Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.661
Filtrar
1.
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
2.
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
3.
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
7.
J Med Case Rep ; 13(1): 297, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31537200

RESUMO

BACKGROUND: A unicuspid aortic valve is a rare congenital cardiac abnormality. Despite its uncommon finding on an initial presentation, aortic insufficiency is accompanied with unicuspid aortic valve and this might reflect the natural history of progression in the morphology of unicuspid aortic valve. CASE PRESENTATION: We describe a 65-year-old Japanese man who was evaluated for endocarditis and found to have a unicuspid aortic valve concomitant with moderate aortic insufficiency, which was, owing to the lack of evidence of valve membrane destruction, independent of underlying infectious endocarditis. In addition, aortic insufficiency was progressed because of nonbacterial thrombotic endocarditis on the ventricular side, in areas of high turbulence around the heart valve. CONCLUSIONS: Our case is unusual given the unicuspid aortic valve concomitant with aortic insufficiency, which was presumably independent of underlying infectious endocarditis because of the location of the vegetation and the lack of evidence of valve destruction. Therefore, attention should be paid to a variety of complications in the setting of unicuspid aortic valve.


Assuntos
Insuficiência da Valva Aórtica/diagnóstico , Valva Aórtica/anormalidades , Endocardite/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Ecocardiografia Transesofagiana , Endocardite/tratamento farmacológico , Implante de Prótese de Valva Cardíaca , Humanos , Masculino
8.
Cardiol Young ; 29(9): 1206-1207, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31434603

RESUMO

Ventricular pseudoaneurysm is a rare but well-known complication after valvular endocarditis. The lesion was localised exactly where pre-operative CT scan showed lack of enhancement in the postero-lateral wall of the left ventricle. This case demonstrates how much attention must be paid to myocardial CT images and emphazises the need of close follow-up in patients with infective endocartitis.


Assuntos
Falso Aneurisma/diagnóstico , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Endocardite Bacteriana/complicações , Aneurisma Cardíaco/diagnóstico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Criança , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração , Humanos , Masculino , Reoperação
9.
S D Med ; 72(6): 272-273, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31461233

RESUMO

Quadricuspid aortic valve is a rare cause of symptomatic aortic regurgitation. It tends to present earlier than degenerative native valve aortic regurgitation but with similar symptoms. The condition can occur in isolation or in association with other congenital cardiac abnormalities. Surgical intervention before the development of left ventricular failure is critical to improve long term survival. We describe a case of severe aortic regurgitation due to isolated quadricuspid valve morphology that was treated surgically.


Assuntos
Insuficiência da Valva Aórtica , Valva Aórtica/patologia , Cardiopatias Congênitas , Insuficiência Cardíaca , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Humanos
10.
Clin Res Cardiol ; 108(10): 1069-1073, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31267238

RESUMO

Implantation of bioprosthetic surgical valves has been a common procedure in elderly patients with severe aortic stenosis due to patients´ preferences avoiding anticoagulation therapy. However, this valve presents sometime certain deterioration degree (i.e., dysfunction due to stenosis or regurgitation) or even paravalvular leak. Transcatheter heart valve implantation is a good alternative in high-risk patients. The valve-in-valve procedure has been shown to be a safe and effective procedure. However, the presence of the fixed sewing ring of the surgical bioprosthesis can hamper appropriate expansion of the THV. For this reason, the use of cracking balloon seems to be a safe alternative to increase the effective orifice area. We present a case of a patient with a degenerated previous implanted biological valve and paravalvular leak. We used the treatment strategy of valve-in-valve with post-dilatation with high-pressure balloon, in a way to treat both, the degenerated valve and the paravalvular leak. The use of a single percutaneous procedure was enough and safe to treat both problems without further complications.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/diagnóstico , Ecocardiografia , Humanos , Masculino , Desenho de Prótese , Falha de Prótese , Reoperação
11.
Cardiol Young ; 29(6): 837-839, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169113

RESUMO

A neonate presented with signs of heart failure early after a Norwood procedure, due to increase of aortic and mitral valve regurgitation. Because repeated surgery was considered risky, we closed the aortic valve by catheter intervention with an Amplatzer Duct Occluder. Aortic regurgitation was abolished almost completely and the child improved. Unfortunately, 2 weeks after discharge, the patient died suddenly.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Procedimentos de Norwood/efeitos adversos , Complicações Pós-Operatórias , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Ecocardiografia , Evolução Fatal , Seguimentos , Humanos , Recém-Nascido , Masculino , Reoperação , Fatores de Tempo
12.
PLoS One ; 14(5): e0217544, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150455

RESUMO

AIMS: More than mild paravalvular aortic regurgitation (pAR) negatively impacts prognosis after transcatheter aortic valve implantation (TAVI). "Newer generation" transcatheter heart valves (THVs) including Direct Flow Medical, Medtronic Evolut R, Boston Lotus, and Edwards SAPIEN 3 valve system promise to improve outcome by reducing the rate of TAVI-related issues such as pAR. Aim was to evaluate and compare the hemodynamic performance with AR index of "early" vs. "newer generation" THVs and its impact on outcome. METHODS AND RESULTS: In 805 patients undergoing TAVI, the degree of pAR was assessed using imaging modalities (angiography, echocardiography) and hemodynamic measurements (aortic regurgitation index, ARI ratio). Severity of pAR and outcome were assessed according to the VARC-2 criteria. 805 patients underwent TAVI with use of the CoreValve (n = 400), SAPIEN XT (n = 48), Direct Flow Medical (n = 38), Evolut R (n = 114), Lotus (n = 104), or SAPIEN 3 (n = 101) prosthesis. TTE post TAVI revealed that a total of 7.3% of the patients showed moderate/severe pAR. The occurrence of greater than mild pAR occurred less frequently in patients treated with "newer generation" THVs (p<0.001): CoreValve (11.3%), SAPIEN XT (12.5%), Direct Flow Medical (5.3%), Evolut R (5.3%), Lotus (0.0%), and SAPIEN 3 (0.0%). The AR index was significantly higher (p<0.001) in patients receiving "newer generation" prostheses compared to those in whom "earlier generation" THVs were used. However, the ARI was only predictive of cumulative all-cause mortality at 1 and 3 years in "early generation", but not in "newer generation" THVs. In the overall cohort, 30-day and 1-year mortality was 4.8% and 20.1%, respectively. In patients treated with "newer generation" devices, the respective mortality rates remained substantially below those of patients treated with "earlier generation" THVs (30-day mortality: 2.5% vs. 6.7%, p< 0.001; 1-year mortality: 11.2% vs. 27.2%, p<0.001). CONCLUSION: TAVI with use of "newer generation" THVs showed significantly reduced pAR and improved outcomes compared to "early generation" devices that could at least in part be explained by more favorable hemodynamics.


Assuntos
Insuficiência da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Idoso de 80 Anos ou mais , Angiografia , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/prevenção & controle , Estenose da Valva Aórtica/mortalidade , Ecocardiografia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Desenho de Prótese , Estudos Retrospectivos , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
13.
Heart Lung Circ ; 28(10): e131-e133, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31175018

RESUMO

BACKGROUND: Structural valve degeneration is a known sequel of aortic valve replacement with bioprosthetic valves, not infrequently leading to redo valve replacement. Reoperation on the aortic valve is associated with an incumbent increase in perioperative risk, and this risk is further increased when reoperation is performed on an already replaced aortic root. METHODS: We present a technique of opening the aortic graft and explanting the bioprosthesis by dividing the plane between the stent frame and the sewing ring of the bioprosthesis, followed by re-implantation of a bioprosthesis using simple sutures incorporating the remaining valve seat. RESULTS: The patient experienced an uneventful postoperative course and was discharged on the fifth day postoperatively. CONCLUSIONS: The author presents a simple and reproducible technique to replace a degenerated bioprosthetic aortic valve while preserving the previous aortic root replacement.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas/efeitos adversos , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Ecocardiografia Transesofagiana , Humanos , Masculino , Falha de Prótese , Reoperação , Técnicas de Sutura
14.
World J Pediatr Congenit Heart Surg ; 10(3): 364-366, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31084313

RESUMO

The aim of this study is to analyze the adaptation properties of the pulmonary autograft in four infants who underwent the Ross operation before one year of life. The patients underwent serial echocardiographic assessments of the autograft diameters at short- and long-term follow-up and values were reported as the Z scores for normal aortic and pulmonary diameters. At a median follow-up time of 18.5 years (range: 18.2-19.4 years), all the patients are alive, none requiring autograft reinterventions. This series shows excellent adaptation potential of the "infant pulmonary autograph" in the long-term, during somatic growth of the patient.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Previsões , Valva Pulmonar/transplante , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/congênito , Insuficiência da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Valva Pulmonar/diagnóstico por imagem , Reoperação , Transplante Autólogo
16.
J Vet Intern Med ; 33(3): 1446-1455, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30938891

RESUMO

BACKGROUND: Noninvasive blood pressures (NIBP) and pulse pressures (PP) have not been published in horses with aortic and mitral regurgitation (AR or MR). OBJECTIVES: To investigate NIBP and PP in healthy Warmblood horses and horses with AR and MR and propose PP cutoffs to identify and stage AR severity. ANIMALS: Seventy-three Warmblood horses (healthy, 10; AR, 31; MR, 32). METHODS: Retrospective study. All horses had NIBP and an echocardiogram recorded. Cases were categorized based on severity of regurgitation. Pulse pressures were compared among healthy, MR, and AR groups and among AR severity groups. Cutoffs were determined by receiver operating characteristic curve analyses. RESULTS: Horses with AR had higher PP than horses with MR (mean difference [95% confidence interval (CI)], +17 [9-26] mm Hg, P < .001) and controls (+17 [5-30] mm Hg; P =.004). Horses with severe AR had higher PP compared those with mild (+38 [20-54] mm Hg; P < 0.001) and moderate AR (+33 [18-47] mm Hg; P < .001). The PP cutoffs to distinguish AR from MR and controls were 38 mm Hg (sensitivity [Sn], 100%; specificity [Sp], 19%) for maximal Sn and 61 mm Hg (Sn, 43%; Sp, 100%) for maximal Sp. The PP cutoffs to distinguish severe AR from mild and moderate AR were 57 mm Hg (Sn, 100%; Sp, 70%) for maximal Sn and 77 mm Hg (Sn, 75%; Sp, 100%) for maximal Sp. CONCLUSIONS AND CLINICAL IMPORTANCE: Horses with AR have increased PP. Noninvasive PP measurements interpreted with provided cutoffs may aid clinicians in diagnosing and staging severity of AR in horses.


Assuntos
Insuficiência da Valva Aórtica/veterinária , Pressão Sanguínea/fisiologia , Doenças dos Cavalos/diagnóstico , Insuficiência da Valva Mitral/veterinária , Animais , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/diagnóstico por imagem , Ecocardiografia/veterinária , Feminino , Doenças dos Cavalos/diagnóstico por imagem , Cavalos , Masculino , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/diagnóstico por imagem , Estudos Retrospectivos
17.
Gen Thorac Cardiovasc Surg ; 67(10): 855-860, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30963397

RESUMO

OBJECTIVE: Whether mild to moderate and moderate aortic regurgitation should be corrected surgically during other cardiovascular surgeries remains controversial. We evaluated the effectiveness of external suture annuloplasty in such cases. METHODS: Among 95 patients undergoing aortic valve repair between December 2013 and March 2018, five patients with mild to moderate and moderate aortic regurgitation due to aortic annulus dilatation (type Ic lesion) underwent surgery for mitral regurgitation and/or thoracic aortic aneurysm. Aortic valves were repaired with external suture annuloplasty alone with a mean Hegar dilator size of 20.4 ± 0.8 (20.0-22.0) mm at the same time and were followed up echocardiographically. RESULTS: There were no cases of mortality or major morbidity. Intraoperative direct measurement revealed ventriculoaortic junction size of 25.0 ± 0.8 (24.0-27.0) mm. The average cardiopulmonary bypass time and aortic cross-clamping time were 139 ± 46 (76-205) min and 105 ± 38 (58-172) min, respectively. Postoperative transthoracic echocardiogram during hospitalization showed trivial aortic regurgitation in all cases, with average ventriculoaortic junction size, aortic valve area, and peak and mean transvalvular gradient of 19.1 ± 0.7 (18.0-20.3) mm, 2.24 ± 0.48 (1.60-3.00) cm2, 6.4 ± 1.9 (4.0-9.2) mmHg, and 3.5 ± 1.1 (2.1-5.2) mmHg, respectively. Ventriculoaortic junction size was significantly decreased (P < 0.05). There have been no changes in ventriculoaortic junction size (P = 0.32) or other echocardiographic findings for 24 ± 6 (17-36) months after surgery. CONCLUSIONS: Although concomitant with other cardiac surgeries, mild to moderate and moderate aortic regurgitation could be repaired without clinically relevant additional surgical duration. External suture annuloplasty is a useful, safe, and secure treatment choice for type Ic lesion-induced aortic regurgitation.


Assuntos
Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Técnicas de Sutura , Idoso , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
18.
Int J Cardiol ; 286: 117-120, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30954286

RESUMO

BACKGROUND: Bicuspid aortic valve (BAV) is the most frequent cardiac congenital valvular disease. Although the BAV risk of first degree relatives (FDR) has been assessed (7-9%), there is little information as to the heritable risk for aortopathy. OBJECTIVE: Identify the specific risk for regional aortopathy in FDR with tricuspid aortic valve (TAV) of BAV patients according to their aortic phenotype and aortic regurgitation (AR). METHODS: Using an international consortium, BAV probands were assessed for aortopathy of the root, ascending aorta and for AR. Aortopathy was defined by the presence of segmental dilatation. The presence of segmental aortopathy and AR in BAV probands was evaluated as predictor for aortopathy in FDR with TAV. RESULTS: We identified 74 FDR related to 49 probands with aortopathy and 66 FDR related to 31 probands without aortopathy. Demographic variables were similar between proband groups. Among FDR, 16 individuals had BAV (11.4%). TAV-FDR of probands with ascending aortopathy had higher incidence of root aortopathy (18.8% vs. 3.6% p < 0.05) while TAV-FDR of probands with root aortopathy had higher incidence of aortopathy at all aortic segments (55%vs25%, 55%vs21%, and 4%vs29% at annulus, root and ascending respectively, p < 0.05 for all). Independent predictors for root aortopathy in TAV-FDR were: ascending (OR = 6.23;95%CI:1.27-30.5) and root aortopathy (OR = 9.00;95%CI:1.58-51.1) in probands; and for ascending aortopathy: root aortopathy (OR = 4.04;95%CI:1.33-12.3) and AR in probands (OR = 4.84; 95%CI:1.75-13.4). CONCLUSION: Root and ascending aortopathy in BAV probands are strong predictors of aortopathy in their TAV-FDR. AR in BAV patients has an independent effect on the risk for ascending aortopathy in TAV-FDR.


Assuntos
Aorta Torácica , Doenças da Aorta/etiologia , Insuficiência da Valva Aórtica/complicações , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/complicações , Medição de Risco/métodos , Idoso , Doenças da Aorta/epidemiologia , Doenças da Aorta/genética , Insuficiência da Valva Aórtica/diagnóstico , Aortografia , Estudos Transversais , Ecocardiografia , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Linhagem , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Uruguai/epidemiologia
19.
J Invasive Cardiol ; 31(5): E76-E82, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034438

RESUMO

BACKGROUND: In transcatheter aortic valve implantation (TAVI), prosthesis over-sizing prevents paravalvular leak (PVL). Strategies of over-sizing for self-expanding bioprostheses are not well established at present. METHODS: Patients with aortic valve stenosis scheduled for TAVI underwent preprocedural multislice computed tomography. Based on the degree of over-sizing, a ROC curve was drawn to define the optimal value of valve sizing for reducing PVL after TAVI. RESULTS: A total of 152 consecutive patients were included in the study (mean age, 79.95 ± 7.71 years; log EuroScore: 23.87 ± 8.93%). Based on the ROC curve, sizing of 14% was the optimal that would lead to less moderate/severe PVL (P<.01). Group 1 was defined as sizing <14% (n = 49 patients) and group 2 was defined as sizing ≥14% (n = 103 patients). During a follow-up period of 36 ± 14 months, a total of 9 patients died from group 1 vs 4 patients from group 2 (P<.01). Two of the patients who died had moderate/severe PVL and 11 had no/mild PVL (P=.27). From the population, a total of 49 patients (32%) were found to be in the "borderline" zone. Patients who received the smaller valve had lower mean left ventricular outflow tract diameter (P=.048), higher rate of calcium load (mild: 10 [32%] vs 13 [72%]; moderate: 16 [52%] vs 3 [17%]; severe: 5 [16%] vs 2 [11%]; P=.02) and lower mean of sinus of Valsalva diameter (P=.046) compared with patients who received the bigger valve. CONCLUSIONS: In patients undergoing TAVI, over-sizing the prosthesis at least 14% reduces PVL. In borderline cases, taking into consideration additional anatomical parameters may result in low rates of PVL.


Assuntos
Insuficiência da Valva Aórtica , Valva Aórtica , Próteses Valvulares Cardíacas , Tomografia Computadorizada Multidetectores , Complicações Pós-Operatórias , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/prevenção & controle , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Feminino , Grécia , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/normas , Humanos , Masculino , Tomografia Computadorizada Multidetectores/métodos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Falha de Prótese/etiologia , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA