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2.
Arq. bras. cardiol ; 115(4): 720-775, out. 2020. tab, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1131346
3.
Braz J Cardiovasc Surg ; 33(5): 476-482, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517256

RESUMO

OBJECTIVE: Elaboration and internal validation of the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire adapted to the reality of Brazilian cardiovascular surgery. METHODS: Cross-sectional pilot study of a prospective cohort included in the Documentation and Surgical Registry Center (CEDREC) for internal validation of the QLCS questionnaire. Four hundred forty-five patients submitted to cardiovascular surgery and who answered a QLCS questionnaire 30 days after hospital discharge were included. It was applied via telephone. To verify the questions' internal consistency, Cronbach's alpha was used. The total QLCS score was calculated as the sum of 5 questions, ranging from 5 to 25 points. Mann-U-Whitney test was used to relate the symptoms with the quality of life (QoL). Level of significance was 5%. RESULTS: After 30 days of surgery, about 95% of the patients had already returned to normal routine and 19% of them were already performing physical activity. In the evaluation of the QLCS's internal consistency, a Cronbach's alpha of 0.74 was found, suggesting that this was probably an adequate questionnaire to evaluate QoL in this population. In the comparison between the presence and absence of symptoms and the median of QoL, the presence of pain at the incision (P=0.002), chest pain (P<0.001), shortness of breath (P<0.001), and return to physical activity (P<0.001) were statistically significant. CONCLUSION: The process of elaboration and validation of questionnaires includes a series of steps. The QLCS questionnaire is probably an adequate tool for the evaluation of QoL in the postoperative patient of cardiovascular surgery, in this first stage of internal validation.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/psicologia , Qualidade de Vida , Inquéritos e Questionários , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
4.
Rev. bras. cir. cardiovasc ; 33(5): 476-482, Sept.-Oct. 2018. tab, graf
Artigo em Inglês | LILACS-Express | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-977453

RESUMO

Abstract Objective: Elaboration and internal validation of the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire adapted to the reality of Brazilian cardiovascular surgery. Methods: Cross-sectional pilot study of a prospective cohort included in the Documentation and Surgical Registry Center (CEDREC) for internal validation of the QLCS questionnaire. Four hundred forty-five patients submitted to cardiovascular surgery and who answered a QLCS questionnaire 30 days after hospital discharge were included. It was applied via telephone. To verify the questions' internal consistency, Cronbach's alpha was used. The total QLCS score was calculated as the sum of 5 questions, ranging from 5 to 25 points. Mann-U-Whitney test was used to relate the symptoms with the quality of life (QoL). Level of significance was 5%. Results: After 30 days of surgery, about 95% of the patients had already returned to normal routine and 19% of them were already performing physical activity. In the evaluation of the QLCS's internal consistency, a Cronbach's alpha of 0.74 was found, suggesting that this was probably an adequate questionnaire to evaluate QoL in this population. In the comparison between the presence and absence of symptoms and the median of QoL, the presence of pain at the incision (P=0.002), chest pain (P<0.001), shortness of breath (P<0.001), and return to physical activity (P<0.001) were statistically significant. Conclusion: The process of elaboration and validation of questionnaires includes a series of steps. The QLCS questionnaire is probably an adequate tool for the evaluation of QoL in the postoperative patient of cardiovascular surgery, in this first stage of internal validation.

6.
Echocardiography ; 32(1): 1122-1130, 2015. ilus
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1062476

RESUMO

Left atrial (LA) dilation is associated with worse prognosis in various clinical situationsincluding chronic mitral regurgitation (MR). Real time three-dimensional echocardiography (3DE) hasallowed a better assessment of LA volumes and function. Little is known about LA size and function inearly postoperative period in symptomatic patients with chronic organic MR. We aimed to investigatethese aspects. Methods: By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectivelystudied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twentysubjects were studied as controls. Maximum (Vol-max), minimum, and preatrial contraction LA volumeswere measured and total, passive, and active LA emptying fractions were calculated. Results: Before surgerypatients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls(P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptyingfraction (AAEF). Multivariate analysis showed that independent predictors of early postoperativeVol-max reduction were preoperative diastolic blood pressure (coefficient = 0.004; P = 0.02), lateralmitral annular early diastolic velocity (e0) (coefficient = 0.023; P = 0.008), and the mean transmitral diastolicgradient increment (coefficient = 0.035; P < 0.001). Furthermore, e0 was also independentlyassociated with AAEF increase (odds ratio = 1.66, P = 0.027). Conclusion: Early LA reverse remodelingand functional improvement occur after successful surgery of symptomatic organic MR regardless ofsurgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variablesnegatively related to Vol-max reduction. Besides, e0 is positively correlated with both Vol-max reductionand AAEF increase.


Assuntos
Ecocardiografia , Insuficiência da Valva Mitral , Átrios do Coração
7.
Echocardiography ; 18: 1-9, 2014. ilus
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1062474

RESUMO

Left atrial (LA) dilation is associated with worse prognosis in various clinical situationsincluding chronic mitral regurgitation (MR). Real time three-dimensional echocardiography (3DE) hasallowed a better assessment of LA volumes and function. Little is known about LA size and function inearly postoperative period in symptomatic patients with chronic organic MR. We aimed to investigatethese aspects. Methods: By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectivelystudied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twentysubjects were studied as controls. Maximum (Vol-max), minimum, and preatrial contraction LA volumeswere measured and total, passive, and active LA emptying fractions were calculated. Results: Before surgerypatients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls(P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptyingfraction (AAEF). Multivariate analysis showed that independent predictors of early postoperativeVol-max reduction were preoperative diastolic blood pressure (coefficient = 0.004; P = 0.02), lateralmitral annular early diastolic velocity (e0) (coefficient = 0.023; P = 0.008), and the mean transmitral diastolicgradient increment (coefficient = 0.035; P < 0.001). Furthermore, e0 was also independentlyassociated with AAEF increase (odds ratio = 1.66, P = 0.027). Conclusion: Early LA reverse remodelingand functional improvement occur after successful surgery of symptomatic organic MR regardless ofsurgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variablesnegatively related to Vol-max reduction. Besides, e0 is positively correlated with both Vol-max reductionand AAEF increase.


Assuntos
Ecocardiografia , Insuficiência da Valva Mitral , Átrios do Coração
8.
Arq Bras Cardiol ; 100(4): 368-75, 2013 Apr.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23545994

RESUMO

BACKGROUND: Mitral valve repair is the surgical procedure of choice for patients with chronic Mitral Regurgitation (MR). The good early and late results allow surgical indication before symptom onset. The cardiopulmonary exercise test (CPET) can objectively assess functional capacity, but little is known about the effect of surgery on their variables. OBJECTIVE: Evaluate the effects of mitral repair on CPET variables in patients with chronic MR. METHODS: A total of 47 patients with severe MR were selected; these patients underwent mitral valve repair and were submitted to CPET ± 30 days before surgery, as well as six to 12 months after the surgery. RESULTS: There was predominance of functional class I or II NYHA in 30 (63.8%) and 34 patients (72.3%), respectively. A significant decrease in oxygen consumption (VO2) was observed after surgery, from 1,719 ± 571 to 1609 ± 428 mL min-1, p = 0.036. There was a decrease in Oxygen Uptake Efficiency Slope (OUES) from 1,857 ± 594 to 1763 ± 514, p = 0.073 and oxygen pulse (O2) increased after surgery, from 11.1 ± 3.2 to 11.9 ± 3, 2 mL.beat-1 (p = 0.003). CONCLUSION: The mitral valve repair did not increase peak VO2 and OUES despite positive cardiac remodeling observed seven months after surgery. However, O2 pulse increased postoperatively, suggesting improved LV systolic performance. The CPET is a useful tool to assist in the medical management of patients with MR.


Assuntos
Teste de Esforço/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Consumo de Oxigênio/fisiologia , Ventilação Pulmonar/fisiologia , Função Ventricular Esquerda/fisiologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Estatísticas não Paramétricas , Resultado do Tratamento , Ultrassonografia
9.
Arq. bras. cardiol ; 100(4): 368-375, abr. 2013. ilus, tab
Artigo em Português | LILACS, Sec. Est. Saúde SP | ID: lil-674198

RESUMO

FUNDAMENTO: A plástica valvar mitral é o procedimento cirúrgico de escolha para pacientes com Insuficiência Mitral (IM) crônica. Os bons resultados imediatos e tardios permitem a indicação cirúrgica antes do início dos sintomas. O teste cardiopulmonar de exercício (TCPE) pode avaliar objetivamente a capacidade funcional, mas pouco se conhece o efeito da cirurgia em suas variáveis. OBJETIVOS: Avaliar os efeitos da plástica mitral nas variáveis do TCPE em pacientes com IM crônica. MÉTODOS: Foram selecionados 47 pacientes com IM grave e submetidos plástica da valva mitral, sendo nestes, realizado TCPE ± 30 dias antes da cirurgia, e de seis a 12 meses após a cirurgia. RESULTADOS: Houve predominância da classe funcional I ou II pela NYHA em 30 pacientes (63,8%) e 34 pacientes (72,3%), respectivamente. Após a cirurgia foi observado uma diminuição significativa do consumo de oxigênio (VO2), de 1.719 ± 571 para 1.609 ± 428 mL.min-1, p = 0,036. Houve redução do Oxygen Uptake Efficiency Slope (OUES), de 1.857 ± 594 para 1.763 ± 514, p = 0,073 e o pulso de oxigênio (O2) aumentou após a cirurgia, de 11,1 ± 3,2 para 11,9 ± 3,2 mL.bat-1 (p = 0,003). CONCLUSÃO: A plástica da valva mitral, não determinou aumento do VO2 pico e do OUES apesar do remodelamento cardíaco positivo observado após sete meses de cirurgia. Entretanto, o pulso de O2 aumentou no pós-operatório, sugerindo melhora do desempenho sistólico do VE. O TCPE é uma ferramenta útil, podendo auxiliar na conduta médica em pacientes com IM.


BACKGROUND: Mitral valve repair is the surgical procedure of choice for patients with chronic Mitral Regurgitation (MR). The good early and late results allow surgical indication before symptom onset. The cardiopulmonary exercise test (CPET) can objectively assess functional capacity, but little is known about the effect of surgery on their variables. OBJECTIVE: Evaluate the effects of mitral repair on CPET variables in patients with chronic MR. METHODS: A total of 47 patients with severe MR were selected; these patients underwent mitral valve repair and were submitted to CPET ± 30 days before surgery, as well as six to 12 months after the surgery. RESULTS: There was predominance of functional class I or II NYHA in 30 (63.8%) and 34 patients (72.3%), respectively. A significant decrease in oxygen consumption (VO2) was observed after surgery, from 1,719 ± 571 to 1609 ± 428 mL min-1, p = 0.036. There was a decrease in Oxygen Uptake Efficiency Slope (OUES) from 1,857 ± 594 to 1763 ± 514, p = 0.073 and oxygen pulse (O2) increased after surgery, from 11.1 ± 3.2 to 11.9 ± 3, 2 mL.beat-1 (p = 0.003). CONCLUSION: The mitral valve repair did not increase peak VO2 and OUES despite positive cardiac remodeling observed seven months after surgery. However, O2 pulse increased postoperatively, suggesting improved LV systolic performance. The CPET is a useful tool to assist in the medical management of patients with MR. (Arq Bras Cardiol. 2013; [online].ahead print, PP.0-0).


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Teste de Esforço/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Consumo de Oxigênio/fisiologia , Ventilação Pulmonar/fisiologia , Função Ventricular Esquerda/fisiologia , Doença Crônica , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral , Estatísticas não Paramétricas , Resultado do Tratamento
10.
São Paulo; IDPC; 2012. 129 p.
Monografia em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1077581

RESUMO

A insuficiência mitral (IM) crônica orgânica tem fisiopatologia complexa. Os sintomas de insuficiência cardíaca e piora da capacidade funcional, podem aparecer apenas tardiamente, quando já existe disfunção contrátil do ventrículo esquerdo (VE). O teste cardiopulmonar de exercício (TCPE) pode avaliar objetivamente a capacidade funcional e auxiliar a conduta médica nos pacientes com IM, mas , pouco se conhece sobre o efeito da cirugia em suas variáveis...


Assuntos
Cirurgia Torácica , Exercício Físico , Insuficiência da Valva Mitral , Sinais e Sintomas
11.
In. Serrano Junior, Carlos V; Timerman, Ari; Stefanini, Edson. Tratado de cardiologia SOCESP. Barueri, São Paulo, Manole, 2 ed; 2009. p.1309-1316.
Monografia em Português | LILACS | ID: lil-555517
13.
In. Meneghelo, Zilda; Ramos, Auristela Isabel de Oliveira; Meneghelo, Zilda. Instituto Dante Pazzanese de Cardiologia. BrasilRamos, Auristela Isabel de Oliveira. Instituto Dante Pazzanese de Cardiologia. Brasil. Lesões das Valvas Cardícas do Diagnóstico ao Tratamento. São Paulo, Atheneu, 2007. p.285-296, ilus.
Monografia em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1069859

RESUMO

As próteses valvares têm sido implantadas com sucesso nas últimas quatro décadas e a sua história está estreitamente relacionada com o desenvolvimento da própria cirurgia cardíaca.O marco para o desenvolvimento dessas próteses foi o início da cirurgia cardíaca a céu aberto utilizando técnicas de circulação extracorpórea , possibilitando, assim, a correção de refluxos e implantes de substitutos valvares. A primeira prótese cardíaca de bola foi implantada em 1952, por Hufnagel, e desde então, muitos desenhos de diferentes valvas cardíacas protéticas foram fabricados e avaliados clinicamente. Isto envolveu pesquisa para materiais biologicamente compatíveis e desenhos com uma hemodinâmica mais aceitável...


Assuntos
Cirurgia Torácica , Próteses Valvulares Cardíacas
15.
Arq. bras. cardiol ; 83(n.spe): 46-52, dez. 2004. ilus, tab, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP | ID: lil-390722

RESUMO

OBJETIVO: Avaliar a incidência de trombo intracardíaco e de tromboembolismo nos três primeiros meses após a troca valvar por bioprótese e identificar fatores de risco para a formação de trombo. MÉTODO:Incluídos 184 pacientes, entre 15 e 75 anos de idade, submetidos a implante de bioprótese e realizados ecocardiogramas transtorácico e transesofágico (ETE) na fase hospitalar, média 8,4±3 dias, e três meses após, média 97,4±21,7 dias. RESULTADOS: Incidência de trombo foi significativamente mais elevada nos pacientes com prótese em posição mitral ou mitroaórtica (21,0 por cento) do que em posição aórtica (2,8 por cento), p<0,001. A análise de regressão logística multivariada identificou a prótese em posição mitral ou mitroaórtica como a única variável independente para a formação de trombo. No seguimento de três meses o ETE evidenciou trombo em 35 (20,7 por cento) dos 169 pacientes com evolução ecocardiográfica, 31,7 por cento nos mitrais e 3,1 por cento nos aórticos, p<0,001. No 3º mês a análise de regressão logística multivariada também identificou a prótese em posição mitral ou mitroaórtica como a única variável independente para a formação de trombo. Durante os três meses de seguimento, três (1,6 por cento) pacientes faleceram e oito (4,3 por cento) apresentaram fenômeno embólico, todos para território cerebral. CONCLUSÃO: A incidência de trombo nos três primeiros meses, após o implante da bioprótese foi 14,1 por cento nos 10 primeiros dias e 20,7 por cento em três meses; a prótese em posição mitral ou mitroaórtica foi identificada como fator de risco para a formação de trombo; a incidência de fenômenos embólicos diagnosticados clinicamente foi inferior à proporção de trombo atrial documentado pelo ecocardiograma.


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bioprótese/efeitos adversos , Cardiopatias/epidemiologia , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Trombose/epidemiologia , Ecocardiografia/métodos , Métodos Epidemiológicos , Cardiopatias/etiologia , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Trombose/etiologia
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