Ricardo Benfatti - Academia.edu (original) (raw)
Papers by Ricardo Benfatti
Indication of endovascular treatment of type B aortic dissection -Literature review Revista Brasi... more Indication of endovascular treatment of type B aortic dissection -Literature review Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery, vol. 29, núm. 3, julio-septiembre, 2014, pp. 396-401 Sociedade Brasileira de Cirurgia Cardiovascular São José do Rio Preto, Brasil REVIEW ARTICLE Abstract Aortic dissection is a cardiovascular event of high mortality if not early diagnosed and properly treated. In Stanford type A aortic dissection, there is the involvement of the ascending aorta, whereas in type B the ascending aorta is not affected. The treatment of type A aortic dissection is mainly surgical. The hospital mortality of type B aortic dissection surgical treatment is approximately 20%, while medical therapy is 10%. However, half the patients who are discharged from hospital after medical treatment, progress to aortic complications in the following years, and the mortality in three to five years may reach 25-50%. In addition, the surgical treatme...
The Brazilian Journal of Cardiovascular Surgery (BJCVS) is grateful for the reviewers, listed bel... more The Brazilian Journal of Cardiovascular Surgery (BJCVS) is grateful for the reviewers, listed below, which collaborated in this edition. Without their work would be impossible to keep the high scientific standard of our journal.
Revista Brasileira de Cirurgia Cardiovascular, 2015
Acta Cirurgica Brasileira, 2010
PURPOSE: The development of an experimental model of myocardiopathy induced by Doxorubicin in rat... more PURPOSE: The development of an experimental model of myocardiopathy induced by Doxorubicin in rats. METHODS: 16 wistar male rats were randomized in two groups: Group I (placebo) and Group II (Doxorubicin - 5mg/kg). After six months, the animals were subjected to cardiotomy and their hearts were weighted and submitted to transversal cuts, from which fragments for a macro and micro study were obtained. These fragments were studied considering their external and internal diameters and the thickness of the left ventricle (LV). The histological pieces were analyzed for the presence of fibrosis, cytoplasmic vacuolization, necrosis and size of nucleus variation. Data obtained was submitted to statistical analysis with Student's t test. RESULTS: The hearts of the animals in Group II increased 41% in relation to their weight; 33% in the internal diameter and 14% in the external diameter of the LV cavity; and 24% in the thickness of the wall. Fibrosis of the myocardial tissue was observed...
The treatment for closure of persistent ductus arteriosus (PDA) in adults is still controversial.... more The treatment for closure of persistent ductus arteriosus (PDA) in adults is still controversial. The endovascular approach has been shown as an effective alternative to the surgical treatment. We report a case of a 45 year-old patient submitted to endovascular approach for PDA closure.
Revista brasileira de cirurgia cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
The treatment for closure of persistent ductus arteriosus (PDA) in adults still controversial. Th... more The treatment for closure of persistent ductus arteriosus (PDA) in adults still controversial. The endovascular approach has been shown as an effective alternative to surgical treatment. We report a case of 45 years old patient submitted to endovascular approach for PDA closure.
Revista brasileira de cirurgia cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
The epsilon aminocaproic acid is an antifibrinolytic used in cardiovascular surgery to inhibit th... more The epsilon aminocaproic acid is an antifibrinolytic used in cardiovascular surgery to inhibit the fibrinolysis and to reduce the bleeding after CPB. [corrected] To analyze the influence of the using of epsilon aminocaproic acid in the bleeding and in red-cell transfusion requirement in the first twenty-four hours postoperative of mitral valve surgery. Prospective studying, forty-two patients, randomized and divided in two equal groups: group #1 control and group #2--epsilon aminocaproic acid. In Group II were infused five grams of EACA in the induction of anesthesia, after full heparinization, CPB perfusate after reversal of heparin and one hour after the surgery, totaling 25 grams. In group I, saline solution was infused only in those moments. Group #1 showed average bleeding volume of 633.57 ± 305,7 ml, and Group #2, an average of 308.81 ± 210.1 ml, with significant statistic difference (P = 0.0003). Average volume of red-cell transfusion requirement in Groups 1 and 2 was, respec...
Revista Brasileira de Cirurgia Cardiovascular, 2010
Correção endovascular de persistência do conduto arterioso em paciente adulto Resumo O tratamento... more Correção endovascular de persistência do conduto arterioso em paciente adulto Resumo O tratamento da Persistência do Canal Arterial (PCA), em adultos, ainda é controverso. A utilização de próteses auto-expansíveis tem-se mostrado como uma alternativa eficaz ao tratamento cirúrgico. Apresentamos um caso de uma paciente de 45 anos submetida ao tratamento endovascular com o uso de stent auto-expansível. Descritores: Canal arterial. Cardiopatias congênitas. Permeabilidade do canal arterial.
Revista Brasileira de Cirurgia Cardiovascular, 2011
The blood hypercoagulability proportionate in pregnancy significantly increases the incidence of ... more The blood hypercoagulability proportionate in pregnancy significantly increases the incidence of thrombosis of mechanical valves. Acquired supravalvular aortic stenosis is extremely rare. We report the case of an immediate postpartum patient with aortic mechanical prostheses and stenosis supravalvular aortic acquired, who underwent emergency heart surgery, with severe hemodynamic instability, using adapted surgical technique for correction of supravalvular stenosis with satisfactory clinical and echocardiography results.
Revista Brasileira de Cirurgia Cardiovascular, 2011
Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprisi... more Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprising benign histological characteristics in 75% of these cases. Myxomas account for approximately 50% of these neoplasms. As regards location, 75-80% of myxomas are in the left atrium, 18% in the right atrium, and more rarely in the ventricles. We report a case of a patient in functional class (FC) IV New York Heart Association (NYHA) and postoperative histological diagnosis of multilobular myxoma originating in the posterior left atrial wall. Clinical evaluation 3 months after surgery suggested NYHA functional class I and echocardiographic absence of intracardiac masses.
Revista Brasileira de Cirurgia Cardiovascular, 2013
Woman, 84 years-old, with Stanford type A thoracic aortic dissection committing aortic arch and d... more Woman, 84 years-old, with Stanford type A thoracic aortic dissection committing aortic arch and descending aorta. Proposed and accepted endovascular treatment according to the severity of the clinical picture. Common femoral artery dissection bilaterally was done. Aortography confirmed the exclusion of the false lumen and patency of the coronary ostia.
Revista Brasileira de Cirurgia Cardiovascular, 2014
Indication of endovascular treatment of type B aortic dissection-Literature review Indicação do t... more Indication of endovascular treatment of type B aortic dissection-Literature review Indicação do tratamento endovascular na dissecção de aorta do tipo B-Revisão da literatura
Revista Brasileira de Cirurgia Cardiovascular, 2007
Risk factors for the development of acute renal failure following on-pump coronary artery bypass ... more Risk factors for the development of acute renal failure following on-pump coronary artery bypass grafting Fatores de risco no desenvolvimento de insuficiência renal aguda após cirurgia de revascularização miocárdica com CEC Resumo Objetivos: Avaliar a incidência, a mortalidade e os fatores de risco no desenvolvimento de insuficiência renal aguda (IRA) após cirurgia de revascularização miocárdica com o emprego de circulação extracorpórea (CEC), no serviço de
Revista Brasileira de Cirurgia Cardiovascular, 2013
Initial and pioneer experience of transcatheter aortic valve implantation (Inovare) through femor... more Initial and pioneer experience of transcatheter aortic valve implantation (Inovare) through femoral or iliac artery Experiência inicial e pioneira do implante de valva aórtica transcateter (Inovare) por via femoral ou ilíaca
Revista Brasileira de Cirurgia Cardiovascular, 2012
We present a patient with severe aortic valvular bioprosthesis dysfunction implanted for 11 years... more We present a patient with severe aortic valvular bioprosthesis dysfunction implanted for 11 years, presenting with acute pulmonary edema due to severe valvular insufficiency with severe systolic dysfunction (EF <30%) and comorbid conditions that amounted operative risk (STS score > 10). We carried out the transcatheter aortic valve implantation (Inovare®-Braile Biomedica), which was implemented successfully by transfemoral access and good patient outcomes.
Revista Brasileira de Cirurgia Cardiovascular, 2013
Resumo Fundamentos: O tratamento cirúrgico da insuficiência cardíaca padrão-ouro é o transplante ... more Resumo Fundamentos: O tratamento cirúrgico da insuficiência cardíaca padrão-ouro é o transplante cardíaco, porém, em decorrência das dificuldades desse tratamento, outras propostas cirúrgicas têm sido relatadas, entre elas o implante de ressincronizador cardíaco. Objetivo: Analisar a função ventricular esquerda, por meio da ecocardiografia, de pacientes portadores de insuficiência cardíaca avançada com dissincronia interventricular submetidos a implante de ressincronizador cardíaco. Métodos: Entre junho de 2006 a junho de 2012, foram avaliados 24 pacientes com idade média de 61,5 ± 11 anos, portadores de insuficiência cardíaca congestiva avançada em classe funcional III e IV (NYHA), dissincronia interventricular e tratamento medicamentoso otimizado. Esses pacientes foram submetidos ao implante de ressincronizador cardíaco e avaliados ecocardiograficamente no pós-operatório de seis meses. Resultados: Houve melhora significativa dos parâmetros ecocardiográficos analisados. A média dos diâmetros diastólicos ventriculares esquerdos reduziu de 69,
Revista Brasileira de Cirurgia Cardiovascular, 2008
Surgical treatment of chronic atrial fibrillation with conventional electrocautery in mitral valv... more Surgical treatment of chronic atrial fibrillation with conventional electrocautery in mitral valve surgery Tratamento cirúrgico da fibrilação atrial crônica com eletrocautério convencional em cirurgia valvar mitral Resumo Objetivo: Avaliar os resultados do tratamento cirúrgico da fibrilação atrial por ablação da parede posterior atrial esquerda utilizando o eletrocautério, em cirurgia valvar mitral. Métodos: De maio de 2004 a dezembro de 2006, 23 pacientes foram submetidos a correção cirúrgica de valvopatia mitral e ao tratamento da fibrilação atrial utilizando o eletrocautério convencional para a realização de linhas de ablação no endocárdio atrial esquerdo. A idade média dos pacientes era de 59 anos, sendo 60,8% do sexo feminino. A média do diâmetro atrial esquerdo era de 50,3 ± 5,09 mm e a fração de ejeção do ventrículo esquerdo de 53,6 ± 11,03%. Resultados: O tempo médio de circulação extracorpórea foi de 52,5 ± 13,3 min; pinçamento aórtico, 35,6 ± 12,9 min; ablação do endocárdio atrial, 3,05 ± 0,16 min. Todos os pacientes estavam livres de fibrilação atrial após o procedimento; na alta hospitalar, 69,5%; no 6º mês, 91,3%; no 12º mês, 76,4%; no 18º e 24° meses, 68,4%. No 12º mês, a média do diâmetro atrial esquerdo era de 42,1 ± 3,5 mm; a fração de ejeção do ventrículo esquerdo era de 59,2 ± 3,48%; e a contração atrial esquerda estava presente em 68,8% de todos os pacientes. Conclusão: O tratamento cirúrgico da fibrilação atrial com eletrocautério, em cirurgia valvar mitral, foi capaz de determinar a reversão dessa arritmia a um número significativo de pacientes durante um seguimento clínico de curto e médio prazo, sem mortalidade e com baixa morbidade. Descritores: Fibrilação atrial/cirurgia. Arritmia/cirurgia. Valva mitral/cirurgia. Doenças das valvas cardíacas/cirurgia. Procedimentos cirúrgicos cardíacos. Eletrofisiologia. Diatermia.
Revista Brasileira de Cirurgia Cardiovascular, 2008
Mitral valve replacement with crossed papillopexy and annular constriction in heart failure patie... more Mitral valve replacement with crossed papillopexy and annular constriction in heart failure patients Substituição valvar mitral com papilopexia cruzada e constrição anular em pacientes com insuficiência cardíaca Resumo Objetivo: Analisar os resultados em curto e médio prazo de pacientes portadores de insuficiência cardíaca e insuficiência mitral moderada/grave submetidos a substituição valvar mitral com a técnica da papilopexia cruzada e constrição anular. Métodos: Treze pacientes em classe funcional III ou IV (NYHA), idade média de 54,1 anos, etiologia idiopática, foram submetidos a substituição valvar mitral com constrição do anel e papilopexia cruzada. Foram analisados os parâmetros ecocardiográficos, classe funcional e curva atuarial de sobrevivência. Resultados: Não houve mortes no período trans e pósoperatório imediato. A média dos diâmetros diastólicos e sistólicos ventricular esquerdo reduziu de 71 ± 8,6 mm para 65,3 ± 8,6 mm (p=0,049) e de 59,1 ± 8,5 mm para 50,4 ± 11,1 mm (p=0,002), respectivamente. Os diâmetros atriais variaram de 49,4 ± 6,4 mm para 44 ± 5,9 mm (p=0,017); o percentual de encurtamento sistólico do ventrículo esquerdo foi de 17 ± 4% para 24 ± 8,3% (p=0,014), a fração de ejeção variou de 34 ± 9% para 45 ± 14% (p=0,008), todos estatisticamente significativos. Onze (84,6%) pacientes se encontram em classe funcional I e II. A sobrevivência foi de 100%, 82,6%, 71,6%, respectivamente para 1, 6 e 12 meses após a cirurgia de seguimento, mantendo-se 71,6% em período superior a 36 meses. Conclusão: Os resultados obtidos, em pacientes com insuficiência cardíaca e insuficiência mitral moderada/grave submetidos a substituição valvar mitral com papilopexia cruzada e constrição anular, apresentaram evidências de remodelamento cardíaco favorável e significativa recuperação funcional ventricular esquerda. Descritores: Cardiomiopatia dilatada/cirurgia. Insuficiência da valva mitral/cirurgia. Músculos papilares/ cirurgia.
European Journal of Cardio-Thoracic Surgery, 2006
Objective: To evaluate the results of the surgical treatment of atrial fibrillation for ablation ... more Objective: To evaluate the results of the surgical treatment of atrial fibrillation for ablation of the posterior wall of the left atrium using electrocautery in mitral valve surgery. Methods: From May 2004 to December 2006, 23 patients underwent surgical correction of mitral valve disease and treatment of atrial fibrillation using the conventional electrocautery for the accomplishment of lines of endocardial ablation in the left atrium. The mean age of the patients was 59 years, and 60.8% were female. The left atrium mean diameter was 50.3 ± 5.09 mm and the left ventricular ejection fraction was 53.6 ± 11.03%. Results: The mean time of extracorporeal circulation was 52.5 ± 13.3 min; aortic clamping, 35.6 ± 12.9 min; atrial ablation, 3.05 ± 0.16 min. All the patients were free of atrial fibrillation after the procedure; on hospital discharge, 69.5%; at 6 months, 91.3%; at 12 months, 76.4%; at 18 months, and at 24 months, 68.4%. At 12 months, left atrium mean diameter was 42.1 ± 3.5 mm; left ventricular ejection fraction was 59.2 ± 3.48%; In addition, left atrial contractility was present in 68.8% of the patients. Conclusion: The surgical treatment of the atrial fibrillation with electrocautery in mitral valve surgery was capable to determine the reversion of this arrhythmia in a significant number of patients during short-and middleterm clinical follow-up without mortality and fewer complications.
bjcvs.org
Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprisi... more Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprising benign histological characteristics in 75% of these cases. Myxomas account for approximately 50% of these neoplasms. As regards location, 75-80% of myxomas are in the left atrium, 18% in the right atrium, and more rarely in the ventricles. We report a case of a patient in functional class (FC) IV New York Heart Association (NYHA) and postoperative histological diagnosis of multilobular myxoma originating in the posterior left atrial wall. Clinical evaluation 3 months after surgery suggested NYHA functional class I and echocardiographic absence of intracardiac masses.
Indication of endovascular treatment of type B aortic dissection -Literature review Revista Brasi... more Indication of endovascular treatment of type B aortic dissection -Literature review Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery, vol. 29, núm. 3, julio-septiembre, 2014, pp. 396-401 Sociedade Brasileira de Cirurgia Cardiovascular São José do Rio Preto, Brasil REVIEW ARTICLE Abstract Aortic dissection is a cardiovascular event of high mortality if not early diagnosed and properly treated. In Stanford type A aortic dissection, there is the involvement of the ascending aorta, whereas in type B the ascending aorta is not affected. The treatment of type A aortic dissection is mainly surgical. The hospital mortality of type B aortic dissection surgical treatment is approximately 20%, while medical therapy is 10%. However, half the patients who are discharged from hospital after medical treatment, progress to aortic complications in the following years, and the mortality in three to five years may reach 25-50%. In addition, the surgical treatme...
The Brazilian Journal of Cardiovascular Surgery (BJCVS) is grateful for the reviewers, listed bel... more The Brazilian Journal of Cardiovascular Surgery (BJCVS) is grateful for the reviewers, listed below, which collaborated in this edition. Without their work would be impossible to keep the high scientific standard of our journal.
Revista Brasileira de Cirurgia Cardiovascular, 2015
Acta Cirurgica Brasileira, 2010
PURPOSE: The development of an experimental model of myocardiopathy induced by Doxorubicin in rat... more PURPOSE: The development of an experimental model of myocardiopathy induced by Doxorubicin in rats. METHODS: 16 wistar male rats were randomized in two groups: Group I (placebo) and Group II (Doxorubicin - 5mg/kg). After six months, the animals were subjected to cardiotomy and their hearts were weighted and submitted to transversal cuts, from which fragments for a macro and micro study were obtained. These fragments were studied considering their external and internal diameters and the thickness of the left ventricle (LV). The histological pieces were analyzed for the presence of fibrosis, cytoplasmic vacuolization, necrosis and size of nucleus variation. Data obtained was submitted to statistical analysis with Student's t test. RESULTS: The hearts of the animals in Group II increased 41% in relation to their weight; 33% in the internal diameter and 14% in the external diameter of the LV cavity; and 24% in the thickness of the wall. Fibrosis of the myocardial tissue was observed...
The treatment for closure of persistent ductus arteriosus (PDA) in adults is still controversial.... more The treatment for closure of persistent ductus arteriosus (PDA) in adults is still controversial. The endovascular approach has been shown as an effective alternative to the surgical treatment. We report a case of a 45 year-old patient submitted to endovascular approach for PDA closure.
Revista brasileira de cirurgia cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
The treatment for closure of persistent ductus arteriosus (PDA) in adults still controversial. Th... more The treatment for closure of persistent ductus arteriosus (PDA) in adults still controversial. The endovascular approach has been shown as an effective alternative to surgical treatment. We report a case of 45 years old patient submitted to endovascular approach for PDA closure.
Revista brasileira de cirurgia cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
The epsilon aminocaproic acid is an antifibrinolytic used in cardiovascular surgery to inhibit th... more The epsilon aminocaproic acid is an antifibrinolytic used in cardiovascular surgery to inhibit the fibrinolysis and to reduce the bleeding after CPB. [corrected] To analyze the influence of the using of epsilon aminocaproic acid in the bleeding and in red-cell transfusion requirement in the first twenty-four hours postoperative of mitral valve surgery. Prospective studying, forty-two patients, randomized and divided in two equal groups: group #1 control and group #2--epsilon aminocaproic acid. In Group II were infused five grams of EACA in the induction of anesthesia, after full heparinization, CPB perfusate after reversal of heparin and one hour after the surgery, totaling 25 grams. In group I, saline solution was infused only in those moments. Group #1 showed average bleeding volume of 633.57 ± 305,7 ml, and Group #2, an average of 308.81 ± 210.1 ml, with significant statistic difference (P = 0.0003). Average volume of red-cell transfusion requirement in Groups 1 and 2 was, respec...
Revista Brasileira de Cirurgia Cardiovascular, 2010
Correção endovascular de persistência do conduto arterioso em paciente adulto Resumo O tratamento... more Correção endovascular de persistência do conduto arterioso em paciente adulto Resumo O tratamento da Persistência do Canal Arterial (PCA), em adultos, ainda é controverso. A utilização de próteses auto-expansíveis tem-se mostrado como uma alternativa eficaz ao tratamento cirúrgico. Apresentamos um caso de uma paciente de 45 anos submetida ao tratamento endovascular com o uso de stent auto-expansível. Descritores: Canal arterial. Cardiopatias congênitas. Permeabilidade do canal arterial.
Revista Brasileira de Cirurgia Cardiovascular, 2011
The blood hypercoagulability proportionate in pregnancy significantly increases the incidence of ... more The blood hypercoagulability proportionate in pregnancy significantly increases the incidence of thrombosis of mechanical valves. Acquired supravalvular aortic stenosis is extremely rare. We report the case of an immediate postpartum patient with aortic mechanical prostheses and stenosis supravalvular aortic acquired, who underwent emergency heart surgery, with severe hemodynamic instability, using adapted surgical technique for correction of supravalvular stenosis with satisfactory clinical and echocardiography results.
Revista Brasileira de Cirurgia Cardiovascular, 2011
Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprisi... more Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprising benign histological characteristics in 75% of these cases. Myxomas account for approximately 50% of these neoplasms. As regards location, 75-80% of myxomas are in the left atrium, 18% in the right atrium, and more rarely in the ventricles. We report a case of a patient in functional class (FC) IV New York Heart Association (NYHA) and postoperative histological diagnosis of multilobular myxoma originating in the posterior left atrial wall. Clinical evaluation 3 months after surgery suggested NYHA functional class I and echocardiographic absence of intracardiac masses.
Revista Brasileira de Cirurgia Cardiovascular, 2013
Woman, 84 years-old, with Stanford type A thoracic aortic dissection committing aortic arch and d... more Woman, 84 years-old, with Stanford type A thoracic aortic dissection committing aortic arch and descending aorta. Proposed and accepted endovascular treatment according to the severity of the clinical picture. Common femoral artery dissection bilaterally was done. Aortography confirmed the exclusion of the false lumen and patency of the coronary ostia.
Revista Brasileira de Cirurgia Cardiovascular, 2014
Indication of endovascular treatment of type B aortic dissection-Literature review Indicação do t... more Indication of endovascular treatment of type B aortic dissection-Literature review Indicação do tratamento endovascular na dissecção de aorta do tipo B-Revisão da literatura
Revista Brasileira de Cirurgia Cardiovascular, 2007
Risk factors for the development of acute renal failure following on-pump coronary artery bypass ... more Risk factors for the development of acute renal failure following on-pump coronary artery bypass grafting Fatores de risco no desenvolvimento de insuficiência renal aguda após cirurgia de revascularização miocárdica com CEC Resumo Objetivos: Avaliar a incidência, a mortalidade e os fatores de risco no desenvolvimento de insuficiência renal aguda (IRA) após cirurgia de revascularização miocárdica com o emprego de circulação extracorpórea (CEC), no serviço de
Revista Brasileira de Cirurgia Cardiovascular, 2013
Initial and pioneer experience of transcatheter aortic valve implantation (Inovare) through femor... more Initial and pioneer experience of transcatheter aortic valve implantation (Inovare) through femoral or iliac artery Experiência inicial e pioneira do implante de valva aórtica transcateter (Inovare) por via femoral ou ilíaca
Revista Brasileira de Cirurgia Cardiovascular, 2012
We present a patient with severe aortic valvular bioprosthesis dysfunction implanted for 11 years... more We present a patient with severe aortic valvular bioprosthesis dysfunction implanted for 11 years, presenting with acute pulmonary edema due to severe valvular insufficiency with severe systolic dysfunction (EF <30%) and comorbid conditions that amounted operative risk (STS score > 10). We carried out the transcatheter aortic valve implantation (Inovare®-Braile Biomedica), which was implemented successfully by transfemoral access and good patient outcomes.
Revista Brasileira de Cirurgia Cardiovascular, 2013
Resumo Fundamentos: O tratamento cirúrgico da insuficiência cardíaca padrão-ouro é o transplante ... more Resumo Fundamentos: O tratamento cirúrgico da insuficiência cardíaca padrão-ouro é o transplante cardíaco, porém, em decorrência das dificuldades desse tratamento, outras propostas cirúrgicas têm sido relatadas, entre elas o implante de ressincronizador cardíaco. Objetivo: Analisar a função ventricular esquerda, por meio da ecocardiografia, de pacientes portadores de insuficiência cardíaca avançada com dissincronia interventricular submetidos a implante de ressincronizador cardíaco. Métodos: Entre junho de 2006 a junho de 2012, foram avaliados 24 pacientes com idade média de 61,5 ± 11 anos, portadores de insuficiência cardíaca congestiva avançada em classe funcional III e IV (NYHA), dissincronia interventricular e tratamento medicamentoso otimizado. Esses pacientes foram submetidos ao implante de ressincronizador cardíaco e avaliados ecocardiograficamente no pós-operatório de seis meses. Resultados: Houve melhora significativa dos parâmetros ecocardiográficos analisados. A média dos diâmetros diastólicos ventriculares esquerdos reduziu de 69,
Revista Brasileira de Cirurgia Cardiovascular, 2008
Surgical treatment of chronic atrial fibrillation with conventional electrocautery in mitral valv... more Surgical treatment of chronic atrial fibrillation with conventional electrocautery in mitral valve surgery Tratamento cirúrgico da fibrilação atrial crônica com eletrocautério convencional em cirurgia valvar mitral Resumo Objetivo: Avaliar os resultados do tratamento cirúrgico da fibrilação atrial por ablação da parede posterior atrial esquerda utilizando o eletrocautério, em cirurgia valvar mitral. Métodos: De maio de 2004 a dezembro de 2006, 23 pacientes foram submetidos a correção cirúrgica de valvopatia mitral e ao tratamento da fibrilação atrial utilizando o eletrocautério convencional para a realização de linhas de ablação no endocárdio atrial esquerdo. A idade média dos pacientes era de 59 anos, sendo 60,8% do sexo feminino. A média do diâmetro atrial esquerdo era de 50,3 ± 5,09 mm e a fração de ejeção do ventrículo esquerdo de 53,6 ± 11,03%. Resultados: O tempo médio de circulação extracorpórea foi de 52,5 ± 13,3 min; pinçamento aórtico, 35,6 ± 12,9 min; ablação do endocárdio atrial, 3,05 ± 0,16 min. Todos os pacientes estavam livres de fibrilação atrial após o procedimento; na alta hospitalar, 69,5%; no 6º mês, 91,3%; no 12º mês, 76,4%; no 18º e 24° meses, 68,4%. No 12º mês, a média do diâmetro atrial esquerdo era de 42,1 ± 3,5 mm; a fração de ejeção do ventrículo esquerdo era de 59,2 ± 3,48%; e a contração atrial esquerda estava presente em 68,8% de todos os pacientes. Conclusão: O tratamento cirúrgico da fibrilação atrial com eletrocautério, em cirurgia valvar mitral, foi capaz de determinar a reversão dessa arritmia a um número significativo de pacientes durante um seguimento clínico de curto e médio prazo, sem mortalidade e com baixa morbidade. Descritores: Fibrilação atrial/cirurgia. Arritmia/cirurgia. Valva mitral/cirurgia. Doenças das valvas cardíacas/cirurgia. Procedimentos cirúrgicos cardíacos. Eletrofisiologia. Diatermia.
Revista Brasileira de Cirurgia Cardiovascular, 2008
Mitral valve replacement with crossed papillopexy and annular constriction in heart failure patie... more Mitral valve replacement with crossed papillopexy and annular constriction in heart failure patients Substituição valvar mitral com papilopexia cruzada e constrição anular em pacientes com insuficiência cardíaca Resumo Objetivo: Analisar os resultados em curto e médio prazo de pacientes portadores de insuficiência cardíaca e insuficiência mitral moderada/grave submetidos a substituição valvar mitral com a técnica da papilopexia cruzada e constrição anular. Métodos: Treze pacientes em classe funcional III ou IV (NYHA), idade média de 54,1 anos, etiologia idiopática, foram submetidos a substituição valvar mitral com constrição do anel e papilopexia cruzada. Foram analisados os parâmetros ecocardiográficos, classe funcional e curva atuarial de sobrevivência. Resultados: Não houve mortes no período trans e pósoperatório imediato. A média dos diâmetros diastólicos e sistólicos ventricular esquerdo reduziu de 71 ± 8,6 mm para 65,3 ± 8,6 mm (p=0,049) e de 59,1 ± 8,5 mm para 50,4 ± 11,1 mm (p=0,002), respectivamente. Os diâmetros atriais variaram de 49,4 ± 6,4 mm para 44 ± 5,9 mm (p=0,017); o percentual de encurtamento sistólico do ventrículo esquerdo foi de 17 ± 4% para 24 ± 8,3% (p=0,014), a fração de ejeção variou de 34 ± 9% para 45 ± 14% (p=0,008), todos estatisticamente significativos. Onze (84,6%) pacientes se encontram em classe funcional I e II. A sobrevivência foi de 100%, 82,6%, 71,6%, respectivamente para 1, 6 e 12 meses após a cirurgia de seguimento, mantendo-se 71,6% em período superior a 36 meses. Conclusão: Os resultados obtidos, em pacientes com insuficiência cardíaca e insuficiência mitral moderada/grave submetidos a substituição valvar mitral com papilopexia cruzada e constrição anular, apresentaram evidências de remodelamento cardíaco favorável e significativa recuperação funcional ventricular esquerda. Descritores: Cardiomiopatia dilatada/cirurgia. Insuficiência da valva mitral/cirurgia. Músculos papilares/ cirurgia.
European Journal of Cardio-Thoracic Surgery, 2006
Objective: To evaluate the results of the surgical treatment of atrial fibrillation for ablation ... more Objective: To evaluate the results of the surgical treatment of atrial fibrillation for ablation of the posterior wall of the left atrium using electrocautery in mitral valve surgery. Methods: From May 2004 to December 2006, 23 patients underwent surgical correction of mitral valve disease and treatment of atrial fibrillation using the conventional electrocautery for the accomplishment of lines of endocardial ablation in the left atrium. The mean age of the patients was 59 years, and 60.8% were female. The left atrium mean diameter was 50.3 ± 5.09 mm and the left ventricular ejection fraction was 53.6 ± 11.03%. Results: The mean time of extracorporeal circulation was 52.5 ± 13.3 min; aortic clamping, 35.6 ± 12.9 min; atrial ablation, 3.05 ± 0.16 min. All the patients were free of atrial fibrillation after the procedure; on hospital discharge, 69.5%; at 6 months, 91.3%; at 12 months, 76.4%; at 18 months, and at 24 months, 68.4%. At 12 months, left atrium mean diameter was 42.1 ± 3.5 mm; left ventricular ejection fraction was 59.2 ± 3.48%; In addition, left atrial contractility was present in 68.8% of the patients. Conclusion: The surgical treatment of the atrial fibrillation with electrocautery in mitral valve surgery was capable to determine the reversion of this arrhythmia in a significant number of patients during short-and middleterm clinical follow-up without mortality and fewer complications.
bjcvs.org
Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprisi... more Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprising benign histological characteristics in 75% of these cases. Myxomas account for approximately 50% of these neoplasms. As regards location, 75-80% of myxomas are in the left atrium, 18% in the right atrium, and more rarely in the ventricles. We report a case of a patient in functional class (FC) IV New York Heart Association (NYHA) and postoperative histological diagnosis of multilobular myxoma originating in the posterior left atrial wall. Clinical evaluation 3 months after surgery suggested NYHA functional class I and echocardiographic absence of intracardiac masses.