RESUMO
Left ventricular rupture after mitral valve replacement is a rare but lethal complication. Between 1995 and 2003, left ventricular rupture occurred in 13 of 5,449 patients who underwent mitral valve replacement, with an incidence of 0.24%. There were 4 immediate ruptures and 9 delayed ruptures. Urgent repair of the rupture was performed under cardiopulmonary bypass in 11 cases. All mitral prostheses were explanted. External repair alone was performed in one patient. External repair combined with internal repair was performed in 10 patients. Two patients died of cardiac tamponade and failure of cardiac resuscitation. Of the 11 patients who had a re-operation, 6 died in hospital and 5 survived. The mortality was 61.5% (8/13). At a mean follow-up of 4 years, 2 patients were in New York Heart Association functional class II and 3 were in class III. Proper diseased valve removal, decalcification, and prosthesis selection could minimize the incidence of left ventricular rupture. Immediate diagnosis and urgent surgical intervention are crucial for successful repair.
Assuntos
Traumatismos Cardíacos/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Mitral/cirurgia , Adulto , Idoso , Arritmias Cardíacas/complicações , Pressão Sanguínea , Feminino , Seguimentos , Traumatismos Cardíacos/mortalidade , Traumatismos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca/mortalidade , Ventrículos do Coração/lesões , Hemorragia/complicações , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Fatores de Risco , Ruptura , Análise de SobrevidaRESUMO
OBJECTIVE: To study the efficiency of surgical treatment on coarctation of the aorta and associated with heart defect. METHODS: From 1994 to 2001, 45 patients with aortic coarctation and associated with heart defect underwent surgical repair. They were divided into two groups: single-stage repair group (26 cases) and two-stage repair group (19 cases). There was mild or severe pulmonary hypertension in 23 cases (with mean pulmonary artery pressure being 56 mm Hg). There were two incisions used in first-stage group (single midline incision in 21 cases and left-side combined midline incision in 5 cases). The mean course for the second operation was 105 days in second-stage group. RESULTS: Two patients died in each group. Twenty-four patients had not blood pressure difference between arm and leg after operation. The mean systolic blood pressure difference was less than 10 mmHg in 10 patients. Mean period of follow-up was 28.6 months. No patients died and had re-coarctation. CONCLUSION: The operative results showed no difference between single-stage and two-stage repair in surgical correction of aortic coarctation associated intracardiac defect. The left-side combined midline incision in single-stage operation was an effective and safe technique.