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3.
Int J Cardiol ; 67(2): 143-6, 1998 Dec 01.
Article in English | MEDLINE | ID: mdl-9891947

ABSTRACT

This study aimed at determining risk factors for perioperative mortality for patients undergoing partial left ventriculectomy. Fourteen patients with end-stage congestive heart failure underwent partial ventriculectomy at our institution from February, 1995 to October, 1997. Mean age was 48+/-11 years, symptoms duration 44+/-34 months, New York Heart Association symptoms score 4+/-0, systolic blood pressure 97.69+/-20.06 mmHg, diastolic blood pressure 65.38+/-13.91 mmHg, heart rate 91+/-15 beats/min, furosemide daily dose 121.66+/-96.65 mg and captopril daily dose 68.75+/-76.76 mg. Seven (50%) patients needed inotropic support for hemodynamic stabilization. On echocardiography, left ventricular diastolic dimension was 81.71+/-11.92 mm. Left ventricular ejection fraction determined by radionuclide ventriculography or echocardiography was 16.71+/-5.13. At heart catheterization, mean right atrial pressure was 12.50+/-7.72 mmHg, mean pulmonary capillary wedge pressure 23.60+/-7.79 mmHg, and mean pulmonary artery pressure 34.10+/-12.81 mmHg. Twelve patients had idiopathic dilated cardiomyopathy and two patients had a globally dilated heart with single vessel coronary artery disease. Aneurysmectomy, mitral valve surgery or coronary artery bypass surgery were not performed in any patient. Four (28%) patients died: three in the operating theatre and one from low output syndrome 2 days after surgery. The proportion of patients operated on with cardiogenic shock was four (100%) in nonsurvivors and 0% in survivors (P=0.001). Inotropic support was necessary in three (30%) survivors and in four (100%) nonsurvivors (P=0.06). Thus, preoperative hemodynamic instability may be associated with perioperative mortality after partial left ventriculectomy.


Subject(s)
Cardiac Surgical Procedures/methods , Heart Failure/surgery , Heart Ventricles/surgery , Adult , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Captopril/therapeutic use , Cardiac Surgical Procedures/adverse effects , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/drug therapy , Cardiomyopathy, Dilated/surgery , Diuretics/therapeutic use , Echocardiography , Electrocardiography , Enalapril/therapeutic use , Female , Furosemide/therapeutic use , Heart Failure/complications , Heart Failure/drug therapy , Hemodynamics , Humans , Male , Middle Aged , Perioperative Care , Postoperative Complications/etiology , Postoperative Complications/mortality , Preoperative Care , Risk Factors , Shock, Cardiogenic/complications
4.
Arq Bras Cardiol ; 66(5): 277-9, 1996 May.
Article in Portuguese | MEDLINE | ID: mdl-9008911

ABSTRACT

Two cases of congenital trabecular hypoplasia of the right ventricle are reported. In the first, the neonatal diagnosis was missed and the child did well until the 13th month of life when a modified Blalock-Taussig shunt was done because of increasing cyanosis. Outcome was good until the 4th year of life when symptomatic atrioventricular block was detected in an emergency situation. A bidirectional Glenn anastomosis and pacemaker implantation were successfully carried out after clinical establization and the child is doing well up to now. The second case presents the disease with its worst features: severe cyanosis and acidosis in the first day of life. A modified Blalock-Taussig shunt was performed and death occurred soon after the operation.


Subject(s)
Cyanosis/etiology , Heart Ventricles/abnormalities , Electrocardiography , Female , Heart Ventricles/surgery , Humans , Infant, Newborn
5.
Arq Bras Cardiol ; 61(5): 273-8, 1993 Nov.
Article in Portuguese | MEDLINE | ID: mdl-8147723

ABSTRACT

PURPOSE: To determine the frequency and main features of subsequent cardiovascular surgery in patients operated on for coarctation of the thoracic aorta. METHODS: One hundred and five patients operated on for coarctation of the aorta with a mean follow-up period of 14 years had their notes analysed. The patients were divided in 4 groups according to age at correction of the coarctation. The incidence of recoarctation repair and other cardiovascular operations were noted. RESULTS: Surgical morbidity was important: 33%. Recoarctation occurred in 14% of the cases, mainly in those who had the coarctation resected during the first year of life. Operation for other cardiovascular defects was necessary in 24.5% of the cases. Among these, correction of left-to-right shunts was done in 50% of the patients who had the coarctation resected in the first year of life. Relief of aortic stenosis was the most frequent procedure (73%), tends to be more frequent the other is the patient at coarctation repair and more than one procedure may be necessary in some cases. CONCLUSION: Reoperation is frequent in the long term of patients operated on for coarctation of the aorta. The elective coarctation should be repaired after the first year of life hoping to avoid recoarctation. Routine follow-up is advisable for all patients aiming to detect residual left-to-right shunts and left ventricular outflow tract obstruction. Family counseling regarding prognosis after coarctation resection is recommended.


Subject(s)
Aortic Coarctation/surgery , Adolescent , Adult , Aorta, Thoracic/abnormalities , Aorta, Thoracic/surgery , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Reoperation
6.
Arq Bras Cardiol ; 59(6): 467-9, 1992 Dec.
Article in Portuguese | MEDLINE | ID: mdl-1341871

ABSTRACT

The case of an asymptomatic 6-month-old boy, first seen due to a right arm edema is described. A continuous murmur heard at the right infraclavicular area, cardiomegaly plus increased flow to the lungs on the chest X-ray were associated with an isolated right subclavian artery-to-vein fistula diagnosed at angiography. Successful ligation of the fistula was done at operation with normalization of the arm circumference and heart size on the chest X-ray at 4 years follow up.


Subject(s)
Arteriovenous Fistula/congenital , Arteriovenous Fistula/surgery , Subclavian Artery/abnormalities , Subclavian Artery/surgery , Subclavian Vein/abnormalities , Subclavian Vein/surgery , Arteriovenous Fistula/diagnostic imaging , Humans , Infant , Ligation , Male , Radiography , Subclavian Artery/diagnostic imaging , Subclavian Vein/diagnostic imaging
7.
Arq Bras Cardiol ; 55(1): 55-8, 1990 Jul.
Article in Portuguese | MEDLINE | ID: mdl-2073162

ABSTRACT

The description of hemolytic anemia after mitral valve repair has been infrequent. The present paper presents this complication, discussing its diagnosis and surgical aspects, such as the association with the use of teflon felt for posterior annuloplasty. This complication happened in two children at our institution, one treated medically with supplementation of folic acid and ferrous sulfate and another requiring surgery for replacement of the teflon felt using a piece of heterologous pericardium for a new annuloplasty and leaflet advancement.


Subject(s)
Anemia, Hemolytic/etiology , Mitral Valve Insufficiency/surgery , Postoperative Complications/etiology , Adolescent , Anemia, Hemolytic/drug therapy , Child , Ferrous Compounds/therapeutic use , Folic Acid/therapeutic use , Hematocrit , Hemoglobins/analysis , Humans , Male , Methods , Postoperative Complications/drug therapy , Reoperation
8.
Arq Bras Cardiol ; 52(5): 283-6, 1989 May.
Article in Portuguese | MEDLINE | ID: mdl-2604577

ABSTRACT

The case of a 74 year old woman with pseudo-false aneurysm of the left ventricle after a silent myocardial infarction stimulating left pulmonary neoplasm is presented. Special emphasis in given to the uncommon aspects of the case, its rarity and the association of the pseudo-false aneurysm with a true aneurysm of left ventricle.


Subject(s)
Heart Aneurysm/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Aged , Diagnosis, Differential , Female , Heart Aneurysm/surgery , Humans , Radiography
9.
Arq Bras Cardiol ; 52(3): 153-7, 1989 Mar.
Article in Portuguese | MEDLINE | ID: mdl-2597004

ABSTRACT

The two techniques usually employed for the surgical treatment of tricuspid valve endocarditis are valve replacement or simple valve excision without valve replacement. A third more conservative procedure consists of resection of the vegetation ("vegetectomy") and leaflet repair, if necessary. Valve excision without valve replacement is described in adult patients especially in addicts of intravenous drugs, with normal ventricular function. Two cases of tricuspid valve endocarditis in children with interventricular communication successfully treated by "vegetectomy" and valve excision without valve replacement are reported. In the first case, surgery was performed during acute infection. Contrarily in the other case there was evidence that cure had been obtained, but still the prosthesis was not implanted due to the excellent hemodynamic status at the moment, and to abbreviate bypass time due to the preoperative conditions of the child. The uncommon approach to these two cases of tricuspid valve endocarditis in childhood motivated this presentation.


Subject(s)
Endocarditis, Bacterial/surgery , Tricuspid Valve/surgery , Child , Echocardiography , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Heart Septal Defects, Ventricular/complications , Humans , Male
10.
Arq Bras Cardiol ; 52(1): 19-22, 1989 Jan.
Article in Portuguese | MEDLINE | ID: mdl-2818236

ABSTRACT

Many studies have demonstrated fairly high incidence of supraventricular arrhythmias after coronary artery bypass surgery, and have tried to identify preoperative, operative and postoperative factors related to their appearance. The present paper analysed 186 patients submitted to coronary artery bypass and reported a incidence of atrial fibrillation of 6.04% (11 cases). The male sex was dominant (81.2%) with ages varying from 49 to 73 (mean 54.58) years. The preoperative incidence of diabetes, smoking and systemic hypertension were, respectively, 18.2%, 54.51% and 36.4%. The mean number of vessels bypassed was 2.42 +/- 1.19 and the left circumflex artery was involved in 81.20% of these cases. Cardiopulmonary bypass time was 100 +/- 39.6 min and ischemic arrest time of 79.6 +/- 37.7 min. Single double stage cannulae for venous drainage were used in 45.5% of the patients and ventricular fibrillation and cardiac overdistention occurred in 63.60% immediately after CPB. Atrial fibrillation presented around 1.66 +/- 2.17 days in the postoperative period and 45.5% of the patients had more than one distinct episode of the arrhythmia. Treatment constituted of cardioversion in 25%, atenolol oral in 18.75% and digitalis associated to quinidine in 56.25%. These numbers permit us to suggest that some of the above factors may contribute to the genesis of arrhythmias, such as single double stage cannulation for venous drainage, inadequate myocardial protection, overdistention and cardiac fibrillation and, mainly, the presence of proximal circumflex artery obstructions responsible for atrial ischemia before and during surgery.


Subject(s)
Atrial Fibrillation/etiology , Myocardial Revascularization , Postoperative Complications , Aged , Atrial Fibrillation/therapy , Extracorporeal Circulation , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors
12.
Cardiology ; 75(4): 287-8, 1988.
Article in English | MEDLINE | ID: mdl-3167919

ABSTRACT

The usual surgical treatment of tricuspid endocarditis is valve replacement or valve excision alone without valve replacement. 'Vegetectomy', i.e. local excision of the vegetation and leaflet repair, has been previously described and can be applied to cases with well-circumscribed vegetations and little or no valve damage. A case of tricuspid valve endocarditis successfully managed by surgical excision of the vegetation is reported.


Subject(s)
Endocarditis, Bacterial/surgery , Staphylococcal Infections/surgery , Tricuspid Valve/surgery , Child, Preschool , Endocarditis, Bacterial/complications , Female , Heart Valve Diseases/complications , Heart Valve Diseases/surgery , Humans , Tricuspid Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/surgery
13.
Scand J Thorac Cardiovasc Surg ; 22(3): 295-7, 1988.
Article in English | MEDLINE | ID: mdl-2852402

ABSTRACT

A case of nonfunctioning paraganglioma of the posterior mediastinum in a 20-year-old white man is presented. The diagnosis of aorticosympathetic paraganglioma (Glenner-Grimley classification) was established by histologic examination after surgical removal of the tumor.


Subject(s)
Mediastinal Neoplasms/surgery , Paraganglioma, Extra-Adrenal/surgery , Adult , Humans , Male , Mediastinal Neoplasms/classification , Mediastinal Neoplasms/pathology , Paraganglioma, Extra-Adrenal/classification , Paraganglioma, Extra-Adrenal/pathology , Thoracotomy
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