Objective: To analyze pulmonary functional changes and pain in patients undergoing off-pump coronary artery bypass grafting utilizing a left internal thoracic artery graft, comparing pleural drain insertion through the intercostal space and the subxyphoid approach.Methods: Twenty-eight patients (mean age 57.4 ± ± ± ± ± 8.4 years) were divided into two groups, according to the pleural drain site. Group LI (n=15) had the pleural drain inserted through the sixth left intercostal space at the mid-axillary line and in the MI group (n=13) the drain was placed through the subxyphoid region. All the patients underwent pre-and postoperative evaluations of pulmonary function tests as well as arterial blood gas analysis. Forced vital capacity (FVC) and forced expiratory volume over one second (FEV 1 ) were recorded in the preoperative period, and on the first, third and fifth postoperative days. The pain sensation was evaluated using a standard score from 0 to 10. Results:In both groups, falls in the FVC and FEV 1 were noted, up to the fifth postoperative day (P<0.001). However the decrease was higher in the LI group, when compared to the MI group (p<0.05). Also arterial blood gas analysis showed a decline of the partial oxygen pressure in both groups on the first postoperative day, but more significantly in the LI group (p=0.021). The pain sensation was higher in the LI group (p=0.002).Conclusion: Off-pump coronary artery bypass grafting using the left internal thoracic artery, disregarding the pleural drain site, leads to a significant decrease of postoperative pulmonary function. However, the subxyphoid technique of drain insertion has shown a better preservation of the lung function when compared to the intercostal drain site.Descriptors: Coronary artery bypass surgery. Pleural drain. Pulmonary function. 48GUIZILINI, S ET AL -Effects of the pleural drain site on the pulmonary function after coronary artery bypass grafting Bras Cir Cardiovasc 2004; 19(1): 47-54 Rev

Avaliação da função pulmonar em pacientes submetidos à cirurgia de revascularização do miocárdio com e sem circulação extracorpórea

Although vasoplegic syndrome can complicate OPCAB surgery, the rationale for avoiding CPB remains valid considering the benefits provided by OPCAB.

Objective: This work aimed at analyzing the anatomical relationship among the mitral annulus, the circumflex artery and the posterior left ventricular artery, correlating the distance among these structures to the pattern of coronary network dominance. Method: Eighty-five human hearts, previously preserved in 10% formaldehyde solution, were studied. The coronary network dominance pattern was initially evaluated. Next, atriotomy and left ventriculotomy in the posterior wall of the heart were performed, starting from the pulmonary veins toward the heart apex through the mitral annulus. The atrial wall was removed near the annulus, all around the posterior annulus. Five points were demarcated on the annulus: 1:anterior commissure, 2:-between the anterior commissure and the midpoint of the posterior annulus, 3:-midpoint of the posterior annulus, 4:-between the midpoint of the posterior annulus and the posterior commissure, 5:-posterior commissure. The distance among the structures was measured through these points with an electronic caliper. Results: Right dominance was observed in 81.17% of the cases, balanced dominance in 16.47% and left dominance in 2.35%. Right dominant hearts showed that the region of lowest distance between the annulus and the coronary arteries was the anterior commissure, where the circumflex artery was distant to the annulus 3.996 ± 1.865 mm while the region of greatest distance was the posterior commissure, measuring 7.783 ± 2.615 mm. Conclusion: This study provided better understanding of the anatomical relationship between the mitral valve and the adjacent coronary arteries, thereby helping cardiac surgeons to prevent operative complications.

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