Improvement in left ventricular dysfunction after surgical correction of mitral regurgitation.

OBJECTIVE: To evaluate whether left ventricular end-systolic (ESD) diameters < or = 51mm in patients (pt) with severe chronic mitral regurgitation (MR) are predictors of a poor prognosis after mitral valve surgery (MVS). METHODS: Eleven pt (aged 36 +/- 13 years) were studied in the preoperative period (pre), median of 36 days; in the early postoperative period (post1), median of 9 days; and in the late postoperative period (post2), mean of 38.5 +/- 37.6 months. Clinical and echocardiographic data were gathered from each pt with MR and systolic diameter > or = 51 mm (mean = 57 +/- 4mm) to evaluate the result of MVS. Ten patients were in NYHA Class III/IV. RESULTS: All but 2 pt improved in functional class. Two pt died from heart failure and infectious endocarditis 14 and 11 months, respectively, after valve replacement. According to ejection fraction (EF) in post2, we identified 2 groups: group 1 (n=6), whose EF decreased in post1, but increased in post2 (p=0.01) and group 2 (n=5), whose EF decreased progressively from post1 to post2 (p=0.10). All pt with symptoms lasting < or = 48 months had improvement in EF in post2 (p=0.01). CONCLUSION: ESD > or = 51 mm are not always associated with a poor prognosis after MVS in patients with MR. Symptoms lasting up to 48 months are associated with improvement in left ventricular function.

Estenose valvar aórtica: influência do sexo sobre a geometria e funçäo ventricular esquerda em pacientes abaixo de 70 anos / Aortic stenosis: gender influence on left ventricular geometry and function in patients under 70 years of age

Objetivo - Verificar-se as características adaptativas do ventrículo esquerdo (VE), também, estão presentes em indivíduos < 70 anos, com estenose valvar aórtica grave (EA). Métodos - Estudamos 40 pacientes consecutivos,<70 anos de idade, com EA, sem doença arterial coronariana, encaminhados à cirurgia, sendo 22 homens e 18 mulheres, (idade de 49,8+14,3 anos). Foram coligidos os sintomas cardíacos, presença de hipertensão arterial sistêmica (HAS), classe funcional de acordo com a NYHA e a etiologia do EA. Ao Dopplerecocardiograma foram estudados as dimensões cavitárias, a fração de ejeção (FE) e fração de encurtamento cavitário (FEC), massa (MS) e espessura diastólica relativa (EDR) do VE. Resultados - Quatorze homens e 11 mulheres estavam em CF III/IV (p=0,70). A freqüência de sintomas foi igual em ambos os sexos. Havia mais mulheres com HAS do que nos homens (10 contra 2, p=0,0044). As mulheres apresentaram menor índice de diâmetro diastólico final do VE (32,1+6,5 x 36,5+5,3 mm/m2, p=0,027), de diâmetro sistólico final (19,9+5,9 x 26,5+6,4mm/m2, p=0,0022) e MS (211,4+71,1 x 270,9+74,9g/m2, p=0,017) A FE (66,2+13,4 x 52,0+14,6 por cento, p=0,0032), FEC (37,6+10,7 x 27,9+9,6 por cento, p=0,0046) e EDR (0,58+0,22 x 0,44+0,09), p=0,0095) eram significativamente maiores nas mulheres. Conclusão - É o sexo e não a idade dos pacientes que influi na resposta adaptativa do VE à EA.

Melhora da disfunçäo ventricular esquerda após a correçäo cirúrgica da insuficiência mitral crônica grave / Improvement in left ventricular dysfunction after surgical correction of mitral regurgitation

OBJECTIVE: To evaluate whether left ventricular end-systolic (ESD) diameters £ 51mm in patients (pt) with severe chronic mitral regurgitation (MR) are predictors of a poor prognosis after mitral valve surgery (MVS). METHODS: Eleven pt (aged 36±13 years) were studied in the preoperative period (pre), median of 36 days; in the early postoperative period (post1), median of 9 days; and in the late postoperative period (post2), mean of 38.5±37.6 months. Clinical and echocardiographic data were gathered from each pt with MR and systolic diameter 51mm (mean = 57±4mm) to evaluate the result of MVS. Ten patients were in NYHA Class III/IV. RESULTS: All but 2 pt improved in functional class. Two pt died from heart failure and infectious endocarditis 14 and 11 months, respectively, after valve replacement. According to ejection fraction (EF) in post2, we identified 2 groups: group 1 (n=6), whose EF decreased in post1, but increased in post2 (p=0.01) and group 2 (n=5), whose EF decreased progressively from post1 to post2 (p=0.10). All pt with symptoms lasting £ 48 months had improvement in EF in post2 (p=0.01). CONCLUSION: ESD 51mm are not always associated with a poor prognosis after MVS in patients with MR. Symptoms lasting up to 48 months are associated with improvement in left ventricular function