Fontan Operation and the Cavopulmonary Technique: Immediate and Late Results According to the Presence of Atrial Fenestration

OBJECTIVE: To compare immediate and late results in patients with or without fenestration who underwent cavopulmonary anastomosis so that we could assess the efficiency of the technique. METHODS: Sixty-two patients underwent surgery between 1988 and 1999, 41 with fenestration (group I -G I) and 21 without fenestration (group II -G II). Tricuspid atresia was prevalent in group I (23-56%) and single ventricle was prevalent in group II (14-66%). Mean ages at the time of operation were 7.3 years in group I and 7.6 in group II. At late follow-up, mean ages were 10.6 years in group I and 12.8 years in group II. RESULTS: Immediate and late mortality were 7.3% in G-I and 4.7% in G-II. Significant pleural effusion occurred in 41.4% of G-I patients and in 23.8% of G-II patients. Significant pericardial effusion occurred in 29.2% and 14.2%, respectively, in groups I and II. Central venous pressure was greater in G-II, 17.7 cm in H2O, as opposed to 15 cm in G-I. Hospital stay was similar between the groups, 26.3 and 21.8 days, respectively. Cyanosis and arterial insaturation occurred in 5 patients, and 4 patients were in functional class II, all from G-I. At late follow-up, 58 (93.5%) were in functional class I. Sinus rhythm was present in 94%, and pulmonary perfusion was similar in both groups. Eleven patients who underwent spirometry had good tolerance to physical effort. CONCLUSION: Atrial fenestration did not improve the immediate or late follow-up of patients who underwent cavopulmonary anastomosis, and is, therefore, dispensable.

Late Clinical Outcomes of the Fontan Operation in Patients with Tricuspid Atresia

OBJECTIVE: Evaluation of the long-term clinical results of the Fontan operation in patients with tricuspid atresia. METHODS: A retrospective analysis was made at the Instituto de Cardiologia do Rio Grande do Sul (Institute of Cardiology of Rio Grande do Sul), from August 1980 through January 2000, of 25 patients with a long-term follow-up, out of a series of 36 patients who underwent the Fontan operation or one of its variants due to tricuspid atresia. Their mean age at surgery was 5.4±3.1 years, and their mean weight was 15.8±6.1 kg, the majority of them (63.9%) being males. Four patients underwent the classical Fontan operation, 12 the Kreutzer variant, 6 the Björk variant, 9 total cavopulmonary shunt with a fenestrated tube, and 5 total cavopulmonary shunt with a nonfenestrated tube. RESULTS: The patients were followed-up on an outpatient basis, with a mean long-term survival time of 5.5±4.2 years (50 days to 17.8 years) and a late mortality rate of 8%. Arterial saturation increased from 77.2±18.8% in the preoperative period to 91±6.7% upon the last outpatient visit (p>0.05). At the final check, most (67%) patients were asymptomatic and 87% could tolerate exercise. Ten (40%) patients experienced some kind of complication during the long-term follow-up, such as cardiac arrhythmia, cyanosis, protein-losing enteropathy, neurological events, right heart failure, intolerance to exercise and reoperation. CONCLUSION: The results indicate that, once the immediate postoperative period is over, during which the adaptations to the new circulatory physiology occur, the evolution of patients with tricuspid atresia who underwent the Fontan operation is satisfactory, in spite of a low, yet significant, morbidity.

Microgeneration of electricity with producer gas in dual fuel mode operation

Among the alternatives to meet the increasing of world demand for energy, the use of biomass as energy source is one of the most promising as it contributes to reducing emissions of carbon dioxide in the atmosphere. Gasification is a technological process of biomass energy production of a gaseous biofuel. The fuel gas has a low calorific value that can be used in Diesel engine in dual mode for power generation in isolated communities. This study aimed to evaluate the reduction in the consumption of oil Diesel an engine generator, using gas from gasification of wood. The engine generator brand used was a BRANCO, with direct injection power of 7.36 kW (10 HP) coupled to an electric generator 5.5 kW. Diesel oil mixed with intake air was injected, as the oil was injected via an injector of the engine (dual mode). The fuel gas was produced in a downdraft gasifier. The engine generator was put on load system from 0.5 kW to 3.5 kW through a set of electrical resistances. Diesel oil consumption was measured with a precision scale. It was concluded that the engine converted to dual mode when using the gas for the gasification of wood decreased Diesel consumption by up to 57%.

Cellulase effect on anaerobic digestion of maize silage under discontinuous operation

ABSTRACT This paper studied the effect of adding an enzyme (ellulose) on anaerobic digestion of maize silage. We compared materials at chopping lengths of 8 mm (MSL), 4mm (MSS) and natural size (Ms) under a mesophilic and discontinuous operation (batch process). Hence, we found the process to be significantly influenced by particle size. Moreover, the ellulose addition did not significantly impact biogas production after a 35-day digestion period. Ms and MSS displayed an improved response to all variables when compared with MSL and MSL+C, with significant differences. Studies on the refractory fraction at infinite time (R0) have demonstrated that the lowest values correspond to Ms and MSS (0.122 and 0.155, respectively). The Kinetic approach and the Ultimate Biodegradability test are useful tools to evaluate the effect of the addition of an enzyme to the anaerobic process.