luiz rivetti - Academia.edu (original) (raw)
Papers by luiz rivetti
Revista Brasileira De Cirurgia Cardiovascular, Mar 1, 2014
Introduction: Chagas disease is a major cause of cardiomyopathy and sudden death in our country. ... more Introduction: Chagas disease is a major cause of cardiomyopathy and sudden death in our country. It has a high mortality when their patients develop New York Heart Association (NYHA) class IV. Objective: The objective of this study is to analyze the clinical outcome of patients with Chagas' cardiomyopathy with congestive heart failure with optimized pharmacological therapy, undergoing cardiac resynchronization therapy. Methods: Between January 2004 and February 2009, 72 patients with Chagas' cardiomyopathy in NYHA class III and IV underwent cardiac resynchronization therapy and were monitored to assess their clinical evolution. We used the t test or the Wilcoxon test to compare the same variable in two different times. A P value < 0.05 was established as statistically significant. Results: The average clinical follow-up was 46.6 months (range 4-79 months). At the end of the evaluation, 87.4% of patients were in NYHA class I or II (P<0.001). There was response to therapy in 65.3% of patients (P<0.001), with an overall mortality of 34.7%. Conclusion: In patients with chronic Chagas cardiomyopathy undergoing cardiac resynchronization therapy, we found the following statistically significant changes: improvement in NYHA class and increase of left ventricle ejection fraction, a decrease of the systolic final diameter and systolic final left ventricle volume and improvement of patient survival.
Acute aortic syndrome (AAS) is an emergency condition that includes acute aortic dissection, intr... more Acute aortic syndrome (AAS) is an emergency condition that includes acute aortic dissection, intramural hematoma, aortic ulcer, and iatrogenic and traumatic aortic dissection. Initial management includes pain control (with powerful analgesics if necessary), heart rate and inotropic control with the use of beta-blockers, and strictly blood pressure control. The Stanford classification takes into account the extent of dissection to the ascending aorta, which might be present (Stanford A) or not (Stanford B). Current guidelines recommend surgical treatment for all patients with type A ASS. We report a case of a 77-year-old female who was admitted to the emergency department presenting chest pain for 15 days. Acute coronary syndrome was initially ruled out, and during diagnostic work-up, computed tomography showed an aortic arch aneurysm and important tortuosity of descending aorta. During surgery, an ascending aortic bypass was performed with a bifurcated graft anastomosis to the innominate artery and left carotid artery. The ascending aorta was partially clamped, and the proximal end-to-lateral aortic graft anastomosis was performed, followed by an end-to-lateral anastomosis of the bifurcated grafts to the innominate artery and the left main carotid artery. Twenty days after the surgery, endovascular stent implantation beginning at the ascending aorta until the descending thoracic aorta was performed. The postoperative period was uneventful, and the patient was discharged. It is known that surgical mortality of patients with aortic dissection is very high, with studies reporting rates of up to 30%. The chimney technique in arch aneurysms remains untested and should not be used as an acceptable treatment other than for salvage. There are branched prostheses for the aortic arch in the development and going through tests, and although the results are still not satisfactory, it is possible that this technique overcomes the chimney technique.
Não houve suporte financeiro.
Revista Relato de Casos do CBC, Sep 1, 2019
Arquivos Brasileiros De Cardiologia, Jul 1, 2010
Background: The effectiveness and safety of drug-eluting stents (DES) have still been questioned.... more Background: The effectiveness and safety of drug-eluting stents (DES) have still been questioned. Objective: The objective of this study was to evaluate the effectiveness and safety of these stents, as well as the incidence of target lesion revascularization (TLR), in addition to identifying possible variables influencing the need for TLR. Methods: A total of 203 patients from Hospital Costantini who were clinically followed up for one to 3 years were selected. Results: The sample characteristics were as follows: 470 lesions; 171 (84.24%) male patients; 54 (26.6%) had diabetes; 131 (64.35%) had hypertension; 127 (62.56%), dyslipidemia; 40 (19.70%) were smokers; and 79 (38.92%) had a family history of coronary artery disease. Also: 49 (24.14%) patients presented with stable angina; 58 (28.57%), unstable angina; and 6 (2.96%), myocardial infarction. Eighty five (41.87%) patients were asymptomatic, and 146 (71.92%), had multivessel disease. As for the characteristics of the lesions, 77.45% were B2/C (AHA/ACC). Taxus was implanted in 73.62% of the patients. Stents with diameter > 2.5 mm were used in 381 (81.96%) patients. The stent length was < 30 mm in 67.87% of the lesions, with a mean of 2.3 stents per patient. After follow-up, 19 patients (9.3%) underwent TLR. Four patients died (1.97%), two of them of MI (0.98%), one of stroke (0.49%), and one of abdominal aneurysm (0.49%). Also, one patient died of late thrombosis (0.49%), and one of reinfarction (0.49%). In the statistical analysis carried out, only the bifurcation lesions variable reached values close to the statistical significance level, with p < 0.06. Conclusion: In conclusion, drug-eluting stents have good effectiveness and safety profiles; the incidence of TLR was 9.3%, and we did not identify a variable correlated with the need for TLR. (Arq Bras Cardiol. 2010; [online]. ahead print, PP.0-0) Key words: Drug-eluting stents/utilization; effectiveness; safety/economics; diagnostic services; Curitiba (PR); Brazil. coronary angioplasty (PTCA). Palmaz et al 3 and Sigwart et al 4 were the first to use the percutaneous treatment by means of a solid structure-a coronary endoprosthesis, the stent-which kept the dilated vessel lumen open. This was a major landmark in interventional cardiology, with the purpose of combating restenosis. In 1995, the idea emerged of using drugs capable of preventing the restenotic process using the stent itself as the drug-delivery vehicle 5. Polymers were used as the drug bond, and thus the successful triad of pharmacological stents was formed: stent, polymer and drug. Revascularization of a previously treated lesion, known as target lesion revascularization, has been associated with the assessment of percutaneous treatment effectiveness, whereas thrombosis is associated with stent safety. Therefore, although this safety has been recently questioned 6 , several meta-analyses were later carried out and demonstrated the effectiveness and safety of drug-eluting stents in comparison to bare metal stents 7-9. In a single-center registry from Ontario, Canada 7 , a decrease in the frequency of repeat revascularization procedures was observed in high-risk patients using drug-eluting stents in comparison to bare metal stents; no differences were observed as regards death and infarction. The objective of the present study was to evaluate the effectiveness and safety of drug-eluting stents in the
Brazilian Journal of Cardiovascular Surgery, 2020
The excerpt from Bertold Brecht's play Die Mutter fits well the character Professor Braile was. A... more The excerpt from Bertold Brecht's play Die Mutter fits well the character Professor Braile was. A singular man, a rare, perhaps a unique combination of a highly skilled heart surgeon, a devoted professor, an adroit scientist, a successful entrepreneur and the linchpin of a loving family. An unchallenged leader in the field of cardiovascular surgery among us and the personification of the example to be followed by the younger generation in our country. His unparalleled and extraordinary achievements in life were made possible because of his energetic, persevering, and tireless personality, where every word out of his mouth resonated his real passion for the profession. Nicknamed "the heart mender" in his biography, his endeavor allowed the country to master the production of a wide range of cardiovascular-related medical supplies, making possible the access to heart surgery through the public healthcare system to every patient in need, regardless of how little they earned or saved. And unquestionably contributing to make the Brazilian heart surgery powerful and recognized worldwide.
DOAJ (DOAJ: Directory of Open Access Journals), Jul 1, 2010
Brazilian Journal of Cardiovascular Surgery, Jun 1, 2011
Fundamento: A efetividade e segurança de stents farmacológicos (SF) ainda têm sido questionadas. ... more Fundamento: A efetividade e segurança de stents farmacológicos (SF) ainda têm sido questionadas. Objetivo: O objetivo deste estudo foi avaliar a efetividade e segurança desses stents, e a incidência da revascularização da lesão tratada (RLT), além de identificar possíveis variáveis que influenciam a necessidade de RLT. Métodos: Selecionaram-se 203 pacientes do Hospital Costantini que tiveram acompanhamento clínico no período de 1 a 3 anos. Resultados: Observou-se o seguinte quadro: 470 lesões; 171 (84,24%) pacientes eram homens; 54 (26,6%), diabéticos; 131 (64,35%), hipertensos; 127 (62,56%), dislipidêmicos; 40 (19,70%), tabagistas; e 79 (38,92%) apresentavam história familiar de coronariopatia. Ainda: 49 (24,14%) pacientes apresentavam angina estável; 58 (28,57%), angina instável; e 6 (2,96%), infarto agudo do miocárdio. Desses pacientes, 85 (41,87%) eram assintomáticos, e 146 (71,92%), multiarteriais. Nas características das lesões, 77,45% foram B2/C (AHA/ACC). Taxus foi implantado em 73,62% dos pacientes. Em 381 (81,96%), constataram-se stents com diâmetro > 2,5 mm. O comprimento de stent era < 30 mm em 67,87% das lesões, com média de 2,3 stents por paciente. Após acompanhamento, 19 pacientes (9,3%) submeteram-se à RLT. Houve morte de 4 pacientes (1,97%), sendo 2 pacientes por IAM (0,98%), um com AVC (0,49%) e um com aneurisma de aorta abdominal (0,49%). Ainda observamos um paciente com trombose tardia (0,49%) e um com reinfarto (0,49%). Na análise estatística realizada, apenas a característica da lesão em bifurcação aproximou-se de significância estatística com p < 0,06. Conclusão: Concluímos que os stents farmacológicos apresentam boa efetividade e segurança, observamos incidência de 9,3% de RLT e não identificamos variável que indicasse a necessidade de RLT. (Arq Bras Cardiol. 2010; [online]. ahead print, PP.0-0) Palavras-chave: Stents farmacológicos/utilização, efetividade, segurança/economia, serviços de diagnóstico, Curitiba (PR), Brasil.
Ischemic heart disease is the main cause of congestive heart failure. Left ventricular aneurysm r... more Ischemic heart disease is the main cause of congestive heart failure. Left ventricular aneurysm resection has been recommended to treat congestive heart failure, fatal arrhythmias, to prevent thromboembolic complications, and angina. We describe our experience with left ventricular aneurysmectomy, preservig the elliptical form, with heart beating continuously. Many patients had indication of cardiodesfibrilator implant prior the surgery and 70% became free from this device after the aneurysmectomy. The method is safe, reprodutible, with low mortality and morbidity. DESCRIPTORS: tachyarrhytmia, left ventricle aneurism, implantable cardiodesfibrilator. Relampa 78024-518
O cardiodesfibrilador implantável (CDI) foi introduzido na prática clínica em 1980 e é considerad... more O cardiodesfibrilador implantável (CDI) foi introduzido na prática clínica em 1980 e é considerado o tratamento-padrão para indivíduos sob risco de desenvolverem disritmias ventriculares fatais. Com o intuito de garantir funcionamento adequado do cardiodesfibrilador, a energia necessária para o término da taquicardia ventricular ou da fibrilação ventricular deve ser determinada durante o implante, sendo esse procedimento chamado de teste do limiar de desfibrilação. Para a realização do teste é necessário que seja feita indução de fibrilação ventricular, para que o aparelho possa identificar o ritmo cardíaco e tratá-lo. O objetivo deste estudo foi verificar a ocorrência de disfunção cognitiva 24 horas após o implante de cardiodesfibrilador. MÉTODO: Foi selecionada uma amostra consecutiva de 30 pacientes com indicação de colocação de cardiodesfibrilador implantável (CDI) e 30 pacientes com indicação de implante de marca-passo (MP). Os pacientes foram avaliados nos seguintes momentos: 24 horas antes da colocação do CDI ou MP com ficha de avaliação pré-anestésica, Mini Exame do Estado Mental (MEEM) e Confusion Assessment Method (CAM). Durante o implante do CDI ou MP foram medidas as variáveis: número de paradas cardíacas e tempo total de parada cardíaca. Vinte e quatro horas após colocação do CDI ou MP, foram avaliadas as variáveis: MEEM e CAM. RESULTADOS: O teste de Fisher comprovou não haver diferença da freqüência de escores alterados do MEEM e do CAM entre os grupos antes e depois dos implantes. O tempo médio de PCR foi 7,06 segundos, com máximos e mínimos de 15,1 e 4,7 segundos. CONCLUSÕES: A indução de parada cardíaca durante o teste do limiar de desfibrilação não levou à disfunção cognitiva 24 horas após o implante de cardiodesfibrilador. Unitermos: CIRURGIA, Cardíaca: parada cardíaca induzida; COM-PLICAÇÕES: isquemia encefálica, manifestações neurológicas, transtornos cognitivos; EQUIPAMENTOS: desfibriladores implantáveis; marca-passo.
Arq Bras Cardiol, Sep 1, 1987
Arq Bras Cardiol, Jun 1, 1989
Revista Brasileira de …, 2001
RESUMO: Introdução/Objetivo: O implante de marcapasso cardíaco definitivo é um procedimento carac... more RESUMO: Introdução/Objetivo: O implante de marcapasso cardíaco definitivo é um procedimento caracterizado por um baixo índice de complicações. No entanto, a infecção, principalmente a de loja de fonte geradora, caracteriza-se como uma das complicações mais comuns, com ...
Arquivos Brasileiros De Cardiologia, 1995
Resumo: Objetivo-Determinar, através da ecocardiografia transeofágica (ETE), fatores de risco par... more Resumo: Objetivo-Determinar, através da ecocardiografia transeofágica (ETE), fatores de risco para presença de trombo intracavitário, estado pré-trombótico e fenômenos embólicos em portadores de fibrilaçäo atrial (FA). Métodos-Foram estudados 49 portadores de FA ...
Heart Surgery Forum, Dec 1, 2012
We report a case of myocardial tuberculosis in a 10-yearold girl, diagnosed after recurrence of l... more We report a case of myocardial tuberculosis in a 10-yearold girl, diagnosed after recurrence of left ventricular aneurysm, treated surgically.
Brazilian Journal of Cardiovascular Surgery, Sep 1, 1996
larlzaçAo do miocárdio sem circulaçll.o extracorpórea com derivaçll.o intratuminal temporária (Dt... more larlzaçAo do miocárdio sem circulaçll.o extracorpórea com derivaçll.o intratuminal temporária (Dtl T) na emergên(:11I pós en\JIoplastla transtumlnlll cOfonMa (ATC). Rev Bru C/r Card/ovuc 1996; 11 (3): 137•42. RESUMO, No p. rioclod.novambro 1989ad.z .. mbro 1995. la doantesloramaubm .. tidosaciru rgiada emerglinciapararevascularizaç1iodomioc6.rdiosamcirculaçAoaxtracOfp6r8l(CEC).devidoainsuce s.ode angioplastiatransluminalpe,cutânea(ATC). Todooospaciente.ap,nentavamleso..sdoramointervenlriwtar antenor(RIA).coronárladireita(CD)01.lcoronárladiagonal (Dg),pass{veis de ebordagemsemCEC. Eml0d05 u~lIzamos derivaç"o Intralumin allempOfArla (DITL) pa'a manter O fluxo coronarleno II mlnlmlzar alsquemla Três(16.66O/ .)doente s 1oramoperadosnevigêncladeln1ar1oagudodomioc6.rdio e 4(22.22o/ .)doentescom importante correnle da ledo ao ECG. O choqu e cardlogênlco estava presente em3 (16.66%) doontas. Não houv .. monalidlldu. Realizamos ostudo estatóstico para comparaçlio da mor1a lidade referida por diversos autOfos utilizando rllvascularizaçlio com CEC DESCRITORES: Revascularizaç1io do miocárdio. métodos. Revascularizaçlo do mioc~rdio. cirurgia. Angioplaslia. Vasoscoron~rios.cirurgia. Pról esesvascul arGs INTRODUÇÃO Desde sua introdução em 1978(llaangiOPlastia transluminal coronária {ATC) yem sando cada vez mais utilizada e vem se aprimorando. Os casos de necessidade de operação de emergência devido a insucesso do ATC têm sida bem estudados na literatura (2•7) e apresentam, na atualidade, uma incidência entre 2,8% a 7% ($.9). Devido à instabilidade hemodinê-mica com que se spresentam estes doentes, alguns em choque cardiogênico, o risco cirúrgico é e levado, variando de4,6%e30%(2.M),apesardoempregodasnoyas técnicas de preservação do miocárdio. Atócnicade revascularÍ2:açãOdomi<x;árd iosemo I.lSO da CEC 1em sua história iniciada com CAAAEL (10), em 1910, que realizou uma derivação da aor1ades•
Brazilian Journal of Cardiovascular Surgery, Mar 1, 2001
Técnica de implante subpeitoral para tratamento de infecção de loja de marcapasso: estudo inicial
Revista Brasileira De Cirurgia Cardiovascular, Mar 1, 2014
Introduction: Chagas disease is a major cause of cardiomyopathy and sudden death in our country. ... more Introduction: Chagas disease is a major cause of cardiomyopathy and sudden death in our country. It has a high mortality when their patients develop New York Heart Association (NYHA) class IV. Objective: The objective of this study is to analyze the clinical outcome of patients with Chagas' cardiomyopathy with congestive heart failure with optimized pharmacological therapy, undergoing cardiac resynchronization therapy. Methods: Between January 2004 and February 2009, 72 patients with Chagas' cardiomyopathy in NYHA class III and IV underwent cardiac resynchronization therapy and were monitored to assess their clinical evolution. We used the t test or the Wilcoxon test to compare the same variable in two different times. A P value < 0.05 was established as statistically significant. Results: The average clinical follow-up was 46.6 months (range 4-79 months). At the end of the evaluation, 87.4% of patients were in NYHA class I or II (P<0.001). There was response to therapy in 65.3% of patients (P<0.001), with an overall mortality of 34.7%. Conclusion: In patients with chronic Chagas cardiomyopathy undergoing cardiac resynchronization therapy, we found the following statistically significant changes: improvement in NYHA class and increase of left ventricle ejection fraction, a decrease of the systolic final diameter and systolic final left ventricle volume and improvement of patient survival.
Acute aortic syndrome (AAS) is an emergency condition that includes acute aortic dissection, intr... more Acute aortic syndrome (AAS) is an emergency condition that includes acute aortic dissection, intramural hematoma, aortic ulcer, and iatrogenic and traumatic aortic dissection. Initial management includes pain control (with powerful analgesics if necessary), heart rate and inotropic control with the use of beta-blockers, and strictly blood pressure control. The Stanford classification takes into account the extent of dissection to the ascending aorta, which might be present (Stanford A) or not (Stanford B). Current guidelines recommend surgical treatment for all patients with type A ASS. We report a case of a 77-year-old female who was admitted to the emergency department presenting chest pain for 15 days. Acute coronary syndrome was initially ruled out, and during diagnostic work-up, computed tomography showed an aortic arch aneurysm and important tortuosity of descending aorta. During surgery, an ascending aortic bypass was performed with a bifurcated graft anastomosis to the innominate artery and left carotid artery. The ascending aorta was partially clamped, and the proximal end-to-lateral aortic graft anastomosis was performed, followed by an end-to-lateral anastomosis of the bifurcated grafts to the innominate artery and the left main carotid artery. Twenty days after the surgery, endovascular stent implantation beginning at the ascending aorta until the descending thoracic aorta was performed. The postoperative period was uneventful, and the patient was discharged. It is known that surgical mortality of patients with aortic dissection is very high, with studies reporting rates of up to 30%. The chimney technique in arch aneurysms remains untested and should not be used as an acceptable treatment other than for salvage. There are branched prostheses for the aortic arch in the development and going through tests, and although the results are still not satisfactory, it is possible that this technique overcomes the chimney technique.
Não houve suporte financeiro.
Revista Relato de Casos do CBC, Sep 1, 2019
Arquivos Brasileiros De Cardiologia, Jul 1, 2010
Background: The effectiveness and safety of drug-eluting stents (DES) have still been questioned.... more Background: The effectiveness and safety of drug-eluting stents (DES) have still been questioned. Objective: The objective of this study was to evaluate the effectiveness and safety of these stents, as well as the incidence of target lesion revascularization (TLR), in addition to identifying possible variables influencing the need for TLR. Methods: A total of 203 patients from Hospital Costantini who were clinically followed up for one to 3 years were selected. Results: The sample characteristics were as follows: 470 lesions; 171 (84.24%) male patients; 54 (26.6%) had diabetes; 131 (64.35%) had hypertension; 127 (62.56%), dyslipidemia; 40 (19.70%) were smokers; and 79 (38.92%) had a family history of coronary artery disease. Also: 49 (24.14%) patients presented with stable angina; 58 (28.57%), unstable angina; and 6 (2.96%), myocardial infarction. Eighty five (41.87%) patients were asymptomatic, and 146 (71.92%), had multivessel disease. As for the characteristics of the lesions, 77.45% were B2/C (AHA/ACC). Taxus was implanted in 73.62% of the patients. Stents with diameter > 2.5 mm were used in 381 (81.96%) patients. The stent length was < 30 mm in 67.87% of the lesions, with a mean of 2.3 stents per patient. After follow-up, 19 patients (9.3%) underwent TLR. Four patients died (1.97%), two of them of MI (0.98%), one of stroke (0.49%), and one of abdominal aneurysm (0.49%). Also, one patient died of late thrombosis (0.49%), and one of reinfarction (0.49%). In the statistical analysis carried out, only the bifurcation lesions variable reached values close to the statistical significance level, with p < 0.06. Conclusion: In conclusion, drug-eluting stents have good effectiveness and safety profiles; the incidence of TLR was 9.3%, and we did not identify a variable correlated with the need for TLR. (Arq Bras Cardiol. 2010; [online]. ahead print, PP.0-0) Key words: Drug-eluting stents/utilization; effectiveness; safety/economics; diagnostic services; Curitiba (PR); Brazil. coronary angioplasty (PTCA). Palmaz et al 3 and Sigwart et al 4 were the first to use the percutaneous treatment by means of a solid structure-a coronary endoprosthesis, the stent-which kept the dilated vessel lumen open. This was a major landmark in interventional cardiology, with the purpose of combating restenosis. In 1995, the idea emerged of using drugs capable of preventing the restenotic process using the stent itself as the drug-delivery vehicle 5. Polymers were used as the drug bond, and thus the successful triad of pharmacological stents was formed: stent, polymer and drug. Revascularization of a previously treated lesion, known as target lesion revascularization, has been associated with the assessment of percutaneous treatment effectiveness, whereas thrombosis is associated with stent safety. Therefore, although this safety has been recently questioned 6 , several meta-analyses were later carried out and demonstrated the effectiveness and safety of drug-eluting stents in comparison to bare metal stents 7-9. In a single-center registry from Ontario, Canada 7 , a decrease in the frequency of repeat revascularization procedures was observed in high-risk patients using drug-eluting stents in comparison to bare metal stents; no differences were observed as regards death and infarction. The objective of the present study was to evaluate the effectiveness and safety of drug-eluting stents in the
Brazilian Journal of Cardiovascular Surgery, 2020
The excerpt from Bertold Brecht's play Die Mutter fits well the character Professor Braile was. A... more The excerpt from Bertold Brecht's play Die Mutter fits well the character Professor Braile was. A singular man, a rare, perhaps a unique combination of a highly skilled heart surgeon, a devoted professor, an adroit scientist, a successful entrepreneur and the linchpin of a loving family. An unchallenged leader in the field of cardiovascular surgery among us and the personification of the example to be followed by the younger generation in our country. His unparalleled and extraordinary achievements in life were made possible because of his energetic, persevering, and tireless personality, where every word out of his mouth resonated his real passion for the profession. Nicknamed "the heart mender" in his biography, his endeavor allowed the country to master the production of a wide range of cardiovascular-related medical supplies, making possible the access to heart surgery through the public healthcare system to every patient in need, regardless of how little they earned or saved. And unquestionably contributing to make the Brazilian heart surgery powerful and recognized worldwide.
DOAJ (DOAJ: Directory of Open Access Journals), Jul 1, 2010
Brazilian Journal of Cardiovascular Surgery, Jun 1, 2011
Fundamento: A efetividade e segurança de stents farmacológicos (SF) ainda têm sido questionadas. ... more Fundamento: A efetividade e segurança de stents farmacológicos (SF) ainda têm sido questionadas. Objetivo: O objetivo deste estudo foi avaliar a efetividade e segurança desses stents, e a incidência da revascularização da lesão tratada (RLT), além de identificar possíveis variáveis que influenciam a necessidade de RLT. Métodos: Selecionaram-se 203 pacientes do Hospital Costantini que tiveram acompanhamento clínico no período de 1 a 3 anos. Resultados: Observou-se o seguinte quadro: 470 lesões; 171 (84,24%) pacientes eram homens; 54 (26,6%), diabéticos; 131 (64,35%), hipertensos; 127 (62,56%), dislipidêmicos; 40 (19,70%), tabagistas; e 79 (38,92%) apresentavam história familiar de coronariopatia. Ainda: 49 (24,14%) pacientes apresentavam angina estável; 58 (28,57%), angina instável; e 6 (2,96%), infarto agudo do miocárdio. Desses pacientes, 85 (41,87%) eram assintomáticos, e 146 (71,92%), multiarteriais. Nas características das lesões, 77,45% foram B2/C (AHA/ACC). Taxus foi implantado em 73,62% dos pacientes. Em 381 (81,96%), constataram-se stents com diâmetro > 2,5 mm. O comprimento de stent era < 30 mm em 67,87% das lesões, com média de 2,3 stents por paciente. Após acompanhamento, 19 pacientes (9,3%) submeteram-se à RLT. Houve morte de 4 pacientes (1,97%), sendo 2 pacientes por IAM (0,98%), um com AVC (0,49%) e um com aneurisma de aorta abdominal (0,49%). Ainda observamos um paciente com trombose tardia (0,49%) e um com reinfarto (0,49%). Na análise estatística realizada, apenas a característica da lesão em bifurcação aproximou-se de significância estatística com p < 0,06. Conclusão: Concluímos que os stents farmacológicos apresentam boa efetividade e segurança, observamos incidência de 9,3% de RLT e não identificamos variável que indicasse a necessidade de RLT. (Arq Bras Cardiol. 2010; [online]. ahead print, PP.0-0) Palavras-chave: Stents farmacológicos/utilização, efetividade, segurança/economia, serviços de diagnóstico, Curitiba (PR), Brasil.
Ischemic heart disease is the main cause of congestive heart failure. Left ventricular aneurysm r... more Ischemic heart disease is the main cause of congestive heart failure. Left ventricular aneurysm resection has been recommended to treat congestive heart failure, fatal arrhythmias, to prevent thromboembolic complications, and angina. We describe our experience with left ventricular aneurysmectomy, preservig the elliptical form, with heart beating continuously. Many patients had indication of cardiodesfibrilator implant prior the surgery and 70% became free from this device after the aneurysmectomy. The method is safe, reprodutible, with low mortality and morbidity. DESCRIPTORS: tachyarrhytmia, left ventricle aneurism, implantable cardiodesfibrilator. Relampa 78024-518
O cardiodesfibrilador implantável (CDI) foi introduzido na prática clínica em 1980 e é considerad... more O cardiodesfibrilador implantável (CDI) foi introduzido na prática clínica em 1980 e é considerado o tratamento-padrão para indivíduos sob risco de desenvolverem disritmias ventriculares fatais. Com o intuito de garantir funcionamento adequado do cardiodesfibrilador, a energia necessária para o término da taquicardia ventricular ou da fibrilação ventricular deve ser determinada durante o implante, sendo esse procedimento chamado de teste do limiar de desfibrilação. Para a realização do teste é necessário que seja feita indução de fibrilação ventricular, para que o aparelho possa identificar o ritmo cardíaco e tratá-lo. O objetivo deste estudo foi verificar a ocorrência de disfunção cognitiva 24 horas após o implante de cardiodesfibrilador. MÉTODO: Foi selecionada uma amostra consecutiva de 30 pacientes com indicação de colocação de cardiodesfibrilador implantável (CDI) e 30 pacientes com indicação de implante de marca-passo (MP). Os pacientes foram avaliados nos seguintes momentos: 24 horas antes da colocação do CDI ou MP com ficha de avaliação pré-anestésica, Mini Exame do Estado Mental (MEEM) e Confusion Assessment Method (CAM). Durante o implante do CDI ou MP foram medidas as variáveis: número de paradas cardíacas e tempo total de parada cardíaca. Vinte e quatro horas após colocação do CDI ou MP, foram avaliadas as variáveis: MEEM e CAM. RESULTADOS: O teste de Fisher comprovou não haver diferença da freqüência de escores alterados do MEEM e do CAM entre os grupos antes e depois dos implantes. O tempo médio de PCR foi 7,06 segundos, com máximos e mínimos de 15,1 e 4,7 segundos. CONCLUSÕES: A indução de parada cardíaca durante o teste do limiar de desfibrilação não levou à disfunção cognitiva 24 horas após o implante de cardiodesfibrilador. Unitermos: CIRURGIA, Cardíaca: parada cardíaca induzida; COM-PLICAÇÕES: isquemia encefálica, manifestações neurológicas, transtornos cognitivos; EQUIPAMENTOS: desfibriladores implantáveis; marca-passo.
Arq Bras Cardiol, Sep 1, 1987
Arq Bras Cardiol, Jun 1, 1989
Revista Brasileira de …, 2001
RESUMO: Introdução/Objetivo: O implante de marcapasso cardíaco definitivo é um procedimento carac... more RESUMO: Introdução/Objetivo: O implante de marcapasso cardíaco definitivo é um procedimento caracterizado por um baixo índice de complicações. No entanto, a infecção, principalmente a de loja de fonte geradora, caracteriza-se como uma das complicações mais comuns, com ...
Arquivos Brasileiros De Cardiologia, 1995
Resumo: Objetivo-Determinar, através da ecocardiografia transeofágica (ETE), fatores de risco par... more Resumo: Objetivo-Determinar, através da ecocardiografia transeofágica (ETE), fatores de risco para presença de trombo intracavitário, estado pré-trombótico e fenômenos embólicos em portadores de fibrilaçäo atrial (FA). Métodos-Foram estudados 49 portadores de FA ...
Heart Surgery Forum, Dec 1, 2012
We report a case of myocardial tuberculosis in a 10-yearold girl, diagnosed after recurrence of l... more We report a case of myocardial tuberculosis in a 10-yearold girl, diagnosed after recurrence of left ventricular aneurysm, treated surgically.
Brazilian Journal of Cardiovascular Surgery, Sep 1, 1996
larlzaçAo do miocárdio sem circulaçll.o extracorpórea com derivaçll.o intratuminal temporária (Dt... more larlzaçAo do miocárdio sem circulaçll.o extracorpórea com derivaçll.o intratuminal temporária (Dtl T) na emergên(:11I pós en\JIoplastla transtumlnlll cOfonMa (ATC). Rev Bru C/r Card/ovuc 1996; 11 (3): 137•42. RESUMO, No p. rioclod.novambro 1989ad.z .. mbro 1995. la doantesloramaubm .. tidosaciru rgiada emerglinciapararevascularizaç1iodomioc6.rdiosamcirculaçAoaxtracOfp6r8l(CEC).devidoainsuce s.ode angioplastiatransluminalpe,cutânea(ATC). Todooospaciente.ap,nentavamleso..sdoramointervenlriwtar antenor(RIA).coronárladireita(CD)01.lcoronárladiagonal (Dg),pass{veis de ebordagemsemCEC. Eml0d05 u~lIzamos derivaç"o Intralumin allempOfArla (DITL) pa'a manter O fluxo coronarleno II mlnlmlzar alsquemla Três(16.66O/ .)doente s 1oramoperadosnevigêncladeln1ar1oagudodomioc6.rdio e 4(22.22o/ .)doentescom importante correnle da ledo ao ECG. O choqu e cardlogênlco estava presente em3 (16.66%) doontas. Não houv .. monalidlldu. Realizamos ostudo estatóstico para comparaçlio da mor1a lidade referida por diversos autOfos utilizando rllvascularizaçlio com CEC DESCRITORES: Revascularizaç1io do miocárdio. métodos. Revascularizaçlo do mioc~rdio. cirurgia. Angioplaslia. Vasoscoron~rios.cirurgia. Pról esesvascul arGs INTRODUÇÃO Desde sua introdução em 1978(llaangiOPlastia transluminal coronária {ATC) yem sando cada vez mais utilizada e vem se aprimorando. Os casos de necessidade de operação de emergência devido a insucesso do ATC têm sida bem estudados na literatura (2•7) e apresentam, na atualidade, uma incidência entre 2,8% a 7% ($.9). Devido à instabilidade hemodinê-mica com que se spresentam estes doentes, alguns em choque cardiogênico, o risco cirúrgico é e levado, variando de4,6%e30%(2.M),apesardoempregodasnoyas técnicas de preservação do miocárdio. Atócnicade revascularÍ2:açãOdomi<x;árd iosemo I.lSO da CEC 1em sua história iniciada com CAAAEL (10), em 1910, que realizou uma derivação da aor1ades•
Brazilian Journal of Cardiovascular Surgery, Mar 1, 2001
Técnica de implante subpeitoral para tratamento de infecção de loja de marcapasso: estudo inicial