Papers by Leonardo Canale
Arquivos Brasileiros de Cardiologia, 2007
The incidence of cardiogenic shock following acute myocardial infarction (AMI) is 7.5%, with a le... more The incidence of cardiogenic shock following acute myocardial infarction (AMI) is 7.5%, with a lethality of 60% to 80% 1 . Mortality among these patients remains high even when revascularization of the responsible artery is performed immediately 1,2 . Within this context, the use of mechanical ventricular support seems to improve the surgical results and long-term survival 2,3 .
Arquivos brasileiros de cardiologia
The extracorporeal membrane oxygenation (ECMO) has been used in the neonatal and childhood period... more The extracorporeal membrane oxygenation (ECMO) has been used in the neonatal and childhood periods with excellent results. The adult experience has been modest with inferior immediate results. The intermediate survival, however, has been promising. We have been using the extracorporeal membrane oxygenation for temporary mechanical circulatory support of adults that present with acute refractory cardiogenic shock in our institution. There is no other published experience of the use of this system in this scenario in Brazil. To describe our experience with the use of the extracorporeal membrane oxygenation for circulatory support in adults. Retrospective analysis of the medical files of patients submitted to the implant of extracorporeal membrane oxygenation system for circulatory assistance in acute and refractory cardiogenic shock. Eleven patients (63,5 yo; 45,5% male) were considered for analysis from 2005 to 2007. Median support time was 77 hours (10-240 h) and 5 patients have sur...
Journal of thoracic disease, 2013
Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible ... more Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the "best of both worlds" from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations.
Revista brasileira de cirurgia cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however... more Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.
Arquivos brasileiros de cardiologia, 2011
Atrial fibrillation with tissue ablation device through bipolar radiofrequency in conjunction wit... more Atrial fibrillation with tissue ablation device through bipolar radiofrequency in conjunction with cardiac surgery has proven to be an effective method to treat this arrhythmia. Describe the initial experience of the Instituto Nacional de Cardiologia in the surgical treatment of atrial fibrillation using bipolar radiofrequency device in patients undergoing cardiac surgery, reporting the results of postoperative follow-up of one year. Between January 2008 and March 2009, 47 consecutive patients (36 women), with mean age of 53.7 ± 10.6 years, with atrial fibrillation for a mean period of 34.6 months (3-192 months) underwent surgical ablation of this arrhythmia, through bipolar radiofrequency during the procedure which led to the indication of surgery. Eight of them showed intermittent atrial fibrillation and 39, continued. Eighty-one percent underwent valve surgery as the main procedure. This is a one-year postoperative retrospective, observational evaluation of clinical variables and...
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Brazilian Journal of Cardiovascular Surgery, 2006
Post-infarct sub-acute left ventricular free wall rupture: case report and review of the literatu... more Post-infarct sub-acute left ventricular free wall rupture: case report and review of the literature Abstract Post-infarction left ventricular free wall rupture is life threatening and not uncommon. Surgical experience is largely anecdotal with different techniques being used since the first successful surgical treatment was described. Here we present two patients with subacute left ventricular rupture that were managed using different perioperative strategies. Although the aim of surgical intervention was first and foremost to remove the threat to life by relieving the tamponade and closure of the ventricular defect, longer-term goals were those of conventional coronary artery operations, i.e., to prevent or limit the development of angina postoperatively and to improve the prognosis. These latter goals are controversial, and are discussed. The small number of patients involved prevent us to determine which approach is best but some surgeons, like us, advocate the concomitant procedure, whenever feasible, which achieves revascularization early and avoids the risk of repeat infarctions in the early postoperative period and the difficulties of early pericardial adhesions at reoperation. Combining the epicardial patch repair and complete myocardial revascularization appears to be the most attractive option for some patients that present with subacute left ventricular free wall rupture.
Interactive CardioVascular and Thoracic Surgery, 2009
Myxomas are the most common type of cardiac benign tumors and most of them are located in the lef... more Myxomas are the most common type of cardiac benign tumors and most of them are located in the left atrium, followed by the right atrium. Myxomas in the right atrium may rarely embolize to the pulmonary arterial vasculature. Here, we present a case report of a patient with right atrial myxoma and massive embolism to the pulmonary arteries treated surgically with right atrial mass removal and pulmonary embolectomy. The right atrium mass presented with prolapse through the tricuspid valve causing a stenotic physiology. The left pulmonary artery was completed occluded and the right pulmonary artery was partially obstructed. Surgical tactics included a brief hypothermic circulatory arrest. The patient had an uneventful recovery and was asymptomatic after 6 months of follow-up.
Revista Brasileira De Cirurgia Cardiovascular, 2006
Resumo A ruptura da parede livre do ventrículo esquerdo é uma complicação potencialmente fatal e ... more Resumo A ruptura da parede livre do ventrículo esquerdo é uma complicação potencialmente fatal e de tratamento essencialmente cirúrgico. A correção cirúrgica é o tratamento de escolha, mas o manejo pré-operatório e as técnicas de correção ainda não estão claramente definidos, sendo determinados conforme as condições clínicas do paciente. Há carência na literatura de grandes séries envolvendo este tipo de
Interactive cardiovascular and thoracic surgery, 2007
We report our results on surgical treatment of complete atrioventricular septal defects using the... more We report our results on surgical treatment of complete atrioventricular septal defects using the two-patch technique. Forty patients with complete atrioventricular septal defects were operated on in the period from November 1995 to January 2004 and retrospectively analyzed. The age at the time of surgery ranged from 4 months to 20 years (average=18.8+/-37 months). Their weights ranged from 3 to 39 kg (average=7.6+/-5.8 kg). Associated tetralogy of Fallot was present in 20% of the cases (8 patients). Monitoring was complete until January 2007, corresponding to a follow-up ranging from 36 to 135 months (average=74+/-33.7 months). The surgical mortality rate was 2.5% and the hospital mortality rate was 5%. A third patient died from a brain abscess two years after surgery. Over the long-term, two patients needed further operations: one was submitted to mitral plasty due to severe residual mitral insufficiency, one year later; the other underwent a resection of a sub-aortic membrane aft...
Interactive cardiovascular and thoracic surgery, 2009
Anomalous coronary arteries arising from the pulmonary trunk is a rare but potentially fatal cond... more Anomalous coronary arteries arising from the pulmonary trunk is a rare but potentially fatal condition. We report the clinical presentation, surgical treatment and long-term follow-up of seven surgical cases of anomalous left coronary and one case of anomalous right coronary artery arising from the pulmonary artery. Age ranged from 7 months to 13 years (average: 5.09+/-3.7 years) and weight ranged from 7 to 50 kg (average: 19.9+/-8.8 kg). Follow-up was 100% complete: average 78 months (S.D.: 52.7 months). Direct reimplantation was the surgical technique in six cases, Takeuchi procedure in one case and subclavian artery interposition in one case. Concomitant mitral valve repair was undertaken in two cases. In two children the coronary artery anomaly was diagnosed and treated only after a first surgery for other congenital heart anomaly. Left ventricle ejection fraction was restored in those cases of pre-operative dysfunction. Mortality was not observed and all children are asymtomati...
Revista Brasileira de Cirurgia Cardiovascular, 2010
Introduction: The present report describes the technique for &amp;amp;amp;amp;amp;amp;amp;amp... more Introduction: The present report describes the technique for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;inverted L&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; upper ministernotomy with central canulation for the treatment of simple congenital cardiopathies and presents the initial results. Methods: Ten patients (mean age: 7 ± 4.2 years; mean weight 29.1 ±13.5 kg) were operated on between January 2006 and July 2007. Results: All defects were corrected. No death was observed and
Revista Brasileira de Cirurgia Cardiovascular, 2014
Current technology in robotic surgery allows us to perform myocardial revascularization procedure... more Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy).
Anomalous coronary arteries arising from the pulmonary trunk is a rare but potentially fatal cond... more Anomalous coronary arteries arising from the pulmonary trunk is a rare but potentially fatal condition. We report the clinical presentation, surgical treatment and long-term follow-up of seven surgical cases of anomalous left coronary and one case of anomalous right coronary artery arising from the pulmonary artery. Age ranged from 7 months to 13 years (average: 5.09"3.7 years) and weight ranged
Revista brasileira de cirurgia cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. ... more Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system.
Arquivos Brasileiros De Cardiologia, 2007
The incidence of cardiogenic shock following acute myocardial infarction (AMI) is 7.5%, with a le... more The incidence of cardiogenic shock following acute myocardial infarction (AMI) is 7.5%, with a lethality of 60% to 80% 1 . Mortality among these patients remains high even when revascularization of the responsible artery is performed immediately 1,2 . Within this context, the use of mechanical ventricular support seems to improve the surgical results and long-term survival 2,3 .
CEP
Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however... more Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.
Cardiology in the Young, 2008
Our aim is to describe our surgical approach in dealing with patients having atrioventricular sep... more Our aim is to describe our surgical approach in dealing with patients having atrioventricular septal defect with common atrioventricular junction and ventricular shunting associated with tetralogy of Fallot over the last 8 years, and to present our results in mid-to-long term follow-up. Between November 1995 and January 2004, we performed surgical correction in 8 consecutive children with atrioventricular septal defect, common atrioventricular junction, interventricular shunting, and associated tetralogy of Fallot. The age at surgical correction varied from 8 months to 20 years, with a mean of 45 months, and standard deviation of 74 months. A palliative systemic-to-pulmonary shunt had previously been performed in 3 patients. Follow-up ranged from 57 to 135 months, with a mean of 93.5 months, and standard deviation of 32 months. We used a two-patch technique to repair of the atrioventricular septal defect, and a pericardial transjunctional patch for relief of the obstruction in the right ventricular outflow tract. There were no deaths, nor reoperations either in the postoperative period or during follow-up. All patients are asymptomatic, or in the second class created by the New York Heart Association. The mean period of cardiopulmonary by-pass was 136 minutes, and the mean stay in hospital was 11.8 days. At the last examination, pulmonary valvar insufficiency was considered severe in 2 patients, and moderate in another 2. No patient developed more than a trace of regurgitation across the reconstituted left atrioventricular valve. The two-patch technique, associated with ventriculotomy and a transjunctional pulmonary patch is safe and efficient when correcting atrioventricular septal defect associated with tetralogy of Fallot, resulting in good mid-to-long term clinical outcomes.
Arquivos Brasileiros de Cardiologia, 2009
Alexandre Siciliano Colafranceschi1,2, Andrey José de Oliveira Monteiro1,2, Eduardo Souza Leal Bo... more Alexandre Siciliano Colafranceschi1,2, Andrey José de Oliveira Monteiro1,2, Eduardo Souza Leal Botelho1,2, Leonardo Secchin Canale1, Arnaldo Rabischoffsky2, Ieda Prata Costa1,2, Fernando Eugênio dos Santos Cruz Filho2, Roberto Luiz Menssing da Silva Sá1,2, Ana Luiza ...
Arquivos Brasileiros de Cardiologia, 2008
Artigo recebido em 03/07/07; revisado recebido em 15/09/07; aceito em 30/11/07. Resumo Fundamento... more Artigo recebido em 03/07/07; revisado recebido em 15/09/07; aceito em 30/11/07. Resumo Fundamento: A oxigenação por membrana extracorpórea (ECMO) em recém-nascidos e crianças tem resultados excelentes. A experiência em adultos é mais modesta e os resultados imediatos são inferiores. Entretanto, a sobrevida em cinco anos de pacientes que sobrevivem a esse método é bastante promissora. Não há relato na literatura brasileira de experiências com esse sistema nesse contexto. Objetivo: Relatar a experiência com o uso da oxigenação por membrana extracorpórea no adulto que se apresenta em choque cardiogênico agudo e refratário. Métodos: Análise retrospectiva de prontuários médicos de pacientes submetidos a implante do sistema de oxigenação por membrana extracorpórea para a assistência circulatória no choque cardiogênico agudo e refratário. Resultados: Onze pacientes (63,5 anos; 45,5% homens) foram considerados para análise no período de 2005 a 2007. O tempo médio de suporte circulatório foi de 77 horas (10-240h) e cinco pacientes estavam vivos em 30 dias (45,5%). Dois pacientes foram subseqüentemente submetidos a implante de assistência circulatória prolongada após um período de ressuscitação em ECMO, um dos quais foi submetido ao transplante cardíaco. As causas de morte durante a assistência com ECMO (seis pacientes) incluíram falência multiorgânica (66,6%) ou sangramento refratário (33,4%). Conclusão: O sistema ECMO é uma opção de assistência circulatória temporária para pacientes adultos com falência cardíaca aguda refratária, podendo ser utilizado como ponte para a recuperação ou com o intuito de selecionar candidatos à assistência circulatória prolongada (ponte para a ponte). (Arq Bras Cardiol 2008;91(1):36-41) Palavras-chave: Circulação extracorpórea com oxigenador de membrana, cirurgia torácica, parada cardíaca, falência de múltiplos órgãos, choque cardiogênico.
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Papers by Leonardo Canale