Luís Augusto Palma Dallan

Tratamento cirúrgico da rotura de parede livre do ventrículo esquerdo após infarto agudo do miocárdio

MATERIAL AND METHODS: Between January 1983 and May 1999, 12.405 patients were treated by the surgical team of the Heart Institute (InCor) with the diagnosis of acute myocardial infarction (AMI). From these patients, 127 (1.02%) had left ventricular free wall rupture as an ischemic complication of the myocardial infarction. The cardiac rupture was acute in 98 patients (77.1%) and sub-acute in 29 (22.9%). RESULTS: Twenty-four patients were operated on, 5 on acute rupture with 80% of hospital mortality and 19 on sub-acute rupture with 15.8% of hospital mortality. The post-operative overall survival including both groups was 70.8%. CONCLUSION: The conclusion was drawn that left ventricular free wall rupture is a severe complication of acute myocardial infarction that needs an immediate action. In acute ruptures, most patients develop hemodynamic deterioration without enough time to try to proceed any surgical correction. The sub-acute cases can be detected and monitored through periodic ecocardiographic exams after the AMI. In these cases the early surgical intervention, many times without using extra-corporeal circulation, has been increasing the chances of survival of the majority of these patients.

Approach of the pulmonary valve using right heart bypass and bicaval cannula: experimental study

OBJECTIVE To reproduce the surgery for correction of pulmonary valve anomalies using right heart bypass and a new bicaval cuffed venous cannula for minimal access surgery. METHODS Fifteen Large-White pigs were used for this study. The standard technique model was established with the first five pigs, the experiment was done with nine animals by sternotomy, and one was submitted to a minimally invasive procedure, but has been excluded of the sample. Bicaval drainage by a single cannula was obtained through the internal jugular vein. The cuffs were inflated to increase blood flow to the machine. The return was established by putting the arterial cannula into the pulmonary artery trunk. Pre-bypass parameters were measured and compared with the parameters during the right bypass: Median Arterial Tension (MAT); Heart Rate (HR); O2 Saturation (SAT O2); end-tidal CO2 measures (etCO2); Temperature (T). The statistical analysis was done comparing the pre-bypass and during bypass values. RESULTS Pre-bypass values: MAT: 90.8 mmHg; HR = 101.6 beat/min; O2 SAT = 93.8%; PetCO2 = 28.4 mmHg; T = 36.1 degrees C. During bypass the obtained values were: MAT: 88.1 mmHg; HR = 98.0 beat/min; O2 SAT = 93.1%; PetCO2 = 25.3 mmHg; T = 36.9 degrees C. Comparing the average values between the two abovementioned moments, no significant difference occurred in MAT, HR and O2 SAT; PetCO2 and T presented significant differences. CONCLUSIONS The bicaval cuffed venous cannula showed efficient drainage of both venae cavae with appropriate hemodynamic parameters during right bypass allowing access to the pulmonary valve.

CRT-400.01 Training, Simulation and Validation of Therapeutic Hypothermia as an Adjuvant Treatment in St Segment Elevation Myocardial Infarction

Therapeutic hypothermia (TH) reduces the damage by ischemic / reperfusion syndrome in cases of cardiac arrest, in which its application is already widely established and carried out in centers of excellence. However its use in patients with ST segment elevation myocardial infarction (STEMI) is still

Experiência Inicial com o Uso do Autopulse ® em Sala de Hemodinâmica

The initial experience with the use of AutoPulse® Non-Invasive Cardiac Support Pump in the catheterization laboratory is reported. The device was used in a case of cardiopulmonary arrest in the catheterization laboratory, allowing the percutaneous procedure to move on with simultaneous cardiopulmonary resuscitation. The device provided uninterrupted and effective chest compressions and released a team doctor for other functions during the procedure. There were difficulties related to the setup of the device and regarding the radiopacity of the electronic components, which prevented some angiographic projections from being obtained. The use of mechanical devices for chest compressions during a cardiopulmonary arrest is feasible, however, there is no proof of its benefits when compared to cardiopulmonary resuscitation using manual compressions.

Initial Experience with Autopulse® in a Catheterisation Laboratory

ABSTRACT An initial experience using the AutoPulse® Non-Invasive Cardiac Support Pump in a catheterisation laboratory is reported. The device was used for a case of cardiopulmonary arrest in the catheterisation laboratory, allowing the percutaneous procedure to continue with simultaneous cardiopulmonary resuscitation. The device provided uninterrupted and effective chest compressions and allowed a team physician to perform other functions during the procedure. There were difficulties related to the setup of the device and to the radiopacity of the electronic components, which prevented some angiographic projections from being obtained. The use of mechanical devices for chest compressions during cardiopulmonary arrest is feasible; however, there is no proof of their benefits when compared to cardiopulmonary resuscitation using manual compressions.

Comparação das medidas da área valvar mitral obtidas por parâmetros hemodinâmicos invasivos e ecocardiografia tridimensional em tempo real pré e pós-valvoplastia mitral percutânea

ABSTRACT Comparison of Mitral Valve Area Measurements byInvasive Hemodynamic Parameters and Real-TimeThree-Dimensional Echocardiography Before andAfter Percutaneous Mitral Valvuloplasty Background: Real time three-dimensional (3D) echocar-diography (Echo) is an innovative technique to assessmitral valve area (MVA) that must be validated in comparisonwith established MVA calculation techniques. The calcu-lation of valve area by Gorlin’s method has been wellestablished and correlates adequately with the true MVA.This study was aimed at comparing MVA obtained byhemodynamic and echocardiographic methods, based oninvasive hemodynamic (Gorlin’s formula) and 3D Echoparameters after percutaneous balloon mitral valvuloplasty(PBMV). Method: Prospective study carried out from February2009 to February 2010, in 24 individuals (22 women, 39 +12 years) with symptomatic mitral stenosis undergoing PBMV.2D and 3D Echo were compared before and after thePBMV, with MVA (3D Echo/invasive measurement) andmitral gradient (max/mean) measurements.