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1.
Int Heart J ; 61(2): 273-280, 2020 Mar 28.
Artículo en Inglés | MEDLINE | ID: mdl-32173708

RESUMEN

For its high occurrence and elevated risks for aortic valve dysfunction and vascular complications, bicuspid aortic valve (BAV) represents a great health challenge. However, the prevalence and clinical features of BAV in the Chinese population are inadequately illustrated.From January 2011 to December 2015, 3,673 BAV patients with 69.1% male predominance were identified among 325,910 recipients of transthoracic echocardiography in our institution, demonstrating 58.4% overt aortic valve dysfunction, 52.5% ascending aortic dilatation, and 19.2% aortic root dilatation. The prevalence of pure aortic stenosis and mixed aortic valve dysfunction rose strikingly with age (both P < 0.0001), while pure aortic regurgitation showed significant decrease with age (P < 0.0001). Males showed elevated prevalence of pure aortic regurgitation (OR 3.16, 95% CI 2.55-3.91, P < 0.0001) and mixed aortic valve dysfunction than females (OR 1.63, 95% CI 1.23-2.17, P = 0.0008), but lower prevalence of pure aortic stenosis (OR 0.51, 95% CI 0.43-0.60, P < 0.0001). Aortic root dilatation was associated with male gender (OR 5.02, 95% CI 3.74-6.74, P < 0.0001), pure aortic regurgitation (OR 2.61, 95% CI 2.15-3.17, P < 0.0001), and right-left (RL) cusp fusion type (OR 1.98, 95% CI 1.64-2.40, P < 0.0001). Ascending aortic dilatation was associated with an elder age (OR 1.04, 95% CI 1.04-1.05, P < 0.0001), pure aortic stenosis (OR 1.37, 95% CI 1.16-1.61 P = 0.0002), and mixed aortic valve dysfunction (OR 2.51, 95% CI 1.89-3.33, P < 0.0001).Bicuspid aortic stenosis and ascending aortic dilatation demonstrate a similar pattern of age escalation, while aortic regurgitation is more prevalent in younger BAV patients. Aortic root dilatation intervenes closely with a unique phenotypic subgroup of male BAV patients with pure aortic regurgitation and RL fusion type.


Asunto(s)
Enfermedades de la Aorta/etiología , Válvula Aórtica/anomalías , Enfermedades de las Válvulas Cardíacas/complicaciones , Adolescente , Adulto , Anciano , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/epidemiología , Válvula Aórtica/diagnóstico por imagen , China/epidemiología , Ecocardiografía , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
2.
Clin Oral Investig ; 24(2): 833-840, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31197658

RESUMEN

OBJECTIVES: Infective endocarditis (IE) is a life-threatening infectious disease, but the pathogenesis of the disease remains uncertain. The objective of this study was to examine whether oral infectious conditions are associated with the occurrence of IE in valvular heart disease (VHD) patients. MATERIALS AND METHODS: A total of 119 periodontitis (P) patients with or without VHD were enrolled, and cross-sectional analyses were performed. Patients were classified as follows: (1) mild-to-moderate P without VHD, (2) mild-to-moderate P with VHD, (3) severe P without VHD, or (4) severe P with VHD. A total of 78 VHD patients were classified as (1) VHD without IE or (2) VHD with IE. Conditional logistic regression analysis was performed to compute the odds ratio (OR) and 95% confidence interval (CI). RESULTS: No significant differences were observed between patients with or without VHD in oral conditions. A significant increase in the percentage of alveolar bone loss in VHD patients with IE was observed compared with that of patients without IE. The ratio of both Porphyromonas gingivalis (Pg) IgG titer > 1.68 and Pg fimA type II genotype in patients with IE was significantly higher than in patients without IE. There was a significant correlation between the occurrence of IE and clinical oral findings (number of remaining teeth: OR, 0.17; rate of alveolar bone loss > 40%: OR, 11.8). CONCLUSIONS: VHD patients with IE might have severe periodontitis compared with patients without IE, although further investigation will be needed because this is based on only 7 VHD patients with IE. CLINICAL RELEVANCE: The patients with IE had fewer remaining teeth, more advanced bone resorption compared with those of patients without IE. These findings suggest a possible association between the occurrence of IE and periodontal infection.


Asunto(s)
Endocarditis , Enfermedades de las Válvulas Cardíacas , Periodontitis , Estudios Transversales , Endocarditis/epidemiología , Endocarditis/etiología , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/etiología , Humanos , Incidencia , Periodontitis/complicaciones
3.
Pan Afr Med J ; 33: 156, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31565118

RESUMEN

Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease. This study was designed to assess cardiac abnormalities in patients with SLE by echocardiography and to compare the 2 groups of patients with and without cardiac manifestations. It was a transversal, descriptive study, conducted in the Internal Medicine Department at the Military Hospital of Tunis from January 2016 to June 2018. Eighty lupus patients, diagnosed on the basis of ACR (American college of rheumatology) criteria, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. Out of 80 patients 42 (52%) had abnormal echocardiographic findings. Pericardial effusion was found in 55%, valvular abnormalities in 52% and 38% had pulmonary hypertension. Patients with pleural effusion (45 vs 15%) were more vulnerable to cardiac involvement as well as renal impairment (57 vs 44%). The difference, however, were not statistically significant (p>0.05) in the renal involvement. Active disease with low complement (80%) was associated with higher frequency of cardiac involvement than disease in remission (64%) but the result was not statistically significant (p=0.11). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic form. Echocardiography is an excellent non-invasive tool for cardiac evaluation. Their research must be systematic with echocardiography in order to reduce subsequent cardiac morbidity and mortality among the lupus patients.


Asunto(s)
Ecocardiografía/métodos , Cardiopatías/diagnóstico por imagen , Lupus Eritematoso Sistémico/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Cardiopatías/epidemiología , Cardiopatías/etiología , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/etiología , Hospitales Militares , Humanos , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/epidemiología , Hipertensión Pulmonar/etiología , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/epidemiología , Derrame Pericárdico/etiología , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/epidemiología , Derrame Pleural/etiología , Túnez
4.
BMC Res Notes ; 12(1): 491, 2019 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-31391105

RESUMEN

OBJECTIVES: The purpose of this study to determine the clinical pattern and prevalence of heart disease in pregnancy at the first established cardio-maternal unit in Iraq over the last 4 years; since January 2015 till May 2019. Data are presented as number and percentage. RESULTS: A total of 252 pregnant women presented to cardio-maternal unit included in this study. According to the collected data, among the main diagnosis of heart disease during pregnancy was valvular heart disease 34.1%, followed by congenital heart disease 30.5%, cardiomyopathy 29.8%, pulmonary hypertension 4%, and ischemic heart disease 1.6%. Among subtypes of the main heart diseases in pregnant women, the most clinical pattern was: the prosthetic heart valve (26.7%) in valvular heart disease, both atrial septal defect and ventricular septal defect (35%) in congenital heart disease, and peripartum cardiomyopathy (76%) among cardiomyopathies.


Asunto(s)
Cardiomiopatías/epidemiología , Defectos del Tabique Interatrial/epidemiología , Defectos del Tabique Interventricular/epidemiología , Enfermedades de las Válvulas Cardíacas/epidemiología , Hipertensión Pulmonar/epidemiología , Isquemia Miocárdica/epidemiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Adulto , Cardiomiopatías/diagnóstico , Femenino , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interventricular/diagnóstico , Defectos del Tabique Interventricular/cirugía , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas/estadística & datos numéricos , Unidades Hospitalarias , Humanos , Hipertensión Pulmonar/diagnóstico , Irak/epidemiología , Isquemia Miocárdica/diagnóstico , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/cirugía , Prevalencia
5.
J Thorac Cardiovasc Surg ; 158(5): 1399-1409, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31383559

RESUMEN

BACKGROUND: Infective endocarditis (IE) is rare in children. Limited data have been reported on long-term outcomes of children who undergo surgery for IE. METHODS: Data were retrospectively obtained from medical records for all children who underwent surgery for IE. RESULTS: Between 1987 and 2017, 138 children with IE required surgery (mean age, 8.3 ± 6.5 years). The majority of children (80.4% [111 out of 138]) had underlying cardiac structural anomalies. Prior heart surgery was performed in 50.7% of patients (70 out of 138), including 19.6% (27 out of 138) who had valve replacement. Operative mortality was 5.8% (8 out of 138). Mean follow-up time was 9.7 ± 7.6 years. Long-term survival at 5 and 25 years was 91.5% (95% confidence interval, 85.1%-95.2%) and 79.1% (95% confidence interval, 66.3%-87.5%), respectively. Risk factors associated with death were: age (hazard ratio [HR], 0.88; P = .015), prosthetic valve IE (HR, 3.86; P = .02), coagulase-negative staphylococci (HR, 4.52; P = .015), increased duration of preoperative antibiotic therapy (HR, 1.02; P = .009), shock (HR, 3.68; P = .028), and aortic valve replacement (HR, 3.22; P = .044). In patients with left-sided IE, risk factors independently associated with death were heart failure (HR, 18.8; P = .025) and vegetation size adjusted to body surface area (HR, 1.06; P = .008). Freedom from recurrent endocarditis was 94.7% (95% confidence interval, 87.7%-97.8%) at 25 years. CONCLUSIONS: Children undergoing surgery for IE had good long-term survival and recurrence of IE was uncommon. Surgery during the active phase of endocarditis did not increase risk of mortality or reoperation. In patients with left-sided IE, vegetation size adjusted for patient body surface area was identified as a risk factor for death, and a useful indicator of prognosis.


Asunto(s)
Endocarditis , Cardiopatías Congénitas , Enfermedades de las Válvulas Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Infecciones Estafilocócicas , Adolescente , Antibacterianos/uso terapéutico , Australia/epidemiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Niño , Preescolar , Endocarditis/diagnóstico , Endocarditis/microbiología , Endocarditis/mortalidad , Endocarditis/cirugía , Femenino , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/epidemiología , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Registros Médicos Orientados a Problemas/estadística & datos numéricos , Pronóstico , Factores de Riesgo , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/terapia , Sobrevivientes/estadística & datos numéricos
6.
S Afr Med J ; 109(8): 592-596, 2019 Jul 26.
Artículo en Inglés | MEDLINE | ID: mdl-31456555

RESUMEN

BACKGROUND: Little is known about the current clinical profile and outcomes of patients with infective endocarditis (IE) in South Africa (SA). OBJECTIVES: To provide a contemporary and descriptive overview of IE in a representative SA tertiary centre. METHODS: We conducted a retrospective review of the records of patients admitted to Groote Schuur Hospital, Cape Town, between 2009 and 2016 fulfilling universal criteria for definite or possible IE, in search of demographic, clinical, microbiological, echocardiographic, treatment and outcome information. RESULTS: A total of 105 patients fulfilled the modified Duke criteria for IE. The median age of the cohort was 39 years (interquartile range (IQR) 29 - 51), with a male preponderance (61.9%). The majority of the patients (72.4%) had left-sided native valve endocarditis, 14.3% had right-sided disease, and 13.3% had prosthetic valve endocarditis. A third of the cohort had rheumatic heart disease. Although 41.1% of patients with left-sided disease had negative blood cultures, the three most common organisms cultured in this subgroup were Staphylococcus aureus (18.9%), Streptococcus spp. (16.7%) and Enterococcus spp. (6.7%). Participants with right-sided endocarditis were younger (29 years, IQR 27 - 37) and were mainly intravenous drug users (73.3%), and the majority cultured positive for S. aureus (73.3%) with frequent septic pulmonary complications (40.0%). The overall in-hospital mortality was 16.2%, with no deaths in the group with right-sided endocarditis. Predictors of death in our patients were heart failure (odds ratio (OR) 8.16, 95% confidence interval (CI) 1.77 - 37.70; p=0.007) and age >45 years (OR 4.73, 95% CI 1.11 - 20.14; p=0.036). Valve surgery was associated with a reduction in mortality (OR 0.09, 95% CI 0.02 - 0.43; p=0.001). CONCLUSIONS: IE remains an important clinical problem in a typical teaching tertiary care centre in SA. In this setting, it continues to affect mainly young people with post-inflammatory valve disease and congenital heart disease. The in-hospital mortality associated with IE remains high. Intravenous drug-associated endocarditis caused by S. aureus is an important IE subset, comprising ~10% of all cases, which was not reported 15 years ago, and culture-negative endocarditis remains highly prevalent. Heart failure in IE carries a significant risk of death and needs a more intensive level of care in hospital. Finally, cardiac surgery was associated with reduced mortality, with the largest impact in patients with heart failure.


Asunto(s)
Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Adulto , Factores de Edad , Consumidores de Drogas , Endocarditis Bacteriana/terapia , Femenino , Insuficiencia Cardíaca/mortalidad , Enfermedades de las Válvulas Cardíacas/epidemiología , Prótesis Valvulares Cardíacas/efectos adversos , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/terapia , Estudios Retrospectivos , Cardiopatía Reumática/epidemiología , Sudáfrica/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología
7.
Ann Thorac Cardiovasc Surg ; 25(5): 265-273, 2019 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-31378750

RESUMEN

PURPOSE: Our study aimed to investigate the potential pathogenetic theories of different phenotype prevalence in bicuspid aortopathy. METHODS: A total of 407 bicuspid aortic valve (BAV) patients with aortic dilation were retrospectively reviewed. Association was determined between aortic valve lesion types and aortic configurations to confirm the homogeneous BAV subsets, and then, dominance analysis was used to evaluate the relative importance of two components of aortic valve lesion (BAV phenotype and valvular dysfunction) that associated with aortic configurations in each subgroup. RESULTS: Dominance analysis showed that Type-1 LR was the dominant contributor (79.0% and 79.6%) associated with the higher prevalence of the dilation of aortic root (AoR) and ascending aorta (AAo) in BAV patients with Type-1 LR and aortic regurgitation (AR) or aortic stenosis (AS) + AR. However, AS was the main contributor (60.0%) associated with the raised incidence of the dilation of AAo and proximal aortic arch (PArc) in Type-0 LAT and AS. CONCLUSIONS: Different dominant pathogenetic theory determined the phenotype of BAV aortopathy. In patients of Type-1 LR with AR, inherent disposition is mainly responsible for the higher frequency of AoR dilation. Valve-related hemodynamics determined greater prevalence of the dilation of AAo and PArc in patients of Type-0 LAT with AS.


Asunto(s)
Aneurisma de la Aorta/epidemiología , Insuficiencia de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/epidemiología , Válvula Aórtica/anomalías , Enfermedades de las Válvulas Cardíacas/epidemiología , Adulto , Anciano , Aorta/diagnóstico por imagen , Aorta/patología , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/patología , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/patología , Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Beijing/epidemiología , Dilatación Patológica , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/patología , Enfermedades de las Válvulas Cardíacas/fisiopatología , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Fenotipo , Prevalencia , Estudios Retrospectivos
8.
Curr Med Sci ; 39(4): 523-525, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31346985

RESUMEN

China is one of the countries which have a high incidence of heart valvular disease, but the use of biological valve is limited in China before because the majority of patients are young patients suffering from rheumatic heart disease. The biological valve has a good application prospect in China. On the one hand, the new generation of biological valves have been significantly improved in the aspects of anti-calcification treatment, anti-metabolism, material quality control, valve frame mechanics design, and leaflet sewing technology, and the application effect is improved; on the other hand, surgeons should adapt to the new concept changes, and correctly understand and rationally apply biological valves, master valve repair, atrial fibrillation ablation and other techniques, combined with interventional, minimally invasive techniques, etc., according to the specific conditions of the disease and choose the surgery type to ensure the patients' long-term life quality.


Asunto(s)
Fibrilación Atrial/terapia , Bioprótesis , Procedimientos Quirúrgicos Cardíacos , Enfermedades de las Válvulas Cardíacas/terapia , Fibrilación Atrial/epidemiología , Ablación por Catéter/métodos , China/epidemiología , Enfermedades de las Válvulas Cardíacas/epidemiología , Humanos , Implantación de Prótesis/métodos , Factores de Riesgo , Resultado del Tratamiento
9.
Arch Cardiovasc Dis ; 112(6-7): 381-389, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31303461

RESUMEN

BACKGROUND: Bacterial infective endocarditis (IE) is rarely suspected in patients with a low C-reactive protein (CRP) concentration. AIMS: To address the incidence, characteristics and outcome of left-sided valvular IE with low CRP concentration. METHODS: This was a retrospective analysis of cases of IE discharged from our institution between January 2009 and May 2017. The 10% lowest CRP concentration (<20mg/L) was used to define low CRP concentration. Right-sided cardiac device-related IE, non-bacterial IE, sequelar IE and IE previously treated by antibiotics were excluded. RESULTS: Of the 469 patients, 13 (2.8%; median age 68 [61-76] years) had definite (n=8) or possible (n=5) left-sided valvular IE with CRP<20mg/L (median 9.3 [4.7-14.2] mg/L). The median white blood cell count was 6.3 (5.3-7.5) G/L. The main presentations were heart failure (n=7; 54%) and stroke (n=3; 23%). Transthoracic echocardiography (TTE) showed vegetations (n=5) or isolated valvular regurgitation (n=4). Overall, eight patients (62%) had severe valvular lesions on transoesophageal echocardiography (TOE), and nine patients (69%) underwent cardiac surgery. All patients survived at 1-year follow-up. Bacterial pathogens were documented in eight patients (streptococci, coagulase-negative Staphylococcus, Corynebacteriumjeikeium, HACEK group, Coxiella burnetii, Bartonella henselae) using blood cultures, serology or valve culture and/or polymerase chain reaction analysis. CONCLUSIONS: Left-sided valvular IE with limited or no biological syndrome is rare, but is often associated with severe valvular and paravalvular lesions. TOE should be performed in presence of unexplained heart failure, new valvular regurgitation or cardioembolic stroke when TTE is insufficient to rule out endocarditis, even in patients with a low CRP concentration.


Asunto(s)
Proteína C-Reactiva/análisis , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Mediadores de Inflamación/sangre , Anciano , Biomarcadores/sangre , Toma de Decisiones Clínicas , Ecocardiografía Transesofágica , Endocarditis Bacteriana/sangre , Endocarditis Bacteriana/terapia , Femenino , Francia/epidemiología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/microbiología , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/microbiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Selección de Paciente , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/microbiología
10.
Lakartidningen ; 1162019 May 15.
Artículo en Sueco | MEDLINE | ID: mdl-31192394

RESUMEN

Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, affecting 1-2% of the general population. BAV is associated with an increased morbidity and mortality related to diseases of the aortic valve (aortic stenosis and aortic regurgitation) and the thoracic aorta (aortic aneurysm and aortic dissection). These conditions can often be treated surgically to prevent adverse events and reduce mortality. However, optimal management of BAV patients requires knowledge about the natural history of common clinical complications and involved pathological mechanisms. The aim of this article is to present common complications associated with BAV and to summarize the recently published evidence-based guidelines focusing solely on BAV patients.


Asunto(s)
Válvula Aórtica/anomalías , Enfermedades de las Válvulas Cardíacas , Válvula Aórtica/cirugía , Consenso , Ecocardiografía , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Guías de Práctica Clínica como Asunto , Estados Unidos
11.
Innovations (Phila) ; 14(3): 209-217, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31203738

RESUMEN

OBJECTIVE: To assess early and late clinical outcomes in patients who underwent aortic valve repair surgery for aortic valve insufficiency, and to investigate predictors for recurrence. METHODS: Of 151 consecutive patients who underwent aortic valve repair surgery for varying degrees of aortic insufficiency (AI) in our department between 2004 and 2018, 60 (40%) underwent aortic root replacement, 71 (47%) aortic cusp plication, 31 (20%) subcommissural annuloplasty, 29 (19%) circular annuloplasty, and 28 (18%) autologous pericardial patch augmentation. RESULTS: One patient died in the hospital (0.7%). Mean clinical and echocardiographic follow-up was 62±43 months (range 1 to 159) and 50 ± 40 months (range 1 to 158), respectively. The overall survival rate was 99.3% at 1 year and 98% at 5 years of follow-up. Seventeen patients (11.3%) had recurrent severe AI, and all of them underwent reoperation with a mean duration to reoperation of 35 ± 39 months. Risk factors for the development of recurrent significant AI (≥3) or reoperation, by univariable analysis, were unicuspid or bicuspid aortic valve (AV) (P = 0.018), the use of subcommissural annuloplasty (P = 0.010), the need for cusp repair (P = 0.001), and the use of pericardial patch augmentation (P < 0.001). By multivariable analysis only the use of pericardial patch augmentation emerged as a significant independent predictor for the development of recurrent significant AI (≥3) or reoperation (P = 0.020). CONCLUSION: AV repair can be performed with low morbidity and mortality, with good early and late clinical outcomes. However, in our experience there was a significant rate of recurrent AI especially in patients who underwent cusp augmentation using glutaraldehyde-treated autologous pericardial patch.


Asunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Anuloplastia de la Válvula Cardíaca/métodos , Adulto , Anciano , Válvula Aórtica/anomalías , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/epidemiología , Ecocardiografía , Femenino , Enfermedades de las Válvulas Cardíacas/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pericardio/trasplante , Complicaciones Posoperatorias/epidemiología , Recurrencia , Reoperación , Factores de Riesgo , Tasa de Supervivencia
13.
J Card Surg ; 34(6): 482-494, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31012137

RESUMEN

Bicuspid aortic valves (BAVs) are the most common congenital cardiac condition and are characterized by a structural abnormality whereby the aortic valve is composed of two leaflets instead of being trileaflet. It is linked to an increased risk for a variety of complications of the aorta, many with an immunological pathogenesis. The aim of this study is to review and analyze the literature regarding immunological processes involving BAVs, associated common pathologies, and their incidence in the population. This study will also examine current trends in surgical and therapeutic approaches to treatment and discuss the future direction of BAV treatment.


Asunto(s)
Válvula Aórtica/anomalías , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/inmunología , Enfermedades del Sistema Inmune/etiología , Enfermedades del Sistema Inmune/inmunología , Válvula Aórtica/inmunología , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/terapia , Humanos , Enfermedades del Sistema Inmune/epidemiología , Incidencia , Riesgo , Reemplazo de la Válvula Aórtica Transcatéter
14.
Circ Cardiovasc Imaging ; 12(3): e008129, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30841707

RESUMEN

BACKGROUND: Both bicuspid aortic valve (BAV) and Marfan syndrome have been associated with aortic dissection risk, but it is unknown whether the presence of BAV is associated with an increased aortic risk in patients with an FBN1 gene mutation. We evaluated aortic diameters, aortic valve function, and aortic shape in Marfan syndrome patients with and without BAV and reported aortic events during follow-up. METHODS: All patients with an FBN1 gene mutation evaluated in our clinic were included. Aortic root diameters were measured, and the aortic valve was studied using echocardiography at each visit. RESULTS: Of the 1437 patients with an FBN1 gene mutation, 26 patients (1.8%) had a BAV. Both aortic root maximal diameter and normalized Z score were larger at all ages, in patients with BAV when compared with patients with tricuspid aortic valve. Prophylactic aortic root surgery tended to be performed in younger patients when BAV was present, although aortic diameter threshold was similar in the 2 populations. No aortic dissection was observed in Marfan syndrome patients with BAV. CONCLUSIONS: In patients with a FBN1 mutation, BAV is associated with larger aortic root diameter, with no difference in evolution of Z score with age. We found a trend towards prophylactic aortic root surgery at younger ages but similar aortic diameter thresholds without occurrence of aortic dissection. We did not find any evidence for lowering aortic diameter thresholds used to propose preventive aortic root surgery in the presence of BAV in patients with FBN1 mutations.


Asunto(s)
Aorta/fisiopatología , Aneurisma de la Aorta/epidemiología , Válvula Aórtica/anomalías , Enfermedades de las Válvulas Cardíacas/epidemiología , Síndrome de Marfan/epidemiología , Remodelación Vascular , Adolescente , Adulto , Aorta/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/fisiopatología , Válvula Aórtica/diagnóstico por imagen , Niño , Ecocardiografía , Femenino , Fibrilina-1/genética , Predisposición Genética a la Enfermedad , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Humanos , Masculino , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/genética , Mutación , Paris/epidemiología , Prevalencia , Pronóstico , Factores de Riesgo , Factores de Tiempo , Adulto Joven
15.
Surg Technol Int ; 34: 351-358, 2019 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-30825317

RESUMEN

Endovascular treatment of arterial diseases has become first-line in most cases due to improved technology. However, until recently, excessive atherosclerotic calcification has been a major limiting factor in the endovascular management of peripheral arterial disease, as well as vascular access for endovascular aneurysm repair (EVAR) and transcatheter aortic valve replacement (TAVR). The Peripheral Intravascular Lithotripsy (IVL) System (Shockwave Medical, Inc., Fremont California) applies pulsatile mechanical energy under fluoroscopic guidance to disrupt calcified lesions. The purpose of this paper is to introduce IVL in the treatment of calcific access vessels in preparation for EVAR and TAVR, as well as peripheral arterial disease applications to enhance luminal gain. Using the IVL System, angioplasty can be performed with lower pressures, which may minimize arterial dissection. Further, the lithotripsy effect on calcium will enhance vessel compliance. We describe several cases where IVL was applied successfully and present additional cases that may have benefitted from the use of this technology.


Asunto(s)
Aneurisma/cirugía , Procedimientos Endovasculares/instrumentación , Enfermedades de las Válvulas Cardíacas/terapia , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Calcificación Vascular/cirugía , Aneurisma/epidemiología , Aneurisma/fisiopatología , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Procedimientos Endovasculares/métodos , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/fisiopatología , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Resultado del Tratamiento , Calcificación Vascular/epidemiología , Calcificación Vascular/fisiopatología
16.
Rev. cuba. pediatr ; 91(1)ene.-mar. 2019. tab
Artículo en Español | CUMED | ID: cum-73697

RESUMEN

Introducción: Las valvulopatías congénitas son un grupo de entidades en las cuales la principal alteración anatomofuncional está en las válvulas cardiacas. Objetivo: Caracterizar los pacientes pediátricos nacidos vivos con diagnósticos de valvulopatías congénitas. Métodos: Se realizó una investigación descriptiva retrospectiva a partir de los registros de valvulopatías congénitas del Servicio de Cardiología del Hospital Pediátrico Universitario José Luis Miranda en Santa Clara, Cuba, en el periodo de 2005 a 2016. La población estuvo conformada por los 147 niños nacidos vivos con diagnóstico de valvulopatías congénitas. Se empleó un muestreo no probabilístico intencional por criterios y la muestra quedó conformada por 143. La recogida de la información se realizó a través de la revisión documental de las historias clínicas. Resultados: La tasa de incidencia de la valvulopatías congénitas fue de 1,5 x 1 000 nacidos vivos, predominó la estenosis pulmonar que agrupó el 70,6 por ciento de los diagnosticados. Se encontró predominio del sexo masculino con 50,3 por ciento, se determinó que 45,5 por ciento de los casos se diagnosticaron antes de los 29 días de nacido, período que incluye un diagnóstico prenatal. Conclusiones: El desarrollo del diagnóstico prenatal de las cardiopatías congénitas ha posibilitado la disminución de la incidencia de las malformaciones más complejas. El conocimiento de las enfermedades congénitas del corazón contribuye a operar de forma segura y con resolución anatómica completa a muchos de estos niños en el período prenatal o cuando son lactantes pequeños, para evitar el deterioro global de estos cuando la cardiopatía no está resuelta(AU)


Introduction: The congenital valvulopatías is a group of entities in which the main alteration anatomofuncional is in the heart valves. Objective: To characterize the pediatric patients with diagnostic of born congenital valvulopatías. Methods: He/she was carried out a retrospective descriptive investigation starting from the registrations of congenital valvulopatías of the service of Cardiology of the Hospital Pediatric University student José Luis Miranda in the period of 2005 at the 2016. The population was conformed by the 147 alive born children with diagnostic of congenital valvulopatías, a sampling was not used intentional probabilístico by approaches, being conformed the sample by 143. The collection of the information was carried out through the documental revision of the clinical histories. Results: The rate of incidence of the congenital valvulopatías was of 1,5 x 1000 born alive, the lung estenosis prevailed containing to 70,6 percent of those diagnosed he/she was prevalence of the masculine sex in 50,3 percent, it was determined that 45,5 percent of the cases was diagnosed before the 29 days where a prenatal diagnosis is included. Conclusions: The development of the prenatal diagnosis of the congenital cardiopatías has facilitated the decrease of the incidence of the most complex malformations. The knowledge of the congenital illnesses of the heart contributes to operate in a sure way and with complete anatomical resolution to many of these children in the prenatal period or when they are small nurslings, to avoid the global deterioration of these when the cardiopatía is not resolved(AU)


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Diagnóstico Clínico/diagnóstico , Defectos del Tabique Interventricular/epidemiología , Enfermedades de las Válvulas Cardíacas/congénito , Enfermedades de las Válvulas Cardíacas/epidemiología , Epidemiología Descriptiva , Estudios Retrospectivos , Ultrasonografía Prenatal/métodos , Enfermedades del Recién Nacido
17.
Rev. cuba. pediatr ; 91(1): e634, ene.-mar. 2019. tab
Artículo en Español | LILACS | ID: biblio-985594

RESUMEN

Introducción: Las valvulopatías congénitas son un grupo de entidades en las cuales la principal alteración anatomofuncional está en las válvulas cardiacas. Objetivo: Caracterizar los pacientes pediátricos nacidos vivos con diagnósticos de valvulopatías congénitas. Métodos: Se realizó una investigación descriptiva retrospectiva a partir de los registros de valvulopatías congénitas del Servicio de Cardiología del Hospital Pediátrico Universitario José Luis Miranda en Santa Clara, Cuba, en el periodo de 2005 a 2016. La población estuvo conformada por los 147 niños nacidos vivos con diagnóstico de valvulopatías congénitas. Se empleó un muestreo no probabilístico intencional por criterios y la muestra quedó conformada por 143. La recogida de la información se realizó a través de la revisión documental de las historias clínicas. Resultados: La tasa de incidencia de la valvulopatías congénitas fue de 1,5 x 1 000 nacidos vivos, predominó la estenosis pulmonar que agrupó el 70,6 por ciento de los diagnosticados. Se encontró predominio del sexo masculino con 50,3 por ciento, se determinó que 45,5 por ciento de los casos se diagnosticaron antes de los 29 días de nacido, período que incluye un diagnóstico prenatal. Conclusiones: El desarrollo del diagnóstico prenatal de las cardiopatías congénitas ha posibilitado la disminución de la incidencia de las malformaciones más complejas. El conocimiento de las enfermedades congénitas del corazón contribuye a operar de forma segura y con resolución anatómica completa a muchos de estos niños en el período prenatal o cuando son lactantes pequeños, para evitar el deterioro global de estos cuando la cardiopatía no está resuelta(AU)


Introduction: The congenital valvulopatías is a group of entities in which the main alteration anatomofuncional is in the heart valves. Objective: To characterize the pediatric patients with diagnostic of born congenital valvulopatías. Methods: He/she was carried out a retrospective descriptive investigation starting from the registrations of congenital valvulopatías of the service of Cardiology of the Hospital Pediatric University student José Luis Miranda in the period of 2005 at the 2016. The population was conformed by the 147 alive born children with diagnostic of congenital valvulopatías, a sampling was not used intentional probabilístico by approaches, being conformed the sample by 143. The collection of the information was carried out through the documental revision of the clinical histories. Results: The rate of incidence of the congenital valvulopatías was of 1,5 x 1000 born alive, the lung estenosis prevailed containing to 70,6 percent of those diagnosed he/she was prevalence of the masculine sex in 50,3 percent, it was determined that 45,5 percent of the cases was diagnosed before the 29 days where a prenatal diagnosis is included. Conclusions: The development of the prenatal diagnosis of the congenital cardiopatías has facilitated the decrease of the incidence of the most complex malformations. The knowledge of the congenital illnesses of the heart contributes to operate in a sure way and with complete anatomical resolution to many of these children in the prenatal period or when they are small nurslings, to avoid the global deterioration of these when the cardiopatía is not resolved(AU)


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Diagnóstico Clínico/diagnóstico , Defectos de la Almohadilla Endocárdica/epidemiología , Enfermedades de las Válvulas Cardíacas/congénito , Enfermedades de las Válvulas Cardíacas/epidemiología , Epidemiología Descriptiva , Estudios Retrospectivos , Ultrasonografía Prenatal/métodos , Enfermedades del Recién Nacido/diagnóstico por imagen
18.
Circ Cardiovasc Imaging ; 12(2): e008513, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30712363

RESUMEN

BACKGROUND: Mitral annular calcification (MAC) is associated with cardiovascular events and mitral valve dysfunction. However, the underlying pathophysiology remains incompletely understood. In this prospective longitudinal study, we used a multimodality approach including positron emission tomography, computed tomography, and echocardiography to investigate the pathophysiology of MAC and assess factors associated with disease activity and progression. METHODS: A total of 104 patients (age 72±8 years, 30% women) with calcific aortic valve disease, therefore predisposed to MAC, underwent 18F-sodium fluoride (calcification activity) and 18F-Fluorodeoxyglucose (inflammation activity) positron emission tomography, computed tomography calcium scoring, and echocardiography. Sixty patients underwent repeat computed tomography and echocardiography after 2 years. RESULTS: MAC (mitral annular calcium score >0) was present in 35 (33.7%) patients who had increased 18F-fluoride (tissue-to-background ratio, 2.32 [95% CI, 1.81-3.27] versus 1.30 [1.22-1.49]; P<0.001) and 18F-Fluorodeoxyglucose activity (tissue-to-background ratio, 1.44 [1.37-1.58] versus 1.17 [1.12-1.24]; P<0.001) compared with patients without MAC. MAC activity (18F-fluoride uptake) was closely associated with the local calcium score and 18F-Fluorodeoxyglucose uptake, as well as female sex and renal function. Similarly, MAC progression was closely associated with local factors, in particular, baseline MAC. Traditional cardiovascular risk factors and calcification activity in bone or remote atherosclerotic areas were not associated with disease activity nor progression. CONCLUSIONS: MAC is characterized by increased local calcification activity and inflammation. Baseline MAC burden was associated with disease activity and the rate of subsequent progression. This suggests a self-perpetuating cycle of calcification and inflammation that may be the target of future therapeutic interventions.


Asunto(s)
Calcinosis/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Válvula Mitral/diagnóstico por imagen , Imagen Multimodal/métodos , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/patología , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/fisiopatología , Calcinosis/epidemiología , Calcinosis/fisiopatología , Angiografía por Tomografía Computarizada , Angiografía Coronaria/métodos , Progresión de la Enfermedad , Ecocardiografía , Femenino , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/fisiopatología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Válvula Mitral/fisiopatología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Prevalencia , Pronóstico , Factores de Tiempo
19.
Crit Care Nurs Clin North Am ; 31(1): 31-38, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30736933

RESUMEN

Valvular heart dysfunction (VHD) affects up to 7% of adults up to age 44 year, whereas up to 13% of individuals older than 75 years are affected. The broad term of valvular heart disease includes dysfunction of one or more of the 4 heart valves, including the pulmonary valve, tricuspid valve, mitral valve, or aortic valve. Specifically the more frequent anomalies, implication, assessment, and treatment that will be described more extensively include aortic regurgitation, aortic stenosis, mitral regurgitation, or tricuspid regurgitation. The most prevalent cause of valvular heart disease stems from calcification and stiffening of the valve leaflets contributing to stenosis.


Asunto(s)
Enfermería de Cuidados Críticos , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Estenosis de la Válvula Aórtica , Enfermedades de las Válvulas Cardíacas/epidemiología , Humanos , Insuficiencia de la Válvula Mitral , Estenosis de la Válvula Mitral , Índice de Severidad de la Enfermedad
20.
Front Immunol ; 10: 87, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30804931

RESUMEN

Atherosclerosis is a progressive disease characterized by chronic inflammation of the arterial walls, associated with genetic and infectious factors. The present study investigated the involvement of Chlamydia trachomatis and Chlamydia pneumoniae infections and immunological markers (C-reactive protein, CRP, TNF-α, IL-6, IL-8, and IL-10) in the process of atherosclerosis. The evaluation included 159 patients for surgical revascularization (CAD) and 71 patients for surgical heart valve disease (HVD) at three hospitals in Belém, Brazil. The control group (CG) comprised 300 healthy individuals. Blood samples collected before surgery were used for antibodies detection (enzyme immunoassay), CRP (immunoturbidimetry) and IL-6 levels (enzyme immunoassay). Tissue fragments (atheroma plaque, heart valve and ascending aorta) were collected during surgery and subjected to qPCR for detection of bacterial DNA. Promoter region polymorphisms of each marker and relative quantification of TNF-α, IL-8, and IL-10 gene expression were performed. Demography and social information were similar to the general population involved with both diseases. Antibody prevalence to C. trachomatis was 30.6, 20.3, and 36.7% (in the CAD, HVD, and CG, respectively) and to C. pneumoniae was 83.6, 84.5, and 80.3% (in the CAD, HVD, and CG, respectively). C. trachomatis cryptic plasmid DNA was detected in 7.4% of the samples. Frequency of IL6-174G>C polymorphism was higher in CAD and HVD than in CG regardless of previous exposure to Chlamydia. Previous C. trachomatis infection showed involvement in HVD and CAD. Significant association between disease and previous C. pneumoniae infection was found only among HVD. GG genotype of IL6-174G>C is apparently a risk factor for heart disease, whereas AT genotype of IL8-251A>T was mainly involved in valvulopathies, including patients with prior exposure to C. pneumoniae.


Asunto(s)
Aterosclerosis/microbiología , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/fisiología , Chlamydophila pneumoniae/fisiología , Enfermedades de las Válvulas Cardíacas/microbiología , Interleucina-6/genética , Interleucina-8/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antibacterianos/sangre , Aterosclerosis/epidemiología , Aterosclerosis/inmunología , Brasil/epidemiología , Proteína C-Reactiva/genética , Femenino , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/inmunología , Humanos , Interleucina-10/genética , Interleucina-6/sangre , Masculino , Persona de Mediana Edad , Polimorfismo Genético , Prevalencia , Regiones Promotoras Genéticas/genética , Riesgo , Factor de Necrosis Tumoral alfa/genética , Adulto Joven
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