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1.
Int J Cardiovasc Imaging ; 36(1): 23-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31388814

RESUMO

While the impairment of left atrial (LA) mechanics in mitral valve disease is well known, the exact onset of reservoir, conduit, and contractile dysfunction in mitral stenosis (MS) and mitral regurgitation (MR) remains unclear. We aimed to clarify the LA deformation mechanics in patients with moderate mitral valve disease. We conducted a prospective observational study of 80 patients with moderate isolated MR, 80 patients with moderate isolated MS, and 64 age-matched controls without mitral valve disease. Strain (ɛ) and strain rate (SR) on speckle tracking echocardiography were assessed as indicators of LA and right atrium (RA) reservoir (ɛsys, SRs), conduit (ɛe, SRe), and contractile (ɛa, SRa) functions. Conventional echocardiographic parameters of the left ventricle (LV) were also assessed. Comparisons were conducted according to mitral valve pathology (MR patients, MS patients, controls). The mean LV ejection fraction, end-diastolic diameter, and global longitudinal strain did not differ across the groups. The pulmonary artery systolic pressure, LA volume indexed to body surface area, and LA mechanics were significantly impaired in mitral valve disease (patients vs controls). While LA ɛ did not vary between MR and MS, MR patients had better LA SRs and SRe but worse SRa (p < 0.01). SRe > - 0.65% had higher specificity for MS, with an area under the curve of 0.85 (p < 0.01). RA mechanics were significantly impaired in mitral valve disease (patients vs controls) but did not vary significantly with disease pathology (MS vs MR). Patients with moderate mitral valve disease exhibit early and pathology-specific changes in the LA deformation mechanics, manifesting mainly as impaired contractile-phase SR in MR and impaired conduit-phase SR in MS. Our findings highlight SR as a potentially useful early marker of LA dysfunction in relation to mitral valve disease.


Assuntos
Função do Átrio Esquerdo , Átrios do Coração/fisiopatologia , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/fisiopatologia , Valva Mitral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Átrios do Coração/diagnóstico por imagem , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico por imagem , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Função Ventricular Esquerda
2.
Artigo em Inglês | MEDLINE | ID: mdl-31593380

RESUMO

In this video tutorial, we emphasize the main pitfalls in adequate sizing and expansion of the Perceval valve during a concomitant mitral valve replacement with a bioprosthetic. Following mitral valve replacement with a tissue-stented bioprosthesis, a transverse aortotomy was performed at 3 cm above the level of the aortic annulus. Three guiding sutures were then placed 120° apart in each valve sinus, 2-3 mm below the leaflet hinge point. The commissural struts of the mitral prosthesis can be seen in the aortic annulus. This positioning minimizes any potential protrusion in the left ventricular outflow tract.  Next, sizing of the Perceval was performed. The small transparent sizer fit nicely; however, a clear gap at the annulus could be appreciated with the small white sizer. The medium transparent sizer was then utilized, and it fit nicely; however, the medium white sizer was not able to pass through the aortic annulus. Given the gap present with the small sizer, we opted for a medium-size prosthesis. A medium Perceval prosthesis was parachuted into the aortic annulus with the help of the guiding sutures and the valve was deployed. Next, balloon expansion of the stent was performed. Given the potential concern of under-expansion of the stent, we opted for a longer dilatation at 4 atm for 1 min rather than the usual 30 sec. The aortotomy was then closed.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Estenose da Valva Aórtica/complicações , Feminino , Humanos , Estenose da Valva Mitral/complicações , Desenho de Prótese
3.
Heart Surg Forum ; 22(5): E340-E342, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31596708

RESUMO

Patients diagnosed with ocular myasthenia gravis (MG) and mitral valve disease represent a significant perioperative management problem, especially for the anaesthesiologist, due to complex inter-actions between the disease, drugs to treat the disease, and anaesthetic agents, such as neuromuscu-lar blocking agents (NMBAs). This paper describes the successful management of a 31-year-old female with mitral valve stenosis and ocular MG who was diagnosed with MG 4 years prior to the indication for cardiac surgery. Preoperatively, the patient was under treatment with Pyridostigmine and Prednisone. Mitral valve replacement and full thymectomy were performed, under general anaesthesia, using Fentanyl, Sevoflurane and low doses of non-depolarising NMBAs. The postoperative course was uneventful, the patient was extubated at 6 hours postoperatively, in-tensive care unit stay was 48 hours, and the patient was discharged after 6 days without any compli-cations. After 3 months, at the follow-up examination, the patient's ocular symptoms (eyelid ptosis) disappeared.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Miastenia Gravis/cirurgia , Timectomia , Adulto , Anestésicos Combinados , Anti-Inflamatórios/uso terapêutico , Interações de Medicamentos , Feminino , Fentanila , Humanos , Estenose da Valva Mitral/complicações , Miastenia Gravis/complicações , Miastenia Gravis/tratamento farmacológico , Prednisona/uso terapêutico , Brometo de Piridostigmina/uso terapêutico , Sevoflurano
4.
Indian Heart J ; 71(3): 284-287, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543203

RESUMO

OBJECTIVE: This study was conducted to evaluate the prevalence of significant coronary artery disease (CAD) in patients with severe valvular heart disease (VHD) and the association between these two cardiac entities. Our research aims to introduce the theory of a possible causal relationship. METHODS: A retrospective study was conducted on 1308 consecutive patients who underwent surgery for severe VHD in the cardiovascular department of Notre-Dame de Secours University Hospital (NDSUH) between December 2000 and December 2016. According to transthoracic echocardiography, patients were divided into 4 groups: patients with severe aortic stenosis (AS), patients with severe aortic regurgitation (AR), patients with severe mitral stenosis (MS), and patients with severe mitral regurgitation (MR). Preoperative coronary angiographies were reviewed for the presence or the absence of significant CAD (≥50% luminal stenosis). Chi-square test and 2 × 2 tables were used. RESULTS: Of the 1308 patients with severe VHD, 1002 patients had isolated aortic valve disease, 240 patients had isolated mitral valve disease, and 66 patients had combined aortomitral valve disease. CAD was detected in 27.75% of all patients with severe VHD, in 32% of patients with isolated aortic valve disease, and in 15% of patients with isolated mitral valve disease. Statistical analysis showed a higher prevalence in patients with severe aortic valve stenosis and a significant relationship between CAD and aortic valve disease, mainly severe AS (p < 0.0001). CONCLUSION: The prevalence of CAD in patients with VHD is 27.75%, and it correlates significantly with aortic valve disease, in particular with severe AS. Future large studies are needed to evaluate the possible causal relationship.


Assuntos
Doença da Artéria Coronariana/complicações , Doenças das Valvas Cardíacas/complicações , Idoso , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Angiografia Coronária , Feminino , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/cirurgia , Prevalência , Estudos Retrospectivos
5.
Cardiol Young ; 29(7): 986-988, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31331408

RESUMO

Patients with a significant left-to-right shunt at ventricular level may become inoperable at an early age due to irreversible pulmonary vascular disease. On the other hand, even suprasystemic pulmonary hypertension due to mitral stenosis remains treatable. We report a 24-year-old patient with large ventricular septal defect, severe mitral stenosis and cyanosis who improved after surgical correction of both the lesions. This emphasises the importance of additional post-capillary pulmonary hypertension in Eisenmenger syndrome.


Assuntos
Cianose/complicações , Complexo de Eisenmenger/cirurgia , Comunicação Interventricular/complicações , Comunicação Interventricular/cirurgia , Hipertensão Pulmonar/complicações , Estenose da Valva Mitral/complicações , Complexo de Eisenmenger/complicações , Complexo de Eisenmenger/diagnóstico , Feminino , Comunicação Interventricular/diagnóstico , Humanos , Adulto Jovem
6.
Echocardiography ; 36(6): 1217-1218, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31116438

RESUMO

We present the case of a healthy young woman that was evaluated before participation in amateur sports. A systolic and diastolic murmur was heard during the physical examination. Two-dimensional echocardiography was performed, and a direct insertion of the posteromedial papillary muscle into the mitral valve leaflets was found. Mild mitral stenosis and moderate regurgitation were also found. Because she was asymptomatic, a follow-up in 6 months was planned to control the evaluation of her valve disease.


Assuntos
Ecocardiografia/métodos , Sopros Cardíacos/complicações , Insuficiência da Valva Mitral/complicações , Estenose da Valva Mitral/complicações , Valva Mitral/diagnóstico por imagem , Músculos Papilares/anormalidades , Adulto , Cardiomiopatia Hipertrófica , Feminino , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Músculos Papilares/diagnóstico por imagem
7.
Echocardiography ; 36(5): 897-904, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31002179

RESUMO

BACKGROUND: Recent advances had allowed measurement of myocardial deformation parameters using 3D speckle-tracking echocardiography (STE). Agreement between these two modalities and interchangeability of findings remain as an issue since 2DSTE is more widely available than 3DSTE. The aim of this study was to investigate the correlation and agreement between 2DSTE and 3DSTE in healthy volunteers and in patients with mild mitral stenosis (MS). METHODS: Data from 31 patients with mild MS and 27 healthy volunteers were included in this study. Data were analyzed for the correlation and agreement between 2DSTE and 3DSTE for volumetric, strain, and rotational parameters. RESULTS: There were no significant differences between 2DSTE and 3DSTE in both control and MS groups for left ventricular volumetric and rotational parameters. 3D global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly higher in healthy volunteers (P < 0.001 for both), while only 3DGCS was significantly higher than 2DGCS in MS group (P < 0.001). The correlation between 3DSTE and 2DSTE was weak-to-moderate in both groups for strain and rotational parameters, and overall, correlation coefficients were higher in MS group. An exception was GLS in MS group, where coefficient of correlation was excellent (r = 0.907). Agreement between two modalities was poor for strain and rotational parameters, and the average bias was high. CONCLUSIONS: Overall, the agreement between 2DSTE and 3DSTE for strain and rotational measures was poor with a high average bias. The agreement between 2DSTE and 3DSTE is affected by the presence of underlying MS and the direction of strain.


Assuntos
Ecocardiografia Tridimensional/métodos , Estenose da Valva Mitral/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/patologia , Adulto , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Masculino , Estenose da Valva Mitral/complicações , Tamanho do Órgão , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/complicações
8.
J Am Coll Cardiol ; 73(10): 1123-1131, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30871695

RESUMO

BACKGROUND: Patients with mitral stenosis and atrial fibrillation (AF) require anticoagulation for stroke prevention. Thus far, all studies on direct oral anticoagulants (DOACs) have excluded patients with moderate to severe mitral stenosis. OBJECTIVES: The aim of this study was to validate the efficacy of DOACs in patients with mitral stenosis. METHODS: The study population was enrolled from the Health Insurance Review and Assessment Service (HIRA) database in the Republic of Korea, and it included patients who were diagnosed with mitral stenosis and AF and either were prescribed DOACs for off-label use or received conventional treatment with warfarin. The primary efficacy endpoint was ischemic strokes or systemic embolisms, and the safety outcome was intracranial hemorrhage. RESULTS: A total of 2,230 patients (mean age 69.7 ± 10.5 years; 682 [30.6%] males) were included in the present study. Thromboembolic events occurred at a rate of 2.22%/year in the DOAC group, and 4.19%/year in the warfarin group (adjusted hazard ratio for DOAC: 0.28; 95% confidence interval: 0.18 to 0.45). Intracranial hemorrhage occurred in 0.49% of the DOAC group and 0.93% of the warfarin group (adjusted hazard ratio for DOAC: 0.53; 95% confidence interval: 0.22 to 1.26). CONCLUSIONS: In patients with AF accompanied with mitral stenosis, DOAC use is promising and hypothesis generating in preventing thromboembolism. Our results need to be replicated in a randomized trial.


Assuntos
Anticoagulantes , Fibrilação Atrial , Estenose da Valva Mitral , Acidente Vascular Cerebral , Tromboembolia , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico , Estenose da Valva Mitral/tratamento farmacológico , Estenose da Valva Mitral/epidemiologia , República da Coreia/epidemiologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Tromboembolia/prevenção & controle
9.
Ann Thorac Surg ; 108(3): e175-e177, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30790549

RESUMO

Left atrial (LA) thrombus with calcification is a rare anomaly in rheumatic mitral stenosis. An accurate preoperative evaluation is critical for making clinical decisions and surgical plans. This report describes a case of rheumatic heart disease in a patient who presented with the unusual imaging manifestation of massive LA thrombus with calcification. The precise anatomic features of massive LA thrombus with calcification were demonstrated by enhanced multidetector computed tomography.


Assuntos
Átrios do Coração/cirurgia , Estenose da Valva Mitral/cirurgia , Tomografia Computadorizada Multidetectores/métodos , Trombectomia/métodos , Trombose/diagnóstico por imagem , Trombose/cirurgia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/patologia , Calcinose/cirurgia , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Humanos , Pessoa de Meia-Idade , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Cardiopatia Reumática/complicações , Cardiopatia Reumática/diagnóstico , Medição de Risco , Trombose/etiologia , Resultado do Tratamento
10.
Am J Cardiol ; 123(9): 1510-1516, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777321

RESUMO

Little is known about the outcome of patients with mitral stenosis (MS) who underwent transcatheter aortic valve implantation (TAVI). Therefore, we sought to evaluate the potential impact of MS on the outcome of patients who underwent TAVI using the US national cohort. Using weighted data from the National Inpatient Sample database between 2011 and 2015, we identified patients who had undergone a TAVI as a primary procedure. Patients with MS diagnosis were compared with those without MS. Univariate and multivariate logistic regression analyses were performed for the outcomes of in-hospital mortality and postprocedural complications. Outcomes were also stratified by the type to TAVI (endovascular vs transapical). A total of 62,110 patients underwent TAVI (mean age 81 ± 8.72, 47.4% females, and 3.7% African-Americans) and 887 patients had MS (1.43%). Patients with concomitant MS had higher in-hospital mortality (5.1% vs 3.5% adjusted odds ratio [aOR] 1.455; 95% confidence interval [CI] 1.059 to 2.001, p = 0.021), major adverse cardiac events (9.0% vs 7.1% aOR 1.297; 95% CI 1.012 to 1.663, p = 0.040), major bleeding (16.3% vs 12.1% aOR 1.303; 95% CI 1.067 to 1.593, p = 0.010), cardiac complications (21.8% vs 16.0% aOR 1.536; 95% CI, 1.300 to 1.815, p < 0.001), and acute myocardial infarction (4.5% vs 2.8% aOR 1.783; 95% CI 1.249 to 2.545, p = 0.007) when compared with patients without MS. In conclusion, MS is an independent risk factor for mortality and morbidity after TAVI procedure for patients with severe aortic stenosis.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Estenose da Valva Mitral/complicações , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Cateterismo Cardíaco/métodos , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
14.
Am J Cardiol ; 123(4): 650-657, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30612725

RESUMO

Mitral annular calcium (MAC) is common in older adults in the Western World and if extensive may cause mitral stenosis . The purpose of this report is to describe outcomes of 12 patients having mitral valve replacement for mitral stenosis secondary to massive MAC. Operatively excised deposits of calcium removed from the mitral annular area and the accompanying stenotic mitral valves were examined and then the patients' medical records were examined to confirm the diagnosis and the degree of valvular dysfunction. A total of 12 patients with massive MAC causing mitral stenosis and receiving mitral valve replacement with or without aortic valve replacement for aortic stenosis were observed in 2013 to 2015. Of the 12 patients, 7 died from 5 to 44 days (mean 19) after the valve operation and all had "stormy" postoperative courses; one survived 150 days and another, 600 days; the remaining 3 were improved by the operation and are alive 22, 27, and 59 months postoperatively. In conclusion, the high mortality in these patients suggests that mitral valve replacement in the setting of massive MAC be considered with caution.


Assuntos
Estenose da Valva Aórtica/complicações , Calcinose/complicações , Implante de Prótese de Valva Cardíaca/efeitos adversos , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Calcinose/mortalidade , Calcinose/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/mortalidade , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
16.
Semin Cardiothorac Vasc Anesth ; 23(1): 88-107, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30229690

RESUMO

Right ventricular (RV) function is an independent prognostic factor for short- and long-term outcomes in cardiac surgical patients. Patients with mitral valve (MV) disease are at increased risk of RV dysfunction before and after MV operations. Yet RV function is not part of criteria for decision making or risk stratification in this setting. The role of MV disease in the development of pulmonary hypertension (PHTN) and the ultimate impact of PHTN on RV function have been well described. Nonetheless, there are other mechanisms by which MV disease and MV surgery affect RV performance. Research suggests that PHTN may not be the most important determinant of RV dysfunction. Both RV dysfunction and PHTN have independent prognostic significance. This review explores the unique anatomic and functional features of the RV and the pathophysiologic and prognostic implications of RV dysfunction in patients with MV disease in the perioperative period.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/cirurgia , Disfunção Ventricular Direita/complicações , Humanos , Hipertensão Pulmonar/complicações , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia
17.
Interact Cardiovasc Thorac Surg ; 28(2): 318-320, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30053112

RESUMO

Extrinsic compression of coronary arteries causing angina pectoris is very unusual. No data regarding the optimal treatment for coronary artery compression due to dilated cardiac chambers have been reported. In this case report, we describe a man with severe mitral valve stenosis and the dilated left atrium, which resulted in coronary artery compression, and the successful management of his condition by surgical reconstruction.


Assuntos
Angina Pectoris/etiologia , Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Dilatada/complicações , Estenose Coronária/etiologia , Estenose da Valva Mitral/complicações , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/cirurgia , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/cirurgia , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Dilatação Patológica/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/cirurgia
18.
Acta Cardiol ; 74(3): 265-266, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29909737

RESUMO

A 28-year-old lady with rheumatic heart disease presented with dyspnoea and overt right heart failure and was admitted for stabilization. She had respirophasic desaturation predominantly during inspiration. Trans-oesophageal echocardiography revealed the aetiology of the same and dictated the management strategy.


Assuntos
Hemodinâmica , Estenose da Valva Mitral/complicações , Valva Mitral/fisiopatologia , Mecânica Respiratória , Cardiopatia Reumática/complicações , Insuficiência da Valva Tricúspide/complicações , Estenose da Valva Tricúspide/complicações , Valva Tricúspide/fisiopatologia , Adulto , Dispneia/etiologia , Dispneia/fisiopatologia , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/fisiopatologia , Cardiopatia Reumática/cirurgia , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/cirurgia , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/fisiopatologia , Estenose da Valva Tricúspide/cirurgia
20.
Indian Heart J ; 70(5): 685-689, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30392507

RESUMO

INTRODUCTION: Mitral stenosis due to rheumatic heart disease is a common problem in India causing significant morbidity and mortality. We have compared the maternal and fetal outcome of women with severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. METHODS: A total of 24 women of severe rheumatic mitral stenosis who underwent balloon mitral valvotomy before pregnancy (14 women, group 1) or during pregnancy (10 women, group 2) were included in the retrospective descriptive analysis. RESULTS: The mean age was 25.5±3.6 yrs in group 1 and 25.7±3.5 yrs in group 2. There was no difference in characteristics -primigravidas, time since diagnosis from pregnancy, NYHA (New York Heart Association) class and associated medical problems in the two groups. There was significant difference in cardiac events during pregnancy in the two groups. New York Heart Association class deterioration was observed in only 3(21.4% women in group 1) as compared to all (10; 100% women) in group 2(p<0.001). The incidence of arrhythmias and atrial fibrillation was not different in two groups. Obstetric events were similar in the two groups. Mode of delivery and caesarean section rate was also similar in the two groups. There was no significant difference in mean birth weights (2399.75±601.8gm vs. 2641.70±580.6gm),rate of fetal growth restriction, still birth and congenital malformation rates in the two groups. CONCLUSION: Percutaneous mitral valvotomy for patients with severe mitral stenosis can be safely performed during pregnancy and has equivalent maternal and fetal outcomes as that performed before pregnancy.


Assuntos
Valvuloplastia com Balão/métodos , Estenose da Valva Mitral/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Cardiopatia Reumática/complicações , Ultrassonografia Pré-Natal/métodos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Incidência , Índia , Recém-Nascido , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , Resultado da Gravidez , Prognóstico , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/cirurgia , Taxa de Sobrevida/tendências , Fatores de Tempo , Adulto Jovem
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