Luís Felipe Moreira

I Latin American Guidelines for the assessment and management of decompensated heart failure

Edimar Alcides Bocchi, Fabio Vilas-Boas, Sergio Perrone, Angel G Caamano, Nadine Clausell, Maria da Consolacao VMoreira, Jorge Thierer, Hugo Omar Grancelli, Carlos Vicente Serrano Junior, Denilson Albuquerque, Dirceu Almeida,Fernando Bacal, Luis Felipe Moreira, Adonay Mendonza, Antonio Magana, Arturo Tejeda, Daniel Chafes, Efraim Gomez,Erick Bogantes, Estela Azeka, Evandro Tinoco Mesquita, Francisco Jose Farias B Reis, Hector Mora, Humberto Vilacorta,Jesus Sanches, Joao David de Souza Neto, Jose Luis Vuksovic, Juan Paes Moreno, Julio Aspe y Rosas, Lidia ZytynskiMoura, Luis Antonio de Almeida Campos, Luis Eduardo Rohde, Marcos Parioma Javier, Martin Garrido Garduno, MucioTavares, Pablo Castro Galvez, Raul Spinoza, Reynaldo Castro de Miranda, Ricardo Mourilhe Rocha, Roberto Paganini,Rodolfo Castano Guerra, Salvador Rassi, Sofia Lagudis, Solange Bordignon, Solon Navarette, Waldo Fernandes, AntonioCarlos Pereira Barretto, Victor Issa, Jorge Ilha Guimaraes.

Fetal Heart Block: A New Experimental Model to Assess Fetal Pacing

Epicardial fetal pacing via thoracotomy has the potential of being a safer and more reliable procedure to treat congenital complete heart block (CHB) associated with fetal hydrops refractory to medical therapy. To assess the acute electrophysiological characteristics of two ventricular epicardial leads, a new experimental model of fetal heart block induced by cryosurgical ablation of the AV node without the need for fetal cardiac bypass was performed in 12 pregnant ewes at 110–115 days gestation. A modified screw‐in lead (1½ turns) was used in six fetal lambs and a stitch‐on lead in the other six lambs. CHB was achieved in 100% of the fetal lambs, with no ventricular escape rate noticed in any of the lambs. The acute stimulation thresholds were consistently low for both leads, with lower values for the screw‐in lead at pulse duration below 0.9 msec (P < 0.03). Current measured at voltage threshold with pulse width below 0.5 msec was lower for the screw‐in lead (P < 0.048). Stimulation resistance, measured during constant‐voltage pacing, was not statistically different between the two leads (441.8 ± 13.7 Ω for the screw‐in lead vs 480.2 ± 59.2 Ω for the stitch‐on lead). No significant differences (P > 0.20) were found in R wave amplitude between the two electrodes. Slew rates were significantly higher in the screw‐in group than in the stitch‐on group (1.40 ± 0.2 vs 0.62 ± 0.2 V/sec, P = 0.04). This model of CHB is a simple and reproducible method to assess fetal pacing. We find the screw‐in electrode to be a better option when fetal pacing is indicated.

Left ventricular regional wall motion, ejection fraction, and geometry after partial left ventriculectomy. Influence of associated mitral valve repair

OBJECTIVE Left partial ventriculectomy has been proposed for treatment of heart failure. We investigated the effects of isolated left partial ventriculectomy and left partial ventriculectomy associated with mitral annuloplasty on refractory heart failure due to idiopathic dilated cardiomyopathy. METHODS Nineteen patients underwent partial left partial ventriculectomy associated with mitral annuloplasty and six patients isolated left partial ventriculectomy. In two patients the left partial ventriculectomy associated with mitral annuloplasty was combined with tricuspid annuloplasty. We evaluated before and after the surgery (24+/-14 days): the functional class, left ventricular ejection fraction (LVEF), right ventricular ejection fraction (EF), regional wall motion, hemodynamics, mitral regurgitation, left ventricular geometry and coronary angiography. RESULTS For the overall group LVEF improved from 14.5+/-8.0 to 30.3+/-12.2% (P<0.0002) and right ventricular EF from 21.2+/-7.1 to 28.4+/-8.3% (P<0.002). In patients who underwent left partial ventriculectomy associated with mitral annuloplasty LVEF increased from 14.5+/-8.6 to 29.5+/-12.2% (P<0. 002). Isolated left partial ventriculectomy increased LVEF from 13. 5+/-7.5 to 31.5+/-11.1% (P<0.04). Distal segments of marginal branches of the circumflex artery were not visualized by coronary angiography. Left partial ventriculectomy associated with mitral annuloplasty reduced the wedge pressure from 25.0+/-12.1 to 18.0+/-7. 0 mmHg (P<0.03) and increased cardiac output from 3.8+/-0.8 to 4. 6+/-1.1 l/min (P<0.004), while isolated left partial ventriculectomy increased cardiac output from 3.7+/-1.0 to 4.8+/-1.3 l/min (P<0.03). Regional wall motion increment was more evident in anterolateral region from 4.2+/-6.8 to 14+/-8.3% (P<0.002) except in two patients. Left ventricular geometry changed in most patients, but a homogeneous pattern was not identified. Seven patients died during a mean follow-up of 546+/-276 days. Survivors had improvement in functional class. Augmentation of LVEF >5% was associated with a favorable clinical outcome with improvement in clinical status without death. CONCLUSIONS Effects of left partial ventriculectomy are not necessarily dependent upon reduction of mitral regurgitation or changes in left ventricular geometry. However, risk of death after the surgery must be reduced for a clinical application.

Uso do balão intra-aórtico no choque cardiogênico no pós-operatório de cirurgia cardíaca: análise prospectiva durante 22 meses

Intra-aortic balloon pump is a cardiac assist device developed to help in recovery from postcardiotomy heart failure. All patients submitted to intra-aortic balloon pump were followed prospectively at the Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo-InCor over a period of 22 months. Although we did not find statistically significant evidence of correlation between mortality and patient data (Surgery done, emergency or not, redo or not, age, gender, medical problem, functional class, cardiac function, clamp, bypass, and support time and complications) the evaluation showed our patient universe in the InCor Institute.

Variation of the Anthropometric Index for pectus excavatum relative to age, race, and sex

OBJECTIVES: To determine possible variations in the Anthropometric Index for pectus excavatum relative to age, race, and sex in individuals free of thoracic wall deformities. METHODS: Between 2002 and 2012, 166 individuals with morphologically normal thoracic walls consented to have their chests and the perimeter of the lower third of the thorax measured according to the Anthropometric Index for pectus excavatum. The participant characteristics are presented (114 men and 52 women; 118 Caucasians and 48 people of African descent). RESULTS: Measurements of the Anthropometric Index for pectus excavatum were statistically significantly different between men and women (11–40 years old); however, no significant difference was found between Caucasians and people of African descent. For men, the index measurements were not significantly different across all of the age groups. For women, the index measurements were significantly lower for individuals aged 3 to 10 years old than for individuals aged 11 to 20 years old and 21 to 40 years old; however, no such difference was observed between women aged 11 to 20 years old and those aged 21 to 40 years old. CONCLUSION: In the sample, significant differences were observed between women aged 11 to 40 years old and the other age groups; however, there was no difference between Caucasian and people of African descent.

Modificação de antigo método (Vineberg) na era das células tronco: nova tática?

Innumerous patients present with refractory angina despite optimized management whether with drug or surgical treatment. Currently, we are not uncommonly asked about the possibility of reintervention on patients that have already undergone several hemodynamic procedures, with repeated angioplasties and stent placement. Frequently, these patients have also already been operated on once or more times, some of them presenting with still patent although little effective grafts due to the diffuse pattern of their coronary diseases. Many of them show good left ventricular function, with high degrees of myocardial ischemia.In this context, we have worked on replacing early techniques for more modern and alternative ones, or even on giving a new focus to original techniquesCorrespondencia: Adriano Milanez • Rua Dr. Eneas de Carvalho Aguiar, 44 Bloco II 2o Andar, Sala 11 05403-000 Jardim Paulista Sao Paulo – SP E-mail: milanez@secrel.com.br Articulo recibido el 04/04/08; revisado recibido el 22/08/08; aceptado el 21/10/08. Introduccion Un sinnumero de pacientes son portadores de angina refractaria, a pesar del tratamiento optimizado, medicamentoso o quirurgico. Actualmente, no es raro ser consultados sobre la posibilidad de reintervenir sobre pacientes ya sometidos a diversos procedimientos hemodinamicos, con seguidas angioplastias y stents. Con frecuencia, esos paciente tambien ya fueron operados una o mas veces, algunos presentando todavia injertos previos, pero con poca efectividad, debido al grado difuso de la enfermedad coronaria. Muchos de ellos presentan buena funcion ventricular izquierda, siendo portadores de elevados niveles de isquemia miocardica. En ese contexto, hemos actuado apuntando a sustituir tecnicas iniciales por otras mas modernas y alternativas, o incluso intentando dar a tecnicas originales1,2 un nuevo enfoque, proporcionando soluciones quirurgicas para soluciones antes inabordables.

Modification of an Old Procedure (Vineberg) in the Stem Cell Era - a New Strategy?

Innumerous patients present with refractory angina despite optimized management whether with drug or surgical treatment. Currently, we are not uncommonly asked about the possibility of reintervention on patients that have already undergone several hemodynamic procedures, with repeated angioplasties and stent placement. Frequently, these patients have also already been operated on once or more times, some of them presenting with still patent although little effective grafts due to the diffuse pattern of their coronary diseases. Many of them show good left ventricular function, with high degrees of myocardial ischemia.In this context, we have worked on replacing early techniques for more modern and alternative ones, or even on giving a new focus to original techniquesCorrespondencia: Adriano Milanez • Rua Dr. Eneas de Carvalho Aguiar, 44 Bloco II 2o Andar, Sala 11 05403-000 Jardim Paulista Sao Paulo – SP E-mail: milanez@secrel.com.br Articulo recibido el 04/04/08; revisado recibido el 22/08/08; aceptado el 21/10/08. Introduccion Un sinnumero de pacientes son portadores de angina refractaria, a pesar del tratamiento optimizado, medicamentoso o quirurgico. Actualmente, no es raro ser consultados sobre la posibilidad de reintervenir sobre pacientes ya sometidos a diversos procedimientos hemodinamicos, con seguidas angioplastias y stents. Con frecuencia, esos paciente tambien ya fueron operados una o mas veces, algunos presentando todavia injertos previos, pero con poca efectividad, debido al grado difuso de la enfermedad coronaria. Muchos de ellos presentan buena funcion ventricular izquierda, siendo portadores de elevados niveles de isquemia miocardica. En ese contexto, hemos actuado apuntando a sustituir tecnicas iniciales por otras mas modernas y alternativas, o incluso intentando dar a tecnicas originales1,2 un nuevo enfoque, proporcionando soluciones quirurgicas para soluciones antes inabordables.

QT Interval Dispersion Analysis in Patients Undergoing Left Partial Ventriculectomy (Batista Operation)

Background: QT interval dispersion (QTd) has been valued as a marker of increased vulnerability for cardiac arrhythmias. QTd was analyzed in patients undergoing the left partial ventriculectomy (LPV) or Batista operation, a palliative surgery for patients in the line for heart transplantation, which is associated with complex arrhythmia and death from sustained ventricular tachyarrhythmia (SVT).

Influência da lidocaína na proteção miocárdica com solução cardioplégica sangüínea

OBJECTIVE: The purpose of this research is to evaluate the efficacy of the lidocaine in myocardial protection with normothermic antegrade blood cardioplegia. METHOD: Twenty six dogs were studied divided at random into two groups of ten and one group of six, depending on which cardioplegic solution they had received. Group I received a cardioplegic solution induction of lidocaine 5mg/kg, 41,6mEq/l of KCl and 180ml of normothermic blood. Group II received the same solution except for the lidocaine and group III received only 180ml of blood. Every 20min 120ml of normothermic blood was reinfused. All dogs underwent cardiopulmonary bypass, two hours of myocardial ischemia and three hours of reperfusion. These dogs were evaluated through operative mortality, myocardial enzymes such as cardiac troponin I and creatine kinase, lactate production, hemodynamic performance measured by ejection fraction and cardiac output, and morphometrics mitochondrial ultrastructural changes. Statistical analysis tests used to compare the results were the Fisher exact test and the two-way Anova. RESULTS: The results have shown that the animals from group I in comparison to those of group II, had no mortality (p=0,08), a lower production of creatine kinase (p<0,05), lower mitochondrial ultrastructural changes (p=0,036) and had no difference with cardiac troponin I production, lactate production and hemodynamic performance. CONCLUSIONS: In conclusion it can be said that lidocaine offered an additional protection to the ischemic myocardial during cardiopulmonary bypass and that animals from groups I and II, with time, showed significant changes, compatible with cellular damage, for all the subjects evaluated.

Modificación del antiguo método (Vineberg) en la era de las células madre: ¿nueva táctica?

Innumerous patients present with refractory angina despite optimized management whether with drug or surgical treatment. Currently, we are not uncommonly asked about the possibility of reintervention on patients that have already undergone several hemodynamic procedures, with repeated angioplasties and stent placement. Frequently, these patients have also already been operated on once or more times, some of them presenting with still patent although little effective grafts due to the diffuse pattern of their coronary diseases. Many of them show good left ventricular function, with high degrees of myocardial ischemia.In this context, we have worked on replacing early techniques for more modern and alternative ones, or even on giving a new focus to original techniquesCorrespondencia: Adriano Milanez • Rua Dr. Eneas de Carvalho Aguiar, 44 Bloco II 2o Andar, Sala 11 05403-000 Jardim Paulista Sao Paulo – SP E-mail: milanez@secrel.com.br Articulo recibido el 04/04/08; revisado recibido el 22/08/08; aceptado el 21/10/08. Introduccion Un sinnumero de pacientes son portadores de angina refractaria, a pesar del tratamiento optimizado, medicamentoso o quirurgico. Actualmente, no es raro ser consultados sobre la posibilidad de reintervenir sobre pacientes ya sometidos a diversos procedimientos hemodinamicos, con seguidas angioplastias y stents. Con frecuencia, esos paciente tambien ya fueron operados una o mas veces, algunos presentando todavia injertos previos, pero con poca efectividad, debido al grado difuso de la enfermedad coronaria. Muchos de ellos presentan buena funcion ventricular izquierda, siendo portadores de elevados niveles de isquemia miocardica. En ese contexto, hemos actuado apuntando a sustituir tecnicas iniciales por otras mas modernas y alternativas, o incluso intentando dar a tecnicas originales1,2 un nuevo enfoque, proporcionando soluciones quirurgicas para soluciones antes inabordables.