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1.
BMJ Case Rep ; 14(7)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285025

RESUMO

Transcatheter aortic valve replacement (TAVR) is becoming the standard of care in the management of severe aortic stenosis for patients in all risk stratifications. Many causes have been identified for acute drop in blood pressure during TAVR. Mitral regurgitation (MR) is a rare, but important acute intraprocedural complication that requires rapid assessment and treatment. Two important reasons for acute MR during TAVR include entanglement of the guide wire in papillary muscles and extension of the guidewire into the left atrium. Here, we report a case of acute reversible MR which was assessed using an echocardiogram and rapidly reversed by removing the stiff preshaped Safari2 wire from the left ventricle post valve deployment.


Assuntos
Estenose da Valva Aórtica , Insuficiência da Valva Mitral , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
2.
Curr Cardiol Rep ; 23(8): 95, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196796

RESUMO

PURPOSE OF REVIEW: Transcatheter mitral valve replacement (TMVR) has been developed to address the need for an alternative therapeutic option to surgery in patients suffering from severe mitral regurgitation who are at high surgical risk. The present review illustrated the state-of-the-art of catheter-based mitral valve replacement evaluating technical characteristics and early clinical experience of different devices to outline prospects and challenges of TMVR. RECENT FINDINGS: Several devices are currently under clinical assessment. Early experience has demonstrated high procedural success of TMVR. However, TMVR faces several possible hurdles such as left ventricular outflow tract obstruction (LVOTO) after prosthesis deployment, access site complications, and thrombotic risk requiring anticoagulatory therapy. Future studies should assess long-term prosthesis stability, optimal anticoagulation regime, and occurrence of paravalvular leakage. The development of smaller TMVR prostheses suitable for transseptal implantation could overcome bleeding complications. In perspective, TMVR may emerge to a clinically relevant therapeutic approach for patients with severe MR at high surgical risk.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Cateterismo Cardíaco , Cateteres , Humanos , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento
4.
Kyobu Geka ; 74(6): 439-442, 2021 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-34059587

RESUMO

We performed mitral valve plasty( MVP) with vegetation debridement by rubbing with a small gauze ball and by rinsing with saline( named "washing and rubbing method") for mitral regurgitation( MR) due to active infective endocarditis (IE). A 28-year-old male was referred to our hospital with a two-week history of fever. He had renal impairment and anemia, and echocardiography showed severe MR and two vegetations measuring more than 1 cm on the anterior and posterior mitral leaflets( A2-A3 and P2-P3). Severely damaged leaflets were resected and the vegetations were removed by "washing and rubbing method". After the method, treatment by 0.625% glutaraldehyde solution was added to leaflets for its bactericidal and reinforcing effects. MVP using only autologous leaflets was then performed. "Washing and rubbing method" enabled us to avoid using pericardium (autologous/xenogeneic) and/or artificial chordae in infected sites. MVP using "washing and rubbing method" may improve the long-term prognosis of active IE.


Assuntos
Endocardite Bacteriana , Endocardite , Insuficiência da Valva Mitral , Adulto , Endocardite/cirurgia , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Pericárdio/transplante
5.
JAMA ; 325(24): 2480-2494, 2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34156404

RESUMO

Importance: More than 40 million people are living with either mitral or aortic valve disease worldwide, and more than 180 000 heart valve replacement surgeries are performed each year in the US. Transcatheter valve repair has emerged as an important therapeutic option for patients who are candidates for heart valve replacement. Observations: All transcatheter valve therapies involve a multidisciplinary team of interventional cardiologists, cardiothoracic surgeons, radiologists, echocardiographers, nurses, and social workers, termed the heart team, to determine the optimal approach for managing each patient. Transcatheter aortic valve implantation (TAVI) is an aortic valve replacement procedure that is performed percutaneously and is currently approved for patients with severe, symptomatic aortic stenosis in all surgical risk categories. The TAVI procedure can be performed using a balloon-expandable or self-expanding valve. In a low-risk cohort of patients (PARTNER [Placement of Aortic Transcatheter Valves] 3 trial), the rates of death from any cause, stroke, or rehospitalization were 8.5% for patients receiving TAVI and 15.1% for patients undergoing surgical aortic valve replacement. Decision-making regarding therapy choice should be based on individual anatomy (including the number of leaflets, annular size, and peripheral arterial anatomy), comorbidities (including concomitant coronary artery disease and aortopathies), and patient preference guide. A mitral transcatheter edge-to-edge repair device is approved by the US Food and Drug Administration for high-risk patients with degenerative and functional mitral regurgitation that has excellent safety and efficacy in these populations. In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, the annualized rate of all hospitalizations for heart failure was 35.8% among patients who underwent transcatheter edge-to-edge repair and received medical therapy compared with 67.9% among patients in the medical therapy alone group. Transcatheter tricuspid valve repair and replacement trials are ongoing and show promise for the treatment of patients with tricuspid regurgitation, which previously had limited therapeutic options. Multimodality imaging, which includes transthoracic echocardiography, transesophageal echocardiography, computed tomography, and intracardiac echocardiography, is important for preprocedural planning, device selection, and optimal outcomes. Conclusions and Relevance: Approximately 78 000 TAVI procedures and 10 000 transcatheter mitral valve repairs take place yearly in the US to treat patients with severe, symptomatic aortic stenosis and mitral regurgitation, respectively. Transcatheter valve therapies have expanded therapeutic options for patients, including for those who previously had no viable surgical options.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Substituição da Valva Aórtica Transcateter , Humanos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/métodos , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/cirurgia
6.
Echocardiography ; 38(7): 1115-1124, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34085714

RESUMO

BACKGROUND: The current data on the impact of the increased mitral gradient (MG) on outcomes are ambiguous, and intraprocedural assessment of MG can be challenging. Therefore, we aimed to evaluate (a) peri-interventional dynamics of MG, (b) the impact of intraprocedural MG on clinical outcomes, and (c) predictors for unfavorable MG values after MitraClip. METHODS: We prospectively included patients who underwent MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after 6 months. 12-month survival was documented. RESULTS: One hundred and seventy five patients (age 81.2 ± 8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups according to intraprocedural MG with a threshold of 4.5 mm Hg, determined by a multivariate analysis of predictors for 12-month mortality (<4.5 mm Hg: Group 1, ≥4.5 mm Hg: Group 2). Intraprocedural MG ≥4.5 mm Hg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, P = .03, OR: 1.70, P = .05), and >3.9 mm Hg was associated with adverse functional outcomes (OR: 1.96, P = .04). The baseline leaflet-to-annulus index >1.1 was found to be the strongest independent predictor (OR: 9.74, P = .001) for unfavorable intraprocedural MG, followed by the number of implanted clips (P = .01), MG at baseline (P = .02), and central clip implantation (P = .05). CONCLUSION: An intraprocedural MG <3.9 mm Hg appears to be the best strategy for 1-year survival and favorable functional outcomes after edge-to-edge MV repair with MitraClip independently from MR etiology. Peri-interventional echocardiographic and procedural parameters are useful for the adequate assessment of intraprocedural MG.


Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco , Ecocardiografia , Feminino , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento
7.
Arq Bras Cardiol ; 116(6): 1059-1069, 2021 06.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34133587

RESUMO

BACKGROUND: Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of MR in survival of TAVI patients. OBJECTIVE: To examine the relationship between TAVI and MR in a patient population from the Brazilian TAVI Registry. METHODS: Seven hundred and ninety-five patients from the Brazilian TAVI Registry were divided at baseline, discharge, and follow-up according to their MR grade as follows: absent/mild (AMMR) or moderate/severe (MSMR). They were subsequently regrouped according to their immediate and late changes in MR severity after TAVI as follows: no change, improved, or worsened MR. Predictors and prognostic impact on baseline as well as changes in MR severity were analyzed. Statistical significance was set at p < 0.05. RESULTS: Baseline MSMR was present in 19.3% of patients and was a predictor of increased late mortality. Immediately after TAVI, 47.4 % of cases improved to AMMR, predicted by a higher Society of Thoracic Surgeons score and a higher grade of baseline aortic regurgitation. Upon follow-up, 9.2% of cases of AMMR worsened to MSMR, whereas 36.8% of cases of MSMR improved to AMMR. Lower baseline left ventricular ejection fraction (LVEF) and improvement in LVEF at follow-up were predictors of MR improvement. Progressive worsening of MR upon follow-up was an independent predictor of higher late mortality after TAVI (p = 0.005). CONCLUSIONS: Baseline MSMR predicts late mortality after TAVI. Lower LVEF and improved LVEF at follow-up predict MR improvement after TAVI. Progressive worsening of MR severity at follow-up is an independent predictor of late mortality, which is a rare finding in the literature.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Brasil , Seguimentos , Humanos , Insuficiência da Valva Mitral/cirurgia , Índice de Gravidade de Doença , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
9.
J Cardiothorac Surg ; 16(1): 175, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130728

RESUMO

BACKGROUND: Mitral regurgitation (MR) is a rather common valvular heart disease. The aim of this systematic review and meta-analysis was to compare the outcomes, and complications of mitral valve (MV) replacement with surgical MV repair of non-ischemic MR (NIMR) METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until October, 2020. Studies were eligible for inclusion if they included patients with MR and reported early (30-day or in-hospital) or late all-cause mortality. For each study, data on all-cause mortality and incidence of reoperation and operative complications in both groups were used to generate odds ratios (ORs) or hazard ratios (HRs). This study is registered with PROSPERO, CRD42018089608. RESULTS: The literature search yielded 4834 studies, of which 20 studies, including a total of 21,898 patients with NIMR, were included. The pooled analysis showed that lower age, less female inclusion and incident of hypertension, significantly higher rates of diabetes and atrial fibrillation in the MV replacement group than MV repair group. No significant differences in the rates of pre-operative left ventricle ejection fraction (LVEF) and heart failure were observed between groups. The number of patients in the MV repair group was lower than in the MV replacement group. We found that there were significantly increased risks of mortality associated with replacement of MR. Moreover, the rate of re-operation and post-operative MR in the MV repair group was lower than in the MV replacement group. CONCLUSIONS: In patients with NIMR, MV repair achieves higher survival and leads to fewer complications than surgical MV replacement. In light of these results, we suggest that MV repair surgery should be a priority for NIMR patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/mortalidade , Razão de Chances , Complicações Pós-Operatórias , Modelos de Riscos Proporcionais , Viés de Publicação , Reoperação/estatística & dados numéricos , Volume Sistólico , Resultado do Tratamento
10.
Mayo Clin Proc ; 96(6): 1522-1529, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34088415

RESUMO

In 2013, the Food and Drug Administration approved the first transcatheter mitral valve repair (TMVr) device for degenerative mitral regurgitation for patients at prohibitive surgical risk. To better understand contemporary utilization trends and outcomes, we reviewed hospitalizations, identified using International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes, in which the patient underwent TMVr or mitral valve repair (MVr) with a diagnosis of mitral regurgitation, without stenosis, from the National (Nationwide) Inpatient Sample from 2014 to 2017. We included 10,020 hospitalizations in which the patient underwent TMVr and 5845 in which the patient underwent MVr and assessed trends in demographic characteristics, patient comorbidities, total hospital charges, and outcomes. Transcatheter mitral valve repair experienced exponential growth, increasing from 150 to 5115 over the study period (P<.001 for trend), whereas MVr grew to a lesser degree. The median length of stay for TMVr decreased from 4 to 2 days; mortality declined from 3.3% to 1.6% (P<.001 for both). Both TMVr and MVr rates of discharge home increased over the study period. Total charges for TMVr increased from $149,582 to $178,109, whereas those for MVr increased to a lesser degree, from $149,426 to $157,146 (P<.001 for both). Discharge disposition, length of stay, and in-hospital mortality all exhibited favorable trends for both procedures. Caution must be exercised in direct comparisons between procedures as they target somewhat different populations. With expanded indications for TMVr, we anticipate further increases in procedural volume, although the effect on MVr remains unclear.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Fatores Etários , Idoso , Feminino , Custos de Cuidados de Saúde , Implante de Prótese de Valva Cardíaca/economia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Methodist Debakey Cardiovasc J ; 17(1): e1-e4, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104329

RESUMO

Patients with symptomatic stage D heart failure who require left ventricular assist device (LVAD) support and suffer concomitant severe mitral regurgitation are often difficult to manage. One reason is due to cardiac anatomic constraints that limit optimization of the mechanical assist device. Typically, these patients are not candidates for repeat sternotomy with surgical mitral valve repair, and heart transplantation may not be feasible or timely. This case describes two patients with LVAD support who received transcatheter edge-to-edge mitral valve repair for severe, symptomatic mitral regurgitation. We believe this procedure may be a therapeutic option in stable patients with severe mitral regurgitation who require mechanical support.


Assuntos
Insuficiência Cardíaca/terapia , Implante de Prótese de Valva Cardíaca , Coração Auxiliar , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Função Ventricular Esquerda , Adulto , Idoso , Cateterismo Cardíaco , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Desenho de Prótese , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Rev Med Chil ; 149(1): 137-141, 2021 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-34106146

RESUMO

Reintervention of a mitral degenerated bioprosthesis has a high surgical risk, especially in elderly patients with multiple comorbidities. We report a 74 years old female with two previous cardiac surgical procedures and a new structural mitral bioprosthesis deterioration with severe mitral regurgitation. Considering her high-surgical risk, a fully percutaneous treatment was performed with a balloon-expandable aortic valve in mitral position (valve-in-valve) through a transseptal approach with a favorable outcome. This technique is an attractive and effective option with a relatively low rate of complications that could solve this challenging and complex disease.


Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Idoso , Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Cateterismo Cardíaco , Feminino , Humanos , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Falha de Prótese , Resultado do Tratamento
13.
J Int Med Res ; 49(5): 3000605211014375, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33983087

RESUMO

OBJECTIVE: The present study aimed to investigate the effect of functional mitral regurgitation (FMR) on recurrence of paroxysmal atrial fibrillation (PAF) in patients undergoing radiofrequency catheter ablation. METHODS: This prospective cohort study comprised 107 patients with PAF. The patients were divided into the FMR and non-FMR groups. FMR was assessed by Doppler echocardiography before index ablation. All patients initially underwent circumferential pulmonary vein isolation (CPVI) and were followed up for 12 months after ablation. PAF, atrial tachycardia, or atrial flutter served as the endpoint indicator. RESULTS: The median duration of PAF was 24 (3-60) months. Binary logistic univariate and multivariate analyses showed that FMR was not a risk factor for recurrence of catheter ablation for PAF (hazard ratio=0.758, 95% confidence interval: 0.191-3.004; hazard ratio=0.665, 95% confidence interval: 0.134-3.300, respectively). Kaplan-Meier analysis showed no significant difference in the recurrence rate between the groups. Fifteen (15/107, 14%) cases of PAF were triggered by the pulmonary vein. Three (3/107, 2.8%) cases of PAF were triggered by the superior vena cava. CONCLUSIONS: FMR is not an independent risk factor for predicting recurrence of catheter ablation for PAF. FMR does not affect patients undergoing radiofrequency catheter ablation for PAF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência da Valva Mitral , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Veia Cava Superior/cirurgia
16.
Gen Thorac Cardiovasc Surg ; 69(7): 1041-1049, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33970433

RESUMO

Atrial functional mitral regurgitation is a hot research topic in the field of mitral valve disease. Atrial functional mitral regurgitation is distinctly different from ventricular functional mitral regurgitation. The surgical indications for atrial functional mitral regurgitation have not been well established because of the small amount of evidence gathered to date. Mitral annular plication with an artificial ring is an essential surgical procedure because dilatation of the mitral valve annulus is a main factor underlying this pathology. Most of these cases can be treated by mitral annuloplasty alone. However, additional procedures, such as application of artificial chordae to the anterior leaflet for pseudo-prolapse, and posterior leaflet augmentation with a pericardial patch, are required in advanced cases with a giant left atrium and extremely enlarged mitral annulus. Chronic atrial fibrillation causes enlargement of the right and left atria. This pathology is a bilateral atrioventricular valve disease (dual-valve disease). Therefore, the conventional guidelines of single-valve disease should not be applied. Although atrial functional tricuspid regurgitation is underappreciated, tricuspid annuloplasty should be considered for most patients to prevent future regurgitation. In addition to the mitral and tricuspid valve procedure, integrated surgical management, including plication of the atrium and left appendage closure, is required. This review summarizes the current considerations of surgical treatment for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism.


Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Insuficiência da Valva Tricúspide , Átrios do Coração , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgia
18.
Kyobu Geka ; 74(5): 353-357, 2021 May.
Artigo em Japonês | MEDLINE | ID: mdl-33980794

RESUMO

A 57-year-old man was referred to our hospital due to dyspnea on exertion with severe mitral regurgitation. Because he had underdone right pneumonectomy 37 years earlier due to congenital defect of the right pulmonary artery, his mediastinum was severely shifted to the right, and his pulmonary function was poor. Mitral valve repair was successfully performed with right thoracotomy approach, which made excellent exposure of the mitral valve. The patient was extubated three hours after the surgery. He was discharged on the 30th postoperative day without postoperative respiratory complications. With an appropriate plan of the surgery and postoperative optimal management, cardiac surgery can be performed on patients with a single lung.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Insuficiência da Valva Mitral , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Pneumonectomia , Toracotomia
19.
Kyobu Geka ; 74(5): 358-361, 2021 May.
Artigo em Japonês | MEDLINE | ID: mdl-33980795

RESUMO

Reports of takotsubo cardiomyopathy following cardiac surgery are rare. We report a case of postoperative takotsubo cardiomyopathy after mitral valve replacement (MVR). The patient was a 70-yearold woman with mitral stenosis, regurgitation, and a medical history of long-standing persistent atrial fibrillation. Preoperative echocardiogram confirmed severe mitral regurgitation, severe mitral stenosis, severe tricuspid regurgitation, and slight left ventricular dysfunction. Coronary lesions were not observed on preoperative diagnostic coronary angiography. MVR with a bioprosthetic valve, tricuspid annuloplasty, and left atrial maze were performed. Electrocardiogram on postoperative day (POD) 1 revealed a deep negative T wave in V3-V6. Echocardiogram revealed "takotsubo-like" wall motion, and the ejection fraction( EF) was 19%. The EF improved on POD 7. After three months, the electrocardiogram findings and EF appeared normal. We suspected takotsubo cardiomyopathy although postoperative coronary angiography was not performed. Takotsubo cardiomyopathy should be considered as a possible complication of cardiac surgery, especially after MVR.


Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Estenose da Valva Mitral , Cardiomiopatia de Takotsubo , Idoso , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/etiologia , Resultado do Tratamento
20.
Kyobu Geka ; 74(2): 152-155, 2021 02.
Artigo em Japonês | MEDLINE | ID: mdl-33976024

RESUMO

A 78-year-old man with mitral regurgitation incidentally diagnosed with aneurysm of the left internal thoracic artery(LITA) and several internal thoracic artery-pulmonary artery( ITA-PA) fistulas originating from the aneurysm. To prevent rupture of the aneurysm, ITA ligation was performed during surgery for the mitral valve. Because of the complex anatomy surrounding the aneurysm, the main duct of the ITA was ligated at the peripheral and center of the aneurysm, then arterial fistulae were resected as many as possible. Postoperative computed tomography (CT), however, showed patent LITA and contrast material in the aneurysm. Second stage coil embolization procedure was performed with successful results. Intravascular treatment is effective for ITA aneurysms or ITA-PA fistulae because we can clearly visualize and confirm blood flow during operation.


Assuntos
Aneurisma , Fístula , Artéria Torácica Interna , Insuficiência da Valva Mitral , Idoso , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Humanos , Masculino , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/cirurgia , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia
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