Volume 6 - Número 3
ORIGINAL ARTICLE
Single lung transplantation: experience of Escola Paulista de Medicina
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
Two cases of left single lung transplantation for pulmonary fibrosis are reported, one of a 50 years old white male who is alive and well 8 months after the transplantation and the other of a 36 years old female weighing 45 kg who received an upper lobe transplantation from a 85 kg donor. This patient died of multiple organ failure in the 8th postoperative day due to complications related to an unexplained cardiac tamponade and also possible rejection but was able to maintain good ventilatory and hemodynamic conditions in the first 3 days following transplantation; radiographic studies showed adequate expansion of the transplanted lobe. Autopsy revealed no problems in the anastomotic sites and signs of difuse bronchopneumonia. In the two cases a flap of pericardial fat was utilized instead of omental flap to protect the bronchial anastomosis and in the first case a telescoping anastomotic technique was done. Both patients received corticoids since the begining and the immunossupression protocol consisted of cyclosporin, prednisone and azathioprine and had no airways complications. In spite of being an initial experience, the authors express their hope in single lung and lobe transplantation for selected terminal lung diseases and in the near future also as an alternative in the surgical treatment of complex congenital cardiac anomalies.
Keywords: lung transplantation
Dynamic subaortic stenosis: surgical treatment and postoperative evaluation
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
The dynamic subaortic stenosis, more commonly named hypertrofic subaortic stenosis (HSS) presents some aspects specially related with its diagnosis and surgical treatment. From September/83 to September/89, sixteen patients (10 men) with age between 7 month and 66 years (30.87 ± 2.42) were submitted to surgical treatment to correct the HSS. The surgical technique employed the muscular resection in left ventricular outflow tract, in the anterior wall, between left and right coronary aortic sinus. This resection was characterized by an extensive and deeply miectomy and was performed with no other procedures in 10 patients and in association with other procedures in 6 patients (correction of patent arterious ductus with fibrotic subaortic stenosis in 2; surgical conservative procedure in aortic valve stenosis in one; right ventricle muscular anomalous band resection of vegetative lesion in aortic leaflet in one; interventricular septum communication closure and aortic valve conservative procedure in one. After cardiopulmonary by-pass, intraoperative evaluation in aortic and left ventricle pressure were made in all patients. No immediate deaths were present in this group of patients. There was one (6.2%) death with one year of follow-up, not related with the disease. After surgery related to AV disturbances, one (6.2%) patient presented AV block with need of pacemaker implantation; two (12.5%) presented left bundle block; three (18.7%) presented left bundle branch block, with no alteration in the other patients. In the late follow-up, between 19 and 90 months (56.00 ± 23.72), 14 (87.5%) patients are with no symptoms.
Keywords: hypertrofic subaortic stenosis, surgery
Coronary artery bypass grafting without cardiopulmonary bypass in patients with myocardial infarction innitially treated with intravenous streptokinase
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
The authors have performed coronary artery bypass grafting without cardiopulmonary bypass in 25 patients with myocardial infarction treated innitially with intravenous streptokinase. Our goal is to offer a tatic option to this kind of patients. Our satisfactory results authorize us to continue to perform this procedure, particulary in patients who need one or two bypass graftings.
Keywords: myocardial revascularization, surgery; myocardial infarct, surgery; streptokinase
Coronary atherosclerosis following heart transplantation
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
Late post-operative serial coronariographic evaluation was performed in a series of 6 patients submitted to cardiac transplantation. They were part of a series of 16 patients operated on from June 1984 to December 1990. Their age were from 10 days to 54 years, 14 male and 2 female. The followup time was from 2 to 6 years. The cineangiograms were performed yearly for coronary pattern evolutive evaluation. The mean donor age was 18 ± 3 years. In 4 patientes it was possible to compare late results with the preoperative donor cinecoronaryangiogram. The comparative morphometric analysis, at serial examination did not reveal any proximal or distal coronary lesion in any patient. Left ventricular function was considered normal, but varied degrees of myocardial hypertrophy were present in all patients. In conclusion: 1) coronary artery disease, although frequent in transplanted hearts, was not present in this series; 2) early donor age could have been an important factor, as well as the immunossupressive regime emploied; 3) cinecoronary ventriculoangiogram is important for follow-up of transplanted patients, and could eventually orient for retransplantation.
Keywords: heart transplantation, coronary atherosclerosis
The surgical treatment of congenital mitral stenosis through a left ventriculotomy
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
From June 1987 to October 1990, nine patients with congenital mitral stenosis (CMS) underwent surgical correction through an apical left ventriculotomy. Seven patients had parachute mitral valve and two had other forms of CMS. The surgical treatment of the mitral valve apparatus starts from below: first the papillary muscle is split and the cordae are divided and fenestrated. Then, the commissurotomies were performed through the ventricles aspect of the mitral valve. Associated anomalies were corrected simultaneously. There was no in-hospital death and only one late death (nonrelated). The echocardiography showed non significant residual stenosis and normal global function of the left ventricle. In conclusion, the appical left ventriculotomy is a good approach for treatment of CMS.
Keywords: heart valves, mitral, surgery; ventriculotomy, apical, left
Surgical treatment of annuloaortic ectasia with aortic valve preservation
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
The substitution by synthetic graft and aortic valve replacement is the commonest treatment of AE. The aortic valve replacement generally occurs due to aortic insufficiency caused by aortic annulus dilatation; a mechanical prosthesis Is generally used. The authors present two male patients (34 and 62 y.) operated on for treatment of AE. The first had Marfan Syndrome and associated chronic aortic dissection. The surgical technique used was the substitution of the ascending aorta by a Dacron double velour graft. The pathologic aortic wall was excised, preserving the aortic valve. The tube was implanted externally to the valve and fixed bellow the aortic annulus and the aortic valve was suspended and fixed internally in the tube. The coronary ostia were then implanted in the graft. Both patients had good postoperative evolution being asymptomatic and with no aortic insufficiency after a post-operative period of 5 and 7 months. This technique could be used as an option for the treatment of AE with the advantage of aortic valve preservation.
Keywords: annuloaortic ectasia, surgery
Valvar reoperation
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
In this paper we analyse the mortality results in the valve reoperation. We compare the results of the conservative procedures and valve replacement, and relating this results to the number of previous operations. Two hundred and ninety-six patients were included in this paper, aged five to 72 years. Two hundred and eigth patients were submitted to mitral reoperations, 23 (7.8%) mitral recomissurotomy, two (0,7%) third comissurotomy, 26 (8.8%) first mitral valve replacement, 127 (42.9%) second mitral valve replacement, 26 (8.8%) third mitral valve replacement, three (1%) fourth mitral valve replacement. Aortic reoperations were performed in 67 patients, five (1.7%) first aortic replacement, 48 (16.2%) second aortic replacement, 11 (3.7) third aortic replacement and three (1%), fourth. Nineteen (6.4%) patients were submitted to mitro-aortic rereplacement, one (0.3%) to tricuspid rereplacement and one 0.3%) to mitrotricuspid rereplacement. The Hospital mortality was 0% (0/26), in mitral recomissurotomies, 15,4% (4/26) in first mitral replacement and no mortality in fourth and fifth mitral valve replacement. Relating to the aortic patients the Hospital mortality was 40% (2/5) in the first replacement, 14.6% (7/48) in the second replacement, no mortality (0/11) in the third replacement and 100% (3/3) in the fourth replacement. Relating to the mitro-aortic patients the statistical analysis showed no relation between mortality and mumber of previous operation.
Keywords: heart valves, surgery; heart valves prostheses, surgery
Study of mitral ring and fibrous, trigone with different variables
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
The purpose of this study is to evaluate important anatomic data in the mitral valve reconstruction, specially mitral ring characteristics related to position and distance of fibrous trigone. We seek correlation of this aspect with sex, age, ethnic group and "mitral-aortic position". Ninety-four human normal hearts were analysed. Two measures were realized in mitral ring, the measure A the higher distance between the fibrous trigone and B the smaller distance: the sum of the two measures represent total perimeter of the ring. We established the relation A/B that changed 1.88 to 3.96 (2.69 + 0.38). The analysis of this relation don't present statistical difference when correlated individually with sex (p=0.6857), age (p=0.1157). However, in the association of the variables ethnic group and "mitral-aortic position" (p=0.0285), we observed that in hearts from non white persons was tendency to decrease of the relation A/B in anterior and much anterior position. In conclusion, the relation A/B is not fixed, presented variation in dependence of association by ethnic group and "mitral-aortic position".
Keywords: heart valves, mitral, anatomy
Lung preservation in dogs kept under autoperfusion
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
Fourteen heart-lung blocks, kept in an autoperfusion system for a period of two to eight hours, were studied. Lung biopsies were performed each two hours. Ten lungs were preserved until four hours with slight degrees of alteration in the microscopic study. After the fourth hour, severe alterations developed and were represented by intra-alveolar edema, intra-alveolar haemorrhage, perivascular and peribronquial enfisema, and alveolar rupture.
Keywords: lung preservation; blood, autotransfusion
Myocardial revascularization: risck factors of nosocomial morbidity and mortality in elderly
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
Seventy-two consecutive patients with complete observations were studied at the Heart Institute (InCór) between January and December 1988, to determine the main risk factors of nosocomial morbidity and mortality of elderly coronary patients (>65 years) submitted to elective isolated myocardial revascularization. Clinical, radiologic, hemodynamic, operative and post-operative factors were included in the protocol. The results were analysed through Pearson's X2 test and Fisher's Exact Test using the SPSS (Statistical Package for Social Science). Among the analyzed factors, smoking habit, number of impaired coronary vessels, duration of extracorporeal circulation, time of aortic clamping, total number of performed grafts, presence of the coronary-mammary anastomisis and index of the left ventricular wall movement present statistical significance.
Keywords: myocardial revascularization, elderly patients; myocardial revascularization, risk factors
Importance of lung ventilation on oxygen transport and acid-base balance after intermittent aortic cross: desclamping in coronary artery bypass graft
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
In coronary artery bypass graft employing the surgical technique of intermittent aortic cross-clamping appeared the controversy of the need of lung ventilation on prevention of the hypoxemia. The purpose of this work was to verify the importance of lung ventilation on oxygen transport and acidbase balance in blood that will reperfuse the myocardium following aortic desclamping. Ten patients undergoing coronary artery bypass graft under moderate hypothermia were divided in two groups: I - Lung ventilation was carried out after aortic desclamping. II - Lung ventilation wasn't done following aortic desclamping. Blood samples were collected from the left right atrium, aorta, radial and pulmonary artery and the both sides of bypass circuit (venous and arterial). Oxygem saturation, oxygen tension, carbon dioxide tension, and blood pH were evaluated in the both groups. The results showed no statistical difference between groups concerning oxygen saturation. The pH decreases significantly in patients of Group II, due to a sharp elevation of PCO2. Although no significative hypoxemia could be observed, the respiratory acidosis that appeared in Group II suggests the importance of ventilation of the lungs as soon as possible after aortic desclamping. It is important to remember that myocardial contractility may be depressed by hydrogen ions (H+) in excess.
Keywords: myocardial revascularization, surgery; lung ventilation; aortic desclamping
CASE REPORT
Simultaneous surgical treatment of epithelial liomyosarcoma and coronary artery insufficiency disease
Braz J Cardiovasc Surg 6;
Publish in: 8/2/2025
The authors describe a case of a 64 year-old woman with a four-year history of angina. The patient was operated upon under standart cardiopulmonary bypass and had received two saphenous vein grafts and an internal mamary artery graft, concomitant with a mediastinal mass resection. The histological tumor diagnosis was epithelial leiomyosarcoma. The patient had first presented, 13 years ago, an uterine fibrosis, that had been resected. The radiograph diagnosis of the tumor was difficulted by several pleural opacities secondary to a previous pulmonary tuberculosis and a left thoracotomy. This rare association and the validity of the simultaneous surgical procedure are here emphasided.
Keywords: myocardial revascularization + mediastinal tumor, simultaneous surgery; myorcardial revascularisation, surgery; mediastinal tumors, surgery