Renato Rocha Rabello

Comparação da perviedade entre artéria radial e veia safena em pacientes em pós-operatório de cirurgia de revascularização miocárdica com retorno dos sintomas

OBJECTIVE: To compare the radial artery and saphenous veins patency in patients with recurrence of symptoms in a coronary artery bypass grafting (CABG). METHODS: Retrospective study. From January 1998 to December 2005, 469 CABGs were performed using the radial artery as a graft, in Vera Cruz Hospital in Belo Horizonte/ MG. Among the patients who underwent those surgeries, 94 presented ischemic changes in early or late postoperative period, which led them to be re-evaluated by coronary angiography. The grafts were divided in three groups: internal thoracic artery (ITA), radial artery (RA) and saphenous vein (SV), and they were stratified according to the severity of injury: uninjured or patent (< 70%), severe obstruction (70 to 99%) and occlusion. RESULTS: For the 94 patients in the study, 86 grafts of ITA, 94 of RA and 111 of SV were used. For the 86 ITA grafts, 73 (84.88%) were found patent. For the 94 RA grafts, 55 (58.51%) were found patent, and for the 111 SV grafts, 73 (65.76%) were uninjured. A statistically significant difference (P= 0.001) was found between RA and SV grafts, with a higher patency found for VS graft. For the RA grafts, women presented a worse result concerning the RA patency (65.7% and 40.7%), with P = 0.006. Concerning coronary revascularization, a statistically significant difference was found only for the grafts used for the right coronary, with a better result for the SV (P = 0.036). CONCLUSION: Radial artery (RA) presented worse results when compared to Saphenous vein (SV) as a second graft in a CABG, especially in women who were anastomosed in the right coronary artery.

Análise da atividade da enzima conversora da angiotensina na hipertrofia aguda do ventrículo direito em modelo experimental de estenose endovascular ajustável do tronco pulmonar

INTRODUCTION: The pulmonary trunk (PT) banding has been used to promote rapid left ventricular (LV) hypertrophy in patients with transposition of the great vessels (TGV) with intact septum, treated after the neonatal period. This procedure carries a high morbidity and mortality rates. Genetic alterations of the cardiomyocytes resulting from acute hypertrophy have not been evaluated in models of variable systolic overload of the subpulmonary ventricle. In order to evaluate the activity of angiotensin converting enzyme (ACE) in acute right ventricular (RV) hypertrophy, a balloon catheter was implanted in the PT of six young goats. MATERIAL AND METHODS: Systolic overload was carried out throughout progressive balloon insufflations for a period of 96 hours. Hypertrophy was followed by daily hemodynamic and echocardiographic evaluations. At the end of the 96 hours, the animals were killed to harvest the heart. The ventricles and septum were weighted separately. Samples of each cardiac muscle were collected for ACE analysis. Eight goats (with similar age and weight) were used as control for weight and ACE activity. RESULTS: At the end of the protocol, the following parameters were increased: RV/PT gradient (p=0.001), RV to LV ratio (p=0.005), thickness of the free wall of RV (p=0.002) and RV weight (p=0.002). The evaluation of ACE activity showed an increase only in the hypertrophied RV muscle (p=0.002), indicating a high correlation with the increase in the RV to LV ratio (r=0.87). CONCLUSION: The progressive systolic overload in the RV of goats induces ventricular hypertrophy. This hypertrophy is related to a significant increase in ACE activity, an important molecular marker of this process.

Impact of body mass index on outcome in patients undergoing coronary artery bypass grafting and/or valve replacement surgery

Objective This study aimed to analyze the impact of body mass index on outcomes of 101 patients undergoing coronary artery bypass grafting, valve replacement, or combined valve/ coronary artery bypass grafting surgery in a private hospital in Belo Horizonte, Brazil. Methods This was a prospective cross-sectional study of patients undergoing cardiac surgery from May 2009 to December 2012. All patients were followed up from the first day of admission until discharge or death. Patients were divided into three groups according to BMI: normal weight, overweight, and obese. The main outcome measure was the association between BMI and postoperative morbidities and mortality. Results Multivariate analysis identified obesity as an independent predictor of increased risk of surgical reintervention (odds ratio [OR] 13.6; 95%CI 1.1 - 162.9; P=0.046) and reduced risk of bleeding (OR 0.05; 95% CI 0.09 - 0.69; P=0.025). Univariate analysis showed that obesity was associated with increased frequency of wound dehiscence (P=0.021). There was no association between BMI and other complications or mortality in univariate analysis. There was also no association between body mass index and duration of cardiopulmonary bypass, aortic clamping, mechanical ventilation, and intensive care unit or hospital stay. Conclusion Obese individuals undergoing coronary artery bypass grafting, valve replacement, or combined surgery have a higher postoperative risk of surgical reintervention and lower chances of bleeding.

Divertículo congênito do ventrículo esquerdo associado a defeitos da parede tóraco-abdominal: relato de paciente operada em idade adulta

Muscular diverticulum of the left ventricle is a rare anomaly. It is frequently associated with other congenital anomalies of the abdominal wall, sternum, diaphragm, pericardium and the heart itself. These have been described as Cantrell syndrome. This paper reports a case of a 25-year-old female patient submitted to surgical repair of this syndrome.

The transvalvar gradient after the aortic porcine stented valve replacement can be predicted

OBJECTIVE: This work aimed at establishing scientific criteria using the valve size mismatch to predict the transvalvar gradient resultant of aortic valve replacement. METHOD: Thirty-one consecutive patients who survived aortic valve replacement surgeries using Labcor porcine stented prosthesis, in the period from March 1993 to June 2002 were studied. Each patient was submitted to an echocardiogram within three postoperative months at the same institution. The mean transvalvar gradient pressure was compared with the diameter of the prosthesis and the patients body surface area. RESULTS: The p-value for the diameter of the prosthesis was 0.81 and 0.59 for the R Index. CONCLUSION: No relation at all was found to help to predict the postoperative pressure gradient, based on the prosthesis size and the body surface area of the patients.