Mário Gesteira Costa

Diretrizes para a prevenção, diagnóstico e tratamento da hiperidrose compensatória

With the objective of establishing guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis, consensus meetings were held. Attendees included a general surgeon and thoracic surgeons affiliated with the Brazilian Society of Thoracic Surgery. The topics addressed were those that would ostensibly broaden multidisciplinary knowledge. Based on recent guidelines for the prevention, diagnosis and (clinical and surgical) treatment of compensatory hyperhidrosis, as well as on a review of the medical literature, the participants prepared a preliminary text, whose recommendations were revised and subsequently approved by all of the participants. The consensus text was posted on the Internet, becoming the object of further corrections and revisions prior to taking on its present form.

Aspectos técnicos na esqueletização da artéria torácica interna com bisturi ultra-sônico

Resumo Objetivo: Descrever a tecnica e avaliar os resultados imediatos da utilizacao do bisturi ultra-sonico nas esqueletizacoes da arteria toracica interna, na cirurgia de revascularizacao do miocardio. Metodo: Foram operados com essa tecnica 188 pacientes submetidos a cirurgia de revascularizacao do miocardio, no periodo de janeiro de 2000 a outubro de 2006. Setenta e um (37,8%) pacientes eram do sexo feminino. A idade variou de 28 a 81 anos. A tecnica utilizada na dissecacao consistiu em expor toda arteria toracica interna, abrindo-se a fascia endotoracica com tesoura o mais proximo possivel da adventicia da arteria. Com o bisturi ultra-sonico e feita a seccao dos ramos colaterais e sua respectiva hemostasia, dispensando-se o uso de “clips” metalicos na arteria toracica interna. Resultados: As arterias toracicas internas esqueletizadas

Bronquiolite obliterante na forma nodular

A 54 year old female patient, public servant, ex-smoker, after two weeks of a common cold complained of cough with yellow sputum, nasal obstruction and facial pain. A chest X-ray showed a solitary nodular lesion in the upper left lobe. The patient was submitted to a left thoracotomy, which established the diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP).

Echocardiographic “Eyewitness” of Aortic Valve Vegetation Detachment

Embolic phenomena are associated with endocarditis. We report a patient suffering from infective endocarditis, in which the exact moment of detachment of an aortic valve vegetation and subsequent embolization was eyewitnessed during two‐dimensional echocardiography, and the entire episode was recorded on video tape.

Experiência clínica inicial na desmineralização química da valva aórtica: potencial aplicação como procedimento minimamente invasivo

Objective: To discuss the use of new technology in the chemical demineralization of the aortic valve in coronary artery bypass surgery, together with its hemodynamic changes and to report events related to the technique. Method: Five patients with mild to moderate aortic stenosis submitted to myocardial revascularization underwent chemical treatment of the aortic valve. The patients’ ages ranged from 65 to 81 years, with a mean of 73 years. All were men. One patient had the involvement of a single artery and four multiple arteries (four vessels). The gradient ranged from 13 to 49 mmHg, with a mean of 25 mmHg. The size of the aortic orifice ranged from 0.8 to 1.3 cm 2 , with a mean of 1.1 cm 2 . The following comorbidities were observed: arterial hypertension, hypercholesterolemia, diabetes mellitus and smoking. Results: The aorta clamping time ranged from 94 to 126 minutes, with a mean of 107 minutes and the bypass time was from 134 to 171 minutes, with a mean of 152 minutes. The time of surgery was from 13 to 33 minutes with a mean of 28 minutes. No deaths were recorded. The only postoperative complication noted was a total AV block in three patients. No events were observed that might impair the integrity of the aortic valve or cause aortic insufficiency following treatment. Likewise, no neurologic, systemic, metabolic or hematologic events were seen. The postoperative transvalvular gradient identified by echocardiography showed an improvement in the systolic gradient and in the mean gradient. Conclusions: The treatment proved to be effective and safe, causing no lesions of the valve or any systemic event.

Mitral-aortic annular enlargement: modification of Manouguian's technique

We hereby present a technical modification for mitral-aortic annular enlargement. The mitral valve is replaced through the retro-septal approach, avoiding patches for left atrial roof closure. We report a mitral-aortic valve replacement in a patient whose original annuli would preclude adequate prostheses. The simultaneous annular enlargement may be necessary for avoiding patient-prosthesis mismatch and for reconstructing destroyed mitral and aortic annuli. The technique may minimize the risk of bleeding and of paravalvular leakage, using an approach well known to cardiac surgeons.