Volume 12 - Número 3
EDITORIAL
Publicações em duplicata e secundárias de trabalhos científicos: quais as regras?
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
Keywords:
ORIGINAL ARTICLE
Partial left ventriculectomy: alternative option to transplantation in patients with refractory heart failure and pulmonary hypertension
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
Medically refractory heart failure is traditionally managed with cardiac transplantation although some limited success has also been obtained in selected patients with alternative surgical options. Scarce donors, significant morbidity secondary to the antirejection therapy, post-transplantation coronary disease and the high costs of transplantation programs, all together are limiting factors. For those on the waiting list of transplantation the one year mortality may be as high as 46%. Furthermore, a significant number of patients have contraindication to transplantation due to severe pulmonary arterial hypertension and elevated pulmonary vascular resistance. Partial Left Ventriculectomy (PLV) attempts to relieve symptoms of congestive heart failure by reducing left ventricular dimensions and mass and restoring the normal mass-to-volume ratio of the left ventricle. As a consequence, cardiac index and forward ejection fraction increase thus unloading the pulmonary vascular bed. The ultimate result is a decrease in both pulmonary arterial pressure and resistance, in some patients.
Keywords: Heart ventricle, surgery; Heart transplantation; Heart failure, congestive, surgery; Hypertension, pulmonary; Ventricular function, left
Myocardial revascularization without cardiopulmonary bypass, using a temporary intraluminal shunt: a 12 years experience
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
An analysis was made of the results in a group of 419 patients that underwent myocardial revascularization without cardiopulmonary bypass, by means of a technique using a temporary intraluminal shunt (TIS) described originally by Rivetti and Gandra in 1991. The technique consists of inserting a shunt of a flexible and transparent sylastic tube with external diameter varying from 1 mm to 3 mm into the coronary artery which allows distal irrigation of the coronary artery during the anastomosis between the vein or mammary artery and the coronaries. It offers safety to the patient by avoiding ischemia and its consequences, by molding the coronary artery and maintaining a bloodless field. Mortality was 1,4% in this series and 1,6% of myocardial infarction. There were no life-threatening complications during the procedure. There were no complications similar those normally occurring in the post-operative period of cardiopulmonary procedures. This technique is useful for any patient with coronary stenosis in the antero-diaphragmatic region, but it also provided a good quality of the anastomosis in the cases studied.
Keywords: Myocardial revascularization, methods; Arteriovenous shunt, surgical; Surgery, minimally invasive
Minimally invasive coronary artery bypass graft: results with videothoracoscopy and restrained device
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
Purpose: In order to associate the major benefits of the coronary artery bypass graft (CABG), with a less aggressive procedure, minimally invasive coronary artery bypass graft (MICABG) has begun to be utilized. The aim of this work is to report our initial experience with this technical approach, using video assisted thoracic surgery (VATS) to facilitate the operation.
Methods: Seventy three patients, 51 males, ranging ages from 37 to 83, and with an isolated lesion in the anterior descending artery were operated upon. Left anterior minithoracotomy, of 8-10 cm was performed at the fourth intercostal space. Through this incision the optical device for VATS as well as the surgical instruments were placed in order to provide the complete left internal mammary artery (LIMA) dissection. Bypass circulation was not used and cardiac rate decreased with the use of intravenous betablockers. For LIMA - anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was intravenously administered, besides the restrained device in the 15 last cases.
Results: The 73 patients presented satisfactory postoperative progress, being released from hospital between 2 and 13 days after their operation, with a mean of 4 days. Cinecoronary angiography, which was carried out in 48 (65,7%) patients during the postoperative period, before discharge, showed occlusion of anastomosis in 2(4,2%) patients, and occlusion after anastomosis in 1 (2,1%) patient. During the follow-up, there was one death due to pneumonia and another due to thromboembolysm. The other patients remained asymptomatic during a mean period of one year.
Conclusions: Surgery with MICABG is possible with better esthetic effect, lower cost and faster recovery than the conventional one in a group of patients. The use of VATS through the thoracotomy itself and restrained device are good methods in this surgical approach.
Keywords: Myocardial revascularization, methods; Surgery, minimally invasive; Thoracoscopy, methods
Radial artery graft myocardial revascularization: immediate results of initial experience
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
Twenty patients underwent myocardial revascularization with a radial artery (RA) between May and November 1996. The mean age was 57.1 years (35 to 69) and 16 patients (80%) were male. Midsternotomy, extracorporeal circulation and antegrade blood cardioplegia were always used. A total of 64 grafts, 3.2 per patient (2 to 5), were performed: in 9 patients (45%) to the diagonal branch, in 6 (30%) to the obtuse marginal branch, in 4 (20%) to the right coronary artery and 1(5%) to the left anterior descending artery. The left internal mammary artery (LIMA) was also used in every patient, the right IMA in 7 (35%) and additional saphenous vein grafts in another 13 (65%). Calcium channel blockers were used orally to prevent RA spasm. There were no hospital deaths nor during follow up of 10 months. Seventeen immediate coronary angiographies have been performed. RA grafts were patent in 16 (94.1%). There was no ischemic sequelae of the superior limb secondary to graft harvesting. Our results are similar to many other recent published series, and no morbidity or mortality increase has been noticed with RA used for Coronary artery bypass grafting.
Keywords: Myocardial revascularization methods; Radial artery, transplantation
Minimally invasive saphenous vein graft harvest for the myocardial revascularization surgery
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
We present here the initial results of patients submitted to myocardial revascularization with the employment of minimally invasive technique of saphenous vein graft dissection. We utilized small incisions (3 to 4 cm) over the skin of the inferior limb, repeated at intervals of 8 to 14 cm to obtain the vein graft, with the aid of an adequate ilumination and special retractors. This method provided veins of 30 to 65 cm of length, through 2 to 4 small skin incisions. We operated on 8 patients who received 25 saphenous vein grafts plus the arterial ones. All patients improved well, without complications of the inferior limb and with a very good stetic effect.
Keywords: Surgery, minimally invasive; Saphenous vein, dissection; Saphenous vein, surgery; Myocardial revascularization
Subvalvular implantation of the prosthesis sewing ring in the surgical treatment of ascending aorta aneurysms
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
A techinical modification of the Bentall and DeBono operation for treatment of ascending aorta aneurysm is presented. The subvalvular insertion of the prosthesis sewing ring is accomplished, passing interrupted U sutures, consecutively in the sewing ring and in the native aortic valve annulus. As a result, direct reimplatation of the coronary arteries to the graft is simplified, particularly when the coronary ostia presents little or no cephalad displacement, as is usually the case in small aneurysms. In addition, it provides a more secure proximal anastomosis. Fifteen patients were operated on by this technique. In all but one, the coronary ostia were reattached to the vascular prosthesis. There were two hospital deaths not related to the technique. The 13 survivors were followed from 72 days to 109 months. No dysfunction of the valvular prosthesis was observed at periodic clinical and ecocardiographic evaluations. However, two late deaths occurred: one, of unknown cause, after 6 months; the other, after 40 months, related to a new surgery for treatment of a dissecting thoracoabdominal aneurysm.
Keywords: Aortic aneurysm, surgery; Blood vessel prosthesis, methods
Video-assisted cardioscopy in congenital heart surgery
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
Objetive: Analyze the use of video-assisted cardioscopy in congenital heart surgery.
Methods: From September 1994 to June 1996, 8 patients with complex congenital heart defects were operated on using the video-assisted cardioscopy as an auxilliary method for surgical correction. Ages ranged from 5 to 13 years (mean-age 9.9 years).
Results: The video-assisted intraoperative cardioscopy permitted in all cases a broad anatomic and dynamic visualization of the intracardiac structures before and after correction providing an assessment of the final results, while still on extracorporeal circulation. No intraoperative or postoperative complications related to the use of the video-assisted cardioscopy were noted.
Conclusions: The video-assisted intraoperative cardioscopy proved valuable for pre and postoperative assessment of complex congenital heart defects.
Keywords: Heart surgery, methods; Heart defects, congenital, surgery; Cardioscopy, methods
Detection and analysis of myocardial monophasic action potential in cardiomyopathy and heart transplantation
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
Monophasic Action Potential (MAP) is a technique which assesses in vivo cellular potencial using special catheters without the need of using in vitro transmembrane cellular electrodes. We studied the implementation and the results of in vivo endocardial MAPs using electrode-catheters as well as the algorithm used for computed analysis of captured signals. Myocardial repolarization may be affected by several factors that are not detected by the electrocardiogram and are detected by MAP. The algorithm used to analyse the MAP uses morphological and temporal characteristics to assess cellular potencial. Heart transplantation and any cardiomyopathy may alter myocardial fiber structure. We studied 23 patients who were submitted to endomyocardial biopsies, of whom 8 (34.8%) underwent this procedure to evaluate their cardiomyopathy, and 15 (65,2%) in order to evaluate postoperative rejection of the graft. After the biposies we formed 2 groups of 5 patients each; one group was formed of 5 patients with myocardiopathies without active myocarditis, and the other one was formed by 5 patients with and without grad 3A rejection. Our results demonstrated that: 1) the electrode-catheter presented similar results to previous experimental reports; 2) the computed algorithm was efficient and presented similar results to previous experiments; 3) MAP interference due to cardiomyopathy or rejection induces proportional alterations that maintain repolarization morfology; 4) depolarization speed during rejection undergoes a two or three-fold increase.
Keywords: Action potentials; Myocardium; Myocardial diseases; Heart transplantation; Action potentials, myocardium
Surgical treatment of recurrent ventricular tachycardia: a new technique
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
The ventricular reentry circuits commonly found in Chagas'Disease(CD) frequently originate ventricular tachycardia(VT) that can lead to the patient's death. Most of this arrhythmia is drug-resistant. A new surgical technique was used on 9 patients, with VT and CD. 8 had aneurysms in the apical and 1 in the infero-basal portion of the left ventricle. Ages ranged from 34-62 (mean 48), with five females. All patients were classified as functional class III and IV (NYHA), and most presented syncope associated with VT. During surgery, clinical tachycardias were induced by programmed ventricular pacing and were interrupted by endocardial touch mapping, using a surgical instrument in the region of probable origin of tachycardia. Previous morphology registered on the 12 leads surface EKG oriented by its. In that and its surrounding area, radiofrequence was applied using a 7f ablation catheter. The patients did not require any antiarrhythmic drugs and were followed up for 13+/-7 months; eight are in good status, asymptomatic and in functional class I and II, without any tachycardia; one died from lung disease three months later without tachycardia during this period. This technique is simple, reproducible and achieves a high rate of success (100% in our series) and does not require sophisticated electrophysiological personnel and facilities.
Keywords: Tachycardia, ventricular, surgery, methods; Catheter ablation; Chagas cardiomyopathy, complications
Utilization of auto - expandable stents in diseases of the thoracic descending aorta of the dog
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
We present 5 dogs who underwent treatment with an auto-expandable Dacron-covered stent in the thoracic aorta. The catheter with stents was deployed through the abdominal aorta. The procedure was performed under total anesthesia and full heparinization. A perfect integration of the stent and thoracic aorta was observed on histological examination. We believe that utilization is an improvement in relation to the "elephant trunk" technique and that it should contribute to improve surgical results in type B dissection.
Keywords: Aorta, thoracic, surgery, dogs; Stents
Intermittent anterograde normothermic blood cardioplegia: experimental study in rabbits
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
Purpose: To study the degree of myocardial protection provided by intermittent infusion of normothermic blood cardioplegia during 60 minutes in normal rabbit hearts.
Methods: The study was conducted on 32 New Zeland rabbits. There were 2 stages in this study: Stage I: Metabolic study after ischemia without reperfusion, and Stage II: Metabolic and functional study after reperfusion. The reperfusion was performed with a parabiotic system of perfusion. The glycogen concentration and mitochondrial respiration of the ventricular myocardium immediately after the intermittent infusion period of cardioplegia (Stage I) and after reperfusion (Stage II). During reperfusion the assessment of left ventricular function (dP/dtmax) was realized.
Results: There was significant fall in myocardial glycogen levels of 58% in comparison with controls at the end of the intermittent infusion period of cardioplegia (Stage I). Glycogen level differences were not significant after reperfusion (Stage II). The differences in the results of the mitochondrial respiration were not significant in both Stages. The values of dP/dtmax, in Stage II were 903.39 ± 113.46 mmHg/s and 1.043 ± 256.94 mmHg/s, for experimental and control groups respectively. The difference was not significant.
Conclusions: The intermittent anterograde normothermic blood cardioplegia infusion every 20 minutes during 60 minutes is an efficient method of myocardial protection in normal rabbit hearts.
Keywords: Heart arrest, induced, methods; Myocardial reperfusion, rabbits; Myocardium, metabolism, rabbits; Ventricular function, left, rabbits
Ischemic contracture of the heart: an experimental assay in rats
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
Ischemic contracture of the heart (ICH) has been largely employed for the investigation of global heart ischemia physiopathology. We herein describe a simple ICH experimental model. Eight Wistar rats, anesthetized with sulfuric ether, were studied. The heart was rapidly removed by thoracotomy, and then immersed in a 37°C saline bath. A latex balloon catheter placed in the left ventricle and distended to 20 mmHg was used to detect ICH onset (ICHO) and intensity (ICHI). A 5 mmHg baseline elevation pepresented ICHO. ICHI was represented by peak balloon pressure. ICH dP/dT was calculated. The results (mean ± standard deviation) were similar to the literature: ICHO (min) = 15.5 ± 0.59; ICHI (mmHg) = 62.0 ± 5.81; dP/dT (mmHg/min) = 14.2 ± 3.05.
Keywords: Myocardial contraction, rats; Myocardial ischemia, rats
CASE REPORT
The intracavitary right coronary artery surgical management
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
An intracavitary location of a coronary artery is rare in our surgical experience with revascularization. This variant has occured in the right coronary artery (0.01%) and in left anterior descending coronary artery (0.2%). The location of the lesion and the pathological condition, length and size of the coronary may dictate exposure of an intracavitary coronary artery for proper revascularization; more commonly surgeons are anaware of the intracavitary position and during intramyocardial dissection of an artery will open a cardiac chamber where the vessel traverses the cavity. Problems that arise are introducion of air, dificulty in exposure due to blood and depth of position and obstruction of the coronary artery during closure of the myotomy. Three patients are presented who required revascularization of intracavitary vessels (three right coronary arteries). The location and lenght of the intracavitary portion of the artery determined the surgical management the methods used to close the cavity varied. The techniques employed were simple closure moving the artery into an aerial position with cavitary closure using bovine pericardium; anastomosis in the intracavitary position with closure of the myotomy, or selection of an alternate distal site for anastomosis.
Keywords: Coronary vessels, surgery; Myocardial revascularization
Right and left coronary arteriovenous fistula to pulmonary artery: surgical treatment
Braz J Cardiovasc Surg 12;
Publish in: 8/2/2025
Coronary arteriovenous fistulas belong to a group of cardiac pathologies that are rarely diagnosed because they do not present symptoms. However, when suspected of causing the clinical picture, they must be investigated to determine adequate treatment. The case of a 65-year-old man with a history of sudden angina, progressing to acute myocardial infarction of the inferior wall is presented. After diagnostic investigation, the presence of right and left coronary arteriovenous fistulas to pulmonary artery were found. After surgical and clinical treatment, the patient's course was satisfactory.
Keywords: Arteriovenous fistula, surgery; Coronary vessels, surgery; Pulmonary artery, surgery; Coronary vessel anomalies, surgery; Pulmonary artery, abnormalities