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Browsing by Author "Fernandes, LE"

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  • Coronary artery bypass surgery with intermittent aortic cross-clamping
    Publication . Antunes, MJ; Bernardo, JE; Oliveira, JM; Fernandes, LE; Andrade, CM
    Despite the generally accepted use of cardioplegia for myocardial protection during cardiac revascularization and other operations, non-cardioplegic methods have been used by many surgeons throughout the world. We have prospectively studied 229 patients consecutively subjected to isolated coronary artery bypass surgery from March 1990 to February 1991 by a single surgeon who used intermittent aortic cross-clamping for construction of the distal anastomoses. The mean age of the patients was 58.9 +/- 8.9 years. One hundred and nine patients (47.6%) with unstable angina were subjected to urgent or emergent surgery and 129 (56.3%) had a previous myocardial infarction. The mean number of grafts per patient was 3.0. The ischaemic time per graft was 6.5 +/- 1.4 min. At least one internal mammary artery was used in 98% of the cases (1.4 internal mammary artery grafts/patient). Hospital mortality was 0.9% (two patients, in neither case related to the procedure). Only nine patients (3.9%) required inotropes and none needed intra-aortic counterpulsation. The analysis of serum enzymes specific of myocardial lesion showed a CPK-MB/CPK ratio of 10.5 +/- 10.2 after surgery, 6.4 +/- 6.6% at 24 h after surgery, and 6.9 +/- 2.6% by the 5th day. Only four patients (1.7%) had ECG criteria of myocardial infarction. These results were compared retrospectively with those of the 40 immediately preceding patients (December 1989 to February 1990), in whom crystalloid cardioplegia had been used. There were no differences between the two groups with regard to age, prevalence of unstable angina and of previous myocardial infarction, and technique used.
    1992Journal article Open access Show more
  • Surgery of chest wall deformities
    Publication . Matos, AC; Bernardo, JE; Fernandes, LE; Antunes, MJ
    OBJECTIVE: To evaluate the medium-term results of 77 surgical corrections in patients with chest wall deformities, 53 (68.8%) with pectus excavatum and 24 with pectus carinatum, operated upon from 1985 to 1994. METHODS: The mean age of the patients was 14.7 years (4-39 years) and 77% were younger than 15 years of age. There were 59 male (76.7%) and 18 female patients. Only four had a family history of the malformation. Seven patients (9.1%) presented with asthma-like symptoms, and 13 (16.9%) referred dyspnea and tiredness for small efforts. The remainder (74.2%) were asymptomatic, but most were psychologically disturbed by the deformity and postural abnormality. Two patients had other skeletal abnormalities. The modified surgical technique used in all cases consisted of subperichondrial resection of the abnormal costal cartilages, transverse and longitudinal osteotomies of the sternum and internal stabilization with a steel rod which was generally removed between 6 and 12 months postoperatively. RESULTS: There was neither early nor late mortality. One patient had a pneumothorax which required chest tube drainage. The mean admission time was 10.5 days (8-14 days). Follow-up was complete, and 90% of the patients had increased effort tolerance. Five of the seven patients (72%) with 'asthmatic' symptoms showed a decrease in the frequency of the crises. Two patients had recurrence of the depression by 3 and 8 months, respectively. The remaining 75 patients (97.3%) were satisfied with the cosmetic result of the surgery. CONCLUSIONS: Surgical treatment of chest wall deformities using this technique leads to good cosmetic, orthopedic and psychological results. We believe that the operations should be performed at any age in patients who have at least a moderate deformity.
    1997Journal article Open access Show more