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1.
J Cardiovasc Surg (Torino) ; 41(1): 7-9, 2000 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10836214

RESUMO

BACKGROUND: We evaluated the possibility of video-endoscopic dissection of both internal thoracic arteries (rTAs) through the left thoracic approach and right gastroepiploic artery (GEA) via a small laparoscopic access, for use in minimally invasive coronary artery bypass surgery. METHODS: The procedure was performed on twenty-two mongrel dogs. Three 10 mm ports were inserted in the left hemithorax to enable the introduction of a rigid 0-degree videoscope and forceps which allowed access to the left and right ITAs. For dissection of the GEA, one 10 mm and two 5 mm ports were inserted in the para-umbilical region. RESULTS: The left and right ITAs and the GEA were easily visualized and dissection and complete mobilization was achieved without injury, which was checked by the presence of good blood flow. The ITAs and GEA were divided distally, exteriorized through a small left anterior thoracotomy and the length of these three grafts were able to reach all of the left coronary artery branches. CONCLUSIONS: We have demonstrated, in dogs, the feasibility of video-assisted dissection of both the left and right ITAs through the left thoracic approach, without sternotomy, avoiding the risks of sternal complications and expanding its use for all patients. Furthermore, a third arterial conduit (the RGA) can be used without requiring laparotomy.


Assuntos
Angioscopia , Ponte de Artéria Coronária/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Artérias Torácicas/transplante , Gravação em Vídeo/instrumentação , Animais , Cães , Desenho de Equipamento
2.
J Cardiovasc Surg (Torino) ; 39(5): 619-23, 1998 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9833722

RESUMO

BACKGROUND: A new form of postperfusion manifestation is detailed, a vasoplegic syndrome presenting in the postoperative period after cardiopulmonary bypass (CPB) heart surgery. METHODS: This retrospective study included sixteen patients who underwent cardiovascular surgery using CPB and exhibited clinical and hemodynamic features compatible with vasoplegic syndrome. The technique of CPB was hypothermic (28 degrees C) in 15 and normothermic in 1 patient, and hypothermic blood cardioplegia was employed in all patients, except 1. The mean CPB time was 121 minutes, ranging from 80 to 210 minutes. RESULTS: The patients presented a severe feature comprising hypotension, tachycardia, normal or elevated cardiac output, low systemic vascular resistance and decreased filling pressures. Fluid administration alone was not capable of restoring hemodynamic parameters. Physical examination revealed normal capillary filling at the extremities although oliguria and hypotension were observed. These patients needed a high dosage of vasoconstrictor drugs (norepinephrine) for blood pressure control but even high dose norepinephrine did not produce the classical situation of cool extremities and weak peripheral pulses, with increased morbidity and mortality. Severe systemic complications could develop if the vasoplegic syndrome persisted 36-48 hours after its onset. All patients, except 3, presented associated postoperative complications and 4 patients died. The characteristics of vasoplegic syndrome are similar to those observed in septic shock, where the alterations are mediated by cytokines and tumor necrosis factor-alpha. CONCLUSIONS: The appearance of vasoplegic syndrome augmented operative morbidity with a consequent increased risk to the patient in the early postoperative period.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hipotensão/etiologia , Complicações Pós-Operatórias , Taquicardia/etiologia , Adulto , Idoso , Ponte Cardiopulmonar/efeitos adversos , Feminino , Seguimentos , Hemodinâmica/efeitos dos fármacos , Humanos , Hipotensão/tratamento farmacológico , Hipotensão/mortalidade , Masculino , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Estudos Retrospectivos , Taxa de Sobrevida , Síndrome , Taquicardia/tratamento farmacológico , Taquicardia/mortalidade , Vasoconstritores/uso terapêutico
3.
Ann Thorac Surg ; 66(1): 256-8, 1998 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9692480

RESUMO

This is a case of a patient with two saccular aneurysms in the descending aorta. Two self-expanding stents were inserted through an opening in the aortic arch, guided by the use of an Olympus endoscope, under profound hypothermia and total circulatory arrest. The bloodless field made possible the identification of the main thoracic branches, facilitating the positioning and deployment of both stents. Immediate postoperative recovery was excellent.


Assuntos
Angioscopia , Aneurisma da Aorta Torácica/terapia , Stents , Idoso , Angioscópios , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/patologia , Desenho de Equipamento , Parada Cardíaca Induzida , Humanos , Hipotermia Induzida , Masculino , Artéria Mesentérica Superior/patologia , Polietilenotereftalatos , Artéria Renal/patologia , Aço , Técnicas de Sutura
4.
Eur J Cardiothorac Surg ; 13(2): 135-43, 1998 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9583818

RESUMO

OBJECTIVE: To present long-term results after mitral valve replacement with stent mounted glutaraldehyde preserved aortic allografts in patients older than 15 years. The clinical support for this study was to combine the glutaraldehyde technique of biological tissue preservation with the advantages of allografts when compared to xenografts. This was demonstrated in previous studies using other methods of tissue processing. METHODS: Between September 1984 and November 1994, 70 patients aged 16-77 years (mean 35.4 years) underwent mitral valve replacement with this preserved and mounted allograft. Of these, 40 patients (57.2%) were aged 16-35 years and 15 (21.4%) were 20 years old or younger; 46 (65.7%) were females and 24 (34.3%) males. Single mitral valve replacement was performed in 60 patients and 10 were also subjected to other combined cardiac procedures. Human aortic valves were obtained during routine autopsy, processed in glutaraldehyde and mounted into flexible stents, using the same technique as that used for porcine bioprostheses. RESULTS: Hospital mortality was 1.4%. Total follow-up was 543.1 patient-years, corresponding to a mean follow-up of 7.9 years per patient. Echocardiography demonstrated a hemodynamic performance similar to porcine bioprostheses. Late mortality was 0.7 +/- 0.6% per patient-year and the causes were congestive heart failure in 2, prosthetic endocarditis in 1 and acute myocardial infarction in 1. The 12-year actuarial survival was 92.4 +/- 3.2%. The incidence of late complications was 5.2 +/- 1.2% per patient-year, including congestive heart failure, prosthetic endocarditis, periprosthetic leak, thromboembolic episodes, recurrence of rheumatic disease, coronary artery disease and allograft failure. Complications related to heart disease represented 2.8 +/- 0.6% and allobioprosthesis-related 2.4 +/- 0.5% per patient-year. The 12-year actuarial freedom from primary valve failure was 81.0 +/- 15.0%. The incidence of reoperations was 1.5 +/- 0.8% per patient-year and the main indication was prosthetic endocarditis. Other causes were periprosthetic leak, aortic insufficiency in the native aortic valve and allobioprosthesis dysfunction. Functional results demonstrated a significant improvement in patients clinical condition. CONCLUSION: This 12-year follow-up shows a very low incidence of primary allograft failure for patients older than 15 years undergoing mitral valve replacement, and much superior than our results with porcine bioprosthesis in the same age group. This supports our assumption that this investigational valve represents a new advance in cardiac valve surgery.


Assuntos
Valva Aórtica/transplante , Bioprótese , Próteses Valvulares Cardíacas , Adolescente , Adulto , Idoso , Endocardite/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Complicações Pós-Operatórias/mortalidade , Infecções Relacionadas à Prótese , Reoperação , Análise de Sobrevida , Transplante Homólogo , Resultado do Tratamento
5.
Ann Thorac Surg ; 65(4): 1135-7, 1998 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9564944

RESUMO

We describe a case of a patient who had a ruptured aorta repaired by femorofemoral bypass with an interposition graft and subsequently had a graft infection. The patient was taken to operation and the old graft was removed. It was replaced by a spiral great saphenous vein graft. The patient has been followed up for 36 months with computed tomographic scanning, which has shown that the vein graft has not dilated.


Assuntos
Aorta Torácica/cirurgia , Prótese Vascular/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Veia Safena/transplante , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/cirurgia , Adulto , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Ponte Cardiopulmonar/métodos , Artéria Femoral , Veia Femoral , Seguimentos , Humanos , Imipenem/uso terapêutico , Masculino , Polietilenotereftalatos , Desenho de Prótese , Infecções Relacionadas à Prótese/tratamento farmacológico , Reoperação , Veia Safena/diagnóstico por imagem , Tienamicinas/uso terapêutico , Tomografia Computadorizada por Raios X
6.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 8(3): 559-70, maio 1998. ilus, tab
Artigo em Português | LILACS | ID: lil-234307

RESUMO

As dissecçöes agudas da aorta representam uma entidade clínica não rara e de extrema gravidade. O diagnóstico precoce pode ser realizado e, para tanto, é necessário alto grau de suspeita clínica, que irá direcionar os exames a serem realizados com presteza, levando sempre em consideração a experiência da instituição com diversos exames complementares. Recomenda-se a utilização do método diagnóstico de maior acurácia e que proporcione menor estresse ao paciente. Assim que for levantada suspeita clínica de dissecção da aorta, deve ser instituída terapêutica clínica. Com a confirmação diagnóstica de diassecção envolvendo a aorta ascendente, é mandatório o tratamento cirúrgico imediato. Nos casos de dissecção da aorta descendente, o tratamento clínico é o de escolha, a menos que haja indícios de complicaçöes decorrentes da dissecção, Recentemente, novas perspectivas terapêuticas têm sido desenvolvidas e testadas com resultados bastante promissores, entre as quais destacam-se a técnica cirúrgica a tromba de elefante e o tratamento com prótese endovascular ("stent"), pela via percutânea, para correçäo das dissecçöes da aorta descendente.


Assuntos
Humanos , Aorta , Sistema Cardiovascular , Diagnóstico , Dissecação/classificação
7.
Eur J Cardiothorac Surg ; 12(4): 666-7, 1997 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9370416

RESUMO

Intracoronary stenting has now become a widely established method for treatment of complications of coronary angioplasty. The risk of stent embolism exists and if not retrieved, it may lead to thrombosis and coronary occlusion with myocardial infarction. We report a case of embolism of an undeployed intracoronary stent where there was failure of percutaneous attempts to pull back the stent, requiring surgical retrieval and simultaneous coronary artery bypass grafting, both without cardiopulmonary bypass.


Assuntos
Ponte Cardiopulmonar , Vasos Coronários , Corpos Estranhos/cirurgia , Stents , Adulto , Angioplastia Coronária com Balão/efeitos adversos , Ponte de Artéria Coronária , Doença das Coronárias/terapia , Vasos Coronários/lesões , Corpos Estranhos/etiologia , Humanos , Masculino
8.
Ann Thorac Surg ; 63(4): 1081-4, 1997 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9124909

RESUMO

BACKGROUND: The surgical treatment of acute complicated type B aortic dissection continues to be a challenge and is still associated with high morbidity and mortality rates. METHODS: Seventy consecutive patients with an acute type B aortic dissection underwent an elephant trunk procedure through a median sternotomy during deep hypothermic circulatory arrest. An endoprosthesis that was 22 to 24 mm in diameter was inserted through an incision in the arch and held in place with only proximal sutures. RESULTS: The mean arrest time was 31.4 +/- 8.7 minutes, and it was possible to adequately position the endoluminal graft in every patient. The procedure was done in association with other procedures in 13 patients. There were six in-hospital deaths not related to the endoprosthesis, and four late deaths. Late reoperation was necessary in 6 patients to manage leakage at the proximal suture line. CONCLUSIONS: The insertion of an endoprosthesis through the arch for the management of a complicated acute type B dissection has several advantages over the conventional thoracotomy approach. The hospital mortality rate in this series of 70 patients was 20%, and the actuarial 5-year survival rate was 62.5%. We consider the elephant trunk procedure the treatment of choice in patients with type B acute dissections, regardless of whether the dissection is complicated or not.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Prótese Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese
9.
Arq Bras Cardiol ; 68(1): 27-30, 1997 Jan.
Artigo em Português | MEDLINE | ID: mdl-9334456

RESUMO

PURPOSE: Our experience with surgical treatment of heart diseases in Indians living in the Amazon rain forest in primitive stages was reviewed. METHODS: From 1988 to 1995, 18 patients underwent cardiovascular surgical procedures at the São Paulo Hospital of the Escola Paulista de Medicina. Seven patients had valvar disease, nine congenital heart defects, one submitral aneurysm and one arrhythmia. Thirteen Indians came from tribes of the Amazon rain forest area: three from the Xavante, two from Waiapi, two from Tucano, two from Macuxi, two from Mayoruna, and one of each tribe of Xikrin, Guajajara, Terena, Surui, Galibi, Cinta-Larga and Pataxó. RESULTS: We performed 22 operations, with two hospital deaths. Follow-up was possible in 87.5% of cases, with one late death. The majority of cases were due to congenital heart defects and in this series it was noted the absence of operations to treat coronary artery disease. The incidence of valve disease was higher in accultured or semi-accultured Indians. CONCLUSION: The surgical treatment of cardiovascular disease has made possible to the surviving indians to return to and be accepted by their fellow tribesmen.


Assuntos
Cardiopatias/cirurgia , Indígenas Sul-Americanos , Adolescente , Adulto , Idoso , Brasil , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
11.
Ann Thorac Surg ; 58(5): 1532-4, 1994 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-7979691

RESUMO

A woman pregnant for 21 weeks underwent an emergency operation because of an aortic arch aneurysm that had ruptured into her left lung. Cardiopulmonary bypass and deep hypothermia were used and she needed 37 minutes of circulatory arrest at a core temperature of 19 degrees C. Both the mother and fetus survived, and a normal baby was delivered by cesarean section at the 39th week of gestation.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Parada Cardíaca Induzida , Hipotermia Induzida , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Emergências , Feminino , Humanos , Recém-Nascido , Gravidez
13.
Arq Bras Cardiol ; 62(3): 149-53, 1994 Mar.
Artigo em Português | MEDLINE | ID: mdl-7980074

RESUMO

PURPOSE: To report our experience of 12 years of myocardial revascularization without cardiopulmonary bypass (CPB) and to discuss its expanding surgical indications. METHODS: This technique was employed in 1090 patients, between September/81 and April/93, corresponding to 17.4% of all revascularized patients. Regarding gender, male patients were the majority (73.7%) and ages ranged from 28 to 86 year-old (mean 57). Chronic coronary insufficiency was the main indication (69.4%) and 18.9% of our global experience were operated on during acute ischemia. The average number of grafts per patient was 1.6 and internal mammary artery was utilized in 60.1% of patients. Left anterior descending coronary artery and right coronary artery were the coronary arteries most often treated. RESULTS: Our hospital mortality rate was 2.5% (28/1090) although it was 7% for patients over 70 years. The most common cause of death was cardiogenic shock after failed angioplasty. Postoperative complications included AMI in 4.8%, arrhythmias in 5.5% and pulmonary in 3.2%. Mean of any type of blood derivate utilization was 0.28 units/patients. CONCLUSION: Myocardial revascularization without CPB is a valid alternative in a selected cohort of patients and it is performed with low morbidity and mortality. Nowadays it represents an excellent tactical option for high-risk patients and in failed angioplasties.


Assuntos
Doença das Coronárias/cirurgia , Vasos Coronários/cirurgia , Revascularização Miocárdica , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Estudos Retrospectivos , Fatores Sexuais
14.
Arq Bras Cardiol ; 61(4): 237-9, 1993 Oct.
Artigo em Português | MEDLINE | ID: mdl-8155004

RESUMO

Air embolism during extracorporeal circulation is a life-threatening complication, requiring immediate response. During a recent case, brain damage was avoided using hypothermic retrograde cerebral perfusion, connecting the arterial line to superior vena cava cannula. Perfusion lasted 5 minutes at flow of 200ml/min. The patient had complete recovery and was discharged with normal neurologic status. The technique employed is described and steps for a face this accident are proposed.


Assuntos
Circulação Cerebrovascular , Embolia Aérea/terapia , Circulação Extracorpórea/efeitos adversos , Hipotermia Induzida , Complicações Intraoperatórias/terapia , Perfusão , Adulto , Embolia Aérea/etiologia , Feminino , Humanos , Veia Cava Superior
15.
Arq Bras Cardiol ; 61(2): 93-7, 1993 Aug.
Artigo em Português | MEDLINE | ID: mdl-8297228

RESUMO

PURPOSE: To test the hypothesis of respiratory support and to study the consequent hemodynamic alterations, we performed pumpless A-V ECMO using a 1.2m2 polipropylene hollow fiber membrane oxygenator, specially adapted from conventional model utilized in routine cardiac surgery. METHODS: Two canine groups of six dogs each were studied. Group 1 had normal lungs and group 2 acute respiratory failure induced by 0.035ml/kg intravenous oleic acid. The dogs were anesthetized and maintained in apnea with curare. Heparin was given in a single dose of 400U/kg. Gasimetric and hemodynamic parameters were monitored each 30 minutes during a 3 hour period. Then the oxygenator was discontinued and after 15 minutes a final arterial blood gas sample was taken for analysis. RESULTS: Blood samples at 3 hours have shown a mean PaO2 of 260.6mmHg in group 1 and 114.4mmHg in group 2 and PaCO2 of 54.3 and 56.2mmHg, respectively. After the oxygenator was discontinued PaCO2 levels increased to 161.6 and 193.7mmHg, respectively. The hemodynamic parameters shown few alterations. CONCLUSION: In both groups pumpless A-V ECMO was able to maintain gasimetric parameters within acceptable patterns and compatible with life, with few hemodynamic alterations. However, an adequate mean arterial blood pressure is needed to provide flow through membrane oxygenator.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Animais , Cães , Ácidos Oleicos , Pressão Parcial , Insuficiência Respiratória/induzido quimicamente
16.
Arq Bras Cardiol ; 60(3): 187-8, 1993 Mar.
Artigo em Português | MEDLINE | ID: mdl-8250749

RESUMO

The authors relate a case of 69 years old patient with unstable angina and left main coronary artery disease, who underwent aggressive mediastinal radiotherapy for lymphoproliferative syndrome 20 years ago and who needed urgent myocardial revascularization. Due to great calcification and heavily heart adherences it was performed 20 degrees C deep hypothermic circulatory arrest to avoid aortic clamping and to make the anastomosis with better exposition of the aorta and coronary arteries.


Assuntos
Parada Cardíaca Induzida , Mediastino/efeitos da radiação , Revascularização Miocárdica , Lesões por Radiação/complicações , Idoso , Humanos , Masculino
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