Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short‐ and long‐term results in ischemic cardiomyopathy

INTRODUCTION: The purpose of this study was to (1) identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and (2) identify predictors of favorable outcomes. METHODS AND MATERIAL: Patients (n = 169) with angiographic left ventricular ejection fraction of 22±5% underwent aneurysm surgery and were prospectively followed for three years. Prior to surgery, 40% and 60% of the patients were in congestive heart failure NYHA class I/II and III/IV, respectively. Concomitant revascularization was performed on 95% of the patients. RESULTS: Cumulative in-hospital and 36-month mortalities were 7% and 15%, respectively. These respective rates varied according to preoperative parameters: CHF class I-II, 4% and 13%; CHF class III-IV, 8% and 16%; LVEF,20%, 12% and 26%; LVEF 21-30%, 2% and 6%; gated LVEF exercise/rest .5%, ,1% and 4%; and gated LVEF exercise/rest #5%, 17% and 38%. Higher LVEF ex/rest ratio (p = 0.01), male sex (p = 0.05), and a higher number of grafts (p = 0.01) were predictive of improvement in CHF class at follow-up based on the results of a multivariate analysis. After three years of follow-up, 84% of the patients were in class I/II, LVEF was 45±7%, and gated LVEF ex/rest ratio was 13% higher (p,0.01) compared to the beginning of the study. CONCLUSIONS: These data suggest that aneurysmectomy among patients with severe LV dysfunction result in shortand long-term favorable functional outcome and survival. Selection of appropriate surgical candidates may substantially improve survival rates among these patients

Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short-and long-term results in ischemic cardiomyopathy

INTRODUCTION: The purpose of this study was to (1) identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and (2) identify predictors of favorable outcomes. METHODS AND MATERIAL: Patients (n = 169) with angiographic left ventricular ejection fraction of 22±5% underwent aneurysm surgery and were prospectively followed for three years. Prior to surgery, 40% and 60% of the patients were in congestive heart failure NYHA class I/II and III/IV, respectively. Concomitant revascularization was performed on 95% of the patients. RESULTS: Cumulative in-hospital and 36-month mortalities were 7% and 15%, respectively. These respective rates varied according to preoperative parameters: CHF class I-II, 4% and 13%; CHF class III-IV, 8% and 16%; LVEF,20%, 12% and 26%; LVEF 21-30%, 2% and 6%; gated LVEF exercise/rest .5%, ,1% and 4%; and gated LVEF exercise/rest #5%, 17% and 38%. Higher LVEF ex/rest ratio (p = 0.01), male sex (p = 0.05), and a higher number of grafts (p = 0.01) were predictive of improvement in CHF class at follow-up based on the results of a multivariate analysis. After three years of follow-up, 84% of the patients were in class I/II, LVEF was 45±7%, and gated LVEF ex/rest ratio was 13% higher (p,0.01) compared to the beginning of the study. CONCLUSIONS: These data suggest that aneurysmectomy among patients with severe LV dysfunction result in shortand long-term favorable functional outcome and survival. Selection of appropriate surgical candidates may substantially improve survival rates among these patients

Chemical weed control in areas of no-till cassava

O objetivo do trabalho foi avaliar a seletividade para a cultura da mandioca e o comportamento de vários herbicidas, aplicados em pré e pós-emergência, no controle das plantas daninhas Avena sativa, Bidens pilosa, Commelina benghalensis, Raphanus sativus e Sida rhombifolia. O experimento foi conduzido em área de plantio direto, em Araruna, noroeste do Paraná. Embora alguns herbicidas avaliados tenham se destacado em relação ao controle de uma ou mais das espécies de plantas daninhas e outros tenham demonstrado seletividade para a mandioca, os melhores resultados foram obtidos, considerando- se tanto a seletividade quanto a eficácia, com as misturas arnetryne+clornazone (1,50+1,00 kg/ha) e arnetryne+diuron (0,62+0,96 kg/ha), ambas aplicadas em pós-emergência das plantas daninhas e quando a mandioca encontrava-se com 5 a 10% de brotações emergidas. The aim of this work was to evaluate the selectivity of some pre and postemergence herbicides on cassava, as well as their efficiency to control the weeds Avena sativa, Bidens pilosa, Commelina benghalensis, Raphanus sativus and Sida rhombifolia. The field trial was carried out in no-till areas, in Araruna, northwestern Paraná State. Although some herbicides provided outstanding results either in relation to weed control or crop selectivity, when both aspects were taken into consideration, the best results were achieved with arnetryne-i-clornazone (1.50+ 1.00 kg/ha) and ametryne--diuron (0.62+0.96 kg/ha), both applied postemergence of weeds, when 5 to 10% of cassava sprouts had already emerged from the soil

Tratamento cirúrgico da comunicação interventricular pós infarto agudo do miocárdio: conduta atual Present surgical management of post-myocardial infarction ventricular septal rupture

Os autores descrevem sua experiência com o tratamento cirúrgico de 42 pacientes portadores de comunicação interventricular (CIV) pós infarto agudo do miocárdio (IAM). Destacam a elevada mortalidade cirúrgica nos pacientes com choque cardiogênico instalado (66,6%) em relação aos demais (9,5%). A observação de descompensações súbitas em pacientes hemodinâmicamente estáveis tem levado à indicação cirúrgica precoce, se possível, assim que estabelecido o diagnóstico da rotura do septo interventricular (RSI). O comprometimento de múltiplas artérias coronárias e faixas etárias elevadas foram considerados fatores agravantes no prognóstico cirúrgico. O mesmo não ocorreu com a relação fluxo pulmonar/sistêmico e shunt E-D, que não guardaram relação com a mortalidade. A técnica de exposição de ambas as cavidades ventriculares e reforço das 2 faces do septo roto com tecido biológico tem fornecido resultados gratificantes na correção da RSI, especialmente de localização posterior.The authors describe the experience with surgical treatment of 42 patients with ventricular septal rupture (VSR) in post acute myocardial infarction (AMI). They showed increased mortality in patients with cardiogenic shock (66.6%) with respect to others (9.5%). Sudden descompensations in patients hemodinamically stable were indications to early surgeries, if possible when the diagnosis of ventricular septum rupture (VSR) was made. The compromise of multiple coronary arteries and advanced age were considered as aggravating factors in the prognosis of surgery. The same prognosis did not occur regarding pulmonary/systemic flow and shunt E-D. The technique of exposure in both ventricular cavity and reinforcement in the both sides of the ruptured septum with biological tissue offered good results in the correction of posterior VSR

Cirurgia valvar e coronária simultânea Combined coronary and valvular surgery

Este trabalho analisa 172 pacientes consecutivos operados de cirurgia valvar e coronária simultânea, no período compreendido entre julho de 1980 e junho de 1989.0 número de pacientes submetidos a revascularização do miocárdio e tratamento cirúrgico da valva aórtica (RAo) foi de 95, sendo que 75 foram submetidos a tratamento cirúrgico da valva mitral e revascularização do miocárdio (RMi). As lesões valvares mais freqüentes foram a estenose aórtica, 44 casos de insuficiência mitral em 40 casos. O número de anastomoses por paciente foi de 1,87 em média para os pacientes RMi e de 1,56 nos pacientes RAo. A mortalidade hospitalar foi de 9,8% sendo que a mortalidade para os pacientes RAo foi de 7,3% e para os pacientes RMi foi de 12%. Não houve diferença significativa (x²=04423) entre a mortalidade dos pacientes portadores de insuficiência mitral isquémica, operados eletivamente ou em caráter de emergência, sendo a mortalidade de 20% nos eletivos e de 37,5% nos de emergência. Não houve relação entre mortalidade e número de anastomoses por paciente. Houve tendência de melhores resultados com relação à mortalidade nos pacientes RMi com cirurgia conservadora (x²=1,6382). A curva actuarial de sobrevida mostra 82,6% em 19 semestres para os pacientes RMi, 90,4% para os pacientes RAo e 86,3% para o estudo global de pacientes. Com uma evolução de 5172 meses/pacientes, 75% apresentam-se em classe funcional I (NYHA).<br>In the period between July 1980 and June 1989,172 consecutive patients were submitted to combined coronary and valvular surgery. There were patients with predominantly valvular indications and others with predominant coronary indications. In 95 cases, myocardial revascularization and surgical treatment of the aortic valve (RAo) were simultaneously performed. Seventy five patients were submitted to myocardial revascularization and surgical treatment of the mitral valve (RMi). The more frequent valvular lesions were aortic stenosis (44 cases) and mitral insufficiency (40 cases). The mean number of anastomoses per patient was 1,87 for RMi cases and 1,56 for RAo patients. Overall hospital mortality was 9,8%; RAo mortality was 7,3% and RMi mortality was 12%. Mortality of patients with ischemic mitral insufficiency operated on electively (20%) or in an emergency basis (37,5%) was not statistically significant (x²=04423). There was not a relationship between mortality and the number of anastomoses per patient. A tendency for better results regarding mortality was observed in RMi patients in which the valve was preserved (x²=1,6382). The survival actuarial curves in 19 semesters demonstrates a valve of 82,6% for RMi patients, 90,4% for RAo patients and 86,3% for the whole series. After evolution of 5172 months/patients, 75% were in functional class I (NYHA)