A dedicated stitch to allow early safe mobilization avoiding drain-induced heart injury

Abstract Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.

The effect of beta-blockade on myocardial remodelling in Chagas' cardiomyopathy

OBJECTIVE: Chagas' disease has spread throughout Latin America because of the high rate of migration among these countries. Approximately 30% of Chagas' patients will develop cardiomyopathy, and 10% of these will develop severe cardiac damage leading to heart failure. Beta-blockade improves symptoms and survival in heart failure patients; however, its efficacy has not been well established in Chagas' disease. We evaluated the role of carvedilol in cardiac remodeling and mortality in a Chagas' cardiomyopathy animal model. METHODS: We studied Trypanosoma cruzi infection in 55 Syrian hamsters that were divided into three groups: control (15), infected (20), and infected + carvedilol (20). Animals underwent echocardiography, electrocardiography, and morphometry for collagen evaluation in ventricles stained with picrosirius red. RESULTS: The left ventricular diastolic diameter did not change between groups, although it was slightly larger in infected groups, as was left ventricular systolic diameter. Fractional shortening also did not change between groups, although it was slightly lower in infected groups. Collagen accumulation in the interstitial myocardial space was significantly higher in infected groups and was not attenuated by carvedilol. The same response was observed in the perivascular space. The survival curve showed significantly better survival in the control group compared with the infected groups; but no benefit of carvedilol was observed during the study. However, in the acute phase (up to 100 days of infection), carvedilol did reduce mortality. CONCLUSION: Carvedilol did not attenuate cardiac remodeling or mortality in this model of Chagas' cardiomyopathy. The treatment did improve survival in the acute phase of the disease.

O papel do betabloqueador na miocardiopatia chagásica experimental: avaliação morfo-funcional / The role of betablockade on experimental chagasic cardiomyopathy: morpho-functional evaluation

A doença de Chagas, descrita há quase 100 anos por Carlos Chagas, continua sendo um problema de saúde pública na América Latina, com 15 milhões de infectados e 28 milhões de indivíduos susceptíveis. Vários mecanismos fisiopatológicos foram propostos para a progressão da miocardiopatia chagásica crônica, entre eles a denervação simpática. O uso do betabloqueador na insuficiência cardíaca congestiva diminuiu morbidade e mortalidade. Entretanto, nenhum trabalho conclusivo incluiu a miocardiopatia chagásica como etiologia. OBJETIVO: Avaliar o papel do carvedilol na sobrevida e remodelamento miocárdico na miocardiopatia chagásica experimental. MATERIAL E MÉTODOS: Foram avaliados 55 Hamsters Sirius, divididos em grupo controle, grupo infectado com Trypanosoma cruzi com 105 formas tripomastigotas via intraperitoneal e grupo infectado, tratado inicialmente com carvedilol 10 mg/Kg/dia e após 6 meses com 15 mg/Kg/dia em dose única por gavagem. Foi analisado o peso do animal; os diâmetros ventriculares, função sistólica e diastólica obtidas pelo ecocardiograma; a freqüência cardíaca, a duração do QRS, a presença de extra-sístoles e o ritmo cardíaco usando o eletrocardiograma e a avaliação da mortalidade. Após 12 meses os animais sobreviventes foram sacrificados e realizada a quantificação da fração do volume de colágeno intersticial e perivascular no miocárdio. RESULTADO: A razão dos diâmetros diastólico e sistólico pelo tamanho da tíbia não mostrou diferenças estatísticas, apesar de maiores nos grupos infectados. A fração de encurtamento também não mostrou diferença estatística, apesar de menor nos grupos infectados. A fração do volume de colágeno do ventrículo esquerdo e perivascular mostrou maior acúmulo nos grupos infectado e carvedilol em relação ao controle de forma significativa (p<0,001), mas sem diferença nos grupos infectados tratados ou não. A mortalidade foi maior nos grupos infectado e carvedilol (p = 0,001) e não ocorreu diferença entre estes grupos...

Chagas' disease was described 100 years ago by Carlos Chagas and nowadays it is a public health problem in Latin America yet. There are about 15 million infected people and another 28 million at risk to be infected. Several pathophysiologic mechanisms are suggested to be responsible for the progression of chronic Chagas' cardiomyopathy. Among them the sympathetic denervation seems to be an important issue. The use of beta blockade regarding heart failure has been proving to improve morbidity and mortality. However, none of these papers included Chagas' cardiomyopathy as etiology. OBJECTIVES: To evaluate the role of carvedilol upon survival and myocardial remodeling in a Chagas' cardiomyopathy animal model. MATERIAL AND METHODS: 55 Hamsters Sirius were studied and divided into control group, intraperitoneously infected group with Trypanosoma cruzi and infected group treated with carvedilol 10 mg/Kg/day by gavage which was increased to 15 mg/Kg/day after 6 months. Ventricular diameters, systolic and diastolic left ventricular function were evaluated by 2D-echocardiogram. The heart rate, QRS lasting, premature ventricular complex and cardiac rhythm were analyzed by ECG. We evaluated clinical parameters as the case for body weight. The survival curve was also studied. After 12 months the survivors were sacrificed and the myocardial interstitial and perivascular collagen volume fraction were analyzed. RESULTS: The ratio of diastolic or systolic diameters over tibia length did not show statistical differences although it was larger on infected groups. The fractional shortening also did not show statistical differences although it was decreased on infected groups. The left ventricular collagen volume fraction at the interstitial and perivascular area showed a higher accumulation on infected groups compared to control (p<0.001) but no differences were observed between infected and carvedilol treated animals. The mortality was higher in the infected groups...

O papel do acúmulo de colágeno no interstício miocárdico na sobrevida dos pacientes com cardiomiopatia dilatada idiopática e chagásica / The role of storage of interstitial myocardial collagen on the overlife rate of patients with idiopathic and chagasic dilated cardiomyopathy

OBJETIVO: Avaliar a correlação entre um marcador estrutural do miocárdio e a sobrevida dos pacientes com cardiomiopatia dilatada. MÉTODOS: Mediante realização da biópsia endomiocárdica e exame ecocardiográfico foram estudados 9 indivíduos sem doença estrutural miocárdica (controle) e 45 pacientes com cardiomiopatia dilatada grave de etiologia idiopática (MCDI) e chagásica (MCDC). Foi analisada a correlação entre a quantidade de colágeno miocárdico intersticial (FVCI) e a sobrevida desses pacientes, se a FVCI diferia entre as etiologias, e se a fibrose interferia na função e geometria do miocárdio. RESULTADOS: Foi observado que a FVCI foi 15 vezes maior nos cardiomiopatas em relação ao grupo-controle, mas não diferiu em relação às MCDI e MCDC (*p < 0,001). Não houve correlação da FCVI com a sobrevida dos pacientes com cardiomiopatias (MCDI p = 0,249 e na MCDC p = 0,587) e apenas na MCDI a fração de ejeção do ventrículo esquerdo teve correlação com a FVCI. O diâmetro diastólico final do ventrículo esquerdo não se correlacionou com a FCVI nas duas etiologias. CONCLUSÃO: A fibrose miocárdica não diferiu entre as duas etiologias, não se correlacionou com o prognóstico das MCDC e MCDI e apenas na MCDI ela se correlacionou com a FEVE.

OBJECTIVE: To find out whether there is a correlation between a myocardial structural marker and the overlife rate of patients with dilated cardiomyopathy. METHODS: Using endomyocardial biopsy and 2D-echocardiogram, we studied nine patients with no changes in myocardial structure (control) and 45 patients with severe dilated cardiomyopathy of idiopathic etiology (IDCM) and of Chagasic etiology (CDCM). We analyzed the correlation between the quantity of interstitial myocardial collagen (ICVF) and the overlife rates of these patients. We also evaluated the difference in ICVF between these groups and whether fibrosis interfered on the geometry and function of the myocardium. RESULTS: We observed that ICVF was 15 times higher in cardiomyopathy patients than in the control group, but there was no difference in ICVF between CDCM and IDCM (*p < 0.001) patients. There was no correlation between ICVF and the overlife rate in cardiomyopathy patients (IDCM p = 0.249, and CDCM p = 0.587). We observed a significant correlation between ICVF and left ventricular ejection fraction (LVEF) only for IDCM. There was no correlation between ICVF and left ventricular diastolic diameter in either etiology. CONCLUSION: There was no difference in myocardial fibrosis between patients with CDCM or IDCM, and there was no correlation between fibrosis and the prognosis either for IDCM or CDCM. There was a correlation between myocardial fibrosis and LVEF only for IDCM.