Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Humanos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Resultado do Tratamento , Fatores de RiscoAssuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Fluoroscopia , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoAssuntos
Cardiologia/educação , Procedimentos Cirúrgicos Cardiovasculares/educação , Competência Clínica/normas , Educação , Capacitação em Serviço/organização & administração , Internato e Residência/métodos , Educação/métodos , Educação/organização & administração , Humanos , Japão , Avaliação das Necessidades , Melhoria de QualidadeRESUMO
A 52-year-old man underwent surgery due to shortness of breath caused by severe aortic regurgitation with right coronary cusp prolapse. Operative findings revealed 3 symmetric cusps with small raphe between the right and noncoronary cusps situated lower than the others, indicating a forme fruste bicuspid aortic valve (BAV). The BAV was successfully repaired by tricuspidization, including raphe suspension, right coronary cusp plication, and double annuloplasty. The postoperative course was uneventful, and echocardiography at 3 months showed mild aortic regurgitation with adequate left ventricular reverse remodeling. Here we present the technical details of the raphe suspension procedure for forme fruste BAV.
Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Doença da Válvula Aórtica Bicúspide , Doenças das Valvas Cardíacas , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/etiologia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Estenose da Valva Aórtica , Fragilidade , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Fragilidade/diagnóstico , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversosRESUMO
Ultrasound cardiography showed severe aortic regurgitation (AR) due to bicuspid aortic valve with dilatation of the aortic annulus and sinotubular junction in a 27-year-old man hospitalized with loss of consciousness. He underwent aortic valvuloplasty combined with external suture annuloplasty using an expanded polytetrafluoroethylene (ePTFE) suture. Intraoperative findings revealed thickening and adhesion of the aortic root despite the first surgery. He developed recurrent AR 7 months later and underwent redo surgery. An ePTFE suture was found inside the aorta. Aortic root replacement with a mechanical composite graft was performed, as reconstruction appeared difficult because the aortic annulus was damaged and there were multiple holes on all cusps. Here, we report a rare case of aortic root destruction after external suture annuloplasty.
Assuntos
Insuficiência da Valva Aórtica , Doença da Válvula Aórtica Bicúspide , Anuloplastia da Valva Cardíaca , Adulto , Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Humanos , Masculino , Resultado do TratamentoRESUMO
Surgery for active infective endocarditis( IE) carries the greatest risk of any valve surgery, especially when complicated by cerebral infarction or bleeding. Surgical candidates with IE associated with neurologic symptoms should have a neurologic evaluation and brain imaging either by computed tomography (CT) or magnetic resonance imaging (MRI). Even among patients without neurologic symptoms, routine preoperative screening can be justified, especially those with high-risk vegetation. Current recommendations indicate that surgery should be delayed for 1 to 2 weeks in patients with non-hemorrhagic strokes and 3 to 4 weeks in patients with hemorrhagic strokes. If patients have suffered from stroke, any anticoagulation increases the risk of hemorrhagic conversion, and if bleeding has already occurred, this risk further increases. Accordingly, the treatment team has to make a difficult decision whether anticoagulation should be withheld or decreased. Transesophageal echocardiography (TEE) and/or transthoracic echocardiography (TTE) play a major role in determining the size of vegetation, abscess and fistula formation, and severity of regurgitation during the pre- and intra-operative periods. Cerebral MRI/CT are also important to diagnose the severity of cerebral infarction or bleeding before and after surgery. The risk of IE patients with cerebral complication may change by the hour, so a solid heart team approach is mandatory to make a prompt diagnosis and determine the optimal timing for surgery.
Assuntos
Endocardite Bacteriana , Endocardite , Infarto Cerebral , Ecocardiografia , Ecocardiografia Transesofagiana , Endocardite/complicações , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , HumanosRESUMO
OBJECTIVES: To investigate the relationship between body mass index (BMI) and early outcomes, and specific types of morbidities associated with low and high BMI, in patients undergoing coronary artery bypass grafting. METHODS: This was a retrospective study on isolated coronary artery bypass grafting patients (aged ≥60 years) between 2008 and 2017 in the Japan Cardiovascular Surgery Database. The primary end point was defined as operative mortality. The secondary end point was combined morbidity (ie, operative mortality, reoperation for bleeding, stroke, new onset of hemodialysis, mediastinitis, and prolonged ventilation). Patient characteristics and outcomes were compared among BMI groups. Spline curves were fit between BMI and outcomes. Multivariable logistic regression models with categorized BMI and generalized additive models with spline-transformed BMI were used to estimate and visualize the effect of BMI adjusted for other covariates. RESULTS: A total of 96,058 patients were included in the analysis. Low (<18.5) and high (≥30) BMI were both associated with a higher risk of mortality (low: adjusted odds ratio, 1.34; 95% confidence interval, 1.16-1.54; P < .0001, and high: adjusted odds ratio, 2.10; 95% confidence interval, 1.70-2.59; P < .0001) and combined morbidity (low: adjusted odds ratio, 1.18; 95% confidence interval, 1.08-1.29; P = .0002 and high: adjusted odds ratio, 1.82; 95% confidence interval, 1.63-2.03; P < .0001). Low and high BMI were associated with different types of morbidities. In models using spline transformation, the deviation of BMI from a proximately 21 to 23 was proportionally associated with increased risk. CONCLUSIONS: In patients undergoing coronary artery bypass grafting, low and high BMI were risk factors of mortality associated with different types of morbidities, which may warrant tailored preventive approaches.