Ulisses Alexandre Croti

Assessment of the pulmonary vascular blood supply in patients with pulmonary atresia, ventricular septal defect, and aortopulmonary collateral arteries

OBJECTIVE: To study the morphometric characteristics of the central pulmonary arteries and aortopulmonary collateral arteries by assessing the morphology of the pulmonary vascular blood supply, to determine their significance in surgical treatment. METHOD: From January 1990 to June 2001, 40 patients were studied. Those who had the complete cineangiocardiographic study prior to the first surgical intervention were included in the study. The morphometric characteristics of the central pulmonary arteries (PPAA) and aortopulmonary collateral arteries (APCA) were analyzed, as was the distribution of blood irrigation to the lungs. The following indices were calculated: pulmonary arterial index (PPAAI), aortopulmonary collateral arterial index (APCAI), and total neopulmonary arterial index (TNPAI = PPAAI + APCAI). The surgical treatment was considered palliative (PT), palliative definitive (PDT), and definitive (DT). RESULTS: The palliative treatment predominated. No statistically significant differences were observed in the patients undergoing PT, PDT, and DT, in regard to PPAAI, APCAI, and TNPAI. Comparing PPAAI and APCAI, no difference was observed for DT (P=0.4309); APCAI was greater than PPAAI for PT (P=0.0176); and APCAI was descriptively greater for PDT. The TNPAI of patients undergoing DT was greater than that of patients undergoing PT (P=0.0959). Five morphologically similar subgroups were identified and designated as B1, B2, B3, B4, and B5. Overall mortality was 17.5%. CONCLUSION: The morphometric characteristics are important, but the morphology of the pulmonary vascular blood supply of the PPAA and APCA proved to be better for guiding the surgical treatment. Independently of the didactical division into subgroups, PT predominated. Mortality was not correlated with the morphometric characteristics.

Atrioventricular septal defect with intact septal structures presenting as left atrioventricular valvar insufficiency

We describe the findings in a six-year-old girl who presented with signs of left atrioventricular valvar insufficiency. The echocardiogram showed a common atrioventricular junction, intact atrial and ventricular septal structures. At surgery, the left-sided atrioventricular valve was found to be tri-foliate, and corrected by valvoplasty. To the best of our knowledge, this is the first case of atrioventricular septal defect with common atrioventricular junction and intact septal structures diagnosed during life.

Inalação de solução salina hipertônica como coadjuvante da fisioterapia respiratória para reversão de atelectasia no pós-operatório de cirurgia cardíaca pediátrica

The case of an eleven-month-old female child is presented diagnosed as having congenital heart disease with pulmonary hyperflow, who was submitted to a surgery to close an interventricular communication, interatrial communication and arterial canal ligature. The infant evolved with persistent atelectasis at the right lung base in the postoperative period which did not respond to conventional physiotherapeutic measures. Inhalation of hypertonic saline solution with 6% NaCl was associated as a coadjuvant therapy, giving a total cure of the atelectasis after three days of treatment.

Partial tricuspid valve transfer for repair of mitral insufficiency due to ruptured chordae tendineae

BACKGROUND A new technique is suggested for the reconstructive surgical treatment of mitral regurgitation. It involves partial transfer of the tricuspid valve of the patient to the mitral valve, in order to provide chordae to correct anterior leaflet prolapse of the mitral valve, secondary to rupture of the chordae tendineae. METHODS From January 1991 to May 1997, 20 patients with mitral insufficiency due to rupture of the chordae were operated on. The prevailing cause was myxomatous degeneration (70%). Patients were in New York Heart Association functional class III and IV. RESULTS There were no hospital deaths. Two patients were reoperated on. Eighteen patients (90%) are alive with their own valves (class I and II). Doppler echocardiogram mean values were: ejection fraction, 0.65; left atrial diameter, 4.2 cm; mitral area, 2.4 cm2; mitral transvalvular gradient, 3.3 mm Hg. No regurgitation or mild regurgitation was observed in 16 (94.1%) of the 17 cases evaluated. Mean tricuspid valvular area was 3.3 cm2. In all cases, no tricuspid regurgitation was present or it was mild. CONCLUSIONS Partial transfer of the tricuspid valve to the mitral valve is an effective procedure for the surgical treatment of mitral valve insufficiency secondary to ruptured chordae tendineae of the anterior leaflet.

Right ventricle and tricuspid valve myxoma

1. Sao Jose do Rio Preto Pediatric Cardiovascular Surgery Service -Hospital de Base - Sao Jose do Rio Preto Medical School, SP,Brazil.Correspondence address: Ulisses Alexandre CrotiHospital de Base – FAMERP – Avenida Brigadeiro Faria Lima, 5544.CEP 15090-000 – Sao Jose do Rio Preto – SP - BrasilFone (Fax): 55 - 17 - 3201 5025 / 3222 6450 / 9772 6560E-mail: uacroti@uol.com.br

Concepts of basic physics that every cardiovascular surgeon should know: part I - mechanics of fluids

The professional activity that the cardiovascular surgeon performs is much more than a simple gesture to mechanically operate the patients heart. There is in every act of intraoperative most notions of physiology and physics than we generally realize. This paper discusses, in the light of mathematics, on the dynamics of fluids, ie blood, focused on invasive measurements of blood pressure, the effect of vessel size on its internal resistance and the flow passing through it in conversion of various units of measurements of pressure and resistance, blood viscosity and its relationship to the vessel, hemodilution, differences in laminar and turbulent flow, velocity and blood pressure and wall tension after a stenosis and the origin of poststenotic aneurysm. This study is not to enable the reader to the knowledge of all physics, but to show it as a useful tool in explaining phenomena known in the routine of cardiovascular surgery.

A Trileaflet “Mitral Valve” with Three Papillary Muscles: Brand New Echocardiographic Finding

Congenital mitral valve malformations are rare, but are well known and described entities. Mitral valve malformations involve mitral valve apparatuses (leaflets and annulus) and subvalvar apparatuses (chordae and papillary muscle). Case reports of accessory mitral leaflets were already described, but were usually an appendix of the normal valve. We describe here a case report and present the images of a trileaflet mitral valve sustained by three papillary muscles in a young girl with subaortic stenosis.

Alternative to an extracardiac Fontan-type operation: direct anastomosis between pulmonary trunk and inferior vena cava

Article received on August 22th, 2008 Article accepted on September 12th, 2008 CLINICAL DATA We report a case of a 9-year-old boy, weighing 20.8 kg, born in Salvador, BA. Cyanosis had been reported since birth by his mother, and two years ago she noticed a worsening in his physical condition when he started presenting episodes of dyspnea and fatigue with mild exertion. He was not taking any medication and had no previous surgical interventions. On physical examination, he was in a good health condition, red-faced, hydrated, cyanosis ++++/4+, and digital hipocratism. Systolic fremitus ++/4+ on the left upper sternal border was perceptible on the precordial region, cardiac auscultation with two clicks with a hyperphonetic second heart sound (S2), and systolic murmur ++++/6+ on upper sternal border irradiating to the right. Abdomen was normal. Peripheral pulses were present and symmetrical, and peripheral saturation was 73% on ambient air.

Alterações da função pulmonar após tratamento cirúrgico de cardiopatias congênitas com hiperfluxo pulmonar

BACKGROUND Analysis of pulmonary status of pediatric patients in the postoperative phase of cardiac surgery. OBJECTIVE To assess pulmonary compliance and airway resistance in patients with congenital heart disease and pulmonary hyperflow submitted to surgical treatment with the use of extracorporeal circulation. METHODS Thirty-five patients were evaluated during surgery with measurements of static compliance and airway resistance at four different timepoints. Pulmonary measurements were performed non-invasively using end-inspiratory airway occlusion and specific mathematical formulas. The variables examined and related to pulmonary changes were: preoperative - age, weight, and relationship between systemic and pulmonary blood flow; intraoperative - perfusion times, anoxia times and minimum temperature; postoperative - time on mechanical ventilation and length of stay in the intensive care unit. RESULTS Pulmonary compliance in all patients had an immediate and significant increase (P<0.001) at the end of surgery. Patients older than 30 months experienced a greater increase (P=0.0004). Those with more than 10 kg also had a greater increase (P=0.0006). In patients on extracorporeal circulation for more than 50 minutes, the increase in pulmonary compliance took longer to occur (P=0.04). Airway resistance was not significantly changed at the end of surgery (P=0.393). CONCLUSION All patients experienced improved pulmonary compliance at the end of surgery, and this was significantly influenced by age, weight and time on extracorporeal circulation. Airway resistance, however, was not changed.

A Trileaflet "Mitral valve" with three papillary muscles

Congenital mitral valve malformations are rare, but are well known and described entities. Mitral valve malformations involve mitral valve apparatuses (leaflets and annulus) and subvalvar apparatuses (chordae and papillary muscle). Case reports of accessory mitral leaflets were already described, but were usually an appendix of the normal valve. We describe here a case report and present the images of a trileaflet mitral valve sustained by three papillary muscles in a young girl with subaortic stenosis.