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ARTIGO ORIGINAL

Autotransplante cardíaco: um novo método no tratamento de problemas cardíacos complexos

Randas J. V BatistaI; Marcos FranzoniI; Dalton PrécomaI; Lise BochinoI; Paulo NeryI; Eduardo OliveiraI; Rosane CarvalhoI; Noriaki TakeshitaI; Murilo FurukawaI; Lisias ThomeI; Francisco J LinoII; José Luiz Verde dos SantosI; Marco A CunhaII

DOI: 10.1590/S0102-76381995000200005

RESUMO

No período de janeiro de 1990 a maio de 1995 foram operados com a técnica do autotransplante cardíaco 92 pacientes com cardiopatias complexas e arritmias supraventriculares, principalmente fibrilação atrial (n=89), reentrada (n=2), QT longo (n=1). O sexo feminino predominou (n=63). A idade variou de 18 a 76 anos (m=43). Os defeitos concomitantes foram: átrio esquerdo gigante (medido pelo ecocardiograma > 6 cm) (n=65); átrio direito gigante (n=9); átrio esquerdo aumentado (< 6 cm/>4 cm) (n=23); estenose mitral (n=46); insuficiência mitral (n=28); dupla lesão mitral (n=16); estenose aórtica (n=12); insuficiência aórtica (n=5); insuficiência tricúspide (n=78); trombose atrial (n=23); calcificação atrial (n=12); hipertensão pulmonar (n=86); fibroelastose biventricular (n=3); rotura atrioventricular (pós-troca de valva mitral) (n=1); aneurisma da raiz aórtica (n=1); ventriculectomia parcial (n=8); 88 pacientes saíram do centro cirúrgico em ritmo sinusal e assim permaneceram; 6 precisaram de drogas inotrópicas e 3 de drogas antiarrítmicas. Todos os pacientes que apresentavam átrio esquerdo ou direito gigante com fibrilação atrial tiveram seus átrios reduzidos ao tamanho normal. Não houve mortalidade operatória e 6 evoluíram a óbito hospitalar. Na reavaliação aos seis meses de pós-operatório, os sobreviventes estavam bem, em ritmo sinusal. A técnica do autotransplante cardíaco facilita o reparo intracardíaco, proporciona a redução atrial e conseqüente retorno do paciente ao ritmo sinusal e abre novas perspectivas.

ABSTRACT

From January 1990 to May 1995,92 patients with complex cardiac problems and supraventricular arrhythmias were operated upon with the technique of heart autotransplantation. The arrhythmias were: atrial fibrillation (n=89); reentry (n=2); long QT syndrome (n=1). Females predominated (n=63). The age varied from 18 to 76 years (m=43). Concomittant defects were: giant left atrium (> 6 cm measured by echo) (n=65); giant right atrium (n=9); large left atrium (< 6 cm./>4 cm) (n=23); mitral stenosis (n=46); mitral insufficiency (n=28); mitral double lesion (n=16); aortic stenosis (n=12); aortic insufficiency (n=5); tricuspid insufficiency (n=75); atrial thrombosis (n=23); atrial calcification (n=12); pulmonnary hypertension (n=86); biventricular fibroelastose (n=3); atrioventricular rupture (n=1); aortic root aneurysm (n=1); partial ventriculectomy (n=8); 88 patients left the operating room and remained in sinus rhythm; 6 required inotropic drugs and 3 antiarrhythmic drugs. All patients with giant atria and atrial fibrillation had their atria reduced to normal sizes. There were no OR mortality and 6 patients died during hospitalization. Six months later the survivors were clinically well, in sinus rhythm. The technique of heart autotransplantation facilitates intracardiac reppairs, provides atrial reduction and returns patients with atrial fibrillation into sinus rhythm, and opens new frontiers.
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