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Enxerto venoso intercoronariano na revascularização de artéria coronária comprometida por dissecção de aorta tipo I

Carlos Alberto C Abreu FilhoI; Richard H CabralI; Alexandra P GasparI; Luís Alberto DallanI; Sérgio Almeida de OliveiraI; Adib D JateneI

DOI: 10.1590/S0102-76381995000100008

RESUMO

Between January 1980 and December 1993, 291 patients underwent valve replacement with mechanical valves in the Heart Institute of HCFMUSP. One hundred and eighty seven (64.3%) patients were male, aged between 2 months and 78 years (average 38.3 +/-18.5). The ethiology was rheumatic in 132 patients (45.4%). Were inserted 315 mechanical valves, 201 aortic, 77 mitral, 15 double aortic-mitral, 2 tricuspid, 1 double mitral-tricuspid, and 1 triple mitral-aortic-tricuspid. There were associated procedures in 164 patients (56.4%), the most frequent was replacement of ascending aorta in 49 (16.8%). One hundred and forty one patients (48.4%) underwent previous heart valve surgery. Follow-up data are reported concerning functional status (NYHA) and valve related complications. Early mortality rate was 12.4% (36 patients). Followup totaled 10078 months/patient (159 patients), with a mean follow-up period of 40.6 months. The linearized rates of thromboembolism, hemorrhage related to antithrombotic therapy, late death, endocarditis, paravalvular leak and hemolysis were 1.33%, 0.95%, 1.9%, 0.19%, 0.57% and 0.57% patients/year, respectively. Fourteen year survival rate was 63.8%. Eighty two percent of the patients were in functional class I in the postoperative period. It was possible to conclude that the patients submitted to mechanical valve replacement had a satisfactory clinical evolution.

ABSTRACT

A thirty nine-year-old patient presenting arterial hypertension was operated upon for type I acute aortic dissection. Due to important alterations in the ascendent aorta with involvement of the right coronary ostium, the surgical procedure included resection of the segment of aorta containing the intimal tear and replacement with a Dacron prosthesis, suspension of the aortic valve and ligadure of the right coronary ostium. Technical difficulties brought the necessity of a different approach for the myocardium revascularization. Instead of the traditional described procedures, an intercoronary venous graft was put between the anterior interventricular artery (branch of the left coronary artery) and the right coronary artery. The intercoronary graft presented a good flow since the begining, keeping a good myocardial contratility. Patient left the hospital in a good clinical condition, with preserved myocardial function. Intercoronary graft should be an efficient alternative for revascularization of a corohary artery involved by aortic dissections.
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Article receive on quarta-feira, 31 de maio de 1995

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