Objective: To report the institution experience with the surgical treatment of adults with congenital heart disease due to the increasing number of these patients and the need for a better discussion of the subject.Methods: Retrospective analysis describing demographic data, risk factors and results.Results: 191 patients between 16 and 74 years old were operated on. Primary correction was done in 171 cases, 93 (55%) for atrial septal defect repair. Among 20 (12%) reoperations, pulmonary valve replacement was done in six cases. The mean intensive care and hospital stay were 2.7 and 8.5 days respectively, significantly greater for the reoperated cases (P=0.001). The mean bypass and clamping times were 68.6 and 44.7 minutes respectively, greater for the reoperated cases (P<0.0001 and P=0.0003 respectively). Hospital mortality was 4.2% and male sex, functional class III-IV and older age at operation were predictive risk factors. Significant complications were more frequent in the reoperated cases (P<0.003), mainly atrial flutter and fibrillation. Among 183 patients discharged, 149 (82%) are being followed and atrial flutter and fibrillation are common. The mean functional class value improved significantly after operation (1.66 to 1.11; P<0.0001). The estimated survival was 96.2% in six years. Conclusion:Heart surgery in adults with congenital heart disease can be accomplished with low mortality and functional class improvement. Immediate and late complications are frequent. Multicenter studies are important to better characterize this patient population in the country.Descriptors: Heart defects, congenital. Adult. Cardiac surgical procedures.Resumo Objetivo: Relatar a experiência da instituição com o tratamento cirúrgico de adultos com cardiopatia congênita devido ao crescente aumento no número desses pacientes e consequentes necessidades de maior discussão do tema.Métodos: Análise retrospectiva dos pacientes operados, com análise de dados demográficos, fatores de risco e resultados.Resultados: Cento e noventa e um pacientes, com idade entre 16 e 74 anos, foram operados. Cirurgia primária foi realizada em 171 pacientes, 93 (55%) com comunicação interatrial. Dentre 20 (12%) reoperações, substituição de valva pulmonar ocorreu em seis casos. Os tempos médios de unidade de terapia intensiva e hospitalar foram 2,7 e 8,5 dias, respectivamente, maiores nas reoperações (P=0,001). Os tempos médios de cir- 372Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Rev Bras Cir Cardiovasc 2013;28(3):371-9Amaral FTV, et al. -Adult congenital heart disease: experience with the surgical approach city area (n=40, 20%) or in the region (n=133, 70%) while 17 (10%) were referred from other states. An Excel data base was created containing general information of the patients, possible preoperative risk factors such as diabetes, cyanosis, smoking, systemic hypertension, obesity and chronic lung disease, detailed information regarding the surgical procedure, hospital complications and follow up information.The preoperative data collec...

During the last decades, advances in diagnosis and treatment of congenital heart disease have allowed many individuals to reach adulthood. Due mainly to the great diagnostic diversity and to the co-morbidities usually present in this age group, these patients demand assistance in a multidisciplinary facility if an adequate attention is aimed. In this paper we reviewed, based in the international literature and also on the authors’ experience, the structural conditions that should be available for these patients. We highlighted aspects like the facility characteristics, the criteria usually adopted for patient transfer from the paediatric setting, the composition of the medical and para- medical staff taking into account the specific problems, and also the model of outpatient and in-hospital assistance. We also emphasized the importance of patient data storage, the fundamental necessity of institutional support and also the compromise to offer professional training. The crucial relevance of clinical research is also approached, particularly the development of multicenter studies as an appropriate methodology for this heterogeneous patient population.

RBCCV 44205-156 CARBONE Jr. , C.; ROSELlNO, J.E.S.; CARNEIRO, J.J.; SADER, AA -Análise comparativa da reserva de glicogênio do miocárdio isquêmico de coelhos submetidos a cardioplegia hipotérmica ou normotérmica. Rev. Bras. Cir. Cardiovasc., 7(1) :9-13,1992.RESUMO: Neste trabalho, a comparação da reserva de glicogênio é utilizada para entender as modificações na sensibilidade mitocondrial ao íon cálcio . Basicamente porque alterações mitocondriais que envolvam perda da atividade de fosforilação oxidativa provocam rápida utilização dos estoques de glicogênio . Nossos resultados sugerem que as alterações mitocondriais fazem parte do mecanismo de lesão isquêmica. DESCRITORES: proteção miocárdica, cardioplegia; miocárdio, reserva de glicogênio. INTRODUÇÃOO conceito da hipotermia sistêmica como meio de proteção celular foi introduzido por BIGELOW et alii 2, em 1950; logo depois, em 1953, a hipotermia sistêmica foi utilizada com sucesso na primeira cirurgia cardíaca a céu aberto, com a finalidade de fechar uma comunicação interatrial 13 • Com o advento da cirurgia cardíaca com circulação extracorpórea 10, os cirurg iões logo sentiram as dificuldades e os riscos de operar o coração que se contrai normalmente . 16 introduziram os conhecimentos adquiridos nos laboratórios de fisiologia, empregando o citrato de potássio para induzir a parada card íaca intra-operatória. No entanto, a alta concentração usada e a elevada osmolaridade da solução condenaram o método ao insucesso, motivo pelo qual ficou abandonado por mais de uma década . Em 1955, MELROSE et a/iiSó em 1972, o trabalho de KIRCH et a/ii 12 estimulou a retomada da discussão sobre a proteção miocárdica pelo de uso de substâncias químicas que pudessem proporcionar a parada cardíaca e, por conseqüência, a proteção miocárdica. A partir de então, surgiram numerosos trabalhos relacionados a composição, temperatura e modo de administração das soluções denominadas cardioplégicas 3.8,9,12,21 . Os vários tipos de soluções propostas e empregadas tinham , em comum, o íon potássio como agente de rápida parada cardíaca e a hipotermia como elemento redutordo metabolismo miocárdico e de suas necessidades energéticas,

Sanguineous normothermic, intermittent cardioplegia, effects on hypertrophic myocardium. Morphometric, metabolic and ultrastructural studies in rabbits hearts Abstract Objectives: The present investigation aimed to study the protective effect of intermittent normothermic cardioplegia in rabbit's hypertrophic hearts.Methods: The parameters chosen were 1) the ratio heart weight / body weight, 2) the myocardial glycogen levels, 3) ultrastructural changes of light and electron microscopy, and 4) mitochondrial respiration.Results: 1) The experimental model, coarctation of the aorta induced left ventricular hypertrophy; 2) the temporal evolution of the glycogen levels in hypertrophic myocardium demonstrates that there is a significant decrease; 3) It was observed a time-dependent trend of higher oxygen consumption values in the hypertrophic group; 4) there was a significant time-dependent decrease in the respiratory coefficient rate in the hypertrophic group; 5) the stoichiometries values of the ADP: O2 revealed the downward trend of the values of the hypertrophic group; 6) It was possible to observe damaged mitochondria from hypertrophic myocardium emphasizing the large heterogeneity of data.Conclusion: The acquisition of biochemical data, especially the increase in speed of glycogen breakdown, when anatomical changes are not detected, represents an important result even when considering all the difficulties inherent in the process of translating experimental results into clinical practice. With regard to the adopted methods, it is clear that morphometric methods are less specific. Otherwise, the biochemical data allow detecting alterations of glycogen concentrations and mitochondria respiration before the morphometric alterations should be detected Descriptors: Heart arrest, induced. Hypertrophy, left ventricular. Cardiovascular surgical procedures. 622Rev Bras Cir Cardiovasc 2012;27(4):621- INTRODUCTIONThe current success of cardiac surgery was provided, among other relevant factors, by better understanding the myocardium protection. The timeline of this understanding includes: 1) systemic hypothermia [1]; 2) intra-operative cardiac arrest induced by potassium citrate [2]; 3) anoxic arrest of the heart [3]; 4) the use of chemicals that could rapidly determine cardiac arrest [4]; 5) Miscellaneous studies relating to the composition, temperature and mode of drug administration named cardioplegic solution [5][6][7], and; 6) normothermic cardioplegia [8,9].In cardiac hypertrophy, whether it is induced in an experimental model or observed clinically, energy metabolism is compromised highlighting that Sink et al.[10] demonstrated that the hypertrophic heart must be stopped immediately emphasizing the need of additives to the cardioplegia solution. It is noteworthy that Cooley et al., in 1972, described the "Stone Heart", i.e., ischemic contracture, more frequent and severe in the hypertrophic heart [11]. This ischemia/reperfusion phenomenon allowed the resumption of the discussion, and final conclusion, about the pivota...