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Pequena história da cirurgia cardíaca: e tudo aconteceu diante de nossos olhos...

Objective: To evaluate the safety, feasibility and initial and clinical effects on myocardial perfusion, intramyocardial, transthoracic administration of plasmid VEGF 165 in patients with advanced coronary artery disease and refractory angina, which are not qualified for percutaneous revascularization and surgery.Methods: A cohort study phase I. Thirteen patients with ischemic heart disease refractory angina despite maximum medical treatment for at least six months, not qualifying for surgical or catheter underwent intramyocardial injection of VEGF 165 plasmid 2000ìg. Patients were evaluated by myocardial scintigraphy, exercise testing, quality of life questionnaire (Minnesota) and determining the classes of heart failure (NYHA) and angina (CCS).Results: There were no deaths or recurrences. During the period of maximum medical treatment, there was no difference in myocardial scintigraphy, exercise stress tests and questionnaires on quality of life also found a trend towards worsening of NYHA class (P = 0.05) and CCS (P = 0.05) . Three months after intervention we observed improvements in scintigraphic SSS scores (18.38 ± 7.51 vs. 15.31 ± 7.29, P = 0.003) and SRS (11.92 ± 7.49 vs. 8.53 ± 6.68, P = 0.002) but not in proportion to the areal extent of ischemic Rev Bras Cir Cardiovasc 2010; 25(3): 311-321 of administration of VEGF. Clinical trials bring controversial results, many showing evidence of clinical improvement and angiogenesis [8][9][10][11][12][13][14][15][16][17][18][19] and others showing no differences in myocardial perfusion when compared to their controls [7,20]. Thus, although promising, remain still not completely clear the clinical effects on the myocardium vascularization of the therapy with VEGF in its various forms and ways of administration, justifying further studies. KALIL, RAK ET AL -VEGF gene therapy for angiogenesis in refractory angina: clinical trial phase I/IIThis clinical assay aims to evaluate the safety, feasibility and initial clinical effects (featuring a clinical assay phase I / II), under myocardial perfusion, intramyocardial, transthoracic administration of plasmid VEGF 165 in patients with advanced CAD and refractory angina, which are not qualified for surgery and percutaneous revascularization. We emphasize that we used for the first time, a plasmid entirely produced in Brazil.

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Fatores de risco para mortalidade hospitalar no implante de prótese valvar mecânicaRisk factors for hospital mortality in valve replacement with mechanical prosthesis Rev Bras Cir Cardiovasc 2009; 24(3): 334-340 requiring long time of anticoagulation and for those who wishes to minimize the need for reoperation. The aim of this prospective study, with retrospective data acquisition, is to review the number of patients who underwent implantation of mechanical heart valve prosthesis, St Jude Medical model, in order to identify risk factors that can influence hospital mortality. METHODS Study CharacteristicsProspective study with retrospective data acquisition. PopulationThe study included 335 patients who underwent at least one mechanical prosthesis of St. Jude Medical model, from December 1994 to September 2005, at Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology. Of these, 181 (54%) were male and 154 (46%) were females, aged between 16 and 78 years, mean 46.8 ±

Intramyocardial transplantation of BMMC in dilated cardiomyopathy cases is feasible and safe. There were early improvements in symptoms and LV performance. Medium-term evaluation revealed regression of LV function, although maintaining improved functional class.

Bone marrow mononuclear cells (BMMC) effects have been investigated in small series of nonischemic dilated cardiomyopathy (NIDC). Left ventricular myocardial contractility improvements occur, but doubt remains about their mechanism of action. We compared contractility changes in areas treated (free wall) and nontreated (septal wall) with BMMC, in selected patients who have showed significant ventricular improvement after free wall-only intramyocardial stem cells injection. From 15 patients with functional class III/IV (NYHA) and LVEF inferior to 35%, who received 9.6 ± 2.6 × 10(7) BMMC divided into 10 points over the left ventricular free wall, 7 (46.7%) showed LVEF relative improvement greater than 15%. Those patients were selected for further contractility study. BMMC were collected from iliac bone and isolated with Ficoll-Hypaque. Magnetic resonance imaging was used to measure the systolic thickening of the septal (nontreated) and free wall (treated) before injection and 3 months postoperatively. Mean systolic septal wall thickening increased from 0.46 to 1.23 mm (an absolute 0.77 ± 1.3 mm and relative 167.4% increase) and in the free wall from 1.13 to 1.87 mm (an absolute 0.74 ± 1.5 mm and relative increase of 65.5%). There was no difference in the rate of absolute or relative systolic thickening between the two walls (p = 0.866 and 1.0, respectively), when cells were injected only in the left ventricular free wall. BMMC transplantation in nonischemic dilated cardiomyopathy can improve ventricular function by an overall effect, even in areas that are not directly injected. This finding favors the existence of a diffuse mechanism of action, rather than a local effect, and should be reminded when the pathophysiology of stem cells is considered.

(1)(2)(3) . Foi descrita por William Harvey como "movimento atrial ondulante", caracterizando-se pelo ritmo irregular e anárquico do coração, há mais de 300 anos (4) . Sua prevalência aumenta dramaticamente com a idade, resultando, nos pacientes idosos, em substancial morbidade (5) . Na FA ocorre um aumento de três a cinco vezes no risco de acidente vascular cerebral isquêmico, sendo esse maior quando existe concomitância de valvopatia (6) . A importância no manejo de FA na população geral reside no fato de que os índices de mortalidade dobram em relação aos controles sem essa patologia (7) . Acidentes vasculares cerebrais (AVC) são grandes responsáveis pelas taxas de mortalidade e morbidade em pacientes acometidos por FA. 130Evidências recentes (8,9) atribuem como focos desencadeantes de fibrilação atrial paroxística (trigger points) zonas remanescentes de músculo cardía-co, provenientes do seio venoso durante o período de desenvolvimento embrionário, no interior das veias pulmonares, podendo a FA originar-se de uma ou de múltiplas zonas dessa região. Esse fato foi descrito inicialmente por BRUNTON & FAYER (10) , que observaram pulsações em veias pulmonares de coelhos cujo coração havia sido previamente mantido em assistolia. Em um estudo realizado na China (11) , o uso de mapeamento com múltiplos eletrodos durante estudos eletrofisiológicos, mostrou que 30% das FA originavam-se dos óstios das veias pulmonares e o restante de zonas no interior dos vasos pulmonares. Em 1987, COX et al. (12) desenvolveram um procedimento cirúrgico para o tratamento definitivo da FA, conhecido como técnica do Labirinto (Maze). Esse procedimento visa interromper os macrocircuitos reentrantes arritmogênicos e, através de um verdadeiro labirinto de incisões, conduzir o estímulo gerado no nó sinusal até o nó atrioventricular. SUEDA et al. (13) descreveram uma modificação da técnica da cirurgia do Labirinto em associação à correção valvar com incisões cirúrgicas restritas à parte posterior do átrio esquerdo isolando eletricamente as veias pulmonares e realizando crioablação no istmo entre a veia cava inferior e a valva tricús-pide para impedir circuitos reentrantes de flutter atrial. A relativa complexidade técnica do procedimento do Labirinto, associada às evidências de serem as veias pulmonares a origem da maioria das FA, nos levam a testar a hipótese de que apenas o isolamento cirúrgico dos óstios das veias pulmonares (IVP) seja eficaz para o controle da FA crônica secundária à lesão valvar.Neste estudo são analisados os resultados preliminares dos pacientes submetidos ao IVP associado à correção valvar mitral, comparando-os com os resultados prévios dos autores com o procedimento do Labirinto modificado (14) em pacientes com cardiopatia de etiologia reumática ou degenerativa. CASUÍSTICA E MÉTODOSNo período de julho de 1999 a janeiro de 2000, 7 pacientes foram submetidos ao IVP associado à correção valvar mitral. Esses foram comparados à série de 57 pacientes submetidos ao procedimento de Cox 3, cujos dados já foram previamente ...