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1.
Khirurgiia (Mosk) ; (12): 141-143, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825356

RESUMO

An efficacy and safety of valve-sparing aortic root surgery with aortic ring annuloplasty have been demonstrated in various trials. The main technical features of aortic root remodeling with external aortic ring annuloplasty are reported in the article.


Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Doenças das Valvas Cardíacas/cirurgia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos
2.
Braz J Cardiovasc Surg ; 34(5): 535-541, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719007

RESUMO

INTRODUCTION: Metabolic syndrome (MetS) is defined as an association between diabetes, hypertension, obesity and dyslipidemia and an increased risk of cardiovascular disease. Mitral annular calcification (MAC) is associated with several cardiovascular disorders, including coronary artery disease, atrial fibrillation (AF), heart failure, ischemic stroke and increased mortality. The CHA2DS2-VASc score is used to estimate thromboembolic risk in AF. However, the association among MAC, MetS and thromboembolic risk is unknown and was evaluated in the current study. METHODS: The study group consisted of 94 patients with MAC and 86 patients with MetS. Patients were divided into two groups: those with and those without MAC. RESULTS: Patients with MAC had a higher MetS rate (P<0.001). In patients with MAC, the CHA2DS2-VASc scores and the rate of cerebrovascular accident and AF were significantly higher compared to those without MAC (P<0.001, for both parameters). The results of the multivariate regression analysis showed that history of smoking, presence of MetS and high CHA2DS2-VASc scores were associated with the development of MAC. ROC curve analyses showed that CHA2DS2-VASc scores were significant predictors for MAC (C-statistic: 0.78; 95% CI: 0.706-0.855, P<0.001). Correlation analysis indicated that MAC was positively correlated with the presence of MetS and CHA2DS2-VASc score (P=0.001, r=0.264; P<0.001, r=0.490). CONCLUSION: We have shown that CHA2DS2-VASc score and presence of MetS rates were significantly higher in patients with MAC compared without MAC. Presence of MAC was correlated with CHA2DS2-VASc score, presence of MetS, AF and left atrial diameter and negatively correlated with left ventricular ejection fraction.


Assuntos
Calcinose/complicações , Doenças das Valvas Cardíacas/complicações , Síndrome Metabólica/complicações , Valva Mitral , Tromboembolia/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Calcinose/fisiopatologia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Tromboembolia/fisiopatologia
3.
Diab Vasc Dis Res ; 16(6): 562-576, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31530180

RESUMO

Diabetes contributes directly to the development of cardiovascular aortic valve disease. There is currently no drug therapy available for a dysfunctional valve and this urges the need for additional research to identify distinctive mechanisms of cardiovascular aortic valve disease evolution. The aim of this study was to evaluate changes of valvular aortic lesions induced in a hyperlipemic ApoE-/- mouse model by early type 1 diabetes onset (at 4 and 7 days after streptozotocin induction). The haemodynamic valve parameters were evaluated by echography and blood samples and aortic valves were collected. Plasma parameters were measured, and inflammatory, remodelling and osteogenic markers were evaluated in the aortic valves. Next, correlations between all parameters were determined. The results showed early aortic valve dysfunction detected by echography after 1 week of diabetes; lesions were found in the aortic root. Moreover, increased expression of cell adhesion molecules, extracellular matrix remodelling and osteogenic markers were detected in hyperlipemic ApoE-/- diabetic mice. Significant correlations were found between tissue valve biomarkers and plasmatic and haemodynamic parameters. Our study may help to understand the mechanisms of aortic valve disease in the diabetic milieu in order to discover and validate new biomarkers of cardiovascular aortic valve disease in diabetes and reveal new possible targets for nanobiotherapies.


Assuntos
Valva Aórtica , Aterosclerose/complicações , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Tipo 1/complicações , Doenças das Valvas Cardíacas/etiologia , Animais , Valva Aórtica/metabolismo , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Aterosclerose/metabolismo , Aterosclerose/patologia , Glicemia/metabolismo , Moléculas de Adesão Celular/metabolismo , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/patologia , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/patologia , Matriz Extracelular/metabolismo , Matriz Extracelular/patologia , Hemoglobina A Glicada/metabolismo , Doenças das Valvas Cardíacas/metabolismo , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/fisiopatologia , Hemodinâmica , Mediadores da Inflamação/metabolismo , Lipídeos/sangue , Masculino , Camundongos Knockout para ApoE , Osteogênese , Fatores de Tempo
5.
Ann Thorac Cardiovasc Surg ; 25(5): 265-273, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31378750

RESUMO

PURPOSE: Our study aimed to investigate the potential pathogenetic theories of different phenotype prevalence in bicuspid aortopathy. METHODS: A total of 407 bicuspid aortic valve (BAV) patients with aortic dilation were retrospectively reviewed. Association was determined between aortic valve lesion types and aortic configurations to confirm the homogeneous BAV subsets, and then, dominance analysis was used to evaluate the relative importance of two components of aortic valve lesion (BAV phenotype and valvular dysfunction) that associated with aortic configurations in each subgroup. RESULTS: Dominance analysis showed that Type-1 LR was the dominant contributor (79.0% and 79.6%) associated with the higher prevalence of the dilation of aortic root (AoR) and ascending aorta (AAo) in BAV patients with Type-1 LR and aortic regurgitation (AR) or aortic stenosis (AS) + AR. However, AS was the main contributor (60.0%) associated with the raised incidence of the dilation of AAo and proximal aortic arch (PArc) in Type-0 LAT and AS. CONCLUSIONS: Different dominant pathogenetic theory determined the phenotype of BAV aortopathy. In patients of Type-1 LR with AR, inherent disposition is mainly responsible for the higher frequency of AoR dilation. Valve-related hemodynamics determined greater prevalence of the dilation of AAo and PArc in patients of Type-0 LAT with AS.


Assuntos
Aneurisma Aórtico/epidemiologia , Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/epidemiologia , Adulto , Idoso , Aorta/diagnóstico por imagem , Aorta/patologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Pequim/epidemiologia , Dilatação Patológica , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Prevalência , Estudos Retrospectivos
6.
Dtsch Med Wochenschr ; 144(16): 1138-1144, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31416106

RESUMO

The acute valvular dysfunction is a rapidly growing and critical condition in the intensive care unit with a cardiogenic shock as the most serious clinical entity. There are clearly defined guidelines for the diagnosis and treatment of heart failure and for stable patients with valvular heart disease. However, data regarding acutely valvular decompensated patients are currently limited. In case of secondary organ dysfunction despite optimal medical treatment, various percutaneous interventional procedures such as TAVI and MitraClip are now available besides surgical valvular repair. Moreover, balloon valvuloplasty for aortic stenosis and percutaneous mechanical circulatory support devices are emerging tools for the treatment and stabilization of valvular decompensated patients in the intensive care unit.


Assuntos
Insuficiência Cardíaca , Doenças das Valvas Cardíacas , Procedimentos Cirúrgicos Cardíacos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/terapia , Valvas Cardíacas/fisiopatologia , Humanos , Unidades de Terapia Intensiva
7.
J Card Surg ; 34(10): 1055-1061, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31389647

RESUMO

BACKGROUND: We investigated hospital and midterm outcome of patients operated for an aortic valve replacement (AVR) with a pericardial Perimount or a Porcine Hancock-II valve. METHODS: We analyzed 353 patients with Perimount Magna (n = 189) or Hancock-II valves (n = 164). Echocardiographic data, hospital outcome, and follow-up were collected and compared. The role of the type of valve on perioperative and midterm outcome was investigated. RESULTS: Mean age was 75.3 ± 6.8 and 74.3 ± 7.1 years (P = .17) for Perimount and Hancock-II group, respectively. Fifty-four Perimount (28.6%) and 24 patients with Hancock-II (14.6%) required urgent procedures (P = .002), including six type-A dissections and five endocarditis. EuroSCORE-II was 3.1 ± 2.7% (Perimount) and 2.7 ± 2.2% (Hancock-II). Combined procedures were performed in 115 Perimount (60.8%) and 71 patients with Hancock (43.3%); redo procedures counted for 1% and 2.4%, respectively (P = .42). Mean valve size was 23.2 ± 1.8 mm for pericardial and 23.6 ± 1.9 mm for porcine valves (P = .08). Hospital mortality (6.3% vs 2.4%; P = .05), kidney failure (11.6% vs 9.8%; P = .73), and new pacemaker implantation rates (6.3% vs 3.0%; P = .21) were higher in the Perimount group reflecting the fact that more urgent, combined, and critical procedures were implanted with a Perimount Magna. Overall, 51 patients died over 60 months (34 Perimount, 17 Hancock), corresponding to a mortality of 5.3 per 100-persons year (95% confidence interval [CI]: 3.8-7.4) and 3.0 (95% CI: 1.8-4.8), respectively. Survival at 5 years was 76% (95% CI: 68-82) and 83% (95% CI: 74-89) in the Perimount and Hancock groups (log-rank test; P = .099). CONCLUSIONS: We confirm a good clinical outcome of patients with AVR with modern pericardial or a porcine bioprosthesis. Despite better hemodynamic, the Perimount does not improve the midterm clinical outcome compared with the porcine valve.


Assuntos
Bioprótese , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Hemodinâmica/fisiologia , Pericárdio/transplante , Idoso , Animais , Ecocardiografia , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Suínos
8.
Med Biol Eng Comput ; 57(10): 2129-2143, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31372826

RESUMO

Calcific aortic valve disease (CAVD) is characterized by stiffened aortic valve leaflets. Bicuspid aortic valve (BAV) is the most common congenital heart disease. Transcatheter aortic valve replacement (TAVR) is a treatment approach for CAVD where a stent with mounted bioprosthetic valve is deployed on the stenotic valve. Performing TAVR in calcified BAV patients may be associated with post-procedural complications due to the BAV asymmetrical structure. This study aims to develop refined computational models simulating the deployments of Evolut R and PRO TAVR devices in a representative calcified BAV. The paravalvular leakage (PVL) was also calculated by computational fluid dynamics simulations. Computed tomography scan of severely stenotic BAV patient was acquired. The 3D calcium deposits were generated and embedded inside a parametric model of the BAV. Deployments of the Evolut R and PRO inside the calcified BAV were simulated in five bioprosthesis leaflet orientations. The hypothesis of asymmetric and elliptic stent deployment was confirmed. Positioning the bioprosthesis commissures aligned with the native commissures yielded the lowest PVL (15.7 vs. 29.5 mL/beat). The Evolut PRO reduced the PVL in half compared with the Evolut R (15.7 vs. 28.7 mL/beat). The proposed biomechanical computational model could optimize future TAVR treatment in BAV patients. Graphical abstract.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/cirurgia , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Fenômenos Biomecânicos , Simulação por Computador , Elasticidade , Feminino , Análise de Elementos Finitos , Humanos , Hidrodinâmica , Modelos Cardiovasculares , Pressão , Stents , Tomografia Computadorizada por Raios X
9.
Medicina (Kaunas) ; 55(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31382702

RESUMO

Valvular heart disease and atrial fibrillation often coexist. Oral vitamin K antagonists have represented the main anticoagulation management for antithrombotic prevention in this setting for decades. Novel direct oral anticoagulants (DOACs) are a new class of drugs and currently, due to their well-established efficacy and security, they represent the main therapeutic option in non-valvular atrial fibrillation. Some new evidences are exploring the role of DOACs in patients with valvular atrial fibrillation (mechanical and biological prosthetic valves). In this review we explore the data available in the medical literature to establish the actual role of DOACs in patients with valvular heart disease and atrial fibrillation.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Doenças das Valvas Cardíacas/tratamento farmacológico , Anticoagulantes/farmacologia , Fibrilação Atrial/fisiopatologia , Inibidores do Fator Xa/farmacologia , Inibidores do Fator Xa/uso terapêutico , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Fatores de Risco
10.
Heart Lung Circ ; 28(9): 1436-1446, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266726

RESUMO

Multivalvular heart disease (MVD) is a highly prevalent condition causing significant morbidity and mortality. The complex haemodynamic interactions between coexisting valve lesions makes the diagnosis and treatment challenging. Current guidelines may not be adequate for managing the varying clinical scenarios of MVD and, therefore, the expertise of a multidisciplinary Heart Valve Team is of paramount importance. The indications for intervention should be based on a global assessment of the consequences of the multiple valve lesions after a careful estimation of the added surgical risk of combined procedures, the long-term risk of morbidity and mortality associated with multiple valve prostheses and the risk of reoperation if less-than-severe valve lesions are left untreated at the time of first evaluation. Echocardiography plays an important role in assessing patients and, as a general rule, an accurate echo diagnosis needs to combine different measurements. The emerging transcatheter valve therapies should be considered an option for high risk patients. More data on the natural history of MVD and the impact of intervention on outcome are required to better define the optimal management strategy.


Assuntos
Ecocardiografia , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valvas Cardíacas , Hemodinâmica , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/cirurgia , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Valvas Cardíacas/cirurgia , Humanos
11.
Mayo Clin Proc ; 94(8): 1488-1498, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31279542

RESUMO

OBJECTIVE: To explore the burden and clinical correlates of valvular heart disease in Hispanics/Latinos in the United States. PATIENTS AND METHODS: A total of 1818 individuals from the population-based study of Latinos/Hispanics from 4 US metropolitan areas (Bronx, New York; Chicago, Illinois; San Diego, California; and Miami, Florida) underwent a comprehensive clinical and echocardiographic examination from October 1, 2011, through June 24, 2014. Logistic regression analysis was used to examine the associations of clinical and sociodemographic variables with valvular lesions. RESULTS: The mean age was 55.2±0.2 years; 57.4% were female. The prevalence of any valvular heart disease (AVHD) was 3.1%, with no considerable differences across sex, and a higher prevalence with increasing age. The proportion of US-born vs foreign-born individuals was similar in those with vs without AVHD (P=.31). The weighted prevalence of AVHD was highest in Central Americans (8.4%) and lowest in Mexicans (1.2%). Regurgitant lesions of moderate or greater severity were present in 2.4% of the population and stenotic lesions of moderate or greater severity in 0.2%. Compared with those without AVHD, individuals with AVHD were more likely to have health insurance coverage (59.6% vs 79.2%; P=.007) but similar income (P=.06) and educational status (P=.46). Univariate regression models revealed that regurgitant lesions were associated with lower body mass index whereas stenotic lesions were associated with higher body mass index. CONCLUSION: Our data provide the first population-based estimates of the prevalence of valvular heart disease in Hispanic/Latinos. Valvular heart disease is fairly common in the Hispanic/Latino population and may constitute an important public health problem.


Assuntos
Efeitos Psicossociais da Doença , Ecocardiografia/métodos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etnologia , Hispano-Americanos/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Feminino , Seguimentos , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Estados Unidos , População Urbana
12.
Pediatr Cardiol ; 40(7): 1450-1459, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342116

RESUMO

Bicuspid aortic valve (BAV) disease demonstrates a range of clinical presentations and complications. We aim to use cardiac MRI (CMR) to evaluate left ventricular (LV) parameters, myocardial strain and aortic hemodynamics in pediatric BAV patients with and without aortic stenosis (AS) or regurgitation (AR) compared to tricuspid aortic valve (TAV) controls. We identified 58 pediatric BAV patients without additional cardiovascular pathology and 25 healthy TAV controls (15.3 ± 2.2 years) who underwent CMR with 4D flow. BAV cohort included subgroups with no valvulopathy (n = 13, 14.3 ± 4.7 years), isolated AS (n = 19, 14.5 ± 4.0 years), mixed valve disease (AS + AR) (n = 13, 17.1 ± 3.2 years), and prior valvotomy/valvuloplasty (n = 13, 13.9 ± 3.2 years). CMR data included LV volumetric and mass indices, myocardial strain and aortic hemodynamics. BAV patients with no valvulopathy or isolated AS had similar LV parameters to controls excepting cardiac output (p < 0.05). AS + AR and post-surgical patients had abnormal LV volumetric and mass indices (p < 0.01). Post-surgical patients had decreased global longitudinal strain (p = 0.02); other subgroups had comparable strain to controls. Patients with valvulopathy demonstrated elevated velocity and wall shear stress (WSS) in the ascending aorta (AAo) and arch (p < 0.01), while those without valve dysfunction had only elevated AAo velocity (p = 0.03). Across the cohort, elevated AAo velocity and WSS correlated to higher LV mass (p < 0.01), and abnormal hemodynamics correlated to decreased strain rates (p < 0.045). Pediatric BAV patients demonstrate abnormalities in LV parameters as a function of valvular dysfunction, most significantly in children with AS + AR or prior valvotomy/valvuloplasty. Correlations between aortic hemodynamics, LV mass and strain suggest valvular dysfunction could drive LV remodeling. Multiparametric CMR assessment in pediatric BAV may help stratify risk for cardiac remodeling and dysfunction.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/fisiopatologia , Adolescente , Aorta/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estudos de Casos e Controles , Criança , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Hemodinâmica , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Remodelação Ventricular
14.
Rev Port Cardiol ; 38(5): 315-321, 2019 05.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31221488

RESUMO

INTRODUCTION: The Ross procedure is an alternative to standard aortic valve (AV) replacement in young and middle-aged patients. However, durability and incidence of reoperation remain a concern for most cardiac surgeons. Our aim was to assess very long-term clinical and echocardiographic outcomes of the Ross procedure. METHODS: We conducted a single-center retrospective analysis of 56 consecutive adult patients who underwent the Ross procedure. Mean age at surgery was 44±12 years (range, 16-65 years) and 55% were male. Clinical endpoints included overall mortality and the need for valve reoperation due to graft failure. The echocardiographic endpoint was the presence of any graft deterioration. Median clinical follow-up was 20 years (1120 patient/years). RESULTS: Indications for surgery were dominant aortic stenosis in 50% and isolated aortic regurgitation in 21%. Concomitant mitral valve repair was performed in 21% and a subcoronary technique was most commonly used (86%). Overall long-term survival was 91%, 80% and 77% at 15, 20 and 24 years, respectively. The survival rate was similar to the age- and gender-matched general population (p=0.44). During the follow-up period, freedom from graft reoperation was 80%. Eleven patients (31%) developed moderate AV regurgitation, three (8.6%) developed moderate pulmonary regurgitation and one (2.9%) presented moderate pulmonary stenosis. CONCLUSION: The Ross procedure, mostly using a subcoronary approach, proved to have good clinical and hemodynamic results, with low reoperation rates in long-term follow-up. Moderate autograft regurgitation was a frequent finding but had no significant clinical impact.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana/métodos , Previsões , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Valva Pulmonar/transplante , Adolescente , Adulto , Idoso , Aloenxertos , Valva Aórtica/diagnóstico por imagem , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia , Adulto Jovem
15.
Semin Thorac Cardiovasc Surg ; 31(4): 643-649, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31229691

RESUMO

Aortic valve surgery in non-elderly patients represents a very challenging patient population. The younger the patient is at the point of aortic valve intervention, the longer their anticipated life expectancy will be, with longer exposure to valve-related complications and risk for re-operation. Although the latest international guidelines recommend aortic valve repair in patients with aortic valve insufficiency, what we see in the real world is that the vast majority of these aortic valves are replaced. However, current prosthetic valves has now been shown to lead to significant loss of life expectancy for non-elderly patients up to 50% for patients in their 40s undergoing mechanical aortic valve replacement. Bioprostheses carry an even worse long-term survival, with higher rates of re-intervention. The promise of trans-catheter valve-in-valve technology is accentuating the trend of bioprosthetic implantation in younger patients, without yet the appropriate evidence. In contrast, aortic valve repair has shown excellent outcomes in terms of quality of life, freedom from re-operation and freedom from major adverse valve-related events with similar life expectancy to general population as it is also found for the Ross procedure, the only available living valve substitute. We are at a time when the paradigm of aortic valve surgery needs to change for the better. To better serve our patients, we must acquire high quality real-world evidence from multiple centers globally - this is the vision of the AVIATOR registry and our common responsibility.


Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Adulto , Fatores Etários , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Bioprótese , Medicina Baseada em Evidências , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/fisiopatologia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Expectativa de Vida , Pessoa de Meia-Idade , Falha de Prótese , Recuperação de Função Fisiológica , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
16.
J Vet Cardiol ; 23: 21-31, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31174726

RESUMO

INTRODUCTION: Pulmonary hypertension (PH) is a common consequence of myxomatous mitral valve disease (MMVD). Cavalier King Charles spaniels (CKCS) are frequently affected with MMVD and appear to have different disease progression compared to other dogs. This study aimed to determine if CKCS are more likely to develop PH as a result of MMVD than dogs of other breeds. A secondary aim was to explore whether breed or PH impacted survival. ANIMALS: A total of 187 dogs diagnosed with MMVD, 94 CKCS and 93 non-CKCS, were included in this study. METHODS: This is a retrospective review of dogs with MMVD. Data were analyzed for presence of PH, congestive heart failure (CHF) and echocardiographic variables including the ratio between mitral E wave velocity (E vel) and isovolumic relaxation time (E/IVRT) and were compared between CKCS/non-CKCS and dogs with/without PH. Survival analysis was also performed. RESULTS: American College of Veterinary Internal Medicine (ACVIM) stage (p < 0.001), CKCS (p = 0.005), left atrium-to-aortic ratio (LA/Ao) (p < 0.001), E vel (p < 0.001) and log10(E/IVRT) (p < 0.001) were significant at the univariate level for PH development. At the multivariate level, only ACVIM stage remained significant (p = 0.044), suggesting that worsening MMVD was the predominant determinant of PH development in this study. Pulmonary hypertension was associated with greater likelihood of CHF (p < 0.001) and death (both cardiac [p < 0.001] and all-cause mortality [p = 0.011]). Cavalier King Charles spaniels were more likely to experience cardiac death than non-CKCS (p = 0.004). CONCLUSIONS: In this study, development of PH was associated with worse MMVD, according to ACVIM stage.


Assuntos
Doenças do Cão/fisiopatologia , Doenças das Valvas Cardíacas/veterinária , Hipertensão Pulmonar/veterinária , Animais , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/mortalidade , Cães , Ecocardiografia/veterinária , Feminino , Insuficiência Cardíaca/veterinária , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/mortalidade , Hipertensão Pulmonar/fisiopatologia , Masculino , Prevalência , Estudos Retrospectivos , Especificidade da Espécie
19.
Semin Thorac Cardiovasc Surg ; 31(4): 796-802, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31077808

RESUMO

Surgical management for patients with long-standing persistent (LSP) AF and giant left atria (GLA) associated with mitral valve diseases remains a challenge. We aimed to assess the efficacy of the cut-and-sew maze procedure (CSM) in this subgroup of patients, in terms of maintenance of sinus rhythm (SR), atrial function, and to identify the operative risks of this procedure. A total of 229 patients with LSP-AF underwent CSM at our institution from December 2013 to October 2017. Patients were divided into 2 groups based on LA diameter: NGLA group (<65 mm, n = 171), GLA group (≥65 mm, n = 58). Patients with GLA were propensity score matched to patients without GLA resulting in 45 pairs of patients. Early death occurred in 1 (2.2%) in GLA group and no deaths in NGLA group (P = 0.315). Early complications did not differ significantly between the 2 groups. The GLA group showed similar rates of SR on and off antiarrhythmic drugs compared with NGLA group at 2 years (86.36% vs 93.9%, P = 0.338; 81.82% vs 90.91%, P = 0.322). At 2 years, LA contraction was comparable between patients with and without GLA (81.81% vs 90.9%, P = 0.322). Right atrial contraction recovery rate was 96% in NGLA group, and 86.36% in GLA group (P = 0.138). Concomitant CSM is effective and feasible for restoration of SR and atrial contraction, for patients with LSP-AF and GLA associated with mitral valve diseases with acceptable operative risks.


Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Valva Mitral/cirurgia , Técnicas de Sutura , Suturas , Adulto , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Remodelamento Atrial , Criocirurgia/efeitos adversos , Criocirurgia/mortalidade , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/fisiopatologia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Complicações Pós-Operatórias/mortalidade , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Int J Cardiovasc Imaging ; 35(10): 1925-1934, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31144256

RESUMO

Bicuspid aortic valve (BAV) is associated with abnormal valve-mediated hemodynamics including high velocity jets and elevated wall shear stress (WSS). This study investigated interval changes in flow and WSS in a multi-year follow-up study. This cross-sectional study included n = 44 patients with BAV (age = 44.9 ± 12 years), n = 17 patients with tricuspid aortic valve and thoracic aortic dilatation (TAV with dilation, age = 54.6 ± 16.5 years), and n = 9 healthy controls (age = 49.3 ± 14.7 years) underwent baseline and serial aortic 4D flow MRI (follow-up duration: BAV: 2.6 ± 0.7 years, TAV with dilation: 2.7 ± 0.5 years, controls: 1.1 ± 0.5 years). Data analysis included quantification of aortic dimensions, peak systolic velocities, as well as regional 3D WSS in the ascending aorta. At baseline, BAV patients demonstrated uniformly elevated peak velocity and WSS compared to TAV with dilation and control groups (peak velocity 2.2 m/s vs. 1.6 m/s vs. 1.5 m/s, p < 0.004; WSS: 0.74 Pa vs. 0.45 Pa vs. 0.55 Pa, p < 0.001). For BAV, peak velocity increased from baseline to follow up (2.2 ± 0.8 to 2.3 ± 0.9 m/s, p < 0.001) while WSS decreased (0.74 ± 0.22 to 0.65 ± 0.21 Pa, p < 0.001). Aortic growth was minimal for both BAV (0.05 cm/year) and TAV with dilation (0.03-0.04 cm/year) patients. For BAV patients, increase of ascending aorta peak velocities indicated worsening of valve function at follow-up. Compared to TAV with dilation patients, BAV patients demonstrated a reduction in WSS which may indicate a compensatory mechanism to reduce elevated WSS forces by aortic remodeling.


Assuntos
Aorta/diagnóstico por imagem , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/diagnóstico por imagem , Hemodinâmica , Angiografia por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Adulto , Idoso , Aorta/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estudos Transversais , Dilatação Patológica , Progressão da Doença , Feminino , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Estresse Mecânico , Fatores de Tempo , Remodelação Vascular
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