A endocardite na mitral foi tratada em 34 pacientes, sendo 18 na valva nativa e 16 em próteses artificiais, com um deles apresentando abcesso, que destruiu parte do anel valvar, e necessitando correção com pericárdio bovino, para posterior implante da prótese. Nesses pacientes fizemos 2 plastias e utilizamos 24 próteses biológicas e 8 metálicas . Em 18 pacientes, tanto a mitral como a aórtica estavam comprometidas , sendo 11 vezes nas valvas nativas, 6 em prótese biológica mitral com metálica aórtica e 1 vez com portador de prótese biológica mitral e aorta nativa. Em 11 deles usou-se protese biológica mitral e metálica aórtica, em 4 prótese metálica em ambas as posições, em 1 prótese biológica nas 2 posições e, nos 2 casos restantes, plastia de 1 valva associada à prótese da outra. Em 1 dos pacientes que apresentava abcesso tanto na mitral como na aortica, usou-se retalho único de pericárdio bovino, para corrigir os abcessos , e as próteses foram implantadas parcialmente nesse retalho. Os 8 restantes apresentavam endocardite em cardiopatias congênitas (6 casos), em fio de marcapasso endovitário (1 caso) e nas 3 valvas (mitro-aórtico-tricuspídeo 1 caso) . A mortalidade cirúrgica foi de 18,09%, a maioria por síndrome de baixo débito ou septicemia. As endocardites em posição mitral tiveram o maior índice de mortalidade (23 ,5%) e as da posição aórtica o menor (15,5%) , com os mitro-aórticas tendo uma mortalidade de 16,6%. A cirurgia para endocardite tem apresentado melhoria nos resultados, principalmente depois que os cirurgiões tornaram-se mais agressivos, retirando todo o tecido infectado, com amplas ressecções e corrigindo todos os defeitos adicionais, procurando restaurar a integridade do coração e a função valvar. DESCRITORES: endocardite infecciosa, cirurgia. INTRODUÇÃOpara que a evolução não seja tão favorável. O agente causador, a valva acometida, e as lesões anatômi-cas provocadas, são importantes no resultado do tratamento , seja cl ínico ou cirúrgico . As próteses , quando acometidas de endocardite, apresentam mortalidade ainda elevada, chegando a 78% quando a instalação é precoce e a 46% quando tardia 5 .

Syncope, the transient loss of consciousness and postural tone, is one of the oldest of recorded medical problems. Indeed, Hippocrates, the father of medicine, recorded the first description of syncope, and it is from the Greek that we derive the medical term for fainting (syncoptein -to cut short). Both a sign and a syndrome, syncope may result from a wide variety of causes. Over the last decade, considerable attention has been focused on one particular cause of syncope, the phenomenon previously called vasovagal syncope. Research into the nature of this disorder has demonstrated that it is only one aspect of a much broader group of disturbances of the autonomic nervous system that may lead to hypotension, orthostatic intolerance, and ultimately syncope. Indeed, recent discoveries have caused us to reevaluate our entire classification of autonomic disorders, and to develop a new system that better reflects our current knowledge. Because it is the cardiologist and the clinical cardiac electrophysiologist who are now frequently called upon to recognize and treat these disorders, this review is designed to acquaint the reader with these conditions, their diagnosis, and management. The autonomic nervous systemBecause these nervous disorders all result from a disturbance in normal autonomic function, it would seem appropriate to briefly review some aspects of the structure and operation of the nervous system.The human nervous system has two basic components: the central nervous system, made up of the brain and the spinal cord 1 , and the peripheral nervous system, which is comprises groups of neurons called ganglia, and of peripheral nerves that lie outside the brain and spinal cord. Although anatomically separate, the two systems are functionally interconnected. The peripheral nervous system is further divided into somatic and autonomic divisions. The somatic division is principally concerned with sensory information about the environment outside the body as well as muscle and limb position. The autonomic division (usually called the autonomic nervous system or ANS) is the motor system for the viscera, the smooth muscles of the body (especially those of the vasculature), and the exocrine glands. It is composed of three distinct parts: the sympathetic, parasympathetic, and enteric nervous systems. The sympathetic nervous system helps control the reaction of the body to stress, and the parasympathetic system works to conserve the body's resources and to restore equilibrium to the resting state. The enteric system controls the function of the gut. The organ systems governed by the ANS are, for the most part, independent of volitional control (although they sometimes can be affected by volitional or emotional inputs) and include the cardiorespiratory organs, the gastrointestinal and genitourinary tracts. The autonomic system is vital to the maintenance of internal homeostasis and achieves this by mechanisms that regulate blood pressure, fluid and electrolyte balance, and body temperature.Although representative of one ...