Volume 22 - Número 3
EDITORIAL
Indexing and scientific production
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
ORIGINAL ARTICLE
Clinical and hemodynamic outcome following coronary artery bypass surgery in diabetic patients using glucose-insulin-potassium (GIK) solution: a randomized clinical trial
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Objective: This study was undertaken to determine whether GIK infusion improves hemodynamic performance by reducing the use of inotropic agents, as well as the morbidity of diabetic patients submitted to CABG.
Methods: Patients with type 2 DM referred for CABG were randomized to receive GIK or subcutaneous insulin from anesthetic induction up to 12 hours postoperatively. The primary clinical outcome was the cardiac index (CI) and the secondary clinical outcomes were the remaining hemodynamic parameters; the use of inotropics and vasodilators, the glycemic control (maintenance of plasma glucose levels), and the postoperative morbidity. Hemodynamic and laboratory measurements were performed in the first 24 hours postoperatively, and the patients were followed up for 30 days to detect any surgery-related complications.
Results: Twenty-four patients were randomly included in the study. IC did not show significant difference (mean cardiac index at 24 hours in both GIK group 3.49±0.94 and Control group 3.38±0.75; p=0.74). The GIK group revealed lower blood glucose levels in the infusion period (glucose at 12 hours GIK group 195.6±68.25 versus Control group 269.6±78.48; p=0.02), with a lower incidence of hyperglycemia in the GIK group, two (16%) against eight (64%) in the control group (RR 0.25; 95%CI 0.07-0.94; p=0.03). Postoperative infectious complications were less frequent in the GIK group than in Control group, three (25%) against 10 (80%), respectively (RR 0.30; 95%CI 0.11 - 0.83; p=0.01).
Conclusions: Studies have proven that GIK improves hemodynamic performance of both patients with or without DM submitted to CABG, what was not confirmed in this study. The use of GIK neither improved the CI improvement nor reduced the use of inotropic drugs, but it provided better glucose control. Secondary clinical outcome, including postoperative infections, was more frequent in the control group.
Keywords: Glucose; Insulin; Potassium; Myocardial revascularization; Diabetes mellitus
Minimally invasive thoracotomy (muscle-sparing thoracotomy) for occlusion of ductus arteriosus in preterm infants
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Objectives: To analyze the feasibility, the safety, and the primary outcomes of a minimally invasive thoracotomy for the occlusion of ligamentum arteriosum (ductus arteriosus) in preterm infants.
Methods: Between October 1991 and June 2003, 273 preterm infants and very low birth weight preterm infants were submitted to a surgical occlusion of the ligamentum arteriosum (ductus arteriosus) through muscle-sparing thoracotomy under general anesthesia in the neonatal ICU. Pre-operative demographic data, mortality outcomes, and adverse events were retrospectively analyzed through medical records consultation.
Results: There were no deaths related to surgery, and 234 (86%) patients were discharged from hospital. Thirty-nine deaths have occurred between the 1st and the 51st days. The cause of death was sepsis (14 patients); intracranial bleeding (11 patients); and necrotizing enterocolitis (9 patients). All causes were related to prematurity. In five patients the cause of death was not established or could not be found in the medical records. The most frequent adverse events related to the surgery were: pneumothorax: 3.3% (9 patients), bleeding: 1.4% (4 patients).
Conclusions: The minimally invasive thoracotomy technique for the occlusion of the ligamentum arteriosum (ductus arteriosus) when performed in preterm infants and very low birth weight infants is feasible, safe, efficient, related to low morbidity, and not dependent of hospital resources.
Keywords: Ductus Arteriosus, Patent, surgery; Ductus Arteriosus; Infant; Infant, Very Low Birth Weight; Thoracotomy
Coronary artery bypass grafting using both internal mammary arteries in patients with diabetes mellitus
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Objective: We sought to describe the use of both internal mammary arteries (IMA) in patients with diabetes mellitus (DM) submitted to coronary artery bypass grafting (CABG).
Method: Between January of 1995 to August of 2005, 4.569 patients received isolated CABG in our institution, of these, 1.298 had DM. Mean sample age was 62 years, and total mortality was 2.18% (100 patients). We have used both IMA's in 700 patients, that here are split in two groups, with DM (group I, 148 patients), and without DM (group II, 552 patients). Patient selection for double IMA grafting was based on coronary artery anatomy and sternal bone quality, the later was evaluated during sternal transsection. When these two factors were considered favorable, we harvested both IMA's, not mattering if the patient had or had not DM. During IMA's harvest, care was taken not to open the pleural spaces.
Results: There was small difference between the two groups in terms of morbidity and mortality.
Conclusion: Our data suggest that patients with DM can benefit of double IMA's grafting, with little increase in risk for complications if its application is carefully indicated.
Keywords: Myocardial revascularization; Mammary arteries; Internal mammary-coronary artery anastomosis; Diabetes mellitus
Influence of the practice physical activity in the coronary artery bypass graft surgery results
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Objective: To evaluate the modifications of the frequency of physical activities practice of the patients submitted to coronary artery bypass graft surgery (CABG) and the influence of the frequency of physical practice activity of the patients before surgery in the surgical prognostic.
Methods: Cases studies of 55 patients submitted to CABG divided in active and sedentary in relation to physical practice activities.
Results: After CAGB 14 (47%) of the patients classified as sedentary before surgery were practing exercises (p=0.03). Seventeen (59%) sedentary patients in the pre-operatory period presented complications after the surgery comparing to 8 (31%) in those actives (p= 0.4%). The post-operatory period of hospitalization in the sedentary group and in those that were active in the pre-operatory period were respctively 15 (SD=8) and 12 (SD=5) days p=0.03.
Conclusion: This study showed the importance of pre-operatory physical activity practice in the results of coronary artery bypass surgery. The patients physically active had a shorter time of postoperative hospital stay and a smaller number of hospital and one year follow up surgery complications. The cardiac surgery promoted a modification of the habits of the patients increasing the number of physically active patients during the one year follow up.
Keywords: Exercise; Surgery; Post-operative complications; Myocardial revascularization; Risk reduction behavior
L-glutamic acid in the prevention of the calcification of bovine pericardial fixed in glutaraldehyde: study in rats
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Objective: To evaluate the efficiency of L-glutamic acid to prevent calcification of glutaraldehyde bovine pericardium implanted in rats' subcutaneous tissues.
Methods: Fifty four Wistar rats were divided in six groups according to the type of the bovine pericardium implanted. At first, all pericardia were initially cross-linked with 0.5% glutaraldehyd (GDA) fixative for 72 h. In Group I, after the initial fixation, the pericardia were preserved in 0.2% GDA fixative until the implantation, whereas in Group II they were stocked in Paraben solution. In Groups III and IV, after the initial fixation in 0.5% GDA fixative, the pericardia were treated with 8% L-glutamic acid at pH 7.4 and 3.5, respectivelly, being subsequently stocked in Paraben solution. Groups V and VI were similar to III and IV, except for the concentration of L-Glutamic acid which was 0.8%. Explantation was done at 15, 30, and 60 days, and the specimens submitted to histological analysis with Hematoxylin and eosin (HE) and Von Kossa stains, besides calcium quantification with atomic spectrofotometry.
Results: Microscopic analysis demonstrated severe and progressive calcification in groups I, II, and III, whereas in groups IV, V, and VI calcification, when present, was mild and focal. Spectrofotomety confirmed these findings, revealing calcium contents of 1.93µg/mg of tissue at 60 days in the control group. Groups IV and VI showed the least calcium contents (0.063 e 0.066, respectively).
Conclusions: The use of L-glutamic acid in segments of bovine pericardium with glutaraldehyde fixative was effective in preventing the calcification when implanted in rats' subcutaneous up to 60 days.
Keywords: Glutamic acid; Glutaral; Pericardium; Calcinosis
Analysis of the immediate outcomes of a comparative randomized study between aorto-saphenous mechanical anastomosis versus conventional anastomosis
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Objective: To evaluate the immediate results of mechanical aorto-saphenous anastomosis compared with conventional anastomosis.
Method: We evaluated 12 patients. The mean age ranged from 62.33 ± 7.30 years. Of 12 patients submitted to surgery without extracorporeal circulation, 10 (83.3%) patients were male. Thirty-three proximal anastomoses were evaluated, 21 of them being performed through the conventional manner and 12 with the St. Jude Symmetry aortic connector. The time spent on anastomosis, and free flow and patency on the 4th day postoperative were analysed.
Results: The mechanical anastomosis was successfully performed in all patients. Electrocardiographic alteration compatible with myocardial infarctation (MI) on the 2nd day postoperative was observed only in one patient. The patient was referred to angiographic restudy, becoming evident a conventional proximal anastomosis occlusion for the marginal branch. Three patients had atrial fibrillation. The average time spent to perform the mechanical anastomosis was 44.08 ± 9.26 seconds against 3.86 ± 0.61 minutes of the conventional anastomosis (p = 0.0022). The average blood free flow observed in the mechanical anastomosis was 302.75 ± 82.76 mL/min versus 190.75 ± 51.53 mL/min (p = 0.0022). In the angiographic restudy performed on the 4th postoperative day, it was detected the occlusin of three mechanical anastomosis. There was no new conventional anastomosis (p = 0.2500).
Conclusion: The present study showed a statistically significant superiority for mechanical anastomosis of the saphenous vein with the aorta when evaluated the blood free flow and the time to perform the anastomosis. In relation to the artery condition in the postoperative angiography, one cannot say there was statistically significant difference between the procedures studied.
Keywords: Myocardial revascularization, methods; Surgical equipment; Anastomosis, surgical, instrumentation; Coronary artery bypass, instrumentation
Surgical treatment of the aortic coarctation: three-decade experience
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Objective: To make a 30-year review of the immediate results of coarctation of the aorta (CoAo) operation, between 1974 and 2004. All the patients underwent CoAo whether in isolation or associated with other congenital defects.
Methods: The following data was investigated: age at the time of surgery, gender, associated lesions, type of surgical technique, and immediate surgical outcome, particularly focusing the presence of systemic arterial hypertension.
Results: One hundred and four patients underwent CoAo. Of the 104 enrolled patients, 75 (72%) were pediatric patients and 29 (28%) adults patients. In the pediatric group, 23 (22%) were considered neonates, 17 (16%) infants, and 35 (34%) children. The associated defects were present in 66 (63.5%) patients, 54 (51.9%) in the pediatric group and 12 (11.3%) in the adult group. Seven (6.7%) deaths were observed in the immediate postoperative period. Among the various surgical techniques employed, aortoplasty was used in 80 patients (76.9%); end-to-end anastomosis in 15 (14.4%); Teles technique in seven (6.7%), Waldhausen technique in one (1%), and it was not possible to identify the technique in one patient (1%).
Conclusions: Despite the limitations of the present study, it may be noted that the results were good with the corrective surgery being performed safely and with a low mortality rate. Medium- and long-term follow-up was impaired by the well-known structural deficiencies in Brazil.
Keywords: Aortic coarctation, surgery; Cardiac surgical procedures; Heart defects, congenital; Retrospective studies
Morphometrical quantification of Chlamydia pneumoniae and Mycoplasma pneumoniae in human atherosclerotic abdominal aortic aneurysms
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Objective: Atherosclerotic inflammation, with a possible role of infectious agents, could contribute to the pathogenesis of abdominal aortic aneurysms (AAA). Finding of Chlamydia pneumoniae (CP) in these lesions in previous, non-quantifying studies ranged from 0-100%. The objective is to quantify the presence of CP and Mycoplasma pneumoniae (MP) in AAA.
Methods: Thickness, number of cells positive for CP by immunohistochemistry and percent area occupied by MP, detected by "in situ" hybridization in the three layers of the aorta, were measured in the three aortic layers using an image-analysis system in 10 necropsy abdominal aneurysmatic aortas. Three groups of controls were used: 1) samples of the same aortas, outside the aneurysms, except if the dilatation took the whole sub-renal portion of the artery (n=7); 2) aortas with severe atherosclerosis but without aneurysms (n=10); 3) aortas with no or mild atherosclerosis (n=10). All specimens were obtained at necropsies. Wald's test was used to compare groups; significance level was established at 5%.
Results: The intima was thinner and the media thicker in the normal cases than in the other groups (p<0.01). Positive cells for CP were found in all groups, more frequently at the adventitia; no significant difference was detected between them (p>0.05). MP was also detect in all groups. This agent predominated in the group of patients with atherosclerosis, but no aneurysms at both intima and adventitia; nevertheless, differences between the groups were not significant (p>0.05).
Conclusions: our data suggest that the bacteria we focused have not an important role in the pathogenesis of AAA.
Keywords: Aorta, pathology; Aortic aneurysm, abdominal; Chlamydophila pneumoniae; Mycoplasma pneumoniae; Atherosclerosis; Autopsy
Effect of temporary right atrial pacing in prevention of atrial fibrillation after coronary artery bypass graft surgery
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Objective: To evaluated the effects of temporary atrial pacing to prevent the atrial fibrillation after coronary artery bypass graft surgery and the risk factors to the occurrence of this arrhytmia.
Methods: We have studied 160 patients who, at the end of coronary artery bypass graft surgery, were submitted to epicardial electrode implantation in the right atrium lateral wall. They were randomized into two groups: non-pacing (NP) group and right atrial (RA) pacing group. The cardiac rhythm was monitorized over 72 hours following to the end of surgery and the variables studied were as follow: incidence of atrial fibrillation; the risk factors pre-, intra-, and postoperative for its occurrence, and postoperative events.
Results: There were 21 (13.1%) episodes of atrial fibrillation, 20 in NP group and one in RA group. The relative risk (RR) for development of atrial fibrillation was 0.18 (95% CI; 0.05-0.60) for the RA group when compared to the NP group. The logistic regression identified that the study variables, such as younger age; use of beta-blockers in the preoperative, and the presence of right atrial pacing had been associated to a lower Odds ratios (ORs) for the occurrence of atrial fibrillation in the postoperative.
Conclusions: The temporary atrial pacing reduced the incidence of atrial fibrillation after the CABG surgery. Older age and a non-atrial pacing were the independent predictive factors of the occurrence of this arrhythmia.
Keywords: Cardiac pacing, artificial; Atrial fibrillation; Myocardial revascularization; Postoperative complications; Extracorporeal circulation
EXPERIENCE THE OF SERVICE
Left thoracotomy for reoperations in myocardium revascularization
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Objective: To describe patient selection criteria, surgical technique and early outcomes in patients undergoing reoperative coronary artery bypass surgery (RECABG) through a left thoracotomy without cardiopulmonary bypass (CPB).
Methods: Eight patients with patent grafts to the left interventricular coronary artery (four of whom had also patent grafts to the right coronary artery) requiring revascularization of the circumflex coronary system had redo-CABG without CPB through a left posterolateral thoracotomy.
Results: There were no in-hospital mortality or serious postoperative complications. All patients are angina-free.
Conclusions: An off-pump redo-CABG through a left posterolateral thoracotomy may reduce risks attributable to resternotomy in patients who met the selection criteria.
Keywords: Myocardial revascularization; Reoperation; Coronary artery bypass, methods; Thoracotomy
CASE REPORT
Coronary artery bypass grafting in a patient with situs inversus totalis and dextrocardia
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Situs inversus totalis is a rare congenital anomaly. We report a 78 year old woman with this condition and ischemic coronary artery disease who underwent myocardial revascularisation. The cardiac catheterism showed severe proximal stenosis with aneurysms in the interventricular, diagonal and right coronary. The procedure was done with the surgeon positioned in the left hand side of the patient, with the righ internal thoracic artery anastomosed to the interventricular artery and two more vein grafts. Very few cases were reported in the world and this is the third case in Brazil and the first in the world with coronary aneurysms.
Keywords: Situs inversus; Coronary disease; Dextrocardia; Myocardial revascularization
Giant pericardial cyst: case report
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Pericardial cysts are uncommon congenital abnormalities. Most are asymptomatic and are found incidentally on chest roentgenograms. Giant cysts are an even more uncommon finding, and reports of their natural history, presentation and management are few. In this report the authors describe a case of a giant pericardial cyst with symptoms of mediastinal compression for which the surgical excision guaranteed a 12-month follow-up of complete remission of the symptomatology.
Keywords: Pericardium, pathology; Mediastinal cyst, surgery; Constriction, pathologic, complications
Vascular ring related to Kommerell diverticula: case report
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
Report of a surgical treatment of the vascular ring (right aortic arch and the anomalous origin of the left subclavian artery) related with Kommerel diverticula with the section of the ligamentum arteriosum (ductus arteriosus), suture of the Kommerell diverticula, and reimplantation of left subclavian artery in the ipsilateral carotid artery through left thoracotomy in a 13-year-old female.
Keywords: Aorta, thoracic, abnormalities; Subclavian artery, abnormalities; Aortic diseases, surgery
Simultaneous repair of congenital heart defect and pectus excavatum
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
The author describes the simultaneous treatment of pectus excavatum and congenital intracardiac defect (atrial septal defect) represented by the interatrial foramen secundum. An 8-year-old boy, with clinical and echocardiography diagnosis of atrial septal defect associated with pectus excavatum was referred to a simultaneous surgical treatment of both abnormalities. The simultaneous surgical treatment of both pectus excavatum and congenital intracardiac defects make it difficult to access the heart. In this case, the simultaneous surgical treatment of atrial septal defect and pectus excavatum was a valuable alternative to surgical repair of both abnormalities, mainly due to its cosmetic outcome.
Keywords: Thorax, abnormalities; Funnel chest, surgery; Heart defects, congenital; Heart septal defects, atrial
Lung nodule, tracheal stenoses and coronary disease: how to approach when are all associated to?
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
A 67-year-old male patient underwent exploratory thoracotomy for pulmonary nodule resection. The patient presented a cardiorespiratory arrest during anesthesia due to myocardium infarction. After reanimation the patient was sent to ICU where he remained intubated for 7 days. Subsequently, he developed cervical tracheal stenosis. At first, the patient underwent a myocardium revascularization followed by surgical resection of tracheal stenosis through tracheoplasty.
Keywords: Tracheal stenosis; Myocardial revascularization; Lung neoplasms; Hamartoma
Partial absence of the inferior vena cava associated with bowel malformation
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
A 6-year-old female child sought medical service due to a gastrointestinal malformation. During a medical follow-up a partial absence of the inferior vena cava was diagnosed, which is a rare congenital alteration, involving the vascular drainage from the inferior segment of the body. Imaging exams were performed, which contributed to evaluation and description of the case. Conservative treatment with an oral anticoagulant was maintained. The patient presents good evolution after a long-term cardiovascular follow-up.
Keywords: Venae cavae, abnormalities; Vena cava, inferior, abnormalities; Heart Defects, congenital, surgery
CLINICAL-SURGICAL CORRELATION
The uncommon association between the aortopulmonary window and the aortic coarctation
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
A child with transposition of the great arteries submitted to surgical correction at preschool age
Braz J Cardiovasc Surg 22;
Publish in: 8/2/2025
LETTERS TO THE EDITOR
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