Standardization of an isolated pig heart preparation with parabiotic circulation: methodological considerations

In the present study we standardized an experimental model of parabiotic circulation of isolated pig heart. The isolated heart was perfused with arterial blood from a second animal as support and submitted to regional ischemia for 30 min, followed by total ischemia for 90 min and reperfusion for 90 min. Parameters for measurement of ventricular performance using different indices measured directly or indirectly from intraventricular pressure were defined as: maximum peak pressure, final diastolic pressure, pressure developed, first derivative of maximum pressure (dP/dt max), first derivative of minimum pressure (dP/dt min), systolic stress of the left ventricle (sigmas), and maximum elastance of the left ventricle. Isolated hearts subjected to regional and global ischemia presented significant worsening of all measured parameters. Less discriminative parameters were dP/dt max and dP/dt min. Elastance was the most sensitive parameter during the reperfusion period, demonstrating an early loss of ventricular function during reperfusion. The model proved to be stable and reproducible and permitted the study of several variables in the isolated heart, such as ischemia and reperfusion phenomena, the effects of different drugs, surgical interventions, etc. The model introduces an advantage over the classical models which use crystalloid solutions as perfusate, because parabiotic circulation mimics heart surgery with extracorporeal circulation.64965

A Bovine Pericardium Rigid Prosthesis For Left Ventricle Restoration: 12 Years Of Follow-up [prótese Rígida De Pericárdio Bovino Para Remodelamento Ventricular Esquerdo: 12 Anos De Seguimento]

Background: Myocardial infarction might result in dilated left ventricle and numerous techniques have been described to restore the original left ventricle shape and identify tools for late survival assessment. The aim of this study is to compare our experience with a modified Dor procedure using a rigid prosthesis to the septal anterior ventricular exclusion procedure (SAVE) for left ventricle restoration. The EuroScore index for prediction of late follow up survival was evaluated. Methods: We evaluated 80 patients who underwent left ventricle restoration between 1999 to 2007 and eight patients were excluded with incomplete data. A modified Dor procedure with rigid prosthesis (MD group) was performed on 53 patients and 19 underwent the septal anterior ventricular exclusion procedure (SAVE group). The patients were classified according their left ventricle shape as type I, II or III. Kaplan-Meier and Cox proportional hazard ratio regressions analysis were performed to assess survival after both techniques and expected surgical mortality using EuroScore index ranking after 12 years of follow up. Results: The operative mortality was comparable in both groups ranked by EuroScore index. The groups were comparable for all clinical data, except the MD group had more patients using intra-aortic balloon pumps before surgery, (5.7% vs. 0; P<0.01). Kaplan Meier analysis by left ventricle shape showed comparable survival for all patients, with slightly higher survival for type I. Kaplan Meier analysis of all death showed equivalent survival curves for both techniques after 12 years of follow up (71.5 ± 12.3 vs. 46.6 ±20.5 years; P=0.08). Kaplan Meier analysis of EuroScore index for all patients showed a difference between the three ranked categories, i.e., 0 to 10%, 11 to 49% and higher than 50% expected surgical mortality after 12 years of follow up (70.9 ± 16.2 vs. 67.5 ± 12.7 vs. 53.0 ± 15.5; P=0.003). Conclusion: The MD procedure showed consistent ejection fraction improvements after long term follow up. Survival was comparable for all ventricular types and for the MD and SAVE procedures. The EuroScore index is a useful index for late survival assessment of ventricular restoration techniques.262164172Cooley, D.A., Hallman, G.L., Henly, W.S., Left ventricular aneurysm due to myocardial infarctionexperience with 37 patients undergoing aneurysmectomy (1964) Arch Surg, 88, pp. 114-121Jatene, A.D., Left ventricular aneurysmectomy. Resection or reconstruction (1985) J Thorac Cardiovasc Surg, 89 (3), pp. 321-331Dor, V., Saab, M., Coste, P., Kornaszewska, M., Montiglio, F., Left ventricular aneurysm: A new surgical approach (1989) Thorac Cardiovasc Surg, 37 (1), pp. 11-19Dor, V., Sabatier, M., di Donato, M., Montiglio, F., Toso, A., Maioli, M., Efficacy of endoventricular patch plasty in large postinfarction akinetic scar and severe left ventricular dysfunction: Comparison with a series of large dyskinetic scars (1998) J Thorac Cardiovasc Surg, 116 (1), pp. 50-59Braile, D.M., Mustafa, R.M., Ardito, R.V., Zaiantchick, M., Coelho, W.M., (1991) Correction of the Left Ventricle Geometry with Semi Rigid Bovine Pericardial Prosthesis Rev Bras Cir Cardiovasc, 6 (2), pp. 109-115Isomura, T., Horii, T., Suma, H., Buckberg, G.D., Septal anterior ventricular exclusion operation (Pacopexy) for ischemic dilated cardiomyopathy: Treat form not disease (2006) Eur J Cardiothorac Surg, 29 (SUPPL. 1), pp. S245-S250. , RESTORE GroupJones, R.H., Velazquez, E.J., Michler, R.E., Sopko, G., Oh, J.K., O'Connor, C.M., Coronary bypass surgery with or without surgical ventricular reconstruction (2009) N Engl J Med, 360 (17), pp. 1705-1717di Donato, M., Castelvecchio, S., Kukulski, T., Bussadori, C., Giacomazzi, F., Frigiola, A., Surgical ventricular restoration: Left ventricular shape influence on cardiac function, clinical status, and survival (2009) Ann Thorac Surg, 87 (2), pp. 455-461Najafi, M., Sheikhvatan, M., Montazeri, A., Sheikhfathollahi, M., Predictors of quality of life among patients undergoing coronary artery bypass surgery (2008) Acta Cardiol, 63 (6), pp. 713-721Messaoudi, N., de Cocker, J., Stockman, B.A., Bossaert, L.L., Rodrigus, I.E., Is EuroSCORE useful in the prediction of extended intensive care unit stay after cardiac surgery? (2009) Eur J Cardiothorac Surg, 36 (1), pp. 35-39Santarpino, G., Onorati, F., Rubino, A.S., Abdalla, K., Caroleo, S., Santangelo, E., Preoperative intraaortic balloon pumping improves outcomes for high-risk patients in routine coronary artery bypass graft surgery (2009) Ann Thorac Surg, 87 (2), pp. 481-488Nashef, S.A., Roques, F., Michel, P., Gauducheau, E., Lemeshow, S., Salamon, R., European system for cardiac operative risk evaluation (EuroSCORE) (1999) Eur J Cardiothorac Surg, 16 (1), pp. 9-13Dor, V., Sabatier, M., di Donato, M., Maioli, M., Toso, A., Montiglio, F., Late hemodynamic results after left ventricular patch repair associated with coronary grafting in patients with postinfarction akinetic or dyskinetic aneurysm of the left ventricle (1995) J Thorac Cardiovasc Surg, 110 (5), pp. 1291-1299Athanasuleas, C.L., Buckberg, G.D., Stanley, A.W., Siler, W., Dor, V., Didonato, M., RESTORE Group. Surgical ventricular restoration: The RESTORE Group experience (2004) Heart Fail Rev, 9 (4), pp. 287-297Salati, M., di Biasi, P., Paje, A., Santoli, C., Left ventricular geometry after endoventriculoplasty (1993) Eur J Cardiothorac Surg, 7 (11), pp. 574-578Buckberg, G.D., Coghlan, H.C., Torrent-Guasp, F., The structure and function of the helical heart and its buttress wrapping. VI. Geometric Concepts of Heart Failure and Use For Structural Correction (2001) Semin Thorac Cardiovasc Surg, 13 (4), pp. 386-401di Donato, M., Sabatier, M., Dor, V., Gensini, G.F., Toso, A., Maioli, M., Effects of the Dor procedure on left ventricular dimension and shape and geometric correlates of mitral regurgitation one year after surgery (2001) J Thorac Cardiovasc Surg, 121 (1), pp. 91-96Suma, H., Horii, T., Isomura, T., Buckberg, G., A new concept of ventricular restoration for nonischemic dilated cardiomyopathy (2006) Eur J Cardiothorac Surg, 29 (SUPPL. 1), pp. S207-S212. , RESTORE GroupForm versus disease: Optimizing geometry during ventricular restoration (2006) Eur J Cardiothorac Surg, 29 (SUPPL. 1), pp. S238-S244. , RESTORE GroupKieser, T.M., The left ventricle: To reconstruct or not: Lessons from the STICH trial (2009) J Thorac Cardiovasc Surg, 138 (3), p. 784Suma, H., Isomura, T., Horii, T., Buckberg, G., Role of site selection for left ventriculoplasty to treat idiopathic dilated cardiomyopathy (2004) Heart Fail Rev, 9 (4), pp. 329-336. , RESTORE GroupDancini, J.L., Rodrigues, J.J., Santos, J.S., Pinto, R.F.A., Burgos, F.J.C., Conforti, C.A., Left ventricular aneurysmectomy: Late followup (1996) Rev Bras Cir Cardiovasc, 1 (11), pp. 23-29Almeida, R.M.S., Lima, J.D., Bastos, L.C., Carvalho, C.T., Loures, D.R., Endoventricular circular patch plasty with septal exclusion: Initial experience (2000) Rev Bras Cir Cardiovasc, 4 (15), pp. 302-307Campagnucci, V.P., Rivetti, L.A., Pinto e Silva, A.M.R., Gandra, S.M.A., Pereira, W.L., Aneurismectomia de ventrículo esquerdo com o coração batendo ininterruptamente: Resultados imediatos (2006) Rev Bras Cir Cardiovasc, 21 (1), pp. 55-61Herrera, C.B., Insalralde, A., Brandi, A.C., Santos, C.A., Herrera, D.D., Soares, M.J.F., Correção de aneurisma de ventrículo esquerdo em paciente chagásico empregando prótese de pericárdio bovino (2000) Rev Bras Cir Cardiovasc, 15 (1), pp. 72-74Sgarbi, C.J., Ardito, R.V., Santos, R.C., Bogdan, R.A.B., Arruda Jr., F.V., Silva, E.M., Correção cirúrgica do aneurisma de ventrículo esquerdo: Comparação entre as técnicas de sutura linear e reconstrução geométrica (2000) Rev Bras Cir Cardiovasc, 15 (4), pp. 293-301Versteegh, M.I., Lamb, H.J., Bax, J.J., Curiel, F.B., van der Wall, E.E., de Roos, A., MRI evaluation of left ventricular function in anterior LV aneurysms before and after surgical resection (2003) Eur J Cardiothorac Surg, 23 (4), pp. 609-613Use of cardiac magnetic resonance imaging in surgical ventricular restoration (2006) Eur J Cardiothorac Surg, 29 (SUPPL. 1), pp. S216-S224. , Buckberg GD;RESTORE GroupWalker, J.C., Guccione, J.M., Jiang, Y., Zhang, P., Wallace, A.W., Hsu, E.W., Helical myofiber orientation after myocardial infarction and left ventricular surgical restoration in sheep (2005) J Thorac Cardiovasc Surg, 129 (2), pp. 382-39

Eficiência do protocolo Ovsynch em ovelhas da raça Santa Inês

Twenty six Santa Inês ewes were asigned to three treatments to evaluate the efficiency of the Ovsynch protocol. In the treatment 1 - control (n= 8), the estrus was synchronized with sponges containing 60 mg MAP for 14 days. On D14, 300 IU eCG were administered. In treatment 2 (n= 9) the Ovsynch protocol was used: 25 µg of GnRH (D0), 37.5 µg of PGF2a (D7) and 25 µg of GnRH (D9). In treatment 3 (n= 9) the modified Ovsynch protocol was used: the administration of PGF2a and second GnRH as two days early. Estrus detection was accomplished using teaser. All ewes were mated twice with 12 hours of interval. Pregnancy rate (PR) was evaluated by ultrasonography 30 days after the end of mating. Estrus response was of 88.46% on average, and without differences among treatments (p>0.05). The interval for onset of estrus was greater (p0.05). Pregnancy rate was significantly greater (p0,05). O intervalo entre o final do tratamento e o início do estro foi maior (p0,05) entre tratamentos. A TP diferiu entre os grupos (37,5%, 62,5% e 25%, respectivamente. p<0,05). Os resultados mostram eficiência superior do protocolo Ovsynch, sob as restantes condições expe-rimentais

Endovascular Treatment Of Pseudoaneurysm Of The Thoracic Aorta From A Firearm Injury

A 24-year-old male patient was the victim of a firearm wound that penetrated the thorax. He arrived at another hospital hemodynamically unstable and was submitted to exploratory surgery by means of bithoracotomy. A lesion of the left branch of the pulmonary artery was detected and successfully repaired. He was submitted for computer-aided tomography on the fifth postoperative day, and a lesion of the mid-thoracic aorta was detected, which formed a saccular image. Considering that the patient had already been submitted to a bithoracotomy and that a direct approach to repair would involve another thoracotomy within a short period of time, endovascular treatment was chosen in our hospital. The procedure was performed under fluoroscopy. A second computer-aided tomography indicated adequate treatment of the lesion, with no indication of an endoleak. He has undergone ambulatory follow-up for 36 months without any problem related to the procedure. While endovascular treatment of the aorta has developed enormously, multicenter studies are needed to better define the long-term results of this approach. © 2008 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.73529530Petrucci, O., de Oliveira, P.P.M., Martins, A.S., Vieira, R.W., Endovascular treatment of pseudoaneurysm of the thoracic aorta from a firearm injury (2008) Interact CardioVasc Thorac Surg, 7, pp. 529-531Jamieson, W.R., Janusz, M.T., Gudas, V.M., Burr, L.H., Fradet, G.J., Henderson, C., Traumatic rupture of the thoracic aorta: Third decade of experience (2002) Am J Surg, 183, pp. 571-575Von Oppell, V.D., Dunne, T.T., De Groot, M.K., Zilla, P., Traumatic aortic rupture: Twenty year metanalysis of mortality and risk of paraplegia (1994) Ann Thorac Surg, 58, pp. 585-593Bent, C.L., Matson, M.B., Sobeh, M., Renfrew, I., Uppal, R., Walsh, M., Brohi, K., Kyriakides, C., Endovascular management of acute blunt traumatic thoracic aortic injury: A single center experience (2007) J Vasc Surg, 46, pp. 920-92

Standardization of an isolated pig heart preparation with parabiotic circulation: methodological considerations

In the present study we standardized an experimental model of parabiotic circulation of isolated pig heart. The isolated heart was perfused with arterial blood from a second animal as support and submitted to regional ischemia for 30 min, followed by total ischemia for 90 min and reperfusion for 90 min. Parameters for measurement of ventricular performance using different indices measured directly or indirectly from intraventricular pressure were defined as: maximum peak pressure, final diastolic pressure, pressure developed, first derivative of maximum pressure (dP/dt max), first derivative of minimum pressure (dP/dt min), systolic stress of the left ventricle (sigmas), and maximum elastance of the left ventricle. Isolated hearts subjected to regional and global ischemia presented significant worsening of all measured parameters. Less discriminative parameters were dP/dt max and dP/dt min. Elastance was the most sensitive parameter during the reperfusion period, demonstrating an early loss of ventricular function during reperfusion. The model proved to be stable and reproducible and permitted the study of several variables in the isolated heart, such as ischemia and reperfusion phenomena, the effects of different drugs, surgical interventions, etc. The model introduces an advantage over the classical models which use crystalloid solutions as perfusate, because parabiotic circulation mimics heart surgery with extracorporeal circulation

Traumatic Fistula Between The Brachiocephalic Trunk And The Brachiocephalic Vein Due To Gunshot Wound [fístula Traumática Entre Tronco Braquiocefálico E Veia Braquiocefálica Por Arma De Fogo]

We describe the case of a 49-year old male patient who suffered a gunshot wound in the chest which transfixed the medial mediastinum. He was hemodynamically stable, but had tachycardia and tachypnea. He was submitted to integrated work-up with chest radiogram, transthoracic echocardiography, computerized chest tomography, and arteriography of the aortic arch. A traumatic fistula was evidenced between the brachiocephalic trunk and the brachiocephalic vein. Surgical repair was performed using extracorporeal circulation and deep hypothermia with total circulatory arrest. The patient progressed well and was discharged on the fifth day postoperatively.904e20e22+e21+e23Demetriades, D., Theodorou, D., Murray, J., Corrwell, E., Asensio, J., Mortality and prognostic factors in penetrating injuries of the aorta (1996) J Trauma, 40, pp. 761-763Roye, G.D., Zorn, G.L., McGiffin, D.C., Kirklin, J.W., Hamrick, K.M., Bessey, P.Q., Acute repair of aorta-innominate vein fistulas (1995) J Trauma, 39, pp. 753-756Demetriades, D., Penetrating injuries to the thoracic great vessels (1997) J Card Surg, 12 (SUPPL.), pp. 173-180Beall, A.C., Roof, W.R., De Bakey, M.E., Successful surgical management of through-through stab wounds of aortic arch (1962) Ann Surg, 156, pp. 823-826Bickell, W.H., Wall Jr, M.J., Pepe, P.E., Martin, R.R., Genger, V.F., Allen, M.K., Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries (1994) N Engl J Med, 331, pp. 1105-1109Fang, T.D., Peterson, D.A., Kirilcuk, N.N., Dicker, R.A., Spain, D.A., Brundage, S.I., Endovascular management of a gunshot wound to the thoracic aorta (2006) J Trauma, 60, pp. 204-208Demers, P., Miller, D.C., Mitchell, R.S., Kee, S.T., Chagonjian, L., Dake, M.D., Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta: Mid term results (2004) Ann Thorac Surg, 77, pp. 81-8

Early changes in contractility indices and fibrosis in two minimally invasive congestive heart failure models

FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOHeart failure is a common and often fatal disease. Numerous animal models are used to study its aetiology, progression and treatment. This article aims to demonstrate two minimally invasive models of congestive heart failure in a rabbit model and a precise method to assess cardiac performance. Methods: Fifty New Zealand White rabbits underwent cervicotomy incision and were then divided into three groups. Aortic regurgitation (AR group) was induced in 17 animals by catheter lesion through the right carotid artery, proximal aortic constriction (AC group) was created in 17 animals by metallic clip placement in the ascending aorta through a neck incision, while 16 animals served as controls (CO group). Eight weeks later, myocardial function and contractility indices were assessed by sonomicrometry crystals. Hearts were then collected for morphometric measurements and left ventricular tissues were subjected to immunohistochemical analysis of fibrosis, necrosis and apoptosis. Statistical analysis was by analysis of variance (ANOVA) with a Dunnett's post hoc test or by Kruskal-Wallis test with Dunn's post hoc test as appropriate, with significance at p < 0.05. Results: The model of aortic regurgitation indicated early stages of heart failure by volume overload with increased end-diastolic and end-systolic volumes, stroke volume, cardiac output and pressure-volume loop areas. The elastance was higher in the control group compared with that in the AC and AR groups (131.00 +/- 51.27 vs 88.77 +/- 40.11 vs 75.29 +/- 50.70; p = 0.01). The preload recruitable stroke work was higher in the control group compared with that in the AC and AR groups (47.70 +/- 14.19 vs 33.87 +/- 7.46 vs 38.58 +/- 9.45; p = 0.01). Aortic constriction produced left ventricular concentric hypertrophy. Fibrosis appeared in both heart failure models and was elevated by aortic constriction when compared with that in controls. Necrosis and apoptosis indices were very low in all the groups. Clinical signs of congestive heart failure were not present. Conclusions: The two heart failure models we describe were relatively simple to create and maintain, minimally invasive, accurate, inexpensive and, importantly, had a low mortality rate. These models rapidly induced deterioration of contractility indices and onset of fibrosis, the hallmarks of early myocardial dysfunction associated with heart failure. Sonomicrometry assessments were able to detect early contractility changes prior to clinical signs372368375FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOsem informaçã