Orlando Petrucci Junior

Variáveis capnográficas pré e pós-tromboendarterectomias pulmonares

In these case report, the results of late dead space fraction (fDlate), end-tidal alveolar dead space fraction (AVDSf), arterial-alveolar gradient CO2 [P(a-et)CO2], and slope phase 3 of spirogram of two patients who underwent thromboendarterectomy for pulmonary embolism (PE) are shown. PE was diagnosed by pulmonary scintigraphy, helical tomography, and pulmonary angiography. The calculation of fDlate, AVDSf and P(a-et)CO2 was based on volumetric capnography associated with arterial blood gas analysis. The pre-operative fDlate of the first patient was 0.16 (cutoff 0.12) and AVDSf was 0.30 (cutoff 0.15). However, the fDlate of the second patient was false-negative (0.01) but, the AVDSf was positive (0.28). Postoperative fDlate of the first patient was -0.04 and AVDSf was 0.16; for the second patient, the values were 0.07 and 0.28, respectively. The association of these capnographic variables with image exams reinforces the importance of this noninvasive diagnosis method.

Padronização de modelo de coração isolado "working heart" com circulação parabiótica

Objective: To develop an isolated working heart model with parabiotic circulation in swine and to verify its stability and possibility for allowing effective measurements of hemodynamic and metabolic data. Methods: This model was developed during an association study of cardiolegia agents. Eighteen experiments were performed, each with a support animal and a donor animal. Donor animal heart was perfused as isolated working heart with parabiotic circulation from the support animal. The isolated heart underwent regional ischemia by interventricular artery clamping, followed by global ischemia. During reperfusion in a isolated heart in working state at 30, 60, and 90 minutes, contractility indices such as elastance, preload recruitable stroke work index, and metabolic data were acquired. Results: Support animals were kept stable throughout the procedures without use of blood transfusions or vasoactive drugs. Variables such as pH, oxygen partial pressure and hematocrit were kept stable and within physiologic ranges. The isolated heart was perfused adequately throughout the experiment. All hemodynamic and metabolic data proposed were adequately measured in the isolated heart in working state. Conclusion: This isolated swine “working heart” model was kept stable throughout the experiments with no administration of vasoactive drugs, and it allowed adequate measurements of metabolic and hemodynamic data.

Coeficientes de proporcionalidade nas valvas atrioventriculares: estudo anatômico dos segmentos valvares em indivíduos normais

ABSTRACT OBJECTIVE: To describe the anatomical relationships that exist between the heart valve structures taking into account the segments of the fibrous annuli and the left ventricular volume METHOD: Digital photographs of 41 hearts from autopsies performed by a coroners office were analyzed. The photographs were processed using MATLAB® software, which supplies measurements of the valvar perimeter and area and the left ventricular volume. RESULTS: The average age of the corpses studied was 33 years old (standard deviation ± 17 years). Several ratios involving the tricuspid and mitral valves were tested, with strongly significant correlations found between the inter-commissural distance (ItD) and the perimeter of the anterior annulus (PA) of the tricuspid valve (r = 0.72; p-value < 0.05) and between the inter-commissural distance (ImD) and the perimeter of the posterior annulus (PP) of the mitral valve (r = 0.63; p-value < 0.05). The proportions between these parameters were PA/ItD = 1.36 ± 0.24 and PP/ImD = 1.38 ± 0.16. CONCLUSION: The proportions between the perimeter of the anterior annulus (tricuspid) and the perimeter of the posterior annulus (mitral) and their respective distances have high statistical significance and can be applied during surgery of valvar reconstruction.Objective: To describe the anatomical relationships that exist between the heart valve structures taking into consideration the segments of the fibrous annuli and the left ventricular volume Method: Digital photographs of 41 hearts from autopsies performed by a Coroner’s Office were analyzed. The photographs were processed using MATLAB® software, which supplies measurements of the valvar perimeter and area and the left ventricular volume. Results: The average age of the studied corpses was 33 years old (standard deviation ± 17 years). Several correlations involving the tricuspid and mitral valves were tested, with strongly significant correlations found between the intercommissural distance (ItD) and the perimeter of the anterior annulus (PA) of the tricuspid valve (r = 0.72; p-value < 0.05) and between the inter-commissural distance (ImD) and the perimeter of the posterior annulus (PP) of the mitral valve (r = 0.63; p-value < 0.05). The proportions between the parameters were PA/ItD = 1.36 ± 0.24 and PP/ImD = 1.38 ± 0.16. Conclusion: The proportions between the perimeter of the anterior annulus (tricuspid) and the perimeter of the posterior annulus (mitral) and their respective distances have high statistical significance and can be applied as part of surgical techniques of valvar reconstruction. Descriptors: Heart, anatomy & histology. Mitral valve. Tricuspid valve

Risk factors for transient dysfunction of gas exchange after cardiac surgery

Objective A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. Methods We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011. Results Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451). Conclusion Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures.

Resultados a médio prazo de anuloplastia com órtese maleável de pericárdio bovino na insuficiência mitral reumática

Objectives: Mitral valve repair presents many advantages over valve replacement but the mid-term outcome depends on the technique applied and the underlying disease. The authors have evaluated the results of mid-term mitral valve repair both clinical and echocardiographic variables in rheumatic mitral insufficiency. Patients and Methods: From January 1995 to February 1997, 23 patients with rheumatic valve disease underwent mitral valve repair. There were 17 females (73.9%) and 6 males (26.1%), all patients with mitral insufficiency or double mitral dysfunction. All of them had no rheumatic activity at time of surgery. Eleven patients (47.8%) were in NYHA class III or IV. All patients underwent annuloplasty with bovine pericardial ring, and were evaluated with trans-thoracic echocardiography before surgery and at each six months after sugery. Results: There were no peri-operative deaths. Follow-up time was 25.8 ± 7.8 months, 83.9% patients were free from reoperation in 36.09 ± 1.2 months (confidence interval 33.7 to 38.48 months). Statistically, an improvement occurred in left ventricle and diastolic volume (from 58.52 ± 12.87 to 53 ± 12.15 mm) (p = 0.001), and functional class (p = 0.0001). Ejection fraction and left ventricle systolic volume showed no significant improvement. Two patients were reoperated at 22.7 and 28.5 months of follow-up. One patient presented moderate mitral insufficiency and all others showed satisfactory results (mild insufficiency or none). Conclusions: We conclude that mitral valve annuloplasty repair presents good results at mid-term, with improvement of clinical and echocardiographic variables. Reoperation incidence was very low.

A Simpler and Shorter Neuromuscular Electrical Stimulation Protocol Improves Functional Status and Modulates Inflammatory Profile in Patients with End-Stage Congestive Heart Failure

Background: Neuromuscular electrical stimulation (NMES) using a stimulation wave for 5 days/week over 8 weeks has been used as a treatment option for congestive heart failure (CHF) patients who are unable to tolerate aerobic exercise. Objective: We assessed the impact of a shorter NMES protocol using a Russian stimulation wave on the functional status, quality of life (QoL) and inflammatory profile of end-stage CHF patients. Methods: Twenty-eight patients with end-stage CHF (53 ± 11 years) were randomized to the NMES or control group. Treatment was an NMES training program with Russian stimulation wave, applied for 50 minutes to both quadriceps femoral muscles twice weekly over seven weeks. The stimulation intensity was chosen to elicit muscle contractions in the NMES group and current input up to sensory threshold in the control group. Distance in the 6-minute walk test (6MWD) and QoL score by the Minnesota Living with Heart Failure Questionnaire were evaluated before, immediately after and one month after NMES protocol completion. Peripheral leukocytes were obtained to measure the gene expression levels of inflammatory cytokines. Results: The NMES group showed increases in the 6MWD (324 ± 117 vs. 445 ± 100 m; p = 0.02) and QoL score (64 ± 22 vs. 45 ± 17; p < 0.01) immediately but not 1 month after protocol completion, as well as increased gene expression levels of IL-1β, IL-6 and IL-8 after protocol completion. Conclusion: Using a shorter and fewer sessions NMES protocol improved the QoL score and functional class of severe CHF patients, and modulated the gene expression levels of some cytokines. This protocol might be a good alternative for patients with severe CHF and limitations in protocol adherence. (Int J Cardiovasc Sci. 2017;30(6)484-495)Mailing Address: Maria Carolina Basso Sacilotto Avenida Arlindo Joaquim de Lemos, 865, Apto: 32. Postal Code: 13100450, Vila Lemos, Campinas, SP – Brazil E-mail: mariacarolinasacilotto@gmail.com; orlandopetrucci@gmail.com A Simpler and Shorter Neuromuscular Electrical Stimulation Protocol Improves Functional Status and Modulates Inflammatory Profile in Patients with End-Stage Congestive Heart Failure Maria Carolina Basso Sacilotto, Carlos Fernando Ramos Lavagnoli, Lindemberg Mota Silveira-Filho, Karlos Alexandre de Souza Vilarinho, Elaine Soraya Barbosa de Oliveira, Daniela Diógenes de Carvalho, Pedro Paulo Martins de Oliveira, Otávio Rizzi Coelho-Filho, Orlando Petrucci Junior

Laser Doppler anemometry measurements of steady flow through two bi-leaflet prosthetic heart valves

Introduction In vitro hydrodynamic characterization of prosthetic heart valves provides important information regarding their operation, especially if performed by noninvasive techniques of anemometry. Once velocity profiles for each valve are provided, it is possible to compare them in terms of hydrodynamic performance. In this first experimental study using laser doppler anemometry with mechanical valves, the simulations were performed at a steady flow workbench. Objective To compare unidimensional velocity profiles at the central plane of two bi-leaflet aortic prosthesis from St. Jude (AGN 21 - 751 and 21 AJ - 501 models) exposed to a steady flow regime, on four distinct sections, three downstream and one upstream. Methods To provide similar conditions for the flow through each prosthesis by a steady flow workbench (water, flow rate of 17L/min. ) and, for the same sections and sweeps, to obtain the velocity profiles of each heart valve by unidimensional measurements. Results It was found that higher velocities correspond to the prosthesis with smaller inner diameter and instabilities of flow are larger as the section of interest is closer to the valve. Regions of recirculation, stagnation of flow, low pressure, and flow peak velocities were also found. Conclusions Considering the hydrodynamic aspect and for every section measured, it could be concluded that the prosthesis model AGN 21 - 751 (RegentTM) is superior to the 21 AJ - 501 model (Master Series). Based on the results, future studies can choose to focus on specific regions of the these valves.

Flow visualization in blood aspirator and cardiotomy reservoir used in cardiopulmonary bypass

OBJECTIVE One of the major damage caused by occlusion in roller pumps is hemolysis. Comparative studies between roller pump with adjustments non occlusive and centrifugal pumps have been made in recent decades in an attempt to develop new products and adjustments that cause fewer traumas to the figurative elements of blood. Usually the roller pumps are adjusted by the static method due to concern variables flow that can occur with non-occlusive settings. Excessive slack in the rollers provoke back flow and can provides errors in the calculation of flow by the rotation of the pump, according to the devices added to the circuit and the systemic resistance of the patient. The objective of this study is to evaluate the back flow caused by two types of roller pumps in blood aspirator and cardiotomy reservoir. METHOD Back flow visualization was performed in blood aspirator and cardiotomy reservoir. It was tested two different models of roller pumps, adjusted by drop rate and dynamic calibration. The tests were conducted with silicone tubes of 3/8 x 1/16 e 1/2 x 3/32 inches in diameter in water and solution similar to blood. RESULTS We recorded back flow visually in blood aspirator and in cardiotomy reservoir with their measure of values. The pumps had differences in refluxes measured adjusted by the dynamic calibration method. Pump#2 presents back flow adjusted fully occluded. CONCLUSION The back flow measured in two models of pump present differences (P <0.008). The results indicate differences in its characteristics caused by the process of manufacturing, design or possible wear. Non-occlusive adjustments may cause variations in flow with the increase of resistance added to the circuit, with difficulty to fix the flow by increasing the rotation.

Avaliação a médio prazo de procedimentos conservadores das lesões da valva mitral de origem reumática

Objective: Conservative procedures on the valve mitral have advantages over its replacement. We evaluated the mid term results in patients with rheumatic mitral disease regarding clinical and echocardiography variables. Material and Methods: Fifty six patients with rheumatic etiology were submitted to mitral valve repair. Forty six patients were female (82.1%) and ten male (17.9%). The average age was 34.70 years (standard deviation 13.88 years). Average time of follow-up was 23.84 months (standard deviation 9.23 years). Twenty five patients (44.6%) were in functional class III or IV and eleven patients with atrial fibrillation (19.6%) before surgery. The procedures were commissurotomy, commissurotomy with papillaromyotomy in 11 patient (19.6%), commissurotomy with malleable annuloplasty bovine pericardium prosthesis in 27 patients (48.2%) and malleable annuloplasty bovine pericardium prosthesis in 18 patients (32.1%). Results: There was one death (30 days) in this series (1.7%). One patient presented transitory vascular accident in the operative period with total recovery. Improvement ocurred with regard to the final diastolic volume of the left ventricule from 52.0 ± 12.4 mm to 48.8 ± 9.9 (p = 0.001), left atrium size from 53.0 ± 8.0 mm to 47.8 ± 7.6 mm (p < 0.0001). Functional class improved significantly (p = 0.0001), with just one patient in class III (1.8%). It happened two reoperations with 28.5 months and 2.93 months of follow-up, 96.43% were free reoperation in the follow-up period. Conclusion: We conclude that mitral valve repair over the mid term provides good results with improvement of echocardiography and clinical parameters.