Alfonso Roque Albanese (1906-2005) is considered a pioneer of Latin American heart surgery because of his important contributions. He was founding member of the Pan American Association of Anatomy. Researcher and teacher of anatomy and surgery, joining both disciplines.

Alfonso Roque Albanese (1906-2005) es considerado un pionero de la cirugía cardíaca Latinoamericana por sus importantes aportes. Fue miembro fundador de la Asociación Panamericana de Anatomía. Investigador y docente tanto de la anatomía como de la cirugía, uniendo ambas disciplinas.

The study of the International Morphological Terminology and its implementation in a system of rules is complex. The work done by the group of experts in morphology is not enough. Some aspects that will get us closer to the understanding of this problem will be explained and a way of solving it will be shown.

El estudio de la terminología morfológica internacional y su implementación en una normativa es complejo. La tarea que realiza el grupo de expertos morfólogos no es suficiente. Se explican algunos aspectos que nos acercarán al entendimiento de esta problemática y se muestra el camino para superar este desafío.

On the occasion of meeting the first two years of life, it makes a review of SILAT as scientific and educational program that serves as a tool to analyze and solve the problems of morphological medical terminology in the countries of Hispanic and Portuguese-speaking America. It describes the basis of its creation, strategy and scope in the region, the founding years and its immediate future. Finally, some conclusions are indicated and it Statute is annexed.

Con motivo de cumplir los dos primeros años de vida, se realiza una reseña de SILAT como programa científico y educativo que sirve de instrumento para analizar y solucionar los problemas de la terminología médica morfológica en los países de habla hispana y portuguesa de América. Se describen los fundamentos de su creación, su estrategia y el alcance en la región, los años fundacionales y su futuro inmediato. Finalmente, se señalan algunas conclusiones y se anexa su Estatuto.

It describes the main features of SILAT as a multinational scientific and educational program that serves as a tool to analyze and solve the morphological medical terminology problems in Spanish and Portuguese speaking countries of America. It treated history and creation, members, aims and functions, resources, activities, organizational structure, board, relations with other organizations and publications.

Se describen las principales características de SILAT como programa científico y educativo multinacional, que sirve de instrumento para analizar y solucionar los problemas de la terminología médica morfológica en los países de habla hispana y portuguesa de América. Se detallan antecedentes y creación, miembros, fines y funciones, medios, actividades, estructura organizativa, consejo directivo, relaciones con otros organismos y publicaciones.

This work was carried out aiming at studying at the light microscope the diagonal artery of the pig's heart to analyse the composition of the arterial wall and the morphometry of its tunicas as well. The hearts of twelve pigs of both sexs were used. From those 12 hearts, six had diagonal artery and other six tacked it. From those with the artery 18 blocks of 1cm² were removed from the intimal segment of the arteries, six blocks bling form the diagonal artery, six from the anterior interventricular arteries and six from the circunflex arteries. From another 6 hearts without diagonal artery 12 blocks of the 1 cm² were removed, six blocks bling from the anterior interventricular arteries and six from the circunflex arteries. In each arterial segment 20µm thick histological sections were made. The laminal obtained were stained by the following methods: resorcine-fucsine of Weigert counter-stained with picrofucsine of van Gieson; method of Verhoef; method of Azan . It was observed that the diagonal arteries belonged to the groups of muscular, or medium diameter arteries. As for the histomorphometric analysis, considering the tickness of the wall of the anterior interventricular, circunflex and diagonal arteries, it was observed that a larger thickness occured at the epicardial wall, followed by the miocardial wall. It was demonstrated a larger wall in the anterior interventricular artery, followed by the circunflex and then the diagonal arteries. Comparing the mean thickness of the wall of the anterior interventricular artery in the hearts with or without diagonal artery, it was observed that in the former it was thinner than in the latter. This finding was also made for the mean thickness of the wall of the circunflex artery in the hearts with ou without diagonal artery, showing that presence of the diagonal artery determns a change in the initial thicness of the walls of the two arteries

Se realizó este trabajo con el objetivo de estudiar al microscopio la luz de la arteria diagonal en los corazones de los suinos para analizar la constitución de la pared arterial y la morfometria de las túnicas. Se utilizaron 12 corazones de suinos, de ellos 6 poseían la arteria diagonal mientras que en otros 6 corazones el referido vaso no estaba presente. De los corazones con arteria diagonal, se obtuvieron 18 bloques de 1 cm² del seguimiento inicial de las arterias, siendo 6 de arterias diagonales, 6 de arterias interventriculares anteriores y 6 de arterias circunflejas. De los otros 6 corazones sin arteria diagonal fueron retirados 12 bloques de 1 cm², 6 del seguimiento inicial de las arterias interventriculares anteriores y 6 del seguimiento inicial de las arterias circunflejas. Estas piezas fueron sometidas a rutinas histológicas obteniéndose cortes transversales y logintudinales de 20µm de grosor. Las láminas obtenidas fueron teñidas por los métodos de Weigert - Van Gieson, Verhoef y Azan. La arteria diagonal del corazón del suino puede ser clasificada como una arteria muscular; siendo posible diferenciar las tres túnicas. De éstas, la túnica media es la más diferenciada; mostrando mayor grosor la pared de la arteria interventricular anterior, seguida de la arteria circunfleja y, finalmente, de la diagonal; en todas las arterias (IVA, circunfleja y diagonal) se observó que la pared miocárdica era la más fina, comparada con la epicárdica. Se concluye que la longitud del vaso influye en el grosor de la pared. Cuanto mayor es la extensión del vaso, mayor el grosor inicial de la pared y que la presencia de la arteria diagonal determina un menor grosor de la pared de las arterias IVA y circunfleja, comparadas a los corazones que no presentan arteria diagonal

SUMMARY: Considering the importance of the diagonal artery for myocardial vascularization and the existence of a series of similar features between the hearts of men and pigs, this reserch was carried out to make a morphometric study of the diagonal artery in hearts of pigs. For this study 100 hearts of pigs were used. Coronary arteries of these hearts were injected with 15% gelatin solution stained with red chess. Next, the hearts were fixed in 10% formol solution for 10 days and dissectd to allow visualization of the diagonal artery and measurement of the ventricular height. It was considered diagonal artery only the vessel emerging from the angle between the anterior interventricular and circunflex arteries. It was observed that the diagonal artery in the hearts of pigs was present in 20% of the samples. Its lenght varied from 11,33 mm to 39,5 mm, with mean of 22,4 mm, being the majority (95%) described as artery of short course on the subepidardial plane. As for its behaviour, it was noted that it gave rise to a single branch in 50% of the cases, two branches in 45% of the cases and in one case (5%) it gave rise to three brances. It can be concluded that in case of absence of the diagonal artery the circunflex artery gives rise to many branches, possibly to play the role of irrigation suplly of the left ventricle.

RESUMEN: Debido a la importancia de la arteria diagonal en la vascularización del miocardio y a la existencia de características semejantes entre el corazón del hombre y del porcino, realizamos un estudio morfométrico de la arteria diagonal en 100 corazones de porcinos. Se inyectaron las arterias coronarias con una solución de gelatina al 15%, teñida de rojo. Luego, los corazones fueron fijados en solución de formol al 10%, por un período de 10 días y disecados para visualización de la arteria diagonal y comparación de la altura ventricular. Sólo se consideró como arteria diagonal al vaso que emergía de la bisectriz del ángulo formado por la arteria interventricular anterior y circunfleja. La arteria diagonal estuvo presente en el 20% de los casos. Su longitud varió entre 11,3 mm y 39,5 mm (x 22,4 mm), por lo que se clasificó a la mayoría de ellas (95%), como arterias de corto trayecto en el plano subepicárdico. Con relación a su ramas, se verificó que dicha arteria emitía una rama en el 50% de los casos, 2 ramas en el 45% y 3 ramas en el 5%. Se puede concluir entonces, que en el caso de ausencia de la arteria diagonal, la arteria circunfleja emitiría varias ramas, seguramente para suplir la insuficiente irrigación del ventrículo izquierdo.

SUMMARY: The retrograde cardioplegia is a procedure regularly used to protect the miocardium during cardiac surgeries. The cardioplegic solution is retrogradly perfused through the coronary sinus, the main vein of the heart, and it is useful since the coronary venous system has shown to be free of any obstructing atherosclerotic disease. The opening of the coronary sinus occurs directly in the right atrium and an ostial valve at this level has long been related. However, a parietal valve in the coronary sinus has renewed the interest in this study. These valves could make difficult a perfect perfusion of the cardioplegic solution, particularly when low coronary sinus pressures are used. In order to understand the morphology of the parietal valve of the coronary sinus we decided to perform a study of the valve under SEM. Six fragments of the coronary sinus containing the parietal valve were taken from adult individuals, post mortem, with no gross cardiac pathologies. The samples were submitted to the usual techniques of Scanning Electron Microscopy. The parietal valve of the coronary sinus showed a half-moon shape, with a well defined structure. Its endothelium was arranged in parallel lines, similar to a stem of a tree, where we could evidence the nuclei of the endothelial cells. Under the endothelial layer we found abundant collagen and elastic fibers. Owing to its developed form seen under SEM, the parietal valve of the coronary sinus must play an important role in guiding the blood flow through the coronary sinus to the right atrium in physiological conditions and could raise difficulties to the flow of the cardioplegic solution during the retrograde cardioplegia.

RESUMEN: La cardioplegia retrógrada es un procedimiento usado regularmente para proteger el miocardio durante las cirugías del corazón. Consiste en hacer una perfusión retrógrada, a través del seno coronario, la principal vena cardíaca. Este método ha mostrado ser muy útil, pues el sistema venoso del corazón no presenta procesos obstructivos ateroscleróticos. La desembocadura del seno coronario ocurre directamente en el atrio derecho, donde una valva ostial es referida a este nivel. Pero la presencia de una valva parietal en el seno coronario ha renovado el interés de estudio. Esta valva podría dificultar la perfecta perfusión de la solución cardioplégica, particularmente cuando se usan presiones bajas. Para entender mejor la morfología y por tanto la función de la valva parietal del seno coronario, realizamos un estudio de esta valva en microscopio electrónico de barrido (MEB). Utilizamos 6 muestras de 1cm², conteniendo el seno coronario a nivel de la valva parietal, las que fueron retiradas de individuos adultos post mortem, sin patologías macroscópicas. Las muestras fueron sometidas a las técnicas habituales de MEB. La valva parietal mostró un aspecto en media luna bien definido. Su endotelio presentó estructuras paralelas, semejantes a troncos de árboles, en los cuales se pudieron evidenciar los núcleos de las células endoteliales. Por debajo de la capa endotelial encontramos abundantes fibras colágenas y elásticas. Debido al gran desarrollo de la valva del seno coronario observada al MEB, ésta debe tener un papel importante en la orientación del contenido sanguíneo por el seno coronario, en dirección al atrio derecho, en condiciones fisiológicas y podrá crear dificultades al flujo de la solución durante el procedimiento de la cardioplegia retrógrada.

A artéria radial (AR) foi estudada sob o ponto de vista anatômico, histológico, imunohistoquímico e ultramicroscópico. Paralelamente, foram analisados os resultados de seu emprego na revascularização do miocárdio de 269 pacientes. No total, 319 artérias coronárias foram revascularizadas pela AR. Houve predomínio do sexo masculino (80,7%) e da raça branca (93,7%). A artéria torácica interna esquerda (ATIe) foi empregada em 246 pacientes. Outros 17 já haviam sido previamente revascularizados com a ATIe, perfazendo um total de 97,8%. A artéria torácica interna direita (ATId) foi empregada em 59 (21,9%) pacientes, a artéria gastroepiplóica direita (AGEd) em 17 (6,3%) pacientes e em 161 (59,8%) foram também realizadas 1 a 4 pontes de veia safena. A média de enxertos por paciente foi de 3,4. Não houve complicações isquémicas ou infecciosas no membro em que a AR foi retirada. Os estudos imuno-histoquímicos e ultramicroscópicos permitiram observar o grande espessamento da membrana limitante elástica interna da AR e o predomínio de fibras colágenas sobre as elásticas na camada média. As principais complicações pósoperatórias foram a fibrilação atrial em 21 (7,8%) pacientes, insuficiência respiratória em 21 (7,8%), alterações no ECG e/ou elevação de CKMB em 12 (4,5%) pacientes. O balão intra-aórtico foi utilizado em 6 (2,2%) pacientes. O cateterismo no pós-operatório precoce foi realizado em 21 pacientes. Em 1 paciente houve dissecção sem oclusão do óstio da AR pelo cateter, 1 (4,7%) apresentou sinais de espasmo da AR; nos demais a AR encontrava-se pérvia e sem lesões. Houve 6 (2,2%) óbitos hospitalares, sendo 3 por acidente vascular cerebral, 2 por baixo débito cardíaco e 1 paciente teve morte súbita. Nos últimos meses temos visado à revascularização miocárdica com o emprego máximo de enxertos arteriais. Como tática especial usamos a AR para anastomoses seqüenciais com as artérias de parede inferior e lateral do ventrículo esquerdo. A anastomose do coto proximal é realizada na ATIe que, por sua vez, é habitualmente anastomosada ao ramo interventricular anterior (RIA). As artérias AGEd e ATId in situ ou, como enxerto livre, têm complementado o procedimento. Dentre 64 pacientes operados nos últimos 3 meses com a utilização da AR, 62 (96,9%) receberam pelo menos 2 enxertos arteriais, 27 (42,2%) receberam pelo menos 3 enxertos arteriais e 8 (12,5%) pacientes receberam 4 ou 5 enxertos arteriais. Em 29 (45,3%) deles a AR foi anastomosada à ATIe ou ATId. Acreditamos que essa técnica reduza a excessiva pressão conseqüente à anastomose direta da AR na aorta e que o maior fluxo decorrente das anastomoses seqüenciais auxilie na manutenção da perviabilidade da AR. A despeito de considerarmos o enxerto pediculado da ATIe o principal método de revascularização do miocárdio, os resultados preliminares indicam que a AR constitui uma excelente via complementar na busca da revascularização completa do miocárdio com enxertos arteriais.

The aim of our study is to determine the microscopical anatomy imunohistochemistry and electronical scanning analysis of the radial artery (RA); 269 patients underwent myocardial revascularization with a RA graft were studied, performing 319 RA anatomoses; 80.7% patients were male and 93.7% Caucasians. The left internal thoracic artery (LITA) was used in 246 patients at the present surgery and 17 LITA were used before (redo-operation), performing 97.8%. LITA conduits employed altogether. The patients received another additional conduits: 59 (21.9%) right internal thoracic arteries (RITA); 17 (6.3%) right gastroepiploic arteries (RGEA); 161 (59.8%) saphenous vein grafts. An average of 3.4 anastomoses/patient were constructed. There was no post-operative complications such as ischemia or infection envolving the hand with interruption of the RA supply. The RA immunohistochemistry and electronical scanning microscopy showed that the internal elastic layer is developed and the media layer presented muscular fibers sheafs surrounded by collagen fibers more than elastic fibers. The post-operative complications include respiratory distress (21 -7.8%), atrial fibrillation (21 -7.8%), and enzymatic or electrocardiographic signs (12-4.5%) of acute myocardial infarction. Six (2.2%) patients needed mechanical support with intraortic balloon pump. Early angiographic controls have been performed in 21 patients. One patient developed RA dissection during the angiographic study; in all other patients the RA patency was 100%. The overall in-hospital mortality rate was 2.2% (6 patients). Recently, different arrangements of the arterial grafts were adopted to achieve a more complete myocardial revascularization. The RA are frequently employed to sequential anastomosis with the inferior and lateral left ventricular coronaries. The RA proximal anastomosis is often performed with the LITA. Both the RGEA and the RITA are used as complementar arterial grafts. From 64 patients submitted to myocardial revascularization with RA last 3 months, 2 arterial conduits were performed in 62 (96.9%) patients, 3 arterial conduits were performed in 27 (42.2%) patients and 4 or 5 arterial conduits were performed in 8 (12.5%). Although the pedicled internal thoracic artery graft remains the primary arterial conduit for myocardial revascularization, the radial artery is an excellent additional bypass conduit.

O conhecimento anatômico do tipo de circulação, com a identificação da dominância das artérias coronárias na irrigação do coração, apresenta grande interesse clínico e cirúrgico, devido a que variações nessa irrigação ocasionam diferentes graus de gravidade em casos de obstrução. Foram estudados 50 corações retirados de indivíduos adultos, de ambos os sexos e diferentes raças, nos quais as artérias coronárias foram dissecadas, visando identificar o tipo de circulação. Realizamos, ainda, estudo morfométrico em corações cujo peso médio foi 291 gramas e altura ventricular média de 97 mm. Em 72% dos corações estudados havia dominância da direita, 16% circulação balanceada e 12% dominância da esquerda. Identificamos o número de ramos que ultrapassam a crux cordis, sendo o mínimo de um ramo e o máximo de cinco ramos, com valor médio de 2,2 nos casos de dominância da direita e em apenas dois corações um ramo (em cada um) nos 8 de dominância da esquerda. Em 50% dos corações estudados o ramo interventricular anterior ultrapassa o ápice cardíaco, atingindo a sua face diafragmática.

The type of circulation and the predominance of the coronary arteries have a great interest in Cardiology as well as in Cardiac Surgery. There is a close relationship between the type of circulation and the risk of myocardial injuries after coronary obstruction. We carried out 50 normal hearts (35 males and 15 females) of 28 Caucasian and 22 non-caucasian individuals. The arteries were injected with colored gelatine. The average cardiac weight was 291 g and the ventricular length was 97 mm. The right coronary predominance was the most common pattern of distribution (72%) and is followed in incidence by a left coronary predominance (16%) and least frequently by a balanced circulation (12%). The incidence of branches crossing the crux cordis ranged from 1 to 5 (average 2,2) in right coronary predominance. On the other hand, in the left coronary predominance we found one branch in two hearts. The most frequent branch reaching the diaphragmatic from the sternocostal surface was the interventricuiaris anterioris ramus (50%).

O conhecimento anatômico do tipo de circulação, com a identificação da dominância das artérias coronárias na irrigação do coração, apresenta grande interesse clínico e cirúrgico, devido a que variações nessa irrigação ocasionam diferentes graus de gravidade em casos de obstrução. Foram estudados 50 corações retirados de indivíduos adultos, de ambos os sexos e diferentes raças, nos quais as artérias coronárias foram dissecadas, visando identificar o tipo de circulação. Realizamos, ainda, estudo morfométrico em corações cujo peso médio foi 291 gramas e altura ventricular média de 97 mm. Em 72% dos corações estudados havia dominância da direita, 16% circulação balanceada e 12% dominância da esquerda. Identificamos o número de ramos que ultrapassam a crux cordis, sendo o mínimo de um ramo e o máximo de cinco ramos, com valor médio de 2,2 nos casos de dominância da direita e em apenas dois corações um ramo (em cada um) nos 8 de dominância da esquerda. Em 50% dos corações estudados o ramo interventricular anterior ultrapassa o ápice cardíaco, atingindo a sua face diafragmática.

The type of circulation and the predominance of the coronary arteries have a great interest in Cardiology as well as in Cardiac Surgery. There is a close relationship between the type of circulation and the risk of myocardial injuries after coronary obstruction. We carried out 50 normal hearts (35 males and 15 females) of 28 Caucasian and 22 non-caucasian individuals. The arteries were injected with colored gelatine. The average cardiac weight was 291 g and the ventricular length was 97 mm. The right coronary predominance was the most common pattern of distribution (72%) and is followed in incidence by a left coronary predominance (16%) and least frequently by a balanced circulation (12%). The incidence of branches crossing the crux cordis ranged from 1 to 5 (average 2,2) in right coronary predominance. On the other hand, in the left coronary predominance we found one branch in two hearts. The most frequent branch reaching the diaphragmatic from the sternocostal surface was the interventricularis anterioris ramus (50%).