Volume 2 - Número 1
ORIGINAL ARTICLE
Heart transplantation in patients with chagasic cardiomiopathy
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
Among 27 heart transplanted patients, 4 had chagasic cardiomiopathy. They were male, with ages from 28 to 43 years, 3 in the NYHA class IV and 1 in class II, but with refractory arrhythmias. The immunosuppressive protocol included cyclosporin and steroids in the first patient and cyclosporin, azathioprine and steroids in the last. Three patients had one or more rejection episodes and 1 had no episode. Usual complications were observed and in 1 patient a lymphoproliferative intestinal disease occurred. Three patients had a new acute phase of Chagas disease in the 59th, 81rst and 420th postoperative days with fever, skin lesions and myocarditis. Trypanosoma cruzi were found in skin lesion in all 3 patients and in myocardial byopsies in 2 patients. The laboratory tests were not the expected for the acute phase. All the alterations were reversed by specific therapy in a few days. One patient died in the 197th postoperative day due to rejection; the immunosuppression regimen had been diminished due to the lymphoproliferative disease; the others were well 107, 160 and 500 days, respectively, after the transplant.
Keywords: heart transplantation, chagasic patients; chagasic cardiomiopathy, heart transplantation
Mammary-coronary artery anastomosis: analysis of 2923 cases
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
At the Instituto Dante Pazzanese de Cardiollogia, the use of mammary-coronary anastomosis was iniciated in 1972, isolated or with saphenous vein by-pass or other procedure. Initially only left internal mammary artery LAD anastomosis was employed in a few (57) cases. In 1973/1974, the aplication of this technique was intensified-386 cases. The method was practically descontinued between 1975 to 1982 - only 43 cases were performed. Since then, its use increased steadily and the right internal mammary artery has been used as well. In 1984, studying 177 patients, we observed that this technique does not influence the incidence of external dehiscence on the reoperation for bleeding; but in 25% occurred an elevation of hemolateral diaphragm, in 17% atelectasis, and in 27.6% pleural effusion. In 654 patients with mammary-coronary anastomoses and saphenous vein grafts followed up to nine years; patency was 91.5% for mammaries and 70.6% for saphenous veins. In another group of 102 patients with isolated mammarycoronary anastomosis patency was 94.4% in a period between 5 and 10 years. The mortality rate of all 2923 cases was 3.45%.
Keywords: mammary-coronary artery anastomosis
New surgical techniques for treatment of pulmonary atresia with ventricular septal defect and pulmonary arteries anomalies including the so-called tipo IV truncus
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
Fourty-two patients with pulmonary atresia and interventricular septal defect were submited to a partial or total correction, between January 1975 and October 1986, with a range of 2 months to 18 years of age. Three groups were identified: Group A: 34 patients with all bronco-pulmonary segments connected to pulmonary arteries (PA); Group B: 6 patients with some of the bronco-pulmonary segments connected to PA's; Group C: 2 patients with all bronco-pulmonary segments connected to systemic pulmonary collaterals. One to three stages were utilized to perform the proper correction. In Group A 17 were treated in one stage, with 3 deaths; 9 were submitted to a first stage where the pulmonary arteries were reconstructed with an additional Blalock-Taussig (BT) shunt, with 1 death. In two of them a second stage for total correction was performed, with no death. In the remaining 8 patients the collateral circulation was ligated and a BT shunt performed, with 1 hospital death. In Group B the first stage joining the intra or extra-pulmonary collaterals was obtained in 6 cases, without death. In two of them a total correction was performed, with 1 death. In group C a three stage operation was done in 1 patient. In the first stage an intermediate arterial segment was constructed between the lobar arteries and the BT shunt. In the second stage the contra-lateral collaterals were joined. The third stage was the establishment of the continuity between the right ventricle and the reconstructed pulmonary circulation with a good result. In the other patient of this group, until now, only the first stage was done. Serial hemodynamic studies were carried out in 32 patients. These proposed techniques demonstrate the possibility of total correction with appropriate righ-to-left ventricular pressure relation.
Keywords: pulmonary atresia, surgery; ventricular septal defect, surgery; pulmonary arteries, anomalies, surgery
Can surgical correction of congenital heart diseasse go along with low mortality?: 10 year experience in 1088 surgeries
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
From November 1976 to November 1986,1088 cardiac surgeries were performed in patients younger than fifteen years old. In 670 cases we used extracorporeal circulation, and in 418 we performed surgery without extracorporeal circulation. One hundred and eleven (10.2%) patients were reoperated. One hundred and twenty (11.1%) patients had acquired valvular heart disease. The total hospital mortality was 10.4%; 11.2% after extracorporeal circulation and 9.1% without it. We observed a decrease in the mortality rate in the years 1985 and 1986, corresponding to 6.8% and 5.7%, respectively. During this period (1985-1986) 179 patients were operated upon; 54 had cianotic congenital heart disease and 7 died (12,9%); 125 had cianotic congenital heart disease and 2 died (1.6%). The highest mortality rate occured in the first year of life (20.7%) while the lowest mortality was observed after the fourth year. Factors which influenced this decrease in mortality included: more frequent indication of palliative surgery in the first year of life; careful analysis of surgical anatomy; precise definitions of the moment of intervention and surgical techniques; better myocardial protection; physical and medical conditions in the post-operative phase and greater surgical experience.
Keywords: heart disease, pediatric, surgery; heart disease, congenital, surgery
Ten years of surgery for endomyocardial fibrosis: what have we learned?
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
In the last 10 years(1977-1987), 53 patients with endomyocardial fibrosis were submitted to endocardial decortication and atrioventricular valve replacement. There were 42 female and 11 male patients, ranging in age from 11 to 59 years (mean 31). The patients were divided into three groups: Group I included 25 patients with bilateral disease; Group II consisted of 23 patients with endomyocardial fibrosis of the right side; and Group III included 5 patients with the disease confined to the left ventricle. All were in Functional Class III or IV (New York Heart Association classification). The 30-day mortality was 20.7% (11 cases). The remainder 42 patients survived the early postoperative period which was quite stormy in 21 (39.6%). There were 10 (18.8%) late deaths. One patient was reoperated two years later to replace the mitral valve which had been preserved during the first intervention. Among the 32 survivors (mean follow-up 4.1 patients/year), 22 (41,5%) are in Functional Class I or II. The actuarial curve showed that the 5-year probability of survival is 75%. Despite the high early and late mortality, and the fact that only 41.5% of the operated patients had good clinical improvement in the late postoperative period, surgical treatment is, at present, the only hope for patients with endomyocardial fibrosis. Technical aspects of the operation are outlined.
Keywords: endomyocardial fibrosis, surgery
Surgical treatment of aortic abscess in infectious endocarditis
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
Infectious endocarditis is a serious complication in patients with valve diseases and sometimes presents technical difficulties for its treatment. One of those situations concerns prosthesis dysfunctions placed in aortic position or of natural aortic valves, in which endocarditis causes partial descontinuity between the left ventricle and the aorta by the lesion of the continuity of the mitral-aortic or of the muscular septum. In the Instituto Dante Pazzanese de Cardiologia we operated three patients with closed abscesses but with a great separation between the left ventricle and the aorta in which the fixation of the prosthesis couldn't be done by the usual technique nor by the suspension of the anterior mitral leaflet. We reestablished continuity between the left ventricle and the aorta using a patch of bovine paricardium and attaching part of the prosthesis to the preserved valvar ring and the other part in a ring created by the mattress sutures passed in the implanted pericardium. One patient died with 26 days post-surgery due to pulmonary emboly. The other two were discharged and are without symptoms at 14 and 4 months of evolution. The last one has a slight aortic reflux.
Keywords: aortic abscess, surgery; endocarditis, infectious
ORIGINAL WORKS
Massive air embolization successfully treated by reversed perfusion
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
The authors report a case of massive air embolization occuring while an operation for mitral valve replacement has been performed. The air entered the aorta due to inattention to reservoir level. At that time the esofaged temperature was 28ºC. The accident was successfully corrected using the reversed perfusion. There were no neurological sequelae and the post-operative evolution was uneventful.
Keywords: air embolization; reversed perfusion; extracorporeal circulation
Occlusion of coronary artery in myocardial revascularization. Relationship between the degree of atherosclerosis and vascular injury: an experimental study
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
Coronary artery surgery, specially when performed without cardiopulmonary bypass, needs an "atraumatic" method that allows temporary coronary occlusion with minimal injury to the vessel wall. An experimental study was performed using the right coronary artery of cadaver hearts in order to evaluate the methods of "atraumatic" clamping of arteries with variable degrees of atherosclerosis. The vessels were evaluated histologically both for intensity of the atherosclerotic disease and intensity of injury to the coronary artery wall. Results suggest a relationship between severity of coronary artery disease and degree of injury to the artery wall.
Keywords: coronary occlusion; vascular injury; coronary atherosclerosis; myocardial revascularization
Re-utilization of blood in surgery with extracorporeal circulation: utilization of discontinous flow procedure
Braz J Cardiovasc Surg 2;
Publish in: 8/2/2025
The authors, following the trends of several Services, have been searching for techniques aiming at reducing, and in some cases eliminating the utilization of blood and derivatives in patients submitted to heart surgery and extracorporeal circulation. This has as objetive to reduce the morbidity as well as avoiding diseases transmission (mainly hepatitis and AIDS) related to blood transfusion. Fifty patients submitted to surgery with extracorporeal circulation were analyzed. Pre or trans-operative auto-transfusion, total hemodilution during perfusion, re-utilization of suctioned blood as well as re-utilization of the oxygenative residual blood (by processing them in discontinuous flow procedure were used. With those methods, there was a significant reduction of transfused volume (324ml in average at trans-operative and 272ml at post-operative period); 34% of patients did not receive blood during operation; 36% did not utilize post-operatively and 20% did not use it during the whole period of hospitalization. Also significant anemia was not noted (hematocrit in immediate post-operative was 38.4% and at the 5th post-operative day 35.9%) what lessens the risk of asthenia, sleepness, inaction, lung secretion and thromboembolic phenomenon, mainly in elderly patients, without interfering in the total cost of surgery.
Keywords: auto-transfusion, blood re-utilization; extracorporeal circulation, blood re-utilization