É apresentada a experiência inicial com a cirurgia minimamente invasiva para o tratamento das afecções da valva aórtica, através da miniesternotomia em L invertido. No período de junho a novembro de 1997, 12 pacientes adultos foram submetidos a troca da valva aórtica. A técnica cirúrgica constitui-se na substituição da valva aórtica por prótese biológica, através de minitoracotomia, com esternotomia parcial do tipo L invertido, estendendo-se da fúrcula ao quarto espaço intercostal direito. O reduzido trauma cirúrgico proporcionou recuperação mais precoce. Em 1 (18,3%) caso, houve necessidade de conversão para esternotomia total por dificuldade de saída de CEC. A evolução tardia foi obtida em 11 (91,6%) casos, estando todos os pacientes assintomáticos. We present our initial experience with minimally invasive surgery for the treatment of aortic valve diseases, through a minithoracotomy. From June to November of 1997, 12 patients underwent aortic valve replacement. The surgical technique utilized was ministernotomy from the notch to the fourth right intercostal space. There was no mortality, nor reoperation. There was necessity of complete sternotomy in one case because of difficult of leaving CPB. Late evolution was possible in 91.6% of the cases and they are all free of symptons
Two invasive techniques for the treatment of occlusive coronary atherosclerosis disease were signed over the years: coronary artery bypass surgery and transcutaneous angioplasty with bare metal stent. The study attempts to compare the histopathological abnormality caused in patients with implantation of bare metal stent in coronary made with: Chromium 20%, Tungsten 15%, Nickel 10% and Cobalt remainder, ASTM F.90 alloy for surgical implant applications, and covered with a thin layer of amorphous silicon carbide, or not, and its total or partial obstruction, after undergoing coronary artery bypass grafting, with those who had coronary artery bypass surgery with no previous angioplasty. Two groups were studied: group I, or control group, patients who underwent coronary artery bypass grafting without previous angioplasty of any kind; group II of patients undergoing coronary artery bypass surgery after coronary-stent restenosis. Patients in both groups were evaluated for the indication and surgical risk; was done routinely during the procedure of conventional coronary artery bypass grafting with cardiopulmonary bypass. Before performing the anastomosis in coronary vascular graft, a small fragment of the endothelium was removed along whit a fragment of the stent, and sent for analysis with hematoxilin-eosin. The presence of chronic inflammatory coronary reaction was detected, mediated by mononuclear cells with phenomenon of fibroblast and smooth muscle proliferation in patients presenting in-stent restenosis. It w coronary reaction as also observed that the inflammatory and proliferative process is more intense at the site of stent implantation. The analysis of surface of the stents used atomic force microscopy proved to be an important method for the surface analysis for stents, and showed on nanometric scale an irregular coverage of silicon carbide. In conclusion, in the patients with restenosis in-stent occurs persistence of chronic inflammation with mononuclear cells and process of fibroblast proliferation.
À secretária da Bioengenharia, Márcia, pela atenção e gentileza na condução protocolar do doutorado.A Sylvia Telarolli e Maria Luísa Telarolli Leite, primas e revisoras ortográficas e de algo mais.Ao estatístico Aristides Tadeu Correa pela presteza na análise dos dados.A Eliana Petroni, gerente do Centro de Tratamento Cardiovascular, meu apoio diário na condução dos meus trabalhos: profissional e doutorado.A Ligia Santos, secretária e instrumentadora, por sempre me auxiliar no dia a dia. À secretária Francine, pela na formatação do trabalho.À minha irmã Tatiana, sempre pronta para me auxiliar.À minha esposa, Malu, pelo carinho, paciência e estímulo.A Ana, esposa do professor Rollo, pelo acolhimento com o carinho de sempre.À Santa Casa na pessoa do Dr. Valter Cury, com quem estive por muito tempo investindo na melhoria desse hospital.
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