RESUMEN
La obstrucción de una válvula protésica es una complicación rara pero que puede ser letal. Las causas más frecuentes son la formación de trombos y pannus, en ausencia de datos infecciosos. El diagnóstico no siempre es sencillo recurriendo a la realización de tomografía computarizada (TC) cardiaca, y en el 46-85% de los casos coexisten trombo y pannus, por lo que el diagnóstico se complica. Un diagnóstico rápido es esencial para evitar un desenlace fatal de esta patología, cuya mortalidad, a pesar de un tratamiento correcto, es elevada.(AU)
Prosthetic valve obstruction is a rare but potentially lethal complication. The most frequent causes are thrombus and pannus formation, in the absence of infectious data. Diagnosis is not always easy using cardiac CT scanning and in 46-85% of cases thrombus and pannus coexist, complicating the diagnosis. A rapid diagnosis is essential to avoid a fatal outcome of this pathology whose mortality, despite correct treatment, is high.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Válvula Mitral/lesiones , Diagnóstico por Imagen , Trombosis/diagnóstico por imagen , Válvula Mitral/diagnóstico por imagen , Angiografía por Tomografía Computarizada , /diagnóstico por imagenRESUMEN
Acute mitral valve injury following percutaneous left atrial appendage (LAA) occlusion is a rare, but potentially life-threatening complication. This report presents a case of severe mitral valve injury following left atrial appendage occlusion (LAAO) that required mitral valve replacement. The LAAO device successfully was removed, and the LAA was closed with a double-running polypropylene suture. In addition, the mitral valve was replaced with an artificial valve. The patient had an uneventful clinical evolution and was discharged 10 days after emergency surgery.
Asunto(s)
Fibrilación Atrial/cirugía , Lesiones Cardíacas/etiología , Válvula Mitral/lesiones , Dispositivo Oclusor Septal/efectos adversos , Anciano , Apéndice Atrial , Fibrilación Atrial/diagnóstico , Remoción de Dispositivos/métodos , Ecocardiografía Transesofágica , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/cirugía , Humanos , Masculino , Válvula Mitral/diagnóstico por imagenAsunto(s)
Implantación de Prótesis de Válvulas Cardíacas/métodos , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/lesiones , Adulto , Aorta/diagnóstico por imagen , Aorta/lesiones , Aorta/cirugía , Ecocardiografía Transesofágica/métodos , Femenino , Prótesis Valvulares Cardíacas , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagenRESUMEN
An 86-year-old female with severe aortic valve stenosis underwent transcatheter aortic valve replacement. A balloon-expandable valve was used, guided by a double-stiff guidewire that successfully straightened the aorta. During valve placement, the balloon shifted. After placement of the prosthetic valve, intraoperative transesophageal echocardiography revealed severe mitral regurgitation from the anterior mitral leaflet. Open conversion was performed immediately. A 5-mm hole was identified in the anterior leaflet, and direct closure was chosen for mitral valve repair. While transcatheter aortic valve replacement has gained popularity for patients with severe aortic stenosis and high operative risk, reports of mitral valve perforation are rare.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Valvuloplastia con Balón/efectos adversos , Lesiones Cardíacas/etiología , Insuficiencia de la Válvula Mitral/etiología , Válvula Mitral/lesiones , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Femenino , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/cirugía , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
BACKGROUND: Primary valvular heart disease is a prevalent cause of morbidity and mortality in both industrialized and developing countries. Although the primary consequence of valvular heart disease is myocardial dysfunction, treatment of valvular heart diseases centers around valve repair or replacement rather than prevention or reversal of myocardial dysfunction. This is particularly evident in primary mitral regurgitation (MR), which invariably results in eccentric hypertrophy and left ventricular (LV) failure in the absence of timely valve repair or replacement. The mechanism of LV dysfunction in primary severe MR is entirely unknown. METHODS: Here, we developed the first mouse model of severe MR. Valvular damage was achieved by severing the mitral valve leaflets and chords with iridectomy scissors, and MR was confirmed by echocardiography. Serial echocardiography was performed to follow up LV morphology and systolic function. Analysis of cardiac tissues was subsequently performed to evaluate valve deformation, cardiomyocyte morphology, LV fibrosis, and cell death. Finally, dysregulated pathways were assessed by RNA-sequencing analysis and immunofluorescence. RESULTS: In the ensuing 15 weeks after the induction of MR, gradual LV dilatation and dysfunction occurred, resulting in severe systolic dysfunction. Further analysis revealed that severe MR resulted in a marked increase in cardiac mass and increased cardiomyocyte length but not width, with electron microscopic evidence of sarcomere disarray and the development of sarcomere disruption. From a mechanistic standpoint, severe MR resulted in activation of multiple components of both the mammalian target of rapamycin and calcineurin pathways. Inhibition of mammalian target of rapamycin signaling preserved sarcomeric structure and prevented LV remodeling and systolic dysfunction. Immunohistochemical analysis uncovered a differential pattern of expression of the cell polarity regulator Crb2 (crumbs homolog 2) along the longitudinal axis of cardiomyocytes and close to the intercalated disks in the MR hearts. Electron microscopy images demonstrated a significant increase in polysome localization in close proximity to the intercalated disks and some areas along the longitudinal axis in the MR hearts. CONCLUSIONS: These results indicate that LV dysfunction in response to severe MR is a form of maladaptive eccentric cardiomyocyte hypertrophy and outline the link between cell polarity regulation and spatial localization protein synthesis as a pathway for directional cardiomyocyte growth.
Asunto(s)
Modelos Animales de Enfermedad , Insuficiencia de la Válvula Mitral/patología , Miocitos Cardíacos/patología , Animales , Moléculas de Adhesión Celular/biosíntesis , Moléculas de Adhesión Celular/genética , Forma de la Célula , Tamaño de la Célula , Ecocardiografía , Fibrosis , Perfilación de la Expresión Génica , Hipertrofia , Bombas de Infusión Implantables , Imagen por Resonancia Magnética , Masculino , Ratones , Válvula Mitral/lesiones , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Miocitos Cardíacos/metabolismo , Polirribosomas/ultraestructura , ARN Mensajero/biosíntesis , Sirolimus/farmacología , Sirolimus/uso terapéutico , Sístole , Serina-Treonina Quinasas TOR/antagonistas & inhibidores , Serina-Treonina Quinasas TOR/fisiología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/patologíaRESUMEN
Inferior vena cava filters are used for patients with pulmonary embolism or those with risk of embolization. Here we present a case of a 38-year-old man who underwent placement of an inferior vena cava filter because of deep vein thrombosis. The operating arm fractured and embolized to the posteromedial papillary muscle of mitral valve and the posterior inferior wall of the left ventricle through right atrium and atrioventricular septum, leading to large symptomatic mitral and tricuspid insufficiency and pericardial tamponade. Here we report a rare case where the filter migrated to the left ventricle and destroyed the mitral valve.
Asunto(s)
Migración de Cuerpo Extraño/diagnóstico , Ventrículos Cardíacos , Insuficiencia de la Válvula Mitral/etiología , Válvula Mitral/lesiones , Insuficiencia de la Válvula Tricúspide/etiología , Filtros de Vena Cava/efectos adversos , Adulto , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Migración de Cuerpo Extraño/complicaciones , Migración de Cuerpo Extraño/cirugía , Humanos , Masculino , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/cirugía , Embolia Pulmonar/etiología , Embolia Pulmonar/prevención & control , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/cirugía , Vena Cava Inferior , Trombosis de la Vena/complicacionesRESUMEN
BACKGROUND: The development of minimally invasive mitral valve surgery has created the motivation for using this approach in young patients with chronic rheumatic valve disease. We report our recent experience with patients undergoing minimally mitral valve surgery in this group of patients. METHODS: Between July 2014 and June 2018, 142 patients with rheumatic mitral valve dysfunction underwent minimally invasive surgery through a right thoracotomy approach at the University Medical Center of Ho Chi Minh City in Vietnam. Diagnosis was confirmed with transthoracic and transesophageal echocardiography (TTE and TEE). We analyzed the in-hospital and midterm follow-up outcomes of this group. RESULTS: The mean age was 42.6 ± 9.6 years. Sixty patients (42.3%) were male. Sixty-three patients were diagnosed with functional severe tricuspid regurgitation, 29 patients were identified with moderate tricuspid regurgitation, and tricuspid annulus was more than 21 mm/m²). Mitral valve repair was performed in 16 patients (11.3%), and 126 patients underwent mitral valve replacement. Mitral valve repair techniques included annuloplasty, leaflet peeling, and commissurotomy. Thirty-day mortality was 0.7%. Two patients had to be converted to conventional sternotomy, due to left atrial appendage laceration and mitral annular rupture. The overall survival rate was 98.6%. Freedom from reoperation was 97.1%. CONCLUSIONS: In patients with rheumatic valve disease, minimally invasive mitral surgery safely and effectively can be performed with few perioperative complications and good midterm results.
Asunto(s)
Enfermedades de las Válvulas Cardíacas/cirugía , Válvula Mitral/cirugía , Cardiopatía Reumática/cirugía , Insuficiencia de la Válvula Tricúspide/cirugía , Adulto , Conversión a Cirugía Abierta/estadística & datos numéricos , Ecocardiografía Transesofágica , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas/estadística & datos numéricos , Humanos , Masculino , Ilustración Médica , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/lesiones , Cardiopatía Reumática/diagnóstico por imagen , Esternotomía , Tasa de Supervivencia , Toracotomía/métodos , Insuficiencia de la Válvula Tricúspide/diagnósticoRESUMEN
There has been great concern with the use of radiofrequency ablation in infants since radiofrequency ablation lesions were shown to have a progressing nature in immature myocardium of animals. In this report, we present a 2-month-old infant with life-threatening medically refractory supraventricular tachycardia. Radiofrequency ablation successfully cured arrhythmia; however, late effects of radiofrequency ablation lesions resulted in a progressive mitral valve perforation requiring surgical repair.
Asunto(s)
Ablación por Catéter/efectos adversos , Lesiones Cardíacas/diagnóstico , Válvula Mitral/lesiones , Complicaciones Posoperatorias , Taquicardia Supraventricular/cirugía , Ecocardiografía , Electrocardiografía , Lesiones Cardíacas/etiología , Lesiones Cardíacas/cirugía , Humanos , Lactante , Masculino , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugíaRESUMEN
Mitral valve disease becomes more prevalent as the population ages. As the number of percutaneous mitral valve interventions expands, obscure clinical scenarios may emerge and challenge conventional treatment algorithms. Strategies for dealing with complex repairs build on prior experience in mitral perivalvular leak repair. Cases using nitinol- and expanded polytetrafluoroethylene-based devices are used to treat mitral regurgitation in cases of focal mitral perforations and leaks between previously placed mitral valve edge-to-edge devices. This review discusses risks and benefits of performing such complex mitral repairs and informs clinicians of the strengths of weaknesses of different occluder devices in the mitral position.
Asunto(s)
Cateterismo Cardíaco/métodos , Lesiones Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/lesiones , Ecocardiografía , Lesiones Cardíacas/complicaciones , Lesiones Cardíacas/diagnóstico , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/etiología , ReoperaciónRESUMEN
: Traumatic mitral valve regurgitation is a rare and often insidious condition. Clinical presentation is variable and influenced by the anatomic structures injured; when papillary muscles are damaged, the clinical presentation is often acute, whereas, in the case of involvement of other anatomic structures of the valvular apparatus (e.g. chordae tendinae), the onset of symptoms may be delayed (days, weeks, or months). Therefore, diagnosis may be belated because of the heterogeneous clinical presentation. Traumatic mitral valve injury should be excluded in patients admitted to the emergency services with blunt chest trauma, in particular when signs or symptoms of acute heart failure occur. Echocardiography, particularly with the transoesophageal approach, may play a pivotal role in this setting. Herein, we present a case of severe mitral regurgitation because of blunt chest trauma and a systematic review of the literature. We examined 192 described cases, classified according to epidemiology, aetiology, anatomic features, clinical presentation, diagnosis, surgical/clinical management and prognosis.
Asunto(s)
Accidentes de Trabajo , Lesiones Cardíacas/etiología , Insuficiencia de la Válvula Mitral/etiología , Válvula Mitral/lesiones , Heridas no Penetrantes/etiología , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/fisiopatología , Lesiones Cardíacas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Válvula Mitral/cirugía , Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/cirugía , Recuperación de la Función , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/fisiopatología , Heridas no Penetrantes/cirugíaAsunto(s)
Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Lesiones Cardíacas/complicaciones , Insuficiencia de la Válvula Mitral/etiología , Válvula Mitral/lesiones , Complicaciones Posoperatorias , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/diagnóstico , Lesiones Cardíacas/diagnóstico , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/diagnósticoRESUMEN
Cardiac gunshot injuries are rare in the United Kingdom, but they are associated with significant morbidity and mortality. We present the case of a young male who was shot at close range with a low-caliber air rifle. The projectile entered the thorax through the right axilla, but it was identified at the cardiac apex on initial imaging. Subsequent investigations demonstrated the pellet at the apex of the left ventricle. The potential for embolization was considered, and the pellet was retrieved after surgical exploration. No significant valvular injury was sustained despite the pellet's trajectory, and the patient made an uncomplicated recovery.
Asunto(s)
Lesiones Cardíacas/etiología , Heridas por Arma de Fuego/complicaciones , Adolescente , Humanos , Masculino , Válvula Mitral/lesionesRESUMEN
Transcatheter atrial septal defect (ASD) device closure has gained increasing popularity over the past decades due to shorter hospital stay and the absence of skin scars. However, concern about the seriousness of device-related complications is accumulating. We report a case of device fracture in a young asymptomatic woman almost 4 years after percutaneous secundum ASD closure, resulting in mitral valve perforation. Subsequently, elective surgical removal of the device and mitral valve reconstruction was performed. This case demonstrates that complications from transcatheter ASD closure may even occur late after implantation.
Asunto(s)
Defectos del Tabique Interatrial/cirugía , Válvula Mitral/lesiones , Dispositivo Oclusor Septal/efectos adversos , Adulto , Femenino , Humanos , Válvula Mitral/cirugíaRESUMEN
Papillary muscle rupture is a rare complication after myocardial infarction. Almost all cases occur in the papillary muscle of the mitral valve. The development of tricuspid regurgitation after right ventricular myocardial infarction caused by papillary muscle rupture is extremely rare. We present a 70-year-old man with massive tricuspid regurgitation caused by papillary muscle rupture after percutaneous coronary intervention to the right coronary artery involving a stent. We performed tricuspid valve repair with a reimplanted papillary muscle in situ using neither artificial chordae nor a prosthetic valve. Previous case reports on this surgical repair technique are not available.
Asunto(s)
Rotura Cardíaca Posinfarto/cirugía , Válvula Mitral/lesiones , Músculos Papilares/lesiones , Intervención Coronaria Percutánea/efectos adversos , Insuficiencia de la Válvula Tricúspide/etiología , Anciano , Ecocardiografía , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/etiología , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Músculos Papilares/diagnóstico por imagen , Músculos Papilares/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
Blunt trauma to the chest can damage any thoracic organ. Heart valve damage and particularly mitral apparatus occurs relatively rare, and the patients are expected to become acutely symptomatic. However, in patients with multiple traumas, other dominant severe damages tend to draw away the attention of the physicians resulting in neglect of less salient heart injuries. Here, we present a patient with history of blunt chest trauma and incidental finding of posttraumatic severe mitral regurgitation.
Asunto(s)
Fístula/etiología , Atrios Cardíacos , Cardiopatías/etiología , Lesiones Cardíacas/complicaciones , Ventrículos Cardíacos , Válvula Mitral/lesiones , Heridas no Penetrantes/complicaciones , Procedimientos Quirúrgicos Cardíacos/métodos , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Fístula/diagnóstico , Fístula/cirugía , Cardiopatías/diagnóstico , Cardiopatías/cirugía , Lesiones Cardíacas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Heridas no Penetrantes/diagnósticoRESUMEN
AIMS: The aim of this study was to describe the incidence, mechanisms, management and outcomes of intracardiac shunts (ICS) following TAVI. METHODS AND RESULTS: This was a multicentre registry across 10 centres aimed at gathering all cases of ICS (1.1%) including infection-related (IRICS, 0.3%) or aseptic (AICS, 0.8%) shunts. Patients presented porcelain aorta (24% vs. 6.8%, p=0.024) and had been treated with predilation (88% vs. 68.5%, p=0.037) or post-dilation (59.1% vs. 19.3%, p<0.001) more often. Median time from intervention to diagnosis of ICS was 10 days (IQR: 2-108), being longer for IRICS (171 [63-249] vs. 3 [1-12] days, p=0.002). Interventricular septum (55.6%) and anterior mitral leaflet (57.2%) were the most common locations for AICS and IRICS, respectively. Most patients (76%) developed heart failure but 64% were medically managed. Seven patients (38.9%) underwent percutaneous closure of AICS. The in-hospital mortality rate was 44% (IRICS 100%, AICS 27.8%) compared to global TAVI recipients (8.1%, p<0.001). At one-year follow-up, 76% of the patients had died. ICS, logistic EuroSCORE, and moderate-severe residual aortic regurgitation were independent predictors of death. CONCLUSIONS: Post-TAVI ICS are an uncommon complication independently associated with high early mortality. Currently, most therapeutic alternatives yield poor results but percutaneous closure of AICS was feasible and is a promising alternative.
Asunto(s)
Complicaciones Intraoperatorias , Válvula Mitral/lesiones , Complicaciones Posoperatorias , Infecciones Relacionadas con Prótesis , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Tabique Interventricular/lesiones , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/cirugía , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/mortalidad , Mortalidad Hospitalaria , Humanos , Incidencia , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/terapia , Masculino , Válvula Mitral/diagnóstico por imagen , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Pronóstico , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/terapia , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , España/epidemiología , Tomografía Computarizada por Rayos X/métodos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Tabique Interventricular/diagnóstico por imagen , Técnicas de Cierre de Heridas/estadística & datos numéricosRESUMEN
Penetrating cardiac injuries with extensive intracardiac components and minimal epicardial components are a rare presentation. A 31-year-old male presented with complex mitral valve and ventricular septal injuries with partial atrioventricular disruption but with hardly visible epicardial injuries; the patient's presentation, progression of injuries and successful management are discussed.