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1.
Arrhythm Electrophysiol Rev ; 9(2): 78-82, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32983528

RESUMO

Cardiac stimulation therapy has evolved significantly over the past 30 years. Currently, cardiac implantable electronic devices (CIED) are the mainstream therapy for many potentially lethal heart conditions, such as advanced atrioventricular block or sustained ventricular tachycardia or fibrillation. Despite sometimes being lifesaving, the implant is surgical and therefore carries all the inevitable intrinsic risks. In the process of technology evolution, one of the most important factors is to make it safer for the patient. In the context of CIED implants, complications include accidental puncture of intrathoracic structures. Alternative strategies to intrathoracic subclavian vein puncture include cephalic vein dissection or axillary vein puncture, which can be guided by fluoroscopy, venography or, more recently, ultrasound. In this article, the authors analyse the state of the art of ultrasound-guided axillary vein puncture using evidence from landmark studies in this field.

2.
Rev Bras Cir Cardiovasc ; 26(3): 338-47, 2011.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22086569

RESUMO

OBJECTIVE: Aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such risk can justify contraindication. Minimally invasive transcatheter aortic valve implantation has emerged as an alternative, with lower morbidity and mortality. The aim of this study was clinical, safety and efficacy assessment. METHODS: Thirty-three high risk patients underwent transcatheter balloon expandable aortic valve implantation. Mean Logistic EuroScore risk was 39.30% and STS score 30.28%. Eight patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis were implanted trough the ventricular apex under rapid ventricular pacing or hemorrhagic shock. Echocardiographic and angiographic controls were performed. RESULTS: Implant was feasible in 30 cases. Three conversions occured. There was only one case of operative death. Median transvalvular aortic gradient reduced from 43.58 mmHg to 10.54 mmHg. Left ventricular function improved in the first 7 postoperative days. Paravalvular aortic regurgitation was mild and present in 30.30%. One case presented major vascular complication and another one permanent pacemaker implant. One major stroke case occurred. Overall 30-day mortality was 18.18%. CONCLUSION: The transapical implantation of catheter mounted bioprosthesis is a safe procedure with acceptable midterm results. Long term follow-up with increased sample power is mandatory in order to access hemodynamic, life quality and survival.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Calcinose/cirurgia , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/fisiopatologia , Brasil , Calcinose/fisiopatologia , Cateterismo Cardíaco/métodos , Estudos de Viabilidade , Feminino , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Medição de Risco/métodos , Resultado do Tratamento
3.
Rev. bras. cir. cardiovasc ; 26(3): 338-347, jul.-set. 2011.
Artigo em Português | LILACS | ID: lil-624514

RESUMO

OBJETIVO: A troca valvar aórtica é procedimento rotineiro com risco aceitável. Em alguns casos, a mortalidade é elevada, contraindicando o procedimento. O implante minimamente invasivo transcateter de valva aórtica parece ser alternativa, reduzindo a morbimortalidade. A avaliação dos resultados clínicos, segurança e eficácia do procedimento são o objetivo desse estudo. MÉTODOS: Uma prótese transcateter, balão expansível foi utilizada em 33 casos de alto risco. EuroScore médio foi de 39,30% e STS score de 30,28%. Oito pacientes apresentavam disfunção de bioprótese e o restante, estenose aórtica calcificada. Os procedimentos foram realizados em ambiente cirúrgico híbrido, sob controle ecocardiográfico e fluoroscópico. Através de minitoracotomia esquerda, as próteses foram implantadas pelo ápice ventricular, sob estimulação de alta frequência ou choque hemorrágico. Foram realizados controles clínicos e ecocardiográficos. RESULTADOS: A correta liberação da prótese foi possível em 30 casos. Três conversões ocorreram. A mortalidade operatória foi de um caso e a mortalidade em 30 dias, 18,18%. O gradiente médio reduziu de 43,58 para 10,54 mmHg. A fração de ejeção apresentou aumento significativo após o 7º pós-operatório. Insuficiência aórtica residual esteve presente em 30,30% dos pacientes. Ocorreu uma complicação vascular periférica e um caso de bloqueio atrioventricular total. Um paciente apresentou acidente vascular cerebral. A mortalidade em 30 dias foi de 18,18%. CONCLUSÃO: O implante transapical de valva aórtica transcateter é procedimento seguro e com resultados de médio prazo satisfatórios. São necessários estudos de longo prazo com maior poder amostral no intuito de determinar resultado hemodinâmico, qualidade de vida e sobrevida em longo prazo.


OBJECTIVE: Aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such risk can justify contraindication. Minimally invasive transcatheter aortic valve implantation has emerged as an alternative, with lower morbidity and mortality. The aim of this study was clinical, safety and efficacy assessment. METHODS: Thirty-three high risk patients underwent transcatheter balloon expandable aortic valve implantation. Mean Logistic EuroScore risk was 39.30% and STS score 30.28%. Eight patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis were implanted trough the ventricular apex under rapid ventricular pacing or hemorrhagic shock. Echocardiographic and angiographic controls were performed. RESULTS: Implant was feasible in 30 cases. Three conversions occured. There was only one case of operative death. Median transvalvular aortic gradient reduced from 43.58 mmHg to 10.54 mmHg. Left ventricular function improved in the first 7 postoperative days. Paravalvular aortic regurgitation was mild and present in 30.30%. One case presented major vascular complication and another one permanent pacemaker implant. One major stroke case occurred. Overall 30-day mortality was 18.18%. CONCLUSION: The transapical implantation of catheter mounted bioprosthesis is a safe procedure with acceptable midterm results. Long term follow-up with increased sample power is mandatory in order to access hemodynamic, life quality and survival.


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Calcinose/cirurgia , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Estenose da Valva Aórtica/fisiopatologia , Brasil , Calcinose/fisiopatologia , Estudos de Viabilidade , Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/mortalidade , Estimativa de Kaplan-Meier , Medição de Risco/métodos , Resultado do Tratamento
4.
Rev Bras Cir Cardiovasc ; 24(2): 126-32, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19768289

RESUMO

OBJECTIVE: To assess the histological changes of the aorta, the renal arteries and the renal parenchyma in swine, induced by a metalic uncovered stent implanted in transrenal position in the abdominal aorta. METHODS: Ten pigs with a mean weight of 86.6 kg and mean age of 6 months underwent implantation of metal stent graft placed in the aorta at the level of the renal arteries after 100 days of implantation. The self-expanding stents were released by laparotomy. Anatomic and histological analyses of the abdominal aorta, the renal arteries and the renal parenchyma were performed. Histological slices were performed in the following sites: 1) transitional zone between the aorta with and without stent graft; 2) portion of the renal arteries ostia; 3) renal parenchyma. The slices were stained through the hematoxylin and eosin stain technique and analyzed according the protocol of histological analyses applied in the clinical practice of pathology labs. RESULTS: The macroscopic findings showed thickening of the aortic wall; patent renal arteries; and normal anatomic renal structures. Microscopic analyses, close to the stents, showed thickening of the vascular wall, renal arteries without changes, and preserved renal parenchyma. CONCLUSION: The uncovered stainless steel stent caused a significant inflammatory reaction with thickening of the aortic wall. However, the renal arteries remained patent and the renal parenchyma did not present embolic or ischemic changes.


Assuntos
Aorta Abdominal/patologia , Prótese Vascular/efeitos adversos , Reação a Corpo Estranho/patologia , Rim/patologia , Artéria Renal/patologia , Stents/efeitos adversos , Animais , Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Inflamação/patologia , Modelos Animais , Desenho de Prótese/efeitos adversos , Obstrução da Artéria Renal/patologia , Suínos
5.
Rev. bras. cir. cardiovasc ; 24(2): 126-132, abr.-jun. 2009. ilus
Artigo em Inglês, Português | LILACS | ID: lil-525543

RESUMO

OBJETIVO: Avaliar as alterações histológicas da aorta, artéria renal e parênquima renal, em suínos, induzidos pelo stent metálico descoberto implantado em localização transrenal na aorta abdominal. MÉTODOS: Foram utilizados 10 suínos com peso médio de 86,6 quilos e idade média de 6 meses, submetidos a implante de stent metálico posicionado na aorta, no nível das artérias renais, após 100 dias do implante. Os stents foram liberados por auto-expansão com laparotomia. Foram realizadas análises anatômicas e histológicas da aorta abdominal, artérias renais e parênquima renal. Os cortes histológicos foram realizados nos seguintes locais: 1) transição entre a aorta normal e aorta contendo stent; 2) porção contendo os óstios das artérias renais, 3) parênquima renal. As lâminas foram coradas pela técnica da hematoxilina e eosina e analisadas conforme protocolo de análise histológica aplicada na prática clínica dos laboratórios de patologia. RESULTADOS: Os achados macroscópicos revelaram espessamento da parede aórtica; artérias renais pérvias; estrutura anatômica renal normal. Análises microscópicas, próximas aos stents, evidenciaram espessamento da parede vascular, artérias renais sem alterações e parênquima renal preservado. CONCLUSÃO: O stent de aço inoxidável descoberto produziu importante reação inflamatória com espessamento da parede da aorta. No entanto, as artérias renais permaneceram pérvias e o parênquima renal sem alterações isquêmicas ou embólicas.


OBJECTIVE: To assess the histological changes of the aorta, the renal arteries and the renal parenchyma in swine, induced by a metalic uncovered stent implanted in transrenal position in the abdominal aorta. METHODS: Ten pigs with a mean weight of 86.6 kg and mean age of 6 months underwent implantation of metal stent graft placed in the aorta at the level of the renal arteries after 100 days of implantation. The self-expanding stents were released by laparotomy. Anatomic and histological analyses of the abdominal aorta, the renal arteries and the renal parenchyma were performed. Histological slices were performed in the following sites: 1) transitional zone between the aorta with and without stent graft; 2) portion of the renal arteries ostia; 3) renal parenchyma. The slices were stained through the hematoxylin and eosin stain technique and analyzed according the protocol of histological analyses applied in the clinical practice of pathology labs. RESULTS: The macroscopic findings showed thickening of the aortic wall; patent renal arteries; and normal anatomic renal structures. Microscopic analyses, close to the stents, showed thickening of the vascular wall, renal arteries without changes, and preserved renal parenchyma. CONCLUSION: The uncovered stainless steel stent caused a significant inflammatory reaction with thickening of the aortic wall. However, the renal arteries remained patent and the renal parenchyma did not present embolic or ischemic changes.


Assuntos
Animais , Aorta Abdominal/patologia , Prótese Vascular/efeitos adversos , Reação a Corpo Estranho/patologia , Rim/patologia , Artéria Renal/patologia , Stents/efeitos adversos , Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Inflamação/patologia , Modelos Animais , Desenho de Prótese/efeitos adversos , Obstrução da Artéria Renal/patologia , Suínos
6.
Nephrol Dial Transplant ; 24(7): 2077-82, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19204016

RESUMO

BACKGROUND: Oxidative stress and the formation of aminoglycoside-iron complexes through iron-dependent Fenton reaction have been proposed to be the major mechanisms in the development of GM-induced acute renal failure (ARF); however, the efficacy of the combination of N-acetylcysteine (NAC) and desferrioxamine (DFX) in the prevention and the treatment of GM-induced ARF has not previously been investigated. METHODS: In the prevention protocol, adult male Wistar rats received gentamicin (GM) [70 mg/kg, intraperitoneally (i.p), each 12 h for 7 days], NAC (20 mg/kg, sc, each 8 h for 7 days) and/or DFX (20 mg/kg, sc, at first, fourth and seventh days). In the treatment protocol animals received GM for 7 days. Additionally, animals received NAC and or DFX starting in the fourth day after GM administration. Parameters of renal function had been evaluated 24 h, 4 and 8 days after the beginning of GM administration in the prevention protocol and in Days 5 and 8 in the treatment protocol. At the end of experiment, lipid peroxidation (TBARS assay) and protein oxidation (protein carbonyls levels) formation were evaluated in kidney tissue as oxidative damage parameters. RESULTS: In the prevention protocol, GM-induced ARF was prevented by the NAC and DFX association. Lipid peroxidation was attenuated by both antioxidant treatments, but the effects of NAC plus DFX were of greater magnitude. In the treatment protocol, plasma markers of renal injury were improved only in the NAC group, despite the similar antioxidant effect of both NAC, DFX and NAC plus DFX. CONCLUSION: Although the combination of NAC and DFX was more effective in the prevention protocol, the use of NAC alone seemed to be superior to NAC-DFX combination, in the treatment of GM-induced ARF in adult male Wistar rats.


Assuntos
Acetilcisteína/administração & dosagem , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/prevenção & controle , Desferroxamina/administração & dosagem , Sequestradores de Radicais Livres/administração & dosagem , Sideróforos/administração & dosagem , Injúria Renal Aguda/induzido quimicamente , Animais , Quimioterapia Combinada , Gentamicinas/administração & dosagem , Masculino , Ratos , Ratos Wistar
7.
Phytother Res ; 23(6): 859-62, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19107736

RESUMO

Vimang is an aqueous extract of Mangifera indica L, used in Cuba for the treatment of immunopathological disorders. Increasing evidence from preclinical studies indicates that Vimang displays antioxidant, antiallergic, analgesic and antiinflammatory actions. The present study investigated the effects of systemic administration of Vimang on behavioural outcomes of neurological function in rats. A single oral administration of Vimang produced an impairment of short- and long-term retention of memory for aversive training when given either 1 h pretraining or immediately posttraining, but not 8 h posttraining. Vimang did not affect open field behaviour or habituation. The results indicate that Vimang might induce deficits of emotionally motivated memory without affecting nonassociative memory, locomotion, exploratory behaviour or anxiety.


Assuntos
Comportamento Animal/efeitos dos fármacos , Memória/efeitos dos fármacos , Extratos Vegetais/farmacologia , Animais , Aprendizagem da Esquiva/efeitos dos fármacos , Habituação Psicofisiológica/efeitos dos fármacos , Masculino , Mangifera/química , Atividade Motora/efeitos dos fármacos , Ratos , Ratos Wistar
8.
Crit Care Med ; 35(9): 2186-90, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17855835

RESUMO

OBJECTIVE: Assess the effect of antioxidant treatment on late memory impairment and early hippocampus oxidative stress after cecal ligation and perforation. SUBJECTS: Male Wistar rats. INTERVENTIONS: Rats underwent sham operation or cecal ligation and perforation. Animals that underwent cecal ligation and perforation were divided into groups: 1) treated with basic support (50 mL/kg saline, 30 mg/kg ceftriaxone, and 25 mg/kg clindamycin every 6 hrs), 2) treated with basic support plus N-acetylcysteine (20 mg/kg N-acetylcysteine at 3, 6, 12, 18, and 24 hrs after cecal ligation and perforation), 3) treated with basic support plus deferoxamine (20 mg/kg deferoxamine at 3 and 24 hrs after cecal ligation and perforation), 4) treated with basic support plus N-acetylcysteine and deferoxamine, or 5) treated with N-acetylcysteine plus deferoxamine. MEASUREMENTS AND MAIN RESULTS: On days 10 and 30 after surgery, the animals underwent behavioral tasks: inhibitory avoidance task, habituation to an open field, and continuous multiple-trials step-down inhibitory avoidance task. The sepsis group showed significantly decreased performance in latency retention compared with the sham group in the inhibitory avoidance task. In the open-field task, the sepsis group presented memory impairment after sepsis. In the continuous multiple-trials step-down inhibitory avoidance task, the sepsis group showed a significant increase in the number of training trials required to reach the acquisition criterion. All these memory impairments were prevented by N-acetylcysteine plus deferoxamine treatment, but not its isolate use. In addition, the combined use of antioxidants attenuated oxidative damage in hippocampus 6 hrs after sepsis induction. CONCLUSIONS: Antioxidant treatment prevented the development of late cognitive deficits in an animal model of sepsis.


Assuntos
Acetilcisteína/administração & dosagem , Antioxidantes/uso terapêutico , Desferroxamina/administração & dosagem , Transtornos da Memória/prevenção & controle , Sepse/complicações , Animais , Aprendizagem da Esquiva/efeitos dos fármacos , Ceco , Modelos Animais de Doenças , Habituação Psicofisiológica/efeitos dos fármacos , Perfuração Intestinal/complicações , Ligadura , Masculino , Transtornos da Memória/etiologia , Ratos , Ratos Wistar
9.
Peptides ; 28(7): 1447-52, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17629354

RESUMO

The gastrin-releasing peptide receptor (GRPR) has emerged as a novel molecular target in neurological and psychiatric disorders, and previous animal studies suggest that GRPR antagonists might display cognitive-enhancing and antipsychotic properties. Hyperlocomotion produced by administration of D-amphetamine (D-AMPH) to rats has been put forward as a model of the manic phase of bipolar disorder (BD). In the present study, we examined the effects of a single systemic administration of the GRPR antagonist [D-Tpi(6), Leu(13) psi(CH(2)NH)-Leu(14)] bombesin (6-14) (RC-3095) on hyperlocomotion induced by a single systemic injection of D-AMPH in male rats. We also evaluated the levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in the hippocampus of rats treated with D-AMPH and RC-3095. Administration of RC-3095 at any of the doses used blocked D-AMPH-induced hyperlocomotion. Specific doses of RC-3095 increased the levels of NGF and BDNF in the dorsal hippocampus. Administration of D-AMPH did not affect NGF or BDNF levels by itself, but blocked the RC-3095 effects. The results suggest that GRPR antagonists might display anti-manic activity.


Assuntos
Bombesina/análogos & derivados , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Dextroanfetamina/antagonistas & inibidores , Hipocampo/efeitos dos fármacos , Atividade Motora/efeitos dos fármacos , Fator de Crescimento Neural/metabolismo , Fragmentos de Peptídeos/farmacologia , Receptores da Bombesina/antagonistas & inibidores , Animais , Transtorno Bipolar/metabolismo , Bombesina/administração & dosagem , Bombesina/farmacologia , Hipocampo/metabolismo , Masculino , Fragmentos de Peptídeos/administração & dosagem , Ratos , Ratos Wistar , Receptores da Bombesina/metabolismo
10.
Cell Biol Int ; 31(9): 1036-41, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17467305

RESUMO

Central nervous system dopaminergic mechanisms have been implicated in the cytokine response to stress and sepsis. We here describe the effects of haloperidol or clozapine in the treatment of sepsis induced by cecal ligation and puncture. Male Wistar rats were subjected to the CLP procedure were treated with haloperidol or clozapine and plasma cytokines, myeloperoxidase activity, markers of organ injury and survival was analyzed. The addition of haloperidol or clozapine to basic support did not diminished hepatic, renal, pancreatic or muscular damage observed after sepsis. Neither haloperidol, nor clozapine, modulates pro and antiinflammatory cytokines after sepsis induction. In addition, haloperidol treatment did not diminished myeloperoxidase activity in the kidney, lung or liver, or altered BALF markers of lung damage or inflammatory infiltration. Our data did not support a role of haloperidol or clozapine as an immunomodulator agent in the treatment of sepsis in an animal model of peritonitis.


Assuntos
Antagonistas de Dopamina/uso terapêutico , Peritônio/patologia , Sepse/tratamento farmacológico , Animais , Biomarcadores/sangue , Clozapina/farmacologia , Clozapina/uso terapêutico , Modelos Animais de Doenças , Antagonistas de Dopamina/farmacologia , Haloperidol/farmacologia , Haloperidol/uso terapêutico , Inflamação , Perfuração Intestinal/induzido quimicamente , Perfuração Intestinal/patologia , Masculino , Infiltração de Neutrófilos/efeitos dos fármacos , Ratos , Ratos Wistar , Sepse/induzido quimicamente
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