Plástica da valva mitral em pacientes com insuficiência mitral reumática: técnicas e resultados de 20 anos / Mitral valve repair in rheumatic patients with mitral insuficiency: twenty years of techniques and results

Objetivo: A plástica da valva mitral em pacientes reumáticos permanece um desafio. O objetivo deste estudo é analisar a técnica e os resultados da plástica da valva mitral em pacientes com insuficiência mitral reumática. Métodos: Foram analisados, retrospectivamente, 330 pacientes portadores de insuficiência mitral reumática submetidos à plástica da valva mitral no Instituto do Coração do HC-FMUSP, entre 1985 e 2005. A idade média foi de 26,9 ± 15,4 anos e 57,6 por cento dos pacientes eram do sexo feminino. No pré-operatório, 39,5 por cento dos pacientes estavam em classe funcional IV. As técnicas de plástica mais comumente utilizadas foram a anuloplastia posterior com tira de pericárdio bovino em 48,4 por cento dos pacientes e a anuloplastia com anel de Carpentier em 22,6 por cento. As técnicas associadas foram empregadas em 55,2 por cento dos pacientes, sendo as mais comuns: encurtamento de cordas (20 por cento) e papilarotomias múltiplas (17,8 por cento). Plástica da valva tricúspide (26,7 por cento) e substituição da valva aórtica (27,2 por cento) foram os procedimentos associados mais frequentes. Resultados: A mortalidade hospitalar foi 0,9 por cento (três pacientes), sendo dois deles crianças em atividade reumática. As taxas linearizadas de tromboembolismo, endocardite, reoperação e óbito tardio foram de 0,2 por cento, 0,2 por cento, 3,5 por cento e 0,5 por cento pacientes-ano, respectivamente. A sobrevida actuarial foi de 86,4 ± 6,6 por cento em 20 anos. A curva livre de reoperação foi de 30,3 ± 11,1 por cento em 20 anos. Conclusões: A plástica da valva mitral em pacientes reumáticos é uma técnica factível na correção da insuficiência mitral, com baixa mortalidade operatória.

Objective: Mitral valve repair in rheumatic patients is still a challenge. The purpose of this study is to analyze the results of mitral valve repair in rheumatic patients in the Heart Institute University of Sao Paulo Medical School. Methods: Were analyzed retrospectively, between 1985 and 2005, 330 patients submitted to mitral valve repair in the Heart Institute of São Paulo. The mean age was 26.9 ± 15.4 years and 57.6 percent were female. According do clinical evaluation, 39.5 percent of patients were in NYHA functional class IV. The most common techniques employed were bovine pericardial strip annuloplasty in 48.4 percent patients and Carpentier ring annuloplasty in 22.6 percent. Shortening of chordae (20 percent) and papillary muscle splitting (17.8 percent) were the most common associated techniques performed. Tricuspid valve repair (26.7 percent) and aortic valve replacement (27.2 percent) were the most common associated procedures. Results: The hospital mortality was 0.9 percent (three patients), two of them in children with active rheumatic fever. Linearized rates of thromboembolism, endocardite, reoperation and late death were 0.2 percent, 0.2 percent, 3.5 percent and 0.5 percent patients-year, respectively. Actuarial survival in 20 years was 86.4 ± 6.6 percent. Freedom from reoperation in 20 years was 30.3 ± 11.1 percent. Conclusion: Mitral valve conservative surgery in rheumatic patients is a feasible procedure with low operative mortality.

Right sinus of Valsalva aneurysm causing extrinsic coronary compression.

Sinus of Valsalva aneurysm is a rare cardiac disorder. It is more frequently a congenital, but it may also be an acquired condition. Takayasu's disease is an extremely rare cause of this disorder. Most cases of unruptured sinus of Valsalva aneurysm are asymptomatic. Compression of the left coronary artery is an unusual manifestation of the disease that can cause angina, myocardial infarction or death. This report describes a 19-year-old black male with an unruptured right sinus of Valsalva aneurysm caused by Takayasu's disease and manifested by an acute coronary syndrome, successfully treated by surgery.

Aneurisma do Seio de Valsalva direito causando compressão coronariana extrínseca / Aneurisma del Seno de Valsalva derecho causando compresión coronaria extrínseca / Right Sinus of Valsalva Aneurysm causing extrinsic coronary compression

O Aneurisma do Seio de Valsalva (ASV) é um distúrbio cardíaco raro. É mais frequentemente um defeito congênito, mas pode ser adquirido. A doença de Takayasu é uma causa extremamente rara desse distúrbio. A maioria dos casos de ASV não-roto é assintomática. A compressão da artéria coronária esquerda é uma manifestação não usual da doença, que pode causar angina, infarto do miocárdio ou morte. Esse relato de caso descreve um paciente negro de 19 anos, do sexo masculino, apresentando um ASV direito não-roto causado por doença de Takayasu, manifestado através de síndrome coronariana aguda, tratada cirurgicamente com sucesso.

Sinus of Valsalva aneurysm is a rare cardiac disorder. It is more frequently a congenital, but it may also be an acquired condition. Takayasu's disease is an extremely rare cause of this disorder. Most cases of unruptured sinus of Valsalva aneurysm are asymptomatic. Compression of the left coronary artery is an unusual manifestation of the disease that can cause angina, myocardial infarction or death. This report describes a 19-year-old black male with an unruptured right sinus of Valsalva aneurysm caused by Takayasu's disease and manifested by an acute coronary syndrome, successfully treated by surgery.

Aneurisma del Seno de Valsalva (ASV) es un disturbio cardíaco raro. Con mayor frecuencia se trata de un defecto congénito, pero puede ser adquirido. La enfermedad de Takayasu es una causa extremadamente rara de este disturbio. La mayoría de los casos de ASV no roto es asintomática. La compresión de la arteria coronaria izquierda es una manifestación no usual de la enfermedad, que puede causar angina, infarto de miocardio o muerte. Este informe de caso describe un paciente negro, de 19 años, del sexo masculino, presentando un ASV derecho no roto causado por enfermedad de Takayasu, manifestado a través de síndrome coronario agudo, tratado quirúrgicamente con éxito.

Mitral valve repair in rheumatic patients with mitral insuficiency: twenty years of techniques and results.

OBJECTIVE: Mitral valve repair in rheumatic patients is still a challenge. The purpose of this study is to analyze the results of mitral valve repair in rheumatic patients in the Heart Institute University of Sao Paulo Medical School. METHODS: Were analyzed retrospectively, between 1985 and 2005, 330 patients submitted to mitral valve repair in the Heart Institute of São Paulo. The mean age was 26.9 +/- 15.4 years and 57.6% were female. According do clinical evaluation, 39.5% of patients were in NYHA functional class IV. The most common techniques employed were bovine pericardial strip annuloplasty in 48.4% patients and Carpentier ring annuloplasty in 22.6%. Shortening of chordae (20%) and papillary muscle splitting (17.8%) were the most common associated techniques performed. Tricuspid valve repair (26.7%) and aortic valve replacement (27.2%) were the most common associated procedures. RESULTS: The hospital mortality was 0.9% (three patients), two of them in children with active rheumatic fever. Linearized rates of thromboembolism, endocardite, reoperation and late death were 0.2%, 0.2%, 3.5% and 0.5% patients-year, respectively. Actuarial survival in 20 years was 86.4 +/- 6.6%. Freedom from reoperation in 20 years was 30.3 +/- 11.1%. CONCLUSION: Mitral valve conservative surgery in rheumatic patients is a feasible procedure with low operative mortality.

Particulate emboli capture by an intra-aortic filter device during aortic valve replacement.

OBJECTIVE: This study aims to analyze the embolic activity in patients with calcified aortic stenosis who underwent aortic valve replacement using intra-aortic filtration with an EMBOL-X System device (Edwards Lifesciences Inc., Mountain View, CA, USA). METHODS: From January 2007 to July 2007, 13 consecutive patients with calcified aortic stenosis, who underwent isolated aortic valve replacement using intra-aortic filtration by an EMBOL-X System for 5 minutes after aortic clamp release, were evaluated. Mean patient age was 63.7 years (range 34 to 79 years) and 61.5% were female. The mean bypass time was 60.2 +/- 7.5 minutes (range 45 to 72 minutes) and the mean cross-clamp time was 50 +/- 7.5 minutes (range 35 to 63 minutes). Following removal, each filter was fixed in formalin and analyzed macroscopically with the captured fragments being counted. Histological examinations of the captured material were performed. RESULTS: There were no strokes or gross neurological events. There were no cases of postoperative renal failure. No deaths were reported during hospitalization. Particulate emboli were found in five (38.5%) of the filters. On histological analysis of the particulate emboli captured, two (40%) contained fibrin, two (40%) presented conjunctive tissue, one (20%) contained red blood cells and in one it was not possible to determine the nature of the particulates captured. CONCLUSION: The EMBOL-X System device was effective in particulate emboli capture in aortic valve replacement surgery of patients with calcified aortic stenosis.

Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica / Particulate emboli capture by an intra-aortic filter device during aortic valve replacement

OBJETIVO: O objetivo deste estudo foi avaliar a atividade embólica de pacientes portadores de estenose aórtica calcificada submetidos a troca valvar aórtica por meio da filtração intra-aórtica com dispositivo EMBOL-X® System (Edwards Lifesciences Inc., Mountain View, CA, USA). MÉTODOS: De janeiro de 2007 a julho de 2007, foi utilizado o filtro intra-aórtico EMBOL-X após o despinçamento aórtico em 13 portadores de estenose aórtica calcificada submetidos a troca valvar aórtica consecutivamente. A média de idade dos pacientes foi 63,7 anos (34-79) e 61,5% eram do sexo feminino. A média do tempo de CEC foi 60,2±7,5 (45-72) minutos e a média do tempo despinçamento aórtico foi 50±7,5 (35-63) minutos. Após a retirada dos filtros, eles foram fixados em formalina, analisados macroscopicamente e quantificados os fragmentos capturados. Foi realizado exame histológico do material capturado. RESULTADOS Não foi observado nenhum caso de complicação neurológica. Nenhum paciente apresentou insuficiência renal pós-operatória. Não houve óbitos hospitalares. Partículas embólicas foram encontradas em cinco (38,5%) dos filtros. Das partículas embólicas capturadas, em dois (40%) filtros havia fibrina, dois (40%) apresentavam tecido conjuntivo, um (20%) continha hemácias e em um não foi possível determinar a natureza. CONCLUSÃO: O dispositivo EMBOL-X® System foi efetivo na captação de fragmentos intra-aórticos na substituição da valva aórtica em pacientes com estenose aórtica calcificada.

OBJECTIVE: This study aims to analyze the embolic activity in patients with calcified aortic stenosis who underwent aortic valve replacement using intra-aortic filtration with an EMBOL-X® System device (Edwards Lifesciences Inc., Mountain View, CA, USA). METHODS: From January 2007 to July 2007, 13 consecutive patients with calcified aortic stenosis, who underwent isolated aortic valve replacement using intra-aortic filtration by an EMBOL-X® System for 5 minutes after aortic clamp release, were evaluated. Mean patient age was 63.7 years (range 34 to 79 years) and 61.5% were female. The mean bypass time was 60.2 ± 7.5 minutes (range 45 to 72 minutes) and the mean cross-clamp time was 50 ± 7.5 minutes (range 35 to 63 minutes). Following removal, each filter was fixed in formalin and analyzed macroscopically with the captured fragments being counted. Histological examinations of the captured material were performed. RESULTS: There were no strokes or gross neurological events. There were no cases of postoperative renal failure. No deaths were reported during hospitalization. Particulate emboli were found in five (38.5%) of the filters. On histological analysis of the particulate emboli captured, two (40%) contained fibrin, two (40%) presented conjunctive tissue, one (20%) contained red blood cells and in one it was not possible to determine the nature of the particulates captured. CONCLUSION: The EMBOL-X® System device was effective in particulate emboli capture in aortic valve replacement surgery of patients with calcified aortic stenosis.