ABSTRACT
Objetivo - Relatar a experiência cirúrgica inicial de 4 casos com a utilizaçäo do auto-enxerto pulmonar para substituiçäo da valva aórtica. Métodos - Quatro pacientes masculinos, brancos, com idades entre 23 e 46 anos, portadoras de valvopatia aórtica, forma submetidos a substituiçäo da valva aórtica pelo auto-enxerto pulmonar pela técnica de substituiçäo total da raiz aórtica. Para a reconstituiçäo da via de saída do ventrículo direito foram utilizados homo-enxertos pulmonares e aórtico conservad em soluçäo de antibióticos. Todos tiveram controle pós-operatório com eco-doppler (ECO) e estudo hemodinâmica para a avaliaçäo da funçäo dos auto e homo-enxertos implantados. Resultados - Todos apresentaram excelentes evoluçäo pós-operatória, sem necessidade de drogas inotrópicas e em ritmo sinusal. Os resultados obtidos através do ECO e estudo hemodinâmico revelaram excelente fuçäo dos auto-enxertos implantados sem gradiente em 3 casos e gradiente médio residual de 15 mmHg em um. Näo se observou reguriaçäo aórtica em 3 casos e insuficiência leve no 4o. ano. Os homo-enxertos implantados no lado direito do coraçäo apresentaram excelentes funcäo, sem gradiente em 2 anos e gradiente médio de 6 e 8 mmHg nos outros dois. Conclusäo - A cirurgia do auto-enxerto pulmonar deve ser implantada de forma definitiva em nosso meio
Purpose - Report the initial surgical experience with four cases utilizing a pulmonary autograft for aortic valve replacement Methods - Four patients, all males, white, age between 23 and 46 years having aortic valve disease were submitted to aortic valve replacement with a pulmonary autograft using the root replacement technique. Right ventricular out flow tracts were reconstructed with antibiotic sterilized pulmonary or aortic homografts. All patients had control bidimensional eco-doppler (ECO) and hemodynamic study to evaluate the function of the implanted auto and homografts. Results - All patients had an excelent postoperative recovery, without the necessity of inotropic drugs. All presented in normal sinus rhythm. Postoperative ECO and hemodynamic studies revealed excelent function of the implanted autografts, without gradients in three and with a 15mmHg mean residual gradient in one case. There was no regurgitation in three cases and only trace aortic insufficiency in one. The right sided homografts also showed good function, with no gradient in two cases and mean systolic gradient of 6 and 8mmHg in the other two. Conclusion - The pulmonary autograft procedure should be implemented definitelly in our country
Subject(s)
Transplantation, Autologous , Aortic Valve/surgeryABSTRACT
In a study of the mechanism of Evans blue (EB) staining of experimental infarcts in rats, it has been reported that when the dye was injected iv before left coronary occlusion (LCO), it diffused centripetally from the periphery of the excluded vascular bed region (ExVB), i. e., the myocardial area with circulation interrupted by LCO, to its center. In the present study, we have attempted to identify the mechanism of this phenomenon. The animals were sacrificed at different times after EB injection, i.e., 10,20, and 30 min and 1,2,5, 4.5, 6, 16, 24 and 48 h. This phenomenon occurred from 4.5 up to 24 h after LCO and could not be ascribed to either collateral circulation or to venous backflow. We conclude that diffusion from one necrotic cell to another, beginning at the ill-perfused periphery of the ExVB (lateral and endocardial margins of the ExVB), and also at the epicardium (bathed by pericardial effusion rich in EB) is responsible for the production of the so-called "blue infarct"