[Mitral valve replacement in patiens with previous right pneumonectomy]. / Subtituição da válvula mitral em doentes com pneumectomia direita prévia.

Adequate exposure of the mitral valve is essential to the safe and effective performance of valve replacement. After a right pneumonectomy, shift of the mediastinum and reduction in respiratory function makes cardiac surgery challenging not only for the surgeon but also for the anaesthetist. We report our experience on performing mitral valve replacement in two patients with previous right pneumonectomy to highlight certain important features while managing these patients.

[Surgical management of pulmonary aspergilloma]. / Tratamento cirúrgico dos aspergilomas pulmonares.

After formation of fungus ball in pre-existing cavities, antifungal agents are very hard to control the infection. Surgical resection offers the only realistic chance of a permanent cure for aspergilloma. However, surgical indications are still a controversy because of the high incidence of postoperative complications. The purpose of this study was to evaluate our indications and results in the surgical treatment of aspergilloma, focusing attention on the postoperative complications and risk factors. From 1990 to 2004, 60 patients with mean age of 44.6 (range, 20-69) were submitted to pulmonary surgery for excision of aspergilloma. Forty-one patients (68.3%) were male, 25 patients (41.7%) were smokers and 47 (78.3%) had tuberculosis as the underlying lung disease. The most frequent indication for surgery was haemoptysis (88.3%). The cavities were mainly situated in the upper lobes (85.0%) and in the right lung (68.3%). Approximately half of aspergillomas (56.7%) were classified as complex aspergillomas. The procedures performed were : 7 pneumectomies (11.7%), 3 bilobectomies (5.0%), 42 lobectomies (70.0%), 7 wedge resections (11.7%) and one cavernostomy (1.7%). There were 3 postoperative deaths (5%), and major complications occurred in 16.3% of the patients including: bleeding (n=3) and bronchopleural fistula (n=2). Recurrence rate was 3.3%. Surgical resection of pulmonary aspergilloma is effective in preventing recurrence of hemoptysis. Preoperative preparation of the patient, meticulous surgical technique, asn postoperative care reduced the rate of complications. We recommend early surgical resection of symptomatic cases with reasonable complications.

[Adult cardiac surgery: impact on age group differences in preoperative risk factors and early mortality]. / O papel da idale como determinante dos factores de risco pré-operatórios e da mortalidade na cirurgia cardíaca do adulto.

Over the past 20 years, there have been marked increased rates in cardiac surgery among the elderly in Portugal. To evaluate the effects of increasing age on outcome after cardiac surgery, 5652 patients who underwent cardiac surgery from 2003 to 2005 in five portuguese hospitals, were entered into a retrospective study. Patients were placed in five groups according to age: (1) 80 and older, (2) 70-79, (3) 60-69, (4) 50-59 or (5) less than 50. Selected variables included risk factors, cardiac status, preoperative hemodynamics and surgical procedures. In-hospital mortality was collected on all patients. The mean age was 64.7+/-11.6 years-old and younger patients were more often male than older patients (74.4% vs 51.9%). Preoperative COPD and peripheral vascular disease rates increased for those older than 60 years and decreased for those aged 30 to 49 years. Octogenarians had more congestive heart failure (62.5% vs 37.7%), urgent operations (39.2% vs 26.4%), aortic valve surgery (44.5% vs 26,8%) and off-pump CABG (77.8% vs 57.3%) than the younger groups. Hospital mortality was less than 2.0% in patients younger than 69 years-old, 3.5% in septuagenarians and 10,0%in octogenarians. While patients age at operation significantly influenced hospital mortality, this appeared to be a consequence of the increased frequency of risk factors and comorbidities together with decreased physiologic reserve in patients over 80 years of age.

[National Registry of Adult's Cardiac Surgery: surgical proceedings]. / Registro Nacional de Cirurgia Cardíaca do Adulto: procedimentos realizados.

Recently we published preoperative risk factors, cardiac status and hemodynamics of Portuguese patients before cardiac surgery. Now we report the type of surgical procedures carried out in 5 portuguese hospitals between January of 2003 and December of 2006. In Portugal coronary artery bypass is still the more prevalent cardiac surgery, in spite of the increase on percutaneous coronary interventions.

[National Registry of Adults Cardiac Surgery: our patients profile]. / Registo nacional de cirgia cardíaca do adulto: O perfil dos nossos doentes.

A task force commission was created with the support of the Portuguese Society for Cardiothoracic and Vascular Surgery with the aim of organizing a National Adult Cardiac Surgery Registry, collecting clinical data and types of cardiac surgical procedures performed in Portugal. Selected variables include risk factors, cardiac status, preoperative hemodynamics, surgical procedure, hospital stay and mortality. The aim of the project is still far from the expected. However, patients' preoperative risk is clearly shown, based on demographic data and risk factors.

[Aortic arch aneurysms: three cases treated with different surgical approaches]. / Cirurgia de aneurismas do arco aórtico: tres casos tratados com diferentes estratégias.

Aortic arch aneurysms may be treated with different surgical approaches. Each case represents a complex opportunity for choosing the best available strategy. We present three different cases in which a particular surgical choice was found to be the most adequate to the specific problem.

[Carney's Complex: familial cardiac myxoma]. / Complexo de Carney: mixoma cardíaco familiar.

The Carney Complex is a very rare autosomal dominant disease including multiple neoplasia syndrome. This syndrome was initially described in 1985 under the rubric "...the complex of myxomas, spotty pigmentation, and endocrine overactivity". We present a case report of an old woman with Carney Complex who had the characteristic features of facial hirsutism and acromegalic facies, a large pigmented swelling over the face and a cardiac myxoma arising from the left atrium. We emphasize the need for periodic echocardiographic screening of patients and family members.

[Transaortic resection of left ventricular fibroelastoma]. / Exerese transaórtica de fibroelastoma do ventrícular esquerda.

Left ventricular tumors are extremely rare. Complete surgical resection is usually curative and recurrence is rare. The left atrial approach is safe and advisable when possible. We report a rare case of left ventricular tumor in a 71-year-old man presented with a cerebellar stroke. A two-dimensional echocardiogram revealed a mobile mass with the stalk attached deeply in left ventricular wall. To improve surgical access, a transversal aortotomy was performed and the mass was gently pulled and excised. Intracavitary left ventricular tumors, which are deeply situated, difficult to see, and inaccessible via left atriotomy, may be made surgically accessible by a transaortic approach. A vetriculotomy should be avoided.