Leandro de Moura

The axillary artery – a new approach for endovascular treatment of thoracic aortic diseases

Endovascular procedures are increasing in number for the treatment of thoracic aortic diseases (TAD). Retrograde approach through the femoral artery is the preferred vascular access. Despite the improvements in the devices, femoral artery complications still occurs and some times this access is not possible because of the small size of the vessels, obstruction, calcification, dissection or extreme tortuosity. An axillary approach could be an alternative. We present a series of five patients and describe the technique we used in the axillary artery approach to treat TAD. There were two ascending aortas and three descending aortic aneurysms treated. The left axillary artery was used in three patients and the right in two. There were no local or neurological complications. In this preliminary approach, both axillary arteries were a good alternative access for endovascular graft insertion to treat aortic diseases when femoral access was not possible or was suboptimal.

Tratamento endovascular dos aneurismas de aorta abdominal: experiência inicial e resultados a curto e médio prazo

Objective: The purpose of this study is to present the short and medium-term results of the endovascular treatment of abdominal aortic aneurysms (AAAs). This is an initial experience of a multidisciplinary team. Method: Between July 2003 and October 2005, 42 patients (25 of whom suffered from AAAs) were treated with endovascular therapy for aortic diseases. The mean patient age was 74 ± 10.2 years with 92% men. The endovascular procedures were performed by a multidisciplinary team in the Hospital de Clinicas de Porto Alegre and Hospital Luterano (ULBRA). In twenty-four of the AAA patients, bifurcated grafts were used and only one had a straight graft. In all patients the procedure was carried out by femoral artery dissection in a catheterization laboratory. There was no need to convert to open repair. Results: There were no operative or postoperative deaths. The survival rate free from re-interventions is 96% after two years and three months. One (4%) patient needed a new endovascular procedure for a type I endoleak one year after, and three extensions were used successfully. Two other patients needed femoro-femoral bypasses, one at the same time as the endovascular procedure and the other one 24 hours later because of lower limb ischemia. Conclusion: The endovascular treatment of AAAs represents a new less invasive alternative to conventional surgery, especially for high risk patients. Further prospective and randomized studies to evaluate the long term outcomes are needed. Excellent results in the short and medium-terms can be obtained by multidisciplinary teams in our country.

Endovascular repair of an abdominal aortic aneurysm in patient with horseshoe kidney: a case report

Horseshoe kidney is a rare congenital anomaly that may cause various technical problems during conventional repairs of abdominal aortic aneurysms. We report the case of a 68-year-old woman with a horseshoe kidney, symptomatic abdominal aortic aneurysm and mild renal failure. The patient underwent endovascular repair using a bifurcated endoprosthesis. The postoperative was uneventful. We describe the diagnosis and the endovascular technique and literature review.

Endovascular repair of ascending aorta and coronary stent implantation

Endovascular treatment of ascending aorta pseudoaneurysms with coronary stents implantation at the same procedure was feasible, although longer followup is necessary.

Ultrastructural study of the myocardium using cardioplegic crystalloid solution with and without procaine in patients undergoing aortic valve replacement

OBJECTIVE The aim of this study was to assess whether the presence of procaine in crystalloid cardioplegic solution increases myocardial protection at the ultra structural level. METHODS Eighteen patients that underwent aortic valve replacement in the Hospital de Clínicas de Porto Alegre over a 10-month period were studied. They were randomly allocated into two groups: group A--eight patients receiving cardioplegia without procaine; group B--ten patients receiving cardioplegia with procaine. Myocardial biopsies were performed in three different periods: 1st--before ischemic arrest, 2nd--at the end of ischemic arrest, and 3rd--15 minutes after reperfusion. RESULTS The ultra structural analysis comparing the groups in the three moments did not show any statistically significant difference. The mean score in group A at moment I, II and III was 0.1 +/- 0.2; 0.4 +/- 0.3; 0.4 +/- 0.4, and group B 0.2 +/- 0.2; 0.4 +/- 0.3; 0.7 +/- 0.2. Comparative analysis of CK-MB was similar. The spontaneous return to sinus rhythm after aortic declamping in group B occurred in 70% and in group A 12.5% (p=0.024). CONCLUSION Both cardioplegic solutions tested were equally effective in myocardial preservation, and we could not demonstrate at the ultrastructural level any benefit when procaine was added. The spontaneous return to sinus rhythm after aortic declamping was significantly greater when procaine was added.

Experimental empyema in rats through intrapleural injection of bacteria

OBJECTIVE: to evaluate empyema formation in rats through the injection of two bacteria (Pasteurella multocida and Staphylococcus aureus), using a simple, easy-to-use surgical technique. METHODS: twenty four anesthetized Wistar white rats, 250-300g in weight, submitted to right anterior thoracotomy, muscular retraction and injection of a 0.2ml solution into pleural space according the following scheme: Group I (n=12): injection of 1010 Pasteurella multocida cultured in brain heart infusion broth. Group II (n=8): injection of 1010 Staphylococcus aureus cultured in brain heart infusion broth. Group III (n=4): injection of bacterium-free brain heart infusion (control). The rats were sacrificed after seven days, and pleural reaction was assessed by macroscopy. Mortality, and intrathoracic liquid volume were evaluated, and bacteriological tests were also performed. RESULTS: Seven rats died within the first 48 hours in Group I (Pasteurella multocida); five completed the experiment, but none of them presented empyema. Only one animal died within the first 24 hours in Group II (Staphylococcus aureus); seven (88%) presented empyema at the time of sacrifice. All animals survived in Group III (control), without empyema or thoracic abnormalities. Pleural inoculation of Staphylococcus aureus (Group II) was significantly associated with empyema formation (P<0.001). In this group, the amount of pleural liquid ranged from 0.9 to 3.9ml. CONCLUSION: It is possible to induce empyema in rats through Staphylococcus aureus pleural injection by a simple surgical technique. Differently from other experiments, the pleural injection of Pasteurella multocida did not provoke empyema in rats.

Sutureless Aortic Prosthesis Implantation: the First Brazilian Experience with Perceval Device

This is a report of the first Brazilian experience with the Perceval sutureless aortic prosthesis in two patients with severe aortic stenosis. Transesophageal echocardiography was used during the procedure. The aortotomy was performed 1 cm above the sinotubular junction, followed by leaflets removal and decalcification. Correct valve size was selected, device released and an accommodation balloon used. The cardiopulmonary bypass times were 47 and 38 min and the cross-clamp times were 38 and 30 min. There was a significant decrease in mean gradients (41 and 75 mmHg preoperatively; 7 and 8 mmHg postoperatively). There was no major complication or paravalvular leak.

Indução de empiema em ratos através da inoculação pleural de bacterias

Objetivo: avaliar a inducao experimental de empiema em ratos, atraves da inoculacao intrapleural de duas bacterias (Pasteurella multocida e Staphylococcus aureus), utilizando tecnica cirurgica simples e de facil execucao. Metodos: foram utilizados 24 ratos albinos da raca Wistar, de ambos os sexos, pesando entre 250 e 300g, que, apos a anestesia geral, foram submetidos a toracotomia anterior direita, afastamento da musculatura e inoculacao de 0,2 ml de solucao, conforme descricao a seguir: grupo I (n = 12), inoculacao de Pasteurella multocida, 10 10 unidades formadoras de colonia/ml cultivados em caldo cerepo-coracao; grupo II (n = 8), inoculacao de Staphylococcus aureus, 10 10 unidades formadoras de colonia/ml cultivados em caldo cerepo-coracao; e grupo III (n = 4), inoculacao de caldo cerepo-coracao esteril (controle). Os animais foram sacrificados em ate 7 dias, e a intensidade da reacao pleural analisada macroscopicamente conforme escala padronizada. Tambem foram avaliados a mortalidade, o volume de liquido na cavidade pleural e o exame bacteriologico (animais mortos e liquido pleural). Resultados:no grupo I (Pasteurella multocida), sete ratos morreram nas primeiras 48 horas de experimento. Cinco ratos foram sacrificados no periodo programado, mas nenhum deles apresentava empiema. No grupo II (Staphylococcus aureus), somente um animal morreu nas primeiras 24 horas, os outros 7 (88%) foram sacrificados e apresentavam empiema. No grupo III, considerados controles, todos os animais sopeviveram, nao se observando nenhuma anormalidade toracica ao sacrificio. Analisando conjuntamente os grupos, a inducao de empiema esteve associada de maneira significativa a inoculacao de Staphylococcus aureus no espaco pleural (p < 0,001). A quantidade de liquido obtida na cavidade pleural dos ratos deste grupo variou de 0,9 ml a 3,9 ml. Conclusoes: e possivel induzir a formacao de empiema em ratos, utilizando tecnica cirurgica simples, com a inoculacao de Staphylococcus aureusno espaco intrapleural. A Pasteurella multocida, diferentemente do que ocorre em outros modelos animais, nao foi capaz de induzir empiema nos ratos