Volume 23 - Número 2
EDITORIAL
New challenges
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
A fair homage
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
The Brazilian Book of Cardiology and Pediatric Cardiovascular Surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
ORIGINAL ARTICLE
Heparin quality control in the Brazilian market: implications in the cardiovascular surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Introduction: The change in the heparin solution trade mark in Brazil that had been commonly used in cardiac surgery has shown increased number in the coagulopathy, re-exploration and other side effects in our Institution and others. Methods: All four different heparin solutions available in the Brazilian market were studied in the Connective Tissue Lab, HUCFF, UFRJ and compared to the Liquemine (out of the market) and the international control solution. All samples were evaluated by magnetic nuclear resonance as well as their anticoagulant effectiveness. Results: There were significant differences among them regarding the anticoagulant activity. It was also observed contamination with other dermatan sulfate, samples chemically degraded and with significant change in the molecular weight. Conclusion: Among the studied samples, none of them can offer security in cardiac surgeries on pump. None of them has demonstrated similar quality to Liquemine, which is not available in the Brazilian market.
Keywords: Heparin; Myocardial revascularization; Extracorporeal circulation
The use of ultrafiltration for inflammatory mediators removal during cardiopulmonary bypass in coronary artery bypass graf surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To investigate the effectiveness of ultrafiltration in removing inflammatory mediators released by cardiopulmonary bypass and to correlate ultrafiltration with alterations in organic function according to the Sequential Organ Failure Assessment Score. Methods: Forty patients were included and randomized into two groups: "no ultrafiltration" (n=20; Group I) and "ultrafiltration" (n=20; Group II). Activated complement 3 and 4, interleukins 1beta, 6, 8 and tumor necrosis factor alfa were measured prior to anesthesia induction (Time 1), 5 minutes before cardiopulmonary bypass (Time 2), in the ultrafiltrated fluid (Time 3), 30 minutes (Time 4), and 6 (Time 5), 12 (Time 6), 24 (Time 7), 36 (Time 8) and 48 (Time 9) hours following cardiopulmonary bypass. Sequential Organ Failure Assessment Score was evaluated at Time 1, 6 and 9. Statistical significance was established at p < 0.05. Results: In the ultrafiltrated fluid, only tumor necrosis factor alfa levels were detected. Levels of activated complement 3 at Times 5 and 7 and activated complement 4 at Times 5 and 6 were significantly higher in the unfiltered Group, and levels of interleukin 6 were higher in the filtered Group at Times 7 and 8. Interleukins 1beta, 8, tumor necrosis factor alfa, and the Sequential Organ Failure Assessment score were not significantly different between the groups. Conclusions: Ultrafiltration significantly filtered tumor necrosis factor alfa but did not influences serum levels of this cytokine. Ultrafiltration with the type of filter used in this study had no effect in organic dysfunction and should be used only for volemic control in patients undergo cardiopulmonary bypass.
Keywords: Extracorporeal circulation; Ultrafiltration; Cytokines; Multiple organ failure/etiology
Standardization of video-assisted cardiac surgery technique: initial experience
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Introduction: Minimally invasive cardiac surgery has been performed in major worldwide centers, including procedure such as valves, coronary and congenital surgery. Objective: To demonstrate our first works with noninvasive cardiac surgery by mean of the experience gained with general and thoracic surgery. Methods: Whenever possible to carry out a minimally invasive cardiac surgery, this was the approach of choice. The left thoracoscopy was used in four cases: (1) symptomatic coronary-pulmonary fistula ligation; (2) implant of an epicardial electrode into the left ventricle for re-synchronization; (3) excision of pericardial giant lipoma in the left atrium, and (4) resection of hemangiolipoma in the mediastinum. Right thoracoscopy with extracorporeal circulation through cardiopulmonary bypass via femoral vein and artery and cardiac arrest in ventricular fibrillation with moderate hypothermia were carried out in the following cases: (5) patient with mitral stenosis after surgical repair with Carpentier ring 12 years before. An anterior and posterior commissurotomy without thoracotomy was successfully made; (6) patient with idiopathic dilated cardiomyopathy, high-response atrial fibrillation, and severe mitral insufficiency, underwent mitral repair surgery with Gregori's ring and ablation of the pulmonary veins with radio-frequency catheter. (MAZZE modified). Result: No death occurred in this series and the surgical result in all cases was highly satisfactory. All patients were discharged from hospital with a mean time of 5.5 ± 5 days after intervention. Conclusion: Our initial experience in this field proves the effectiveness and the viability in introducing this type of technique.
Keywords: Surgical procedures, minimally invasive; Cardiac surgical procedures; Video-assisted surgery
High-frequency ultrasonic waves cause endothelial dysfunction on canine epicardial coronary arteries
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: Application of ultrasound energy by an endarterectomy probe can facilitate the removal of atheromatous plaque, but the effect of this procedure on surrounding vessel structure and function is still a matter of experimental investigations. Methods: To determine whether ultrasound energy impairs the production of nitric oxide or damages vascular smooth muscle function, isolated canine epicardial coronary artery segments were exposed to either high (25 W) or low (0-10 W) ultrasonic energy outputs, for 15 seconds, using an endarterectomy device prototype. After exposure, segments of epicardial coronary artery were studied in organ chambers. The following drugs were used: adenosine diphosphate (ADP), acetylcholine (Ach) and sodium fluoride (NaF) to study endothelium-dependent relaxation and sodium nitroprusside (SNP) and isoproterenol to evaluate endothelium-independent relaxation. Results: Application of high ultrasonic energy power impaired endothelium-dependent relaxation to ADP (10-9 - 10-4 M), Ach (10-9 - 10-4 M) and NaF (0.5 - 9.5 mM) in epicardial coronary arteries. However, low ultrasound energy output at the tip of the probe did not alter the endothelium-dependent relaxation (either maximal relaxation or EC50) to the same agonists. Vascular smooth muscle relaxation to isoproterenol (10-9 - 10-5 M) or SNP (10-9 - 10-6 M) was unaltered following exposure to either low or high ultrasonic energy outputs. Conclusion: These experiments currently prove that ultrasonic energy changes endothelial function of epicardial coronary arteries at high power. However, ultrasound does not alter the ability of vascular smooth muscle of canine epicardial coronary arteries to relax.
Keywords: Ultrasonics; Nitric oxide; Endarterectomy; Coronary disease
The use and midium-term evaluation of decellularized allograft cusp in the surgical treatment of the Tetralogy of Fallot
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To describe the technique of implantation and to show the echocardiographic follow-up of the decellularized cusps allografts used in patients with Tetralogy of Fallot. Methods: Fifteen patients underwent this implantation between March 2005 and August 2007 and they were clinically followed-up. An echocardiogram was performed to evaluate the morphofunctional result of the allografts. Results: The mean follow-up was 12.7 months (1-25 months). The echocardiography results showed that pulmonary insufficiency was mild in nine (60%) patients, moderate in three (20%) patients, and severe in three (20%) patients. The results also showed that the systolic right ventricle function was normal in 13 (86.7%) and that there was mild dysfunction in two (13.3%). Eleven (73.4%) patients did not present any gradient in the right ventricular outflow tract and four (26.6%) presented mild stenosis. The mobility of the cusps were normal in all cases and there was no thickness larger than 1,5mm. There was no calcification; 14 patients (93,3%) presented Z score between -1 and 0,7 and one patient presented dilated pulmonary annulus with a Z score of + 2.5. Conclusion: In midium-term follow-up, the decellularized allograft seemed to be a good option for right ventricle outflow tract enlargement in patients underwent Tetralogy of Fallot.
Keywords: Tetralogy of Fallot/surgery; Heart defects, congenital; Treatment outcome; Child; Follow-up studies; Transplantation, homologous
Effect of ventral cardiac denervation in the incidence of atrial fibrilation after coronary artery bypass graft surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To evaluate the effect of ventral cardiac denervation in the incidence of atrial fibrillation after coronary artery bypass surgery. Methods: Between September and November, 50 patients without history or previous diagnosis of atrial arrhythmia from the same institution presenting coronary heart disease with indication for coronary artery graft bypass surgery were enrolled in a prospective and randomized study. The exclusion criteria were: patients older than 75 years of age, previous history of atrial arrhythmia and associated heart surgeries. Denervation was performed before cardiopulmonary bypass and it was achieved by removing the adipose tissues around the superior vena cava, aorta and pulmonary artery. The groups were compared regarding demographic, clinical and operative variables. Results: There were no hospital mortalities. The additional time for the denervation was 7.64 ± 2.33 minutes, and there were no associated complications. Postoperative atrial fibrillation was present in two (8%) patients of the Control Group and in three (12%) patients who underwent ventral cardiac denervation. The risk of postoperative atrial fibrillation in patients undergoing ventral cardiac denervation was 22% higher than in the Control Group (0.56-2.66,confidence interval); however, this outcome was not statistically significant (p=0.64). Conclusion: Ventral cardiac denervation, despite being a fast and low-risk procedure, does not significantly reduce the incidence of atrial fibrillation after coronary artery bypass graft surgery.
Keywords: Atrial fibrillation/prevention & control; Denervation; Myocardial revascularization
CPAP at 10 cm H2O during cardiopulmonary bypass does not improve postoperative gas exchange
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To compare postoperative (PO) pulmonary gas exchange indexes in patients submitted to myocardial revascularization (MR) with or without the application of continuous positive airway pressure (CPAP) during cardiopulmonary bypass (CPB). Methods: Thirty adult patients submitted to MR with CPB between March and September 2005 were randomly allocated to two groups: CPAP (n=15), patients that received CPAP at 10 cmH2O during CPB, and control (n=15), patients that didn't receive CPAP. PaO2/FiO2 and P(A-a)O2 were analyzed at four moments: Pre (just before CPB, with FiO2=1.0 ); Post (30min post-CPB, with FiO2=1.0); immediate PO period (12h post-surgery, with FiO2=0.4 by using a Venturi® facial mask) and first PO day (24h post-surgery, with FiO2=0.5 by a facial mask). Results: PaO2/FiO2 and P(A-a)O2 tend to get significantly worst as time elapsed during the postoperative period in both groups, but no differences were observed between them at any moment. When PaO2/FiO2 was subdivided into three categories, a greater prevalence of patients with values between 200 mmHg and 300mmHg were observed in CPAP group only at moment Post (30min post-CPB; p = 0.02). Conclusion: CPAP at 10cmH2O administered during CPB, although had lightly improved PaO22/FiO2 at 30 minutes post-CPB, had no significant sustained effect on postoperative pulmonary gas exchange. We concluded that in patients submitted to MR, application of 10 cmH2O CPAP does not improve postoperative pulmonary gas exchange.
Keywords: Continuous positive airway pressure; Extracorporeal circulation; Pulmonary gas exchange; Cardiac surgical procedures
Intracardiac correction of Tetralogy of Fallot in the first year of life. Short-term and midium-term results
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To evaluate short-term and medium-term results of intracardiac correction of Tetralogy of Fallot in the first year of life. Methods: From January 1996 to October 2004, 67 consecutive infants ranging in age from 1 to 11 months (mean: 7.2 months) and weighing from 4 to 10 kilograms (mean: 7.1 kilograms) underwent elective total correction of Tetralogy of Fallot. The surgery was accomplished with conventional cardiopulmonary bypass and moderate hypothermia. Right ventriculotomy was performed in 60 (89.5%) cases and an atriopulmonary approach was used in the other seven (10.5%) cases. Results: Cardiopulmonary bypass time ranged from 35 to 147 minutes (mean: 78.8 ± 21 minutes), and aortic clamping time ranged from 25 to 86 minutes (mean: 51.8 ± 15.6 minutes). Transannular enlargement of the right ventricular outflow tract was needed in 50 (64.1%) patients. Gradient between the right ventricle and pulmonary artery after correction varied from 0 to 54 mmHg (mean: 15.5 ± 10.8 mmHg). There were two (2.98%) early deaths. Follow-up of the 65 survivors ranged from 7 to 115 months (mean:44.0 ± 35 months). There was one late noncardiac death. All other patients are asymptomatic. The actuarial survival curve at 12 years, including operative mortality, was 97%. Ten patients were evaluated by magnetic nuclear angioresonance. Conclusions: Intracardiac correction of Tetralogy of Fallot in the first year of life may be performed with low morbidity and mortality and good late results.
Keywords: Tetralogy of Fallot/surgery; Heart defects, congenital; Treatment outcome; Child; Follow-up studies
Trimetazidine as cardioplegia addictive without pre-treatment does not improve myocardial protection: study in a swine working heart model
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: The aim of this study is to verify in an isolated working heart swine model if the acute administration of trimetazidine to cardioplegia, without pre=treatment improves heart performance. Methods: Eighteen pairs of swines were used in this working heart model, divided into three groups (n = 6) that underwent regional and global ischemia. Each group was selected to a different treatment: St Thomas cardioplegia (ST), St Thomas enriched with trimetazidine (TMZ) and control group (Co). Data was collected during reperfusion period at 30, 60 and 90 minutes. Hemodinamic parameters such as elastance contractility index (Emax), preload recruitable stroke work relationship (PRSW) and heart "stiffness" (EDPVR) were measured. Other data included coronary flow, lactate, oxygen and glucose consumption. Results were statistically analyzed. Results: All contractility data were not significantly different among three groups. Lactate became constantly higher according to time uniformly in all three groups. Coronary flow, glucose consumption and oxygen consumption presented large variations during time periods but according to treatments showed no statistical differences in all three groups. Left ventricle final weight was significantly lower in trimetazidine group compared to both other groups. Conclusion: Administration of trimetazidine enhanced cardioplegia, without pre-treatment, showed no hemodinamic or metabolic improvement in swine isolated working heart model.
Keywords: Trimetazidine; Models, animal; Heart; Cardioplegic solutions
Interatrial sulcus opening during multiple grafts harvesting for heart and lung tranplantation: anatomical study
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To evaluate the impact of the interatrial sulcus opening regarding of left atrium gain when harvesting heart and lungs for transplantation. Methods: It was evaluated the left atrium dimension, from the right mediastinal side, after the interatrial sulcus dissection in fifty human cadaver. The interatrial sulcus gain was related with gender, age and ethnic group. Results: The gain observed through right interatrial opening was, in media, 1.31cm (0.3 cm to 2.5cm). When that value was related to the variable gender it was observed that in the 27 (54%) cases of the male the earnings was 1.19 cm ± 0.6 cm and, in the 23 (46%) female, 1.21 cm ± 0.5 cm (p = 0.895). In relation to age, it was observed that, in the 24 (48%) cases with smaller age than 50 years, the value was 1.08 cm ± 0.6 cm and, in the 26 (52%) with larger age or same to 50 years, 1.36 cm ± 0.6cm (p = 0.088). In relation to ethnic group, it was observed that the value of the earnings in the 31 (62%) cases of whites it was 1.34 cm ± 0.5 cm and, in the 19 (38%) non white, 1.27 cm ± 0.4 cm (p = 0.589). Conclusion: Heart grafts and lung grafts must be harvested maintaining adequate segments of left atrium near the heart and the pulmonary veins of the lungs that will be transplanted. Although there is no correlation between the observed gain in the interatrial sulcus dissection and the variables gender, age and ethnic group, our results confirm that the interatrial sulcus opening can give access to significant extension of left atrium wall when separating heart and lungs.
Keywords: Heart atria; Heart, anatomy & histology; Transplantation
Hybrid CABG: An alternative for perfusion time decrease
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To evaluate the decrease of CPB time and its related complications in CABG using a hybrid alternative method. Methods: Ninety patients were retrospectively analyzed between March 2000 and August 2006. All were treated with three or more grafts and divided into two groups: Group 1 was the hybrid group - 45 patients who had been operated by the hybrid technique; Group 2 was the total group - 45 patients operated in on-pump. Results: In the hybrid group, the CPB time varied from 20 min. to 81 min. In the total group, the CPB time varied from 60 min. to 210 min. (p<0.001). The aorta cross-clamping time varied in the first group from 7 min. to 70 min. In Group 2, from 34 to 100 min. (p<0.001). A statistically significant difference was found between these two groups in relation to the occurrence of postoperative atrium fibrillation and renal dysfunction. Conclusion: Using the hybrid technique it is possible to reduce the CPB time, as well as the occurrence of some postoperative complications. Probably, this decreasing in atrial fibrillation and renal dysfunction incidences could be explained due to a less significant inflammatory activation, which is a consequence of a shorter CPB time.
Keywords: Myocardial revascularization/methods; Coronary vessels/surgery; Coronary artery bypass/methods; Retrospective studies; Extracorporeal circulation
REVIEW ARTICLE
Postoperative cognitive dysfunction after cardiac surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Postoperative cognitive dysfunction is frequent in cardiac surgeries leading to major consequences. The physiopathological processes involved in this condition are still not completely elucidated, despite the multifactor character. Besides pre-operative factors such as age and education, some intra-operative factors are also of extreme importance. However, according to a vast literature on the subject, these factors are not capable to clarify the totality of the cases, taking us to a genetic base for this neurological sequel. In this revision, we briefly assess the factors involved in this cognitive dysfunction as well as discuss the pharmacotherapy in the prevention of this event.
Keywords: Myocardial revascularization; Extracorporeal circulation; Cognition; Cognition disorders/etiology; Cardiac surgical procedures/adverse effects
SERVICE EXPERIENCE
Bentall and De Bono surgery for correction of valve and ascending aortic disease: long-term results
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: A retrospective study was perfomed in a series of consecutive patients who underwent a Bentall and De Bono procedure. Methods: Data were removed of medical records and follow-up data were obtained from clinical records and direct contact with patients. A total of 39 patients were studied between January 1996 and December 2005. Results: The median age was 47 years (range 14-70). There were 33 males and six females. Eleven (25.5%) patients presented Marfan syndrome and one (2.5%) Turner syndrome. Nineteen (48.5%) patients had hypertension, eight (20.5%) had history of smoking, six (15.5%) had history of alcoholism, eight (20.5%) had dyslipidemia, two (5.0%) had diabetes and one (2.56%) had myocardial infarct previously. Twenty-eight (72%) patients were in II-III NYHA class in the moment of the surgery. Annulo-aortic ectasy was present in 14 (35.9%) patients and aortic aneuryms in 16 (41%). The median time in intensive care unit was 8.79 days with range 2-23 days. Four (10.0%) patients underwent an emergency opertation and 35 (90%) elective. The overall hospital mortality was 5% (2/39). The event-free survival is 94.87% at 1 year and 84.61% at in 5 and 10. The median time of follow-up was 46.5 months (range 14-120 months). Conclusion: The Bentall and De Bono technique obtained excellent results in the short-term and long-term, which support the continued use of the compositive graft technique as the preferred method of treatament for patients with aortic root disease. Our findings confirm the current literature data.
Keywords: Aorta/surgery; Aortic aneurysm/surgery; Aneurysm, dissecting/surgery
EuroSCORE and the patients undergoing coronary bypass surgery at Santa Casa de São Paulo
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: The aim of this study was to assess the performance of the European Risk System in Cardiac Operations (EuroSCORE) model to predict mortality in patients undergoing myocardial revascularization at the Division of Cardiovascular Surgery of Santa Casa de São Paulo Medical School. Methods: From May 2005 to November 2006, 100 consecutive patients undergoing coronary artery bypass surgery were retrospectively analyzed. The records of these patients were reviewed in order to retrieve those variables included in the EuroSCORE risk scoring method. The correlation of predicted and observed mortality was compared. Statistical analysis was performed using chi-square test for univariate analysis and Hosmer-Lemeshow Test for logistic regression model. Results: Hospital mortality was 5%. For EuroSCORE univariate analysis, findings were as follows: score 0-2 predicted mortality 0.40%, observed 0.00%; score 3-5 predicted mortality 1.45%, observed 0.00%; score greater than 6 predicted mortality 3.15%, observed 7.94%. Although these differences, p-value was 0.213 with no statistical significance. The p-value for the Hosmer-Lemeshow Test was < 0.001 indicating poor calibration of the model for this sample. Conclusion: The EuroSCORE model is a simple, objective system to estimate hospital mortality. However, to validate the logistic regression analysis, it is necessary hundreds of patients, which limit its widespread application.
Keywords: Myocardial revascularization/mortality; Risk assessment; Survival analysis; Severity of illness index
CASE REPORT
Operative treatment after iatrogenic left main dissection
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Coronary dissection has a significant morbity and mortality. The ideal management of acute coronary occlusion is the prompt restoration of the vessel patency to limit the extent and duration of ischemia. In the setting of dissection during percutaneous procedure, the usual approach has been emergency aortocoronary bypass surgery. The authors present a case of a patient with left main dissection during percutaneous transluminal coronary angioplasty. This problem was successfully managed with emergent aortocoronary bypass surgery.
Keywords: Angioplasty, transluminal, percutaneous coronary/adverse effects; Coronary vessels/injuries; Iatrogenic disease; Catheterization
Technical option on tetralogy of Fallot with abnormal coronary artery. Cases report
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Report on two children, one 11 year-male and another one year-six-month-female with tetralogy of Fallot associated with anomalous origin of coronary artery crossing the right ventricle outlet tract. Diagnosis was done by echocardiography and cardiac catheterization. On surgical correction we used an external composite tubular pericardium bovine graft and posterior wall of the pulmonary artery between the right ventricle and the pulmonary artery trunk. Patients had an uneventful post-operative period and were discharged asymptomatic. It is more an option on correction of tetralogy of Fallot with anomalous coronary artery.
Keywords: Tetralogy of Fallot/surgery; Heart defects, congenital, surgery; Coronary vessel anomalies/surgery
Giant myxoma in the left atrium - Case report
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
In this study is reported the case of a 63-year-old-woman with history of dyspnea, palpitations, and precordial pain who underwent cardiologic evaluation. The physical examination did not reveal abnormalities. The echocardiogram showed great mass in the left atrium, suggesting myxoma which was confirmed by tomography and catheterization. The patient underwent surgical treatment with a good postoperative evolution. The diagnosis of myxoma was confirmed by histopathologic study. In this study is included a bibliographic review and a comment emphasizing the diagnostic difficulty based on signs and symptoms, as well as the details about the development of bilateral pleural effusion possibly related to the myxoma.
Keywords: Myxoma/diagnosis; Myxoma/surgery; Heart neoplasms/surgery; Myxoma/complications
Parasternal approach for redo in ascending aorta pseudoaneurysm
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Aortic ascending pseudoaneurysm is a rare complication following aortic root surgery. The surgical solution of the complication is rather demanding and complex, especially when reaching the mediastinum. The latter translates into an elevated morbidity and mortality. We present a case performed through a minimal anterior right thoracotomy, which allowed us to dissect between the pseudoaneurysm and the internal site of the sternum as a first step prior to a second esternotomy. By using this approach, we minimized bleeding risks and the possibility of aortic rupture. This technique could have the potential to be generally applicable in this complication after further evaluation.
Keywords: Aorta/surgery; Aortic aneurysm/surgery; Aneurysm, dissecting/surgery; Aneurysm, false/surgery
Cardiac surgery of emergency for resection of left atrial myxoma
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
We report case of a female patient who during months presented pulmonary manifestation associated with nonspecific systemic symptoms resulting in several hospitalizations with the diagnostic hypothesis of pulmonary fibrosis. The echocardiographic study showed a great pedunculated left atrial myxoma prolapsing through the mitral valve for the left ventricle. In quite unfavorable clinical conditions the patient was sent to our Service for surgical treatment, evolving during the preparation for surgery with acute pulmonary edema and hemodinamic instability being submitted to a successfully surgery of emergency for resection of the tumor. The patient is asymptomatic.
Keywords: Myxoma; Heart neoplasms; Heart atria
CLINICAL-SURGICAL CORRELATION
Surgical repair of rheumatic mitral valve disease with Gregori-Braile's Ring
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
The use of decellularized homograft monocuspid in the treatment of truncus arterious by Barbero Marcial technique
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
LETTERS TO THE EDITOR
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INFORMATION
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