Volume 26 - Número 1
EDITORIAL
BJCVS: 25 years of brilliant career
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
The aorta, the elastic tissue and cystic medial necrosis
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
The surgeon
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
ORIGINAL ARTICLE
The 2000 Bernstein-Parsonnet score and EuroSCORE are similar in predicting mortality at the Heart Institute, USP
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objective: To evaluate the performance of 2000 Bernstein-Parsonnet (2000BP) and additive EuroSCORE (ES) for predicting surgical mortality at the Heart Institute, University of São Paulo. Methods: A prospective observational design. Seven hundred and seventy four patients were operated for coronary artery bypass graft, valve or combined procedure between May and October, 2007, were analyzed. The mortality was estimated with the 2000BP and ES. The correlation between expected mortality and observed mortality was validated through calibration and discrimination test. Results: The patients were stratified into five groups for the 2000BP and three for the ES. The Hosmer-Lemeshow test for 2000BP (P = 0.70) and for ES (P = 0.39) indicate a good calibration. The ROC curve for the 2000BP = 0.84 and for the ES = 0.81 confirms that the models are good predictors (P<0.001). Conclusion: Both models are similar and adequate in predicting surgical mortality at the InCor-USP.
Keywords: Risk Factors; Hospital Mortality; Cardiac Surgical Procedures
The implications of serum enzymes and coagulation activities in postinfarction myocardial rupture
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objectives: Associations between cardiovascular diseases and serum enzymes or coagulation activities have been sufficiently documented in patients with myocardial infarction. However, the alterations of these biomarkers in patients with postinfarction myocardial rupture have rarely been reported. The aim of this study is to present the profiles of the markers in patients with postinfarction myocardial rupture. Methods: From 2004 to 2008, 19 consecutive patients were referred to this hospital for surgical repair of postinfarction myocardial rupture. Eight (42.1%) patients had free wall rupture, 5 (26.3%) had papillary muscle rupture, 5 (26.3%) had ventricular septal rupture, and 1 (5.3%) had double structure (ventricular septum + free wall) rupture. Thirteen patients survived the operation, and 6 died. Laboratory findings including serum enzymes and coagulation activities were collected and analyzed. Results: The coagulation markers and serum enzymes except for fibrinogen increased significantly after the development of myocardial rupture. Statistical differences in D-dimer, partial thromboplastin time, peak lactate dehydrogenase, peak creatine kinase and creatine kinase fraction MB were found between non-survivors and survivors. Troponin I values were elevated significantly during the early days after the onset or surgical repair of myocardial rupture. Multivariant regression analysis did not show any significant relationship between creatine phosphokinase fraction MB (Y) and D-dimer (X1) or fibrinogen (X2). Conclusion: Myocardial rupture leads to extremely high serum enzyme and coagulation activities except for fibrinogen after the onset. The evaluation of these biomarkers may help in making diagnostic and treatment decisions and in judging the clinical prognosis of such patients.
Keywords: Blood Coagulation Factors; Myocardial Infarction; Cardiac Surgical Procedures; Enzymes; Heart Rupture, Post-Infarction
Nitrite exhaled breath condensate study in patients undergoing cardiopulmonary bypass cardiac surgery
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Background: There is a relative lack of studies on postoperative changes in nitrite (NO2-) concentrations, a marker of injury, following cardiac surgery. In this context, investigations on how exhaled NO concentrations vary in the postoperative period of cardiac surgery will certainly contribute to new clinical findings. Objective: The objective of this study was to compare the EBC NO levels in both the pre and postoperative (24 hours) periods of cardiac surgery. Methods: Twenty-eight individuals were divided into three groups: 1) control, 2) coronary artery bypass grafting, and 3) valve surgery. The nitrite (NO2-) levels were measured by chemiluminescence in blood samples and exhaled breath condensate (EBC). Data were analyzed by the Mann-Whitney and Wilcoxon tests. Results: 1) Preoperatively, the EBC NO2- levels from groups 2 and 3 patients were higher than control individuals; 2) The postoperative (24 hours) NO2- levels in the EBC from group 3 patients were lower compared with preoperative values; 3) The NO2- levels in the plasma from group 2 patients were lower in the preoperative compared with the postoperative (24h) values and; 4) Preoperatively, there was no difference between groups 2 and 3 in terms of plasma NO2- concentrations. Conclusion: These data suggest that NO measurement in EBC is feasible in cardiac surgery patients.
Keywords: Nitrites; Nitric Oxide; Respiratory Function Tests; Thoracic Surgery; Cardiaca Surgical Procedures
Long-term survival of octogenarian patients submitted to isolated coronary artery bypass graft surgery
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Introduction: An increasing number of octogenarian patients is undergoing coronary artery bypass graft surgery (CABG). The short-term results of this procedure have been broadly studied, but there are few national reports on long-term outcomes. Objectives: To describe hospital mortality and long-term survival of patients aged > 80 years undergoing isolated CABG. Methods: Retrospective cohort study with 142 consecutive patients aged > 80 years undergoing isolated CABG in the period between January/1996 and December/2007 in a Brazilian reference center. Mean age (± SD) was 82.3 ± 2.1 years, and 56.3% were male. The prevalence of hypertension was 73.2%, of previous myocardial infarction 30.3%, of diabetes 26.8%, and of renal dysfunction (creatinine3 2.0 mg/ml) was 4.9%. The median follow-up was 4.0 years, with a loss of 11.6% of patients. Survival analysis was performed by the Kaplan-Meier method. Results: Overall hospital mortality was 14.8% (95% CI: 8.8 to 20.8), with a reduction of this rate during the study period (1996-1999: 25.9%, 2000-2003: 15.8%, and 2004-2007: 8.6%). Mean survival was 6.5 years (95% CI: 5.5 to 7.5), and the survival rate at 1, 3 and 5 years was 79.4, 73.4 and 65.2%, respectively. Conclusion: Results are in agreement with international reports. Mean survival was 6.5 years and the survival rate at 5 years was 65.2%.
Keywords: Myocardial Revascularization; Aged, 80 and over; Survival Analysis
Risk factors for mediastinitis after coronary artery bypass grafting surgery
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objectives: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. The aim of this study is to identify risk factors for mediastinitis in patients undergoing coronary artery bypass grafting (CABG), without the use of bilateral internal thoracic artery (ITA), at the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Methods: A retrospective study of 500 consecutive patients operated on between May 2007 and April 2010. Ten preoperative variables, seven intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were performed. Results: The incidence of mediastinitis was 5.6% (n=28), with a lethality rate of 32.1% (n=9). In multivariate analysis using logistic regression, five variables remained as independent risk factors: obesity (OR 2.60, 95% CI 1.11 to 6.68), diabetes (OR 2.71, 95% CI 1.18 to 6.65), smoking (OR 2.10, 95% CI 1.12 to 4.67), use of pedicled internal thoracic artery (OR 5.17, 95% CI 1.45 to 18.42) and on-pump CABG (OR 2.26, 95% CI 1.14 to 5.85). Conclusions: This study identified the following independent risk factors for mediastinitis after CABG: obesity, diabetes, smoking, use of pedicled ITA and on-pump CABG.
Keywords: Risk Factors; Mediastinitis; Myocardial Revascularization
Pediatric cardiac surgery under the parents sight: a qualitative study
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Introduction: Congenital heart defects can often be corrected through surgery, providing for parents to expect a normal life, but the hospitalization experience often early, causes more pain, for which surgery is the worst moment. Objective: The aim of this study was to analyze the experience of families of children undergoing cardiac surgery and to identify the coping resources used by the families. Methods: A qualitative approach was the metodology of choice for this study, which took place with six semi-structured interviews and 100 hours of observation. Thematic analysis was used to understand the data. Results: The results were categorized into four themes: feelings and emotions facing the illness of the child; heart disease under the watchful mother, mother and child on the ICU and coping resources. The speech of mothers demonstrated the importance of the heart due to its symbolism that enhances their emotional fragility in the face of illness. Religiosity and a solid social network of support were contributing factors for the maintenance of the adaptive behaviors. The presence of mothers in all stages of the child's treatment contributed to minimizing the suffering generated by hospitalization. Conclusion: The experience of families was characterized by ambivalent feelings such as fear of death, guilt and helplessness against the different stages of treatment. The anguish and anxiety prevailed in the face of unknown situations when information were required before therapeutic procedures, hospital routines and the actual life situation of the families.
Keywords: Heart Defects, Congenital; Adaptation, Psychological; Mothers
Prevalence of infections in surgical sutures on myocardial revascularization surgery
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objective: To study the prevalence of wound infection on myocardial revascularization surgery stitches as well as the causing microorganisms, predominant sex and age. Methods: A retrospective and transversal study, with analysis of the files of the 21 patients with infected myocardial revascularization wounds among 357 operated patients between the years of 2007 and 2009. The files were checked on 2009. Results: There was no statistics significance analyzing the sex of the patients. The average of patients were old aged and the prevalence is similar to the index found in literature, but there are variations about the found microorganisms all over the years. Conclusion: Besides the raise of wound infections along the 3 years, the prevalence kept stable, once the numbers of maid surgeries proportionately raised. Sex is not a significant variable to the occurrence of myocardium revascularizations wound infection. Old aged people are more predictable to this complication and the causing microorganism is variable.
Keywords: Surgical Wound Infection; Myocardial Revascularization; Postoperative Complications; Infection
Thrombocytopenia in cardiac surgery: diagnostic and prognostic importance
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objective: Patients undergo to cardiac surgery have more probability to develop thrombocytopenia. The heparin induced thrombocytopenia happens in 5% of the patients. The aim from this study was to evaluate the clinical importance from the severe thrombocytopenia in postoperative cardiac surgical patients. Methods: It was included cardiac surgical patients with platelets < 150000 cel/mm3 during firsts 24 h from postoperative. All patients underwent evaluation for four Ts score (thrombocytopenia, use preview of heparin, thrombosis and platelets decreased not related to heparin). In order to a four Ts score e? 6 was considered as suggestive of heparin induced thrombocytopenia type II. The mortality rate in intensive care (ICU) and hospital, length of stay, healthy state and incidence from thrombosis were compared in patients with score > 6 (group 1) and < 6 (group 2). Results: It was include 120 patients who met the inclusions criterions. There was no difference between the groups in related to age, gender, time of cardiopulmonary bypass and surgery. However, the incidence of thrombosis was higher in group 1 (23% vs. 0%, P<0.0001), as well as the greater score is related to higher hospital mortality rate. Conclusion: The score > 6, in postoperative cardiac surgical patients, it is associated to higher incidence of thrombosis as well as the greater score is related to higher hospital mortality rate.
Keywords: Prognosis; Thrombocytopenia; Cardiovascular Surgical Procedures
Pulmonary pressure by echocardiophy in chagasic patients on heart transplant waiting list
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Introduction: The patients suffering heart failure develop an increase in pulmonary pressure because of a retrograde mechanism. The pulmonary hypertension is a prognostic marker. Objective: The aim of this study is to correlate pulmonary hypertension measured by echocardiogram versus catheterization in pre-heart transplant patients on waiting list. Methods: Data from 90 patients of the Clinical Hospital UFMG were collected between 2004 and 2009. All the patients took an echo and catheterization as an integral part of pre-heart transplant. Mean age was 45.5 years old, 68 (75.6%) male. Fourty-two (46.7%) were Chagas? disease patients, 32 (35.6%) presented idiopathic dilated cardiomyopathy, 10 (11.1%) had ischemic cardyomiopathy. Results: The mean eco-PASP was 45 ± 12mmHg). The mean cat-PASP was 47 ±14mmHg. The eco-PASP-Chagas was 41.7 ±12,5 mmHg and non-Chagas 47.6 ±12.8 mmHg P=0.04. The cat-PASP-Chagas was 46 ±12.1 mmHg and non-Chagas 48.7 ±12.8 mmHg P=0.43. Eight patients had cat-PASP>60. The correlation between eco-PASP and cat-PASP in Chagas? patients was r=0.45; P=0.008 and in the non-Chagas was r=0.66; P<0.001. The eco-PASP-Chagas>32,5mmHg has a sensitivity of 79% and specificity of 75% to diagnose PH, with an area under the curve of 0.819. The eco-PASP-non-Chagas>35.5 mmHg has a sensitivity of 82% and a specificity of 70% to diagnose PH, with an area under the curve of 0.776. Conclusions: There is a good correlation between eco-PASP and cat-PASP (r=0.54) in pre-heart transplant patients. The eco-PASP was lower in the Chagas? group. The echocardiogram is an important method to diagnosis and control pulmonary pressure in pre-heart transplant, specifically in Chagas? patients. The catheterization is still important to evaluate pulmonary reactivity during vasodilation test.
Keywords: Pulmonary artery, pathology; Heart transplantation; Catheterization
Catch up in children with Down syndrome and congenital heart disease
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objective: To evaluate the impact of congenital heart diseases in growth of children with Down syndrome (DS) and the weight-height recovery after surgical correction. Methods: Retrospective study of the DS patients between 1984 and 2007. Excluding the mosaics and/or patients with associated morbidities (n=165). Calculated Z scores for weight (Zwb) and length (Zlb) at birth. Those patients submitted to surgical correction (n= 60) these scores (Zw/Zh) were evaluated before surgery and in subsequent periods to five years. Malnutrition was defined as weight/height Z-score < 2.5. Used Chi-square test to verify the relation between weight/length and age at the time of surgery and Student T test to evaluate the postoperative (PO) time of recovery (P < 0.05). Results: Means Zwb (n = 162) and Zlb (n = 156) were -0.95 ± 1.27 and -1.348 ± 1.02. From the total data (n = 165), 65.5% (n = 108) presented heart disease. Those submitted to cardiac surgery (n = 60), Zw was below -2.5 in 55% (n = 33) and Zh in 60% (n = 36). After six months PO, 67.4% achieved Zw > 2.5. In one year, 85.7% achieved Zh > 2.5. Dividing this group by age in tertiles at time of surgery no difference was found. Conclusions: We concluded that malnutrition common in children with DS since birth. DS children with congenital heart and surgical indication were smaller and lighter than those without or with mild disease. PO recovery occurred in 6 months for weight and one year for height, with no difference in the age at the time of surgery.
Keywords: Heart Defects, Congenital; Down Syndrome; Body Weight; Body Height; Growth
Predictors of mortality in patients over 70 years-old undergoing CABG or valve surgery with cardiopulmonary bypass
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objective: To identify risk factors in septuagenarians and octogenarians submitted to cardiovascular surgery with cardiopulmonary bypass (CPB). Methods: Per-operative variables of 265 patients over 70 years of age were analyzed. 248 (93.6%) were septuagenarians and 17 (6.4%) octogenarians. Results: Overall mortality did not differ between the groups, nor did the type of procedure (CABG or valvular) (P=0.545). Pre-operative variables did not increase the death risk, nor did the use of arterial or venous grafts (P=0.261), or the number of grafts per patient (P=0.131). CPB and cross-clamp time are associated with higher mortality. The survivors? group had an average CPB time of 70 ± 27 minutes while the non-survivors group 88.8 ± 25.4 minutes (P<0.001). Cross-clamp time in the survivors was 55.5 ± 20 minutes, while 64.9 ± 16 minutes in the non-survivors (P=0.014). Using multivariate logistic regression, CPB time is associated with death (Pearson?s chi square= 0.0056). CPB time over 75 minutes presents an increased risk of death of 3.2 times (CI 95%: 1.3-7.9) over those with CPB time < 75 minutes. Post-operative variables associated with increased death rates: mechanical ventilation > 12 hours (P<0.001); ICU stay (P=0.033); re-exploration (P=0.001); inotropic support > 48 hours (P<0.001); use of blood components (P<0.001). Conclusion: Overall mortality justifies the interventions. CPB time greater than 75 minutes, mechanical ventilation over 12 hours, length of ICU stay, need for reoperation, inotropic drug support over 48 hours, and use of blood components are associated with a higher mortality rate.
Keywords: Aged; Cardiac Surgical Procedures; Heart Valves; Myocardial Revascularization; Risk Factors
Experimental study of pulsatile implantable electromecanical artificial device
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objective: The objective is to present the results of the application this device in experimental animals unloading only the left ventricle. Methods: Between June 2002 and October 2009, were implanted in 27 calfs with age between 2½ to 4 months and 80 to 100 kg of weight, with general anaesthesia and controled ventilation, by mean of left thoracotomy a cannula in the apex of VE and a lateral anastomose of a GTFE vascular graft tube in the descending portion of the thoracic aorta, both connected to the device implanted below the diaphragm in the subcutaneous (24) and intrathoracic (three). The cardiopulmonary bypass (BP) was used in five calves, and directly introduce the outflow cannula in 22. Results: During the implant two and in the first hours of the post operative period (PO) three deaths were observed, one related to the device. The survival between the first and the six PO day was found in 17 calves and between day 8 and day 31 (PO) in five all caused by clinical/surgical problems, and related to the device. The hemodynamic impact by the systemic pressure analysis showed 20 to 40 mmHg increase and the laboratory parameters showed lower levels of traumatic impact to the blood and a good biocompatibility. Conclusions: This kind of research is arduous and complex where at each experiment many problems are indentified in the implantability and in the device, which are sistematic correct, to became device/procedure safe and effective.
Keywords: Heart, Artificial; Heart-Assist Devices; Heart Failure; Long-Term Care
Long term results of septal myectomy in the treatment of obstructive hypertrophic cardiomyopathy
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objectives: This study analyzed the clinical and echocardiographic late outcomes of surgical septal myectomy in patients with obstructive hypertrophic cardiomyopathy (OHCM). Methods: We examined, retrospectively, 34 consecutive adult patients (age 55.7±15.2 years) with OHCM operated on in our institution from 1988 to 2008. Only four (11.8%) patients had family history of OHCM. Nine (26.5%) patients were in New York Heart Association (NYHA) funcional class IV. Thirty (88.2%) patients had solely OHCM, and four (11.8%) had OHCM associated with coronary insufficiency. The surgical technique used in all patients was septal myectomy performed through an aortotomy. Results: In 26 (76.5%) patients the mitral insufficiency due to systolic anterior motion, decreased after the myectomy. Eight (23.5%) patients had mitral valve procedures. There was one hospitalar death (2.9%). Two (5.9%) patients required permanent pacemaker for complete heart block after the myectomy. The mean peak preoperative left ventricular outflow tract (LVOT) obstruction gradient was 84.9±29.0 mmHg, and decreased to 27.8±12.9 mmHg in the early postoperative and it was 19.2±11.2 mmHg in the late postoperative period (49.0±33.0 months). The NYHA functional class improved from 3.1±0.8 to 1.4±0.5 in the postoperative period. Survival free from death was 87.9% and survival free from cardiovascular events was 77.7% with mean follow-up 9.6±8.4 years. Conclusions: Surgical septal myectomy can be performed safely, with excellent survival, improvement from symptoms and relief for LVOT obstruction in patients with OHCM. The early benefits were remained at long term.
Keywords: Cardiomyopathy, Hypertrophic; Cardiovascular Surgical Procedures; Treatment Outcome; Long-term Effect
Surgical treatment of patent ductus arteriosus in adults
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objective: To analyze 34 patients submitted to surgical treatment of patent arterial duct with age beyond 18 years old. Methods: Retrospective data collected from patient's charts with more than eighteen years old, submitted to surgical correction of patent arterial duct between 1997 and 2008 at Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo. Results: The mean age was 28.7 (18 a 53) years and 22 (64.7%) were female. The more prevalent symptom was dyspnea (76.5%). Left lateral thoracotomy was used in 33 (97.1%); the DA was sectioned and sutured in 25 (73.5%) cases and one patient needed cardiopulmonary bypass support. There were eight (23.5%) calcified arterial duct and 12 (35.3%) previous treatment with transcatheter devices were performed. The complication rate was 32%, with one (2.9%) permanent vocal cord palsy. Two (5.8%) patients had residual shunt less than 2mm. Transient left cord voice palsy was observed in 3 (8.8%) The procedure improves functional class (P< 0.0001) and no mortality was observed. Conclusion: In this series, the surgical treatment of patent arterial duct in adults could be done without mortality and low incidence of complications.
Keywords: Ductus Arteriosus, Patent; Adult; Heart Defects, Congenital
SPECIAL ARTICLE
Anatomical eponyms in Cardiology from to the 60s to the XXI century
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Background: Eponym from the Greek [epi, "upon"] + [onuma, name], is a person, whether real or fictitious, after whom an item is named or thought to be named. Eponymous terms are used every day in Medicine, in our clinical years, and they have been part of the tradition of Medicine, culture, and history. Despite all the inconvenience, all those who are no against eponym has only one statement: "medical eponyms will continue to be used because there is a sense of history to their use. They are use in contemporary life, eponyms are here to stay". Methods: The following study aims at to show the presence of current anatomical eponyms on the best well-known Textbooks and Atlas of Human Anatomy, ranging from the oldest to the newest one, comprising a period from 1960 until 2011, regarding the cardiovascular system, particularly the heart. The three International Anatomical Terminologies have been critical as the basis of our study. Exclusion criteria were syndromes, diseases, signs, anomalies, surgical procedures, indexes, tests, grading, and the methods, which are used as eponyms in Cardiology, once they are not considered Anatomical Terms. It has been our intent to show that different eponyms characterize the same anatomical structure. Results: A list with the 25 most common eponyms listed by the three International Anatomical Terminologies is listed in Table1. Conclusion: Should eponyms be abandoned? Of course not, once they remain a useful reflection of medical history. We could prove to our journey from 1960 to 2011, that the best well-known Atlas and Textbooks available do not use so many anatomical eponyms in Cardiology. They are only 25 (without including arteries, veins, and nerves of the cardiovascular system) and all the authors use no more than 9 or 12 of them. We just want to alert the Health and Allied Health Sciences Professional and students that we 'strongly recommend' not to use an eponym when it is made at the expense of an anatomical structure.
Keywords: Cardiology; Anatomy; Eponyms; Terminology
REVIEW ARTICLE
Cystic medial necrosis: pathological findings and clinical implications
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Cystic medial necrosis (CMN) is a disorder of large arteries, in particular the aorta, characterized by an accumulation of basophilic ground substance in the media with cyst-like lesions. CMN is known to occur in certain connective tissue diseases such as Marfan syndrome, Ehlers-Danlos syndrome, and annuloaortic ectasia, which usually result from degenerative changes in the aortic wall. The relationships between CMN and congenital heart defects as well as other disorders have been evidenced. The mechanisms are still controversial, even though many molecular studies have been conducted. The aim of the present article is to provide a comprehensive overview of the CMN lesion in terms of pathologic features, clinical implications and etiologies based on molecular research results.
Keywords: Aorta; Cardiovascular Abnormalities; Connective Tissue; Pathology, Clinical
Alveolar recruitment in patients in the immediate postoperative period of cardiac surgery
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Lung complications during postoperative period of cardiac surgery are frequently, highlighting atelectasis and hypoxemia. Alveolar recruitment maneuvers have an important role in the prevention and treatment of these complications. Thus, this study reviewed and updated the alveolar recruitment maneuvers performance in the immediate postoperative period of cardiac surgery. We noted the efficacy of alveolar recruitment through different specific techniques and the need for development of new studies.
Keywords: Cardiac Surgical Procedures; Pulmonary Atelectasis; Postoperative Care; Positive-Pressure Respiration; Physical Therapy (Specialty)
BRIEF COMMUNICATION
Vacuum-assisted venous drainage in cardiopulmonary bypass and need of blood transfusion: experience of service
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
Objectives: To report the experience with the vacuum-assisted venous drainage (VAVD) technique in cardiopulmonary bypass (CPBP) and blood transfusion need. Methods: A retrospective study was made about data from 111 patients who were operated, using VAVD between October 2006 and February 2008, at the Esperança Hospital, Recife, Pernambuco. The necessity of blood transfusion was verified on the single group of patients who underwent VAVD, comparing with sex, age and weigh, before the beginning of the CPBP and during the surgery, using Chi-square test and t-student test. Results: Before the beginning of the CPBP only 10% of patients had need for blood transfusion and 12% during the surgery. It was observed that 17% of women received blood transfusion versus 4.7% of men before the beginning of CPBP (P=0.51), and 38% of women versus 9% of men during the surgery (P<0.001). The weight of patients who received blood transfusion were lower both before the beginning of the CPBP as during the surgery (P=0.049 e P=0.001, respectively). Conclusion: The VAVD technique has been used safely and satisfactorily, optimizing venous drainage during CPBP, in the hospital that conducted the study. However, prospective and comparative investigations between conventional drainage and VAVD are needed to better clarify this relation with blood transfusion.
Keywords: Extracorporeal Circulation; Vacuum; Blood Transfusion
CASE REPORT
Ruptured thoracic aortic aneurysm in patient with systemic lupus erythematosus
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
It is reported a ruptured descending thoracic aortic aneurysm in a 25-year-old systemic lupus erythematosus woman who underwent 19 years steroid therapy. She was treated with 2 endovascular stent-grafts, discharged from hospital 13 days after the procedure in good health. Three months later she returned with hemorrhagic shock due to high digestive hemorrhage secondary to an aortic-esophageal fistula. She underwent to an open emergency surgery, and died during the post-operative period.
Keywords: Lupus Erythematosus, Systemic; Stents; Aortic Aneurysm, Thoracic
Infected aneurysm of brachial artery after mitral valve infective endocarditis
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
We present a case of brachial artery infected aneurysm in a patient with infective endocarditis caused by Streptococcus bovis. A 49-year-old man presented with fever dyspnea and a pansystolic murmur with irradiation to axilla. The echocardiogram revealed vegetation in native mitral valve. After mitral valve replacement with bioprosthesis, it was observed pulsatile mass of five centimeters in diameter at antecubital fossa of right upper limb. It was made the diagnosis of infected aneurysm of the brachial artery, and the surgery was performed successfully. The aim of this case report is to show a rare complication after infective endocarditis.
Keywords: Endocarditis; Brachial artery; Aneurysm, infected
MULTIMEDIA
Subvalvular aortic membrane resection
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
CLINICAL-SURGICAL CORRELATION
Fontan postoperative complication: antegrade pulmonary flow
Braz J Cardiovasc Surg 26;
Publish in: 8/2/2025
TRIBUTE
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LETTERS TO THE EDITOR
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ERRATUM
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