Background: Hybrid procedures for the treatment of complex thoracic aortic diseases (CTAD) require the revascularization of one or more supra-aortic arteries, followed by the deployment of one or more aortic endoprosthesis, with lower morbidity and mortality compared to conventional surgery.Objectives: To evaluate the technique and results of hybrid procedures for CTAD.Methods: During two years, 12 patients with CTAD underwent hybrid procedures, including aortic arch aneurysms and acute Stanford A and B aortic dissections. All patients had formal indications to invasive treatment, and inadequate proximal landing zone (less than 20 mm). Half were male and the mean age was 55.5 years (42 to 78). At least three cardiovascular risk factors were present in 75% of patients. The average follow-up was 10.9 months (2 to 25), with periodic consultations and CT scans. Results:The initial technical success was achieved in 10 patients. Bypasses of supra-aortic vessels were performed in a surgical environment and endovascular procedures in an interventional radiology facility. "Through-and-through" technique was used in six patients. INGRUND, JC ET AL -Hybrid procedures for complex thoracic aortic diseasesRev Bras Cir Cardiovasc 2010; 25(3): 303-310 procedures are linked to relevant incidence of paraplegia (6% to 11%) and cerebrovascular accident (3% to19%) [10].Although endovascular treatment of originated and confined lesions to the descending and abdominal aorta represent an important advance in medical practice, the repair of CTDA is difficult as a result of the necessity of surgical intervention in one or more supra-aortic trunks [11,12]. This approach is necessary in order to increase the zone of proximal anchor stent, while preserving the upper limbs and cerebral blood flow. In contrast, recent technological advances in making these devices allowed the treatment of lesions with complex anatomy, previously considered contraindicated for endovascular treatment [13]. The three-dimensional knowledge of anatomy and the involvement of its branches are crucial for the hybrid treatment planning, especially for the aortic arch. The open anatomical surgeries (in-situ) and extra-anatomic revascularization of the supra-aortic trunks provide a proximal segment of the aorta free from disease suitable for anchoring the stent.This study was conducted with the purpose of exposing the hybrid correction results of CTDA, in terms of immediate and medium-term results and its complications. METHODSIt is about longitudinal, retrospective and observational case series. From

70% in all target vessels. Only the left internal thoracic artery and radial artery were used as grafts. Patients were divided into elective group (23 patients) and emergency group (24 patients). Emergency criteria were unstable angina and/or critical coronary stenosis with high risk for acute myocardial infarction. Groups were similar for age and number of diseased vessels. RESULTS: The mean number of left internal thoracic artery grafts per patient in the elective and emergency groups were respectively 1.17 and 1.38 (P = .17). The mean number of radial artery grafts per patient in the elective and emergency groups was respectively 2.26 and 2.08 (P = .48). The 30-day mortality was 0. There was no postoperative cardiogenic shock. The elective group had 1 acute myocardial infarction (4.4%) postoperatively, and emergency group had 5 (20.8%). A nonsignificant trend towards acute myocardial infarction was noted in the emergency group (P = .18). Intensive care unit and postoperative stay were similar in both groups. CONCLUSION: Coronary artery bypass grafting using left internal thoracic artery and radial artery accomplishing complete revascularization can be performed in emergency patients with results similar to those for elective patients.]]>

Objective: Mitral valve insufficiency must be treated by repair whenever as prossible as it provides better resultsespecially within the pediatric population in order to avoid valve replacement incovenients. The aim of this study is to describe mitral valve repair technique based on an anatomical and functional approach.Methods: During a 13 months period, eight children (age ranged from 2 and 12 years old 6.37 +\3.66) with mitral valve insufficiency underwent intermittent anterior and posterior annuloplasty associated with Alfieri's repair -performed by placing a stitch between the anterior and posterior leaflets in the point of maximal regurgitation thus creating a double orificial mitral valve.Results: There were no surgical deaths. All patients underwent postoperative echocardiography. Three patients showed mild insufficiency and five patients showed no insufficiency. The time in intensive care unit ranged from 2 to 4 days (2.5 + 0.75), and the time of stay in hospital ranged from 5 to 8 days (6.37 + 1.06).Conclusion: In spite of the little sample size, the proposed technique proved itself to be simple and effective in the treatment of single mitral valve insufficiency within the pediatric population. In addition, it also yielded satisfactory immediate results. Long-term follow-up is nevertheless necessary in order to evaluate long-term results.Descriptors: Heart defects,congenital. Child. Mitral valve. ResumoObjetivo: A insuficiência mitral com indicação cirúrgica na faixa etária pediátrica deve ser tratada por meio de plastia sempre que possível, evitando-se os inconvenientes da substituição valvar. O objetivo deste trabalho é propor técnica de plastia mitral baseada em abordagem funcional e anatômica.

Reparo de rotura de ventrículo esquerdo após uso de tenecteplase no tratamento do infarto agudo do miocárdioSurgical repair of left ventricular rupture after the use of tenecteplase in the treatment of acute myocardium infarction AbstractThe use of thrombolytic agents in the treatment of acute myocardium infarction represented an important impact in the reduction of overall mortality. But this did not alter the cardiac rupture rate. This complication must be recognized and treated quickly. The authors report on a case of surgical repair of an early left ventricle rupture, after the use of tenecteplase in association with non-fractioned heparin for the treatment of acute myocardium infarction.Descriptors: Myocardial infarction. Thrombolytic therapy, adverse effects. Heart rupture, post infarction.Article received in February, 2005 Article accepted in April, 2005Resumo A utilização do trombolítico no tratamento do infarto agudo do miocárdio apresentou um impacto importante na diminuição da mortalidade geral, porém não alterou a incidência da rotura cardíaca. Esta complicação deve ser reconhecida e tratada rapidamente, necessitando um alto nível de suspeição clínica. Os autores relatam um caso de reparo cirúrgico de rotura precoce de ventrículo esquerdo, após utilização de tenecteplase associado à heparina não fracionada, no tratamento do infarto agudo do miocárdio.Descritores: Infarto do miocárdio. Terapia trombolítica, efeitos adversos. Ruptura cardíaca pós-infarto. 183GUEDES, MAV ET AL -Surgical repair of left ventricular rupture after the use of tenecteplase in the treatment of acute myocardium infarction Braz J Cardiovasc Surg 2005; 20(2): 182-185