Alexandre Visconti Brick

Tratamento intra-operatório da fibrilação atrial crônica com ultra-som

A seat belt system for securing a seated occupant to a seat, the system comprising: a single continuous length of seat belt webbing, the seat belt including first and second ends; a first anchor located near the juncture of the seat belt and seat cushion with a buckle positioned on the other side of the cushion, a movable anchor guide or second web guide for orientating portions of the seat belt relative to the seat; second means for moving the seat belt away from the seat to encourage the occupants entry onto the seat and for thereafter manipulating the seat belt about the seated occupant so that a portion of the seat belt forms a lap belt about the seated occupant and wherein other portions of the seat belt form two relatively criss-crossed shoulder belt segments of seat belt in front of the seated occupant.

Estudo multicêntrico dos resultados das trocas valvares com o uso da bioprótese Biocor no Estado de Minas Gerais

No periodo de marco de 1981 a marco de 1988, foram implantadas 2324 bioproteses, em 2016 pacientes, em 5 Centros do Estado de Minas Gerais. Este estudo inclui somente a analise dos pacientes submetidos a troca valvar aortica (n = 603) e mitral ( n = 1110), isoladamente. Neste grupo (n = 1713), a mortalidade hospitalar foi de 104 pacientes (6,1%). Dos 1609 pacientes que receberam alta do hospital, conseguimos o seguimento de 1101 pacientes (64,3). Esta analise corresponde a um periodo de 1 a 84 meses, com media de 48 meses e com um seguimento cumulativo de: aorticas (n= 385) = 1230 pacientes/ano; mitrais (n = 716) = 3018 pacientes/ano. Foram registradas 102 complicacoes tardias em 716 pacientes mitrais (14,24%) e 51 complicacoes no grupo aortico (13,2%). Com relacao a faixa etaria, encontramos 220 pacientes menores de 20 anos (mitrais = 176/aorticos = 44) e, neste subgrupo, as disfuncoes valvares incidiram em 43% dos pacientes mitrais e em 29% dos pacientes aorticos. A endocardite protetica foi mais encontrada nos aorticos (45%) do que nos mitrais (29,7%). Dos 1101 pacientes, 62 foram reoperados, com mortalidade hospitalar de 12,6%. A reoperacao por disfuncao valvar foi mais frequente no grupo mitral com idade inferior a 20 anos. A curva atuarial livre de mortalidade relacionada a bioprotese foi de 97,1% (32/1101 pacientes). No grupo aortico, 96,9% estiveram livres de disfuncao valvar ao final de 7 anos, enquanto que, no grupo mitral, este indice foi de 95,2%. Nos pacientes menores de 20 anos do grupo mitral, encontramos o maior indice de falencia valvar (85,3% livre apos 7 anos). Ao final deste estudo, a maior parte destes pacientes encontrava-se em classe funcional I e II. Embora a incidencia de reoperacao seja expressiva, esta e aceitavel, tendo em vista que as bioproteses oferecem uma alternativa mais segura do que as proteses mecânicas, durante este mesmo periodo do seguimento. A analise destes resultados sugere a continuacao de pesquisas que tornem possivel a fabricacao de um substituto valvar ideal. Todavia, estes resultados comparam-se, de modo favoravel, a resultados com bioproteses semelhantes da literatura mundial.

Seguimento de 9 anos da bioprótese valvular cardíaca de pericárdio bovino IMC-Biomédica: estudo multicêntrico

A mitral pericardial bioprosthetic valve IMC-Biomedica was implanted in a consecutive series of 798 patients with mean age of 52 years, from December 1977 to November 1978. The 722 patients who survived operation were observed during a period of 9 years (mean 27036 months or 2253 years). Actuarial studies indicated an expected survived rate at 9 years of 66% for adult patients and 68% for younger patients. The probability of complications were the following: rupture 0.4; perivalvar leak 0.4%; thromboembolysm 2.7%; endocarditis 3.2%; calcification 4.4%. The actuarial freedom from calcification between 1977 to 1982 (Group I) was 94.0% to adults and 12.0% to younger patients. On the other hand, between 1982 to 1986 (Group II) the actuarial analysis of calcification showed that 99.0% adults and 92.0% younger patients were free from this complication. Hence we believe that our option for the pericardial bioprosthetic valve was appropriate because 96.0% patients were free of complications deaths with the valve; this means that in 9 years the bioprosthetic lethal potential was only 4.0%.

Chronic Atrial Fibrillation Ablation with Harmonic Scalpel during Mitral Valve Surgery

Objective To evaluate surgical treatment of chronic atrial fibrillation with ultrasound in patients with mitral valve disease, considering preoperative clinical characteristics of patients undergoing surgical procedure and follow-up in the immediate postoperative period, in hospital and up to 60 months after discharge. Methods We studied 100 patients with chronic atrial fibrillation and mitral valve disease who underwent surgical treatment using ultrasound ablation. Patient data were reviewed by consulting the control reports, including signs and symptoms, underlying disease, functional class, hospital stay, surgical procedure time, ablation time, immediate complications, and complications at discharged and up to 60 months later. Actuarial curve (Kaplan-Meier) was used for the study of permanence without recurrence after 12, 24, 36, 48 and 60 months. Results 86% of the patients had rheumatic mitral valve disease, 14% had degeneration of the mitral valve, 40% had mitral regurgitation, and 36% had mitral stenosis. Main symptoms included palpitations related to tachycardia by chronic atrial fibrillation (70%), congestive heart failure (70%), and previous episodes of acute pulmonary edema (27%). Early results showed that 94% of the patients undergoing ultrasound ablation reversed the rate of chronic atrial fibrillation, 86% being in sinus rhythm and 8% in atrioventricular block. At hospital discharge, maintenance of sinus rhythm was observed in 86% of patients and there was recurrence of chronic atrial fibrillation in 8% of patients. At follow-up after 60 months, 83.8% of patients maintained the sinus rhythm. Conclusion Surgical treatment of chronic atrial fibrillation with ultrasound concomitant with mitral valve surgery is feasible and satisfactory, with maintenance of sinus rhythm in most patients (83.8%) after 60 months of follow-up.

Man as a Subject of the Reality of Health: a Personal Reflexion

We have so much to learn. The world is as mysterious as challenging and therein lays the beauty and soul of curious researcher. Leonardo Da Vinci affirmed that knowledge makes the soul younger and reduces the bitterness of elderly age. So when we awake, despite all the problems of modern society, we must reap wisdom and store softness for tomorrow. The quest for knowledge is a source of joy it is the root of the findings and inexhaustible source of progress. Examples of exciting love of knowledge changed the history of humanity. Leonardo Da Vinci was a proof of brain power for life. In addition to the master painter, he was an architect, mechanic, engineer, chemist, botanist, geologist and also developed several other activities. Maybe he was the first to study the human body dissecting corpses, prohibited action at that time and now so important to the learning of everybody of health area. Surely science and technology have done wonders in many fields, but I agree that they did not stimulate goodness. When we remember figures such as Da Vinci and the Dalai Lama, we should take them as examples of great men who changed the world, because they were great observers, its own characteristic of great scientists. What we want represents what is best into universities, it is a time of great curiosities, many questions, intense studies, inquiries and research and we can immortalize youth through knowledge and make smooth each new day (our and everybody’s) to share the blessings of wisdom. The great and immortal Pasteur has already stated: “Science and peace will triumph over ignorance and war. People will understand themselves not to destroy but to build.” In ancient times it reflected a desire which still remains. What is happening on the national scene is the existence of a defective medical education with needy universities, creating new schools, when in fact, we should think about removing some, because we cannot give them the least consistent conditions with its superior design. The demerit is not private medicine, because we still have illiteracy in Basic, Secondary and also in Degree education, intercommunicating in his weakness because its lack of a solid foundation. It is very serious that students traverse of faltering way these various stages and come to the university, it should accept the brain of the nation. Must have a demanding and selective teaching, no prejudice on creed, color, sex or nationality. DOI: 10.5935/1678-9741.20160009

DISCURSO DE ABERTURA DO 32º CONGRESSO DA SOCIEDADE BRASILEIRA DE CIRURGIA CARDIOVASCULAR

Estimados colegas, bons amigos!Vitoria! Vitoria!aro Shariff, a quem aprendi a admirar;Domingo Braile, amigo e orientador,Excelentissimo Governador Paulo Hartung.Voces conseguiram! Vitoria! Bela capitalcapixaba, que nos recebe de bracos abertos.Com carinho, admiracao e respeito, em nome dessestres vencedores, cumprimento a todos os que vaocompartilhar, com a diretoria da Sociedade Brasileira deCirurgia Cardiovascular, de momentos de congracamento,aprendizagem e, sobretudo, de renovacao.No meu discurso de posse citei o poeta CarlosDrummond de Andrade, que escreveu que “no meiodo caminho havia uma pedra, havia uma pedra no meiodo caminho...”Ha, ainda, muitas pedras para serem removidas ouultrapassadas no meio do nosso caminho. Elas sempreexistirao!O que fazemos nos, medicos, todos os dias, senaoremover obstaculos, senao buscar alternativas aosobstaculos aparentemente intransponiveis, senaoencontrar caminhos desobstruidos, possibilitando acontinuidade da vida?Para a continuidade da vida, como e bom ser gratoa tudo e a todos, aprendendo com as pessoas que noscercam, incentivam e criticam, ajudando-nos a enfrentaros desafios da vida.Pensando no que escrever, lembrei de um mitoantigo da cultura mediterrânea sobre orejuvenescimento da aguia:“De tempos em tempos - reza o mito - a aguia, comoa fenix egipcia, se renova totalmente”.Ela voa cada vez mais alto ate chegar perto do sol.Entao, as penas se incendeiam e ela toda comeca aarder. Quando chega a este ponto, ela se precipita doceu e se lanca qual flecha nas aguas frias do lago.Atraves dessa experiencia de fogo e agua, a velha aguiase rejuvenesce totalmente. Volta a ter penas novas,garras afiadas, olhos penetrantes e o vigor da