Browsing by Author "Antunes, MJ"
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- Acute Mitral Regurgitation due to Ruptured ePTFE Neo-chordaePublication . Coutinho, GF; Carvalho, L; Antunes, MJChordal replacement with expanded polytetrafluoroethylene (ePTFE) sutures has proven to be a simple, versatile, and durable technique for the treatment of prolapsed cusps causing mitral valve regurgitation. ePTFE is known for its strong resistance to tension, and is judged to be unbreakable under physiological conditions. Herein are reported two cases of rupture of synthetic chordae tendineae; the possible causes of this extremely rare finding are analyzed.
- Aneurisma da Aurícula Direita - caso clínicoPublication . Afonso, PV; Antunes, MJWe report the case of a 49-year-old patient, with recent onset of fatigue, who was diagnosed with atrial fibrillation, which was cardioverted electrically. A diagnosis of right atrial aneurysm, with no other cardiac pathology, was made. An aneurysmectomy was performed. Both surgery and postoperative recovery were uneventful.
- Angiossarcoma cardíaco primário. Ressecção alargada da parede da aurícula direita coronáriaPublication . Afonso, PV; Antunes, MJWe report the case of a 51-year-old patient who presented with tiredness and leg swelling, with recurrent pericardial effusion; a right atrial tumor, suggestive of sarcoma, was diagnosed, which responded poorly to chemotherapy. In the absence of metastases, surgery for excision of the tumor was undertaken. Two months after surgery she had a new recurrence of pericardial effusion and chemotherapy was reinitiated. She is currently well and asymptomatic, with no signs of recurrence ten months after surgery and nearly 24 months after the initial diagnosis.
- Aortic root enlargement does not increase the surgical risk and short-term patient outcomePublication . Coutinho, GF; Correia, PM; Paupério, G; Oliveira, JF; Antunes, MJObjective: To analyze the short-term outcome of aortic root enlargement (ARE) using death and adverse events as end points. Methods: From January 1999 through December 2009, 3339 patients were subjected to aortic valve replacement (AVR). A total of 678 were considered to have small aortic roots (SARs) in which an aortic prosthesis size 21mm or smaller was implanted. ARE using a bovine pericardial patch was performed in another 218 patients, who constitute the study population. This comprised 174 females (79.8%); the mean age was 69.4±13.4 years (8-87, median 74 years), the body surface area (BSA) was 1.59±0.15m(2) and the body mass index (BMI) 25.77±3.16kgm(-2), and 192 (88.5%) were in New York Heart Association (NYHA) II-III. Preoperative echocardiography revealed significant left ventricular (LV) dysfunction in 17 patients (8%), a mean aortic valve area of 0.57±0.27cm(2), and a mean gradient of 62.51±21.25mmHg. A septal myectomy was performed in 129 subjects (59.2%), and other associated procedures, mostly coronary artery bypass grafting (CABG), in 60 (27.5%). Bioprostheses were implanted in 161 patients (73.9%). The mean valve size was 21.9±1.0 (21-25). The mean extracorporeal circulation (ECC) and aortic clamping times were 82.8±19.8min and 56.8±12.5min, respectively. Results: Hospital mortality was 0.9% (n=2) for ARE as compared with 0.6% (n=4) for the SAR group (p=0.8). Inotropic support was required in only 13 (5.9%) patients and the first 24-h chest drainage was 336.2±202ml. Other complications included pacemaker implantation (7.8%), acute renal failure (10.6%), respiratory (4.1%), and CVA/transient ischemic attack (CVA/TIA) (3.2%). Postoperative echocardiographic evaluation showed a significant decrease in peak and mean aortic gradients (23.7±9.5 and 14±6.2mmHg, respectively, p<0.0001). The mean indexed effective orifice area (iEOA) was 0.92±0.01cm(2)m(-2) (vs 0.84±0.07cm(2)m(-2), in SAR, p<0.0001). Only 11% of patients (n=24) with ARE exhibited moderate patient-prosthesis mismatch (PPM) and none had severe PPM. Mean hospital stay was 9.7±9.29 days (median 7 days). Conclusions: With the growing number of patients with degenerative aortic valve pathology, mainly an older population, sometimes with calcified and fragile aortic wall, the issue of dealing with an SAR poses the dilemma of whether to implant a smaller prosthesis and admit some degree of PPM, or to enlarge the aortic root. This study demonstrates that the latter can be done in a safe and reproducible manner.
- Aortic valve surgery in patients who had undergone surgical myocardial revascularization previously.Publication . Paupério, GS; Pinto, CS; Antunes, PE; Antunes, MJOBJECTIVES: A very high percentage of patients submitted to coronary artery bypass grafting (CABG) develop symptomatic aortic disease requiring surgery upon ageing. The surgical risk of the redo procedure is controversial. We describe our recent experience with patients submitted to this surgery under such conditions. METHODS: From July 1999 to July 2010, 51 patients (mean age, 70.3 ± 7.0 years, 86.3% male) submitted to CABG previously required aortic valve surgery (AVS). The mean interval between the surgeries was 7.1 ± 3.9 years. Twenty-one patients (41.2%) had also undergone AVS during the first surgery [12 patients (57.7%) had valve replacement and 9 patients (42.8%) had valvuloplasty]. At presentation, 51.0% were in New York Heart Association Class III/IV and the standard and logistic EuroSCOREs were 10.1 ± 2.5 and 20.9 ± 16.5%, respectively. RESULTS: Aortic valve replacement was performed in 48 patients (94.1%). Two patients had undergone a surgery for the closure of a peri-prosthetic leak and one patient a valvuloplasty. Thirteen patients (25.5%) needed to undergo additional cardiac procedures, including root enlargement (three patients, 5.9%). Valve surgery was performed with non-dissection of the internal thoracic artery graft, when patented, and antegrade cardioplegic arrest of other territories. Hospital and 30-day mortality rate was 2% (n = 1). The mean duration of hospital stay was 13.0 ± 11.1 days. The most frequent complication was arrhythmias - in 25.5% of the patients, and mostly due to atrial fibrillation (19.6%). Permanent pacemaker for A-V block was required in 5.9% of the cases, stroke was documented in two cases (3.9%) and early re-intervention was observed in two cases. CONCLUSIONS: Redo AVS performed in patients submitted to CABG previously results in mortality and morbidity rates that are much lower than what is expected, bringing clear benefits to the patients.
- Brucella endocarditis of the aortic valvePublication . Leandro, J; Roberto, H; Antunes, MJBrucella endocarditis was diagnosed in two patients with acute renal failure. Both patients had major aortic insufficiency, congestive cardiac failure and clinical and laboratory signs of an active infection, although adequate antibacterial therapy had already been introduced. Replacement of the aortic valve, together with the aortic root in one of the cases, were carried out as emergency procedures, followed by antibacterial treatment with rifampicin, doxycycline and co-trimoxazole. Both patients left the hospital cured and are well 2.5 and 2 years after the surgery, respectively.
- Cardiac allograft systolic function. Is the aetiology (ischaemic or idiopathic) a determinant of ventricular function in the heart transplant patient?Publication . Antunes, MJ; Biernet, M; Sola, E; Oliveira, L; Prieto, D; Franco, F; Providência, LAThe natural history of the LV systolic function (LV-SF) and functional capacity of survivors of heart transplantation (Htx) has not been defined. Some investigators suggest that SF may be different in recipients with different pre-transplant aetiologies: ischaemic or dilated, idiopathic disease. Routine transthoracic echocardiograms (TTE) were performed during a 1-year follow-up in 48 Htx recipients (total 864 examinations; mean 18/patient). Patients were divided into two groups based on pre-transplant diagnosis: ischaemic (CAD-CMP: n=13, age 54+/-1.7 years, 23% females) and idiopathic dilated cardiomyopathy (ID-CMP: n=35, age 51+/-2.3 years, 26% females). Patients with valvular and toxic aetiology were excluded. All patients underwent left ventriculography (VENT) 12-15 months after Htx. The majority of 1-year survivors of Htx maintained normal LV-SF: mean LVEF 65+/-4% by echocardiography and 68+/-3% by ventriculography, but in the ID-CMP group LVEF was significantly higher: 67+/-4% vs. 62+/-4% (TTE) and 77+/-4% vs. 60+/-4% (VENT), without significant differences in functional capacity (NYHA). 82.9% of ID-CMP patients had LVEF >65% vs. 39% in CAD-CMP. The incidence of acute cellular rejection, freedom from cardiac vasculopathy, renal failure, diabetes, hypertension and pre-transplant alloantibody level was similar. Our study shows a strong correlation between pre-transplant heart disease and the systolic function of the cardiac allograft at 1-year follow-up.
- Challenges in rheumatic valvular disease: Surgical strategies for mitral valve preservationPublication . Antunes, MJIn developing countries, rheumatic fever and carditis still constitutes a major public health problem. Patients have special characteristics that differ from those with rheumatic mitral valve disease we still see in developed countries. They are usually young, poor, uneducated, and have low compliance to prophylaxis / therapy. In addition, they usually have great difficulty in accessing medical care. In these situations, the rate of complications associated to valve replacement is significantly increased. Alternatively, mitral valve repair is now known to achieve better long-term results in this pathology, but this was not widely recognized three or four decades ago, when first reports showed worse results after repair of rheumatic regurgitation than with degenerative valves. This has been reported by several groups in developing countries in different continents, with high incidence of repairs and excellent long term results. It is, therefore, becoming increasingly clear that, although, the results may not compare to those obtained with degenerative pathology, repair of rheumatic valves, when feasible, is the procedure of choice, especially in these underprivileged populations.
- Cirurgia de coração aberto sem sangue: simples e seguraPublication . Paiva, P; Ferreira, E; Antunes, MJOBJECTIVES: The use of blood or blood products is routine in cardiac surgery, but is associated with various complications. Aware of this, we have always tried to avoid the use of blood products whenever possible. In this study we sought to evaluate the results of this policy. METHODS: The records of 1505 adult patients who underwent coronary (732) or valve (773) surgery under cardiopulmonary bypass (CPB) in 2002 and 2003 were reviewed retrospectively. Of these, 1058 were male (70.3%) and the mean age was 62.1+/-11.4 years. Mean weight was 68.5+/-10.2 kg and body surface area was 1.7+/-0.2 m2, corresponding to a blood volume of 4119.9+/-593.6 ml. Preoperative hematocrit (Hct) was 40.6+/-4.2% and the prothrombin index was 87.0+/-17.4%. A bloodless prime of the bypass circuit was used for all patients with Hct > or =36%. The prime volume was reduced to the minimum possible. Plasma was used when coagulation was deficient. All blood remaining in the CPB circuit was reinfused at the end of the procedure, either in the operating room or in the ICU. Shed mediastinal blood was retransfused in the first 6 hours in the ICU. RESULTS: Operative mortality was 0.7% for coronary and 0.5% for valve patients. Blood or blood products were not used in 77.3% of the patients (88.7% of coronary and 66.5% of valve patients). Blood and/or plasma was initially added to the prime in 18.2% of cases and during CPB in 11%. Hct was 28.9+/-4.0% after initiation and 28.8+/-3.9% after discontinuation of CPB. The number of units (300 cc) of blood used was 0.25.57 per patient (1.09+/-0.73 per patient transfused). The number of units (300 cc) of plasma used was 0.24+/-0.72. Reoperation for bleeding was required in 2.4% of the patients. CONCLUSIONS: This blood-sparing policy is simple, effective and safe, resulting in low mortality and morbidity rates. More than three quarters of the patients did not require blood or blood products. Additional measures are possible to further decrease the use of blood products.
- Cirurgia do aspergiloma pulmonar: curativa?Publication . Bernardo, JE; Calvinho, P; Eugénio, L; Antunes, MJIntroduction.In lhe last few decades, there has been an increase in fungal diseases, especially in those caused by Aspergillus.The aim of this retrospective study was to confirm or ascertain whether surgical intervention to pulmonary aspergiloma can result in a cure or long term palliative treatment with improvement of quality of life. Methods and materiais. From 1989 to 2001, 23 patients with mean age of 44.1 years (18-69 years) were submitted to pulmonary surgery for excision of aspergilloma. Sixteen patients were mate (70%). The most frequent indication for surgery was haemoptysis in 16 patients (70%) followed by abundant sputum in 3 patients (3%). Four patients (17%) were asymptomatic. Old tuberculosis lesions (87%) or pulmonary abscesses (13%) were lhe basic conditions for lhe aspergilloma. Pre-operative evaluation of respiratory function showed a mean vital capacity of 69.8% (61-84% limits) and lhe mean Fevl was 66% (53-82% limits). Results. This group of patients were submitted to 18 lobectomies (82%), 2 bilobectomies (7%), 2 wedge resections and 1 pneumonectomy (4%). There was no operative mortality and lhe morbidity in lhe post-operative period was: persistent air leak in 7 patients (30%), post-operative bleeding in 2 patients (7%) and residual cavities in 2 patients (7%). The mean time of follow-up was 7.2 years (limits 1.5-14 years) and 3 deaths were registered. Two deaths were related to intestinal neoplasia and 1 related to lhe original disease, 5 years after surgery. All surviving patients referred good improvement of symptoms and quality of life. Conclusions. The resection of pulmonary aspergilloma could be performed with a low morbidity and mortality. The patients referred good improvement of symptoms and quality of life after surgery. Consequently, we suggest that surgical therapy is an option for both symptomatic and asymptomatic patients