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Biomedical subjects

R Bento

Publications and source records attributed to R Bento.

18 recordsLinked to original sources
PubMed1997

[Mitral valve insufficiency caused by tendinous cord rupture and mitral valve aneurysm. Significance of the echocardiographic study].

Mitral valve aneurysm is a rare complication that may occur in a myxomatous valve. We report the case of a 73 year old male patient with severe mitral regurgitation and heart failure-class IV NYHA. Echocardiography showed perforation of an aneurysm of the anterior leaflet of the mitral valve associated with rupture of tendinous cords of the posterior mitral leaflet. Diagnosis was made by transthoracic echocardiography and confirmed by transesophageal echocardiography. The patient was urgently operated with success and a mitral valve prosthesis was implanted.

Aged↗
PubMed1997

[A review of infectious endocarditis due to Candida].

OBJECTIVE: As fungal endocarditis is a serious disease, frequently requiring cardiac surgery, a review was made of the experience of our Departments in this pathology. DESIGN: A retrospective analysis of clinical, echocardiographic and surgical data. SETTING: Patients studied in a tertiary care Hospital with cardiac surgery available. PATIENTS: Between 1984 and 1994 there were ten cases of candida endocarditis in nine patients, four male and five female, mean age--45 +/- 12 years (31-65). INTERVENTIONS: The following parameters were analysed: clinical (predisposing factors, clinical evolution, complications, therapy and mortality), echocardiographic (presence of vegetations, abscesses, valvular regurgitations). Patients studied in other Centres and referred to our Department only for examination (echocardiograms) were excluded from this analysis. RESULTS: Eight cases in seven patients were prosthetic valve endocarditis and two native valve endocarditis. No patient was drug addicted. Seven cases of prosthetic valve endocarditis developed less than one year after surgery and another had a gynecological fungal infection as the cause of the endocarditis. Four patients had had previous endocarditis. There were four embolic events and three developed heart failure. There were three perivalvular infections, six valvular regurgitations and only one case with huge vegetations on echocardiography. Nine patients were treated with amphotericin B, in five fluocytosin was added and in four ketoconazol, which was replaced by flukonazol in one patient. Therapy was continued for at least eight weeks. Six patients were operated during the acute stage and one died. One patient was operated on late after the infection. Three patients died during the active stage. In a follow up of 5.2 +/- 4.8 years (8 months to 8 years) there was one fatal candida endocarditis relapse, one fatal candida sepsis, one non cardiac death, one patient developed a periprosthetic leak and one had recurrent systemic embolization. Abscesses/pseudoaneurysms were found in five out of seven patients submitted to surgery. CONCLUSION: Candida infective endocarditis has a bad prognosis, specially in those patients not operated early; it develops in patients with predisposing factors, which in our series were a previous infective endocarditis (four patients) and/or a prosthetic valve implantation less than one year before; it has important morbidity with multiple embolic events, perivalvular involvement, valvular regurgitation and heart failure.

Adult↗
PubMed1996

[Significance of the exercise test in the assessment of graft patency after myocardial revascularization with arteries only].

UNLABELLED: Although treadmill exercise testing (TET) has been used to identify ischaemia and determine clinical prognosis after myocardial revascularization, considerable controversy remains on its role in the detection of obstructive lesions of the arterial grafts. AIM: To assess the value of TET in determining the patency of arterial conduits after coronary bypass surgery with complete revascularization. METHODS: Twenty five patients - 21 men and 4 women; age 53.7 +/- 8.7 years - submitted to complete myocardial revascularization exclusively with arterial conduits (CABG-A), undergoing coronary angiography and a symptomlimited TET (Bruce protocol) within 9 months after CABG-A. Angiograms were visually classified in 2 groups (Group I - conduits without lesions, n = 14; Group II > 50% stenosis or occlusion of > or = 1 conduit, n = 11). Clinical characteristics and the following parameters of the TET were compared: total exercise time (ETime); metabolic equivalents (METS); % of predicted maximal heart rate (% MHR); exercise-induced ST depression (decreases ST); and occurrence of angina. The arterial conduits used were: left internal mammary artery -24-; right internal mammary artery -11-; gastroepiploic artery -14-. RESULTS: There were no differences in age, gender, left ventricular systolic function, severity of coronary artery disease, and number of conduits per patient. Group I attained superior values for the following parameters: ETime (p < 0.01) and METS (p < 0.01). Among Group II there were more patients with angina (p = 0.03). Fourteen patients exceeded 8 METS (11 from Group I and 3 from Group II - p = 0.002-). There was no statistical difference among the number of patients with ST depression during exercise. CONCLUSIONS: After CABG-A the exercise tolerance seems to be related with the patency of the conduits and may play an important role in the detection of graft abnormalies. On the contrary, exercise-induced ST depression had low specificity in detecting obstructive lesions of the conduits.

Coronary Artery Bypass↗
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↗
PubMed1991

[Hemodynamic assessment after heart transplantation].

OBJECTIVE: Comparative analysis of the results of the hemodynamic evaluations performed at the preoperative period, during the first week and at the end of the first and second years, after orthotopic heart transplantation. DESIGN: Retrospective study of hemodynamic evaluation of patients submitted to orthotopic cardiac transplantation from April 1987 to April 1990. SETTING: Transplanted patients admitted at the cardiology and cardio-toracic surgery departments of the Hospital Santa Marta. PATIENTS: 15 patients (eleven males and four females) aged 21 to 55 years (mean = 33.3 +/- 10.5), with the preoperative diagnosis: dilated cardiomyopathy in 11, ischemic heart disease in three and hypertrophic cardiomyopathy in one patient. All the patients were on triple immunosuppressive therapy (cyclosporine A, azatioprine and prednisolone) at the time of the first week evaluation. Three of the eight patients evaluated at the end of the first year were with double immunosuppressive regimen (without steroids), seven at NYHA functional class I and one patient at class II. The three patients evaluated at the end of the second year were on triple immunosuppressive regimen and in class I. INTERVENTIONS: We considered, preoperatively (PrOp), at the first week (1W), and at the end of the first (1Y) and second (2Y) years: mean right atrial pressure (RA), systolic pulmonary arterial pressure (PAs), mean pulmonary arterial pressure (PAm), pulmonary capillary wedge pressure (PCW), mean systemic arterial pressure (SAm), cardiac index (CI), pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). At 1Y and 2y there were also considered the left ventricular end-diastolic pressure (LVEDP) and the ejection fraction (Ej). RESULTS: (table; see text) The results found at 2Y were similar to those showed at 1Y. At 1Y and 2Y LVEDP and Ej were normal. CONCLUSIONS: A high prevalence of mild to moderate hemodynamic disturbances characterizes the early post-operative period in cardiac transplantation. Abnormal pressures on right atrium, pulmonary artery, pulmonary capillary wedge pressure, are found on a significant number of patients, and pulmonary and systemic vascular resistances are also elevated. However at the end of the first year there is a significant improvement compared with the first week. Normality is the hallmark of hemodynamic evaluation performed in transplant recipients at the end of the first and second years.

Heart Transplantation↗
PubMed1991

[Ebstein's anomaly. Clinical aspects and surgical therapy].

OBJECTIVE: We reviewed the clinical findings and surgical results of Ebstein's anomaly in adult and adolescent age. DESIGN: Retrospective analysis on clinical data, surgery and follow up. SETTING: Patients (pts) studied in the Cardiology and Cardiothoracic Surgery Departments of the Santa Marta Hospital, Lisbon. PATIENTS: All pts in whom Ebstein's anomaly was diagnosed by cardiac catheterization or echocardiography or both, between 1875 and 1989 were included. RESULTS: There were 8 cases (4 female and 4 male). The age varied from 15 and 53 years. Cyanosis and dyspnoea were the presenting features in 7 pts. One of the youngest pts had asymptomatic murmurs. Late appearance of cyanosis had no relation with prognosis. Three pts had pulmonary tuberculosis. One woman had no deterioration in cardiac function during two pregnancies. Clinical findings were variable and ranged from absent murmur with third and fourth sounds to systolic murmurs of high intensity. The ECG was abnormal in all pts. A case with delta wave and normal PQ interval was noted. On the chest X-ray we found cardiomegaly in all pts. Echocardiograms were recorded in 6 pts. The delay of tricuspid valve closure on mitral closure was not always diagnostic. Uncomplicated catheter studies were done in 6 pts. Two pts had associated cardiac lesions: ventricular septal defect (VSD) with pulmonary hypertension and mild pulmonary valve stenosis. Right ventricular angiographies were diagnostic in all cases. During medical follow up from 1 year to 10 years (mean-4) one death occurred in one pt with VSD. In the remaining 4 cases no deterioration in cardiac function or cyanosis was noted. Three pts were operated. The indications for surgery were: severe heart failure and/or increasing cyanosis. Two pts had tricuspid valve replacement with biological prosthesis. One pts had Danielson's tricuspid annuloplasty. During surgical follow up from 2 to 15 years (mean-7) functional class improved and cyanosis disappeared in 2 pts and it decreased in the other. CONCLUSION: In our series of pts with Ebstein's anomaly clinical findings were variable. The indications for surgery were heart failure and cyanosis. The 3 pts operated are alive and have mild symptoms.

Adolescent↗
PubMed1990

[Biopsy of the right ventricle endomyocardium. Experience at the Santa Marta Hospital].

OBJECTIVE: To review the experience of Santa Marta Hospital in the right ventricle endomyocardial biopsy technique. DESIGN: Retrospective analysis of the results, diagnostic value and complications of the myocardial biopsies performed between April/87 and March/90. PATIENTS AND INTERVENTIONS: 255 biopsies were performed; 221 on 13 patients submitted to orthotopic heart transplantation (nine male and four female, aged between 21 and 55 years old), and the remaining on 34 patients (22 male and 12 female aged between 15 and 64 years old), mainly on cardiomyopathies. RESULTS: In 221 biopsies performed in heart transplant recipients, we found: 109 with no rejection, 21 with moderate rejection, 57 with mild rejection and only one case showed severe rejection. In this group six biopsies were considered inconclusive. In the group of patients not submitted to heart transplantation the histological findings were inespecific in the great majority of the cases. In the 255 procedures four complications were detected (1.56%), with no mortality; two hemopericardium with tamponade (0.78%), one pneumothorax and one atrial fibrillation. CONCLUSIONS: Endomyocardial biopsy essential for histological diagnosis of acute rejection following heart transplantation has revealed to be a save procedure with a small number of complications.

Adolescent↗
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↗
PubMed1990

[Infective endocarditis of pulmonary valve. Considerations apropos of a case associated with interventricular communication and aortic insufficiency ].

We report the case of a 23 year old patient in whom heart disease was detected in childhood. He began to have suddenly fever and symptoms of right side heart failure. There were signs of aortic regurgitation, a systodiastolic murmur in the left parasternal region and a diastolic murmur in the left 4th intercostal space. The bidimensional and Doppler Echocardiogram showed a saccular dilatation in the right ventricular outflow tract. He was submitted to catheterisation which confirmed aortic regurgitation and detected ventricular septal defect and pulmonary hypertension. During surgery, a subaortic ventricular septal defect was seen as well as a dilatation of the right coronary aortic cusp which prolapsed through the defect to the right ventricular outflow tract. Vegetations were seen in the pulmonary valve. The aortic valve and a pulmonary cusp were excised and a Björk Shiley aortic prosthetic valve was inserted. The septal defect was closed. The patient is still alive, symptomless, with 40 months of follow up. We discuss some problems related to this case, particularly the surgical indication and the rarity of the morphology discovered.

Adult↗
PubMedDate not supplied

[Endocarditis caused by Candida parapsilosis after total correction of tetralogy of Fallot. Medico-surgical treatment].

Three children with Candida Parapsilosis endocarditis after total surgical correction for Tetralogy of Fallot, are reported. Blood cultures became negative in one child with amphotericin-B and in the other two with Ketoconazole, before reoperation for septal patch replacement. Oral therapy with Ketoconazole continued for a total of 24 months, and during a mean follow-up of 36 months no side effects or reinfection occurred. Medical and surgical conjoined therapy, with surgical timing decided on clinical and laboratorial grounds, were important for good results and cure.

Candidiasis↗
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↗