OBJECTIVE: To assess the major causes of surgical morbidity and mortality in patients with infective endocarditis operated upon in a regional cardiology center. METHODS: Thirty-four patients underwent surgical treatment for infective endocarditis. Their ages ranged from 20 to 68 years (mean of 40.6) and 79% were males. Their NYHA functional classes were as follows: IV - 19 (55.8%) patients; III - 12 (35.2%) patients; II - 3 (8.8%) patients. Blood cultures were positive in only 32% of the cases. Eight patients had already undergone previous cardiac surgery, whose major indication (82.3%) was heart failure refractory to clinical treatment. RESULTS: Four (11.7%) patients died at the hospital. Follow-up was complete in 26 (86%) patients. Five (14.7%) patients died later, 12, 36, 48, 60, and 89 months after hospital discharge. Of the 21 patients being currently followed up, 1 is in NYHA functional class III, and 5 in NYHA functional class II. CONCLUSION: A high degree of clinical suspicion, at an early diagnosis, and indication of surgical treatment prior to deterioration of left ventricular function and installation of generalized sepsis may improve prognosis.

Discute-se o caso clínico de um paciente homem, 38 anos, com insuficiência cardíaca classe IV (NYHA) e angina de repouso em razão de insuficiência aórtica severa, oclusão de óstio da artéria coronária direita e lesão subtotal do óstio da artéria coronária esquerda, em razão de aortite de origem luética. O tratamento constituiu-se de prótese aórtica mecânica e plastia do óstio coronariano esquerdo com "telhado" de veia safena. A evolução clínica pós-operatória foi excelente, tendo o paciente retornado à vida ativa e sem sintomas.

A clinical case of a 38 year old male, with heart failure grade IV (NYHA) and angina at rest related to severe aortic regurgitation, right coronary ostial occlusion, and a sub-total occlusion of the left coronary ostium owing to syphilitic infection in the past is reported and discussed. Treatment was established implanting a mechanical aortic prosthesis and a direct left main angioplasty suturing a patch made of safenous vein. Follow up has been excellent and the patient is today having a normal life, free of symptoms.

RAvaliaram-se as indicações, as alterações e os resultados cirúrgicos de 28 pacientes, operados por endocardite infecciosa (EI) no período de 1983 a 1994. O diagnóstico clínico foi confirmado pela ecocardiografia e pela cineangiocardiografia. Dos pacientes, 65% eram do sexo masculino e 25% do feminino, com média de idades de 35,21 (14 a 67) anos. Noventa e três por cento dos pacientes estavam em classe funcional III e IV (NYHA). O tempo decorrido entre o diagnóstico e a cirurgia foi em média de quatro semanas e meia (1 a 363 dias). A hemocultura foi positiva em 25% dos casos e os germes mais freqüentemente encontrados foram estreptococos e estafilococos. A valva aórtica foi a mais acometida e as vegetações foram as lesões mais comumente encontradas. O tratamento cirúrgico utilizado foi a plastia valvar em 2 casos e a substituição valvar por prótese em 26.Complicações ocorreram em 39,28% dos casos, com 5(18%) mortes. Conclui-se que, embora rara, a EI é doença grave e, se não prevenida com adequada antibiótico-profilaxia ou tratada em tempo hábil, o paciente terá conseqüências graves, podendo, até mesmo, falecer.

The indication, surgical pathology and the results of surgical treatment of 28 patients operated on for infectious endocarditis between 1983 and 1994 are here evaluated. The clinical diagnosis was confirmed by echocardiography and cineangiography. Seventy-five percent of the patients were male and 25% female, with the mean age of 35.2 (14 to 67) years old. Ninety three percent were in functional class III or IV (N Y H A). Elapsed time between diagnosis and surgery was around 4 weeks (1-363 days). A positive hemoculture was present in 25% of the cases and the commonest bacteria found were streptococcus and staphilococcus. The aortic valve was the one usualy affected and vegetations was the usual finding. Surgical treatment consisted of valvuloplasty in 2 cases and valve replacement in 26. Complications were present in 39.28% of the cases, which resulted in the death of five of them (18%). We conclude that, although rare, the infectious endocarditis is a serious disease; if not prevented with adequate antibiotic prophilaxis or treated in due time, serious complications or even death might occur.

A presente dificuldade na obtenção de doadores adequados para o transplante cardíaco obriga à necessidade da utilização de órgãos removidos à distância, prolongando, assim, o tempo de isquemia total (TIT). Os efeitos do TIT sobre a função cardíaca no pós-operatório imediato e a necessidade de agentes inotrópicos ainda são controversos, devendo os limites de segurança serem determinados. As manifestações do TIT no índice cardíaco, durante os primeiros três dias pós transplante cardíaco ortotópico (I/C 1-3), o período total do suporte inotrópico (SIT), a dose total/kg de dopamina e dobutamina (D + D/kg), a necessidade inotrópica máxima e picos dos níveis de CPK-MB (CPK-MB) foram medidos em 96 receptores de transplante cardíaco, na Universidade de Minnesota, para determinar a relação destas variáveis com o TIT. O TIT variou entre 61 e 288 minutos (média 171,7, D.P. 51,9). A população foi dividida entre grupos representando intervalos de 30 minutos. Embora os níveis de CPK-MB fossem inferiores nos grupos de TIT menores, não houve diferença nos parâmetros de função cardíaca, tempo de suporte e necessidade inotrópica. Concluímos que tempos de isquemia até cinco horas são bem tolerados e que outros fatores, como função cardíaca do doador previamente à remoção do órgão, ou possível dano isquêmico durante a remoção, são mais importantes na determinação da performance pós-operatória imediata.

The current scarcity of satisfactory human heart transplant donors has led to the use of distant procurement of donor organs with prolonged total ischemic times (TIT). The effect of TIT is controversial and is important that the safe limits of TIT are determined. The effect of increasing TIT on cardiac index during the first 3 operative days (CI/1-3), total period of dopamine and dobutamine (D + D/Kg), maximum inotropic requirements and peak CPK-MB levels were assessed in 96 consecutive heart transplant recipients, at the University of Minnesota, to determine the relatiosnhip of these variables to TIT. TIT ranged from 61 to 288 min (mean 171.7 min). The population was divided into groups representing 30 minutes increments of IT. Although reduced levels of peak CPK-MB were evident in the lower TIT groups, cardiac function, support times and inotrope requirements were not different. We conclude that ischemic times of up to 5 hours are well tolerated and that other factors, such as donor heart function prior to harvest and possible ischemic damage during harvest and implantation, are more important determinants of early post-transplant function.