Assuntos
Amiloidose/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Gamopatia Monoclonal de Significância Indeterminada/complicações , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Humanos , Imageamento por Ressonância Magnética , Masculino , Marca-Passo ArtificialRESUMO
Persistent pulmonary hypertension (P-PH) after mitral valve replacement (MVR) leads to an increased risk of morbidity and mortality. We sought to determine which factors were involved in its occurrence. Patients undergoing MVR for a 3-year period were collected in a retrospective way. We excluded those with an available follow-up shorter than 3 months. Sample size was 111 patients. PH was diagnosed if systolic pulmonary artery pressure (sPAP) estimated by Doppler echocardiography was >40 mmHg. Clinical, echocardiographic, and surgical factors were analyzed. P-PH was present in 42.3 % of patients after 12.6 months of mean follow-up. P-PH was more frequently observed in elderly and female patients, in those with severe degrees of PH before surgery, and significant tricuspid regurgitation (TR). On multivariable analysis, significant TR (OR 1.739; p = 0.01) and more severe degrees of PH before surgery (OR 1.761; p = 0.03) were significantly associated with the presence of P-PH after MVR. Surgical factors related to P-PH were prosthesis size and tricuspid annuloplasty: no need for the performing of tricuspid annuloplasty (OR 0.345; p = 0.025) and the implantation of a smaller prosthesis (OR 0.656; p = 0.004) were related to higher rates of P-PH after MVR. MVR was associated with high prevalence of P-PH after mid-term follow-up. Both PH and significant TR before surgery were associated with P-PH. Our data point out that MVR should be planned before the development of PH and greater TR. Smaller prosthetic size is also a risk factor for P-PH and bigger prostheses are desirable when possible.
Assuntos
Implante de Prótese de Valva Cardíaca/efeitos adversos , Hipertensão Pulmonar/etiologia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Artéria Pulmonar/fisiopatologia , Fatores Etários , Idoso , Pressão Arterial , Anuloplastia da Valva Cardíaca/efeitos adversos , Anuloplastia da Valva Cardíaca/instrumentação , Distribuição de Qui-Quadrado , Ecocardiografia Doppler , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/fisiopatologia , Análise Multivariada , Razão de Chances , Desenho de Prótese , Artéria Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/cirurgiaRESUMO
Because of an incomplete right bundle branch block, a severe right ventricular dilatation with no left ventricular cardiomyopathy was found in a 44-year-old man. Magnetic resonance and transesophageal echocardiography confirmed the finding and these tests also failed to find any potential cause. A pulmonary hemodynamic study and a coronary angiography were strictly normal. Lastly pulmonary function tests and a pulmonary angiography were performed, which did not find any lung disease causing the right ventricular dilatation. The patient was catalogued as an early stage of an idiopathic form of right ventricular dilated cardiomyopathy.
RESUMO
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