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Chinese Journal of Cardiology ; (12): 549-555, 2022.
Article in Chinese | WPRIM | ID: wpr-940887


Objective: To investigate the acute and long-term outcome of catheter ablation for the treatment of ventricular tachycardia (VT) in patients with arrhythmogenic left ventricular cardiomyopathy (ALVC). Methods: This retrospective, cross-sectional study enrolled ALVC patients undergoing radiofrequency ablation for the treatment of VT at the First Affiliated Hospital of Nanjing Medical University from January 2011 to December 2018 and collected their clinical characteristics and intraoperative electrophysiological examination. Patients were followed up every 6 months after radiofrequency ablation until August 2021. Echocardiographic results and VT recurrence post radiofrequency ablation were analysed. Results: Totally 12 patients were enrolled (mean age: (42±15) years, 11 males(11/12)). The mean of left ventricular end diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) were (51±5)mm and (65±5)%, respectively. Twelve VTs were induced in 10 patients during the electrophysiological study, and the mean tachycardia cycle length was (293±65) ms. Three-dimensional substrate mapping revealed the diseased area at endocardial site in one patient, at epicardial sites in the other 11 patients (involved endocardial sites in 2 cases) with the basal part near the mitral annulus being the predilection for the substrate (10/11). After the catheter ablation at the endocardial and epicardial sites respectively, the complete procedure endpoint was achieved in all patients (VT cannot be induced post ablation). The median follow-up time was 65 (25, 123) months. One patient was lost to follow-up, and the other 11 patients survived without VT. No significant cardiac function deterioration was detected by the echocardiographic examination ((51±5)mm vs. (52±5)mm, P>0.05 for LVDd, (65±5)% vs. (60±6)%, P>0.05 for LVEF) at the end of follow-up. Conclusion: After radiofrequency ablation, the complete procedure endpoint is achieved in ALVC patients, and the catheter ablation provides long-term ventricular tachycardia control during the long-term follow-up.

Adult , Humans , Male , Middle Aged , Cardiomyopathies , Catheter Ablation , Cross-Sectional Studies , Follow-Up Studies , Pericardium/surgery , Recurrence , Retrospective Studies , Stroke Volume , Tachycardia, Ventricular/surgery , Treatment Outcome , Ventricular Function, Left
Chinese Journal of Surgery ; (12): 237-243, 2022.
Article in Chinese | WPRIM | ID: wpr-935606


Objective: To examine the clinical effect of acellular bovine pericardium patch in implant based immediate breast reconstruction. Methods: The clinicopathological information of 141 breast cancer patients, who admitted to Department of Breast Reconstruction and Oncoplastic Surgery, Tianjin Medical University Cancer Hospital, underwent immediate mammoplasty with implants combined with acellular bovine pericardium patches were analyzed from June 2016 to October 2019. All patients were female, with the age of (38.8±8.5) years (range: 13 to 60 years). The body mass index was (21.9±2.5) kg/m2 (range: 16.0 to 32.3 kg/m2). There were 39 cases of duct carcinoma in situ, 46 cases of stage Ⅰ, 40 cases of stage Ⅱ and 16 cases of stage Ⅲ. All patients received nipple-areola-sparing mastectomy or skin-sparing mastectomy with sentinel lymph node biopsy or axillary lymph node dissection, and prosthesis implantation with sub-pectoralis combined with breast patch. The correlation of clinicopathological characters and complications was assessed by t test, χ2 test, Fisher's exact probability method and Logistic regression. Pre-and post-operative aesthetic, quality of life scores were recorded. Results: The operation time (M(IQR)) was 3.6(1.5) hours (range: 3.0 to 6.5 hours). The early postoperative complication rate was 22.0% (31/141), prosthesis removal was the main postoperative complication, accounting for 64.5% (20/31) of the total complications, of which 15 cases occurred in the first 30 patients. The follow-up time was 28(8) months (range: 20 to 53 months), The most frequent long-term complications were capsular contracture and implant displacement, with the incidence of 11.2% (14/125) and 10.4% (13/125), respectively. Multivariate analysis showed that prosthesis volume ≥300 ml (OR=8.173, 95%CI: 1.302 to 51.315, P=0.021) and peri-areolar incision (OR=7.809, 95%CI: 2.162 to 28.211, P<0.01) were independent relative factors for the occurrence of short-term postoperative local complications. After 2 years of operation, the score of breast appearance satisfaction was 71.7±15.5, postoperative effect satisfaction was 90.4±9.5, psychological satisfaction was 90.7±17.1, sexual satisfaction was 70.1±25.1. The immediate postoperative satisfaction rate at discharge was 95.4% (134/141), and 17.6% (22/125) of patients had the intention to received revision surgery. Conclusions: Prosthesis volume ≥300 ml and peri-areolar incision were independent realtive factors for short-term local complications after bovine pericardium patch combined with prosthesis implantation in the immediate breast reconstruction. After completing the learning curve, the postoperative complications of the procedure could be decreased.

Adolescent , Adult , Animals , Cattle , Female , Humans , Middle Aged , Young Adult , Breast Implantation , Breast Implants , Breast Neoplasms/surgery , Mammaplasty/methods , Mastectomy/methods , Pericardium/surgery , Quality of Life , Retrospective Studies
Rev. bras. cir. cardiovasc ; 36(1): 137-139, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155791


Abstract Infective endocarditis is a rather uncommon disease, but it has significant mortality rates in the pediatric population (5% to 10%). We report a case of an infant patient with multiple vegetation in the tricuspid valve secondary to infective endocarditis caused by Corynebacterium diphtheriae. A tricuspid valvuloplasty was performed with a fenestrated autologous pericardium patch, providing satisfactory outcomes. This technique is simple, innovative, effective, and it could be applied in similar cases.

Humans , Child , Endocarditis , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/diagnostic imaging , Cardiac Surgical Procedures , Pericardium/surgery , Pericardium/transplantation , Tricuspid Valve/surgery , Tricuspid Valve/diagnostic imaging
Rev. bras. cir. cardiovasc ; 35(4): 580-483, July-Aug. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137294


Abstract Constrictive pericarditis is a disease where loss of pericardial elasticity and restriction of filling of the cardiac chambers occurs. It is most often seen as an associated symptom of heart failure. Pericardiectomy provides effective treatment for patients with symptomatic constrictive pericarditis, although high rates of morbidity and mortality are related to the procedure. We present a case with extensive calcification, massive caseous necrosis and an important impairment of right ventricular function successfully operated in our institution.

Humans , Pericarditis, Constrictive/surgery , Pericarditis, Constrictive/etiology , Pericarditis, Constrictive/diagnostic imaging , Vascular Calcification/complications , Heart Failure , Pericardium/surgery , Pericardium/diagnostic imaging , Pericardiectomy , Necrosis
Rev. argent. cir ; 112(2): 193-196, 2020. ilus
Article in English, Spanish | LILACS | ID: biblio-1125802


Presentamos el caso de una paciente septuagenaria, con vómitos, neumonía por broncoaspiración y síndrome de impregnación neoplásica. Los estudios por imágenes muestran la totalidad del estómago herniado en el pericardio a través de una ventana pericardio-peritoneal realizada previamente. Se realizó la resolución quirúrgica del caso. Se hacen consideraciones sobre las opciones para el tratamiento del derrame pericárdico persistente, la hernia gástrica intrapericárdica como complicación, su presentación clínica, hallazgos intraoperatorios, forma de estudio y tratamiento.

We report the case of a 73-year- old female patient with vomiting, aspiration pneumonia and constitutional symptoms. The imaging tests showed total gastric herniation in the pericardial sac through a pericardio-peritoneal window previously created. The case was solved with surgery. The therapeutic options for persistent pericardial effusion are considered. Intrapericardial gastric hernia as a complication, its clinical presentation, intraoperative findings, complementary tests and treatment are discussed.

Humans , Female , Aged , Pericardium/surgery , Herniorrhaphy , Hernia/complications , Pericardial Effusion , Peritoneal Cavity , Breast Neoplasms/complications , Radiography, Thoracic
Rev. méd. Maule ; 34(2): 52-57, dic. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1371318


Infective endocarditis (IE) correspond to a serious condition of the endocardium, with clinical and classic risk factors. Heart failure is described as the main complication and cause of mortality. A 58-year-old diabetic female patient, with fever, weight loss and history of 10 months of fatigue, is presented below. She is hospitalized in Hospital Regional de Talca, in Medicine Service, where she is diagnosed of right IE by blood cultures (Streptococcus Sanguis) and transthoracic echocardiogram, that showed vegetations in the tricuspid valve and severe insufficiency. Without clinical improvement despite antibiotic treatment, echocardiography is repeated, showing persistence of vegetations and insufficiency, so that surgical resolution is decided, taking place in Hospital Gustavo Grant Benavente Concepción, with clinical recovery after surgery. It highlights a classic and larval presentation of the disease, but without classic risk factors for right IE, also associated with glomerulonephritis. The antibiotic eliminated bacteremia, but the valve damage was already established.

Humans , Female , Middle Aged , Endocarditis , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/diagnostic imaging , Cardiac Surgical Procedures , Pericardium/surgery , Pericardium/transplantation , Tricuspid Valve/surgery , Tricuspid Valve/diagnostic imaging , Risk Factors
Rev. bras. cir. cardiovasc ; 32(1): 57-59, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-843460


Abstract The authors report the case of a suicide attempt. A 59-year-old man with self-inflicted penetrating chest trauma underwent emergency cardiothoracic surgery. Pre-operative computed tomography scan showed critical proximity between the blade and the right ventricle. Intraoperative findings showed a pericardial laceration and a huge diaphragmatic lesion with heart and abdominal organs integrity. The diaphragm muscle was repaired with a CorMatrix® patch, an acceptable alternative to the traditional synthetic mesh avoiding infection and repeated herniation.

Humans , Male , Middle Aged , Pericardium/surgery , Suicide, Attempted , Thoracic Injuries/surgery , Wounds, Penetrating/surgery , Diaphragm/surgery , Pericardium/injuries , Diaphragm/injuries , Tomography, X-Ray Computed
Rev. bras. cir. cardiovasc ; 31(1): 66-69, Jan.-Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-778364


Abstract Ventricular constraint therapy has been used to prevent and reverse the progression of heart failure in ischemic and nonischemic cardiomyopathies. We hypothesized that ventricular restraint should be tried by closing the pericardium that was previously opened following left ventricle topographical projection. The surgical technique presentation is illustrated by a remarkable 13-year outcome of one patient with dilated cardiomyopathy treated surgically by mitral prosthesis, Cox/Maze III surgery to treat atrial fibrillation, and associated to the ventricular constraint using the patient's own pericardium. The ventricular pericardial restraint role is unclear, since the patient had multiple corrections that could be responsible for the good outcome; however it is viable deserving investigations.

Humans , Male , Middle Aged , Heart Failure/surgery , Heart Ventricles/surgery , Pericardium/surgery , Atrial Fibrillation/surgery , Cardiomyopathy, Dilated/surgery , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation , Heart Failure , Heart Ventricles , Medical Illustration , Mitral Valve/surgery , Pericardium , Treatment Outcome
Rev. bras. cir. cardiovasc ; 31(1): 70-73, Jan.-Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-778373


Abstract Objective: To consider modifications in an experimental model of saccular aortic aneurysm, aiming at better reproducibility, to be used in the development of vascular prostheses. Methods: Experimental study in two phases, developed in the Center of Experimental Surgery and Bioterium (CCEB) of the University of Health Sciences of Alagoas (UNCISAL), with 11 hybrid swine, female, mean weight of 20 ± 5 kg, according to modifications in the Perini technique was performed. In the first phase, the aneurysm was confectioned with bovine pericardial patch. In the second phase, fifteen days later, the patency of the aneurysms was confirmed by Doppler ultrasonography. The described variables were aortic and aneurysm sac patency, incidence of rupture, morbidity and mortality. The statistical analysis program used was STATA v.8. Results: All animals survived to the procedures. Surgical mean time was 73 minutes. Aneurysm rupture, proximal or distal aortic thrombosis, visceral or legs ischemia weren't observed. Parietal thrombus formation was observed in all of the aneurysms, two of which (18%; IC 95% = 3.98 - 48.84) were occluded and nine (82%; IC 95% = 51.15 - 96.01) were patent. Conclusion: In this series, the modifications carried out in the technique related to the surgical approach, race, anesthesia, and imaging exams reproduced the experimental model, reducing its costs, without hindering the analysis of the variables. The satisfactory patency ratio allows the method to be used in experimental models for the development of vascular prostheses.

Animals , Cattle , Female , Aortic Aneurysm, Abdominal/etiology , Aortic Aneurysm, Abdominal/surgery , Disease Models, Animal , Pericardium/surgery , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis , Operative Time , Pericardium , Reproducibility of Results , Swine , Time Factors , Ultrasonography, Doppler , Vascular Patency
Ann Card Anaesth ; 2015 Jul; 18(3): 445-448
Article in English | IMSEAR | ID: sea-162400


Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43‑year‑old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.

Adult , Cardiac Tamponade/etiology , Cardiac Tamponade/mortality , Cardiac Tamponade/surgery , Death, Sudden/etiology , Echinococcosis/complications , Echinococcosis/diagnosis , Echinococcosis/mortality , Heart Ventricles/pathology , Humans , Male , Pericardium/injuries , Pericardium/surgery , Rupture
Rev. bras. cir. cardiovasc ; 25(3): 365-370, jul.-set. 2010. tab
Article in Portuguese | LILACS | ID: lil-565003


OBJETIVO: O fechamento primário do pericárdio pode reduzir o índice de lesão cardíaca durante as reoperações, principalmente do ventrículo direito, vasos da base e enxertos coronarianos. No entanto, a preocupação com as repercussões hemodinâmicas tem evitado a utilização da técnica por grande parte dos cirurgiões. MÉTODOS: Foram estudados trinta pacientes operados consecutivamente que tiveram o pericárdio fechado primariamente, denominados Grupo A. O grupo controle, Grupo B, sem o fechamento do pericárdio, foi constituído de outros 18 pacientes. Foram avaliados: telerradiografia de tórax, eletrocardiograma, ecocardiograma e dosagem de enzimas cardíacas (somente no caso de revascularização do miocárdio), todos os exames, tanto pré quanto pós-operatórios. RESULTADOS: Os pacientes operados, apesar de considerados de baixo risco cirúrgico, não apresentaram complicações (infarto agudo do miocárdio, AVC, sangramento ou tamponamento cardíaco). Foram observadas diferenças estatisticamente significativas entre os grupos, principalmente nos parâmetros do ecocardiograma e no índice cardiotorácico, sem repercussão clínica. CONCLUSÃO: O fechamento primário do pericárdio mostrou-se uma técnica simples para facilitar e reentrada no mediastino em uma reoperação. Contudo, é necessário observar as possíveis alterações hemodinâmicas inerentes ao método, embora nesta série não tenha apresentado repercussão clínica.

OBJECTIVES: Primary pericardium closure may reduce the risk of cardiac injury during chest re opening, especially the right ventricle, aorta and coronary bypass grafts. Nevertheless, concern about adverse hemodynamic effects prevents most heart surgeons of closuring the pericardium. METHODS: We evaluated 48 patients undergoing open heart surgery consecutively which the pericardium was closed in 30 patients (group A) and 18 patients, as a control group (group B) in which the pericardium was left open. All patients underwent posteroanterior and lateral chest roentgenograms before surgery and one week postoperatively. Postoperative evaluation also included echocardiograms, ECG and postoperative enzyme analysis. RESULTS: There were no deaths or any complications in both groups (acute myocardial infarction, stroke, bleeding or cardiac tamponate). It was observed statistically differences between both groups especially in echocardiogram parameters and cardiothoracic ratio without clinical impact. CONCLUSION: Pericardium closure is a simple method to facilitate resternotomy during subsequent re operative procedures. However, cardiac surgeons should be aware of the transient deterioration in hemodynamics associated with it, even thought there was no clinical significance in this study.

Female , Humans , Male , Middle Aged , Cardiac Surgical Procedures/methods , Pericardium/surgery , Case-Control Studies , Cardiac Surgical Procedures/adverse effects , Echocardiography , Electrocardiography , Extracorporeal Circulation , Reoperation , Teleradiology , Treatment Outcome
Korean Journal of Radiology ; : 627-631, 2010.
Article in English | WPRIM | ID: wpr-150791


OBJECTIVE: To define the mechanism associated with abnormal septal motion (ASM) after coronary artery bypass graft surgery (CABG) using comprehensive MR imaging techniques. MATERIALS AND METHODS: Eighteen patients (mean age, 58 +/- 12 years; 15 males) were studied with comprehensive MR imaging using rest/stress perfusion, rest cine, and delayed enhancement (DE)-MR techniques before and after CABG. Myocardial tagging was also performed following CABG. Septal wall motion was compared in the ASM and non-ASM groups. Preoperative and postoperative results with regard to septal wall motion in the ASM group were also compared. We then analyzed circumferential strain after CABG in both the septal and lateral walls in the ASM group. RESULTS: All patients had normal septal wall motion and perfusion without evidence of non-viable myocardium prior to surgery. Postoperatively, ASM at rest and/or stress state was documented in 10 patients (56%). However, all of these had normal rest/stress perfusion and DE findings at the septum. Septal wall motion after CABG in the ASM group was significantly lower than that in the non-ASM group (2.1+/-5.3 mm vs. 14.9+/-4.7 mm in the non-ASM group; p < 0.001). In the ASM group, the degree of septal wall motion showed a significant decrease after CABG (preoperative vs. postoperative = 15.8+/-4.5 mm vs. 2.1+/-5.3 mm; p = 0.007). In the ASM group after CABG, circumferential shortening of the septum was even larger than that of the lateral wall (-20.89+/-5.41 vs. -15.41+/-3.7, p < 0.05) CONCLUSION: Abnormal septal motion might not be caused by ischemic insult. We suggest that ASM might occur due to an increase in anterior cardiac mobility after incision of the pericardium.

Female , Humans , Male , Middle Aged , Contrast Media , Coronary Artery Bypass , Coronary Disease/surgery , Gadolinium DTPA , Image Interpretation, Computer-Assisted , Magnetic Resonance Imaging/methods , Pericardium/surgery , Retrospective Studies , Statistics, Nonparametric , Ventricular Septum/physiopathology
Acta cir. bras ; 24(2): 82-86, Mar.-Apr. 2009. graf, tab
Article in English | LILACS | ID: lil-511319


PURPOSE: To improve the measurement system, during a research for the prevention of adhesions, we explored the feasibility of introducing three continuous numeric variables to quantify the intensity of pericardial adhesions. METHODS: To validate these three new numeric variables - time spent to dissect the adhesions (Δt), the amount of sharp dissection (ShpD) and the adhesion's collagen area (ACA) - as useful tools in measuring the severity of pericardial adhesions, data from a randomized study on adhesion prevention enrolling twenty-four swine, were analysed. A statistical Spearman's test and regressions models were applied to verify the correlation and the relationship between the results of a standard severity score (SS) and Δt, between SS and ShpD used in adhesiolysis and, also, between SS and ACA. RESULTS: There was a statistically significant correlation between SS and Δt, between SS and ShpD, as well as between SS and ACA, all measured by the Spearman's test (r=0.897, r=0.932, r=0.66; p<0.01, respectively). Through a non-linear regression, an exponential relation of SS with ShpD (R²=0.915) and SS with Δt (R²= 0.917) was found. CONCLUSION: The time spent to dissect the adhesions (Δt) and the amount of sharp dissection (ShpD) are new powerful measurement tools in evaluating outcomes of the methods used to prevent pericardial adhesions.

OBJETIVO: A fim de melhorar a metodologia de mensuração das aderências pericárdicas, avaliamos, durante um estudo de prevenção de aderências pericárdicas, a possibilidade da utilização de três de novas variáveis contínuas e numéricas. MÉTODOS: Para validar estas novas variáveis numéricas - tempo de dissecção (Δt), quantidade de dissecção cruenta (ShpD) e a área de colágeno na aderência (ACA) como instrumentos precisos na quantificação das aderências pericárdicas, foram analisados os dados de um estudo para prevenção de aderências que envolveu 24 porcos. Foram aplicados modelos de regressão e o teste de Spearman para avaliar a força e os tipos correlações entre os resultados do escore padrão de classificação de aderências (SS) e o Δt, entre o SS e o ShpD, e, também, entre o SS e a ACA. RESULTADOS: Foram evidenciadas correlações, estatisticamente significativas, entre o SS e o Δt, entre o SS e o ShpD, também como entre o SS e a ACA avaliadas através do teste de Spearman (r=0,897, r=0,932 , r=0,66; p<0,001, respectivamente). Identificou-se, através de regreção não-linear, uma relação exponencial do SS com o ShpD (R²=0,915) e com o Δt (R²= 0,917). CONCLUSÃO: Este estudo mostrou que o Δt e o ShpD são variáveis poderosas para avaliar os resultados dos métodos utilizados para prevenção das aderências pericárdicas.

Animals , Pericardium/surgery , Postoperative Complications/prevention & control , Thoracic Surgical Procedures/methods , Tissue Adhesions/prevention & control , Analysis of Variance , Disease Models, Animal , Postoperative Complications/diagnosis , Random Allocation , Swine , Treatment Outcome , Tissue Adhesions/diagnosis
Ann Card Anaesth ; 2009 Jan-Jun; 12(1): 63-6
Article in English | IMSEAR | ID: sea-1662


Intrapericardial tumours can cause cardiac compromise either from pericardial effusion producing cardiac tamponade or from the mass obstructing the outflow from the heart or both. Respiratory embarrassment may also be present if the mass compresses the trachea or the main stem bronchus. A 1-month-old child presented in the emergency needing prompt measures to relieve compressive symptoms. Successful anaesthetic and surgical management led to uneventful recovery. Histopathology of the mass revealed a rarely occurring intrapericardial teratoma. After surgical removal, the child had clinical follow-up for more than a year. Intrapericardial teratoma is a rare entity that presents a diagnostic and therapeutic challenge. The authors describe the case of a 1-month-old male child with this condition who was successfully managed by resection of the mass.

Anesthesia, General/methods , Heart Neoplasms/complications , Humans , Infant, Newborn , Male , Pericardial Effusion/etiology , Pericardium/surgery , Respiratory Distress Syndrome, Newborn/etiology , Teratoma/complications , Treatment Outcome
Rev. bras. cir. cardiovasc ; 23(4): 480-487, out.-dez. 2008. graf, tab, ilus
Article in English, Portuguese | LILACS | ID: lil-506030


OBJETIVO: Este trabalho tem como objetivo avaliar alterações físico-químicas da carboximetilquitosana após termoesterilização e sua eficácia na prevenção de aderências pericárdicas pós-esternotomia. MÉTODOS: Após ser submetida a termoesterilização em autoclave, a carboximetilquitosana termoestéril (CMQte) foi submetida a análises físico-químicas. Doze animais foram divididos em dois grupos e submetidos à pericardiotomia e a protocolo de indução de aderências. A seguir, foi aplicada de forma tópica a CMQte ou solução salina. Após 8 semanas, foi realizada esternotomia e avaliação macroscópica do grau de aderências, tempo de dissecção e quantidade do uso de dissecção cruenta e avaliação microscópica. RESULTADOS: As análises físico-químicas não mostraram diferença entre a CMQ e CMQte. A avaliação macroscópica mostrou que a intensidade das aderências foi significantemente menor no grupo CMQte (P=0,007). O tempo de dissecção e o uso de dissecção cruenta também apresentaram reduções significativas (P=0,007, P=0,008; respectivamente). CONCLUSÃO: O método de esterilização empregado não alterou as propriedades físico-químicas da carboximetilquitosana. O uso de biopolímeros de barreira como a CMQte pode reduzir a intensidade das aderências pós-cirúrgicas no pericárdio, diminuindo as complicações da esternotomia em reoperações cardiovasculares.

OBJECTIVE: The aim of this study is to evaluate CMC physical-chemical alterations after thermal sterilization and its efficacy in preventing poststernotomy pericardial adhesions. METHODS: After autoclaving thermal sterilization, thermal sterile Carboxymethyl Chitosan (CMCts) was submitted to physical-chemical analysis. Twelve animals were divided into two groups and underwent pericardiotomy and adhesion induction protocol. Afterward, topic CMCts or saline solution was administered. After 8 weeks, a sternotomy was performed for adhesion score macroscopic evaluation, dissection time and the amount of recalcitrant dissection, and microscopic evaluation. RESULTS: Physical-chemical analysis showed no difference between CMC and CMCts. A macroscopic analysis showed that the intensity of adhesions was significantly lower in the CMCts group (P=0.007). Dissection time and use of recalcitrant dissection also decreased significantly (P=0.007, P=0.008; respectively). Microscopic results indicated a significant reduction in the epicardium collagen area and in the total epicardium area (P=0.05) and (P=0.03). CONCLUSION: The sterilization method did not change Carboxymethyl Chitosan physical-chemical properties. Using barrier bipolymer, such as CMCts, can decrease the intensity of pericardium postoperative adhesions, reducing sternotomy complications in cardiovascular reoperations.

Animals , Biocompatible Materials/chemistry , Chitosan/analogs & derivatives , Heart Diseases/prevention & control , Pericardium/surgery , Postoperative Complications/prevention & control , Sterilization/methods , Biocompatible Materials/pharmacology , Chitosan/chemistry , Chitosan/pharmacology , Collagen/metabolism , Models, Animal , Pericardium/metabolism , Pericardium/pathology , Random Allocation , Reoperation , Swine , Sternum/surgery , Tissue Adhesions/pathology , Tissue Adhesions/prevention & control
Arq. bras. cardiol ; 87(4): e101-e103, out. 2006. ilus
Article in Portuguese, English | LILACS | ID: lil-438246


Um paciente portador de marcapasso definitivo bi-atrial-ventricular por fibrilação atrial paroxística e bradicardia sinusal, em uso crônico de anticoagulante oral, apresentou sinais clínicos da síndrome da veia cava superior. A venografia por subtração digital mostrou obstrução total do tronco braquiocefálico venoso direito e grande dificuldade de fluxo sangüíneo da veia inominada para a veia cava superior. A abordagem terapêutica constou da remoção completa do sistema transvenoso seguida de reimplante do sistema bi-atrial-ventricular por técnica epimiocárdica pela via subxifóide assistida por fluoroscopia.

A patient with a bi-atrial-ventricular permanent pacemaker due to paroxystic atrial fibrillation associated to sinus bradycardia, in chronic use of oral anticoagulant, presented clinical signs of superior vena cava syndrome. Digital subtraction venography showed total obstruction of the right brachiocephalic venous trunk and severe stenosis of the connection of the left trunk to the superior vena cava. The therapeutic approach consisted of complete removal of transvenous system followed by re-implant of the bi-atrial-ventricular system using an epicardial subxiphoid access with fluoroscopic assistance

Humans , Male , Aged , Pacemaker, Artificial/adverse effects , Pericardium/surgery , Superior Vena Cava Syndrome/etiology , Fluoroscopy , Reoperation , Superior Vena Cava Syndrome/diagnosis , Superior Vena Cava Syndrome/surgery
Ciênc. rural ; 35(4): 837-842, jul.-ago. 2005. ilus
Article in Portuguese | LILACS | ID: lil-415985


O trabalho teve por objetivo avaliar a capacidade de barreira da membrana de cortical óssea desmineralizada liofilizada bovina, testando sua permeabilidade e integridade, em associação com a membrana de pericárdio bovino liofilizado. Em 15 ratos Wistar, machos, adultos, implantou-se no subcutâneo da região cérvico-torácica dorsal a combinação de duas membranas de cortical óssea desmineralizada tendo no interior a membrana de pericárdio bovino. Os animais (cinco ratos/grupo) foram submetidos à eutanásia aos 15, 30 e 60 dias de pós-operatório. A avaliação microscópica mostrou que, aos 15 dias de pós-cirúrgico, as membranas estavam íntegras, com exceção de pequenas áreas de reabsorção da membrana de cortical óssea junto aos locais referentes aos antigos canais nutritivos. Aos 30 dias, havia apenas restos da membrana de cortical óssea e, aos 60 dias, a sua total ausência. Baseados nos resultados aqui obtidos, é possível concluir que a membrana de cortical óssea bovina é rapidamente absorvida e não confere proteção à membrana de pericárdio bovino liofilizado.

Cattle , Collagen/therapeutic use , Pericardium/surgery
Rev. bras. cir. cardiovasc ; 20(1): 14-22, Jan.-Mar. 2005. ilus
Article in Portuguese | LILACS | ID: lil-413202


Objetivo: Neste estudo, tivemos como objetivo comparar a resistência mecânica do pericárdio decelularizado com o pericárdio convencional, assim como avaliar sua capacidade de induzir resposta inflamatória em modelo experimental com ratos.Método: Dividimos os pericárdios em: GrupoI - pericárdio submetido a tratamento convencional. Após o processamento químico, as amostras do GrupoII foram histologicamente avaliadas para confirmar a eficácia da decelularização. A seguir, apenas para análise da resistência mecânica por testes de tração e de desnaturação térmica, os pericárdios foram divididos em: grupo 1 (pericárdio convencional com critérios de aprovação), grupo 2(pericárdio convencional com critérios de reprovação) e grupo 3(pericárdio decelularizado). A capacidade de induzir resposta inflamatória foi avaliada em estudo experimental em 50 ratos Wistar, os quais foram submetidos a implante subcutâneo d fragmentos dos pericárdios. Nossa terceira etapa de avaliação consistiu em confeccionar três biopróteses com o pericárdio decelularizado e que foram submetidas à avaliação hidrodinâmica, juntamente com uma bioprótese convencional de teste.Resultados: A análise histológica inicial demostrou decelularização completa. A resistência mecânica mostrou diferença significativa com relação às variáveis "tensão de ruptura" e "índice de tenacidade". Não encontramos diferença quanto a atividade inflamatória em modelo experimental com ratos. O desempenho hidrodinâmico foi semelhante e todas biopróteses atingiram a marca de 150 milhões de ciclos. A avaliação histológica ao fim da ciclagem mostrou padrão microscópico habitual, não havendo ruptura ou fragmentação anormal induzida por estresse mecânico.Conclusão: A decelularização mantém a resistência física do pericárdio, além de não induzir resposta inflamatória diferente daquela habitualmente encontrada no pericárdio convencional

Animals , Bioprosthesis/trends , Bioprosthesis , Heart Valve Prosthesis , Pericardium/surgery , Pericardium/physiopathology , Technology Assessment, Biomedical/trends , Technology Assessment, Biomedical