Total Arthroplasty in Complex Elbow Injury.

The authors present an atypical case of a left elbow complex fracture with extensive loss of bone and muscle tissue. The patient was submitted to several surgical procedures, which resulted in a total arthroplasty of the left elbow with triceps reconstruction using a semitendinosus muscle tendon graft.

Total Arthroplasty in Complex Elbow Injury / Artroplastia total na lesão complexa do cotovelo

Abstract The authors present an atypical case of a left elbow complex fracture with extensive loss of bone and muscle tissue. The patient was submitted to several surgical procedures, which resulted in a total arthroplasty of the left elbow with triceps reconstruction using a semitendinosus muscle tendon graft.

Resumo Os autores apresentam um caso atípico de fratura complexa do cotovelo esquerdo com perda extensa de tecido ósseo e muscular. O paciente foi submetido a diversos procedimentos cirúrgicos, que resultaram em uma artroplastia total do cotovelo esquerdo associada à reconstrução do tríceps com enxerto do tendão do músculo semitendíneo.

Infinity Ankle Arthroplasty Early Latin-America Experience and Patient Outcomes.

INTRODUCTION: The promising data from Ankle Arthroplasty are consequence of the evolution of instruments and implants. Recent studies have shown good results in the short and intermediate follow-up, in addition to high patient satisfaction. The aim of this study is to present the results obtained with 49 cases treated with the Infinity total ankle prosthesis in 2 South America countries. METHODS: This is a case series of 48 patients (27 women and 22 men), treated with 49 Infinity prostheses in Brazil and Colombia. They underwent surgical treatment between April 1, 2016, and January 18, 2020. We used the visual-analogue pain scale (VAS), the AOFAS score for ankle and hindfoot and the measurement of range of motion (ROM) in the pre- and post-surgical period. The radiological evaluation was performed on ankle radiographs in anteroposterior and lateral views, obtained in orthostasis, measuring the parameters suggested by Hintermann. Average follow-up was 4 years. RESULTS: VAS reduced from an average of 7.94 to 1.98; AOFAS increased from 28.02 to 83.16 and ROM increased from 11.45 to 28.08. Distal Tibial Slope is higher for higher improvements in VAS and lower for higher improvements in AOFAS and ROM. We observed 4 wound infections, 1 intra-op medial malleolus fracture. No bone cysts, tibial or talar components subsidence, polyethylene component wear or failure were observed. No salvation procedures were required in this series. DISCUSSION: This study results corroborates literature data showing great improvements in pain, functional pattern, and movement. CONCLUSION: Infinity Ankle Arthroplasty is a safe and reproducible procedure with good outcomes at a short-term follow-up. LEVEL OF EVIDENCES: 4 - Case series.

Corin ankle arthroplasty: Case-series.

BACKGROUND: Total Ankle Arthroplasty (TAA) is complex and can bring a wide variety of complications. Implant revision rates can vary from 4% to 8% in 5 years. Recent publications have shown good results in the short and intermediate follow-up and high patient satisfaction. The pre- and postoperative evaluation of these patients should include physical examination and objective radiographic measurements, which may have predictive value for implant failures and survivorship. In this paper we will present the results obtained with 29 patients treated with the Zennith (Corin Group, UK) total ankle prosthesis in Brazil. METHODS: This paper presents the results obtained with 29 patients treated with the Corin-Zennith prosthesis in three tertiary hospitals in Brazil, with an average follow-up of 5 years. The patients were submitted to clinical and radiographic evaluation. There were seventeen women and twelve men, ranging in age from 35 to 76 years, who were submitted to surgical treatment between January 16, 2013 and May 5, 2017. RESULTS: Seven patients (24%) presented cysts, being 4 (13.7%) tibial cysts and 3 (10.3%) tibial and talar cysts. Six patients (20.6%) presented talar subsidence and 3 (10.3%) presented tibial subsidence. Three patients (10.3%) presented component wear. VAS reduced and AOFAS and ROM increased in the post-operative period. The development of Cysts was associated with the theta angle and the difference in LTS (between the post and preoperative period) was associated with tibial subsidence. The complications rate was 44.8%, the revision rate was 6.9% and the survivorship rate was 93.1%. CONCLUSION: The Corin-Zennith prosthesis demonstrated to be a safe implant for improving functional parameters. Functional outcomes were not influenced for most commonly measured radiographic parameters. Further studies are needed to better understand these associations.

Fifth Metatarsal Fractures in Professional Soccer Players: Case Series.

OBJECTIVE: Fifth metatarsal fractures occur mainly in young athletes, with an estimated incidence of 1.8 per 1000 individuals per year. This study aims to evaluate the functional outcome of professional soccer players undergoing surgical treatment of fifth metatarsal base fractures. METHODS: We appraised 34 soccer players operated on from July 2001 to June 2016. All individuals were assessed by the American Orthopedic Foot and Ankle Score (AOFAS) and Visual Analog Scale (VAS) before and after surgery, with a mean 23-month follow-up. The need for grafting, fracture healing, Torg classification, and return to sports were also evaluated. RESULTS: There were 10 attackers, 7 offensive-defensive midfielders, 6 side defenders, 5 central defensive midfielders, 3 defenders, 2 goalkeepers, and 1 defensive midfielder, at an average age of 19 years. Preoperative and postoperative AOFAS averaged 42 and 99 points, respectively, whereas VAS scores were 6 and 0. The longer the time to get operated on, the greater was the need for grafting (P = .011). In our study, all fractures have consolidated. Return to sports occurred, on average, 73 days after surgical treatment, and it was not influenced by the time to get operated on, fracture healing, Torg classification, and grafting. CONCLUSION: Surgical treatment of the fifth metatarsal base fracture in professional soccer players presents good clinical results. Getting back to activities after surgery is not influenced by surgery time, fracture healing, Torg classification, and grafting.Levels of Evidence: Level IV: Therapeutic studies, Case series.

Epidemiological profile and treatment of substance losses by trauma to the lower limbs.

OBJECTIVES: to evaluate the epidemiological profile, the surgical treatment and the postoperative results of patients with complex traumatic injuries to the lower limbs. METHODS: we conducted a retrospective study of patients with traumatic complex injuries treated by the Plastic Surgery Service of a regional hospital in Brasília. We analyzed clinical-epidemiological data, type of surgical procedure and functional recovery of the limb after six months of treatment. RESULTS: 119 patients were treated, with a mean age of 29 years, predominantly men (76.4%). Motorcycle accident was responsible for most of the injuries, in 37.8% of cases. The most frequent surgical treatment was skin grafting (62.1%), followed by the fasciocutaneous flap (21.9%), muscular flap (12.6%) and microsurgical flap (3.4%). Six months after completion of the surgical treatment, 35.3% of the patients needed crutches to move, characterizing a delay in limb functional recovery that, however, was significantly related to the presence of fractures, external fixation or bone exposure in the preoperative period. CONCLUSION: the profile of the patient with complex traumatic lower limb injury was a male, motorcycle accident victim, and grafting was the most used treatment. Orthopedic trauma with bone fracture, bone exposure and the presence of external fixator were significantly associated with a higher risk of limb functional impairment, requiring locomotion crutches after six months of treatment.

Epidemiological profile and treatment of substance losses by trauma to the lower limbs / Perfil epidemiológico e tratamento de perdas de substância por trauma em membros inferiores

ABSTRACT Objectives: to evaluate the epidemiological profile, the surgical treatment and the postoperative results of patients with complex traumatic injuries to the lower limbs. Methods: we conducted a retrospective study of patients with traumatic complex injuries treated by the Plastic Surgery Service of a regional hospital in Brasília. We analyzed clinical-epidemiological data, type of surgical procedure and functional recovery of the limb after six months of treatment. Results: 119 patients were treated, with a mean age of 29 years, predominantly men (76.4%). Motorcycle accident was responsible for most of the injuries, in 37.8% of cases. The most frequent surgical treatment was skin grafting (62.1%), followed by the fasciocutaneous flap (21.9%), muscular flap (12.6%) and microsurgical flap (3.4%). Six months after completion of the surgical treatment, 35.3% of the patients needed crutches to move, characterizing a delay in limb functional recovery that, however, was significantly related to the presence of fractures, external fixation or bone exposure in the preoperative period. Conclusion: the profile of the patient with complex traumatic lower limb injury was a male, motorcycle accident victim, and grafting was the most used treatment. Orthopedic trauma with bone fracture, bone exposure and the presence of external fixator were significantly associated with a higher risk of limb functional impairment, requiring locomotion crutches after six months of treatment.

RESUMO Objetivo: avaliar o perfil epidemiológico, o tratamento cirúrgico e os resultados pós-operatórios de pacientes com feridas complexas traumáticas de membros inferiores. Método: estudo retrospectivo dos pacientes com ferimentos complexos traumáticos tratados pelo Serviço de Cirurgia Plástica de um hospital regional de Brasília. Foram analisados os dados clínico-epidemiológicos, o tipo de procedimento cirúrgico e a recuperação funcional do membro após seis meses do tratamento. Resultados: foram tratados 119 pacientes, com média de idade de 29 anos, predominantemente homens (76,4%). O acidente moto ciclístico foi responsável pela maioria das lesões, em 37,8% dos casos. O tratamento cirúrgico mais realizado foi o enxerto de pele (62,1% dos casos), seguido pelo retalho fascio-cutâneo (21,9%), o retalho muscular (12,6%) e o retalho microcirúrgico (3,4%). Seis meses após a conclusão do tratamento cirúrgico, 35,3% dos pacientes necessitavam de muletas para se locomover, caracterizando um atraso na recuperação funcional do membro que, no entanto, estava relacionado significativamente à presença de fratura, de fixador externo ou de exposição óssea no pré-operatório. Conclusão: o perfil do paciente com ferida complexa traumática de membros inferiores foi homem, vítima de acidente motociclístico e o enxerto foi o tratamento mais utilizado. O trauma ortopédico com fratura óssea, exposição óssea e a presença de fixador externo estiveram associados significativamente a um maior risco de prejuízo funcional do membro com necessidade de muletas para locomoção após seis meses de tratamento.

Quality evaluation of cone biopsy specimens obtained by large loop excision of the transformation zone.

BACKGROUND: Large loop excision of the transformation zone (LLETZ) has been used for the diagnosis and treatment of precancerous cervical lesions, and it is the first choice of treatment in the majority of cervical pathology services. The aim of this study was to evaluate the presence of thermal artifacts, the need for serial sections, the percentage of clear and involved resection margins and the relationship between endocervical gland involvement and the severity of the lesion in samples resected using LLETZ. METHODS: A retrospective study was performed at Santa Casa de Misericordia School of Science (HSCMV), Vitoria, Espirito Santo, Brazil with a sample of 52 histopathology slides from patients submitted to conization because of abnormal cytology findings and a biopsy result of cervical intraepithelial neoplasia (CIN) 2, CIN 3 and adenocarcinoma in situ. Statistical analysis was performed using Student's t-test. RESULTS: Serial sections were required to confirm diagnosis in four of 52 cases. Thermal artifacts were present in all cases, with grade I being the most common (94.2% of cases). Clear margins were found in 96.2% of cases. No association was found between glandular involvement and CIN 1 (P > 0.05); however, there was an association with CIN 2 and CIN 3 (P < 0.05). CONCLUSION: The amount of excised tissue was sufficient, thermal artifacts were slight, resection margins were clear in most of cases, and a possible association was found between glandular involvement and the severity of the lesion.

Poly ɛ-caprolactone nanoparticles loaded with Uncaria tomentosa extract: preparation, characterization, and optimization using the Box-Behnken design.

PURPOSE: The aim of this research was to develop and optimize a process for obtaining poly ɛ-caprolactone (PCL) nanoparticles loaded with Uncaria tomentosa (UT) extract. METHODS: Nanoparticles were produced by the oil-in-water emulsion solvent evaporation method. Preliminary experiments determined the initial conditions of the organic phase (OP) and of the aqueous phase (AP) that would be utilized for this study. Ultimately, a three-factor three-level Box-Behnken design (BBD) was employed during the optimization process. PCL and polyvinyl alcohol (PVA) concentrations (X(1) and X(2), respectively) and the AP/OP volume ratio (X(3)) were the independent variables studied, while entrapment efficiency (Y(1)), particle mean diameter (Y(2)), polydispersity (Y(3)), and zeta potential (Y(4)) served as the evaluated responses. RESULTS: PRELIMINARY EXPERIMENTS REVEALED THAT THE OPTIMAL INITIAL CONDITIONS FOR THE PREPARATION OF NANOPARTICLES WERE AS FOLLOWS: OP composed of 5 mL ethyl acetate/acetone (3/2) mixture containing UT extract and PCL, and an AP of buffered PVA (pH 7.5) solution. Statistical analysis of the BBD results indicated that all of the studied factors had significant effects on the responses Y(1), Y(2), and Y(4,) and these effects are closely described or fitted by regression equations. Based on the obtained models and the selected desirability function, the nanoparticles were optimized to maximize Y(1) and minimize Y(2). These optimal conditions were achieved using 3% (w/v) PCL, 1% (w/v) PVA, and an AP/OP ratio of 1.7, with predicted values of 89.1% for Y(1) and 280 nm for Y(2). Another batch was produced under the same optimal conditions. The entrapment efficiency of this new batch was measured at 81.6% (Y(1)) and the particles had a mean size of 247 nm (Y(2)) and a polydispersity index of 0.062 (Y(3)). CONCLUSION: This investigation obtained UT-loaded nanoparticle formulations with desired characteristics. The BBD approach was a useful tool for nanoparticle development and optimization, and thus should be useful especially in the realm of phytotherapeutics, in which varied compositions may be assessed in quantitative and qualitative terms.

Anticoagulant activity of a sulfated galactan: serpin-independent effect and specific interaction with factor Xa.

An algal sulfated galactan has high anticoagulant and antithrombotic activities. Its serpin-dependent anticoagulant action is due to promoting thrombin and factor (F)Xa inhibition by antithrombin and heparin cofactor II. Here, we evaluated the anticoagulant effect of the algal sulfated galactan using serpin-free plasma. In contrast to heparin, the sulfated galactan is still able to prolong coagulation time and delay thrombin and FXa generation in serpin-free plasma. We further investigated this effect using purified blood coagulation proteins, discovering that sulfated galactan inhibits the intrinsic tenase and prothrombinase complexes, which are critical for FXa and thrombin generation, respectively. We also investigated the mechanism by which sulfated galactan promotes FXa inhibition by antithrombin using specific recombinant mutants of the protease. We show that sulfated galactan interacts with the heparin-binding exosite of FXa and Arg-236 and Lys-240 of this site are critical residues for this interaction, as observed for heparin. Thus, sulfated galactan and heparin have similar high-affinity and specificity for interaction with FXa, though they have differences in their chemical structures. Similar to heparin, the ability of sulfated galactan to potentiate FXa inhibition by antithrombin is calcium-dependent. However, in contrast to heparin, this effect is not entirely dependent on the conformation of the gamma-carboxyglutamic acid-rich domain of the protease. In conclusion, sulfated galactan and heparin have some similar effects on blood coagulation, but also differ significantly at the molecular level. This sulfated galactan opens new perspective for the development of antithrombotic drugs.

Doença arterial coronária na mulher: epidemiologia, métodos diagnósticos e manejo na síndrome coronária aguda / Coronary artery disease in women: epidemiology, diagnosis and management of acute coronary syndrome

Em todo o mundo, as doenças cardiovasculares são as maiores causas de morte entre mulheres, contabilizando um terço de todas as causas de mortalidade. Por causa de sua alta prevalência e da direta interferência na qualidade e na expectativa de vida da mulher, esse tema tem sido amplamente estudado nos últimos anos . Este trabalho teve como objetivo revisar a doença arterial coronária (DAC) na mulher, reportando dados atuais em relação ao tema, tendo em vista a otimização do tratamento nessa população. Muitas diferenças são observadas na apresentação e no manejo da DAC na mulher, como por exemplo, a ocorrência de isquemia sem dor, menor hospitalização, menor abordagem invasiva e menos placas de ateroma. Assim como nos homens, os principais fatores de risco para DAC em mulheres são: idade avançada, dislipidemia, história familiar de DAC, diabetes mellito, tabagismo e hipertensão arterial sistêmica. A apresentação clínica da DAC na mulher pode se dar de forma muito diferente ao habitualmente encontrado nos homens; portanto, a avaliação adequada dos sintomas tem papel fundamental. A realização de exames complemntares diagnósticos e imperiosa, ressaltand-se a menor acurácia do do teste ergométrico em mulheres. Por vezes, o diagnóstico de doença isquêmica é subestimado pelo profissional da saúde, acarretando atraso no início do tratamento e maior incidência de procedimentos de urgência, o que leva a maior mortalidade em relação aos homens.

Doença arterial coronária na mulher: epidemiologia, métodos diagnósticos e manejo na síndrome coronária aguda / Coronary artery disease in women: epidemiology, diagnostic methods and treatment of acute coronary syndrome.

Em todo o mundo, as doenças cardiovasculares (CDV) são as maiores causas de morte entre as mulheres, contabilizando um terço de todas as causas de mortalidade. Devido a sua alta prevlência e direta interferência na qualidade e expectativa de vida da mulher, este tema tem sido amplamente estudado nos últimos anos...

Úlcera genital, nem sempre uma clássica DST: relato de um caso tuberculose vulvar / Genital ulcer, nor always a classic DST: case report of a tuberculosis vulvar

A tuberculose vulvar é uma patologia rara, geralmente associada a um foco primário pulmonar. O objetivo deste relato é apresentar o quadro clínico, diagnóstico e tratamento de um caso de tuberculose vulvar acompanhado no serviço de Ginecologia da Santa Casa de Misericórdia de Vitória em 2004. Relata-se o caso de uma paciente de 54 anos, casada, com uma úlcera genital crônica, de grande extensão, sem outros sintomas associados. Foi submetida a biópsia da lesão e exames para investigação de doenças sexualmente transmissíveis (sífilis, hepatites e HIV). Dos resultados, o estudo histopatológico evidenciou granuloma sugestivo de tuberculose, após descartar outras suspeitas. Realizou-se então como propedêutica radiografia de tórax, o qual apresentou lesões sugestivas de tuberculose. Fez-se baciloscopia do escarro, com resultado positivo. Diante do quadro de tuberculose pulmonar e do resultado encontrado na biópsia da úlcera genital, iniciou-se o tratamento com tuberculostáticos. Obteve-se então confirmação da tuberculose vulvar através da prova terapêutica positiva, com melhora significativa da lesão genital nos primeiros sete dias de tratamento. Observouse a importância de ter a tuberculose como diagnóstico diferencial nas úlceras genitais crônicas, por requerer investigação diagnóstica adequada para se instituir o tratamento preciso e obter a cura.

The tuberculosis to vulvar is a rare pathology, generally associated to a pulmonary primary focus. The objective of this ceport is to present the clinical, diagnostic picture and treatment of a vulvar tuberculosis followied in the service of Gynecology of the Santa Casa de Misericórdia de Vitória in 2004. The case of a patient of 54 years old, married, with a chronic genital ulcer, of great extension, without other symptoms associates. It was submitted the biopsy of the injury and examinations for inquiry of some sexually transmissitted deseases (syphilis, hepatites and HIV). The results the biopsy it evidenced granuloma suggestive of tuberculosis, after to discard others suspicion. It was become fullfilled x-ray of thorax, which presented suggestive injuries of tuberculosis. Baciloscopy of pulmonary secretion became, with positive result. Ahead of the pulmonary picture of tuberculosis and the result found in the biopsy of the genital ulcer, the treatment with tuberculostatics was initiated. Confirmation of the tuberculosis was gotten then to vulvar through positive the therapeutical test, with significant improvement of the genital injury in first the seven days of treatment. It was observed the importance of if having the tuberculosis as diagnostic differential in the chronic genital ulcers, for requiring adequate diagnostic inquiry to do the necessary treatment and getting the cure.

Atualizando o diagnóstico da disfunção erétil / Updating erectile disfunction diagnosis

Dados de pesquisa revelam grande número de homens com disfunção erétil, no mundo. Na tentativa de se determinar o que causa esta disfunção, tem-se analisado sua ocorrência dos mais diversos ângulos. E, embora ainda predomine a idéia de que ela se deve a fatores psicológicos, chegou-se à conclusão de que será preciso desenvolver-se uma metodologia específica para definir sua etiologia(AU)

Estudo radiográfico, na incidência ântero-posterior, dos ângulos intermetatarsiano I-II, articular metatarsiano distal I e articular proximal da falange proximal do hálux, em pés normais de adultos / Radiographic study in the AP incidence of intermetatarsal 1-2, metatarsal 1 distal-articular surface and proximal phalanx 1 - proximal articular surface angles in adult normal feet

Estudaram-se os pés direitos e esquerdos, considerados normais, de 50 homens e 50 mulheres, entre 25 e 49 anos de idade, através de radiografias na incidência ântero-posterior, a partir das quais foram determinados os ângulos intermetatarsiano I-II , articular metatársico distal I e articular proximal da falange proximal do hálux. A análise estatística indicou diferenças significantes entre os sexos para os ângulos articular metatársico distal I e articular proximal da falange proximal do hálux, com predominância dos valores dos homens sobre os das mulheres. Quanto ao comportamento dos ângulos em relação às faixas etárias, verificou-se significância estatística para os valores do ângulo articular metatársico distal I; com o avanço da idade, houve, no sexo masculino, redução e, no feminino, aumento. Com relação à interferência dos ângulos entre si, encontraram-se diferenças estatisticamente significantes do ângulo intermetatársico I-II com os outros dois. Aumenta juntamente com o articular metatársico distal I, em homens e mulheres, e diminui com o aumento do articular proximal da falange proximal do hálux, somente nos homens.

Pressäo da panturrilha em adultos normais / Calf pressure in normal adults

Com um esfigmomanômetro previamente inflado até 100mmHg e o pé em flexão pantar, foram medidos os acréscimos da pressão da panturrilha que ocorrem nos terços proximais e médicos das pernas, ao realizar-se a dorsoflexão podal passiva, de 100 indivíduos entre os sexos e de cinco faixas etárias (25-30, 31-35, 36-40, 41-45 e 46-50 anos). Para verificar se havia diferenças estatísticas entre os valores obtidos, conforme os lados, sexos e faixas etárias, aplicou-se o teste t de Student. Para comparar os valores nos terços proximais e médios, o de Mann-Whitney. Os resultados foram os seguintes: 25,9 + 8,0mmHg para o terço proximal e 62,2 + 12,7mmHg para o terço médio. Estatisticamente, não houve diferença entre os lados, sexos e faixas etárias, enquanto que, quando se cotejaram os valores obtidos nos terços proximais com os dos médios, a diferença foi altamente significante (p<0,01). Os autores concluem que, por tratar-se de um método simples, prático, de baixo custo e de imediata resolução, também deva ser utilizado nas avaliações da integridade funcional do tendão de Aquiles.

Estudo dos ângulos talocalcaneanos em radiografias de frente e perfil dos pés normais de crianças / Study of talocalcaneal angles through anteroposterior and lateral views in X-rays of normal children feet

Radiografias nas incidências de frente e perfil foram realizadas nos pés direitos e esquerdos, considerados normais, de 140 crianças, igualmente divididas entre os sexos e na faixa etária de oito a 13 anos. Em suas imagens foram determinados os ângulos talocalcaneanos de frente (ATCF) e de perfil (ATCP), obtendo-se, respectivamente, os seguintes resultados: 26,0º + 4,7º para meninos e 28,2º + 5,2º para meninas e 43,9º + 4,2º para meninos e 41,1º + 4,4º para meninas. A análise estatística indicou para os dois ângulos diferenças significantes entre os sexos, sendo no ATCF os valores maiores para as meninas e no ATCP, o contrário. No que se refere à correlaçao deles com a idade, houve significância estatística somente no ATCP dos meninos, que diminui quando ela aumenta. Em conclusao, consideramos que os valores angulares aqui encontrados podem ser utilizados como critérios de normalidade podal de crianças, na faixa etária estudada.

Técnica de Cox sem crioablaçäo para tratamento cirúrgico da fibrilaçäo atrial / Cox technique without cryoablation for surgical treatment of atrial fibrillation

Seis pacientes foram submetidos ao tratamento cirúrgico da fibrilaçao atrial (FA) pela técnica do labirinto (Cox), sem a utilizaçao da crioblaçao. Quatro pacientes apresentavam estenose mitral (EM) associada, 1 insuficiência mitral e 1 dupla lesao mitral. Um dos pacientes apresentava estenose tricúspede e 2 insuficiênicia tricúspede associadas. o diâmetro médio do átrio esquerdo, medido pelo ecocardiograma era de 6,0 cm (5-7,3). A etiologia era reumática em 5 pacientes e degenerativa em 1. Plastia valvar mitral foi realizada em 3 pacientes, comissurotomia mitral em 2 e troca valvar mitral em 1. Em 4 pacientes havia tormbos no átrio esquerdo, um deles também no átrio direito. o tempo médio de circulaçao extracorpórea foi de 123 minutos 9110-142) e de anóxia do miocárdio de 91 minutos (80-108). Na sala de operaçoes o ritmo inicial era juncional em 4 e sinusal em 2. No pós-operatório imediato, todos apresentavam ritmo juncional, passando para ritmo sinusal em todos, exceto em 1. Os pacientes receberam alta hospitalar (8-27 dias) em boas condiçoes, sem utilizaçao de drogas antiarrítimicas e o Holter de 24 horas mostrava ritmo sinusal em 5 pacientes e ritmo atrial ectópico em 1 paciente. O estudo hemodinâmico e o ecodoppler revelaram contraçao atrial sincrônica em todos os casos, exceto 1. O diâmetro atrial esquerdo médio era de 4,8 cm (3,7-5,2).