Volume 11 - Número 1

Keywords:

The clinical improvement of cardiac function post left ventricular aneurysmectomy and/or cardiomyoplasty with the latissimus dorsi muscle seems to be due to the remodeling of the left ventricle. We did some experiments with sheep in our laboratory and we concluded that the increment of ventricular diameter is more deleterious than loss of muscle mass to the ventricular function. Since there is no increment in muscle mass to the dilated hearts, we reduced their diameter to accomplish a better ventricular function in a series of very sick patients with dilated hearts. From 1984 to 1995, 103 patients with complex cardiac problems and end stage congestive heart failure (NYHA IV) with dilated cardiomyopathy underwent "Partial Ventriculectomy". The operation was based on Laplace's law (T-P.II.D) and consisted of removal of a large wedge of muscle from the lateral wall of the left ventricle beginning at the apex and extending between the papillary muscles, ending proximal to the mitral annulus. The operation was performed under normothermic cardiopulmonary bypass and no cardioplegia was used. Pre-operative left ventriculography and echocardiography showed global hypocontractility of the hearts with ejection fraction lower than 20% in all patients who were considered candidates for cardiac transplantation. Males were predominant (n=73) and the age varied from 19 to 74 years. The pathologies were: viral miocarditis (n=12); post miocardioplasty (n=1); Chagas' disease (n=15); valvular disease (n=38); ischemic disease (n=16); idiopathic (n=21). Hospital mortality (30 days post operative) (n=13): pulmonary embolus (n=4); renal failure (n=5); bleeding (n=4). Late deaths (after 30 days post-operative) (n=10): arhythmia (n=6); "cardiac failure" (n=2); unknown (n=2); 8 patients required reoperation for bleeding. There were no infection and none required IAPB. All patients had nipride and 19 needed inotropics. Post-op ventriculographies and echocardiographies showed improvement of EF (from 100% to 300%). In conclusion, this new technique "Partial Ventriculectomy", with it's purpose of reducing the ventricular diameter, may benefit patients with end stage heart failure. And this new concept may, in our experience, give the patient improvement in his clinical status and increase life span. Keywords: Ventriculectomy, partial; Myocardiopathies, end stage, surgery

In order to demonstrate the surgical experience of Biocor Hospital with intraoperative acute dissection of the ascending aorta, we reviewed retrospectively 7 251 patients who underwent a cardiac procedure with cardiopulmonary bypass, from January 1988 through January 1995; 11 patients who developed this complication were identified. There were 6 men (54.5%) and 5 women (45.5%), aged 54 to 80 years (mean 66.73±7.54 years). The primary cardiac procedure were: myocardial revascularization in 9 patients: myocardial revascularization plus left ventricular aneurismectomy in 1 (9.1%) and aortic valve replacement in 1 (9.1%) patient. All patients had a previous history of systemic arterial hypertension. In 9 (81.8%) an abnormal ascending aorta was observed during the operation. The surgical repair included: replacement of the ascending aorta with interposition of bovine pericardial graft in 7 (63.6%); replacement of ascending aorta with interposition of valved bovine pericardial graft in 1 (9.1%); aortic reconstruction with bovine pericardial patch in 3 (27.3%) patients. In 90.9% of the cases, deep hypothermia and circulatory arrest was employed. Hospital mortality was 45.5% (5 patients): 2 patients could not be weaned from cardiopulmonary bypass; massive hemorrhage in 1 and postoperative low cardiac output in 2 patients. Follow-up information was available on 5 of 6 hospital survivors, and all are free of cardiac symptoms. We concluded that intraoperative acute aortic dissection is a strongly fatal complication of cardiac procedures. The use of preventive measures when an abnormal ascending aorta is noted must be taken to reduce it's incidence. Descriptors: Ascending aorta, acute dissection, surgery. Keywords:

During the last decade, cardiovascular surgery has experienced an extraordinary impetus through the development of the diagnostic methods, techniques of myocardic and cerebral protection, suture and extracorporeal circulation techniques, which provided greater experience to surgeons and permitted them to question the medical therapy recommendations for acute type B aortic dissection. The surgical treatment seeks to reduce the high mortality rate of this pathology in a short and long run. The Elephant Trunk technique, discribed by Borst and adapted by Palma and Buffolo, for the treatment of acute type B aortic dissection offers good results as well as a simple technique that does not require handling the diseased and friable aortic tissue during the procedure. Between June 31, 1992 and February 20, 1995, 7 patients were operated on using this technique; 1 female patient and 6 male patients. There were 2 (28.5%) deaths but neither of them was related to the surgical technique. In this paper, we present a modification in the Elephant Trunk technique, using the intraluminal ring, developed at our hospital. Descriptors: Aortic type B, dissection, acute, surgery. Aortic type B, dissection, acute, "elephant trunk" technique. "Elephant trunk" technique. Keywords:

During 1994, we performed 49 surgical corrections of left ventricular aneurysm in patients aged 32 to 79 years. The surgical technique was reconstruction (endoaneurysmorraphy) in 7 patients and resection in 42. In all patients the plicature in the interventricular septum was done. The factors studied were: site of the aneurysm, myocardial protection, anoxia time, cardiopulmonary bypass time, simultaneously myocardial revascularization, interval between acute myocardial infarction and the surgical treatment, clinical status and the utilization of intra-aortic balloon pump. The mortality rate was 14% (7 cases). The only factors that predicted mortality were functional class (NYHA) and the type of myocardial protection. Keywords: Left ventricle aneurysms, surgery, hospital mortality

Forty consecutive patients operated on between August 1987 and November 1994 were analysed, aiming at the late assessment of left ventricular aneurysmectomy in terms of symptomatology and global ventricular function. The follow-up ranged from 12 to 99 months. The most common location was anteromedial and most of the patients had both angina and CHF. The average preoperative LVEDP was 25.9 mmHg. Five patients (12.5%) died during hospitalization, due to acute myocardial failure, and 6 (15%) during the late postoperative period. When the series is divided into two groups, the survival rate among those operated on between 1991 and 1994 (the last 22 patients) is 91 % after 4 years. Of the 29 survivors, 12 (30%) are asymptomatic, while 42.5% have some degree of angina or CHF. Two-dimensional echocardiography showed normalization of the ventricular diameters, ejection fraction and percent fractional shortening in only 43% of the cases. After 1 year, only 50% of the patients are free of symptoms. The conclusion is that left ventricular aneurysmectomy caused symptomatic improvement in most of the patients, with an acceptable mortality rate, though nottotally confirmed by the indices of global function in two dimensional echocardiography. Keywords: Left ventricle aneurysms, aneurysmectomy; Left ventricle aneurysms, geometric reconstruction; Left ventricle aneurysms, surgery

The authors describe principal aspects involved in early postoperative period of heart transplantation, to emphasize: postoperative monitoring, hemodynamic evaluation, arrhythmias, fluid management, gastrointestinal system, renal system, ventilatory support, antibiotic prophylaxis, infection, immunosuppression, and rejection. Keywords: Descriptors: Heart transplantation, human, postoperative care; Heart transplantation, human, postoperative complications; Heart transplantation, human

A new form of postperfusion syndrome, termed vasoplegic syndrome and presenting in the postoperative period of heart surgery with cardiopulmonary bypass (CPB) is described. The patients exhibit hipotension, normal or elevated cardiac output, low systemic vascular resistance and decreased filling pressures. Physical examination revealed normal capillary filling atthe extremities, but oliguria and hipotension. These patients needed a high dosage of vasoconstrictor drugs (norepinephrine) for blood pressure control and even high dose of norepinephrine did not produce the classical situation of cool extremities. Twelve patients who presented signals and symptoms of vasoplegic syndrome are shown. The characteristics of vasoplegic syndrome are similar to those observed in the septic shock. In sepsis, the alterations are mediated by cytokines and TNF-a. The appearance of vasoplegic syndrome augments operative morbidity, with an increased risk to the patient. Keywords: Extracorporeal circulation, postperfusion syndromes; Postperfusion syndromes, vasoplegic; Extracorporeal circulation, side effects

We report two cases of intrapericardial teratoma, a rare cardiac tumor, usually found in neonates and young infants, which may cause respiratory distress, large pericardial effusions and cardiac compression leading to intra-uterine or neonatal death. Both cases were diagnosed noninvasively by echocardiogram, in a 3 month-old girl with signs of cardiac tamponade, and by fetal echocardiography, in a 38 week pregnant woman. Successful surgical removal of the tumor was undertaken in both patients at the ages of 3 months and 3 days of life, respectively. Histology confirmed the diagnosis of teratoma. It is emphasized the diagnostic accuracy of achocardiography and the importance of early surgical treatment in the management of intrapericardial teratoma. Keywords: Heart tumors, surgery; Intrapericardial teratoma, surgery

The penetrating heart wounds are extremely dangerous. We report a 38 years old male which was treated in our emergency department after 3 hours of a stab wound in the chest and cardiogenic shock due to tamponade. A left thoracotomy was performed and a pericardial and left lobe of the liver perforations were found. There was no cardiac lesion. The patient became comatous; died after 48 hours. Keywords: Cardiac tamponade; Precordial wounds, surgery