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Search Results: 1 - 10 of 18591 matches for " Miguel Angel Maluf "
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Senning operation for correction of the transposition of the great arteries, results, long-term outcome and quality of life  [PDF]
Miguel Angel Maluf
World Journal of Cardiovascular Diseases (WJCD) , 2012, DOI: 10.4236/wjcd.2012.23036
Abstract: Objective: Long-term results after the Senning operation for transposition of the great arteries are little known. Sinus node dysfunction and systemic ventricular dysfunction are crucial in patient survival. We evaluated the results, long term outcome and quality of life in a group of 39 patients. Methods: The study was a retrospective analysis, of 39 (39/40 = 97.5%) surgical surviving patients, submitted to Senning operation, with a mean follow-up time of 14.7 +/– 3.1 years. Electrocardiogram, echocardiogram, and chest radiograph series were performed every 6 months. Thirty six patients of this series underwent Holter study and ergometric test, to evaluate the physical capacity. Three patients living overseas were excluded. Results: There was only one late death (1/39) (late mortality = 2.5%): a 16 year-old patient had a no cardiac death. The actuarial survival was 95.0% (38/40) (simple or with little VSD, TGA). The probability of staying in sinus rhythm, in 39 surviving patients was 77.1% (30) or normal right ventricular function was 76.5% (29), 10 to 20 years after operation. The incidence of sinus node and right ventricular dysfunction increased gradually over time. No re-operations and pacemaker implantation, was performed. Functional class: I = 30 (85.7%) cases and functional class II = 5 (14.3%) cases. Conclusions: Patients with simple TGA submitted to Senning procedure in our experience, presented during late follow-up: 1—Low incidence of right ventricular dysfunction and active arrhythmias; 2—Low mortality and no sudden death recorded; 3—Good quality of life and 4—Satisfactory surgical results (free of re-operation or definitive pacemaker implantation).
Late outcome of right ventricular outflow tract repair using bicuspid pulmonary prosthesis in tetralogy of Fallot surgery repair: case report
Maluf, Miguel Angel;
Revista Brasileira de Cirurgia Cardiovascular , 2009, DOI: 10.1590/S0102-76382009000500021
Abstract: we present a case of a 19 year-old female patient, with tetralogy of fallot and hypoplastic pulmonary ring. diagnosis was performed by echocardiography and cardiac catheterization. the surgical repair was performed at the age of 2 years old. a right ventricular outflow tract remodeling was performed using a porcine pulmonary bicuspid prosthesis. the patient presented a uneventful follow-up during 17 years. postoperative assessment has shown: mild pulmonary insufficiency and mild pulmonary ventricle gradient, satisfactory right ventricular performance and prosthesis not presenting calcification. this is an option to correct the tetralogy of fallot adopted by our institution in the last two decades.
One and a half ventricular repair as an alternative for hypoplastic right ventricle
Maluf, Miguel Angel;Carvalho, Antonio Carlos;Carvalho, Werther Brunow;
Revista Brasileira de Cirurgia Cardiovascular , 2010, DOI: 10.1590/S0102-76382010000400009
Abstract: objective: patients with complex congenital heart disease, characterized by right ventricle hypoplasia, had a palliative surgical option with one and a half ventricular repair. methods: from july 2001 to march 2009, nine patients (mean age 5.2 years, range 3 to 9 years) with hypoplastic right ventricle, underwent correction with one and a half ventricle technique. preoperative diagnoses included: pulmonary atresia with intact ventricular septum, in six and ebstein's anomaly, in three cases. six patients had bidirectional cavo-pulmonary shunt (glenn operation) previously. the surgical approach was performed with cardiopulmonary bypass to correct intracardiac defects: atrial septal defect closure (nine cases); right ventricle outlet tract reconstruction with porcine pulmonary prosthesis (seven cases); tricuspid valvuloplasty (three cases). results: there was one (11.1%) hospital death. all the patients left the hospital in good clinical conditions. one patient presented pulmonary stenosis at distal prosthesis anastomosis and needed surgical correction. there was one (12.5%) late deaths after reoperation. at mean follow-up of 39.8 months (range 16 months to 8.4 years) seven patients are alive in functional class i (nyha). conclusions: surgical treatment of congenital cardiac anomalies in the presence of a hypoplastic right ventricle by means of one and a half ventricle repair has the advantages of reducing the surgical risk of biventricular repair compared to the fontan circulation; it maintains a low right atrium pressure, a pulsatile pulmonary blood flow and improves the systemic oxygen saturation with short and medium-term promising results. longer follow-up is needed to prove the efficacy of such a repair in the long term.
Reconstru??o da continuidade ventrículo-pulmonar (conex?o VD-TP): técnicas e táticas cirúrgicas
ANIJAR, Alberto Mauro;MALUF, Miguel Angel;BUFFOLO, ênio;
Revista Brasileira de Cirurgia Cardiovascular , 1998, DOI: 10.1590/S0102-76381998000100007
Abstract: the author reviews the surgical techniques utilized for reconstruction of continuity of the right ventricle and pulmonary artery trunk, giving emphasis to the different techniques and their associations, depending on the anatomy of each cardiac malformation. he illustrates two cases operated with the use of a new concept of biologic prosthesis manufactured with pig pulmonary valve and artery trunk, preserved in glutaraldheyde. there are two models: bivalvar graft and tubular valvar graft, in the present experiment. from may 91 to june 95, forty eight cases were operated. in 43 cases the bivalvar graft was used and in 5 cases the tubular valvar graft was used. there were 5 deaths (10.4%) in the early postoperative period and 2 cases (4.6%) in the late period. this new concept of reconstruction of pulmonary valve and outlet of the right ventricle using integral biological graft, avoided pulmonary obstruction, insufficiency, and low incidence of calcification. this technique is easily reproduced.
Reconstru o da continuidade ventrículo-pulmonar (conex o VD-TP): técnicas e táticas cirúrgicas
ANIJAR Alberto Mauro,MALUF Miguel Angel,BUFFOLO ênio
Revista Brasileira de Cirurgia Cardiovascular , 1998,
Abstract: Os autores revisam as técnicas cirúrgicas utilizadas para a reconstru o da continuidade ventrículo direito (VD) e o tronco pulmonar (TP), dando ênfase às diferentes técnicas e associa o, dependendo das formas anat micas de cada les o. Apresentam, para ilustra o, 2 casos, operados com o uso de um novo conceito de prótese biológica produzida com a valva pulmonar e o tronco pulmonar suíno, preservados em glutaraldeído mediante dois modelos: retalho bivalvulado e tubo valvulado na experiência atual. No período de maio/91 e junho/95, foram operados 48 pacientes, em 43 foi usado retalho bivalvulado e, em 5 casos, prótese tubular valvulada. Houve 5 (10,4%) óbitos imediatos e 2 (4,6%) tardios. Este novo conceito de reconstru o da valva pulmonar e via de saída do ventrículo direito, usando heteroenxertos valvulados evita a insuficiência pulmonar significativa e apresenta baixa incidência de calcifica o. é uma técnica facilmente reprodutível.
Late surgical correction of anomalous left coronary artery from pulmonary trunk in children, using autogenous aortic and pulmonary endotheliazed tube  [PDF]
Miguel A. Maluf
World Journal of Cardiovascular Diseases (WJCD) , 2012, DOI: 10.4236/wjcd.2012.23022
Abstract: Background: Direct re-implantation of an anomalous left coronary artery into the aorta is the preferred surgical option for creating a dual coronary arterial system in patients in whom the anomalous artery originated from the pulmonary trunk. This technique, however, is applicable only when the anomalous ar- tery arises from the left posterior pulmonary sinus. We report the successfully late follow-up of series of patients employing a new technique using combined autogenous aortic and pulmonary endotheliazed tube. Patients and Methods: We have treated 3 patients, aged 2 months, 6 months and 8 months respectively, who presented with anomalous origin of the left coronary artery from the left posterior pulmonary sinus and moderated mitral valve insufficiency by left ventricle dysfunction. We used a trapdoor like coronary artery elongation with autogenous aortic and pulmonary endotheliazed tube to connect the left coronary ostium to ascending aorta, avoiding the mitral valve intervention. Results: There was no early or late death. All patients are in functional class I, with good biventricular function and competent mitral valve at a median follow-up of 94 months, ranged from 108 to 132 months. Postoperative Computerized tomogramphy of aorta in our 1st patient showed good arterial flow, without any distortion. A local and distal stenosis of the left pulmonary artery was observed and submitted to stent treatment. Conclusions: The potential benefits of the trapdoor like and its modification technique are excellent operative exposure. The use of autogenous endothelized tube is a viable tissue capable of further growth, avoidance of injury to the aortic and pulmonary valvar apparatus or production of obstruction within the right ventricular outflow tract.
Assessment of splanchnic perfusion with gastric tonometry in the immediate postoperative period of cardiac surgery in children
Souza, Renato Lopes de;Carvalho, Werther Brunow de;Maluf, Miguel Angel;Carvalho, Antonio Carlos;
Arquivos Brasileiros de Cardiologia , 2001, DOI: 10.1590/S0066-782X2001001200002
Abstract: objective - a prospective, nonrandomized clinical study to assess splanchnic perfusion based on intramucosal ph in the postoperative period of cardiac surgery and to check the evolution of patients during hospitalization. methods - we studied 10 children, during the immediate postoperative period after elective cardiac surgery. sequential intramucosal ph measurements were taken, without dobutamine (t0) and with 5mcg/kg/min (t1) and 10 (t2) mcg/kg/min. in the pediatric intensive care unit, intramucosal ph measurements were made on admission and 4, 8, 12, and 24 hours thereafter. results - the patients had an increase in intramucosal ph values with dobutamine 10mcg/kg/min [7.19± 0.09 (t0), 7.16±0.13(t1), and 7.32±0.16(t2)], (p=0.103). during the hospitalization period, the intramucosal ph values were the following: 7.20±0.13 (upon admission), 7.27±0.16 (after 4 hours), 7.26±0.07 (after 8 hours), 7.32±0.12 (after 12 hours), and 7.38±0.08 (after 24 hours), (p=0.045). no deaths occurred, and none of the patients developed multiple organ and systems dysfunction. conclusion - an increase in and normalization of intramucosal ph was observed after dobutamine use. measurement of intramucosal ph is a type of monitoring that is easy to perform and free of complications in children during the postoperative period of cardiac surgery.
Guia de tomada de decis?o em cardiopatias congênitas em página Web na Internet: modelo Atresia Tricúspide
CAL, Ruy Guilherme Rodrigues;MALUF, Miguel Angel;BRANCO, Jo?o Nelson Rodrigues;BUFFOLO, ênio;
Revista Brasileira de Cirurgia Cardiovascular , 1999, DOI: 10.1590/S0102-76381999000200013
Abstract: stimulated by the challenge of updating and organizing all the information acquired in the health field, computer medicine has developed on a wide global scale. the recent success of the internet for distribution of information has created a need for the production and distribution of medical programs for use via this network. the creation of a decision-making program through the world wide web for congenital heart diseases could provide updated information for cardiac surgeons, pediatricians and cardiologists involved in patient management. the objectives of this project were the following: - to create a of decision-making model in pediatric cardiac surgery using tricuspid atresia, a complex congenital heart disease, as an example; - to evaluate the complexity of the creation of this model and the benefits of using the computer and the web interface; - to test its validity in 16 cases treated at the "universidade federal de s?o paulo" (unifesp) between 1980 and march 1997. using suitable hardware and html program language, this program was developed using a group of the texts; 7 pictures and 37 images. during creation of this program, the possibility of its easy development and rapid updating was demonstrated. the validation analysis showed a significant agreement (91.7%) with the surgical indication performed by specialists at the unifesp.
Guia de tomada de decis o em cardiopatias congênitas em página Web na Internet: modelo Atresia Tricúspide
CAL Ruy Guilherme Rodrigues,MALUF Miguel Angel,BRANCO Jo?o Nelson Rodrigues,BUFFOLO ênio
Revista Brasileira de Cirurgia Cardiovascular , 1999,
Abstract: Estimulada pelo desafio de gerenciar toda a informa o envolvida na forma o do conhecimento na área de saúde, a Informática Médica desenvolveu-se em larga escala em todos os países. O recente sucesso da rede Internet como veículo de distribui o de informa o incentiva a elabora o de programas médicos para utiliza o através dessa rede. A elabora o de um programa de apoio à decis o - para cardiopatias congênitas em forma de documento em hipertexto de World-Wide Web - apresentado pela Internet possibilitaria o aproveitamento das características de processamento e armazenamento distribuído dessa rede. Este projeto teve como objetivos: criar um modelo de guia de tomada de decis o em cirurgia cardíaca pediátrica usando como base a Atresia Tricúspide; avaliar o grau de complexidade da cria o deste modelo e os benefícios pelo emprego de interface em página WEB; testar sua valida o com os casos de 16 pacientes tratados na Universidade Federal de S o Paulo, no período de 1980 a mar o de 1997. Com a utiliza o de hardware adequado e da linguagem de programa o HTML, o programa foi desenvolvido com a utiliza o de 7 telas de fluxograma, conjunto de textos e 37 ilustra es. Durante a elabora o deste modelo foi possível constatar a possibilidade de fácil desenvolvimento e rápida atualiza o. O resultado da valida o mostrou concordancia significativa (91,66%) com as indica es cirúrgicas realizadas pelos especialistas, na Universidade Federal de S o Paulo.
Estudo comparativo da ultrafiltra o convencional e associa o de ultrafiltra o convencional e modificada na corre o de cardiopatias congênitas com alto risco cirúrgico
MALUF Miguel Angel,MANGIA Cristina,BERTUCCEZ Jo?o,SILVA Célia
Revista Brasileira de Cirurgia Cardiovascular , 1999,
Abstract: A necessidade de corre o cirúrgica de má-forma es cardíacas complexas, que requerem tempos prolongados de circula o extracorpórea (CEC) aumentou a morbimortalidade devido a reten o hídrica e rea o inflamatória sistêmica. O objetivo deste estudo é comparar a evolu o pós-operatória imediata de pacientes submetidos a ultrafiltra o convencional (UFC) durante a CEC e ultrafiltra o modificada (UFM) após CEC. Quarenta e um pacientes submetidos a corre o cirúrgica de cardiopatias congênitas foram divididos em 2 grupos: G1: 21 pacientes com idade de 15 dias a 36 meses (mediana: 11 meses) e peso de 3,6 a 13,5 kg (M: 7,27 ± 3,07), operados entre 1996 e 1997, foram submetidos a UFC. G2: 20 pacientes com idade de 9 dias a 36 meses (mediana: 5,5 meses) e peso entre 2,2 e 12 kg (M: 5,7 ± 2,5), operados entre 1997 e 1998, foram submetidos a UFC+UFM. Dentre as opera es mais freqüentes temos: ventriculosseptoplastia, 15 (36,5%) casos; opera o de Jatene, 10 (24,3% ) casos; corre o de defeito septal A-V total, 7 (17,0%) casos etc. A análise estatística de idade, peso e complexidade cirúrgica mostrou semelhan a entre os grupos. Houve 6 (28,5%) óbitos no G1 e 4 (20%) no G2, (p=0,71). O volume médio ultrafiltrado no G1 (UFC) foi 143,3 ml e no G2 (UFC+UFM) foi 227,0 ml, (p<0,001), mostrando diferen a estatisticamente significante. Porém o tempo médio de ventila o mecanica (G1: 94.8h, G2: 95.6h, p= 0.97), tempo médio de uso de drogas inotrópicas (G1: 145.2h e G2: 137.6h, p=0.85); tempo médio de permanência em UTIP (G1: 169.6h e G2: 157.8h, p= 0.79) e tempo médio de permanência hospitalar (G1: 14,8 d. e G2 14,6 d., p= 0,95), n o mostraram diferen as significantes entre os grupos. A técnica de UFC utilizada a mais de 8 anos no nosso Servi o mostrou resultados semelhantes quando comparada com a associa o de UFC+UFM. A UFM mostrou-se eficaz na remo o de água corpórea após CEC, n o havendo intercorrências com o método. Talvez um estudo randomizado, recrutando um número maior de pacientes permita detectar diferen as entre os dois métodos.
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