Tratamento cirúrgico da endocardite em valva tricúspide por ressecção valvar / Surgical treatment of endocarditis in tricuspid valve by valvar resection

O tratamento cirúrgico da endocardite de valva tricúspide é controverso. Arbulu & Asfaw (7) indicam a exérese simples da valva tricúspide, podendo se optar ou não pelo implante da prótese em um segundo tempo. Outros autores, como Frater (8), indicam troca no mesmo tempo operatório e Évora et al. (9) a vegetectomia com plastia valvar. O objetivo do nosso trabalho é apresentar a evolução de 3 pacientes operados no período de 9/90 a 4/98, vítimas de endocardite isolada de valva tricúspide, através da técnica de exérese sem substituição valvar. Nenhum dos pacientes fazia uso de drogas injetáveis e foram operados em franca sepse. Um paciente faleceu devido a grave quadro de choque séptico e os outros 2 estão evoluindo em classe I e II da NYHA.

Tratamento cirúrgico em dois tempos do aneurisma toracoabdominal roto com prótese intraluminal sem sutura / Two-stage surgical management of ruptured thoracoabdominal aneurysm by intraluminal prosthesis without suture

The surgical management of thoracoabdominal aneurysms requires thoracophrenic laparotomy, prolonged periods of aortic clamping with visceral ischemia, profuse bleeding leading to a difficult postoperative course with pulmonary, renal, neurological complications, coagulation disturbances and others. All this resulting in an elevated morbidity/mortality very often contraindicating it for the very elderly or those with prior respiratory, renal or cardiac symptoms. Rupture of this aneurysm greatly increases the already high rate of morbidity/mortality. Crawford and Borst have described a two-stage surgery with good results, for aneurysms that affect more than one segment of aorta. The objective of our report is to demonstrate a two-stage operation, employing an intraluminal prosthesis without suture. This procedure results in a less agressive surgery since it approaches only the ruptured segment of aorta, therefore, only one cavity is manipulated (thorax or abdomen). The anastomosis with intraluminal prosthesis greatly decreases the time necessary for clamping the aorta and consequently visceral ischemia and also reduces bleeding. The reduction of surgical aggression on these already severely ill patients yielded very good surgical results.