Roque Paulo Falleiro

Revascularização cirúrgica do miocárdio em pacientes com stents coronários

Objective: To observe the surgical characteristics of patients operated on after percutaneous coronary interventions (PCI). Method: Fifty-six patients (41 M and 15 F), at the time of coronary artery bypass grafting (CABG), had already been submitted to coronary stenting procedures. In 101 PCI, 116 stents were implanted. At the time of the first PCI, 32 patients had three or more coronaries affected by severe stenosis. Six patients were treated with PCI for severe left coronary trunk stenosis. After the implantation of the first stent, 12 patients developed severe de novo lesions of the left coronary trunk. In 6 of these, stenosis developed within 6 months of stent implantation. Diabetes was present in 35.7% of the patients. In 22 patients (39.2%), at the time of CABG, the left ventricular function was reduced (p<0.001). During surgery, 160 grafts were implanted. Surgical studies included coronary and muscle biopsies. Results: Surgical observation showed more arteritis and inflammatory tissues adjacent to the stent when compared to other areas. Seventeen patients that could not have platelet antiaggregates withdrawn needed more blood transfusions. There were no hospital deaths. Conclusion: In patients operated on after stent implantation, facts like loss in LV function or de novo vascular lesions complicate surgical procedures and may impair longterm results. Due to endothelial dysfunction caused by stents, grafts may obstruct earlier. In addition the efficiency of clinical therapy may not be the same.

Infective endocarditis: surgical therapy

OBJECTIVE To assess the major causes of surgical morbidity and mortality in patients with infective endocarditis operated upon in a regional cardiology center. METHODS Thirty-four patients underwent surgical treatment for infective endocarditis. Their ages ranged from 20 to 68 years (mean of 40.6) and 79% were males. Their NYHA functional classes were as follows: IV - 19 (55.8%) patients; III - 12 (35.2%) patients; II - 3 (8.8%) patients. Blood cultures were positive in only 32% of the cases. Eight patients had already undergone previous cardiac surgery, whose major indication (82.3%) was heart failure refractory to clinical treatment. RESULTS Four (11.7%) patients died at the hospital. Follow-up was complete in 26 (86%) patients. Five (14.7%) patients died later, 12, 36, 48, 60, and 89 months after hospital discharge. Of the 21 patients being currently followed up, 1 is in NYHA functional class III, and 5 in NYHA functional class II. CONCLUSION A high degree of clinical suspicion, at an early diagnosis, and indication of surgical treatment prior to deterioration of left ventricular function and installation of generalized sepsis may improve prognosis.

Calcified aneurysms in coronary arteries of a 48-year-old patient

This is a case report of a 48-year-old female patient with a compatible history of Kawasaki disease during childhood, who was admitted to the emergency coronary unit with unstable angina pectoris. Coronary angiography identified two coronary aneurysms, one causing right coronary occlusion and the other causing severe obstruction of the left anterior descending coronary artery. Coronary artery bypass surgery was indicated.

Estimulação cardíaca com variação de freqüência em sistema de alça fechada e sensor de contractilidade miocárdica: avaliação tardia em estudo multicêntrico

INTRODUCTION: The treatment of bradycardias with bicameral pacemakers (PM) with frequency response (DDD,R) has motivated the search of an ideal sensor. We did a late re-evaluation (3 years) the frequency response of those PM with myocardial contractility sensor in closed loop system. MATERIAL AND METHODS: Thirty patients (pts) of the initial study done in 1997, who presented binodal disease and 3-year implantation were evaluated, being 60% male, ages between 17-87 (average = 61). Their heart frequency (HF) was observed through a 24 Holter monitoring and MP frequency histogram on the daily activities, plus 6-minute walk and going up and downstairs tests. Chronic pacing thresholds were determined as well as atrial (A) and ventricular (V) sensitivity, checking them against those obtained in the implantation and immediate post-operative periods. RESULTS: The average threshold in the intra-operative, 30 days and 3 years were as follows: A pacing (0.8, 1.4 and 1.1V) and V (0.5, 1.1 e 1.0V), A sensitivity (2.3, 2.8 e 2.6mV) and V (10.6, 6.3 and 6.3mV). The HF at the 3rd year increased for daily activities (physical and mental) from 33 to 91%, and for physical exercises tests from 21 to 130%, similarly to the results obtained in 30 days (test t student and variation analysis). This contractility sensor kept at the 3rd year the same good results obtained at the 30th day, presenting the following adverse effects: high-energy consumption in 2 pts and difficulty of sensor adjustment in other 2.

Plastia cirúrgica de óstio coronariano esquerdo com estenose não aterosclerótica

A clinical case of a 38 year old male, with heart failure grade IV (NYHA) and angina at rest related to severe aortic regurgitation, right coronary ostial occlusion, and a sub-total occlusion of the left coronary ostium owing to syphilitic infection in the past is reported and discussed. Treatment was established implanting a mechanical aortic prosthesis and a direct left main angioplasty suturing a patch made of safenous vein. Follow up has been excellent and the patient is today having a normal life, free of symptoms.