[Show abstract][Hide abstract] ABSTRACT: We present the case of a 47-year-old man with hypertension for over 20 years, referred to our hospital due to mild aortic dilatation detected on a transthoracic echocardiogram. On physical examination weak lower limb pulses and a blood pressure differential of >50 mmHg between arms and legs were detected. Complete interruption of the aortic arch below the left subclavian artery was diagnosed by computed tomography angiography. With this case we aim to draw attention to aortic coarctation and interrupted aortic arch as potential causes of hypertension and to highlight the importance of the physical examination in the diagnosis of secondary causes of hypertension.
[Show abstract][Hide abstract] ABSTRACT: Apresentamos o caso de um homem de 47 anos, com hipertensão arterial desde há mais de 20 anos, referenciado ao nosso hospital por dilatação ligeira da aorta ascendente detetada em ecocardiograma transtorácico. No exame físico constatou-se que os pulsos femorais eram pouco amplos e existia um diferencial de pressões superior a 50 mmHg entre os membros superiores e inferiores. Por angiotomografia computorizada do tórax diagnosticou-se uma interrupção completa do arco aórtico abaixo da artéria subclávia esquerda. Com este caso pretendemos relembrar a coartação da aorta e interrupção do arco aórtico como potenciais causas de hipertensão e realçar a importância do exame físico no diagnóstico de causas secundárias de hipertensão.
[Show abstract][Hide abstract] ABSTRACT: Superior Vena Cava Syndrome (SVCS) occurs when there is a reduction or blockage of blood flow through the superior vena cava (SVC) and may be associated with debilitating clinical manifestations. Although classically associated with malignant etiologies, increasing number of intravenous procedures (central venous catheters, pacemakers) have raised the percentage of cases of benign etiology, which currently account for 40%. Endovascular management of SVCS has gained increasing popularity, although it is not always feasible or leads to long-term clinical improvement, so sometimes surgical treatment is necessary.
The authors present a patient with superior vena cava syndrome due to pacemaker leads. After unsuccessful attempt of endovascular treatment, the patient underwent surgical reconstruction with resolution of symptoms.
Angiologia e Cirurgia Vascular. 03/2014; 10(1):12–15.
[Show abstract][Hide abstract] ABSTRACT: Transcatheter aortic valve implantation (TAVI) is the standard treatment for patients with severe aortic stenosis and unacceptable surgical risk. These are usually elderly patients with multiple comorbidities. We report the case of a 20-year-old man with mandibuloacral dysplasia, an extremely rare premature ageing syndrome, and severe symptomatic aortic stenosis, referred to our center for TAVI after being considered unsuitable for surgical aortic valve replacement. TAVI by a transfemoral approach was performed successfully. Severe acute respiratory failure that did not respond to optimal conventional treatment led us to employ venovenous extracorporeal membrane oxygenation. The device was removed after 10 days, and the patient was discharged home 27 days later. At one-year follow-up he is in NYHA class I with full functional autonomy. To the best of our knowledge, this is the youngest patient to undergo TAVI reported in the literature.
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology. 10/2013;
[Show abstract][Hide abstract] ABSTRACT: Coronary artery aneurysms are uncommon but potentially hazardous entities found on a small percentage of coronary angiograms. The best management strategy remains to be determined; the coexistence of obstructive coronary artery disease is the main determinant of prognosis. We report the case of a middle-aged woman with mixed aneurysmal and obstructive coronary artery disease presenting as an acute myocardial infarction, probably due to atherosclerosis. The unusual severity and complexity of the angiographic presentation of this case, with involvement of all major coronary arteries, raises important issues in terms of the patient's treatment options.
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology. 07/2013;
[Show abstract][Hide abstract] ABSTRACT: Complete revascularization is considered superior to incomplete revascularization (IR), with better long-term survival and a lower rate of reintervention. However, it has yet to be established whether this difference is due directly to IR as a surgical strategy or whether this approach is merely a marker of more severe coronary disease and more rapid progression. We believe that IR is a prognostic marker for a more complex coronary pathology, and adverse effects are probably due to the preoperative condition of the patient. In fact, although IR may negatively affect long-term outcomes, it may be, when wisely chosen, the ideal treatment strategy in selected high-risk patients. IR can derive from a surgical strategy of target vessel revascularization, where the impact of surgery is minimized to reduce perioperative mortality and morbidity, aiming to achieve the best feasible safe revascularization.
Interactive Cardiovascular and Thoracic Surgery 11/2011; 14(2):176-82. · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Intraventricular pressure gradients have been described between the base and the apex of the left ventricle during early diastolic ventricular filling, as well as, their increase after systolic and diastolic function improvement. Although, systolic gradients have also been observed, data are lacking on their magnitude and modulation during cardiac dysfunction. Furthermore, we know that segmental dysfunction interferes with the normal sequence of regional contraction and might be expected to alter the physiological intraventricular pressure gradients. The study hypothesis is that systolic and diastolic gradients, a marker of normal left ventricular function, may be related to physiological asynchrony between basal and apical myocardial segments and they can be attenuated, lost entirely, or even reversed when ventricular filling/emptying is impaired by regional acute ischemia or severe aortic stenosis.
Animal Studies: Six rabbits will be completely instrumented to measuring apex to outflow-tract pressure gradient and apical and basal myocardial segments lengthening changes at basal, afterloaded and ischemic conditions. Afterload increase will be performed by abruptly narrowing or occluding the ascending aorta during the diastole and myocardial ischemia will be induced by left coronary artery ligation, after the first diagonal branch.Patient Studies: Patients between 65-80 years old (n = 12), both genders, with severe aortic stenosis referred for aortic valve replacement will be selected as eligible subjects. A high-fidelity pressure-volume catheter will be positioned through the ascending aorta across the aortic valve to measure apical and outflow-tract pressure before and after aortic valve replacement with a bioprosthesis. Peak and average intraventricular pressure gradients will be recorded as apical minus outflow-tract pressure and calculated during all diastolic and systolic phases of cardiac cycle.
We expect to validate the application of our method to obtain intraventricular pressure gradients in animals and patients and to promote a methodology to better understand the ventricular relaxation and filling and their correlation with systolic function.
Journal of Cardiothoracic Surgery 01/2011; 6:67. · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Thoracic splenosis is a rare clinical condition consisting in the heterotopic autotransplantation of pieces of splenic tissue into the chest, following a previous trauma, with spleen and diaphragm laceration. In this paper, the authors report the clinical case of a thoracic splenosis in a 26 years old male, who had suffered a severe thoraco-abdominal trauma in childhood, leading to an emergency splenectomy. The patient, with the previous diagnosis of malignancy, namely pleural fibrotic tumors, underwent surgical management for removal of some nodular tumors of the pleura. Pathological studies confirmed the diagnosis of thoracic splenosis. The clinical diagnosis of thoracic splenosis should be suspicious facing asymptomatic patients, with a history of previous thoraco-abdominal trauma and nodular peripheral tumors in the chest x-rays.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 01/2010; 17(3):153-155.
[Show abstract][Hide abstract] ABSTRACT: Staged or combined carotid endarterectomy (CEA) offers the potential benefit of decreased neurological morbidity during and after cardiac surgery; however, the strategy for treating unstable high-risk patients, who need urgent coronary artery surgery, remains unresolved. We report in-hospital and 30-day outcomes of 23 consecutive patients admitted with unstable angina, who underwent carotid angioplasty and stenting (CAS) immediately prior to urgent coronary artery surgery, from October 2007 to October 2008. Aspirin and unfractioned heparin were administrated during carotid stenting and clopidogrel was only started after cardiac surgery. All patients remained event-free during and immediately after the carotid stenting procedure. One patient died due to sepsis 22 days after cardiac surgery. There was neither stroke nor myocardial infarction at follow-up. No patient needed a cardiac or carotid re-intervention. This new approach (combined carotid stenting and coronary artery surgery) provides a less radical intervention, can be performed with a low periprocedural complication rate and may become a valuable alternative in the treatment of high-risk patients with combined carotid and cardiac disease.
Interactive Cardiovascular and Thoracic Surgery 06/2009; 9(2):278-81. · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Transcatheter aortic valve implantation has been increasingly reported as an alternative to the surgical management of aortic stenosis in patients who are contraindicated for surgery. Transcatheter technical limitations for vascular access in some patients created the need for alternative approaches as is the case of the subclavian artery access. The authors report their experience and results in a group of four patients treated with transcatheter aortic valve implantation through subclavian artery access.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 01/2009; 16(2):71-6.
[Show abstract][Hide abstract] ABSTRACT: Multiple strategies to achieve some degree of myocardial revascularization are available. In some, less complete revascularization is accepted to limit invasiveness, mostly in older, high-risk patients and patients with unsuitable coronary anatomy.
Patient and operative data were collected retrospectively for all patients with three-vessel coronary artery disease who had off-pump coronary artery bypass surgery from January 2003 through December 2005. In-hospital outcomes, preoperative risk, survival and postoperative complications were compared between patients with complete (n = 89) and incomplete (n = 61) revascularization.
The mean follow-up was 20.2 +/- 4.6 months. Patients with incomplete revascularization tended to be older (76.8 +/- 1.4 years) than those with complete revascularization (66.3 +/- 1.0 years) and were more likely to have diabetes (43% versus 30%), cerebrovascular disease (18% versus 11%) and peripheral arterial disease (20% versus 9%), poorer ejection fraction (34.7 +/- 1.7% versus 50.8 +/- 1.5%) and greater EuroSCORE risk (9.7 +/- 2.1 vs. 5.1 +/- 1.3). In-hospital (3.3% versus 3.4%) and 6-month (4.9% versus 5.6%) mortality were not statistically different in the two groups, nor was recurrence of angina (3.3% versus 1.1%) or need for repeat revascularization (percutaneous or surgical) (4.9% versus 3.3%).
In high-risk patients with three-vessel coronary artery disease, the potential benefits of less invasive surgery should be considered. Surgical outcomes depend on preoperative condition rather than incomplete revascularization. Medium-term mortality and cardiac-related events associated with this surgical strategy are not increased.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 11/2008; 27(10):1239-47. · 0.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: After formation of fungus ball in pre-existing cavities, antifungal agents are very hard to control the infection. Surgical resection offers the only realistic chance of a permanent cure for aspergilloma. However, surgical indications are still a controversy because of the high incidence of postoperative complications. The purpose of this study was to evaluate our indications and results in the surgical treatment of aspergilloma, focusing attention on the postoperative complications and risk factors. From 1990 to 2004, 60 patients with mean age of 44.6 (range, 20-69) were submitted to pulmonary surgery for excision of aspergilloma. Forty-one patients (68.3%) were male, 25 patients (41.7%) were smokers and 47 (78.3%) had tuberculosis as the underlying lung disease. The most frequent indication for surgery was haemoptysis (88.3%). The cavities were mainly situated in the upper lobes (85.0%) and in the right lung (68.3%). Approximately half of aspergillomas (56.7%) were classified as complex aspergillomas. The procedures performed were : 7 pneumectomies (11.7%), 3 bilobectomies (5.0%), 42 lobectomies (70.0%), 7 wedge resections (11.7%) and one cavernostomy (1.7%). There were 3 postoperative deaths (5%), and major complications occurred in 16.3% of the patients including: bleeding (n=3) and bronchopleural fistula (n=2). Recurrence rate was 3.3%. Surgical resection of pulmonary aspergilloma is effective in preventing recurrence of hemoptysis. Preoperative preparation of the patient, meticulous surgical technique, asn postoperative care reduced the rate of complications. We recommend early surgical resection of symptomatic cases with reasonable complications.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 01/2008; 15(3):135-8.
[Show abstract][Hide abstract] ABSTRACT: Over the past 20 years, there have been marked increased rates in cardiac surgery among the elderly in Portugal. To evaluate the effects of increasing age on outcome after cardiac surgery, 5652 patients who underwent cardiac surgery from 2003 to 2005 in five portuguese hospitals, were entered into a retrospective study. Patients were placed in five groups according to age: (1) 80 and older, (2) 70-79, (3) 60-69, (4) 50-59 or (5) less than 50. Selected variables included risk factors, cardiac status, preoperative hemodynamics and surgical procedures. In-hospital mortality was collected on all patients. The mean age was 64.7+/-11.6 years-old and younger patients were more often male than older patients (74.4% vs 51.9%). Preoperative COPD and peripheral vascular disease rates increased for those older than 60 years and decreased for those aged 30 to 49 years. Octogenarians had more congestive heart failure (62.5% vs 37.7%), urgent operations (39.2% vs 26.4%), aortic valve surgery (44.5% vs 26,8%) and off-pump CABG (77.8% vs 57.3%) than the younger groups. Hospital mortality was less than 2.0% in patients younger than 69 years-old, 3.5% in septuagenarians and 10,0%in octogenarians. While patients age at operation significantly influenced hospital mortality, this appeared to be a consequence of the increased frequency of risk factors and comorbidities together with decreased physiologic reserve in patients over 80 years of age.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 01/2008; 15(4):189-93.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 03/2007; 26(2):185-6. · 0.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aortic arch aneurysms may be treated with different surgical approaches. Each case represents a complex opportunity for choosing the best available strategy. We present three different cases in which a particular surgical choice was found to be the most adequate to the specific problem.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 01/2007; 14(4):191-4.
[Show abstract][Hide abstract] ABSTRACT: The authors report a case of a 68-year-old male, with no known cardiac disease until he suffered a cerebral embolic event related to the presence of a papillary fibroelastoma located in the mid third of the inferior left ventricular wall. They also perform a literature review, particularly of the specific characteristics of the tumor and the surgical approach. They point out that the location of the fibroelastoma described is very unusual; its clinical and echocardiographic characteristics are similar to those described for fibroelastomas with this location and the surgical approach should be decided for each individual patient. Thus transaortotomy, which provided better visualization and enabled complete removal of the tumor (which is essential for good clinical evolution and to avoid recurrence), was the option for surgical removal of this tumor.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 07/2006; 25(6):605-9. · 0.59 Impact Factor
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 07/2005; 24(6):907-8. · 0.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pericardial cysts are uncommon and benign abnormalities, usually asymptomatic, whose main interest lies in differential diagnosis with other mediastinal tumors. The authors present a case report of a 40-year-old male with a symptomatic pericardial cyst, located in the left cardiophrenic angle, which was resected by video-assisted thoracic surgery.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 04/2005; 24(3):435-8. · 0.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A task force commission was created with the support of the Portuguese Society for Cardiothoracic and Vascular Surgery with the aim of organizing a National Adult Cardiac Surgery Registry, collecting clinical data and types of cardiac surgical procedure performed in Portugal. Selected variables include risk factors, cardiac status, preoperative hemodynamics, surgical procedure, hospital stay and mortality. Information is collected into a database in each institution and sent via the internet to a central database responsible for grouping and data analysis. It is hoped that this National Registry, through standardized data collection, will provide information on cardiac surgery activity in Portugal and its risk adjusted results.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 11/2003; 22(10):1173-80. · 0.59 Impact Factor