Constrictive pericarditis with extensive calcification and caseous necrosis

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.

Heart injury with projectile lodged inside the heart

Abstract Penetrating heart injuries present high mortality rates. Increasing rates of urban violence have contributed to a significant rise in the number of heart injuries by firearm projectiles. Such injuries are associated with the highest mortality rates among penetrating cardiac injuries and may involve one or more cardiac chambers. We present the case of a police officer who, in an approach to five robbers, suffered a transfixed cardiac injury by firearm with the projectile having been lodged inside the right ventricle. This patient was successfully operated, 65 days after the injury, at our institution.

Plastica mitral com anel maleável de pericárdio bovino / Mitral valve repair with a malleable bovine pericardium ring

OBJECTIVE: To describe a surgical procedure utilizing a malleable bovine pericardium ring in mitral valve repair and clinical and echodopplercadiographic results. METHODS: Thirty-two (25 female and 7 male) patients, aged between 9 and 66 (M=36.4 + or - 17.2) years, were studied over a 16-month period, with 100 percent follow-up. In 23 (72 percent) of the patients, the mitral approach was the only one applied; 9 patients underwent associated operations. The technique applied consisted of measuring the perimeter of the anterior leaflet and implanting, according to this measurement, a flexible bovine pericardium prosthesis for reinforcement and conformation of the posterior mitral annulus, reducing it to the perimeter of the anterior leaflet with adjustment of the valve apparatus. RESULTS: The patient survival ratio was 93.8 percent, with 2 (6.2 percent) fatal outcomes, one from unknown causes, the other due to left ventricular failure. Only one reoperation was performed. On echodopplercardiography, 88 percent of the patients had functional recovery of the mitral valve (50 percent without and 38 percent with mild insufficiency and no hemodynamic repercussions). Of four (12 percent) of the remaining patients, 6 percent had moderate and 6 percent had seigre insufficiency. Twenty-eight percent of class II patients and 72 percent of class III patients passed into classes I (65 percent), II (32 percent), and III (3 percent), according to NYHA classification criteria. CONCLUSION: Being flexible, the bovine pericardium ring fit perfectly into the valve annulus, taking into account its geometry and contractility. Valve repair was shown to be reproducible, demonstrating significant advantages during patient evolution, which did not require anticoagulation measures

Tratamento cirúrgico das lesöes da aorta torácica utilizando parada circulatória total hipotérmica com perfusäo cerebral retrógrada / Surgical treatment of thoracic aorta diseases using total circulatory arrest with hypothermia with retrograde cerebral perfusion

De setembro de 1991 a fevereiro de 1992, foram operados nove pacientes com lesoes da aorta torácica, usando parada circulatória total (PCT) hipotérmica profunda com perfusao cerebral retrógrada (PCR), sendo seis do sexo masculino e três do feminino, com idade variando de 45 a 80 anos. Quatro deles tinham dissecçao tipo A, três tinham aneurisma verdadeiro de aorta, um tinha uma associaçao de aneurisma verdadeiro com dissecçao tipo A e um tinha ectasia ânulo-aórtica associada a dissecçao tipo B. A técnica utilizada foi a instalaçao da circulaçao extracorpórea (CEC) tipo cava-cava-femoral com hipotermia profunda e parada circulatória total. Utilizou-se cardioplegia retrógrada sangüínea como método de preservaçao de miocárdio. Durante a PCT foi feita PCR usando a linha arterial conectada à cânula da VCS, com fluxo de 250 a 300 ml/min, com PVC monitorizada no membro superior variando entre 30 e 40 cmH20. A correçao cirúrgica foi feita com tubo e patch de pericárdio bovino associados a cola biológica. O tempo de CEC variou de 75 até 169 min, com PCT de 32 até 79 min. e com PCR de 32 até 79 min. Nao houve óbito associado ao ato operatório e nem ao pós-operatório (PO) imediato. Houve apenas um óbito tardio por septicemia. Demais pacientes em seguimento ambulatorial. Os resultados obtidos representam um forte indicador de que a PCT com PCR protege o cérebro de forma mais eficiente que a PCT convencional, sendo vantajosa no tratamento cirúrgico das afecçoes da aorta torácica que requerem PCT.

Tratamento cirúrgico dos defeitos do septo ventricular / Surgical treatment of ventricular septal defects

O autor relata os defeitos do Septo Ventricular, discorrendo resumidamente sobre o histórico do tratamento cirúrgico, embriologia, patogenia, morfologia dos defeitos, sua associaçäo com doença vascular pulmonar, fisiopatologia e principais complicaçöes. Dá especial atençäo a sintomatologia clínica e diagnostico armado, ao tratamento cirúrgico e enfatiza aspectos especiais do mesmo