Fernando Platania

Tratamento cirúrgico da rotura de parede livre do ventrículo esquerdo após infarto agudo do miocárdio

MATERIAL AND METHODS: Between January 1983 and May 1999, 12.405 patients were treated by the surgical team of the Heart Institute (InCor) with the diagnosis of acute myocardial infarction (AMI). From these patients, 127 (1.02%) had left ventricular free wall rupture as an ischemic complication of the myocardial infarction. The cardiac rupture was acute in 98 patients (77.1%) and sub-acute in 29 (22.9%). RESULTS: Twenty-four patients were operated on, 5 on acute rupture with 80% of hospital mortality and 19 on sub-acute rupture with 15.8% of hospital mortality. The post-operative overall survival including both groups was 70.8%. CONCLUSION: The conclusion was drawn that left ventricular free wall rupture is a severe complication of acute myocardial infarction that needs an immediate action. In acute ruptures, most patients develop hemodynamic deterioration without enough time to try to proceed any surgical correction. The sub-acute cases can be detected and monitored through periodic ecocardiographic exams after the AMI. In these cases the early surgical intervention, many times without using extra-corporeal circulation, has been increasing the chances of survival of the majority of these patients.

Right internal thoracic artery remodeling 18 years after circumflex system grafting

A 64-year-old man with left main coronary artery disease underwent myocardial revascularization. The left internal thoracic artery (LITA) was sutured to the left anterior descending artery, and the right internal thoracic artery (RITA) was sutured to the obtuse marginal artery. Eighteen years later, angina reoccurred. Catheterization revealed that both the coronary and the left subclavian arteries were occluded and that a patent RITA graft was maintaining the cardiac blood supply. The RITA graft evaluation revealed increased lumen diameters, suggestive of remodeling. The LITA was subsequently disconnected and sutured to the aorta as a free graft in order to restore appropriate myocardial blood flow. This case emphasizes the benefits of using a live graft for left coronary system grafting, which include long-term patency and flow-dependent remodeling.

Externally supported radial artery graft for myocardial revascularization: A new technique to avoid vasospasm

incision, believing it offered the best exposure for complete excision of the tumor, as well as redoing the bypass grafts. CPB was established via groin cannulas to support the heart during the redo sternotomy. Manipulation of the divided sternum was minimized, because thymomas can adhere to mediastinal structures, even without real invasion. Traction on the tumor or the vein graft might have led to an intraoperative myocardial infarction. Alternatively, a thoracotomy or thoracoscopy could have mobilized the mediastinum from the undersurface of the sternum before sternotomy, but we thought that this did not provide sufficient safety should the vein graft occlude. A favorable outcome was achieved in this case by (1) preoperative coronary arteriography, (2) femoral CPB before the redo sternotomy, and (3) no manipulation of the tumor or graft before cardioplegia. R E F E R E N C E S 1. Filippone G, Savona I, Tomasello V, Guzzetta P, Zarcone N, Agate V. Radical excision of invasive thymoma with intracaval and intracardial extension: a successful case report. J Cardiovasc Surg (Torino) 1997;38:547-9. 2. Fujino S, Tezuka N, Watarida S, Katsuyama K, Inove S, Mori A. Reconstruction of the aortic arch in invasive thymoma under retrograde cerebral perfusion. Ann Thorac Surg 1998;66:263-4. 3. Ohshima K, Ishikawa S, Yoshida I, Ohtaki A, Ohtani Y, Takahashi T, et al. A concomitant operation of coronary artery bypass grafting and thymectomy: a case report [in Japanese]. Kyouba Geka 1994;47:1029-33. 4. Mendez-Fernandez MA, Kremem AF, Geis RC, Henly WS. Reconstruction of the left innominate vein in a patient with invasive thymoma undergoing coronary artery bypass surgery. J Cardiovasc Surg 1986;27:351-4. 5. Allums JA, Gordon FT, Moore CH. Cardiac entrapment by thymoma following coronary bypass surgery. Chest 1979;75:210-1. The Journal of Thoracic and Cardiovascular Surgery Volume 118, Number 3 Brief communications 563

Modificação de antigo método (Vineberg) na era das células tronco: nova tática?

Innumerous patients present with refractory angina despite optimized management whether with drug or surgical treatment. Currently, we are not uncommonly asked about the possibility of reintervention on patients that have already undergone several hemodynamic procedures, with repeated angioplasties and stent placement. Frequently, these patients have also already been operated on once or more times, some of them presenting with still patent although little effective grafts due to the diffuse pattern of their coronary diseases. Many of them show good left ventricular function, with high degrees of myocardial ischemia.In this context, we have worked on replacing early techniques for more modern and alternative ones, or even on giving a new focus to original techniquesCorrespondencia: Adriano Milanez • Rua Dr. Eneas de Carvalho Aguiar, 44 Bloco II 2o Andar, Sala 11 05403-000 Jardim Paulista Sao Paulo – SP E-mail: milanez@secrel.com.br Articulo recibido el 04/04/08; revisado recibido el 22/08/08; aceptado el 21/10/08. Introduccion Un sinnumero de pacientes son portadores de angina refractaria, a pesar del tratamiento optimizado, medicamentoso o quirurgico. Actualmente, no es raro ser consultados sobre la posibilidad de reintervenir sobre pacientes ya sometidos a diversos procedimientos hemodinamicos, con seguidas angioplastias y stents. Con frecuencia, esos paciente tambien ya fueron operados una o mas veces, algunos presentando todavia injertos previos, pero con poca efectividad, debido al grado difuso de la enfermedad coronaria. Muchos de ellos presentan buena funcion ventricular izquierda, siendo portadores de elevados niveles de isquemia miocardica. En ese contexto, hemos actuado apuntando a sustituir tecnicas iniciales por otras mas modernas y alternativas, o incluso intentando dar a tecnicas originales1,2 un nuevo enfoque, proporcionando soluciones quirurgicas para soluciones antes inabordables.

Modification of an Old Procedure (Vineberg) in the Stem Cell Era - a New Strategy?

Innumerous patients present with refractory angina despite optimized management whether with drug or surgical treatment. Currently, we are not uncommonly asked about the possibility of reintervention on patients that have already undergone several hemodynamic procedures, with repeated angioplasties and stent placement. Frequently, these patients have also already been operated on once or more times, some of them presenting with still patent although little effective grafts due to the diffuse pattern of their coronary diseases. Many of them show good left ventricular function, with high degrees of myocardial ischemia.In this context, we have worked on replacing early techniques for more modern and alternative ones, or even on giving a new focus to original techniquesCorrespondencia: Adriano Milanez • Rua Dr. Eneas de Carvalho Aguiar, 44 Bloco II 2o Andar, Sala 11 05403-000 Jardim Paulista Sao Paulo – SP E-mail: milanez@secrel.com.br Articulo recibido el 04/04/08; revisado recibido el 22/08/08; aceptado el 21/10/08. Introduccion Un sinnumero de pacientes son portadores de angina refractaria, a pesar del tratamiento optimizado, medicamentoso o quirurgico. Actualmente, no es raro ser consultados sobre la posibilidad de reintervenir sobre pacientes ya sometidos a diversos procedimientos hemodinamicos, con seguidas angioplastias y stents. Con frecuencia, esos paciente tambien ya fueron operados una o mas veces, algunos presentando todavia injertos previos, pero con poca efectividad, debido al grado difuso de la enfermedad coronaria. Muchos de ellos presentan buena funcion ventricular izquierda, siendo portadores de elevados niveles de isquemia miocardica. En ese contexto, hemos actuado apuntando a sustituir tecnicas iniciales por otras mas modernas y alternativas, o incluso intentando dar a tecnicas originales1,2 un nuevo enfoque, proporcionando soluciones quirurgicas para soluciones antes inabordables.

Análise direcional do fluxo sangüíneo miocárdico após revascularização transmiocárdica com laser de CO2: estudo através da ressonância magnética com imagens de gradiente ultra-rápido

OBJECTIVE: The aim of this work is to analyze the myocardial flow direction of patients submitted to transmyocardial laser revascularization (TMLR), using the first - pass magnetic resonance imaging (MRI). METHODS: Ten patients submitted to TMLR with CO2 laser (potency of 800 W) were studied with magnetic resonance imaging (MRI) of fast gradient ¾ eco- EPI hybrid sequence used in a 1.5 TGE CV/i scanner (Sigma CVMR - General Eletric ¾ Milwaukee-USA) to evaluate myocardial perfusion. Bolus of Gadolinium ¾ DTPA (0.1mmol/Kg) was injected by a peripherical intra-venous line at 5 ml/sec at rest and during peak stress of dypiridamole. The distribution of the contrast through the myocardial regions was analyzed. RESULTS: After a mean follow-up of 14.7 months, 6 (60%) patients showed significant myocardial ischemia at least in one of the left ventricular walls. The blood flow was inverted, from subendocardium to subepicardium, just in 1 (10%) patient. CONCLUSIONS: First-pass MRI is an efficient method to show the direction of the myocardial blood flow. In one of the studied patients, the inverted myocardial blood flow (from the endocardium to the epicardium), suggested the patency of the channels created by TMLR.

Tratamento cirúrgico de mixoma do coração duplamente recidivado, em paciente testemunha de Jeová: relato de caso

Recurrence of cardiac myxoma after excision is uncommon. The complete excision of the base of the tumor from the heart wall prevents its recurrence. In cases without wide resections , the probability of tumor recurrence rises. The authors report the case of a 26 year old male patient with recurrent left atrium myxoma presenting on two occasions. The patient was admitted with a left atrium tumor. Echocardiogram disclosed a tumor in interatrial septum. The patient is a Jehovas witness and did not receive whole blood or any blood products during the hospital stay. At operation a gelatinous mass fixed on interatrial septum was found. A wide resection was done, including the septal insertion of the tumor. Pathological examination revealed it to be a cardiac myxoma.

Modificación del antiguo método (Vineberg) en la era de las células madre: ¿nueva táctica?

Innumerous patients present with refractory angina despite optimized management whether with drug or surgical treatment. Currently, we are not uncommonly asked about the possibility of reintervention on patients that have already undergone several hemodynamic procedures, with repeated angioplasties and stent placement. Frequently, these patients have also already been operated on once or more times, some of them presenting with still patent although little effective grafts due to the diffuse pattern of their coronary diseases. Many of them show good left ventricular function, with high degrees of myocardial ischemia.In this context, we have worked on replacing early techniques for more modern and alternative ones, or even on giving a new focus to original techniquesCorrespondencia: Adriano Milanez • Rua Dr. Eneas de Carvalho Aguiar, 44 Bloco II 2o Andar, Sala 11 05403-000 Jardim Paulista Sao Paulo – SP E-mail: milanez@secrel.com.br Articulo recibido el 04/04/08; revisado recibido el 22/08/08; aceptado el 21/10/08. Introduccion Un sinnumero de pacientes son portadores de angina refractaria, a pesar del tratamiento optimizado, medicamentoso o quirurgico. Actualmente, no es raro ser consultados sobre la posibilidad de reintervenir sobre pacientes ya sometidos a diversos procedimientos hemodinamicos, con seguidas angioplastias y stents. Con frecuencia, esos paciente tambien ya fueron operados una o mas veces, algunos presentando todavia injertos previos, pero con poca efectividad, debido al grado difuso de la enfermedad coronaria. Muchos de ellos presentan buena funcion ventricular izquierda, siendo portadores de elevados niveles de isquemia miocardica. En ese contexto, hemos actuado apuntando a sustituir tecnicas iniciales por otras mas modernas y alternativas, o incluso intentando dar a tecnicas originales1,2 un nuevo enfoque, proporcionando soluciones quirurgicas para soluciones antes inabordables.