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1.
Artigo em Inglês | MEDLINE | ID: mdl-31713609

RESUMO

OBJECTIVES: Our goal was to analyse the initial results of the first 50 transapical transcatheter mitral valve-in-valve procedures performed in a single Latin American centre. METHODS: A prospective, single centre, database analysis was conducted to evaluate immediate, 30-day and 1-year postoperative results of 50 consecutive patients who had a transcatheter mitral valve-in-valve procedure from May 2015 to June 2018. All patients were operated on in a hybrid operating room and received a balloon-expandable valve via the transapical approach. Preoperative and postoperative characteristics were analysed and compared between the first 25 and the second 25 patients to evaluate the impact of the learning curve. Twenty patients had a follow-up examination at 1 year. RESULTS: There was a 98% device success rate. The patients had a mean age of 64.8 years; 72% were women; 80% were in New York Heart Association functional class ≥III preoperatively; and 36% of the procedures were urgent. The mean Society of Thoracic Surgeons scores and EuroSCORE II were 8.3% and 12.4%, respectively. Patients had a median of 2 previous operations; valve durability was 12.1 years; and 64% mitral valve disease of rheumatic fever aetiology. Echocardiography showed decreases in the maximum and mean mitral gradients from 23.5 to 14.6 and 11.5 to 6.4 mmHg postoperatively; the overall mean hospitalization period was 15 days. The overall mortality rate at 30 days was 14%, with 1 intraprocedural death. Further subanalyses between the first and the second half of the cases showed a drop in the mortality rate from 20% to 8% (P < 0.01). CONCLUSION: The transcatheter mitral valve-in-valve procedure was shown to be a safe and effective procedure to treat bioprosthetic dysfunction, with potential benefits in patients with rheumatic disease.

2.
Arq Bras Cardiol ; 113(3): 449-663, 2019 Oct 10.
Artigo em Português | MEDLINE | ID: mdl-31621787
3.
Arq Bras Cardiol ; 2019 Sep 23.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553387

RESUMO

BACKGROUND: Diastolic dysfunction, commonly evaluated by echocardiography, is an important early finding in many cardiomyopathies. Cardiac magnetic resonance (CMR) often requires specialized sequences that extends the test time. Recently, feature-tracking imaging has been made available, but still requires expensive software and lacks clinical validation. OBJECTIVE: To assess diastolic function in patients with aortic valve disease (AVD) and compare it with normal controls by evaluating left ventricular (LV) longitudinal displacement by CMR. METHODS: We compared 26 AVD patients with 19 normal controls. Diastolic function was evaluated as LV longitudinal displacement in 4-chamber view cine-CMR images using steady state free precession (SSFP) sequence during the entire cardiac cycle with temporal resolution < 50 ms. The resulting plot of atrioventricular junction (AVJ) position versus time generated variables of AVJ motion. Significance level of p < 0.05 was used. RESULTS: Maximum longitudinal displacement (0.12 vs. 0.17 cm), maximum velocity during early diastole (MVED, 0.6 vs. 1.4s-1), slope of the best-fit line of displacement in diastasis (VDS, 0.22 vs. 0.03s-1), and VDS/MVED ratio (0.35 vs. 0.02) were significantly reduced in AVD patients compared with controls, respectively. Aortic regurgitation showed significantly worse longitudinal LV shortening compared with aortic stenosis. Higher LV mass indicated worse diastolic dysfunction. CONCLUSIONS: A simple linear measurement detected significant differences on LV diastolic function between AVD patients and controls. LV mass was the only independent predictor of diastolic dysfunction in these patients. This method can help in the evaluation of diastolic dysfunction, improving cardiomyopathy detection by CMR, without prolonging exam time or depending on expensive software.

4.
J Am Coll Cardiol ; 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31562908

RESUMO

BACKGROUND: Transfemoral aortic valve replacement (TAVR) is a guideline-recommended treatment option for patients with severe aortic valve stenosis. Females and males present with different baseline characteristics, which may influence procedural outcomes. OBJECTIVES: To evaluate differences between females and males undergoing transfemoral TAVR across the globe during the last decade. METHODS: The CENTER collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N= 12,381) from 2007-2018. In this retrospective analysis we examined differences in baseline patient characteristics, 30-day stroke and mortality and in-hospital outcomes between female and male patients. We also assessed for temporal changes in outcomes and predictors for mortality per gender. RESULTS: We included 58% (n=7,120) female and 42% (n=5,261) male patients. Females had higher prevalence of hypertension and glomerular filtration rate <30ml/min/m2, but lower prevalence of all other traditional cardiovascular comorbidities. Both genders had similar rates of 30-day stroke (2.3% vs 2.5%, p=0.53) and mortality (5.9% vs. 5.5%, p=0.17). In contrast, females had a 50% higher risk of life-threatening or major bleeding (6.7% vs 4.4%, p<0.01). Over the study period mortality rates decreased to a greater extent in males than in females (60% vs 50% reduction, both p<0.001), with no reductions in stroke rates over time. CONCLUSIONS: In this global collaboration females and males had similar rates of 30-day mortality and stroke. However, females had higher rates of procedural life-threatening or major bleeding after TAVR. Between 2007 and 2018 mortality rates decreased to a greater extent in males than in females.

5.
Bernoche, Claudia; Timerman, Sergio; Polastri, Thatiane Facholi; Giannetti, Natali Schiavo; Siqueira, Adailson Wagner da Silva; Piscopo, Agnaldo; Soeiro, Alexandre de Matos; Reis, Amélia Gorete Afonso da Costa; Tanaka, Ana Cristina Sayuri; Thomaz, Ana Maria; Quilici, Ana Paula; Catarino, Andrei Hilário; Ribeiro, Anna Christina de Lima; Barreto, Antonio Carlos Pereira; Azevedo Filho, Antonio Fernando Barros de; Pazin Filho, Antonio; Timerman, Ari; Scarpa, Bruna Romanelli; Timerman, Bruno; Tavares, Caio de Assis Moura; Martins, Cantidio Soares Lemos; Serrano Junior, Carlos Vicente; Malaque, Ceila Maria Sant'Ana; Pisani, Cristiano Faria; Batista, Daniel Valente; Leandro, Daniela Luana Fernandes; Szpilman, David; Gonçalves, Diego Manoel; Paiva, Edison Ferreira de; Osawa, Eduardo Atsushi; Lima, Eduardo Gomes; Adam, Eduardo Leal; Peixoto, Elaine; Evaristo, Eli Faria; Azeka, Estela; Silva, Fabio Bruno da; Wen, Fan Hui; Ferreira, Fatima Gil; Lima, Felipe Gallego; Fernandes, Felipe Lourenço; Ganem, Fernando; Galas, Filomena Regina Barbosa Gomes; Tarasoutchi, Flavio; Souza, Germano Emilio Conceição; Feitosa Filho, Gilson Soares; Foronda, Gustavo; Guimarães, Helio Penna; Abud, Isabela Cristina Kirnew; Leite, Ivanhoé Stuart Lima; Linhares Filho, Jaime Paula Pessoa; Moraes Junior, João Batista de Moura Xavier; Falcão, João Luiz Alencar de Araripe; Ramires, Jose Antônio Franchini; Cavalini, José Fernando; Saraiva, José Francisco Kerr; Abrão, Karen Cristine; Pinto, Lecio Figueira; Bianchi, Leonardo Luís Torres; Lopes, Leonardo Nícolau Geisler Daud; Piegas, Leopoldo Soares; Kopel, Liliane; Godoy, Lucas Colombo; Tobase, Lucia; Hajjar, Ludhmila Abrahão; Dallan, Luís Augusto Palma; Caneo, Luiz Fernando; Cardoso, Luiz Francisco; Canesin, Manoel Fernandes; Park, Marcelo; Rabelo, Marcia Maria Noya; Malachias, Marcus Vinícius Bolívar; Gonçalves, Maria Aparecida Batistão; Almeida, Maria Fernanda Branco de; Souza, Maria Francilene Silva; Favarato, Maria Helena Sampaio; Carrion, Maria Julia Machline; Gonzalez, Maria Margarita; Bortolotto, Maria Rita de Figueiredo Lemos; Macatrão-Costa, Milena Frota; Shimoda, Mônica Satsuki; Oliveira-Junior, Mucio Tavares de; Ikari, Nana Miura; Dutra, Oscar Pereira; Berwanger, Otávio; Pinheiro, Patricia Ana Paiva Corrêa; Reis, Patrícia Feitosa Frota dos; Cellia, Pedro Henrique Moraes; Santos Filho, Raul Dias dos; Gianotto-Oliveira, Renan; Kalil Filho, Roberto; Guinsburg, Ruth; Managini, Sandrigo; Lage, Silvia Helena Gelas; Yeu, So Pei; Franchi, Sonia Meiken; Shimoda-Sakano, Tania; Accorsi, Tarso Duenhas; Leal, Tatiana de Carvalho Andreucci; Guimarães, Vanessa; Sallai, Vanessa Santos; Ávila, Walkiria Samuel; Sako, Yara Kimiko.
Arq. bras. cardiol ; 113(3): 449-663, Sept. 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1038561
8.
Circ Cardiovasc Imaging ; 12(5): e008353, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31088148

RESUMO

Background Few data exist on the degree of interstitial myocardial fibrosis in patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS) and its association with left ventricular flow reserve (FR) on dobutamine stress echocardiography. This study sought to evaluate the diffuse interstitial fibrosis measured by T1 mapping cardiac magnetic resonance technique in LFLG-AS patients with and without FR. Methods Prospective study including 65 consecutive patients (41 LFLG-AS [mean age, 67.1±8.4 years; 83% men] and 24 high-gradient aortic stenosis used as controls) undergoing dobutamine stress echocardiography to assess FR and cardiac magnetic resonance to determine the extracellular volume (ECV) fraction of the myocardium, indexed ECV (iECV) to body surface area and late gadolinium enhancement. Results Interstitial myocardial fibrosis measured by iECV was higher in patients with LFLG-AS with and without FR as compared with high-gradient aortic stenosis (35.25±9.75 versus 32.93±11.00 versus 21.19±6.47 mL/m2, respectively; P<0.001). However, both ECV and iECV levels were similar between LFLG-AS patients with and without FR ( P=0.950 and P=0.701, respectively). Also, FR did not correlate significantly with ECV (r=-0.16, P=0.31) or iECV (r=0.11, P=0.51). Late gadolinium enhancement mass was also similar in patients with versus without FR but lower in high-gradient aortic stenosis (13.3±10.2 versus 10.5±7.5 versus 4.8±5.9 g, respectively; P=0.018). Conclusions Patients with LFLG-AS have higher ECV, iECV, and late gadolinium enhancement mass compared with high-gradient aortic stenosis. Moreover, among patients with LFLG-AS, the degree of myocardial fibrosis was similar in patients with versus those without FR. These findings suggest that diffuse myocardial fibrosis may not be the main factor responsible for the absence of FR in LFLG-AS patients.

9.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2): 167-171, abr.-jun. 2019. ilus
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1009510

RESUMO

A estenose aórtica degenerativa é uma patologia com incidência elevada em pacientes idosos. Sua fisiopatologia está relacionada à calcificação valvar e não está totalmente elucidada. Sabe-se, entretanto, que inicialmente há grande semelhança com o processo de aterosclerose e, após o inicio da deposição do cálcio, tal processo se autoperpetua, gerando mais calcificação e piora da gravidade anatômica valvar progressivamente. Ainda há uma carência de testes para o diagnóstico das fases iniciais de calcificação. Porém, nas fases finais, a utilização da tomografia com escore de cálcio valvar e o ecocardiograma estão bem estabelecidos. Com relação ao tratamento medicamentoso para reduzir ou deter a progressão da doença valvar, devemos reforçar a necessidade de tratamento para os fatores de risco de aterosclerose. Entretanto, a estatina provou-se ineficaz até o momento e novas medicações, como o esonumabe e os bifosfonados, ainda estão em estudo


Degenerative aortic stenosis is a pathology with high incidence in elderly patients. Its pathophysiology is related to valve calcification and has not been fully elucidated. However, it is known to be very similar to the atherosclerotic process in the initial stages. Once calcium deposition begins, this process is self-perpetuating, generating further calcification and progressive degeneration of the valve anatomy. The number of tests used to diagnose the early stages of calcification is still insufficient. However, in the late stages, the use of computed tomography aortic valve calcium scoring and echocardiogram scans is well established. Regarding medical treatment aimed at reducing or slowing heart valve disease progression, we must emphasize the need for treatment of atherosclerosis risk factors. However, statins have thus far proven ineffective, and new drug products, such as desonumab and bisphosphonates, are still being studied


Assuntos
Humanos , Masculino , Feminino , Estenose da Valva Aórtica/prevenção & controle , Calcificação Vascular , Valva Aórtica , Ecocardiografia/métodos , Tomografia/métodos , Fatores de Risco , Inibidores de Hidroximetilglutaril-CoA Redutases
10.
Clin Infect Dis ; 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30949690

RESUMO

BACKGROUND: 18Fluorodeoxyglucose positron emission tomography (18F-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding the use of 18F-FDG-PET/CT for the diagnosis of native valve IE (NVE). METHODS: Between 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. 18F-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE) / ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and 18F-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis. RESULTS: Among 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of 18F-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were: 22%, 100%, 100%, and 66%. The inclusion of abnormal 18F-FDG cardiac uptake as a major criterion at admission enabled a re-categorization of 76% (47/62) of PVE/AAPI cases initially classified as "possible" to "definite" IE. In the histopathological analysis, a predominance of PMN inflammatory infiltrate and reduced extent of fibrosis were observed in the PVE group only. CONCLUSIONS: The addition of 18F-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the Modified Duke criteria. In patients presenting with suspected NVE, the use of 18F-FDG-PET/CT is less accurate, and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.

11.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2 (Supl)): 201-201, abr.-jun. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1009930

RESUMO

A prótese de Star-Edwards foi a primeira válvula mecânica a ser implantada no mundo, no ano de 1960. Cerca de 200.000 pacientes foram beneficiados com esse modelo, porém, caiu em desuso por suas frequentes complicações como hemólise, anemia e tromboembolismos, apesar de sua notável durabilidade. Neste artigo apresentamos um caso de paciente com a maior durabilidade com manutenção da funcionalidade da prótese S-E, já relatado na literatura. O paciente fez o seguimento cardiológico corretamente, bem como usou a anticoagulação adequada. Apresentou disfunção de outras valvas, porém a prótese S-E manteve-se estável e funcional. Inclusive, necessitou de cirurgia para troca valvar mitral, mas não da prótese de S-E em posição aórtica. Este relato foi realizado através da história clínica do paciente e do levantamento de dados da literatura sobre próteses valvares e sua durabilidade. Existem relatos de durabilidade de próteses valvares com aproximadamente 30 a 40 anos, mas nenhum relato próximo ou igual a este com 49 anos de durabilidade. A importância dos cuidados pós-operatórios, uso correto dos anticoagulantes e o seguimento clínico para controle das possíveis complicações da prótese, foi mostrada neste artigo através do relato desse caso


In 1960, the Starr-Edwards prosthesis became the first mechanical valve to be implanted, worldwide. Roughly 200,000 patients benefited from this model. However, it has now fallen out of use due to its frequent complications, such as hemolysis, anemia and thromboembolisms, despite its noteworthy durability. In this article, we present a case of a patient with the longest durability with maintenance of functionality of the S-E prosthesis reported in the literature. The patient had correctly followed the cardiological follow-up, including adequate use of anti-coagulant medications. The patient presented dysfunction in other valves, but the S-E prosthesis remained stable and functional. The patient even required mitral valve replacement surgery, but not for the S-E prosthesis in the aortic position. This report was based on patient's clinical history and a survey of the literature data on valve prostheses and their durability. There are reports of prostheses remaining stable for approximately 30 to 40 years, but none that came close to this one, which had lasted for 49 years The importance of postoperative care, the correct use of anti-coagulant medicines, and clinical follow-up to minimize the possible complications of the prosthesis, were shown in this article through this case report


Assuntos
Humanos , Masculino , Idoso , Próteses Valvulares Cardíacas , Valvas Cardíacas , Valva Aórtica , Estenose da Valva Aórtica/cirurgia , Ecocardiografia/métodos , Doenças das Valvas Cardíacas , Anticoagulantes/uso terapêutico
14.
Rev. esp. de cardiol. (Internet. Engl. ed.) ; 72(1): 21-29, Jan. 2019. tabela, gráfico
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1023736

RESUMO

Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. METHODS: Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. RESULTS: The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). CONCLUSIONS: Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved. KEYWORDS: Acute kidney injury; Aortic stenosis; Daño renal agudo; Edad avanzada; Elderly; Estenosis aórtica; Implante percutáneo de válvula aórtica; Mortalidad; Mortality; Transcatheter aortic valve implantation; Valve Academic Research Consortium. (AU)


Assuntos
Humanos , Lesão Renal Aguda , Substituição da Valva Aórtica Transcateter/efeitos adversos , Período Pós-Operatório
15.
Rev. esp. cardiol. (Ed. impr.) ; 72(1): 21-29, ene. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182495

RESUMO

Introducción y objetivos: El daño renal agudo (DRA) ocurre con frecuencia tras el implante percutáneo de válvula aórtica (TAVI) y se asocia con una mayor mortalidad. Sin embargo, el impacto del DRA en la evolución a largo plazo continúa siendo controvertida. Por dicho motivo se evalúa el impacto del DRA el resultado a corto y largo plazo tras el TAVI usando los criterios Valve Academic Research Consortium 2. Métodos: Se incluyeron 794 pacientes consecutivos con estenosis aórtica grave en un registro multicéntrico brasileño. Para la identificación de los predictores de DRA se utilizó el análisis de regresión logística. La supervivencia a 4 años se determinó mediante las curvas de Kaplan-Meier y para determinar el impacto del DRA en la mortalidad entre los supervivientes a 12 meses se usó un análisis de punto de referencia ajustado. Resultados: La incidencia de DRA tras el TAVI fue del 18%. Los predictores independientes de DRA fueron: edad, diabetes mellitus, hemorragia mayor o amenazante para la vida y la malaposición valvular. El DRA se asoció independientemente con un riesgo mayor de muerte total (HR ajustada = 2,8; IC95%, 2,0-3,9; p < 0,001) y cardiovascular (HR ajustada = 2,9; IC95%, 1,9-4,4; p < 0,001) durante el periodo de seguimiento completo. Sin embargo, cuando se consideró solo los supervivientes a 12 meses, no hubo diferencias en ambos objetivos clínicos (HR ajustada = 1,2; IC95%, 0,5-2,4; p = 0,71, y HR = 0,7; IC95%, 0,2-2,1; p = 0,57, respectivamente). Conclusiones: El DRA es una complicación frecuente tras el TAVI. La edad avanzada, la diabetes, la hemorragia mayor o amenazante para la vida y la malaposición valvular eran factores predictivos de DRA. El DRA se asoció con el pronóstico a corto y largo plazo, sin embargo, el impacto del DRA sobre la mortalidad se limitó al primer año tras el TAVI


Introduction and objectives: Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. Methods: Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. Results: The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). Conclusions: Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Lesão Renal Aguda/epidemiologia , Substituição da Valva Aórtica Transcateter/métodos , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Fatores de Risco , Complicações Pós-Operatórias
16.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.662-665.
Monografia em Português | LILACS | ID: biblio-1009432
17.
Congenit Heart Dis ; 2018 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-30280492

RESUMO

In the 2017, "Cairo Accord on Rheumatic Heart Disease-From Molecules to The Global Community" experts from endemic areas enumerated an approach to reduce the population burden of rheumatic heart disease. The 10 key recommendations include immediate logistical objectives as well as domains for further study. Echocardiographic population screening programs were relegated to research alone. Given the large body of supporting data, relegating echo screening to an investigational modality is an opportunity lost.

18.
Int J Infect Dis ; 77: 48-52, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30248465

RESUMO

OBJECTIVE: To compare the clinical and epidemiological features, treatments, and outcomes of patients with isolated right-sided and left-sided fungal endocarditis and to determine the risk factors for in-hospital mortality in patients with Candida sp endocarditis. METHODS: A retrospective review of all consecutive cases of fungal endocarditis from five hospitals was performed. Clinical features were compared between patients with isolated right-sided and left-sided endocarditis. In the subgroup of fungal endocarditis due to Candida species, binary logistic regression analysis was performed to determine variables related to in-hospital mortality. RESULTS: Seventy-eight patients with fungal endocarditis were studied. Their median age was 50 years; 55% were male and 19 patients (24%) had isolated right-sided endocarditis. Overall, cardiac surgery was performed in 46 patients (59%), and in-hospital mortality was 54%. Compared to patients with left-side fungal endocarditis, patients with isolated right-sided endocarditis had lower mortality (32% vs. 61%; p=0.025) and were less often submitted to cardiac surgery (37% vs. 66%; p=0.024). The most frequent etiology was Candida spp (85%). In this subgroup, acute heart failure (odds ratio 5.0; p=0.027) and exclusive medical treatment (odds ratio 11.1; p=0.004) were independent predictors of in-hospital death, whereas isolated right-sided endocarditis was related to a lower risk of mortality (odds ratio 0.13; p=0.023). CONCLUSIONS: Patients with isolated right-sided fungal endocarditis have particular clinical and epidemiological features. They were submitted to cardiac surgery less often and had better survival than patients with left-sided fungal endocarditis. Isolated right-sided endocarditis was also a marker of a less harmful illness in the subgroup of Candida sp endocarditis.

19.
Braz J Cardiovasc Surg ; 33(4): 362-370, 2018 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30184033

RESUMO

OBJECTIVE: To analyze the behavior of platelets after transcatheter valve-in-valve implantation for the treatment of degenerated bioprosthesis and how they correlate with adverse events upon follow-up. METHODS: Retrospective analysis of 28 patients who received a valve-in-valve implant, 5 in aortic, 18 in mitral and 5 in tricuspid positions. Data were compared with 74 patients submitted to conventional redo valvular replacements during the same period, and both groups' platelet curves were analyzed. Statistical analysis was conducted using the IBM SPSS Statistics(r) 20 for Windows. RESULTS: All patients in the valve-in-valve group developed thrombocytopenia, 25% presenting mild (<150.000/µL), 54% moderate (<100.000/µL) and 21% severe (<50.000/µL) thrombocytopenia. The platelet nadir was on the 4th postoperative day for aortic ViV, 2nd for mitral and 3rd for tricuspid patients, with the majority of patients recovering regular platelet count. However, the aortic subgroup comparison between valve-in-valve and conventional surgery showed a statistically significant difference from the 7th day onwards, where valve-in-valve patients had more severe and longer lasting thrombocytopenia. This, however, did not translate into a higher postoperative risk. In our study population, postoperative thrombocytopenia did not correlate with greater occurrence of adverse outcomes and only normal preoperative platelet count could significantly predict a postoperative drop >50%. CONCLUSION: Although thrombocytopenia is an extremely common finding after valve-in-valve procedures, the degree of platelet count drop did not correlate with greater incidence of postoperative adverse outcomes in our study population.

20.
Rev. bras. cir. cardiovasc ; 33(4): 362-370, July-Aug. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-958425

RESUMO

Abstract Objective: To analyze the behavior of platelets after transcatheter valve-in-valve implantation for the treatment of degenerated bioprosthesis and how they correlate with adverse events upon follow-up. Methods: Retrospective analysis of 28 patients who received a valve-in-valve implant, 5 in aortic, 18 in mitral and 5 in tricuspid positions. Data were compared with 74 patients submitted to conventional redo valvular replacements during the same period, and both groups' platelet curves were analyzed. Statistical analysis was conducted using the IBM SPSS Statistics(r) 20 for Windows. Results: All patients in the valve-in-valve group developed thrombocytopenia, 25% presenting mild (<150.000/µL), 54% moderate (<100.000/µL) and 21% severe (<50.000/µL) thrombocytopenia. The platelet nadir was on the 4th postoperative day for aortic ViV, 2nd for mitral and 3rd for tricuspid patients, with the majority of patients recovering regular platelet count. However, the aortic subgroup comparison between valve-in-valve and conventional surgery showed a statistically significant difference from the 7th day onwards, where valve-in-valve patients had more severe and longer lasting thrombocytopenia. This, however, did not translate into a higher postoperative risk. In our study population, postoperative thrombocytopenia did not correlate with greater occurrence of adverse outcomes and only normal preoperative platelet count could significantly predict a postoperative drop >50%. Conclusion: Although thrombocytopenia is an extremely common finding after valve-in-valve procedures, the degree of platelet count drop did not correlate with greater incidence of postoperative adverse outcomes in our study population.

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