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OBJECTIVES: The Carpentier-Edwards pericardial (CEP) prostheses are the type of bioprostheses most used worldwide. Although they were designed to minimize the rate of valve deterioration and reoperation, their clinical superiority over other prostheses models still lacks confirmation. The objective of this study was to evaluate its effectiveness. METHODS: We performed a systematic review and meta-analysis in the PubMed, Embase, Cochrane, and Lilacs databases. Operative mortality, overall mortality and reoperation rates after heart valve surgery were compared between the use of CEP and other cardiac prostheses. Two independent reviewers screened studies for inclusion and extracted the data. Disagreements were resolved by consensus. The GRADE criterion was used to assess the evidence quality. RESULTS: A total of twenty-eight studies were selected, including 19,615 individuals. The studies presented a high heterogeneity and low quality of evidence what limited the reliability of the results. The pooled data from the selected studies did not demonstrate significant differences between CEP and porcine, pericardial or stentless prostheses regarding operative mortality, overall mortality and reoperation rates. However, the pooled data from 3 observational trials pointed out a higher risk for reoperation after valve replacement using CEP prostheses against mechanical prostheses (OR 4.92 [95 percent confidence interval 2.43-9.96]). CONCLUSIONS: The current data present in the literature still does not support a clinical advantage for the use of CEP prostheses over other bioprostheses. The quality of the studies in the literature is limited and further studies are needed to address if CEP prostheses will have a clinical advantage over other prostheses.

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Objetivo: As modernas armas de ar comprimido são capazes de propelir projéteis em alta velocidade, provocando injúrias graves. O trauma cardíaco penetrante geralmente se apresenta com paciente instável, hemodinamicamente, necessitando de intervenções de emergência. O manejo desses pacientes, quando estáveis clinicamente, é controverso. Descrição: Descrevemos o caso de um pré-escolar, com 3 anos de idade, atingido no tórax por tiro de ar comprimido, a uma distância de 2 metros. O ecocardiograma mostrou pequena lâmina de derrame pleural à direita, função contrátil dos ventrículos preservada, imagem hiperrefringente no septo interventricular. O ecocardiograma tridimensional sugeriu não haver projeção do projétil para as cavidades ventriculares. Tomografia computadorizada de tórax demonstrou derrame pleural pequeno, à direita, e artefato metálico na projeção do septo interventricular, totalmente intramiocárdico. Comentários: O paciente permaneceu sem instabilidade clínica durante a internação. Conclusão: Optamos pelo manejo conservador e acompanhamento ambulatorial com medidas seriadas do nível sérico de chumbo e revisões ecocardiográficas.

Objective: Modern air guns are capable of propelling projectiles at high speed, causing severe injuries. Penetrating cardiac trauma usually presents with hemodynamically unstable patients, requiring emergency interventions. The management of these patients, when clinically stable, is controversial. Description: We’ll describe the case of a 3-year-old boy hit by a compressed air shot in the chest at a 2 meters distance. At admission, echocardiography showed a small slide of right pleural effusion, preserved cardiac function, and a hyperechoic image projected inside the interventricular septum. Three-dimensional echocardiography showed no projectile extension to the ventricular cavities. Chest CT showed a small right pleural effusion and a totally intramyocardial metallic artifact in the interventricular septum topography. Comments: The patient remained clinically stable during hospitalization. Conclusion: We chose conservative management and outpatient follow-up with serial measurements of serum lead and echocardiographic review.

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