MiRNA-30d and miR-770-5p as potential clinical risk predictors of Vasoplegic Syndrome in Patients undergoing on-pump coronary artery bypass grafting.

The aims of this study were to perform pre-surgery miRNA profiling of patients who develop Vasoplegic syndrome (VS) after coronary artery bypass grafting (CABG) and identify those miRNAs that could be used as VS prognostic tools and biomarkers. The levels of 754 microRNAs (miRNAs) were measured in whole blood samples from a cohort of patients collected right before the coronary artery bypass grafting (CABG) surgery. We compared the miRNA levels of those who developed VS (VASO group) with those who did not (NONVASO group) after surgery. Six miRNAs (hsa-miR-548c-3p, -199b-5p, -383-5p -571 -183-3p, -30d-5p) were increased and two (hsa-1236-3p, and hsa-miR770-5p) were decreased in blood of VASO compared to NONVASO groups. Receiver Operating Characteristic (ROC) curve analysis revealed that a combination of the miRNAs, hsa-miR-30d-5p and hsa-miR-770-5p can be used as VS predictors (AUC = 0.9615, p < 0.0001). The computational and functional analyses were performed to gain insights into the potential role of these dysregulated miRNAs in VS and have identified the "Apelin Liver Signaling Pathway" as the canonical pathway containing the most target genes regulated by these miRNAs. The expression of the combined miRNAs hsa-miR-30d and hsa-miR-770-5p allowed the ability to distinguish between patients who could and could not develop VS, representing a potential predictive biomarker of VS.

Surgical correction of the ascending aorta and an aortic root aneurysm associated with coarctation of the descending aorta.

This case report shows how to perform simultaneously an open surgical correction of an aortic root aneurysm and aortic stenosis by interposition of an aortic composite graft and the transdiaphragmatic extra-anatomical correction of an aortic coarctation.

Blunt aortic injury: Surgical treatment of the ascending and descending aorta.

Traumatic aortic injury is potentially fatal. Although uncommon, involvement of the aortic arch and the ascending aorta can occur. This case shows concomitant dissection of the ascending and descending sections of the aorta after blunt chest trauma where the open surgical approach was successfully performed to treat both aortic injuries.

Transcatheter mitral valve-in-valve implantation: reports of the first 50 cases from a Latin American Centre.

OBJECTIVES: Our goal was to analyse the initial results of the first 50 transapical transcatheter mitral valve-in-valve procedures performed in a single Latin American centre. METHODS: A prospective, single centre, database analysis was conducted to evaluate immediate, 30-day and 1-year postoperative results of 50 consecutive patients who had a transcatheter mitral valve-in-valve procedure from May 2015 to June 2018. All patients were operated on in a hybrid operating room and received a balloon-expandable valve via the transapical approach. Preoperative and postoperative characteristics were analysed and compared between the first 25 and the second 25 patients to evaluate the impact of the learning curve. Twenty patients had a follow-up examination at 1 year. RESULTS: There was a 98% device success rate. The patients had a mean age of 64.8 years; 72% were women; 80% were in New York Heart Association functional class ≥III preoperatively; and 36% of the procedures were urgent. The mean Society of Thoracic Surgeons scores and EuroSCORE II were 8.3% and 12.4%, respectively. Patients had a median of 2 previous operations; valve durability was 12.1 years; and 64% mitral valve disease of rheumatic fever aetiology. Echocardiography showed decreases in the maximum and mean mitral gradients from 23.5 to 14.6 and 11.5 to 6.4 mmHg postoperatively; the overall mean hospitalization period was 15 days. The overall mortality rate at 30 days was 14%, with 1 intraprocedural death. Further subanalyses between the first and the second half of the cases showed a drop in the mortality rate from 20% to 8% (P < 0.01). CONCLUSION: The transcatheter mitral valve-in-valve procedure was shown to be a safe and effective procedure to treat bioprosthetic dysfunction, with potential benefits in patients with rheumatic disease.

Surgical Thrombectomy of Mechanical Valve Thrombosis.

BACKGROUND: The study aim was to review the authors' experience with the surgical thrombectomy of mechanical valve thrombosis at the Heart Institute of the Medical School of São Paulo University, Brazil. METHODS: Between January 1993 and March 2014, a total of 21 patients (16 females, five males; mean age 48.2 years) with mechanical valve thrombosis was treated surgically. Of these patients, 70% were in NYHA class IV, including two in cardiogenic shock; 71% of the patients had inadequate anticoagulation levels. The median period between the initial valve replacement and valve thrombosis was 105 months. Thrombosis occurred in the mitral position in 12 patients (57%) and in the aortic position in nine (43%). Clinical and surgical data were collected from hospital records. RESULTS: The major surgical finding was thrombus (57.1%), and pannus formation was found in 42.9% of patients. The mean cardiopulmonary bypass time was 90 min, and aortic cross-clamp time 63 min. Operative complications occurred in three patients (14%): two patients required revisions for bleeding and one patient needed ventricular assistance and hemodialysis. The operative mortality rate was 19% (n = 4). Two of these deaths occurred in patients who had been transferred to the operating room with cardiopulmonary resuscitation, one death was due to prolonged mechanical ventilator support and sepsis, and one was due to cardiac tamponade. The 11-year actuarial survival rate was 69.3 ± 12.9%, and the actuarial rate freedom from reintervention was 85.7 ± 13.2% during an 11-year follow up period. CONCLUSIONS: Early surgical intervention is a safe and effective treatment in patients with mechanical valve thrombosis.

Axillary hyperhidrosis: T3/T4 versus T4 thoracic sympathectomy in a series of 276 cases.

BACKGROUND: Different techniques of video-assisted thoracic sympathectomy have been suggested to control the symptoms of axillary hyperhidrosis. We compared the results using two different levels of ganglion resection for treating axillary hyperhidrosis: T3/T4 vs. T4. MATERIALS AND METHODS: From a group of 1119 patients operated on between July 2000 and January 2005, 276 patients with axillary hyperhidrosis were studied. The mean age was 26 (range, 13-54 years) and 61.6% were female. Of these patients, 216 (78.3%) were treated with thermal ablation of T3/T4 and 60 (21.7%) with thermal ablation of T4 alone. The procedures were bilateral and simultaneous, using two 5.5-mm trocars and 30-degree optical systems, under general anesthesia in all cases. RESULTS: There was no mortality and no important postoperative complications or need to convert to thoracotomy in either group. The mean follow-up in the T4 group was 11 months (range, 2-23 months) and in the T3/T4 group mean follow-up was 24 months (range, 13-54 months). The immediate therapeutic success rate was 100% in both groups. There were recurrences in 7 (2.5%) patients, all from the T3/T4 group. The satisfaction rate was higher and more stable in the T4 group and compensatory sweating was lower in the T4 group. CONCLUSION: Both techniques proved effective for controlling the axillary symptoms. Group T4 presented a higher satisfaction rate, lower recurrence rate, and lower severity of compensatory sweating.

Persistencia del conducto arterioso en perros: revisión / Patent ductus arteriosus in dogs: a review / Persistência do ducto arterioso em cães: revisão

Objetivo: Presentar una revisión de la literatura acerca de la persistencia del conducto arterioso, levantando los principales aspectos morfológicos, fisiopatológicos, clínicos, del diagnóstico y pronóstico y los posibles tratamientos. Fuentes Consultadas: CAB Abstracts 1990-2002; MEDLINE 1978-2002. Síntesis de los Datos: La persistencia del conducto arterioso (PCA) es la lesión cardiaca congénita encontrada con mayor frecuencia en pen-os. La forma más común se caracteriza por el desvío sanguíneo de izquierda a derecha. Más raramente aparece la PCA revertida, con inversión del flujo a través del conducto. Conclusiones: La consideración global de lodos estos aspectos ayuda a la comprensión de los fenómenos envuenos en la evolución clínica de la afección, contribuyendo de manera decisiva para la indicación derramamiento adecuado y la recuperación del animal.

Objective: To perform a literature review on patent ductus arteriosus, pointing out the main morphological, physiopathological, clinical, diagnostic and prognostic aspects, as well as possible treatments. Data Sources: CAB Abstracts 1990-2002; MEDLINE 1978-2002. Data Synthesis: Patent ductus arteriosus (PDA) is the most common congenital cardiac disease in dogs. The 1I/0s1 common type is the left-to-right shunt, although the reverse PDA may sometimes occur, that is, with inversion of the blood flow through the duct. Conclusions: The joint understanding of all these aspects improves the comprehension of the phenomena involved in the clinical course of the disease, giving a crucial contribution to both, treatment indication and animal recovery.

Objetivo: Apresentar revisão da literatura sobre a persistência do ducto arterioso, levantando os principais aspectos morfológicos, fisiopatológicos, clínicos, de diagnóstico e prognóstico, bem como os possíveis tratamentos. Fontes Consultadas: CAB Abstracts 1990-2002; MEDLINE 1978-2002. Síntese dos Dados: A persistência do ducto arterioso (PDA) é a doença cardíaca congênita encontrada com maior freqüência em cães. A forma mais comum é caracterizada pelo desvio sanguíneo da esquerda para a direita, embora, mais raramente, presencie-se a PDA reversa, ou seja, com inversão do fluxo através do ducto. Conclusões: O entendimento conjunto de todos estes aspectos auxilia na compreensão dos fenômenos envolvidos na evolução clínica da afecção, contribuindo de maneira decisiva para a indicação do tratamento, visando à recuperação do animal.

Persistencia del conducto arterioso en perros: revisión / Patent ductus arteriosus in dogs: a review / Persistência do ducto arterioso em cães: revisão

Objetivo: Presentar una revisión de la literatura acerca de la persistencia del conducto arterioso, levantando los principales aspectos morfológicos, fisiopatológicos, clínicos, del diagnóstico y pronóstico y los posibles tratamientos. Fuentes Consultadas: CAB Abstracts 1990-2002; MEDLINE 1978-2002. Síntesis de los Datos: La persistencia del conducto arterioso (PCA) es la lesión cardiaca congénita encontrada con mayor frecuencia en pen-os. La forma más común se caracteriza por el desvío sanguíneo de izquierda a derecha. Más raramente aparece la PCA revertida, con inversión del flujo a través del conducto. Conclusiones: La consideración global de lodos estos aspectos ayuda a la comprensión de los fenómenos envuenos en la evolución clínica de la afección, contribuyendo de manera decisiva para la indicación derramamiento adecuado y la recuperación del animal.

Objective: To perform a literature review on patent ductus arteriosus, pointing out the main morphological, physiopathological, clinical, diagnostic and prognostic aspects, as well as possible treatments. Data Sources: CAB Abstracts 1990-2002; MEDLINE 1978-2002. Data Synthesis: Patent ductus arteriosus (PDA) is the most common congenital cardiac disease in dogs. The 1I/0s1 common type is the left-to-right shunt, although the reverse PDA may sometimes occur, that is, with inversion of the blood flow through the duct. Conclusions: The joint understanding of all these aspects improves the comprehension of the phenomena involved in the clinical course of the disease, giving a crucial contribution to both, treatment indication and animal recovery.

Objetivo: Apresentar revisão da literatura sobre a persistência do ducto arterioso, levantando os principais aspectos morfológicos, fisiopatológicos, clínicos, de diagnóstico e prognóstico, bem como os possíveis tratamentos. Fontes Consultadas: CAB Abstracts 1990-2002; MEDLINE 1978-2002. Síntese dos Dados: A persistência do ducto arterioso (PDA) é a doença cardíaca congênita encontrada com maior freqüência em cães. A forma mais comum é caracterizada pelo desvio sanguíneo da esquerda para a direita, embora, mais raramente, presencie-se a PDA reversa, ou seja, com inversão do fluxo através do ducto. Conclusões: O entendimento conjunto de todos estes aspectos auxilia na compreensão dos fenômenos envolvidos na evolução clínica da afecção, contribuindo de maneira decisiva para a indicação do tratamento, visando à recuperação do animal.

Implantación de marcapasos en perro - Relato de caso / Pacemaker implantation in a dog - A case report / Implantação de marcapasso em cão - Relato de caso

Un animal de la especie canina, hembra, raza Maltés. con un afio y seis meses de edad y pesando 3,2 kilogramos presentaba una historia clínica de pre-síncope. soplo en el foco mitral y bradicardia ante la auscultación. Se sometió al animal a un examen electrocardiográfico y radiográfico. diagnosticándose bloqueo auriculoventricular de 30 grado y el tratamiento recomendado fue la implantación de un marcapasos. EI período postoperatorio transcurrió normalmente y el animal presenta buen estado general. no presentando ninguna alteración clínica hasta el momento.

A female Maltese dog, 18 months old, with 3.2 kg, was presented with a pre-syncope history. auscultation revealing murmur over the mitral valve area bradycardia. The animal was submitted to electrocardiography and radiographic exams, the diagnosis being third-degree atrioventricular blockade. The recommended treatment was pacemaker implantation. Postoperative evolution was normal and the animal was in good physical condition. No clinical alterations have been detected since the implantation.

Um animal da espécie canina, fêmea, raça Maltês, com um ano e seis meses de idade e pesando 3,2 quilogramas apresentava histórico de pré-síncope, sopro em foco mitral e bradicardia pela auscultação. Submeteu-se o animal a exame eletrocardiográfico e radiográfico, diagnosticando-se bloqueio atrioventricular de 3 grau e o tratan1ento recomendado foi a implantação de marcapasso. O período pós-operatório transcorreu normalmente e o animal apresenta bom estado geral, não apresentando nenhuma alteração clínica até o presente momento.

Implantación de marcapasos en perro - Relato de caso / Pacemaker implantation in a dog - A case report / Implantação de marcapasso em cão - Relato de caso

Un animal de la especie canina, hembra, raza Maltés. con un afio y seis meses de edad y pesando 3,2 kilogramos presentaba una historia clínica de pre-síncope. soplo en el foco mitral y bradicardia ante la auscultación. Se sometió al animal a un examen electrocardiográfico y radiográfico. diagnosticándose bloqueo auriculoventricular de 30 grado y el tratamiento recomendado fue la implantación de un marcapasos. EI período postoperatorio transcurrió normalmente y el animal presenta buen estado general. no presentando ninguna alteración clínica hasta el momento.

A female Maltese dog, 18 months old, with 3.2 kg, was presented with a pre-syncope history. auscultation revealing murmur over the mitral valve area bradycardia. The animal was submitted to electrocardiography and radiographic exams, the diagnosis being third-degree atrioventricular blockade. The recommended treatment was pacemaker implantation. Postoperative evolution was normal and the animal was in good physical condition. No clinical alterations have been detected since the implantation.

Um animal da espécie canina, fêmea, raça Maltês, com um ano e seis meses de idade e pesando 3,2 quilogramas apresentava histórico de pré-síncope, sopro em foco mitral e bradicardia pela auscultação. Submeteu-se o animal a exame eletrocardiográfico e radiográfico, diagnosticando-se bloqueio atrioventricular de 3 grau e o tratan1ento recomendado foi a implantação de marcapasso. O período pós-operatório transcorreu normalmente e o animal apresenta bom estado geral, não apresentando nenhuma alteração clínica até o presente momento.

Avaliação clínica da parada circulatória total em cães (Canis familiaris)

The experiments objective was to verify possible clinic and neurologic complications that could occur in dogs submitted to total circulatory stasis in different periods: five and ten minutes, by the technique of Inflow Occlusion. Ten healthy adults Mongrel dogs were used, males and females, weighing between fifteen and twenty kilograms. The dogs were divided in two groups of five: GROUP A - animals submitted to five minutes of total circulatory stasis; GROUP B - animals submitted to ten minutes of total circulatory stasis. Transoperative and postoperative ( 24 and 48 hours after surgery), were evaluated until six weeks. Alterations such as oftalmologics, neurologic, motor coordination, conscience and comportment by clinic exam were evaluated. It was concluded that the five minutes Inflow Occlusion was surgically viable in dogs.

O objetivo deste experimento foi verificar as possíveis alterações clínicas e neurológicas que possam ocorrer em cães submetidos à dois diferentes períodos de parada circulatória total: cinco e 10 minutos, pela técnica de clampeamento das veias cava cranial e caudal e ázigos. Foram utilizados dez cães, sem raça definida, adultos, machos e fêmeas, com peso entre quinze e vinte quilos e em condições de saúde julgadas satisfatórias para o experimento. Os cães foram divididos aleatoriamente em dois grupos com cinco animais, sendo que no GRUPO A, procedeu-se o bloqueio circulatório por cinco minutos e no GRUPO B, por 10 minutos. Os cães foram avaliados no transoperatório, no pós-operatório imediato e tardio (com 24 e 48 horas após a intervenção cirúrgica) até máximo de seis semanas. Foram observadas alterações oftalmológicas, neurológicas, de coordenação motora, consciência e comportamento por exame clínico. Concluiu-se, diante dos resultados clínicos obtidos, que a técnica de parada circulatória total por até cinco minutos foi exeqüível de ser praticado em cães sadios, sendo contra-indicado para período de 10 minutos.