Alvaro Villela de Moraes

Reconstrução geométrica do ventrículo esquerdo: avaliação intraoperatória por ecocardiograma transesofágico

The surgical treatment of LVA by geometric reconstruction has been increasing the results and the use of TEE is an important method to evaluate the results. From July 91 to January 92,22 consecutive patients (pts) with LVA were operated on, 20 were male and the ages ranged from 35 to 72 y (57.1 y). All pts were operated on with extracorporeal circulation (ECC), moderate hypothermia and intermitent aortic crossclamping. The surgical technique consisted by plicatures of septal and antero-apical wall to reconstruct the LV cavity and 19 pts received bypass grafts. No deaths were observed and in 4 pts was used IABP with good evolution. The TE evaluation was performed before and after the ECC in hemodinamic estability. Some parameters were evaluated as: inferior wall thickning (WT) that was 30% pre ECC and 61 % post ECC (p<0.05). The ejection fraction varied from 25% pre ECC to 52% post ECC (p<0.05). The diastolic diameter came from 65 mm pre ECC to 53 mm post ECC (p<0.05). In conclusion, the geometric reconstruction of LVA showed good results, confirmed by hemodynamic and ECHO parameters in intraoperative period.

Myocardial perfusion by contrast echocardiography. Establishment of normal pattern of intracoronary injection and safety in humans

OBJECTIVE To establish the normal pattern and safety of echocardiographic contrast in patients with no significant obstruction of epicardial coronary arteries. METHODS 67 patients with normal coronary arteries or obstructions < 50% were selected from 277 patients who underwent coronary angiography (CA). Mean age was 56 +/- 11 years and 36 were males. At the end CA, echocardiographic contrast was selectively injected into each coronary artery. The parasternal short axis of the left ventricle (LV) was divided into six segments: anterior (A), antero-lateral (AL), postero-lateral (PL), posterior (P), infero-septal (IS) and antero-septal (AS). Anterolateral (ALPM) and posteromedial papillary muscles (PMPM) were also considered. The pattern and intensity of the appearance of the myocardial contrast was visually analyzed. RESULTS The right coronary artery (RCA) was dominant in 60 patients. Contrast appearance was sudden and simultaneous in the 3 muscle layers. All segments could be contrasted after the injection in both coronary arteries. 100% of the AS, A and AL segments, 97% of the PL and 98% of the ALPM were perfused by the left coronary artery (LCA). P and IS segments were perfused by the RCA in 85% and 82%, respectively, and by a dominant LCA in 71% of the cases. The PMPM was perfused by a dominant RCA in 77% and by a dominant LCA in 86%. There were no symptoms. CONCLUSION Intracoronary injection of the sonicated solution is a safe procedure that allows for an excellent opacification of the myocardium and can potentially be used during routine CA.