[Balloon valvuloplasty outcome of a group previously submitted to mitral percutaneous or surgical valve repair versus first-time valvuloplasty patients. Evolution of the group previously submitted to valve repair procedures]. / Resultados da valvoplastia por balão do grupo submetido a plastia mitral percutânea ou cirúrgica prévias com o tratado pela primeira vez. Evolução do grupo com plastia prévia.

OBJECTIVE: To evaluate 501 procedures of mitral balloon valvuloplasty and the differences among the group already submitted the prior surgical or balloon valvuloplasty, with 59 procedures and the group without previous intervention, with 442 procedures. METHODS: It was used the single balloon in 403, Inoue balloon in 89 and a double balloon in six, with no difference between the 2 groups (p=0.6610). RESULTS: The prior surgical or balloon valvuloplasty group was older, with higher echo score and higher atrial fibrillation rate and of its 59 patients, 48 had been submitted only to mitral surgical commissurotomy, 8 only to mitral balloon valvuloplasty and 3 to surgical commissurotomy and after submitted to balloon valvuloplasty because of restenosis. In prior surgical or balloon valvuloplasty and mitral balloon valvuloplasty without previous intervention groups pre valvuloplasty there were respectively: echo mitral valve area 0.99+/-0.21 and 0.94+/-0.21 cm2 (p=0.0802) and mitral valve area (Gorlin) 0.94+/-0.18 and 0.91+/-0.21 cm2 (p=0.2518) and post mitral valvuloplasty 1.95+/-0.44 and 2.05+/-0.42 cm2 (p=0.1059). CONCLUSIONS: The hemodynamic and angiographic outcome of the prior surgical or balloon valvuloplasty group were similar to the group without previous intervention. The evolution was satisfactory in the prior valvuloplasty subgroup with long-term follow-up.

Resultados da valvoplastia por balão do grupo submetido a plastia mitral percutânea ou cirúrgica prévias com o tratado pela primeira vez: evolução do grupo com plastia prévia / Balloon valvuloplasty outcome of a group previously submitted to mitral percutaneous or surgical valve repair versus first-time valvuloplasty patients: evolution of the group previously submitted to valve repair procedures

OBJETIVO: Avaliar 501 procedimentos de valvoplastia mitral e as diferenças entre um grupo já submetido a plastia valvar prévia por balão ou cirúrgica, com 59 procedimentos e um grupo sem intervenção prévia, com 442 procedimentos. MÉTODOS: Foi utilizado balão único em 406 procedimentos, balão de Inoue em 89, e duplo balão em seis, não havendo diferença entre os balões utilizados nos dois grupos (p=0,6610). Estudou-se a evolução a longo prazo dos pacientes com plastia prévia. RESULTADOS: O grupo submetido a plastia valvar prévia era mais velho, com maior escore ecocardiográfico, maior porcentual de pacientes em fibrilação atrial, e dos seus 59 pacientes, 48 tinham sido submetidos à comissurotomia cirúrgica, oito a valvoplastia com balão e três à comissurotomia cirúrgica e à valvoplastia com balão. Os grupos da valvoplastia com plastia valvar prévia e da valvoplastia sem intervenção prévia apresentaram pré-valvoplastia: área valvar mitral ecocardiográfica de 0,99±0,21 e 0,94±0,21 cm² (p=0,0802) e área valvar mitral (Gorlin) 0,94±0,18 e 0,91±0,21 cm² (p=0,2518) e área valvar mitral pós-valvoplastia mitral de 1,95±0,44 e 2,05±0,42 cm² (p=0,1059). CONCLUSÕES: O grupo com plastia valvar prévia apresentou o mesmo resultado imediato do grupo sem intervenção prévia. O subgrupo com plastia prévia seguido a longo prazo, apresentou evolução satisfatória.

[Percutaneous mitral balloon valvotomy. Long-term outcome and assessment of risk factors for death and major events]. / Valvoplastia mitral percutânea por balão. Evolução a longo prazo e análise dos fatores de risco para óbito e eventos maiores.

OBJECTIVE: To identify the factors that predict death and combined events, (death, new mitral balloon valvotomy, or mitral valve surgery) in long-term follow-up of patients undergoing percutaneous mitral balloon valvotomy. METHODS: Follow-up was 49.0+/-31.0 (1 to 122) months. Techniques used were the single-balloon (84.4%), Inoue-balloon (13.8%), and double-balloon techniques (1.7%). RESULTS: Included in the study were 289 patients 38.0+/-12.6 years of age (range, 13 to 83). Before the procedure, 244 patients had echocardiographic score < or = 8, and 45 patients had score > 8. Females comprised 85%, and 84% patients were in sinus rhythm. During follow-up, survival of the total group was 95.5%, that of the group with < or = 8 was 98.0%, finally that of the group with scores > 8 was 82.2% (P < 0.0001), whereas combined event-free survival was 83.4%, 86.1%, and 68.9%, respectively (P < 0.0001). In the multivariate analysis, the factors that predicted long-term death were a preprocedure echocardiographic score > 8 and the presence of severe valvular mitral regurgitation during the procedure. The events that predicted combined events were a previous history of mitral valvular commissurotomy and atrial fibrillation and the presence of severe mitral valvular regurgitation during the procedure, and postprocedure mitral valvular area < 1.5 m2 (failure). CONCLUSION: Percutaneous mitral balloon valvotomy is an effective procedure, and over 2/3 of the patients were event-free at the end of follow-up. Survival in the group was high, even higher in the group with lower echocardiographic scores.

Valvoplastia mitral percutânea por balão: evolução a longo prazo e análise dos fatores de risco para óbito e eventos maiores / Percutaneous mitral balloon valvotomy: long-term outcome and assessment of risk factors for death and major events

OBJETIVO: Identificar os fatores, que predizem óbito e eventos combinados de óbito, nova valvoplastia mitral por balão ou cirurgia valvar mitral a longo prazo, nos pacientes submetidos à valvoplastia mitral percutânea por balão. MÉTODOS: O período de seguimento foi de 49,0±31,0 (1 a 122) meses. Foram usadas as técnicas do balão único (84,4 por cento), do balão de Inoue (13,8 por cento) e do duplo balão (1,7 por cento). RESULTADOS: Acompanhados 289 pacientes com idade de 38,0±12,6 (13 a 83) anos, no pré-procedimento, 244 apresentavam escore ecocardiográfico < 8 e 45 escore > 8, 85 por cento eram do sexo feminino e 84 por cento estavam em ritmo sinusal. No seguimento, a sobrevida do grupo total, do grupo de escore < 8 e do grupo de escore > 8 foi de 95,5 por cento, 98,0 por cento e 82,2 por cento respectivamente (p<0,0001), enquanto que a sobrevida livre de eventos combinados foi respectivamente 83,4 por cento, 86,1 por cento e 68,9 por cento (p<0,0001). Na análise multivariada, os fatores, que predisseram óbito a longo prazo foram o escore ecocardiográfico > 8 pré-procedimento e a presença de insuficiência valvar mitral grave per-procedimento, e os que predisseram eventos combinados, foram a história prévia de comissurotomia valvar mitral e de fibrilação atrial e a presença de insuficiência valvar mitral grave per-procedimento e de área valvar mitral < 1,5 m² (insucesso) pós-procedimento. CONCLUSAO: A valvoplastia mitral percutânea por balão é um procedimento efetivo, sendo que mais de dois terços dos pacientes estavam livres de eventos ao final do seguimento. A sobrevida no grupo total foi elevada, maior no grupo com menor escore ecocardiográfico.

Hipertensão arterial renovascular: resultados imediatos e evolução intra hospitalar após intervenção percutânea de artéria renal / Renovascular arterial hypertension: outcome and in hospital evolution after renal artery percutaneous intervention

Objetivo: Avaliar características clínicas e angiográficas, resultados imediatos e evolução intra hospitalar de pacientes submetidos à intervenção percutânea de artéria renal.Método: Foram realizados 46 procedimentos no período compreendido entre 1981 e 2004, subdivididos em dois grupos: Grupo A, compreendendo 25 procedimentos realizados em 23 pacientes, utilizando-se somente o balão, no período de 1981 e 1992, quando não estava disponível o stent para intervenção em artéria renal; Grupo N, compreendendo as intervenções realizadas de 1993 a 2004, quando foi usado balão e/ou stent, a critério do operador.Resultados: As características clínicas e angiográficas e os resultados imediatos do grupo A e N foram respectivamente: idade 45,8 e 62,17 (p igual 0,0037); sexo feminino 13(52 por cento) e 9(42,9 por cento) e masculino 12(48 por cento) e 12(52 por cento), (p igual 0,5363), etiologia aterosclerótica 17 (68 por cento) e 19(90,5 por cento); displasia fibromuscular 7(28 por cento) e 2(9,5 por cento) e arterite de Takayasu 2(4 por cento) e 0(0 por cento), (p igual 0,2928); extensão da doença unilateral 22(88,8 por cento) e 19(90,5 por cento) e bilateral 3(11,2 por cento) e 2(9,5 por cento), (p igual 0,5849), localização da doença ostial 3(12 por cento) e 5(23,8 por cento) e não ostial 22 (88 por cento) e 16(76,2 por cento), (p igual 0,2536) e sucesso 21 (84 por cento) e 21 (100 por cento) e insucesso 4(16 por cento) e 0(0 por cento), (p igual 0,0775). No grupo A, utilizou-se apenas balão nos 25 procedimentos e no grupo N, balão em 8(38,1 por cento) e stent em 13 (61,9 por cento), (p menor 0,0001). Os níveis de pressão eram semelhantes nos grupos A e N antes da intervenção, havendo queda significativa dos níveis pressóricos em ambos os grupos. Nos subgrupos de etiologia aterosclerótica e de displasia fibromuscular, a queda da pressão arterial pós procedimento e da pressão diastólica foi semelhante em ambos.Conclusão: O grupo A era mais jovem, não houve diferença significativa para sexo, etiologia, extensão da doença e localização da lesão, e houve tendência para maior sucesso no grupo N. Houve significativa queda da pressão arterial sistólica e diastólica pós procedimento, nos grupos estudados

Baläo único versus baläo de inoue na valvoplastia mitral percutânea por baläo: resultados imediatos e complicaçöes / Single balloon versus inoue balloon in percutaneous mitral balloon valvuloplasty: short-term results and complications

Objetivo - Avaliar os resultados imediatos e complicaçöes da valvoplastia mitral percutânea por baläo (VMPB), com o baläo de Inoue (BI) e com o baläo único (BU). Métodos - Dentre 390 procedimentos utilizaram-se o BI em 29 procedimentos e o BU de baixo perfil em 337. Näo houve diferença na idade e sexo nos 2 grupos. O grupo BI era menossintomático (p=0,0015). Não houve diferença na distribuição do escore ecocardiográfico e da área valvar mitral (AVM) pré-VMPB. Resultados - Quando compararam-se os 2 grupos entre si, os resultados nos grupos BI e BU foram, respectivamente: pré-VMPB para pressäo pulmonar média (PPM) ..."fórmula"...Só houve complicaçöes no grupo BU. Conclusäo - As duas técnicas foram eficientes. Os resultados hemodinâmicos foram semelhantes, embora a AVM pós-VMPB do grupo do BI foi maior.

Valvoplastia mitral percutânea com a técnica do balão único. Resultados imediatos, complicaçoes e evolução intra-hospitalar / Percutaneous mitral valvuloplasty with the single balloon technique. Short-term results, complications and in-hospital follow-up

PURPOSE: To study the short-term results, complication and in-hospital follow-up of 268 percutaneous mitral balloon valvuloplasty (PMBV) procedures performed with the low-profile monofoil balloon (LPMB) technique from 1990 to 1995. METHODS: A single 30mm balloon diameter was used in 247 (92.9) procedures, a single 25mm balloon diameter in 9 (3.3), a single 25mm balloon followed by a single 30mm balloon diameter in 7 (2.6) and in 5 procedures a balloon was not used. The mean age group was 36 +/- 12 years. Two hundred nineteen (81.7) procedures were performed in women (mean age 36 +/- 12 years) and 49 (18.3) in men (mean age, 35 +/- 14 years) (p = 0.78). Patients were in functional class II (NYHA) in 39 (14.5), class III in 198 (73.9) and class IV in 31 (11.6). Patients were in sinus rhythm in 228 (85.1) procedures and in atrial fibrillation in 40 (14.9). The echocardiographic score ranged from 4 to 14 (mean 7.2 +/- 1.5). RESULTS: There were 256 complete procedures, 249 of which were successful (mitral valve area (MVA) > or = 1.5cm2 after PMBV). Echocardiographic calculated MVA before PMBV was 0.9 +/- 0.2cm2. Hemodynamic calculated MVA before PMBV was 0.9 +/- 0.2cm2 and after was 2.0 +/- 0.4cm2 (p < 0.000001). Mean pulmonary artery pressure decreased from 40 +/- 15mmHg to 28 +/- 10mmHg (p < 0.000001) and mitral mean gradient from 20 +/- 7mmHg to 5 +/- 4mmHg (p < 0.000001). In the 256 complete procedures mitral valve (MV) was competent in 214 and there was 1+ mitral regurgitation (MR) in 42. After PMBV, MV was competent in 166 and there was 1+ MR in 68, 2+ in 16, 3+ in 5 and 4+ MR in 1. There were complications in 14 (5.2) procedures, severe MR in 6 (3 or 4+), stroke in 2 and cardiac tamponade in 6. Two patients died during emergency cardiac surgery after left ventricular perforation and 1 after stroke. CONCLUSION: PMBV with the LPMB was an effective procedure with a high success rate and a low rate of complications as the more usual double-balloon and Inoue balloon techniques.

Valvoplastia mitral percutânea por balão. Resultados imediatos, complicaçoes e evolução hospitalar / Percutaneous balloon mitral valvoplasty. Immediate results, complications and hospital outcome

PURPOSE--To study the short-term results, complications and in-hospital follow-up of 223 percutaneous mitral balloon valvuloplasty (PMBV) procedures (proc)in 219 patients. METHODS--It was used a single 20mm balloon diameter in 4 proc, double balloon in 7, Inoue balloon in 4 and low profile balloon in 196. The mean-age group was 37.19 years. One hundred eighty three (82.1) procedures were performed in women (mean age, 36.99 years) and 40 (17.9) in men (mean age, 38.10 years) (p = 0.63). Patients were in functional class II, (NYHA) in 25 (11.2) procedures, class III in 165 (74.0) and class IV in 33 (14.8). Patients were in sinus rhythm in 182 procedures (81.6) and in atrial fibrillation in 41 (18.4). The echocardiographic score range from 4 to 14 (7.4 +/- 1.7). Among 4 and 11 were 98.2 of patients. RESULTS--We had 203 complete proc and success, mitral valve area (MVA) > or = 1.5cm2 after PMBV in 194 proc. Echocardiographic MVA before PMBV was 0.9 +/- 0.2cm2 and after 1.8 +/- 0.3cm2 (p < 0.01). Hemodynamic measures MVA before PMBV was 0.9 +/- 0.2cm2 and after was 1.9 +/- 0.3cm2 (p < 0.01). Mean pulmonary artery pressure decreased from 39 +/- 14mmHg to 27 +/- 11mmHg (p < 0.01) and mitral mean gradient from 20 +/- 9mmHg to 6 +/- 5mmHg (p < 0.01). In the 203 proc, mitral valve (MV) was competent in 176 and there were 1+ mitral regurgitation (MR) in 27. After PMBV, MV was competent in 126, and there were 1+ MR in 60, 2+ in 10.3+ in 6 and 4+ MR in 1. There was complication in 15 proc, severe MR in 7 (3 or 4+), stroke in 3 and cardiac tamponade in 5. Two patients died during emergency cardiac surgery after left ventricular perforation and one by stroke. CONCLUSION--PMBV was an effective procedure with a high grade of success and low rate of complication.

PERFUSION FOR MYOCARDIAL REVASCULARIZATION WITHOUT AN ARTIFICIAL OXYGENATOR (New Method to Reduce Surgical Morbidity).

Thirteen patients were submitted to direct myocardial revascularization (saphenous vein graft) without the use of an artificial oxygenator. The perfusion was done by a left ventricle-to-aorta bypass and autogenous oxygenation. Most patients had three grafts implanted plus endarterectomy of the distal right coronary artery. There was one hospital death that was apparently not related to the method used. Perfusion time ranged from 45 minutes to 4 hours. Body temperature during perfusion was kept between 25 and 30 degrees C. Perfusion flow was maintained between 25 to 50 ml per kg of body weight per minute. Ischemic, hypothermic cardiac arrest was employed. We demonstrated for the first time that perfusion for this kind of heart surgery could be done with no artificial oxygenators and, apparently, is safer for the patients. There were no bleeding problems even in perfusions as long as 4 hours. There was no respiratory dysfunction, and artificial respiration was used for only 6 to 12 hours. The patients awoke at the end of surgery with no signs or symptoms of central nervous system damage, and vasopressor drugs were rarely used after surgery. Although the experience is very small, it suggests that many postoperative problems, especially those related to bleeding and respiratory dysfunction may be reduced or eliminated by this new method.