Objectives: The aim of this work was to analyze the dominance patterns of the circulation of the human heart, the number of branches from the right coronary artery to the left ventricle, the number of branches from the left coronary artery to the right ventricle and the frequency and location of intercoronary anastomoses. Methods: Casts were made by the injection of colored acrylic resin in 25 hearts and subsequent corrosion using hydrochloric acid at the experimental surgery laboratory of FURB. Specimens with lesions or scars were discarded.Results: The hearts, from both men (17 -68%) and women (8 -32%), had a mean age of 40.2 (15 to 70) years old. Right dominance occurred in 18 (72%) subjects, with 1, 2, 3 and 4 branches leading to the left ventricle in 2, 14, 2 and 2 molds, respectively. Left dominance occurred in 5 (20%) with 1 branch leading to the right ventricle in 4 molds and 2 in one. Balanced circulation was observed in two molds (8%). There were significant differences between right and left dominance (á > 5%) and between right dominance and balanced circulation (á > 5%), however the same was not true between left dominance and balanced circulation (á < 5%). Conclusion:The most common form of coronary circulation is right dominance with an average of 2.16 branches leading to the left ventricle: when dominance is left, the average is 1.2 branches. No intercoronary anastomoses were observed using this method. 515 ABUCHAIM, DCS ET AL -Coronary dominance patterns in the human heart investigated by corrosion casting Bras Cir Cardiovasc 2009; 24(4): 514-518 Descriptors Rev

Extubação precoce na sala de operação após cirurgia cardíaca infantilEarly extubation of children in the operating room after cardiac surgery Abstract Introduction: Early extubation is related to short lenth of hospitalization and less complications.Objective: Data analisys from children extubated in the operating room after cardiac surgery with CPB.Methods: Retrospective data analisys. Results 104ABUCHAIM, DCS ET AL-Early extubation of children in the operating room after cardiac surgery Bras Cir Cardiovasc 2010; 25(1): 103-108 morphine 0.05 to 0.1 mg. The anesthesia before and after CPB was maintained by sevorane and, during CPB, by propophol. RevAfter median thoracotomy and heart exposure, it was administered a dosage of heparin 5 mg/kg, performed cannulation of the aorta and both cavas with diameters appropriate to the body surface of each patient and CPB carried out under moderate hypothermia at 25°C. The oxygenator (Edwards Life Sciences) was determined by the body surface. The cardioplegia used was the cold blood type with solution of ST Thomas (Braile Biomédica), administered in the aorta after clamping, induction dosage of 30ml/kg and repeated each 20 minutes with dosage of 20ml/kg. The hematocryt of CPB was maintained at a high level (24). The decision for extubation was made jointly by the anesthesiologist and the surgeon, at the end of thoracorraphy, individually, after evaluation of: hemodynamic stability (without vasoactive drugs), rhythm (sinus), presence of hemorrhage, cardiopathy type and age (over neonatal period).At the end of surgery, the patients were transferred to the neopediatric intensive care unit, using a Venturi oxygen mask at 50% and there were collected biochemical exams after 30 minutes of arrival.The Aristotle Score Risk was determined after filling out the clinical data in the chart available at the site www.aristotleinstitute.org [2].The statistical analysis was performed with the Student's t test, considered significant with P value lower than 0.05. RESULTSIn the period from 3/29/2006 to 1/29/2008, 70 patients aged less than 18 years of age were operated at the Hospital Santa Catarina -Blumenau, with diagnostic of congenital cardiopathy. Among these, 20 patients were submitted to procedures without CPB (ligation of arterial conduit, section of vascular ring, bandage of pulmonary artery, correction of aortic coarctation and pericardial window) and 50 patients were submitted to procedures with CPB (atriosseptoplasty, ventriculosseptoplasty, atrioventricular septal defect, Ebstein anomaly, Jatene operation, supravalvar aortic stenosis, partial septal defect, double outlet right ventricle, subaortic membrane, correction of complex cyanotic cardiopathies using procedures type modified Blalock-Taussig, Glenn or Fontan, intracardiac foreign body, Tetralogy of Fallot, cor triatriatum. Fifteen children, aged 4 to 216 months (mean 76.1 months), were submitted to extubation in the operating room after correction of congenital cardiopathies, using cardiopulmonary bypass. There were exc...

Objective: The aim of this study is to describe our experience in aortic coarctation surgery in adult patients by assessing the immediate and mid-term outcomes.Methods: From January 1997 to March 2000, 50 consecutive adult patients underwent surgery for correction of aortic coarctation, through left lateral thoracotomy. Of these, forty two (84%) patients presented high blood pressure, with mean systolic arterial pressure of 170.56 mmHg (125-220 mmHg). The mean of pressure gradient in the coarctation area was 51.4 mmHg (18-123 mmHg). Other associated surgical cardiovascular diseases were not treated in the same operative act, except in two cases of patent ductus arteriosus (PDA). Three different techniques were used: aortic coarctation resection with end-to-end anastomosis was performed in 20 (40%) patients, coarctation enlargement with bovine pericardial patch was performed in 22 (44%) patients and synthetic tube interposition was performed in eight (16%) patients.Results: Operative morbidity was low; there was one case of bleeding who required reoperation. The most common immediate postoperative event was high blood pressure (98%), but it was easily controlled by intravenous drugs. There was no hospital death. Mean residual pressure gradient was 18.7 (8-33 mmHg). Patients were discharged in 9.5 days (5-30). Postoperative follow-up mean was 46.8 months (1-145 months) in 45 (91.8%) patients. Forty one (91.1%) of these followed-up patients had normal blood pressure, whereas 75.6% of them without drugs intake. 93.3% of these followed-up patients were asymptomatic. Four of them required further surgical operation, one needed a pacemaker implant, other two patients needed a cardiac valve replacement and one had endocarditis. There was one related death due to sepsis secondary to endocarditis.

Fundamentos: Próteses valvares aórticas com desempenho hemodinâmico adequado possibilitariam maior regressão da hipertrofia ventricular e normalização da função ventricular. Isto possivelmente tenha implicações importantes no prognóstico tardio após a substituição da valva aórtica. Objetivo: Avaliar o desempenho hemodinâmico do auto-enxerto pulmonar em posição aórtica e a regressão da hipertrofia ventricular esquerda após a operação de Ross. Casuística e Métodos: De maio/95 a março/97, 45 pacientes com média de idades de 27,1 anos foram submetidos à operação de Ross. Todos os pacientes foram submetidos, no pós-operatório imediato, a ecocardiografia com Doppler e cateterismo cardíaco para avaliação do desempenho hemodinâmico dos auto e homoenxertos, assim como da massa e função ventricular esquerda. Catorze pacientes com evolução superior a seis meses submeteram-se a ecocardiografia de stress com dobutamina, para estudar o desempenho hemodinâmico dos auto e homoenxertos em condição de exercício. Resultados: A mortalidade hospitalar foi de 6%. Após tempo médio de seguimento de 12,8 meses (1-23), ocorreu um óbito súbito tardio e nenhuma complicação relacionada à prótese. O desempenho hemodinâmico imediato e tardio dos auto-enxertos foi praticamente normal, com média de gradiente médio de 1,8 ± 0,6 mmHg e média de gradiente instantâneo máximo de 2,9 ± 0,9 mmHg. O grau de insuficiência valvar foi desprezível. Mesmo em condição de exercício, os gradientes não se elevaram de forma significativa, com média de gradiente médio de 4,3 ± 2,5 mmHg e média de gradiente instantâneo máximo de 10,4 ± 6,1 mmHg. Os homoenxertos utilizados para a reconstrução da via de saída do ventrículo direito tiveram excelente desempenho hemodinâmico imediato; entretanto, no seguimento tardio apresentaram discreto aumento das velocidades de fluxo com média de gradiente médio de 10 ± 7,1 mmHg em repouso e 26 ± 13,3 mmHg durante o exercício. O índice de massa ventricular esquerda caiu de 168 ± 46g/m² no pré-operatório para 115 ± 32g/m² no 6º mês de evolução. A função ventricular esquerda apresentou-se normal em repouso e no exercício na maioria dos pacientes. Conclusões: Dado o desempenho hemodinâmico normal dos auto-enxertos pulmonares, a redução da massa ventricular e normalização da função do ventrículo esquerdo, além da ótima evolução tardia dos pacientes, consideramos a operação de Ross como a operação ideal para pacientes aórticos jovens.
Background: Aortic valve prosthesis with adequate hemodynamic performance should allow more complete left ventricular mass regression and return left ventricular function back to normal. This possibly affects long term prognosis after aortic valve replacement. Objective: Assessment of hemodynamic performance of the pulmonary autograft in the aortic position and the regression of left ventricular mass after the Ross procedure. Material and Methods: Between May/95 and Mar/96, 45 patients with mean age of 27.1 years were submitted to a Ross procedure. Doppler echocardiography and cardiac catheterization wer...

The intrapericardial cardiac tumors are rare; however, the clinical manifestations can be serious, even with symptoms of low debit or cardiogenic shock, depending on the localization of the tumor. We explore the case of a 3-month-old infant who presented with cardiogenic shock during the evolution, due to an intrapericardial tumor, compressing the right atrium and the superior vena cava. Indicated operation of urgency for resection of the tumoral mass, it presented adequate evolution up to 6 months of postoperative.Descriptors: Cardiogenic shock. Infants. Heart neoplasms. Cardiac surgical procedures. ResumoOs tumores cardíacos intrapericárdicos são pouco freqüentes, porém, as manifestações clínicas podem ser graves, até com sintomas de baixo débito ou choque cardiogênico, dependendo da localização do tumor. Relatamos o caso de um lactente com três meses de idade, que apresentou na evolução choque cardiogênico, em decorrência de um tumor intrapericárdico, comprimindo o átrio direito e a veia cava superior. Indicada operação de urgência para ressecção da massa tumoral, apresentou adequada evolução até seis meses de pós-operatório.Descritores: Choque cardiogênico. Lactente. Neoplasias cardíacas. Procedimentos cirúrgicos cardíacos. JATENE, MB ET AL -Intrapericardic surgical treatment of teratoma in infantRev Bras Cir Cardiovasc 2008; 23(1): 123-125

Rev Bras Cir Cardiovasc 2011; 26.1: 93-97

Report of a surgical treatment for vascular ring (right aortic arch and the anomalous origin of the left subclavian artery) related to Kommerell diverticulum with resection of the ligamentum arteriosum (ductus arteriosus), suture of the Kommerell diverticulum, and reimplantation of left subclavian artery in the ipsilateral carotid artery through left thoracotomy in a 13-year-old female.Descriptors: Aorta, thoracic, abnormalities. Subclavian artery, abnormalities. Aortic diseases, surgery. ResumoRelato do tratamento cirúrgico de anel vascular (arco aórtico à direita e origem anômala de artéria subclávia esquerda) relacionado a divertículo de Kommerel, com realização de secção de ligamento arterial, rafia de divertículo e reimplante de artéria subclávia esquerda em carótida ipsilateral, por toracotomia esquerda, em uma paciente de 13 anos.

Fundamentos: A utilização de homoenxertos valvares aórticos criopreservados está associada a excelente qualidade de vida, com baixa morbidade e durabilidade satisfatória. Espera-se obter resultados semelhantes em posição mitral com o emprego de homoenxertos mitrais criopreservados. Objetivo: Avaliar os resultados imediatos e a curto prazo da substituição da valva mitral por homoenxerto mitral criopreservado. Casuística e Métodos: De julho/97 a fevereiro/98, 8 pacientes com média de idades de 40,3 ± 6,2 anos foram submetidos a substituição da valva mitral por homoenxerto mitral criopreservado. A técnica de implante consistiu de fixação látero-lateral dos músculos papilares, sutura anular contínua e anuloplastia com anel de Carpentier. Antes da alta, todos os pacientes realizaram ecocardiografia bidimensional com Doppler para análise da função valvar e ventricular. Os pacientes foram solicitados a retornar no primeiro mês e, subseqüentemente, a cada três meses de pós-operatório, para controles clínico e ecocardiográfico tardio. Resultados: Houve um óbito hospitalar de causa não relacionada ao enxerto. A avaliação ecocardiográfica antes da alta hospitalar demonstrou média das áreas valvares de 3,1 ± 0,6 cm2 e média dos gradientes médios de 3,5 ± 1,6 mmHg. A insuficiência valvar foi quantificada como inexistente ou trivial em 4 casos e leve em 3. A fração de ejeção de 57 ± 7% no pré-operatório foi adequadamente preservada no pós-operatório (62 ± 6%). Os níveis de hipertensão pulmonar regrediram significativamente de 87 ± 15 mmHg no pré-operatório para 48 ± 12 mmHg no pós-operatório. Houve também redução do tamanho da cavidade atrial esquerda de 61 ± 10 mm para 53 ± 7 mm. Nenhum paciente foi perdido do acompanhamento tardio. Após um tempo médio de seguimento de 4,1 ± 2,5 meses, os pacientes encontram-se funcionalmente bem e sem complicações pós-operatórias. O estudo ecocardiográfico tardio demonstra a persistência dos bons resultados imediatos. Conclusões: Os resultados imediatos e a curto prazo da substituição da valva mitral por homoenxerto mitral criopreservado foram bastante satisfatórios. Somente com tempos mais prolongados de observação poderemos determinar a durabilidade desse enxerto e, eventualmente, expandir as suas indicações.
Background: the use of cryopreserved aortic valve homografts is associated with excellent quality of life, low morbidity and satisfactory durability. We expect to achieve similar results in the mitral position with the use of cryopreserved mitral homografts. Objectives: Evaluate the immediate and short-term results of mitral valve replacement with cryopreserved mitral homografts. Material and Methods: Between July/97 and February/98, 8 patients with a mean age of 40.3 ± 6.2 years were submitted to mitral valve replacement with cryopreserved mitral homografts. Operative technique consisted of latero-lateral papillary muscle fixation, a running continuous suture at annulus level and annuloplasty with a Carpentier ring. Before hospital discharge, all patients were submitted to Doppler...