Marcelo José Ferreira Soares

Ressecção de um lipoma de átrio direito e reconstrução parcial com pericárdio bovino

The primary heart tumors have an incidence varying from 0.001% to 0.28% of all tumors, reported in necropsies series. Lipoma consists of a benign tumour corresponding to about 8% of all primary heart tumors. When present, the symptoms are related to the size and location of such tumor. We report a case of a 27-year-old man with a lipoma in the right atrium who underwent surgical treatment with tumor resection and partial reconstruction of the right atrium using bovine pericardium.

Resection of left ventricular myxoma after embolic stroke

Cardiac myxoma is the most common primary tumor of the heart. The tumor is located mainly in the left atrium but can arise from any heart chamber. Clinical symptoms are variable but dyspnea and embolism are the most frequent. We report a case of a young man that had embolic ischemic stroke caused by a large left ventricular myxoma. The patient underwent surgery three weeks after the stroke. The tumor was carefully resected without fragmentation. Surgical treatment was effective. We emphasize the rarity of this location together with a review of the current literature.

Ressecção de mixoma ventricular esquerdo após acidente vascular cerebral embólico

Cardiac myxoma is the most common primary tumor of the heart. The tumor is located mainly in the left atrium but can arise from any heart chamber. Clinical symptoms are variable but dyspnea and embolism are the most frequent. We report a case of a young man that had embolic ischemic stroke caused by a large left ventricular myxoma. The patient underwent surgery three weeks after the stroke. The tumor was carefully resected without fragmentation. Surgical treatment was effective. We emphasize the rarity of this location together with a review of the current literature.

Cardioplegia sangüínea contínua normotérmica

Os autores discutem o emprego da cardioplegia, bem como sua composicao. A parada imediata dos batimentos pode ser conseguida com solucoes cardioplegicas cristaloides ou sanguineas, oxigenadas ou nao. O agente que leva o coracao a parada pode ser potassio, magnesio, procaina ou, mesmo, quelantes e bloqueadores de calcio associados entre si ou nao, contando com a edicao da hipotermia ou nao. Deve-se ficar atento para a falsa sensacao de protecao a que a baixa temperatura possa nos induzir, uma vez que o frio, por si so, nao e suficiente para manter o miocardio viavel por longos periodos. Substratos, como glicose e oxigenio, devem ser fornecidos durante o periodo de clampeamento aortico, para garantir algum metabolismo aerobio, nesse periodo. A adicao de outros substratos, como glutamato, aspartato e lactato, assim como ATP ou creatina fosfato, precursores de intermediarios do ciclo de Krebs, podem melhorar muito a protecao miocardica. A infusao de cardioplegia sanguinea normotermica de forma continua mantem as necessidades metabolicas basicas para a sobrevivencia das celulas. A membrana celular, com todas as suas funcoes estruturais e secretoras, e o ponto mais sensivel a injuria isquemica. Os removedores de radicais livres (scavengers) sao protetores indiretos da membrana celular. A cardioplegia retrograda permite melhorar a distribuicao das solucoes na arvore coronariana, sendo muito util nas reoperacoes. Ela deve fazer parte da tatica cirurgica, sem esquecermos suas limitacoes. O momento da reperfusao e o mais importante da protecao miocardica; e nesse periodo que ocorre a liberacao de radicais livres. O uso de removedores (scavengers) pode melhorar as condicoes e o resultado da reperfusao. A cardioplegia sanguinea oxigenada e normotermica enriquecida com substratos, antes usada em casos extremamente graves, por disfuncao muscular em isquemia miocardica severa, ou por ausencia de protecao adequada, durante a fase de isquemia e/ou reperfusao, foi expandida para todos os casos. E recomendado que o coracao tenha, sempre, suas câmaras drenadas, evitando-se qualquer aumento na tensao da parede, o que levaria a maior consumo de oxigenio. Os autores descrevem a tecnica e as solucoes cardioplegicas aplicadas no Servico de Cirurgia Cardiaca do IMC e os resultados obtidos com o uso das mesmas. Concluem ser satisfatorio o uso de cardioplegia normotermica modificada e reperfusao assistolica, enriquecidas por aminoacidos, na preservacao da funcao miocardica e na reversao dos danos isquemicos.

The importance of troponin I in the diagnosis of myocardial infarction in the postoperative of coronary artery bypass graft surgery

OBJECTIVE The aim of this study is to establish a cut-off value for troponin I by correlating it to occurrence of postoperative myocardial infarction. METHODS 180 consecutive patients with coronary disease referred for surgery were included. The mean age of the patients were 60.6 (+/-9.3) years, with 119 (66.1%) males and 61 (33.9%) females. The patients were divided into two groups: group without myocardial infarction (A)--170 patients--and with myocardial infarction (B)--10 patients.The troponin I was collected from each patient at the beginning of anesthesia and on the second postoperative day by correlating it to presence or not of postoperative myocardial infarction. StatsDirect 1.6.0 for Windows was used for statistical analysis. RESULTS Preoperative troponin I was 1.0 (+/-6) ng/ml as mean. Univariate logistic regression showed correlation of troponin I of the second postoperative day with myocardial infarction (P=0.0005). ROC curve was used to define the cutoff value, and 6.1 ng/ml (sensitivity=90.0%, specificity=82.1%, OR=49.8 with CI=95% 6.1- 410.4, P<0.0001) were found. CONCLUSION The chance of a patient with postoperative myocardial infarction to present troponin I equal to or higher than 6.1 ng/ml is 49.8-fold higher than the chance of a patient without infarction to present troponin I higher than this value.

Forma inusitada de Pericardite Crônica Constritiva Idiopática

A 55-year-old male patient presented in our service with progressive dyspnea and ascitis beginning 1 year and 8 months previously. He weighed 160 kg (normal weight 95 kg), with ascitis and orthopnea. On admission he presented normal echocardiograms. An electrocardiogram showed diffuse inverted T waves. An endomyocardial biopsy was not elucidative. A new echocardiogram confirmed a very thick pericardium. Surgical pericardial resection was indicated. The postoperative period was uneventful with complete remission of symptoms. The anatomopathological analysis was normal. The pericarditis was classified as idiopathic. This case is a warning for the need of much suspicion in patients with apparent causeless voluminous ascitis.

Angina-Like Chest Pain and Syncope as the Clinical Presentation of Left Ventricular Endomyocardial Fibrosis A Case Report

A 47-year-old woman complained of angina-like chest pain, near-syncope, and syncopal episodes of 17 years’ duration. Physical examination was unremarkable. A 12-lead resting ECG showed symmetrically inverted T waves in the inferior and anterolateral leads. A graded treadmill exercise stress test precipitated angina-like chest pain accompanied by a near-syncopal episode associated with a systemic arterial pressure of 60/40 mm Hg. Echocardiography disclosed left ventricular apical obliteration. Left ventriculogram showed a typical “ace of heart” shadow as well as filling defects and apical obliteration. Endomyocardial biopsy of the left ventricle diagnosed left ventricular endomyocardial fibrosis. Thus, angina-like chest pain and near-syncopal episodes should be added to the list of clinical manifestations of pure left ventricular endomyocardial fibrosis.

Ligadura do canal arterial: técnica extrapleural

The authors describe the surgery for patent ductus arteriosus (PDA) with triple ligature through the extrapleural path. After general anesthesia, the child has his position in the right lateral and a little ventral decubitus. A small incision is made in the inferior limit of the scapula. The pleura is dissected and the PDA exposed, double ligated with Polyester 2/0 and transfixed and tightened with Polypropilene 4/0. With this technique it is not necessary to have a chest tube. Fourty seven patients with PDA were submitted to surgery between September 1988 and August 1990; in 40 patients it was possible to do this type of surgery. Ages ranged from 4 months to 11 years, with mean age of 3.1 ± 3.0 years. Twenty children were less than one year old. There were 24 females and 16 males. No cases of intra or post-operative complications were registered. The follow-up ranged from 7 to 30 months (mean 15.3 months). Ali children were submitted to clinical evaluation, thoracic Rx and ecocopplercardiography. No patients presented recanalization or other complications. This experience showed that this tecnique is reliable, efective and it does not present immediate and late morbility or mortality. This technique can be safely used in younger as well as older children.

Avaliação de tubo valvulado de pericárdio bovino em um modelo experimental animal

Congenital diseases as pulmonary atresia, tetralogy of Fallot, among others, have been corrected using the extracardiac conduits. There is a variety of conduits valved or not that make possible the access of sanguineous flux from right ventricle to pulmonary circulation. However, the synthetic conduits with biologic or metalic valves shows prosthesis degeneration and obstruction problems and peeling of the conduit, moreover, they are very expensive. The experience with treated bovine pericardium showing it is impermeable and easy to suture, led to the production of valved conduits that in this study were evaluated for obstruction, calcification and stretching. The utilization of an animal experimental model allowed the detailed periodic evaluation by echodopplercardiography and cateterism during one, three and six months. The recuperated conduits were studied by optical microscopy and X ray, with several parts of the bioprosthesis analysed. The microscopic examination showed the conduits pericardium preserved with signs of pseudo-endotelization, and the majority of valves with moderate calcification, but with good function yet. The surgery technique without extracorporeal circulation and the results with the follow-up of five animals during six months are presented and discussed. The authors conclude that the bovine pericardium valved conduit showed good results in the right ventricule outlet, allowing to expect a satisfatory result when applied in human beings by the known relation of acelerated degeneration of the biological prostheses on the studied experimental model, several times greater than in man.

Correção de aneurisma de ventrículo esquerdo em paciente chagásico empregando prótese de pericárdio bovino

The authors describe the surgical correction of left ventricle aneurysm in a female patient with Chagas disease that presented heart failure. A prosthesis of bovine pericardium was used to reconstruct the aneurysmatic wall of the left ventricle, thus obtaining marked reduction of symptoms. They believe that the benefits of this type of surgery in patients with left ventricle aneurysm of ischemic etiology, can be extended to patients with Chagas disease.