Volume 7 - Número 1

Quality of life is a very new indicator about physical, psychological and social conditions of patients with chronical disease as after a medical intervention. It can be summarized as an addition of representation about incapacity, disability and suffering. 672 patients were evalvated, divided in four strata, submitted to myocardical revascularization, with coronary artery bypass graft and/or internal mammary artery, and coronary angioplasty, about physical, psychological and social conditions after the intervention. The research showed that only 5,06% of those patients referred no pleasure in living, anxiety, fear about death, pain, and tiredness. Keywords: myocardial revascularization, quality of life; quality of life, myocardial revascularization

Glycogen levels are measured in order to further understand the role of Ca++-dependent increased sensibility of mitochondria from ischemic heart. Changes in mitochondrial function that include loss of phosphorylative activity quickly increase glycogenosis. Our results suggest that mitochondrial changes are related to the ischemic damage. Keywords: myocardial protection, cardioplegia; myocardium, glycogen reserve

The authors describe the surgery for patent ductus arteriosus (PDA) with triple ligature through the extrapleural path. After general anesthesia, the child has his position in the right lateral and a little ventral decubitus. A small incision is made in the inferior limit of the scapula. The pleura is dissected and the PDA exposed, double ligated with Polyester 2/0 and transfixed and tightened with Polypropilene 4/0. With this technique it is not necessary to have a chest tube. Fourty seven patients with PDA were submitted to surgery between September 1988 and August 1990; in 40 patients it was possible to do this type of surgery. Ages ranged from 4 months to 11 years, with mean age of 3.1 ± 3.0 years. Twenty children were less than one year old. There were 24 females and 16 males. No cases of intra or post-operative complications were registered. The follow-up ranged from 7 to 30 months (mean 15.3 months). Ali children were submitted to clinical evaluation, thoracic Rx and ecocopplercardiography. No patients presented recanalization or other complications. This experience showed that this tecnique is reliable, efective and it does not present immediate and late morbility or mortality. This technique can be safely used in younger as well as older children. Keywords: patent ductus arteriosus, surgery

The purpose of this study is to evaluate anatomic data of the tricuspid valve and adjacent area to help in diagnostic and surgical procedures. In 101 normal human fixed hearts (84% male; 61 % white ethnic group and mean age of 30.0 + 15.5 years old), we analysed: number of leaflets; tricuspid ring perimeter; size of leaflets and its occupation in ring perimeter; Koch's triangle area. These aspects were related with age, sex and ethnic group. There were 73% with three, in 26% with two and in 1% with four leaflets. The ring perimeter changed 79 to 158 mm (109.6 +12.2) and was larger (9%) in man. Regarding the relative occupation on ring the anterior represented 48%, the septal 36% and the inferior 16% of occupation area in tricuspid ring. The mean area of Koch's triangle was 167.79 mm 2 + 71.88 mm2, 10% larger in non white ethnic group and in elderly patients. In conclusion, normal tricuspid valves presented variations related to sex, age and ethnic group. Keywords: tricuspid valve, anatomy

The objective of this study was to investigate the late performance of the porcine bioprosthesis Carpentier-Edwards model with emphasis on all morbid and/or lethal events which could be related to its presence. One-hundred consecutive patients who underwent a mitral valve implant and 100 consecutive patients who underwent aortic valve implant were studied. The average tracking period for the former was 93 months and 62 months for the latter. Aproximately 80% of these patients remained alive during the follow-up time. The survival curves of patients who received mitral valve implant and patients who received aortic valve implant showed an initial decrease due to in-hospital mortality. Then, the curves stabilized showing another decrease about 5 to 6 years later, probably due to structural degeneration. Patients who needed reoperation to substitute the deteriorated bioprosthesis presented a higher mortality rate than those who did not need reoperation. Nevertheless, this difference had not statistic significance. Mortality related to the bioprosthesis was close to 5% either for patients with bioprosthesis in mitral or in aortic position. Among the 100 patients who received a mitral-position bioprosthesis, 22 needed reoperation to replace it, being the incidence of reoperation higher in those who were under 35 years of age at the time of the first operation. Yet, only 7 among those who received aortic-position bioprosthesis needed reoperation. The thromboembolic complications were rare with use of bioprosthesis although none of the patients received systemic oral anticoagulation. It was concluded that: 1) the use of Carpentier-Edwards porcine bioprosthesis presented satisfactory clinic results concerning in-hospital and late mortality rate, similar not only to other groups but also when other types of valve substitutes are used; 2) the structural deterioration is a remarkable event for patients who bear the bioprosthesis, starting basically 6 to 7 years after the implant; 3) the structural deterioration of the bioprosthesis modifies patient's fate causing, as a result, reoperation to substitute the implanted bioprosthesis. However, the occurance of such cases does not increase significantly mortality rate. Keywords: heart valves prostheses, biologic

The authors present early results in a comparative study using one or two internal thoracic arteries for myocardial revascularization. They find no difference in both groups, regarding hospital mortality or morbidity. Angiographic study showed that early patency of the right internal thoracic artery passed through transverse sinus is similar to the left internal thoracic artery; is also better than saphenous vein grafts. They conclude that the double internal thoracic artery can be used more aften in selected patients. Keywords: myocardial revascularization, surgery; thoracic artery, internal, surgery

The case of 48-years-old man politraumatized, victim of automobile accident is reported. The patient entered the emergency service of the Heart Institute in shock, with multiple fractures in the costal archs, total pneumothorax at the right and fracture of femur. Chest X-ray showed an important mediastinum enlargement. The patient was stabilized with fluids, monitor and submitted to angiography which revealed rupture of aorta at the level of brachycephalic trunk. Surgical treatment was undertaken, with the interposition of a Dacron tube between the ascending aorta and the brachycephalic trunk. Emphasis is given as to the way the case was approached. The approach is responsible for the good outcome reached. The procedure with the tamponage of the aortic lesion permitted suture of the rupture of the brachycephalic trunk in the aorta and the interposition of a Dacron patch between the ascending aorta and brachycephalic trunk, fully reestablishing the cerebral flux. Keywords: brachycephalic trunk, rupture, surgery; thorax, traumatisms

Teenager, presenting congenital anomalous partial drainage of the right pulmonary veins to inferior vena cava in supradiaphragmatic position. The surgical approach was made with the use of extracorporeal circulation and resulted in a wide communication between the anomalous vein and the left atrium. The authors discuss the diagnostic and surgical approach of this rare anomaly. Keywords: pulmonary veins, anomalous drainage, surgery; scimitar syndrome

Muscular diverticulum of the left ventricle is a rare anomaly. It is frequently associated with other congenital anomalies of the abdominal wall, sternum, diaphragm, pericardium and the heart itself. These have been described as Cantrell syndrome. This paper reports a case of a 25-year-old female patient submitted to surgical repair of this syndrome. Keywords: left ventricle, diverticulum, surgery; Cantrell syndrome