Estudo angiográfico da revascularização do miocárdio pelo procedimento de vineberg correlacionado com imagem intraoperatória
Instituto Dr. Glauco Lobo, Fortaleza, CE - Brasil
A técnica de Vineberg consiste no implante da artéria torácica interna (ATI), sem a ligadura dos seus ramos, diretamente na musculatura do ventrículo esquerdo. Nos últimos 8 anos, temos utilizado com sucesso o procedimento de Vineberg modificado pelo autor1, obtendo uma baixa morbimortalidade e uma alta taxa de perviedade do enxerto2, em mais de 60 pacientes que não puderam submeter-se a cirurgia de revascularização direta do miocárdio com anastomose ATI na artéria interventricular anterior (AIA). Nestes casos incomuns, a AIA apresentava-se, na grande maioria dos casos, hipoplásica e com doença ateromatosa difusa, incompatível com a realização de endarterectomia e revascularização direta ou procedimentos angioplásticos. Como última tentativa terapêutica, conforme descrito na literatura atual3-5, dispõe-se da cirurgia de Vineberg. No que concerne à angiogênese, uma das justificativas para a eficácia do procedimento de Vineberg, a literatura registra demonstração da indução de angiogênese em miocárdio isquêmico humano e outros trabalhos sugerem benefícios da associação deste procedimento à terapia angiogênica6-10. Acreditamos que, no futuro próximo, contaremos com essa poderosa combinação para tratamento destes pacientes.
1. Lobo JG Fº. Procedimento de Vineberg: proposta de uma variação técnica. Rev Bras Cir Cardiovasc. 2001;16: 66-9.
2. Lobo JG Fº, Forte AJV, Leitão MCA, Lobo HG Fº, Silva AA, Machado JJA. Vineberg’s procedure modified technique: flow analysis, immediate postoperative results and angiographic evaluation. J Card Surg. 2006; 21 (4): 370-6.
3. Quigley RL. Synergy of old and new technology results in successful revascularization of the anterior myocardium with relief of angina in the absence of suitable targets. Heart Surg Forum. 2004;7 (5): E343-8.
4. Van Langenhove G, Serrano P, Serruys PW. Vineberg revisited: long-term survival more than two decades after direct surgical myocardial revascularization. Int J Cardiol. 2000; 73 (1): 83-6.
5. Nasu M, Akasaka T, Chikusa H, Shoumura T. Flow reserve capacity of left internal thoracic artery 23 years after Vineberg procedure. Ann Thorac Surg. 1996; 61 (4): 1242-4.
6. Pecher P, Schumacher BA. Angiogenesis in ischemic human myocardium: clinical results after 3 years. Ann Thorac Surg. 2000; 69: 1414-9.
7. Johnson WD, Chekanov VS, Nikolaychik VV, Kipshidze N. Vineberg procedure combined with therapeutic angiogenesis: old wine in a new bottle. Ann Thorac Surg. 2001; 72: 1443-4.
8. Robicsek F, Fokin AA. Vineberg Operation combined with growth factor implantation. Ann Thorac Surg. 2002; 74: 973-5.
9. Fokin AA, Robicsek F, Masters TN, Dyke CM, Gordon BE. Enhancement of the Vineberg procedure by bFGF application. J Mol Cell Cardiol. 2000; 32: 142.
10. Henry TD, Annex BH, McKendall GR, Azrin MA, Lopez JJ, Giordano FJ, et al. The VIVA Trial: Vascular endothelial growth factor in ischemia for vascular angiogenesis. Circulation. 2003; 107: 1359-65.
Antonio Jorge de Vasconcelos Forte Rua Silva Jatahy, 355/702, Meireles 60165-070, Fortaleza, CE - Brasil E-mail:
Artigo recebido em 15/03/07; revisado recebido em 03/06/07; aceito em 12/07/07.
Angiographic follow-up of myocardial revascularization using the vineberg procedure correlated with intraoperative imaging
Instituto Dr. Glauco Lobo, Fortaleza, CE - Brazil
The Vineberg procedure comprises implantation of the internal thoracic artery (ITA), without ligating the intercostal side branches, directly into the left ventricle muscle. Over the past 8 years, we have successfully used the Vineberg technique which was modified by the senior author1, obtaining low morbidity and mortality rates and high graft patency rates2, in more than 60 patients who were unable to undergo direct myocardial revascularization with ITA anastomosis to the anterior interventricular artery (AIA). In the majority of these unusual cases, the AIA was hypoplastic, with difuse atheromatous disease, which is incompatible with an endarterectomy procedure and direct revascularization or angioplastic surgery. As per current literature, the Vineberg procedure is a last resort therapeutic option3-5. In regard to angiogenesis, which is one of the justifications for the efficacy of the Vineberg procedure, the medical literature demonstrates the induction of angiogenesis in an ischemic human myocardium; other studies suggest a beneficial association of this procedure with angiogenic therapy6-10. We believe that in the near future, patients will be able to profit from this powerful treatment combination.
1. Lobo JG Fº. Procedimento de Vineberg: proposta de uma variação técnica. Rev Bras Cir Cardiovasc. 2001;16: 66-9.
2. Lobo JG Fº, Forte AJV, Leitão MCA, Lobo HG Fº, Silva AA, Machado JJA. Vineberg’s procedure modified technique: flow analysis, immediate postoperative results and angiographic evaluation. J Card Surg. 2006; 21 (4): 370-6.
3. Quigley RL. Synergy of old and new technology results in successful revascularization of the anterior myocardium with relief of angina in the absence of suitable targets. Heart Surg Forum. 2004;7 (5): E343-8.
4. Van Langenhove G, Serrano P, Serruys PW. Vineberg revisited: long-term survival more than two decades after direct surgical myocardial revascularization. Int J Cardiol. 2000; 73 (1): 83-6.
5. Nasu M, Akasaka T, Chikusa H, Shoumura T. Flow reserve capacity of left internal thoracic artery 23 years after Vineberg procedure. Ann Thorac Surg. 1996; 61 (4): 1242-4.
6. Pecher P, Schumacher BA. Angiogenesis in ischemic human myocardium: clinical results after 3 years. Ann Thorac Surg. 2000; 69: 1414-9.
7. Johnson WD, Chekanov VS, Nikolaychik VV, Kipshidze N. Vineberg procedure combined with therapeutic angiogenesis: old wine in a new bottle. Ann Thorac Surg. 2001; 72: 1443-4.
8. Robicsek F, Fokin AA. Vineberg Operation combined with growth factor implantation. Ann Thorac Surg. 2002; 74: 973-5.
9. Fokin AA, Robicsek F, Masters TN, Dyke CM, Gordon BE. Enhancement of the Vineberg procedure by bFGF application. J Mol Cell Cardiol. 2000; 32: 142.
10. Henry TD, Annex BH, McKendall GR, Azrin MA, Lopez JJ, Giordano FJ, et al. The VIVA Trial: Vascular endothelial growth factor in ischemia for vascular angiogenesis. Circulation. 2003; 107: 1359-65.
Antonio Jorge de Vasconcelos Forte Rua Silva Jatahy, 355/702, Meireles 60165-070, Fortaleza, CE - Brazil E-mail:
Manuscript received March 15, 2007; revised manuscript received June 3, 2007; accepted July 12, 2007.