OBJECTIVEAssess late cardiological evolution of children with rheumatic mitral regurgitation (RMR) who underwent mitral valve reconstructive surgery with implantation of Gregori's ring (MVR), from 1987 to 2003.
METHODSA study was conducted to analyze a series of cases of 43 children with RMR who underwent MVR with ages ranged from fi ve to twelve years (mean age 9.7 ± 2.2 years); 25 of the patients were females (58.1%). Patients were evaluated as per the following clinical parameters: functional class of heart failure, heart auscultation, electrocardiogram, chest X-ray and echocardiographic fi ndings.
RESULTSForty-three patients underwent preoperative evaluation during the postoperative period, the number of patients evaluated decreased to 31 due to the fact that six patients had died and six others underwent valve replacement surgery. Follow-up was carried out for one hundred percent of the patients. A signifi cant reduction of heart failure functional class was observed. Mitral systolic murmur became lesss intense during the postoperative period. The cardiac area on chest X-ray and the presence of left ventricular overload on electrocardiogram were reduced, as well as the mitral regurgitation level on echocardiographic study. After 188 months, the survival rate was 82%, and the annual mortality rate, 0.38%. Thirty-one (72.6%) patients did not require reoperation and the annual rate of patients who required further surgery was 0.51%.
CONCLUSIONMVR is an effective procedure for treating RMR in children, resulting in a signifi cant improvement of functional class, mitral systolic murmur and level of mitral regurgitation, as shown on Doppler echocardiogram.
KEY WORDSr h e u m a t i c m i t r a l r e g u r g i t a t i o n, c h i l d r e n, annuloplasty
A 76-year-old man with situs inversus totalis underwent a
successful off-pump three-vessel coronary artery bypass surgery. The
postoperative course was uneventful, and the patient was discharged 8 days
later. At 9-month follow-up a coronary computed tomography angiography confirmed
the viability of all of the grafts, and one year after the operation the patient
remained asymptomatic. It comprises the fifth Brazilian case of a coronary
surgery in a patient with situs inversus totalis and the first
one of the country of a coronary artery bypass surgery without the use of the
cardiopulmonary bypass in this condition.
In the individual assessment of a scientific performance, five scientometric indices have been used most: the h-index, the index g, the h-major index, the contemporary h-index and the normalized h-index. We propose an alternative index ("Index h-fac"), which considers positively the participation of the first author and that, by having a dynamic characteristic, continuously monitors his/her performance and is easily adaptable to particular or individual situations from different research groups. Results from the geometric mean between the original hindex as proposed by Hirsh and a correction factor ("fac", "first author commitment") and, in turn, this value is divided by the mean interval (
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