Long-term Mortality Predictors in Patients with Small Aortic Annulus Undergoing Aortic Valve Replacement with a 19- or 21-mm Bioprosthesis.

Introduction: Replacement of the aortic valve in patients with a small aortic annulus is associated with increased morbidity and mortality. A prosthesis-patient mismatch is one of the main problems associated with failed valves in this patient population.

Objective: To evaluate the long-term mortality predictors in patients with a small aortic annulus undergoing aortic valve replacement with a bioprosthesis.

Effects of skeletonized versus pedicled radial artery on postoperative graft patency and flow.

Background: Radial artery (RA) was the second arterial graft introduced in clinical practice for myocardial revascularization. The skeletonization technique of the left internal thoracic artery (LITA) may actually change the graft's flow capacity with potential advantages. This leads to the assumption that the behavior of the RA, as a coronary graft, is similar to that of the LITA, when skeletonized.

Assessment of sternal closure using titanium plate.

Introduction: The use of plates and screws for more rigid fixation of the sternum, without maintaining contact between the upper portion of the sternum and mediastinum. The present study seeks new choice of plate with a significant difference, the same does not need to be removed in order to proceed to open when necessary sternal emerging opening of the bone.

Objective: The current study aims to evaluate the efficacy and safety of this procedure.

Surgery for aortic valve endocarditis: treatment options for aortic abscess.

Background: Patients with infective endocarditis show a large diversity of anatomical presentations, which has been a complicating factor for the surgical treatment of this condition, especially in those who develop abscesses in the aortic ring or intracardiac fistulae. For this reason, surgeons have been developing tactical options to repair it. There is consensus around the fact that the removal of infected tissue promotes radical cleaning, and that the outcome of the treatment has been improved by the manufacture of biological glues which facilitate the closure of abscesses and by the creation of new valve replacements.

Fibrinolytic therapy for thrombosis in cardiac valvular prosthesis short and long term results.

Objective: To assess the short- and long-term results of the use of streptokinase (SK) for the treatment of thromboses in cardiac valvular prostheses.

Methods: Seventeen patients with cardiac prosthetic thrombosis diagnosed by clinical, echocardiographic, and radioscopic findings underwent fibrinolytic treatment with a streptokinase bolus of 250,000 U followed by 100.000 U/hour.

Risk factors associated with cardiac surgery during pregnancy.

Background: This study is aimed at analyzing risk factors for fetal and maternal mortality in cardiac surgery during pregnancy.

Methods: Seventy-four pregnant women underwent cardiac surgery and 58 (78.3%) were followed.

Surgical treatment of partial atrioventricular septal defect: functional analysis of the mitral valve in the postoperative period.

Objective: To study mitral valve function in the postoperative period after correction of the partial form of atrioventricular septal defect.

Methods: Fifty patients underwent surgical correction of the partial form of atrioventricular septal defect. Their mean age was 11.

[Surgical treatment of infective endocarditis].

Purpose: To analyse, retrospectively, 83 patients with infective endocarditis (IE) that were operated during the acute phase of the disease and to identify possible subgroups with distinct mortality.

Methods: Between 1985 to 1990, 83 patients comprised the subject of this analysis. Fifty-one (61%) were male, aged between 3 months to 71 years, mean of 31.

[Infective endocarditis associated with pregnancy].

Purpose: To report the intra-hospitalar and late follow-up of patients with infective endocarditis (IE) acquired in the pregnancy or puerperium.

Methods: Eleven patients, between 1984-1992 according to the beginning of the IE episode (fever and other signals) were studied. Patients were divided in two groups: IE of pregnancy (7 cases), and puerperal IE (4 cases).

[Infective endocarditis in children and adolescents].

Purpose: To assess infective endocarditis (IE) predisposing factors, etiologic agents and hospital course in infants and adolescents.

Methods: We Studied 222 patients admitted under compatible IE diagnosis, from 1985 to 1990. The population of this study is fifty patients (23%) under 16 years of age.

[Endocarditis due to Mycobacterium chelonei in a valvular prosthesis].

Male aged 40 year, with infective endocarditis in valvular prosthesis caused by Mycobacterium chelonei. This agent is unusual in this situation and rarely identified by the blood cultures.

[Infective endocarditis in patients with permanent pacemaker].

Five patients who had permanent pacemaker and infective endocarditis were analyzed. Diagnose was confirmed by a positive blood cultures in all patients and 2 of them had identifiable vegetation in the echocardiogram too. The etiologic agent was Staphylococcus aureus in 3, Staphylococcus epidermidis in 1 and Staphylococcus viridans in 1.

[Radiologic signal of dehiscence of Starr-Edwards aortic prosthesis].

A male 54 years-old patient with infective endocarditis through Staphylococcus aureus with prosthesis of Starr-Edwards aortic with clinical and echocardiographic signs compatible with dysfunction classified as severe. The x-ray images presented double silhouette of the prosthesis, thus suggesting its partial dehiscence. This case report points out that the detailed analysis of the X-ray may supply relevant data for the diagnosis of one of this complication thus influencing on management and prognosis.

[Myocardial infarction in infective endocarditis].

Two patients with chronic valvular heart disease and myocardial infarction were assisted at our hospital. Both of them were febrile and only one had petechiae associated with signs of valvular involvement led to suspicion of infective endocarditis. Although blood cultures were negative, echocardiographic, surgical and anatomopathologic findings were compatible with infective endocarditis.

[Embolomycotic pseudoaneurysm of the common femoral artery in infective endocarditis].

A male patient, six years old, with mitral valve endocarditis presented with pseudoaneurysm of the right femoral artery. He was submitted to surgical treatment with reconstruction of the artery with good outcome.

[Infectious endocarditis in a drug addict].

Purpose: To compare two groups of patients with infective endocarditis, the drug addicts and non-drug addicts. We attempted to set particularities among the various aspects that involve the patient with endocarditis, due to the concurrent chronic use of cocaine intravenously.

Methods: Twenty nine patients, group B, whose clinical diagnose was compatible with infective endocarditis, with risk factor of parenteral toxicomania by cocaine were treated at Institute "Dante Pazzanese de Cardiologia" and Hospital "Emilio Ribas" in São Paulo, from 1984 to 1990.

[Meningitis and other neurological complications in infectious endocarditis].

Purpose: To study the localization, etiological agents and the respective prognosis in patients with infective endocarditis with or without neurological complications, with emphasis on the association of endocarditis and meningitis.

Methods: 222 patients with clinical, echocardiographic and laboratory diagnosis of infective endocarditis were treated at Instituto Dante Pazzanese de Cardiologia from 1985 to 1990. They were classified in two groups: group A-116 patients without neurological complications, ages 4 months-76 (mean 30) years old and 66.

[The importance of the early diagnosis of infectious endocarditis in an aortic prosthesis by transesophageal two-dimensional Doppler echocardiography].

A female patient, 21 years old, was submitted to surgical treatment of severe aortic insufficiency. She was doing well until the 9th postoperative day, when she presented sepsis and an embolic cerebrovascular attack. The transesophageal echo-Doppler-cardiogram showed paraprosthetic abscess and vegetations, that were not seen on the transthoracic echo-Doppler-cardiogram performed one day before.

[Surgical management of the aortic valve in patients older than 70 years of age].

Purpose: To assess the short and long-term benefits of patients who were submitted to isolated aortic valve replacement or valve replacement (VR) concomitant myocardial revascularization (MR); to evaluate the incidence of postoperative complications, hospital mortality and late mortality.

Methods: From January 1985, through December 1989, 20 consecutive patients underwent surgical intervention, 15 male (75%) and 5 female (25%), the mean age was 74.8% (ranging from 70 to 86 years old), and the aortic valve gradient ranged between 78 and 180 mmHg (mean = 97 mmHg).

[Mitral valvuloplasty with double balloon catheter. Analysis of 200 cases].

Purpose: To study the immediate clinical, echocardiographic and hemodynamic results of 200 patients who underwent percutaneous mitral balloon valvotomy (PMV) with double balloon technique.

Methods: Two hundred patients were submitted to PVM for treatment of congestive heart failure secondary to severe mitral stenosis, between August 1987 to July 1991. Their mean age was 35.

[Technical modification of total cavo-pulmonary connection].

A variation of total cavopulmonary connection without anastomosing the superior vena cava to the right pulmonary artery branch is presented. Both vena cava flow go through an intra atrial tunnel to the right atrial appendage, which is anastomosed to the right pulmonary artery, in anatomical eligible cases.

[Syphilitic aneurysm communicating with an aortic sinus of Valsalva. A case report].

The authors present the case of a 27-year old woman with an aneurysm, possibly originating from an ectopic coronary sprout and communicating with the right anterior sinus of Valsalva. Secondary syphilitic lesions were observed. By virtue of its great size and localization, this aneurysm produced obstruction of the outlet of the right ventricle and dislocation of the left coronary artery.