Abstract Background The wide range of clinical presentations of acute coronary syndrome (ACS) makes it indispensible to use tools for risk stratification and for appropriate risks management; thus, the use of prognosis scores is recommended in the immediat clinical decision-making. Objective To validate the Global Registry of Acute Coronary Events (GRACE) score as a predictor of in-hospital and 6-month post-discharge mortality in a population diagnosed with ACS. Methods This is a prospective cohort study of consecutive patients diagnosed with ACS between May and December 2018. GRACE scores were calculated, as well as their predictive value for in-hospital and 6-month post-discharge mortality. The validity of the model was assessed by two techniques: discriminative power using the area under the receiver operating characteristic curve (AUC) and goodness-of-fit, using the Hosmer-Lemeshow (HL) test, at the 5% level of significance. Results A total of 160 patients were included, mean age 64 (±10.9) years; of which 60% were men. The risk model showed to have satisfactory ability to predict both in-hospital mortality, with an area under the curve (AUC) of 0.76 (95% confidence interval [CI], 0.57-0.95; p = 0.014), and 6-month post-discharge mortality, with AUC of 0.78 (95%CI, 0.62-0.94), p = 0.002. The HL test indicated good-fit for both models of the GRACE score. Conclusion In this study, the GRACE risk score for predicting mortality was appropriately validated in patients with ACS, with good discriminative power and goodness-of-fit. The results suggest that the GRACE score is appropriate for clinical use in our setting.

Abstract Introduction: Heart preservation benefits cardiac performance after operations decreasing morbidity but the contribution of the vascular reactivity has been neglected. Objective: We evaluated whether cardioprotective solutions, Krebs-Henseleit (KH), Bretschneider-HTK (BHTK), St. Thomas No. 1 (STH-1), and Celsior (CEL), affect vascular reactivity. Methods: Aortic rings from Wistar rats were used in two protocols. First, the rings were exposed to BHTK, STH-1 or CEL for 1 hour of hypoxia at 37 °C. Second, the rings were exposed to 10 °C or 20 °C for 1 hour under hypoxia. After treatment, the rings were immersed in KH at 37 °C, endothelial integrity was tested and concentration-response curves to phenylephrine were performed. Results: In the first protocol, the solutions did not damage the endothelium; CEL and BHTK reduced KCl-induced contractions but not STH-1; only CEL and BHTK reduced vascular reactivity; there was a positive correlation between Rmax and KCl concentration. At 20 °C, 1 hour under hypoxia, the solutions produced similar KCl-induced contractions without endothelial damage. CEL, BHTK and STH-1 decreased vascular reactivity. At 10 °C, STH-1 increased reactivity but CEL and BHTK decreased. After 1 hour under hypoxia in CEL or BHTK solutions, reactivity was similar at different temperatures. At 20 °C, endothelial damage after exposure to STH-1 produced more vasoconstriction than CEL and BHTK. However, at 10 °C, endothelial damage after CEL and BHTK exposure elicited more vasoconstriction while STH-1 showed a small vasoconstrictor response, suggesting endothelial damage. Conclusion: STH-1 decreased reactivity at 20 °C and increased at 10 °C. CEL promoted greater endothelial modulation at 10 °C than at 20 °C, while STH-1 promoted higher modulation at 20 °C than at 10 °C. Vascular tone was reduced by CEL and BHTK exposure, also depending on the KCl concentration.

Abstract Introduction: The result of surgical ablation of atrial fibrillation remains controversial, although prospective and randomized studies have shown significant differences in the return to sinus rhythm in patients treated with ablation versus control group. Surgery of the Labyrinth, proposed by Cox and colleagues, is complex and increases the morbidity rate. Therefore, studies are needed to confirm the impact on clinical outcomes and quality of life of these patients. Objective: To analyze the results obtained in the treatment of atrial fibrillation by surgical approach, by Gomes procedure, for mitral valve surgery in patients with rheumatic heart disease associated with chronic atrial fibrillation. Methods: We studied 20 patients with mitral valve dysfunction of rheumatic etiology, evolving with chronic atrial fibrillation, submitted to surgical treatment of valvular dysfunction and atrial fibrillation by Gomes procedure. Results: The mean duration of infusion ranged from 65.8±11.22 and aortic clamping of 40.8±7.87 minutes. Of 20 patients operated, 19 (95%) patients were discharged with normal atrial heart rhythm. One (5%) patient required permanent endocardial pacing. In the postoperative follow-up of six months, 18 (90%) patients continued with regular atrial rhythm, one (5%) patient returned to atrial fibrillation and one (5%) patient continued to require endocardial pacemaker to maintain regular rhythm. Conclusion: Gomes procedure associated with surgical correction of mitral dysfunction simplified the surgical ablation of atrial fibrillation in patients with rheumatic mitral valve disease and persistent atrial fibrillation. The results showed that it is a safe and effective procedure.

INTRODUÇÃO: Existe crescente necessidade de aprimorar a proteção miocárdica, para melhor desempenho das operações cardíacas e diminuição da morbimortalidade. Portanto, o objetivo deste estudo foi comparar a eficácia da proteção miocárdica usando tanto solução cristaloide tipo intracelular como extracelular quanto ao desempenho do sistema de condução elétrica, contratilidade do ventrículo esquerdo e edema, após parada isquêmica e posterior reperfusão. MÉTODOS: Corações isolados de ratos Wistar foram montados em Langendorff e aleatoriamente divididos em quatro grupos. de acordo com as soluções cardioprotetoras utilizadas Krebs-Henseleit-Buffer (KHB), Bretschneider-HTK (HTK), St. Thomas-1(STH-1) e Celsior (CEL). Após a estabilização com KHB a 37ºC, valores basais (controle) foram coletados para frequência cardíaca (FC), pressão sistólica do ventrículo esquerdo (PSVE), derivada máxima de aumento da pressão ventricular esquerda (+dP/dt), derivada máxima de queda da pressão ventricular esquerda (-dP/dt) e fluxo coronariano (FCo). Os corações foram então perfundidos a 10ºC por 5 min e mantidos por 2 h em isquemia estática a 20ºC em cada solução cardioprotetora. Avaliação dos dados foi por análise de variância inteiramente casualizados em One-Way ANOVA e teste de Tukey para comparações múltiplas. O nível de significância estatística escolhido foi P<0,05. RESULTADOS: Houve recuperação da FC com todas as soluções utilizadas. A avaliação da contratilidade ventricular esquerda (PSVE, +dP/dt e -dP/dt) demonstrou que o tratamento com a solução CEL foi melhor em comparação às outras soluções. Ao analisar o CF, a solução HTK indicou melhor proteção contra edema. CONCLUSÃO: Apesar das soluções cristaloides cardioprotetoras estudadas não serem capazes de suprimir os efeitos deletérios da isquemia e reperfusão no coração de ratos, a solução CEL apresentou resultado superior seguido por HTK>KHB>STH-1.

BACKGROUND: There is a growing need to improve myocardial protection, which will lead to better performance of cardiac operations and reduce morbidity and mortality. Therefore, the objective of this study was to compare the efficacy of myocardial protection solution using both intracellular and extracellular crystalloid type regarding the performance of the electrical conduction system, left ventricular contractility and edema, after being subjected to ischemic arrest and reperfusion. METHODS: Hearts isolated from male Wistar (n=32) rats were prepared using Langendorff method and randomly divided equally into four groups according the cardioprotective solutions used Krebs-Henseleit-Buffer (KHB), Bretschneider-HTK (HTK), St. Thomas-1 (STH-1) and Celsior (CEL). After stabilization with KHB at 37ºC, baseline values (control) were collected for heart rate (HR), left ventricle systolic pressure (LVSP), maximum first derivate of rise left ventricular pressure (+dP/dt), maximum first derivate of fall left ventricular pressure (-dP/dt) and coronary flow (CF). The hearts were then perfused at 10ºC for 5 min and kept for 2 h in static ischemia at 20ºC in each cardioprotective solution. Data evaluation was done using analysis of variance in completely randomized One-Way ANOVA and Tukey's test for multiple comparisons. The level of statistical significance chosen was P<0.05. RESULTS: HR was restored with all the solutions used. The evaluation of left ventricular contractility (LVSP, +dP/ dt and -dP/dt) showed that treatment with CEL solution was better compared to other solutions. When analyzing the CF, the HTK solution showed better protection against edema. CONCLUSION: Despite the cardioprotective crystalloid solutions studied are not fully able to suppress the deleterious effects of ischemia and reperfusion in the rat heart, the CEL solution had significantly higher results followed by HTK>KHB>STH-1.

O objetivo deste artigo é mostrar a técnica da papilopexia cruzada com o uso de enxerto de pericárdio bovino na substituição mitral por fibrose e calcificação intensa valvar e subvalvar. Esta técnica permite a preservação funcional do aparelho subvalvar mitral e foi aplicada pela primeira vez, na literatura alcançada, em paciente portador de estenose mitral reumática calcificada, submetido a troca valvar mitral. O paciente evoluiu sem complicações, com alta hospitalar em seis dias. Controles ecocardiográficos mostraram função ventricular esquerda preservada sem interferência na dinâmica da prótese mitral.

The aim of this study is to present the crossed papillopexy technique using bovine pericardial graft in mitral replacement caused by intense valvar and subvalvar fibrosis and calcification. This technique allows the functional preservation of the mitral subvalvar apparatus and was successfully applied, by the first time as far as we known, in a patient with calcified rheumatic mitral stenosis, who underwent mitral valve replacement surgery. The patient had an uneventful recovery and was discharged home on postoperative day 6. Echocardiography controls showed normal left ventricular function without any interference on the mitral prosthesis dynamics.

INTRODUÇÃO: O advento do ecocolor Doppler vascular tornou possível informar o estado anatômico e funcional da safena interna ao cirurgião cardiovascular, no pré-operatório da cirurgia de revascularização miocárdica, sem riscos para o paciente ou para o conduto venoso. O objetivo do estudo foi, juntamente com o cirurgião, avaliar a utilidade do mapeamento da safena interna no pré-operatório. CASUÍSTICA E MÉTODOS: Foram estudados, entre março de 1995 e maio de 1998, 208 extremidades inferiores de 104 pacientes selecionados para cirurgia de revascularização miocárdica. O critério utilizado para a seleção da safena foi a safena patente e o diâmetro maior ou igual a 3,0 mm, utilizando os aparelhos de ultra-sonografia ATL - HDI 3000 e Acuson-Sequóia 512. RESULTADOS: Dentre as 208 extremidades estudadas, 186 (89,4%) das safenas preenchiam os critérios e a análise do cirurgião estava de acordo com a descrição do ecocolor Doppler. Dezessete (8,2%) não preenchiam os critérios e, em 5 (2,4%) ,o exame foi compatível com safenectomia radical. Das 17 safenas consideradas não apropriadas, 2 foram exploradas cirurgicamente, sendo a análise do cirurgião concordante com o ultra-som. CONCLUSÃO: Os autores concluem que o ecocolor Doppler, sendo um método diagnóstico não invasivo, pode ser útil no mapeamento da safena interna no pré-operatório de revascularização miocárdica devido à sua capacidade de identificar e selecionar com segurança o vaso a ser utilizado como conduto vascular, o que permite ao cirurgião cardíaco o planejamento cirúrgico.

INTRODUCTION: The vascular echocolor Doppler, has made possible the observation of the greater saphenous vein (GSV) state without additional risk to the patient or to vascular lesions. The objective of the study was, working with a group of cardiovascular surgeons, to show the utility of the mapping of the GSV before coronary artery bypass graft (CABG) surgery. METHOD: During the period from March 1995 to May 1998, 208 extremities of 104 patients selected for CABG were studied. The criteria used for the selection of the GSV was the patency and a diameter larger than or equal to 3.0 mm, using the the ultra-sound equipment ATL - HDI 3000 and Acuson-Sequóia 512. RESULTS: Within the 208 extremities studied, 186 (89.4%) were appropriate for CABG in accordance with the description from the echocolor Doppler, seventeen (8.2%) did not fulfill the criteria, and five (2.4%) showed GSV stripping. Two of the seventeen inappropriate GSV were surgically explored, confirming the echoultrasound findings. CONCLUSIONS: The authors conclude that the echocolor Doppler can be effective in the mapping of GSV in the preoperative examination of the greater saphenous vein and its selection for CABG. Due to it´s capacity to correctly identify and select veins for by - pass surgery, the echocolor Doppler saves time in the search for veins and permits the surgeon to better plan the surgery.