[Comparative study of Toronto SPV prosthesis and bileaflet mechanical aortic prosthesis with 2D-Doppler echocardiography]. / Estudo comparativo entre próteses toronto SPV e próteses mecânicas bidisco em posição aórtica por ecocardiografia 2D-Doppler.

AIM: The aim of this study was to make a noninvasive comparison, by means of Doppler echocardiography, of the hemodynamic performance of biological stentless xenografts and mechanical bileaflet (MB) prostheses (P) in aortic position. METHODS: We studied 20 patients (pts) with normofunctional (nf) aortic Toronto (T) Stentless Porcine valves (SPV)--Group I--8 males, aged 69 +/- 12 years, 32 +/- 9 months after surgery, and 30 pts with nf MB aortic P (Carbomedics or St. Jude Medical)--Group II--17 males (p = NS vs G I), aged 61 +/- 12 years (p < 0.01 vs G I), 30 +/- 12 months after implantation (p = NS vs G I). Both groups were comparable with regard to body surface area and surgical indication. P diameters ranged from 21 to 25 mm (G I: 22.9 +/- 1.7; G II: 22.8 +/- 1.7 - p = NS), the number of pts with the same P diameter in each group being similar. We analysed, at rest: aortic orifice diameter (AoOd - cm), maximal (GMax) and mean (GMean) transprosthesic pressure gradients, P functional area (PFA) and P resistance (PRes). Gradients (mm Hg) were calculated by means of the Bernoulli equation, PFA (cm2) by means of the continuity equation and PRes (dynes.s.cm-5) as 1333 x Gmean x SEP/SV (SEP = systolic ejection period; SV = stroke volume). RESULTS: AoOd (G I vs G II): P 21--1.78 +/- 0.04 vs 2.00 +/- 0.10 (p < 0.001); P 23--1.91 +/- 0.10 vs 2.19 +/- 0.10 (p = 0.01); P 25--2.22 +/- 0.24 vs 2.29 +/- 0.19 (NS). Doppler parameters: [table: see text] CONCLUSIONS: P T SPV show better hemodynamic performance when compared to P MB with the same diameter, in aortic position. In addition, our results suggest that P T SPV allow the use of larger valve sizes for the same aortic orifice diameter.

[Experience of the exclusive use of arteries in myocardial revascularization]. / Experiência na utilização exclusiva de artérias em revascularização miocárdica.

OBJECTIVES: To present the initial experience of a surgical team from Santa Marta Hospital using exclusive arterial grafts on coronary bypass surgery. SETTING: Cardiology and Cardiothoracic Departments. POPULATION AND METHODS: From November 1987 to May 1994, 176 consecutive patients were submitted to surgical myocardial revascularization with the exclusive use of arterial grafts. The patients were operated by one cardiothoracic surgical team. A revision of clinical and angiographic characteristics of the patients was done along with the surgical procedure and intrahospital morbidity. After hospital discharge, follow-up was done by direct evaluation and/or by a questionnaire made using phone or letter on a periodical basis. RESULTS: The medium number of coronary bypasses performed were 2.07 +/- 0.8. The left internal mammary artery was the vessel more frequently used, specially to the myocardial area supplied by the left coronary descending artery. The right internal mammary artery was the second arterial graft more currently used. Gastroepiploic artery was utilized preferentially to coronary arteries supplying the inferior wall of the heart. Hospital mortality was 3.4%-6 patients. One hundred twenty patients have a normal life, without physical restrictions, 25% of the patients have symptoms of angina that is severe in 9. Mean follow-up time was 34 +/- 10 months. IN CONCLUSION: Coronary artery bypass surgery with exclusive use of arterial grafts can be executed with an acceptable mortality and low morbidity rates, even in urgent cases, with relieve of cardiac symptoms and good quality of life.

[Hemolytic anemia in the malfunction of a mitral bioprosthesis]. / Anemia hemolítica em disfunção de bioprótese mitral.

Valvular cardiac prosthesis have dramatically altered the prognosis of patients with valvular cardiac disease; however, they are not free of complications. Prosthesis disfunction and problems related to anticoagulation are the more common, but hemolytic anemia should also be considered. In this case, hemolytic anemia appears as the major complication of a mitral bioprosthesis; the decision concerning the presentation of this case report rests upon its rarity and peculiar circumstances of appearance. A brief revision of the diagnostic work-up is also made.

[The assessment of the histomorphological characteristics of the arteria gastroepiploica dextra and its potential as an artery for myocardial revascularization]. / Avaliação das características histomorfológicas da artéria gastroepiplóica direita e do seu potencial como artéria para revascularização miocárdica.

OBJECTIVE: Comparative analysis of the histomorphological characteristics of left (LIMA) and right (RIMA) internal mammary arteries, right gastroepiploic (RGEA) and anterior descending artery (ADA) with evaluation of the respective prevalence of atherosclerotic changes. SETTINGS: Laboratory of Anatomo-Pathology of a Central Hospital with necropsy material obtained from consecutive individuals, deceased of a non-cardiac cause and older than 60 years. MATERIAL AND METHODS: In 31 cadaver fragments of the RIMA, LIMA, GEA and ADA, were obtain, subsequently fixed and stained in order to become evident the structure of the medial layer, and the presence of possible atherosclerotic changes (intimal Hyperplasia, cholesterol clefts, foam-cells, inflammatory cells infiltrate, rupture of the internal elastic lamina, medial fibroses and calcifications). RESULTS: 1--The RGEA has the structure of a muscular artery as the ADA, opposed to the LIMA and RIMA that are elastic arteries. 2--The atherosclerotic changes were predominantly found in the ADA with no significative differences in there prevalence in the RIMA, LIMA or RGEA. CONCLUSIONS: The RGEA despite having histological characteristics diverse than the LIMA and RIMA, has a similar prevalence of atherosclerotic changes and intimal hyperplasia; those allow us to predict a behaviour and a long-term patency comparable, when used as bypass graft for myocardial revascularization.