Rev Bras Cir Cardiovasc 2009; 24(1): 101-102
Letters to the Editor
CardiomyoplastyDear Mr. Editor
It is undeniable that we are living in a time of change of the heart surgery. With the maturity reached by the fiftiethanniversary of this speciality, we realize that some cycleshave occurred. Despite the immeasurable progress andsubstantial improvement of outcomes in all types of heartsurgery procedures, a clinical entity still needs our deepestattention, that is the heart failure syndrome. This is clear inthe European Journal of Cardio-Thoracic Surgery of February (vol 35, No. 02, 2009), on which the first six articlesdeal with heart failure, starting with the editorial andculminating with an article about the management of diastolic heart failure in cardiac surgery. Mainly, it startswith cardiomyoplasty. And cardiomyoplasty is the reasonI write this letter. I mean, due to the editor of our Journal.When watching the lectures of PhD Professor Domingo M.Braile about heart failure, we always have heard and stillhear the message about the fact that cardiomyoplasty wasneglected early and that it could be an interesting option.We enter in a cycle of modern approach to heart failurepatients, on which the treatment must be multidisciplinaryand requires full cooperation between surgeons andcardiologists. A number of innovative options are beingimplemented, such as cell therapy and ventricular assistdevices, however, there is a considerable contingent of patients who may have better quality of life and increasedsurvival with existing procedures on which we surgeonsare trained: CABG, replacement and valve repair, ventricularreconstruction, and resynchronization therapy after hearttransplantation.Another almost immeasurable amount of patients willhave no option. Either by stagnancy in the number of organdonors or the high mortality on the waiting list or, finally,the limitations and contra-indications to hearttransplantation. Due to the greater involvement of surgeonsin heart failure programs, the greatest knowledge of imagingmethods, better care of patients and major advance in termsof electrophysiology make us believe that cardiomyoplastywill return. Twenty five years after the initiation of cardiomyoplasty, we have strong reasons to invest in thistechnique: 1) new concepts in preservation and musclestimulation, 2) maturity of indications and contra-indications, 3) overcome in resynchronization therapy, 4)the use of associated implantable defibrillators; 5) theurgent need for alternatives to transplantation, 6) the cost,and the insoluble problems with the anti-clotting and theventricular assist devices infection.Thanks to PhD Professor Braile for allowing us to viewmore distant horizons.
Gustavo Calado A Ribeiro, Campinas-SP
The Stretchers from Emergency Room (ER)
In July 1990, Professor Adib Jatene wrote on Folha deSão Paulo: “The ER of the Clinics Hospital always has morepatients on stretchers than in bed”.This fact, reported by the press, resulted in thesuperintendent’s resignation, as written by him.In the article from 1990, he describes the dedication of anursing assistant - Joaninha - true symbol of the ClinicsHospital’s employees.The number of stretchers, as usual, was greater thanbeds. And he recalls that he imediatly felt what the ERstretchers mean.Despite the dedication of many Joaninhas, the ERstretcher is a symbol and a libel: symbol of the unequalstruggle of Health personnel to meet those suffering.Symbol of fraternity and solidarity, who does not hesitateto assist, even under unfavorable conditions, and doesnot surrender, stands, waits, believes and acts with thebraveness of those who fulfills a mission, not a timetable.Symbol of dignity, who does not reject the charity anddonates his own work, not to the Government, but to thepatient, while claims to this same Government. Libel againstthe indifference, the inability of this Government to solvethe problem and the lack of political will and humanity,because the Government does not sorely feel the socialproblems.In Brazil, we are used to find the culprits, and not tooffer solutions, that is what we need now.More than one hundred years ago, Dr. João Penido, inMinas, addressed his colleagues and authorities during acholera epidemic that threatened the city, assuming thatthe news was true, but he did not have resources to solvethe problem. Any costs, any measures, all medicines,depended on the central government. Thus, the alternativeof Municipal Councils was to request all through theProvincial Assembly but they were not met at all.The situation is still actual. The SUS was created undermunicipal basis. The Constitution and health legislation