RESUMO
AIM: To analyze clinical-diagnostic and surgical aspects of cardiac valve solid lesions as well as long-term results of surgical treatment. MATERIAL AND METHODS: Clinical, diagnostic and surgical aspects of treatment of 51 patients with tumorous and pseudotumorous lesions of cardiac valves were analyzed. RESULTS AND DISCUSSION: Hospital complications were observed in 17.7% of patients. Mortality rate was 3.9%. 1- and 28-year overall survival was 100% and 94.1% respectively. Quality of life was good, satisfactory and unsatisfactory in 73.5%, 20.4% and 6.1% of cases respectively. CONCLUSION: Timely diagnostics of tumorous and pseudotumorous lesions of cardiac valves is very difficult but possible based on short history, positional dependence of symptoms, embolic events without rhythm disturbances. Additional instrumental methods including TTE, TEE, CT and MRI are necessary to define diagnosis. Intraoperative diagnostics and immediate histological survey are useful to determine volume of surgery in each case. Successful surgical treatment implies urgency, hypothermic perfusion and pharmaco-cold cardioplegia during operation.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Embolia , Neoplasias Cardíacas , Doenças das Valvas Cardíacas , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana/métodos , Embolia/diagnóstico , Embolia/etiologia , Feminino , Neoplasias Cardíacas/classificação , Neoplasias Cardíacas/mortalidade , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/fisiopatologia , Neoplasias Cardíacas/cirurgia , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Cuidados Intraoperatórios/métodos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Moscou , Seleção de Pacientes , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
We present here analysis of surgical treatment of 24 patients (5 women, 19 men, age 20-75, mean age 50.7 +/- 2.5 years) with dilated cardiomyopathy (DCM) operated during the period from 2008 to 2013. Duration of the disease ranged from 4 months to 12 years (mean 49.4 +/- 7.5 months). According to symptoms and results of 6-minute walk test 3 patients (13%) had heart failure NYHA class III and 21 patients (87%)--NYHA class IV. Average end-diastolic left ventricular size was 7.4 +/- 0.18 cm (6.0-9.2 cm), ejection fraction--26.7 +/- 2.1% (13-47%), mean pulmonary artery pressure 54.9 +/- 2.9 mm Hg (35-80 mmHg). All patients underwent organ-conserving surgery aimed at reverse remodeling of the heart. Surgery was accompanied with implantation of implantable cardioverter defibrillator in 3 patients and/or cardiac resynchronization therapy device in 6 patients. Two patients (8.3%) died during hospitalization of hemodynamically significant ventricular arrhythmias; seven patients (29.2%) died in the late postoperative period. The results of the analysis indicate that reverse-remodeling surgery may be effective in patients with DCM of any age group with preserved reserves of the liver, kidney, and lung function in the absence of active myocarditis. Further observations are needed to determine the place of this operation in the protocol of treatment of patients with DCM.
Assuntos
Arritmias Cardíacas , Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Dilatada/cirurgia , Complicações Pós-Operatórias/mortalidade , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Terapia de Ressincronização Cardíaca , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiomiopatia Dilatada/classificação , Cardiomiopatia Dilatada/tratamento farmacológico , Cardiomiopatia Dilatada/fisiopatologia , Fármacos Cardiovasculares/uso terapêutico , Desfibriladores Implantáveis , Feminino , Seguimentos , Testes de Função Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Moscou/epidemiologia , Tratamentos com Preservação do Órgão/métodos , Período Pós-Operatório , Análise de Sobrevida , Resultado do TratamentoAssuntos
Brucella , Brucelose , Pericardiectomia/métodos , Pericardite Constritiva , Pericárdio/cirurgia , Idoso , Antibacterianos/administração & dosagem , Brucella/efeitos dos fármacos , Brucella/patogenicidade , Brucelose/complicações , Brucelose/tratamento farmacológico , Brucelose/microbiologia , Brucelose/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pericardite Constritiva/diagnóstico , Pericardite Constritiva/etiologia , Pericardite Constritiva/fisiopatologia , Pericardite Constritiva/cirurgia , Pericárdio/patologia , Resultado do TratamentoRESUMO
Clinical, diagnostic and surgical aspects of primary heart tumors, pseudotumor and morphologically unidentified heart space-occupying lesions were analyzed at 52 childhood and adolescence patients. Difficulty of early diagnosis, more aggressive clinical course in majority cases, and individual approach to the choice of surgical approach has been demonstrated. Principle of oncological determinant has been ensured the success in surgical treatment of patients with non-malignant intracavitary and intramuscular neoplasms, and also with pseudotumor space-occupying lesions. Postoperative lethality was low (2.2%), and there were no true recurrences of disease in long-term period after surgery.