascular injury and repair.
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients
BACKGROUND: Mediastinitis is a serious complication of median
sternotomy and is associated to significant morbidity and mortality. Diabetes
is a feared risk factor for mediastinitis and viewed with caution by
cardiovascular surgeons.
OBJECTIVE: To identify risk factors for mediastinitis in diabetics
undergoing CABG surgery with use of unilateral ITA in the Division of
Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE.
METHODS: Retrospective study of 157 diabetics operated between May 2007
and April 2010. Nine preoperative variables, five intraoperative variables and
seven postoperative variables possibly involved in the development of
postoperative mediastinitis were evaluated. Univariate and multivariate
logistic regression analyses were applied.
RESULTS: The incidence of mediastinitis was 7% (n=11), with a lethality
rate of 36.1% (n=4). Variables associated with increased risk of mediastinitis
were: use of pedicled ITA (OR 8.25, 95% CI 2.03 to 66.10, P=0.016),
postoperative renal complications (OR 5.10, 95% CI 1.03 to 25.62, P=0.049)
and re-operation (OR 7.45, 95% CI 1.24 to 42.17, P=0.023). In
multivariate analysis using backward logistic regression, only one variable
remained as independent risk factor: use of pedicled ITA (OR 7.64, 95% CI 1.95
to 61.6, P=0.048), in comparison to skeletonized ITA.
CONCLUSIONS: We suggest that diabetics should be considered for
strategies to minimize risk of infection. In diabetics that undergo unilateral
ITA, the problem seems to be related to how ITA is harvested. Diabetics should
always be considered for use of skeletonized ITA.
Right coronary artery anatomy: anatomical and morphometric analysis
BACKGROUND: It is necessary knowing the large variability of right
coronary (RCA) artery specialty for its implications in surgical procedures and
clinic events. This variability is usually related to the length, branches
quantity, origin and irrigated territories.
OBJECTIVE: To evaluate by direct examination the morphologic expression
of RCA in Colombian people.
METHODS: RCA were measured in 221 fresh hearts by RCA ostium
canalization with polyester synthetic resin that was injected in their
branches.
RESULTS: The caliber of the RCA proximal segment and at the level of the
acute angle of the heart was 3.42 ± 0.66 mm and 2.9 ± 0.50 mm, respectively. It
ended between crux cordis and the left margin in 75.6% of specimens. Posterior
interventricular artery (PIA) reached the inferior third, or the apex, or the
anterior interventricular sulcus in 149 (67.4%) cases. Sinoatrial node artery
(SNA) originated in the right coronary in 134 (60.6%) cases, 77 (34.9%) from
circumflex artery (CxA) and from both in 10 (4.5%). Posterior right diagonal
artery (PRDA) was noted in 38 (17.2%) hearts, but only 6% of the sample with
long PIA, concomitantly presented the PRDA (P = 0.001). In right
dominance SNA were originated from RCA in 54.7% and form CxA in 46.3% (P
= 0.06).
CONCLUSIONS: Caliber of the RCA and its branches is lesser than the
majority of previous studies, while the PRDA frequency is slightly higher than
the reported in literature. Clinical and pathological scenarios by these
variations should be taken into account: hemodynamic procedures, cardiac
surgery and arrhythmias from coronary occlusive disease.
Mortalidade no tratamento endovascular nas dissecções aórticas tipo B
BACKGROUND: Endovascular stent-graft repair of aortic
dissections is a relatively new procedure, and although apparently less invasive,
the efficacy and safety of this technique have not been fully established.
OBJECTIVE: To evaluate mortality in patients with complicated Stanford
type B aortic dissections submitted to endovascular treatment.
METHODS: Clinical, anatomical, imaging and autopsy data of 23 patients
with complicated type B aortic dissections were reviewed from November 2004 to
October 2007. The main indications for transluminal thoracic stent-grafting
included: persistent pain in spite of medical therapy, signs of distal limb
ischemia, signs of aortic rupture, progression of aneurismal dilation of the
descending aorta during follow-up (defined as a diameter > 50 mm) and the
diameter of descending thoracic aorta of 40mm or larger at the onset of aortic
dissection. Data were analyzed statistically; all p-values were two-tailed and
differences < 0.05 were considered to indicate statistical significance.
Continuous variables were expressed as mean (± SD), and medians were compared
by the Student's t test. Differences in categorical variables between the
groups were analyzed by the Chi-square or Fisher's exact test.
RESULTS: The procedure presented primary technical success in 82.6% of
patients. Four patients (17.4%) had an incomplete proximal entry seal. Three
patients (13%) died within 30 days of the procedure and eight patients (34.8%)
died after 30 days.
CONCLUSION: Endovascular correction of complicated Stanford type B
aortic dissections is a feasible and effective treatment option.
The impact of carotid artery disease on outcomes of patients undergoing coronary artery bypass grafting
OBJECTIVE: Although the overall complication rate has been
decreased significantly in recent years, stroke is a severe complication after
coronary bypass operations. The purpose of this study is to evaluate the
influence of carotid artery disease on the results of patients under CABG
operation.
METHODS: In a retrospective cohort study, 1,978 patients under CABG
operation were studied in Shariati Hospital between April 2002 and March 2006.
The patients who had only valve replacement or non-CABG procedure were excluded
from this study. As part of preoperative evaluation, carotid duplex
ultrasonography scans were performed. In order to estimate the degree of
carotid arteries stenosis, ultrasound imaging measurement and velocity criteria
were considered. The patients were classified into three groups: those with no
significant stenosis of the internal carotid artery (ICA) (moderate) group A,
those with significant stenosis (sever) group B and those with the occluded ICA
(critical) group C. Finally, all data were analyzed by SPSS software.
Statistical analyses were performed using the following testes; chi-square,
Fisher exact and Student's t tests.
RESULTS: The distribution of the 1,978 patients undergoing CABG
operation were as follows: group A = 1,938, group B = 30, and group C = 10. The
results of the evaluations show that perioperative stroke rates were 1.2% (24
patients) in group A, 0.4% (eight patients) in group B and 0.3% (six patients)
in group C (P<0.0001). Furthermore, perioperative mortality rates for
groups A, B and C were 0.1% (two patients), 0.3% (five patients) and 0.4%
(seven patients), respectively (P<0.0001).
CONCLUSION: The stroke and mortality in patients undergoing CABG are
increased when ICA occlusion is present.
Pediatric cardiac surgery: what to expect from physiotherapeutic intervention?
This study aims to gather and present scientific evidence on the role of a physiotherapist in the pre, peri and postoperative of pediatric cardiac surgery. This professional is able to prevent, minimize or reverse possible respiratory dysfunction and motor sequelae resulting from these interventions. Studies discuss the involvement of respiratory system, specifically the clearance of bronchial secretions and ventilatory adequacy, as a result of surgical procedure. Scientific evidences suggest the effectiveness of physiotherapy in reducing indices of: pneumonia, atelectasis, hospitalization, sequelae deleterious and length of bed restriction, beyond clinical improvement. These data confirm positive contribution of physiotherapeutic intervention in these surgeries.
Keywords: Physical therapy modalities; Cardiac surgical procedures; Heart defects, congenitalCardiac surgery and hypertension: a dangerous association that must be well known
It is well-known that hypertension is a very common disease, and severe cerebrovascular accidents might occur if the blood pressure is not properly controlled. However, conditions associated with uncontrolled hypertension may be overlooked, and may become critical and eventually require a surgical intervention on an urgent basis. Coronary artery disease, acute aortic syndrome, congenital and valvular heart disease, and arrhythmias are under this topic of discussion. Of them, coronary artery disease including myocardial infarction and especially postinfarction myocardial rupture, and aortic dissection are major critical situations that physicians may encounter in clinical practice. The role that hypertension plays in these conditions can be complex, including hemodynamic, electrophysiological and biomolecular factors, where the latter may prevail in the current era. Coronary artery disease may be associated with a reduced nitric oxide synthesis. Transforming growth factor and matrix metalloproteinases have been observed in relation to aortic syndrome. Wnt, p38 and JNK signaling pathway may be involved in the development of ventricular hypertrophy responsible for cardiac arrythmias. Various gene phynotypes may present in different congenital heart defects. This article is to present these conditions, and to further discuss the possible etiologies and the potential treatment strategies so as to highlight the relevance at a prognostic level.
Keywords: Cardiac surgical procedures; Heart Diseases; HypertensionComparative experimental study between L-Hydro treated pulmonary homograft and fresh pulmonary homograft
OBJECTIVE: In an effort to make available homografts
preserved in a simpler and less costly way, we evaluated the
polyethyleneglycol, L-Hydro (LH) method, that consists in the controlled
extraction of antigenic substances and the incorporation of anti-inflammatory
and anti-thrombotic agent.
METHODS: We substituted the pulmonary trunk in ten ovines, seven
received LH treated pulmonary homografts and three, fresh pulmonary homografts,
orthotopically implanted and followed-up for 320 days. Ovines where evaluated
by means of laboratory tests, echocardiographic exams. At the 320 days, were
euthanized, hemodynamic, radiology, macroscopic, optic/electronic microscopic,
scanning/transmission evaluations were performed. Results were analyzed by
Student t test of independent samples for continuous data, by variance analysis
of repeated measures, and by Fisher exact test for categorical data.
RESULTS: We couldn't establish relevant differences in clinical
evolution and laboratory tests between groups. Echocardiogram revealed
difference in pulmonary medium gradient, which was significant 10 months
follow-up, higher in the control group. Radiologic and macroscopic evaluations
didn't established differences. In the optic/electronic microscopic evaluation,
liner and interstitial cells were equally found in both groups. The cell liner
percent calculated in both groups was similar. Cellularity nodules were
observed only infresh homograft group.
CONCLUSIONS: These data indicate that both groups presented similar
clinical/hemodynamic performances. The LH group's echocardiogram presented a
better performance. It also presented histological evidences of interstitial
and endothelial cell repopulation. In the macro/optic and electronic
microscopic analysis, group L-H presented macroscopy/histological structure and
ultra-structural similar to the fresh group, with the exception of nodules with
higher interstitial cellularity, present only in the fresh homograft group.
Emergency autologous vein graft reconstruction after using a vascular closure device
Postpartum patient with thrombosis of mechanical prostheses and acquired supravalvular aortic stenosis
The blood hypercoagulability in pregnancy increases significantly the incidence of thrombosis of mechanical valves. Acquired supravalvular aortic stenosis is extremely rare. We report the case of an immediate postpartum patient with aortic mechanical prostheses and acquired supravalvular aortic stenosis who underwent emergency heart surgery, with severe hemodynamic instability, using adapted surgical technique for correction of supravalvular stenosis with satisfactory clinical and echocardiography results.
Keywords: Aortic Stenosis, Supravalvular; Heart valve prosthesis; Thromboembolism; Pregnancy Complications, CardiovascularTransfixing gunshot wound to the heart: case report
Penetrating cardiac trauma carries high mortality rates. It has been commonly associated with stabbing, but increasing urban violence has led to growing numbers of gunshot heart wounds. The latter have higher mortality rates among penetrating cardiac injuries and may affect multiple heart chambers, with mortality rates even higher. We report a patient, victim of an attempted armed robbery, who had a transfixing gunshot wound to the heart, successfully operated at our institution.
Keywords: Heart injuries; Wounds, gunshot; Heart ventricles