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1.
Asian Cardiovasc Thorac Ann ; 25(3): 192-198, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28325072

RESUMO

Background Bicuspid aortic valve patients have an increased risk of aortic dilatation. A deficit of nitric oxide synthase has been proposed as the causative factor. No correlation between flow-mediated dilation and aortic diameter has been performed in patients with bicuspid aortic valves and normal aortic diameters. Being a hereditary disease, we compared echocardiographic features and endothelial function in these patients and their first-degree relatives. Methods Comprehensive physical examinations, routine laboratory tests, transthoracic echocardiography, and measurements of endothelium-dependent and non-dependent flow-mediated vasodilatation were performed in 18 bicuspid aortic valve patients (14 type 1 and 4 type 2) and 19 of their first-degree relatives. Results The first-degree relatives were younger (36.7 ± 18.8 vs. 50.5 ± 13.9 years, p = 0.019) with higher ejection fractions (64.6% ± 1.7% vs. 58.4% ± 9.5%, p = 0.015). Aortic diameters indexed to body surface area were similar in both groups, the except the tubular aorta which was larger in bicuspid aortic valve patients (19.3 ± 2.7 vs. 17.4 ± 2.2 mm·m-2, p = 0.033). Flow-dependent vasodilation was similar in both groups. A significant inverse correlation was found between non-flow-dependent vasodilation and aortic root diameter in patients with bicuspid aortic valve ( R = -0.57, p = 0.05). Conclusions Bicuspid aortic valve patients without aortopathy have larger ascending aortic diameters than their first-degree relatives. Endothelial function is similar in both groups, and there is no correlation with ascending aorta diameter. Nonetheless, an inverse correlation exists between non-endothelial-dependent dilation and aortic root diameter in bicuspid aortic valve patients.


Assuntos
Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Valva Aórtica/anormalidades , Família , Doenças das Valvas Cardíacas/complicações , Adulto , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/epidemiologia , Aortografia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Uruguai/epidemiologia , Vasodilatação
2.
J Cardiovasc Surg (Torino) ; 57(1): 121-6, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26771735

RESUMO

BACKGROUND: With the increase of elderly population, cardiologists and surgeons are faced with an increased incidence of mitral regurgitation. Most of these patients are denied surgery due to a misconceived perception of ominous surgical results. Our objective was to analyze early and late survival in elderly patients after mitral valve surgery in a center in which replacement is the procedure of choice. METHODS: We obtained clinical follow-up of patients older than 70 years who underwent first-time isolated replacement from January 2000 to January 2012. Observed survival was compared with expected survival in the general population of Uruguay. Independent predictors of operative mortality and survival were determined. RESULTS: A total of 127 patients were included. Global operative mortality was 9.4% (1.8% after year 2006 vs. 15.3% before 2006; P<0.05). Surgery performed before 2006, preoperative hematocrit and creatinine were independent predictors for operative mortality after multivariate analysis. 6-year survival was 70.2% for females (72.4% expected survival, P=ns) and 40.1% in males (63.5% expected survival, P<0.05). Independent predictors of survival were surgery performed before 2006 (HR=3.2) and female sex (HR=0.4). CONCLUSION: Mitral valve replacement is a feasible option for elderly patients with mitral valve disease in centers with lack expertise in valve repair. Actual surgical results provide low operative mortality and similar survival to general the population (mainly in females).


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Idoso , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/mortalidade , Complicações Pós-Operatórias/mortalidade , Taxa de Sobrevida , Resultado do Tratamento
3.
Rev. urug. cardiol ; 29(2): 181-186, ago. 2014. graf, tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-754302

RESUMO

Antecedentes: la estenosis aórtica (EA) es la enfermedad valvular cardíaca más común en adultos mayores. Contamos con escasa evidencia sobre el impacto que tiene la clase funcional preoperatoria en el pronóstico a corto y largo plazo de los pacientes a quienes se les realiza una sustitución valvular por EA. Objetivo: analizar la asociación entre la clase funcional (CF) preoperatoria y el pronóstico vital a corto y largo plazo de los pacientes a quienes se les realizó sustitución valvular aórtica (SVA) por estenosis, ajustado a comorbilidad. Material y método: estudio analítico de cohorte. De los 8.340 pacientes operados de cirugía cardíaca en la institución desde el 1º de enero de 2000 al 31 de diciembre de 2010 incorporados en forma prospectiva a la base de datos del servicio, se incluyeron únicamente a aquellos pacientes a quienes se les realizó una SVA por estenosis como único procedimiento y que tuvieran al menos un año de seguimiento activo hasta el 31de diciembre de 2011. En estos pacientes se registró comorbilidad, la clase funcional preoperatoria clasificada según la NYHA, la fracción de eyección del ventrículo izquierdo (FEVI) y se calculó el índice EuroSCORE (EC) y EuroSCORE Logístico (ECL) como indicadores globales de la carga de comorbilidad. Resultados: 570 pacientes cumplieron con los criterios de inclusión. La edad promedio fue: 69,3 ± 9,8 años, 50,9% eran mujeres. La FEVI promedio fue: 56,4 ± 10,9%. NYHA: CF I 51,3%; CF II 40,1%; CF III 8,1%; CF IV 0,5%. Según la CF, la FEVI fue: CF I: 59,4 ± 8,9%; CF II: 55,5 ± 12,3; CF III: 51,1 ± 12,4; CF IV: 50,6 ± 9,2 (p<0,05). La mortalidad operatoria (30 días) fue de 3,9%. La supervivencia global a diez años fue de 64%. Los pacientes en CF NYHA ³ II tuvieron una supervivencia a diez años menor que aquellos en CF I: 0,53 vs 0,79 (p<0,05), con un cambio de la pendiente hacia mayor mortalidad luego del quinto año del posoperatorio (p<0,05). En el análisis multivariado, la CF de la NYHA igual o mayor a II (OR: 1,59) y el puntaje de EC (OR: 1,18) se asociaron de manera independiente a mortalidad alejada luego de la cirugía valvular (p<0,05). Conclusiones: los pacientes que llegan a la cirugía en clase funcional mayor o igual a II de la NYHA presentan una supervivencia significativamente menor en el seguimiento posoperatorio a largo plazo, luego de ajustar a variables de confusión como la comorbilidad y la edad. Estos resultados sugieren que este grupo de pacientes podría beneficiarse de la cirugía antes de presentar síntomas de insuficiencia cardíaca.


Background: aortic stenosis is the most common valvular heart disease in the elderly. There is not much evidence concerning the impact of preoperative NYHA functional class on short-term and long-term prognosis in patients undergoing valve replacement for aortic stenosis. Objective: to analyze the association between preoperative NYHA functional class (NYHA) and the short and long-term prognosis in patients who underwent aortic valve replacement for stenosis, adjusted for co-morbidity. Methods: analytical study cohort. Out of 8340 patients undergoing cardiac surgery at our institution from 1/01/2000 to 31/12/2010 that were prospectively incorporated into the Department´s database, only those who had an aortic valve replacement performed as a single procedure and also had at least 1 year of active follow-up until 31/12/2011 were included. Comorbidities, preoperative functional class according to the NYHA classification, LVEF and calculated EuroSCORE index (EC) and logistic EuroSCORE (ECL) as global indicators of the burden of co -morbidity were recorded in all patients. Results: 570 patients met the inclusion criteria. Mean age was 69.3 ± 9.8 years, 50.9 % were women. The mean LVEF was 56.4 ± 10.9%. NYHA I: 51.3%, NYHA II: 40.1%, NYHA III: 8.1%, NYHA IV: 0.5%. According to the NYHA, LVEF was: NYHA I: 59.4 ±8.9 %, NYHA II: 55. ± 12.3, NYHA III: 51.1 ±12.4, NYHA IV: 50.6 ± 9.2 (p<0.05). Operative mortality (30 days) was 3.9 %. Overall survival at 10 years was 64 %. Patients in NYHA ³ II had a lower 10-year survival than those in NYHA I: 0.53 vs. 0.79 (p<0.05), with a change in slope towards higher mortality after the fifth year after surgery (p<0.05). In multivariate analysis, NYHA II or above (OR: 1.59) and EC score (OR: 1.18) were independently associated with late mortality after valve surgery (p<0.05). Conclusions: patients who underwent aortic valve replacement in NYHA class II or above have a significantly lower long-term survival, after adjusting for confounding variables such as co -morbidity and age. These results suggest that this group of patients may benefit from surgery before symptoms of heart failure start.

4.
Rev. guatem. cardiol. (Impresa) ; 24(1): 6-11, ene.-jun. 2014. tab
Artigo em Espanhol | LILACS | ID: biblio-869903

RESUMO

Introducción y objetivos: La válvula aórtica bicúspide (VAB) esta vinculada con la patología aórtica.Pacientes con VAB tienen elevada probabilidad de requerir cirugía debido a dilatación aórtica o afectaciónvalvular. La progresión en la dilatación aortica luego de la sustitución de la válvula aórtica (SVA), no se haevaluado forma definitoria. Métodos: Un total de 23 pacientes con VAB y diámetro de la raíz aortica inferior a45 mm fueron seguidos durante una media de 8 años luego de la SVA. La medición ecocardiográfica de laraíz aórtica y la aorta tubular se realizó a los 6 y 8 años de la cirugía. Se determinaron predictores dedilatación. Resultados: La raíz aórtica entre 6 (34,6 ± 7,4 mm) y 8 años (37,6 ± 7,7 mm) de seguimientoincrementó significativamente (p <0,023), no se encontraron diferencias con la aorta tubular. La dilatación seobservó principalmente entre fumadores, con antecedentes familiares y dislipémia. Los factores predictorespara dilatación de la raíz aórtica fueron: antecedentes familiares de VAB o patología aórtica, tamaño de laprótesis y superficie corporal (SC). El análisis de regresión multivariado evidenció solo la SC y antecedentesfamiliares como predictores significativos. Conclusión: La raíz aórtica continúa dilatándose tras la SVA enpacientes con VAB. La SC y la historia familiar de patología aórtica, son fuertes predictores de dilatación de laraíz aórtica. Estos pacientes deben ser seguidos de cerca luego de la SVA.


Background: Bicuspid aortic valve (BAV) has been closely correlated with aortic pathology. BAV patientshave a high probability of being operated along their lifetime for aortic disease. Progression of aortic dilatationafter aortic valve replacement (AVR) has not being definitely assessed. Methods: A total of 23 BAV withaortic diameter ≤ 45mm patients were followed for a mean of 8 years after AVR. Echocardiographicmeasurement of the aortic root and tubular aorta was done after a mean of 6 and 8 years post-operatively.Predictors for dilatation were estimated. Results: Paired comparison of aortic root diameter between 6(34.6±7.4 mm) and 8 years (37.6±7.7 mm) of follow-up showed that its dimension increased significantly(p<0.023) while no differences were found with the tubular aorta. Dilatation was seen mainly in smokers,family history and dyslipemic patients. Univariate predictors for aortic root dilatation were: family history ofBAV or aortic pathology, prosthesis size and body surface area (BSA). Multivariate regression evidenced onlyBSA (beta coefficient 11.5) and family history (beta coefficient 4.5) as significant predictors. Conclusion:Aortic root continues to dilate after AVR in BAV patients. Higher BSA and family history of aortic pathologywere found as strong predictors of aortic root dilatation. These patients should be closely followed after AVR.


Assuntos
Humanos , Cardiopatias Congênitas/complicações , Valva Aórtica/transplante , Valva Mitral/fisiologia
6.
Ann Thorac Surg ; 97(3): 758-65, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24370200

RESUMO

BACKGROUND: Ischemic mitral regurgitation (IMR) occurs in 20% of patients after myocardial infarction. There is no agreement as to the best surgical option. With no prospective randomized controlled trials available, our objective was to perform a meta-analysis comparing replacement and repair. METHODS: A literature search was performed in PubMed, EMBASE, Ovid, and Google Scholar. The following keywords were included: "ischemic mitral regurgitation" and "repair or replacement." Inclusion and exclusion criteria were used to reflect current surgical practice (subvalvular preservation, ring annuloplasty). Primary outcomes of interest were operative mortality and survival. Secondary outcomes analyzed were change in ejection fraction (EF), left ventricular (LV) dimensions, New York Heart Association (NYHA) class, reoperation rate, and 2+ or greater recurrence of mitral regurgitation. RESULTS: Of 280 articles, only 12 satisfied all inclusion and exclusion criteria. These articles included 2,508 patients, 64% of whom received valve replacement. Operative mortality was lower after repair (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.38-0.85; p = 0.001); no difference was found when only articles with patients operated on mainly after 1998 were included (OR, 0.70; 95% CI, 0.44 -1.12; p = 0.14). Survival was similar (hazard ratio [HR], 0.86; 95% CI, 0.66-1.13; p = 0.28). No differences in EF, ventricular dimensions, NYHA class, and reoperation were found. Regurgitation recurrence was higher in the repair group (OR, 7.51; 95% CI, 3.7-15.23; p < 0.001). CONCLUSIONS: Mitral valve repair is associated with lower operative mortality but higher recurrence of regurgitation in patients with ischemic mitral regurgitation. No differences were found regarding survival, NYHA class, and functional indicators.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/cirurgia , Humanos , Insuficiência da Valva Mitral/complicações , Isquemia Miocárdica/complicações , Taxa de Sobrevida
7.
Rev. urug. cardiol ; 28(2): 151-162, ago. 2013. ilus, graf
Artigo em Espanhol | LILACS | ID: lil-723562

RESUMO

Antecedentes: la insuficiencia mitral isquémica (IMI) representa una complicación frecuente de la cardiopatía isquémica. La misma resulta de la remodelación ventricular postisquemia, afectando de forma secundaria el mecanismo valvular. Por ser secundaria a patología ventricular, tiene peor pronóstico que la insuficiencia mitral primaria. Aunque la indicación quirúrgica en casos de IMI severa está reconocida, no está definido si la sustitución (SM) o la reparación mitral(RM) son la mejor opción en estos casos. Objetivo: realizar una revisión y meta-análisis de la literatura actual referente a SM versus RM en IMI centrándonos principalmente en la mortalidad operatoria, supervivencia y recurrencia de insuficiencia mitral. Métodos: mediante el uso de palabras claves definidas se revisaron las bases de Pubmed, Embase, Ovid y Google Scholaren busca de trabajos comparativos entre SM y RMen pacientes con IMI. Se definieron criterios de inclusión y exclusiónestrictos que representen la práctica quirúrgica actual. Utilizando un modelo de efectos aleatorios, se calculó el hazard-ratio (HR) combinado para supervivencia y el odds-ratio (OR) combinado para mortalidad operatoria y recurrenciade insuficiencia mitral. Para evaluar el efecto de covariables en los resultados así como en la heterogeneidad, se realizó análisis de subgrupos y meta-regresión. Resultados: se identificaron un total de 280 artículos, de los cuales 36 cumplían estrictamente con los criterios de búsqueda. De éstos, sólo 12 cumplieron con los criterios de inclusión y exclusión predeterminados. Estos trabajos engloban un total de 2.509 pacientes, de los cuales 64% recibió RMy el resto SM. La mortalidad operatoria fue menor en pacientescon RM con un OR de 0,56 (IC 95% 0,38-0,85, p = 0,001). Sin embargo, cuando se incluyeron sólo aquellos trabajos conpacientes operados principalmente luego de 1998, el OR fue de 0,70 (IC 95% 0,44-1,12, p=0,14) ...


Background: Ischemic Mitral Regurgitation is a frequent complication of coronary artery disease. It results in post-ischemic ventricular remodeling with secondary compromise of the valvular mechanism. As it is a consequence of a ventricular pathology its prognostic is worst than primary mitral regurgitation. Despite surgical indication is clear, it is not defined the best strategy: valvular substitution or repair.Objective: To review and meta-analyze current published evidence in reference to mitral substitution (MS) versus mitral repair (MR) in ischemic mitral regurgitation with focus on surgical mortality, survival and recurrence.Methods: using predefined keywords, Pubmed, Embase, Ovid and Google Scholar databases were reviewed looking for comparative publications between MS and MR in ischemic mitral regurgitation. Strict inclusion and exclusion criteria representing actual surgical practice were defined. Using a model of random effects, hazard-ratio (HR) combined for survival and odds-ratio (OR) combined for surgical mortality and recurrence of mitral regurgitation were calculated. Sub-group and meta-regression analysis were performed to evaluate co-variables effects on results and heterogeneity. Results: A total of 280 publications were identified of whom 36 fulfill search criteria. Twelve out of 36 fulfill the predefined inclusion and exclusion criteria. These publications include a total of 2509 patients, in 64% of whom a MR was performed and a MS in the rest. There was less surgical mortality in patients with MR (OR 0.70; CI 95% 0.38-0.85, p 0.001). However, considering only patients operated after 1998, OR was 0.70 (CI 95% 0.44-1.12, p 0.14). Survival was similar in both groups (HR 0.86; CI 95% 0.66-1.13, p 0.28). Mitral valve regurgitation recurrence was more frequent in MR (OR 7.51; CI 95% 3.7-15.23, p 0.001) ...


Assuntos
Humanos , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/complicações , Próteses Valvulares Cardíacas
9.
Rev. chil. cardiol ; 32(2): 104-110, 2013. ilus
Artigo em Espanhol | LILACS | ID: lil-688430

RESUMO

Introducción: La válvula aórtica bicúspide (VAB) está vinculada con la patología aórtica. Pacientes con VAB tienen elevada probabilidad de requerir cirugía debido a dilatación aórtica o afectación valvular. La progresión en la dilatación aortica luego de la sustitución de la válvula aórtica (SVA) no se ha evaluado en forma definitoria. Métodos: Un total de 23 pacientes con VAB y diámetro de la raíz aortica inferior a 45 mm fueron seguidos durante una media de 8 años luego de la SVA. La medición ecocardiográfica de la raíz aórtica y la aorta tubular se realizó a los 6 y 8 años de la cirugía. Se determinaron predictores de dilatación. Resultados: La raíz aórtica entre 6 y 8 años de seguimiento incrementó significativamente de 34,6 +/- 7,4 a 37,6 +/- 7,7 mm (p <0,023), mientras que no se encontraron diferencias con la aorta tubular. La dilatación se observa principalmente en los fumadores, aquellos con antecedentes familiares y en los pacientes dislipémicos. Los factores predictores para dilatación de la raíz aórtica fueron: antecedentes familiares de VAB o de patología aórtica, el tamaño de la prótesis y la superficie corporal (SC). El análisis de regresión multivariado evidenció solo la SC y antecedentes familiares como predictores significativos de dilatación. Conclusión: La raíz aórtica continúa dilatándose tras la SVA en pacientes con VAB. La SC y la historia familiar de patología aórtica son fuertes predictores de dilatación de la raíz aórtica. Estos pacientes deben ser seguidos de cerca luego de la SVA.


Background: The presence of a bicuspid aorotic valve (BAV) is associated to aortic disease. Along their lifetime, BAV patients are highly likely to require surgery. Progression of aortic dilatation after aortic valve replacement (AVR) has not been definitely assessed. Methods: A total of 23 BAV patients with aortic diameter < 45mm were followed for a mean of 8 years after AVR. The aortic root and proximal ascending aorta were measured by echocardiografy 6 and again 8 years after surgery. Predictors for dilatation were estimated based on demographic data and pharmacologic treatment. Results: The aortic root diameter increased from 34.6+/-7.4 to 37.6+/-7.7 mm at 6 and 8 years post surgery, respectively (p=0.023). No change was observed at the tubular aorta . Mean progression of aortic root and tubular aorta during the 2-year interval was 2.9+/-4.7 mm and 0.4+/-5.8 mm respectively. Dilatation was seen mainly in smokers, those with a family history or dyslipidemia. Univariate predictors for aortic root dilatation were: family history of BAV or aortic pathology, prosthesis size and body surface area (BSA). Multivariate regression evidenced only BSA (beta coefficient 11.5) and family history (beta coefficient 4.5) as significant predictors. Conclusion: Aortic root continues to dilate after AVR in BAV patients. Higher BSA and family history of aortic pathology were found to be strong predictors of aortic root dilatation. These patients should be closely followed after AVR.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Valva Aórtica/cirurgia , Valva Aórtica/fisiopatologia , Doenças da Aorta/cirurgia
10.
Interact Cardiovasc Thorac Surg ; 15(1): 166-8, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22493151

RESUMO

Cardiac involvement in Churg-Strauss syndrome is common and represents the main cause of mortality. We report the case of a patient with Churg-Strauss vasculitis, mitral regurgitation with left ventricular dysfunction, paroxysmal atrial fibrillation and refractory angina with non-significant coronary lesions. Cardiac denervation was proposed as an associated procedure to treat angina. The total removal of peri-adventitial and adventitial tissue around the superior vena cava, ascending aorta and main pulmonary trunk was performed. After 3 months of follow-up, the patient was angina-free and could resume his normal lifestyle.


Assuntos
Angina Pectoris/cirurgia , Denervação Autônoma , Síndrome de Churg-Strauss/complicações , Doença da Artéria Coronariana/cirurgia , Coração/inervação , Adulto , Angina Pectoris/complicações , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/fisiopatologia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/fisiopatologia , Humanos , Masculino , Resultado do Tratamento
11.
Rev. urug. cardiol ; 25(3): 212-216, dic. 2010. ilus
Artigo em Espanhol | LILACS | ID: lil-665296

RESUMO

Introducción. La reducción anular mitral es una de las técnicas quirúrgicas utilizadas en la reparación de la insuficiencia mitral funcional. Para su realización, se implanta un anillo protésico restrictivo para lograr la coaptación de los velos mitrales. Los anillos protésicos disponibles tienen tamaño fijo y existe el riesgo de implantar un anillo de tamaño inadecuado que resulte en una reparación imperfecta. Además algunos pacientes con disfunción ventricular severa no toleran la corrección de la insuficiencia mitral. Por esto, hemos diseñado un nuevo anillo regulable desde un dispositivo extracardíaco que podría resolver algunas deficiencias actuales en el tratamiento de dicha afección. Objetivo. Evaluar el comportamiento in vitro del anillo mitral regulable en cuanto a su capacidad de modificar sus dimensiones, corregir la insuficiencia mitral y producir voluntariamente nuevamente la insuficiencia. Material y métodos. Se utilizó un modelo de corazón porcino aislado al que se produjo insuficiencia mitral por dilatación anular. Se implantó el anillo regulable y se realizaron maniobras de reducción y dilatación observando su comportamiento y su efecto sobre la insuficiencia valvular. Resultados. Las maniobras de reducción y dilatación anular permitieron variar las dimensiones protésicas proporcionalmente sin modificar la forma anular. Se logró corregir y reproducir la insuficiencia mitral desde el control extracardíaco. Conclusión. In vitro el anillo regulable es capaz de modificar sus dimensiones proporcionalmente con el fin de corregir o reproducir la insuficiencia mitral


Background. Mitral ring downsizing is one of the techniques used in ischemic mitral regurgitation (MR) and MR due to dilated cardiopathy. In this technique, a prosthetic ring smaller than the native one is implanted in order to achieve mitral leaflet coaptation. Mitral ring prosthesis available up to date have fixed sizes and there is a risk that the chosen size turns out to be inadequate at follow-up. Some patients with severe ventricular dysfunction don’t tolerate mitral valve repair and the increase in afterload that accompanies it. In order to overcome these difficulties, we designed a new mitral ring adjustable through an extra-cardiac device and tested it in vitro. Methods. Mitral regurgitation was obtained in a porcine isolated heart after forced dilatation of the mitral annulus. The mitral ring prototype was sutured to the mitral annulus using the conventional technique. Using the extra-cardiac device, the mitral annulus could be reduced and dilated obtaining annular diameters from 24 to 32 mm. Results. Proportional modification of annulus dimensions maintaining the characteristic shape of the mitral ring and its proportions was achieved. Mitral regurgitation was corrected and the optimal annulus dimension was determined after various dilatation and reduction maneuvers. Conclusions. Through this isolated porcine heart model of MR, we demonstrated that our prototype can reduce and dilate the mitral annulus proportionately without changing the native mitral annulus shape through the use of an extra-cardiac device


Assuntos
Animais , Anuloplastia da Valva Mitral/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Modelos Animais de Doenças , Estenose Subaórtica Fixa/cirurgia , Estenose Subaórtica Fixa/diagnóstico
12.
Rev. urug. cardiol ; 25(1): 5-10, jun. 2010. tab, graf
Artigo em Espanhol | LILACS | ID: lil-588001

RESUMO

Introducción: la miectomía quirúrgica del septum interventricular es el gold standard en el tratamiento de la miocardiopatía hipertrófica (MH) que requiere cirugía para alivio sintomático. No se encontró publicada ninguna serie de pacientes tratados mediante miectomía en Uruguay, lo que motivó analizar una serie de nuestro centro, valorando variables para su comparación con series de referencia. Material y método: se incluyeron todos los pacientes con miectomía entre enero de 2001 y enero de 2008. Se consignaron variables demográficas, ecocardiográficas y sobrevida a los 18 y 72 meses. Resultados: se incluyeron 23 pacientes, 14 mujeres. Edad promedio 59 años. Siete presentaban familiar de primer grado con MH. Seis presentaban lesiones coronarias significativas. El promedio del gradiente intraventricular máximo fue 96,32 mmHg, SIVD 21,4 mm y FEVI 66%. 17 tenían SAM, y de ellos, 15 presentaban insuficiencia mitral severa. En el preoperatorio, 14 presentaban CF NYHA III y nueve CF IV; 20 recibieron algún procedimiento asociado. La mortalidad operatoria fue de 8,7% (dos pacientes). El gradiente máximo postoperatorio promedio fue 12 mmHg, SIVD 16,65 mm y FEVI 64%. A los 18 meses, 20 estaban vivos y en CF I. La sobrevida actuarial a seis años fue 76,7%. Conclusiones: en 20 de los 23 pacientes se asoció otro procedimiento, mayormente sustitución valvular mitral. La miectomía redujo significativamente los gradientes intraventriculares, el espesor del SIVD y los síntomas en todos los pacientes (p < 0,0001). La mortalidad operatoria fue de 8,7% (dos pacientes) y la sobrevida actuarial a seis años de 76,7%. Estos resultados se equiparan a series de referencia.


Introduction: surgical septum myectomy remains the gold standard for the treatment of obstructive hypertrophic cardiomyopathy requiring surgery forsymptomatic relief. Wasn’t found in the literature, any series of patients underwent myectomy in Uruguay.Our objetive was the analysis of our center series, assessing variables for comparison with reference series.Materials and methods: were included all patients with myectomy from january 2001 to 2008. Demographicsand ultrasonographics variables, and survival at 18 and 72 months were consignated. Results: Were included 23 patients, 14 women. Mean age 59 years. Seven with a first grade relativeaffected of hypertrophic cardiomyopathy (HM). Six with coronary lessions. The mean maximum intraventricular gradient was 96,32 mmHg, dyastolic interventricular septum wide 21,4 mm, EF 66%. 17with systolic anterior motion, 15 with severe mitral insufficience. Before surgery, 14 shows NYHA functionalclass (FC) III, and 9 FCIV. 20 with one additional surgical procedure. Operative mortality was 8,7% (two patients). The mean maximum intraventriculargradient after surgery was 12 mmHg, dyastolic interventricular septum wide 16,65mmand EF 64%. At 18 months, survival was 20 patients, all in FC I. Actuarial survival at 6 years was 76,7%. Conclussions: 20 of 23 patients with an additional procedure, mainly mitral valve substitution. Myectomyimproved intraventricular gradients, DIVS wide and symptoms in all patients (p<0,0001). Operative mortality was 8,7% (two patients), and actuarialsurvival at 6 years was 76,7%. This results are comparable with reference series.


Assuntos
Humanos , Masculino , Feminino , Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Uruguai
13.
Rev. urug. cardiol ; 25(1): 28-32, jun. 2010.
Artigo em Espanhol | LILACS | ID: lil-588004

RESUMO

Presentamos el caso de una paciente de 42 años con antecedentes de fiebre reumática en la infancia y sustitución valvular mitro aórtica con prótesis mecánicas hace 10 años. En el curso de una gestación del tercer trimestre presenta insuficiencia cardíaca rápidamente progresiva diagnosticándose por ecografía y radioscopia, una disfunción de la prótesis en posición aórtica. Tras realizar fibrinolíticos y conducta expectante inicial se descompensa en un episodio agudo de fibrilación auricular requiriendo cesárea de urgencia y cirugía cardíaca posterior. En la misma se evidencia afectación extensa de las prótesis aórtica y mitral por pannus resolviéndose quirúrgicamente. Se analiza el tratamiento instituido en esta compleja situación y la evolución de la paciente.


Case report: female, 42 years old, antecedents of rheumatic fever in childhood and mitro aortical valvular substitution by mechanical prosthesis ten years ago. In third trimesterpregnancy, shows quickly progressive cardiac fail. Ultrasonography and fluoroscopy show aortic prosthesisvalve dysfunction. After thrombolytic therapy,descompensation occured, due to an acute atrial fibrillation episode.Emergency caesarean is required and subsequent cardiac surgery showed length affectation by pannus in both,aortic and mitral prosthesis. Analysis of the treatment and patient`s evolution in this complex situation.


Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Implante de Prótese de Valva Cardíaca/efeitos adversos , Falha de Prótese , Insuficiência Cardíaca/cirurgia , Valva Aórtica/cirurgia , Valva Mitral/cirurgia
15.
Ann Thorac Surg ; 87(6): 1954-6, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19463639

RESUMO

Isolated pulmonary endocarditis is rare. Two cases that required surgical treatment are reported: a 35-year-old woman with predisposing factors for right-sided endocarditis who presented with complete heart block; and a healthy 65-year-old man with no predisposing factors who was admitted with septic shock. Both patients presented with septic shock and pulmonary septic emboli requiring urgent surgical treatment. Surgical correction using pulmonary homograft was done, with immediate postoperative recovery. The current literature of isolated pulmonary endocarditis is also reviewed.


Assuntos
Endocardite/cirurgia , Valva Pulmonar/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Valva Pulmonar/transplante
16.
Rev Med Chil ; 136(6): 753-6, 2008 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-18769832

RESUMO

We report a 63 year-old female with a pulmonary embolism in whom echocardiography revealed the presence of right heart thrombus. A section of this thrombus was entrapped in a patent foramen oval and floating in both atria. This rare situation, named impending paradoxical embolism, prompted us to perform a surgical intervention, removing the thrombus and repairing the foramen ovale.


Assuntos
Embolia Paradoxal/diagnóstico por imagem , Forame Oval Patente/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Trombose/diagnóstico por imagem , Idoso , Ecocardiografia Transesofagiana , Embolia Paradoxal/cirurgia , Feminino , Forame Oval Patente/cirurgia , Humanos , Embolia Pulmonar/cirurgia , Trombose/cirurgia
17.
Rev. méd. Chile ; 136(6): 753-756, jun. 2008. ilus
Artigo em Espanhol | LILACS | ID: lil-490761

RESUMO

We report a 63 year-old female with a pulmonary embolism in whom echocardiography revealed the presence ofríght heart thrombus. A section ofthis thrombus was entrapped in a patent foramen oval and floating in both atria. This rare situation, named impending paradoxical embolism, prompted us to perform a surgical intervention, removing the thrombus andrepairing the foramen ovale.


Assuntos
Idoso , Feminino , Humanos , Embolia Paradoxal , Forame Oval Patente , Embolia Pulmonar , Trombose , Ecocardiografia Transesofagiana , Embolia Paradoxal/cirurgia , Forame Oval Patente/cirurgia , Embolia Pulmonar/cirurgia , Trombose/cirurgia
18.
Rev. urug. cardiol ; 23(1): 15-20, mayo 2008. tab
Artigo em Espanhol | LILACS | ID: lil-544143

RESUMO

Objetivo: evaluar los resultados y la evolución de la cirugía coronaria que requirió conversión de emergencia, en relación con cirugía con y sin circulación extracorpórea (CEC). Material y método: estudio de cohorte de 3.738 pacientes coronarios operados en el Instituto Nacional de Cirugía Cardíaca (INCC) entre enero de 2002 y diciembre de 2006; 1.486 pacientes se coordinaron sin CEC y 2.252 pacientes con CEC. De los pacientes sin CEC, 39 requirieron conversión (grupo I); se compararon con pacientes revascularizados con CEC (grupo II, n = 2.252) y sin CEC (grupo III, n=1.447).Se buscaron factores asociados a la conversión. Se compararon variables de la evolución postoperatoria entre los grupos. Resultado: no se identificaron factores asociados a conversión, salvo mayor frecuencia de enfermedad cerebrovascular. Evolución: mayor incidencia en grupo I de estadía en unidad de cuidados intensivos (UCI)*, ventilación asistida*, stroke (p=NS), fibrilación auricular*, infarto de miocardio*, hemodiálisis*, mayor necesidad de apoyo inotrópico* y balón intraaórtico de contra pulsación (BIAC)* (*=p<0,05). Probabilidad de muerte según EuroSCORE: 7,7% (grupo I) versus 5,9% (grupo II) versus 5,7% (grupo III) (NS). Mortalidad operatoria observada: 10,3% versus 4,8% versus 3,5%*. La mortalidad operatoria según intención de tratamiento fue 4,8% para pacientes con CEC versus 3,7% sin CEC (convertidos + no convertidos) (p=NS). Conclusión: la cirugía de revascularización que requiere conversión de emergencia presenta mayor morbimortalidad, pero, sin embargo, en el análisis según intención de tratamiento, no afecta negativamente los beneficios otorgados por la cirugía sin CEC en cuanto a la mortalidad operatoria.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Revascularização Miocárdica , Emergências , Circulação Extracorpórea
19.
Ann Thorac Surg ; 85(3): 896-900, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18291167

RESUMO

BACKGROUND: During harvest of the saphenous vein (SV), the most important relationship to take into account is the saphenous nerve (SN) to avoid pain and paresthesias after surgery. METHODS: We harvested the SV and SN in 20 cadaveric lower limbs. Relationships between both structures were recorded using a millimetric ruler, and distances were measured from the medial malleolus at the ankle. RESULTS: The SV was superficial to the leg fascia 32 cm above the malleolus in 95% of the legs. During its course in the leg, 40% of SNs are posterior to the SV; 40% are anterior and then posterior to the SV; and 10% are posterior and then hidden by the SV. The SN crosses the SV in 55% of the legs. Three constant branches of the SN were identified: middle-posterior, middle-anterior, and inferior-anterior. The SN ends by splitting 5.9 cm above the malleolus. A vulnerable region occurs in the lowest 13.2 cm, where the SN adheres to the SV. At this level the SN gives off the inferior-anterior branch that crosses the SV in 66% of the legs. Between 21.6 cm and 28.8 cm the SN crosses deep to the SV. CONCLUSIONS: During harvest of the SV, the most vulnerable area is the inferior third of the leg because of venonervous adhesion.


Assuntos
Perna (Membro)/inervação , Nervos Periféricos/anatomia & histologia , Veia Safena/anatomia & histologia , Cadáver , Feminino , Humanos , Masculino , Veia Safena/cirurgia , Coleta de Tecidos e Órgãos
20.
Rev. urug. cardiol ; 19(2/3): 99-121, nov. 2004. ilus, graf, tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-694319
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