MI access for correction of the MV disease and ASD implicated in a longer cardiopulmonary bypass time for finalization of the main procedure, nevertheless it didn't affect patient's recuperation. MI treated patients were discharged earlier than sternotomy treated patients.

BackgroundMinimally invasive cardiovascular procedures have been progressively used in heart surgery. ObjectiveTo describe the techniques and immediate results of minimally invasive procedures in 5 years. MethodsProspective and descriptive study in which 102 patients were submitted to minimally invasive procedures in direct and video-assisted forms. Clinical and surgical variables were evaluated as well as the in hospital follow-up of the patients. ResultsFourteen patients were operated through the direct form and 88 through the video-assisted form. Between minimally invasive procedures in direct form, 13 had aortic valve disease. Between minimally invasive procedures in video-assisted forms, 43 had mitral valve disease, 41 atrial septal defect and four tumors. In relation to mitral valve disease, we replaced 26 and reconstructed 17 valves. Aortic clamp, extracorporeal and procedure times were, respectively, 91,6 ± 21,8, 112,7 ± 27,9 e 247,1 ± 20,3 minutes in minimally invasive procedures in direct form. Between minimally invasive procedures in video-assisted forms, 71,6 ± 29, 99,7 ± 32,6 e 226,1 ± 42,7 minutes. Considering intensive care and hospitalization times, these were 41,1 ± 14,7 hours and 4,6 ± 2 days in minimally invasive procedures in direct and 36,8 ± 16,3 hours and 4,3 ± 1,9 days in minimally invasive procedures in video-assisted forms procedures. ConclusionMinimally invasive procedures were used in two forms - direct and video-assisted - with safety in the surgical treatment of video-assisted, atrial septal defect and tumors of the heart. These procedures seem to result in longer surgical variables. However, hospital recuperation was faster, independent of the access or pathology.

Background: Composite grafting techniques for coronary artery bypass grafts (CABG) have been widely used. However, it remains unclear whether this technique provides similar blood flow to the left coronary artery when compared to the conventional alternative. We sought to compare the total blood flow to the left coronary branches that are revascularized with left internal thoracic (LITA) and radial artery (RA) grafts using composite and non-composite techniques.Method: A total of 42 patients were randomly assigned to three groups according to the CABG technique to be used: Group A or composite LITA-RA in a Y format (n=14); Group B or modified composite LITA-RA intercoronary graft with RA and LITA to RA at the left anterior descending artery (LADn=14)]; and Group C or pedicled LITA to the LAD and aortocoronary RA (n=14). The patients were submitted to postoperative blood flow velocity analysis using a 0.014 inch 12 MHz Doppler flowire. Coronary flow reserve (CFR) was calculated by determining the average hyperemic peak velocity (APV) after an injection of adenosine.Results: Proximal LITA baseline APV was 28.4 ± 4.8 cm/s in group A, 34.4 ± 7.9 cm/s in group B (p=0.0384 x C) and 25.8 ± 8.6 cm/s in group C. The CFR was 2.1 ± 0.4, 2.0 ± 0.3 and 2.0 ± 0.4 in groups A, B and C respectively (p=0.7208 A, B x C). The total Q to LCA branches was 110 ± 30 in group A, 145 ± 59 in B and 133 ± 58 mL/min in C (p=0.3232 A, B x C).Conclusions: The LITA-RA composite graft maintains an adequate CFR and conveys similar blood flow to the left coronary artery branches when compared with conventional CABG technique. The utilization of two internal thoracic arteries has given benefits [2], but this can be associated with a greater morbidity in obese and diabetic patients [3].The radial artery (RA), in spite of its easy dissection and handling, initially demonstrated unfavorable results as evidenced by cineangiography. However, with modifications in the surgical dissection technique, in the preparation and handling of the graft, the RA was safely reintroduced for the treatment of coronary artery disease [4]. This graft now gives good results over the long term [5][6][7].With experience, it seemed evident that the different sizes between the wall of the RA and the wall of the ascending aorta could compromise the proximal anastomosis of the graft.Based on works of anastomosis of the right internal thoracic artery (RITA) in the LITA [8][9][10], some surgeons started to anastomose the RA proximally to the left internal thoracic artery, to revascularize the branches of the left coronary artery (LC) [11] giving the same results in the postoperative period when compared to the RITA under the same conditions [12,13] or the RA anastomosed proximally to the aorta [7].In composite arterial grafts, all the blood flow (Q) distributed to the revascularized arteries is from the LITA. This can lead to the question about if the blood flow available from the LITA is enough to irrigate the myocardium or, if in the composite arterial grafting techni...

Objetivo: descrever a técnica empregada, as complicações e as alterações histológicas de pacientes submetidos à biópsia endomiocárdica no pós-operatório de transplante cardíaco. Métodos: estudo transversal de 232 procedimentos de biópsia endomiocárdica do ventrículo direito em 38 pacientes que foram submetidos a transplante cardíaco entre janeiro de 2000 e dezembro de 2002. Os critérios de exclusão foram: óbitos hospitalares (sem realização de biópsia) e dados incompletos para preenchimento de protocolo. Resultados: A técnica empregada foi a da punção da veia jugular interna direita. O biótomo utilizado foi o de 2,2 x 510mm e a localização de sua ponta confirmada por fluoroscopia. Obtiveram-se, em média, 5,1 fragmentos por biópsia. Dez biópsias (4,3%) não foram interpretadas. Em 42 procedimentos (18,1%) não foi evidenciada rejeição (grau 0), segundo a classificação da sociedade internacional. Sendo que entre as rejeições, a mais comum foi a aguda, focal e discreta (grau IA) – 55 %. Até seis meses após o implante, o grau IA foi de 41,2% e o grau IB (difusa e discreta) de 32,4%. A partir do sexto mês, os graus foram de 56% e 12,5%, respectivamente. Ocorreram nove complicações (3,8%). A mais comum foi o hemopericárdio com necessidade de drenagem pericárdica (1,3%). Conclusões: A biópsia endomiocárdica do ventrículo direito foi um procedimento realizado com baixa morbidade, sendo a principal complicação o hemopericárdio. Pela avaliação do grau histológico de rejeição aguda, o principal tipo foi o grau IA, sendo 41,2% até seis meses e 56% após seis meses do transplante cardíaco.

Objective -To study mitral valve function in the postoperative period after correction of the partial form of atrioventricular septal defect. Methods -

A síndrome da cimitarra, retorno anômalo parcial da drenagem venosa pulmonar para veia cava inferior (VCI), é lesão rara, razão pela qual a maioria dos cirurgiões não tem grande experiência com a técnica de correção. Relatamos o caso de paciente do sexo feminino, com 29 anos de idade, com o diagnóstico de síndrome da cimitarra comprovado pelo cateterismo cardíaco, que revelava calibrosa veia anômala do pulmão direito em direção à VCI e desembocando na junção entre esta e o átrio direito. Para o tratamento cirúrgico optamos, inicialmente, pela técnica de Kirklin, porém os achados operatórios nos obrigaram a mudar de técnica, levando-nos a dividir a veia anômala e reimplantá-la na parede do átrio direito, conforme descrito por Cooley. São técnicas diferentes com tempos distintos, prolongando, portanto, o tempo de operação. Um dos objetivos deste trabalho é contribuir para o processo de decisão dos cirurgiões, já que a comparação entre as técnicas não é encontrada na literatura.
The scimitar syndrome, anomalous drainage of pulmonary veins from the right lung to the inferior vena cava, is not a common pathology. Most surgeons when faced with such a case have doubts about which surgical technique is best for its treatment. This paper shows some of the controversies in the surgical repair of this syndrome based upon one case successfully treated by us