Ivan de Lima Cavalcanti

Pulmonary hypertension in schistosomiasis.

Although there is a high rate of pulmonary involvement in patients with schistosomiasis (Shaw and Ghareeb, 1938; Faria, 1952; Menezes, 1957) there have been few publications containing an extensive analysis of the clinical picture and haemodynamic alterations caused by this disease. Outstanding among the few are those by Shaw and Ghareeb (1938), Kenawy (1950), Barbato (1952), Girgis (1952), El Ramly et al. (1953), and Marchand et al. (1957). The present paper aims at presenting our contribution to this subject.

Ventricular septal defect following nonpenetrating trauma. Case report and review of the surgical literature

From the Institute of Diseases of the Chest of Recife. Real Hospital Português de Beneficência em Pernambuco. Av. Portugal, 163, Recife Brazil. Rupture of the interventricular septum may result from blunt trauma of the chest or from a penetrating wound of the heart. Patients with traumatic ventricular septal defect from a penetrating wound usually have symptoms and signs of cardiac tamponade or hemothorax and do not develop the typical clinical picture of an acute ventricular septal defect, due to blunt trauma, which is quite similar to those of interventricular septal ruptures following myocardial infarction. Traumatic ventricular septal defect was first described by Hewett’ in 1847. EaSt2 made the first diagnosis in life and Guilfoil and Doyle3 reported the first case proven by cardiac catheterization. The first successful repair of traumatic ventricular septal defect was performed by Lillehei in 1955. This case was reported upon by Campbell .4 Since then, at least twenty-one4-23 patients have received surgical treatment for ventricular septal defect due to indirect trauma. In the present paper a case of traumatic ventricular septal defect repaired surgically is described and the surgical literature reviewed.

Profilaxia da fibrilação atrial no pós-operatório imediato de cirurgia coronária: comparação entre propranolol e sotalol utilizados em baixas doses

OBJETIVO: Comparar a eficacia de dois protocolos terapeuticos usando baixas doses de betabloqueadores para prevencao de fibrilacao atrial no pos-operatorio imediato de cirurgia coronaria. METODOS: 154 pacientes, submetidos a cirurgia coronaria, foram randomizados em dois grupos: no grupo I (n = 72), os doentes receberam Sotalol (80 mg/dia) e, no grupo II, (n = 82) usaram Propranolol (40 mg/dia), ambos iniciados no primeiro dia de pos-operatorio. Na unidade de terapia intensiva, o eletrocardiograma foi continuamente observado por monitorizacao a beira do leito. Adicionalmente, eletrocardiograma nas 12 derivacoes foi realizado no pre-operatorio, nos 1o, 3o e 6o dias de pos-operatorio e sempre que os pacientes apresentaram queixas de palpitacoes ou surgiram sinais de arritmias (pulso irregular ou frequencia cardiaca acima de 100 bpm). RESULTADOS: Fibrilacao atrial foi documentada em 3 (4,2%) pacientes do grupo I (Sotalol) e em 8 (9,8%) do grupo II (Propranolol). CONCLUSAO: A incidencia geral de fibrilacao atrial em pacientes que receberam baixas doses de Sotalol e Propranolol apos cirurgia coronaria foi baixa (7,1%), tendo alcancado o menor valor (4,2%) no grupo de pacientes que receberam Sotalol, embora nao tenha sido observada uma diferenca estatisticamente significante entre os dois grupos (p= 0,221).

Congenital Aneurysm of the Left Atrium

Aneurysm of the left atrium is considered to be congenital in origin, in the absence of predisposing conditions such as mitral valve disease, congenital heart disease, or acquired inflammatory changes in the myocardium. It is a rare condition that may involve either the atrial appendage (aneurysmal dilatation of the left atrial appendage) or the atrial wall (aneurysm of the body of the left atrium). Aneurysmal dilatation of the left atrial appendage may occur with an intact pericardium or may be associated with a pericardial defect. In 1974

Mitral Valve Surgery in Children

During the period from January 1960 to April 1977, 585 patients underwent mitral valve surgery at the Federal University of Pernambuco Medical School Hospital and at the Institute of Diseases of the Chest, Recife, Brazil. Among these patients, 50 (8.5%) were under 15 years of age. There were 28 girls and 22 boys ranging in age from 6 to 15 years (average 11 years). Forty-six (92%) had a history of rheumatic disease or were in active carditis at the time of hospital admission. Mitral valve lesion was diagnosed on the basis of clinical, electrocardiographic, and radiologic findings, but in 33 patients the severity of the lesion was estimated by cardiac catheterization and cineangiocardiography. Every effort was made to operate in the inactive phase of the rheumatic fever, and medical treatment was instituted whenever there was clinical

A cirurgia da endomiocardiofibrose revisitada

Eighty-three patients with endomyocardial fibrosis (EMF) underwent endocardial decortication and atrioventricular valve replacement or repair between December, 1977, and December, 1997. There were 66 (79.6%) female and 17 (20.4%) male patients, ranging in age from 4 to 59 years (mean, 31). Thirty-seven (44.5%) had biventricular disease 134 (41.0%) had disease of the right ventricle alone and 12 (14.5%) had EMF confined to the left ventricle. All were in functional class III or IV (New York Heart Association classification). Sixty-eight (81.9%) patients survived the operation and were followed-up for periods of time ranging from 1 month to 17 years. The total follow-up time was 6,290 patient/months (mean, 92 months). There were 15 late deaths but in 6 the cause was not related to the underlying disease. Four (5.8%) patients presented recurrence of the fibrosis and were reoperated and in 6 (8.8%) EMF appeared in the other ventricle. Five (7.3%) patients were reoperated to replace either a valve prosthesis or a native valve which had been preserved during the first procedure. Only 24 (45%) of the 53 living patients are in functional class I or II. The actuarial probability of survival at 17 years, including operative mortality, was 55%. In conclusion, surgical treatment of EMF should be considered a palliative procedure because surgery does not stop the progressive nature of the disease. However, surgical therapy is recommended for patients with EMF and heart failure as it is the only hope for them.

Operação de Rastelli utilizando-se conduto valvulado de pericárdio bovino: experiência inicial

O presente trabalho descreve a experiencia inicial com a operacao de Rastelli, utilizando-se um conduto valvulado de pericardio bovino preservado em glutaraldeido. O enxerto consta de um conduto, que serve para reconstruir a via de saida do ventriculo direito e o tronco pulmonar, com uma valvula tricuspide suturada em seu interior sem anel de suporte, permitindo, assim, um mecanismo de fluxo unidirecional. De maio de 1986 a outubro de 1987, 5 criancas foram submetidas a operacao de Rastelli empregando-se este tipo de conduto valvulado. Tres eram do sexo feminino e 2, do masculino, variando a idade de 1 a 8 anos x 5). Tres pacientes tinham transposicao das grandes arterias, comunicacao interventricular (CIV) e estenose subpulmonar. Uma crianca era portadora de atresia pulmonar com CIV e de um shunt previo tipo Waterston e, finalmente, a outra tinha um tronco arterial comum tipo II. Dois doentes faleceram de causas nao relacionadas ao tipo de conduto valvulado utilizado. O conduto valvulado de pericardio bovino preservado em glutaraldeido mostrou excelente flexibilidade, facilitando o manuseio cirurgico e permitindo perfeita adaptabilidade dentro do saco pericardico. A ausencia de anel de suporte tem a vantagem de eliminar qualquer gradiente e de abolir o turbilhonamento do sangue - causas reconhecidas de calcificacao.

Dez anos de cirurgia da endomiocardiofibrose: o que aprendemos?

In the last 10 years(1977-1987), 53 patients with endomyocardial fibrosis were submitted to endocardial decortication and atrioventricular valve replacement. There were 42 female and 11 male patients, ranging in age from 11 to 59 years (mean 31). The patients were divided into three groups: Group I included 25 patients with bilateral disease; Group II consisted of 23 patients with endomyocardial fibrosis of the right side; and Group III included 5 patients with the disease confined to the left ventricle. All were in Functional Class III or IV (New York Heart Association classification). The 30-day mortality was 20.7% (11 cases). The remainder 42 patients survived the early postoperative period which was quite stormy in 21 (39.6%). There were 10 (18.8%) late deaths. One patient was reoperated two years later to replace the mitral valve which had been preserved during the first intervention. Among the 32 survivors (mean follow-up 4.1 patients/year), 22 (41,5%) are in Functional Class I or II. The actuarial curve showed that the 5-year probability of survival is 75%. Despite the high early and late mortality, and the fact that only 41.5% of the operated patients had good clinical improvement in the late postoperative period, surgical treatment is, at present, the only hope for patients with endomyocardial fibrosis. Technical aspects of the operation are outlined.

Correction of transposition of the great arteries using homologous dura mater: a preliminary report.

were present. His blood pressure was 100/70 mm Hg, and the pulse regular at 100/minute. The heart showed a hyperdynamic right ventricular impulse. A Grade II/VI systolic murmur was heard in the second and third intercostal spaces at the left sternal edge. The second heart sound was loud at the pulmonic area. The ECG showed right ventricular hypertrophy. On the chest x-rays, the heart appeared slightly enlarged and an increase in pulmonary vascular markings could be noted. Cardiac catheterization data is given in Table I. The cineangiograms (Fig. 1) established the diagnosis of simple transposition of the great arteries.

Tratamento cirúrgico da tetralogía de Fallot no adulto

Twenty-nine cyanotic patients with tetralogy of Fallot ranging in age from 16 to 43 years (mean, 21 yrs) have undergone total correction. Only two (6.8%) patients had previous Blalock-Taussig shunt. The established intracardiac technique for total repair was used throughout. In four (13.75) patients, reconstruction of the pulmonary outflow tract was required. The hospital mortality was 13.7% (4 of 29 patients). All deaths occurred in the beginning of the experience (1967-1977), when disposable oxygenators and myocardial protection were not used. The follow-up for the surviving patients was 1560 patient-months (mean, 62 months). There was one late death, not cardiac related. All but two survivors had good clinical results. These two patients were successfully reoperated for correction of residual defects at six months and 11 years after the initial procedure, respectively. We believe that advanced age is not a contraindication for total repair of tetralogy of Fallot since patients with this anomaly surviving to adulthood usually show favourable morphology.