COVID-19 complicating perioperative management of LVAD implantation: A case report and systematic review.

The coronavirus 2019 disease (COVID-19) affected 125 million people worldwide and caused 2.7 million deaths. Some comorbidities are associated with worse prognosis and left ventricular assist device (LVAD) recipients are probably part of this high-risk population. We report a 31-year-old male patient who developed COVID-19 during LVAD implantation. His postoperative period was complicated by severe pneumonia and mechanical ventilation (MV) leading to right ventricular failure (RVF) and inotrope necessity. He experienced multiple complications, but eventually recovered. We present a systematic review of LVAD recipients and COVID-19. Among 14 patients, the mean age was 62.7 years, 78.5% were male. A total of 5 patients (35.7%) required MV and 3 patients (21.4%) died. A total of 2 patients (14.2%) had thromboembolic events. This case and systematic review suggest LVAD recipients are at particular risk of unfavorable outcomes and they may be more susceptible to RVF in the setting of COVID-19, particularly during perioperative period.

Heterotopic Heart Transplantation as a Left Ventricular Biological Assistance: a New Two-Stage Method Proposal.

Since Barnard's first heterotopic heart transplant in 1974, Copeland's method has been the greatest contribution to heterotopic transplants but has the drawback of donor's right ventricular atrophy. This new method proposes a modification in the anastomosis of the superior vena cava aiming to pre-serve donor's right ventricular function by decompressing the pulmonary territory and reducing the pulmonary arterial pressure, as a biological ventricular assist device. Finally, a second intervention is proposed, where a "twist" is performed to place the donor's heart in an orthotopic position after re-moval of the native heart. A pioneering research on this method received approval from the ethics committee of the Heart Institute of São Paulo. We believe that this method has the potential to im-prove quality of life in a selected group of patients.

Heterotopic heart transplantation as a left ventricular biological assistance: a new two-stage method proposal

Abstract Since Barnard's first heterotopic heart transplant in 1974, Copeland's method has been the greatest contribution to heterotopic transplants but has the drawback of donor's right ventricular atrophy. This new method proposes a modification in the anastomosis of the superior vena cava aiming to pre-serve donor's right ventricular function by decompressing the pulmonary territory and reducing the pulmonary arterial pressure, as a biological ventricular assist device. Finally, a second intervention is proposed, where a "twist" is performed to place the donor's heart in an orthotopic position after re-moval of the native heart. A pioneering research on this method received approval from the ethics committee of the Heart Institute of São Paulo. We believe that this method has the potential to im-prove quality of life in a selected group of patients.

Quadricuspid Aortic Valve: Three Cases Report and Literature Review.

Quadricuspid aortic valve (QAV) is a rare cardiac malformation. Many cases are incidentally diagnosed in aortic surgeries or autopsies and it usually appears as an isolated anomaly. The most widely classification used is the one by Hurwitz and Roberts[], which divides 7 alphabetical subtypes based on the cusps size. The aim of this report is to describe three different anatomic presentations of this rare aortic valve anomaly.

Quadricuspid aortic valve: three cases report and literature review

Abstract Quadricuspid aortic valve (QAV) is a rare cardiac malformation. Many cases are incidentally diagnosed in aortic surgeries or autopsies and it usually appears as an isolated anomaly. The most widely classification used is the one by Hurwitz and Roberts[1], which divides 7 alphabetical subtypes based on the cusps size. The aim of this report is to describe three different anatomic presentations of this rare aortic valve anomaly.

Óxido nítrico inalatório no tratamento da hipertensão pulmonar persistente do recém-nascido / Inhaled nitric oxide to treat persistent pulmonary hypertension of the newborn

Objetivos: conhecer as indicações do uso de NOi, dose média utilizada e resposta ao tratamento em recém-nascidos internados em Unidade de Terapia Intensiva Neonatal. Métodos: foram analisados 62 prontuários e considerados dois grupos de recém-nascidos (RN) de acordo com o desfecho para sobrevida (n=39) ou óbito (n=23). Testes t-Student e binomial, p<0,05. Resultados: do total, 47 eram masculinos, 18 nasceram de parto normal e 44 de cesariana. Os RNs que sobreviveram tinham maior idade gestacional clínica e mais peso ao nascimento (p<0,05). Cardiopatia congênita, hipoplasia pulmonar, sepse e síndrome da membrana hialina (SMH) foram mais frequentes nos RNs que evoluíram para óbito, enquanto que a síndrome de aspiração de mecônio (SAM)estava mais presente nos RNs que sobreviveram (p<0,05). Não houve diferença significativa quanto a: asfixia perinatal, hérnia diafragmática, hipertensão pulmonar persistente neonatal (HPPN) e taquipneia transitória do recém-nascido (p>0,05). A dose inicial de NOi e a duração do tratamento foram maiores nos RNs que sobreviveram (p<0,05). A idade de início do tratamento, a dose máxima de NOi e o tempo de ventilação mecânica não apresentaram diferenças entre os grupos (p>0,05). O índice de oxigenação foi significativamente mais alto nos óbitos (p<0,05). Não foram observados efeitos colaterais. Conclusões: a terapia com NOi foi indicada principalmente na asfixia perinatal, SAM, SMH e sepse. As doses de NOi entre 15 e 30 ppm mostraram-se seguras e a diminuiçãodo índice de oxigenação sugere resposta positiva ao tratamento.

Objectives: To know the inhaled nitric oxide (iNO) use indications, the average used dose, and the reaction to treatment in newborns hospitalized at the Neonatal Intensive Care Unit. Methods: 62 medical records were analyzed and two newborn groups were considered according to the survival (n=39) or death (n=23) outcome. t-Student and binomial tests, p<0.05. Results: From the total, 47 subjects were male, 18 were born from natural childbirth, and 44 from cesarean section. The newborns that survived had a higher clinical gestational age and more weight at birth (p>0.05). Congenital heart defect, pulmonary hipoplasia, sepsis, and hyaline membrane syndrome (HMS) were more frequent in newborns that evolved to death, while the meconium aspiration syndrome (MAS) was more present in the ones that survived (p<0.05). There was no significant difference concerning: perinatal asphyxia, diaphragmatichernia, neonatal persistent pulmonary hypertension (NPPH), and newborn transient taquipneia (p>0.05). The iNO initial dose and treatment time were superior in newborns that survived (p<0.05). Age in the beginning of the treatment, maximum doses of iNO, and time of mechanical ventilation did not present significant differences between the groups (p>0.05).The oxygenation index was significantly higher in the deceased ones (p<0.05). No adverse effects were seen. Conclusions: Therapy with iNO was mainly indicated for perinatal asphyxia, MAS, HMS, and sepsis. iNO doses between 15 and 30 ppm proved to be safe, and the decrease of the oxygenation index suggests a positive reaction to the treatment.

Teste da fosfatase alcalina e contagem de bactérias totais e em leite humano ordenhado / Alkaline phosphatase test and counting of total bacteria and in human milk

A excelência do leite materno como fonte de alimentação exclusiva para lactentes até os seis meses de idade não constitui motivo de dúvida, uma vez que esse alimento possui uma composição química que corresponde perfeitamente às necessidades fisiológicas do metabolismo normal do bebê. Porém, existem vários fatores que impedem o processo natural de amamentação, surgindo assim a necessidade de centros de armazenamento e distribuição de leite humano, os Bancos de leite Humano. Sabendo-se que o leite humano é um alimento extremamente nutritivo, passível de contaminação, e tendo em vista os receptores de tal alimento, um rígido controle de qualidade torna-se necessário. Assim, técnicas adequadas e sensíveis de controle de qualidade são importantes. Os objetivos do estudo foram testar a eficácia do Teste da Fosfatase Alcalina, utilizado rotineiramente em leite de vaca, em leite humano e avaliar o padrão microbiológico dos leites pasteurizados...

[Right atrium myxoid chondrosarcoma]. / Condrossarcoma mixóide de átrio direito.

We report a case of a 46 years-old woman, Caucasian, with hypertension and a primary diagnosis of infectious endocarditis. A transthoracic echocardiogram was performed suggesting right atrium myxoma. The patient was submitted to surgery, which found a tumor mass with a jelly-like exterior. The mass was sent to anatomo-pathological analysis which diagnosed a myxoid chondrosarcoma tumor. After surgical resection, the patient achieved complete recovery with no signs of recidivation after 14 months.

Condrossarcoma mixóide de átrio direito / Right atrium myxoid chondrosarcoma

Relatamos o caso de uma paciente de 46 anos, cor branca, hipertensa há 20 anos, com suspeita de endocardite infecciosa. Foi realizado ecocardiograma transtorácico, o qual levou à hipótese de mixoma de átrio direito. A paciente foi submetida à cirurgia, observando-se massa tumoral de aspecto muco-gelatinoso friável. A massa foi submetida a congelação para exame anatomopatológico, com laudo sugestivo de tumor maligno mesenquimal. Foi realizado exame imunohistoquímico compatível com condrossarcoma mixóide. A paciente evoluiu com remissão espontânea do quadro após ressecção completa da neoplasia. Realizou acompanhamento ambulatorial por 14 meses, sem apresentar sinais de recidiva do tumor.

We report a case of a 46 years-old woman, Caucasian, with hypertension and a primary dianosis of infectious endocarditis. A transthoracic echocardiogram was performed suggesting right atrium myxoma. The patient was submitted to surgery, which found a tumor mass with a jelly-like exterior. The mass was sent to anatomo-pathological analysis which diagnosed a myxoid chondrosarcoma tumor. After surgical resection, the patient achieved complete recovery with no signs of recidivation after 14 months.