RBCCV 44205-769 Nova abordagem técnica para papilopexia cruzada em operação de substituição valvar mitral: resultados imediatosNew technical approach for crossed papillopexy in mitral valve replacement surgery: short term results Abstract Objective: To present the crossed papillopexy technique and its initial results in the preservation of papillary muscles in mitral valve replacement and ventricular remodeling surgeries for heart failure (CHF).Method: Ten patients, 70% male, with ages between 15 and 75 years old (mean 44.4 ± ± ± ± ± 18.7 years old), suffering from rheumatic mitral valve disease (50%), mitral valve prolapse (10%) or dilated cardiomyopathy (40%), were studied. After opening the left atrium and adequate exposure of the mitral valve, the anterior leaflet already free of its annulus fixation was centrally divided and each half, with its cordae tendineae complex fixed to the commissure on the opposite side. Following this, mechanical (seven cases) or biological (three cases) prostheses were implanted using single sutures in the valve annuli, with reduction of the mitral valve annulus for better ventricular remodeling in CHF cases.Results: All patients were discharged from hospital in good clinical conditions. Additionally all presented with great improvement in the cardiac performance at the end of the first month of follow-up, with significant reductions in the left ventricular and left atrium systolic diameters (p<0.05) and mean increases in the left ventricle ejection fraction of from 46.7 to 56.4 % (p<0.05).Conclusion: The crossed papillopexy technique in valve replacement surgeries for mitral valve lesions and CHF presented significant increases in the left ventricular function and improvement of ventricular remodeling in the studied postoperative period. Descriptors: Mitral valve, surgery. Papillary muscles, surgery. Heart valve prosthesis. Resumo Objetivo: Apresentar a técnica de papilopexia cruzada e seus resultados iniciais na preservação dos músculos papilares em operações de substituição valvar mitral e remodelamentoDescritores: Valva mitral, cirurgia. Músculos papilares, cirurgia. Prótese das valvas cardíacas.
Objective: The effects on myocardial contractility (dT/dt max) and coronary blood flow of common drugs used in clinical practice (diazepam, midazolam, propofol and etomidate) were studied. Method: Fifty Wistar rat hearts were divided into five groups of ten and perfused using the Langendorff method with Krebs-Henseleit solution (K-H), with the perfusion pressure stable at 90 cm H 2 O and the temperature at 37.0 ± 0.5 °C. With the exception of Group I (control), they were submitted to single one-minute infusions of diazepam (50 micrograms)-Group II; midazolam (25 micrograms)-Group III; propofol (25 and 50 micrograms)-Group IV and etomidate (25 micrograms)-Group V. The drugs were diluted in 0.1 mL of K-H solution and the coronary blood flow rate and perfusion pressure controlled during infusion. The heart rate (beats per minute), myocardial tension (grams) and coronary blood flow (millimeters per minute) were measured at 1, 3, 5, 10, 15, 20, 25 and 30 minutes. The myocardial contractility was obtained by calculating the first derived tension/time (dT/dt max), at each time interval. Results: The heart rate showed variations in Groups I, III and IV. A variation in the myocardial tension was seen in all groups except Group I and alterations in the coronary blood flow were seen in all groups except Group IV during the experiment. The myocardial contractility decreased in all groups, except for Group I. Conclusion: The assayed drugs diminished the myocardial contractility (p<0.05); the variations of the coronary blood flow were not directly correlated to those that occurred with the myocardial contractility.
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