Ratti M

Plástica da valva mitral em pacientes consecutivos: como é a evolução tardia?: avaliação clínica e ecocardiográfica

Thirty-nine patientes with mitral insufficiency or mitral stenosis and incompetence submitted to valvular repair were evaluated in the late postoperative period. Mean age of the patients was 30.5 years, with standard deviation of 17.2 years. Twenty-four patients were females (61.5%) and 15 (38.5%) males. Twenty-one Carpentier ring annuloplasties, 12 repair with a posterior sling, five Merendino type annuloplasties and one Kay type annuloplasty were performed. Twenty-three (58.97%) patients presented symptons related to rheumatic fever disease, 12 (30.76%) had no definite etiology and four (10.25%) presented mucoid degeneration occurred in this series. Evolution time was 1497 months/standard (meam 38.39 months and Standard deviation of 16.08 months). In the late postoperative period 34 (87.74%) patients were in NYHA functional class I. Two late deaths (5.12%) occurred, and two (5.12%) patients were reoperated on. Linearilized rates of the reoperation and thromboembolism events were 1.6% and 0.8% per patient/year, respectively. Estimated survival rate was 94.87%. Echocardiographic evaluation of the pre and postoperative values demonstrated significant decrease of the left ventricular diastolic diameter (p = 0.0001), of the left ventricular systolic diameter (p = 0.0001) of the left venticular systolic diameter (p = 0.0001) and of the left atrial diameter (p = 0.0001). The postoperative Doppler echocardiograpfic studies demonstrated absence of valvular area changes at effort. It was possible to conclude that patients submitted to mitral valve repair benefited from higher survival rates and satisfactory clinical evolution.

Novas técnicas cirúrgicas para o tratamento da atresia pulmonar com comunicação interventricular e anomalias de artérias pulmonares incluindo o assim chamado truncus tipo IV

Fourty-two patients with pulmonary atresia and interventricular septal defect were submited to a partial or total correction, between January 1975 and October 1986, with a range of 2 months to 18 years of age. Three groups were identified: Group A: 34 patients with all bronco-pulmonary segments connected to pulmonary arteries (PA); Group B: 6 patients with some of the bronco-pulmonary segments connected to PAs; Group C: 2 patients with all bronco-pulmonary segments connected to systemic pulmonary collaterals. One to three stages were utilized to perform the proper correction. In Group A 17 were treated in one stage, with 3 deaths; 9 were submitted to a first stage where the pulmonary arteries were reconstructed with an additional Blalock-Taussig (BT) shunt, with 1 death. In two of them a second stage for total correction was performed, with no death. In the remaining 8 patients the collateral circulation was ligated and a BT shunt performed, with 1 hospital death. In Group B the first stage joining the intra or extra-pulmonary collaterals was obtained in 6 cases, without death. In two of them a total correction was performed, with 1 death. In group C a three stage operation was done in 1 patient. In the first stage an intermediate arterial segment was constructed between the lobar arteries and the BT shunt. In the second stage the contra-lateral collaterals were joined. The third stage was the establishment of the continuity between the right ventricle and the reconstructed pulmonary circulation with a good result. In the other patient of this group, until now, only the first stage was done. Serial hemodynamic studies were carried out in 32 patients. These proposed techniques demonstrate the possibility of total correction with appropriate righ-to-left ventricular pressure relation.