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Efetividade do metoprolol na prevenção de fibrilação e flutter atrial no pós-operatório de cirurgia de revascularização miocárdica

Objective - To assess the effectiveness of metoprolol in preventing clinically detectable atrial fibrillation (AF) and flutter after coronary artery bypass graft (CABG) surgery . Methods - An open, randomized study was carried out to treat 200 patients who had undergone isolated CABG surgery with extracorporeal circulation. The patients were randomized to either receive metoprolol orally or not to receive the medication in the postoperative period. The outcomes were the detection of sustained atrial AF and flutter, which were symptomatic or required treatment. The patients with the following characteristics were excluded from the study: baseline left ventricular ejection fraction < 35%; previous AF; history of bronchospasm; second- and third-degree atrioventricular blocks, low cardiac output, and heart failure. Results - Arrhythmias occurred in 11 out of 100 patients in the metoprolol group and in 24 out of 100 patients in the control group (P=0.02). The relative risk (RR) was 0.46 (95% CI = 0.24-0.88), and the number necessary to treat (NNT) and avoid the outcome was 8 patients. AF was the arrhythmia most frequently observed (30/35). In 38 patients aged 70 years or more, the arrhythmias occurred in 2 out of 19 patients in the metoprolol group and in 10 out of 19 patients in the control group (χ2 Yates: P=0.01). The relative risk was 0.20 (95% CI = 0.05-0.79) and the number necessary to treat was 2 patients. Conclusion - Metoprolol is effective in preventing AF and flutter in the postoperative period of CABG surgery, and this effect was more evident in the group of elderly patients.

Left internal mammary artery graft patency demonstrated by bedside retrograde brachial arteriography

of the thoracic aorta has been used in some centers only in children lz2 because its viability may be questionable in adu1ts.l On studying these arteriograms in our institution, we noted that the internal mammary artery (IMA] was always contrasted by the peripheral injection. We decided to test the technique in adults

Silent Patent Ductus Arteriosus Aneurysm

Ductus arteriosus aneurysm, a rare and potentially fatal condition, has been reported as a complication after surgical ductus arteriosus closure. Its spontaneous appearance as a septic complication, which was common in the presurgical and preantibiotic era, has been rarely reported in the contemporary literature. Persistence of silent ductus arteriosus in healthy children and adults is a frequent condition that currently has an increasing diagnostic possibility due to the availability of more accurate investigative methods, especially echocardiography. We report the case of a 1-year-old child, in whom no previous heart disease was known, who developed a giant aneurysm of the ductus arteriosus during a staphylococcal infection. This complication appeared after craniotomy for emptying an accidental subdural hematoma. This report associates the persistence of ductus arteriosus with a complication considered rare, which has a rapidly fatal evolution.

Tratamento cirúrgico para ectasia ânulo-aórtica

This is a report of 27 patients presenting annulo-aortic ectasia submitted to surgical correction with a composite valve-tube graft (Bentall-De Bono technique), between 1976 and 1985. Twenty three (85.2%) had cystic medial necrosis, 3 (11,1%) were chronic aortic disections and 1 (3.7%) was luetic aortitis. Age ranged from 29 to 64 years (m = 48). Three were female and 24 male patients. The valves used were homologous dura maier in 7 cases, heterologous aorta in 9 and mechanical prosthesis in 11. Functional class (NYHA) was I-II in 7 and III-IV in 9 patients. There was 1 (3.7%) hospital death, due to bleeding and renal failure. Significant early complications were represented by arrhythmias in 13 cases (48%) and bleeding in 3 (11%). In the late follow-up therev.were 9 deaths, due to: sudden death (2 patients, 7.4%), bleeding in reoperation (1 patient, 3.7%), hospital infection (1 patient, 3.7%), infectious endocarditis (1 patient, 3.7%) and accidental causes (2 patients, 7.4%). Five patients (18.5%) needed reoperation in the late follow-up: 2 due to bioprosthetic failure, 2 for replacement of an infected Dacron tube and 1 for repair of pseudo-aneurysm and periprosthetic leak. The actuarial survival curve showed a probability of 83.7% up to the 3rd. year, 61 % for the 5th. year and 42.7% from the 6th. to the 9th. year of follow-up. The 17 patients surviving are in functional class I-II (NYHA). The composite valve-Dacron tube graft (Bentall-De Bono) technique for correction of annulo-aortic ectasia is associated with a low hospital mortality. The improvement in functional class is significant. There have been a small number of complications and the long term survival is very satisfactory.