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1.
Sultan Qaboos Univ Med J ; 21(3): 403-407, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34522405

RESUMO

Objectives: Bicuspid aortic valve (BAV) is the most common congenital lesion found in adults. It can be seen in combination with a transverse left ventricular (LV) band. This study aimed to find an essential relationship between the presence of transverse ventricular band and BAV. Methods: A total of 13 patients from a tertiary care centre in India with transverse LV band were investigated during a six-month period from January 2019 to July 2019. LV band thickness and gradients at the site of the LV band were evaluated as part of its effect on LV haemodynamics. The morphology of the aortic valve and LV outflow tract gradients was assessed. Results: The mean age of the participants was 41 years. A majority had a BAV (n = 11). Average thickness of the LV band was 6.2 mm and the average mean aortic gradient was 4 mmHg. Sequestration of blood was noted at the level of the transverse band in all the patients with two separate jets at the left ventricular outflow tract. The anterolateral jet was deflected from the transverse band and showed higher velocity compared to the other jet, causing turbulence at the BAV. No correlation was found between the thickness of the transverse band and aortic valve gradient. Conclusion: Presence of a robust transverse LV band can serve as a surrogate marker for BAV.


Assuntos
Estenose da Valva Aórtica , Doença da Válvula Aórtica Bicúspide , Doenças das Valvas Cardíacas , Adulto , Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/diagnóstico , Hemodinâmica , Humanos
2.
BMJ Case Rep ; 14(8)2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344658

RESUMO

Right-sided native valve infective endocarditis is common in patients with congenital or valvular heart disease, intracardiac device, central venous catheter and intravenous drug abuse, usually manifesting in adulthood. However, in the absence of predisposing risk factors and in younger age groups, this disease may pose a diagnostic challenge. We report a case series of three juvenile patients with isolated tricuspid valve infective endocarditis without any risk factors and paucity of cardiovascular findings in two of them, in an attempt to highlight the importance of maintaining a high index of suspicion to arrive a timely diagnosis.


Assuntos
Endocardite Bacteriana , Endocardite , Doenças das Valvas Cardíacas , Abuso de Substâncias por Via Intravenosa , Adulto , Endocardite/diagnóstico , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Abuso de Substâncias por Via Intravenosa/complicações , Valva Tricúspide/diagnóstico por imagem
4.
Curr Cardiol Rep ; 23(10): 140, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34410525

RESUMO

PURPOSE OF REVIEW: Mitral valve repair is a common surgical procedure for both primary and secondary mitral regurgitation. With operations performed earlier in disease progression and increased patient longevity, the need for a repeat intervention is not infrequent. With the associated risks of reoperation and patient comorbidities, percutaneous techniques for acute or delayed failure after ring annuloplasty are emerging. RECENT FINDINGS: Current commercially available devices, used in "off-label" ways, such as the MitraClip, may be effective in repairing recurrent mitral regurgitation after annuloplasty. Similarly, a valve-in-ring transcatheter mitral valve replacement can be considered in patients at high risk for surgical reoperation. These procedures are not without risk, for example, resultant mitral stenosis in the setting of edge-to-edge repair or left ventricular outflow tract (LVOT) obstruction with valve-in-ring transcatheter mitral valve replacement. Newer devices are emerging to permit more options for this subset of patients, which include transcatheter valves that are specifically designed for the mitral position. Undoubtedly, surgical reoperation has increased risk as compared to primary operation. Though percutaneous options are evolving, use in this patient population is currently limited to "off-label" use and is also associated with procedural complexities and risk. It is prudent for cardiologists, surgeons, and anesthesiologists to weigh risks, benefits, and limitations when considering patients for surgical reoperation, percutaneous repair, or transcatheter replacement after failed mitral annuloplasty.


Assuntos
Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Cateterismo Cardíaco , Doenças das Valvas Cardíacas/cirurgia , Humanos , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento
5.
Herz ; 46(4): 385-396, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34259894

RESUMO

Women with known cardiovascular diseases (CVD) and a desire to have children should receive a timely comprehensive counselling before becoming pregnant. This is critical as the foundation for an informed decision-making process of the mother and her family. Furthermore, a detailed interdisciplinary management plan should be developed and discussed with the patient. The modified World Health Organization (mWHO) classification should be applied for maternal cardiovascular risk stratification. Although the prevalence of aortic pathologies is infrequent, they are often life-threatening conditions. Following the recent advances in terms of surgical management and anticoagulation, the adequate management of valvular heart disease is particularly challenging. Cardiomyopathies during pregnancy are associated with high maternal mortality and severe cardiovascular complications, such as progressive heart failure and thromboembolic events; however, novel treatment options have recently become available.


Assuntos
Cardiomiopatias , Insuficiência Cardíaca , Doenças das Valvas Cardíacas , Complicações Cardiovasculares na Gravidez , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Criança , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/terapia , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Medição de Risco
6.
BMJ Case Rep ; 14(7)2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34290026

RESUMO

Redo mitral valve replacement surgery due to bioprosthetic valve failure can carry serious surgical challenges. In addition to the usual redo sternotomy risk, there is risk of circumflex coronary artery injury or atrioventricular disruption from explanting the prosthesis. Alternatives to prosthesis explantation may be needed in some cases.We report a case of mitral bioprosthetic valve failure in a young patient who had a history of atrioventricular disruption during the first surgery and had pericardial patch repair of the defect. The risk of explanting the bioprosthesis during redo surgery was very high. Therefore, we performed valve replacement using valve-on-valve technique in which the new valve is implanted within the sewing ring of the previous bioprosthesis without explanting the valve. This technique converted a very highly futile surgery to a conventional redo surgery risk. The patient had a successful surgery with no intraoperative or postoperative complications.


Assuntos
Bioprótese , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Bioprótese/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Falha de Prótese , Reoperação , Resultado do Tratamento
8.
Eur Heart J ; 42(30): 2899-2908, 2021 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-34245252

RESUMO

AIMS: Reports have suggested an increased risk of aortic and mitral regurgitation associated with oral fluoroquinolones (FQs) resulting in a safety warning published by the European Medicines Agency (EMA). However, these findings have not yet been replicated. METHODS AND RESULTS: Using Danish administrative registers, we conducted a nested case-control study in a nationwide cohort of individuals between 2005 and 2018. Cases were defined as the first occurrence of aortic or mitral regurgitation. Exposure of interest was the use of oral FQs. Hazard ratios (HRs) with 95% confidence intervals (95% CI) were obtained by fitting time-dependent Cox regression models, with penicillin V as comparator, to assess the association between FQ use and incident valvular regurgitation. We identified 38 370 cases of valvular regurgitation with 1 115 100 matched controls. FQ exposure was not significantly associated with increased rates of aortic or mitral regurgitation (HR 1.02, 95% CI 0.95-1.09) compared with penicillin V users. Investigating the cumulative defined daily doses (cDDD) of FQs yielded similar results with no significant association between increasing FQ use and valvular regurgitation (e.g. HR 1.08, 95% CI 0.95-1.23 for cDDD >10 compared with cDDD 1-5). These results were consistent across several analyses including a cohort of patients with hypertension and using a case definition based on valvular surgical interventions. CONCLUSIONS: In a nationwide nested case-control study, FQs were not significantly associated with increased rates of valvular regurgitation. Our findings do not support a possible causal connection between FQ exposure and incident valvular regurgitation.


Assuntos
Doenças das Valvas Cardíacas , Insuficiência da Valva Mitral , Estudos de Casos e Controles , Estudos de Coortes , Fluoroquinolonas , Humanos , Insuficiência da Valva Mitral/induzido quimicamente , Insuficiência da Valva Mitral/epidemiologia
10.
J Clin Periodontol ; 48(8): 1085-1092, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34060116

RESUMO

AIM: Periodontitis and valvular heart disease (VHD) are common diseases. Both diseases are related to chronic inflammation and share many common risk factors. Previous periodontal studies had focused mainly on atherosclerotic cardiovascular disease. This study aimed to determine whether periodontitis is associated with the development of VHD. MATERIALS AND METHODS: This was a retrospective nationwide cohort study using Taiwan's Longitudinal Health Insurance Database. Using ICD-9-CM coding, both the periodontitis and non-periodontitis groups were matched. RESULTS: There were 8483 cases and 4919 cases of VHD diagnosed in the periodontitis group and non-periodontitis group, respectively. The cumulative incidence of VHD was significantly higher in the periodontitis group (log-rank test, p < .001), with the incidence density of 6.44 (95% CI, 6.31-6.58) per 1000 person-years in the periodontitis group compared to 4.65 (95% CI, 4.52-4.78) in the non-periodontitis group. The relative risk for VHD was 1.39 (95% CI, 1.34-1.44). After multivariate analysis, periodontitis was independently associated with a risk for VHD (HR, 1.38; 95% CI, 1.33-1.42, p < .001). Intensive treatment of periodontitis significantly lowered the risk for VHD (HR, 0.68; 95% CI, 0.60-0.77, p < .001). CONCLUSIONS: Periodontitis was significantly associated with the development of VHD. Treatment of periodontitis reduced the risk for VHD.


Assuntos
Doenças das Valvas Cardíacas , Periodontite , Estudos de Coortes , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Incidência , Periodontite/complicações , Periodontite/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
12.
Int J Cardiol ; 338: 50-57, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34090957

RESUMO

BACKGROUND: Rheumatic mitral valve disease (RMVD) is a major cause of acquired valvular disease in India. We compared the cost-effectiveness of surgical treatment strategies for young adults with severe RMVD from an Indian public payer perspective. METHODS: We developed a Markov model to reflect the burden of RMVD among a hypothetical cohort of 20-year-olds in India and to estimate quality-adjusted life years (QALYs) and lifetime costs associated with three strategies: (1) Repair; (2) Mechanical valve replacement (MVR-M); and (3) Bioprosthetic valve replacement (MVR-B), compared to a baseline strategy involving a mix of surgeries approximating the standard of care in India (32% Repair, 33% MVR-M, 35% MVR-B). Data on disease burden, intervention effects, and direct medical costs (2018 US$) were obtained from the literature. Deterministic and probabilistic sensitivity analyses were conducted to assess model uncertainty. RESULTS: Repair ($2530, 9.7 QALYs) was less costly and more effective than the standard of care ($2990, 8.7 QALYs) and MVR-M ($3220, 6.2 QALYs). The incremental cost-effective ratio for MVR-B ($3190, 10.1 QALYs) compared to Repair was $1590 per QALY, which may be cost-effective at a threshold of India's per-capita gross domestic product (GDP: $2005). The optimal choice between Repair or MVR-B was sensitive to variations in surgery costs, background mortality, and risks for reoperation. CONCLUSIONS: Our model-based analysis suggests that Repair is the optimal strategy and MVR-M should not be recommended for this subpopulation. MVR-B may be cost-effective in contexts where quality of Repair is not assured, newer generation bioprostheses are used, or the costs of the bioprosthetic valve decrease.


Assuntos
Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Análise Custo-Benefício , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Índia/epidemiologia , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Resultado do Tratamento , Adulto Jovem
13.
J Cardiothorac Surg ; 16(1): 163, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099017

RESUMO

BACKGROUND: CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. METHODS: Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. RESULTS: In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. CONCLUSION: We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Valvas Cardíacas/lesões , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Ruptura/etiologia , Técnicas de Sutura/efeitos adversos , Adulto , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Valvas Cardíacas/cirurgia , Humanos , Incidência , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Ruptura/diagnóstico , Ruptura/epidemiologia , Técnicas de Sutura/instrumentação , Titânio , Resultado do Tratamento
16.
Eur J Pediatr ; 180(10): 3129-3139, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33970315

RESUMO

Congenital anomalies of the aortic valve frequently necessitate intervention in childhood. The most common aortic valve pathologies present in childhood are aortic stenosis and insufficiency. Presentation of aortic valve disease depends on severity and presence of concomitant syndromes and valvular disorders. Treatment options are largely categorised as medical, percutaneous repair or surgical repair and replacement. Surgical techniques have been refined over the last few years making this the mainstay of treatment in paediatric cases. Whilst repair is considered in most instances before replacement, there are substantial limitations which are reflected in the frequency of reintervention and restenosis rate. Replacements are typically undertaken with tissue or mechanical prosthesis. The current gold-standard aortic valve replacement surgery is called the Ross procedure-where replacement is undertaken with a competent pulmonic valve and a simultaneous pulmonary homograft.Conclusion: In this review, we aim to outline the various surgical options and discuss efficacy and complications of various interventions. What is Known: • Congenital aortic valve defects repair options medically and surgically What is New: • Comparisons between surgical options for aortic valve repair including efficacy, risks and long-term outcomes.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Criança , Doenças das Valvas Cardíacas/cirurgia , Humanos , Resultado do Tratamento
17.
Wien Klin Wochenschr ; 133(15-16): 786-789, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34057577

RESUMO

The advent of transcatheter procedures for treatment of valvular heart disease has accelerated the pace of research in the diagnosis and treatment of heart valve disease. Rapid accumulation of novel knowledge in the field necessitates timely revisions of clinical guidelines. This paper comments on some important and novel issues addressed in the recently published American College of Cardiology/American Heart Association (ACC/AHA) guidelines.


Assuntos
Cardiologia , Doenças das Valvas Cardíacas , Substituição da Valva Aórtica Transcateter , American Heart Association , Doenças das Valvas Cardíacas/cirurgia , Doenças das Valvas Cardíacas/terapia , Humanos , Estados Unidos
18.
J Am Coll Cardiol ; 78(1): 1-9, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-33945832

RESUMO

BACKGROUND: Transcatheter edge-to-edge (TEER) mitral repair may be complicated by residual or recurrent mitral regurgitation. An increasing need for surgical reintervention has been reported, but operative outcomes are ill defined. OBJECTIVES: This study evaluated national outcomes of mitral surgery after TEER. METHODS: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was used to identify 524 adults who underwent mitral surgery after TEER between July 2014 and June 2020. Emergencies (5.0%; n = 26), previous mitral surgery (5.3%; n = 28), or open implantation of transcatheter prostheses (1.5%; n = 8) were excluded. The primary outcome was 30-day or in-hospital mortality. RESULTS: In the study cohort of 463 patients, the median age was 76 years (interquartile range [IQR]: 67 to 81 years), median left ventricular ejection fraction was 57% (IQR: 48% to 62%), and 177 (38.2%) patients had degenerative disease. Major concomitant cardiac surgery was performed in 137 (29.4%) patients: in patients undergoing isolated mitral surgery, the median STS-predicted mortality was 6.5% (IQR: 3.9% to 10.5%), the observed mortality was 10.2% (n = 23 of 225), and the ratio of observed to expected mortality was 1.2 (95% confidence interval [CI]: 0.8 to 1.9). Predictors of mortality included urgent surgery (odds ratio [OR]: 2.4; 95% CI: 1.3 to 4.6), nondegenerative/unknown etiology (OR: 2.2; 95% CI: 1.1 to 4.5), creatinine of >2.0 mg/dl (OR: 3.8; 95% CI: 1.9 to 7.9) and age of >80 years (OR: 2.1; 95% CI: 1.1 to 4.4). In a volume outcomes analysis in an expanded cohort of 591 patients at 227 hospitals, operative mortality was 2.6% (n = 2 of 76) in 4 centers that performed >10 cases versus 12.4% (n = 64 of 515) in centers performing fewer (p = 0.01). The surgical repair rate after failed TEER was 4.8% (n = 22) and was 6.8% (n = 12) in degenerative disease. CONCLUSIONS: This study indicates that mitral repair is infrequently achieved after failed TEER, which may have implications for treatment choice in lower-risk and younger patients with degenerative disease. These findings should inform patient consent for TEER, clinical trial design, and clinical performance measures.


Assuntos
Cateterismo Cardíaco , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral , Valva Mitral , Complicações Pós-Operatórias , Reoperação , Fatores Etários , Idoso , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Feminino , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Mortalidade Hospitalar , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Valva Mitral/cirurgia , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Prognóstico , Recidiva , Reoperação/efeitos adversos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Fatores de Risco , Estados Unidos
19.
J Card Surg ; 36(8): 2628-2635, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33960500

RESUMO

BACKGROUND AND AIM: Although bicuspid aortic valve (BAV) anatomy might influence aortic aneurysm development, BAV-related root involvement still lacks standardized surgical management. We aimed to evaluate late clinical outcomes and risk factors for root dilation after proximal aortic replacement in patients with BAV and right-left fusion (RL-BAV). METHODS: Clinical and echocardiographic data of all patients with intraoperative RL-BAV who underwent ascending aortic replacement with or without noncoronary sinus (NCS) replacement (Groups 1 and 2, respectively) between 1999 and 2017, were retrospectively revised. A multivariable analysis assessed hazard factors for root dilation during follow-up (FU). RESULTS: Of 206 surgeries performed (M 81%; age: 57 ± 13 years, EuroSCORE II: 2.7 ± 1.9%), 79 (38%) required NCS replacement. One hundred fifty-seven patients (76%) underwent aortic valve replacement (with aortic regurgitation predominating in Group 1, p = .04). The preoperative aortic root was larger in patients requiring NCS replacement (43.3 ± 5.1 vs. 39.2 ± 4.8 mm, p < .001). At a median FU time of 7 years (interquartile range: 4-10), no residual root dissections occurred, and only two patients (belonging to Group 2) required redo root surgery. Preoperative mild aortic regurgitation and aortic root diameter >35 mm at discharge were risk factors for root dilation >40 mm at FU (p = .02). Aortic root did not dilate over time, irrespective of NCS replacement (p = .06). CONCLUSIONS: Aortic root in patients with RL-BAV undergoing ascending aortic replacement (±NCS replacement) does not significantly dilate over time, even if patients with preoperative aortic regurgitation and postoperative root more than 35 mm might require more surveillance.


Assuntos
Doença da Válvula Aórtica Bicúspide , Doenças das Valvas Cardíacas , Adulto , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco
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