[Partial median sternotomy in H. A new approach for cardiac surgery]. / Esternotomia parcial mediana em H. um novo acesso para a cirurgia cardíaca.

PURPOSE: To present our results with the minimally invasive thoracotomy (MIT) in patients with valve disease and to describe a new type of thoracotomy. METHODS: Twenty-five patients with valve disease as the major cardiac problem were operated during a five month period. Two types of incisions were used: one in an inverted-T fashion and another in a H fashion. Fourteen patients were submitted to an inverted-T incision and eleven to a H incision. In 24% of the patients reoperation was being performed. RESULTS: The incisions ranged from 7.5 to 11 cm (mean 9.1 cm), mean ICU stay was 31 h and hospital stay 4.8 days. In all but one patient the operation could be adequately in performed through the MIT, in only one patient total sternotomy had to be performed. CONCLUSION: The MIT may have some advantages such as, better aesthetic results, less pain and more sternal stability. These factors may improve early extubation and decrease hospital stay. The H type incision allows an adequate exposition of the most central part of the chest and all heart valves with adequate exposure. This technique led to no complications during reoperations and we believe it to be as safe as the total sternotomy.

Total inversion of the left lung circulation: morphologic and functional analyses.

BACKGROUND: An experimental model for total inversion of left lung circulation was developed. With this model, the authors demonstrate that it is possible to reverse the pulmonary circulation and preserve the normal function and morphology of the lung. METHODS: Eight dogs had their left pulmonary circulation reversed. The blood from the pulmonary artery trunk was diverted to the pulmonary veins, and returned from the pulmonary artery into the left atrium. In order to monitor the flow through the reversed system, color Doppler echocardiography was performed on the ninth postoperative day. The dogs were reoperated after 15 days for re-evaluation. Blood gas analyses from the aorta and the pulmonary artery were used to study the functional status of the lung in both operations. The morphology was studied by comparing biopsies of the lung performed before and after reversal of flow. RESULTS: Blood gas analysis showed no significant difference between the samples of from the aorta and pulmonary artery. Color Doppler echocardiography was a reliable method for the study of the inverted circulation. The histological study showed no differences in the morphology of the lung after the reversed circulation. CONCLUSIONS: Left pulmonary circulation was fully reversed. Pulmonary function and morphology remained normal.

Carcinoma epidermóide de amígdala pós-transplante cardíaco: relato de caso / Squamous carcinoma of the tonsil after heart transplantation: case report

Paciente de 52 anos submetida a transplante cardíaco ortotópico em maio de 1991, tendo apresentado como complicaçäo tardia o surgimento de carcinoma epidermóide de amígdala. O diagnóstico inicial foi de neoplasia metastática de sítio primário desconhecido porque o tumor primário somente manifestou-se após 6 meses do surgimento da metástase à distância. A incidência de neoplasia no primeiro ano pós-transplante cardíaco é pouco freqüente, assim como o carcinoma epidermóide de amígdala na populaçäo normal. Näo encontramos relato de caso na literatura entre pacientes submetidos a transplante cardíaco e apresentando carcinoma epidermóide de amígdala.