[Use of a thin retrocardiac drain after open heart surgery. Description of the technique]. / Uso de dreno fino retrocardíaco em pós-operatório de cirurgia cardíaca. Descrição de técnica.

PURPOSE: To describe a technique with a thin drainage system placed behind the heart, avoiding reoperation caused by tamponade due to pericardial effusion in patients who undergo open heart surgery. METHODS: We studied 59 patients, average age of 50 years. Twenty-six (44%) patients had undergone CABG, 25 (42%) valvar procedures and 8 (14%) different procedures. The control group were 20 patients, average age 44 years. Nine (45%) underwent CABG, 6 (30%) valvar procedures and 5 (25%) other procedures. Every patient was submitted to echocardiographic study to verify presence of pericardial effusion after operation. RESULTS: There was one patient with pericardial effusion with 8mm in the study group. Six patients showed pericardial effusion in the control group. The control group had mean drainage flow of 320 +/- 110ml and average permanence time was 45 +/- 10h. The study group had mean drainage flow of 410 +/- 122ml, the average permanence time was 46 +/- 10h. There was statistic difference between both groups when we compared the frequency of pericardial effusion. CONCLUSION: This drainage system reduces pericardial effusion comparing with the literature and causes little discomfort to the patient. The fixed rule to remove the drains did not present more discomfort to the patient and there were no complications related to its permanence.

-Rate-responsive pacemaker with an unexpected chronotropic response-. / Marcapasso responsivo com resposta cronotrópica inesperada.

The pacemaker with rate-responsiveness was a great advance in cardiac stimulation, however, the choice of the best biosensor is still object of research. A 35 year-old woman with a responsive pacemaker implanted due to a complete heart block after interventricular septal defect surgical correction was admitted. The pacemaker showed improper cronothropic response with high frequency due to biosensing malfunction. Malfunction related to muscle stimulation in the generator pocket and a high response rate. A palliative procedure was made until the end of pregnancy, by reducing the sensitivity of biosensing.

Marcapasso responsivo com resposta cronotrópica inesperada / Rate-responsive pacemaker with an unexpected chronotropic response

Os marcapassos responsivos foram um grande avanço na estimulaçäo cardíaca, contudo, a escolha de um biossensor fisiológico adequado é objeto de muito estudo. Mulher de 35 anos com marcapasso responsivo devido a bloqueio atrioventricular total (BAVT) secundário a correçäo de comunicaçäo interventricular deu entrada com insuficiência cardíaca (IC) e estimulaçäo peitoral importante na loja do marcapasso, que levou a interpretaçäo errônea, causando IC. Uma soluçäo paliativa foi tomada até o fim da gestäo, dimunuindo-se a sensibilidade do biossensor.

Penetrating heart wounds.

In 3 years, 26 patients were operated for penetrating heart wounds at our institution, the majority between 30 to 60 minutes after injury. Twenty-two patients with a possible heart wound were immediately taken to the operating room for thoracotomy. One patient initially underwent laparotomy while 2 were observed before operating-room thoracotomy. One patient underwent emergency-room thoracotomy. Three patients with no vital signs on admission died, 82.6% of the remainder survived. Stab wounds determined the best survival rate: 94%, whereas for gunshot wounds it was only 50%. Our experience at this Brazilian Trauma Center reveals that delay in reaching the hospital selected the patients, that clinical condition on arrival, method of injury (knife or gunshot), emergency room staffed with trauma surgeons and aggressive operating room treatment for penetrating heart wounds results in a remarkable survival rate. Emergency-room thoracotomy should be reserved for patients "in extremis" or when there is no operating room available.

[Fracture of endocardial electrode at the tricuspid valve level]. / Fratura de eletrodo endocárdico a nível da valva tricúspide.

Female, 72 years old, had a permanent pacemaker system with endocardial pacing lead, and developed fracture of electrode at the point of passage across the tricuspid valve with episodes of asystole.