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Arq. bras. cardiol ; 116(1): 119-126, Jan. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1152966


Resumo Fundamento A ablação da taquicardia atrial (TA) com local de ativação mais precoce próxima ao feixe de His é um desafio, devido ao risco de bloqueio de AV completo por sua proximidade ao sistema de His-Purkinje (SHP). Uma alternativa para minimizar esse risco é posicionar o cateter na cúspide não coronária (CNC), que é anatomicamente contígua à região para-Hissiana. Objetivos O objetivo deste estudo foi fazer uma revisão de literatura e avaliar as características eletrofisiológicas, a segurança e o índice de sucesso de aplicação de radiofrequência (RF) por cateter na CNC para o tratamento de TA para-Hissiana em uma série de casos. Métodos Avaliamos retrospectivamente dez pacientes (Idade: 36±10 anos) que foram encaminhados para ablação de taquicardia paroxística supraventricular (TPSV) e haviam sido diagnosticados com TA focal para-Hissiana confirmada por manobras eletrofisiológicas clássicas. Para a análise estatística, um P valor d <0.05 foi considerado estatisticamente significativo. Resultados A ativação atrial mais precoce na posição His foi de 28±12ms da onda P, e a CNC foi 3±2ms antes da posição His, sem evidência de potencial His em todos os pacientes. Foi aplicada RF à CNC (cateter de ponta de 4-mm; 30W, 55°C) e a taquicardia foi interrompida em 5±3s sem aumento no intervalo PR ou evidência de um ritmo juncional. Os testes eletrofisiológicos não induziram novamente a taquicardia em 9/10 pacientes. Não houve complicações em nenhum procedimento. Durante o período de acompanhamento de 30 ± 12 meses, nenhum paciente apresentou recorrência de taquicardia. Conclusão O tratamento percutâneo de TA para-Hissiana por meio de CNC é uma estratégia segura e eficiente, tornando-se uma opção interessante para o tratamento de arritmia complexa. (Arq Bras Cardiol. 2021; 116(1):119-126)

Abstract Background Atrial tachycardia (AT) ablation with earliest activation site close to the His-Bundle is a challenge due to the risk of complete AV block by its proximity to His-Purkinje system (HPS). An alternative to minimize this risk is to position the catheter on the non-coronary cusp (NCC), which is anatomically contiguous to the para-Hisian region. Objectives The aim of this study was to perform a literature review and evaluate the electrophysiological characteristics, safety, and success rate of catheter-based radiofrequency (RF) delivery in the NCC for the treatment of para-Hisian AT in a case series. Methods This study performed a retrospective evaluation of ten patients (Age: 36±10 y-o) who had been referred for SVT ablation and presented a diagnosis of para-Hisian focal AT confirmed by classical electrophysiological maneuvers. For statistical analysis, a p-value of <0.05 was considered statistically significant. Results The earliest atrial activation at the His position was 28±12ms from the P wave and at the NCC was 3±2ms earlier than His position, without evidence of His potential in all patients. RF was applied on the NCC (4-mm-tip catheter; 30W, 55ºC), and the tachycardia was interrupted in 5±3s with no increase in the PR interval or evidence of junctional rhythm. Electrophysiological tests did not reinduce tachycardia in 9/10 of patients. There were no complications in all procedures. During the 30 ± 12 months follow-up, no patient presented tachycardia recurrence. Conclusion The percutaneous treatment of para-Hisian AT through the NCC is an effective and safe strategy, which represents an interesting option for the treatment of this complex arrhythmia. (Arq Bras Cardiol. 2021; 116(1):119-126)

Humans , Adult , Tachycardia, Supraventricular/therapy , Catheter Ablation , Bundle of His/surgery , Retrospective Studies , Electrocardiography , Heart Atria/surgery , Middle Aged
Rev. bras. cir. cardiovasc ; 35(5): 841-843, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137322


Abstract Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.

Humans , Female , Aged , Atrial Fibrillation/surgery , Atrial Fibrillation/complications , Catheter Ablation/methods , Adenocarcinoma, Mucinous/surgery , Adenocarcinoma, Mucinous/complications , Adenocarcinoma, Mucinous/diagnostic imaging , Pneumonectomy/methods , Pulmonary Veins/surgery , Thoracoscopy , Tomography, X-Ray Computed , Treatment Outcome , Atrial Appendage/surgery , Heart Atria/surgery , Lung Neoplasms/surgery , Lung Neoplasms/complications , Lung Neoplasms/diagnostic imaging
Rev. bras. cir. cardiovasc ; 35(3): 399-401, May-June 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137256


Abstract Primary malignant neoplasms of the heart are rare. Cardiac rhabdomyosarcoma is the second most common primary sarcoma. We report a rare case of a 49-year-old woman with a huge biatrial cardiac rhabdomyosarcoma treated by performing surgical resection followed by salvage chemotherapy for local recurrence. Cardiac sarcoma that occupy both atria are extremely rare. Although the prognosis of cardiac rhabdomyosarcoma is dismal, surgical resection should be recommended as a first line therapy to clarify the diagnosis and to relieve symptoms associated with the tumor.

Humans , Female , Middle Aged , Rhabdomyosarcoma/surgery , Rhabdomyosarcoma/diagnostic imaging , Heart Neoplasms/surgery , Heart Neoplasms/diagnostic imaging , Heart Atria/surgery , Heart Atria/diagnostic imaging , Neoplasm Recurrence, Local
Rev. bras. cir. cardiovasc ; 34(6): 723-728, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057508


Abstract Introduction: Adrenocortical and renal cell carcinomas rarely invade the right atrium (RA). These neoplasms need surgical treatment, are very aggressive and have poor prognostic and surgical outcomes. Case series: We present a retrospective cohort of nine cases of RA invasion through the inferior vena cava (four adrenocortical carcinomas and five renal cell carcinomas). Over 13 years (2002-2014), nine patients were operated in collaboration with the team of urologists. Surgery was possible in all patients with different degrees of technical difficulty. All patients were operated considering the imaging examinations with the aid of CPB. In all reported cases (renal or suprarenal), the decision to use CPB with deep hypothermic circulatory arrest (DHCA) on surgical strategy was decided by the team of urological and cardiac surgeons. Conclusion: Data retrospectively collected from patients of public hospitals reaffirm: 1) Low incidence with small published series; 2) The selected cases did not represent the whole historical casuistry of the hospital, since they were selected after the adoption of electronic documentation; 3) Demographic data and references reported in the literature were presented as tables to avoid wordiness; 4) The series highlights the propensity to invade the venous system; 5) Possible surgical treatment with the aid of CPB in collaboration with the urology team; 6) CPB with DHCA is a safe and reliable option; 7) Poor prognosis with disappointing late results, even considering the adverse effects of CPB on cancer prognosis are expected but not confirmed.

Humans , Male , Female , Child, Preschool , Middle Aged , Aged, 80 and over , Vena Cava, Inferior/surgery , Carcinoma, Renal Cell/pathology , Heart Atria/pathology , Kidney Neoplasms/pathology , Prognosis , Carcinoma, Renal Cell/surgery , Cardiopulmonary Bypass , Tomography, X-Ray Computed , Retrospective Studies , Treatment Outcome , Heart Atria/surgery , Kidney Neoplasms/surgery , Neoplasm Invasiveness
Rev. bras. cir. cardiovasc ; 34(5): 525-534, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042053


Abstract Objective: To evaluate the factors impacting on the conversion to sinus rhythm and on the postoperative rhythm findings in the six-month follow-up period of a mitral valve surgery combined with cryoablation Cox-Maze III procedure, in patients with atrial fibrillation. Methods: In this study, we evaluated 80 patients who underwent structural valve disease surgery in combination with cryoablation. Indications for the surgical procedures were determined in the patients according to the presence of rheumatic or non-rheumatic structural disorders in the mitral valve as evaluated by echocardiography. Cox-Maze III procedure and left atrial appendix closure were applied. Results: The results of receiver operating characteristics analysis indicated that the rate of conversion to the sinus rhythm was significantly higher in patients with left atrial diameters ≥ 45.5 mm and with ejection fraction (EF) ≥ 48.5%. However, the statistical differences disappeared in the sixth month. Thromboembolic (TE) events were seen only in three patients in the early period and no more TE events occurred in the six-month follow-up period. Conclusion: The EF and the preoperative left atrial diameter were determined to be the factors impacting on the conversion to sinus rhythm in patients who underwent mitral valve surgery in combination with cryoablation. Mitral valve surgery in combination with ablation for atrial fibrillation does not affect mortality and morbidity in the experienced health centers; however, it remains controversial whether it will provide additional health benefits to the patients compared to those who underwent only mitral valve surgery.

Humans , Male , Female , Adult , Middle Aged , Atrial Fibrillation/surgery , Atrial Fibrillation/physiopathology , Heart Valve Prosthesis Implantation/methods , Cryosurgery/methods , Heart Rate/physiology , Mitral Valve/surgery , Postoperative Period , Reference Values , Atrial Fibrillation/prevention & control , Time Factors , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Treatment Outcome , Electrocardiography , Preoperative Period , Heart Atria/surgery , Mitral Valve/physiopathology
Rev. bras. cir. cardiovasc ; 34(3): 285-289, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013466


Abstract Introduction: This study aimed to evaluate the feasibility and efficacy of robotically assisted, minimally invasive mitral valve surgery combined with left atrial reduction for mitral valve surgery and elimination of atrial fibrillation (AF). Methods: Eleven patients with severe mitral regurgitation, AF, and left atrial enlargement who underwent robotic, minimally invasive surgery between May 2013 and March 2018 were evaluated retrospectively. The da Vinci robotic system was used in all procedures. The patients' demographic data, electrocardiography (ECG) findings, and pre- and postoperative transthoracic echocardiography findings were analyzed. During follow up ECG was performed at postoperative 3, 6, and 12 months additionally at the 3rd month trans thoracic echocardiography was performed and functional capacity was also evaluated for all patients. Results: All patients underwent robotic-assisted mitral valve surgery with radiofrequency ablation and left atrial reduction. Mean age was 45.76±16.61 years; 7 patients were male and 4 were female. Preoperatively, mean left atrial volume index (LAVI) was 69.55±4.87 mL/m2, ejection fraction (EF) was 54.62±8.27%, and pulmonary artery pressure (PAP) was 45.75±9.42 mmHg. Postoperatively, in hospital evaluation LAVI decreased to 48.01±4.91 mL/m2 (P=0.008), EF to 50.63±10.13% (P>0.05), and PAP to 39.02±3.11 mmHg (P=0.012). AF was eliminated in 8 (72%) of the 11 patients at the 1st postoperative month. There were significant improvements in functional capacity and no mortality during follow-up. Conclusion: Left atrial reduction and radiofrequency ablation concomitant with robotically assisted minimally invasive mitral valve surgery can be performed safely and effectively to eliminate AF and prevent recurrence.

Humans , Male , Female , Adult , Middle Aged , Atrial Fibrillation/surgery , Robotic Surgical Procedures/methods , Radiofrequency Ablation/methods , Heart Atria/surgery , Mitral Valve/surgery , Time Factors , Echocardiography , Reproducibility of Results , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Statistics, Nonparametric
Rev. bras. ter. intensiva ; 31(2): 262-265, abr.-jun. 2019. graf
Article in Portuguese | LILACS | ID: biblio-1013780


RESUMO O traumatismo cardíaco é comum em acidentes com veículos automotores. Uma mulher com 50 anos de idade foi transportada para nosso hospital após sofrer múltiplos traumatismos em um acidente de automóvel quando dirigia em alta velocidade. Após admissão à unidade de terapia intensiva, uma ultrassonografia cardíaca revelou ruptura traumática de músculo papilar da valva tricúspide e forame oval patente, enquanto se observou, no exame físico, o sinal de Lancisi. Foi realizado tratamento cirúrgico com anuloplastia da valva e fechamento do forame oval patente; durante o ato cirúrgico, diagnosticou-se ruptura oculta do átrio direito.

ABSTRACT Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.

Humans , Female , Papillary Muscles/injuries , Tricuspid Valve/injuries , Foramen Ovale, Patent/etiology , Heart Atria/surgery , Papillary Muscles/surgery , Tricuspid Valve/surgery , Accidents, Traffic , Foramen Ovale, Patent/surgery , Foramen Ovale, Patent/diagnosis , Cardiac Valve Annuloplasty/methods , Heart Atria/injuries , Heart Injuries/surgery , Heart Injuries/diagnosis , Heart Injuries/etiology , Middle Aged
Rev. bras. cir. cardiovasc ; 34(1): 104-106, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985251


Abstract Congenital aneurysm or enlargement of the right atrium is a rare condition. Two children operated on at the age of 14 months and 11 years old for congenital aneurysm of the right atrium are reported. Both presented cardiomegaly and symptoms of paroxysmal supraventricular tachycardia. Diagnosis was established by echocardiography. Surgical resection was successful. Both patients are free of symptoms and their chest X-ray and echocardiogram are normal. The first patient is now in her 17th postoperative year. The patients' evolution suggests that the surgery is a curative procedure.

Humans , Male , Female , Infant , Adolescent , Heart Aneurysm/surgery , Heart Aneurysm/congenital , Echocardiography , Radiography, Thoracic , Treatment Outcome , Dilatation, Pathologic , Electrocardiography , Heart Aneurysm/diagnostic imaging , Heart Atria/abnormalities , Heart Atria/surgery , Heart Atria/diagnostic imaging
Arq. bras. cardiol ; 110(4): 312-320, Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-888058


Abstract Background: Atrial fibrillation frequently affects patients with valvular heart disease. Ablation of atrial fibrillation during valvular surgery is an alternative for restoring sinus rhythm. Objectives: This study aimed to evaluate mid-term results of successful atrial fibrillation surgical ablation during valvular heart disease surgery, to explore left atrium post-ablation mechanics and to identify predictors of recurrence. Methods: Fifty-three consecutive candidates were included. Eligibility criteria for ablation included persistent atrial fibrillation <10 years and left atrium diameter < 6.0 cm. Three months after surgery, echocardiogram, 24-hour Holter monitoring and electrocardiograms were performed in all candidates who maintained sinus rhythm (44 patients). Echo-study included left atrial deformation parameters (strain and strain rate), using 2-dimensional speckle-tracking echocardiography. Simultaneously, 30 healthy individuals (controls) were analyzed with the same protocol for left atrial performance. Significance was considered with a P value of < 0.05. Results: After a mean follow up of 17 ± 2 months, 13 new post-operative cases of recurrent atrial fibrillation were identified. A total of 1,245 left atrial segments were analysed. Left atrium was severely dilated in the post-surgery group and, mechanical properties of left atrium did not recover after surgery when compared with normal values. Left atrial volume (≥ 64 mL/m2) was the only independent predictor of atrial fibrillation recurrence (p = 0.03). Conclusions: Left atrial volume was larger in patients with atrial fibrillation recurrence and emerges as the main predictor of recurrences, thereby improving the selection of candidates for this therapy; however, no differences were found regarding myocardial deformation parameters. Despite electrical maintenance of sinus rhythm, left atrium mechanics did not recover after atrial fibrillation ablation performed during valvular heart disease surgery.

Resumo Fundamento: A fibrilação atrial frequentemente afeta pacientes com doenças das valvas cardíacas. A ablação da fibrilação atrial durante a cirurgia das válvulas é uma alternativa para restaurar o ritmo sinusal. Objetivos: Este estudo teve como objetivos avaliar resultados em médio prazo da ablação cirúrgica bem sucedida da FA durante cirurgia para doença valvar, para explorar a mecânica do AE após a ablação e identificar preditores de recorrência. Métodos: Foram incluídos 53 candidatos consecutivos. Os critérios de elegibilidade para ablação foram fibrilação atrial persistente <10 anos e diâmetro do átrio esquerdo < 6 cm. Três meses após a cirurgia, foram realizados ecocardiografia, Holter por 24 horas, e eletrocardiografias em todos os candidatos que mantiveram o ritmo sinusal (44 pacientes). O estudo eco incluiu parâmetros de deformação ao átrio esquerdo (strain e taxa de strain) usando ecocardiografia bidimensional com speckle tracking. Simultaneamente, 30 indivíduos sadios (controles) foram analisados com o mesmo protocolo para o desempenho do átrio esquerdo. Um valor de P < 0,05 foi considerado significativo. Resultados: Após um período médio de acompanhamento de 17 ± 2 meses, 13 novos casos de fibrilação atrial no pós-operatório foram identificados. Um total de 1245 segmentos do átrio esquerdo foi analisado. O grupo pós-cirúrgico apresentou dilatação grave do átrio esquerdo, e as propriedades mecânicas do átrio esquerdo não se recuperaram após a cirurgia quando comparadas com valores normais. O volume do átrio esquerdo (≥ 64 mL/m2) foi o único preditor independente de recorrência de fibrilação atrial (p = 0,03). Conclusões: O volume do átrio esquerdo foi maior nos pacientes com fibrilação atrial recorrente, e desponta como o principal preditor de recorrência, melhorando, assim, a seleção de candidatos para essa terapia. No entanto, não foram encontradas diferenças em relação aos parâmetros de deformação do miocárdio. Apesar da manutenção elétrica do ritmo sinusal, a função mecânica do átrio esquerdo não se recuperou após a ablação da fibrilação atrial realizada durante a cirurgia para doença da valva cardíaca.

Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/surgery , Atrial Fibrillation/diagnostic imaging , Cryosurgery/methods , Heart Valve Diseases/surgery , Heart Valve Diseases/diagnostic imaging , Recurrence , Atrial Fibrillation/physiopathology , Time Factors , Echocardiography/methods , Prospective Studies , Reproducibility of Results , Risk Factors , Follow-Up Studies , Atrial Function, Left/physiology , Treatment Outcome , Statistics, Nonparametric , Electrocardiography , Heart Atria/surgery , Heart Atria/physiopathology , Heart Atria/diagnostic imaging , Heart Rate/physiology , Heart Valve Diseases/physiopathology
Rev. bras. cir. cardiovasc ; 32(6): 542-544, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-897956


Abstract Left atrial dissection is a rare factor that may cause left ventricular assist device obstruction. Prompt diagnosis and surgical repair are essential. This case report describes our experience and a successful surgical management in a patient after HeartMate 3 implantation and mitral valve inflow obstruction due to a left atrial dissection.

Humans , Male , Adult , Atrial Fibrillation/surgery , Heart-Assist Devices/adverse effects , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/diagnostic imaging , Heart Atria/surgery , Atrial Fibrillation/diagnostic imaging , Echocardiography , Ventricular Dysfunction, Left/surgery , Extracorporeal Circulation , Heart Atria/diagnostic imaging , Heart Failure , Cardiac Surgical Procedures/methods
Rev. bras. cir. cardiovasc ; 32(5): 438-441, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-897935


Abstract The median sternotomy remains the standard approach in cardiovascular surgery but, in some conditions, it can be considered difficult to perform, especially in patients with history of esophagectomy. This case report describes a successful resection of a left atrial myxoma through a right anterolateral thoracotomy approach in a patient with a previous retrosternal gastric tube reconstruction. The decision for the best surgical approach was made after a heart surgery team discussion. Through this surgical access, a safe and excellent exposure of the left atrium was possible, and a complete resection of the myxoma was performed without any injury to the gastric tube.

Humans , Male , Aged , Heart Neoplasms/surgery , Myxoma/surgery , Thoracotomy , Gastrostomy , Treatment Outcome , Heart Atria/surgery , Heart Atria/pathology
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 30(3): f:99-l:103, jul.-set. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-877281


Introdução: A lidocaína é o anestésico local mais amplamente utilizado durante os procedimentos de implante de marcapasso, principalmente pelo seu perfil seguro e baixo custo. Atualmente, nosso grupo vem utilizando a ropivacaína no lugar da lidocaína. Essa substância é um anestésico local do tipo amida de longa duração com efeitos anestésico e analgésico, proporcionando, assim, maior conforto aos pacientes. Método: O presente estudo transversal foi realizado em 1.178 pacientes que necessitavam de implante de marcapasso dupla-câmara. Durante o implante do dispositivo eletrônico implantável, 450 pacientes foram submetidos a anestesia do músculo peitoral (direito ou esquerdo) com 20 ml de lidocaína 2% sem vasoconstritor, enquanto 728 pacientes foram submetidos a anestesia local na mesma região com 20 ml de ropivacaína 7,5%. Avaliamos o tempo de ausência da sensação dolorosa após o implante do marcapasso e a segurança relacionada ao uso de lidocaína vs. ropivacaína. Resultados: A ausência de dor após o implante avaliada em horas demonstrou que a ropivacaína promove efeito anestésico de 6,5 ± 0,4 horas ao término do procedimento, enquanto a lidocaína só foi capaz de aliviar a dor durante 2,3 ± 0,6 horas (P < 0,0001). Em relação à segurança dos fármacos, a taxa de complicação anestésica foi muito semelhante: 15 pacientes (2,03%) com utilização de ropivacaína e 12 pacientes (2,67%) com uso de lidocaína (P = 0,5482). Conclusão: A ropivacaína parece ser tão segura e mais eficaz que a lidocaína durante a anestesia local, tendo efeitos analgésicos mais prolongados após implante de dispositivos cardíacos eletrônicos implantáveis

Background: Lidocaine is the most widely used local anesthetic during pacemaker implantation procedures, mainly because of its safe profile and low cost. Currently, our group has been using ropivacaine instead of lidocaine. This substance is a long-acting amide-type local anesthetic with anesthetic and analgesic effects, thus providing greater patient comfort. Method: The present cross-sectional study was performed in 1,178 patients who required a dual-chamber pacemaker implantation. During implantation of the implantable electronic device 450 patients underwent right or left pectoral muscle anesthesia with 20 mL of 2% lidocaine without vasoconstrictor, while 728 patients underwent local anesthesia in the same region with 20 mL of 7.5% ropivacaine. We evaluated the time of absence of the pain after the implantation of the pacemaker and the safety of the use of lidocaine vs. ropivacaine. Results: The absence of post-implant pain evaluated in hours showed that ropivacaine promotes an anesthetic effect of 6.5 ± 0.4 hours at the end of the procedure, whereas lidocaine was only able to relieve pain for 2.3 ± 0.6 hours (P < 0.0001). Regarding drug safety, the rate of anesthetic complication was very similar: 15 patients (2.03%) with ropivacaine and 12 patients (2.67%) with lidocaine (P = 0.5482). Conclusion: Ropivacaine seems to be as safe and effective as lidocaine during local anesthesia and has longer analgesic effects after the implantation of implantable electronic cardiac devices

Humans , Male , Female , Middle Aged , Anesthesia, Local/methods , Lidocaine/administration & dosage , Pacemaker, Artificial , Prostheses and Implants , Analysis of Variance , Arrhythmias, Cardiac , Atrioventricular Block , Cross-Sectional Studies , Echocardiography/methods , Electrocardiography/methods , Heart Atria/surgery , Heart Ventricles/surgery , Sinoatrial Node , Stroke Volume
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(1): 39-48, jan.-mar. 2017. ilus
Article in Portuguese | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-836944


A comunicação interatrial tipo ostium secundum (CIA OS) é uma cardiopatia congênita relativamente frequente, que causa repercussão hemodinâmica para o ventrículo direito, com sobrecarga volumétrica e dilatação da câmara. A maioria dos pacientes é assintomática, porém sintomas podem aparecer depois da segunda década de vida. O tratamento eletivo é usualmente realizado próximo ao quinto ano de vida, podendo ser indicado mais precocemente quando houver sintomatologia exuberante. O fechamento transcateter usando uma prótese de duplo disco é bem estabelecido como a primeira escolha de tratamento para a maioria dos pacientes de anatomia favorável. Foi comprovado que o forame oval patente (FOP) está associado à acidente vascular cerebral isquêmico (AVCI) em pacientes com poucos ou nenhum fator de risco de doença cardiovascular. Recentemente, foi demonstrado que a oclusão transcateter do FOP é superior ao tratamento clínico para prevenir recorrências de AVCI nessa população, em um estudo randomizado com acompanhamento clínico de longo prazo. Este manuscrito revisa as atuais indicações, critérios de seleção do paciente e o seguimento clínico dos pacientes com CIA OS e FOP submetidos ao tratamento transcateter

Ostium secundum atrial septal defect (OS-ASD) is a relatively frequent congenital heart defect that causes hemodynamic burden on the right ventricle with volume overload and chamber dilatation. Most patients are asymptomatic, however symptoms can appear after the second decade of life. Elective treatment is usually performed around the fifth year of life, and may be occasionally indicated earlier if there are exuberant symptoms. Transcatheter closure using a double disc device is well established as the first choice of treatment for most patients with suitable anatomy. Patent foramen ovale (PFO) has been shown to be associated with ischemic stroke in patients with no or limited risk factors for cardiovascular disease. It was recently demonstrated in a randomized trial with long-term follow-up that transcatheter closure of PFO is superior to medical treatment for preventing recurrences of stroke in this patient population. This manuscript reviews the current indications, patient selection criteria, and long-term follow-up in patients with OS-ASD and PFO submitted to transcatheter closure

Humans , Male , Female , Child , Foramen Ovale, Patent/therapy , Heart Atria/surgery , Heart Defects, Congenital/physiopathology , Heart Septal Defects, Atrial/therapy , Heart Ventricles , Thoracic Surgery , Echocardiography/methods , Cardiac Catheterization/methods , Heparin/administration & dosage , Aspirin/administration & dosage , Risk Factors , Treatment Outcome , Femoral Artery , Cardiac Catheters , Heart/physiopathology
Arch. cardiol. Méx ; 86(2): 123-129, abr.-jun. 2016. tab, graf
Article in Spanish | LILACS | ID: biblio-838361


Resumen Los resultados a largo plazo del procedimiento de maze con criotermia en pacientes con fibrilación auricular durante procedimientos quirúrgicos concomitantes son todavía inciertos. Método Entre 2006 y 2011, 150 pacientes consecutivos con fibrilación auricular persistente y cardiopatía asociada fueron sometidos a cirugía de ablación mediante criotermia asociada a cirugía concomitante. El procedimiento de Cox-Maze biauricular fue realizado en 67 pacientes y ablación aislada de la aurícula izquierda en 83 pacientes. Los resultados a tres años en estos grupos fueron comparados mediante seguimiento clínico, electrocardiográfico y mediante Holter 24 horas y ecocardiografía con medición de la onda A transmitral al mes, a los 6 y 12 meses y después anualmente. Resultados Los pacientes sometidos a ablación Cox-Maze presentaron una libertad de fibrilación auricular del 97, 94, 89, 80 y 54% a 1, 6, 12, 24 y 36 meses respectivamente. En el seguimiento de los 12 meses estas diferencias resultaron significativas (p < 0.05). Como factor de riesgo de recurrencia de fibrilación auricular se identificó la ablación aislada de la aurícula izquierda. Conclusiones La ablación mediante criotermia tiene un elevado porcentaje de éxitos a dos años; la recurrencia se incrementa a partir de entonces independientemente de la técnica realizada. Para el tratamiento de la fibrilación auricular persistente asociada a otra patología quirúrgica cardiaca se debe realizar un tratamiento intensivo mediante ablación biauricular.

Abstract The long-term results of cryomaze in patients with longstanding persistent atrial fibrillation during concomitant surgical procedures are still uncertain. Methods Between 2006 and 2011, 150 consecutive patients with associated long-lasting permanent atrial fibrillation and associated heart disease underwent heart surgery were treated by biatrial Cox-Maze (63 patients) or by isolated endocardial or epicardial left atrial cryoablation (83 patients) concomitantly. The results at 3 years in these groups were compared with clinical monitoring, electrocardiography, 24-hour Holter, and echocardiography with measurement of the transmitral A wave at 1, 6 and 12 months and annually thereafter in all patients. Results Patients undergoing Cox-Maze IV ablation presented rates of freedom from atrial fibrillation of 97, 94, 89, 80 and 54% at 1, 6, 12, 24 and 36 months, respectively. In the 12-month follow-up, these differences were significant (p < .05). The independent risk factors of atrial fibrillation recurrence was isolated ablation of left atrium. Conclusions Atrial fibrillation by cryothermia ablation had a high success rate before 2 years postoperatively. Recurrence of atrial fibrillation increased thereafter regardless of the technique used, although it was more intense and developed earlier in cases of monoatrial ablation. For the treatment of other long-lasting permanent atrial fibrillation cardiac surgery-associated pathology, an aggressive biatrial treatment with Cox maze ablation should be performed.

Humans , Male , Female , Aged , Atrial Fibrillation/surgery , Cryosurgery/methods , Heart Atria/surgery , Recurrence , Time Factors , Prospective Studies , Cardiac Surgical Procedures/methods
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 29(2): 49-56, mai.-jun.2016. tab, graf
Article in Portuguese | LILACS | ID: lil-794470


O presente estudo examinou pacientes submetidos a implante de marcapasso dupla-câmara em decorrência de doença do nó sinusal ou bloqueio atrioventricular de 3o ou 2o graus do tipo 2 na doençarenal crônica em estágios 2, 3 e 4. O estudo teve como objetivo registrar os eventos arrítmicos durante 12 mesesde acompanhamento e comparar a incidência e a gravidade deles nas diferentes fases da doença renal crônica.Método: No total, 305 pacientes foram avaliados a cada 4 meses até 12 meses de acompanhamento. Os eventosarrítmicos foram avaliados em cada visita de acompanhamento. Resultados: Dentro do mesmo grupo de estágio da doença renal crônica não houve diferença entre as causas doença do nó sinusal e bloqueio atrioventricular, a respeito da ocorrência de qualquer arritmia. No entanto, menor incidência de taquicardia atrial/fibrilação atrial foi observada para todas as comparações entre todos os pacientes e os mesmos subgrupos em pacientes no estágio 2 (total: 58%; doença do nó sinusal: 63%; bloqueio atrioventricular: 51%), comparativamente aos estágios 3 (total:87%, P < 0,0001; doença do nó sinusal: 89%, P = 0,0020; bloqueio atrioventricular: 84%, P = 0,0019) e 4 (total: 85%, P < 0,0001; doença do nó sinusal: 81%, P = 0,0409; bloqueio atrioventricular: 90%, P < 0,0001). Em relação à taquicardia ventricular não sustentada/taquicardia ventricular sustentada, foi observada incidência mais elevada para todas as comparações entre todos os pacientes e os mesmos subgrupos em pacientes no estágio 4 (total: 32%; doença do nó sinusal: 16%; bloqueio atrioventricular: 16%), comparativamente aos estágios 3 (total: 11%, P = 0,0007; doença do nó sinusal: 9%, P = 0,0110; bloqueio atrioventricular: 14%, P = 0,0441) e 2 (total: 3%, P < 0,0001; doença do nó sinusal: 3%, P < 0,0001; bloqueio atrioventricular: 4%, P < 0,0001). Conclusão: Nossos resultados sugerem que quanto mais avançado o estágio da doença renal crônica maior a incidência de arritmias malignas...

The present study evaluated patients who had received a dual chamber pacemaker implant due to sinus node disease or 3rd/2nd degree type 2 atrioventricular block in chronic kidney disease stages 2, 3 and 4. The study was aimed at registering arrhythmic events for 12 months of follow-up and comparing their incidence and severity in different stages of chronic kidney disease. Method: Three hundred and five patients were evaluated every 4 months up to 12 months of follow-up. Arrhythmic events were assessed at each follow-up visit. Results: Within the same chronic kidney disease stage group there was no difference between the causes ofsinus node disease and atrioventricular block for the occurrence of any arrhythmia. However, a lower incidence of atrial fibrillation/tachycardia was observed for all comparisons among all patients and the same subgroups in stage 2 patients (total: 58%; sinus node disease: 63%; atrioventricular block: 51%) compared to stages 3 (total: 87%,P < 0.0001; sinus node disease: 89%, P = 0.0020; atrioventricular block: 84%, P = 0.0019) and 4 (total: 85%,P < 0.0001; sinus node disease: 81%, P = 0.0409; atrioventricular block: 90%, P < 0.0001). Regarding nonsustained/ sustained ventricular tachycardia, a higher incidence was observed for all comparisons among all patients and the same subgroups in stage 4 patients (total: 32%; sinus node disease: 16%; atrioventricular block: 16%) compared to stages 3 (total: 11%, P = 0.0007; sinus node disease: 9%, P = 0.0110; atrioventricular block: 14%, P = 0.0441) and 2 (total: 3%, P < 0.0001; sinus node disease: 3%, P < 0.0001; atrioventricular block: 4%,P < 0.0001). Conclusion: Our findings suggest that the more advanced the stage of chronic kidney disease, thegreater the incidence of malignant arrhythmias...

Humans , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/diagnosis , Renal Insufficiency, Chronic/complications , Sinoatrial Node/physiopathology , Pacemaker, Artificial , Patients , Heart Atria/surgery , Sinoatrial Block/physiopathology , Cohort Studies , Risk Factors , Statistical Analysis , Treatment Outcome , Heart Ventricles/surgery
ABC., imagem cardiovasc ; 29(1): 28-32, jan.-mar.2016. ilus
Article in Portuguese | LILACS | ID: lil-777624


A dilatação idiopática do átrio direito (AD) é uma condiçãorara, frequentemente assintomática, com tratamentocontroverso, podendo se restringir ao acompanhamentoclínico ou tratamento cirúrgico. Descrevemos aqui um caso deum adolescente com achados ecocardiográficos compatíveiscom essa doença...

Humans , Male , Adult , Adolescent , Heart Atria/abnormalities , Heart Atria/surgery , Dilatation, Pathologic/diagnosis , Echocardiography, Transesophageal/methods , Echocardiography/methods , Treatment Outcome