RESUMO
Submitral left ventricular aneurysm is a cardiac pathology widely recognized, but relatively unknown, occurred almost exclusively in African black patients. Although still this idea of racial prevalence exists, cases have been described in patients of all the races. Ten Brazilian cases were reported. One of them was presented inside an Italian paper that refers the surgical treatment of a Brazilian patient of black race. We reported one more submitral left ventricular aneurysm case in a brown female patient, with antecedents of peripheral thromboembolism initially not identified as consequence of the cardiac pathology.
Assuntos
Aneurisma Cardíaco/diagnóstico , Feminino , Aneurisma Cardíaco/cirurgia , Humanos , Pessoa de Meia-Idade , Valva MitralRESUMO
BACKGROUND: We investigated the degree of myocardial protection provided by intermittent anterograde normothermic blood cardioplegia infusion for 60 minutes at 37 degrees C in normal rabbit hearts. METHODS: Thirty-two New Zealand rabbits were studied and divided into two groups: experimental group and control group. In the experimental group, normothermic blood cardioplegia was infused into the aortic root every 20 minutes over a one-hour period using a two-minute infusion dose. This amounted to an ischemic (unperfused) time of 52 minutes (or 86.6% of the total time). The biochemical investigation was carried out in two phases; Phase I: metabolic study after ischemia with no reperfusion and Phase II: metabolic and functional study after reperfusion. Reperfusion was carried out using a parabiotic perfusion system. Myocardial glycogen and mitochondrial respiration in the ventricular myocardium were established immediately after the end of intermittent cardioplegic solution infusion (Phase I) and after blood reperfusion (Phase II), when left ventricular function (dP/dt max) was also evaluated. RESULTS: At the end of Phase I, there was a significant decrease in myocardial glycogen levels to 58% compared with the control group. In Phase II, the differences in myocardial glycogen between the experimental and the control group were not significant. Mitochondrial respiration analysis did not show significant differences between the experimental and control groups, either in Phase I or II. In Phase I, dP/dtmax values were 903.39 +/- 113.46 mmHg/sec and 1,043 +/- 256.94 mmHg/sec for the experimental and control group, respectively. These differences were not statistically significant. CONCLUSIONS: Intermittent anterograde blood cardioplegia infusion every 20 minutes for 60 minutes at 37 degrees C was an effective myocardial protection method in normal rabbit hearts.
Assuntos
Metabolismo Energético/fisiologia , Parada Cardíaca Induzida , Traumatismo por Reperfusão Miocárdica/patologia , Miocárdio/patologia , Função Ventricular Esquerda/fisiologia , Animais , Masculino , Coelhos , TemperaturaRESUMO
A case of newborn intrapericardial teratoma is reported. The clinical, echocardiographic, tomographic and histologic features are described, and also, the therapeutic options. The newborn was submitted to surgical excision of the intrapericardial tumor and has a clinical follow-up greater than four years.
Assuntos
Neoplasias Cardíacas/diagnóstico , Teratoma/diagnóstico , Seguimentos , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Pericárdio , Teratoma/patologia , Teratoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We report a permanent complete heart block, in a 27 year-old female patient, developed during mitral percutaneous valvotomy using a single inflation of the Inoue balloon catheter. After one month, even using corticoids, a Mobitz II second-degree atrioventricular block persisted, the patient became symptomatic to moderate efforts and a cardiac pacemaker was implanted.
Assuntos
Cateterismo/efeitos adversos , Bloqueio Cardíaco/etiologia , Estenose da Valva Mitral/terapia , Adulto , Eletrocardiografia , Feminino , Seguimentos , Bloqueio Cardíaco/diagnóstico , Hemodinâmica , Humanos , Marca-Passo Artificial , PrognósticoRESUMO
A valvoplastia mitral percutânea (VMP) tem sido utilizada como tratamento näo cirúrgico para pacientes selecionados portadores de estenose mitral, sendo uma laternativa à comissurotomia cirúrgica. Complicaçöes maiorese da VMP incluem: morte durante o procedimento, perfuraçäo cardíaca, embolismo sistêmico (causando acidente vascular cerebral, infarto do miocárdio ou êmbolo periférico), e lesäo valvar grave resultando em regurgitaçäo mitrla. Complicaçöes menores incluem: criaçäo de comunicaçäo interaial, reflexos vaso-vagais, lesäo vascular ou snagramento nos locais de inserçào dos cateteres, taquiarrtimais atriais e ventriculares, e distúrbios de conduçäo temporários. Descreve-se o caso de uma paciente que desenvolveu bloqueio atrioventricular total (BAVT) permanente após valvoplastia mitral percutânea utilizando-se o cateter-baläo de Inoue. Os disturbios da conduçäo cardíaca neste procedimento näo säo infrequentes, sendo em geral transitórios. O levantamento da bibliografia médica, täo extenso quno possível, revelou relatos de apenas dois casos de BAVT permanente como complicaçäo da VMP. Um destes pacientes foi tratado com a técnica do duplo baläo, o outro tratado com o baläo de Inoue, e ambos necessitaram de implante de marcapasso cardíaco.
Assuntos
Marca-Passo Artificial , Cateterismo , Valva Mitral/cirurgia , Bloqueio CardíacoRESUMO
Cervical trachea reconstruction with a non-stented platysma myocutaneous door flap (NPMCF) was studied in 23 dogs. Window defects involving 5, 10, or 15 rings and the whole anterior tracheal wall were produced in 3 different groups of animals. A segmentary defect involving the resection of 3 tracheal rings but preserving the posterior membranous wall was created in another group. The results were evaluated by clinical follow-up of up to 100 days, by tracheoscopy 1 week after surgery, and by macroscopic and microscopic examination after the animals' natural death or sacrifice. The NPMCF proved to be adequate for the reconstruction of window defects limited to 5 and 10 rings, with success rates of 100% and 75%, respectively. The use of the NPMCF for tracheal reconstruction had the following main advantages: 1. relatively simple, easy, and expeditious surgery; 2. use of a single operative field; 3. availability of large amounts of donor tissue; 4. adequate thickness; 5. reliable irrigation; 6. resistance to environmental exposure as evidenced by absence of infection; and 7. 100% take rate with no granulomas or scar stenosis at the suture lines. However, luminal occlusion due to flap collapse was a 100% fatal complication when the NPMCP was used either for reconstruction of larger window tracheal defects (15 rings-group 3) or segmentary defects (group 4); this was the main limitation of the method, followed by hair growth with accumulation of secretions, which can be easily dealt with. It can be anticipated that this method has a potential for application in well-selected patients.
Assuntos
Retalhos Cirúrgicos/métodos , Traqueia/cirurgia , Animais , Cães , Feminino , Masculino , Complicações Pós-OperatóriasRESUMO
Alkaline reflux gastritis is a clinical syndrome that results from a mucosal injury by duodenal contents. In this study, the amount of duodenogastric reflux was assessed in patients who previously underwent proximal gastric vagotomy (PGV group; n = 11) and PGV plus duodenoplasty (PGV+D group; n = 10) as a treatment for duodenal ulcer. The control group (A) consisted of 11 healthy volunteers without endoscopic abnormalities. A quantitative index of duodenogastric reflux was obtained in each case by determining the percentage of the injected dose of 99mTechnetium-DISIDA that was recovered by continuous aspiration of gastric juice in fasting subjects. In the PGV group, the percentage of administered 99mTechnetium-DISIDA recovered from the stomach (median: 0.69%; range: 0.09%-3.61%) did not differ significantly (P > 0.05) from that of the PGV+D group (median: 0.49%; range: 0.09%-3.91%) and from that of the A group (median: 1.47%; range: 0.22%-3.01%). The results show that proximal gastric vagotomy plus duodenoplasty did not increase duodenogastric reflux.
Assuntos
Refluxo Duodenogástrico/fisiopatologia , Duodeno/cirurgia , Iminoácidos , Compostos de Organotecnécio , Vagotomia Gástrica Proximal , Úlcera Duodenal/complicações , Úlcera Duodenal/cirurgia , Refluxo Duodenogástrico/etiologia , Refluxo Duodenogástrico/patologia , Feminino , Humanos , Masculino , Valores de Referência , Reoperação , Disofenina Tecnécio Tc 99mRESUMO
Two patients who underwent bypass surgery with saphenous grafts had a fistula resulting from inadvertent grafting of the cardiac vein correspondent to a targeted diagonal artery. Hemodynamic effects at rest were restricted to moderate elevation of the pulmonary blood flow, by 23 and 13% respectively, at 5 and 12 months postoperatively. No objective signs of ischemia could be elicited in either patient, in the fistula related region, and left ventricular function remained within normal limits in both cases throughout the follow-up period (36 and 24 months, respectively).
Assuntos
Doenças da Aorta/etiologia , Fístula Arteriovenosa/etiologia , Ponte de Artéria Coronária/efeitos adversos , Vasos Coronários , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Veia Safena/transplante , Fatores de TempoRESUMO
Two cases of this anomaly, in women (26 and 49 years old), with symptoms of short duration (4 and 3 months) of dysphagia, regurgitation and esophagitis, without loss of weight, are presented. In both, the final diagnosis was made by mean of thoracic aortogram. Esophagoscopy realized only in the first patient, demonstrated the pulsatile esophageal compression. The first patient was operated on through a right cervical incision, made in the anterior border of the sternomastoid muscle. In the second, a partial sternotomy, combined with a right supraclavicular prolongation, was used. In both, the anomalous artery was taken from the aorta and behind the esophagus, and anastomosed to the right common carotid artery. The dysphagia disappeared in the second case, but persisted attenuated, in the first one. Manometric studies realized in the 3rd and 18th months postoperatively demonstrated an aperistaltic segment of the esophagus (between 4 and 7 cm from the superior sphincter).
Assuntos
Transtornos de Deglutição/cirurgia , Estenose Esofágica/etiologia , Artéria Subclávia/anormalidades , Adulto , Constrição Patológica/complicações , Constrição Patológica/cirurgia , Transtornos de Deglutição/etiologia , Estenose Esofágica/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , RadiografiaRESUMO
Realizaram-se medidas do fluxo sanguineo periferico do pe, por plestimografia de oclusao venosa em 11 pacientes portadores de estenose mitral, submetidos a cateterismo cardiaco, e a medida da area util da valva mitral durante intervencao cirurgica Os valores foram baixos na maioria dos pacientes e a correlacao entre o fluxo sanguineo periferico e a area util da valva mitral bem como o indice cardiaco, volume sistolico e resistencia arteriolar sistemica nao foram extatisticamente significantes.Concluem que os achados nao sugerem que o fluxo sanguineo periferico dependa do grau de estenose da valva.Diante do volume de informacoes que contestam a participacao universal do sistema nervoso autonomo simpatico os autores invocam a autorregulacao local para explicar as respostas da circulacao periferica nos portadores de estenose mitral