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Biomedical subjects

M B Marcial

Publications and source records attributed to M B Marcial.

At least 19 recordsLinked to original sources
PubMed2000

Influence of the maze procedure on the treatment of rheumatic atrial fibrillation - evaluation of rhythm control and clinical outcome in a comparative study.

OBJECTIVE: The aim of this study was to evaluate the influence of the maze procedure on the treatment of rheumatic atrial fibrillation in patients with mitral valve disease. METHODS: Fifty-five patients (mean age 51 years; 47 females) with rheumatic mitral valve disease and associated atrial fibrillation in New York Heart Association functional class III or IV, preoperatively, were operated upon. Thirty-five had double dysfunction, 19 had stenosis, and one had mitral regurgitation. None had other associated heart diseases or previous operations. The patients were divided into two groups: GI, 20 patients were treated for mitral valve disease with associated maze procedure; GII, 35 patients were treated for mitral valve disease without the maze procedure. The preoperative echocardiogram showed a left atrial diameter in GI of 5.35 mm and in GII of 5.57 mm (P=0.779). The groups were considered clinically similar (P=0.759). Cardiopulmonary bypass was used in all patients. The mitral valve was replaced with a biological prosthesis in 24 patients and repaired in 31 patients. RESULTS: Three hospital deaths occurred, one in GI, two in GII. After cardiopulmonary bypass, 37.1% of patients in GII remained in atrial fibrillation. All patients in GI recovered regular rhythm (P<0.0001). In the ICU, atrial fibrillation was detected in 80% of patients in GII and maintained in 76.4% in a mean follow-up period of 38.5 months. In GI, atrial fibrillation occurred in 20% of patients in the ICU and maintained in 5.3% in 41 months of mean follow-up (P=0.0001). None of the patients in GI and 20.6% of patients in GII had a thromboembolic episode 1-63 months after the operation (P=0.041). Four late deaths occurred (two in each group), two being due to progression of valvular disease, one after an episode of pulmonary infection and one with no cardiac cause. CONCLUSION: The maze procedure is effective in treating atrial fibrillation in patients with rheumatic mitral valve disease. The results are sustained in the mid-term follow-up period, preventing postoperative thromboembolic episodes, and with acceptable morbidity and mortality.

Atrial Fibrillation↗
PubMed2000

Coronary bilateral ostial enlargement using the saphenous vein in a patient with syphilitic aortitis.

A patient with tertiary syphilis presenting with bilateral coronary ostial lesions and aortic regurgitation underwent surgical reconstruction of the coronary ostia by the anterior approach with autogenous saphenous vein grafting and substitution of the aortic valve with a bovine bioprosthesis. The procedure was easily performed and had good outcomes both early and late. The rarity of the association of a lesion in both coronary ostia with aortic regurgitation in syphilis and the surgical technique employed are discussed.

Aortic Valve↗
PubMed1999

Ebstein's anomaly with coarctation of the aorta. An unusual association.

Ebstein's anomaly with coarctation of the aorta is an extremely unusual condition. In this report, the clinical and surgical features of 3 male patients, aged 7 months, 4 years and 14 years, are discussed. All patients were in situs solitus. The first 2 patients had atrioventricular and ventriculoarterial discordance and progressed to heart failure in the neonatal period. The third had atrioventricular and ventriculoarterial concordance, as well as Wolf-Parkinson-White syndrome, with frequent episodes of paroxysmal tachycardia. The 3 patients underwent surgery for correction of the coarctation of the aorta. The patient with atrioventricular and ventriculoarterial concordance underwent tricuspid valvuloplasty using a DeVega-like technique. In addition, ablation of 2 anomalous pathways (Kent bundle), which were detected by the electrophysiologic study, was also subsequently performed. The 3 patients showed a good postoperative outcome for 2 years, although, in those with discordance, the surgical procedure did not influence the dysplasia of the tricuspid valve, because this valve showed light to moderate dysfunction.

Adolescent↗
PubMed1998

[Hemodynamic evaluation and clinical outcome of children with severe dilated cardiomyopathy eligible for heart transplantation].

PURPOSE: To evaluate hemodynamic parameters and clinical outcome of children with severe cardiomyopathy who are candidates for heart transplantation. METHODS: Twenty four children aged from 4 months to 10 years and 8 months (mean 3.7 +/- 2.5 years) from February 1992 to May 1996, were submitted to hemodynamic study and the following parameters were measured: cardiac output, mean pulmonary artery pressure (MPAP) and capillary wedge pressure. The pulmonary vascular resistance index (PVRI) and transpulmonary pressure gradient (TGP) were calculated. RESULTS: Ten (41.6%) children were transplanted (group A), 5 (20.8%) are still waiting heart transplantation (group B) and 9 (37.6%) died (group C). The mean age of the B and C group were significantly different. The PVRI, MPAP and TPG were significant lower in group A than group C (p = 0.01; p = 0.044 and p = 0.023 respectively). CONCLUSION: The profile of the hemodynamic parameters of children with severe dilated cardiomyopathy was compatible with the clinical findings. The age was the only difference comparing groups B and C. PVRI, MPAP and TPG were significant factors between group A and C. The older the patient, the worse was the prognosis.

Age Factors↗
PubMed1997

[Pulmonary artery sling].

The authors present a case of a two-year-old boy with stridor since birth, and also recurrent episodes of pulmonary infections, due to mechanical compression of distal trachea by a left pulmonary artery sling. They discussed diagnostic approach, surgical management and review of the literature. To our knowledge, it is the first case of sling of the pulmonary artery reported in Brazil and the fifth in a latin language country.

Child, Preschool↗
PubMed1997

[Complete atrioventricular septal defect. Anatomo-functional correlation between patients with and without Down's syndrome].

PURPOSE: To compare clinical course, causes and symptoms beginning enset time in children with complete atrioventricular canal with and without Down's syndrome. METHODS: Records of 80 patients < 2 years of age, were reviewed. There were 55 (69%) with Down's syndrome-group I (GI) and 25 (31%) without-group II (GII). Age at synpton enset intensity, functional class, clinical repercussion and anatomic variations in patients undergoing corrective surgery were evaluated. RESULTS: Mean age at symptoms onset was similar for the two groups (50 +/- 75 days). Class II (NYHA) was more frequent in GI (31 patients-56.5%) and class III-IV (NYHA) in GII (19 patients-76%) p < 0.005. Clinical repercussion evaluation showed that congestive heart failure was present in 34 (62%) patients of GI and 21 (84%) of GII; and, pulmonary hypertension was in 21 (38%) patients of GI and 4 (16%) patients of GII p < 0.04. Mean pulmonary arterial pressure of 50 mmHg or more was present in 68% of children with Down's syndrome and in 35% of GII. Clinical course until surgical correction was down hill in 33 (60%) from GI and 21 (84%) from GII p < 0.03. Seventy seven patients underwent surgical correction. CAVC type A of the Rastelli classification was predominant in both groups, GI 37 (67%)-GII 25 (100%). There or more severe valvar morphologic lesions in group II (38%) than in group I (8%). CONCLUSION: There seems to be a pulmonary vascular hyperreactivity predominance in Down's children and cardiac insufficiency signs in the normal genetic group.

Down Syndrome↗
PubMed1996

[Tetralogy of Fallot associated with left atrial isomerism].

The association of tetralogy of Fallot with atrial isomerism has been rarely reported. Eight cases (five with left isomerism and three with right isomerism) are known. This paper reports two other cases of tetralogy of Fallot with left atrial isomerism. The syndrome's defects were disguised and without clinical expression because of the presence of the right ventricular outlet obstruction of tetralogy of Fallot. These diagnostic elements, not recognized in one of the patients previous to surgical correction of tetralogy of Fallot, were present: junctional rhythm, bronchial isomerism, partial anomalous pulmonary vein connection, agenesy of inferior vena cava and abdominal heterotaxy; their identification previous to surgical correction of tetralogy of Fallot, is necessary for an adequate surgical management.

Abnormalities, Multiple↗
PubMed1992

[The surgical treatment of nodal reentry tachycardia. The late results].

PURPOSE: To analyze the long-term results of surgical treatment of atrioventricular nodal reentrant tachycardia (AVNT). METHODS: From March 1987 to March 1990, 20 patients with AVNT were submitted to surgical therapy, 14 female, aged 12 to 70 (42.8 +/- 17) years. All presented crisis of AVNT from 6 months to 60 (18.4 +/- 15.9) years. Ten of them had syncope or near syncope and two with cardiac arrest during reversion of AVNT with antiarrhythmic drugs. They used 1 to 6 (3.75 +/- 1.45) antiarrhythmic drugs before surgery. The electrophysiologic study (EPS) showed the common form of AVNT in all cases. The surgical procedure was anatomically directed to the posterior area of the AV node. Programmed atrial stimulation (PAS) were applied on 18 patients after surgery. The long-term results were analysed by clinical evaluation, EPS and Holter when they were necessary. RESULTS: The postoperative PAS was done in 18 patients and did not induce any AVNT, even after atropine IV. The PR interval was 153 +/- 50 ms before and 152 +/- 38 ms after surgery (p > 0.05). During follow up (26 +/- 10 m) there were not AVNT recurrence. Two patients developed chronic atrial fibrillation after 24 months of surgery. CONCLUSION: The perinodal dissection technique used was safe and successful to treat AVNT, preserving AV nodal conduction.

Adolescent↗
PubMed1992

Recurrent ventricular tachycardia associated with postinfarction aneurysm. Results of left ventricular reconstruction.

Left ventricular reconstruction was used to control recurrent ventricular tachycardia in 19 patients (16 male), mean age of 56 years, with postinfarction anteroseptal aneurysms. The "origin" of recurrent ventricular tachycardia was not determined because the ventricular tachycardia induced by programmed stimulation produced hemodynamic deterioration in all patients. The average ejection fraction was 30.7% +/- 10.1%. In the left ventricular reconstruction technique, the plication of the aneurysmal septum and the reduction of the orifice of the left ventricular cavity after aneurysmal resection with a purse-string suture appear important to prevent the functioning of the reentry circuits. There was one death in the immediate postoperative period. The mean ejection fraction was 47.8% +/- 8.1% (p less than 0.001). The postoperative programmed stimulation induced ventricular tachycardia in only one patient. There were two late deaths. The other 16 patients are asymptomatic (five with antiarrhythmic drugs) in functional class I and without recurrence of ventricular tachycardia. Left ventricular reconstruction is an acceptable technique that changes the spatial orientation in eventual tachycardia circuits. Hence this technique is an alternative for long-term control of the right ventricular tachycardia associated with postinfarction anteroseptal aneurysm without previous electrophysiologic mapping.

Bundle-Branch Block↗
PubMed1991

Incessant ectopic atrial tachycardia and sudden death.

A patient with refractory and incessant ectopic atrial tachycardia (IEAT) is reported in whom it was possible to document, during ECG (Holter) the occurrence of aborted sudden death by spontaneous ventricular fibrillation (VF). Following the second of two attempts at surgical ablation of the origin of the IEAT, the patient has been asymptomatic without antiarrhythmic drugs and in sustained sinus rhythm for 24 months. Although we cannot exclude the residual action of amiodarone and flecainide (proarrhythmia) or the residual peripartum cardiomyopathy it is probable that the observed VF was a true complication of a cardiomyopathy induced by a chronically increased heart rate (HR). Although unclear, this VF might be considered as a form of adrenergic-dependent long QT syndrome due to early afterdepolarization in the presence of predisposing myocardial conditions.

Adult↗
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

[Hearts with double inlet ventricle. Morphological aspects in 20 cases].

PURPOSE: The authors intended to verify the most common anatomical presentations of hearts with double inlet ventricle (DIV) and the associated lesions, in order to provide information regarding surgical palliation/correction. MATERIAL AND METHODS: Twenty hearts presenting DIV, from pathological collections. The sequential segmental analysis was applied. RESULTS: Fourteen cases showed usual atrial arrangement, and six isomeric atria (4 with right isomerism and 2 with left isomerism). "Situs solitus" showed two atrioventricular (AV) valves, and the others a single valve. The main ventricle was morphologically left in 13 cases, right in one and of indeterminate morphology in six. The ventriculoarterial connexion was discordant in 10 cases, concordant in two, of double outlet type in eight (6 from an indeterminate ventricle, one from the main chamber and one from the rudimentary ventricle). Pulmonary obstructive lesions were common in the group with atrial isomerism (67%). AV valve stenosis was present in 4 cases, two of the left valve and two of the right one. Straddling of one AV valve was observed in 5 cases and aortic coarctation in three. The ventricular septal defect was restrictive in two cases, both with double inlet to a dominant left ventricle and a concordant AV connexion (Holmes'heart). CONCLUSION: In those with atrial isomerism, the obstructive pulmonary lesions are the dominant feature and require early attention. For the other group, the atriopulmonary anastomosis procedures should take into account peculiarities such as AV valve dysfunctions and aortic coarctation.

Atrioventricular Node↗
PubMed1990

[Transluminal angioplasty of aortopulmonary anastomosis by the Jatene surgical technique. Report of 2 cases].

Two patients with transposition of the great arteries submitted to Jatene surgery at ages of 6 days and 6 months respectively, presented in the postoperative period stenosis of the aorto-pulmonary anastomosis. The diagnosis was made three and six years after the surgery. In both patients successful percutaneous transluminal angioplasty (PTA) was performed, respectively six months and immediately after the diagnosis. Pressure gradients decreased from 83 mmHg to 24 mmHg in the first case, and from 76 mmHg to 13 mmHg in the other case, with clear improvement of the angiographic image. Complications of the procedure did not occur in any case. This application for PTA was not previously reported and should be considered as an alternative to the surgical correction of the "new" pulmonary trunk stenosis in the Jatene surgery.

Angioplasty, Balloon, Coronary↗
PubMed1989

[The quality of life of patients with cardiac arrhythmia undergoing surgical treatment].

The handling of patients with malign ventricular arrhythmia, since 1979, can count on intracardiac electrophysiological studies, cardiac mapping and unconventional cardiac surgery. Such service, which requires the use of sophisticated equipment and specialized professionals, is being provided to patients from all over the country and from all social strata. The Hospital, which maintains the costly, infrastructure required to provide such service, is interested in knowing the reach of the therapeutic action, going beyond the mere knowledge of the success in the immediate treatment. In order to situate the patient as well as his family and social relations, a Social Service professional has been appointed, and same, from a group of 37 patients under treatment (there were 15 deaths), has selected for the survey 17 residents in the metroplitan region of São Paulo, because of contact with them was easier. Evaluation of the changes in the quality of life of the patients that have undergone surgery has been structured in such a way to detail the research procedure, treatment of the data and discussion of the results. Thus, an attempt has been made to characterize the extent of the benefits obtained in the surgeries, at the individual, familiar and social level. Basicaly, in the group of patients surveyed, 70% have been identified as males, 70% as married, 65% older than 50 years, 76% associated to the social security system, 70% with primary level schooling and thus a low family income (1.6 minimum wages per capita).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗