Vinícius Giuliano Gonçalves Mendes

Cisto pericárdico gigante: relato de caso

Pericardial cysts are uncommon congenital abnormalities. Most are asymptomatic and are found incidentally on chest roentgenograms. Giant cysts are an even more uncommon finding, and reports of their natural history, presentation and management are few. In this report the authors describe a case of a giant pericardial cyst with symptoms of mediastinal compression for which the surgical excision guaranteed a 12-month follow-up of complete remission of the symptomatology.

O escore de risco ajustado para cirurgia em cardiopatias congênitas (RACHS-1) pode ser aplicado em nosso meio?

OBJECTIVE: The aim of this study was to evaluate the applicability of the RACHS-1 (Risk Adjustment in Congenital Heart Surgery) as a predictor of surgical mortality in a pediatric population of a public hospital of the Northeast of Brazil. METHODS: From June 2001 through June 2004, 145 patients undergone surgical treatment of CHD in our institution of whom 62% were female, and the mean age was 5.1 years. The RACHS-1 was used to classify the surgical procedures into categories of risk 1 to 6, and logistic regression analysis was used to identify the risk factors related to surgical death. RESULTS: Age, type of CHD, pulmonary flow, surgical procedure, pump time and cross clamp time were identified as a risk factor for postoperative mortality (p<0.001). There was a linear correlation between the categories of the RACHS-1 and the mortality rate; however, the observed mortality was greater than the predicted figures by that scoring system. CONCLUSION: Although the RACHS-1 is easily applicable, it can not be applicable in our scenario because it takes into account only the surgical procedure as a categorized variable, not considering others factors presented in our scenario that could interfere in the final surgical result.OBJECTIVE The aim of this study was to evaluate the applicability of the RACHS-1 (Risk Adjustment in Congenital Heart Surgery) as a predictor of surgical mortality in a pediatric population of a public hospital of the Northeast of Brazil. METHODS From June 2001 through June 2004, 145 patients undergone surgical treatment of CHD in our institution of whom 62% were female, and the mean age was 5.1 years. The RACHS-1 was used to classify the surgical procedures into categories of risk 1 to 6, and logistic regression analysis was used to identify the risk factors related to surgical death. RESULTS Age, type of CHD, pulmonary flow, surgical procedure, pump time and cross clamp time were identified as a risk factor for postoperative mortality (p<0.001). There was a linear correlation between the categories of the RACHS-1 and the mortality rate; however, the observed mortality was greater than the predicted figures by that scoring system. CONCLUSION Although the RACHS-1 is easily applicable, it can not be applicable in our scenario because it takes into account only the surgical procedure as a categorized variable, not considering others factors presented in our scenario that could interfere in the final surgical result.

Remoção cirúrgica pós-traumática de corpo estranho intracardíaco em criança

The authors report the successful surgical removal of a foreign body (7 x 1 cm wooden stick) from the right atrial of a 8 year-old child 77 days after a transfixing chest trauma caused by falling over a fence. The clinical presentation was infective endocarditis confirmed by the presence of an intraatrial mass at echocardiography. The postoperative course was uneventful. At 6 months follow-up, the patient is in Function Class I (NYHA) and in complete remission of infection.

Reconstruction of the chest wall with external metal brace: alternative technique in poststernotomy mediastinitis

OBJECTIVE To demonstrate the experience with the reconstruction of the chest wall utilizing metal brace to reduce the tension in the suture lines of myocutaneous flap in cases of mediastinitis. METHODS From July 2001 to February 2006, 1389 heart surgeries were performed in our institution of which eight (0.6%) developed mediastinitis. Seven were male and the mean age was 56.7 years. The risk factors for infection were diabetes and obesity in seven and malnutrition in one case. Seven patients had been undergone CABG and one repair of a congenital heart disease. The chest wall reconstruction consisted of percutaneous insertion of Kirshner wires parallel to the edges of the wound for anchoring of sutures to the muscular plane in order to allow the reduction of tension in the free edges of the wound and subsequent closure of the subcutaneous tissue and skin. RESULTS There was one death in the immediate postoperative due to arrhythmia and one late death secondary to sepsis. The remaining patients presented satisfactory postoperative course with good healing of the wound after the removal of the metal braces on the 21st postoperative day and in the follow-up of 6 to 54 months. CONCLUSION The reconstruction of the chest wall utilizing temporary metal braces showed to be a safe and effective procedure with good aesthetic and functional outcomes in this group of patients.

Mixossarcoma atrial esquerdo: relato de caso

Primary cardiac myxosarcoma is a very rare disease and is difficult to differentiate from myxoma, both clinically and pathologically. In this study, the authors report the first case of surgical excision of left atrial myxosarcoma in Brazil, in a 36-year-old woman. The operation was sucessful, and the patient remains asymptomatic for more than 180 postoperative days (Functional Class I - NYHA), with no signs of relapse of the tumor.