RESUMO
From 1980 to 1996, 111 patients (83 females, 28 males, mean age 51.47 +/- 15.73 years, range 1-76) underwent mitral valve replacement. Seventy-five patients underwent replacement of a biological valve and 36 of a mechanical valve. Three patients underwent a third operation. Seventy prostheses were replaced because of a structural dysfunction. Other causes of valve failure were: 24 thrombosis (23 mechanical and 1 biological), 10 endocarditis (7 mechanical, 3 biological) and 4 leakages (3 mechanical and 1 biological). One patient who had recurrent anticoagulant-related haemorrhage underwent reoperation to replace his mechanical valve with a biological prosthesis. Two patients had their valve replaced because of mismatch between size of the valve and body surface area. Thirteen operations were performed on emergency and 29 on urgency. There were 22 in-hospital deaths with a hospital mortality of 19.82%. Fourteen deaths (63.63%) occurred in patients operated on emergency or urgency. All deceased patients were in NYHA functional class III or IV. Our data suggest that risk of reoperation on mitral prosthesis is highly influenced by the preoperative functional class. In spite of the fact that replacement of biological valves should be more elective than that of mechanical valves, we did not find any difference between the two groups of patients.
Assuntos
Próteses Valvulares Cardíacas , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Reoperação , Fatores de RiscoRESUMO
Arteriographic findings of neovascularity and fistula formation between coronary arteries and left atrium have occasionally been described in association with left atrial thrombosis in patients with mitral valve disease. The validity of these coronary arteriographic findings in diagnosis of atrial thrombi has been evaluated in 112 patients with mitral valve disease. Comparison was made with surgery. The study furnished these diagnostic values: sensitivity 70%, specificity 85%, positive predictive value 72%. Even if this angiographic finding is complementary in diagnosis of atrial thrombosis, its identification during coronary arteriography in patients with mitral valve disease is useful. Its detection could improve diagnostic prediction of thrombosis, especially in patients without previous embolic events or where echocardiography failed to reveal thrombi.
Assuntos
Angiografia Coronária , Cardiopatias/diagnóstico por imagem , Insuficiência da Valva Mitral/complicações , Estenose da Valva Mitral/complicações , Trombose/diagnóstico por imagem , Angiografia , Feminino , Átrios do Coração , Cardiopatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/diagnóstico por imagem , Estudos Prospectivos , Sensibilidade e Especificidade , Trombose/etiologiaRESUMO
Arteriographic findings of neovascularity and fistula formation between coronary arteries and left atrium have occasionally been described in association with left atrial thrombosis in patients with mitral valve disease. The validity of these coronary arteriographic findings in diagnosis of atrial thrombi has been evaluated in 164 patients with mitral valve disease. Comparison was made with surgery. The study provided these diagnostic values: sensitivity 65%, specificity 85%, positive predictive value 72%. Even if this angiographic finding is complementary in diagnosis of atrial thrombosis, its identification during coronary arteriography in patients with mitral valve disease is useful. Its detection could improve diagnostic prediction of thrombosis especially in patients without previous embolic events or where echocardiography failed to show thrombi.