BJCVS - Brazilian Journal Of Cardiovascular Surgery From Braile, Domingo Marcolino

4 - The importance of troponin I in the diagnosis of myocardial infarction in the postoperative of coronary artery bypass graft surgery

Marcos Aurélio Barboza de Oliveira; Paulo Henrique Husseni Botelho; Antônio Carlos Brandi; Carlos Alberto Dos Santos; Marcelo José Ferreira Soares; Marcos Zaiantchick; Maurício de Nassau Machado; Moacir Fernandes de Godoy; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2009;24(1):11-14

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OBJECTIVE: The aim of this study is to establish a cut-off value for troponin I by correlating it to occurrence of postoperative myocardial infarction. METHODS: 180 consecutive patients with coronary disease referred for surgery were included. The mean age of the patients were 60.6 (±9.3) years, with 119 (66.1%) males and 61 (33.9%) females. The patients were divided into two groups: group without myocardial infarction (A) - 170 patients - and with myocardial infarction (B) - 10 patients.The troponin I was collected from each patient at the beginning of anesthesia and on the second postoperative day by correlating it to presence or not of postoperative myocardial infarction. StatsDirect 1.6.0 for Windows was used for statistical analysis. RESULTS: Preoperative troponin I was 1.0 (±6) ng/ml as mean. Univariate logistic regression showed correlation of troponin I of the second postoperative day with myocardial infarction (P=0.0005). ROC curve was used to define the cutoff value, and 6.1 ng/ml (sensitivity=90.0%, specificity=82.1%, OR=49.8 with CI=95% 6.1- 410.4, P<0.0001) were found. CONCLUSION: The chance of a patient with postoperative myocardial infarction to present troponin I equal to or higher than 6.1 ng/ml is 49.8-fold higher than the chance of a patient without infarction to present troponin I higher than this value.

Keywords: Troponin I. Myocardial infarction. Cardiac surgical procedures.

12 - Development and assessment of sterility of a closed-system pediatric peritoneal dialysis

Ana Paula Pereira Biazi; Ulisses Alexandre Croti; Domingo Marcolino Braile; Marcos Aurélio Barboza de Oliveira; Jane Gonçalves Soares Costa; Lucas Monteiro Cardoso

Rev Bras Cir Cardiovasc 2009;24(1):64-67

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Objective: To develop an easy-handling totally closed pediatric peritoneal dialysis system and assess the sterility assurance level. Methods: From February to December 2008 was designed and developed a closed-system pediatric peritoneal dialysis at the Bioengineering Division of Braile Biomédica Indústria, Comércio e Representações S/A®. Twenty systems were manufactured and submitted to sterility assurance level testing, and were divided into Group A (10) - using the sterility test - and B (10) - ethylene oxide gas penetration. Results: In Group A, the sterility test was negative for bacteria and fungi proliferation within 14 days in all systems. In Group B, the gas penetration test showed that there was gas penetration in all points assessed. Conclusions: It was possible to develop a new easy-handling closed-system pediatric peritoneal dialysis and ensure its sterility.

Keywords: Peritoneal dialysis. Sterilization. Child.

18 - Technical option for redirection of flow in the partial anomalous pulmonary veins connection

Ulisses Alexandre Croti; Domingo Marcolino Braile; Adriana Érica Yamamoto; Renata Geron Finoti

Rev Bras Cir Cardiovasc 2009;24(1):92-93

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19 - Early cyanosis after bidirectional glenn operation by venovenous connection via hemiazygos vein

Ulisses Alexandre Croti; Domingo Marcolino Braile; Moacir Fernandes de Godoy; Fabiana Nakamura Avona

Rev Bras Cir Cardiovasc 2009;24(1):94-97

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20 - Implantable cardioverter-defibrillator in a child with isolated noncompacted myocardium

Ulisses Alexandre Croti; Domingo Marcolino Braile; Marcos Aurélio Barboza de Oliveira; Sírio Hassem Sobrinho

Rev Bras Cir Cardiovasc 2009;24(1):98-99

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22 - Right atrial lipoma resection and partial reconstruction using bovine pericardium

Marcos Rogério Joaquim; Domingo Marcolino Braile; Marcus Vinícius Ferraz de Arruda; Marcelo José Ferreira Soares

Rev Bras Cir Cardiovasc 2009;24(2):239-241

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The primary heart tumors have an incidence varying from 0.001% to 0.28% of all tumors, reported in necropsies series. Lipoma consists of a benign tumour corresponding to about 8% of all primary heart tumors. When present, the symptoms are related to the size and location of such tumor. We report a case of a 27-year-old man with a lipoma in the right atrium who underwent surgical treatment with tumor resection and partial reconstruction of the right atrium using bovine pericardium.

Keywords: Lipoma. Heart neoplasms. Heart atria/surgery.

25 - Ebstein's disease: the level of right ventricular dysfunction and the surgical approach

Alexandra Regina Siscar; Marcelo Felipe Kozak; Ulisses Alexandre Croti; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2009;24(2):249-251

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26 - Partial anomalous pulmonary venous connection with interventricular communication: the rare and possible difficulty on the anatomic definition of left atrial isomerism

Ulisses Alexandre Croti; Domingo Marcolino Braile; Arthur Soares Souza Jr; Antônio Soares Souza

Rev Bras Cir Cardiovasc 2009;24(2):252-255

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27 - Repair of the total anomalous pulmonary venous connection

Ulisses Alexandre Croti; Domingo Marcolino Braile; Camilo Ernesto Viana Fritz; Carlos Henrique de Marchi

Rev Bras Cir Cardiovasc 2009;24(2):256-257

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4 - Guidelines for surgery of aortic diseases from the Brazilian Society of Cardiovascular Surgery - Updated in 2009

Luciano Cabral Albuquerque; Domingo Marcolino Braile; José Honório Palma; Eduardo Keller Saadi; Rui Manuel Sequeira de Almeida; Walter José Gomes; Enio Buffolo

Rev Bras Cir Cardiovasc 2009;24(2 Suppl 1):7-33

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4 - Journal impact factor: this editorial, academic and scientific influence

Milton Artur Ruiz; Oswaldo Tadeu Greco; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2009;24(3):273-278

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In this report the authors present information on the bibliometric instruments and their importance in measuring the quality of scientific journals and researchers. They in particular the history and deployment of the impact factor of the existing Institute for Scientific Information since 1955. Are presented and discussed the criticism regarding the inadequacy of the impact factor for evaluation of scientific production, misuse and strategies editorial handling of the bibliometric index. It is presented to the new classification CAPES for the journals, based on various criteria and the impact factor and its influence on national scientific and academic life. The authors conclude that, despite all obstacles and discussions, the impact factor of the Institute for Scientific Information is still an useful tool and the only isolation available to assess the scientific and intellectual productivity.

Keywords: Impact factor. Citation index. Bibliometrics indicators.

28 - Atrioventricular septal defect with tetralogy of Fallot in patient with Down's syndrome

Maria Fernanda Ferrari Balthazar Jacob; Carlos Henrique de Marchi; Ulisses Alexandre Croti; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2009;24(3):422-424

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24 - Jatene's operation without Lecompte maneuver in child with Taussig-Bing heart

Betsy Maria Villegas Pertuz; André Luis de Andrade Bodini; Ulisses Alexandre Croti; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2009;24(4):584-585

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6 - Concepts of basic physics that every cardiovascular surgeon should know. Part I - Mechanics of fluids

Marcos Aurélio Barboza de Oliveira; Fernanda Tomé Alves; Marcos Vinícius Pinto e Silva; Ulisses Alexandre Croti; Moacir Fernandes de Godoy; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2010;25(1):1-10

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The professional activity that the cardiovascular surgeon performs is much more than a simple gesture to mechanically operate the patient's heart. There is in every act of intraoperative most notions of physiology and physics than we generally realize. This paper discusses, in the light of mathematics, on the dynamics of fluids, ie blood, focused on invasive measurements of blood pressure, the effect of vessel size on its internal resistance and the flow passing through it in conversion of various units of measurements of pressure and resistance, blood viscosity and its relationship to the vessel, hemodilution, differences in laminar and turbulent flow, velocity and blood pressure and wall tension after a stenosis and the origin of poststenotic aneurysm. This study is not to enable the reader to the knowledge of all physics, but to show it as a useful tool in explaining phenomena known in the routine of cardiovascular surgery

Keywords: Physics. Hemodynamics. Cardiovascular surgical procedures. Fluid mechanics.

25 - Bidirectional Glenn procedure without cardiopulmonary bypass in a patient with left juxtaposed atrial appendages

Ulisses Alexandre Croti; Domingo Marcolino Braile; Wilson Botelho Filho; Karla Luiza M Pedrosa

Rev Bras Cir Cardiovasc 2010;25(1):122-123

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3 - The article of the future

Eliana Pereira Salles de Souza; Eliana Márcia Sotello Cabrera; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2010;25(2):141-148

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Technological advances and the Internet have contributed to the increased disclosure and updating of knowledge and science. Scientific papers are considered the best form of disclosure of information and have been undergoing many changes, not on their way of development, but on the structure of publication. The Future paper, a name for this new structure, uses hypermediatic resources, allowing a quick, easy and organized access to these items online. The exchange of information, comments and criticisms can be performed in real time, providing agility in science disclosure. The trend for the future of documents, both from professionals or enterprises, is the "cloud computing", in which all documents will be developed and updated with the use of various equipments: computer, palm, netbook, ipad, without need to have the software installed on your computer, requiring only an Internet connection.

Keywords: Education, distance. Internet. Publications. Selective dissemination of information. Online systems. Medical informatics.

18 - Implantable cardioverter-defibrillator in pregnant women with hypertrophic cardiomyopathy

João Carlos Leal; Victor Rodrigues Ribeiro Ferreira; Luis Ernesto Avanci; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2010;25(3):403-405

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Surgical treatment of aortic dissection is a challenge for the cardiac surgeon, especially in patients undergoing cardiac operations. Our objective in this case report is to demonstrate how we treat the chronic type A aortic dissection in patients revascularized using percutaneous arterial and venous cannulae.

Keywords: Extracorporeal circulation. Myocardial revascularization. Systemic inflammatory response syndrome. Aortic aneurysm/surgery.

22 - Enlargement of the neopulmonary after Jatene's operation

Ulisses Alexandre Croti; Domingo Marcolino Braile; Marcelo Felipe Kozak; Lilian Beani

Rev Bras Cir Cardiovasc 2010;25(3):419-421

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23 - Surgical correction of the anomalous origin of right pulmonary artery of aorta

Ulisses Alexandre Croti; Domingo Marcolino Braile; Marcos Aurélio Barbosa de Oliveira; Carlos Henrique de Marchi

Rev Bras Cir Cardiovasc 2010;25(3):422-423

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28 - Correction of aortic coarctation with interposition of a tube in a 12 years-old child

Ulisses Alexandre Croti; Domingo Marcolino Braile; Daniela Patini Espada; Betsy Maria Villegas

Rev Bras Cir Cardiovasc 2010;25(4):596-597

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5 - Aortic reconstruction with bovine pericardial grafts

Lindemberg Mota Silveira; Orlando Petrucci Jr; Pedro Paulo Martins de Oliveira; Reinaldo Wilson Vieira; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2003;18(1):9-14

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INTRODUCTION: Glutaraldehyde-treated crimped bovine pericardial grafts are currently used in aortic graft surgery. These conduits have become good options for these operations, available in different sizes and shapes and at a low cost. OBJECTIVE:To evaluate the results obtained with bovine pericardial grafts for aortic reconstruction, specially concerning late complications. METHOD: Between January 1995 and January 2002, 57 patients underwent different types of aortic reconstruction operations using bovine pericardial grafts. A total of 29 (50.8%) were operated on an urgent basis (mostly acute Stanford A dissection) and 28 electively. Thoracotomy was performed in three patients for descending aortic replacement (two patients) and aortoplasty with a patch in one. All remaining 54 underwent sternotomy, cardiopulmonary bypass and aortic resection. Deep hypothermia and total circulatory arrest was used in acute dissections and arch operations. RESULTS: Hospital mortality was 17.5%. Follow-up was 24.09 months (18.5 to 29.8 months confidence interval) and complication-free actuarial survival curve was 92.3% (standard deviation ± 10.6). Two patients lately developed thoracoabdominal aneurysms following previous DeBakey II dissection and one died from endocarditis. One "patch" aortoplasty patient developed local descending aortic pseudoaneurysm 42 months after surgery. All other patients are asymptomatic and currently clinically evaluated with echocardiography and CT scans, showing no complications. CONCLUSION: Use of bovine pericardial grafts in aortic reconstruction surgery is adequate and safe, with few complications related to the conduits

Keywords: Aorta, surgery. Aneurysm dissecting, surgery. Pericardium. Bioprosthesis.

13 - A rare association of total anomalous pulmonary venous connection and cor triatriatum

Ulisses Alexandre Croti; Domingo Marcolino Braile; Moacir Fernandes de Godoy; Carlos Henrique de Marchi

Rev Bras Cir Cardiovasc 2003;18(3):273-276

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The association between total anomalous pulmonary venous connection and cor triatriatum is extremely rare. We emphasize the possibility of rupturing the membrane of cor triatriatum in the preoperative cineangiographic study, providing a significant improvement of the clinical features, as well as surgical correction and successful evolution.

Keywords: Heart defects, congenital, surgery. Heart atrium, abnormalities.

9 - Current treatment of the persistent arterial duct

José Luiz Balthazar Jacob; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2003;18(4):350-358

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10 - Perspective of clinical application of pumpless extracorporeal lung assist (ECMO) in newborn

José Francisco Gandolfi; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2003;18(4):359-363

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Extracorporeal lung assist (ECLA) has been proposed as an invasive alternative to conventional treatment when oxygenation is not possible by rigorous mechanical ventilation alone. Usually, ECLA is carried out by establishing a venovenous or venoarterial shunt consisting of a roller or centrifugal pump, a membrane oxygenator, and a heat exchanger. However, the extracorporeal membrane oxygenation (ECMO) with circulatory support lead hemolysis, coagulation disorders, inflammatory response, and specific technical complications inherent to a procedure of high risk and cost. To reduce the drawbacks of mechanical blood trauma during prolonged ECLA, the patient´s arteriovenous pressure gradient as the driving force for the blood flow through for the extracorporeal circuit can be used. In this article are analysed the main contributions of pumpless ECMO, used experimentally and in children and adults with respiratory failure, with perspective of clinical application in newborn.

Keywords: Extracorporeal membrane oxygenation. Membrane oxygenators. Oxygenators. Infant, newborn.

13 - Case 2/2003 - Pediatrics Cardiac Surgery Service - Hospital de Base, State Medicine School of São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2003;18(4):374-375

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15 - Case 1/2004 - Pediatric cardiology department, Hospital de Base, Medical School of São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile; Airton Camacho Moscardini

Rev Bras Cir Cardiovasc 2004;19(1):86-87

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16 - Case 2/2004 - Pediatric cardiology department, Hospital de Base, Medical School of São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile; André Luís de Andrade Bodini; Sírio Hassem Sobrinho

Rev Bras Cir Cardiovasc 2004;19(1):88-89

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15 - Case 3/2004 - Pediatric Heart Surgery, Hospital de Base Medical School, São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile; Márcio Pimentel Fernandes; Moacir Fernandes de Godoy

Rev Bras Cir Cardiovasc 2004;19(2):186-187

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16 - Case 4/2004 - Pediatric Heart Surgery, Hospital de Base, Medical School, São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile; Ana Carolina Leiroz Ferreira Botelho Maisano; Fábio Augusto Selig

Rev Bras Cir Cardiovasc 2004;19(2):188-189

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4 - Should the Bidirectional Glenn Operation be performed with or without cardiopulmonary bypass?

Ulisses Alexandre Crotti; Domingo Marcolino Braile; Moacir Fernandes de Godoy; Harold Gonzalez Murillo; Carlos Henrique de Marchi; Miriam Yukiko Chigutti; Omar Yesid Prieto Rincon; Airton Camacho Moscardini

Rev Bras Cir Cardiovasc 2004;19(3):274-279

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OBJECTIVE: To compare patients who underwent the Bidirectional Glenn Operation with and without cardiopulmonary bypass (CPB), analyzing the characteristics and confirming if there is superiority of either of the employed techniques. METHOD: Between January 2002 and January 2004, 16 patients with complex heart defects were submitted to this operative technique. The mean age of the patients was 19 months and 14 were female. The patients were divided into two groups: Group A with seven patients (using CPB) and group B with 9 patients (without the use of CPB). Gender, age, mean pulmonary artery pressure (MPAP), CPB time, aortic clamping time, venoatrial shunt, previous operations, time in intensive care unit (ICU), total hospitalization time and immediate complications were all compared between the two groups. RESULTS: The median MPAP was 13 mmHg. In group A the CPB time was 91 ± 47 minutes (57-195 minutes), myocardial ischemia was 25 ± 33 minutes (0-80 minutes). Of these four patients required intracardiac procedures or enlargement of the pulmonary branches and in three, CPB assistance as ventilatory support was needed. In group B the venoatrial shunt was 21 ± 10 minutes (0-39 minutes). The time to extubation was 9 ± 13 hours with a median of 3 hours (1-43 hours). The ICU stay was 8 ± 12 days with a median of 5 days (1-50 days). Hospitalization was 12 ± 12 days with a median of 7 days (0-50 days). Five patients had been submitted to surgeries previously. Two, one patient from each group, died (12.5%). No neurological complications, pleural or pericardial effusions were observed. No significant differences were evidenced between the two groups in respect to all the variables studied. CONCLUSION: In spite of the relatively small cohort, this study suggests that the bidirectional Glenn operation can be performed with or without CPB giving similar results in respect to morbidity and mortality. Thus, the operation without CPB can be safely employed when the anatomic findings are appropriate and there is no severe hypoxia.

Keywords: Heart defects, congenital, surgery. Pulmonary artery, surgery. Vena cava, superior, surgery. Extracorporeal circulation.

6 - Assessment of a new technique of hemoconcentration and the necessities of blood derivates for transfusion in patients submitted to heart surgery using cardiopulmonay bypass

Dulcimar Donizete de Souza; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2004;19(3):287-294

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OBJECTIVE: To assess a new technique of hemoconcentration and the necessity of blood derivative transfusion. METHOD: Eighty-six male (61.4%) and 54 female (38.6%) patients submitted to heart surgery under cardiopulmonary bypass were divided into two groups of 70 patients each according to conventional technique of blood preparation (Group A) and the use of the new technique of hemoconcentration. RESULTS: The hemoconcentration technique is feasible and did not alter the intra- and postoperative complications of the patients. The amount of blood and plasma used during and after cardiopulmonary bypass was less in Group B patients. Moreover, the fluid balance after cardiopulmonary bypassin this group was better when compared to the Group A patients. CONCLUSIONS: The new technique of hemoconcentration was efficient regarding removal of fluids, allowed a better use of oxygenator residual contents and decreased the amounts of blood derivatives used during and after cardiopulmonary bypass.

Keywords: Hemofiltration, methods. Cardiac surgical procedures. Blood transfusion, autologous, method. Extracorporeal circulation, methods.

12 - Case 5/2004 - Pediatric Heart Surgery Service - Hospital de Base, Medical School, São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile; Harold Gonzalez Murilo; André Luis de Andrade Bodini

Rev Bras Cir Cardiovasc 2004;19(3):323-324

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13 - Case 6/2004 - Pediatric Heart Surgery Service - Hospital de Base, Medical School, São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile; Harold Gonzalez Murilo; André Luis de Andrade Bodini

Rev Bras Cir Cardiovasc 2004;19(3):325-326

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10 - Myocardial infarction and aortic dissection: an important differential diagnosis

José Fernando Vilela Martin; Letícia Goto Andrade; Afonso Augusto Carvalho Loureiro; Moacir Fernandes de Godoy; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2004;19(4):386-390

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We report on a case of a 54-year-old man suffering from untreated high blood pressure who presented with a hypertensive emergency and target-organ damage. Initially, he was treated for myocardial infarction but later was diagnosed as having a type-A aortic dissection which was successfully operated with adequate control of blood pressure within the first 24 hours. We emphasize the necessity of the differential diagnosis of thoracic pain in the hospital emergency department and the correct treatment of arterial hypertension aiming at a better prognostic over the long term.

Keywords: Hypertension. Myocardial infarction. Aortic aneurysm, diagnosis, surgery. Aneurysm dissecting, diagnosis, surgery. Diagnosis differential.

17 - Case 7/2004 - Pediatric Heart Surgery Service - Hospital de Base, Medical School, São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile; Sírio Hassem Sobrinho; Carlos Henrique de Marchi

Rev Bras Cir Cardiovasc 2004;19(4):417-418

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18 - Case 8/2004 - Pediatric Heart Surgery Service - Hospital de Base, Medical School, São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile; Miriam Yukiko Chigutti; Antônio Soares de Souza

Rev Bras Cir Cardiovasc 2004;19(4):419-420

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7 - Comparison between the decellularized bovine pericardium and the conventional bovine pericardium used in the manufacture of cardiac bioprostheses

Jean Newton Lima Costa*; Pablo Maria Alberto Pomerantzeff; Domingo Marcolino Braile; Vladimir Aparecido Ramirez; Gilberto Goissis; Noedir Antônio Groppo Stolf

Rev Bras Cir Cardiovasc 2005;20(1):14-22

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Introduction: In this paper, our objective was to compare the decellularized and conventional pericardium mechanical resistance and also its capability of inducing inflammatory response in an animal experimental model. Method: In order to study these properties, we divided the pericardia into two groups: Group I - pericardium conventionally treated with GTA - and Group II - pericardium previously decellularized and then treated with GTA in the conventional way. After the chemical treatment, Group II samples were histologically evaluated to confirm the efficacy of the decellularization process. Then, only for the analysis of mechanical resistance, pericardia were divided in: Groups 1 (conventional pericardia with criteria of approval), 2 (conventional pericardial with criteria of disapproval) and 3 (decellularized pericardia). The capacity of inducing inflammatory response was tested in a rat experimental model with 50 Wistar rats, in which rats of each group received patches of the pericardia in the abdomen. Our third step of analysis was manufacturing three decellularized pericardium bioprosthesis which were submitted to hydrodynamic evaluation together with a conventional bioprosthesis test. Results: The histological analysis showed complete decellularization. Mechanical resistance gave statistical differences in the "tension of rupture" and "tenacity index" tests. We found no difference in the inflammatory activity in the animal model. Hydrodynamic performance was similar and all prostheses reached 150 million cycles. The final histological analysis assessed the standard microscopic pattern, and no rupture or abnormal fragmentation caused by mechanical stress. Conclusion: The decellularization technique maintains the physical resistance of the pericardium when compared with the conventionally prepared pericardium. And also, there was no difference in both groups regarding to inflammatory response studied in the animal model.

Keywords: Heart valve prosthesis. Bioprosthesis. Pericardium. Comparative study.

15 - Polarizing cardioplegic solution: state of the art

Marcos Aurélio Barboza de Oliveira; Moacir Fernandes de Godoy; Domingo Marcolino Braile; Ana Paula Marques de Lima-Oliveira

Rev Bras Cir Cardiovasc 2005;20(1):69-74

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The mean of the term "cardioplegia" is "lesion, attack, wound or blow", very different to how its is most commonly understood in most heart centers, where it relates to cardiac protection. Thus, "cardioplegic solution" is better defined as a solution capable of inducing cardiac arrest. Cardiac arrest induced by cardioplegic solutions can occur by hyperpolarizaton, depolarization or by inhibiting the calcium channels of the myocardial fibers. This paper discusses hyperpolarizing cardioplegic solutions, which arrest the heart in the diastolic phase, thus decreasing the ATP depletion and improving the conditions of the heart to be reanimated at the end of the procedure.

Keywords: Cardioplegic solutions. Heart arrest, induced. Myocardium, metabolism.

21 - Caso 1/2005 - Pediatric Heart Surgery Service - Hospital de Base, Medical School, São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile; Marcelo Felipe Kozak; Ana Carolina Leiroz Ferreira Botelho Maisano Kozak

Rev Bras Cir Cardiovasc 2005;20(1):94-95

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22 - Case 2/2005 - Pediatric Heart Surgery Service - Hospital de Base, Medical School, São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile; André Luis de Andrade Bodini; Lílian Goraieb

Rev Bras Cir Cardiovasc 2005;20(1):96-97

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17 - Case 3/2005 - Valvar treatment in a child suffering from rheumatic disease

Ulisses Alexandre Croti; Domingo Marcolino Braile; Maura Cristina Negrelli; Miriam Yukiko Chigutti

Rev Bras Cir Cardiovasc 2005;20(2):192-193

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18 - Obstruction of the systemic-pulmonary shunt in Fallot tetralogy

Ulisses Alexandre Croti; Domingo Marcolino Braile; Sírio Hassem Sobrinho; Airton Camacho Moscardini

Rev Bras Cir Cardiovasc 2005;20(2):194-195

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5 - Coefficients of proportions of the atrioventricular valves: an anatomical study of valvar segments of normal individuals

Natália Martins Magacho de Andrade; Eduardo Tinois; Reinaldo Wilson Vieira; Domingo Marcolino Braile; Orlando Petrucci Junior; Pedro Paulo Martins de Oliveira; Lindenberg da Mota Silveira Filho

Rev Bras Cir Cardiovasc 2005;20(3):255-260

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Objective: To describe the anatomical relationships that exist between the heart valve structures taking into account the segments of the fibrous annuli and the left ventricular volume Method: Digital photographs of 41 hearts from autopsies performed by a coroner's office were analyzed. The photographs were processed using MATLAB® software, which supplies measurements of the valvar perimeter and area and the left ventricular volume. Results: The average age of the corpses studied was 33 years old (standard deviation ± 17 years). Several ratios involving the tricuspid and mitral valves were tested, with strongly significant correlations found between the inter-commissural distance (ItD) and the perimeter of the anterior annulus (PA) of the tricuspid valve (r = 0.72; p-value < 0.05) and between the inter-commissural distance (ImD) and the perimeter of the posterior annulus (PP) of the mitral valve (r = 0.63; p-value < 0.05). The proportions between these parameters were PA/ItD = 1.36 ± 0.24 and PP/ImD = 1.38 ± 0.16. Conclusion: The proportions between the perimeter of the anterior annulus (tricuspid) and the perimeter of the posterior annulus (mitral) and their respective distances have high statistical significance and can be applied during surgery of valvar reconstruction.

Keywords: Heart, anatomy & histology. Mitral valve. Tricuspid valve.

12 - Technical aspects of lead implantation for left ventricle pacing through the coronary sinus, using anatomic radiology and intracavitary electrography in the cardiac resynchronization therapy

Fernando Sérgio Oliva de Souza; Domingo Marcolino Braile; Reinaldo Wilson Vieira; Salomon Ordinola Rojas; Nicola Luciano Mortati; Alexandre Caputo Rabelo; Sérgio Almeida de Oliveira

Rev Bras Cir Cardiovasc 2005;20(3):301-309

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Objective: To present the experience of 157 implantations using a simplified technique for coronary sinus catheterization, based on the atrial component of the intracavitary electrogram and radiological anatomy, showing the success rate and total time of radioscopy use. Method: From October 2001 to February 2005, 157 biventricular pacemaker implantations were performed in previously selected patients, using radiological anatomy and observation of the intracavitary electrogram, focusing on the atrial component. Here we show the success rate, complications and total time of radioscopy use. Results: The implantation of the system employing left ventricular pacing via the coronary sinus was not possible in 11 patients. Difficulties in cannulation of the coronary ostium were felt in 20 patients and difficulties of lead advancement through the coronary sinus existed in 39 patients. The mean time of radioscopy use was 18.27 ± 15.46 minutes. Conclusion: The implantation technique, proposed by the author, using the atrial component morphology of the intracavitary electrogram and radiological anatomy proved to be safe and effective for the cannulation of the coronary sinus ostium requiring shorter radioscopy times.

Keywords: Heart failure, congestive. Cardiomyopathy, congestive. Cardiac pacing, artificial.

19 - Extracardiac total cavopulmonary connection using a corrugated bovine pericardium graft without using cardiopulmonary bypass case 5/2005

Ulisses Alexandre Croti; Domingo Marcolino Braile; Aírton Camacho Moscardini; Moacir Fernandes de Godoy

Rev Bras Cir Cardiovasc 2005;20(3):346-347

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20 - Extracardiac total cavopulmonary connection with cryopreserved homograft Case 6/2005

Ulisses Alexandre Croti; Domingo Marcolino Braile; Sírio Hassem Sobrinho; Carlos Henrique de Marchi

Rev Bras Cir Cardiovasc 2005;20(3):348-349

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16 - Joint applicability of endoprosthesis in reoperation of aortic dissection - Case 7/2005

João Carlos Ferreira Leal; Luis Ernesto Avanci; Crecêncio Cêntola; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2005;20(4):449-450

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17 - Atriocavoplasty with atrial tissue in the treatment of upper sinus-venous type interatrial communication - Case 8/2005

Ulisses Alexandre Croti; Domingo Marcolino Braile; Moacir Fernandes de Godoy; Aírton Camacho Moscardini

Rev Bras Cir Cardiovasc 2005;20(4):451-452

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5 - Guidelines for Surgery of Aortic Diseases from Brazilian Society of Cardiovascular Surgery

Luciano Cabral Albuquerque; Domingo Marcolino Braile; José Honório Palma; Walter José Gomes; Joseph Coselli

Rev Bras Cir Cardiovasc 2006;21(1):1-23

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8 - Conventional ultrafiltration with technical modification in congenital heart defect surgery

Reginaldo Pereira de Castro; Ulisses Alexandre Croti; Maurício de Nassau Machado; Harold Gonzalez Murillo; Omar Yesid Prieto Rincon; Sebastião Rodrigues Policarpo; Renata Geron Finoti; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2006;21(1):42-49

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Objective: To compare patients submitted to the conventional ultrafiltration (CUF) with and without a technical modification that allows use of residual blood from the circuit tubes and oxygenator. Method: From March 2002 to January 2005, 301 patients undergoing to congenital heart defects surgery with cardiopulmonary bypass (CPB) were retrospectively analyzed and divided in two groups: Group A - 130 submitted to CUF and Group B, 171 patients submitted to CUF with a technical modification that uses residual blood. Demographic data, diagnosis, surgical treatment, intra-operative and postoperative data, the need and amount of blood transfusions, laboratorial results and length of hospital stay were compared between the groups. Results: There was no differences in the initial hematocrit before CPB (p = 0.06), but in the Group B, the values after ultrafiltration were higher (p <0.0001). Group B patients received more transfusions in the first 48 hours of the postoperative period (p <0.0001). There was no signicant difference in the time of mechanical ventilation (p = 0.34), but the inotropic support (p <0.0001), antibiotic therapy (p = 0.0006), length of stay in the intensive care unit (p <0.0001) and length of hospital stay (p <0.0001) were greater for Group B. Conclusions: CUF with the technical modification was not better than conventional CUF, because in spite of elevating the hematocrit after the CBP, it caused greater postoperative bleeding with a greater need of blood transfusions and longer hospitalar stays.

Keywords: Ultrafiltration. Extracorporeal circulation. Heart defects, congenital.

19 - Juxtaposition of the atrial appendages in tetralogy of Fallot - Case 1/2006

Ulisses Alexandre Croti; Domingo Marcolino Braile; Rafael Clark de Oliveira Piteri; Gustavo Eduardo Diaz Suarez

Rev Bras Cir Cardiovasc 2006;21(1):102-103

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20 - Endoarteritis in adult with tetralogy of Fallot - Case 2/2006

Ulisses Alexandre Croti; Domingo Marcolino Braile; Alfredo Lara Gaillard; Lílian Beani

Rev Bras Cir Cardiovasc 2006;21(1):104-105

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9 - Incidence of atherosclerosis in radial arteries of cadavers

João Augusto Ferraz de Sampaio; Domingo Marcolino Braile; Maria Cecília Ferro; Luis Alberto Magna; Décio Cardoso da Silva Junior; André Portella Alcoléa

Rev Bras Cir Cardiovasc 2006;21(2):165-172

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Objective: To verify the incidence of atherosclerotic obstructions and microscopic atherosclerotic lesions in radial arteries dissected from cadavers of over 34-years-olds. Methods: Twenty-nine cadavers had both radial arteries dissected as if they were going to be utilized as a coronary artery bypass grafts. An angiogram was performed to determine atherosclerotic obstruction of the radial arteries Subsequently, three fragments of the artery (proximal, medial, distal) were prepared on microscopic slides using hematoxylin-eosin in order to identify microscopic atherosclerotic lesions. Results were compared with risk factor found in patient's records: age, gender, hypertension, diabetes, history of smoking, myocardial infarctation, stroke, peripheral vascular disease, obesity, family history. Results: No obstructive lesions were found in the angiograms. Four cadavers presented with microscopic atherosclerotic and pre-atherosclerotic lesions. Among the risk factors considered, only age was correlated with microscopic lesions. The arteries measured, on average, 19.22 cm in males and 17.45 cm in females. Theirs diameters were 1.87 mm for men and 1.72 for women. Conclusions: No atherosclerotic obstructions were found in the radial arteries of those cadavers. Age is a risk factor for microscopic atherosclerotic lesions.

Keywords: Radial artery. Arteriosclerosis. Cardiac surgical procedures.

19 - Breastfeeding baby with fungal endocarditis at the right ventricle outflow tract - Case 3/2006

Ulisses Alexandre Croti; Domingo Marcolino Braile; Carlos Henrique de Marchi; Lilian Beani

Rev Bras Cir Cardiovasc 2006;21(2):225-226

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20 - Pulmonary artery aneurysm post pulmonary valve stenosis - Case 4/2006

Ulisses Alexandre Croti; Domingo Marcolino Braile; Sírio Hassem Sobrinho; Airton Camacho Moscardini

Rev Bras Cir Cardiovasc 2006;21(2):227-228

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5 - Proportion among the segments of the normal tricuspid valve annulus: parameter for valve annuloplasty

Fernando Antoniali; Domingo Marcolino Braile; Glória Maria Braga Potério; Cledicyon Eloy da Costa; Maurício Marson Lopes; Gustavo Calado de Aguiar Ribeiro; Luciano Dos Santos Tarelho

Rev Bras Cir Cardiovasc 2006;21(3):262-271

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Objective: The purpose of this study was to determine the proportions among the segments of the human tricuspid valve annulus. Methods: A descriptive autopsy study was made of 30 human hearts without fixation, within six hours of death, without congenital or acquired lesions and without tricuspid regurgitation. Tricuspid valve insufficiency was excluded by the infusion of pressurized water in the right ventricle with the pulmonary valve closed. Digital images of the tricuspid ring in its anatomical position and after flattening were analyzed by specific software. The mean measurements and ratios were compared in the two different situations. Results: The mean measurements of the perimeter, septal and antero-posterior segments of the tricuspid ring in the anatomical position were: 105mm (±12.7), 30.6mm (±3.7) and 74mm (±9.4), respectively. When flattened, the mean measurement of the perimeter was 117.5mm (±13.3) and sizes of the septal, anterior and posterior segments were 32mm (±3.7), 46.3mm (±8.3) and 39.1mm (±8.5), respectively. The mean ratio between the antero-posterior and septal segments was 2.43 (±0.212) in the anatomical position and when flattened it was 2.67 (±0.304). Statistical differences were observed in the measurements of perimeter (p<0.0001), septal segment (p=0.003) and antero-posterior segment (p<0.0001) in both situations. Statistical differences also occurred in the ratios between the antero-posterior and septal segments (p=0.0005). Conclusions: The proportion between the septal and antero-posterior segments of the normal human tricuspid valve is 1:2.43. Flattening the tricuspid ring to measure the segments, changes the values and the ratios between them.

Keywords: Anatomy. Heart. Tricuspid valve.

18 - Rastelli procedure with decellularized pulmonary homograft

Ulisses Alexandre Croti; Domingo Marcolino Braile; Ana Carolina Leiroz Ferreiro Botelho Maisano Kozak; Lilian Beani

Rev Bras Cir Cardiovasc 2006;21(3):356-357

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19 - Extended aortoplasty with bovine pericardium in the treatment of supravalvar aortic stenosis (Doty technique)

Ulisses Alexandre Croti; Domingo Marcolino Braile; Marcelo Felipe Kozak; Tatiana de Oliveira Vieira

Rev Bras Cir Cardiovasc 2006;21(3):358-359

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21 - Anomalous origin of the left coronary artery from pulmonary artery: Takeuchi operation

Ulisses Alexandre Croti; Domingo Marcolino Braile; Cristiane de Resende; Lilian Beani

Rev Bras Cir Cardiovasc 2006;21(4):478-479

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22 - The Ross operation in the treatment of calcified bicuspid aortic valves

Ulisses Alexandre Croti; Domingo Marcolino Braile; Gustavo Eduardo Diaz Suarez; Valdester Cavalcante Pinto Júnior

Rev Bras Cir Cardiovasc 2006;21(4):480-481

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5 - Unusual presentation of idiophatic chronic constrictive pericarditis

Moacir Fernandes de Godoy; Fábio Barros de Francischi; Paulo Roberto Pavarino; Marcos Aurélio Barboza de Oliveira; Marcelo José Ferreira Soares; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2007;22(1):1-6

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A 55-year-old male patient presented in our service with progressive dyspnea and ascitis beginning 1 year and 8 months previously. He weighed 160 kg (normal weight 95 kg), with ascitis and orthopnea. On admission he presented normal echocardiograms. An electrocardiogram showed diffuse inverted T waves. An endomyocardial biopsy was not elucidative. A new echocardiogram confirmed a very thick pericardium. Surgical pericardial resection was indicated. The postoperative period was uneventful with complete remission of symptoms. The anatomopathological analysis was normal. The pericarditis was classified as idiopathic. This case is a warning for the need of much suspicion in patients with apparent causeless voluminous ascitis.

Keywords: Pericarditis, constrictive. Heart failure, congestive. Cardiomyopathy, restrictive. Echocardiography.

8 - Effects of myocardial protection in hypertrophic rabbit hearts: structural and ultra structural analysis

Elthon Silveira Cressoni; Luiz Ernesto Avanci; Domingo Marcolino Braile; Ana Paula Marques Lima-Oliveira; Sebastião Roberto Taboga; Antonio Sérgio Martins; Rosa Sayoko Kawasaki Oyama; Marcos Aurélio Barbosa de Oliveira

Rev Bras Cir Cardiovasc 2007;22(1):24-32

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Objective: To experimentally compare the structural and ultrastructural changes in isolated hypertrophied rabbits' hearts submitted to cardiac arrest protected using sanguineous and crystalloid cardioplegia solutions. Method: The study comprised two experimental groups and one control group. In Experimental Group I, cardiac arrest was achieved by the continuous infusion of tepid sanguineous cardioplegia solution. In Experimental Group II, cardiac arrest was obtained by an intermittent infusion of a cold crystalloid cardioplegia solution. In the Control Group the hearts were submitted to normothermic anoxic arrest for 45 minutes. After the procedures, eight samples of the left ventricle lateral wall were collected and fixed in 10% formaldehyde and 2.5% glutaraldehyde for structural and ultrastructural analysis. Results: The structural and ultrastructural results demonstrated that the hearts submitted to cardiac arrest protected by continuous tepid sanguineous cardioplegia, Group I, were better preserved and with less accentuated cellular alterations compared to those submitted to cardiac arrest protected using intermittent cold crystalloid cardioplegia and the Control Group. Conclusion: Continuous tepid sanguineous cardioplegia was more efficient in the preservation of the structural and ultrastructural integrity of the myocardium when compared to intermittent cold crystalloid cardioplegia.

Keywords: Cardioplegic solutions, pharmacology. Hypertrophy. Cardiac surgical procedures.

22 - Juxtaposition of atrial appendix at left side on great arteries transposition

Ulisses Alexandre Croti; Domingo Marcolino Braile; Airton Camacho Moscardini; Lilian Beani

Rev Bras Cir Cardiovasc 2007;22(1):123-124

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23 - Left atrial isomerism in the defect of partial atrioventricular septum

Ulisses Alexandre Croti; Domingo Marcolino Braile; Sírio Hassem Sobrinho; Moacir Fernandes de Godoy

Rev Bras Cir Cardiovasc 2007;22(1):125-126

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2 - Guidelines for surgery of aortic diseases from Brazilian Society of Cardiovascular Surgery

Editores: Luciano Cabral Albuquerque; Domingo Marcolino Braile; José Honório Palma; Eduardo Keller Saadi4. Revisores: Walter José Gomes; Enio Buffolo

Rev Bras Cir Cardiovasc 2007;22(2):137-159

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6 - Echocardiographic evaluation of patients submitted to replacement of ruptured chordae tendineae

João Carlos Ferreira Leal; Francisco Gregori Jr.; Luis Eduardo Galina; Rubens S. Thevenard; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2007;22(2):184-191

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Objective: The objective of this study was to evaluate, using echocardiography, the functioning of the mitral valve apparatus in patients submitted to standardized bovine pericardium chordae implantation to substitute ruptured chordae tendineae or elongated chordae with a significant degree of thinning. Method: Standardized bovine pericardium chordae were implanted in 23 patients with mitral valve insufficiency due to ruptured or elongated chordae with significant thinning. The ages of the patients varied from 23 to 84 years old (mean 62 years old). The most common cause was fibroelastic degeneration affecting 20 (87.0%) patients. The standardized bovine pericardium chordae were manufactured in sets connected at both ends by two polyester-reinforced rods thereby forming a single block. The bovine pericardium chordae measure 2 mm wide with 3 mm between the chordae. The sets of bovine pericardium chordae are produced in lengths varying from 20 to 35 mm. In 17 (73.9%) patients bovine pericardium chordae were implanted in the posterior cusp and in 6 (26.1%) in the anterior cusp. All the patients were evaluated in the postoperative period by echocardiography after a mean follow-up of six months. Results: The echocardiography in the postoperative period demonstrated an absence of reflux in 11 (47.8%) patients, slight reflux in 8 (34.8%) and slight to moderate reflux in 3 (13.0%). The opening and mobility of the mitral valve was normal in the 22 surviving patients. Conclusion: The echocardiography demonstrated good functioning of the mitral valve apparatus in patients submitted to the implantation of standardized bovine pericardium chordae to substitute ruptured chordae tendineae or elongated chordae with a significant degree of thinning.

Keywords: Regurgitation. Mitral valve insufficiency. Chordae tendineae, surgery. Prostheses and implants. Biocompatible materials.

18 - IAortic coarctation: Aortoplasty with interposition of the left subclavian artery (the Teles Mendonça Technique)

Ulisses Alexandre Croti; Domingo Marcolino Braile; Carlos Henrique de Marchi; Lílian Beani

Rev Bras Cir Cardiovasc 2007;22(2):255-256

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19 - Aortic coarctation: Insertion of a tubular graft for post-endocarditis aneurysm

Ulisses Alexandre Croti; Domingo Marcolino Braile; Renata Geron Finoti; Rossano César Bonatto

Rev Bras Cir Cardiovasc 2007;22(2):257-258

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18 - The uncommon association between the aortopulmonary window and the aortic coarctation

Ulisses Alexandre Croti; Domingo Marcolino Braile; Marcelo Felipe Kozak; Gustavo Eduardo Diaz Suarez

Rev Bras Cir Cardiovasc 2007;22(3):365-366

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19 - A child with transposition of the great arteries submitted to surgical correction at preschool age

Ulisses Alexandre Croti; Domingo Marcolino Braile; Ana Carolina Leiroz Ferreira Botelho Maisano Kozak; André Luis de Andrade Bodini

Rev Bras Cir Cardiovasc 2007;22(3):367-368

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4 - Tricuspid valve repair using the proportion between segments of normal tricuspid annulus as a parameter for annuloplasty

Fernando Antoniali; Domingo Marcolino Braile; Glória Maria Braga Potério; Gustavo Calado de Aguiar Ribeiro; Cledicyon Eloy da Costa; Maurício Marson Lopes

Rev Bras Cir Cardiovasc 2007;22(4):393-399

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Objective: To determine the proportion between the segments of the normal human tricuspid valve (TV) annulus and its use as a parameter for ring annuloplasty "in vitro" and "in vivo". Methods: Digital images of the tricuspid ring of 30 human cadaveric hearts, without fixation and without tricuspid regurgitation (TR), were analyzed and the proportion between the antero-posterior and septal segments was determined. This proportion was used for TV annuloplasty with bovine pericardium (BP) flexible rings on 15 hearts from adult cadavers with TR and ring dilatation. The same proportion and technique were used for TV repair on 11 patients with functional TR. Preoperatively, seven patients had severe and four moderate TR; five patients were class IV and six class III (NYHA). Results: The mean ratio between the antero-posterior and septal segments was 2.43±0.212 in the 30 hearts without TR. The mean size of the BP flexible ring used for "in vitro" surgical procedure was 71.5±5.2 mm, median 70 mm, and there was no TR after that in all 15 hearts. The mean size of the orthesis used on the patients was 73.4±6.5 mm, median 72 mm. There was 1 hospital death. Six months after surgery, 7 patients had no TR and 3 had mild TR; 6 patients were in NYHA class I, 3 in class II and 1 in class III. Conclusion: The use of the ratio 2.43:1 between the anterior-posterior and septal segments as a parameter in tricuspid valve annuloplasty with a bovine pericardium flexible ring leads to satisfactory results.

Keywords: Heart, anatomy & histology. Tricuspid valve. Heart valve diseases. Cardiac surgical procedures.

5 - Late pulmonary tomography assessment in premature infants with bronchopulmonary dysplasia submitted to patent ductus artLate pulmonary tomography assessment in premature infants with bronchopulmonary dysplasia submitted to patent ductus arteriosus managemnenteriosus managemnent

Lilian Beani; Airton Camacho Moscardini; Antonio Soares Souza; Arthur Soares Souza Jr; Adriana Érica Yamamoto; Ulisses Alexandre Croti; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2007;22(4):400-406

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Objective: To assess through high-resolution computed tomography the pulmonary parenchyma of children prematurely born with both very low birth weight and patent ductus arteriosus submitted to medical or surgical treatment that developed bronchopulmonary dysplasia. Methods: Between December 2006 and January 2007, 14 children prematurely born with a weight less than 1500g with bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) were submitted to high-resolution computed tomography (HRCT). All of them underwent surgical closure of the canal divided into two groups: A - medical (n=6) and B - surgical (n=8). The pool of patients comprised 9 baby boys and 5 girls who were 36.5±4.3 month-old. The HRCT were analyzed by two independent observers and quantified in each patient. The statistical analyses were assessed using the Mann-Whitney test, and p<0.05 was considered statistically significant. Results: Three patients presented normal tomographies, being two of A group and one of B. In A, the most frequent finding was multifocal ground-glass opacity. In B, multifocal ground-glass opacity, atelectasis, and low attenuation areas with relatively decreased number and caliber of vessels were prevalent (62.5%). There was a statistically significant difference between both groups, with B having higher averages in the intubation times, use of oxygen, and admission. However, as to the number of injuries found on HRCT there was no statistically significant difference (p=0.0787). Conclusion: The lately use of HRCT have shown no significant difference between both medical and surgical treatment aiming at to occlude the PDA in pulmonary parenchyma injuries of premature with PDA that developed bronchopulmonary dysplasia.

Keywords: Tomography. Patent ductus arteriosus. Bronchopulmonary dysplasia.

6 - Hemodynamic disorders related to beating heart surgery using cardiac stabilizers: experimental study

Pedro Paulo Martins de Oliveira; Domingo Marcolino Braile; Reinaldo Wilson Vieira; Orlando Petrucci Junior; Lindemberg Mota Silveira Filho; Karlos Alexandre de Sousa Vilarinho; Elaine Soraia de Oliveira Barbosa; Nilson Antunes

Rev Bras Cir Cardiovasc 2007;22(4):407-415

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Objective: To study in swine the hemodynamic changes secondary to the use of stabilizers for off-pump coronary artery bypass graft surgeries by means of both a suction device "Octopus" and a compression device (Speroni). Methods: Ten swine underwent median sternotomy. Monitoring of ECG, continuous cardiac output, mean arterial pressure, mean pulmonary artery pressure, mean right and left atrial pressures, and right and left ventricular diastolic pressure were performed. Stroke volume and systemic vascular resistance were calculated. Both stabilizers were studied placed on three vessels: anterior interventricular branch, posterior interventricular branch, and the left marginal artery of the circumflex branch. Each animal was randomly designed to application regarding the type of stabilizer and the target artery. The measurements were carried out 5 minutes before and after the stabilizer application. Results: In the anterior interventricular branch changes have occurred only with the compression device, thus reducing cardiac output, stroke volume, and mean arterial pressure, but increasing the systemic vascular resistance. In the posterior interventricular branch changes have occurred with the compression device (Speroni), reducing cardiac output and stroke volume, but increasing the heart rate. With the suction device (octopus) there was an increase of both heart rate and systemic vascular resistance, but a decrease in stroke volume. In the left marginal artery of the circumflex branch there was a decrease of cardiac output, stroke volume, and mean arterial pressure with both stabilizers. Also, there was a decrease in the mean pulmonary artery pressure and an increase in the mean right atrial pressure with the compression device (Speroni). Conclusion: Both stabilizers have caused hemodynamic changes. The compression device (Speroni) is more associated with changes than the suction device (Octous).

Keywords: Myocardial revascularization, methods. Heart, physiopathology. Hemodynamics. Intraoperative period. Animal models.

22 - Pre and post-pulmonary thromboendarterectomies campnographic variables

Marcos Mello Moreira; Renato Giusepe Giovani Terzi; Reinaldo Wilson Vieira; Orlando Petrucci Junior; Ilma Aparecida Paschoal; Pedro Paulo Martins de Oliveira; Karlos Alexandre de Souza Vilarinho; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2007;22(4):509-512

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In these case report, the results of late dead space fraction (fDlate), end-tidal alveolar dead space fraction (AVDSf), arterial-alveolar gradient CO2 [P(a-et)CO2], and slope phase 3 of spirogram of two patients who underwent thromboendarterectomy for pulmonary embolism (PE) are shown. PE was diagnosed by pulmonary scintigraphy, helical tomography, and pulmonary angiography. The calculation of fDlate, AVDSf and P(a-et)CO2 was based on volumetric capnography associated with arterial blood gas analysis. The pre-operative fDlate of the first patient was 0.16 (cutoff 0.12) and AVDSf was 0.30 (cutoff 0.15). However, the fDlate of the second patient was false-negative (0.01) but, the AVDSf was positive (0.28). Postoperative fDlate of the first patient was -0.04 and AVDSf was 0.16; for the second patient, the values were 0.07 and 0.28, respectively. The association of these capnographic variables with image exams reinforces the importance of this noninvasive diagnosis method.

Keywords: Pulmonary embolism. Pulmonary gas exchange. Capnography.

23 - Partial anomalous pulmonary venous connection into the right atrium with absence of interatrial communication

Ulisses Alexandre Croti; Domingo Marcolino Braile; Sírio Hassem Sobrinho; Carlos Henrique de Marchi

Rev Bras Cir Cardiovasc 2007;22(4):513-514

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24 - Interatrial communication and hypothyroidism in patient with Down Syndrome

Ulisses Alexandre Croti; Domingo Marcolino Braile; André Luis de Andrade Bodini; Airton Camacho Moscardini

Rev Bras Cir Cardiovasc 2007;22(4):515-516

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4 - Development of isolated swine

Lindemberg da Mota Silveira Filho; Orlando Petrucci Junior; Marcio Roberto do Carmo; Pedro Paulo Martins de Oliveira; Karlos Alexandre de Sousa Vilarinho; Reinaldo Wilson Vieira; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2008;23(1):14-22

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Objective: To develop an isolated working heart model with parabiotic circulaton in swines and verify its stability and possibility to allow effective measurements of hemodinamic and metabolic data. Methods: This model was developed during study of association of agents to cardiolegia. There were performed 18 experiments, each with a support animal and a donor animal. Donor animal heart was perfused as isolated working heart with parabiotic circulation from support animal. Isolated heart underwent regional ischemia by interventricular artery clamping, followed by global ischemia. During reperfusion in working heart state mode at 30, 60 and 90 minutes, contractility indices such as elastance, preload recruitable stroke work index and metabolic data were acquired. Results: Support animals were kept stable throughout the procedures without use of blood transfusions or vasoactive drugs. pH, oxygen partial pressure and hematocrit were kept stable and within physiologic ranges. Isolated heart was perfused adequately throughout the experiment. All hemodinamic and metabolic data proposed were adequately measured in working heart state mode. Conclusion: This swine isolated "working heart" model was kept stable throughout the experiments with no administration of vasoactive drugs and it allowed adequate measurements of metabolic and hemodinamic data

Keywords: Heart/surgery. Models, animal. Swine. Cardioplegic solutions. Cardiac surgical procedures. Myocardial reperfusion/methods.

6 - Blood mesenchymal stem cell culture from the umbilical cord with and without Ficoll-Paque density gradient method

Rosa Sayoko Kawasaki-Oyama; Domingo Marcolino Braile; Heloisa Cristina Caldas; João Carlos Ferreira Leal; Eny Maria Goloni-Bertollo; Érika Cristina Pavarino-Bertelli; Mário Abbud Filho; Izaura Dos Santos

Rev Bras Cir Cardiovasc 2008;23(1):29-34

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Objectives: Implantation of cell separation and mesenchymal stem cell culture techniques from human umbilical cord blood with and without using the Ficoll-Paque gradient density method (d=1.077g/ml). Methods: Ten samples of the umbilical cord blood obtained from full-term deliveries were submitted to two different procedures of mesenchymal stem cell culture: a) Method without the Ficoll-Paque density gradient, which concentrates all nucleated cells; b) Method with the Ficoll-Paque density gradient, which selects only low-density mononuclear cells. Cells were initially plated into 25 cm2 cultures flasks at a density of 1x107 nucleated cells/cm2 and 1x106 mononuclear cells/cm2. Results: It was obtained 2-13x107 (median = 2.35x107) nucleated cells/cm2 by the method without the Ficoll-Paque gradient density, and 3.7-15.7x106 (median = 7.2x106) mononuclear cells/cm2 by the method with the Ficoll-Paque gradient density. In all cultures adherent cells were observed 24 hours after being cultured. Cells presented fibroblastoid and epithelioid morphology. In most of the cultures, cell proliferation occurred in the first week, but after the second week only some cultures - derived from the method without the Ficoll-Paque gradient density - maintained the growth rate reaching confluence. Those cultures were submitted to trypsinization with 0.25% trypsin/EDTA solution and cultured for two to three months. Conclusion: In the samples analyzed, cell separation and mesenchymal stem cell culture techniques from human umbilical cord blood by the method without the Ficoll-Paque density gradient was more efficient than the method with the Ficoll-Paque density gradient.

Keywords: Umbilical cord blood. Mesenchymal stem cells/cytology. Cells, cultured. Cell culture techniques.

7 - The use of the vancomycin paste for sternal hemostasis and mediastinitis prophylaxis

Marcus Vinicius Ferraz de Arruda; Domingo Marcolino Braile; Marcos Rogério Joaquim; Fabio Augusto Suzuki; Raquel Helena Alves

Rev Bras Cir Cardiovasc 2008;23(1):35-39

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Introduction: Mediastinitis is one of the most feared complications for thoracic surgeons, being a significant factor in morbidity and mortality in thoracic surgery. Objective: To find a new alternative in order to prevent mediastinitis, reducing the morbidity and mortality. Methods: A retrospective study including 1020 patients operated between February 2002 and October 2005. Patients underwent bypass surgery and vancomycin paste was used rather than bone wax in all cases. Results: Patients were followed-up for 45 months; there were only five (0.49%) cases of mediastinitis; no deaths were observed. Conclusion: The use of Vancomycin paste to replace bone wax proved to be a great allied to prevent mediastinitis after thoracic surgery.

Keywords: Mediastinitis, prevention & control. Vancomycin. Cardiac surgical procedures.

15 - Myocardial protection to the hypertrophied heart: the eternal challenge

Elthon Silveira Cressoni; Luiz Ernesto Avanci; Domingo Marcolino Braile; Antonio Carlos Cicogna; Ana Paula Marques Lima-Oliveira; Milena Alonso Egéa Gerez; Antonio Sérgio Martins

Rev Bras Cir Cardiovasc 2008;23(1):97-107

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The myocardial protection allowed great advance in cardiac surgery, decreasing the mortality and making more feasible complex surgeries. Latterly, the patient population elected for cardiac procedures has been changing towards elderly patients with ventricular function depressed and myocardial hypertrophy. The myocardial hypertrophy condition represents a great challenge since the beginning of the cardiac surgery. Several techniques have been described to protect the myocardial hypertrophy, however with no satisfactory results. In this manuscript we present the state of the art technique of myocardial protection.

Keywords: Cardioplegic solutions. Hypertrophy, left ventricular. Hypertrophy, right ventricular. Heart arrest, induced/methods.

25 - Solitary fibrous tumor in a child's heart

Ulisses Alexandre Croti; Domingo Marcolino Braile; Aírton Camacho Moscardini; Patrícia Maluf Cury

Rev Bras Cir Cardiovasc 2008;23(1):139-141

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26 - Right ventricle and tricuspid valve myxoma

Ulisses Alexandre Croti; Domingo Marcolino Braile; Antônio Soares Souza; Patrícia Maluf Cury

Rev Bras Cir Cardiovasc 2008;23(1):142-144

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5 - The use of ultrafiltration for inflammatory mediators removal during cardiopulmonary bypass in coronary artery bypass graf surgery

Nilson Antunes; Desanka Dragosavc; Orlando Petrucci Junior; Pedro Paulo Martins de Oliveira; Carolina Kosour; Maria Heloisa Souza Lima Blotta; Domingo Marcolino Braile; Reinaldo Wilson Vieira

Rev Bras Cir Cardiovasc 2008;23(2):175-182

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Objective: To investigate the effectiveness of ultrafiltration in removing inflammatory mediators released by cardiopulmonary bypass and to correlate ultrafiltration with alterations in organic function according to the Sequential Organ Failure Assessment Score. Methods: Forty patients were included and randomized into two groups: "no ultrafiltration" (n=20; Group I) and "ultrafiltration" (n=20; Group II). Activated complement 3 and 4, interleukins 1beta, 6, 8 and tumor necrosis factor alfa were measured prior to anesthesia induction (Time 1), 5 minutes before cardiopulmonary bypass (Time 2), in the ultrafiltrated fluid (Time 3), 30 minutes (Time 4), and 6 (Time 5), 12 (Time 6), 24 (Time 7), 36 (Time 8) and 48 (Time 9) hours following cardiopulmonary bypass. Sequential Organ Failure Assessment Score was evaluated at Time 1, 6 and 9. Statistical significance was established at p < 0.05. Results: In the ultrafiltrated fluid, only tumor necrosis factor alfa levels were detected. Levels of activated complement 3 at Times 5 and 7 and activated complement 4 at Times 5 and 6 were significantly higher in the unfiltered Group, and levels of interleukin 6 were higher in the filtered Group at Times 7 and 8. Interleukins 1beta, 8, tumor necrosis factor alfa, and the Sequential Organ Failure Assessment score were not significantly different between the groups. Conclusions: Ultrafiltration significantly filtered tumor necrosis factor alfa but did not influences serum levels of this cytokine. Ultrafiltration with the type of filter used in this study had no effect in organic dysfunction and should be used only for volemic control in patients undergo cardiopulmonary bypass.

Keywords: Extracorporeal circulation. Ultrafiltration. Cytokines. Multiple organ failure/etiology.

12 - Trimetazidine as cardioplegia addictive without pre-treatment does not improve myocardial protection: study in a swine working heart model

Lindemberg da Mota Silveira Filho; Orlando Petrucci Jr; Marcio Roberto do Carmo; Pedro Paulo Martins de Oliveira; Karlos Alexandre Sousa Vilarinho; Reinaldo Wilson Vieira; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2008;23(2):224-234

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Objective: The aim of this study is to verify in an isolated working heart swine model if the acute administration of trimetazidine to cardioplegia, without pre=treatment improves heart performance. Methods: Eighteen pairs of swines were used in this working heart model, divided into three groups (n = 6) that underwent regional and global ischemia. Each group was selected to a different treatment: St Thomas cardioplegia (ST), St Thomas enriched with trimetazidine (TMZ) and control group (Co). Data was collected during reperfusion period at 30, 60 and 90 minutes. Hemodinamic parameters such as elastance contractility index (Emax), preload recruitable stroke work relationship (PRSW) and heart "stiffness" (EDPVR) were measured. Other data included coronary flow, lactate, oxygen and glucose consumption. Results were statistically analyzed. Results: All contractility data were not significantly different among three groups. Lactate became constantly higher according to time uniformly in all three groups. Coronary flow, glucose consumption and oxygen consumption presented large variations during time periods but according to treatments showed no statistical differences in all three groups. Left ventricle final weight was significantly lower in trimetazidine group compared to both other groups. Conclusion: Administration of trimetazidine enhanced cardioplegia, without pre-treatment, showed no hemodinamic or metabolic improvement in swine isolated working heart model.

Keywords: Trimetazidine. Models, animal. Heart. Cardioplegic solutions.

23 - Surgical repair of rheumatic mitral valve disease with Gregori-Braile's Ring

Ulisses Alexandre Croti; Domingo Marcolino Braile; Sírio Hassem Sobrinho; Carlos Henrique de Marchi

Rev Bras Cir Cardiovasc 2008;23(2):288-289

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24 - The use of decellularized homograft monocuspid in the treatment of truncus arterious by Barbero Marcial technique

Ulisses Alexandre Croti; Domingo Marcolino Braile; Lílian Beani; Maria Cristina Passos Fleury

Rev Bras Cir Cardiovasc 2008;23(2):290-291

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12 - Evaluation of infant membrane oxygenator in sheep

Renata Geron Finoti; Domingo Marcolino Braile; Ulisses Alexandre Croti; Marcos Aurélio Barboza de Oliveira; Moacir Fernandes de Godoy; João Carlos Ferreira Leal; Sebastião Rodrigues Policarpo; Marden Leonardi Lopes

Rev Bras Cir Cardiovasc 2008;23(3):358-364

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Objective: To analyze the security and efficacy of a new membrane oxygenator, the so-called OXM - 1500. Methods: From May 2005 to September 2006, six sheep of Santa Inês breed (five male and one female, respectively) were studied. The average body weight was 14.1 (±5) kg, body surface 0.6 (±0.2) m2 and a mean age 3.8 (±1.5) months. All of them were submitted to extracorporeal circulation (CEC) with evaluation at 10, 30, 60, 120, 180 and 240 minutes. The following values were obtained: values of oxygen transference (TTO2) and carbon dioxide transference (TTCO2), haemoglobin (HBS) and free haemoglobin (HBL), the score of platelets and of leucocytes, and heat transference rate. Results: TTO2 and TTCO2 were adequate. Lesion of the majority formed blood elements was insignificant; there no modifications in HBS, HBL levels; platelets and leucocytes decreased over time. Heat exchange was effective (p < 0.05). Conclusions: The membrane OXM - 1500 infant oxygenator, tested in sheep, showed adequate oxygenation capacity, CO2 removal capacity, and small alteration of haemoglobin and platelets without significant decrease of leucocytes, as expected. Heat exchanger connected to the oxygenator was efficient in temperature changes.

Keywords: Extracorporeal membrane oxygenation. Extracorporeal circulation. Sheep.

25 - Total cavopulmonary with extracardiac conduit without cardiopulmonary bypass

Ulisses Alexandre Croti; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2008;23(3):429-430

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27 - Enlargement of the ascending aorta with Brom technique in a patient with Williams-Beuren syndrome

Ulisses Alexandre Croti; Domingo Marcolino Braile; André Luís de Andrade Bodini; Marcos Aurélio Barboza de Oliveira

Rev Bras Cir Cardiovasc 2008;23(3):436-438

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28 - Alternative to an extracardiac Fontan-type operation: direct anastomosis between pulmonary trunk and inferior vena cava

Ulisses Alexandre Croti; Domingo Marcolino Braile; Moacir Fernandes de Godoy; Fabiana Nakamura Avona

Rev Bras Cir Cardiovasc 2008;23(3):439-441

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22 - Resection of left ventricular myxoma after embolic stroke

Marcus Vinicius Ferraz de Arruda; Domingo Marcolino Braile; Marcos Rogério Joaquim; Marcelo José Ferreira Soares; Raquel Helena Alves

Rev Bras Cir Cardiovasc 2008;23(4):578-580

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Cardiac myxoma is the most common primary tumor of the heart. The tumor is located mainly in the left atrium but can arise from any heart chamber. Clinical symptoms are variable but dyspnea and embolism are the most frequent. We report a case of a young man that had embolic ischemic stroke caused by a large left ventricular myxoma. The patient underwent surgery three weeks after the stroke. The tumor was carefully resected without fragmentation. Surgical treatment was effective. We emphasize the rarity of this location together with a review of the current literature.

Keywords: Stroke. Heart neoplasms. Myxoma. Heart ventricles/pathology. Cardiac surgical procedures. Extracorporeal circulation.

23 - Ostium Secundum-type interatrial communication: few clinical symptoms and great hemodynamic repercussion

Ulisses Alexandre Croti; Domingo Marcolino Braile; Adriana Érica Yamamoto; Ana Carolina Leiroz Ferreira Botelho Maisano Kozak

Rev Bras Cir Cardiovasc 2008;23(4):581-582

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24 - Enlargement of the right ventricular outflow tract using autologous pediculated pericardium in the tetralogy of fallot treatment

Ulisses Alexandre Croti; Domingo Marcolino Braile; Airton Camacho Moscardini; Marcelo Felipe Kozak

Rev Bras Cir Cardiovasc 2008;23(4):583-585

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25 - Acute aortic dissection associated with hypertensive emergency

Renan Oliveira Vaz de Melo; José Fernando Vilela Martin; Juan Carlos Yugar Toledo; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2008;23(4):586-588

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26 - Closure of the interventricular communication of right ventricular inflow tract

Ulisses Alexandre Croti; Domingo Marcolino Braile; Marcos Aurélio Barboza de Oliveira; Fábio Villaça Guimarães Filho

Rev Bras Cir Cardiovasc 2008;23(4):589-590

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27 - Total correction of tetralogy of Fallot in child with left pulmonary artery agenesis

Fabiana Nakamura Avona; Ana Carolina Leiroz Ferreira Botelho Maisano Kozak; Ulisses Alexandre Croti; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2009;24(3):419-421

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23 - Heart transplantation in child with noncompacted myocardium

Ulisses Alexandre Croti; Domingo Marcolino Braile; Airton Camacho Moscardini

Rev Bras Cir Cardiovasc 2010;25(2):261-263

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27 - Correction of coarctation of the aorta with end anastomosis in premature newborn

Ulisses Alexandre Croti; Domingo Marcolino Braile; Adriana Érica Yamamoto; Ana Carolina Leiroz Ferreira Botelho Maisano Kozak

Rev Bras Cir Cardiovasc 2010;25(4):594-595

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24 - Subvalvular aortic membrane resection

Joseph A. Dearani; Ulisses Alexandre Croti; Theolyn Nan Price; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2011;26(1):135-136

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14 - Case 1 - 2003 - Pediatric Cardiac Surgery Department - Hospital de Base, State Medical School, São José do Rio Preto

Ulisses Alexandre Croti; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2003;18(3):277-277

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4 - Coronary artery bypass grafting:

Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2006;21(4):IX-XI

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3 - The importance of the internet for medical societies

Vinicius José da Silva Nina; Walter José Gomes; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2011;26(2):vi-vii

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5 - A bovine pericardium rigid prosthesis for left ventricle restoration: 12 years of follow-up

Lindemberg Mota Silveira Filho; Orlando Petrucci; Karlos Alexandre de Souza Vilarinho; R. Scott Baker; Fernando Garcia; Pedro Paulo Martins de Oliveira; Reinaldo Wilson Vieira; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2011;26(2):164-172

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BACKGROUND: Myocardial infarction might result in dilated left ventricle and numerous techniques have been described to restore the original left ventricle shape and identify tools for late survival assessment. The aim of this study is to compare our experience with a modified Dor procedure using a rigid prosthesis to the septal anterior ventricular exclusion procedure (SAVE) for left ventricle restoration. The EuroScore index for prediction of late follow up survival was evaluated.
METHODS: We evaluated 80 patients who underwent left ventricle restoration between 1999 to 2007 and eight patients were excluded with incomplete data. A modified Dor procedure with rigid prosthesis (MD group) was performed on 53 patients and 19 underwent the septal anterior ventricular exclusion procedure (SAVE group). The patients were classified according their left ventricle shape as type I, II or III. Kaplan-Meier and Cox proportional hazard ratio regressions analysis were performed to assess survival after both techniques and expected surgical mortality using EuroScore index ranking after 12 years of follow up.
RESULTS: The operative mortality was comparable in both groups ranked by EuroScore index. The groups were comparable for all clinical data, except the MD group had more patients using intra-aortic balloon pumps before surgery, (5.7% vs. 0; P<0.01). Kaplan Meier analysis by left ventricle shape showed comparable survival for all patients, with slightly higher survival for type I. Kaplan Meier analysis of all death showed equivalent survival curves for both techniques after 12 years of follow up (71.5 ± 12.3 vs. 46.6 ±20.5 years; P=0.08). Kaplan Meier analysis of EuroScore index for all patients showed a difference between the three ranked categories, i.e., 0 to 10%, 11 to 49% and higher than 50% expected surgical mortality after 12 years of follow up (70.9 ± 16.2 vs. 67.5 ± 12.7 vs. 53.0 ± 15.5; P=0.003).
CONCLUSION: The MD procedure showed consistent ejection fraction improvements after long term follow up. Survival was comparable for all ventricular types and for the MD and SAVE procedures. The EuroScore index is a useful index for late survival assessment of ventricular restoration techniques.

Keywords: Ventricular Dysfunction, Left. Heart aneurysms, surgery. Myocardial infarction. Angina, Unstable. Heart Ventricles surgery.

34 - Checklist in pediatric cardiac surgery in Brazil: an useful and necessary adaptation of the Quality Improvement Collaborative International Congenital Heart Surgery in Developing Countries

Ulisses Alexandre Croti; Kathy J Jenkins; Domingo Marcolino Braile

Rev Bras Cir Cardiovasc 2011;26(3):511-515

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RBCCV Brazilian Journal of Cardiovascular Surgery Revista Brasileira de Cirurgia Cardiovascular

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