Eduardo Souza Leal Botelho

Intraoperative monitoring with transesophageal echocardiography in cardiac surgery

BACKGROUND AND OBJECTIVES Since its clinical introduction in the 80s, intraoperative transesophageal echocardiography (TEE) has represented one of the greatest advances in modern cardiac anesthesia. It is a semi-invasive technique that allows direct and fast visualization of structural anatomy of the heart and great vessels as well as contributes to hemodynamic and functional evaluation of the cardiovascular system. Thus, it has become an important monitor in aiding the diagnosis of cardiac pathologies and anesthesia and surgical interventions. The objective of this report was to perform a comprehensive review on the use of intraoperative TEE in cardiac surgery. CONTENTS This article reviews some aspects of ultrasound physics, imaging techniques, echocardiographic cuts used more oftenly, indications, and main clinical applications in addition to contraindications and complications. CONCLUSIONS Intraoperative TEE is a safe method of cardiovascular monitoring, which is useful in the formulation of a surgical strategy, orientation of hemodynamic interventions, and immediate assessment of surgical outcomes. Once qualified to use the method, the anesthesiologist expands its role in perioperative medicine, providing clinical information necessary to the anesthetic-surgical procedure in cardiac surgery.

Surgical treatment of right atrial myxoma complicated with pulmonary embolism

Myxomas are the most common type of cardiac benign tumors and most of them are located in the left atrium, followed by the right atrium. Myxomas in the right atrium may rarely embolize to the pulmonary arterial vasculature. Here, we present a case report of a patient with right atrial myxoma and massive embolism to the pulmonary arteries treated surgically with right atrial mass removal and pulmonary embolectomy. The right atrium mass presented with prolapse through the tricuspid valve causing a stenotic physiology. The left pulmonary artery was completed occluded and the right pulmonary artery was partially obstructed. Surgical tactics included a brief hypothermic circulatory arrest. The patient had an uneventful recovery and was asymptomatic after 6 months of follow-up.

Videothoracoscopy for isolated atrial fibrillation ablation through bipolar radiofrequency

BACKGROUND The prevalence of atrial fibrillation, expenses with the healthcare system and the associated high morbidity and mortality have justified the search for new therapeutic approaches. OBJECTIVE To evaluate the reproducibility of the surgical technique, its safety and the initial outcome of the video-assisted surgery for the isolated atrial fibrillation ablation with bipolar radiofrequency. METHODS Ten patients (90% men) with symptomatic atrial fibrillation (50% paroxystic type) that was refractory to drug therapy, with no heart disease that required concomitant surgical treatment, were submitted to arrhythmia ablation guided by thoracoscopy from May 2007 to May 2008. Clinical, laboratory and image variables were prospectively collected before, during surgery and at the postoperative follow-up. RESULTS The surgery was carried out as planned in all patients. There was no intra-thoracic structure iatrogenic lesion or deaths. At the mean 6-month follow-up, 80% of the patients were free of atrial fibrillation. There was a significant improvement in the symptoms of New York Heart Association Functional Class heart failure (2.4 + or - 0.5 to 1.6 + or - 0.7; p = 0.011). There was no evidence of pulmonary vein stenosis at the angiotomography in this series. CONCLUSION The video-assisted surgery for the treatment of atrial fibrillation is reproducible and safe. There is a heart failure symptom evolution improvement after the surgery.FUNDAMENTO: A prevalencia da fibrilacao atrial, os gastos com o sistema de saude e a elevada morbidade e mortalidade associadas a ela, tem justificado a procura por novas abordagens terapeuticas. OBJETIVO: Avaliar a reprodutibilidade da tecnica cirurgica, a seguranca e os resultados inicias da cirurgia video-assistida para a ablacao da fibrilacao atrial isolada com radiofrequencia bipolar. METODOS: Dez pacientes (90% homens) com fibrilacao atrial (50% paroxistica) sintomatica e refrataria a terapia medicamentosa, sem doenca cardiaca que requeresse cirurgia concomitante, foram submetidos a ablacao da arritmia guiada por toracoscopia, no periodo de maio de 2007 a maio de 2008. Variaveis clinicas, laboratoriais e de imagem foram prospectivamente coletadas antes, durante e no seguimento pos-operatorio. RESULTADOS: A cirurgia foi realizada conforme o planejado em todos os pacientes. Nao houve lesao iatrogenica de estruturas intratoracicas ou obitos. No seguimento medio de seis meses, 80% dos pacientes estao livres de fibrilacao atrial. Houve melhora significativa dos sintomas de insuficiencia cardiaca classe funcional New York Heart Association (2,4 ± 0,5 para 1,6 ± 0,7; p = 0,011). Nao houve evidencia de estenose de veias pulmonares a angiotomografia, nesta serie. CONCLUSAO: A cirurgia video-assistida para o tratamento da fibrilacao atrial e reprodutivel e segura. Ha melhora evolutiva dos sintomas de insuficiencia cardiaca apos a cirurgia.

Cirurgia vídeo-assistida para a ablação da fibrilação atrial isolada por radiofrequência bipolar

BACKGROUND The prevalence of atrial fibrillation, expenses with the healthcare system and the associated high morbidity and mortality have justified the search for new therapeutic approaches. OBJECTIVE To evaluate the reproducibility of the surgical technique, its safety and the initial outcome of the video-assisted surgery for the isolated atrial fibrillation ablation with bipolar radiofrequency. METHODS Ten patients (90% men) with symptomatic atrial fibrillation (50% paroxystic type) that was refractory to drug therapy, with no heart disease that required concomitant surgical treatment, were submitted to arrhythmia ablation guided by thoracoscopy from May 2007 to May 2008. Clinical, laboratory and image variables were prospectively collected before, during surgery and at the postoperative follow-up. RESULTS The surgery was carried out as planned in all patients. There was no intra-thoracic structure iatrogenic lesion or deaths. At the mean 6-month follow-up, 80% of the patients were free of atrial fibrillation. There was a significant improvement in the symptoms of New York Heart Association Functional Class heart failure (2.4 + or - 0.5 to 1.6 + or - 0.7; p = 0.011). There was no evidence of pulmonary vein stenosis at the angiotomography in this series. CONCLUSION The video-assisted surgery for the treatment of atrial fibrillation is reproducible and safe. There is a heart failure symptom evolution improvement after the surgery.FUNDAMENTO: A prevalencia da fibrilacao atrial, os gastos com o sistema de saude e a elevada morbidade e mortalidade associadas a ela, tem justificado a procura por novas abordagens terapeuticas. OBJETIVO: Avaliar a reprodutibilidade da tecnica cirurgica, a seguranca e os resultados inicias da cirurgia video-assistida para a ablacao da fibrilacao atrial isolada com radiofrequencia bipolar. METODOS: Dez pacientes (90% homens) com fibrilacao atrial (50% paroxistica) sintomatica e refrataria a terapia medicamentosa, sem doenca cardiaca que requeresse cirurgia concomitante, foram submetidos a ablacao da arritmia guiada por toracoscopia, no periodo de maio de 2007 a maio de 2008. Variaveis clinicas, laboratoriais e de imagem foram prospectivamente coletadas antes, durante e no seguimento pos-operatorio. RESULTADOS: A cirurgia foi realizada conforme o planejado em todos os pacientes. Nao houve lesao iatrogenica de estruturas intratoracicas ou obitos. No seguimento medio de seis meses, 80% dos pacientes estao livres de fibrilacao atrial. Houve melhora significativa dos sintomas de insuficiencia cardiaca classe funcional New York Heart Association (2,4 ± 0,5 para 1,6 ± 0,7; p = 0,011). Nao houve evidencia de estenose de veias pulmonares a angiotomografia, nesta serie. CONCLUSAO: A cirurgia video-assistida para o tratamento da fibrilacao atrial e reprodutivel e segura. Ha melhora evolutiva dos sintomas de insuficiencia cardiaca apos a cirurgia.

Use of mechanical circulatory support in cases of end-stage acute heart failure

Mailing address: Alexandre Siciliano Colafranceschi • Rua Dona Mariana 143 S/A 12 – 22280-020 – Rio de Janeiro, RJ Brasil E-mail: asiciliano@cardiosuporte.com.br Manuscript received November 15, 2006; revised manuscript received March 1, 2007; accepted April 5, 2007. Introducao The incidence of cardiogenic shock following acute myocardial infarction (AMI) is 7.5%, with a lethality of 60% to 80%1. Mortality among these patients remains high even when revascularization of the responsible artery is performed immediately1,2. Within this context, the use of mechanical ventricular support seems to improve the surgical results and long-term survival2,3. The aim of this study is to report the initial experiences with the left ventricular assist device (VAD) EXCOR® (Berlin Heart).

Consenso sobre Ecocardiografia Transesofágica Perioperatória da Sociedade Brasileira de Anestesiologia e do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia

Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.

Monitorização intraoperatória com ecocardiografia transesofágica em cirurgia cardíaca

JUSTIFICATIVA Y OBJETIVOS: Desde su introduccion clinica en la decada del 80, la ecocardiografia transesofagica (ETE) intraoperatoria ha venido siendo uno de los mayores avances en la anestesia cardiaca moderna. Es una tecnica semiinvasiva, que permite una visualizacion directa y rapida de la anatomia estructural del corazon y de los grandes vasos, ademas de aportar a la evaluacion hemodinamica y funcional del sistema cardiovascular. Asi, se ha convertido en un importante monitor en el auxilio diagnostico de patologias cardiacas e intervenciones anestesico-quirurgicas. El objetivo del articulo, es realizar una revision abarcadora sobre la utilizacion de la ETE en el intraoperatorio de cirugia cardiaca. CONTENIDO: El articulo aborda algunos aspectos relacionados con la fisica del ultrasonido, con las tecnicas para la obtencion de las imagenes, los cortes ecocardiograficos mas utilizados en el intraoperatorio, las indicaciones y las principales aplicaciones clinicas del metodo, ademas de las contraindicaciones y complicaciones. CONCLUSIONES: La ETE intraoperatoria es un metodo de monitorizacion cardiovascular seguro y util en la formulacion del plan quirurgico, en la orientacion de intervenciones hemodinamicas y en la evaluacion inmediata del resultado operatorio. El anestesiologo, una vez habilitado para la utilizacion del metodo, amplia su rol en el contexto de la medicina perioperatoria, suministrando informaciones clinicas que son imprescindibles para la consecucion del acto anestesico quirurgico en cirugia cardiaca.

Cirugía videoasistida para ablación de fibrilación atrial aislada por radiofrecuencia bipolar

BACKGROUND The prevalence of atrial fibrillation, expenses with the healthcare system and the associated high morbidity and mortality have justified the search for new therapeutic approaches. OBJECTIVE To evaluate the reproducibility of the surgical technique, its safety and the initial outcome of the video-assisted surgery for the isolated atrial fibrillation ablation with bipolar radiofrequency. METHODS Ten patients (90% men) with symptomatic atrial fibrillation (50% paroxystic type) that was refractory to drug therapy, with no heart disease that required concomitant surgical treatment, were submitted to arrhythmia ablation guided by thoracoscopy from May 2007 to May 2008. Clinical, laboratory and image variables were prospectively collected before, during surgery and at the postoperative follow-up. RESULTS The surgery was carried out as planned in all patients. There was no intra-thoracic structure iatrogenic lesion or deaths. At the mean 6-month follow-up, 80% of the patients were free of atrial fibrillation. There was a significant improvement in the symptoms of New York Heart Association Functional Class heart failure (2.4 + or - 0.5 to 1.6 + or - 0.7; p = 0.011). There was no evidence of pulmonary vein stenosis at the angiotomography in this series. CONCLUSION The video-assisted surgery for the treatment of atrial fibrillation is reproducible and safe. There is a heart failure symptom evolution improvement after the surgery.FUNDAMENTO: A prevalencia da fibrilacao atrial, os gastos com o sistema de saude e a elevada morbidade e mortalidade associadas a ela, tem justificado a procura por novas abordagens terapeuticas. OBJETIVO: Avaliar a reprodutibilidade da tecnica cirurgica, a seguranca e os resultados inicias da cirurgia video-assistida para a ablacao da fibrilacao atrial isolada com radiofrequencia bipolar. METODOS: Dez pacientes (90% homens) com fibrilacao atrial (50% paroxistica) sintomatica e refrataria a terapia medicamentosa, sem doenca cardiaca que requeresse cirurgia concomitante, foram submetidos a ablacao da arritmia guiada por toracoscopia, no periodo de maio de 2007 a maio de 2008. Variaveis clinicas, laboratoriais e de imagem foram prospectivamente coletadas antes, durante e no seguimento pos-operatorio. RESULTADOS: A cirurgia foi realizada conforme o planejado em todos os pacientes. Nao houve lesao iatrogenica de estruturas intratoracicas ou obitos. No seguimento medio de seis meses, 80% dos pacientes estao livres de fibrilacao atrial. Houve melhora significativa dos sintomas de insuficiencia cardiaca classe funcional New York Heart Association (2,4 ± 0,5 para 1,6 ± 0,7; p = 0,011). Nao houve evidencia de estenose de veias pulmonares a angiotomografia, nesta serie. CONCLUSAO: A cirurgia video-assistida para o tratamento da fibrilacao atrial e reprodutivel e segura. Ha melhora evolutiva dos sintomas de insuficiencia cardiaca apos a cirurgia.