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Biomedical subjects

P M Pêgo-Fernandes

Publications and source records attributed to P M Pêgo-Fernandes.

At least 19 recordsLinked to original sources
PubMed2001

Video-assisted pericardioscopy. How to improve diagnostic efficacy in pericardial effusions.

OBJECTIVE: To assess, in a prospective way, the experience with video-assisted pericardioscopy obtained in patients with pericardial effusion of unclear etiology in the preoperative period. METHODS: From January 1998 to June 2000, 20 patients were operated upon with the aid of video-assisted pericardioscopy. On echocardiography, 17 of these patients had significant pericardial effusion, and 3 had moderate pericardial effusion. Video-assisted pericardioscopy was performed through a small incision of the Marfan type. RESULTS: The diagnosis of pericardial effusion was established as follows: idiopathic in 9 (45%) patients, neoplastic in 4 (20%), resulting from hypothyroidism in 3 (15%), tuberculous in 2 (10%), due to cholesterol in 1 (5%), and chylopericardial in 1 (5%). The biopsy was positive in 30% of the patients, and the etiology could not be defined in 45% of the patients. CONCLUSION: Video-assisted pericardioscopy proved to be a method with low morbidity and a high index of diagnostic positivity. A high percentage of pericardial effusions are caused by viral infections, which are not diagnosed through current methods, being, therefore, classified as idiopathic.

Adolescent↗
PubMed2000

Angiographic evaluation of graft patency in minimally invasive direct coronary artery bypass grafting.

BACKGROUND: The objective of this report is to describe our experience using minimally invasive direct coronary artery bypass grafting and to evaluate angiographic patency of anastomoses. METHODS: A total of 120 patients (86 men) were operated on, with ages ranging from 30 to 83 years (mean = 61.2 years). Two access routes were used: for single left anterior descending coronary artery lesions an 8 cm anterior minithoracotomy was performed at the fourth left intercostal space. Extracorporeal circulation was not used. In the last 82 patients a restraining device was used for the regional reduction of heart beats. Coronary cineangiography was carried out between postoperative days 1 and 3 in 84 (70%) patients. Anastomoses were graded: grade A, no blocks; grade B, blocks of more than 50%; grade C, occlusion. This evaluation was performed for two different periods: in the first period a restraining device was not used and in the second period a restraining device was used. RESULTS: In the first study period (38 anastomoses) coronary cineangiography showed grade A, 79%, grade B, 5.2%, and grade C, 15.8%. In the second study period (62 anastomoses), angiography showed grade A, 90.4%, grade B, 6.4%, and grade C, 3.2%. Early mortality was 1.6%. CONCLUSIONS: Minimally invasive coronary artery bypass grafting is a good alternative for some groups of patients. Anastomotic results seem to be better when a restraining device is used.

Adult↗
PubMed2000

Influence of biopump with and without intraaortic balloon on the coronary and carotid flow.

BACKGROUND: The objective of this study was to evaluate the influence of biopump used for left ventricular assistance on the coronary and carotid flows in dogs with normal heart. The efficacy of the simultaneous use of an intraaortic balloon pump to compensate the possible deleterious effects of the circulatory assistance with continuous flow was also analyzed. METHODS: Fifteen dogs were studied. The hemodynamic evaluation included serial measurements of the classic parameters. Carotid and coronary blood flows were obtained by electromagnetic transducers. RESULTS: The hemodynamic evaluation did not show significant statistical changes. The use of circulatory-isolated assistance with biopump shows reduction (24.6% +/- 6.1%) in coronary flow, in relation to the control situation and the concomitant use of biopump and intraaortic balloon pump showed similar coronary flow. Regarding carotid flow, a similar trend was observed in relation to the positive influence of the pulsatile flow with an intraaortic balloon pump without statistical significance (p = 0.0582). CONCLUSIONS: The biopump reduces the coronary flow in dogs. The use of intraaortic balloon pump with the biopump increases the coronary flow significantly, reaching similar values to those observed without the circulatory assistance.

Animals↗
PubMed1999

Management of aortic dissection that involves the right coronary artery.

A report on the follow-up of 11 patients who suffered from aortic dissection involving the right coronary artery and who underwent surgical treatment is reported. In two patients, the left coronary ostia was also affected. In seven patients, the dissection was acute and in four, chronic. The ascending aorta was substituted by a Dacron graft in all patients, and right coronary artery saphenous vein bypass or Gore-Tex graft to the coronary ostia or right coronary artery was performed in nine, and reimplantation of both dissected coronary in two. There were three early postoperative deaths (27.3%) caused by low-output syndrome and myocardial infarction. There were two late deaths. The six surviving patients were followed-up from 78 to 96 months (mean 83 months). This experience suggests that although carrying a high risk, the involvement of the coronary ostia in aortic dissection can be successfully managed if made before irreversible complications arise.

Acute Disease↗
PubMed1999

Chylothorax after myocardial revascularization with the left internal thoracic artery.

A 38-year-old male underwent coronary artery bypass grafting (CABG). A saphenous vein graft was attached to the left marginal branch. The left internal thoracic artery was anastomosed to the left anterior descending artery (LAD). The early recovery was uneventful and the patient was discharged on the 5th postoperative day. After three months, he came back to the hospital complaining of weight loss, weakness, and dyspnea on mild exertion. Chest X-rays showed left pleural effusion. On physical examination, a decreased vesicular murmur was detected. After six days, the diagnosis of chylothorax was made after a milky fluid was detected in the plural cavity and total pulmonary expansion did not occur. On the next day, both anterior and posterior pleural drainage were performed by videothoracoscopy, and prolonged parenteral nutrition (PPN) was instituted for ten days. After seven days the patient was put on a low-fat diet for 8 days. The fluid accumulation ceased, the drains were removed and the patient was discharged with normal pulmonary expansion.

Adult↗
PubMed1997

VATS for complete dissection of LIMA in minimally invasive coronary artery bypass grafting.

BACKGROUND: The aim of this work is to report our initial experience with minimally invasive coronary artery bypass grafting, using video-assisted thoracic surgery (VATS) to facilitate the operation and provide complete dissection of the left internal mammary artery (LIMA). METHODS: Of 44 scheduled patients, 43 patients, 30 (69.8%) male, ranging in age from 31 to 83 years (60.8 +/- 12.0 years), with a severe lesion in the anterior descending artery, were operated upon. An 8-cm left anterior minithoracotomy was performed at the fourth intercostal space. Through this incision the optical device for video-assisted thoracic surgery as well as the surgical instruments were placed to provide complete LIMA dissection. This permits dissection until the subclavian region, allowing for anastomosis without tension or distortion. Bypass circulation was not used, and the cardiac rate was decreased with the use of intravenous beta-blockers. For LIMA-to-anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was administered intravenously. RESULTS: Video-assisted thoracic surgery provided a complete dissection of LIMA. The 43 patients presented satisfactory postoperative progress, being released from the hospital between 2 and 12 days after their operation, with a mean of 4 days. The patients have remained asymptomatic during a period that ranged from 1 to 13 months (6.3 +/- 3.5 months). During the follow-up, there was one death as a result of stroke and pneumonia 2 months after the release from the hospital. CONCLUSIONS: The use of video-assisted thoracic surgery through thoracotomy allows the LIMA dissection without the necessity of other incisions. The procedure also permitted more ample dissection of LIMA when compared with minithoracotomy without video-assisted thoracic surgery.

Adult↗
PubMed1995

Clinical and left ventricular function outcomes up to five years after dynamic cardiomyoplasty.

Improvement in congestive heart failure and left ventricular function after dynamic cardiomyoplasty has been reported in patients with severe cardiomyopathies, but the long-term effects of this procedure remain unclear. In this investigation 31 patients undergoing cardiomyoplasty for treatment of idiopathic dilated cardiomyopathy were annually investigated with radionuclide scintigraphy, Doppler echocardiography, and right-sided heart catheterization. They were in New York Heart Association functional class III or IV before the operation. No hospital deaths occurred, but one patient with progressive heart failure required urgent heart transplantation 42 days after cardiomyoplasty. The other patients were followed up from 6 to 70 months (mean 25.6 months) and 12 patients died at late follow-up. Actuarial survivals were 86% at 1 year, 61.4% at 2 years, and 42.5% at 3 to 5 years of follow-up. Multivariate analysis of factors influencing outcome showed that long-term survival was significantly affected by preoperative functional class and pulmonary vascular resistance. Functional class improved from 3.2 +/- 0.4 to 1.7 +/- 0.7 in the surviving patients (p < 0.01). Furthermore, left ventricular ejection fraction improved from 19.8% +/- 3% to 23.9% +/- 7.2% (p < 0.01), and significant changes in stroke index, arterial pressure, pulmonary wedge pressure, and left ventricular stroke work index were also found at 6 months of follow-up. In the late postoperative period, the left ventricular ejection fraction tended to decrease and returned to preoperative levels at 5 years, whereas hemodynamic variables did not change significantly. Thus, despite the tendency of the left ventricular ejection fraction to decrease at late follow-up, the long-term course of these patients seems to be characterized by the maintenance of hemodynamic improvement. However, long-term survival after cardiomyoplasty is limited by the severity of the patient's condition before the operation.

Actuarial Analysis↗
PubMed1991

Management of aortic insufficiency in chronic aortic dissection.

From January 1980 to December 1988, 44 patients with chronic aortic dissection and aortic insufficiency underwent operation. This group of patients was analyzed to evaluate the outcome of those in whom the aortic valve was preserved compared with those having valve replacement. The overall preoperative characteristics of the two groups were similar except for the incidence of Marfan's syndrome. Valve replacement was the elected procedure in patients with valve degeneration or annuloaortic ectasia. In patients with leaflet prolapse with or without an enlarged annulus, a plastic procedure was used. In 48% of the patients, it was possible to preserve the valve. There were five hospital deaths (11%): three were due to low-output syndrome, one was due to bleeding, and one was due to neurological complications. There were two late deaths (5%). Follow-up of the 37 surviving patients ranged from 2 to 108 months (mean follow-up, 18 months). Seventy-eight percent of the survivors were in functional class I and the others were in class II. Two patients in whom the aortic valve was preserved had mild aortic insufficiency. Three patients with bioprostheses underwent reoperation because of prosthetic valve dysfunction. One patient who had aortoplasty and an aortic valve plastic procedure was seen with redissection and aortic insufficiency after 60 months and was reoperated on using the Bentall technique. The actuarial survival curves showed that patients who underwent valvoplasty had higher, but not significantly higher, survival rates than the valve replacement patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Assisted circulation with centrifugal pump for cardiogenic shock after extracorporeal surgery].

A 59 year old woman with aneurysm of the left ventricle anterior wall developed heart failure, class III-IV (NYHA). The radioisotopic angiography showed left ventricular function impairment, ejection fraction of 16% and the aneurysm. She was submitted to aneurysm correction with bovine pericardium patch. In spite of technically successful cardiac surgery, the patient cannot be weaned from cardiopulmonary bypass with maximal pharmacological therapy and intra-ortic balloon pump. Then, we used Biomedicus centrifugal pump for left ventricular assistance. Cannulation was made by aorta and left atrial appendage. Myocardial function evolution was accompanied by hemodynamic parameters and by intra-esophagic echocardiography. The patient was assisted during 42 hours. After this time, assist cannulas were removed in operating room without difficulty. She was submitted to another radioisotopic study on the 50th post-operative day and ejection fraction was 24%. She was discharged from hospital at 52th post-operative day. Nowadays she is in NYHA class II at third post-operative month. More frequent utilization of circulatory assistance devices will reduce global mortality from cardiac surgery and improve safety in surgery of severe cardiac disease.

Assisted Circulation↗
PubMed1991

Survival improvement with dynamic cardiomyoplasty in patients with dilated cardiomyopathy.

Surgical support to the failing heart has been investigated in the treatment of severe myocardial failure. Dynamic cardiomyoplasty was indicated in 32 patients with dilated or chagasic cardiomyopathy who were in New York Heart Association (NYHA) class III or IV despite maximum medical therapy. Fifteen patients were operated on, and 17 refused the surgical treatment and were maintained by clinical means. With an average follow-up period of 12.3 months, actuarial survival rates for cardiomyoplasty patients were 86.6% at 6 months, 78.7% at 1 year, and 65.6% at 2 years of follow-up, whereas patients under medical therapy presented survival rates of 58.8%, 41.1%, and 27.4% at the same periods, respectively (p = 0.03). Furthermore, five of the 11 surviving patients of the cardiomyoplasty group are in NYHA class I, five in class II, and one in class III. At 6 months of cardiomyoplasty follow-up, rest radioisotopic left ventricular ejection fraction increased from 20.1 +/- 3.9% to 26.8 +/- 7.5% (p less than 0.01). Cardiopulmonary exercise testing showed that maximum oxygen consumption during treadmill testing improved from 14.7 +/- 3.9 to 18.3 +/- 3.9 ml/kg/min (p = 0.01). At 1 year of follow-up, these data remained essentially unchanged. In conclusion, dynamic cardiomyoplasty reverses congestive heart failure and improves the long-term survival of patients with severe cardiomyopathies.

Adult↗
PubMed1990

[Results of replacement of ascending aorta, and aortic valve with reimplantation of coronary arteries].

PURPOSE: To analyse a 10-year experience with the Bentall and De Bono technique for surgical treatment of aneurysms of ascending aorta. PATIENTS AND METHODS: From January 1980 to December 1989, the Bentall and De Bono technique was employed in 38 patients. Twenty-two patients had aneurysm of ascending aorta with aortic insufficiency; 14 had chronic aortic dissections. Four patients were operated on previously by other techniques. RESULTS: The immediate mortality was 5.2%; one patient due to low-output syndrome and one had neurological complications. Five patients (13.1%) died late postoperatively. The surviving 31 patients were followed up from two to 72 months (mean 25). Of these, 29 (93.5%) were in functional class I and two in class II. Sixteen patients had late evaluation by one or more of the following methods: digital angiography, chest computerized tomography, echocardiography, or conventional angiography, 6 to 60 (mean 33) months after operation. All of them had good conditions of composite valve graft and coronary artery reattachment. The immediate and late results were similar in patients with aneurysms and aortic dissections. CONCLUSION: The aortic valve and aortic ascending portion replacement with reimplantation of coronary arteries is of low mortality and fairly good late outcome.

Actuarial Analysis↗
PubMed1989

Cardiomyoplasty benefits in experimental myocardial dysfunction.

Beneficial effects of cardiomyoplasty have been documented and the use of this technique in the treatment of dilated cardiomyopathy have been suggested. This study was undertaken to evaluate the effectiveness of stimulated preconditioned latissimus dorsi muscle flaps wrapped around the heart in order to restore ventricular contractility in six adult mongrel dogs with induced myocardial dysfunction by administration of beta blockers and volume loading. Hemodynamic and two-dimensional echocardiographic evaluation were performed 1 week after the surgical procedure and immediately after heart failure induction. With synchronous pulse train electrical stimulation, cardiac output increased from 1.46 +/- 0.13 (+/- SD) to 2.01 +/- 0.16 L/min (p less than 0.01), pulmonary wedge pressure decreased from 15.5 +/- 1.2 to 11.3 +/- 1.6 mmHg (p less than 0.01) and left ventricular end-diastolic pressure from 18.3 +/- 2.4 to 13.5 +/- 1.4 mmHg (p less than 0.04). Echo derived left ventricular ejection fraction increased from 39.3 +/- 2.4 to 59.6 +/- 2.9% (p less than 0.01) and segmental wall shortening from 15.4 +/- 1.2 to 26.3 +/- 1.7% (p less than 0.01), inclusive when the muscle flap was wrapped only around the left ventricle. In conclusion, this study suggests that cardiomyoplasty may be an alternative method of treatment for irreversible cardiomyopathy, including in patients with a great cardiac enlargement in which muscle flap may only be wrapped partially around the heart.

Animals↗
PubMed1989

[Combined surgical treatment of endocarditis of the right atrium by Aspergillus sp and pulmonary fungus ball. Report of a case].

Endocarditis due to Aspergillus is rare and associated with a high mortality. The authors report the case of a 23 year-old patient with Klippel-Trenaunay syndrome who was admitted with dyspnea and loss of weight. The physical examination showed split second sound and presystolic accentuation. In the chest x ray there were cavities in the upper lobe of the right lung and pleural thickening. The echocardiogram and the hemodynamic evaluation demonstrated an image suggesting a right atrial tumor. The patient was operated on under cardiopulmonary bypass, a vegetation in the valve of the inferior vena cava was resected and a lesion of the right lung was also resected. The histologic study showed that the lesions was caused by Aspergillus. The patient had had an uneventful recovery, was discharged on the 13th postoperative day and is well 65 months after the operation.

Adult↗