Coronary artery bypass graft: state of the art

A doença aterosclerótica cardiovascular é a maior causa de morte tanto no Brasil quanto nos países desenvolvidos, sendo, portanto, um assunto de relevância tanto para profissionais da área de saúde quanto para a população geral. Apresentamos, então, as formas de tratamento da doença, principalmente no enfoque cirúrgico, com a revascularização do miocárdio. Para tanto, iniciamos com um pequeno histórico que nos mostra como se chegou à operação como conhecemos hoje. Discutimos as técnicas atualmente empregadas neste tipo de operação e quando ela é feita com ou sem circulação extra-corpórea; quais são os pacientes com indicação para esse tipo de tratamento e o que se espera dos resultados, quais as perspectivas desse procedimento; e como a prática de cirurgias minimamente invasivas e a utilização da robótica auxiliam o cirurgião. Por fim, contextualizamos dois procedimentos novos: a revascularização percutânea, que ainda apresenta resultados incertos a longo prazoe a neoangiogênese, que é um procedimento em fase de estudo.The atherosclerotic cardiovascular disease is the greatest cause of death in Brazil as much as in the developed world. Therefore, it’s a relevant issue for health professionals and for general population. So, we present the treatments for the disease, focusing the surgery, with revascularization of the myocardium. Then, we start with a short report that shows how the operation achieves its actual state, the techniques currently applied in this kind of operation and when it’s done with or without extracorporeal circulation; who the patients for this treatment are and what results we can expect; the perspectives for this procedure, such as the practice of minimally invasive surgeries and the utilization of robotics to help the surgeon. At last, we contextualize two new procedures: the percutaneous revascularization, that still shows uncertain long-term results, and the neoangiogenesis, which still is in study phase

Localized O6-plane solutions with Romans mass

Orientifold solutions have an unphysical region around their source; for the O6, the singularity is resolved in M-theory by the Atiyah-Hitchin metric. Massive IIA, however, does not admit an eleven-dimensional lift, and one wonders what happens to the O6 there. In this paper, we find evidence for the existence of localized (unsmeared) O6 solutions in presence of Romans mass, in the context of four-dimensional compactifications. As a first step, we show that for generic supersymmetric compactifications, the Bianchi identity for the F_4 RR field follows from constancy of F_0. Using this, we find a procedure to deform any O6-D6 Minkowski compactification at first order in F_0. For a single O6, some of the symmetries of the massless solution are broken, but what is left is still enough to obtain a system of ODEs with as many variables as equations. Numerical analysis indicates that Romans mass makes the unphysical region disappear.Comment: 38 pages, 1 figur

The descending branch of the lateral femoral circumflex artery is a good option in CABG with arterial grafts

INTRODUCTION: The descending branch of the lateral femoral circumflex artery is an option for coronary artery bypass grafting. OBJECTIVE: To evaluate the early patency and adaptation of lumen diameter using multidetector computed angiotomography. METHODS: Thirty-two patients were selected to undergo coronary artery bypass grafting using the descending branch of the lateral circumflex artery, the internal thoracic artery, and other grafts. Evaluations were carried out through high resolution computed tomography performed on the 7th and 90th postoperative day. Diameters of the descending branch of the lateral circumflex artery and the left internal thoracic artery were measured 3 cm before the distal anastomosis, in the middle portion, and 3 cm after the proximal anastomosis. Diameters were compared using paired t-test (P<0.05). RESULTS: Descending branch of the lateral femoral circumflex artery wDescending branch of the lateral femoral circumflex artery was used in 26 patients, as its use was not viable in six patients (18%). It was used as composite graft in all cases. The anterior descending branch was revascularized by the left internal thoracic artery in all cases. Patency rates of the descending branch of the lateral femoral circumflex artery were 96% and 92%, respectively. No occlusions were observed in the left internal thoracic artery (LITA) and no ischemic events were observed in the descending branch of the lateral circumflex. Descending branch of the lateral femoral circumflex artery increased the lumen diameter in the middle (P=0.001) and distal portions (P=0.006); the left internal thoracic artery (LITA) increased in the middle portion (P=0.001). CONCLUSION: Similar to the left internal thoracic artery, the descending branch of the lateral femoral circumflex artery showed high patency rate and positive luminal adaptation. This early evaluation confirms the descending branch of the lateral femoral circumflex artery as a potential alternative for grafting. Due to anatomical variations, preoperative femoral angiographic evaluation appears to be mandatory

Substituição da valva mitral com tração dos músculos papilares em pacientes com miocardiopatia dilatada Mitral valve replacement with chordae tendineae preservation, traction and fixation in end-stage dilated cardiomyopathy

OBJETIVO: Avaliar a geometria e a função do ventrículo esquerdo (VE) após a troca mitral com tração e fixação dos papilares, em portadores de insuficiência cardíaca terminal com insuficiência mitral secundária. MÉTODO: Dos 20 pacientes avaliados, 70% eram homens, com idade média de 50,2 anos e 55% recebiam inotrópicos. A fração de ejeção (FEVE) foi menor que 30% em todos; 85% estavam em classe funcional (CF) IV. Dezoito receberam próteses de pericárdio bovino e dois, mecânicas. Os períodos considerados foram: 3, 6, 12 e 18 meses. As variáveis consideradas: volume sistólico do VE (VS), a FEVE, os diâmetros sistólico e diastólico finais (DSF e DDF) e os volumes sistólico e diastólico finais (VSF e VDF). No estudo estatístico, empregou-se da análise de variância (AV) e o teste de Friedmann (F). A sobrevida foi aferida pelo método de Kaplan-Meyer. RESULTADOS: Dois (10%) faleceram no período imediato. A sobrevida no primeiro ano foi de 85%, no segundo, 44%, no terceiro, 44%, no quarto, 44% e no quinto, 44%. A comparação entre pré e 3 meses, empregando-se a AV, não revelou alteração significativa para o VS (p=0,086). Houve acréscimo da FEVE (p=0,008) e decréscimo do DDF (p=0,038); do DSF (p=0,008); do VDF (p=0,029) e do VSF (p=0,009). Os momentos pré, 3 e 6 meses, com o teste F, não revelaram alterações. Entre os momentos pré, 3 meses e final, empregando-se a AV, não houve significância. CONCLUSÃO: Há melhora da FEVE, dos VDF, VSF, DDF e DSF; até o terceiro mês. A partir de então, as variáveis permanecem estáveis.<br>OBJECTIVE: This study aimed at evaluating results of mitral valve replacement using a new technique of complete chordae tendineae adjustment for left ventricular remodeling. METHODS: Twenty end-stage idiopathic dilated cardiomyopathy patients with severe functional mitral valve regurgitation underwent mitral valve replacement. Seventeen (85%) were in functional class IV. Both anterior and posterior leaflets of the mitral valve were divided to obtain 4 pillars of chordae tendineae. These were displaced with traction toward the left atrium and anchored between the mitral annulus and a valvular prosthesis. To evaluate the left ventricular remodeling, Doppler echocardiography was performed. For statistical analysis, variance analysis and the Friedman's test were employed. RESULTS: Two (10%) early deaths occurred. Kaplan-Meyer showed survival at one year post-operative was 85%, 2 years it was 44%, at 3 years 44%, at 4 years 44% and at 5 years it was 44%. In the 48- and 54-month follow-ups, the McNemar test showed improvement in the functional class (p<0.001). In the third month of follow-up, variance analysis showed improvement in the ejection fraction (p=0.008) and reductions of the end diastolic diameter (p=0.038), end systolic diameter (p=0.008), end systolic volume (p=0.029) and end diastolic volume (p=0.009). No statistical differences were noted in the systolic volume. Comparing pre-operative and third- and six-month follow-ups, the Friedman test showed no statistical differences for all studied variables. Variance analyses between pre, three-month and final evaluations showed no significant differences. CONCLUSION: This technique of mitral valve replacement improved the left ventricle ejection fraction and decreased the end diastolic and systolic diameters and the end systolic diastolic volumes up to the third month of follow-up. From then on the variables stabilized

Fontes protéicas vegetais na alimentação da carpa húngara Plant protein sources on common carp feeding

A substituição parcial da farinha de carne suína por farelos vegetais em dietas para juvenis de carpa húngara (Cyprinus carpio) foi avaliada em cinco dietas experimentais: um controle (farinha de carne suína (FCS) como fonte protéica) e quatro dietas vegetais: farelo de soja (FS), farelo de canola (FC), farelo de girassol (FG) ou farelo de linhaça (FL), substituindo 50% da proteína proveniente da FCS. 195 juvenis (43,4&plusmn;0,4g) foram alimentados duas vezes ao dia (9 e 15 horas) durante 71 dias. Ao final do experimento, maior peso (205,69g), ganho em peso (2,29g dia-1), taxa de crescimento específico (2,2% dia-1) e conversão alimentar (1,74) foram obtidos nas dietas com FCS, seguido dos tratamentos FC e FS que não diferiram entre si. Os peixes alimentados com FCS, FG e FS apresentaram maior gordura corporal. A dieta FL apresentou piores resultados de desempenho, coeficiente de retenção protéica, deposição de proteína e gordura corporal e no filé. Pode-se concluir que a dieta à base de farinha de carne suína proporciona maior crescimento e deposição de proteína em juvenis de carpa húngara, comparada às dietas com farelos vegetais; os parâmetros de carcaça (rendimentos e índices digestivos) não são afetados pelas fontes protéicas da dieta.<br>This study was conducted to evaluate the partial replacement of porcine meat meal by plant-protein meals in diets for common carp (Cyprinus carpio). Five experimental diets were evaluated: control (FCS), only porcine meat meal as protein source, and four plant-based diets: soybean meal (FS), canola meal (FC), sunflower meal (FG) or linseed meal (FL) replacing 50% of protein from porcine meat meal. Juveniles (195, 43.4&plusmn;0.4g) were fed twice daily (9:00 am and 03:00pm) for 71 days. At the end of the trial, the best weight (205,69g), weight gain (2,29g day-1), specific growth rate (2,2% day-1) and food conversion ratio (1,74) were obtained in FCS, followed by FC and FS, that did not differ among each other. Fish fed FCS, FG and FS showed higher body fat. The FL diet had the worst performance, protein retention coefficient, protein and fat deposition in whole body and fillet. It was concluded that a diet based on porcine meat meal provides higher growth and protein deposition in common carp juveniles, compared to diets with plant-protein meals; carcass parameters (carcass and fillet yield and digestive indices) are not affected by the dietary protein sources