Реферат
Fundamento: A avaliação da área valvar mitral por meio da reconstrução multiplano na ecocardiografia tridimensional é restrita a softwares específicos e à experiência dos ecocardiografistas. Eles precisam selecionar manualmente o frame do vídeo que contenha a área de abertura máxima da valva mitral, dimensão fundamental para a identificação de estenose mitral. Objetivo: Automatizar o processo de determinação da área de abertura máxima da valva mitral, por meio da aplicação de Processamento Digital de Imagens (PDI) em exames de ecocardiograma, desenvolvendo um algoritmo aberto com leitura de vídeo no formato avi. Método: Este estudo piloto observacional transversal foi realizado com vinte e cinco exames diferentes de ecocardiograma, sendo quinze com abertura normal e dez com estenose mitral reumática. Todos os exames foram realizados e disponibilizados por dois especialistas, com autorização do Comitê de Ética em Pesquisa, que utilizaram dois modelos de aparelhos ecocardiográficos: Vivid E95 (GE Healthcare) e Epiq 7 (Philips), com sondas multiplanares transesofágicas. Todos os vídeos em formato avi foram submetidos ao PDI através da técnica de segmentação de imagens. Resultados: As medidas obtidas manualmente por ecocardiografistas experientes e os valores calculados pelo sistema desenvolvido foram comparados utilizando o diagrama de Bland-Altman. Observou-se maior concordância entre valores no intervalo de 0,4 a 2,7 cm². Conclusão: Foi possível determinar automaticamente a área de máxima abertura das valvas mitrais, tanto para os casos advindos da GE quanto da Philips, utilizando apenas um vídeo como dado de entrada. O algoritmo demonstrou economizar tempo nas medições quando comparado com a mensuração habitual. (AU)
Background: The evaluation of mitral valve area through multiplanar reconstruction in 3-dimensional echocardiography is restricted to specific software and to the experience of echocardiographers. They need to manually select the video frame that contains the maximum mitral valve opening area, as this dimension is fundamental to identification of mitral stenosis. Objective: To automate the process of determining the maximum mitral valve opening area, through the application of digital image processing (DIP) in echocardiography tests, developing an open algorithm with video reading in avi format. Method: This cross-sectional observational pilot study was conducted with 25 different echocardiography exams, 15 with normal aperture and 10 with rheumatic mitral stenosis. With the authorization of the Research Ethics Committee, all exams were performed and made available by 2 specialists who used 2 models of echocardiographic devices: Vivid E95 (GE Healthcare) and Epiq 7 (Philips), with multiplanar transesophageal probes. All videos in avi format were submitted to DIP using the image segmentation technique. Results: The measurements obtained manually by experienced echocardiographers and the values calculated by the developed system were compared using a Bland-Altman diagram. There was greater agreement between values in the range from 0.4 to 2.7 cm². Conclusion: It was possible to automatically determine the maximum mitral valve opening area, for cases from both GE and Philips, using only 1 video as input data. The algorithm has been demonstrated to save time on measurements when compared to the usual method. (AU)
Тема - темы
Humans , Heart Valve Diseases/mortality , Mitral Valve/physiopathology , Mitral Valve/diagnostic imaging , Mitral Valve Stenosis/etiology , Image Processing, Computer-Assisted/methods , Doxorubicin/radiation effects , Echocardiography, Transesophageal/methods , Echocardiography, Three-Dimensional/methods , Transcatheter Aortic Valve Replacement/methods , Isoproterenol/radiation effects , Mitral Valve/surgeryРеферат
Abstract Introduction: Left ventricular dysfunction after surgical treatment of mitral stenosis is uncommon. We intend to determine the pattern of left ventricular remodeling, shortly after open mitral valve replacement for rheumatic mitral stenosis, with in-hospital postoperative outcomes and the determinants of postoperative worsening of left ventricular ejection fraction. Methods: From January 2008 to January 2015, 107 adult patients with rheumatic mitral stenosis were submitted to open mitral valve replacement. Their mean age was 45±11 years and 93 (86.9%) were women. Left ventricular morphology and function were studied longitudinally with echocardiography. The end point was postoperative worsening of left ventricular ejection fraction, defined by a decrease of 10% compared to preoperative basal assessment. Determinants of worsening left ventricular ejection fraction were determined by multivariable logistic regression analysis. Results: The end point occurred in 18 patients (16.8%). We tested clinical and echocardiographic parameters to verify independent variables related to the decrease in postoperative ejection fraction. Lower body weight (P=0.005; odds ratio [OR]=0.89) and smaller preoperative mitral valve area (P=0.02; OR=0.02) were independent predictors of left ventricular dysfunction. These patients presented higher mortality and morbidity rates. Conclusion: Left ventricular remodeling patterns differed among patients with predominant rheumatic mitral stenosis undergoing open mitral valve replacement. Lower preoperative body weight and mitral valve area were independent determinants of deteriorating ejection fraction with increased end-systolic volumes, indicating that this specific problem may occur in anthropometric smaller patients with more extensive rheumatic disease.
Тема - темы
Humans , Female , Adult , Mitral Valve Stenosis/surgery , Mitral Valve Stenosis/etiology , Mitral Valve Stenosis/diagnostic imaging , Stroke Volume , Ventricular Function, Left , Ventricular Remodeling , Middle Aged , Mitral Valve/surgery , Mitral Valve/diagnostic imagingРеферат
Abstract Objective: To examine the relationship between the left atrial (LA) thrombus presence and the epicardial adipose tissue (EAT) thickness. Methods: Three hundred and twelve consecutive rheumatic mitral valve stenosis (RMVS) patients with mitral valve area (MVA) < 2 cm2 were included in this cross-sectional study. Patients were divided into two groups, those with and those without LA thrombus. Routine biochemical analysis and electrocardiographic examinations were carried out. EAT was measured using transthoracic echocardiography. Results: LA thrombus was determined in 84 (26.9%) RMVS patients. In echocardiographic examinations, higher mean gradient and LA diameter as well as lower MVA were found in the group with LA thrombus (P<0.001). In this group, higher C-reactive protein (CRP) and EAT values were also determined (P<0.001). There was significant correlation between EAT and MVA, CRP, LA appendage peak flow velocity, LA anteroposterior diameter, and mean gradient (P<0.001). Higher EAT values were identified as independently associated with the presence of LA thrombus (odds ratio 59.5; 95% confidence interval 12.1-290.10; P<0.001). Conclusion: Transthoracic echocardiography, routinely used in patients with RMVS, can measure EAT to determine patients who are under risk for thrombus.
Тема - темы
Humans , Male , Female , Adult , Middle Aged , Aged , Thrombosis/complications , Thrombosis/diagnostic imaging , Mitral Valve Stenosis/etiology , Mitral Valve Stenosis/diagnostic imaging , Adipose Tissue/diagnostic imaging , Cross-Sectional Studies , Echocardiography, Transesophageal , Heart Atria/diagnostic imagingРеферат
A valvoplastia mitral percutânea é o tratamento de escolha da estenose mitral reumática comanatomia favorável, por sua capacidade de prevenir complicações inerentes ao tratamento cirúrgico e com manutenção da eficácia. Faz-se necessário promover comparações entre os resultados obtidos com o procedimento por centros de referência e alta drenagem de pacientes e por instituições de menor volume e casuística, sendo este o objetivo principal deste estudo. Métodos: Foram analisados 31 pacientes consecutivos submetidos à valvoplastia mitral percutânea no período de setembro de 2006 a janeiro de 2015. Avaliaram-se o sucesso imediato do procedimento e a sobrevida livre de eventos tardios, definidos como morte cardiovascular ou necessidade de novaintervenção valvar mitral. Resultados: A média de idade foi de 40,9 ± 14,2 anos, com predomínio do sexo feminino (96,8%). O escore médio de Wilkins e Block foi de 8,1 ± 1,2. A totalidade dos procedimentos foi efetivada pela técnica de Inoue, com taxa de sucesso imediato de 90,3%. Em acompanhamento médio de 6,8 ± 2,5 anos, foram constatadossete eventos (22,6%), sendo dois óbitos de etiologia cardiovascular, quatro cirurgias de troca valvar mitral e uma comissurotomia mitral. Conclusões: Em um hospital com volume intermediário de procedimentos, os resultados da valvoplastia mitral percutânea no tratamento da estenose mitral reumática com anatomia favorável foram comparáveis àqueles alcançados por centros de alto referenciamento...
Background: Percutaneous mitral valvuloplasty is the treatment of choice for rheumatic mitral stenosis with favorable anatomy, for its ability to prevent complications inherent to a surgical procedure, while maintaining effectiveness. It is necessary to promote comparisons between the results obtained by the procedure performed at referral centers with high patient inflow and at institutions with lower volume and fewer patients, which represents the main objective of this study. Methods: Thirty-one consecutive patients undergoing percutaneous mitral valvuloplasty were analyzed from September 2006 to January 2015. Immediate procedural success and late event-free survival rates were evaluated, defined as cardiovascular death or need for a new mitral valve intervention. Results: The mean age was 40.9 ± 14.2 years, with a predominance of females (96.8%). The mean Wilkinsand Block score was 8.1 ± 1.2. All procedures were performed using the Inoue technique, with na immediate success rate of 90.3%. At mean follow-up of 6.8 ± 2.5 years, seven events (22.6%) were observed: two cardiovascular deaths, four surgeries for mitral valve replacement, and one mitral commissurotomy Conclusions: In a hospital with intermediate procedure volume, the results of percutaneous mitral valvuloplasty in the treatment of rheumatic mitral stenosis with favorable anatomy were comparable to those achieved by high-volume centers...
Тема - темы
Humans , Male , Female , Middle Aged , Mitral Valve Stenosis/etiology , Rheumatic Fever/etiology , Balloon Valvuloplasty/methods , Data Interpretation, Statistical , Cardiovascular Diseases , Echocardiography/methods , Mitral Valve/surgery , Heart Ventricles , Heart AtriaТема - темы
Humans , Mitral Valve Stenosis/diagnosis , Mitral Valve Stenosis/etiology , Mitral Valve Stenosis/physiopathology , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/physiopathology , Practice Guidelines as Topic , Aortic Valve/abnormalities , Mitral Valve/abnormalitiesТема - темы
Humans , Mitral Valve Stenosis/pathology , Mitral Valve Stenosis/therapy , Antibiotic Prophylaxis , Adrenergic beta-Antagonists/therapeutic use , Anticoagulants/therapeutic use , Cardiac Catheterization , Electrocardiography , Rheumatic Diseases/complications , Mitral Valve Stenosis/etiology , Mitral Valve Stenosis , Mitral Valve Stenosis , Physical Examination , Radiography, Thoracic , Severity of Illness IndexРеферат
Homem de 20 anos, previamente hígido, com quadro clínico de dispneia paroxística noturna e cansaço aos médios esforços com evolução em torno de dez dias, apresentou, ao exame ecocardiográfico, mixoma em átrio esquerdo funcionando como estenose mitral grave.
The echocardiogram of a twenty-year-old man, previously healthy, suffering from paroxysmal nocturnal dyspnea and fatigue after moderate exertion that intensified over a period of about ten days, showed the left atrium myxoma working as severe mitral stenosis.
Hombre de 20 años, previamente sano, con cuadro clínico de disnea paroxística nocturna y cansancio a los esfuerzos medios con evolución alrededor de diez días, presentó, al examen ecocardiográfico, mixoma en atrio izquierdo funcionando como estenosis mitral grave.
Тема - темы
Humans , Male , Young Adult , Heart Neoplasms , Mitral Valve Stenosis , Myxoma , Diagnosis, Differential , Heart Atria , Heart Neoplasms/complications , Mitral Valve Stenosis/etiology , Myxoma/complicationsРеферат
As disfunções primárias da valva mitral podem ter várias etiologias, entre elas doenças reumáticas, prolapso da valva mitral, doença isquêmica, calcificação do anel mitral e congênita...
Тема - темы
Humans , Mitral Valve Stenosis/etiology , Mitral Valve Stenosis/physiopathology , Rheumatic Diseases/complications , Rheumatic Diseases/etiology , Mitral Valve Prolapse/complications , Mitral Valve Prolapse/etiologyРеферат
As valvulopatias mitrais de etiologia reumática ainda são muito prevalentes em nosso meio...
Тема - темы
Humans , Mitral Valve Stenosis/etiology , Mitral Valve Stenosis/therapy , Atrial Fibrillation/therapy , Endocarditis/complications , Endocarditis/therapy , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/therapyРеферат
Um paciente de 26 anos, portador de volumoso hemangiopericitoma primário de pulmão direito, diagnosticado por biópsia cirúrgica prévia, apresentou parada cardíaca irreversível durante dissecção hilar de pneumectomia direita. O paciente não respondeu às manobras de ressuscitação. A necropsia mostrou obstrução total de valva mitral por êmbolo tumoral. Os autores recomendam, em casos de grandes massas pulmonares com envolvimento hilar, como no caso aqui apresentado, a avaliação pré-operatória com ecocardiografia transesofágica, ressonância magnética nuclear ou angiotomografia. Se for detectada lesão em vasos pulmonares ou cavidades atriais, deve-se programar a cirurgia com circulação extracorpórea, para permitir ressecção da massa intra-vascular ou cardíaca, combinada com a ressecção pulmonar. Os autores recomendam cuidados para reconhecer e tratar este problema, se o diagnóstico pré-operatório não for feito.
A 26-year-old patient with a voluminous primary pulmonary hemangiopericytoma in the right lung, diagnosed through previous surgical biopsy, presented irreversible cardiac arrest during the hilar dissection portion of a right pneumonectomy. The patient did not respond to resuscitation efforts. Autopsy showed total obstruction of the mitral valve by a tumor embolism. In cases of large lung masses with hilar involvement, as in the case presented, we recommend preoperative evaluation using transesophageal echocardiography, magnetic resonance imaging or angiotomography. If injury to the pulmonary vessels or atrial cavities is detected, surgery with extracorporeal circulation should be arranged in order to allow resection of the intravascular or cardiac mass, together with pulmonary resection. We recommend that care be taken in order to recognize and treat this problem in patients not receiving a preoperative diagnosis.
Тема - темы
Adult , Humans , Male , Heart Arrest/etiology , Heart Neoplasms/secondary , Hemangiopericytoma/surgery , Lung Neoplasms/surgery , Mitral Valve Stenosis/etiology , Pneumonectomy/adverse effects , Fatal Outcome , Heart Arrest/pathology , Intraoperative Complications/etiology , Lung Neoplasms/pathology , Mitral Valve Stenosis/pathology , Neoplastic Cells, Circulating , Preoperative CareТема - темы
Aged , Female , Humans , Atrial Fibrillation/etiology , Gastrointestinal Hemorrhage/etiology , Mitral Valve Stenosis/etiology , Rheumatic Heart Disease/complications , Shock/etiology , Atrial Fibrillation/pathology , Chronic Disease , Fatal Outcome , Gastrointestinal Hemorrhage/pathology , Mitral Valve Stenosis/pathology , Rheumatic Heart Disease/pathology , Shock/pathologyРеферат
Ao se recomendar atividade física e esporte, o médico deve considerar as característica da atividade proposta, associada ao tipo de valvopatia e sua gravidade. Uma das formas de se classificar esporte,atividade física é pelo tipo de exercício e pela intensidade empregados em sua prática. Assim, os exercícios podem ser classificados em dinâmicos e estáticos leves, moderados e intensos. A avaliação da doença valvar, por outro lado, inicia-se pelo diagnóstico, com anamnese, exame físico e exames complementares, acrescentada pela estratificação de gravidade que leva em conta parâmetros anatômicos e funcionais das valvas, alterações anatômicas do coração e presença de síntomas, principalemnte dispnéia aos esforços. Dessa forma, baseado no diagnóstico tanto anatômico como funcional da valvopatia, e com a caracterização da gravidade, o médico pode recomendar atividade física e/ou esporte de forma individualizada para o paciente.
Тема - темы
Male , Female , Humans , Motor Activity/physiology , Mitral Valve Stenosis/etiology , Exercise/physiologyРеферат
Mulher de 67 anos de idade, apresentando estenose mitral grave, não-reumática, após 18 anos da realização de miotomia/miectomia septal cirúrgica para correção de miocardiopatia hipertrófica septal assimétrica. A paciente foi submetida a troca da valva mitral por prótese mecânica, tornando-se caso único, em razão da combinação das duas síndromes, extremamente rara e com grave prognóstico.
Тема - темы
Humans , Female , Aged , Cardiomyopathy, Hypertrophic/surgery , Heart Valve Prosthesis , Heart Septum/surgery , Mitral Valve Stenosis/surgery , Mitral Valve/surgery , Cardiomyopathy, Hypertrophic/complications , Echocardiography, Transesophageal , Heart Valve Prosthesis/adverse effects , Mitral Valve Stenosis/etiology , ReoperationРеферат
Percutaneous transvenous mitral commissurotomy using Inoue balloon is an effective procedure for the management of patients with juvenile mitral stenosis. Inability to cross the mitral valve by the Inoue balloon catheter is one of the important reasons for failure of the procedure. We describe a new technique, facilitating left atrium to left ventricular entry using double loop of Inoue balloon catheter in a child with small left atrium.
Тема - темы
Angiography/methods , /instrumentation , Child , Echocardiography, Doppler , Follow-Up Studies , Cardiac Catheterization/methods , Humans , Male , Mitral Valve Stenosis/etiology , Rheumatic Heart Disease/complications , Risk Assessment , Treatment OutcomeРеферат
Este estudio se realizó con el objetivo de conocer los cambios clínicos y ecocardiográficos en pacientes con estenosis mitral reumática sometidos a valvuloplastia mitral percutánea en el Centro Nacional de Cardiología en el periodo de Septiembre del 2000 a Septiembre del 2002. Se realizó el procedimiento en 61 pacientes (52 femenino y 9 masculino), con edad promedio (15- 66 años) el 59 porciento con antecedentes de fiebre reumática, y el 78 porciento de amigdalitis. El 30 porciento presentó ritmo cardíaco de fibrilación auricular con anticoagulación, y el 9.8 porciento reportó complicaciones hemorrágicas. El área mitral prevalvuloplastia promedio 0.94cm gradiente diastólico máximo promedio de 22 mmHg, presión sistólica pulmonar de 56.26 mmHg. Clase funcional prevalvuloplastia III IV. Método: este procedimiento se realizó bajo anestesia local por punción de la vena femoral derecha se realizó cateterismo transeptal, después de dilatar el septum, se pasó el balón de Inoue, se llevó al ventrículo izquierdo, y colocó en la válvula mitral, donde se realizaron la separación de las comisuras, fracturas de las calcificaciones. Se valoró las complicaciones durante las valvuloplastia presentándose 1 embolia cerebral, Insuficiencia mitral 1, taponamiento cardiaco 2, hemorragia en el sitio de venopunción 5. Resultados: el área mitral posvalvuloplastia promedio 1.6cm2 DS 0.45, el gradiente diastólico máximo promedio de l3mmhg DS 4.98, presión sistólica pulmonar promedio 39.71mmhg DS 12.93, disminución del tamaño de la aurícula izquierda Capacidad funcional mejoró notablemente, encontrándose clase funcional I- II. Conclusiones: Se valoró que la valvuloplastia mitral percutánea es un procedimiento seguro, tiene excelentes resultados clínicos, evita la cirugía de recambio valvular...