L. W. R. Alves

Dorsal minithoracotomy for ductus arteriosus clip closure in premature neonates

We present a new surgical technique for patent ductus arteriosus (PDA) occlusion in premature neonates (PN). Through a dorsal minithoracotomy the PDA is dissected extrapleurally with q-tips and clipped. The short surgical time, avoidance of pleural drainage, and prevention of late breast deformity are the operation highlights.

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.

Blood Cardioplegia with N-Acetylcysteine May Reduce Coronary Endothelial Activation and Myocardial Oxidative Stress

OBJECTIVES The aim of this prospective study was to compare the efficacy of intermittent antegrade blood cardioplegia with or without n-acetylcysteine (NAC) in reducing myocardial oxidative stress and coronary endothelial activation. METHODS Twenty patients undergoing elective isolated coronary artery bypass graft surgery were randomly assigned to receive intermittent antegrade blood cardioplegia (32 degrees C-34 degrees C) with (NAC group) or without (control group) 300 mg of NAC. For these 2 groups we compared clinical outcome, hemodynamic evolution, systemic plasmatic levels of troponin I, and plasma concentrations of malondialdehyde (MDA) and soluble vascular adhesion molecule 1 (sVCAM-1) from coronary sinus blood samples. RESULTS Patient demographic characteristics and operative and postoperative data findings in both groups were similar. There was no hospital mortality. Comparing the plasma levels of MDA 10 min after the aortic cross-clamping and of sVCAM-1 30 min after the aortic cross-clamping period with the levels obtained before the aortic clamping period, we observed increases of both markers, but the increase was significant only in the control group (P= .039 and P= .064 for MDA; P= .004 and P= .064 for sVCAM-1). In both groups there was a significant increase of the systemic serum levels of troponin I compared with the levels observed before cardiopulmonary bypass (P< .001), but the differences between the groups were not significant (P= .570). CONCLUSIONS Our investigation showed that NAC as an additive to blood cardioplegia in patients undergoing on-pump coronary artery bypass graft surgery may reduce oxidative stress and the resultant coronary endothelial activation.

Isolated mitral and aortic valve replacement with the St. Jude Medical valve: a midterm follow-up

BACKGROUND In our country, the biological valvular prostheses predominate, considering the difficulties related to anticoagulation, even in young patients, in spite of the need for repeated operations due to the degeneration of the bioprostheses. OBJECTIVES To report our consecutive series of recipients of isolated St Jude Medical mechanical valve prosthesis in the mitral (MVR) or aortic (AVR) position. METHODS Data from patients operated between January 1995 and December 2003 were revised in order to determine patient survival and prosthesis-related events up to December 2006. RESULTS One hundred sixty eight patients had MVR and 117 had AVR. In the MVR cohort, the mean age was 45 years, 75% were 55 years old or younger, and 65% were females. In the ARV cohort, the mean age was 45 years, 66% were 55 years old or younger and 69% were males. Operative mortality for AVR and MVR was 7% and 7.5%, respectively. Freedom from late mortality was 81.8% at 10 years for MVR and 83% for AVR (p=0.752). Freedom from valve-related death at 10 years for the MVR cohort and AVR was 85.6% and 88.7%, respectively (p=0.698). In the MVR cohort, the freedom from reoperation was 97% and 99% in the AVR cohort (p=0.335). Freedom from thromboembolic events was 82% in the MVR cohort and 98% in the AVR cohort (p=0.049). Freedom from bleeding was 71% in the MVR cohort and 86% n the AVR cohort (0.579). Freedom from endocarditis was 98% in the MVR cohort and 99% in the AVR cohort (p=0.534). CONCLUSIONS This series of predominantly young adult patients undergoing isolated MVR and AVR with the St Jude Medical mechanical prosthesis confirms the good performance of this valve prosthesis in agreement with previous reports.FUNDAMENTO: Em nosso meio as proteses valvares biologicas predominam, considerando-se as dificuldades relacionadas a anticoagulacao, mesmo em pacientes jovens, a despeito da necessidade de repetidas operacoes devido a degeneracao das proteses biologicas. OBJETIVO: Apresentar a evolucao em medio prazo de pacientes submetidos a substituicao da valva mitral ou aortica por protese valvar mecânica St. Jude. METODOS: Foi analisada retrospectivamente a evolucao dos pacientes operados entre janeiro de 1995 e dezembro de 2003 e seguidos ate dezembro de 2006. RESULTADOS: Cento e sessenta e oito pacientes receberam protese valvar mitral e 117, aortica. A idade media de ambos os grupos foi de 45 anos. Entre os mitrais, 75% tinham ate 55 anos e 65% eram mulheres. Entre os aorticos, 66% tinham ate 55 anos e 69% eram homens. Considerando-se apenas mortes relacionadas as proteses valvares, a sobrevida foi de 85,6% para os mitrais e de 88,7% para os aorticos (p=0,698). Entre os mitrais, 97% estavam livres de reoperacao, e entre os aorticos 99% (p=0,335). Quanto aos eventos tromboembolicos, a porcentagem de pacientes livres foi de 82% entre os mitrais e de 98% entre os aorticos (p=0,049), e para os eventos hemorragicos foi de 71% e 86% respectivamente (0,579). Quanto a ocorrencia de endocardite, 98 % entre os mitrais e 99% entre os aorticos estavam livres ao final de 10 anos (p=0,534). CONCLUSAO: Nossa experiencia com proteses metalicas St. Jude em uma populacao predominantemente jovem confirma o bom desempenho desta protese, em acordo com outras experiencias publicadas.

Substituição valvar isolada com próteses metálicas St. Jude Medical em posição aórtica ou mitral: seguimento de médio prazo

BACKGROUND In our country, the biological valvular prostheses predominate, considering the difficulties related to anticoagulation, even in young patients, in spite of the need for repeated operations due to the degeneration of the bioprostheses. OBJECTIVES To report our consecutive series of recipients of isolated St Jude Medical mechanical valve prosthesis in the mitral (MVR) or aortic (AVR) position. METHODS Data from patients operated between January 1995 and December 2003 were revised in order to determine patient survival and prosthesis-related events up to December 2006. RESULTS One hundred sixty eight patients had MVR and 117 had AVR. In the MVR cohort, the mean age was 45 years, 75% were 55 years old or younger, and 65% were females. In the ARV cohort, the mean age was 45 years, 66% were 55 years old or younger and 69% were males. Operative mortality for AVR and MVR was 7% and 7.5%, respectively. Freedom from late mortality was 81.8% at 10 years for MVR and 83% for AVR (p=0.752). Freedom from valve-related death at 10 years for the MVR cohort and AVR was 85.6% and 88.7%, respectively (p=0.698). In the MVR cohort, the freedom from reoperation was 97% and 99% in the AVR cohort (p=0.335). Freedom from thromboembolic events was 82% in the MVR cohort and 98% in the AVR cohort (p=0.049). Freedom from bleeding was 71% in the MVR cohort and 86% n the AVR cohort (0.579). Freedom from endocarditis was 98% in the MVR cohort and 99% in the AVR cohort (p=0.534). CONCLUSIONS This series of predominantly young adult patients undergoing isolated MVR and AVR with the St Jude Medical mechanical prosthesis confirms the good performance of this valve prosthesis in agreement with previous reports.FUNDAMENTO: Em nosso meio as proteses valvares biologicas predominam, considerando-se as dificuldades relacionadas a anticoagulacao, mesmo em pacientes jovens, a despeito da necessidade de repetidas operacoes devido a degeneracao das proteses biologicas. OBJETIVO: Apresentar a evolucao em medio prazo de pacientes submetidos a substituicao da valva mitral ou aortica por protese valvar mecânica St. Jude. METODOS: Foi analisada retrospectivamente a evolucao dos pacientes operados entre janeiro de 1995 e dezembro de 2003 e seguidos ate dezembro de 2006. RESULTADOS: Cento e sessenta e oito pacientes receberam protese valvar mitral e 117, aortica. A idade media de ambos os grupos foi de 45 anos. Entre os mitrais, 75% tinham ate 55 anos e 65% eram mulheres. Entre os aorticos, 66% tinham ate 55 anos e 69% eram homens. Considerando-se apenas mortes relacionadas as proteses valvares, a sobrevida foi de 85,6% para os mitrais e de 88,7% para os aorticos (p=0,698). Entre os mitrais, 97% estavam livres de reoperacao, e entre os aorticos 99% (p=0,335). Quanto aos eventos tromboembolicos, a porcentagem de pacientes livres foi de 82% entre os mitrais e de 98% entre os aorticos (p=0,049), e para os eventos hemorragicos foi de 71% e 86% respectivamente (0,579). Quanto a ocorrencia de endocardite, 98 % entre os mitrais e 99% entre os aorticos estavam livres ao final de 10 anos (p=0,534). CONCLUSAO: Nossa experiencia com proteses metalicas St. Jude em uma populacao predominantemente jovem confirma o bom desempenho desta protese, em acordo com outras experiencias publicadas.

Sustitución valvular aislada con prótesis metálicas St. Jude Medical en posición aórtica o mitral: seguimiento de medio plazo

BACKGROUND In our country, the biological valvular prostheses predominate, considering the difficulties related to anticoagulation, even in young patients, in spite of the need for repeated operations due to the degeneration of the bioprostheses. OBJECTIVES To report our consecutive series of recipients of isolated St Jude Medical mechanical valve prosthesis in the mitral (MVR) or aortic (AVR) position. METHODS Data from patients operated between January 1995 and December 2003 were revised in order to determine patient survival and prosthesis-related events up to December 2006. RESULTS One hundred sixty eight patients had MVR and 117 had AVR. In the MVR cohort, the mean age was 45 years, 75% were 55 years old or younger, and 65% were females. In the ARV cohort, the mean age was 45 years, 66% were 55 years old or younger and 69% were males. Operative mortality for AVR and MVR was 7% and 7.5%, respectively. Freedom from late mortality was 81.8% at 10 years for MVR and 83% for AVR (p=0.752). Freedom from valve-related death at 10 years for the MVR cohort and AVR was 85.6% and 88.7%, respectively (p=0.698). In the MVR cohort, the freedom from reoperation was 97% and 99% in the AVR cohort (p=0.335). Freedom from thromboembolic events was 82% in the MVR cohort and 98% in the AVR cohort (p=0.049). Freedom from bleeding was 71% in the MVR cohort and 86% n the AVR cohort (0.579). Freedom from endocarditis was 98% in the MVR cohort and 99% in the AVR cohort (p=0.534). CONCLUSIONS This series of predominantly young adult patients undergoing isolated MVR and AVR with the St Jude Medical mechanical prosthesis confirms the good performance of this valve prosthesis in agreement with previous reports.FUNDAMENTO: Em nosso meio as proteses valvares biologicas predominam, considerando-se as dificuldades relacionadas a anticoagulacao, mesmo em pacientes jovens, a despeito da necessidade de repetidas operacoes devido a degeneracao das proteses biologicas. OBJETIVO: Apresentar a evolucao em medio prazo de pacientes submetidos a substituicao da valva mitral ou aortica por protese valvar mecânica St. Jude. METODOS: Foi analisada retrospectivamente a evolucao dos pacientes operados entre janeiro de 1995 e dezembro de 2003 e seguidos ate dezembro de 2006. RESULTADOS: Cento e sessenta e oito pacientes receberam protese valvar mitral e 117, aortica. A idade media de ambos os grupos foi de 45 anos. Entre os mitrais, 75% tinham ate 55 anos e 65% eram mulheres. Entre os aorticos, 66% tinham ate 55 anos e 69% eram homens. Considerando-se apenas mortes relacionadas as proteses valvares, a sobrevida foi de 85,6% para os mitrais e de 88,7% para os aorticos (p=0,698). Entre os mitrais, 97% estavam livres de reoperacao, e entre os aorticos 99% (p=0,335). Quanto aos eventos tromboembolicos, a porcentagem de pacientes livres foi de 82% entre os mitrais e de 98% entre os aorticos (p=0,049), e para os eventos hemorragicos foi de 71% e 86% respectivamente (0,579). Quanto a ocorrencia de endocardite, 98 % entre os mitrais e 99% entre os aorticos estavam livres ao final de 10 anos (p=0,534). CONCLUSAO: Nossa experiencia com proteses metalicas St. Jude em uma populacao predominantemente jovem confirma o bom desempenho desta protese, em acordo com outras experiencias publicadas.