Volume 10 - Número 3

Since Jan/91 we have been using the "open distal" technique (ODT) described by Cooley, for surgical treatment of diseases of the descending thoracic and thoracoabdominal aorta. From jan/91 to jan/95, the technique was used in 35 instances (25 for descending aorta and 10 for thoracoabdominal aorta). Degenerative aneurysms and aortic dissections had similar incidence in this group (48.5% and 40.0%, respectively). In 8 patients the aorta was ruptured which was partially occluded by the lung (5 cases), abdominal organs (2 cases) and esophagus (1 case). Surgical exposure was obtained either by left thoracotomy or thoraco-phreno-laparotomy. Heparin was used in a dosis of 1.5 mg/kg and all the blood was collected from the patient and returned through the femoral vein. There were 4(11.4%) hospital deaths and 2 (5,8%) patients with thoracoabdominal aneurysms developed paraplegia. Morbi - mortality of the group was related to the pre-operative clinical condition and extension of the disease. In our opinion ODT is a simple and effective surgical technique for diseases of the descending thoracic and thoraco-abdominal aorta. Maybe for extensive resections with long aortic cross clamping time, other methods providing a better spinal cord protection should be evaluated. Keywords: Aorta, descending, surgery; Aorta, thoracoabdominal, surgery; Cooley technique, "open distal"; "Open distal", Cooley technique

From January 1990 to November 1994, 72 patients with congenital heart defects and low pulmonary flow underwent modified Blalock-Taussig produce. There were 44 (61.1%) males and 28 (38.8%) females with ages ranging from 2 days to 11 years (average 9 months). Thirty eight (52,8%) patients had Tetralogy of Fallot; 7 (9,7%) had pulmonary atresia with intact ventricular septum (PA/IVS); 6 (8.4%), had transposition of the great arteries (TGA) with pulmonary stenosis (PS); 6 (8,4%) had tricuspid atresia (TA) with PS; 6 (8.4%) had double inlet of right ventricle (RV) or left ventricle (LV) and PS; 3 (4.2%) had corrected transposition of the great arteries (CTGA) with ventricular septal defects (VSD) and PS; 2 (2.7%) had double outlet of RV or LV and PS; 2 (2.7%) had atrio-ventricular canal defects (A-VC) and PS; 2 (2.7%) patients had right or left Isomerism and PS. The decision to surgical indication was based on: a) new borns with "ductus dependent" heart defects; b) lactents with important cianosis or hypoxia; c) infants with heart defects without possibilities of biventricular correction. The surgical technique employed was the Blalock-Taussig operation using 4 or 5 mm Polytetrafluoroethy (PTFE) prosthesis in 69 (94.5%) cases, umbilical vein in 3 (4.1%) cases and bovine thoracic artery in 1 (1.4%) case. Before the arteries were clamped 1 mg/kg of héparine was given without mobilization, with protamine, after the procedure. During the post-operative period, anticoagulants were not given. The prosthesis obstruction was the main cause of death and was related to artery anatomy: subclavian and pulmonary artery diameter and/or problems with the technique. The modified Blalock-Taussig operation showed itself to be a reliable palliative treatment to heart defects with low pulmonary flow. Keywords: Blalock-Taussig operation, modified; Heart defects, congenital, Blalock-Taussig operation; Heart defects, congenital, low pulmonary flow, surgery

The Ventricular Assist Devices (V A D) have been used to maintain the cardiocirculatory conditions in patients waiting for a heart transplantation (bridge to transplant) or in patients with an acute myocardial failure during a period enough to allow a myocardial recovery. The Pierce-Donachy System (Thoratec Laboratories Corporation) is one of those devices, a pulsatile flow model, pneumatic, external, used as uni or biventricular support. The training program for different groups of surgeons, phisicians, nurses and thecnicians is difficult in many situations, mainly when it is necessary to repeat those experiences several times to permit to those groups to be more familiar with the equipment. The authors developed an experimental model (utilizing a bovine heart and an arterial pump for extracorporeal circulation) to allow a simplified way of training, analising surgical aspects, use of the drive console and simulating clinical and emergencies situations. Keywords: Ventricular assistance, experimental; Assisted circulation, mechanic, experimental

Between April of 1975 and January of 1994, 28 patients underwent correction of simple transposition of the great arteries by a modification of the Mustard operation, designed to avoid dysrhythmias and to minimize systemic and pulmonary venous obstruction. Age ranged from 21 days to 7 years (mean age 18 months). The majority (22 patients) were in the first year of life. Early mortality occurred in 6 patients. Four of the early deaths were in children younger than 4 months. Among the 22 survivors no serious dysrhythmias or right ventricular dysfunction were detected. Three patients presented superior vena cava (2) and pulmonary (1) venous obstruction, and were easily managed at reoperation. Current results with the modified Mustard operation are good and this procedure is still an alternative in children with simple transposition who are not candidates for anatomical repair. Keywords: Transposition of the great arteries, surgery; Mustard operation

It was analysed the experience of the Department of Thoracic Surgery of Faculdade de Medicina da Universidade de São Paulo, in 24 patients undergone non-cardiac thoracic surgeries, and who had been submitted to previous myocardial revascularization. Factors related to morbi-mortality were studied in this group of patients. Results showed a better outcome in patients who were submitted to myocardial revascularization between 6 months and 5 years before the thoracic surgery. It was noted a worst outcome in patients with previous myocardial infarction. The kind of surgeries and age greater than 70 years old showed to be important immediate and late risk factors. Keywords: Thoracic surgery, non-cardiac, in patients with previous revascularization, risk factors

The purpose of this study is to present a simple Delivery System of Blood Cardioplegia for myocardial preservation during congenital cardiac operation. We prospectively analysed 71 patients (pts) with 10/12 kg of body mean weight, 34 were female and mean age was 2/1 years. From the arterial line, passing through a mini heat exchanger, blood at 8 C is aspirated to a 50 cc syringe, which is conected to a 10 cc syringe with a KCL + decimal solución using 2 stopcocks. The mixture originates a cold blood with 15 mEq/l of KCL + that is infused into the aortic root, according to the pts weight (10 cc/kg). In all pts cardiac arrest was obtained. The mean extracorporeal circulation time and crossclamping was 87.2 and 60.7 min. All pts recovered sinus rhythm with good ventricular function. Thirteen patients died, 6 with respiratory failure, 3 with low cardiac output, 2 with dysrhythmias, 1 with renal failure and 1 with hematologic disorder; the other 58 patients left the hospital with no complications. In conclusion, this method showed good results with efficient myocardial preservation and low morbi-mortality. Keywords: Cardioplegia; Cardioplegia, surgery for congenital cardiopathies; Myocardial protection, cardioplegia

The experience of the Heart Institute of the University of Sao Paulo with surgical management of left coronary ostial lesions was made of 11 patients. They were operated on from January 1984 to July 1994. Eight of them were female, 3 were male. They were of white race. The ages ranged from 39 to 68 years old (mean 53). Two patients were asymptomatic, 2 were with unstable angina and the others with chronic angina. All of them had ostial stenosis of 90% or more. They were operated on with cardio-pulmonary bypass, posterial oblique aortotomy prolonged through the left main coronary artery. The ostioplasty was made with saphenous vein patch in 8 cases and with gluteraldehyde preserved xenopericardial patch in 3 cases. The aortic root biopsies showed inespecif mucoid infiltrations in all studied cases. All patients were angiografically studied 2 weeks after surgery. The ostial angioplasty were opened widely in all cases. One patient died 7 hours after angiografic study, and the necropy revealed a large thrombus of 8 mm inside of the left ostioplasty. One patient died 9 months later, with a diagnosis of hepatitis. The other 9 patients have been followed up from 6 months to 10 years, and are all free of angina and doing well. The results take us to believe that the surgical technique is applicable to this kind of stenosis, with good results. Keywords: Coronary ostium, surgery