Use of total venous inflow occlusion to enable correction of an atrial septal defect in a dog

Background: Atrial septal defects are generally classified into three types: ostium secundum, ostium primum, and sinus venosus. Diagnose is normaly confirmed with Doppler echocardiography, which can identify and classify atrial septal defects types. This cardiac anomaly may be corrected by different surgical approaches, such as cardiopulmonary bypass or transvenous approaches. Therefore, we chose to close the atrial septal defect using a total venous inflow occlusion technique (TIVO), which has been successfully used in other procedures without major postoperative complications, and are notably cheaper and requires no specialized equipment, been able to be done in different places.Case: An American Pit Bull Terrier was referred to our surgical service for ostium secundum atrial septal defect correction, by the time of surgery the patient presented dyspneic; normal capillary refill time and rectal temperature; the owner mentioned the patient exhibited exercise intolerance and delayed development compared to other dogs of the same age or from the same litter. Cardiac auscultation revealed a systolic murmur at the left base, femoral pulse was normokinetic, and patient was emaciated and prostrated at the time of clinical evaluation. Atrial septal defect was suspected and then confirmed by Doppler echocardiography that revealed a discontinuous area in the interatrial septum, and by color doppler images an aliased signal, that extended through the interatrial septum and shunted from the left to the right atria, was visualized, confirming an ostium secundum atrial septal defect. After a right intercostal thoracotomy, a subphrenic pericardiectomy was performed to provide access to the heart. Cranial and caudal vena cava as well as the azygos vein, were dissected, which allowed placement of a Satinsky’s clamp to proceed with TIVO. Before TIVO initiation, a pursestring suture with 3-0 polypropylene was applied to the right atrium.[...]

Use of total venous inflow occlusion to enable correction of an atrial septal defect in a dog

Background: Atrial septal defects are generally classified into three types: ostium secundum, ostium primum, and sinus venosus. Diagnose is normaly confirmed with Doppler echocardiography, which can identify and classify atrial septal defects types. This cardiac anomaly may be corrected by different surgical approaches, such as cardiopulmonary bypass or transvenous approaches. Therefore, we chose to close the atrial septal defect using a total venous inflow occlusion technique (TIVO), which has been successfully used in other procedures without major postoperative complications, and are notably cheaper and requires no specialized equipment, been able to be done in different places.Case: An American Pit Bull Terrier was referred to our surgical service for ostium secundum atrial septal defect correction, by the time of surgery the patient presented dyspneic; normal capillary refill time and rectal temperature; the owner mentioned the patient exhibited exercise intolerance and delayed development compared to other dogs of the same age or from the same litter. Cardiac auscultation revealed a systolic murmur at the left base, femoral pulse was normokinetic, and patient was emaciated and prostrated at the time of clinical evaluation. Atrial septal defect was suspected and then confirmed by Doppler echocardiography that revealed a discontinuous area in the interatrial septum, and by color doppler images an aliased signal, that extended through the interatrial septum and shunted from the left to the right atria, was visualized, confirming an ostium secundum atrial septal defect. After a right intercostal thoracotomy, a subphrenic pericardiectomy was performed to provide access to the heart. Cranial and caudal vena cava as well as the azygos vein, were dissected, which allowed placement of a Satinskys clamp to proceed with TIVO. Before TIVO initiation, a pursestring suture with 3-0 polypropylene was applied to the right atrium.[...](AU)

Multi drug resistance in strong biofilm forming clinical isolates of Staphylococcus epidermidis

Staphylococcus epidermidis which exists in healthy human skin as a commensal inhabitant is also an important pathogen forming biofilms on many surfaces and recently, increased resistance traits were suggested to be acquired in biofilm environments. In this study; clinical Prevalences, antibiotic resistances and biofilm formations of S. epidermidis strains were determined and comparison of all these findings with each other was carried out in order to take precautions against them and figure out if high biofilm forming S. epidermidis strains display multi drug resistance. According to our results; samples of wound and blood were the most S. epidermidis isolated clinical materials (40%; 35%) and cardiothoracic surgery was the most S. epidermidis observed service unit. All of these strains were sensitive to vancomycin, however 65% of them showed resistance to all β-lactam antibiotics (Penicillin, Oxacillin, Amoxicilin / Clavulonic acid), used in this study and 60% of all S. epidermidis strains were found as multi drug resistant. When the results of strong biofilm forming S. epidermidis strains are examined; they were isolated from sample of blood and service unit of cardiovascular surgery in highest frequency and 80% of them were β-lactam resistant whereas 100% of them were multi drug resistant. One of these multi drug resistant strains which was resistant to maximum amount of different antimicrobial classes, was also observed as maximum biofilm forming strain among all the other S. epidermidis isolates. Multi drug resistance in strong biofilm forming strains shows that; biofilms play a role in antimicrobial resistance traits of S. epidermidis.

Cryopreserved tracheal segments: a new tool for bench surgical training in thoracic surgery / Segmentos criopreservados de traqueia: uma nova ferramenta para auxiliar o treinamento na cirurgia torácica

PURPOSE: To present a new low-cost high fidelity bench model of cryopreserved trachea that can be used to learn surgical skills from medical students to cardiothoracic surgery fellows. METHODS: Ten tracheas were harvested from ten non-trachea related research dogs at the moment of euthanasia. Each trachea was trimmed in six or seven rings segments. They were cryopreserved and stored during 60 days. The day programmed for surgical skills practice, they were thawed to room temperature. RESULTS: Forty segments have been used. After defrosting, all the segments kept their normal anatomic shape and structural integrity. Two incisions were made on every tracheal segment and sutured with running or separate stitches with 5-0 polypropilene. There were no complications such as cartilage ruptures, neither tears on the mucosae, the cartilages nor the membranous posterior membrane. CONCLUSIONS: The cryopreserved trachea is a high fidelity, practical, reproducible, portable, low-cost bench model. It allows cardiothoracic fellows to learn how to handle a trachea, as well as to perfect their surgical and suture abilities before applying them on a real patient's trachea.(AU)

OBJETIVO: Apresentar novo modelo de traquéia criopreservada de baixo custo e alta fidelidade que pode ser usado tanto por estudantes de medicina como por cirurgiões cardiotorácicos no aprendizado e desenvolvimento de suas habilidades cirúrgicas. MÉTODOS: Foram coletados amostras de dez traquéias de dez cães utilizados para pesquisa após a eutanásia. Cada segmento de traquéia foi dividida em seis ou sete anéis, criopreservadas e armazenadas durante 60 dias. No dia programado para a prática cirúrgica os segmentos foram descongelados a temperatura ambiente. RESULTADOS: Foram utilizados 40 segmentos no estudo. Após o descongelamento todos os segmentos mantiveram sua forma anatômica e sua integridade estrutural. Foram realizadas duas incisões em cada segmento traqueal que foram suturadas em padrão continuo ou com pontos separados utilizando sutura de polipropileno 5-0. Não houve nenhuma complicação como a ruptura da cartilagem, rasgos na mucosa, cartilagem ou na membrana membranosa posterior. CONCLUSÕES: O modelo de traquéia criopreservada é altamente fidedigno, prático, reproduzível, portátil e de baixo custo. Permite que os cirurgiões cardiotorácicos aprendam como manipular a traquéia, assim como aperfeiçoar suas habilidades cirúrgicas antes de sua aplicação em traquéias de pacientes reais.(AU)

Circulação extracorpórea - revisão / Cardiopulmonary bypass –- review

A cirurgia cardiotorácica teve amplo período de estagnação em relação às demais cirurgias devido a alta complexidade envolvida nos procedimentos e à mistificação do coração como sede da alma. Com o desenvolver das técnicas cirúrgicas, equipamentos mais precisos e métodos anestésicos que forneciam maior segurança, a cirurgia cardiotorácica teve grandes avanços, chegando ao desenvolvimento de uma máquina que substituía as funções do coração e pulmão e até mesmo na efetivação do transplante cardíaco e desenvolvimento de coração artificial.AU

The cardiothoracic surgery had long period of stagnation in relation to other surgeries due to the high complexity involved in the procedures and the mystification of the heart as seat of the soul. With the development of surgical techniques, equipment and more accurate methods that provided safer anesthetics, cardiothoracic surgery has made great advances, achieving the development of a machine that replaced the functions of the heart and lungs and even heart transplantation and the realization of an artificial heart implant.AU

Circulação extracorpórea - revisão / Cardiopulmonary bypass –- review

A cirurgia cardiotorácica teve amplo período de estagnação em relação às demais cirurgias devido a alta complexidade envolvida nos procedimentos e à mistificação do coração como sede da alma. Com o desenvolver das técnicas cirúrgicas, equipamentos mais precisos e métodos anestésicos que forneciam maior segurança, a cirurgia cardiotorácica teve grandes avanços, chegando ao desenvolvimento de uma máquina que substituía as funções do coração e pulmão e até mesmo na efetivação do transplante cardíaco e desenvolvimento de coração artificial.

The cardiothoracic surgery had long period of stagnation in relation to other surgeries due to the high complexity involved in the procedures and the mystification of the heart as seat of the soul. With the development of surgical techniques, equipment and more accurate methods that provided safer anesthetics, cardiothoracic surgery has made great advances, achieving the development of a machine that replaced the functions of the heart and lungs and even heart transplantation and the realization of an artificial heart implant.

Procedimentos básicos padronizados aplicados nos períodos pré, trans e pós-circulação extracorpórea em cães / Standard basic procedures applied before, during and after cardiopulmonary bypass in dogs

O objetivo desta dissertação foi descrever em veterinária seqüência padrão de procedimentos que devem ser realizados nos períodos pré, trans e pós-circulação extracorpórea (CEC) para sua aplicação em cão, com base na literatura existente, e em observações levadas a efeito no Laboratório de Cirurgia Cardiotorácica, do Departamento de Cirurgia da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo. O referido trabalho concerne sobre a escolha do material, montagem e preparo da máquina ECOBEC ? Braile Biomédica - para circulação extracorpórea em cães, e descreve procedimentos básicos para entrada, condução, monitorização e saída de CEC, a fim de obter-se resultado técnico exeqüível no procedimento. Diante do exposto na literatura compulsada, baseado na metodologia e material proposto e com observações pessoais, é licito afirmar que esta é factível, desde que obedecidos os preceitos enumerados e descritos no presente trabalho para os períodos pré, trans e pós-circulação extracorpórea

The purpose of this assay was to describe the standard basic procedures that should be followed before, during, and after cardiopulmonary bypass (CPB) in dogs, based on the existing literature and personal observations that took place in the Laboratory of Cardiothoracic Surgery, of the Surgical Department of the Faculdade de Medicina Veterinária e Zootecnia of the University of São Paulo. This assay reports how to choose the material, to prepare and to assemble the ECOBEC machine ? Braile Biomédica ? for cardiopulmonary bypass in dogs, and describes the basic procedures to start, conduct, follow up and finish it, in order to obtain a feasible technical results. Based on the literature, based on the methodology and material proposed and personal observations, it is reliable to state that this procedure can be accomplished since all paths described are followed before, during and after cardiopulmonary bypass