150 results on '"Carlos Manuel de Almeida Brandão"'
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2. HANDS-ON: Training Simulation in Surgery
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Carlos Manuel de Almeida Brandão and Paulo Manuel Pêgo-Fernandes
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Medicine - Published
- 2023
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3. Impacto da Primeira Onda da Pandemia de COVID-19 na Cirurgia Cardiovascular no Brasil: Análise de um Centro Terciário de Referência
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Luiz Augusto Lisboa, Omar Asdrúbal Vilca Mejia, Elisandra Trevisan Arita, Gustavo Pampolha Guerreiro, Lucas Molinari Veloso da Silveira, Carlos Manuel de Almeida Brandão, Ricardo Ribeiro Dias, Luís Roberto Palma Dallan, Leonardo Miana, Luiz F. Caneo, Marcelo Biscegli Jatene, Luís Alberto Oliveira Dallan, and Fabio Biscegli Jatene
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COVID-19 ,Cirurgia Torácica ,Hospitalização ,Atenção Terciária à Saúde ,Mortalidade ,Procedimentos Cirúrgicos Eletivos ,Cardiopatias Congênitas/cirurgia ,Pandemia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2022
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4. Quadricuspid Aortic Valve: Three Cases Report and Literature Review
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Elinthon Tavares Veronese, Carlos Manuel de Almeida Brandão, Samuel Padovani Steffen, Pablo Pomerantzeff, and Fabio B. Jatene
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Congenital Heart Defects ,Aortic Valve - Pathology ,Aortic Valve - Abnormalities ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Quadricuspid aortic valve (QAV) is a rare cardiac malformation. Many cases are incidentally diagnosed in aortic surgeries or autopsies and it usually appears as an isolated anomaly. The most widely classification used is the one by Hurwitz and Roberts[1], which divides 7 alphabetical subtypes based on the cusps size. The aim of this report is to describe three different anatomic presentations of this rare aortic valve anomaly.
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- 2019
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5. A Técnica de Duplicação de Orifício na Plastia Valvar Mitral: 35 Anos de História
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Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, Arlindo Riso, and Fabio Biscegli Jatene
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Valva Mitral/cirurgia ,Doenças das Valvas Cardíacas/cirurgia ,Morbidade e Mortalidade ,Tromboembolismo/prevenção e controle ,Endocardite/prevenção e controle ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2021
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6. Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair
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Marco Antônio Vieira Guedes, Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, Marcelo Luiz Campos Vieira, Flávio Tarasoutchi, Pablo da Cunha Spinola, and Fábio Biscegli Jatene
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Valva Mitral ,Anuloplastia da Valva Mitral ,Insuficiência da Valva Mitral ,Ecocardiografia Tridimensional ,Ecocardiografia ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
AbstractIntroduction:Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce.Objective:To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique.Methods:Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P
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- 2015
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7. Late outcome analysis of the Braile Biomédica® pericardial valve in the aortic position
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Lisandro Gonçalves Azeredo, Elinthon Tavares Veronese, José Augusto Duncan Santiago, Carlos Manuel de Almeida Brandão, Pablo Maria Alberto Pomerantzeff, and Fabio Biscegli Jatene
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Implante de Prótese de Valva Cardíaca ,Valva Aórtica ,Análise de Sobrevida ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objective: Aortic valve replacement with Braile bovine pericardial prosthesis has been routinely done at the Heart Institute of the Universidade de São Paulo Medical School since 2006. The objective of this study is to analyze the results of Braile Biomédica® aortic bioprosthesis in patients with aortic valve disease. Methods: We retrospectively evaluated 196 patients with aortic valve disease submitted to aortic valve replacement with Braile Biomédica® bovine pericardial prosthesis, between 2006 and 2010. Mean age was 59.41±16.34 years and 67.3% were male. Before surgery, 73.4% of patients were in NYHA functional class III or IV. Results: Hospital mortality was 8.16% (16 patients). Linearized rates of mortality, endocarditis, reintervention, and structural dysfunction were 1.065%, 0.91%, 0.68% and 0.075% patients/year, respectively. Actuarial survival was 90.59±2.56% in 88 months. Freedom from reintervention, endocarditis and structural dysfunction was respectively 91.38±2.79%, 89.84±2.92% and 98.57±0.72% in 88 months. Conclusion: The Braile Biomédica® pericardial aortic valve prosthesis demonstrated actuarial survival and durability similar to that described in the literature, but further follow up is required to assess the incidence of prosthetic valve endocarditis and structural dysfunction in the future.
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- 2014
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8. Fatores de risco pré-operatórios para mediastinite após cirurgia cardíaca: análise de 2768 pacientes Preoperative risk factors for mediastinitis after cardiac surgery: analysis of 2768 patients
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Marcos Gradim Tiveron, Alfredo Inácio Fiorelli, Eduardo Moeller Mota, Omar Asdrúbal Vilca Mejia, Carlos Manuel de Almeida Brandão, Luís A. O. Dallan, Pablo A. M. Pomerantzeff, and Noedir A.G Stolf
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Mediastinite ,Complicações pós-operatórias ,Infecção da ferida operatória ,Cuidados pré-operatórios ,Mediastinitis ,Postoperative complications ,Surgical wound infection ,Preoperative care ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
INTRODUÇÃO: A esternotomia mediana longitudinal é a via de acesso mais utilizada no tratamento das doenças cardíacas. As infecções profundas da ferida operatória no pós-operatório das cirurgias cardiovasculares são uma complicação séria, com alto custo durante o tratamento. Diferentes estudos têm encontrado fatores de risco para o desenvolvimento de mediastinite e as variáveis pré-operatórias têm tido especial destaque. OBJETIVO: O objetivo deste estudo é identificar fatores de risco pré-operatórios para o desenvolvimento de mediastinite em pacientes submetidos a revascularização do miocárdio e a substituição valvar. MÉTODOS: Este estudo observacional representa uma coorte de 2768 pacientes operados consecutivamente. O período considerado para análise foi de maio de 2007 a maio de 2009 e não houve critérios de exclusão. Foi realizada análise univariada e multivariada pelo modelo de regressão logística das 38 variáveis pré-operatórias eleitas. RESULTADOS: Nesta série, 35 (1,3%) pacientes evoluíram com mediastinite e 19 (0,7%) com osteomielite associada. A idade média dos pacientes foi de 59,9 ± 13,5 anos e o EuroSCORE de 4,5 ± 3,6. A mortalidade hospitalar foi de 42,8%. Na análise multivariada, foram identificadas três variáveis como preditoras independentes de mediastinite: balão intra-aórtico (OR 5,41, 95% IC [1,83 -16,01], P=0,002), hemodiálise (OR 4,87, 95% IC [1,41 - 16,86], P=0,012) e intervenção vascular extracardíaca (OR 4,39, 95% IC [1,64 - 11,76], P=0,003). CONCLUSÃO: O presente estudo demonstrou que necessidade do suporte hemodinâmico pré-operatório com balão intra-aórtico, hemodiálise e intervenção vascular extracardíaca são fatores de risco para o desenvolvimento de mediastinite após cirurgia cardíaca.BACKGROUND: Longitudinal median sternotomy is the most common surgical approach for access to heart disease treatment. The deep wound infections in postoperative period of cardiovascular surgery are a serious complication requiring high costs during treatment. Different studies have indicated some risk factors for the development of mediastinitis and preoperative variables are currently under investigation. OBJECTIVE: The aim of this study is to identify the preoperative risk factors for postoperative development of mediastinitis in patients undergoing coronary artery bypass grafting and valve replacement. METHODS: This observational study represents a cohort of 2768 consecutive operated patients. The period considered for analysis was from May 2007 to May 2009 and there were no exclusion criteria. Analysis was performed by univariate and multivariate logistic regression model of 38 preoperative variables. RESULTS: Thirty-five (1.3%) patients developed mediastinitis and 19 (0.7%) associated with osteomyelitis. The patient age average was 59.9 ± 13.5 years and the EuroSCORE of 4.5 ± 3.6. Hospital mortality was 42.8%. The multivariate analysis identified three variables as independent predictors of postoperative mediastinitis: intra-aortic balloon pump (OR 5.41, 95% CI [1.83 -16.01], P = 0.002), hemodialysis (OR 4.87, 95% CI [1.41 to 16.86], P = 0.012) and extracardiac vascular intervention (OR 4.39, 95% CI [1.64 to 11.76], P = 0.003). CONCLUSION: This study showed that necessity of preoperative hemodynamic support with intra-aortic balloon, hemodialysis, and extracardiac vascular intervention were risk factors for development of mediastinitis after cardiac surgery.
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- 2012
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9. Experiência inicial com a técnica de Pomerantzeff para redução do tamanho do átrio esquerdo gigante Initial experience with Pomerantzeff's technique for reduction of the size of giant left atrium
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Jocerlano Santos de Sousa, Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, Lisandro Azeredo Gonçalves, Marcos Gradim Tiveron, Marcelo Luiz Campos Vieira, Flavio Tarasoutchi, and Noedir Antônio Groppo Stolf
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Valva mitral ,Fibrilação atrial ,Doenças das valvas cardíacas ,Mitral valve ,Atrial fibrillation ,Heart valve diseases ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
INTRODUÇÃO: A mais comum indicação de correção cirúrgica de átrio esquerdo gigante está associada à insuficiência da valva mitral, com ou sem fibrilação atrial. Diversas técnicas para este fim já estão descritas com resultados variáveis. OBJETIVO: Apresentar a experiência inicial com a técnica da ressecção triangular tangencial (Pomerantzeff). MÉTODOS: De 2002 a 2010, quatro pacientes foram submetidos a operação da valva mitral com redução do volume do átrio esquerdo pela técnica da ressecção triangular tangencial em nosso serviço. Três pacientes eram do sexo feminino. A idade variou de 21 a 51 anos. Os quatro pacientes encontravam-se com fibrilação atrial. A fração de ejeção do ventrículo esquerdo no pré-operatório variava de 38% a 62%. O diâmetro do átrio esquerdo variou de 78 a 140 mm. Após o tratamento da disfunção mitral, o átrio esquerdo foi reduzido por meio de ressecção triangular tangencial da sua parede posterior, entre as veias pulmonares, para evitar distorções anatômicas do anel mitral ou veias pulmonares, reduzindo a tensão na linha de sutura. RESULTADOS: Tempo médio de internação hospitalar foi de 21,5 ± 6,5 dias. O tempo de circulação extracorpórea médio foi de 130 ± 30 minutos. Não houve sangramento cirúrgico ou mortalidade no período pós-operatório. Todos os pacientes tiveram o ritmo sinusal restabelecido na saída de circulação extracorpórea, mantendo esse ritmo no pós-operatório. O diâmetro médio do átrio esquerdo foi reduzido em 50,5 ± 19,5%. A fração de ejeção do ventrículo esquerdo melhorou em todas as pacientes. CONCLUSÃO: Os resultados iniciais com essa técnica têm demonstrado redução efetiva do átrio esquerdo.INTRODUCTION: The most common indication for surgical correction of giant left atrium is associated with mitral valve insufficiency with or without atrial fibrillation. Several techniques for this purpose are already described with varying results. OBJECTIVE: To present the initial experience with the tangential triangular resection technique (Pomerantzeff). METHODS: From 2002 to 2010, four patients underwent mitral valve operation with reduction of left atrial volume by the technique of triangular resection tangential in our service. Three patients were female. The age ranged from 21 to 51 years old. The four patients presented with atrial fibrillation. Ejection fraction of left ventricle preoperatively ranged from 38% to 62%. The left atrial diameter ranged from 78mm to 140mm. After treatment of mitral dysfunction, the left atrium was reduced by resecting triangular tangential posterior wall between the pulmonary veins to avoid anatomic distortion of the mitral valve or pulmonary veins, reducing tension in the suture line. RESULTS: Average hospital stay was 21.5 ± 6.5 days. The mean cardiopulmonary bypass time was 130 ± 30 minutes. There was no surgical bleeding or mortality in the postoperative period. All patients had sinus rhythm restored in the output of cardiopulmonary bypass, maintaining this rate postoperatively. The average diameter of the left atrium was reduced by 50.5% ± 19.5%. The left ventricular ejection fraction improved in all patients. CONCLUSION: Initial results with this technique have shown effective reduction of the left atrium.
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- 2012
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10. Evolução tardia da comissurotomia mitral em pacientes reumáticos com baixo escore ecocardiográfico Long-term evolution of mitral commissurotomy in rheumatic patients with low echocardiographic score
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Luciano Rapold Souza, Carlos Manuel de Almeida Brandão, Pablo Maria Alberto Pomerantzeff, Osanam Amorim Leite Filho, Luiz Francisco Cardoso, and Noedir Antonio Groppo Stolf
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Cardiopatia Reumática ,Estenose da Valva Mitral ,Procedimentos Cirúrgicos Cardiovasculares ,Rheumatic Heart Disease ,Mitral Valve Stenosis ,Cardiovascular Surgical Procedures ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
INTRODUÇÃO: Os bons resultados da comissurotomia mitral a céu aberto são bem conhecidos e existe a hipótese de que se poderiam obter melhores resultados em pacientes selecionados pelo escore ecocardiográfico. OBJETIVO: Analisar os resultados tardios da comissurotomia mitral em pacientes selecionados pelo escore ecocardiográfico e identificar variáveis com influência nesses resultados. MÉTODOS: De janeiro de 1990 a agosto de 1994, 50 pacientes com estenose mitral reumática foram submetidos à comissurotomia mitral a céu aberto no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram incluídos pacientes com idade < 60 anos, classe funcional II, III ou IV (New York Heart Association) e escore ecocardiográfico 9. A idade média foi de 32,68 ± 8,29 anos, sendo 41 (82%) pacientes do sexo feminino. Três (6%) pacientes estavam em classe funcional II, 46 (92%) em III e um (2%) em IV. Quarenta e seis (92%) pacientes apresentavam ritmo sinusal e quatro (8%), fibrilação atrial. A área valvar mitral média foi de 0,9 ± 0,2 cm². RESULTADOS: Não houve mortalidade hospitalar. Ocorreram dois óbitos tardios, um relacionado à valvopatia. A sobrevida actuarial foi de 95,5 ± 3,1%, sobrevida livre de reoperação, 62,3 ± 11,8%, e sobrevida livre de tromboembolismo, 88,2 ± 5,0% em 18 anos. Não houve endocardite. O escore ecocardiográfico não teve influência significante em reoperações na evolução tardia. CONCLUSÃO: A comissurotomia mitral a céu aberto obteve resultados tardios excelentes nos pacientes com baixo escore ecocardiográficoINTRODUCTION: The good results of open mitral commissurotomy are well known and there is a hypothesis that it could provide better results in patients selected by echocardiographic score. OBJECTIVE: The purpose of this study is to analyze the late results with open mitral commissurotomy in patients selected by score and to identify variables influencing these results. METHODS: From January 1990 to August 1994, 50 patients were submitted to open mitral commissurotomy due to rheumatic mitral stenosis in Heart Institute of University of Sao Paulo Medical School. Patients with age < 60 years, in functional class II, III or IV (New York Heart Association) and echocardiographic score 9 were included. The mean age was 32.7 ± 8.3 years and 41 patients (82%) were female. The functional class was II in three patients (6%), III in 46 (92%) and IV in one (2%). Forty six patients (92%) were in sinus rhythm and four (8%) were in atrial fibrillation. The mean mitral valve area was 0.9 ± 0.2 cm². RESULTS: There was no hospital mortality. There were two late deaths, one related to valve disease. Actuarial survival was 95.5 ± 3.1 %, freedom from reoperation was 62.3 ± 11,8% and freedom from tromboembolism was 88,2 ± 5,0% in 18 years. There was no endocarditis. The grade of the echocardiographic score had no significant influence on the reoperations in late evolution. CONCLUSION: Open mitral commissurotomy presented excelent long term results in rheumatic patients with low echocardiographic score
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- 2011
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11. Plastia valvar mitral pela técnica do Duplo Teflon: análise do remodelamento cardíaco pela ecocardiografia tridimensional Mitral valve repair by Double Teflon technique: cardiac remodeling analysis by tridimensional echocardiography
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Marco Antonio Vieira Guedes, Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, Marcelo Luiz Campos Vieira, Osanam Amorim Leite Filho, Marcos Floripes da Silva, Pablo da Cunha Spinola, and Noedir Antonio Groppo Stolf
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Valva mitral ,Insuficiência da valva mitral ,Prolapso da valva mitral ,Procedimentos cirúrgicos reconstrutivos ,Ecocardiografia tridimensional ,Mitral valve ,Mitral valve insufficiency ,Mitral valve prolapse ,Reconstructive surgical procedures ,Echocardiography, three-dimensional ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
INTRODUÇÃO: A plastia valvar mitral é o tratamento de escolha para a insuficiência mitral, porém a literatura é escassa em relação ao comportamento do átrio e ventrículo esquerdos após a plastia mitral sem utilização de anéis protéticos. OBJETIVO: Analisar a morfologia e a função cardíaca de indivíduos submetidos à plastia valvar mitral pela técnica de Duplo Teflon, por meio da ecocardiografia tridimensional. MÉTODOS: Foram incluídos 14 pacientes com insuficiência mitral mixomatosa, submetidos à plastia mitral pela técnica de Duplo Teflon. Treze pacientes encontravam-se em classe III/IV. Os pacientes foram avaliados nos períodos pré-operatório, pós-operatório imediato (POI), 6 meses e 1 ano após a plastia mitral. Foi utilizado teste de análise de variância de medidas repetidas para o estudo estatístico, sendo considerado estatisticamente significante PINTRODUCTION: Mitral valve repair is the treatment of choice to correct mitral insufficiency. Although the literature related to left atrial and ventricular behavior after mitral repair without use of prosthetic rings is scarce. OBJECTIVE: To analyze cardiac morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique. METHODS: Were included 14 patients with mixomatous mitral valve insufficiency that were submitted to mitral valve repair with the Double Teflon technique. Of them, 13 patients were in class III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistic analysis was made by repeated measures ANOVA test and was considered statistically significant P < 0.05. RESULTS: The analysis of systolic volumes, atrial and ventricular, demonstrated a significant volumetric reduction between immediate postoperative period and 1 year (P=0.028 and P=0.020, respectively). Between preoperative period and 1 year, there was a mean reduction in atrial and ventricle volumes of 19.9% and 15.4%, respectively. Atrial and ventricle diastolic volumes presented a significant reduction in immediate postoperative period (P
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- 2010
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12. Mitral valve surgery using right anterolateral thoracotomy: is the aortic cannulation a safety procedure? Cirurgia valvar mitral via toracotomia ântero-lateral direita: a canulação aórtica é segura?
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Marco Antonio Vieira Guedes, Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, Marcelo Luiz Campos Vieira, Max Grinberg, and Noedir Antonio Groppo Stolf
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Valva mitral ,Circulação extracorpórea ,Cirurgia torácica ,Valvas cardíacas ,Procedimentos cirúrgicos minimamente invasivos ,Mitral valve ,Extracorporeal circulation ,Thoracic surgery ,Heart valves ,Surgical procedures, minimally invasive ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
INTRODUCTION: The right anterolateral thoracotomy is an alternative technique for surgical approach of mitral valve. In these cases, femoral-femoral bypass still has been used, rising occurrence of complications related to femoral cannulation. Objective: Describe the technique and results of mitral valve treatment by right anterolateral thoracotomy using aortic cannulation for cardiac pulmonary bypass (CPB). METHODS: From 1983 e 2008, 100 consecutive female patients, with average age 35 ±13 years, 96 (96%) underwent mitral valve surgical treatment in the Heart Institute of São Paulo. A right anterolateral thoracotomy approach associated with aortic cannulation was used for CPB. Eighty (80%) patients had rheumatic disease and 84 (84%) patients presented functional class III or IV. RESULTS: Were performed 45 (45%) comissurotomies, 38 (38%) valve repairs, 7(7%) mitral valve replacements, seven (7%) recomissurotomies and three (3%) prosthesis replacement. Sparing surgery was performed in 90 (90%) patients. The average CPB and clamp time were 57 ± 27 min e 39 ± 19 min, respectively. There were no in-hospital death, reoperation due to bleeding and convertion to sternotomy. Introperative complications were related to heart harvest (5%), especially in reoperations (3%). The most important complications in postoperative period were related to pulmonary system (11%), followed by atrial fibrilation (10%) but without major systemic repercussions. The mean inhospital length of stay was 8 ± 3 days. Follow-up was 6.038 patients/month. Actuarial survival was 98.0 ± 1.9% and freedom from reoperation was 81.4 ± 7.8% in 180 months. CONCLUSION: The right anterolateral thoracotomy associated with aortic cannulation in mitral valve surgery is a simple technique, reproducible and safety.INTRODUÇÃO: A toracotomia ântero-lateral direita tem sido utilizada como uma alternativa para a abordagem cirúrgica da valva mitral. Nestes casos, a canulação femoral continua sendo utilizada, possibilitando a ocorrência de complicações. OBJETIVO: Descrever a técnica e os resultados do tratamento da valva mitral via toracotomia ântero-lateral direita, utilizando a canulação aórtica para instalação da circulação extracorpórea. MÉTODOS: Entre 1983 e 2008, 100 pacientes consecutivos, com média de idade 35 13 anos, 96 (96%) do sexo feminino, foram submetidos ao tratamento cirúrgico da valva mitral no InCor-HC-FMUSP, através da toracotomia ântero-lateral direita associada à canulação aórtica. Destes, 80 (80%) pacientes apresentavam etiologia reumática e 84 (84%) classe funcional III ou IV. RESULTADOS: Foram realizadas 45 (45%) comissurotomias, 38 (38%) plásticas, sete (7%) substituições da valva mitral, sete (7%) re-comissurotomias e três (3%) substituição de prótese mitral. Cirurgia conservadora foi realizada em 90 (90%) dos pacientes. O tempo médio de CEC e pinçamento foi 57 27 min e 39 19 min, respectivamente. Não ocorreram óbitos hospitalares, reoperações por sangramento ou conversão para esternotomia. Complicações intraoperatórias foram relacionadas à dissecção cardíaca (5%), principalmente nas reoperações (3%). As principais complicações pós-operatórias foram relacionadas ao sistema pulmonar (11%), seguidas de fibrilação atrial (10%), porém sem repercussões sistêmicas graves. A média de internação hospitalar foi de 8 3 dias. O seguimento foi 6.038 pacientes/mês. A sobrevida atuarial e livre de reoperação foi de 98,0 ± 1,9% e 81,4 ± 7,8% em 180 meses, respectivamente. CONCLUSÃO: A utilização da toracotomia ântero-lateral direita associada a canulação aórtica na abordagem cirúrgica da valva mitral é uma técnica simples, reprodutível e segura.
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- 2010
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13. Plástica da valva mitral em pacientes com insuficiência mitral reumática: técnicas e resultados de 20 anos Mitral valve repair in rheumatic patients with mitral insuficiency: twenty years of techniques and results
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Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, Osanan Amorim Leite Filho, Marco Antônio Vieira Guedes, Marcos Floripes da Silva, Max Grinberg, and Noedir Antônio Groppo Stolf
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Valva mitral ,Insuficiência da valva mitral ,Febre reumática ,Mitral valve ,Mitral valve insufficiency ,Rheumatic fever ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: A plástica da valva mitral em pacientes reumáticos permanece um desafio. O objetivo deste estudo é analisar a técnica e os resultados da plástica da valva mitral em pacientes com insuficiência mitral reumática. MÉTODOS: Foram analisados, retrospectivamente, 330 pacientes portadores de insuficiência mitral reumática submetidos à plástica da valva mitral no Instituto do Coração do HC-FMUSP, entre 1985 e 2005. A idade média foi de 26,9 ± 15,4 anos e 57,6% dos pacientes eram do sexo feminino. No pré-operatório, 39,5% dos pacientes estavam em classe funcional IV. As técnicas de plástica mais comumente utilizadas foram a anuloplastia posterior com tira de pericárdio bovino em 48,4% dos pacientes e a anuloplastia com anel de Carpentier em 22,6%. As técnicas associadas foram empregadas em 55,2% dos pacientes, sendo as mais comuns: encurtamento de cordas (20%) e papilarotomias múltiplas (17,8%). Plástica da valva tricúspide (26,7%) e substituição da valva aórtica (27,2%) foram os procedimentos associados mais frequentes. RESULTADOS: A mortalidade hospitalar foi 0,9% (três pacientes), sendo dois deles crianças em atividade reumática. As taxas linearizadas de tromboembolismo, endocardite, reoperação e óbito tardio foram de 0,2%, 0,2%, 3,5% e 0,5% pacientes-ano, respectivamente. A sobrevida actuarial foi de 86,4 ± 6,6% em 20 anos. A curva livre de reoperação foi de 30,3 ± 11,1% em 20 anos. CONCLUSÕES: A plástica da valva mitral em pacientes reumáticos é uma técnica factível na correção da insuficiência mitral, com baixa mortalidade operatória.OBJECTIVE: Mitral valve repair in rheumatic patients is still a challenge. The purpose of this study is to analyze the results of mitral valve repair in rheumatic patients in the Heart Institute University of Sao Paulo Medical School. METHODS: Were analyzed retrospectively, between 1985 and 2005, 330 patients submitted to mitral valve repair in the Heart Institute of São Paulo. The mean age was 26.9 ± 15.4 years and 57.6% were female. According do clinical evaluation, 39.5% of patients were in NYHA functional class IV. The most common techniques employed were bovine pericardial strip annuloplasty in 48.4% patients and Carpentier ring annuloplasty in 22.6%. Shortening of chordae (20%) and papillary muscle splitting (17.8%) were the most common associated techniques performed. Tricuspid valve repair (26.7%) and aortic valve replacement (27.2%) were the most common associated procedures. RESULTS: The hospital mortality was 0.9% (three patients), two of them in children with active rheumatic fever. Linearized rates of thromboembolism, endocardite, reoperation and late death were 0.2%, 0.2%, 3.5% and 0.5% patients-year, respectively. Actuarial survival in 20 years was 86.4 ± 6.6%. Freedom from reoperation in 20 years was 30.3 ± 11.1%. CONCLUSION: Mitral valve conservative surgery in rheumatic patients is a feasible procedure with low operative mortality.
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- 2009
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14. Cirurgia de preservação da valva aórtica em idosos com estenose aórtica Aortic valve preservation surgery in elderly patients with aortic stenosis
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Rodrigo Coelho Segalote, Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, and Noedir Antônio Groppo Stolf
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Estenose da valva aórtica ,Valva aórtica ,Doenças das valvas cardíacas ,Idoso ,Resultado de tratamento ,Aortic valve stenosis ,Aortic valve ,Heart valve diseases ,Aged ,Treatment outcome ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: O objetivo deste estudo é apresentar resultados imediatos e tardios da cirurgia de preservação da valva aórtica por meio do desbastamento, descalcificação e comissurotomia da valva aórtica na estenose aórtica em idosos. MÉTODOS: Estudo realizado no InCor FMUSP, no qual foram operados 32 pacientes > 65 anos com estenose aórtica isolada, submetidos a plastia da valva aórtica. Observamos os resultados imediatos e tardios, o seguimento ecocardiográfico e clínico; sendo este último pela revisão das consultas ambulatoriais e entrevista por contato telefônico. A sobrevida atuarial e livre de eventos foi calculada pelo método de Kaplan-Meier. RESULTADOS: Quatro (15,4%) pacientes apresentaram reestenose da valva aórtica. Cinco pacientes evoluíram com insuficiência aórtica moderada e dois com insuficiência aórtica grave. Os procedimentos realizados na cirurgia foram: descalcificação, comissurotomia e desbastamento em 28, 20 e 16 pacientes, respectivamente. As complicações pós-operatórias graves totalizaram nove (28,1%) pacientes. Ocorreram dois óbitos hospitalares, estes por sepse causada por pneumonia hospitalar, e cinco tardios. A classe funcional pós-operatória, segundo a NYHA, em ordem decrescente foi de 70,5%, 17,6%, 5,8% e 5,8%; para as classes funcionais I, II, III e IV, respectivamente. A sobrevida actuarial foi de 66,9% + 12,1% em oito anos. A curva livre de tromboembolismo e endocardite foram de 90,9% + 8,7% e 100% em oito anos, respectivamente. CONCLUSÃO: A cirurgia de preservação da valva aórtica em idosos com estenose aórtica nesta série de pacientes mostrou-se com baixa morbidade e mortalidade, taxa de sobrevida satisfatória em oito anos e melhora da classe funcional no seguimento apresentado.OBJECTIVE: The aim of the present study was to investigate early and late results of the aortic valve preservation surgery (AVPS) through rough-hewing, demineralization and commissurotomy of the aortic valve (AV) in aortic stenosis (AS) at elderly people. METHODS: Thirty-two patients operated for pure AS, older than 65 years-old were studied at InCor FMUSP. Early and late results, clinical (ambulatory and phone interview) and echocardiographic follow-up were investigated. Actuarial and event-free survival analysis was done using the Kaplan-Meier method. RESULTS: Four patients (15.4%) had presented de novo AV stenosis. Five patients had progressed to moderate and two to serious aortic regurgitation. Demineralization, commissurotomy and rough-hewing were realized in 28, 20 and 16 patients, respectively. Nine patients had presented serious postoperative complications (28.1%). Two hospital-acquired pneumonia sepsis and five late deaths had occurred. Postoperative NYHA functional status were 70.5%, 17.6%, 5.8% and 5.8% for functional classes I, II, III and IV, respectively. Actuarial eight-year survival rate was 66.9 ± 12.1%. Eight-year free thromboembolism and endocarditis rate were 90.9 ± 8.7% and 100%, respectively. CONCLUSION: Aortic valve preservation surgery at the aged with AS was revealed a low morbidity and mortality procedure and presented an eight-year acceptable survival rate and functional status improvement among the studied series of patients.
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- 2008
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15. Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíaca Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery
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Célia Regina Lopes, Carlos Manuel de Almeida Brandão, Emília Nozawa, and José Otávio Costa Auler Jr
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Procedimentos cirúrgicos cardíacos ,Unidades de terapia intensiva ,Respiração artificial ,Desmame do respirador ,Ventilação com pressão positiva intermitente ,Cardiac surgical procedures ,Intensive care units ,Respiration, artificial ,Ventilator weaning ,Intermittent positive-pressure ventilation ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: Demonstrar os benefícios da utilização da ventilação não-invasiva (VNI) no processo de interrupção da ventilação mecânica, no pós-operatório de cirurgia cardíaca. MÉTODOS: Estudo prospectivo, randomizado e controlado, com 100 pacientes submetidos a cirurgia de revascularização do miocárdio ou cirurgia valvar. Os pacientes foram admitidos na Unidade de Terapia Intensiva (UTI), sob ventilação mecânica e randomizados posteriormente em grupo estudo (n= 50) que utilizou VNI com dois níveis pressóricos após a extubação por 30 minutos, e grupo controle (n= 50) que fez uso apenas de cateter nasal de O2. Foram analisadas as variáveis antropométricas, os tempos correspondentes à anestesia, cirurgia e circulação extracorpórea, bem como o tempo necessário para a supressão da ventilação mecânica invasiva. As variáveis gasométricas e hemodinâmicas também foram avaliadas antes e após a extubação. RESULTADOS: Os grupos controle e estudo evoluíram de forma semelhante e não apresentaram diferença estatisticamente significante na análise das variáveis, exceto para a PaO2. A utilização da VNI por 30 minutos após a extubação promoveu melhora na PaO2 quando comparados os grupos, com p= 0,0009, mas não apresentou diferença estatisticamente significante na PaCO2 (p=0,557). CONCLUSÃO: O uso da VNI por 30 minutos após extubação produziu melhora na oxigenação do pacientes em pósoperatório imediato de cirurgia cardíaca.OBJECTIVE: to show the benefits of the use of non-invasive positive pressure ventilation (NPPV) in the process of weaning from mechanical ventilation in the immediate postoperative period of heart surgery. METHODS: A prospective, randomized and controlled study was performed involving 100 consecutive patients submitted to coronary artery bypass grafting or valve surgery. The subjects were admitted into the Intensive Care Unit (ICU) under mechanical ventilation and randomized in a study group (n=50), which used NPPV with bilevel pressure for 30 minutes after extubation, and a control group (n=50) which only used a nasal O2 catheter. Anthropometric variables and the times of the intra-operative periods corresponding to anesthesia, surgery and cardiopulmonary bypass, as well as the time required for weaning from invasive mechanical ventilation were analysed. The arterial blood gases and hemodynamic variables were also assessed before and after extubation. RESULTS: The evolution was similar for the control and study groups without statistically significant differences of the variables analyzed except for the PaO2. On comparing the groups, the PaO2 improved significantly (p = 0.0009) with the use of NPPV for 30 minutes after extubation, but there was no statistically significant difference in the PaCO2 (p = 0.557). CONCLUSION: The use of NPPV for 30 minutes after extubation improved oxygenation in the immediate postoperative period of heart surgery.
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- 2008
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16. Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica Particulate emboli capture by an intra-aortic filter device during aortic valve replacement
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Osanan Amorim Leite Filho, Carlos Manuel de Almeida Brandão, Pablo Maria Alberto Pomerantzeff, Marco Antônio Vieira Guedes, Maria de Lourdes Higuchi, and Noedir Antônio Groppo Stolf
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Estenose da valva aórtica ,Embolia ,Acidente vascular cerebral ,Filtração ,Implante de prótese de valva ,Aortic valve stenosis ,Embolism ,Stroke ,Filtration ,Heart valve prosthesis implantation ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: O objetivo deste estudo foi avaliar a atividade embólica de pacientes portadores de estenose aórtica calcificada submetidos a troca valvar aórtica por meio da filtração intra-aórtica com dispositivo EMBOL-X® System (Edwards Lifesciences Inc., Mountain View, CA, USA). MÉTODOS: De janeiro de 2007 a julho de 2007, foi utilizado o filtro intra-aórtico EMBOL-X após o despinçamento aórtico em 13 portadores de estenose aórtica calcificada submetidos a troca valvar aórtica consecutivamente. A média de idade dos pacientes foi 63,7 anos (34-79) e 61,5% eram do sexo feminino. A média do tempo de CEC foi 60,2±7,5 (45-72) minutos e a média do tempo despinçamento aórtico foi 50±7,5 (35-63) minutos. Após a retirada dos filtros, eles foram fixados em formalina, analisados macroscopicamente e quantificados os fragmentos capturados. Foi realizado exame histológico do material capturado. RESULTADOS Não foi observado nenhum caso de complicação neurológica. Nenhum paciente apresentou insuficiência renal pós-operatória. Não houve óbitos hospitalares. Partículas embólicas foram encontradas em cinco (38,5%) dos filtros. Das partículas embólicas capturadas, em dois (40%) filtros havia fibrina, dois (40%) apresentavam tecido conjuntivo, um (20%) continha hemácias e em um não foi possível determinar a natureza. CONCLUSÃO: O dispositivo EMBOL-X® System foi efetivo na captação de fragmentos intra-aórticos na substituição da valva aórtica em pacientes com estenose aórtica calcificada.OBJECTIVE: This study aims to analyze the embolic activity in patients with calcified aortic stenosis who underwent aortic valve replacement using intra-aortic filtration with an EMBOL-X® System device (Edwards Lifesciences Inc., Mountain View, CA, USA). METHODS: From January 2007 to July 2007, 13 consecutive patients with calcified aortic stenosis, who underwent isolated aortic valve replacement using intra-aortic filtration by an EMBOL-X® System for 5 minutes after aortic clamp release, were evaluated. Mean patient age was 63.7 years (range 34 to 79 years) and 61.5% were female. The mean bypass time was 60.2 ± 7.5 minutes (range 45 to 72 minutes) and the mean cross-clamp time was 50 ± 7.5 minutes (range 35 to 63 minutes). Following removal, each filter was fixed in formalin and analyzed macroscopically with the captured fragments being counted. Histological examinations of the captured material were performed. RESULTS: There were no strokes or gross neurological events. There were no cases of postoperative renal failure. No deaths were reported during hospitalization. Particulate emboli were found in five (38.5%) of the filters. On histological analysis of the particulate emboli captured, two (40%) contained fibrin, two (40%) presented conjunctive tissue, one (20%) contained red blood cells and in one it was not possible to determine the nature of the particulates captured. CONCLUSION: The EMBOL-X® System device was effective in particulate emboli capture in aortic valve replacement surgery of patients with calcified aortic stenosis.
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- 2008
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17. Plastia da valva mitral com a técnica do 'Duplo Teflon': resultados de 10 anos Mitral valve repair with 'Double Teflon' technique: 10-year results
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Carlos Manuel de Almeida Brandão, Marco Antonio Vieira Guedes, Marcos Floripes da Silva, Marcelo Luiz Vieira, Pablo Maria Alberto Pomerantzeff, and Noedir Antonio Groppo Stolf
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Insuficiência da valva mitral ,Valva mitral ,Valvas cardíacas ,Mixomatose infecciosa ,Mitral valve insufficiency ,Mitral valve ,Heart valves ,Myxomatosis, infectious ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: O objetivo deste trabalho é apresentar os resultados clínicos tardios da plástica da valva mitral com a técnica do "Duplo Teflon". MÉTODOS: A plástica de "Duplo Teflon" consiste em técnica de reparo mitral com ressecção quadrangular da cúspide posterior, anuloplastia segmentar com plicatura do anel com de fios com "pledgets" sobre uma tira de Teflon, e sutura borda a borda da cúspide. Entre abril de 1994 e dezembro de 2003, 133 pacientes com diagnóstico de insuficiência mitral degenerativa com alongamento ou rotura de cordas da cúspide posterior foram submetidos à plástica com esta técnica. A idade média foi de 60,4 anos e 60,9% eram do sexo feminino. Quanto à avaliação clínica no pré-operatório, 29,3% dos pacientes estavam em classe funcional IV, 55,7% em classe III e 15,0% em classe II. Técnicas associadas de plástica mitral foram utilizadas em 15,2% dos pacientes, sendo a mais comum o encurtamento de cordas. Vinte e seis (19,5%) pacientes foram submetidos a operações associadas. RESULTADOS: Houve um (0,75%) óbito hospitalar. No período pós-operatório tardio, 95,5% dos sobreviventes estavam em classe funcional I. As taxas linearizadas de tromboembolismo, reoperação e óbito foram 0,9%, 0,3% e 0,6% pacientes/ano, respectivamente. A sobrevida atuarial em 10 anos foi de 94,1% ± 3,6%. As sobrevidas atuariais livre de tromboembolismo e reoperação foram de 97,3 ± 1,5% e 99,2 ± 0,8%, respectivamente. Não houve casos de endocardite ou hemólise. CONCLUSÃO: A plástica da valva mitral com a técnica do "Duplo Teflon" apresenta baixa morbi-mortalidade e boa evolução clínica tardia.OBJECTIVE: The purpose of this paper is to present the late clinical results of mitral valve repair with the "Double Teflon" technique. METHODS: "Double Teflon" technique consists of a quadrangular resection of the posterior leaflet, annulus plication with "pledgetted" stitches over a Teflon patch, and leaflet suture. Between 1994 and 2003, 133 patients with degenerative mitral insufficiency due to ruptured or elongated chordae in the posterior leaflet underwent repair with this technique. The mean patient age was 60.4 years and 60.9% patients were male. According to clinical evaluation, 29.3% of the patients were in New York Heart Association functional class IV, 55.7% in class III and 15.0% in class II. Associated techniques of mitral valve repair were used in 15.2% of the patients; the most common was chordal shortening. Twenty six (19.5%) patients had associated procedures. RESULTS: There was one (0.75%) operative death. In the late postoperative period, 95.5% of the surviving patients were in New York Heart Association functional class I. Linearized rates of thromboembolism, reoperation and death were 0.9%, 0.3% and 0.6% patient/year, respectively. The actuarial survival at 10 years was 94.7% ± 3.6%. Actuarial freedom from thromboembolism and reoperation were 97.3 ± 1.5% and 99.2 ±0.8%, respectively. There were no episodes of hemolysis or endocarditis. CONCLUSION: Mitral valve repair with "Double Teflon" technique presents low morbimorbidity and good clinical late evolution.
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- 2007
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18. Study of the traction resistance of mitral valve chordae tendineae Estudo da resistência à tração das cordas da valva mitral
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Frederico Lafraia Lobo, Flávio Roberto Takeda, Carlos Manuel de Almeida Brandão, Domingo Marcolino Braile, Fabio Biscegli Jatene, and Pablo Maria Alberto Pomerantzeff
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Cordoalha ,Corda Tendinea ,Valva Mitral ,Aparelho atrio-ventricular ,Resistência ,Alongamento ,Chordae Tendineae ,Mitral Valve ,Left Atrioventricular Apparatus ,Elongation ,Stretching Resistance ,Medicine (General) ,R5-920 - Abstract
OBJECTIVE: To determinate the extension and the resistance of the primary mitral valve chordae tendineae when submitted to traction. The importance of keeping the integrity of papillary muscle, chordae tendineae, and mitral valve cuspid when the replacement of this valve occurs is clear, but the knowledge of the maximum resistance that a primary tendinea chorda can withstand is not known. METHODS: Eight hearts were dissected, and one hundred and thirty two primary human chordae tendineae were measured (length and thickness) and submitted to traction under controlled conditions so that the absolute resistance, resistance relative to thickness (relative resistance), and elongation could be measured. RESULTS: The correlation between the elongation at the moment of rupture and the thickness was equal to 1.54 + 17.02 x thickness (P = 0.026); and to absolute resistance was equal to 0.95 + 1.42 x resistance (P < 0.001); and to the resistance relative to thickness (relative resistance) was equal to 1.95 + 0.08 x relative resistance (P = 0.009). The correlation between the absolute resistance and the thickness was equal to 0.26 + 14.53 x thickness (P < 0.001). CONCLUSION: The resistance of primary mitral valve chordae tendineae is associated with its thickness and elongation at the moment of rupture, but is not associated with the length. The elongation at the moment of rupture shows a relationship with the resistance relative to thickness (relative resistance) and with the thickness of the primary chordae tendineae, but not with the length of the chordae tendineae.OBJETIVO: Determinar o alongamento e a resistência à tração das cordas tendíneas primárias humanas da valva mitral cardíaca. Sabe-se da importância de se manter a integridade do músculo papilar, corda tendínea e cúspide da valva mitral, quando da substituição desta valva, mas não se tem conhecimento da resistência máxima que uma corda tendínea primaria pode sofrer resistência máxima que uma corda tendínea apresenta. MÉTODO: Foram dissecados 8 corações que permitiram a tração de cento e trinta e duas cordas tendíneas primárias humanas. Foram dissecados 8 corações que permitiram a tração de cento e trinta e duas cordas tendíneas primárias humanas, as quais foram medidas (comprimento e espessura) e submetidas a trações em condições controladas, e assim a resistência absoluta, a resistência relativa a espessura (resistência relativa) e o alongamento puderam ser medidos. RESULTADOS: A correlação entre alongamento no momento da ruptura e espessura foi igual a 1,54 + 17,02*espessura (p=0,026); e à resistência absoluta foi igual a 0,95 + 1,42*resistência (p
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- 2006
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19. Mitral valve annuloplasty with a bovine pericardial strip - 18-year results Anuloplastia mitral com tira de pericárdio bovino resultados de 18 anos
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Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, João Marcelo Ancilon Albuquerque, Paola Yastrevov Pomerantzeff, Flavio Takeda, and Sergio A. Oliveira
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Valva mitral ,Anuloplastia ,Cirurgia valvar ,Pericardio bovino ,Plástica valvar ,Mitral valve ,Annuloplasty ,Valve surgery ,Bovine pericardium ,Valve repair ,Medicine (General) ,R5-920 - Abstract
PURPOSE: Prosthetic annuloplasty rings are currently used in mitral reconstruction. Posterior annuloplasty with a bovine pericardial strip is a technique largely used in the Heart Institute of University of São Paulo Medical School. The purpose of the study was to analyze the late results of mitral valve repair with posterior annuloplasty using a bovine pericardial strip. METHODS: Between January 1984 and December 2002, 273 patients underwent mitral valve repair with posterior pericardial annuloplasty in the Heart Institute of University of São Paulo Medical School. One hundred and forty four (52.7%) were women and ages ranged between 1 and 76 years (38.3 ± 21.1). Rheumatic fever was present in 52.0% of the patients. Associated techniques were employed in 26.0% of the patients, and the most frequent was chordal shortening (9.2%). RESULTS: Hospital mortality was 3.3% (9 patients), with the major cause being low cardiac output (6 patients). Actuarial survival was 55.1% ± 16.8% in 18 years. During the 18-year follow-up: patients were free from the following: reoperation (59.1% ±± 13.9%, (percent +/- Standard Error), thromboembolism (97.4% ± 2.3%), hemolysis (99.2% ± 0.2%), and endocarditis (99.6% ± 1.0%). In the late follow-up period, 83.9% were classified as New York Heart Association functional class I. CONCLUSIONS: Late results with mitral valve repair with posterior annuloplasty using a bovine pericardial strip were satisfactory. The technique is feasible, reproducible, and cost effective.OBJETIVO: Anéis protéticos para anuloplastia são usados nas plásticas da valva mitral de forma rotineira. A anuloplastia posterior com tira de pericárdio bovino é uma técnica largamente utilizada no Instituto do Coração - HC - FMUSP. O objetivo deste estudo foi analisar os resultados tardios da plástica da valva mitral com a utilização desta técnica na nossa instituição. MÉTODOS: Entre janeiro de 1984 e dezembro de 2002, 273 pacientes foram submetidos a plástica da valva mitral com anuloplastia posterior no Instituto do Coração. Foram excluídos os pacientes submetidos a outros procedimentos no anel posterior. Cento e quarenta e quatro (52,7%) eram do sexo feminino e a idade variou entre 1 e 76 anos (média: 38,3 ± 21,1 anos). Em 52% dos pacientes, havia história de febre reumática. Técnicas associadas para reconstrução valvar foram empregadas em 26% dos casos, sendo a mais utilizada, o encurtamento de cordas (9,2%). RESULTADOS: A mortalidade hospitalar foi de 3,3% (9 casos). A principal causa de óbito foi baixo débito cardíaco (6 pacientes). A sobrevida actuarial foi de 55,1 ± 16,8% (percent +/- Standard Error) em 18 anos, sobrevida livre de reoperação, tromboembolismo, hemólise e endocardite foram respectivamente de 59,1 ± 13,9%, 97,4 ± 2,3%, 99,2 ± 0,2%, 99,6 ± 1,0% em 18 anos. No seguimento tardio, 83,9% dos pacientes se encontravam em classe funcional I (NYHA). CONCLUSÕES: Concluímos que os resultados tardios foram satisfatórios. A técnica é fácil, reprodutível e de baixo custo.
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- 2005
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20. Plástica valvar mitral pela técnica de 'Duplo Teflon' em pacientes com anel valvar calcificado e degeneração mixomatosa Mitral valve repair using the double Teflon technique in patients with severely calcified annuli and myxomatous disease
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João Marcelo A.C. de Albuquerque, Paola Y. Pomerantzeff, Carlos Manuel de Almeida Brandão, Max Grinberg, Pablo M. A. Pomerantzeff, and Sérgio Almeida de Oliveira
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Insuficiência da valva mitral ,Valva mitral ,Valvas cardíacas ,Calcinose ,Mitral valve insufficiency ,Mitral valve ,Heart valves ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: O objetivo deste estudo é apresentar resultados imediatos e tardios da plástica da valva mitral pela técnica de Duplo Teflon, em pacientes com insuficiência mitral importante que apresentam anel valvar gravemente calcificado e degeneração mixomatosa. MÉTODO: Entre 1985 e 2002, 162 pacientes com insuficiência mitral devido à degeneração mixomatosa foram submetidos a plástica da valva mitral no Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo. Deste total, 13 pacientes que apresentavam anel valvar gravemente calcificado foram submetidos à plástica da valva com ressecção quadrangular e anuloplastia pela técnica de Duplo Teflon. A idade média dos pacientes foi 65,4 +/- 12,9 anos, e 69,2% dos pacientes eram do sexo masculino. Um (7,7%) paciente tinha doença coronariana associada e foi submetido à cirurgia de revascularização do miocárdio. No período pré-operatório, 15,4% dos pacientes estavam em classe funcional IV, 69,2% em classe III e 15,4% em classe II. RESULTADOS: Não houve óbito no período pós-operatório imediato. No período pós-operatório tardio, 90,9% dos pacientes vivos estavam em classe funcional I. Não houve complicações como hemólise ou endocardite. Um paciente foi reoperado no segundo mês do período pós-operatório sendo realizada troca da valva mitral. A sobrevida atuarial em 14 anos foi 71,4 +/- 17,1%. CONCLUSÃO: A plástica da valva mitral com a técnica de Duplo Teflon, em pacientes com insuficiência mitral importante devido à degeneração mixomatosa e anel valvar gravemente calcificado, apresentou taxa de sobrevida satisfatória e boa evolução clínica, sugerindo ser melhor alternativa em relação à troca valvar.OBJECTIVE: The purpose of this study is to present the immediate and long-term results of mitral valve repair using the double Teflon technique in patients with mitral insufficiency due to myxomatous disease and severely calcified annuli. METHOD: Between 1985 and 2002, 162 patients with mitral insufficiency due to myxomatous degeneration were submitted to mitral valve repair in the Heart Institute of University of São Paulo Medical School. From these, 13 presented severely calcified annuli and underwent mitral valve repair with quadrangular resection and annuloplasty using the double Teflon technique. The mean patient age was 65.4 +/- 12.9 year with 69.2% of the patients being male. One (7.7%) patient had associated coronary artery disease and was submitted to coronary artery bypass grafting. In the preoperative period, 15.4% of the patients were in functional class IV of the New York Heart Association, 69.2% in class III and 15.4% in class II. RESULTS: There was no operative death.In late postoperative period, 90.9% of the surviving patients were in functional class I. There were no episodes of hemolysis or endocarditis. One patient was reoperated on the second postoperative month and was submitted to mitral valve replacement. The actuarial survival at 14 years was 71.4% +/- 17.1%. CONCLUSIONS: Mitral valve repair using the double Teflon technique in patients with myxomatous disease and severely calcified annuli presented satisfactory survival rates and good clinical evolution and proved to be a better alternative than mitral valve replacement.
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- 2005
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21. Endotelização in vivo das biopróteses cardíacas: preservação convencional versus não-aldeídica In vivo endothelialization of cardiac bioprostheses: conventional versus non-aldehyde preservation
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Vinicius José da Silva Nina, Pablo Maria Alberto Pomerantzeff, Ivan Sérgio Joviano Casagrande, David Chung, Carlos Manuel de Almeida Brandão, Sérgio Antonio Barbosa do Nascimento, Luiz Alberto Benvenuti, and Sérgio Almeida de Oliveira
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Bioprótese ,Prótese das valvas cardíacas ,Glutaral ,Bioprosthesis ,Heart valve prosthesis ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: O revestimento endotelial in vitro das biopróteses com células do hospedeiro parece ter ação protetora contra a calcificação, trombose, inflamação e o desgaste mecânico. O objetivo deste estudo é analisar o potencial para endotelização in vivo com um processo alternativo de preservação tecidual (L-HydroTM). MÉTODO: A preservação L-Hydro consiste na extração controlada de substâncias antigênicas pela ação do polietilenoglicol e na incorporação de um agente antiinflamatório e antitrombótico. Para testar a re-endotelização in vivo, foram implantadas em posição mitral de ovelhas jovens sete próteses porcinas L-Hydro (grupo teste) e três convencionais preservadas com glutaraldeído (GA - grupo controle). Estas próteses foram explantadas com 150 dias após avaliação ecocardiográfica e angiográfica. A avaliação histológica consistiu em microscopia de varredura e transmissão, e imuno-histoquímica (von Willebrand) para detecção da presença e viabilidade das células endoteliais, respectivamente. Utilizou-se o teste-t não pareado para análise estatística. RESULTADOS: Não houve diferença hemodinâmica significativa nos dois grupos (p>0.05). Entretanto, a microscopia mostrou no grupo teste um revestimento endotelial quase completo formado por células confluentes, viáveis com expressão do fator vW, as quais encontravam-se em contato direto com a matriz colagênica subjacente. No grupo controle (GA), as superfícies valvulares estavam recobertas por fibrina, macrófagos, cálcio, material trombótico e células endoteliais esparsas com expressão fraca do fator vW, e com pouco contato direto com o colágeno. CONCLUSÕES: Estes dados indicam que o processo L-HydroTM permite endotelização espontânea com boa adesividade celular à matriz colagênica, o que favoreceria maior durabilidade às biopróteses porcinas.OBJECTIVE: A protective layer of endothelial cells (EC) of host origin on the entire surface of bioprosthetic heart valves has never been reported. Current commercial bioprosthetic heart valves are commonly preserved in glutaraldehyde (GA) and are cytotoxic to host cells preventing spontaneous endothelialization. The aim of this study is to demonstrate the potential for in vivo endothelialization of heart valves treated by the L.-Hydro™ preservation process. METHOD: L-Hydro™ preservation process consists of mild extraction of antigenic substances by the action of polyethyleneglycol and incorporation of an anti-inflammatory and a anti-thrombotic agent. Seven stented porcine valves treated by the L-Hydro™ process and three GA-fixed porcine valves were implanted in the mitral position of juvenile sheep. The valves were evaluated by echocardiography and angiography prior to sacrifice at five months. Recovered valves were also histologically and histo-chemically evaluated. RESULTS: There were no hemodynamic differences between the groups. However, scanning and transmission electron microscopy showed a nearly complete coverage of EC on the surfaces of all leaflets in the L-Hydro™ treated valves. The EC were in direct contact with the underlying collagen layer and expressed von Willebrand-related antigens (vW). The surfaces of the GA-treated valves were covered by fibrin deposition, macrophages, calcium and thrombotic material. Only sparse EC were observed and contact of the EC where the underlying tissue was incomplete. CONCLUSION: These data indicate that L-Hydro™ treated porcine valve tissues are capable of inducing spontaneous endothelialization with evidence of strong cell attachment of the new endothelium to the collagen matrix.
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- 2004
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22. Substituição valvar com próteses mecânicas de duplo folheto
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Carlos Manuel de Almeida BRANDÃO, Pablo M. A. POMERANTZEFF, Cláudio Ribeiro da CUNHA, Juan Ignácio Espinoza MORALES, Luiz Boro PUIG, Max GRINBERG, Luís Francisco CARDOSO, Flávio TARASOUTCHI, and Noedir A. G. STOLF
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Implante de prótese de valva ,Doenças das valvas cardíacas ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: O objetivo deste estudo é analisar a experiência do Instituto do Coração com a utilização de próteses mecânicas de duplo folheto. CASUÍSTICA E MÉTODOS: No período compreendido entre junho de 1989 e agosto de 1998, foram implantadas 323 próteses mecânicas de duplo folheto em 300 pacientes. A idade média foi de 38,7 ± 18,4 anos. Cento e noventa e um (63,7%) pacientes eram do sexo masculino. A etiologia foi reumática em 161 (53,7%) pacientes. Foram realizadas 186 substituições da valva aórtica, 89 da valva mitral, 2 da valva tricúspide, 22 substituições mitro-aórticas e 1 mitro-tricuspídea. Quanto à classe funcional (CF), 73 (24,3%) pacientes se encontravam em CF IV, 165 (55,4%) em CF III e 61 (20,3%) em CF II. RESULTADOS: A mortalidade hospitalar foi de 9% (27 pacientes), sendo de 13,5% no grupo mitral, 7,5% no grupo aórtico e 4,5% no mitro-aórtico. As taxas linearizadas dos eventos no pós-operatório tardio são: 0,2% pacientes/ano (pac./ano) para endocardite, 0,3% pac./ano para escape paravalvar, 0,2% pac./ano para hemorragia relacionada à anticoagulação e 1,0% pac./ano para tromboembolismo. No pós-operatório tardio 213 (91%) pacientes encontram-se em classe funcional I ,16 (6,8%) em CF II e 4 (1,7%) em CF III e 1 (0,5%) em CF IV. A sobrevida actuarial em 9 anos foi de 68,1 ± 15,5% para a posição mitral e 67,5 ± 10,8% para a aórtica. CONCLUSÃO: Concluímos que os resultados com a utilização das próteses mecânicas de duplo folheto são satisfatórios.
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- 2000
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23. Mitral valve repair. Quadrangular resection of the posterior leaflet in patients with myxomatous degeneration
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Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, Eduardo Giusti Rossi, Luís Francisco Cardoso, Flávio Tarasoutchi, Max Grinberg, Noedir Antonio Groppo Stolf, Luiz Boro Puig, Geraldo Verginelli, and Adib Domingos Jatene
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mitral valve repair ,valvular surgery ,mitral annuloplasty ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJECTIVE - To analyze the immediate and late results of mitral valve repair with quadrangular resection of the posterior leaflet without the use of a prosthetic ring annuloplasty. METHODS - Using this technique, 118 patients with mitral valve prolapse who underwent mitral repair from January '84 through December '96 were studied. Age ranged from 30 to 86 (mean = 59.1±11.8) years and 62.7% were males. An associated surgery was performed in 22% of the patients, and coronary artery bypass graft was the most frequently performed surgery (15 patients - 12.7%). In 20 (16.9%) patients other associated techniques of mitral valve repair were used and shortening of elongated chordae tendineae was the most frequent one (6 patients). RESULTS - Immediate mortality was 0.9% (one patient). Long-term rates for thromboembolism, endocarditis, re-operation and death in the late postoperative period were 0.4%, 0.4%, 1.7% and 2.2% patients/year, respectively. The actuarial curve of survival was 83.8±8.6% over 12 years; survival free from re-operation was 91.8±4.3%, free from endocarditis was 99.2±0.8% and free from thromboembolism was 99.2±0.8%. In the late postoperative period, 93.8% of the patients were in functional class 1 (NYHA), with a complete follow-up in 89.7% of the patients. CONCLUSION - Patients with mitral valve prolapse who undergo mitral valve repair using this technique have a satisfactory prognosis over 12 years.
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- 1999
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24. Cirurgia valvar em gestantes. Experiência em oito casos
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Pablo Maria Alberto Pomerantzeff, Anderson Benício, Carlos Manuel de Almeida Brandão, Walkiria Samuel Ávila, Paulo Cesar Luiz Bueno, Max Grinberg, Maria Rita Lemos Bortolotto, Noedir Antonio Groppo Stolf, and Adib Domingos Jatene
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cirurgia cardíaca ,gravidez ,circulação extracorpórea ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: Analisar, em gestantes, os resultados da cirurgia cardíaca e as conseqüências da circulação extracorpórea (CEC) nas gestantes e fetos. MÉTODOS: Estudo de 8 gestantes submetidas à cirurgia cardíaca valvar entre janeiro/86 e dezembro/96. Idade média de 31,4±8,9 anos, e idade gestacional entre 12 a 31 (média de 26,6±7,1) semanas. Em todas as pacientes foi realizada monitorização fetal. Durante a CEC manteve-se sempre o fluxo elevado e a temperatura acima de 34°C. Foram realizadas 4 cirurgias da valva aórtica e 4 da valva mitral, sendo duas reoperações. RESULTADOS: Não houve mortalidade materna. Ocorreram dois partos prematuros e em uma criança houve comprometimento neurológico. As demais crianças não apresentaram nenhum comprometimento em seu desenvolvimento. CONCLUSÃO: Os cuidados com o fluxo durante a CEC e a monitorização fetal no intra-operatório foram fundamentais para a obtenção de resultados bastante satisfatórios.
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- 1998
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25. Uso do pericárdio autólogo para reforço da aortorrafia no tratamento cirúrgico da valva aórtica The use of autologous pericardium to reinforce the aorta suture in the surgical treatment of the aortic valve
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Marco Antonio Vieira Guedes, Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, and Sérgio Almeida de Oliveira
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Pericárdio ,Técnicas de sutura ,Retalhos cirúrgicos ,Procedimentos cirúrgicos cardíacos ,Pericardium ,Suture techniques ,Surgical flaps ,Cardiac surgical procedures ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
O reparo da aortotomia no tratamento cirúrgico da valva aórtica pode ser realizado por meio de diferentes técnicas. Em alguns casos, porém, a aorta ascendente encontra-se aterosclerótica, fina e friável, aumentando o risco de rotura no pós-operatório imediato e formação tardia de aneurismas. Este trabalho descreve uma técnica de reforço da aortorrafia com a utilização de pericárdio autólogo e seus resultados, através da análise retrospectiva de 23 casos realizados no Instituto do Coração de São Paulo, entre 1999 e 2003.The repair of the aortotomy in the surgical treatment of aortic valve can be achieved using different techniques. Nevertheless, in some cases, the ascending aorta is atherosclerotic, thin and friable, making the risk of aorta rupture and late aneurysm development higher. This article describes the technique and the results obtained from the reinforcement of aortic suture with autologous pericardium by retrospective analysis of 23 cases from the Heart Institute of São Paulo, between 1999 and 2003.
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- 2004
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26. Paciente portadora de doença de von Willebrand submetida a cirurgia da valva mitral: uma estratégia para o controle da coagulopatia Patient with von Willebrand disease undergoing mitral valve repair: a strategy for the control of the coagulopathy
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Ally Nader Roquetti Saroute, Carlos Manuel de Almeida Brandão, Marco Antônio Vieira Guedes, Cyrillo Cavalheiro Filho, and Pablo Maria Alberto Pomerantzeff
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Doença de von Willebrand ,valva mitral ,coagulação intravascular disseminada ,Von Willebrand disease ,mitral valve ,disseminated intravascular coagulation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Relatamos o caso de uma mulher de 60 anos portadora da doença de von Willebrand tipo I, submetida a cirurgia da valva mitral. A paciente necessitou de cuidados especiais em razão da coagulopatia e foi necessária a utilização de concentrado de fator VIII (VIIIf) e fator de von Willebrand (vWf) antes, durante e depois da cirurgia. Não houve complicações durante e após a cirurgia. Nove meses depois, a paciente encontra-se assintomática. A correção para valores adequados de VIIIf e vWf permitiu a realização da cirurgia com segurança.We report a case of a 60 year-old woman with von Willebrand disease type I that was submitted to a mitral valve repair. The patient needed special care due coagulopathy and needed VIII factor (VIIIf) and von Willebrand factor (vWf), before, during and after surgery. There was no complication during or after surgery. Patient is asymptomatic nine months postoperatively. The correction of VIIIf and vWf allowed the realization of a safety surgery.
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- 2007
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27. Atualização das Diretrizes Brasileiras de Valvopatias: Abordagem das Lesões Anatomicamente Importantes
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Flavio Tarasoutchi, Marcelo Westerlund Montera, Auristela Isabel de Oliveira Ramos, Roney Orismar Sampaio, Vitor Emer Egypto Rosa, Tarso Augusto Duenhas Accorsi, Antonio Sergio de Santis Andrade Lopes, João Ricardo Cordeiro Fernandes, Lucas José Tachotti Pires, Guilherme Sobreira Spina, Marcelo Luiz Campos Vieira, Paulo de Lara Lavitola, Tiago Costa Bignoto, Dorival Julio Della Togna, Evandro Tinoco Mesquita, William Antonio de Magalhães Esteves, Fernando Antibas Atik, Alexandre Siciliano Colafranceschi, Valdir Ambrósio Moisés, Alberto Takeshi Kiyose, Pablo Maria Alberto Pomerantzeff, Pedro Alves Lemos Neto, Fábio Sândoli de Brito Júnior, Clara Weksler, Carlos Manuel de Almeida Brandão, Robinson Poffo, Ricardo Simões, Salvador Rassi, Paulo Ernesto Leães, Ricardo Mourilhe Rocha, José Luiz Barros Pena, Fabio Biscegli Jatene, Márcia de Melo Barbosa, João David de Souza Neto, and José Francisco Kerr Saraiva
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Full Text
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28. Analysis of >100,000 Cardiovascular Surgeries Performed at the Heart Institute and a New Era of Outcomes
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Omar A.V. Mejia, Luiz Augusto Ferreira Lisboa, Luiz Fernando Caneo, Elisandra Trevisan Arita, Carlos Manuel de Almeida Brandão, Ricardo Ribeiro Dias, Roberto Costa, Marcelo Biscegli Jatene, Pablo Maria Alberto Pomerantzeff, Luís Alberto Oliveira Dallan, and Fabio Biscegli Jatene
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cardiovascular surgical procedures/trends ,quality improvement ,patient safety ,hospital mortality ,database ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background: The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes. Objective: To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clínicas Heart Institute of the University of São Paulo Medical School (InCor-HCFMUSP). Methods: An outcome analysis of CVSs performed at the InCor, between January 1984 and June 2019. We observed the surgical volume and mortality rates in 5 time periods: 1st (1984-1989), 2nd (1990-1999), 3rd (2000-2007), 4th (2008-2015) and 5th (2016-2019). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures. Results: A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001). Conclusion: In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards.
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29. Perioperative Management of the Diabetic Patient Referred to Cardiac Surgery
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Camila Perez de Souza Arthur, Omar Asdrúbal Vilca Mejía, Gisele Aparecida Lapenna, Carlos Manuel de Almeida Brandão, Luiz Augusto Ferreira Lisboa, Ricardo Ribeiro Dias, Luís Alberto Oliveira Dallan, Pablo Maria Alberto Pomerantzeff, and Fabio B. Jatene
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Cardiac Surgery ,Perioperative Management of the Diabetic Patient ,Diabetes Mellitus ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (< 180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. This update is based on the latest current literature derived from articles and guidelines regarding perioperative management of diabetic patients to cardiovascular surgery.
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30. Pre-validation Study of the Brazilian Version of the Disruptions in Surgery Index (DiSI) as a Safety Tool in Cardiothoracic Surgery
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Vinicius José da Silva Nina, Fabio B. Jatene, Nick Sevdalis, Omar Asdrúbal Vilca Mejía, Carlos Manuel de Almeida Brandão, Rosangela Monteiro, Luiz Fernando Caneo, Paula Gobi Scudeller, Augusto Dimitry Mendes, Vinícius Giuliano Mendes, and Bellkiss Wilma Romano
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Surveys and Questionnaires ,Translating ,Environment ,Medical Errors/Prevention & Control ,Patient Care Team/Organization & Administration ,Quality Assurance, Health Care ,Safety Management ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Introduction: Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective: The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods: A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results: The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion: Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study.
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31. Atualização das Diretrizes Brasileiras de Valvopatias – 2020
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Flavio Tarasoutchi, Marcelo Westerlund Montera, Auristela Isabel de Oliveira Ramos, Roney Orismar Sampaio, Vitor Emer Egypto Rosa, Tarso Augusto Duenhas Accorsi, Antonio de Santis, João Ricardo Cordeiro Fernandes, Lucas José Tachotti Pires, Guilherme S. Spina, Marcelo Luiz Campos Vieira, Paulo de Lara Lavitola, Walkiria Samuel Ávila, Milena Ribeiro Paixão, Tiago Bignoto, Dorival Júlio Della Togna, Evandro Tinoco Mesquita, William Antônio de Magalhães Esteves, Fernando Atik, Alexandre Siciliano Colafranceschi, Valdir Ambrósio Moises, Alberto Takeshi Kiyose, Pablo M. A. Pomerantzeff, Pedro A. Lemos, Fabio Sandoli de Brito Junior, Clara Weksler, Carlos Manuel de Almeida Brandão, Robinson Poffo, Ricardo Simões, Salvador Rassi, Paulo Ernesto Leães, Ricardo Mourilhe-Rocha, José Luiz Barros Pena, Fabio Biscegli Jatene, Márcia de Melo Barbosa, Alexandre Abizaid, Henrique Barbosa Ribeiro, Fernando Bacal, Carlos Eduardo Rochitte, José Honório de Almeida Palma da Fonseca, Samira Kaissar Nasr Ghorayeb, Marcelo Antonio Cartaxo Queiroga Lopes, Salvador Vicente Spina, Ricardo H. Pignatelli, and José Francisco Kerr Saraiva
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Full Text
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32. Creative strategies for spatial policy making in Brazilian ‘new left regionalism’: fighting inequalities and COVID-19 in the north-east region
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Carlos Manuel de Almeida Brandão and Hipólita Siqueira
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Economics and Econometrics ,Sociology and Political Science ,Inequality ,Coronavirus disease 2019 (COVID-19) ,Policy making ,Political science ,Political economy ,media_common.quotation_subject ,Geography, Planning and Development ,Regionalism (international relations) ,New Left ,North east ,media_common - Abstract
The literature on the new regionalism has highlighted the leading role played by regions in the contemporary process of state rescaling and the governance of policy-making. We argue that a (re)politicisation of North-east Brazil and the emergence of a new left regionalism are underway. We examine the political and socioeconomic circumstances of this process through the creation of the Interstate Consortium for the Sustainable Development of the North-east. We conclude that while many challenges still lie ahead, this experience has demonstrated potential for the coherence of policies, and for constituting new political actors and arenas for the concertation of interests.
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- 2021
33. Partial pericardiectomy for refractory acute tuberculous pericarditis: A case report
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André Loureiro Fernandes, Fabrício José Dinato, Elinthon Tavares Veronese, Carlos Manuel de Almeida Brandão, Vera Demarchi Aiello, and Fabio Biscegli Jatene
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Surgery - Published
- 2023
34. Quality improvement program in Latin America decreases mortality after cardiac surgery: a before-after intervention study
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Omar Asdrúbal Vilca Mejia, Gabrielle Barbosa Borgomoni, Luís Roberto Palma Dallan, Bruno Mahler Mioto, Tarso Augusto Duenhas Accorsi, Eduardo Gomes Lima, Alexandre de Matos Soeiro, Felipe Gallego Lima, Carlos Manuel de Almeida Brandão, Pablo Maria Alberto Pomerantzeff, Luís Alberto Oliveira Dallan, Luiz Augusto Ferreira Lisboa, and Fábio Biscegli Jatene
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Latin America ,Treatment Outcome ,Postoperative Complications ,Humans ,Thoracic Surgery ,Surgery ,General Medicine ,Hospital Mortality ,Cardiac Surgical Procedures ,Coronary Artery Bypass ,Quality Improvement ,Retrospective Studies - Abstract
The current challenge of cardiac surgery (CS) is to improve outcomes in adverse scenarios. The aim of this study was to assess the impact of a quality improvement program (QIP) on hospital mortality in the largest CS center in Latin America.Patients were divided into two groups: before (Jan 2013-Dec 2015, n = 3534) and after establishment of the QIP (Jan 2017-Dec 2019, n = 3544). The QIP consisted of the implementation of 10 central initiatives during 2016. The procedures evaluated were isolated coronary artery bypass grafting surgery (CABG), mitral valve surgery, aortic valve surgery, combined mitral and aortic valve surgery, and CABG associated with heart valve surgery. Propensity Score Matching (PSM) was used to adjust for inequality in patients' preoperative characteristics before and after the implementation of QIP. A multivariate logistic regression model was built to predict hospital mortality and validated using discrimination and calibration metrics.The PMS paired two groups using 5 variables, obtaining 858 patients operated before (non-QIP) and 858 patients operated after the implementation of the QIP. When comparing the QIP versus Non-QIP group, there was a shorter length of stay in all phases of hospitalization. In addition, the patients evolved with less anemia (P = 0.001), use of intra-aortic balloon pump (P = 0.003), atrial fibrillation (P = 0.001), acute kidney injury (P 0.001), cardiogenic shock (P = 0.011), sepsis (P = 0.046), and hospital mortality (P = 0.001). In the multiple model, among the predictors of hospital mortality, the lack of QIP increased the chances of mortality by 2.09 times.The implementation of a first CS QIP in Latin America was associated with a reduction in length of hospital stay, complications and mortality after the cardiac surgeries analyzed.
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- 2022
35. Evaluation method of training simulation on biological models for cardiovascular surgery residents
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Fabio Biscegli Jatene, Carlos Manuel de Almeida Brandão, Rosangela Monteiro, Fabrício José Dinato, Luís Roberto Palma Dallan, and Alfredo I Fiorelli
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Swine ,medicine.medical_treatment ,media_common.quotation_subject ,Fidelity ,030204 cardiovascular system & hematology ,Models, Biological ,Session (web analytics) ,Simulation training ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Evaluation methods ,medicine ,Animals ,Computer Simulation ,Quality (business) ,Curriculum ,media_common ,business.industry ,Internship and Residency ,Surgery ,Cardiac surgery ,030228 respiratory system ,Education, Medical, Graduate ,Cardiothoracic surgery ,Cattle ,Clinical Competence ,Cardiology and Cardiovascular Medicine ,business ,Performance rating - Abstract
Objectives: The goal of this study was to describe and evaluate our simulation training program on biological models for the cardiovascular surgery residency program at our institution. Material and Methods: Since 2016, with the purpose to develop better practical performance and evaluate the improvement of resident’s surgical skills, it was implemented a simulation training program, composed of some elemental procedures in cardiovascular surgery. It was established one wet lab session weekly lasting 2 hours, coached by 2 expert cardiovascular surgeons. Bovine and porcine hearts were used as biological models. At the end of the hands on program, an objective assessment consisting of 2 practical modules was applied and performance was rated by way of a 5-point scale. In addition, to provide a subjective assessment, each resident filled out a questionnaire consisting of 3 items reviewing the overall quality of the workshops on a 10-point scale. Results: The objective evaluation applied at the end of the training program consisted by valve replacement and coronary artery bypass grafting (CABG) modules. The mean performance rating scores for valve replacement module ranged from 4.2 to 4.79, and to CABG, from 4.33 to 4.87. Regarding subjective assessment, all items evaluated, such as expert’s didactics, simulation performance and biological simulator fidelity, received high grades (above 9 on a 10-point scale). Conclusions: Simulator training on biological models for cardiac surgery medical residents is a simple and effective learning method of surgical skills.
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- 2021
36. Atualização das Diretrizes Brasileiras de Valvopatias – 2020
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Tarso Augusto Duenhas Accorsi, João Ricardo Cordeiro Fernandes, Samira Kaissar Nasr Ghorayeb, T. C Bignoto, Carlos Manuel de Almeida Brandão, Pablo Maria Alberto Pomerantzeff, Walkiria Samuel Avila, Carlos E. Rochitte, José Honório de Almeida Palma da Fonseca, Paulo Leães, Fabio Biscegli Jatene, William A. M. Esteves, Lucas José Tachotti Pires, Ricardo Simoes, Pedro A. Lemos, Auristela Isabel de Oliveira Ramos, Henrique Barbosa Ribeiro, Alexandre Abizaid, Milena Ribeiro Paixão, Robinson Poffo, Salvador Rassi, Ricardo H. Pignatelli, Fabio Sandoli de Brito Junior, Marcia M. Barbosa, Dorival Julio Della Togna, Guilherme Sobreira Spina, Alexandre Siciliano Colafranceschi, Marcelo Luiz Campos Vieira, Roney Orismar Sampaio, Alberto Takeshi Kiyose, Marcelo Westerlund Montera, Ricardo Mourilhe-Rocha, José Luiz Barros Pena, Fernando Antibas Atik, Antonio de Santis, Vitor Emer Egypto Rosa, Salvador Spina, Valdir Ambrósio Moisés, Marcelo Antônio Cartaxo Queiroga Lopes, Paulo de Lara Lavitola, Clara Weksler, Flávio Tarasoutchi, Evandro Tinoco Mesquita, Fernando Bacal, and José Francisco Kerr Saraiva
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Gynecology ,medicine.medical_specialty ,business.industry ,valvular heart disease ,Heart Valve Diseases ,American Heart Association ,030204 cardiovascular system & hematology ,medicine.disease ,Update ,03 medical and health sciences ,0302 clinical medicine ,RC666-701 ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Humans ,Atualização ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
1. Introducao Atualmente, ha grande variedade de estrategias intervencionistas – tanto transcateter, quanto cirurgicas – que podem ser indicadas para pacientes portadores de valvopatia cardiaca, com objetivo de reducao da morbimortalidade associada a esta doenca. O correto momento de indicacao e o tipo de tratamento intervencionista estao atrelados ao preciso diagnostico anatomico e funcional da valvopatia cardiaca e a uma minuciosa avaliacao global do paciente. Estas Diretrizes Brasileira de Valvopatias de 2020, alem da compilacao de evidencias cientificas e opiniao [...]
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- 2020
37. Blunt aortic injury: Surgical treatment of the ascending and descending aorta
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Gustavo Pampolha Guerreiro, Vagner Madrini Junior, Rômullo Medeiros Santos, Carlos Manuel de Almeida Brandão, Andressa Da Silva Elicker, Fabio Biscegli Jatene, and Elinthon Tavares Veronese
- Subjects
Aortic arch ,medicine.medical_specialty ,Aorta ,business.industry ,Aortic injury ,Dissection (medical) ,medicine.disease ,Surgery ,Blunt ,medicine.artery ,Concomitant ,Descending aorta ,Ascending aorta ,cardiovascular system ,Medicine ,business - Abstract
Traumatic aortic injury is potentially fatal. Although uncommon, involvement of the aortic arch and the ascending aorta can occur. This case shows concomitant dissection of the ascending and descending sections of the aorta after blunt chest trauma where the open surgical approach was successfully performed to treat both aortic injuries.
- Published
- 2021
38. Applicability of the Disruptions in Surgery Index in the Cardiovascular Management Scenarios - A Marker for Developing Functionally Efficient Teams
- Author
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Vinícius Giuliano Gonçalves Mendes, Omar Mejía, Augusto Gonçalves Mendes, Vinicius José da Silva Nina, Rosangela Monteiro, Carlos Manuel de Almeida Brandão, Fabio Biscegli Jatene, Nick Sevdalis, and Aubyn Marath
- Subjects
medicine.medical_specialty ,Operating Rooms ,RD1-811 ,media_common.quotation_subject ,Psychological intervention ,Self-concept ,Patient safety ,Self-Concept ,Cronbach's alpha ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Humans ,Adverse effect ,Reliability (statistics) ,media_common ,Patient Care Team ,Problem Behavior ,Surgeons ,Teamwork ,Cardiovascular Surgery ,business.industry ,Communication ,Reproducibility of Results ,General Medicine ,Surgery ,Test (assessment) ,RC666-701 ,Original Article ,Perception ,Patient Safety ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: To support the development of practices and guidelines that might help to reduce adverse events related to human factors, we aimed to study the response and perception by members of a cardiovascular surgery team of various error-driven or adverse features that might arise in the operating room (OR). Methods: A previously validated Disruptions in Surgery Index (DiSI) questionnaire was completed by individuals working together in a cardiovascular surgical unit. Results were submitted to reliability analysis by calculating the Cronbach’s alpha coefficient. Non-parametric Kruskal-Wallis test and Dunn’s post-test were performed to estimate differences in perceptions of adverse events or outcomes between the groups (surgeons, nurses, anesthesiologists, and technicians). P
- Published
- 2021
39. Mixoma Atrial Esquerdo Gigante e Obstrução da Valva Mitral: Relato de Caso
- Author
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Carlos Manuel de Almeida Brandão, Carlos E. Rochitte, Elinthon Tavares Veronese, Pablo Maria Alberto Pomerantzef, Fabio Biscegli Jatene, and Cardoso Lf
- Subjects
General Medicine - Abstract
Os mixomas são entidades raras e representam a maioria dos tumores cardíacos benignos em adultos. Sua apresentação clínica pode variar de acordo com suas dimensões e sua localização, como também podem ocorrer em indivíduos assintomáticos, sendo um achado incidental de massa cardíaca ao exame de imagem. Nós apresentamos o caso de uma paciente do sexo feminino sem comorbidades conhecidas, admitida no setor de emergência com quadro de insuficiência cardíaca aguda e achado ao ecocardiograma transtorácico de grande massa cardíaca no interior do átrio esquerdo, correspondendo a um mixoma gigante, causando obstrução da via de entrada do ventrículo esquerdo, com necessidade de abordagem cirúrgica de urgência.
- Published
- 2020
40. Redo aortic valve surgery in a case of dextrocardia with situs inversus totalis
- Author
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Fabrício José Dinato, Carlos Manuel de Almeida Brandão, Elinthon Tavares Veronese, Pablo Maria Alberto Pomerantzeff, and Fabio Biscegli Jatene
- Subjects
Surgery - Published
- 2022
41. Quadricuspid Aortic Valve: Three Cases Report and Literature Review
- Author
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Carlos Manuel de Almeida Brandão, Samuel Padovani Steffen, Elinthon Tavares Veronese, Pablo Maria Alberto Pomerantzeff, and Fabio Biscegli Jatene
- Subjects
Heart Defects, Congenital ,Male ,Aortic valve ,medicine.medical_specialty ,RD1-811 ,Case Report ,030204 cardiovascular system & hematology ,Aortic Valve - Pathology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Heart Valve Prosthesis Implantation ,business.industry ,Aortic Valve - Abnormalities ,General Medicine ,Middle Aged ,Congenital Heart Defects ,medicine.disease ,Treatment Outcome ,Quadricuspid aortic valve ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,RC666-701 ,cardiovascular system ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Quadricuspid aortic valve (QAV) is a rare cardiac malformation. Many cases are incidentally diagnosed in aortic surgeries or autopsies and it usually appears as an isolated anomaly. The most widely classification used is the one by Hurwitz and Roberts[1], which divides 7 alphabetical subtypes based on the cusps size. The aim of this report is to describe three different anatomic presentations of this rare aortic valve anomaly.
- Published
- 2019
42. Impact of the First Wave of the COVID-19 Pandemic on Cardiovascular Surgery in Brazil: Analysis of a Tertiary Reference Center
- Author
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Luiz Augusto, Lisboa, Omar Asdrúbal Vilca, Mejia, Elisandra Trevisan, Arita, Gustavo Pampolha, Guerreiro, Lucas Molinari Veloso da, Silveira, Carlos Manuel de Almeida, Brandão, Ricardo Ribeiro, Dias, Luís Roberto Palma, Dallan, Leonardo, Miana, Luiz F, Caneo, Marcelo Biscegli, Jatene, Luís Alberto Oliveira, Dallan, and Fabio Biscegli, Jatene
- Subjects
COVID-19 ,Humans ,Pandemics ,Brazil - Published
- 2021
43. Bentall–de Bono procedure for acute aortic dissection
- Author
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Luís Roberto Palma Dallan, Ricardo Ribeiro Dias, Carlos Manuel de Almeida Brandão, Luís Alberto Oliveira Dallan, José Augusto Duncan Santiago, and Fabio Biscegli Jatene
- Subjects
Male ,Aortic dissection ,medicine.medical_specialty ,Aortic Aneurysm, Thoracic ,business.industry ,Aortic root ,Bentall procedure ,Dissection (medical) ,Middle Aged ,Aortic surgery ,medicine.disease ,Aortic disease ,Surgery ,Aortic Dissection ,Aortic aneurysm ,Acute type ,Replantation ,cardiovascular system ,medicine ,Humans ,business ,Vascular Surgical Procedures ,Aorta - Abstract
We present a patient with an acute type A aortic dissection that involves the aortic root. The high mortality of patients with this condition is often associated with operations performed by surgeons with minimal experience dealing with aortic diseases. Therefore, less-experienced surgeons often opt for less complicated techniques like supracoronary ascending aortic replacement. However, according to the latest guidelines for the management of aortic diseases, the aortic root should be replaced when it is compromised by the dissection. The Bentall–de Bono technique treats the aortic root and demands less experience than valve-sparing aortic surgery.
- Published
- 2021
44. The Double-Orifice Technique in Mitral Valve Repair: 35 Years of History
- Author
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Arlindo Riso, Carlos Manuel de Almeida Brandão, Pablo Maria Alberto Pomerantzeff, and Fabio Biscegli Jatene
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Tromboembolismo/prevenção e controle ,Doenças das Valvas Cardíacas/cirurgia ,Improved survival ,Endocardite/prevenção e controle ,Thromboembolism/prevention and control ,Resection ,Endocarditis/prevention and control ,Lesion ,Posterior leaflet ,medicine ,Heart Valve Diseases/surgery ,Endocarditis ,Humans ,Diseases of the circulatory (Cardiovascular) system ,cardiovascular diseases ,Cardiac Surgical Procedures ,Mitral Valve/surgery ,Mitral regurgitation ,Anterior leaflet ,Mitral valve repair ,business.industry ,Mitral Valve Insufficiency ,Morbidity and Mortality ,Valva Mitral/cirurgia ,medicine.disease ,Surgery ,Morbidade e Mortalidade ,Editorial ,RC666-701 ,cardiovascular system ,Mitral Valve ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The advantages of mitral valve repair are lower morbidity and mortality, reduced risk of thromboembolism and endocarditis, improved survival, and better preservation of left ventricular function. The most common cause of degenerative mitral regurgitation is a myxomatous valve with segmental prolapse of the posterior leaflet, a lesion that can be corrected by classical techniques such as quadrangular resection, but other lesions may require more complex surgical techniques, for instance, correction of anterior leaflet prolapse or Barlow disease. Mitral valve repair [...]
- Published
- 2021
45. Development of Gastronomic Strategies for the Application and Valorization of New Inverse Emulsions of Vegetable Origin
- Author
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Cátia Morgado, Maria João Sousa Lima, Carlos Manuel de Almeida Brandão, Manuela Guerra, Nelson Félix, Cristina Laranjeiro, and Ana T. Silva
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Food service ,Business ,Wine tasting ,Marketing - Abstract
In order to develop gastronomic applications with five emulsions prototypes (three strawberry and bell pepper—red and yellow—processed differently, with aqueous vegetable phase) and two mustards with red fruits and beet, a sensory evaluation was carried out at first with a taste panel and also the online Foodpairing® tool was used. Based on previous results and also on culinary know-how, creative/aesthetic talent of the researchers 34 recipes were developed for different culinary preparation (starter, main course, dessert, for Food Service or domestic end consumer) and some were selected for a tasting lunch with 40 consumers (domestic/food professionals). Overall, results indicate good acceptance of the emulsions and incremental acceptation according to the gastronomic use.
- Published
- 2021
46. Cardiac Magnetic Resonance Analysis of Mitral Annular Dynamics after Mitral Valve Repair
- Author
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Ariane B Pacheco, Fabio Biscegli Jatene, Pablo Maria Alberto Pomerantzeff, Carlos Manuel de Almeida Brandão, Antonio S Santis, Carlos E. Rochitte, Elinthon Tavares Veronese, Flávio Tarasoutchi, and Ahmad Ali Abdouni
- Subjects
medicine.medical_specialty ,Medicine (General) ,Magnetic Resonance Spectroscopy ,medicine.medical_treatment ,Diastole ,030204 cardiovascular system & hematology ,Resection ,03 medical and health sciences ,0302 clinical medicine ,R5-920 ,Posterior leaflet ,Internal medicine ,Mitral valve ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,business.industry ,Mitral Valve Insufficiency ,General Medicine ,Circumference ,Mitral Valve Repair ,Treatment Outcome ,medicine.anatomical_structure ,Cardiology ,Mitral Valve ,Original Article ,Cardiac Magnetic Resonance ,Cardiac magnetic resonance ,business ,Follow-Up Studies - Abstract
OBJECTIVES: The aim of this study was to analyze mitral annulus (MA) dynamics using cardiac magnetic resonance (CMR) in patients with degenerative mitral insufficiency who underwent mitral valve repair (MVR). METHODS: Mitral valve imaging was performed by CMR in twenty-nine patients with degenerative mitral insufficiency who underwent MVR between July 2014 and August 2016, with quadrangular resection of the posterior leaflet without ring annuloplasty. They were prospectively followed up from the preoperative period up to 2 years postoperatively. RESULTS: We observed a significant reduction in all measurements of the MA after surgery. The mean systolic circumference of the MA was reduced from 13.28±1.95 cm to 11.50±1.59 cm, and the diastolic circumference was reduced from 12.51±2.01 cm to 10.66±2.09 cm in the immediate postoperative period, measures that remained stable 2 years after MVR (p
- Published
- 2020
47. Underdevelopment in Brazil and Its Interpretations
- Author
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Carlos Manuel de Almeida Brandão and Hipólita Siqueira
- Subjects
Underdevelopment ,National development ,Political science ,Development economics ,Dependency (project management) - Abstract
Brazil is a vast and highly complex country that is subordinated to its central hegemonic poles and that combines both backwardness, modernity, progress interrupted by unfinished cycles of growth, and extreme inequality. Paradoxically, it is on the one hand ranked among the nine most advanced capitalist countries in the world and, on the other, listed as one of the nine countries with the worst income distribution. Attempts to interpret these dilemmas, historical disjunctives, and impasses have produced a plethora of original intellectual work that deals with the specificities of this most dynamic and yet highly contradictory national space. A select few authors have produced extensive work on the subject and have legitimized themselves as the pinnacle of classical interpreters of Brazilian social and political thought. The originality, broad scope of analysis, and ingenuity of these great national thinkers have made them the authors of choice for those seeking to better understand Brazil as a nation. Their classics have formulated key and critical questions relating to the often-interrupted construction of this nation and the truncated, material, and spiritual or immaterial development of the Brazilian civilization as a whole, which began as a former Portuguese colony founded on slave labor. These are very comprehensive formulations, with a long-term historical perspective produced by those who have taken a very profound and highly structural look at Brazil, shedding light on aspects of its hitherto-obscure or unquestioned reality, enlightening and inviting to think more coherently, boldly, and consequently about its present and, indeed, future. Among the main contributors are the likes of Caio Prado Júnior, Celso Furtado, Fernando Henrique Cardoso, and Florestan Fernandes, who have developed approaches to help unveil the nature and characteristics of the processes of dependence and underdevelopment that are so specific to Brazil’s peripheral capitalism.
- Published
- 2020
48. Análise de >100.000 Cirurgias Cardiovasculares Realizadas no Instituto do Coração e a Nova Era com Foco nos Resultados
- Author
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Luiz Fernando Caneo, Luiz Augusto Ferreira Lisboa, Fabio Biscegli Jatene, Roberto Costa, Carlos Manuel de Almeida Brandão, Marcelo B. Jatene, Pablo Maria Alberto Pomerantzeff, Ricardo Ribeiro Dias, Luís Alberto Oliveira Dallan, Elisandra Cristina Trevisan Calvo Arita, and Omar Mejía
- Subjects
Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Incidence (epidemiology) ,Treatment outcome ,MEDLINE ,Medicine ,Hospital mortality ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Fundamento: O desafio atual da cirurgia cardiovascular (CCV) e melhorar resultados em pacientes cada vez mais graves. Nesse sentido, Programas de Melhoria Continua da Qualidade (PMCQ) tem impactado os resultados. Objetivo: Avaliar a evolucao da incidencia e mortalidade das CCV, assim como os resultados atuais do Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (InCor). Metodos: Analise dos resultados das CCV realizadas no InCor entre jan-1984 e jun-2019. Foram observadas as tendencias [...]
- Published
- 2020
49. Relation of mitral valve morphology to surgical repair results in patients with mitral valve prolapse: A three-dimensional transesophageal echocardiography study
- Author
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Maria Cristina Donadio Abduch, Carlos Manuel de Almeida Brandão, M. M. Pardi, Wilson Mathias, Roney Orismar Sampaio, Pablo Maria Alberto Pomerantzeff, Max Grinberg, Flávio Tarasoutchi, and Marcelo L. C. Vieira
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Echocardiography, Three-Dimensional ,030204 cardiovascular system & hematology ,DIAGNÓSTICO POR IMAGEM ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Mitral valve ,medicine ,Humans ,Mitral valve prolapse ,Radiology, Nuclear Medicine and imaging ,In patient ,030212 general & internal medicine ,Papillary muscle ,Surgical repair ,Mitral valve repair ,Mitral regurgitation ,Mitral Valve Prolapse ,business.industry ,Middle Aged ,medicine.disease ,Cardiac surgery ,Treatment Outcome ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
BACKGROUND The identification of predictors of mitral valve (MV) repair results is important for quality improvement in cardiac surgery. The aim of this study was to evaluate the relationship between MV morphological quantification by three-dimensional (3D) transesophageal echocardiography and mitral repair results. METHODS Fifty-four patients with MV prolapse who were submitted to surgical repair were divided into 2 groups according to their postoperative mitral regurgitation (MR) degree (group 1, grade 0-I MR; group 2, ≥grade II MR). Morphological parameters related to the mitral ring, dimension of leaflets and prolapse, coaptation line, distance from papillary muscles to the leaflet border and valve angles were analyzed by 3D MV quantification. Cardiac remodeling and MR quantitative parameters were also evaluated. RESULTS There was no correlation between 3D MV quantification and surgical results; a multivariate analysis did not show an association between morphological parameters and surgical outcome. The distance from the posteromedial papillary muscle to the leaflet border was higher (P = .038) in patients with ≥grade II postoperative MR. The left atrial diameter, left ventricular end-systolic diameter, left ventricular end-diastolic and end-systolic volumes were larger in patients with a significant residual MR (P
- Published
- 2018
50. Mitral Balloon Valvuloplasty via Transapical Access: an Option in Extreme Situations
- Author
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Elinthon Tavares Veronese, Gisele Aparecida Lapenna, Pedro Alves Lemos Neto, Fabio Biscegli Jatene, Carlos Manuel de Almeida Brandão, Flávio Tarasoutchi, and Pablo Maria Alberto Pomerantzeff
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Balloon valvuloplasty ,business ,Surgery - Published
- 2020
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