Navegando por Palavras-chave "Artéria pulmonar"
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- ItemAcesso aberto (Open Access)Estudo angiográfico comparativo da artéria pulmonar no pré e pós-operatório de pacientes submetidos a operação de derivação cavopulmonar bidirecional(Sociedade Brasileira de Cirurgia Cardiovascular, 2001-12-01) Westphal, Fernando Luiz [UNIFESP]; Maluf, Miguel Angel [UNIFESP]; Silva, Célia Maria Camelo da [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: This study analyzed the alterations in the pulmonary artery (PA) diameters after bilateral cavopulmonary derivation (BCPD). MATERIAL AND METHODS: Eighteen patients submitted to BCPD in the period from March 1990 to January 1997, with available cineangiographic examinations in the pre- and postoperative period, were included. Measurements in right pulmonary artery (RPA) and left pulmonary artery (LPA) were performed at three sites: at the origin, immediately before bifurcation and at the beginning of the inferior lobe artery. The diameters of each site were indexed with respect to body surface or diameter of the aorta at the level of the diaphragm. Angiographic and oximetric data were submitted to statistical analysis. RESULTS: On analyzing absolute diameters, it was observed that most suffered a non-significant increase in the postoperative period, while the LPA diameter presented a decrease. The total indexes I e III presented a significant decrease in the postoperative period, this reduction of the total index II being non-significant. Analysis of the postoperative follow-up variable showed a significant reduction in the total indexes in patients with a postoperative follow-up less than 23,6 months. Presence of additional blood flow elicited an increase in RPA I and III indexes and a small reduction in the other. The PA measurements indexed with respect to the diameter of the aorta showed a behavior similar to those with respect to body surface. In the absence of collateral venous circulation (CVC) a significant increase in O2 saturation was observed. On the other hand, its presence elicited a non-significant increase during the period of observation.
- ItemAcesso aberto (Open Access)Nova bandagem ajustável das artérias pulmonares na Síndrome de Hipoplasia de Câmaras Esquerdas(Sociedade Brasileira de Cirurgia Cardiovascular, 2007-03-01) Assadi, Renato Samy; Zamith, Marina Maccagnano [UNIFESP]; Silva, Maria Fernanda; Thomaz, Petrônio Generoso; Miana, Leonardo Augusto; Guerra, Vitor Coimbra; Pedra, Carlos Augusto Cardoso; Barbero-marcial, Miguel; Universidade de São Paulo (USP); Children's Hospital; Hospital Samaritano de São Paulo; Universidade Federal de São Paulo (UNIFESP); UNIFES Curso de Rastreamento Pré-Natal das Malformações Cardíacas; Instituto do Coração de Ipatinga; Instituto do Coração de Juiz de Fora; Hospital for Sick Children; Instituto Dante Pazzanese de Cardiologia; Instituto Dante Pazzanese de Cardiologia Seção Médica de Intervenção em Cardiopatias Congênitas; Hospital Samaritano de São Paulo Laboratório de Cateterismo; Associação Sanatório Sírio Hospital do CoraçãoOBJECTIVE: Hypoplastic left heart syndrome remains a challenge for worldwide surgeons. Initial palliation employing bilateral pulmonary artery banding along with ductal stent implantation and atrial septostomy has been proposed as an alternative approach. However, the surgically placed bands are fixed and may become inadequate after sternum closure or with somatic growth of the patient. We describe the first case in which a neonate with hypoplastic left heart syndrome was initially managed using a mini banding system that allows for fine percutaneous adjustments of pulmonary blood flow. METHOD: Through a mid sternotomy, a 5 day-old neonate underwent bilateral pulmonary artery banding using this new system combined with placement of a main pulmonary artery to innominate artery shunt. RESULTS: The patient had an uneventful postoperative course. Three percutaneous adjustments of the banding system were necessary to keep the arterial oxygen saturation in the 75%-85% range. On the 48th day of life, she was submitted to stent placement (6 mm) within the atrial septum to treat a restrictive atrial septal defect. The Norwood operation and the bidirectional Glenn shunt were carried out on the 106th day of life. The bands were removed with no distortion of the pulmonary arteries. CONCLUSIONS: The clinical use of this innovative pulmonary artery banding system was feasible, safe and effective. It allowed for customization of the pulmonary blood flow according to the underlying clinical needs, resulting in a more precise balance between the pulmonary and systemic circulations.
- ItemAcesso aberto (Open Access)Perfusão da artéria pulmonar não melhora os índices de fator natriurético cerebral (BNP) em estudo experimental em suínos(Sociedade Brasileira de Cirurgia Cardiovascular, 2010-12-01) Gabriel, Edmo Atique [UNIFESP]; Locali, Rafael Fagionato; Matsuoka, Priscila Katsumi; Almeida, Ludmila Santiago; Silva, Paulo Sérgio Venerando; Ishigai, Marcia Marcelino de Souza [UNIFESP]; Salerno, Tomas; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Miami Divisão de Cirurgia CardiotorácicaOBJECTIVE: Assess if the main pulmonary artery controlled perfusion over cardiopulmonary bypass (CPB) modifies BNP levels expressed by the ventricular myocardium. METHODS: Experimental research involving 32 pigs, divided into two groups according to CPB strategy - group I (cardioplegia) and group II (beating heart). Both groups were allocated into three subgroups according to lung perfusion strategy - subgroup A (control: no lung perfusion), subgroup B (lung perfusion with arterial blood) and subgroup C (lung perfusion with venous blood). In subgroups B and C, lung was perfused for 30 minutes, using preoperative mean pulmonary artery pressure (MPAP) as perfusion pressure, which was monitored through manometer. MPAP and pulmonary vascular resistance (PVR) were measured after coming off CPB using Swan-Ganz catheter. At preoperative time and 30 minutes after lung perfusion, specimens were taken from the right ventricular myocardium aiming to assess brain natriuretic peptide (BNP) and histologic pattern. Immunohistochemical and hematoxylin-eosin techniques were used to determine, respectively, BNP expression and inflammatory myocardial lesions. RESULTS: In animals submitted to controlled lung perfusion, there was a postoperative reduction of MPAP (P=0.03) and PVR (P=0.005).There was no differences among subgroups within the group, I (P=0.228) and subgroups within group II (P=0.325) as to postoperative BNP expression. There were no differences among subgroups with and without lung perfusion as to postoperative inflammatory lesions (P>0.05). CONCLUSION: Main pulmonary artery controlled perfusion for 30 minutes did not yield substantial modifications in BNP expression and histologic pattern of the right ventricular myocardium.