João de Deus e Brito

One-stage management of infected sternotomy wounds using bilateral pectoralis major myocutaneous advancement flap

OBJECTIVE To assess the results of single-stage treatment of infected sternotomy wounds using bilateral pectorals major myocutaneous advancement flaps. METHODS Between January 2000 and July 2007, 1972 heart surgeries with median transesternal thoracotomy were performed. Thirteen (0.65%) patients presented wound infections and dehiscence after sternotomy. To treat those patients we adopted exclusively single-stage management, drainage, early intervention and immediate wounds closure using bilateral pectoralis major myocutaneous advancement flaps to the medium line of the sternum. Two patients with superficial wounds infection and other two who underwent torsion adjustment of the steel wire were not included in this study. RESULTS There was one death in the 30-day postoperative period. There was no intraoperative death. Four patients needed additional surgical intervention to drain residual seroma or local infection. There was total resolution of the sternal infection in 12 patients. CONCLUSION The authors recommend the single-stage early management of sternotomy infected wounds with debridement, drainage and immediate closure of the wound using bilateral pectoralis major myocutaneous advancement flaps to the medium line of the sternum. The procedure is effective and may contribute to decrease the morbidity.

Thirtieth Anniversary of the Brazilian Journal of Cardiovascular Surgery. And Devising the Next Decades

anniversary of the Brazilian Journal of Cardiovascular Surgery (BJCVS). We asked some collaborators of the Journal to express their sentiments about the interaction of them with the publication, and the importance that it represented in their lives. Was not surprise to have many important manifestations of the colleagues, to show historical facts and personal impressions about the challenge that the former “Revista Brasileira de Cirurgia Cardiovascular” faced since its foundation up to nowadays. The BJCVS was a dream of the members from the “Sociedade Brasileira de Cirurgia Cardiovascular” (SBCCV) that is supporting the publication along all years by a decision of all the associates. Even with sacrifice, are maintaining the Journal, without any reimbursement, from the authors, or from the readers. From the very beginning, we had the possibility to count with the manuscripts from the Brazilian Cardiovascular Surgeons, offering the best products of the researches done in Brazil, to be published in our own Journal. To grow in the very restrict field of the specialty, was not easy. However, with the total compromise of all collaborators was possible, step by step, to arrive at the 30 anniversary in a consolidated position, publishing seven editions per year, six conventional and one supplement. Being recognized by Main International Databases, like Medline PubMed, PubMed Central, SCImago – Scopus, Thomson Reuters, and others, is a reason of great proud. Today we have the privilege to be in a good position in the Latin American Journals ranking in our field, where we are surpassed only by the sister organization “Arquivos Brasileiros de Cardiologia” See at the link: https://goo.gl/Kkiuxg Our efficient Associate Editor, Prof. Dr. Paulo Evora, wisely decided to bring part of those emotional homages to thanks EDITORIAL

Opção técnica na tetralogia de Fallot com artéria coronária anômala: relato de casos

Report on two children, one 11 year-male and another one year-six-month-female with tetralogy of Fallot associated with anomalous origin of coronary artery crossing the right ventricle outlet tract. Diagnosis was done by echocardiography and cardiac catheterization. On surgical correction we used an external composite tubular pericardium bovine graft and posterior wall of the pulmonary artery between the right ventricle and the pulmonary artery trunk. Patients had an uneventful post-operative period and were discharged asymptomatic. It is more an option on correction of tetralogy of fallot with anomalous coronary artery.

Aneurisma do seio de Valsalva esquerdo englobando a parede anterior do ventrículo direito

The case of a 33-year-old male suffering from left sinus Valsalva aneurysm into anterior right ventricle and severe aortic valve regurgitation is presented. Diagnosis of this association was achieved before surgery by cardiac catheterization and Echocardiography. The patient was submitted to surgical repair by closing the orifice of the aneurysm using a bovine pericardium patch. The aortic valve regurgitation was repaired using Trusler’s procedure.

Cardioplegia retrógrada atrial: estudo clínico

This study presents the results in a group of fifteen patients submitted to cardiac surgery, using continuous atrial retrograde warm blood cardioplegia for myocardial protection. Eleven patients were submitted to myocardial revascularization and four were submitted to valvular transplantation. There was no need for inotropic drugs or intraaortic balloon pump support during or after the procedure, and no myocardial infarction was detected in this group. When the heart was arrested, the cardioplegia line was switched to the atrial cannula. The aortic root was vented throughout the cross-clamp period, and retrograde perfusion was assured by noting the engorged exygenated cardiac veins as well as the return of dark blood through the vent in the aortic root. The patients presented good clinical and laboratory course. No right ventricular dysfunction was detected. Two patients were in atrial fibrillation before the surgery, one of them returned to this cardiac rhythm three days after the procedure.

Proteção medular em cirurgia da aorta descendente com uso de "bio-pump" e exsangüinação controlada

The authors have used for spinal cord protection during descending aortic surgery, partial extracorporeal circulation from left atrium to left femoral artery, low dose of heparin (1 mg/kg), centrifugal pump (bio-pump) and controlled exsanguination. They have operated upon with this methodology 4 patients without mortality, paraplegia or excessive bleeding.

Proteção cerebral no tratamento cirúrgico dos aneurismas do arco aórtico: estudo experimental em cães

The authors proposition is to make an experimental study of two methods of cerebral protection to be used during aortic arch aneurysm resection. The methods to be evaluated were profound systemic hypothermia (under 20oC) whith great vessels occlusion and profound systemic hypothermia with selective right carotid artery perfusion. Two groups of 15 dogs each were submitted either to profound systemic hypothermia with great vessels occlusion (Group I), or to profound systemic hypothermia with selective right carotid artery perfusion (Group II). Serial jugular vein samples for pH and PaCO2 were analyzed to evaluate ischemic cerebral metabolic derangements. Hystopathological studies were also performed 45, 90 and 135 minutes, through animal sacrifice in each experiment. The results have shown good cerebral protection with both methods in the 45 minutes ischemic interval. At 90 minutes Group II method has conferred better cerebral protection than Group I. At 135 minutes of cerebral ischemia neither method could afford cerebral protection against ischemia.