Ninety-day outcomes in patients diagnosed with COVID-19 in São Paulo, Brazil: a cohort study.

OBJECTIVE: COVID-19 has been associated with a significant burden to those who survive the acute phase. We aimed to describe the quality of life and symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) at 90 days after hospital discharge of COVID-19 patients. METHODS: Patients with COVID-19 admitted to a private hospital in the city of São Paulo, Brazil, between April of 2020 and April of 2021 were interviewed by telephone at 30 and 90 days after discharge to assess the quality of life and symptoms of depression, anxiety, and PTSD. RESULTS: A total of 2,138 patients were included. The mean age was 58.6 ± 15.8 years, and the median length of hospital stay was 9.0 (5.0-15.8) days. Between the two time points, depression increased from 3.1% to 7.2% (p < 0.001), anxiety increased from 3.2% to 6.2% (p < 0.001), and PTSD increased from 2.3% to 5.0% (p < 0.001). At least one physical symptom related to COVID-19 diagnosis persisted in 32% of patients at day 90. CONCLUSIONS: Persistence of physical symptoms was high even at 90 days after discharge. Although the prevalence of symptoms of anxiety, depression, and PTSD was low, these symptoms persisted for three months, with a significant increase between the time points. This finding indicates the need to identify at-risk patients so that they can be given an appropriate referral at discharge.

Vaccination status and long COVID symptoms in patients discharged from hospital.

Effective vaccination against coronavirus mitigates the risk of hospitalisation and mortality; however, it is unclear whether vaccination status influences long COVID symptoms in patients who require hospitalisation. The available evidence is limited to outpatients with mild disease. Here, we evaluated 412 patients (age: 60 ± 16 years, 65% males) consecutively admitted to two Hospitals in Brazil due to confirmed coronavirus disease 2019 (COVID-19). Compared with patients with complete vaccination (n = 185) before infection or hospitalisation, those with no or incomplete vaccination (n = 227) were younger and had a lower frequency of several comorbidities. Data during hospitalisation revealed that the no or incomplete vaccination group required more admissions to the intensive care unit (ICU), used more corticosteroids, and had higher rates of pulmonary embolism or deep venous thrombosis than the complete vaccination group. Ninety days after hospital discharge, patients with no or incomplete vaccination presented a higher frequency of symptoms (≥ 1) than patients with complete vaccination (40 vs. 27%; p = 0.013). After adjusting for confounders, no or incomplete vaccination (odds ratio [OR] 1.819; 95% confidence interval [CI] 1.175-2.815), female sex (OR 2.435; 95% CI 1.575-3.764) and ICU admission during hospitalisation (OR 1.697; 95% CI 1.062-2.712) were independently associated with ≥ 1 symptom 90 days after hospital discharge. In conclusion, even in patients with severe COVID-19, vaccination mitigates the probability of long COVID symptoms.

Ninety-day outcomes in patients diagnosed with COVID-19 in São Paulo, Brazil: a cohort study / Desfechos em 90 dias entre pacientes com diagnóstico de COVID-19 em São Paulo (SP): estudo de coorte

ABSTRACT Objective: COVID-19 has been associated with a significant burden to those who survive the acute phase. We aimed to describe the quality of life and symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) at 90 days after hospital discharge of COVID-19 patients. Methods: Patients with COVID-19 admitted to a private hospital in the city of São Paulo, Brazil, between April of 2020 and April of 2021 were interviewed by telephone at 30 and 90 days after discharge to assess the quality of life and symptoms of depression, anxiety, and PTSD. Results: A total of 2,138 patients were included. The mean age was 58.6 ± 15.8 years, and the median length of hospital stay was 9.0 (5.0-15.8) days. Between the two time points, depression increased from 3.1% to 7.2% (p < 0.001), anxiety increased from 3.2% to 6.2% (p < 0.001), and PTSD increased from 2.3% to 5.0% (p < 0.001). At least one physical symptom related to COVID-19 diagnosis persisted in 32% of patients at day 90. Conclusions: Persistence of physical symptoms was high even at 90 days after discharge. Although the prevalence of symptoms of anxiety, depression, and PTSD was low, these symptoms persisted for three months, with a significant increase between the time points. This finding indicates the need to identify at-risk patients so that they can be given an appropriate referral at discharge.

RESUMO Objetivo: A COVID-19 tem sido associada a um fardo significativo para aqueles que sobrevivem à fase aguda. Nosso objetivo foi descrever a qualidade de vida e sintomas de ansiedade, depressão e transtorno de estresse pós-traumático (TEPT) 90 dias após a alta hospitalar em pacientes com COVID-19. Métodos: Pacientes com COVID-19 internados em um hospital privado na cidade de São Paulo (SP) entre abril de 2020 e abril de 2021 foram entrevistados por telefone 30 e 90 dias após a alta para avaliar a qualidade de vida e sintomas de depressão, ansiedade e TEPT. Resultados: Foram incluídos 2.138 pacientes. A média de idade foi de 58,6 ± 15,8 anos, e a mediana do tempo de internação hospitalar foi de 9,0 (5,0-15,8) dias. Entre os dois momentos, a depressão aumentou de 3,1% para 7,2% (p < 0,001), a ansiedade, de 3,2% para 6,2% (p < 0,001), e o TEPT, de 2,3% para 5,0% (p < 0,001). Pelo menos um sintoma físico relacionado ao diagnóstico de COVID-19 persistia em 32% dos pacientes no 90º dia. Conclusões: A persistência dos sintomas físicos foi elevada mesmo 90 dias após a alta. Embora a prevalência de sintomas de ansiedade, depressão e TEPT tenha sido baixa, esses sintomas persistiram por três meses, com aumento significativo entre os momentos. Esse achado indica a necessidade de identificar os pacientes de risco para que possam receber o encaminhamento adequado no momento da alta.

SARS-Cov-2 seroprevalence and risk factors among health care workers: Estimating the risk of COVID-19 dedicated units.

We evaluated the seroprevalence of SARS-CoV-2 and risk factors among 1,996 oligo/asymptomatic health care workers. The seroprevalence was 5.5% and risk factors associated with being infected with SARS-CoV-2 was professional category of cleaning (adj odds ratio 2.22, 95% confidence interval: 1.12-4.44, P: .023) and male gender (adj odds ratio: 1.54, 95% confidence interval: 1.03-2.32, P: .035).Working at dedicated COVID-19 units (high-risk group) was not an independent risk factor for seropositivity.

Results of a venous thromboembolism prophylaxis program for hospitalized patients.

INTRODUCTION: Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed. OBJECTIVE: The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital. PATIENTS AND METHODS: This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel-Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P<0.05. RESULTS: With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033). CONCLUSION: The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the rate of VTE events in the discharge records.

Hemodynamic Effects of Noninvasive Ventilation in Patients with Venocapillary Pulmonary Hypertension / Efeitos Hemodinâmicos da Ventilação não Invasiva em Pacientes com Hipertensão Pulmonar Venocapilar

Background: The hemodynamic effects of noninvasive ventilation with positive pressure in patients with pulmonary hypertension without left ventricular dysfunction are not clearly established. Objectives: Analyze the impact of increasing airway pressure with continuous positive airway pressure on hemodynamic parameters and, in particular, on cardiac output in patients with variable degrees of pulmonary hypertension. Methods: The study included 38 patients with pulmonary hypertension caused by mitral stenosis without left ventricular dysfunction or other significant valvulopathy. The hemodynamic state of these patients was analyzed in three conditions: baseline, after continuous positive pressure of 7 cmH2O and, finally, after pressure of 14 cmH2O. Results: The population was composed of predominantly young and female individuals with significant elevation in pulmonary arterial pressure (mean systolic pressure of 57 mmHg). Of all variables analyzed, only the right atrial pressure changed across the analyzed moments (from the baseline condition to the pressure of 14 cmH2O there was a change from 8 ± 4 mmHg to 11 ± 3 mmHg, respectively, p = 0.031). Even though there was no variation in mean cardiac output, increased values in pulmonary artery pressure were associated with increased cardiac output. There was no harmful effect or other clinical instability associated with use application of airway pressure. Conclusion: In patients with venocapillary pulmonary hypertension without left ventricular dysfunction, cardiac output response was directly associated with the degree of pulmonary hypertension. The application of noninvasive ventilation did not cause complications directly related to the ventilation systems. .

Fundamento: Os efeitos hemodinâmicos da ventilação não invasiva com pressão positiva em pacientes com hipertensão pulmonar sem disfunção ventricular esquerda não estão bem estabelecidos. Objetivos: Analisar o impacto da pressurização aérea crescente através da pressão positiva contínua das vias aéreas nos parâmetros hemodinâmicos e, principalmente, no débito cardíaco de pacientes com graus variáveis de hipertensão pulmonar. Métodos: Foram incluídos 38 pacientes com hipertensão pulmonar causada por estenose mitral sem disfunção ventricular esquerda ou outra valvopatia significativa. O estado hemodinâmico deses pacientes foi estudado em três condições: basal, após uso de pressão positiva contínua de 7 cmH2O e , finalmente, após pressão de 14 cmH2O. Resultados: A população foi composta por indivíduos predominantemente jovens, do sexo feminino e com elevação significativa da pressão arterial pulmonar (pressão sistólica média de 57 mmHg). De todas as variáveis analisadas, apenas a pressão de átrio direito apresentou variação ao longo dos momentos estudados (da condição basal para a de pressão de 14 cmH2O houve aumento de 8 ± 4 mmHg para 11 ± 3 mmHg, respectivamente, p = 0,031). Apesar de não ter havido variação do valor médio do débito cardíaco, valores mais elevados de pressões na artéria pulmonar estiveram associados ao aumento do débito cardíaco. Não houve efeito deletério ou qualquer instabilidade clínica associada ao uso da pressurização das vias aéreas. Conclusão: Em pacientes com hipertensão venocapilar pulmonar sem disfunção ventricular esquerda, a resposta ...

Hemodynamic Effects of Noninvasive Ventilation in Patients with Venocapillary Pulmonary Hypertension.

Background: The hemodynamic effects of noninvasive ventilation with positive pressure in patients with pulmonary hypertension without left ventricular dysfunction are not clearly established. Objectives: Analyze the impact of increasing airway pressure with continuous positive airway pressure on hemodynamic parameters and, in particular, on cardiac output in patients with variable degrees of pulmonary hypertension. Methods: The study included 38 patients with pulmonary hypertension caused by mitral stenosis without left ventricular dysfunction or other significant valvulopathy. The hemodynamic state of these patients was analyzed in three conditions: baseline, after continuous positive pressure of 7 cmH2O and, finally, after pressure of 14 cmH2O. Results: The population was composed of predominantly young and female individuals with significant elevation in pulmonary arterial pressure (mean systolic pressure of 57 mmHg). Of all variables analyzed, only the right atrial pressure changed across the analyzed moments (from the baseline condition to the pressure of 14 cmH2O there was a change from 8 ± 4 mmHg to 11 ± 3 mmHg, respectively, p = 0.031). Even though there was no variation in mean cardiac output, increased values in pulmonary artery pressure were associated with increased cardiac output. There was no harmful effect or other clinical instability associated with use application of airway pressure. Conclusion: In patients with venocapillary pulmonary hypertension without left ventricular dysfunction, cardiac output response was directly associated with the degree of pulmonary hypertension. The application of noninvasive ventilation did not cause complications directly related to the ventilation systems.

Disseminating cardiopulmonary resuscitation training by distributing 9,200 personal manikins.

OBJECTIVES: Community members should be trained so that witnesses of cardiac arrests are able to trigger the emergency system and perform adequate resuscitation. In this study, the authors evaluated the results of cardiopulmonary resuscitation (CPR) training of communities in four Brazilian cities, using personal resuscitation manikins. METHODS: In total, 9,200 manikins were distributed in Apucarana, Itanhaém, Maringá, and São Carlos, which are cities where the populations range from 80,000 to 325,000 inhabitants. Elementary and secondary school teachers were trained on how to identify a cardiac arrest, trigger the emergency system, and perform chest compressions. The teachers were to transfer the training to their students, who would then train their families and friends. RESULTS: In total, 49,131 individuals were trained (6.7% of the population), but the original strategy of using teachers and students as multipliers was responsible for only 27.9% of the training. A total of 508 teachers were trained, and only 88 (17.3%) transferred the training to the students. Furthermore, the students have trained only 45 individuals of the population. In Maringá and São Carlos, the strategy was changed and professionals in the primary health care system were prepared and used as multipliers. This strategy proved extremely effective, especially in Maringá, where 39,041 individuals were trained (79.5% of the total number of trainings). Community health care providers were more effective in passing the training to students than the teachers (odds ratio [OR] = 7.12; 95% confidence interval [CI] = 4.74 to 10.69; p < 0.0001). CONCLUSIONS: Instruction of CPR using personal manikins by professionals in the primary health care system seems to be a more efficient strategy for training the community than creating a training network in the schools.

Long-term evolution of mitral commissurotomy in rheumatic patients with low echocardiographic score.

INTRODUCTION: The good results of open mitral commissurotomy are well known and there is a hypothesis that it could provide better results in patients selected by echocardiographic score. OBJECTIVE: The purpose of this study is to analyze the late results with open mitral commissurotomy in patients selected by score and to identify variables influencing these results. METHODS: From January 1990 to August 1994, 50 patients were submitted to open mitral commissurotomy due to rheumatic mitral stenosis in Heart Institute of University of Sao Paulo Medical School. Patients with age < 60 years, in functional class II, III or IV (New York Heart Association) and echocardiographic score 9 were included. The mean age was 32.7 ± 8.3 years and 41 patients (82%) were female. The functional class was II in three patients (6%), III in 46 (92%) and IV in one (2%). Forty six patients (92%) were in sinus rhythm and four (8%) were in atrial fibrillation. The mean mitral valve area was 0.9 ± 0.2 cm². RESULTS: There was no hospital mortality. There were two late deaths, one related to valve disease. Actuarial survival was 95.5 ± 3.1 %, freedom from reoperation was 62.3 ± 11,8% and freedom from tromboembolism was 88,2 ± 5,0% in 18 years. There was no endocarditis. The grade of the echocardiographic score had no significant influence on the reoperations in late evolution. CONCLUSION: Open mitral commissurotomy presented excelent long term results in rheumatic patients with low echocardiographic score.

Evolução tardia da comissurotomia mitral em pacientes reumáticos com baixo escore ecocardiográfico / Long-term evolution of mitral commissurotomy in rheumatic patients with low echocardiographic score

INTRODUÇÃO: Os bons resultados da comissurotomia mitral a céu aberto são bem conhecidos e existe a hipótese de que se poderiam obter melhores resultados em pacientes selecionados pelo escore ecocardiográfico. OBJETIVO: Analisar os resultados tardios da comissurotomia mitral em pacientes selecionados pelo escore ecocardiográfico e identificar variáveis com influência nesses resultados. MÉTODOS: De janeiro de 1990 a agosto de 1994, 50 pacientes com estenose mitral reumática foram submetidos à comissurotomia mitral a céu aberto no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram incluídos pacientes com idade < 60 anos, classe funcional II, III ou IV (New York Heart Association) e escore ecocardiográfico 9. A idade média foi de 32,68 ± 8,29 anos, sendo 41 (82%) pacientes do sexo feminino. Três (6%) pacientes estavam em classe funcional II, 46 (92%) em III e um (2%) em IV. Quarenta e seis (92%) pacientes apresentavam ritmo sinusal e quatro (8%), fibrilação atrial. A área valvar mitral média foi de 0,9 ± 0,2 cm². RESULTADOS: Não houve mortalidade hospitalar. Ocorreram dois óbitos tardios, um relacionado à valvopatia. A sobrevida actuarial foi de 95,5 ± 3,1%, sobrevida livre de reoperação, 62,3 ± 11,8%, e sobrevida livre de tromboembolismo, 88,2 ± 5,0% em 18 anos. Não houve endocardite. O escore ecocardiográfico não teve influência significante em reoperações na evolução tardia. CONCLUSÃO: A comissurotomia mitral a céu aberto obteve resultados tardios excelentes nos pacientes com baixo escore ecocardiográfico.

INTRODUCTION: The good results of open mitral commissurotomy are well known and there is a hypothesis that it could provide better results in patients selected by echocardiographic score. OBJECTIVE: The purpose of this study is to analyze the late results with open mitral commissurotomy in patients selected by score and to identify variables influencing these results. METHODS: From January 1990 to August 1994, 50 patients were submitted to open mitral commissurotomy due to rheumatic mitral stenosis in Heart Institute of University of Sao Paulo Medical School. Patients with age < 60 years, in functional class II, III or IV (New York Heart Association) and echocardiographic score 9 were included. The mean age was 32.7 ± 8.3 years and 41 patients (82%) were female. The functional class was II in three patients (6%), III in 46 (92%) and IV in one (2%). Forty six patients (92%) were in sinus rhythm and four (8%) were in atrial fibrillation. The mean mitral valve area was 0.9 ± 0.2 cm². RESULTS: There was no hospital mortality. There were two late deaths, one related to valve disease. Actuarial survival was 95.5 ± 3.1 %, freedom from reoperation was 62.3 ± 11,8% and freedom from tromboembolism was 88,2 ± 5,0% in 18 years. There was no endocarditis. The grade of the echocardiographic score had no significant influence on the reoperations in late evolution. CONCLUSION: Open mitral commissurotomy presented excelent long term results in rheumatic patients with low echocardiographic score.

Comparação das medidas da área valvar mitral obtidas por parâmetros hemodinâmicos invasivos e ecocardiográfia tridimensional em tempo real pré e pós-valvoplastia mitral percutânea / Comparison of mitral valve area measurements by invasive hemodynamic parameters and real-time three-dimensional echocardiography before and after percutaneous mitral valvuloplasty

INTRODUÇÃO: A técnica de ecocardiografia tridimensional em tempo real (eco-3D) para avaliação da área valvar mitral (AVM) é uma técnica inovadora, que deve ser validada na compração com técnicas de cálculos de AVM já consagrados. O cálculo da AVM pelo método de Gorlin já foi bem estabelecido e correlaciona-se de forma adequada com a verdadeira AVM. Nosso objetivo foi comparar as medidas de AVM obtidas pelos métodos hemodinâmicos e ecocardiográfico, a partir de parâmetros hemodinâmicos invasivos (fórmula de Gorlin) e de eco-3D após valvoplastia mitral percutânea por cateter-balão (VCB). Método: Estudo prospectivo, realizado entre fevereiro de 2009 e fevereiro de 2010, em que foram selecionados 24 indivíduos (dos quais 22 mulheres, na faixa etária de 39 + ou - 12 anos) portadores de estenose mitral sintomática submetidos a VCB. Foi feita análise ecocardiográfica transtorácica bidimensonal e tridimensional antes e após VCB, em que foram aferidos a AVM (eco-3D/medida invasiva) e o gradiente...

BACKGROUND: Real time three-dimensional (3D) echocardiography (Echo) is an innovative technique to assess mitral valve area (MVA) that must be validated in comparison with established MVA calculation techniques. The calculation of valve area by Gorlin's method has been well established and correlates adequately with the true MVA. This study was aimed at comparing MVA obtained by hemodynamic and echocardiographic methods, based on invasive hemodynamic (Gorlin's formula) and 3D Echo parameters after percutaneous balloon mitral valvuloplasty (PBMV). METHODS: Prospective study carried out from February 2009 to February 2010, in 24 individuals (22 women, 39 ± 12 years) with symptomatic mitral stenosis undergoing PBMV. 2D and 3D Echo were compared before and after the PBMV, with MVA (3D Echo/invasive measurement) and mitral gradient (max/mean) measurements. RESULTS: Two patients were excluded (one because of a left atrial thrombus and another due to MVA > 1.5 cm²). Mean MVA obtained by the hemodynamic method was 1.73 cm², whereas the mean value obtained by 3D Echo was 1.72 cm². There was a significant correlation between MVA obtained by Gorlin's formula and 3D Echo pre-valvuloplasty (r: 0.7638; P < 0.001) and post-valvuloplasty (r: 0.6659; P < 0.0019). CONCLUSIONS: 3D Echo is an adequate method for the assessment and calculation of MVA before and after PBMV procedures providing accurate values when compared to the established MVA calculation obtained by Gorlin's formula.

Immediate and late results of percutaneous mitral valve repair in patients with mitral stenosis.

BACKGROUND: The analysis of immediate and long-term results of mitral valvoplasty by balloon catheter (MVRBC) are still lacking in literature, mainly in the national context. OBJECTIVE: To assess the immediate and late results of patients submitted to mitral valve repair by balloon catheter. METHOD: A total of 330 consecutive patients were followed-up by 47 +/- 36 months (up to 126 months). Univariate and multivariate analyses assessed the factors associated with the success of the procedure, restenosis and late events (death or necessity of new intervention on mitral valve). Kaplan-Meier method estimated survival without events. RESULTS: The procedure was successful in 305 cases (92.4%). The mitral valve anatomy was the main predictor for immediate success for the procedure. During the procedure, restenosis occurred in 77 (23.3%) patients and was associated with smaller mitral valve area and with larger calcification before the process. In a mean period of 38 +/- 26-month follow-up, 67 events occurred. The probability of survival without events was of 95% in one year, 75% in five years and 61% in ten years. The predictors of survival without events were: age, echocardiography score and immediate result of the procedure. CONCLUSION: Mitral valve repair by balloon catheter is an effective procedure, as 60% patients did not present events after the follow-up. The anatomical condition of the mitral valve and the patient's age were the best predictors of survival without events, and should be taken into account when selecting patients for the mentioned procedure.

Resultados imediatos e tardios da valvoplastia mitral percutânea em pacientes com estenose mitral / Immediate and late results of percutaneous mitral valve repair in patients with mitral stenosis

FUNDAMENTO: A análise dos resultados imediatos e a longo prazo da valvoplastia mitral por catéter-balão (VMCB) ainda são escassos na literatura, principalmente no contexto nacional. OBJETIVO: Avaliar os resultados imediatos e tardios dos pacientes submetidos à VMCB. MÉTODO: 330 pacientes consecutivos foram seguidos por 47 ± 36 meses (até 126 meses). Análises univariadas e multivariadas avaliaram os fatores relacionados ao sucesso do procedimento, à reestenose e aos eventos tardios (morte ou necessidade de nova intervenção na valva mitral). O método de Kaplan-Meier estimou a sobrevida livre de eventos. RESULTADOS: Houve sucesso do procedimento em 305 (92,4 por cento). A anatomia valvar mitral foi o principal preditor de sucesso imediato do procedimento. Durante o seguimento, a reestenose ocorreu em 77 (23,3 por cento) pacientes e esteve associada a menor área valvar mitral e maior calcificação antes do procedimento. Ocorreram 67 eventos em um tempo médio de seguimento de 38 ± 26 meses. A probabilidade de sobrevida livre de eventos foi de 95 por cento em 1 ano, 75 por cento aos 5 anos e 61 por cento aos 10 anos. Os preditores de sobrevida livre de eventos foram: idade, escore ecocardiográfico e resultado imediato do procedimento. CONCLUSÃO: A VMCB é um procedimento efetivo, sendo que mais de 60 por cento dos pacientes estiveram livres de eventos ao final do seguimento. A condição anatômica da valva mitral e a idade do paciente foram os melhores preditores da sobrevida livre de eventos e devem ser levados em consideração na seleção dos pacientes para VMCB.

BACKGROUND: The analysis of immediate and long-term results of mitral valvoplasty by balloon catheter (MVRBC) are still lacking in literature, mainly in the national context. OBJECTIVE: To assess the immediate and late results of patients submitted to mitral valve repair by balloon catheter. METHOD: A total of 330 consecutive patients were followed-up by 47 ± 36 months (up to 126 months). Univariate and multivariate analyses assessed the factors associated with the success of the procedure, restenosis and late events (death or necessity of new intervention on mitral valve). Kaplan-Meier method estimated survival without events. RESULTS: The procedure was successful in 305 cases (92.4 percent). The mitral valve anatomy was the main predictor for immediate success for the procedure. During the procedure, restenosis occurred in 77 (23.3 percent) patients and was associated with smaller mitral valve area and with larger calcification before the process. In a mean period of 38 ± 26-month follow-up, 67 events occurred. The probability of survival without events was of 95 percent in one year, 75 percent in five years and 61 percent in ten years. The predictors of survival without events were: age, echocardiography score and immediate result of the procedure. CONCLUSION: Mitral valve repair by balloon catheter is an effective procedure, as 60 percent patients did not present events after the follow-up. The anatomical condition of the mitral valve and the patient's age were the best predictors of survival without events, and should be taken into account when selecting patients for the mentioned procedure. (Arq Bras Cardiol 2010; 94(3):383-390)

Reposição volêmica no cardiopata grave / Fluid responsiveness in critical patients

Desde os estudos iniciais de Hales, no século 18, passando pelos conceitos desenvolvidos por Guyton, na década de 70, o conhecimento da fisiologia cardiovascular possibilitou a avaliação sensível do status volêmico em pacientes críticos. A partir das medidas de pressão venosa central e de pressão capilar pulmonar, incorporando conceitos de interdependência ventricular, hoje é possível mensurar a resposta à sobrecarga de volume em pacientes sedados e sob ventilação mecânica, de forma a ajustar e evitar a hipervolemia, deletéria nessas condições. Para esse objetivo, podemos utilizar a variação da pressão de pulso, a variação da amplitude da curva de pressão venosa central e, mais recentemente, a variação do diâmetro da veia cava inferior, analisada ecocardiograficamente. Esses conhecimentos também se aplicam aos pacientes sob ventilação mecânica em uso de pressão positiva expiratória final positiva, assim como contribuem para o manejo do desmame da ventilação mecânica em pacientes com isquemia miocárdica, predispostos a desmame difícil.