Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.701
Filtrar
2.
Angiol Sosud Khir ; 26(4): 108-118, 2020.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-33332313

RESUMO

AIM: The aim of our investigation was to assess the remote results of valve-sparing aortic root reimplantation into the graft (Florida Sleeve technique) compared with reimplantation of the aortic valve into the graft (David technique) during surgical correction of ascending aortic aneurysms accompanied by concomitant aortic insufficiency. PATIENTS AND METHODS: Our single-centre, blind, prospective, randomized study carried out from 2011 to 2015 included a total of 64 patients with ascending aortic aneurysms and aortic insufficiency. The patients were randomized into 2 groups: group I - aortic root reimplantation according to the Florida Sleeve technique (FS group) and group II - reimplantation of the aortic valve according to the T. David technique in David I modification (D group). The groups did not statistically differ by the baseline clinical profile. RESULTS: The overall 7-year survival for the FS group and D group amounted to 83% and 85.6%, respectively (p=0.98). Assessing the competing risks of mortality related to cardiovascular or other causes revealed no differences. Freedom from prosthetic repair of the aortic valve in the remote follow-up period amounted to 92.8% and 85.8% for the FS group and D group, respectively (p=0.4). According to the obtained findings, the technique of a valve-sparing operation is not a predictor of either lethality (RR 0.98 (95% CI 0.23-4.15), p=0.98) or prosthetic repair of the aortic valve (RR 2.03 (95% CI 0.40-14.63), p=0.40) in the remote period of follow up. RCONCLUSION: Aortic root reimplantation inside the prosthesis according to the Florida Sleeve technique makes it possible to simplify and accelerate the procedure of aortic root reconstruction in patients with aortic root aneurysms and concomitant aortic insufficiency, demonstrating long-term results comparable with those of the David technique.


Assuntos
Aneurisma Aórtico , Insuficiência da Valva Aórtica , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Humanos , Estudos Prospectivos , Resultado do Tratamento
3.
Am J Case Rep ; 21: e925931, 2020 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-32980852

RESUMO

BACKGROUND The worldwide spread of the severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) has created unprecedented situations for healthcare professionals and healthcare systems. Although infection with this virus is considered the main health problem currently, other diseases are still prevalent. CASE REPORT This report describes a 59-year-old man who presented with symptoms of dyspnea and fever that were attributed to Covid-19 infection. His clinical condition deteriorated and further examinations revealed a subjacent severe aortic regurgitation due to acute infective endocarditis. Surgical treatment was successful. CONCLUSIONS The results of diagnostic tests for Covid-19 should be re-evaluated whenever there are clinical mismatches or doubts, as false-positive Covid-19 test results can occur. Clinical interpretation should not be determined exclusively by the Covid-19 pandemic. This case report highlights the importance of using validated and approved serological and molecular testing to detect infection with SARS-CoV-2, and to repeat tests when there is doubt about presenting symptoms.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Diagnóstico Tardio , Endocardite/complicações , Endocardite/diagnóstico , Pneumonia Viral/diagnóstico , Anticorpos Antivirais/análise , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/complicações , Estado Terminal , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Endocardite/virologia , Reações Falso-Positivas , Febre/diagnóstico , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Resultado do Tratamento
4.
Am Heart J ; 228: 57-64, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32828047

RESUMO

AIMS: Data regarding outcomes for patients with severe aortic stenosis (AS) with concomitant aortic insufficiency (AI), undergoing transcatheter aortic valve replacement (TAVR) are limited. This study aimed to analyze the prevalence of severe AS with concomitant AI among patients undergoing TAVR and outcomes of TAVR in this patient group. METHODS AND RESULTS: Using data from the STS/ACC-TVT Registry, we identified patients with severe AS with or without concomitant AI who underwent TAVR between 2011 and 2016. Patients were categorized based on the severity of pre-procedural AI. Multivariable proportional hazards regression models were used to examine all-cause mortality and heart failure (HF) hospitalization at 1-year. Among 54,535 patients undergoing TAVR, 42,568 (78.1%) had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001). CONCLUSIONS: Severe AS with concomitant AI is common among patients undergoing TAVR, and is associated with lower 1 year mortality and HF hospitalization. Future studies are warranted to better understand the mechanisms underlying this benefit. SHORT ABSTRACT: In this nationally representative analysis from the United States, 78.1% of patients undergoing TAVR had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001).


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Valva Aórtica , Insuficiência Cardíaca , Complicações Pós-Operatórias , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/cirurgia , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Próteses Valvulares Cardíacas , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Sistema de Registros/estatística & dados numéricos , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Estados Unidos/epidemiologia
5.
Ann Hematol ; 99(9): 2081-2084, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32691113

RESUMO

Aortic valve disease (AVD) has similarities to atherosclerosis in the case of aortic stenosis. The important role of platelet in the pathogenesis of atherosclerosis is known. The goal of this study is to evaluate whether platelet disorders play any role in aortic valve disease. We used patients with idiopathic thrombocytopenic purpura (ITP) for this study. We evaluated any association between ITP and AVD using a large inpatient database. The International Classification of Diseases, Ninth Revision, and Clinical Modification (ICD-9-CM) codes for ITP and AVD from the Nationwide Inpatient Sample (NIS) database were used for this study. Uni- and multivariate analyses were performed on data from 2002 to 2011 to evaluate any association between ITP and AVD. In the 2002 database, AVD was present in 1.73% of ITP patients versus 1.12% in the control population (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.34-1.81; p < 0.001). In the 2011 database, AVD was present in 1.96% of ITP patients versus 1.33% in the control population (OR, 1.48; 95% CI, 1.30-1.68; p < 0.001). ITP remained independently associated with AVD following a multivariate logistic regression analysis adjusting for age, gender, diabetes mellitus, hypertension, and hyperlipidemia in 2002 (OR, 1.35; 95% CI, 1.16-1.57; p < 0.001) with a trend of this association in 2011 (OR, 1.12; 95% CI, 0.98-1.27; p = 0.096). ITP was strongly associated with AVD over the 10-year period analyzed in a large inpatient database. The reason for this association is not known warranting further investigations.


Assuntos
Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Púrpura Trombocitopênica Idiopática/epidemiologia , Idoso , Insuficiência da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/diagnóstico , Bases de Dados Factuais/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/tendências , Prevalência , Púrpura Trombocitopênica Idiopática/diagnóstico , Estudos Retrospectivos
8.
Interact Cardiovasc Thorac Surg ; 30(5): 754-761, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31971228

RESUMO

OBJECTIVES: Aortic valve-sparing root replacement (David procedure) offers the benefit of preserving the native aortic valve but is often criticized for being technically challenging and time-consuming. We analysed whether the surgeon's level of experience affects the early and long-term outcome after the David procedure. METHODS: From July 1993 to October 2015, a total of 582 patients underwent aortic valve-sparing David I procedure at our institution. A retrospective review with follow-up (mean follow-up time 8.6 ± 5.6 years) was performed. Statistical analysis of the surgeon's level of experience was performed as a categorical variable, after patients were chronologically assigned to groups of tens. Study end points assessing the surgeon's learning curve included both measures of patient outcome and measures of task efficiency. Study end points included both short- and long-term outcomes. RESULTS: Analysis of task efficiency showed that there was a statistically significant inverse correlation between the surgeon's level of experience and both cardiopulmonary bypass time (P = 0.026) and aortic cross-clamp time (P = 0.017). Analysis of patient outcome revealed that the incidence of aortic valve-related reoperation during follow-up showed a significant inverse correlation with the surgeon's level of experience (P = 0.048). Cox regression analysis found that the surgeon's level of experience (odds ratio 0.802, 95% confidence interval 0.673-0.957; P = 0.014) was a significant risk factor for aortic valve-related reoperation-free survival during follow-up. CONCLUSIONS: There is a surgeon's learning curve for aortic valve-sparing David procedure. The surgeon's experience has a direct impact on both the perioperative outcome and the long-term performance of the aortic valve.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Feminino , Implante de Prótese de Valva Cardíaca/educação , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
9.
BMC Cardiovasc Disord ; 20(1): 20, 2020 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-31952508

RESUMO

BACKGROUND: Cardiorenal syndrome (CRS) is a group of pathophysiological disorders affecting heart and kidneys. CASE PRESENTATION: We present 44-year-old kidney transplant recipient with acute-on-chronic graft failure in the course of CRS due to acutely decompensated heart failure associated with severe aortic regurgitation successfully treated with aortic valve replacement. Because of graft failure progression and difficult to eradicate infections he was treated with dialysis and radical minimization of immunosuppression. After 74 days of renal replacement therapy the patient regained graft function after successful aortic valve replacement. The dialysis could be stopped and immunosuppressive therapy was reintroduced. Heart and renal function are stable and patient is doing well without dialysis for 3 years. CONCLUSIONS: The return of kidney graft function can occur even after a long period of dialysis therapy due to improved cardiovascular function. Therefore, distinguishing an acute-on-chronic CRS subtype is mandatory to enable specific patient approach.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Síndrome Cardiorrenal/cirurgia , Insuficiência Cardíaca/fisiopatologia , Implante de Prótese de Valva Cardíaca , Transplante de Rim/efeitos adversos , Insuficiência Renal Crônica/fisiopatologia , Adulto , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Síndrome Cardiorrenal/diagnóstico , Síndrome Cardiorrenal/etiologia , Síndrome Cardiorrenal/fisiopatologia , Sobrevivência de Enxerto , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Imunossupressores/administração & dosagem , Masculino , Recuperação de Função Fisiológica , Diálise Renal , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Ann Thorac Surg ; 110(3): 836-843, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31991135

RESUMO

BACKGROUND: The aim of this study was to evaluate the incidence, risk factors, and clinical impact of progression of aortic insufficiency (AI) after left ventricular assist device (LVAD) implantation. METHODS: Patients undergoing primary durable LVAD implantation between 2004 and 2018 were included. Significant AI was defined as more than mild AI. Clinical and echocardiographic data were collected. Patients were stratified by degree of pre-LVAD AI into 3 groups: no AI, group I; trace AI, group II; and mild AI, group III. RESULTS: Three hundred sixteen eligible patients underwent LVAD implant, 229 patients (72.5%) in group I, 54 (17.1%) in group II, and 33 (10.4%) in group III. Median follow-up was 469 days. Forty-two patients (13.3%) progressed to significant AI during follow-up. Group III patients had the highest rate of developing significant AI (I, 10.0%; II, 13.0%; III, 36.4%; P = .002). Freedom from significant AI at 1 year after LVAD implant was 94.5% in group I, 86.1% in group II, and 62.4% in group III (P < .001). Predictors of developing significant AI included mild preoperative AI, ischemic cardiomyopathy, and shorter duration of LVAD support. Patients with significant AI after LVAD implantation had higher mortality compared with those without (59.5% vs 37.2%; P = .006). CONCLUSIONS: Although some patients supported with an LVAD develop significant AI, this risk is increased in those with mild AI preoperatively. This finding, in conjunction with the increased mortality risk once significant AI develops, suggests that closer follow-up and management of LVAD patients with mild preoperative AI may be prudent.


Assuntos
Insuficiência da Valva Aórtica/epidemiologia , Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Insuficiência da Valva Aórtica/diagnóstico , Progressão da Doença , Ecocardiografia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
11.
Ann Thorac Surg ; 109(6): e435-e437, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31760052

RESUMO

The history of aortic valve surgery began with the Hufnagel procedure. In 1953, Hufnagel reported the first successful treatment of aortic insufficiency by the implantation of a ball-valve prosthesis into the descending aorta. We present a 33-year-old male patient with a complicated surgical history needing a sixth-time redo aortic valve replacement for severe prosthetic paravalvular leak in the presence of fresh intracranial hemorrhage. His deteriorating clinical picture was successfully temporized by a transcatheter valve placement in the descending aorta (modified Hufnagel procedure). This report illustrates a potential role of a modified Hufnagel procedure as a bridge to definitive surgery.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Adulto , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Ecocardiografia Transesofagiana , Endossonografia , Humanos , Masculino , Desenho de Prótese , Tomografia Computadorizada por Raios X
12.
Ann Thorac Surg ; 109(3): 945-949, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31756319

RESUMO

PURPOSE: Aortic insufficiency (AI) significantly affects morbidity and mortality in patients with left ventricular assist devices. Although AI may be commonly assessed by echocardiography, expert techniques are required for accurate quantification of AI severity. DESCRIPTION: In this prospective blinded study, screenshots from the HVAD (Medtronic, Framingham, MA) display and simultaneous echocardiographic measurements were obtained. Each screenshot was digitized and the early diastolic phase slope was calculated, with blinding to the echocardiographic results. The regurgitant fraction of AI was quantified by Doppler echocardiography of the outflow graft. EVALUATION: A total of 30 patients (median, 57 years old; 57% male) were enrolled. A cutoff of -17.6 L/min/s for the early diastolic phase slope had a sensitivity of 0.92 and a specificity of 0.53 to estimate significant AI with a regurgitant fraction of 30% or greater, and it significantly stratified patients into a low regurgitant faction group (0.3%) and a high regurgitant fraction group (33.0%) (P = .009). The early diastolic phase slope had a moderate correlation with the actually measured regurgitant fraction (r = .50). CONCLUSIONS: The early diastolic phase slope of the HVAD flow waveform may be a parameter that can estimate the presence of clinically significant AI.


Assuntos
Insuficiência da Valva Aórtica/diagnóstico , Valva Aórtica/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo/fisiologia , Ecocardiografia Doppler/métodos , Coração Auxiliar/efeitos adversos , Adulto , Idoso , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/epidemiologia , Insuficiência da Valva Aórtica/etiologia , Feminino , Humanos , Illinois/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença
13.
Ann Thorac Surg ; 109(6): 1820-1825, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31697908

RESUMO

BACKGROUND: Aortic annular erosion is a serious complication of aortic valve endocarditis or previous aortic valve replacement. This study examined the outcomes of a technique for left ventricular outflow tract reconstruction using a polyester tube graft, followed by translocation of the aortic valve and coronary arteries. METHODS: A total of 23 patients with extensive annular erosion resulting from endocarditis or previous aortic valve replacement with or without pseudoaneurysm formation, or occurring after excision of the native valve, underwent suture of a polyester tube graft in the left ventricular outflow tract below the annulus, replacement of the aortic valve and proximal ascending aorta with a composite graft, and reimplantation of the coronary arteries with the use of interposition polyester grafts. The mean age of the patients was 50 years, and 57% were men. RESULTS: There were no hospital deaths. The mean duration of follow-up was 6.5 years and extended to 16 years. Actuarial survival at 1, 5, and 10 years was 86.7%, 82.2%, and 62.6%, respectively. Two patients required reoperation for a graft-graft pseudoaneurysm and for degeneration of a porcine bioprosthesis. Echocardiograms obtained at a mean of 75 months postoperatively in 15 of the 23 patients demonstrated normal left ventricular outflow tract dimensions and velocities and a mean effective valve orifice area of 1.07 cm2/m2. All coronary artery grafts were patent on angiography a mean of 40 months postoperatively in 13 patients. CONCLUSIONS: Extended experience with this technique confirms its safety and effectiveness for patients with extensive destruction of the aortic annulus. It represents a suitable alternative to other currently used techniques.


Assuntos
Aorta/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Prótese Vascular , Endocardite/cirurgia , Previsões , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Ecocardiografia , Endocardite/complicações , Endocardite/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos
14.
Ann Thorac Surg ; 109(5): 1605-1610, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31881195

RESUMO

PURPOSE: The aortic root pressurizing device was developed for aortic valve repair surgery. It allows echocardiographic evaluation of the aortic valve during cardioplegic arrest by mimicking diastolic afterload. DESCRIPTION: This polyoxymethylene or polyether ether ketone-based device consists of a sealing cap nut, a sealing ring, a plug screw, and both a filling and a ventilation line. It can be easily connected to any size of aortic Dacron grafts. EVALUATION: The device was tested in 15 porcine hearts using a beating heart biosimulator including hemodynamic and echocardiographic monitoring. Valve competence was analyzed on both the beating and resting heart at 60 and 45 mm Hg root pressure. Aortic insufficiency was surgically induced by leaflet manipulation. Native aortic valves showed either none or trivial aortic insufficiency. After leaflet manipulation echocardiographic proof of valve insufficiency was possible in all specimen. Jet direction was identic in all cases at 60 mm Hg and 93% at 45 mm Hg root pressure. CONCLUSIONS: The aortic root pressurizing device shows highly comparable results of echocardiographic aortic valve evaluation between static and dynamic settings under experimental conditions.


Assuntos
Aorta Torácica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Parada Cardíaca Induzida/métodos , Próteses Valvulares Cardíacas , Animais , Insuficiência da Valva Aórtica/diagnóstico , Cateterismo Cardíaco , Modelos Animais de Doenças , Ecocardiografia , Pressão , Desenho de Prótese , Suínos
15.
Revista Digital de Postgrado ; 9(1): e194, 2020. ilus
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1095043

RESUMO

El implante valvular aórtico transcatéter, es un procedimiento cardiovascular de mínima invasión y una alternativa frente a la intervención convencional, en insuficiencia aórtica severa. En este trabajo se realiza una revisión de las complicaciones y la sobrevida, en pacientes sometidos a TAVI, frente a remplazo aórtico tradicional. Para ello se realizó una investigación documental con información entre los años 2010-2018. El implante valvular aórtico transcatéter debe efectuarse vía transfemoral o transapical, con una válvula Core o Sapien XT, según la necesidad del individuo, para evitar la regurgitación para valvular. Con este implante disminuyen las complicaciones y se remodela el ventrículo izquierdo; reduciendo la disnea y mejorando el pronóstico vida y la tasa de mortalidad en comparación con otros métodos(AU)


The transcatheter aortic valve implant is a minimally invasive cardiovascular procedure and, an alternative to conventional intervention in severe aortic insufficiency. In this work, a review of complications and survival is performed in patients undergoing TAVI, compared to traditional aortic replacement. For this, a documentary investigation was carried out with information between the years 2010-2018. The transcatheter aortic valve implant should be performed transfemorally or transapically, with a Core or Sapien XT valve, depending on the individual's need, to avoid regurgitation to valvulate. With this implant the complications decrease and the left ventricle is remodeled; reducing breathlessness and improving the life prognosis and mortality rate compared to other methods(AU)


Assuntos
Humanos , Insuficiência da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Radiografia Torácica/métodos , Substituição da Valva Aórtica Transcateter/métodos , Liberação de Cirurgia , Angiografia/métodos , Cateterismo Cardíaco , Taxa de Sobrevida , Estudos Retrospectivos
16.
J Cardiothorac Surg ; 14(1): 219, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852537

RESUMO

BACKGROUND: Left ventricular assist devices (LVAD) have become a common treatment option in advanced heart failure. Lack of aortic valve opening during left ventricular unloading is a common complication and associated with a worse outcome. Maintaining a minimum pulse pressure is an important goal during the early postoperative period after LVAD implantation since it is commonly seen as secure sign of aortic valve opening. AIMS/OBJECTIVE: We report a case of an LVAD-supported patient with early permanent closure of the aortic valve despite a pulse pressure > 15 mmHg at all times following LVAD implantation. We demonstrate how careful assessment of the invasive arterial blood pressure curve can indicate aortic valve closure irrespective of pulsatile blood flow. METHOD: A 69-year old male patient with terminal ischemic cardiomyopathy was referred for long-term mechanical circulatory support. Due to mild aortic regurgitation both an aortic bioprosthesis and a continuous-flow left ventricular assist device were implanted. Postoperative echocardiography documented a patent aortic bioprosthesis and an acceptable residual systolic left ventricular contractility. During invasive arterial blood pressure monitoring repetitive transient slight blood pressure decreases followed by slight blood pressure increases coincided with programmed LVAD flushing cycles. Permanent pulsatile flow with a pulse pressure of ≥15 mmHg conveyed systolic opening of the aortic valve. Echocardiography, however, proved early permanent aortic valve closure. In retrospect, transformation of the automated LVAD flushing cycles into visible changes of the arterial blood pressure curve during invasive blood pressure monitoring is indicative of ejection of the complete cardiac output through LVAD itself, and therefore an early clinical sign of aortic valve closure. DISCUSSION/CONCLUSION: We present this interesting didactic case to highlight caveats during the early postoperative period after LVAD implantation. Moreover, this case demonstrates that careful and differentiated observation of the arterial blood pressure waveform provides crucial information in this unique and growing patient population of continuous-flow LVAD support.


Assuntos
Insuficiência da Valva Aórtica/diagnóstico , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Idoso , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Pressão Sanguínea/fisiologia , Diagnóstico Diferencial , Ecocardiografia , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Fluxo Pulsátil , Sístole
17.
Medicine (Baltimore) ; 98(48): e18169, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770266

RESUMO

INTRODUCTION: Sinus of Valsalva aneurysm (SVA) protruding into the mitral anterior leaflet is an extremely rare clinical condition; herein, we present a case of unruptured noncoronary SVA protruding into the mitral anterior leaflet. PATIENT'S CONCERNS: A 46-year-old male was referred to hospital for exertional dyspnea. DIAGNOSIS: Transthoracic echocardiography (TTE) and coronary computed tomography angiography (CTA) suggested a noncoronary SVA protruding into the mitral anterior leaflet, causing mitral regurgitation and aortic insufficiency. INTERVENTIONS: The aneurysm was resected and the aortic and mitral valves were replaced with mechanical valves via a transaortic approach. OUTCOMES: Postoperative recovery was uneventful. CONCLUSIONS: A rare noncoronary SVA protruding into the mitral anterior leaflet can be diagnosed via TTE and CTA. Transaortic mitral surgery is feasible in patients with a dilated aortic annulus ring and mitral valve diseases.


Assuntos
Aneurisma Aórtico , Insuficiência da Valva Aórtica , Dispneia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral , Valva Mitral , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/fisiopatologia , Aneurisma Aórtico/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Dispneia/diagnóstico , Dispneia/etiologia , Dispneia/fisiopatologia , Ecocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/fisiopatologia , Resultado do Tratamento
18.
J Am Coll Cardiol ; 74(20): 2480-2492, 2019 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-31727286

RESUMO

BACKGROUND: The natural history of stage B aortic regurgitation (AR) is unknown. OBJECTIVES: This study sought to examine determinants, rate, and consequences of progression of AR. METHODS: Consecutive patients with ≤moderate chronic AR quantified by effective regurgitant orifice area (EROA) and regurgitant volume (RVol) from 2004 to 2017 who had ≥1 subsequent echocardiogram with quantitation were included. RESULTS: Of 1,077 patients (66 ± 15 years of age), baseline trivial/mild AR was noted in 196 (18%), mild-to-moderate AR in 465 (43%), and moderate AR in 416 (39%); 10-year incidence of progression to ≥moderate-severe AR (stage C/D; progressors) was 12%, 30%, and 53%, respectively. At 4.1-year follow-up (interquartile range: 2.1 to 7.2 years), there were 228 progressors (21%), whose annualized progression rates within 3 years before diagnosis of ≥moderate-severe AR were 4.2 mm2/year for EROA and 9.9 ml/year for RVol. Baseline AR severity and dimensions of sinotubular junction and annulus were associated with progression (all p ≤ 0.007); hypertension and systolic blood pressure were not. Progressors had faster chamber remodeling, functional class decline, and more aortic valve/aortic surgery. At medium-term follow-up, 242 patients (22%) died; poor survival was linked to age, comorbidities, functional class, resting heart rate, and left ventricular (LV) ejection fraction (p ≤ 0.003), not LV end-systolic dimension index. Survival after progression to stage C/D AR was associated with LV end-systolic dimension index (adjusted p = 0.02). CONCLUSIONS: Progression from stage B to stage C/D AR was observed in 21% patients. Repeat echocardiography for trivial/mild, mild-to-moderate, and moderate AR at every 5, 3, and 1 years, respectively, was reasonable. EROA, RVol, annulus, and sinotubular junction should be routinely measured to estimate progression rates and identify patients at high risk of progression, which was associated with adverse consequences.


Assuntos
Insuficiência da Valva Aórtica/complicações , Idoso , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/mortalidade , Estudos de Coortes , Progressão da Doença , Ecocardiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico , Taxa de Sobrevida , Função Ventricular Esquerda
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...