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1.
Kyobu Geka ; 74(6): 413-417, 2021 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-34059582

RESUMO

Aortic valve-sparing surgery is a delicate procedure that requires specialized skills to control aortic valve regurgitation. Therefore, simulating the surgery before performing it on a patient is good practice for inexperienced surgeons. Herein, we present our experience of a simulation surgery using a three-dimensionally printed aortic root model of a 60-year-old man with severe aortic regurgitation and aortic root enlargement. We fabricated the model using multi-slice computed tomography data. The model revealed the two pitfalls:unbalanced commissure position and lower coaptation height of the right coronary cusp. We completed the simulation surgery from the proximal suture and valve reimplantation to coronary ostial reconstructions during approximately three hours with medical staffs. In the actual operation, the aortic valve regurgitation completely disappeared by accurately reconstructing the commissure in the Valsalva graft and adjusting the height of the right coronary cusp using central plication procedure. We believe that carrying out simulations before the actual surgery improves the surgeon's confidence and the patient's outcomes.


Assuntos
Insuficiência da Valva Aórtica , Procedimentos Cirúrgicos Cardíacos , Aorta/diagnóstico por imagem , Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Reimplante
2.
Kyobu Geka ; 74(5): 375-378, 2021 May.
Artigo em Japonês | MEDLINE | ID: mdl-33980799

RESUMO

Valve sparing aortic root replacement( VSRR) is currently an established option for patients with annuloaortic ectasia( AAE). A newly designed Valsalva graft, the J Graft Shield Neo Valsalva, was used for VSRR in three cases. All operations were successful and postoperative courses were uneventful. Graft designs closer in shape to the native Valsalva may contribute to the improvement of late outcomes in VSRR.


Assuntos
Aneurisma da Aorta Torácica , Insuficiência da Valva Aórtica , Implante de Prótese Vascular , Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Humanos
3.
Kyobu Geka ; 74(3): 187-190, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33831870

RESUMO

Pericardial adhesions can pose serious problems during cardiac reoperation. Here, we report three cases where circular pericardial drainage (CPD) was performed during the initial surgery and no pericardial adhesions were found during reoperation. All three patients had initially undergone an aortic valve replacement with CPD. Case 1:An 80-year-old female was reoperated this time for an aneurysm of the ascending aorta. A replacement of the ascending aorta was performed. Case 2:A 76-year-old male underwent a second aortic valve repair indicated for prosthetic valve infection. Case 3:The patient was an 82-year-old female. This time, mitral valve replacement, indicated for severe mitral valve stenosis, was performed. In these three cases, there were almost no adhesions in the CPD route. The diaphragmatic pericardial surface, the oblique sinus of pericardium, and the lateral side of the left ventricle were also adhesion-free. CPD can effectively drain postoperative pericardial hemorrhage and thus prevent pericardial adhesions.


Assuntos
Insuficiência da Valva Aórtica , Próteses Valvulares Cardíacas , Idoso , Idoso de 80 Anos ou mais , Aorta , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Drenagem , Feminino , Humanos , Masculino , Reoperação
4.
Angiol Sosud Khir ; 27(1): 191-198, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825748

RESUMO

According to the results of modern researchers, the main techniques used in congenital pathology of the aortic valve in children include balloon catheter dilatation of the aortic valve, surgical valvuloplasty, the Ross procedure and replacement of the aortic valve with a mechanical prosthesis. Many surgeons point out that these techniques in congenital pathology of the aortic valve yield suboptimal results. This is often due to the lack of a clear-cut definition between surgeons as to what operation should be performed in a particular age group. According to the reports of the majority of researchers, biological prostheses undergo early degeneration and structural changes in paediatric cardiac surgery and yield the worst results. Comparing the main techniques, optimal haemodynamics is observed after the Ross procedure. A disadvantage of this operation is the necessity of repeat intervention on the right ventricular outflow tract, which is required in 20 to 40%. Concomitant surgery of the mitral valve and/or aortic arch during the Ross procedure significantly increases the lethality and the risk of postoperative complications. Compared with an adult cohort of patients, children after prosthetic repair of the aortic valve using a mechanical prosthesis are more often found to have postoperative complications and a higher mortality rate. Yet another problem encountered in paediatric valve surgery is the unavailability of commercial prostheses sized ?19 mm. The duration of the intraoperative parameters for reconstructions of the aortic valve, the Ross procedure, and replacement of the aortic valve by the results of many studies averagely amounts to 74±34 min, 100±56 min, and 129±71 min, respectively. Yet another method which can be used for neocuspidization of the aortic valve in reconstructive surgery of the aortic root in paediatric patients is the use of glutaraldehyde-treated autologous pericardium. In our opinion, given the simplicity of the procedure, duration of the intraoperative parameters, and acceptable initial results reported by some researchers, the Ozaki procedure may be performed in children.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Adulto , Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Criança , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Transplante Autólogo , Resultado do Tratamento
6.
J Card Surg ; 36(6): 1953-1957, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33651397

RESUMO

BACKGROUND: Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed. METHODS: From June 2002 to January 2020, 75 patients with mild-to-moderate BAV regurgitation (±mild-to-moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyzed. Clinical and echocardiographic follow-up was 100% complete (mean: 7.4 ± 3.9 years, max: 16.4). Kaplan-Meier estimates were employed to analyze long-term survival. Cumulative incidence function (CIF) for time to reoperation, recurrence of aortic regurgitation (AR) ≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed. RESULTS: There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4 ± 2.5%, 95% confidence interval (CI: 83.16-99.63). At follow-up there were no cases of aortic root surgery whereas three patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6 ± 2.5%, 95% CI [0.20-11.53]. At follow-up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR more than 2+/4+ was 5.1 ± 4.98% and of AS more than moderate 6.9 ± 3.8%. CONCLUSIONS: In our study mild to moderate regurgitation of a BAV did not do significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement.


Assuntos
Aneurisma Aórtico , Valvopatia Aórtica , Insuficiência da Valva Aórtica , Doenças das Valvas Cardíacas , Aorta/cirurgia , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
9.
J Card Surg ; 36(7): 2225-2232, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33783050

RESUMO

BACKGROUND: We report our 1-year single-center experience of a new technique of aortic valve replacement using a rapid-deployment valve (RD-AVR) to avoid postoperative complications. We also report the unexpected pitfalls and handling techniques that we have seen in past cases. METHODS: We performed aortic valve replacement on 38 patients between May 2019 and April 2020. Their mean age was 74 years. The primary outcomes were in-hospital mortality and short-term results during a 1-year follow-up period, while the secondary outcomes were related to prosthetic valve function, especially paravalvular leakage (PVL). We further analyzed the relationship between the new technique and its outcomes. RESULTS: The mean operative time was 196 min. There were no in-hospital deaths, and the mean duration of postoperative hospital stay was 11.8 days. Valvular measurements using three-dimensional computed tomography were larger and more accurate than those measured using ultrasonic echocardiography. Postoperative RD-AVR prosthetic valve function was excellent. However, PVL occurred in four cases 1 week and 1 year postoperatively and regurgitation did not improve. A gap associated with PVL was identified below the right-noncoronary commissure. To prevent PVL, we additionally stitched this gap in the later 18 cases; there was no case of PVL and no new pacemaker implantation in these cases. CONCLUSIONS: PVL is more likely to occur if there is a gap below the R-N commissure, especially in cases with a large annulus; therefore, applying an additional stitch to the R-N commissure is extremely useful.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/prevenção & controle , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Humanos , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
11.
J Card Surg ; 36(6): 2117-2120, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33586247

RESUMO

The use of transcatheter aortic valves for aortic regurgitation presents unique challenges. Although studies describe their successful off-label use, there is a paucity of literature on transcatheter aortic valve replacement after valve-sparing aortic root surgery. We present a patient with severe aortic regurgitation following valve-sparing aortic root replacement that was treated with an oversized transcatheter aortic valve.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Humanos , Resultado do Tratamento
14.
Braz J Cardiovasc Surg ; 36(1): 130-132, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33594867

RESUMO

Aortic valve endocarditis can lead to secondary involvement of aorto-mitral curtain and the adjacent anterior mitral leaflet (AML). The secondary damage to AML is often caused by the infected jet of aortic regurgitation hitting the ventricular surface of the mitral leaflet, or by the pronounced bacterial vegetation that prolapses from the aortic valve into the left ventricular outflow tract. This is called 'kissing lesion'. We describe a patient with infective endocarditis of the aortic valve causing perforation of both noncoronary cusp of aortic valve and the AML, which is rare.


Assuntos
Insuficiência da Valva Aórtica , Endocardite Bacteriana , Insuficiência da Valva Mitral , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia
15.
Med Sci Monit ; 27: e928218, 2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33558450

RESUMO

BACKGROUND Recently, new therapeutic approaches have revolutionized the management of left ventricular dysfunction (LVD) and valvular heart disease (VHD), which are a growing public health problem. In parallel, there are no available epidemiological data about LVD and VHD in developing countries, especially in the Mediterranean area. This retrospective study was conducted at a single center and aimed to evaluate the associations between mitral and aortic valvular disease and left ventricle systolic and diastolic dysfunction in the Lebanese population. MATERIAL AND METHODS A retrospective study was conducted of 4520 consecutive patients aged >18 years who were referred to the Cardiovascular Department of Notre Dame de Secours-University Hospital in Jbeil-Lebanon for transthoracic echocardiography between December 2016 and December 2019. The study population was divided into different groups based on types of LVD and VHD. Left ventricle systolic dysfunction was defined as a left ventricle ejection fraction (EF) ≤40%. Statistical analysis was carried out using SPSS software version 20. RESULTS VHD and systolic dysfunction were more common in men, whereas diastolic dysfunction was more common in women. Being older than age 65 years and smoking were significantly associated with heart failure with preserved EF, whereas female sex was a significant preventive factor against heart failure with reduced EF. Systemic hypertension was correlated with mitral stenosis and tricuspid regurgitation, whereas diabetes mellitus was associated with tricuspid regurgitation (TR). Smoking and older age also appeared to be associated with aortic stenosis. CONCLUSIONS Mitral valve disease (regurgitation and stenosis) was significantly correlated with systolic dysfunction, whereas aortic and mitral regurgitation were associated with diastolic dysfunction. Better monitoring of cardiovascular disease risk factors may lead to a reduced burden of LVD and VHD.


Assuntos
Insuficiência da Valva Aórtica/epidemiologia , Insuficiência da Valva Mitral/epidemiologia , Estenose da Valva Mitral/epidemiologia , Insuficiência da Valva Tricúspide/epidemiologia , Disfunção Ventricular Esquerda/epidemiologia , Adulto , Fatores Etários , Idoso , Insuficiência da Valva Aórtica/complicações , Diabetes Mellitus/epidemiologia , Ecocardiografia , Feminino , Humanos , Hipertensão/epidemiologia , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Estenose da Valva Mitral/complicações , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Volume Sistólico , Insuficiência da Valva Tricúspide/complicações , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Adulto Jovem
19.
Rev. bras. cir. cardiovasc ; 36(1): 130-132, Jan.-Feb. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1155797

RESUMO

Abstract Aortic valve endocarditis can lead to secondary involvement of aorto-mitral curtain and the adjacent anterior mitral leaflet (AML). The secondary damage to AML is often caused by the infected jet of aortic regurgitation hitting the ventricular surface of the mitral leaflet, or by the pronounced bacterial vegetation that prolapses from the aortic valve into the left ventricular outflow tract. This is called 'kissing lesion'. We describe a patient with infective endocarditis of the aortic valve causing perforation of both noncoronary cusp of aortic valve and the AML, which is rare.


Assuntos
Humanos , Insuficiência da Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Mitral/cirurgia , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral
20.
J Card Surg ; 36(4): 1264-1269, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33476446

RESUMO

BACKGROUND AND AIM: Untreated ruptured sinus of Valsalva aneurysms ultimately develop into heart failure, thereby affecting patients' survival. We retrospectively analyzed our 13-year experience of the surgical repair for ruptured sinus of Valsalva aneurysm to study the optimal surgical strategy, operative risk and long-term surgical outcome. METHODS: Twenty-six patients underwent surgical repair of ruptured sinus of Valsalva aneurysm from January 2008 to February 2020. Follow-up data were obtained from the outpatient department records and telephone calls. RESULTS: Patch closure of ruptured sinus of Valsalva aneurysm was done in all the 26 patients, most often through the transaortic (69%) and dual-chamber approach (23%). Aortic valve repair was done in one patient while seven patients underwent aortic valve replacement for associated significant aortic regurgitation. There was one in-hospital mortality because of noncardiac cause. The median duration of postoperative hospital stay was 8 days (range, 6-11 days). Follow-up data were available for 89% (23/26) patients. The mean follow-up period was 69 ± 43 months (range, 7-147 months). All survivors were in New York Heart Association functional Class I or II. There was no late death. One patient required rehospitalization for recurrent ruptured sinus of Valsalva aneurysm. There was no recurrent or new-onset significant aortic regurgitation and prosthesis-related complications in late follow-up. CONCLUSION: Surgical repair for ruptured sinus of Valsalva aneurysm carries an acceptable low operative risk and excellent long-term outcome. Though high-risk population, an early diagnosis and optimal surgical approach can prevent worsening of symptoms and consequent heart failure.


Assuntos
Aneurisma/cirurgia , Ruptura Aórtica , Insuficiência da Valva Aórtica , Seio Aórtico , Ruptura Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Seguimentos , Humanos , Estudos Retrospectivos , Seio Aórtico/cirurgia
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