No abstract

Introduction: Ventricular septal rupture (VSR) is a serious mechanical complication after acute coronary syndrome and is related to high mortality. Even with advances in the management of acute myocardial infarction (AMI) such as reperfusion therapies, complication rates are still high. During quarantine, patients presenting mechanical complications after AMI have increased in our institution.Methods: From a retrospective database analysis in our institution between the years 2004 and 2020, we identified 37 cases of VSR after AMI. Four chronic cases were excluded from our analysis. The primary endpoint was to identify baseline characteristics that increased 30-day mortality.Results: Among 33 acute cases of VSR, 24 cases were submitted to surgery. The 30-day mortality of the operated patients was 45.8%. From 2004 to 2019 our average number of operations of VSR was 1.9 cases/year with an increase to 4 cases/year in 2020. Diabetes mellitus, age, cardiogenic shock, and use of intraaortic balloon pump were associated with significantly increased mortality using logistic regression. Conclusion:We reported an increased number of mechanical complication cases from April to September 2020, compared to our historical records. Despite therapeutic advances, mortality rates remain high. Although the number of cases is small to conclude that the pandemic was responsible for this augmentation, we believe that it is related to the decreased number of patients seeking medical assistance.

Luis Alberto O. Dallan completed invitation and concept of the article. Luiz Augusto F. Lisboa completed drafting of the article. Luis Roberto P. Dallan competed critical revision of the article. Fabio B.

Objective The objective of this study is to evaluate protamine sulfate effects on graft's blood flow by comparing transit‐time flow measurement (TTFM) values before and after protamine administration. Methods This is an observational study with data collected between years 2018 and 2020. Immediate graft patency was evaluated using TTFM. Only patients with TTFM parameters registered before and after protamine infusion were included. The main three parameters studied were:  mean graft flow  (MGF),  pulsatility index (PI), and  diastolic flow (DF). In the first analysis, all conduits were evaluated regardless of the surgical technique used. In a second analysis, on‐pump and off‐pump groups were compared. Evaluated grafts were left internal thoracic artery, saphenous vein graft (SVG), radial artery, and right internal thoracic artery. Since SVG was numerically the most used graft, an exclusive analysis was created. Results Our study included 575 patients, resulting in a total of 1686 grafts, mean 2.93 grafts/patient. Off‐pump surgery was performed in 158 patients. Before protamine infusion, inadequate TTFM parameters were observed in 3.8% of grafts. Overall, after protamine administration, MGF decreased in all grafts, but its reduction was not statistically significant. PI values increased in the SVG and DF values reduced in LIMA grafts. SVG group analysis showed that after protamine PI values were higher in OM1 and RCA. DF values increased in RCA. The comparison between off and on‐pump surgeries, showed that in off‐pump cases TTFM measures did not present statistically significant differences. Conclusion Significant variations were observed in TTFM values before and after protamine administration. Although different, those values remained within the normal reference ranges. We recommend that flow measurement should be performed before protamine infusion.

Arterial revascularization, and in particular, left internal mammary artery (LIMA), has shown to improve survival of patients with coronary artery disease. Complete revascularization often requires the use of other grafts and saphenous vein graft is still the most common conduit used. Several other types of grafts have been utilized during revascularization, including the radial artery and gastroepiploic artery. It is recognized that its venous structure can change when submitted to long‐term blood pressure regimen. We, herein, report left internal mammary vein (LIMV) utilized as a novel conduit for coronary artery revascularization, that was patent after 6 years. LIMV is an easy graft to harvest if the LIMA is dissected as a pedicle. The long‐term patency of LIMV is unknown, but its usage could be suggested for elderly patients with peripheral vascular disease, when long graft patency is not required

Dextrocardia with situs inversus totalis is a rare congenital abnormality. Most coronary artery bypass grafting surgeries in patients with dextrocardia were performed with anastomosis, using the right internal thoracic artery to revascularize the left anterior descending. It should be noted that in the literature there are few reports of coronary artery bypass grafting surgery, in a patient with this abnormality, its anatomical complexity constitutes a challenge in planning the surgical technique and the grafts to be used. We present an unusual case of a patient with situs inversus totalis and coronary artery disease who underwent coronary artery bypass grafting surgery making it a more technically complex procedure for surgeons, in addition to the difficulty in choosing grafts.