Volume 14 - Número 4
ORIGINAL ARTICLE
Late evolution of patients with small aortic prostheses (19 - 21 mm)
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
OBJECTIVES: Evaluate patients, before and after surgery, with change of aortic valve for a small prosthesis (19 and 21 mm), in order to check the viability of their use.
MATERIALS AND METHODS: In our Service, from January 1989 to November 1997, 1497 patients had the aortic valve changed. The small prostheses were used in 100 patients. Females predominated (74%) in this group, with average body surface of 1.57 m2. The biological prosthesis were used in 33% of the cases. Postoperatively, these patients were followed by Doppler echocardiography and clinical evaluation.
RESULTS: This group of patients presented improvement in functional class; 86.3% of them are in class I, and the others in class II. The VE-Ao gradient was significantly reduced, with a postoperative average of 30.9 mmHg. In 64% of the cases an associated procedure was necessary: the most common was mitral valve replacement. The survival rate of this group, in 101 months of follow-up, is 83%.
CONCLUSION: Considering the clinical improvement in these patients, most are asymptomatic and with an acceptable trans-prosthetic gradient, we fell that the small prosthesis can be used safely when the relationship between the size of the prosthesis and the patient's body surface area is appropriate.
Keywords: Heart valve prosthesis, implant; Heart valve prosthesis, follow-up; Aortic valve, surgery; Mitral valve, surgery
Surgical treatment of aneurysms and dissections of the aortic arch
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
From Jan/1990 to Mar/1999 we performed 354 operations on the thoracic aorta in our hospital. Among these, 47 procedures involved the aortic arch; 31 patients were male (66.0%) and ages ranged from 26-74 years (mean = 54.9 ± 10.9). Aortic dissection was present in 33 patients (70.2%) and fusiform or sacular aneurysms in 14 (29.8%). Previous cardíac procedures had been performed in 11 patients (23.4%), rupture with cardíac tamponade was present in 4 patients. Median sternotomy was used in 42 cases and bilateral thoracotomy in 5. Deep hypothermia with circulatory arrest was used in 97.8% of cases with the arrest period ranging from 15 to 60 minutes (m = 30.6 ± 12.6). Anterior hemiarch reconstruction was used in 19 patients (40.4%), posterior hemiarch in 5 (10.6%), total arch replacement in 18 (38.3%) aortoplasty in 4 (8.5%) and extra-anatomic bypass with exclusion in 1 (2.1%). The main associated procedures were: myocardial revascularization (9), ascending aorta replacement by a valved conduit (15), elephant trunk (5) and aortic valve replacement (3). Hospital mortality was 12,3% (6 patients) and respiratory insufficiency was the most common non-fatal complication (7 cases). Determinant factors for hospital mortality showed a statistical tendency for age over 60 years (p = 0.17) and for acute aortic dissection (p = 0.07). Late follow-up was achieved in 95.12% of the hospital survivors. There were 3 late deaths (1 cerebro-vascular accident, 2 reoperations). The 9 year survival rate is 80.85%.
Keywords: Aortic aneurysm, thoracic, surgery; Aneurysm dissecting, surgery; Aorta, thoracic, surgery
Chronic atrial fibrillation reversion by a modified Cox Maze procedure using radiofrequency and transoperatory ultrasound
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
The Cox Maze procedure has been used to restore the sinus rhythm in patients (pts) with chronic atrial fibrillation (CHF). Usually dissection and suture increase the operative time and postoperative complications. Hence, to avoid this we have used transoperative radiofrequency (RF) or ultrasound applications to create the lines. Since 1998, five pts. have been operated (3 females) with average age of 145.8 years. All suffered from valve disease and CAF. The peripheral leads were monitored and extracorporeal circulations initiated without cardioplegia. After opening the right atrium, the RF lesion lines were created using a modified Maze procedure. Regulation of the R-R and increase in the "F" waves, resembling an atypical atrial flutter accurred soon after. Following aortic clamping and left atrial opening the left auricle was isolated and the RF lines were done. After liberations of the aorta, the heart contracted spontaneously and retuned to sinus rhythm. After valve replacement and reduction of the left atrium, the ECG continued to record sinus rhythm. We have used ultrasound in our last two patients to procedure deeper and easier lesion lines. All pts. displayed sinus rhythm both in the early and late postoperative periods. All pts. were maintained on 120 gms/day of oral Verapamil to aid in atrial remodiling. In conclusion this technique has shortened the time necessary to accomplish the Maze procedure, reducing tissue damage and complications.
Keywords: Atrial fibrillation, surgery; Cardiac surgical procedures, methods; Catheter ablation; Ultrasonography
Senning operation with autologous tissue for atrial septum augmentation or pulmonary venous pathway enlargement
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
One of the main theoretical advantages of the original Senning Operation is the ability to avoid either biologic or synthetic patches for atrial septum augmentation or to enlarge pulmonary venous pathways. To accomplish this we have performed the Senning procedure with some modifications that allow the operation to be completed without the use of heterologous tissue. Twelve children, aged 5 months to 4 years (mean age: 20 months) with transposition of great arteries who had previous balloon atrial septostomy were submitted to the Senning procedure. The following associated lesions were diagnosed: ventricular septal defect in 1 patient, valvular pulmonary stenosis in 1 and auricular juxtaposition in 1. The modified technique used for atrial septum augmentation was the use of open inverted left auricula in 5 cases, inverted auricula in 2 and in situ autologous pericardium for venous pathway enlargement in 5. The hospitalization was 10 to 24 days (mean = 15 days) and the post-operative period was 7 to 22 days (mean = 12 days). There were no in-hospital or late deaths during a mean follow-up period of 23 months (range 8 to 34 months). All patients had a good clinical outcome and their follow-up echocardiographic examinations showed no evidence of venous pathway obstruction. This modified Senning Operation can be performed without either biologic or synthetic patches for atrial septum augmentation or to enlarge pulmonary venous pathway. The use of autologous in situ tissues with potential for growth, retains the main theoretical advantage of the original technique.
Keywords: Transposition of great vessels, surgery; Cardiac surgery procedures, methods; Surgical flaps
Echocolor Doppler saphenous vein mapping prior to myocardial revascularization
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
INTRODUCTION: The vascular echocolor Doppler, has made possible the observation of the greater saphenous vein (GSV) state without additional risk to the patient or to vascular lesions. The objective of the study was, working with a group of cardiovascular surgeons, to show the utility of the mapping of the GSV before coronary artery bypass graft (CABG) surgery.
METHOD: During the period from March 1995 to May 1998, 208 extremities of 104 patients selected for CABG were studied. The criteria used for the selection of the GSV was the patency and a diameter larger than or equal to 3.0 mm, using the the ultra-sound equipment ATL - HDI 3000 and Acuson-Sequóia 512.
RESULTS: Within the 208 extremities studied, 186 (89.4%) were appropriate for CABG in accordance with the description from the echocolor Doppler, seventeen (8.2%) did not fulfill the criteria, and five (2.4%) showed GSV stripping. Two of the seventeen inappropriate GSV were surgically explored, confirming the echoultrasound findings.
CONCLUSIONS: The authors conclude that the echocolor Doppler can be effective in the mapping of GSV in the preoperative examination of the greater saphenous vein and its selection for CABG. Due to it´s capacity to correctly identify and select veins for by - pass surgery, the echocolor Doppler saves time in the search for veins and permits the surgeon to better plan the surgery.
Keywords: Myocardial revascularization; Echocardiography, Doppler color; Saphenous vein, ultrasonography; Preoperative care, methods
Vascular reactivity of the internal mammary artery: comparative pharmacological studies between canine right and left arteries
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
To study factors which modulate the tone of internal mammary artery (IMA) bypass grafts, right and left canine IMAs were studied in vitro in organ chambers: 1) increasing concentrations of the platelet-derived products adenosine diphosphate (ADP) or serotonin (5-HT) induced vasodilation of contracted right and left IMAs. The vasodilation caused by ADP was endothelium-dependent while serotonin acted directly on the vascular smooth muscle; 2) the autacoids histamine and bradykinin also induced IMA vasodilation, histamine via a direct action on the smooth muscle, and bradykinin through the release of nitric oxide; 3) in canine IMAs, the calcium ionophore A23187, which acts independently of receptors produced endothelium-dependent vasodilation of contracted blood vessels; 4) dopamine, dobutamine, and papaverine induced vasodilation of the IMA, regardless of the presence or absence of an intact intima; 5) norepinephrine induced profound IMA vasoconstriction which was comparable to contraction to potassium ions or the constrictor peptide endothelin; 6) in 83% of 20 biological assays the basal release of nitric oxide was bigger in left IMAs than right IMAs; 7) biological assays of IMAs confirmed the importance of prostacyclin (PGI2) in response to hypoxia; 8) no differences between right and left IMAs were observed studying the different drugs.
Keywords: Mammary arteries, drug effects; Endothelium, vascular, drug effects; Neurotransmitters, pharmacology; Autacoids, pharmacology; Anoxia, metabolism; Nitric oxide, metabolism; Epoprostenol, metabolism; Biological assay
Comparative distribution of glycosaminoglycans in arteries and veins of different mammals
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
A comparative analysis of the glycosaminoglycan distribution in arteries and veins of humans, rats and dogs was realized. The results showed that the glycosaminoglycan distribution of the arteries was similar to that of venous tissues, where dermatan sulfate was the main glycosaminoglycan found. However, the proportion of dermatan sulfate is significantly greater in venous than in arterial tissues, in the three species. The total amount of the glycosaminoglycans was significantly higher in arteries than in veins, and the highest contents were found in the aortas. These increases may be associated with structural differences of the wall of these two types of blood vessels walls. The blood pressure is significantly lower in venous tissues and veins may exhibit less compressibility than arterial. These findings open perspectives for a better understanding of biochemical changes that could be related to the progressive degenerative vascular process, especially in the structural changes that saphenous veins undergo, when used as grafts in myocardial revascularization.
Keywords: Glicosaminoglycans, analysis; Arteries, chemistry; Veins, chemistry
Study of evolutive coronary arteries anatomy in vertebrates using vinyl acetate technique
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
Thirty anatomic models of vertebrate hearts were produced in order to study the right and left coronary arteries in different species such as fish, amphibians, reptiles, birds and mammals. The hearts were injected with vinyl acetate and then submited to corrosion and/or partial corrosion with hydrochloric acid to obtain the anatomical coronary artery model allowing correlation with the evolution of the species and its morphological adaptations. Based on these models we concluded that: the technique using vinyl acetate associated to corrosion produced models of coronary vessels with enough details to visualize the branches; the number of structures and the vascular complexity increased as the species evolved in the zoological scale. In the reptile Iguana iguana a three outlet double ventricle was found, which has not yet been reported as a human congenital disease in the literature surveied.
Keywords: Coronary vessels, anatomy; Vertebrates, anatomy; Models, anatomic
CASE REPORT
False aneurysm of crimped bovine pericardial conduit after reconstruction of the ascending aorta: case report
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
The authors describe the case of a patient who had an aneurysm of the ascending aorta repaired with biologic valved crimped bovine pericardial conduit. Nine years after the surgery he presented a false aneurysm of the ascending aorta, located posteriorly on the suture line of the pericardial tube. The patient was reoperated and the pericardial tube was replaced by a valved Dacron composite graft using the hemi- Cabrol technique for the reimplantation of the coronary ostia. At 12 months follow-up the patient remains free of symptoms.
Keywords: Blood vessel prosthesis; Bioprosthesis; Aneurysm, false, surgery; Aortic aneurysm, surgery
Surgical repair of ruptured sinus of Valsalva aneurysms: report of two cases
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
The purpose of this article is to report the surgical treatment of ruptured sinus of Valsalva aneurysms in two patients. First case was a young woman whose aneurysm originated in the right sinus and entered the right ventricle, besides a mild coarctation of the aorta. Surgical repair was carried out using cardiopulmonary bypass with moderate hypothermia. After aortotomy the ruptured sinus of Valsalva was directly closed with interrupted pledgeted sutures. The second case, a 35 years old man with symptoms for six months, including dyspnea and chest pain. Diagnosis was established by echocardiogram and cardiac catheterization findings. It was a ruptured aneurysm of the right sinus of Valsalva which drained into the right ventricle. There was no ventricular septal defect or aortic regurgitation. Surgical approach was made through ascending aortotomy. Aortic valve had three practically normal leaflets. A patch of bovine pericardium was used to close the defect by means of interrupted fine monofilament sutures. Postoperative period in both cases was uneventful. Both patients were discharged one week later. After a short follow-up, they are completely asymptomatic.
Keywords: Sinus of Valsalva, surgery; Aortic rupture, surgery; Aortic aneurysm, surgery; Cardiac surgery procedures, methods
Defect of the posterior mitral fibrous ring with left atrial aneurysm and mitral insufficiency: successful surgical treatment
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
Atrial aneurysm is a rare condition and can be found on the atrial appendage or on the atrial wall. Most patients are asymptomatic, but arrhythmias, thromboembolism, and heart failure are common complications. We present a 39 years old female patient with posterior mitral ring defect causing a great aneurysm of the left posterior atrial wall with mitral insufficiency. The diagnosis was achieved by chest roentgenogram (marked prominence of the upper left heart border) and echocardiography (great left atrial aneurysm behind the left posterior ventricular wall with mitral insufficiency). Left ventricular cineangiogram suggested the presence of a false aneurysm of the left ventricle. The patient subsequently underwent surgical treatment with cardiopulmonary bypass. Posterior mitral valve annuloplasty was performed with aneurysm exclusion and posterior left atrial wall reconstruction using a bovine pericardial patch. The postoperative course was uneventful, and the patient was discharged sympton-free on the eighth postoperative day.
Keywords: Heart aneurysm, congenital, surgery; Mitral valve insufficiency, surgery; Heart atrium; Heart valve, surgery
BRIEF COMMUNICATION
Improvement in the intraluminal sutureless prosthesis for replacement of aortic segments: brief communication
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
OBJECTIVE: To report on an improved model of intraluminal sutureless prosthesis for partial aortic replacement.
METHOD: A grooved multidrilled plastic ring was employed to facilitate the intraoperative handcrafting of the vascular prosthesis and its sutureless intraluminal fixation to the aorta. A 42 years old male patient with type A Dissecting Aneurysm was treated by the Bentall - De Bono technique using a valved and ringed bovine vascular prosthesis which was implanted in the aortic annulus with interrupted sutures and tied distally inside the aorta.
RESULTS: The improved ringed vascular prosthesis simplified the sutureless intraluminal anastomosis procedure. The postoperative evolution was uneventfull and the patient remains asymptomatic one year after the operation.
CONCLUSION: The improved ringed vascular prosthesis simplified the intraluminal sutureless procedure for treatment of dissecting aneurysm of the aorta.
Keywords: Aneurysm dissecting, surgery; Aortic aneurysm, surgery; Blood vessel prosthesis implantation, methods; Blood vessel prosthesis