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Biomedical subjects

N Castelão

Publications and source records attributed to N Castelão.

8 recordsLinked to original sources
PubMed1999

[Comparative study of Toronto SPV prosthesis and bileaflet mechanical aortic prosthesis with 2D-Doppler echocardiography].

AIM: The aim of this study was to make a noninvasive comparison, by means of Doppler echocardiography, of the hemodynamic performance of biological stentless xenografts and mechanical bileaflet (MB) prostheses (P) in aortic position. METHODS: We studied 20 patients (pts) with normofunctional (nf) aortic Toronto (T) Stentless Porcine valves (SPV)--Group I--8 males, aged 69 +/- 12 years, 32 +/- 9 months after surgery, and 30 pts with nf MB aortic P (Carbomedics or St. Jude Medical)--Group II--17 males (p = NS vs G I), aged 61 +/- 12 years (p < 0.01 vs G I), 30 +/- 12 months after implantation (p = NS vs G I). Both groups were comparable with regard to body surface area and surgical indication. P diameters ranged from 21 to 25 mm (G I: 22.9 +/- 1.7; G II: 22.8 +/- 1.7 - p = NS), the number of pts with the same P diameter in each group being similar. We analysed, at rest: aortic orifice diameter (AoOd - cm), maximal (GMax) and mean (GMean) transprosthesic pressure gradients, P functional area (PFA) and P resistance (PRes). Gradients (mm Hg) were calculated by means of the Bernoulli equation, PFA (cm2) by means of the continuity equation and PRes (dynes.s.cm-5) as 1333 x Gmean x SEP/SV (SEP = systolic ejection period; SV = stroke volume). RESULTS: AoOd (G I vs G II): P 21--1.78 +/- 0.04 vs 2.00 +/- 0.10 (p < 0.001); P 23--1.91 +/- 0.10 vs 2.19 +/- 0.10 (p = 0.01); P 25--2.22 +/- 0.24 vs 2.29 +/- 0.19 (NS). Doppler parameters: [table: see text] CONCLUSIONS: P T SPV show better hemodynamic performance when compared to P MB with the same diameter, in aortic position. In addition, our results suggest that P T SPV allow the use of larger valve sizes for the same aortic orifice diameter.

Aged↗
PubMed1995

[Experience of the exclusive use of arteries in myocardial revascularization].

OBJECTIVES: To present the initial experience of a surgical team from Santa Marta Hospital using exclusive arterial grafts on coronary bypass surgery. SETTING: Cardiology and Cardiothoracic Departments. POPULATION AND METHODS: From November 1987 to May 1994, 176 consecutive patients were submitted to surgical myocardial revascularization with the exclusive use of arterial grafts. The patients were operated by one cardiothoracic surgical team. A revision of clinical and angiographic characteristics of the patients was done along with the surgical procedure and intrahospital morbidity. After hospital discharge, follow-up was done by direct evaluation and/or by a questionnaire made using phone or letter on a periodical basis. RESULTS: The medium number of coronary bypasses performed were 2.07 +/- 0.8. The left internal mammary artery was the vessel more frequently used, specially to the myocardial area supplied by the left coronary descending artery. The right internal mammary artery was the second arterial graft more currently used. Gastroepiploic artery was utilized preferentially to coronary arteries supplying the inferior wall of the heart. Hospital mortality was 3.4%-6 patients. One hundred twenty patients have a normal life, without physical restrictions, 25% of the patients have symptoms of angina that is severe in 9. Mean follow-up time was 34 +/- 10 months. IN CONCLUSION: Coronary artery bypass surgery with exclusive use of arterial grafts can be executed with an acceptable mortality and low morbidity rates, even in urgent cases, with relieve of cardiac symptoms and good quality of life.

Adult↗
PubMed1995

[Acute aortic dissection. Therapeutic strategies and results].

OBJECTIVE: To analyse early and medium-term results of patients (pts) with acute aortic dissection (DAO) regarding the importance of the different therapeutic modalities adopted. DESIGN: Retrospective study of the cases with DAO admitted in the cardiology intensive care unit of Santa Marta Hospital. POPULATION: 46 pts (aged 25 to 80 years) with the diagnosis of DAO from January/1989 throughout December/1993. RESULTS: early mortality rate (30 days) was 36%. DAO type A Two cases were treated only with medical therapy for they suffer from severe associated pathology. Twenty eight pts were treated surgically. In this group mortality concerning time passed from the beginning of the symptoms throughout the surgery was: < 24 h-31%, 24-72 h-40%, > 72 h-63%. Among 17 discharged pts mortality occurred in 7% during the first year. DAO type B In pts with uncomplicated Stanford type B DAO survival was 90%. Emergency surgery was performed in pts who developed complications such as rupture of the aorta, occlusion of major arteries or extension of dissection. In this particular group mortality was 66%. Among 11 discharged pts with type B DAO 9% died within one year. During the follow-up period of 17.4 +/- 14.8 months one third of the pts discharged from hospital had clinical events. CONCLUSION: despite new advances in diagnostic and therapeutic approaches, DAO still's reported as a relatively high hospital mortality situation. Remove pts to an institution with ability to perform quickly the correct diagnosis and treatment becomes essential. Clinical presentation, type of DAO, surgery timing when indicated and major complications were of particular importance in the prognosis of pts with DAO. The frequency of cardiovascular events in pts who left the hospital alive emphasized the need to maintain blood pressure within normal limits.

Acute Disease↗
PubMed1994

[Acute aortic dissection in pregnancy. Report of a clinical case].

Aortic Dissection seldom affects young women. Nevertheless, the structural changes in the arterial wall, that occur during pregnancy, may predispose women to this complication, particularly in the third trimester and peripartum period. Aortic Dissection in gestation is associated specially with the Marfan's syndrome. The authors report a case of a pregnant woman in the 35th week of gestation, without Marfan's disease, admitted to Hospital on suspicious of type A aortic dissection.

Acute Disease↗
PubMed1993

[The assessment of the histomorphological characteristics of the arteria gastroepiploica dextra and its potential as an artery for myocardial revascularization].

OBJECTIVE: Comparative analysis of the histomorphological characteristics of left (LIMA) and right (RIMA) internal mammary arteries, right gastroepiploic (RGEA) and anterior descending artery (ADA) with evaluation of the respective prevalence of atherosclerotic changes. SETTINGS: Laboratory of Anatomo-Pathology of a Central Hospital with necropsy material obtained from consecutive individuals, deceased of a non-cardiac cause and older than 60 years. MATERIAL AND METHODS: In 31 cadaver fragments of the RIMA, LIMA, GEA and ADA, were obtain, subsequently fixed and stained in order to become evident the structure of the medial layer, and the presence of possible atherosclerotic changes (intimal Hyperplasia, cholesterol clefts, foam-cells, inflammatory cells infiltrate, rupture of the internal elastic lamina, medial fibroses and calcifications). RESULTS: 1--The RGEA has the structure of a muscular artery as the ADA, opposed to the LIMA and RIMA that are elastic arteries. 2--The atherosclerotic changes were predominantly found in the ADA with no significative differences in there prevalence in the RIMA, LIMA or RGEA. CONCLUSIONS: The RGEA despite having histological characteristics diverse than the LIMA and RIMA, has a similar prevalence of atherosclerotic changes and intimal hyperplasia; those allow us to predict a behaviour and a long-term patency comparable, when used as bypass graft for myocardial revascularization.

Abdomen↗
PubMed1990

Aortic-left ventricular tunnel. A case report.

It is described a clinical case of aorto left ventricular tunnel, initially diagnosed as aneurysm of the right Sinus of Valsalva with aortic incompetence in a 18 years old patient. The rarity of this congenital abnormality, together with a successful surgical correction, stimulated us to publish this case. The patient improved from Class IV to Class I NYHA. The surgery of theses cases doesn't mean necessarily complete cure, because the intracardiac repair can cause aortic valve incompetence, eventually worse than before, and for this reason some surgeons prefer use a patch to close it. However in our adult patient, direct suture was enough to get a good result. In what concerns the Wooler's annuloplasty to correct the mitral incompetence, it was not so well succeeded and we think that we should implant a prosthetic ring instead.

Adolescent↗
PubMedDate not supplied

[Hemolytic anemia in the malfunction of a mitral bioprosthesis].

Valvular cardiac prosthesis have dramatically altered the prognosis of patients with valvular cardiac disease; however, they are not free of complications. Prosthesis disfunction and problems related to anticoagulation are the more common, but hemolytic anemia should also be considered. In this case, hemolytic anemia appears as the major complication of a mitral bioprosthesis; the decision concerning the presentation of this case report rests upon its rarity and peculiar circumstances of appearance. A brief revision of the diagnostic work-up is also made.

Anemia, Hemolytic↗