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INTRODUCTION: Diabetes is a well known risk factor for early and late adverse outcomes in patients undergoing coronary artery bypass graft surgery (CABG); however, few studies have investigated the impact of this risk factor in the group of older patients, especially octogenarians. OBJECTIVES: To compare in-hospital mortality and morbidity of diabetic and nondiabetic patients aged > 80 years submitted to CABG. METHODS: A total of 140 consecutive cases were studied, of whom 37 (26.4%) were diabetics, in a retrospective cross-sectional study, that included all patients aged > 80 years submitted to isolated/associated CABG. The patients' mean age was 82.5 ± 2.2 years and 55.7% were males. RESULTS: The hospital mortality rate did not significantly differ in multivariate analysis: 16.2% diabetic x 13.6% nondiabetic (P = 0.554), as well as morbidity: 43.2% x 37.9%, respectively (P = 0.533). Regarding to operative morbidity, the occurrence of stroke was significantly higher in diabetic patients in the univariate analysis (10.8% x 1.9%, P = 0.042). In multivariate analysis, however, the incidence of stroke was not associated with the presence of diabetes (P = 0.085), but it was associated with atrial fibrillation (P = 0.044). There was no significant difference related to other complications. CONCLUSION: In this small consecutive retrospectively analyzed series, there was no significant increase in hospital mortality and morbidity related to diabetes for CABG in octogenarian patients. The impact of the results of this study is limited by the sample size and might be confirmed by future randomized clinical trials.

INTRODUÇÃO: O diabetes é um fator de risco conhecido para eventos adversos precoces e tardios em pacientes submetidos à cirurgia de revascularização miocárdica (CRM); entretanto, poucos estudos investigaram sua influência no grupo de pacientes mais idosos, especialmente nos octogenários. OBJETIVOS: Comparar a mortalidade e a morbidade hospitalar de pacientes com idade > 80 anos diabéticos e não-diabéticos submetidos à CRM. MÉTODOS: Foram estudados 140 casos consecutivos, sendo 37 (26,4%) diabéticos, em um estudo transversal retrospectivo incluindo todos os pacientes com idade > 80 anos submetidos à CRM isolada/associada. A idade média dos pacientes foi de 82,5 ± 2,2 anos e 55,7% eram do sexo masculino. RESULTADOS: A taxa de mortalidade hospitalar não diferiu de maneira significativa na análise multivariada entre os grupos, 16,2% diabéticos x 13,6% não-diabéticos (P=0,554), assim como a morbidade pós-operatória, 43,2 x 37,9%, respectivamente (P=0,533). Em relação à morbidade, a ocorrência de acidente vascular cerebral foi significativamente maior em pacientes diabéticos na análise univariada (10,8% x 1,9%; P = 0,042). Na análise multivariada, no entanto, a incidência dessa complicação não foi associada com a presença de diabetes (P=0,085), mas com a presença de fibrilação atrial (P=0,044). Não se observou nenhuma diferença significativa em relação às outras complicações. CONCLUSÃO: Nessa pequena série de casos retrospectiva, não houve um aumento significativo da morbimortalidade hospitalar no grupo de pacientes octogenários diabéticos. O impacto dos resultados desta série é limitado pelo tamanho amostral e poderá ser confirmado por futuros ensaios clínicos randomizados.

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INTRODUCTION: Diabetes is a well known risk factor for early and late adverse outcomes in patients undergoing coronary artery bypass graft surgery (CABG); however, few studies have investigated the impact of this risk factor in the group of older patients, especially octogenarians. OBJECTIVES: To compare in-hospital mortality and morbidity of diabetic and nondiabetic patients aged > 80 years submitted to CABG. METHODS: A total of 140 consecutive cases were studied, of whom 37 (26.4%) were diabetics, in a retrospective cross-sectional study, that included all patients aged > 80 years submitted to isolated/associated CABG. The patients' mean age was 82.5 ± 2.2 years and 55.7% were males. RESULTS: The hospital mortality rate did not significantly differ in multivariate analysis: 16.2% diabetic x 13.6% nondiabetic (P = 0.554), as well as morbidity: 43.2% x 37.9%, respectively (P = 0.533). Regarding to operative morbidity, the occurrence of stroke was significantly higher in diabetic patients in the univariate analysis (10.8% x 1.9%, P = 0.042). In multivariate analysis, however, the incidence of stroke was not associated with the presence of diabetes (P = 0.085), but it was associated with atrial fibrillation (P = 0.044). There was no significant difference related to other complications. CONCLUSION: In this small consecutive retrospectively analyzed series, there was no significant increase in hospital mortality and morbidity related to diabetes for CABG in octogenarian patients. The impact of the results of this study is limited by the sample size and might be confirmed by future randomized clinical trials.

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Bone marrow mononuclear cells (BMMC) effects have been investigated in small series of nonischemic dilated cardiomyopathy (NIDC). Left ventricular myocardial contractility improvements occur, but doubt remains about their mechanism of action. We compared contractility changes in areas treated (free wall) and nontreated (septal wall) with BMMC, in selected patients who have showed significant ventricular improvement after free wall-only intramyocardial stem cells injection. From 15 patients with functional class III/IV (NYHA) and LVEF inferior to 35%, who received 9.6 ± 2.6 × 10(7) BMMC divided into 10 points over the left ventricular free wall, 7 (46.7%) showed LVEF relative improvement greater than 15%. Those patients were selected for further contractility study. BMMC were collected from iliac bone and isolated with Ficoll-Hypaque. Magnetic resonance imaging was used to measure the systolic thickening of the septal (nontreated) and free wall (treated) before injection and 3 months postoperatively. Mean systolic septal wall thickening increased from 0.46 to 1.23 mm (an absolute 0.77 ± 1.3 mm and relative 167.4% increase) and in the free wall from 1.13 to 1.87 mm (an absolute 0.74 ± 1.5 mm and relative increase of 65.5%). There was no difference in the rate of absolute or relative systolic thickening between the two walls (p = 0.866 and 1.0, respectively), when cells were injected only in the left ventricular free wall. BMMC transplantation in nonischemic dilated cardiomyopathy can improve ventricular function by an overall effect, even in areas that are not directly injected. This finding favors the existence of a diffuse mechanism of action, rather than a local effect, and should be reminded when the pathophysiology of stem cells is considered.

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OBJECTIVE: A review of experience with techniques of correction used, in the last 20 years, in children younger than one year old. METHODS: In the period from 1978 to 1998, 148 patients (pt) with coarctation of the aorta (CoAo), under one year of age, with or without associated intracardiac defects, were submitted to surgery. Median age 50 days, 92 female pt (62.1%). The average weight was 4,367 +/- 1,897 gr. The average follow-up was 1,152 +/- 1,462 days. The population was divided in 3 groups: Group I, isolated CoAo: 74 pt (50%); Group II, CoAo and interventricular communication (IVC): 41 pt (27.7%) and Group III, CoAo with complex intracardiac malformations: 33 pt (22.3%). RESULTS: The total mortality was of 43 patients (29%). In patients younger than 30 days, the mortality was 53%, p=0.009, DR=4.5, between 31 and 90 days, 14.7%, p=0.69, and over 91 days, 15%, p=0.004. The probability of actuarial survival of the whole population was 67% at 5 and 10 years. Thirty-six patients (24.3%) had recoarctation, from which 18 patients (50%) were younger than 30 days, DR=6.35. The incidence of recoarctation was with Waldhausen technique in 4 patients (10%) and with the classic termino-terminal technique in 19 patients (26%) p=0.03, and isthmusplastic operation in 6 patients (37.5%). The patients younger than 30 days showed a relative risk for recoarctation de DR=6.35. The probability of actuarial survival, free of coarctation repair, at 5 and 10 years was of 69% with Waldhausen's technique and 63% with the classic termino-terminal technique. CONCLUSION: Patients younger than 30 days showed increased mortality and recoarctation risk. Waldhausen's technique in patients older than 30 days showed effective. The classic termino-terminal technique did not show to be a good option in all age ranges, being imperative to carry out more radical technical variations, such as the extended termino-terminal.

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OBJETIVO: Revisão da experiência com diversas técnicas de correcão empregadas, nos últimos 20 anos, em criancas menores de um ano de idade. MÉTODOS: No período de 1978 a 1998, foram operados 148 pacientes (pc) consecutivos com coartacão de aorta (CoAo) com até um ano de idade, com ou sem defeitos intracardíacos associados. A idade apresentou mediana de 50 dias, 92 pc do sexo feminino (62,1 por cento). O peso foi de 4.367n1.897 gramas. O seguimento foi em média de 1.152n1.462 dias. A populacão foi dividida em 3 grupos: Grupo I, CoAo isolada: 74 pc (50 por cento); Grupo II, CoAo e comunicacão interventricular (CIV): 41 pacientes (27,7 por cento) e Grupo III, CoAo com malformacões complexas: 33 pc (22,3 por cento). RESULTADOS: Mortalidade total foi 43 pc (29 por cento): com menos de 30 dias, foi 53 por cento, p=0,009, OR=4,5, entre 31 e 90 dias, foi 14,7 por cento, p=0,69, e acima de 91 dias, 15 por cento, p=0,004. A probabilidade de sobrevida atuarial de toda a populacão foi de 67 por cento aos 5 e 10 anos. Trinta e seis pacientes (24,3 por cento) recoartaram, dos quais 18 pacientes (50 por cento) tinham menos de 30 dias, OR=6,35. A incidência de recoartacão foi com a técnica de Waldhausen em 4 pacientes (10 por cento) e com a término-terminal clássica em 19 pacientes (26 por cento) p=0.03, e a istmoplastia em 6 pacientes (37,5 por cento). A probabilidade de sobrevida atuarial livre de recoartacão aos 5 e 10 anos foi de 69 por cento com a técnica de Waldhausen e 63 por cento com a técnica término-terminal clássica. CONCLUSAO: Pacientes com menos de 30 dias apresentaram risco aumentado de mortalidade e recoartacão. A técnica de Waldhausen em pacientes com mais de 30 dias mostrou-se efetiva. A técnica término-terminal clássica mostrou não ser uma boa opcão em todas as faixas etárias, sendo imperativo executar variantes técnicas como término-terminal estendida.

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BACKGROUND: The Cox Maze procedure has been used to treat atrial fibrillation in patients with mitral valve disease. Recently, ectopic foci, originating in the pulmonary veins, were demonstrated in patients with atrial fibrillation, and the indication was that their arrhythmia could have a focal origin. In the light of this new evidence, a simplified surgical technique to isolate the pulmonary veins was developed to eliminate permanent atrial fibrillation in patients undergoing mitral valve surgery. This study compares three surgical procedures proposed to maintain sinus rhythm after mitral valve surgery. METHODS: A prospective clinical trial of 30 patients with mitral valve disease and permanent atrial fibrillation who had undergone mitral valve surgery were randomized in accordance with the type of surgery used on each: (1). associated en bloc isolation of pulmonary veins, (2). the Maze procedure, or (3). mitral valve correction alone. The preoperative clinical characteristics were similar in the three groups. RESULTS: The overall postoperative complications were similar in all three groups. The cardiopulmonary bypass time and the aortic cross-clamping time were shorter in the control group, but this factor bore no relation to increased morbidity in the intervention groups. The relative risk of atrial fibrillation after surgery was 0.08 in the group undergoing isolation of pulmonary veins (p = 0.010; 95% confidence interval, 0.01 to 0.71) and 0.20 in the Maze group (p = 0.044; 95% confidence interval, 0.04 to 1.02) compared with the control group. CONCLUSIONS: En bloc isolation of pulmonary veins associated with mitral valve surgery appears to be safe and just as effective as the Maze procedure in maintaining sinus rhythm in patients with permanent atrial fibrillation.

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We report an exceedingly rare case of primary bronchogenic cyst in the outflow tract of the right ventricle in a 48-year-old woman. In our review of the world literature, we found only 1 other report of an intracardiac bronchogenic cyst. Our patient's only symptom was mild dyspnea not associated with physical exertion, and the cyst was resected successfully. We report clinical aspects of the case, diagnostic methods, surgical management, and histopathologic findings.

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OBJECTIVE: To assess the surgical results of endoventricular patch plasty repair in akinetic and dyskinetic left ventricular areas. METHODS: We studied 52 patients who had undergone endoventricular patch plasty repair associated with myocardial revascularization. The preoperative functional class distribution was as follows: class I in 1 (1.9%) patient; class II in 2 (3.8%) patients; class III in 23 (44.2%) patients; and class IV in 26 (50%) patients. RESULTS: The immediate mortality rate was 7.6% (4 patients). The clinical outcome of 44 patients followed up within a mean postoperative time of 29+/-25 months was as follows: class I in 33 (75%) patients; class II in 7 (15.9%) patients; class III in 2 (4.5%) patients; and class IV in 2 (4.5%) patients. Comparison between pre- and postoperative catheterization in 21 patients showed that the ejection fraction increased from 46.3% to 51.3% (p=0.17); the left ventricular systolic volume decreased from 76.4 mL to 57.5 mL, (p=0.078); and the left ventricular diastolic volume decreased from 141.2 mL to 105.8 mL (p=0.0 73). These findings showed the tendency toward improvement, but with nonsignificant results. CONCLUSION: The technique proved to be effective, to have a low mortality rate, to cause significant clinical improvement, an increase in ejection fraction, and a reduction in left ventricular volumes.

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OBJETIVO: Estudar as variações do peptídio natriurético atrial (PNA) introduzidas pela circulação extracorpórea (CEC) durante operação cardíaca e testar a hipótese de que existe correlação entre os níveis plasmáticos de PNA, pressão atrial direita (PAD) pressão atrial esquerda (PAE), diurese e natriurese. MÉTODO: Estudo de coorte de 15 pacientes submetidos a revascularização do miocárdio com CEC. Os intervalos de tempo de observação foram: t0 = 10 minutos antes da CEC (valor controle); t1 = 10 minutos depois de fluxo total em CEC; t2 30 minutos em fluxo total em CEC; t3 = fase final da CEC em temperatura nasofaringeana de 36º C; e t4 = 30 minutos após o término da CEC. RESULTADOS: Os valores do PNA, PAE e PAD variaram significativamente (p<0,001). O PNA diminuiu de t0 para t1 (NS) e após elevou-se progressivamente até t4 (p<0,001). A PAE e a PAD reduziram (p<0,001) entre t0 e t1, elevando-se progressivamente até t4 (p<0,001). O Na+ urinário aumentou entre t0 e t3 (p<0,001), com queda em t4. A diurese aumentou progressivamente em todos os tempos considerados (p<0,001). Foi encontrada correlação significativa entre PNA e o volume de diurese no t0, coeficiente de correlação de 0,535 (p=0,040), e no tempo igual a t2 entre PNA e PAD, coeficiente de correlação de 0,590 (p=0,021). CONCLUSÃO: As concentrações do PNA apresentam variações durante a operação de revascularização com CEC, o que favorece o conceito de estar relacionadas com as pressões atriais, e ao término da CEC, têm uma importante função na excreção de sódio e no volume da diurese

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OBJECTIVE - To assess the surgical results of endoventricular patch plasty repair in akinetic and dyskinetic left ventricular areas. METHODS - We studied 52 patients who had undergone endoventricular patch plasty repair associated with myocardial revascularization. The preoperative functional class distribution was as follows: class I in 1 (1.9 percent) patient; class II in 2 (3.8 percent) patients; class III in 23 (44.2 percent) patients; and class IV in 26 (50 percent) patients. RESULTS - The immediate mortality rate was 7.6 percent (4 patients). The clinical outcome of 44 patients followed up within a mean postoperative time of 29±25 months was as follows: class I in 33 (75 percent) patients; class II in 7 (15.9 percent) patients; class III in 2 (4.5 percent) patients; and class IV in 2 (4.5 percent) patients. Comparison between pre- and postoperative catheterization in 21 patients showed that the ejection fraction increased from 46.3 percent to 51.3 percent (p=0. 17); the left ventricular systolic volume decreased from 76.4 mL to 57.5 mL, (p=0.078); and the left ventricular diastolic volume decreased from 141.2 mL to 105.8 mL (p=0.0 73). These findings showed the tendency toward improvement, but with nonsignificant results. CONCLUSION - The technique proved to be effective, to have a low mortality rate, to cause significant clinical improvement, an increase in ejection fraction, and a reduction in left ventricular volumes

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