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M R Gomes

Publications and source records attributed to M R Gomes.

13 recordsLinked to original sources
PubMed1992

[Surgical treatment of ventricular septal defect in the first year of life].

Forty six infants with a large ventricular septal defect (VSD) underwent surgical treatment during the first 12 months of life. Forty three patients ranging in age from 3 to 12 months (mean age 10.4 months) and weighting from 3.0 to 8.2 kg (mean weight 6.8 kg) had primary surgical closure of their VSD. All infants were below the third percentile for weight preoperatively. In 40 patients (93%) the defect was closed through the right atrium. Three patients (7.0%) died in the early postoperative period. Surgically induced heart block occurred in one patient (2.3%). Late results were assessed in 29 surgical survivors (mean follow-up 26 months). There was no late mortality. Relief of congestive heart failure was prompt in all patients following closure of VSD. Right bundle branch block with left anterior hemiblock developed in 5 patients (17.2%), and right bundle branch block alone in 10 patients (34.5%). Three patients (mean age 4.3 months, mean weight 2.7 kg) underwent initial palliative pulmonary artery banding (PAB). There were no operative or late mortality. Closure of VSD and pulmonary artery debanding was performed in two of these patients, with no mortality. Prior to intracardiac correction the pulmonary artery pressure distal to the band was normal; no band related complications were found. Early primary closure is the treatment of choice for symptomatic infants with large VSDs. In particular circumstances, however, PAB may provide effective palliation.

Age Factors↗
PubMed1992

[Echocardiographic assessment of interventricular septal defect corrected during the first year of life].

OBJECTIVE: To evaluate the medium term results of surgical closure of ventricular septal defect (VSD) performed during the first year of life, using echocardiography (echo). MATERIAL AND METHODS: We studied prospectively 29 patients aged from 17 to 68 months (mean = 37) who underwent surgical closure of perimembranous VSD during the first year of life. The postoperative follow-up time ranged from 6 to 60 months (mean = 26). Fifteen age-matched normal children were used as a control group in evaluating the left ventricular (LV) systolic function. The echo study included: 1) the assessment of LV systolic function using the shortening fraction, ejection fraction, pre-ejection to ejection time ratio (PET/ET), aortic flow acceleration time, acceleration to ejection time ratio, mean aortic flow acceleration; 2) detection and quantification of residual VSD as well as tricuspid and or aortic regurgitation; 3) determination of right ventricular systolic pressure (RVSP). The RVSP was evaluated from the maximum flow velocity from a residual VSD or tricuspid regurgitation, using the simplified Bernoulli equation. RESULTS: The LV systolic function parameters from patients versus (vs) normals showed a significantly different shortening fraction (34 +/- 5 vs 39 +/- 4; p = 0.005) and PET/ET ratio (0.34 +/- 0.04 vs 0.31 +/- 0.03; p = 0.02). None of the other studied parameters was significantly different from normal. Five (17%) patients had a small residual VSD. Two (7%) patients had mild aortic regurgitation. Tricuspid regurgitation was detected in 23 (79%) patients being trivial in 20 and mild to moderate in 3. The RVSP was quantified in 22 (76%) patients, ranging from 30 to 45 mmHg (mean +/- SD = 36 +/- 4). None of the remaining 7 patients showed changes in the end-systolic interventricular septal configuration. CONCLUSIONS: Our study shows that surgical closure of perimembranous VSD performed during the first year of life was possible without significant mobility. Furthermore, the echo allowed a complete and noninvasive cardiac evaluation of the anatomic, functional and hemodynamic status of this group of patients, thus limiting the need for postoperative control cardiac catheterization.

Echocardiography↗
PubMed1992

[Echocardiographic study of 53 patients with rheumatoid mitral stenosis].

In 53 patients with rheumatic mitral stenosis we performed echocardiographic study in order to define anatomic and functional alterations. We used 3.5 MHZ probe and obtained images from apical and parasternal windows. Determinations were performed by standards of the American Society of Echocardiography. Thirteen patients were men and forty women. Men's mean age was 43.5 years and women's mean age 40 years. In the men anatomic mitral valve area was 1.1 cm2 and in the women 1.3 cm2. Correlation anatomic to functional valve area was strong (r = 0.9). Mitral diastolic gradient had correlation with cardiac output, mitral valve area and ejection fraction. Pulmonary artery pressure had strong correlation with valve area and cardiac output. In conclusion, our study showed the usefulness of functional valve area in the graduation of mitral stenosis, the dependence of the mitral diastolic gradient of several cardiac events, the independence of the left atrium dimensions and also the strong dependence of pulmonary artery pressure of cardiac output and valve area.

Adult↗
PubMed1991

[Valve replacement with Macchi prosthesis].

OBJECTIVE: to evaluate the performance of a new ball valve prosthesis. DESIGN: set up of two groups of patients who underwent mitral valve replacement with two different prosthesis: the Macchi prosthesis under evaluation and the well known Starr-Edwards model prosthesis. The chi-square test was used to compare the results. PATIENTS: Patients referred for valvular surgery. INTERVENTIONS: One group of 98 consecutive patients who underwent isolated mitral valve replacement with a Macchi prosthesis from January 1984 to June 30 1986 was compared to a matched group of 49 patients who received a Starr-Edwards prosthesis in the same period of time. Follow-up data were available from 99% patients in the Macchi group 96% in the Starr-Edwards group, with a mean follow-up time of 35.2 (2-57) and 42.9 (4-62) months, respectively. RESULTS: There was no statistical difference in the incidence per 100 patients--month of prosthetic complications--thromboembolism, hemorrhagic events, prosthetic endocarditis, reoperation and mechanical failure. CONCLUSIONS: In our experience and with the available follow-up data the Macchi prosthesis is a good cost effective option when there is indication for a ball valve prosthesis.

Adult↗
PubMed1991

[Transesophageal echocardiography. Evaluation of the technique and clinical indications. Experience at the Center of Thoracic Surgery of the S. João-Porto Hospital].

The purpose of this paper is to report the early experience with Transesophageal Echocardiography (TEE) after its availability at Thoracic Surgery, Hospital S. João, Oporto, Clinical advantages of the esophageal acoustic window over other approaches and technical development background of the procedure are reviewed. Updated clinical indications of the procedure and illustrative clinical cases from daily practice are presented. From October 1990 to February 1991, 75 examinations have been performed, 59 in awake patients and 16 in unconscious patients, either in the operating theatre or in intensive care unit. The examination protocol was similar to the one followed at Mayo Clinic. All patients accepted to undergo the study when indicated. No technical difficulties were found and no complications were reported during the study period. Finally, based on this introductory experience, a comment is made on main indications for using TEE complemented by few notes on future perspectives with this using ultrasound technique.

Aged↗
PubMed1991

[Pseudoaneurysm of the outflow chamber of the left ventricle as a complication of bacterial endocarditis of the aortic valve -- a clinical case].

After reporting a clinical case of a patient with a Staphylococcus Aureus Acute Endocarditis involving the aortic valve being complicated with cardiac failure irresponsive to medical treatment, which required a surgical procedure, the authors describe the preoperative echocardiography features. These features have the particularity of identifying a pseudoaneurysm rising in the outflow tract of the left ventricle, that involves the annulus and the anterior mitral leaflet, opening into the left atrium. They also take the opportunity to review the main local complications of Infective Endocarditis, affecting native or prosthetic valves, and make some comments on the diagnostic echocardiographic possibilities.

Adult↗
PubMed1990

[Aorto-left ventricular tunnel arising from the left sinus of Valsalva].

Aortic-left ventricular tunnel (ALVT) is a rare congenital anomaly in which an abnormal communication connects the ascending aorta with the left ventricle, bypassing the aortic valve. Usually the ALVT takes its origin from the right aortic sinus. We report a patient with an ALVT arising from the left sinus of Valsalva who underwent surgery at five months of age. The diagnosis was first established by two-dimensional echocardiography.

Aorta↗
PubMed1989

External and middle ear malformations: autosomal dominant genetic transmission.

Congenital malformations of the external and middle ear relatively frequent anomalies (one to five cases in 20,000 live births). They are part of genetic syndromes such as Treacher Collins and Goldenhar's syndromes, but most cases are isolated and sporadic. A few cases of familial incidence of isolated external and middle ear malformations with autosomal recessive, autosomal dominant, and sex-linked modes of transmission have been described. We report on two siblings with almost identical anomalies of the external and middle ear and no other congenital defects. Their father had similar malformations, but nobody else in his large sibship presented ear malformations. The defects were also absent in two previous generations. We discuss the possibility, not previously mentioned in the literature, that these congenital malformations could have appeared by spontaneous mutation in the father and transmitted themselves as an autosomal dominant trait to his children.

Child↗
PubMed1989

[Echocardiographic evaluation of simple transposition of great vessels subjected to physiologic correction].

The aim of the present study was to evaluate the cardiovascular morphology after Senning's operation for transposition of the great vessels (TGV) using Döppler-echocardiography. The study included 25 patients (pts) aged 17 to 127 months (mean = 60 +/- 27) who were evaluated 6 to 112 months (mean = 42 +/- 27) after surgery. The following parameters were analysed: right (RV) and left ventricular (LV) morphology and function; tricuspid regurgitation and its severity; caval and pulmonary venous pathways and the presence of pulmonary stenosis, its type and severity. All the 25 pts had an abnormal end-systolic interventricular septal (IVS) configuration, with left convexity in 22 (88%) and a flat septum present in 3 (12%). The LV fractional shortening (FS) ranged from 25 to 60% (mean = 41 +/- 10) and the preejection/ejection time ratio (PET/ET) from 0.18 to 0.33 (mean = 0.24 +/- 0.04). The RV mean FS ranged from 23.0 to 32.5% (mean = 26.9 +/- 3.0) and PET/ET from 0.27 to 0.46 (mean = 0.38). The RV wall motion study revealed that the IVS was hypokinetic in 3 pts (12%), akinetic in 19 (76%) and dyskinetic in 3 (12%). Three pts also had an hypokinetic antero-apical segment. TR was detected in 22 (88%) pts being trivial in 16 (64%), mild in 4 (16%) and moderate in 2 (8%). It was always possible to visualise the neo left and right atria as well as the caval-right atrial junctions. No systemic or pulmonary venous obstruction was detected. In 3 pts there was a mild subpulmonic dynamic stenosis related with septal buldging and mitral valve apposition. In conclusion, Döppler-echocardiography can provide accurate information for the follow-up of patients with TGV submitted to physiological correction and it can reduce the number and frequency of late postoperative cardiac catheterization.

Child↗
PubMed1985

Congenital aneurysm of the sinus of Valsalva. Surgical repair in an infant.

We report the case of a 5-month-old infant with cardiac failure and an unruptured aneurysm of the right coronary sinus of Valsalva. Emphasis is put on the diagnostic value of the echocardiogram. Cardiac failure was probably due to a combination of aortic regurgitation and compression of the outflow tract of the right ventricle. The surgical approach is discussed. The defect was repaired through an aortotomy. The aneurysmal sac was resected and an aortic valvuloplasty was performed. Twelve months postoperatively the patient continues to be asymptomatic; an aortic root angiogram shows only trivial aortic insufficiency.

Aortic Aneurysm↗
PubMedDate not supplied

[Upper cleft of the sternum].

Superior sternal cleft is a rare congenital malformation that should be repaired during the first weeks of life, while the thorax is still complaint. We report the case of a two-week-old neonate with superior sternal cleft and describe the technique used to close the defect.

Female↗