Revista Brasileira De Cirurgia Cardiovascular最新文献

{"title":"Dexmedetomidine Leads to the Mitigation of Myocardial Ischemia/Reperfusion-Induced Acute Lung Injury in Diabetic Rats Via Modulation of Hypoxia-Inducible Factor-1α","authors":"Siyu Chen, Jianjiang Wu, Long Yang, Taiwangu Tailaiti, T. Zou, Yidan Huan, Jiangyou Wang","doi":"10.21470/1678-9741-2020-0591","DOIUrl":"https://doi.org/10.21470/1678-9741-2020-0591","url":null,"abstract":"Introduction The objective of this study is to investigate the protective mechanism of dexmedetomidine (Dex) in myocardial ischemia/reperfusion (MIR)-induced acute lung injury (ALI) of diabetic rats by inhibiting hypoxia-inducible factor-1α (HIF-1α). Methods Initially, healthy male Sprague Dawley rats were treated with streptozocin to induce diabetes. Then, three weeks after the induction, Dex or lentiviral vector (LV)-HIF-1α was injected into the rats 30 minutes prior to the MIR modeling. After four weeks, lung tissues were harvested for pathological changes observation and the wet/dry weight (W/D) ratio determination. Afterwards, oxidative stress indicators and pro-inflammatory factors were measured. In addition, HIF-1α expression was assessed by immunohistochemistry and western blot analysis. Results Dex could suppress inflammatory cell infiltration, improve lung tissue structure, reduce pathological score and the W/D ratio, and block oxidative stress and inflammatory response in MIR-induced ALI of diabetic rats. Besides, Dex could also inhibit HIF-1α expression. Moreover, Dex + LV-HIF-1α reversed the protective role of Dex on diabetic MIR-induced ALI. Conclusion Our study has made it clear that Dex inhibited the upregulation of HIF-1α in diabetic MIR-induced ALI, and thus protect lung functions by quenching the accumulation of oxygen radical and reducing lung inflammatory response.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41581867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Culprits for Retrosternal Deformation After Coronary Artery Bypass Surgery","authors":"Abdulkerim Özhan, M. Baştopçu","doi":"10.21470/1678-9741-2021-0507","DOIUrl":"https://doi.org/10.21470/1678-9741-2021-0507","url":null,"abstract":"We have read with interest the article “Retrosternal Deformations after Coronary Artery Bypass Surgery Using Statistical Shape Analysis” by Bademci et al.[1] The authors have used novel statistical methods to demonstrate geometric changes in the mediastinum following coronary artery bypass grafting (CABG) surgery. The authors conclude that, following CABG, “the main pulmonary artery approximates to the sternum” with “narrowing of the retrosternal area”. They attribute this finding to the formation of scar tissue and adhesions which are the result of inflammation associated with cardiac surgery. We would like to inquire if the authors believe operative techniques affect the geometric changes in the mediastinum. Surgeons vary greatly in their CABG techniques, choice of grafts, pericardial closure, and use of cardiopulmonary bypass (CPB). On-pump CABG may precipitate inflammatory processes more potently compared to off-pump CABG[2]. Another technique that produces less inflammation is the mini-extracorporeal circulation (MECC) during CABG[3]. Therefore, postoperative adhesions and scar tissue formation could be attenuated in patients who are revascularized with offpump CABG or using MECC. It is also possible that CPB times, blood transfusions, perioperative medications, and patient factors affect the amount of inflammatory response in the postoperative period. Data related to CPB and other factors that induce inflammation in the patient group in the study may be relevant. The cannulation strategy is also important, as central arterial cannulation may result in more retrosternal adhesions than femoral cannulation. The placement of a pulmonary vent catheter and the extent of tissue dissection around the pulmonary artery may influence the adhesions present in the postoperative period. For their statistical shape analysis, the authors have compared patients with previous CABG with a control group without a history of cardiac surgery. In our opinion, this overlooks interpersonal geometric differences in mediastinal anatomy. The size of the great vessels can be different in the population of patients who require cardiothoracic surgery than individuals who did not require an operation. Comorbidities accompanying heart diseases, including, but not limited to, aortic enlargement or elevated pulmonary pressure increasing great vessel diameters, may complicate the comparison of retrosternal distance[4]. If the authors can identify a cohort of patients who had chest computed tomography before and after surgery, their methods can be applied to distinctly assess the effect of CABG surgery on retrosternal adhesions. This would also allow controlling or comparing other important factors in inflammation. We congratulate the authors for their study in the underexplored field of retrosternal adhesions in cardiac surgery. The findings from this study can guide cardiac surgeons who face the perils of retrosternal adhesions in redo operations.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45622326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Heart Transplant: Initial Experience in a Tertiary Center in Brazil","authors":"Francisco Candido Monteiro Cajueiro, U. Croti, Alexandra Regina Siscar Barufi, A. Bodini, Karolyne Barroca Sanches Postigo, C. Marchi, Fernando Cesar Gimenes Barbosa Santos, L. Beani, Bruna Cury Borim, M. Godoy, A. Moscardini","doi":"10.21470/1678-9741-2021-0483","DOIUrl":"https://doi.org/10.21470/1678-9741-2021-0483","url":null,"abstract":"Introduction Pediatric heart transplantation is the definitive therapy for children with end-stage heart failure. This paper describes our initial experience in pediatric heart transplantation in a tertiary center in Brazil Methods This is a historical prospective descriptive cohort study based on a review of the medical records of children undergoing heart transplantation at Hospital de Base and Hospital da Criança e Maternidade de São José do Rio Preto. Variables were displayed as frequency, mean, or median. Statistical analysis and Kaplan-Meier actuarial curve were obtained with the aid of Microsoft® Excel® 2019 and STATSDirect version 3.3.5. Results Between January 2010 and December 2020, ten children underwent bicaval orthotopic heart transplantation, 30% of which were under one year of age. Nine patients had end-stage heart failure (International Society for Heart and Lung Transplantation-Heart Failure D) and 50% of the recipients were transplanted under conditions of progressive clinical deterioration (Interagency Registry for Mechanically Assisted Circulatory Support ≤ 2). Forty percent of the recipients had a panel-reactive antibody > 20% on virtual crossmatch. In the postoperative period, 80% of patients required high dose of inotropic support (vasoactive-inotropic score > 10) for > 48 hours. The death-free survival rate at 131 months was 77.1±14.4%. Most patients (88.9%) in late follow-up had an episode of active cytomegalovirus infection. Cellular rejection, with or without clinical repercussion, was present in 44.4% of the patients. Conclusion Pediatric heart transplantation produces acceptable and feasible outcomes as definitive therapy for children with end-stage heart failure.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42454690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculous Aortic Aneurysm - A Review","authors":"Abdulmajeed Altoijry","doi":"10.21470/1678-9741-2020-0611","DOIUrl":"https://doi.org/10.21470/1678-9741-2020-0611","url":null,"abstract":"Introduction Tuberculous aortic aneurysm (TBAA) is an exceedingly rare but severe manifestation of tuberculosis, with a high risk of sudden rupture of the aorta in absence of medical or surgical intervention. This review aimed to provide a detailed understanding of TBAA, including its associated complications, affected population, treatment measures, and outcomes. Methods Case studies and relevant research articles were analyzed to understand the recent advances in medical scientific knowledge on TBAA. Recent clinical case reports on TBAA were searched from the year 2010 to 2020. Results Case reports indicated a higher prevalence of TBAA in the male population. The most affected age group was 15 to 79 years. The most common treatment for TBAA included surgery followed by antituberculous medication. The case reports discussed in this review reflected open surgery, endovascular repair, coil embolization, laparotomy, aortic valve and root replacement as some of the surgical procedures used depending on the complication and type of aneurysm. The treatment outcome was considered effective in most cases. Conclusion Postoperative chemotherapy and medications reduce the risk of severity. Early diagnosis of TBAA is imperative, followed by surgical resection and postoperative antituberculous medication with careful follow-up to prevent relapse.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48015779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ring Fracture of Brazilian Aortic Valve Bioprostheses Using Non-Compliant High-Pressure Transcatheter Balloon, an Ex Vivo Test","authors":"A. Mota, D. Gaia, J. H. P. D. Fonseca","doi":"10.21470/1678-9741-2021-0272","DOIUrl":"https://doi.org/10.21470/1678-9741-2021-0272","url":null,"abstract":"Introduction Aortic valve bioprostheses ring fracture in valve-in-valve procedures has shown low complication rates and presents as an option in the treatment of patients at high risk for conventional surgery, avoiding high transvalvular gradients, which are associated with increased mortality. Some prostheses available in the market cannot be fractured. In an ex vivo test, the possibility of ring fracture of aortic valve bioprostheses produced in Brazil when submitted to radial force application using a high-pressure non-compliant balloon was evaluated. Methods One unit of each aortic valve bioprosthesis model, sizes 19 and 21 mm, produced by Brazilian companies (Braile Biomédica, Cardioprótese, and Labcor), was used. In the experiment, a non-compliant high-pressure balloon (Atlas®-Gold), 1 mm larger than the external diameter of the prosthesis, was positioned inside the valve annulus and inflated gradually aiming to fracture the prosthesis. Fracture pressures and photographic and radiological images of the prostheses before and after test were recorded. Results All prostheses were fractured. In the models with metal ring, the fracture pressures were between 23 and 25 atm. In the other prostheses, the rupture occurred between 10 and 13 atm. No deformations in the structure were observed, which could potentially damage the aortic root. Conclusion All the Brazilian prostheses evaluated were fractured, although the presence of a metal ring in the prosthesis framework increases the pressure required for fracture. The information obtained helps in the planning of valve-in-valve procedures in patients with aortic valve bioprostheses.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42345510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Cultural Translation into Brazilian Portuguese and Validation of the Oral Anticoagulation Knowledge Tool (AKT-Br)","authors":"F. F. Mainka, V. L. Ferreira, Antonio M. Mendes, G. L. Marques, C. J. Correr, F. Tonin, R. Pontarolo","doi":"10.21470/1678-9741-2020-0731","DOIUrl":"https://doi.org/10.21470/1678-9741-2020-0731","url":null,"abstract":"Introduction Oral anticoagulants are the treatment of choice for diverse types of coagulation disorders. Warfarin is widely used by the Brazilian population, possibly due to its lower cost than other oral anticoagulants. However, it has a high risk of serious adverse effects if used incorrectly. The Anticoagulation Knowledge Tool (AKT) can assess a patient’s knowledge about her/his oral anticoagulant therapy and can assist health professionals in identifying patients with difficulties in adherence. This study aimed to translate, culturally adapt, and validate the AKT into Brazilian Portuguese. Methods After a standard forward-backward procedure to translate the AKT into Brazilian Portuguese (AKT-Br), a version of the instrument was applied in three groups (patients, pharmacists, and the general population). The reliability of the AKT-Br was tested using an internal consistency measure and test-retest. The validity of the instrument was confirmed with data from the contrasted groups. All statistical analyses were performed with RStudio. Results The median scores obtained with the AKT-Br were 29.0, 17.0, and 7.5 for pharmacists, patients, and the general population, respectively (maximum score of 35 points). There was moderate internal consistency for the instrument and test-retest reliability was satisfactory. Analysis of variance for validity of the groups revealed a significant relationship between the total score and the evaluated groups. Conclusion The ATK-Br is a reliable and valid tool to assess knowledge about oral anticoagulants. AKT-Br can be used in clinical practice as an auxiliary tool to improve patient care through personalised educational interventions.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42297557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Epicardial Cyst Eroding Left Ventricular Wall Mimicking as Simple Pericardial Cyst","authors":"Kishore Gupta, Dhiren Shah, D. Naik, A. Chandan, Chintan Sheth, Gautam Shah","doi":"10.21470/1678-9741-2020-0623","DOIUrl":"https://doi.org/10.21470/1678-9741-2020-0623","url":null,"abstract":"Epicardial cysts are rarer benign tumors than pericardial cysts. There have been few reports on surgical management of epicardial cysts. A 17-year-old normotensive boy presented with chest pain and palpitations, which on evaluation was found to be a mediastinal mass (pericardial cyst). Surgical resection of the cyst via thoracotomy was planned. The cyst was diagnosed as an epicardial cyst intraoperatively. However, due to the epicardial origin of cyst and posterior adhesions, resection was done via midline approach. The base was formed by visceral pericardium and eroding into myocardium of left ventricle, so the resection was concluded with on-pump surgery. In case of erroneous diagnosis or undesirable finding, a safer midline approach with on-pump surgery, as an alternative to minimally invasive approach for complicated epicardial cysts (erosion into ventricle/lying in close proximity to important structures or near to coronary arteries) should be considered.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46680655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Reconstruction of a Left Ventricular Aneurysm Using an Extracellular Matrix Patch","authors":"Igor S Zivkovic, V. Mihajlović, Djordje Zdravkovic, Djordje Krstic, Srasa Krasic, Jelena Lesanovic, M. Perić, P. Milačić","doi":"10.21470/1678-9741-2021-0045","DOIUrl":"https://doi.org/10.21470/1678-9741-2021-0045","url":null,"abstract":"The left ventricular aneurysm is a pathological condition defined as an akinetic or dyskinetic area of the left ventricle (LV) wall associated with reduced ejection fraction. The most common surgical technique to reconstruct a left ventricular aneurysm is endoventricular patch plasty (Dor procedure). In this case, endoventricular reconstruction of the left ventricular aneurysm using a double-layer extracellular matrix was performed.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49407815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter: Mean Platelet Volume and Related Parameters May Not Contribute to the Diagnosis in Patients with Ascending Thoracic Aortic Aneurysm","authors":"Y. Tekin, G. Tekin, İ. Korkmaz, Sefa Yurtbay","doi":"10.21470/1678-9741-2021-0024","DOIUrl":"https://doi.org/10.21470/1678-9741-2021-0024","url":null,"abstract":"We carefully read the comments of dear colleagues Cengiz Beyan and Esin Beyan[1]. about our article titled “Mean Platelet Volume and Related Parameters May not Contribute to the Diagnosis in Patients with Ascending Thoracic Aortic Aneurysm”[2]. Beyan et al.[1] commented that “The control group did not consist of healthy volunteers, and it was made up of individuals who applied in the hospital at the same time. The fact that the control group is not composed of healthy volunteers and does not represent the society makes it difficult to interpret the results obtained.”. Our study results have a statistically significant value, and while we have excluded the patients previously diagnosed with hematological malignancy, chronic obstructive pulmonary disease (or COPD), autoimmune liver disease, cirrhosis, metastatic bone marrow infiltration, acute or chronic inflammatory disease — such as physical trauma, tonsillitis, asthma, rheumatoid arthritis, and active hepatitis —, and current or recent treatment (in the past three months) with oral or intravenous steroids or other medications that might cause pancytopenia from the control group according to their background, it is possible that all the exclusion criteria cannot be made in a retrospective study and that there can be pre-analytical and analytical errors, but this does not change the statistical difference. Additionally, Beyan et al.[1] tried to draw attention that mean platelet volume (MPV) is a complete blood count parameter whose measurement has not been standardized to date and, therefore, it has been reported to have no role in diagnosis and prognosis of acquired diseases according to a study, but there are many studies about the prognostic value of MPV in many clinical diseases. Vardon-Bounes et al.[3] reported that MPV was an independent predictive factor of 90-day mortality. They suggested that continuous monitoring of MPV may be a useful parameter to stratify mortality risk in septic shock. Ma et al.[4] reported that high MPV can be considered as an independent biomarker for predicting three-month mortality in patients with hepatitis B virus-related decompensated cirrhosis. Lee Response to the Letter: Mean Platelet Volume and Related Parameters May Not Contribute to the Diagnosis in Patients with Ascending Thoracic Aortic Aneurysm","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48049413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonatherosclerotic Giant Right Coronary Artery Aneurysm","authors":"L. Cardoso, R. Dias, L. Demarchi, Lucas Molinari Veloso da Silveira, C. Mady, F. Jatene","doi":"10.21470/1678-9741-2020-0649","DOIUrl":"https://doi.org/10.21470/1678-9741-2020-0649","url":null,"abstract":"We present an unusual case of a 67-year-old woman with an incidental finding of a cardiac mass on a chest computed tomography. Coronary angiotomography confirmed the diagnosis of right coronary artery aneurysm, with 5.7×5.7 cm. The patient underwent aneurysm resection and coronary bypass surgery, with subsequent histologic study suggestive of arteritis sequelae. Giant coronary artery aneurysms have a high risk of complications and aneurysm exclusion must be beneficial. This is a rare condition that can also be part of a systemic inflammatory disease.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43135429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}