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1.
West Afr J Med ; 37(1): 58-61, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030713

RESUMO

BACKGROUND: Transthoracic open surgical ligation (TTOSL) of patent ductus arteriosus (PDA) remains the most readily available and affordable treatment option in resource-poor countries such as Nigeria. OBJECTIVES: To determine the incidence and outcome of aortic valve regurgitation (AR) following TTOSL of PDA. METHODS: Retrospective audit of consecutive patients who underwent TTOSL of PDA over a 4½-year period (January 2015 to June 2019) at the OAUTHC, Ile-Ife, Nigeria. Hospital records including echocardiograms (pre-operative, immediate post-operative and follow-up performed a day after TTOSL, at 1, 3 and 12 months) were reviewed for presence and severity of AR. RESULTS: Twenty-six patients (11 males and 15 females) aged 3 months 24 years (Mean = 3.16 years) had TTOS PDA ligation. Only 3 (11.5%) patients had AR pre-operatively; 2 graded moderate AR and 1 graded mild. Twenty (76.9 %) patients had immediate post-operative AR; 4 (20.0%) of which were moderate and the others (80.0%) were mild. Eighteen (69.2%) patients still had AR post-operative day 1; 16 were mild and the rest 2 which were moderate were the same patients that had AR pre-operatively. At 3 months follow-up, 6 of 20 patients (30.0%) had AR; all were mild. Only 2 of 18 (11.1%) followed up for 12 months had AR. They both had had moderate AR pre-operatively which were now graded as mild. There was no mortality. CONCLUSION: Aortic regurgitation is common after TTOSL of PDA. However, in most instances, it is mild and transient.


Assuntos
Insuficiência da Valva Aórtica/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/cirurgia , Adolescente , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/epidemiologia , Criança , Pré-Escolar , Permeabilidade do Canal Arterial/epidemiologia , Ecocardiografia , Feminino , Humanos , Incidência , Lactente , Masculino , Nigéria/epidemiologia , Complicações Pós-Operatórias , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
2.
J Cardiothorac Surg ; 15(1): 28, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992348

RESUMO

BACKGROUND: To investigate the safety and efficacy of perventricular device closure of doubly committed subarterial ventricular septal defects (dcsVSDs). METHODS: PubMed and Scopus were searched for studies in English that focused on perventricular device closure of dcsVSDs and were published up to the end of September 2019. We used a random-effects model to obtain pooled estimates of the success and complication rates. RESULTS: A total of 9 publications including 459 patients with dcsVSDs were included. The median follow-up duration ranged from 2 months to 5 years, with the mean age of patients ranging from 6.1 months to 4.5 years. The pooled estimate of the overall success rate of device closure in the 9 studies was 0.89 (95% CI: 0.86-0.93, I2 = 26.5%, P = 0.208). Further meta-regression analysis indicated no significant correlation between the success rate and the following factors: publication year, sample size, study type, mean age, mean weight, mean VSD size, and ratio of device size/weight. The pooled rate of postoperative aortic regurgitation was 0.045 (95% CI: 0.018-0.071, I2 = 50.96%, P = 0.000). The pooled rate of follow-up aortic regurgitation (AR) was 0.001 (95% CI, - 0.003-0.004, I2 = 63.00%, P = 0.009.) The pooled estimated rate of severe intraoperative complications was 0.106 (0.073-0.140, I2 = 70.7%, P = 0.208). Postoperative and follow-up complications were rare. No occurrence of a complete atrioventricular block was reported up to the last follow-up visit. CONCLUSIONS: Perventricular device closure may be an alternative to conventional surgical repair in selected patients with dcsVSDs. The success rate was stable regarding the publication year and sample size, suggesting a relatively short learning curve and the technique's potential for application.


Assuntos
Procedimentos Cirúrgicos Cardíacos/instrumentação , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal , Insuficiência da Valva Aórtica/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Complicações Intraoperatórias , Curva de Aprendizado , Masculino , Complicações Pós-Operatórias , Resultado do Tratamento
3.
N Engl J Med ; 382(9): 799-809, 2020 02 27.
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
4.
J Cardiothorac Surg ; 15(1): 6, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915041

RESUMO

BACKGROUND: Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, with an incidence of less than 1% of open heart surgery cases. Its evolution is most frequently silent, being found incidentally or discovered in the event of its acute rupture. Non-ruptured giant SVAs may cause unusual clinical manifestations, as a consequence of their protrusion into the heart chambers or compression of the coronary vessels and are frequently associated with aortic insufficiency of various degrees of severity. The gold standard treatment for SVAs consists of complete replacement of the aortic root and valve. However, in certain cases, valve-sparing procedures may prove to be a more suitable alternative. CASE PRESENTATION: A 68-year-old male patient presented with dyspnea as symptom caused by a large (> 5 cm) right sinus of Valsalva aneurysm. The aneurysm was occupying most of the right ventricle and was associated with severe aortic regurgitation. The surgical treatment of the condition involved valve-sparing root reconstruction procedure (remodeling technique), completed with external stabilization of the aortic valve annulus via running suture annuloplasty. Following the uneventful intervention, the patient did well and his status improved. The follow-up transthoracic echocardiography obtained 1 month after surgery showed a fully competent aortic valve with no regurgitation. CONCLUSIONS: Despite complete aortic root and valve replacement being considered the safest approach to large SVAs complicated with aortic insufficiency, valve-sparing procedures should not be overlooked in case of a dilated aortic root with uncalcified aortic valve. Performing valve-sparing by applying a remodeling technique operation completed with annuloplasty reduces aortic valve insufficiency, avoiding side-effects related to implanted valves.


Assuntos
Aneurisma Aórtico/cirurgia , Insuficiência da Valva Aórtica/etiologia , Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca , Seio Aórtico , Idoso , Aneurisma Aórtico/complicações , Valva Aórtica/diagnóstico por imagem , Ecocardiografia , Humanos , Masculino , Tratamentos com Preservação do Órgão
5.
BMJ Case Rep ; 12(12)2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31862813

RESUMO

Erysipelothrix Rhusiopathiae is a Gram-positive bacillus that is ubiquitous in nature. The bacterium is a zoonotic pathogen known to infect wild and domestic animals. Human infections, however, are uncommon and typically present with localised or generalised cutaneous lesions. Systemic infection in the form of bacteraemia with seeding to various organs is the least common form of the disease. Infections in humans tend to be associated with occupational exposure and close contact with animals. Clinical data of a 61-year-old male patient with Gram-positive bacilli bacteraemia and E. Rh usiopathiae-induced endocarditis are presented here. The patient presented with refractory congestive heart failure secondary to severe acute aortic regurgitation mandating surgical valve replacement. The described case has special clinical merit given the lack of fever and leukocytosis, absence of erysipeloid cutaneous manifestations and refractoriness to medical management. E. Rhusiopathiae should be considered in the differential diagnosis for Gram-positive bacilli bacteraemia and endocarditis. In the proper clinical setting, occupational exposure and animal contacts are helpful clues to raise suspicion for this bacillus. The high mortality associated with the pathogen should urge for early identification and initiation of antimicrobial treatment.


Assuntos
Bacteriemia/diagnóstico , Endocardite Bacteriana/diagnóstico , Infecções por Erysipelothrix/diagnóstico , Erysipelothrix/isolamento & purificação , Animais , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Bacteriemia/complicações , Bacteriemia/microbiologia , Bacteriemia/cirurgia , Diagnóstico Diferencial , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Infecções por Erysipelothrix/microbiologia , Infecções por Erysipelothrix/cirurgia , Insuficiência Cardíaca/etiologia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Zoonoses
6.
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
8.
BMJ Case Rep ; 12(9)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31494585

RESUMO

Infections of proximal aortic vascular grafts are a catastrophic complication of aortic surgery. Despite aggressive antimicrobial and surgical intervention, mortality and reinfection rates remain significant. Here, we describe a man aged 71 years with a medical history of bioprosthetic aortic valve with aortic arch replacement (modified Bentall's procedure), who developed a large periprosthetic abscess due to Staphylococcus aureus 7 years after his initial surgery. The patient's preference was to avoid redo surgery, however despite high-dose intravenous flucloxacillin and oral rifampicin therapy, there was rapid progression of the abscess, necessitating urgent surgery. Notwithstanding the burden of infection, the patient underwent successful surgical excision and graft re-implantation and remains independent and well, almost 2 years postoperatively.


Assuntos
Abscesso/microbiologia , Insuficiência da Valva Aórtica/microbiologia , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Abscesso/fisiopatologia , Abscesso/cirurgia , Idoso , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Infecções Relacionadas à Prótese/fisiopatologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Fatores de Tempo , Resultado do Tratamento
10.
Rev Port Cir Cardiotorac Vasc ; 26(2): 143-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476816

RESUMO

INTRODUCTION: Mechanical prosthetic valve thrombosis (PVT) and obstruction is a lifethreatening event. The significant morbidity and mortality associated with this condition warrants rapid diagnostic evaluation and treatment. CASE REPORT: A 66-year-old female patient with a history of aortic valve replacement 13 years before, was admitted to our intensive cardiac care unit with symptoms and signs of prosthetic aortic valve dysfunction. During cardiac angiography, she collapsed and fluoroscopy showed an immobile disc, stopped in an open position and causing free aortic regurgitation. Cardio-pulmonary resuscitation (CPR) was initiated and a VA-ECMO was inserted as a bridge to emergent cardiac surgery. Surgery was then performed and the patient was successfully discharged with no neurological impairment. DISCUSSION: We present a case where Veno-Arterial Extracorporeal Membrane Oxygenation (VA- ECMO) was successfully used as a bridge to emergent surgery in a cardiac arrest patient due to prosthetic valve thrombosis. CONCLUSIONS: This case illustrates how a relative contraindication (severe aortic insufficiency) to VA-ECMO may, in the end, be an indication in a very particular scenario.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Oxigenação por Membrana Extracorpórea , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Trombose/etiologia , Idoso , Insuficiência da Valva Aórtica/etiologia , Feminino , Humanos , Trombose/cirurgia
11.
Heart Surg Forum ; 22(4): E281-E282, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31398091

RESUMO

We report a 62-year-old male who had severe aortic insufficiency after a homograft root replacement, requiring venoarterial extracorporeal membrane oxygenation prior to surgery due to profound cardiogenic shock. Severe aortic insufficiency is a contraindication for venoarterial extracorporeal membrane oxygenation, but we were able to stabilize the patient and successfully perform an urgent reoperative surgery.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Complicações Pós-Operatórias/cirurgia , Falha de Prótese/efeitos adversos , Reoperação , Choque Cardiogênico/etiologia , Aloenxertos , Insuficiência da Valva Aórtica/etiologia , Contraindicações de Procedimentos , Ponte de Artéria Coronária , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Terapia de Salvação/métodos , Choque Cardiogênico/cirurgia
12.
Heart Surg Forum ; 22(4): E287-E288, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31398093

RESUMO

The rupture of sinus of Valsalva aneurysm (SVA) into the pericardial cavity is extremely rare and fatal. A 52-year-old man presented with an abrupt onset of chest pain and dizziness. An echocardiography and a computed tomographic angiography revealed a giant aneurysm of the noncoronary sinus (NCS) (maximum, 70 mm) and pericardial effusion in favor of tamponade with a moderate degree of aortic insufficiency. On the way to the operating room, he suffered cardiac arrest, and extracorporeal cardiopulmonary resuscitation (ECPR) was initiated immediately. While he was prepared for surgery, the patient was supported by extracorporeal life support (ECLS) until cardiopulmonary bypass (CPB) was initiated. The sinus defect was reconstructed using a Dacron patch, followed by resection of the aneurysm. ECLS and CPB were discontinued successfully in the operating room. This study reports a case of an extracardiac rupture of SVA and the successful completion of surgery following ECPR.


Assuntos
Aneurisma Aórtico/cirurgia , Ruptura Aórtica/cirurgia , Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea/métodos , Doenças Raras/cirurgia , Seio Aórtico/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Angiografia por Tomografia Computadorizada , Ecocardiografia Transesofagiana , Parada Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Doenças Raras/diagnóstico por imagem , Seio Aórtico/diagnóstico por imagem
14.
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
15.
Mayo Clin Proc ; 94(7): 1158-1170, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31272566

RESUMO

OBJECTIVE: To study contemporary etiologies, mechanisms, and corresponding surgical approaches in isolated aortic regurgitation (AR). PATIENTS AND METHODS: Consecutive patients undergoing surgery for moderately severe and severe AR were retrospectively identified from January 1, 2006, through October 20, 2017. Intraoperative echocardiograms, surgical reports, and pathology reports were reviewed. RESULTS: Of 382 patients (54±16 years, 82% men), there were 207 (54%) tricuspid (TAV), 167 (44%) bicuspid (BAV), 5 quadricuspid, and 3 unicuspid aortic valves. Isolated AR mechanisms (n=116, 30%) included cusp prolapse (n=44, 11%), restriction/retraction (n=33, 9%), aortic root dilatation (n=33, 9%), perforation (n=5, 1%), and fenestration (<1%); mixed mechanisms were present in 266 (70%). The most common mixed mechanism was root dilatation and prolapse (27% BAV vs 16% TAV, P=.01). Valve repair (AVr) was performed in 31% BAV and 23% TAV (P=.06). Aortic surgery was more common in BAV (37% vs 27%, P<.001). Overall, root dilatation was associated with AVr. In TAV, cusp prolapse and restriction/retraction were associated with replacement; in BAV, prolapse was associated with AVr. AR etiology was idiopathic in 43% TAV patients, 47% of whom had root dilatation. CONCLUSIONS: BAV accounted for 44% of surgical referrals for AR and, compared with TAV, was more often associated with prolapse, root dilatation, and mixed mechanisms of AR. Because mechanisms affected the choice of AVr differently in BAV and TAV, comprehensive mechanistic description of surgical AR is critical.


Assuntos
Aorta/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/etiologia , Doenças das Valvas Cardíacas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/patologia
16.
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
18.
Interact Cardiovasc Thorac Surg ; 29(3): 331-338, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31220275

RESUMO

In the majority of patients presenting with acute type A aortic dissection (AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can be preserved by AV resuspension. A meta-analysis was performed to investigate the outcomes following AV resuspension for AAD. A systematic literature search for publications reporting outcomes after AV resuspension in AAD published between January 1998 and June 2018 was conducted. Early outcome events and linearized occurrence rates for late outcome events were derived. The retrieval process yielded 18 unique studies involving 3295 patients with a total of 17 532 patient-years (pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95% CI) 11.5-19.4%, I2 = 91.9%], and the linearized late mortality rate was 3.21%/pt-yrs (95% CI 2.49-3.77, I2 = 29%). The linearized occurrence rates for aortic root reintervention was 1.4%/pt-yrs (95% CI 0.88-1.79, I2 = 48%); for recurrent significant aortic valve insufficiency (>2+), it was 1.12%/pt-yrs (95% CI 0.79-1.45, I2 = 68%); and for endocarditis, it was 0.01%/pt-yrs (95% CI 0-0.04, I2 = 7%). The composite rate of thromboembolism and bleeding was 1.41%/pt-yrs (95% CI 0.18-2.63, I2 = 82%). A more recent surgical period was associated with a decreased hazard of reoperation on the aortic root (P < 0.001). Requirement of AV resuspension alone in AAD is a risk factor for mortality. The long-term durability of AV resuspension is excellent, with low rates of endocarditis and thromboembolism and bleeding. Root reoperation hazard has become acceptable in recent years. Preoperative aortic valve insufficiency grade exceeding 2+ is a predictor for root reoperation.


Assuntos
Aneurisma Dissecante/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Aneurisma Dissecante/complicações , Insuficiência da Valva Aórtica/etiologia , Humanos , Medidas de Resultados Relatados pelo Paciente , Reoperação
19.
Curr Cardiol Rep ; 21(7): 65, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31161305

RESUMO

PURPOSE OF REVIEW: Aortic regurgitation (AR) is a common form of valvular disease which is characterized by reflux of blood from the aorta into the left ventricle (LV) during diastole. AR results from various etiologies, affecting the aortic valve cusps or the aortic root. The clinical presentation of patients with AR depends on the severity of the regurgitation and differs whether AR develops acutely or if it progresses over a prolonged period, allowing the cardiac chambers to adapt. Echocardiography is the primary method to determine the etiology of AR and to define its severity. We review the current data regarding the diagnosis and treatment of AR. RECENT FINDINGS: No single parameter is sufficient to determine AR severity; thus, an integrative, multi-parametric approach is required. Echocardiography is key for imaging the aortic valve morphology and flow as well as aortic root and ascending aorta. Determining LV ejection fraction and dimensions is essential for patient management and optimizing timing for intervention. Three-dimensional (3D) echocardiography is useful in the evaluation of AR etiology and severity. The use of Trasncatheter aortic valve replacement (TAVR) has emerged as an alternative to surgery in patients at high operative risk. The diagnosis and management of AR requires a comprehensive approach and routine clinical and echocardiographic follow-up. Surgical or percutaneous therapy is indicated when symptoms develop and in those who have LV dysfunction or LV dilation.


Assuntos
Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Ecocardiografia , Implante de Prótese de Valva Cardíaca/métodos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Procedimentos Cirúrgicos Cardíacos , Próteses Valvulares Cardíacas , Humanos , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
20.
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
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