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Biomedical subjects

A Jatene

Publications and source records attributed to A Jatene.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Origin of left coronary artery from right and left pulmonary arteries--clinical, anatomico surgical and follow-up evaluation of 3 cases].

Three infants with anomalous origin of left coronary artery, being two from the right pulmonary artery and one from the left, without other congenital defects, ages of 5, 15 and 3 months old, presented with early congestive heart failure due to anterolateral myocardial infarction. Anatomical characteristic was peculiar in two cases since the left coronary artery, before the anastomosis with the right pulmonary artery, presented a wy, 15 mm extension path within the aortic wall which has facilitated the surgical correction by the proximity of these structures. In the third case, the left coronary artery was anastomosed with the left pulmonary artery, 2 cm from its origin and anterior to the left atrium being the surgical correction by direct implant at the ascending aorta. Post-operative follow-up, 36, 30 and 33 months respectively, showed clinical and laboratorial normalization except for the second case in which ST segment remained upward due to ventricular aneurysm. Myocardial recovery, even after extensive infarction, in this anomaly, emphasizes the need for earlier diagnosis and management.

Coronary Vessel Anomalies↗
PubMed1991

[Pseudoaneurysm of the left ventricle resected 20 years after acute myocardial infarction].

A 67 year-old-man suffered an uncomplicated myocardial infarction twenty years ago. By January 1990 an abnormal cardiac contour was noted on a chest radiography. Contrast ventriculography revealed a pseudoaneurysm of the left ventricle. The patient underwent open heart surgery and remains asymptomatic 12 months after surgery. This is the longest time interval between the myocardial infarction and successful surgery that has been reported.

Aged↗
PubMed1990

Infective endocarditis in the 1980s: experience at a heart hospital.

Three hundred episodes of infective endocarditis (IE) in 287 patients were studied from October 1978 to August 1986. The patients were in the age range of 0.2-78 (mean 30.76 +/- 16.06) years; 185 (68%) occurred in male patients. The etiologic agents were: Streptococci viridans group (93), enterococci (21), streptococci D group, nonenterococci (19), other streptococci (14), Staphylococcus aureus (59), Staphylococcus epidermidis (14), gram-negative bacteria (16), other gram-positive bacteria (16), fungi (4). Etiologic agents were not isolated in 52 (negative cultures). Valvular heart diseases occurred in 231 episodes, congenital heart diseases in 37, other heart diseases in 6. Sixty-nine occurred in patients with prosthetic heart valves. In 69 there was no previous heart disease. Surgical treatment was performed in 102 episodes (37 with prosthetic valve IE and 65 with native valve IE); 22 patients (21%) died, 12 with prosthetic valve and 10 with native valve IE. The in-hospital mortality (medical and surgical patients) was 26% (78 patients). Long-term follow-up of 206 patients up to 7.1 (mean 2.13 +/- 1.68) years revealed that 26 patients died. Thus, IE remains a disease with high mortality and is fatal to a third of the patients, in spite of the progress in therapeutic methods. Its morbidity and mortality continues beyond the microbiological cure.

Adolescent↗
PubMed1990

[Preoperative HIV infection in cardiovascular surgery].

PURPOSE: To evaluate patients in the preoperative period of cardiovascular surgery for HIV antibody in the serum. MATERIAL AND METHODS: 1200 patients older than 15 years tested for HIV antibody before cardiovascular surgery with an enzyme immunoassay test (ELISA). When the results were ELISA positive ou inconclusive, another sample was collected for confirmatory test (Western Blot). We also analysed risk factors, clinical status of HIV infection and postoperative evolution. RESULTS: ELISA test for HIV antibody were negative in 1180 (98.3%) patients, inconclusive in 14 and positive in 6. One ELISA inconclusive and six ELISA positive patients resulted Western Blot positive. All of the seven patients were asymptomatic (group II) in relation to HIV infection, including four bisexual men, two transfusion recipients men and a woman with an undetermined source of infection. Only the two transfusion recipients had their risk factor identified before testing. All of them were submitted to surgery with no immediate postoperative complication. CONCLUSION: Seven (0.58%) patients had HIV antibody (Western Blot assay) but in only two risk factors were identified by routine preoperative anamnesis.

AIDS Serodiagnosis↗
PubMed1990

[Bilateral diaphragmatic paralysis in the immediate postoperative period after cardiac surgery].

A 56 years old man was submitted to an aortic replacement with mechanical prosthesis and to saphenous vein graft to the right coronary artery. He developed respiratory insufficiency after surgery which was finally related to bilateral diaphragmatic paralysis whose diagnosis was confirmed through thorax ultrasonography. The patient remained under ventilatory assistance with positive pressure for 75 days. The introduction of thorax ventilatory negative pressure (VNP), jacket type, allowed the tracheostomy closure. The patient gradually recovered his spontaneous breathing and was discharged after 90 days with instructions to use VNP at night. He returned to his normal professional activities, without auxiliary respiratory support, 40 days after his discharge.

Aortic Valve Insufficiency↗
PubMed1990

[Cerebral malformation of the conceptus associated with maternal bacterial endocarditis and with aortic valve replacement during pregnancy].

A twenty-three years old woman, without previous heart disease developed endocarditis with negative bloods cultures on the fourth month of her third pregnancy. Fever was controlled through antibiotics, however she developed cardiac insufficiency and was submitted to surgery for replacement of aortic valve with a bioprosthesis. The post operative period showed no problems and the patient was discharged on the forty second day after admission. On the thirty ninth week of pregnancy she gave cesarean birth, without complications. The newly born, apgar 5 (1 min.) and 7 (5 min) presented signs of neurological problems, characterized on the second month as a cerebral atrophy. Among various possible factors, the most likely would be cardiopulmonary bypass circulation as the cause of the neurological malformation.

Adult↗
PubMed1990

[Mitral valve prolapse in infective endocarditis. Incidence and characteristics].

UNLABELLED: PURPOSE valve prolapse (MVP) cases, complicated with infective endocarditis (IE), seen at a cardiologic reference hospital. METHODS: The MVP cases were diagnosed within a series of 276 cases of IE without previous cardiac surgery with clinical-echocardiographic criteria. We emphasised in our study; a) incidence; b) age and sex distribution; c) risk factors for IE; d) clinical-bacteriological data; e) echocardiographic features; f) therapeutic aspects; f) evolution and complications. RESULTS: a) We diagnosed 40 (14.4%) cases of MVP; b) mean age of 40.6 years, with 29 men (72.5%); c) dental procedures without prophylactic antibiotic-therapy in seven patients (17.5%), mitral regurgitation in 33 (82.5%), mitral valve redundancy in six (15%); d) fever was found in all patients (100%), cachexia was diagnosed in eight (20%), polyarthritis in six (15%) and congestive heart failure in six (15%). A systolic murmur of mitral regurgitation was found in all the patients and a nonejective click was encountered in four (10%), a Streptococcus was cultivated in 30 (75%), Staphylococcus in three (7.5%) Haemophilus sp in three (7.5%) Peptostreptococcus products in one (2.5%) and negative in three (7.5%) patients; e) echocardiographic signs of vegetation in 23 (57.5%), mitral regurgitation in 33 (82.5%), rupture of mitral chordae in 11 (27.5%) and mitral redundance in six (15.2%); f) 37 (92.5%) patients were medically treated and three (7.5%) required surgery; g) we registered in the hospital evolution: stroke in 10 (25%) and noncerebral mycotic aneurysm in 2 (5%) cases, two patients died (5%), one due to a hemorrhagic complication after surgery of bioprosthesis implantation and another of rupture of a cerebral mycotic aneurysm. CONCLUSION: The MVP was frequent in the population of patients with IE with of patients with mitral regurgitation, and male with mean age greater than the other cases. We observed low incidence of surgical need (7.5%) and lethal outcome (5%) but frequent (25%) neurological complications.

Adolescent↗
PubMed1990

[Infective endocarditis: analysis of 300 episodes].

PURPOSE: Study of clinical features and etiologic agents, treatment and mortality of patients with infective endocarditis (IE). PATIENTS AND METHODS: 300 episodes of IE occurring in 288 patients, ages ranged between 0.2 and 78 (mean 30.76) years; 185 (62%) episodes occurred in males. RESULTS: a) etiologic agents: viridans group streptococci in 93 (31%) episodes, enterococci en 21 (7%), group D-non enterococci in 19 (6%) (13 S. bovis), other streptococci in 14 (5%), Staphylococcus aureus in 59 (20%), Staphylococcus epidermidis in 14 (5%), gram-negative bacteria in 16 (5%), gram-positive bacteria other than streptococci and staphylococci in 8 (3%), fungi in 4 (1%). The etiologic agents were not identified in 52 (17%) episodes; b) underlying cardiac diseases: valvular heart disease in 119 (40%) episodes, congenital heart disease in 37 (12%), prosthetic heart valves in 69 (23%), other heart diseases in 6 (2%). There was no evidence of previous heart disease in 69 (23%); c) treatment: surgical treatment was undertaken in 102 (34%) episodes. The frequency of surgical treatment in relation to the etiologic agents ranged between 1% (non-group D streptococci) and 62% (negative blood cultures). The frequency of operation in relation to underlying heart disease ranged between 17% (other heart diseases), 19% (congenital heart disease) and 54% (prosthetic heart valve); d) mortality: 78 (26%) patients died, 56 (28%) of the 198 submitted to medical treatment and 22 (21%) of the 102 submitted also to surgical treatment. The mortality in the different groups of etiologic agents ranged between 5% (non-group D streptococci) and 62% (gram-positive bacteria other than streptococci and staphylococci); in relation to the underlying heart disease, the mortality was 16% in patients with other heart disease, 19% in valvular heart disease patients, 21% in patients with congenital heart disease, 23% in patients without known heart disease and 43% in patients with prosthetic heart valves. CONCLUSION: The mortality associated with IE remains still high in spite of modern treatment; the mortality is different in relation to the different etiologic agents and in relation to the cardiac status before the IE.

Adolescent↗
PubMed1990

[Late potentials in patients with myocardial infarction subjected to coronary thrombolysis].

PURPOSE: Analyse the behavior of the late potentials (LP) in patients submitted to thrombolysis with success. MATERIAL AND METHODS: Thirty-five patients with acute myocardial infarction, 32 (91.4%) male with ages varying from 33 to 68 (mean 52.6). Thrombolysis was obtained during cinecoronarography with intravenous infusion "in bolus" of doses of 50 mg, 60 mg and 70 mg of rt-PA, with a new bolus of 30 mg at 60 minutes after the procedure. A new angiographic study was performed 12-48 hours late. The high resolution ECG was taken with the ART system model 1200 EPX, before, after and 72 hours later. The presence of electrical activity in the last 40 ms of the QRS complex with less than 20 mu volts in amplitude and more than 35 ms in duration characterized the LP. RESULTS: LP was observed in 16 (46%) patients during the phase of arterial occlusion. LP was recorded only in 23% after recanalization and in 26% when the infarcted related artery (IRA) remain opened. The reduction in the LP was 43.5%. Only one patient with LP had threatening arrhythmia. CONCLUSION: In patients with demonstrated thrombotic occlusion of the IRA, the recanalization diminished the incidence of LP in 43.5% of the patients. Further studies are necessary to achieve the exact clinical importance of these findings.

Action Potentials↗
PubMed1990

A technique for correction of truncus arteriosus types I and II without extracardiac conduits.

A new corrective operation for truncus arteriosus without the use of an extracardiac conduit was performed in seven patients with truncus type I (six patients) or type II (one patient) aged from 2 to 9 months. The common truncus arteriosus was septated with a patch into aortic and pulmonary segments and the ventricular septal defect was closed through a ventriculotomy. A direct anastomosis between the pulmonary arteries and the right ventricle was performed, the anterior wall being constructed with a patch with a monocusp valve. There was one death in the immediate postoperative period. In the surviving six patients the postoperative right ventricular/left ventricular peak systolic pressure ratio was less than 0.51 in five and 0.60 in one with a residual ventricular septal defect. All are in functional class I between 1 and 14 months after the operation. On the basis of these results, we propose this technique for patients with truncus type I or II in the first year of life.

Blood Vessel Prosthesis↗
PubMed1989

[Histopathologic aspects of hyperacute graft rejection in human cardiac transplantation. A case report].

The first case of a hyperacute rejection of a human cardiac allograft in Brazil is reported. The histopathological aspects of hyperacute cardiac rejection in its earlier moments are described when degenerative and necrotic features of the cardiac fibers are not totally developed. The authors believe that neutrophilic exudation and lesion of the vessel wall are good signs for a correct diagnosis of hyperacute rejection. Furthermore, they observed that the process is diffuse enough to justify the indication of endomyocardial biopsy when there are reasons to suspect this diagnosis. Presence of IgM and complement (C3) are also useful.

Adult↗