The prevalence of congenital heart disease (CHD) is between 8 and 10 children per 1000 live births. Thus, it is estimated that 28,846 new cases of CHD emerge in Brazil each year. For about 20% of the cases that are related to less complex defects and those with discrete hemodynamic repercussions, the cure is spontaneous. The average number of cardiovascular surgeries for CHD that are necessary in Brazil is of the order of 23,077 procedures per year, including newborn babies with CHD and cases requiring reoperations. In 2002, 8,092 procedures were actually performed thereby giving a deficit of 65%, with the greatest shortfalls seen in the Northern and Northeastern regions (93.5% and 77.4%, respectively) and the least problems experienced in the Southern and Central Western regions (46.4% and 57.4%, respectively) as illustrated in Table 1.

No abstract

I A -Experiencia cirúrgica inicial com a operação de Ross (auto-enxerto pulmonar) . Rev Bras CirResultados: A mortalidade hospitalar foi de 4%. Os sobreviventes tiveram alta hospitalar em ritmo sinusal e sem sopro diastólico de insuficiência aórtica. O desempenho hemodinâmico dos auto-enxertos foi muito satisfatório, com baixos gradientes de pico (4,0 ± 1,3 mmHg pelo ecocardiograma e 2,8±1,2 mmHg pelo cateterismo) . Vinte e um pacientes apresentaram auto-enxertos suficientes e/ou com insuficiência trivial , e 2 pacientes tiveram insuficiência leve . Nenhum paciente teve insuficiência moderada ou importante . Os gradientes de pico dos homoenxertos também foram baixos (3,0 ± 0,9 mmHg pelo ecocardiograma e 4,3 ± 1,4 mmHg pelo cateterismo) e apenas 2 apresentaram insuficiência leve. Houve significativa redução das dimensões sistólica e diastólica do ventrículo esquerdo no pós-operatório imediato, assim como da massa ventricular esquerda. Após um tempo médio de seguimento clínico de 5,1 meses (1-9 meses), todos os pacientes encontram-se em classe funcional I e livres de eventos. Três pacientes, com tempo de evolução superior a seis meses, realizaram ecocardiograma, que demonstrou normalização da função e massa ventricular, assim como manutenção do adequado desempenho hemodinâmico dos enxertos .Conclusões: A operação de Ross pode ser realizada em nosso meio com baixa mortalidade e resultados satisfatórios a curto prazo. Acreditamos que será amplamente empregada.

No abstract

Mortalidade hospitalar na cirurgia de reconstrução da via de saída do ventrículo direito com homeonxerto pulmonarHospital mortality in surgery for right ventricular outflow tract reconstruction using pulmonary homograft Abstract Background: Hospital mortality in surgical reconstruction of the right ventricular outflow tract using pulmonary homograft is variable.Objectives: To identify risk factors associated with hospital mortality and patients' clinical profile.Methods: Study on children who had undergone reconstruction of the right ventricular outflow tract using pulmonary homograft. We analyzed as risk factors the clinical and surgical variables and prosthesis's morphological aspects.Results: Ninety-two patients underwent surgery between 1998 and 2005, presenting mainly pulmonary atresia with ventricular septal defect and tetralogy of Fallot. Forty patients were treated in the first month of life. 38 patients needed Blalock Taussig surgeries due to clinical severity. The median age at surgery for total correction was 22 months, ranging from 1 to 157 months. Pulmonary homograft size ranged from 12 to 26 mm and length of cardiopulmonary bypass was 132 ± 37 minutes. Postoperatively, there were seventeen deaths (18% cases), on average 10.5 ± 7.5 days after surgery. The predominant cause was multiple organ failure. In the univariate analysis between the types of heart disease, they related to age, time of surgery, size of homograft, pulmonary valve Z value, CPB time, maintenance of the integrity of the homograft and pulmonary tree change. There was no statistical difference in hospital mortality between the variables and the type of heart disease.Conclusion: The right-sided obstructive heart diseases require surgical care in the first days of life. The total correction surgery has a mortality risk rate of 18% but there was no association with any variable studied.Descriptors: Heart defects, congenital. Cardiovascular surgical procedures. Transplantation, homologous. Mortality. Resumo