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Scanavacca MI, Sternick EB, Pisani C, Lara S, Hardy C, d’Ávila A, Correa FS, Darrieux F, Hachul D, Marcial MB, Sosa EA. Accessory Atrioventricular Pathways Refractory to Catheter Ablation. Circ Arrhythm Electrophysiol 2015; 8:128-36. [DOI: 10.1161/circep.114.002373] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Epicardial mapping and ablation of accessory pathways through a subxiphoid approach can be an alternative when endocardial or epicardial transvenous mapping has failed.
Methods and Results—
We reviewed acute and long-term follow-up of 21 patients (14 males) referred for percutaneous epicardial accessory pathway ablation. There was a median of 2 previous failed procedures. All patients were highly symptomatic, 8 had atrial fibrillation (3 with cardiac arrest) and 13 had frequent symptomatic episodes of atrioventricular reentrant tachycardia. Six patients (28.5%) had a successful epicardial ablation. Five patients (23.8%) underwent a successful repeated endocardial mapping, and ablation after epicardial mapping yielded no early activation site. Epicardial mapping was helpful in guiding endocardial ablation in 2 patients (9.5%), showing that the earliest activation was simultaneous at the epicardium and endocardium. Four patients (19%) underwent successful open-chest surgery after failing epicardial/endocardial ablation. Two patients (9.5%) remained controlled under antiarrhythmic drugs after unsuccessful endocardial/epicardial ablation. Two patients had a coronary sinus diverticulum and one a right atrium to right ventricle diverticulum. Three patients acquired postablation coronary sinus stenosis. There was no major complication related to pericardial access.
Conclusions—
Percutaneous epicardial approach is an alternative when conventional endocardial or transvenous epicardial ablation fails in the elimination of the accessory pathway. A new attempt by endocardial approach was successful in a significant number of patients. Open-chest surgery may be required in symptomatic cases refractory to endocardial–epicardial approach.
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Affiliation(s)
- Maurício Ibrahim Scanavacca
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
| | - Eduardo Back Sternick
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
| | - Cristiano Pisani
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
| | - Sissy Lara
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
| | - Carina Hardy
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
| | - André d’Ávila
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
| | - Frederico Soares Correa
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
| | - Francisco Darrieux
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
| | - Denise Hachul
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
| | - Miguel Barbero Marcial
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
| | - Eduardo A. Sosa
- From the Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.I.S., C.P., S.L., C.H., F.D., D.H., M.B.M., E.A.S.); Biocor Instituto, Nova Lima, Brazil (E.B.S., F.S.C.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); and Hospital Cardiológico, Florianópolis, Santa Catarina, Brazil (A.d’.A.)
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Jatene MB, Abuchaim DCS, Tiveron MG, Tanamati C, Miura N, Riso A, Atik E, Lopes AA, Marcial MB. Tratamento cirúrgico da persistência do canal arterial na população adulta. Braz J Cardiovasc Surg 2011; 26:93-7. [DOI: 10.1590/s0102-76382011000100017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 02/15/2011] [Indexed: 11/21/2022] Open
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Sousa JSD, Tanamati C, Marcial MB, Stolf NAG. Tumor amorfo calcificado do coração. Braz J Cardiovasc Surg 2011; 26:500-3. [DOI: 10.5935/1678-9741.20110031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 04/05/2010] [Indexed: 11/20/2022] Open
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Lisboa LAF, Moreira LFP, Mejia OV, Dallan LAO, Pomerantzeff PMA, Costa R, Puig LB, Jatene FB, Marcial MB, Stolf NAG. [Evolution of cardiovascular surgery at the Instituto do Coração: analysis of 71,305 surgeries]. Arq Bras Cardiol 2010; 94:162-8, 174-81, 164-71. [PMID: 20428610 DOI: 10.1590/s0066-782x2010000200006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 06/29/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiovascular surgery has been undergoing transformations due to the advancement of percutaneous techniques, clinical treatment and primary prevention. OBJECTIVE Evaluation of incidence and mortality of heart surgeries performed at the Instituto do Coração (InCor-HCFMUSP). METHODS Using database from the Instituto do Coração, analysis was carried out on cardiovascular surgeries performed between 1984 and 2007, taking into consideration trends of main procedures and of mortality rates. RESULTS In 24 years, 71,305 heart surgeries were performed, with an annual average of 2971 procedures. The number of coronary artery bypass graft surgeries, which in the 1980s had an average of 856/year, is currently around 1.106/year. Heart valve procedures increased from 400 to 597 surgeries per year, growing 36.7%, when compared to the 1990s. Repair of congenital heart disease also had a significant increase of 50.8% in relation to the last decade. Global mortality average rate, which at baseline was 7.5%, is currently at 7.0% and 4.9% among elective procedures. In coronary artery bypass graft surgery, current average mortality rate is 4.8% and 8.5% in valve surgery. Repair of congenital heart disease accounts for 5.3%. CONCLUSION Cardiovascular surgery continues increasing. The coronary artery bypass graft is still the most commonly performed surgery. However, profile of procedures has been undergoing changes with the largest increase of approach to cardiac valves and congenital heart disease. Mortality rates are higher when compared to international rates, reflecting the high complexity presented in tertiary service of national reference.
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Affiliation(s)
- Luiz Augusto F Lisboa
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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Farah MCK, Castro CRP, Moreira VDM, Binotto MA, Guerra VC, Riso ADA, Marcial MB, Lopes AA, Mathias W, Aiello VD. The Impact of Preexisting Myocardial Remodeling on Ventricular Function Early after Tetralogy of Fallot Repair. J Am Soc Echocardiogr 2010; 23:912-8. [PMID: 20650609 DOI: 10.1016/j.echo.2010.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Indexed: 11/28/2022]
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Guedes MAV, Riso ADA, Barbero Marcial M, Stolf NAG. Off-pump correction of coronary fistula: the single suture technique approach. Braz J Cardiovasc Surg 2010; 24:581-3. [PMID: 20305935 DOI: 10.1590/s0102-76382009000500023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 08/14/2009] [Indexed: 11/21/2022] Open
Abstract
The single suture technique was developed to obtain stabilization and exposure of all all coronary branches during off-pump coronary artery bypass, while maintaining hemodynamic stabilily during the procedure. We describe the use of this technique during an off-pump correction of a coronary artery fistula associated with right coronary dilatation. The suggested technique is quicker and less complex than on-pump surgery. Furthermore, it can be a useful tool for congenital fistula correction in select cases, stimulating the practice of less invasive heart surgery in these patients.
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Jatene MB, Miana LA, Pessoa AJ, Riso A, Azeka E, Tanamati C, Gimenez S, Lopes AA, Marcial MB, Stolf NAG. Pediatric heart transplantation in refractory cardiogenic shock: a critical analysis of feasibility, applicability and results. Arq Bras Cardiol 2009; 90:329-33. [PMID: 18516404 DOI: 10.1590/s0066-782x2008000500010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 10/17/2007] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In children with dilated cardiomyopathy who are on the waiting list for heart transplantation, we evaluate the seriousness of their hemodynamic conditions. Some develop cardiogenic shock, and the mortality rate is high. Even with inotropic and respiratory support, heart transplantation is considered an extremely grave circumstance. OBJECTIVE The objective of this study is to report on our experience with children in this condition, in an attempt to analyze the viability, applicability and results of heart transplantation in these children. METHODS From March 2001 to February 2004, 22 children with dilated cardiomyopathy who were on the waiting list for heart transplantation developed cardiogenic shock, requiring transfer to pediatric intensive care unit (ICU), intubation and inotropic support. Their ages ranged from 11 months to 11 years (mean age: 4.3 years), 55% were males, 14 could be listed as clinical priority, and the remaining 8 were removed from the waiting list due to their unfavorable clinical conditions. RESULTS Eight heart transplantations were performed, and 6 children died while on the waiting list (42.9%). Two children died (25%) after transplantation and the remaining 6 were discharged from hospital in good clinical condition. The two main complications were organ rejection in 4 cases and infection in 5 cases. Two patients developed neurological complications, and one of them fully recovered. CONCLUSION Children with cardiomyopathy and cardiogenic shock require immediate heart transplantation; only 57.1% could be transplanted, with an early 25% mortality rate. Those who survived transplantation showed good clinical progress, similar to that of children transplanted on an elective basis.
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Affiliation(s)
- Marcelo Biscegli Jatene
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil.
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Jatene MB, Jatene IB, Oliveira PMD, Moysés RA, Souza LCBD, Fontes V, Miura N, Lopes AA, Marcial MB, Jatene AD. Prevalência e abordagem cirúrgica da estenose supravalvar pulmonar pós-operação de jatene para transposição das grandes artérias. Arq Bras Cardiol 2008; 91:17-24. [DOI: 10.1590/s0066-782x2008001300003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 12/05/2007] [Indexed: 11/22/2022] Open
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Barbosa NDF, Azeka E, Aiello VD, Viana F, Jatene M, Tanamati C, Marcial MB. Isolated left ventricular noncompaction: unusual cause of decompensated heart failure and indication of heart transplantation in the early infancy--case report and literature review. Clinics (Sao Paulo) 2008; 63:136-9. [PMID: 18297218 PMCID: PMC2664197 DOI: 10.1590/s1807-59322008000100022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Jatene MB, Azeka E, Atik E, Riso A, Tanamati C, Marcial MB, de Oliveira SA. Ascending Aortic Aneurysm After Pediatric Heart Transplantation: Case Report of an Unusual Complication. J Heart Lung Transplant 2005; 24:638-41. [PMID: 15896768 DOI: 10.1016/j.healun.2004.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2002] [Revised: 02/03/2004] [Accepted: 03/01/2004] [Indexed: 11/20/2022] Open
Abstract
A 28-month-old boy, weighing 11 kg, with severe dilated cardiomyopathy, was transplanted on December 1995. Hypertension and supraventricular tachycardia were detected in the immediate post-operative period, with favorable outcome. After 5 months of clinically asymptomatic follow-up, a dilation in the ascending aorta was observed on routine echocardiogram. Nuclear magnetic resonance imaging (NMRI) confirmed an ascending aortic aneurysm, with a diameter of 38 mm. An operation was performed, a bovine pericardium patch was sutured with reconstruction of the aortic wall, excluding the aneurysm. Good recovery was obtained and the child was discharged on Day 7 postoperatively. A post-operative echocardiogram showed absence of the aortic aneurysm and good surgical results. Another NMRI was done 5 months later, showing an intact ascending aorta. After 64 months, the patients clinical condition was confirmed as normal by echocardiogram. Surgical treatment was successful and the positive results have been maintained.
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Jatene MB, Contreras ISB, Lameda LCR, Oliveira JDL, Ebaid M, Iwahashi ER, Abellan DM, Aiello VD, Marcial MB, de Oliveira SA. Endomyocardial fibrosis in infancy. Arq Bras Cardiol 2003; 80:438-45. [PMID: 12754563 DOI: 10.1590/s0066-782x2003000400007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The patient was a 4-month-old infant, who underwent persistent ductus arteriosus interruption with titanium clips at the age of 13 days and, since the age of 2 months, had crises of hypoxia and hypertonicity. After clinical investigation, the presence of pulmonary hypertension was confirmed and left ventricular inflow tract obstruction was suspected. The patient underwent surgical treatment at the age of 4 months, during which right and left ventricular endocardial fibrosis was identified. The fibrosis was resected, but the infant had an unfavorable clinical evolution with significant diastolic restriction and died on the sixth postoperative day. Anatomicopathological and surgical findings suggested endomyocardial fibrosis, although that pathology is very rare at the patient's age.
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Affiliation(s)
- Marcelo Biscegli Jatene
- Divisão Cirúrgica, Setor de Cirurgia Cardíaca Pediátrica, Instituto do Coração, Hospital das Clínicas, FMUSP, Sao Paulo, SP, Brazil.
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Dias CA, Assad RS, Caneo LF, Abduch MCD, Aiello VD, Dias AR, Marcial MB, Oliveira SA. Reversible pulmonary trunk banding. II. An experimental model for rapid pulmonary ventricular hypertrophy. J Thorac Cardiovasc Surg 2002; 124:999-1006. [PMID: 12407385 DOI: 10.1067/mtc.2002.124234] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE An experimental model with a reversible pulmonary trunk banding device was developed with the aim of inducing rapid ventricular hypertrophy. The device consists of an insufflatable cuff connected to a self-sealing button. METHODS The right ventricles of 7 young goats (average weight, 8.7 kg) were submitted to systolic overload and evaluated according to the hemodynamic, echocardiographic, and morphologic aspects. Baseline biopsy specimens were taken from the myocardium for microscopic analysis. The device was implanted on the pulmonary trunk and inflated so that a 0.7 right ventricular/left ventricular pressure ratio was achieved. Echocardiographic and hemodynamic evaluations were performed every 24 hours. Systolic overload was maintained for 96 hours. The animals were then killed for morphologic study. Another 9 goats (average weight, 7.7 kg) were used for control right ventricular weight. RESULTS The systolic right ventricular/pulmonary trunk pressure gradient varied from 10.1 +/- 4.3 mm Hg (baseline) to 60.0 +/- 11.0 mm Hg (final). Consequently, the right ventricular/left ventricular pressure ratio increased from 0.29 +/- 0.06 to 1.04 +/- 0.14. The protocol group showed a 74% increase in right ventricular mass when compared with the control group. Serial 2-dimensional echocardiography showed a 66% increase in right ventricular wall thickness. There was a 24% increase in the mean myocyte perimeter, and the myocyte area increased 61%. CONCLUSIONS The device is easily adjustable percutaneously, enabling right ventricular hypertrophy in 96 hours of gradual systolic overload. This study suggests that the adjustable pulmonary trunk banding might provide better results for the 2-stage Jatene operation and for the failed atrial switch operations to convert to the double-switch operation.
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Affiliation(s)
- Carlos A Dias
- Heart Institute University of São Paulo Medical School, São Paulo, Brazil
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Azeka E, Marcial MB, Jatene M, Auler JOC, Ramires JAF. Eight-year experience of pediatric heart transplantation: clinical outcome using non-invasive methods for the evaluation of acute rejection. Pediatr Transplant 2002; 6:208-13. [PMID: 12100504 DOI: 10.1034/j.1399-3046.2002.01075.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Combined immunosuppression therapy and acute rejection surveillance after heart transplantation may influence clinical outcome. This prospective, longitudinal study investigated 27 pediatric patients (12 days to 12 yr of age; mean 3.0 yr) who underwent a post-operative regimen that included long-term treatment with cyclosporin A and azathioprine (double immunosuppression) and polyclonal anti-thymocyte serum induction therapy. Non-invasive parameters were used to diagnose acute rejection. The actuarial survival, clinical outcomes, and complications were analyzed. The actuarial survival after double immunosuppression and induction therapy with polyclonal anti-thymocyte serum was 89%, 73%, and 57% at 1, 4, and 8 yr, respectively. The rejection frequency was 2.6 episodes/patient and the infection frequency, 3.7 episodes/patient. One year after transplantation, systemic arterial hypertension was detected in 21% of patients. Hence, double immunosuppression with polyclonal anti-thymocyte serum induction therapy combined with surveillance of acute rejection with non-invasive tests may provide promising clinical outcome in pediatric heart transplant recipients.
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Affiliation(s)
- Estela Azeka
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
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Jatene MB, Marcial MB, Tarasoutchi F, Cardoso RA, Pomerantzeff P, Jatene AD. Influence of the maze procedure on the treatment of rheumatic atrial fibrillation - evaluation of rhythm control and clinical outcome in a comparative study. Eur J Cardiothorac Surg 2000; 17:117-24. [PMID: 10731646 DOI: 10.1016/s1010-7940(00)00326-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of the maze procedure on the treatment of rheumatic atrial fibrillation in patients with mitral valve disease. METHODS Fifty-five patients (mean age 51 years; 47 females) with rheumatic mitral valve disease and associated atrial fibrillation in New York Heart Association functional class III or IV, preoperatively, were operated upon. Thirty-five had double dysfunction, 19 had stenosis, and one had mitral regurgitation. None had other associated heart diseases or previous operations. The patients were divided into two groups: GI, 20 patients were treated for mitral valve disease with associated maze procedure; GII, 35 patients were treated for mitral valve disease without the maze procedure. The preoperative echocardiogram showed a left atrial diameter in GI of 5.35 mm and in GII of 5.57 mm (P=0.779). The groups were considered clinically similar (P=0.759). Cardiopulmonary bypass was used in all patients. The mitral valve was replaced with a biological prosthesis in 24 patients and repaired in 31 patients. RESULTS Three hospital deaths occurred, one in GI, two in GII. After cardiopulmonary bypass, 37.1% of patients in GII remained in atrial fibrillation. All patients in GI recovered regular rhythm (P<0.0001). In the ICU, atrial fibrillation was detected in 80% of patients in GII and maintained in 76.4% in a mean follow-up period of 38.5 months. In GI, atrial fibrillation occurred in 20% of patients in the ICU and maintained in 5.3% in 41 months of mean follow-up (P=0.0001). None of the patients in GI and 20.6% of patients in GII had a thromboembolic episode 1-63 months after the operation (P=0.041). Four late deaths occurred (two in each group), two being due to progression of valvular disease, one after an episode of pulmonary infection and one with no cardiac cause. CONCLUSION The maze procedure is effective in treating atrial fibrillation in patients with rheumatic mitral valve disease. The results are sustained in the mid-term follow-up period, preventing postoperative thromboembolic episodes, and with acceptable morbidity and mortality.
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Affiliation(s)
- M B Jatene
- InCor-Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
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Croti UA, Gregori F, Marcial MB, Dallan LA, Gregori TE, Oliveira DS. Coronary bilateral ostial enlargement using the saphenous vein in a patient with syphilitic aortitis. Arq Bras Cardiol 2000; 74:153-8. [PMID: 10904289 DOI: 10.1590/s0066-782x2000000200006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A patient with tertiary syphilis presenting with bilateral coronary ostial lesions and aortic regurgitation underwent surgical reconstruction of the coronary ostia by the anterior approach with autogenous saphenous vein grafting and substitution of the aortic valve with a bovine bioprosthesis. The procedure was easily performed and had good outcomes both early and late. The rarity of the association of a lesion in both coronary ostia with aortic regurgitation in syphilis and the surgical technique employed are discussed.
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Affiliation(s)
- U A Croti
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, S. Paulo, SP, 05403-900, Brazil
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Abstract
Ebstein's anomaly with coarctation of the aorta is an extremely unusual condition. In this report, the clinical and surgical features of 3 male patients, aged 7 months, 4 years and 14 years, are discussed. All patients were in situs solitus. The first 2 patients had atrioventricular and ventriculoarterial discordance and progressed to heart failure in the neonatal period. The third had atrioventricular and ventriculoarterial concordance, as well as Wolf-Parkinson-White syndrome, with frequent episodes of paroxysmal tachycardia. The 3 patients underwent surgery for correction of the coarctation of the aorta. The patient with atrioventricular and ventriculoarterial concordance underwent tricuspid valvuloplasty using a DeVega-like technique. In addition, ablation of 2 anomalous pathways (Kent bundle), which were detected by the electrophysiologic study, was also subsequently performed. The 3 patients showed a good postoperative outcome for 2 years, although, in those with discordance, the surgical procedure did not influence the dysplasia of the tricuspid valve, because this valve showed light to moderate dysfunction.
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Affiliation(s)
- M Ebaid
- Instituto do Coração do Hospital das Clínicas, FMUSP, Brazil
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Cavalini JF, Aiello VD, Guedes de Souza P, Trevisan IV, Marcial MB, Ebaid M. Double outlet right ventricle with intact atrial septum and restrictive ventricular septal defect: an analysis of two cases. Pediatr Cardiol 1998; 19:490-4. [PMID: 9770581 DOI: 10.1007/s002469900367] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Two cases of double outlet right ventricle with restrictive ventricular septal defect are described. This is an uncommon presentation that causes left ventricular dysfunction because of left ventricular outflow tract obstruction. The presence of an intact atrial septum leads to severe pulmonary hypertension, which tends to aggravate the right ventricular output. In the presence of a normal left ventricle, the authors suggest the possibility of enlargement of the ventricular septal defect in order to perform a biventricular repair. The association of a supramitral valve ring in both cases, and the isolation of the left subclavian artery and an aortopulmonary fenestration in one of these cases, are also discussed. In addition we explore factors that cause restrictive ventricular septal defects as well as the mechanisms that may lead to spontaneous closure of ventricular septal defect in a double outlet right ventricle.
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Affiliation(s)
- J F Cavalini
- Division of Pediatric Cardiology, Instituto do Coração do Hospital das Clínicas da FMUSP, Avenida Dr. Enéas de Carvalho Aguiar, 44, CEP 05403-000, São Paulo, SP-Brazil
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18
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Azeka E, Marcial MB, Camargo PR, Kajita L, Aliman AC, Auler JO, Atik E, Ebaid M. [Hemodynamic evaluation and clinical outcome of children with severe dilated cardiomyopathy eligible for heart transplantation]. Arq Bras Cardiol 1998; 71:661-6. [PMID: 10347948 DOI: 10.1590/s0066-782x1998001100004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate hemodynamic parameters and clinical outcome of children with severe cardiomyopathy who are candidates for heart transplantation. METHODS Twenty four children aged from 4 months to 10 years and 8 months (mean 3.7 +/- 2.5 years) from February 1992 to May 1996, were submitted to hemodynamic study and the following parameters were measured: cardiac output, mean pulmonary artery pressure (MPAP) and capillary wedge pressure. The pulmonary vascular resistance index (PVRI) and transpulmonary pressure gradient (TGP) were calculated. RESULTS Ten (41.6%) children were transplanted (group A), 5 (20.8%) are still waiting heart transplantation (group B) and 9 (37.6%) died (group C). The mean age of the B and C group were significantly different. The PVRI, MPAP and TPG were significant lower in group A than group C (p = 0.01; p = 0.044 and p = 0.023 respectively). CONCLUSION The profile of the hemodynamic parameters of children with severe dilated cardiomyopathy was compatible with the clinical findings. The age was the only difference comparing groups B and C. PVRI, MPAP and TPG were significant factors between group A and C. The older the patient, the worse was the prognosis.
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Affiliation(s)
- E Azeka
- Instituto do Coração do Hospital das Clínicas, FMUSP
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19
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Ferrín LM, Atik E, Ikari NM, Martins TC, Marcial MB, Ebaid M. Defeito total do septo atrioventricular. Correlação anatomofuncional entre pacientes com e sem síndrome de Down. Arq Bras Cardiol 1997. [DOI: 10.1590/s0066-782x1997000700003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Ferrín LM, Atik E, Ikari NM, Martins TC, Marcial MB, Ebaid M. [Complete atrioventricular septal defect. Anatomo-functional correlation between patients with and without Down's syndrome]. Arq Bras Cardiol 1997; 69:19-23. [PMID: 9532811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare clinical course, causes and symptoms beginning enset time in children with complete atrioventricular canal with and without Down's syndrome. METHODS Records of 80 patients < 2 years of age, were reviewed. There were 55 (69%) with Down's syndrome-group I (GI) and 25 (31%) without-group II (GII). Age at synpton enset intensity, functional class, clinical repercussion and anatomic variations in patients undergoing corrective surgery were evaluated. RESULTS Mean age at symptoms onset was similar for the two groups (50 +/- 75 days). Class II (NYHA) was more frequent in GI (31 patients-56.5%) and class III-IV (NYHA) in GII (19 patients-76%) p < 0.005. Clinical repercussion evaluation showed that congestive heart failure was present in 34 (62%) patients of GI and 21 (84%) of GII; and, pulmonary hypertension was in 21 (38%) patients of GI and 4 (16%) patients of GII p < 0.04. Mean pulmonary arterial pressure of 50 mmHg or more was present in 68% of children with Down's syndrome and in 35% of GII. Clinical course until surgical correction was down hill in 33 (60%) from GI and 21 (84%) from GII p < 0.03. Seventy seven patients underwent surgical correction. CAVC type A of the Rastelli classification was predominant in both groups, GI 37 (67%)-GII 25 (100%). There or more severe valvar morphologic lesions in group II (38%) than in group I (8%). CONCLUSION There seems to be a pulmonary vascular hyperreactivity predominance in Down's children and cardiac insufficiency signs in the normal genetic group.
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Affiliation(s)
- L M Ferrín
- Instituto do Coração do Hospital das Clínicas, FMUSP
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21
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Cavalini JF, Atik E, Soares AM, Marcial MB, Ebaid M. [Pulmonary artery sling]. Arq Bras Cardiol 1997; 68:289-92. [PMID: 9497513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The authors present a case of a two-year-old boy with stridor since birth, and also recurrent episodes of pulmonary infections, due to mechanical compression of distal trachea by a left pulmonary artery sling. They discussed diagnostic approach, surgical management and review of the literature. To our knowledge, it is the first case of sling of the pulmonary artery reported in Brazil and the fifth in a latin language country.
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Affiliation(s)
- J F Cavalini
- Instituto do Coração do Hospital das Clínicas, FMUSP
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22
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Ferrín LM, Atik E, Aiello V, Marcial MB, Ebaid M. [Tetralogy of Fallot associated with left atrial isomerism]. Arq Bras Cardiol 1996; 67:249-53. [PMID: 9181723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The association of tetralogy of Fallot with atrial isomerism has been rarely reported. Eight cases (five with left isomerism and three with right isomerism) are known. This paper reports two other cases of tetralogy of Fallot with left atrial isomerism. The syndrome's defects were disguised and without clinical expression because of the presence of the right ventricular outlet obstruction of tetralogy of Fallot. These diagnostic elements, not recognized in one of the patients previous to surgical correction of tetralogy of Fallot, were present: junctional rhythm, bronchial isomerism, partial anomalous pulmonary vein connection, agenesy of inferior vena cava and abdominal heterotaxy; their identification previous to surgical correction of tetralogy of Fallot, is necessary for an adequate surgical management.
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Affiliation(s)
- L M Ferrín
- Instituto do Caração do Hospital das Clínicas-FMUSP
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Scanavacca MI, Sosa E, Marcial MB, Consolim FM, Sabbag LM, Bellotti G, Pileggi F. [The surgical treatment of nodal reentry tachycardia. The late results]. Arq Bras Cardiol 1992; 59:99-103. [PMID: 1341166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To analyze the long-term results of surgical treatment of atrioventricular nodal reentrant tachycardia (AVNT). METHODS From March 1987 to March 1990, 20 patients with AVNT were submitted to surgical therapy, 14 female, aged 12 to 70 (42.8 +/- 17) years. All presented crisis of AVNT from 6 months to 60 (18.4 +/- 15.9) years. Ten of them had syncope or near syncope and two with cardiac arrest during reversion of AVNT with antiarrhythmic drugs. They used 1 to 6 (3.75 +/- 1.45) antiarrhythmic drugs before surgery. The electrophysiologic study (EPS) showed the common form of AVNT in all cases. The surgical procedure was anatomically directed to the posterior area of the AV node. Programmed atrial stimulation (PAS) were applied on 18 patients after surgery. The long-term results were analysed by clinical evaluation, EPS and Holter when they were necessary. RESULTS The postoperative PAS was done in 18 patients and did not induce any AVNT, even after atropine IV. The PR interval was 153 +/- 50 ms before and 152 +/- 38 ms after surgery (p > 0.05). During follow up (26 +/- 10 m) there were not AVNT recurrence. Two patients developed chronic atrial fibrillation after 24 months of surgery. CONCLUSION The perinodal dissection technique used was safe and successful to treat AVNT, preserving AV nodal conduction.
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25
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Sosa E, Jatene A, Kaeriyama JV, Scanavacca M, Marcial MB, Bellotti G, Pileggi F. Recurrent ventricular tachycardia associated with postinfarction aneurysm. Results of left ventricular reconstruction. J Thorac Cardiovasc Surg 1992; 103:855-60. [PMID: 1569766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Left ventricular reconstruction was used to control recurrent ventricular tachycardia in 19 patients (16 male), mean age of 56 years, with postinfarction anteroseptal aneurysms. The "origin" of recurrent ventricular tachycardia was not determined because the ventricular tachycardia induced by programmed stimulation produced hemodynamic deterioration in all patients. The average ejection fraction was 30.7% +/- 10.1%. In the left ventricular reconstruction technique, the plication of the aneurysmal septum and the reduction of the orifice of the left ventricular cavity after aneurysmal resection with a purse-string suture appear important to prevent the functioning of the reentry circuits. There was one death in the immediate postoperative period. The mean ejection fraction was 47.8% +/- 8.1% (p less than 0.001). The postoperative programmed stimulation induced ventricular tachycardia in only one patient. There were two late deaths. The other 16 patients are asymptomatic (five with antiarrhythmic drugs) in functional class I and without recurrence of ventricular tachycardia. Left ventricular reconstruction is an acceptable technique that changes the spatial orientation in eventual tachycardia circuits. Hence this technique is an alternative for long-term control of the right ventricular tachycardia associated with postinfarction anteroseptal aneurysm without previous electrophysiologic mapping.
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Affiliation(s)
- E Sosa
- São Paulo University Medical School Heart Institute (INCOR), Brazil
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26
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Atik E, Marcial MB, Ikari NM, Kajita L, Machado D, Ebaid M, Jatene A. [Origin of left coronary artery from right and left pulmonary arteries--clinical, anatomico surgical and follow-up evaluation of 3 cases]. Arq Bras Cardiol 1991; 57:121-7. [PMID: 1823770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Three infants with anomalous origin of left coronary artery, being two from the right pulmonary artery and one from the left, without other congenital defects, ages of 5, 15 and 3 months old, presented with early congestive heart failure due to anterolateral myocardial infarction. Anatomical characteristic was peculiar in two cases since the left coronary artery, before the anastomosis with the right pulmonary artery, presented a wy, 15 mm extension path within the aortic wall which has facilitated the surgical correction by the proximity of these structures. In the third case, the left coronary artery was anastomosed with the left pulmonary artery, 2 cm from its origin and anterior to the left atrium being the surgical correction by direct implant at the ascending aorta. Post-operative follow-up, 36, 30 and 33 months respectively, showed clinical and laboratorial normalization except for the second case in which ST segment remained upward due to ventricular aneurysm. Myocardial recovery, even after extensive infarction, in this anomaly, emphasizes the need for earlier diagnosis and management.
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Affiliation(s)
- E Atik
- Instituto do Coração do Hospital das Clinicas USP, São Paulo
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27
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Abstract
A patient with refractory and incessant ectopic atrial tachycardia (IEAT) is reported in whom it was possible to document, during ECG (Holter) the occurrence of aborted sudden death by spontaneous ventricular fibrillation (VF). Following the second of two attempts at surgical ablation of the origin of the IEAT, the patient has been asymptomatic without antiarrhythmic drugs and in sustained sinus rhythm for 24 months. Although we cannot exclude the residual action of amiodarone and flecainide (proarrhythmia) or the residual peripartum cardiomyopathy it is probable that the observed VF was a true complication of a cardiomyopathy induced by a chronically increased heart rate (HR). Although unclear, this VF might be considered as a form of adrenergic-dependent long QT syndrome due to early afterdepolarization in the presence of predisposing myocardial conditions.
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Affiliation(s)
- E Sosa
- Sao Paulo University Medical School Heart Institute (INCOR), Sao Paulo, Brazil
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28
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Affiliation(s)
- R S Assad
- Heart Institute, University of Sao Paulo Medical School, Brazil
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29
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Aiello VD, Gomes FA, Monteiro DC, Marcial MB. [Hearts with double inlet ventricle. Morphological aspects in 20 cases]. Arq Bras Cardiol 1991; 56:19-24. [PMID: 1872704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The authors intended to verify the most common anatomical presentations of hearts with double inlet ventricle (DIV) and the associated lesions, in order to provide information regarding surgical palliation/correction. MATERIAL AND METHODS Twenty hearts presenting DIV, from pathological collections. The sequential segmental analysis was applied. RESULTS Fourteen cases showed usual atrial arrangement, and six isomeric atria (4 with right isomerism and 2 with left isomerism). "Situs solitus" showed two atrioventricular (AV) valves, and the others a single valve. The main ventricle was morphologically left in 13 cases, right in one and of indeterminate morphology in six. The ventriculoarterial connexion was discordant in 10 cases, concordant in two, of double outlet type in eight (6 from an indeterminate ventricle, one from the main chamber and one from the rudimentary ventricle). Pulmonary obstructive lesions were common in the group with atrial isomerism (67%). AV valve stenosis was present in 4 cases, two of the left valve and two of the right one. Straddling of one AV valve was observed in 5 cases and aortic coarctation in three. The ventricular septal defect was restrictive in two cases, both with double inlet to a dominant left ventricle and a concordant AV connexion (Holmes'heart). CONCLUSION In those with atrial isomerism, the obstructive pulmonary lesions are the dominant feature and require early attention. For the other group, the atriopulmonary anastomosis procedures should take into account peculiarities such as AV valve dysfunctions and aortic coarctation.
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Affiliation(s)
- V D Aiello
- Instituto do Coração do Hospital das Clínicas e Departamento de Patologia da FMUSP, São Paulo
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30
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Rati MA, Kajita LJ, Arie S, Piccioni JL, Ikari NM, Atik E, Ebaid M, Marcial MB, Jatene AD. [Transluminal angioplasty of aortopulmonary anastomosis by the Jatene surgical technique. Report of 2 cases]. Arq Bras Cardiol 1990; 54:211-3. [PMID: 2288508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Two patients with transposition of the great arteries submitted to Jatene surgery at ages of 6 days and 6 months respectively, presented in the postoperative period stenosis of the aorto-pulmonary anastomosis. The diagnosis was made three and six years after the surgery. In both patients successful percutaneous transluminal angioplasty (PTA) was performed, respectively six months and immediately after the diagnosis. Pressure gradients decreased from 83 mmHg to 24 mmHg in the first case, and from 76 mmHg to 13 mmHg in the other case, with clear improvement of the angiographic image. Complications of the procedure did not occur in any case. This application for PTA was not previously reported and should be considered as an alternative to the surgical correction of the "new" pulmonary trunk stenosis in the Jatene surgery.
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Affiliation(s)
- M A Rati
- Instituto do Coraçao do Hospital das Clínicas-FMUSP, São Paulo
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31
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de Carvalho TA, Sosa E, Marcial MB, Scanavacca M, Bonetti D, Bellotti G, Pileggi F. [The quality of life of patients with cardiac arrhythmia undergoing surgical treatment]. Arq Bras Cardiol 1989; 53:147-50. [PMID: 2629669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The handling of patients with malign ventricular arrhythmia, since 1979, can count on intracardiac electrophysiological studies, cardiac mapping and unconventional cardiac surgery. Such service, which requires the use of sophisticated equipment and specialized professionals, is being provided to patients from all over the country and from all social strata. The Hospital, which maintains the costly, infrastructure required to provide such service, is interested in knowing the reach of the therapeutic action, going beyond the mere knowledge of the success in the immediate treatment. In order to situate the patient as well as his family and social relations, a Social Service professional has been appointed, and same, from a group of 37 patients under treatment (there were 15 deaths), has selected for the survey 17 residents in the metroplitan region of São Paulo, because of contact with them was easier. Evaluation of the changes in the quality of life of the patients that have undergone surgery has been structured in such a way to detail the research procedure, treatment of the data and discussion of the results. Thus, an attempt has been made to characterize the extent of the benefits obtained in the surgeries, at the individual, familiar and social level. Basicaly, in the group of patients surveyed, 70% have been identified as males, 70% as married, 65% older than 50 years, 76% associated to the social security system, 70% with primary level schooling and thus a low family income (1.6 minimum wages per capita).(ABSTRACT TRUNCATED AT 250 WORDS)
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Sosa E, Marcial MB, Scanavacca ML, Bellotti G, Pileggi F. [Surgical treatment of nodal reentry tachycardia. Initial experiences]. Arq Bras Cardiol 1988; 51:397-401. [PMID: 3255257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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33
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Borzellino DA, Puig LB, Martins SN, de Borzellino MR, Macruz H, de Oliveira SA, Marcial MB, Verginelli G, Jatene AD. [Evaluation of the surgical treatment of left ventricular aneurysms]. Arq Bras Cardiol 1984; 43:245-9. [PMID: 6536248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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34
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Atik E, Moromizato JH, Peviani AP, Maluf M, Baucia JA, Konstadinidis T, Vargas H, Marcial MB. [Heart diseases in children: comparative study of 1257 cases attended in outpatient clinics and hospital wards]. Arq Bras Cardiol 1984; 42:311-4. [PMID: 6508586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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35
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Maluf M, Baucia JA, Vargas H, Furlan H, Nascimento DS, Atik E, Baratella JR, Marcial MB. [Congenital stenosis of the inferior vena cava in the suprahepatic region. Surgical correction of a case]. Arq Bras Cardiol 1983; 41:389-93. [PMID: 6675633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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36
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Pomerantzeff PM, Chamone DF, Puig LB, Cossermelli M, Marcial MB, Bellotti G, Pileggi F, Bittencourt D, Verginelli G. [Autotransfusion in cardiac surgery]. Arq Bras Cardiol 1983; 41:247-54. [PMID: 6675617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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37
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Sosa E, Marcial MB, Scalabrini A, Pieracciani G, Ratti M, Pileggi F, Verginelli G. [Surgical treatment of recurrent ventricular tachycardia. Late clinical, electrophysiological and angiographic evaluation]. Arq Bras Cardiol 1983; 41:241-6. [PMID: 6675616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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38
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Sosa E, Marcial MB, Rati M, Pileggi F, Scalabrini A, Macruz R, Barbosa S, Verginelli G. [Arrhythmogenic right ventricular dysplasia. Clinical and therapeutic aspects]. Arq Bras Cardiol 1983; 41:175-80. [PMID: 6675606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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39
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Atik E, Peviani AP, Maluf M, Vargas H, Baucia JA, Konstadinidis T, Marcial MB, Verginelli G. [Mitral atresia associated with transposition of great arteries, with well developed left ventricle. Clinical and angiographic analysis and results of atrial septostomy]. Arq Bras Cardiol 1983; 41:207-10. [PMID: 6675613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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40
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Baucia JA, Marcial MB, Vargas H, Maluf M, Sirera JC, Verginelli G. [Treatment of chronic increase in the stimulation threshold with the use of corticosteroids in patients with artificial pacemakers]. Arq Bras Cardiol 1983; 41:115-8. [PMID: 6675597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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41
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Marcial MB, Maluf M, Atik E, Vargas H, Baucia JA, Verginelli G. [Use of prostaglandin E1 in ductus-dependent congenital cardiopathies]. Arq Bras Cardiol 1983; 40:383-6. [PMID: 6686760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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42
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Marcial MB, Sosa E, Pieracciani G, Scalabrini A, Ariê S, Pileggi F, Verginelli G. [Surgical treatment of cardiac arrhythmias. Analysis of the technics used on 40 patients]. Arq Bras Cardiol 1983; 40:183-9. [PMID: 6651556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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43
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Marcial MB, Baucia JA, Verginelli G, Maluf M, Vargas H, Atik E, Ebaid M, Zerbini EJ. [Surgical treatment of ventricular septal defect in 68 children less than 12 months old]. Arq Bras Cardiol 1982; 39:95-7. [PMID: 6763520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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44
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Marcial MB, Maluf M, Verginelli G, Atik E, Zerbini EJ. [Surgical treatment of pulmonary atresia with intact intraventricular septum. Analysis of the immediate and late results in 27 patients]. Arq Bras Cardiol 1982; 39:35-9. [PMID: 7168686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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45
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Sosa E, Marcial MB, Pileggi F, Arié S, Scalabrini A, Roma L, Grupi C, Takeshita N, Verginelli G. [Ventricular tachycardia--directed surgical treatment. Initial experience]. Arq Bras Cardiol 1982; 38:449-54. [PMID: 7168674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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46
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Marcial MB, Sosa EA, Pileggi F, Verginelli G, Arie S, Scalabrini A, Roma L, Grupo C, Zerbini J. [Surgical treatment of the paroxysmal tachycardia in Wolff-Parkinson-White syndrome]. Arq Bras Cardiol 1982; 38:33-8. [PMID: 7150053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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47
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Maluf MA, Marcial MB, Verginelli G, Vargas H, Baucia JA, Atik E, Ebaid M, Macruz R, Zerbini EJ. [Double outlet of the right ventricle and left ventricle. Surgical treatment in 33 patients]. Arq Bras Cardiol 1981; 37:291-300. [PMID: 6926952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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48
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Atik E, Bustamante LN, Marcial MB, Verginelli G, Ebaid M. [Congenital heart diseases in the 1st year of life: clinical aspects, incidence and management]. Arq Bras Cardiol 1981; 36:315-9. [PMID: 7325850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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49
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Bustamante LN, Kedor HH, Macruz R, Atik E, Verginelli G, Marcial MB, Ebaid M. [Cor triatriatum. Clinical study of 6 cases]. Arq Bras Cardiol 1981; 36:263-8. [PMID: 7325843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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50
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Atik E, Bustamante LN, Braga AM, Marcial MB, Ebaid M. [Tricuspid valve atresia associated with an atrioventricular anomaly--report of a case]. Arq Bras Cardiol 1980; 34:41-3. [PMID: 7406737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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