Revista Brasileira De Cirurgia Cardiovascular最新文献

英文中文

Surgery for Functional Tricuspid Regurgitation in Adult Atrial Septal Defect — An Increasing Subject in a Decreasing Matter 成人房间隔缺损功能性三尖瓣反流的手术治疗-在减少的问题中增加的主题

4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Brasileira De Cirurgia Cardiovascular

Pub Date : 2022-04-18 DOI: 10.21470/1678-9741-2020-0503

A. Iosifescu, A. Popescu, Toma Andrei Iosifescu, Alina Teodora Timișescu, S. Maximeasa, V. Iliescu

Introduction Functional tricuspid regurgitation (TR) is known to complicate adult atrial septal defect (ASD), but its management is still under debate. We reviewed our experience in ASD surgery, focusing on associated functional TR and its treatment. Methods This retrospective study (2005-2019) included 206 consecutive adult ASD surgical cases without associated valve pathology, except functional TR. Variables were statistically compared on TR classes and surgery-defined groups. Results Mean age of the patients was 40.3±13 years; 19.9% had sinus venosus syndrome. TR severity was directly related to age, pulmonary systolic pressure, right ventricular and tricuspid annulus diameters, and heart failure class. TR ≥ 2 was found in 134 (65%) patients, while TR ≥ 3 in 56 (27.2%) patients. Tricuspid surgery was associated to shunt closure in 66 (32%) patients, almost all through valve repair; indication was directly related to age, right ventricular and tricuspid annulus diameters, and heart failure class ≥ 3. Tricuspid surgery was more efficient than isolated shunt closure in decreasing TR (79±23% vs. 36±26%; P=1.8 E-18). Device closure availability (last four years of the study) was associated with 1/3 reduction of surgical cases but increased the share of cases with TR>2 (> 51% vs. < 31%; P<0.05). Conclusion In the era of device closure, surgery for adult ASD is less frequent, but the share of significant TR cases is in net increase. To avoid long-term postoperative TR, we plead for valve repair in all patients with severe TR and for considering repair in moderate TR at risk of persistence.

引言功能性三尖瓣反流（TR）是已知的使成人房间隔缺损（ASD）复杂化的疾病，但其治疗仍存在争议。我们回顾了我们在ASD手术中的经验，重点关注相关的功能性TR及其治疗。方法这项回顾性研究（2005-2019）包括206例连续的成人ASD手术病例，除功能性TR外，无相关瓣膜病理。对TR类别和手术定义组的变量进行统计比较。结果患者平均年龄40.3±13岁；19.9%患有静脉窦综合征。TR的严重程度与年龄、肺收缩压、右心室和三尖瓣环直径以及心力衰竭分级直接相关。TR≥2者134例（65%），TR≥3者56例（27.2%）。66名（32%）患者的三尖瓣手术与分流关闭相关，几乎全部通过瓣膜修复；适应症与年龄、右心室和三尖瓣环直径、心力衰竭分级≥3直接相关。在降低TR方面，三尖瓣手术比单独的分流闭合更有效（79±23%对36±26%；P=1.8E-18）。器械闭合可用性（研究的最后四年）与手术病例减少1/3有关，但TR>2的病例比例增加（>51%对<31%；P<0.05）。结论在器械闭合时代，成人ASD的手术频率较低，但显著TR病例的比例净增加。为了避免术后长期TR，我们呼吁所有严重TR患者进行瓣膜修复，并考虑对有持续风险的中度TR进行修复。

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引用次数: 0

To Treat or Not to Treat? This Is the Question… About the Incidental Finding of Double Sinus of Valsalva Aneurysm in A 91-Year-Old Woman 治疗还是不治疗?这是一个关于偶然发现的双窦Valsalva动脉瘤在91岁妇女的问题

4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Brasileira De Cirurgia Cardiovascular

Pub Date : 2022-04-18 DOI: 10.21470/1678-9741-2021-0403

L. Marco, G. Comentale, M. Bruno, V. Lanzillotti, M. Colletta, V. Russo, D. Pacini, G. Casella

Sinus of Valsalva aneurysm is a very uncommon clinical finding and often requires emergency surgery due to its high risk of rupture. This educational text reports the case of a 91-year-old Italian women who was incidentally discovered to have a huge double aneurysm of the sinuses of Valsalva.

Valsalva动脉瘤窦是一种非常罕见的临床发现，由于其破裂的高风险，经常需要紧急手术。这个教育文本报告的情况下，一个91岁的意大利妇女谁偶然发现有一个巨大的双动脉瘤的鼻窦Valsalva。

引用次数: 0

Circumflex Coronary Artery Fistula Draining into Coronary Sinus 旋冠状动脉瘘管引流至冠状窦

4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Brasileira De Cirurgia Cardiovascular

Pub Date : 2022-04-18 DOI: 10.21470/1678-9741-2021-0254

Gabriela Carvalho Silva, Diana Patricia Lamprea Sepulveda Silva, E. Tenório, Edmilson Cardoso dos Santos Filho, Fabiana Michelle Feitosa de Oliveira, João Henrique de Andrade Torres, Patrícia Eduardo Teles Correia, Clístanes Lucas Henrique Ferreira, Petrus Thiago Jorge Lopes da Silva, F. Moraes

Coronary artery fistula draining into the coronary sinus is a rare vascular malformation, and its diagnosis and clinical manifestations usually occur late. We describe the case of a 72-year-old female patient with dyspnea on exertion (New York Heart Association Class III) associated with palpitations. The transthoracic echocardiogram showed significant tricuspid insufficiency. Cardiac catheterization showed aneurysm of the circumflex coronary artery and fistula of this artery draining into the coronary sinus. The patient underwent fistula ligation and tricuspid valve repair, with excellent surgical results.

冠状动脉瘘引流至冠状窦是一种罕见的血管畸形，其诊断和临床表现通常发生较晚。我们描述了一例72岁的女性患者，其在运动时呼吸困难（纽约心脏协会III级）并伴有心悸。经胸超声心动图显示三尖瓣功能不全。心导管插入术显示旋支冠状动脉的动脉瘤和该动脉的瘘流入冠状窦。患者接受了瘘管结扎和三尖瓣修复术，手术效果良好。

引用次数: 0

A Modified Ascending Aortic Cannulation Technique in Minimally Invasive Totally Thoracoscopic Cardiac Surgery 改良升主动脉插管技术在微创全胸腔镜心脏手术中的应用

4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Brasileira De Cirurgia Cardiovascular

Pub Date : 2022-04-18 DOI: 10.21470/1678-9741-2021-0234

S. Liao, Xiaoshen Zhang

Cannulation through the femoral artery is the preferred method of establishing peripheral cardiopulmonary bypass in minimally invasive totally thoracoscopic cardiac surgery. However, faced with the contraindication of femoral artery cannulation, modified ascending aortic cannulation is an alternative approach to minimally invasive totally thoracoscopic cardiac surgery.

在微创全胸腔镜心脏手术中，股动脉插管是建立外周心肺转流的首选方法。然而，面对股动脉插管的禁忌症，改良升主动脉插管是微创全胸腔镜心脏手术的替代方法。

引用次数: 0

Experimental Evaluation of Chitosan Membrane and Collagen Sponge (TachoSil®) as Sealants in Cardiovascular Surgery 壳聚糖膜和胶原海绵（TachoSil®）作为心血管外科密封剂的实验评价

4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Brasileira De Cirurgia Cardiovascular

Pub Date : 2022-04-18 DOI: 10.21470/1678-9741-2021-0432

Renan Nalin dos Santos, G. C. Cardoso, M. R. Cunha, E. Marchi, M. V. Carvalho

Introduction The objectives of this study are to experimentally evaluate the haemostatic effects of two organic substances, a membrane of chitosan and a collagen sponge coated with thrombin and human fibrinogen (TachoSil®), in sealing 7-0 needle stitches holes on the femoral arteries of rats as well as to evaluate local histological reactions. Methods Twenty-four rats were included, and four holes were made in each common femoral artery. In the control group, haemostasis was achieved only by compression with gauze sponge; and in the two other groups, haemostasis was achieved with application of one of these two substances. Results Membrane of chitosan and TachoSil® showed a power to reduce the time to achieve haemostasis compared with the control group (P=0.001), and the haemostatic effects of these two substances were comparable. There was lower blood loss in the groups where these two substances were used when compared with the control group, but no difference was found comparing the two substances. Conclusion The use of these sealants did not promote more adhesion or local histological reactions when compared to the control group. Since chitosan is easy to find in nature, has a positive effect to promote haemostasis, and did not bring considerable local reactions, it might be used as a sealant in cardiovascular surgery.

引言本研究的目的是通过实验评估两种有机物质（壳聚糖膜和涂有凝血酶和人纤维蛋白原的胶原海绵（TachoSil®））对大鼠股动脉7-0针孔的止血效果，并评估局部组织学反应。方法取24只大鼠，在股总动脉上各钻4个孔。对照组仅采用纱布海绵压迫止血；在另外两组中，通过应用这两种物质中的一种来实现止血。结果与对照组相比，壳聚糖膜和TachoSil®显示出缩短止血时间的能力（P=0.001），这两种物质的止血效果相当。与对照组相比，使用这两种物质的组的失血量较低，但比较两种物质没有发现差异。结论与对照组相比，这些密封剂的使用并没有促进更多的粘附或局部组织学反应。由于壳聚糖在自然界中很容易找到，具有积极的止血作用，并且不会引起相当大的局部反应，因此它可以用作心血管手术的密封剂。

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引用次数: 2

Usefulness of Immature Granulocytes as A Prognostic Factor in ST-Elevation Myocardial Infarction 未成熟粒细胞作为st段抬高型心肌梗死预后因素的有效性

4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Brasileira De Cirurgia Cardiovascular

Pub Date : 2022-04-18 DOI: 10.21470/1678-9741-2021-0088

M. Korkut, C. Bedel, Ramazan Sivil, Mücahit Alp Arslan, F. Selvi, G. Kuş, Ökkeş Zortuk

Objective ST-segment elevation myocardial infarction (STEMI) is a serious, life-threatening disease. Inflammatory markers have recently become the focus of attention in the assessment of severity in the early stages of STEMI. This study aimed to evaluate the importance of immature granulocytes (IG) as a prognostic marker in STEMI. Methods Patients admitted to the coronary care unit with a diagnosis of STEMI and who underwent primary percutaneous coronary intervention (pPCI) within the period from January 1, 2019 to January 1, 2020, were retrospectively scanned. A total of 146 patients were analised; of these, 112 (76.7%) were male and 34 (33.3) were female, with a mean age of 62.65±14.06 years. Patients’ age, gender, haemogram, biochemistry, and mortality results were recorded. The patients were divided into two groups as low (<0.6) and high (≥0.6) IG levels and compared. Results The mean IG levels were significantly higher in the non-survivor group compared to the survivor group (1.12±0.22 vs. 0.50±0.28, P<0.001). Mortality rates were significantly higher in the high IG group compared to the low IG group (26.9% vs. 9.6%, P=0.006). IG was shown to predict mortality with a sensitivity of 72.2% and a specificity of 77.8% at a cut-off value of 0.65 (area under the curve: 0.740, 95% CI: 0.635-0.846, P<0.001). Conclusion High IG values in the blood collected at the time of admission to the emergency department are a marker of mortality in patients with STEMI.

目的st段抬高型心肌梗死(STEMI)是一种严重的、危及生命的疾病。近年来，炎症标志物已成为STEMI早期严重程度评估的关注焦点。本研究旨在评估未成熟粒细胞(IG)作为STEMI预后标志物的重要性。方法回顾性分析2019年1月1日至2020年1月1日期间经皮冠状动脉介入治疗(pPCI)的STEMI患者。共分析了146例患者;其中男性112例(76.7%)，女性34例(33.3)，平均年龄62.65±14.06岁。记录患者的年龄、性别、血象、生化及死亡率。将IG水平低(<0.6)和高(≥0.6)两组患者进行比较。结果非存活组IG水平显著高于存活组(1.12±0.22∶0.50±0.28,P<0.001)。高IG组的死亡率明显高于低IG组(26.9%比9.6%，P=0.006)。IG预测死亡率的敏感性为72.2%，特异性为77.8%，临界值为0.65(曲线下面积:0.740,95% CI: 0.635-0.846, P<0.001)。结论急诊入院时采血IG值高是STEMI患者死亡的一个标志。

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引用次数: 3

Outcomes of Aortic Valve Replacement Via Right Anterior Minithoracotomy and Central Cannulation Versus Conventional Aortic Valve Replacement in Obese Patients 肥胖患者经右前小胸切开联合中央插管主动脉瓣置换术与常规主动脉瓣置换术的效果

4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Brasileira De Cirurgia Cardiovascular

Pub Date : 2022-04-18 DOI: 10.21470/1678-9741-2021-0098

Burcin Abud, O. Saydam, A. Engin, Kemal Karaarslan, A. Kunt, M. Karaçelik

Introduction The minimally invasive implantation of aortic valve prosthesis via thoracotomy has numerous advantages and is comfortable, especially during the early postoperative period. Disadvantages of this method include peripheral vessel complications and groin infections. Central cannulation (direct aortic cannulation with superior vena cava cannulation) eliminates these drawbacks. In this report, we evaluated this method of treatment in patients with obesity. Methods We retrospectively analyzed the medical records of 21 obese patients with severe aortic stenosis who underwent minimally invasive aortic valve implantation via thoracotomy and central cannulation with a bovine pericardial aortic prosthesis between 2017 and 2021. We compared these records with the medical records of 27 obese patients with severe aortic stenosis who underwent conventional aortic valve surgery. Results Mean cross-clamp and cardiopulmonary bypass times were similar in both groups. Operating time was significantly longer in the minimally invasive group (P <0.05). In the minimally invasive group, acute renal failure occurred in 2 patients. In terms of postoperative complications, deep sternal wound infection/sternal instability was much higher in the conventional group. This was not statistically significant (P=0.090). Minimally invasive operated patients had a comfortable early postoperative period, with a mean visual analog scale for pain of 1.10±0.83 (no pain-mild pain). When we assessed patient satisfaction with the postoperative period, 13 patients were extremely satisfied, 7 patients were satisfied, and 1 patient was quite satisfied. Conclusion Minimally invasive aortic valve implantation via thoracotomy and central cannulation is a safe and effective treatment for obese patients.

经开胸微创主动脉瓣假体植入术具有诸多优点，且舒适，尤其是在术后早期。这种方法的缺点包括周围血管并发症和腹股沟感染。中心置管(直接主动脉置管加上腔静脉置管)消除了这些缺点。在本报告中，我们评估了这种治疗方法在肥胖患者中的应用。方法回顾性分析2017年至2021年21例重度主动脉瓣狭窄的肥胖患者的医疗记录，这些患者通过开胸和牛心包主动脉假体中心插管行微创主动脉瓣植入术。我们将这些记录与27例重度主动脉瓣狭窄的肥胖患者进行常规主动脉瓣手术的医疗记录进行比较。结果两组患者平均交叉钳夹次数和体外循环次数相似。微创组手术时间明显长于对照组(P <0.05)。微创组2例发生急性肾功能衰竭。术后并发症方面，常规组胸骨深创面感染/胸骨不稳发生率明显高于常规组。差异无统计学意义(P=0.090)。微创手术患者术后早期舒适，平均视觉模拟疼痛评分为1.10±0.83(无疼痛-轻度疼痛)。在对患者术后满意度进行评估时，非常满意13例，满意7例，比较满意1例。结论开胸中心置管微创主动脉瓣植入术是治疗肥胖患者安全有效的方法。

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引用次数: 1

Three-Dimensional Printing in Minimally Invasive Cardiac Surgery: Optimizing Surgical Planning and Education with Life-Like Models 三维打印在微创心脏手术:优化手术计划和教育与逼真的模型

4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Brasileira De Cirurgia Cardiovascular

Pub Date : 2022-03-10 DOI: 10.21470/1678-9741-2020-0409

P. Montanhesi, G. Coelho, S. A. F. Curcio, R. Poffo

Over recent years, the surgical community has demonstrated a growing interest in imaging advancements that enable more detailed and accurate preoperative diagnoses. Alongside with traditional imaging methods, three-dimensional (3-D) printing emerged as an attractive tool to complement pathology assessment and surgical planning. Minimally invasive cardiac surgery, with its wide range of challenging procedures and innovative techniques, represents an ideal territory for testing its precision, efficacy, and clinical impact. This review summarizes the available literature on 3-D printing usefulness in minimally invasive cardiac surgery, illustrated with images from a selected surgical case. As data collected demonstrates, life-like models may be a valuable adjunct tool in surgical learning, preoperative planning, and simulation, potentially adding safety to the procedure and contributing to better outcomes.

近年来，外科社区对成像技术的发展越来越感兴趣，这些技术可以使术前诊断更加详细和准确。除了传统的成像方法外，三维(3d)打印也成为一种有吸引力的工具，用于补充病理评估和手术计划。微创心脏手术，以其广泛的具有挑战性的程序和创新的技术，代表了一个理想的领域来测试其准确性，有效性和临床影响。这篇综述总结了3d打印在微创心脏手术中的可用性的现有文献，并从一个选定的手术病例中插图说明。正如所收集的数据所表明的那样，仿生模型可能是外科学习、术前计划和模拟中有价值的辅助工具，可能会增加手术的安全性，并有助于获得更好的结果。

引用次数: 5

A Case of Using No-Touch Saphenous Vein Graft in Redo CABG after Multiple Failed Percutaneous Coronary Interventions. 一个在多次经皮冠状动脉介入手术失败后使用无触点隐静脉移植物重新进行 CABG 的病例。

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Brasileira De Cirurgia Cardiovascular

Pub Date : 2022-03-10 DOI: 10.21470/1678-9741-2021-0203

Victor Edin, Håkan Geijer, Piotr Jakuszewski, Domingos Souza

The modality of repeat revascularization due to late graft failure is a debated topic. The latest available European guidelines recommend redo coronary artery bypass graft (CABG) for cases of extensively diseased and/or occluded grafts and those with diffuse native vessel disease. We present the case of a patient being relieved of recurrent unstable angina pectoris with redo CABG using no-touch saphenous vein grafts after repeated and unsuccessful attempts with percutaneous coronary intervention (PCI). This could be an alternative to PCI in patients with a complex medical history. Teamwork between cardiologists and surgeons is pivotal in deciding the best treatment modality.

因后期移植物失败而再次进行血管重建的方式是一个备受争议的话题。最新的欧洲指南建议，对于广泛病变和/或闭塞的移植物以及伴有弥漫性原生血管病变的病例，应重新进行冠状动脉旁路移植术（CABG）。我们介绍了一例患者的病例，该患者在多次尝试经皮冠状动脉介入治疗（PCI）未果后，通过使用无触点大隐静脉移植物重做冠状动脉旁路移植术，缓解了反复发作的不稳定型心绞痛。对于病史复杂的患者来说，这可以作为 PCI 的替代方案。心脏病专家和外科医生之间的团队合作对于决定最佳治疗方式至关重要。

引用次数: 0

Surviving the Struggle of COVID-19: Practical Recommendations for Pediatric/Adult Cardiology and Cardiac Surgical Programs in Resource-Limited Settings: a Review. 在新冠肺炎的斗争中幸存：在资源有限的环境中对儿科/成人心脏病学和心脏外科项目的实用建议：综述

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Brasileira De Cirurgia Cardiovascular

Pub Date : 2022-03-10 DOI: 10.21470/1678-9741-2021-0477

Kevin Pilarczyk, Vinicius Nina, Lynn Boshkov, Barbara Ferdman, Emily A Farkas, Nicole Burnham, Renzo Cifuentes, Daniel Ntogwiachu, Aubyn Marath

Introduction: The primary aim of this systematic review is to provide perioperative strategies to help restore or preserve cardiovascular services under threat from financial and personnel constraints imposed by the coronavirus disease 2019 (COVID-19) pandemic.

Methods: The Medical Literature Analysis and Retrieval System Online, Excerpta Medica dataBASE, Cochrane Central Register of Controlled Trials/CCTR, and Google Scholar were systematically searched using the search terms "(cardiac OR cardiology OR cardiothoracic OR surgery) AND (COVID-19 or coronavirus OR SARS-CoV-2 OR 2019-nCoV OR 2019 novel coronavirus OR pandemic)". Additionally, the webpages of relevant medical societies, including the World Federation Society of Anesthesiologists, the Cardiothoracic Surgery Network, and the Society of Thoracic Surgeons, were screened for relevant information.

Results: Whereas cardiac surgery and cardiology practices were reduced by 50-75% during the pandemic, mortality of patients with COVID-19 increased significantly. Healthcare workers are among those at high risk of infection with COVID-19.

Conclusion: Hospitals must provide maximum protective equipment and training on how to use it to healthcare workers for their mutual protection. Triage management of patients - which accounts for patient's clinical status and risk-factor profile relatable to which services are available during the COVID-19 pandemic - is recommended. A strict reorganization of the hospital resources including preoperative, intraoperative, and postoperative detailed protective measures is necessary to reduce probability of vector contamination, to protect patients and the cardiovascular teams, and to permit safe resumption of cardiological and cardiac surgical activity.

引言本系统综述的主要目的是提供围手术期策略，以帮助在2019冠状病毒病（新冠肺炎）大流行造成的财务和人员限制的威胁下恢复或保存心血管服务。方法利用检索词“（心脏或心脏病学或心胸外科）与（新冠肺炎或冠状病毒或SARS-CoV-2或2019-nCoV或2019新型冠状病毒或大流行）”，系统检索医学文献分析与检索系统在线、医学数据库摘录、Cochrane对照试验中央注册中心/CTR和Google学者。此外，还对包括世界麻醉师联合会、心胸外科网络和胸外科医生学会在内的相关医学会的网页进行了相关信息筛选。结果尽管在大流行期间心脏手术和心脏病实践减少了50-75%，但新冠肺炎患者的死亡率显著上升。医护人员是感染新冠肺炎的高危人群之一。结论医院必须为医护人员提供最大限度的防护设备，并对其进行使用培训，以实现他们的相互保护。建议对患者进行分类管理，考虑患者的临床状况和与新冠肺炎大流行期间提供的服务相关的风险因素概况。有必要严格重组医院资源，包括术前、术中和术后详细的保护措施，以降低病媒污染的可能性，保护患者和心血管团队，并允许安全地恢复心脏病和心脏外科活动。

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