Fernando T. Amaral

Late surgical repair of ventricular septal defect due to nonpenetrating chest trauma: review and report of two contrasting cases.

Traumatic rupture of the interventricular septum is a rare condition usually presenting in infancy and childhood. This report describes two cases: a 3-year-old boy operated on soon after the diagnosis was made, and a 15-year-old girl operated on 12 years following the causative accident. Both patients had the diagnosis confirmed by cardiac catheterization. The typical appearance of a traumatic ventricular septal defect (VSD) was seen during surgical repair that was successfully carried out in both patients. The protracted clinical course of the second patient, eventually requiring corrective intervention, contributes to the understanding of natural history of traumatic VSD.

Incidence of heart defects in Down syndrome

Eighty-six patients with Down Syndrome were studied with the main purpose of quantifying the incidence of congenital heart defects and the risk of occurrence according to the mothers age. Thirty-eight patients had the cariotypes determined, 35 of them having trissomy of chromosome 21 and translocation in 3 cases. Congenital heart disease was found in 44 (51%) of the patients, the most common one being ventricular septal defect. An important incidence of Fallots tetralogy was also found (20%). These 86 children were submitted to 41 surgical procedures, most of them on the cardiovascular system. The maternal mean age was 33 -/+ 8.6 years and the estimated risk of Down Syndrome was 1/590, a lower value than the one reported in other studies.

Compressão extrínseca da artéria coronária esquerda por dilatação aneurismática do tronco pulmonar em adolescente: involução após oclusão cirúrgica de comunicação interatrial seio venoso e plastia redutora do tronco pulmonar

We report the case of an adolescent referred with initial diagnosis of pulmonary hypertension. Non-invasive investigation disclosed a sinus venous atrial septal defect with pulmonary hypertension. The hemodynamic study confirmed diagnosis, and also showed extrinsic compression of left main coronary artery by pulmonary trunk. Surgical closure of the defect in addition to pulmonary trunk plasty were undertaken. Two years after the surgery the patient is well, with clinical signs of mild pulmonary hypertension, and showing no evidence--also on echocardiogram--of left coronary artery trunk obstruction.

Congenital coarctation of the lower thoracic aorta. A rare surgically correctable cause of hypertension in the young — case report

We report a case of congenital coarctation of the lower thoracic aorta. The patient, a 15-year-old man, presenting with the signs of classical coarctation, had the diagnosis confirmed by an aortography. A good surgical result was achieved by means of resection of the internal shelf and aortoplasty using a bovine pericardium patch. One year after the operation the patient has normal blood pressure with good femoral pulses.

Myocardial Reperfusion by Thrombolysis After Acute Total Left Main Artery Occlusion—A Case Report

Coronary recanalization with thrombolytic agents is a new therapeutic approach to the treatment of acute myocardial infarction that can be beneficial even to patients in cardiogenic shock. Although few cases have been reported in the literature, treatment of acute occlusion of the left main coronary artery (LMCA) has been made possible by myocardial reperfusion. This communication concerns a patient with acute LMCA occlusion who was successfully treated by thrombolytic therapy with streptokinase followed by revascularization of the myocardium seventy-two hours after reperfusion was achieved.

Participação de estudantes de medicina como avaliadores em exame estruturado de habilidades clínicas (Osce)

ABSTRACT Two educational experiments developed to verify if senior medical students could act as exami-ners in an Osce of basic clinical skills are described. In the first experience, 6 interns and 6 staffmembers assessed 59 students from the traditional curriculum in a 6-station Osce structured toassess medical history, physical examination and communication skills. The scores attributedby the staff members were higher than that of the students in all but the communication skillstation. However, no significant difference was found among scores except in one physicalexamination station (p < 0,001) (Wilcoxon test). In the second experience, 15 interns from thetraditional curriculum and 9 staff members assessed 58 PBL curriculum students in a 3-stationOsce to assess clinical history, physical examination and manipulation of sterilized gloves. Thestudents were paired to the staff members and an independent assessment was done using thesame protocol. In 50% of the stations the mean scores attributed by the staff members and

Recommendations for starting a grown up congenital heart disease (GUCH) unit.

During the last decades, advances in diagnosis and treatment of congenital heart disease have allowed many individuals to reach adulthood. Due mainly to the great diagnostic diversity and to the co-morbidities usually present in this age group, these patients demand assistance in a multidisciplinary facility if an adequate attention is aimed. In this paper we reviewed, based in the international literature and also on the authors’ experience, the structural conditions that should be available for these patients. We highlighted aspects like the facility characteristics, the criteria usually adopted for patient transfer from the paediatric setting, the composition of the medical and para- medical staff taking into account the specific problems, and also the model of outpatient and in-hospital assistance. We also emphasized the importance of patient data storage, the fundamental necessity of institutional support and also the compromise to offer professional training. The crucial relevance of clinical research is also approached, particularly the development of multicenter studies as an appropriate methodology for this heterogeneous patient population.

Adult congenital heart disease: experience with the surgical approach

OBJECTIVE To report the institution experience with the surgical treatment of adults with congenital heart disease due to the increasing number of these patients and the need for a better discussion of the subject. METHODS Retrospective analysis describing demographic data, risk factors and results. RESULTS 191 patients between 16 and 74 years old were operated on. Primary correction was done in 171 cases, 93 (55%) for atrial septal defect repair. Among 20 (12%) reoperations, pulmonary valve replacement was done in six cases. The mean intensive care and hospital stay were 2.7 and 8.5 days respectively, significantly greater for the reoperated cases (P=0.001). The mean bypass and clamping times were 68.6 and 44.7 minutes respectively, greater for the reoperated cases (P<0.0001 and P=0.0003 respectively). Hospital mortality was 4.2% and male sex, functional class III-IV and older age at operation were predictive risk factors. Significant complications were more frequent in the reoperated cases (P<0.003), mainly atrial flutter and fibrillation. Among 183 patients discharged, 149 (82%) are being followed and atrial flutter and fibrillation are common. The mean functional class value improved significantly after operation (1.66 to 1.11; P<0.0001). The estimated survival was 96.2% in six years. CONCLUSION Heart surgery in adults with congenital heart disease can be accomplished with low mortality and functional class improvement. Immediate and late complications are frequent. Multicenter studies are important to better characterize this patient population in the country.

Enteropatia perdedora de proteínas após cirurgia de Fontan

Operation, Fontan, protein loss. In 1971, Fontan and Baudet were the first to describe a surgical technique for the successful separation of the systemic and pulmonary circulations in a patient with tricuspid atresia1. Soon after, Kreutzer suggested a similar procedure for a patient with the same condition2. This innovative procedure became known as “the Fontan operation”, which, especially in the 1970’s and 1980’s, provided a better prognosis for patients with functionally univentricular hearts. Since these early impressive reports, several modifications of the techniques have been described as an attempt to further improve the function of both circulations3-5.

Valvoplastia mitral percutânea de urgência em gestante

We report the case of a 33-year-old woman in the 28th week of pregnancy and with signs of fetal death, admitted to hospital in an emergency due to pulmonary edema secondary to severe mitral valve stenosis. Intensive medical treatment was unsuccessful and the patient was submitted to an emergency percutaneous balloon mitral valvoplasty with prompt clinical improvement. Subsequent clinical deterioration secondary to fetal death was managed by cesarean section resulting in clinical estabilization. The patient was discharged 10 days after admission and at 11 months after the procedure she had mild symptons without drug therapy and echocardiographic signs of mild residual mitral stenosis (mitral valve area: 2,0cm2).