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1.
N Engl J Med ; 382(9)2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31995682

RESUMO

BACKGROUND: There are scant data on long-term clinical outcomes and bioprosthetic-valve function after transcatheter aortic-valve replacement (TAVR) as compared with surgical aortic-valve replacement in patients with severe aortic stenosis and intermediate surgical risk. METHODS: We enrolled 2032 intermediate-risk patients with severe, symptomatic aortic stenosis at 57 centers. Patients were stratified according to intended transfemoral or transthoracic access (76.3% and 23.7%, respectively) and were randomly assigned to undergo either TAVR or surgical replacement. Clinical, echocardiographic, and health-status outcomes were followed for 5 years. The primary end point was death from any cause or disabling stroke. RESULTS: At 5 years, there was no significant difference in the incidence of death from any cause or disabling stroke between the TAVR group and the surgery group (47.9% and 43.4%, respectively; hazard ratio, 1.09; 95% confidence interval [CI], 0.95 to 1.25; P = 0.21). Results were similar for the transfemoral-access cohort (44.5% and 42.0%, respectively; hazard ratio, 1.02; 95% CI, 0.87 to 1.20), but the incidence of death or disabling stroke was higher after TAVR than after surgery in the transthoracic-access cohort (59.3% vs. 48.3%; hazard ratio, 1.32; 95% CI, 1.02 to 1.71). At 5 years, more patients in the TAVR group than in the surgery group had at least mild paravalvular aortic regurgitation (33.3% vs. 6.3%). Repeat hospitalizations were more frequent after TAVR than after surgery (33.3% vs. 25.2%), as were aortic-valve reinterventions (3.2% vs. 0.8%). Improvement in health status at 5 years was similar for TAVR and surgery. CONCLUSIONS: Among patients with aortic stenosis who were at intermediate surgical risk, there was no significant difference in the incidence of death or disabling stroke at 5 years after TAVR as compared with surgical aortic-valve replacement. (Funded by Edwards Lifesciences; PARTNER 2 ClinicalTrials.gov number, NCT01314313.).


Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estudos de Coortes , Ecocardiografia , Feminino , Nível de Saúde , Humanos , Incidência , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Complicações Pós-Operatórias/mortalidade , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(2): e18651, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914049

RESUMO

RATIONALE: Heart-valve replacement is one of the main surgical methods for various heart-valve diseases. Warfarin is the only oral anticoagulant used for thrombosis prevention after heart-valve replacement. However, warfarin has a narrow therapeutic window, large differences in efficacy between individuals, and can be affected by drugs, food and disease status. PATIENT CONCERNS: We used the Hamberg model to develop an anticoagulation regimen for a 10-month-old Chinese male after mitral-valve replacement. DIAGNOSES: Echocardiography revealed mitral malformation with severe regurgitation, patent foramen ovale, thickening of the left ventricular wall, enlargement of the left atrium, and the overall systolic function of the left ventricle was lower than normal. INTERVENTIONS: First, the patient was treated with Mitral valvuloplasty plus temporary implantation of a pacing wire. Since this was inadequate, he underwent mitral-valve replacement. Then, we used the Hamberg model to develop an anticoagulation regimen. OUTCOMES: After discharge from hospital, the pharmacist provided anticoagulation management for this pediatric patient using an "Online Anticoagulation Clinic" (OAC). Point-of-care testing could be employed by the boy's mother at home to obtain the International Normalized Ratio. His time to response was 89.6% during the 6 months after hospital discharge, and adverse reactions such as bleeding or thrombosis did not occur. LESSONS: This is the first time the Hamberg model has been employed to design anticoagulation therapy for an Asian infant. His anticoagulation therapy may be managed using the OAC.


Assuntos
Anticoagulantes/administração & dosagem , Cálculos da Dosagem de Medicamento , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Tromboembolia/prevenção & controle , Grupo com Ancestrais do Continente Asiático , Humanos , Lactente , Coeficiente Internacional Normatizado , Masculino , Sistemas Automatizados de Assistência Junto ao Leito
3.
Rev Med Suisse ; 16(676-7): 16-22, 2020 Jan 15.
Artigo em Francês | MEDLINE | ID: mdl-31961076

RESUMO

In 2019, the guidelines on the new entity « chronic coronary syndrome ¼ have been published. They influence importantly the work-up and treatment of patients with stable coronary artery disease. We will also report on publications showing the benefit of percutaneous aortic valve implantation (TAVI) in patients with aortic stenosis and low risk surgical risk. With regard to infectious endocarditis, we elucidate the importance of the vegetation's size for predicting mortality and the prognostic value of the positron emission tomography in predicting septic embolism. We highlight the spectacular results of the DAPA-HF study in patients with heart failure and review publications showing the important role of the detection of myocardial fibrosis and scar by cardiac MRI for risk stratification of sudden cardiac death.


Assuntos
Estenose da Valva Aórtica , Cardiologia , Implante de Prótese de Valva Cardíaca , Valva Aórtica , Cateterismo Cardíaco , Cardiologia/tendências , Humanos , Fatores de Risco , Resultado do Tratamento
4.
Mymensingh Med J ; 29(1): 97-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915343

RESUMO

This study was aimed to compare the long-term outcomes and survival rate among mitral valve replacement using thoracotomy and standard median sternotomy in a single surgeon's practice. Total 250 patients were evaluated; Group I (n=65) patients had anterolateral thoracotomy and Group II (n=185) had standard median sternotomy for valve replacement. Mean age was 25.1±5 years in Group I and 41.8±10.5 years in Group II. Female was predominant in Group I. Total operative time and bypass time was statistically significant in Group I (235.5±25.8 minutes; 84.2±12.75 minutes) in contrast to Group II (203.8±15.5 minutes; 71.5±10.5 minutes). Incision scar was not visible in females in Group I but full incision scar was visible in Group II. Post-operative ICU stay duration was significant high in Group II. Though, wound infection incidence was 0% in Group I; however, 9.73% patient had wound infection in Group II. Only 1.62% patient developed unstable sternum in Group II. Most of the patients from both study group were in regular follow up and 1-year mortality rate was 4.62% and 5.94% in Group I and Group II respectively. Mitral valve replacement through a right anterolateral thoracotomy is easy and safe to perform; while getting maximum benefits for the patients. Besides satisfactory cosmetic outcome especially in female, this approach provides better exposure to mitral apparatus even in patients with small left atrium, cost effectiveness, less duration of hospital stays and absence of the risk for unstable sternum.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Esternotomia/métodos , Esterno/cirurgia , Toracotomia/métodos , Adulto , Bangladesh/epidemiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Doenças das Valvas Cardíacas/mortalidade , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
5.
Expert Opin Drug Metab Toxicol ; 16(1): 1-9, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914334

RESUMO

Background: Warfarin acts in heart valve replacement patients to minimize thromboembolic complications. We investigated whether patients can be distinguished based on their genotypes to efficiently and safely administer warfarin therapy after heart valve replacements.Research design and methods: A retrospective analysis was conducted in patients with warfarin therapy who underwent elective heart valve replacements between January 2013 and September 2018. The patients were divided into normal, sensitive, and highly sensitive bins based on their CYP2C9 and VKORC1 genotypes. The primary endpoints were over-anticoagulation and overt bleeding.Results: 375 patients were enrolled, with 65 classified as normal, 281 as sensitive, and 29 as highly sensitive responders. Compared with normal responders, sensitive and highly sensitive responders spent more time on over-anticoagulation in the first 28 (P < 0.001) and 90 (P = 0.001) days; experienced more frequent bleeding events in the first 28 days (P = 0.029; OR, 2.18; 95% CI, 1.15-4.13); required lower warfarin doses to obtain stable INR (P < 0.001); had higher warfarin sensitivity indices (P < 0.001).Conclusion: Predicting evidence have been obtained with CYP2C9 and VKORC1 genotypes in identifying heart valve replacement patients with higher efficient sensitivity and with a higher risk of bleeding and over-anticoagulation.


Assuntos
Anticoagulantes/administração & dosagem , Citocromo P-450 CYP2C9/genética , Hemorragia/induzido quimicamente , Vitamina K Epóxido Redutases/genética , Varfarina/administração & dosagem , Adulto , Idoso , Anticoagulantes/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Genótipo , Implante de Prótese de Valva Cardíaca/métodos , Hemorragia/epidemiologia , Hemorragia/genética , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tromboembolia/prevenção & controle , Varfarina/efeitos adversos
7.
EuroIntervention ; 15(13): 1181-1189, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31566569

RESUMO

AIMS: Approximately 40% of severe aortic stenosis (AS) patients have a low-gradient (<40 mmHg) AS (LG-AS). The aim of this study was to investigate the invasively measured haemodynamic changes and long-term outcome after transcatheter aortic valve replacement (TAVR) in the subgroups of LG-AS. METHODS AND RESULTS: A total of 600 LG-AS patients with haemodynamic assessment by left and right heart catheterisation were divided into three groups: normal-flow (NFLG-AS; n=296), paradoxical low-flow (PLFLG-AS; n=153), and classic low-flow (CLFLG-AS; n=151). Post TAVR, PLFLG-AS and CLFLG-AS showed a significant reduction in global afterload (p<0.005), as well as a significant elevation of stroke volume index (SVI), and left and right ventricular stroke work index (p<0.001). NFLG-AS was associated with an elevation of global afterload and a decrease of SVI (p<0.05). Overall survival was highest in NFLG-AS, followed by PLFLG-AS and CLFLG-AS. All subgroups experienced similar symptomatic improvement. CONCLUSIONS: NFLG-AS was the most prevalent form of LG severe AS and was associated with adequate left ventricular compensation and good prognosis. On the other hand, CLFLG-AS represents the heart failure with reduced ejection fraction (HFrEF) form of AS and was associated with the worst prognosis, whereas PLFLG-AS represents the heart failure with preserved ejection fraction (HFpEF) form of AS with intermediate prognosis. Both groups showed early haemodynamic reverse response after TAVR.


Assuntos
Estenose da Valva Aórtica , Insuficiência Cardíaca , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Valva Aórtica , Estenose da Valva Aórtica/cirurgia , Hemodinâmica , Humanos , Índice de Gravidade de Doença , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
8.
Khirurgiia (Mosk) ; (12): 121-125, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825352

RESUMO

Minimally invasive approach in mitral valve surgery has been applied since the late 1990s. Considerable experience of mini-thoracotomy in cardiac surgery has been gained over this period. Stages of the development of minimally invasive cardiac surgery are reviewed in the article. Features of mitral valve surgery through right-sided mini-thoracotomy are discussed. Surgical outcomes of these procedures are reported considering data of various cardiac surgery centers. Moreover, the authors determined indications and limitations of this technique.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Toracotomia/métodos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
9.
Zhonghua Wai Ke Za Zhi ; 57(12): 898-901, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826592

RESUMO

Objective: To examine the short-term outcomes of minimally invasive reoperation for severe tricuspid regurgitation after left-sided valve surgery. Methods: From January 2015 to December 2018, a total of 89 patients with severe tricuspid regurgitation after left-sided valve surgery received reoperation in Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study. There were 21 males and 68 females, aging of (56.4±7.9) years (range: 41 to 74 years). The interval between previous left-sided valve surgery and tricuspid reoperation was (14.1±6.1) years (range: 4 to 33 years). A combination of multiple minimally invasive techniques were adopted, including endoscopy-assist right minithoracotomy approach, peripheral cannulation strategy with the vacuum-assist single venous drainage technique, heart beating technique, and temporary percutaneous pacemaker implantation, with a concomitant enhancement in preoperative right cardiac function optimization. Results: All patients received minimally invasive isolated tricuspid valve replacement (n=81) or tricuspid valve repair (n=8). After the application of multiple minimally invasive techniques, the operative mortality rate was only 3.4% (3/89). The causes of death were progressive right heart failure with multiorgan failure (n=1) and low cardiac output associated with postoperative bleeding (n=2). Regarding to the perioperative complications, renal replacement therapy rate was 5.6% (5/89), permanent pacemaker implantation rate was 1.1% (1/89), and the incidence of stroke was 0. Mechanical ventilation time was 24(24) hours, ICU stay time was 2.5 (3.0) days (M(Q(R))). During the short-term follow-up, there were no case of severe tricuspid regurgitation, 2 cases of moderate regurgitation, 4 cases of mild-to-moderate regurgitation. Conclusions: For severe tricuspid regurgitation after left-sided valve surgery, the advanced minimally invasive techniques can significantly reduce the operative mortality and morbidity. Minimally invasive bioprosthetic tricuspid valve replacement is a reliable alternative for severe tricuspid regurgitation after left-sided valve surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Idoso , Feminino , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Reoperação , Resultado do Tratamento , Insuficiência da Valva Tricúspide/etiologia
10.
Zhonghua Wai Ke Za Zhi ; 57(12): 902-907, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826593

RESUMO

Objectives: To evaluate the efficacy of minimally invasive surgery in patients with late severe tricuspid regurgitation after cardiac surgery, and to evaluate the role of leaflets augmentation technique in tricuspid valvuloplasty. Methods: From January 2015 to June 2019, 85 patients undergoing tricuspid valve repair procedure with minimally invasive approach at Department of Cardiovascular Surgery, Guangdong provincial People's Hospital were enrolled. There were 22 males and 63 females, aging of (53.6±12.4) years (range: 15 to 75 years). The interval between the prior and current operations was (16.0±7.3) years (range: 0.2 to 35.0 years). The diameter of right atrium and right ventricle was (77.3±17.2) mm and (61.0±8.4) mm, respectively. Tricuspid regurgitation was severe or extremely severe, the tricuspid regurgitation area was (19.0±10.3) cm(2). All patients underwent minimally invasive tricuspid valvuloplasty or tricuspid valve replacement on beating-heart with totally endoscopic technique and port-access approach through right chest wall. The operations included tricuspid valve replacement and tricuspid valvuloplasty, the technique of tricuspid valvuloplasty including leaflets augmentation with patch, ring implantation, chordae tendineaes reconstruction, release of papillary muscle, edge to edge method, etc. Postoperative hospitalization days, the time of ICU stay, blood transfusion rate, ventilator time and the results of echocardiography were recorded. Follow-up was completed regularly by WeChat, telephone and outpatient visit. Results: Sixty-five patients underwent tricuspid valve repair, and 20 patients underwent tricuspid valve replacement because of prosthetic failure and plasty failure. Five patients died during hospitalization, with mortality rate 5.9%. One patient was transferred to local hospital for anti-infection treatment, the other 79 patients were discharged from hospital in well condition and followed-up. The postoperative hospitalization time was 7.0 (5.5) days (M(Q(R))) days, the mean ventilator time was 18.0 (16.2) hours, and the mean ICU stay time was 68.0 (75.5) hours. There were 35 patients without blood conduction transfusion, the transfusion rate was only 58.9% (50/85). Four cases of severe, 9 cases of moderate and 67 cases of mild to zero tricuspid regurgitation were examined before being discharged, with tricuspid regurgitation area of (2.8±3.5) cm(2) (range: 0 to 19.1 cm(2)). The follow-up time was 1 to 38 months. Two patients died during follow-up, one patient died from infective endocarditis and mitral perivalvular leakage, the other one died of intractable right heart failure. One patient was implanted with permanent pacemaker due to Ⅲ atrioventricular block. Valvular re-replacement was performed in 2 patients who were re-admitted for the artificial valve infection and mechanical valve obstruction. No re-operation of tricuspid valve. Conclusions: Totally endoscopic minimally invasive technique provided satisfactory surgical outcomes for critically sick patients with severe tricuspid regurgitation following cardiac surgery. The application of leaflets augmentation technique achieved ideal repair effect for previously unrepairable lesions.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Reoperação , Resultado do Tratamento , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/etiologia , Adulto Jovem
11.
Zhonghua Wai Ke Za Zhi ; 57(12): 947-950, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826601

RESUMO

Late tricuspid regurgitation after left-sided valve surgery can negatively affect long-term prognosis. The surgical timing and strategy of tricuspid valve reoperation will have important impact on the surgical outcomes. However, there is no clear recommendations of the surgical timing for this condition in the current guidelines. Generally, tricuspid valve reoperation should be performed before irreversible right heart failure occurs. Although tricuspid valve repair is the first choice for tricuspid regurgitation, bioprosthetic tricuspid valve replacement might be a reliable alternative when tricuspid leaflets have severe rheumatic damage or right ventricle and tricuspid annulus significantly dilate. Combined minimally invasive surgical techniques, including right minithoracotomy approach, accessing the right atrium directly through the pericardium with limited dissection, peripheral cannulation strategy with the vacuum-assist single venous drainage technique and heart beating technique, can significantly decrease the operative mortality and postoperative bleeding. With development of interventional therapy, transcatheter tricuspid valve repair or replacement may become alternatives for tricuspid regurgitation after left-sided valve surgery in the future.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Bioprótese , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Reoperação , Resultado do Tratamento , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/etiologia
12.
Rev Med Liege ; 74(12): 637-641, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31833273

RESUMO

Aortic valve replacement is nowadays a safe procedure with low morbidity and mortality. However, the evolution of surgery requires the development of less invasive techniques. Aortic valve replacement through a right mini-thoracotomy, technically more complicated, offers a lower rate of complications including less postoperative pain and less blood loss and transfusion, with a faster recovery. We report our early experience of aortic valve replacement through a right anterior mini-thoracotomy.


Assuntos
Valva Aórtica , Implante de Prótese de Valva Cardíaca , Procedimentos Cirúrgicos Minimamente Invasivos , Hospitais Universitários , Humanos , Tempo de Internação , Estudos Retrospectivos , Esternotomia , Toracotomia , Resultado do Tratamento
13.
Kyobu Geka ; 72(13): 1057-1060, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879379

RESUMO

Pregnant women undergoing mechanical valve replacement are at a considerable risk of thromboembolic events, bleeding, and fetotoxicity associated with the administration of vitamin K antagonists and some other anticoagulants. We present our clinical experience of pregnancy and childbirth in a young woman who underwent aortic valve replacement (AVR) with a mechanical valve. A young woman underwent AVR with a bioprosthetic valve for a diagnosis of aortic regurgitation and bicuspid aortic valve at age 23. Four years later, structural valve deterioration(SVD) of the prosthetic valve necessitated redo AVR with bioprosthesis. Three years after the redo AVR, she developed recurrent SVD of the bioprosthesis, and the 3rd AVR operation was performed using an On-X mechanical valve, which allows reduced anticoagulation. She conceived 5 months after AVR using the On-X valve. Anticoagulation therapy was administered with a low-dose vitamin K antagonist combined with heparin infusion during pregnancy. No anticoagulation-induced maternal and fetal complications occurred throughout the pregnancy. The On-X valve, which allows lower levels of anticoagulation is useful in women wishing to get pregnant.


Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Complicações Cardiovasculares na Gravidez/cirurgia , Anticoagulantes , Valva Aórtica , Feminino , Humanos , Gravidez , Resultado da Gravidez , Reoperação , Resultado do Tratamento , Adulto Jovem
14.
J Cardiothorac Surg ; 14(1): 185, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684992

RESUMO

BACKGROUND: Cardiac radiofrequency ablation is a popular treatment for arrhythmias. However, it does have some complications, some of which are severe, even fatally. And there were limited reports on cardiac internal perforation after radiofrequency catheter ablation (RFCA) that required a surgical repair. CASE PRESENTATION: A 47-year-old male was admitted to our hospital due to chest congestion for 4 months. He received a radiofrequency catheter ablation (RFCA) 9 months prior to admission. On admission, an echocardiogram showed an abnormal perforation between the left ventricle and the left atrium with moderate mitral valve regurgitation. We therefore performed a mitral valve replacement (MVR) and fixed the abnormal atrial-ventricular breakage via median sternotomy. CONCLUSIONS: Cardiac perforation is a severe complication of cardiac RFCA, operators should be extremely cautious to minimize radiofrequency associated perforations. Such a challenging and complex procedure should be deliberately considered by doctors and patients before implementation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Traumatismos Cardíacos/diagnóstico , Ecocardiografia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Complicações Pós-Operatórias
15.
Methodist Debakey Cardiovasc J ; 15(3): 223-225, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687103

RESUMO

Anomalous origin of the right coronary artery (ARCA) is an extremely rare cardiac pathology. The coronary artery can potentially course between the aorta and the pulmonary artery, putting the patient at risk for sudden cardiac death. Even rarer is an ARCA that arises from the left main coronary artery (LMCA). To our knowledge, this is the first case where an ARCA arising entirely from the LMCA is associated with critical bicuspid aortic valve stenosis.


Assuntos
Estenose da Valva Aórtica/etiologia , Valva Aórtica/anormalidades , Anomalias dos Vasos Coronários/complicações , Doenças das Valvas Cardíacas/complicações , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Kyobu Geka ; 72(12): 969-973, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701905

RESUMO

This is a 3-case report of mitral valve replacement (MVR) with an On-X mechanical valve followed up to 10 years. Case 1(64-year-old man) and case 2 (66-year-old woman) experienced traffic accident and traumatic event, respectively, in their chronic phase after MVR. Case 1 had multiple bone fractures of the bilateral lower limbs, which was followed by systemic infection and pyogenic spondylitis. He needed long-term antibiotics therapy for more than 4 years. Case 2 fell down at home and severely hit her head, which resulted in a traumatic subarachnoid hemorrhage. She was in a deep coma, and needed discontinuation of anticoagulation therapy for 4 weeks. Case1, 2, and 3(54-year-old man) are doing well in New York Heart Association functional class I without any valve-related thromboembolic or hemorrhagic events at 10, 9 and 8 years after MVR, respectively. On-X valve performance has also been found well maintained in all cases by echocardiography, even after traumatic accident or discontinuation of anticoagulation in Case 1 and 2. In this report, the On-X mechanical valve demonstrated good midterm result of its valve performance in the mitral position and its potential advantages in antithrombogenicity.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Mitral , Tromboembolia , Idoso , Anticoagulantes , Valva Aórtica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Kyobu Geka ; 72(12): 1015-1018, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701914

RESUMO

An 81-year-old man who had undergone aortic valve replacement was transferred to our hospital due to suspected prosthetic valve endocarditis(PVE) from the regional hospital. Transesophageal echocardiography findings showed severe aortic regurgitation with mobile vegetation on the right coronary cusp and annular abscess corresponding to left-none coronary cusps. Urgent operation was performed under the diagnosis of PVE with aortic root abscess. Intraoperative findings demonstrated tiny vegetation on one of the bio-prosthetic leaflets and abscess formation beneath the left sinus of valsalva( LSOV). Complete debridement of the infected tissue followed by patch closure of the cavity below the LSOV and reconstruction of the aortic root with Freestyle stentless aortic bioprosthesis was performed. His postoperative course was uneventful. Aortic root replacement using a stentless bioprosthesis seems to represent one of the useful options for PVE with aortic root abscess.


Assuntos
Bioprótese , Endocardite , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Abscesso , Idoso de 80 Anos ou mais , Valva Aórtica , Humanos , Masculino
18.
Lancet ; 394(10213): 2002-2011, 2019 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-31708188

RESUMO

BACKGROUND: Tricuspid regurgitation is a prevalent disease associated with high morbidity and mortality, with few treatment options. The aim of the TRILUMINATE trial is to evaluate the safety and effectiveness of TriClip, a minimally invasive transcatheter tricuspid valve repair system, for reducing tricuspid regurgitation. METHODS: The TRILUMINATE trial is a prospective, multicentre, single-arm study in 21 sites in Europe and the USA. Patients with moderate or greater triscuspid regurgitation, New York Heart Association class II or higher, and who were adequately treated per applicable standards were eligible for enrolment. Patients were excluded if they had systolic pulmonary artery pressure of more than 60 mm Hg, a previous tricuspid valve procedure, or a cardiovascular implantable electronic device that would inhibit TriClip placement. Participants were treated using a clip-based edge-to-edge repair technique with the TriClip tricuspid valve repair system. Tricuspid regurgitation was graded using a five-class grading scheme (mild, moderate, severe, massive, and torrential) that expanded on the standard American Society of Echocardiography grading scheme. The primary efficacy endpoint was a reduction in tricuspid regurgitation severity by at least one grade at 30 days post procedure, with a performance goal of 35%, analysed in all patients who had an attempted tricuspid valve repair procedure upon femoral vein puncture. The primary safety endpoint was a composite of major adverse events at 6 months, with a performance goal of 39%. Patients were excluded from the primary safety analysis if they did not reach 6-month follow-up and did not have a major adverse event during previous follow-ups. The trial has completed enrolment and follow-up is ongoing; it is registered with ClinicalTrials.gov, number NCT03227757. FINDINGS: Between Aug 1, 2017, and Nov 29, 2018, 85 patients (mean age 77·8 years [SD 7·9]; 56 [66%] women) were enrolled and underwent successful TriClip implantation. Tricuspid regurgitation severity was reduced by at least one grade at 30 days in 71 (86%) of 83 patients who had available echocardiogram data and imaging. The one-sided lower 97·5% confidence limit was 76%, which was greater than the prespecified performance goal of 35% (p<0·0001). One patient withdrew before 6-month follow-up without having had a major adverse event and was excluded from analysis of the primary safety endpoint. At 6 months, three (4%) of 84 patients experienced a major adverse event, which was less than the prespecified performance goal of 39% (p<0·0001). Single leaflet attachment occurred in five (7%) of 72 patients. No periprocedural deaths, conversions to surgery, device embolisations, myocardial infarctions, or strokes occurred. At 6 months, all-cause mortality had occurred in four (5%) of 84 patients. INTERPRETATION: The TriClip system appears to be safe and effective at reducing tricuspid regurgitation by at least one grade. This reduction could translate to significant clinical improvement at 6 months post procedure. FUNDING: Abbott.


Assuntos
Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Tricúspide/cirurgia , Idoso , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Feminino , Seguimentos , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Índice de Gravidade de Doença , Instrumentos Cirúrgicos , Resultado do Tratamento
19.
Tex Heart Inst J ; 46(3): 195-198, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708702

RESUMO

The MitraClip system can be used to control regurgitant blood flow in patients with mitral regurgitation who cannot tolerate open surgery to replace the mitral valve. Technical limitations make the right femoral vein the standard access point for placing the MitraClip. However, this route is not always suitable. We present the case of an 85-year-old woman in whom we successfully used a left-sided approach for inserting a MitraClip because her right femoral vein was occluded. This apparently novel left femoral approach merits consideration as an option for device insertion when right femoral vein access is precluded.


Assuntos
Cateterismo Cardíaco/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Veia Femoral , Fluoroscopia , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Resultado do Tratamento
20.
Tex Heart Inst J ; 46(3): 222-224, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708709

RESUMO

Low origin of the coronary arteries, defined as an origin less than 10 mm above the functional aortic annulus, is not usually considered to be a notable anomaly because functional impairment is not intrinsic. We describe a case of severe complications after surgical aortic valve replacement in a 59-year-old woman who had symptomatic aortic valve stenosis, low origin of both main coronary arteries, and a hypoplastic aortic annulus less than 19 mm in diameter. The aortic prosthesis had to be implanted above the hypoplastic anatomic annulus. An inferior-wall myocardial infarction, hypotension, right-sided heart failure, and atrial fibrillation developed during the early perioperative period. Coronary angiograms showed occlusion of the right coronary artery ostium and critical stenosis of the left coronary ostium. During reoperation, posterior aortic patch annuloplasty enabled lower reimplantation of the prosthetic aortic valve, jointly with right coronary artery-venous grafting. To prevent potentially severe complications, we recommend that low origin of the coronary arteries be reported before patients undergo surgical aortic valve replacement. If the ostia are not seen when routine coronary angiography is used, computed tomography should be prospectively performed to characterize this anomaly.


Assuntos
Anormalidades Múltiplas , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Anuloplastia da Valva Cardíaca/métodos , Anomalias dos Vasos Coronários/diagnóstico , Implante de Prótese de Valva Cardíaca/métodos , Complicações Intraoperatórias , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico , Angiografia Coronária , Ponte de Artéria Coronária/métodos , Anomalias dos Vasos Coronários/cirurgia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade
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