Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short-and long-term results in ischemic cardiomyopathy

INTRODUCTION: The purpose of this study was to (1) identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and (2) identify predictors of favorable outcomes. METHODS AND MATERIAL: Patients (n = 169) with angiographic left ventricular ejection fraction of 22±5 percent underwent aneurysm surgery and were prospectively followed for three years. Prior to surgery, 40 percent and 60 percent of the patients were in congestive heart failure NYHA class I/II and III/IV, respectively. Concomitant revascularization was performed on 95 percent of the patients. RESULTS: Cumulative in-hospital and 36-month mortalities were 7 percent and 15 percent, respectively. These respective rates varied according to preoperative parameters: CHF class I-II, 4 percent and 13 percent; CHF class III-IV, 8 percent and 16 percent; LVEF,20 percent, 12 percent and 26 percent; LVEF 21-30 percent, 2 percent and 6 percent; gated LVEF exercise/rest .5 percent, ,1 percent and 4 percent; and gated LVEF exercise/rest #5 percent, 17 percent and 38 percent. Higher LVEF ex/rest ratio (p = 0.01), male sex (p = 0.05), and a higher number of grafts (p = 0.01) were predictive of improvement in CHF class at follow-up based on the results of a multivariate analysis. After three years of follow-up, 84 percent of the patients were in class I/II, LVEF was 45±7 percent, and gated LVEF ex/rest ratio was 13 percent higher (p,0.01) compared to the beginning of the study. CONCLUSIONS: These data suggest that aneurysmectomy among patients with severe LV dysfunction result in shortand long-term favorable functional outcome and survival. Selection of appropriate surgical candidates may substantially improve survival rates among these patients.

Paralisia bilateral do diafragma no pós-operatório imediato de cirúrgia cardíaca / Immediate post-operative bilateral diaphragmatic paralysis after cardiac surgery

Homem de 56 anos, submetido a implante de prótese metálica em posiçäo aórtica, e a enxerto de safena para artéria coronária direita, evoluiu no pós-operatório imediato com insuficiência respiratória de difícil reconhecimento etiopatogênico, finalmente relacionada à paralisia bilateral do diafragma, diagnóstico confirmado através do exame ultrasonográfico de tórax. O paciente permaneceu sob assistência ventilatória com pressäo positiva por 75 dias, quando foi introduzido ventilador de pressäo negativa (VPN), tipo colete, permitindo o fechamento da traqueostomia e recuperaçäo da respiraçäo espontânea. Alta hospitalar no 90§ dia, com orientaçäo do uso de VPN no período noturon. Após 40 dias, o paciente retornou as suas atividades profissionais, sem qualquer apoio à respiraçäo

A 56 years old man was submitted to an aortic replacement with mechanical prosthesis and to saphenous vein graft to the right coronary artery. He developed respiratory insufficiency after surgery which was finally related to bilateral diaphragmatic paralysis whose diagnosis was confirmed through thorax ultrassonography. The patient remained under ventilatory assitance with positive pressure for 75 days. The introduction of thorax ventilatory negative pressure (VNP), jacket type, allowed the traqueostomy closure. The patient gradually recovered his spontaneous breathing and was discharged after 90 days with instructions to use VNP at night. He returned to his normal professional activities, without auxiliary respiratory support, 40 days after his discharge.