Lipoma de átrio direito / Lipoma of the right atrium

The patient is a 54-year-old asymptomatic male with a tumor in the right atrium that was diagnosed on transesophageal echocardiography and confirmed as a lipoma of the right atrium on computerized tomography. The patient underwent surgical repair with extracorporeal circulation. The tumor was resected, and its base of implantation in the atrium was repaired with a flap of bovine pericardium. The diagnosis of lipoma was confirmed on histopathological examination. Locating of the tumor with the aid of transesophageal echocardiography was very useful in the strategy of cannulation of the venae cava for installation of the circuit of extracorporeal circulation. The patient had a good postoperative evolution

Evoluçäo imediata de pacientes submetidos a aneurismectomia de ventrículo esquerdo / Short-term follow-up of patients after aneurysmectomy of the left ventricle

OBJECTIVE: Left ventricular aneurysm is a complication of myocardial infarction that can best be treated by reconstructive surgeries that can restore ventricular geometry. We analyzed immediate results in a group of consecutive patients who underwent surgical correction of left ventricular aneurysms. METHODS: From January '90 to August '99, 94 patients - mean age 58.4 (ranging from 36 to 73 years), 65 (69.1 percent) males and 9 ( 30.8 percent) females - were operated upon. Pre-operative ejection fraction ranged from 0.22 to 0.58 (mean = 0.52), and the aneurysm was located in the antero-lateral area in 90.4 percent of the cases. Functional class III and IV (NYHA) was present in 82 (87.2 percent) patients, and 12 (12.7 percent) were in functional class I and II. Congestive heart failure was the most frequent cause (77.6 percent), occurring in isolation in 24.4 percent or associated with coronary artery diseases in 53.2 percent. RESULTS: Short-term follow-up showed a 7.4 percent mortality, and low cardiac output was the main cause of death. Coming off pump was uneventful in 73 patients (77.6 percent), with a 3.2 percent mortality and with the use of inotropics in 20 (21.3 percent). One patient (1 percent) did not come off the pump. CONCLUSION: Surgical correction was adequate in the immediate follow-up of operated patients, and mortality was higher in patients with higher functional class

Cirurgia de revascularizaçäo do miocárdio através de minitoracotomia esquerda / Myocardial revascularization surgery trough a left minithoracotomy

Objetivo - Atualmente existe uma tendência mundial para realização de cirurgias através de incisões mínimas, denominadas minimamente invasivas, tornando o ato operatório cada vez menos agressivo. A introdução desta nota técnica possibilita a dissecção da artéria torácica interna esquerda (ATIE) e sua anastomose com a artéria interventricular anterior (AIA), através de uma minitoracotomia esquerda. Métodos - De maio/97, 11 portadores de insuficiência coronária, com lesão única e proximal da AIA, foram submetidos a revascularização do miocárdio (RM). A abordagem cirúrgica constitui de uma coracotomia ântero-lateral esquerda, de aproximadamente 10cm, através do 4§ espaço intercostal esquerdo, e nos últimos 6 casos com ressecção de parte da cartilagem da 4ª e 5ª costelas dissecção da ATIE, abertura e reparo do período adjacente à AIA. Todos pacientes receberam ponte única para AIA com enxerto da ATIE, sem auxílio de circulação extracorpórea (CEC). Resultados - A idade variou de 46 a 76 (média = 58.55) anos, sendo 10 (90,90 por cento) pacientes do sexo masculino e 1 (9,09 por cento) feminino. O tempo de permanência hospitalar variou de 4 a 8 (média de 5,2) dias. Nenhum paciente apresentou alteração eletrocardiográfica no pós-operatório imediato. Um paciente apresentou no controle, trombose no 1/3 distal da ATIE com comprometimento importante de fluxo e, outro, estenose ao nível da anastomose. sendo ambos submetidos a angioplastia com sucesso. Não houve mortalidade no grupo estudado. Conclusão - A ausência de mortalidade, sugere que a cirurgia de RM através de cirurgia minimamente invasiva, em grupos selecionados, é uma excelente alternativa de revascularização da AIA.

Operação de Fontan Modificada / Modification of the Fontan Operation

Nine-year-old female patient presented with cianosis since she was born, fatique and dyspnea when sucking. The diagnosis was univentricular heart with left ventricular morphology, transposition of the great arteries, moderate pulmonary valve stenosis and atrial septal defect. Submitted to surgical correction with superior vena cava-right pulmonary artery anastomosis, inferior vena cava anastomosis using lateral tunnel, with cardiopulmonary bypass. After surgical correction, the clinical and laboratorial (echocardiogram and cardiac catheterization) evaluation showed Fontan operation with good surgical results. Total cavopulmonary connection was proposed as a modification of the Fontan procedure that might have greater benefits than previous proposed techniques. The results demonstrate that this modification provides excellent early definitive treatment, increasing hemodynamic profile, with low morbidity and mortality, for a variety of complex congenital heart lesions.

Anomalia de Ebstein associada a comunicação interventricular / Ebstein's Anomaly Associated to Interventricular Septal Defect

Twelve-year-old patient, with congestive heart failure and mild, caused by Ebstein's anomaly with interventricular septal defect, was studied and submitted to surgical correction which consisted in covering the interventricular defect with a path of bovine pericardium and substituting for the tricuspid valve with a biological prosthesis (porcine). After surgical correction, the patient was submitted to strict clinical and laboratorial (echocardiogram and cardiac catheterization) evaluation which presented excellent adjustment of the cardiac antriums, with improvement of myocardial function index. The problems related to the diagnosis of the association of the Ebstein's anomaly with interventricular septal defect can be solved with a well done semiology, helped by accurate laboratorial procedures like echodopplercardiogram and cardiac catheterization. The total surgical correction can be achieved with results and, with this fact, change the natural development of the disease.