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1.
Int Heart J ; 61(1): 183-185, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956133

RESUMO

Transcatheter closure of ostium secondum atrial septal defect has become an alternative method to surgical closure. However, the incidence of complications and long-term results of using large size (> 40 mm) Amplatzer septal occluders are unknown. This case reported a 59 years old woman, whom received transcatheter closure of atrial septal defect (36 mm) with a 40 mm Amplatzer septal occluder 10 years ago and was diagnosed with heart failure. Transthroacic echocardiography showed severe mitral valve regurgitation. Intra-operatively, we confirmed and removed the large device, but we found that the mitral annulus was badly damaged. Mitral valve replacement was performed. We believe large size devices need to be implanted cautiously, especially for the large defect with insufficient rims, and also routinely follow-up is necessary.


Assuntos
Comunicação Interatrial/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Dispositivo para Oclusão Septal/efeitos adversos , Remoção de Dispositivo , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Resultado do Tratamento
2.
Int J Cardiovasc Imaging ; 36(1): 23-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31388814

RESUMO

While the impairment of left atrial (LA) mechanics in mitral valve disease is well known, the exact onset of reservoir, conduit, and contractile dysfunction in mitral stenosis (MS) and mitral regurgitation (MR) remains unclear. We aimed to clarify the LA deformation mechanics in patients with moderate mitral valve disease. We conducted a prospective observational study of 80 patients with moderate isolated MR, 80 patients with moderate isolated MS, and 64 age-matched controls without mitral valve disease. Strain (ɛ) and strain rate (SR) on speckle tracking echocardiography were assessed as indicators of LA and right atrium (RA) reservoir (ɛsys, SRs), conduit (ɛe, SRe), and contractile (ɛa, SRa) functions. Conventional echocardiographic parameters of the left ventricle (LV) were also assessed. Comparisons were conducted according to mitral valve pathology (MR patients, MS patients, controls). The mean LV ejection fraction, end-diastolic diameter, and global longitudinal strain did not differ across the groups. The pulmonary artery systolic pressure, LA volume indexed to body surface area, and LA mechanics were significantly impaired in mitral valve disease (patients vs controls). While LA ɛ did not vary between MR and MS, MR patients had better LA SRs and SRe but worse SRa (p < 0.01). SRe > - 0.65% had higher specificity for MS, with an area under the curve of 0.85 (p < 0.01). RA mechanics were significantly impaired in mitral valve disease (patients vs controls) but did not vary significantly with disease pathology (MS vs MR). Patients with moderate mitral valve disease exhibit early and pathology-specific changes in the LA deformation mechanics, manifesting mainly as impaired contractile-phase SR in MR and impaired conduit-phase SR in MS. Our findings highlight SR as a potentially useful early marker of LA dysfunction in relation to mitral valve disease.


Assuntos
Função do Átrio Esquerdo , Átrios do Coração/fisiopatologia , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/fisiopatologia , Valva Mitral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Átrios do Coração/diagnóstico por imagem , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico por imagem , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Função Ventricular Esquerda
3.
J Clin Ultrasound ; 48(1): 29-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31566758

RESUMO

PURPOSE: This study aimed to analyze left ventricular (LV) remodeling in patients with LV dilation using three-dimensional (3D) echocardiography, and to compare geometry and systolic function between patients with dilated cardiomyopathy (DCM) and with mitral regurgitation (MR) but similar LV dimension. METHODS: Cross-sectional study of 60 DCM and 60 MR patients with LV end diastolic diameter (LVEDD) > 35 mm/m2 , and of 60 healthy control volunteers. RESULTS: Despite a similar LVEDD, DCM patients showed a significantly higher 3D sphericity index (3D-SI) than MR patients, whereas 3D ejection fraction (3D-EF) was significantly lower (P < .01). There was a linear relationship between 3D-EF and 3D-SI in both DCM and MR patients (r = -0. 745 and r = -0. 642, respectively; both P < .001). Receiver operating characteristic (ROC) curves showed that 3D-SI had could better discriminate between DCM and MR (sensitivity 90%; specificity 73%; AUC 0.852, P < .01) than other variables. The area under the ROC curve of 3D-SI was significantly larger than that of 3D-EF for detecting heart failure in both patients with DCM and MR. CONCLUSIONS: LV geometry appears to be more spherical and associated with worse systolic function in DCM than in MR patients, in spite of similar LV dimensions. Systolic function correlated significantly with 3D-SI, which provided a better description of LV remodeling and could be a stronger indicator of heart failure in patients with LV dilation.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia Tridimensional , Ventrículos do Coração/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Remodelação Ventricular , Adulto , Cardiomiopatia Dilatada/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/etiologia
5.
Herz ; 44(7): 574-585, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31555893

RESUMO

Severe mitral regurgitation (MR) is associated with increased morbidity and mortality. Thus, the correct evaluation of the underlying etiology, pathomechanism and severity is crucial for optimal treatment. Echocardiography is the predominant diagnostic modality in the clinical routine as it enables grading of mitral regurgitation, which can frequently be achieved by readily available qualitative parameters. Additionally, echocardiography provides several methods to quantify the hemodynamic significance of MR. The effective regurgitation orifice area (EROA) is the quantitative parameter best correlated with clinical events. American and European imaging guidelines both recommend the use of quantitative parameters even though they disagree on the cut-off values for secondary MR. The evaluation of MR should always include an assessment of the adjacent heart chambers in order to be able to assess the impact of volume overload on size and function of the left ventricle and left atrium. The final interpretation of the quantitative parameters requires knowledge of left ventricular volume and ejection fraction. Newer 3D-echocardiographic approaches to quantify MR are less dependent on mathematical assumptions and have shown convincing results in several studies but still lack sufficient clinical validation. As an alternative to echocardiography, for specific indications cardiac magnetic resonance imaging (MRI) has proven to be a systematic and observer-independent method for quantification of MR.


Assuntos
Ecocardiografia Tridimensional , Insuficiência da Valva Mitral , Ecocardiografia Doppler em Cores , Ventrículos do Coração , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Índice de Gravidade de Doença
9.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466970

RESUMO

A 62-year-old man with essential hypertension and right L4-L5 hemilaminectomy was referred to rheumatology for evaluation of severe arthralgia and myalgia for 12 months. Review of symptoms was significant for night sweats and 20 pounds unintentional weight loss. Physical examination was significant for holosystolic murmur best heard at the cardiac apex of unclear chronicity. Laboratory investigations revealed elevated inflammatory markers, white blood cell count and B-type natriuretic peptide. Transoesophageal echocardiogram showed flail posterior mitral leaflet with severe mitral regurgitation and two vegetations (2.5×1 cm and 1.6×0.3 cm). Abdominal CT showed new focal splenic infarcts, and a brain MRI revealed subacute infarcts, consistent with the embolic phenomenon. Blood cultures grew Granulicatella elegans The patient underwent mitral valve replacement surgery followed by 6 weeks of parenteral therapy with vancomycin and gentamicin, with full recovery at a 3-month follow-up.


Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/microbiologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Dor Musculoesquelética/diagnóstico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Carnobacteriaceae/isolamento & purificação , Ecocardiografia Transesofagiana , Endocardite/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Dor Musculoesquelética/etiologia , Peptídeo Natriurético Encefálico/sangue , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
J Thorac Cardiovasc Surg ; 157(5): 1841-1848.e1, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31288361

RESUMO

BACKGROUND: The management of severe mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation is controversial. We adopted an approach of systematic repair of severe MR at the time of LVAD implantation and report our experience. METHODS: We performed mitral valve repair (MVr) on 78 consecutive patients with severe MR undergoing LVAD implantation at our institution between 2013 and 2017. We compared data on these patients to 28 historical controls with severe MR from the immediate preceding period between 2011 and 2013 where the MR was not treated, using Cox modeling and propensity score methods. Median follow-up time was 17.7 months. RESULTS: Patients who underwent MVr were younger than those who did not (non-MVr group) (55 vs 63 years; P = .006), but otherwise had similar preoperative characteristics. The incidence of 30-day mortality (2.6% vs 3.6%; P = .78) and other early major adverse events was similar in both groups. At 3 months, no patient in the MVr group had more than mild MR compared with 7 patients (29%) in the non-MVr group (P < .001). Cardiac catheterization done 3 to 6 months after surgery showed tendency toward greater reduction from preoperative pulmonary artery systolic pressure in the MVr group compared with the non-MVr group (-20 vs -13 mm Hg; P = .10). The cumulative incidence of readmission due to congestive heart failure at 2 years was lower in the MVr group than in non-MVr group (7.1% vs 19.7%; adjusted hazard ratio, 0.18; 95% confidence interval, 0.04-0.76; P = .02). CONCLUSIONS: Concurrent MVr at the time of LVAD implantation can be done safely without increase in perioperative adverse events. MVr may be associated with better reduction in severity of MR and may have potential benefit in terms of reduction in readmissions for heart failure.


Assuntos
Insuficiência Cardíaca/terapia , Implante de Prótese de Valva Cardíaca , Coração Auxiliar , Hemodinâmica , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Função Ventricular Esquerda , Adulto , Idoso , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Anuloplastia da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Desenho de Prótese , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
11.
J Cardiovasc Surg (Torino) ; 60(5): 617-623, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31274274

RESUMO

BACKGROUND: Mitral valve (MV) repair has been recommended for MV diseases. Good repair requires a full understanding of the three-dimensional (3D) structure of the MV, however, currently little is known about the 3D structure of the rheumatic MV. METHODS: A total of 82 cases underwent 3DTEE. Of these, 41 patients with rheumatic valvular disease (RVD) were studied intraoperatively (17 had severe mitral stenosis, 8 had severe mitral regurgitation, 16 had severe mitral stenosis coupled with regurgitation). There were 19 patients with degenerative MV disease (mitral valve prolapse [MVP] with severe regurgitation) and 22 cases with normal MV served as control subjects (CS). RESULTS: Compared with CS, the anteroposterior diameter, anterolateral posteromedial, annulus circumference, and annulus area of both pathological groups, i.e., the RVD and MVP groups, were understandably greater. Though the sphericity index was greater in the RVD group vis-à-vis CS, the MVP group had nearly the same sphericity index as CS. The mitral annulus of patients with RVD tended to be round. Annular unsaddling, defined as annular height to commissural width ratio (an indicator of saddle degree) less than 15%, was significantly more prevalent in the group with degenerative MV disease. Automatic dynamic analysis revealed that the parameters of annular maximum displacement and annulus area fraction (two-dimensional) were considerably decreased in the RVD group. CONCLUSIONS: Annular unsaddling was significantly more prevalent in the degenerative MV disease group. The mitral annulus of patients with RVD tended to be round and stiff.


Assuntos
Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Cardiopatia Reumática/diagnóstico por imagem , Adulto , Idoso , Tomada de Decisão Clínica , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/cirurgia , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Prospectivos , Desenho de Prótese , Recuperação de Função Fisiológica , Cardiopatia Reumática/fisiopatologia , Cardiopatia Reumática/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Intern Med ; 58(21): 3093-3098, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292399

RESUMO

An 80-year-old woman with rheumatoid arthritis presented with chest pain. Clinical examination revealed new-onset paroxysmal atrial fibrillation with symptomatic sinus pauses and worsening mitral regurgitation, which were both resistant to conventional therapies. Based on her skin lesions, an increase in pleural and pericardial effusion, possible myocardial involvement, and a positive finding for immune complex testing, rheumatoid vasculitis was diagnosed. Subsequent glucocorticoid therapy suppressed systemic inflammation, resulting in structural, functional, and electrical reverse remodeling of the left atrium with complete remission of atrial arrhythmias and also an improvement of mitral regurgitation. This case highlights the importance of evaluating the underlying disease activity in a case of de novo paroxysmal atrial fibrillation associated with systemic autoimmune disease.


Assuntos
Artrite Reumatoide/complicações , Fibrilação Atrial/etiologia , Insuficiência da Valva Mitral/etiologia , Vasculite Reumatoide/diagnóstico , Síndrome do Nó Sinusal/etiologia , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Ecocardiografia , Eletrocardiografia , Feminino , Glucocorticoides/uso terapêutico , Átrios do Coração/efeitos dos fármacos , Átrios do Coração/patologia , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Prednisolona/uso terapêutico , Radiografia , Vasculite Reumatoide/tratamento farmacológico , Síndrome do Nó Sinusal/diagnóstico
13.
J Cardiothorac Surg ; 14(1): 140, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331355

RESUMO

BACKGROUND: Atrial septal defect (ASD) is a congenital cardiac defect often diagnosed in adult patients. Mitral regurgitation (MR) observed in ASD patients mostly improves after ASD closure. However, a subset of adult ASD patients present new-onset MR or aggravation of preexisting MR after ASD closure. Intraoperative MR aggravation after surgical ASD closure is a rare occurrence which has not been reported in the literature to date. CASE PRESENTATION: A 54-year-old woman was referred to our center due to large secundum ASD with a diameter of 17 mm which was incidentally detected on pre-operative echocardiography at a local clinic. Surgical repair of ASD under mini-thoracotomy was performed. After completion of the operation, intra-operative transesophageal echocardiography showed newly developed Grade II MR which subsequently deteriorated to severe level on postoperative day 3. Because the patient was asymptomatic, we decided to observe closely and treat conservatively with diuretics. Thereafter, echocardiography was evaluated on postoperative day 10 and MR disappeared to trivial level. CONCLUSIONS: Intraoperative MR aggravation is a rare complication following ASD closure. The possibility of MR aggravation should be evaluated in all ASD patients prior to surgery. This case highlights the importance of mitral leaflet examination after ASD closure for early detection of MR.


Assuntos
Ecocardiografia Transesofagiana , Comunicação Interatrial/cirurgia , Complicações Intraoperatórias/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Feminino , Comunicação Interatrial/complicações , Humanos , Cuidados Intraoperatórios , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia
14.
J Cardiovasc Med (Hagerstown) ; 20(10): 660-666, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31361652

RESUMO

AIMS: Blood stasis is the main cause of left atrial thrombosis (LAT) in atrial tachyarrhythmias. The high-velocity flow inside the left atrium, due to mitral valve regurgitation, may prevent clot formation but the topic has never been investigated in large-scale studies. The aim of our study was to evaluate whether the presence and degree of mitral regurgitation have a protective role against LAT risk. METHODS: A total of 1302 consecutive adult patients with paroxysmal or persistent atrial fibrillation or flutter undergoing cardioversion, submitted to transesophageal echocardiography, were retrospectively enrolled in the study. The study population was divided into three groups according to the mitral regurgitation degree: absent, mild-to-moderate and severe. RESULTS: Among 1302 patients enrolled in the study, patients without mitral regurgitation were 248 (19%), those with mild-to-moderate 970 (75%), whereas 84 had severe mitral regurgitation (6%). LAT incidence was significantly lower in patients with severe mitral regurgitation compared with those with mild-to-moderate (mitral regurgitation) (2.4 vs. 8.9%, P < 0.05), and similar to subjects without mitral regurgitation (2.4%). CONCLUSION: Despite patients with severe regurgitation having clinical and echo characteristics predisposing to LAT (higher age, heart failure, higher atrial size, lower ventricular function) thrombosis prevalence was significantly lower than for those with mild-to-moderate mitral regurgitation. The percentage of LAT in severe mitral regurgitation cases was very low and similar to that of cases without regurgitation which were characterized by lower age, normal left ventricular function or other risk factors, reinforcing the hypothesis of a protecting role against atrial thrombosis of mitral regurgitation.


Assuntos
Fibrilação Atrial/fisiopatologia , Flutter Atrial/fisiopatologia , Hemodinâmica , Insuficiência da Valva Mitral/fisiopatologia , Valva Mitral/fisiopatologia , Trombose/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Flutter Atrial/diagnóstico , Flutter Atrial/epidemiologia , Ecocardiografia Transesofagiana , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/epidemiologia , Prevalência , Fatores de Proteção , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Trombose/diagnóstico , Trombose/epidemiologia , Trombose/fisiopatologia
15.
J Cardiovasc Med (Hagerstown) ; 20(10): 701-708, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31343448

RESUMO

BACKGROUND: The aim of this study was to identify variables that are associated with the durability of percutaneous repair of secondary mitral regurgitation at 6-month follow-up. METHODS AND RESULTS: Thirty-five consecutive patients with functional mitral regurgitation scheduled for MitraClip implant were enrolled. Left ventricular (LV) volumes and function and mitral valve characteristics were assessed before and immediately after MitraClip implantation using three-dimensional transesophageal echocardiography. Five patients with an unsuccessful procedure were excluded. The other patients were subdivided according to repair durability: group 1 with a durable repair (19 patients, 65%) and group 2 with significant mitral regurgitation recurrence (11 patients, 35%). At baseline, group 1 patients had smaller and more elliptical mitral valve annulus (1055 ±â€Š241 vs. 1273 ±â€Š359 mm, P = 0.02 and 125 ±â€Š11 vs. 117 ±â€Š16%, P = 0.02), a smaller left atrial volume (54.1 ±â€Š26 vs. 71.5 ±â€Š20 ml, P = 0.005) and lower systolic pulmonary artery pressure (38 ±â€Š11 vs. 49 ±â€Š12 mmHg, P = 0.03). Baseline LV end systolic volume had a linear correlation with the 3D annulus area (P = 0.048) and an inverse correlation with annulus ellipticity (P = 0.021). Group 1 patients showed an increase in annulus ellipticity after MitraClip (125 ±â€Š17 vs. 141 ±â€Š23%, P = 0.014). CONCLUSION: Percutaneous mitral valve repair leads to a significant and stable mitral regurgitation reduction in a large number of patients. Annulus dimensions and remodeling as well as left atrial area and pulmonary hypertension seem to be associated with durability of the procedure.


Assuntos
Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , 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 , Recidiva , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
18.
Pan Afr Med J ; 32: 178, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312292

RESUMO

Mitral valve aneurysm is a rare abnormality whose pathophysiology is poorly understood. It is defined as a bulge of the mitral valve leaflet toward the left atrium. Aneurysm in the posterior leaflet is exceptional. We report the case of a 26-year old man, who had been followed up for rheumatic aortic regurgitation for 4-years, hospitalized for febrile syndrome associated with episodes of left heart failure. Transthoracic echocardiographic examination (TTE) and transesophageal echocardiography (TEE) showed aortic valve vegetations with wide aneurysm of the small mitral valve associated with severe mitral valve regurgitation. The patient underwent mitral and aortic valve replacement with simple postoperative outcome. Clinical suspicion associated with suitable preoperative imaging and early surgical treatment are essential to recognize and treat this rare complication of infectious endocard.


Assuntos
Endocardite/complicações , Aneurisma Cardíaco/etiologia , Insuficiência da Valva Mitral/etiologia , Valva Mitral/diagnóstico por imagem , Adulto , Insuficiência da Valva Aórtica/patologia , Insuficiência da Valva Aórtica/cirurgia , Ecocardiografia/métodos , Ecocardiografia Transesofagiana/métodos , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia
19.
J Cardiothorac Surg ; 14(1): 112, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221174

RESUMO

BACKGROUND: Surgical management of the mitral valve (MV) in patients with mild-to-moderate mitral dysfunction undergoing aortic valve replacement is still controversial. We investigated the echocardiographic data from patients with mild-to-moderate mitral dysfunction who did not undergo MV surgery. MATERIALS AND METHODS: From January 1989 to June 2012, a total of 2731 patients underwent aortic valve replacement. Among these, 560 patients with mild-to-moderate mitral dysfunction were screened. Of these, 292 patients (61.9 ± 13.0 years; 113 females) who had not undergone MV surgery formed our study cohort. Survival, valve-related complication, and echocardiographic data were evaluated. RESULTS: There were three early deaths. During the mean follow-up period of 56.9 ± 46.5 months, there were 23 late deaths and 28 valve-related complications. Valve-related event-free survival at 5 years was 85.9% ± 2.4%. In serial postoperative echocardiographic evaluations (mean follow-up duration: 40.8 ± 44.5 months), 21 patients experienced a progression in late mitral dysfunction. At 5 years, 88.8% ± 2.7% of patients did not suffer from late mitral dysfunction. Based on multivariate analysis, rheumatic pathology of MV (Hazard Ratio: 3.88, 95% confidence intervals 1.60-9.39, p = 0.003) was an independent predictor of late mitral dysfunction. CONCLUSIONS: Conservatively treated patients with mild-to-moderate mitral dysfunction exhibited acceptable clinical outcomes. Rheumatic pathology of MV is associated with a higher risk of progressive native MV dysfunction.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/mortalidade , Estudos de Coortes , Intervalo Livre de Doença , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Complicações Pós-Operatórias , Modelos de Riscos Proporcionais , República da Coreia , Fatores de Tempo , Resultado do Tratamento
20.
BMJ Case Rep ; 12(6)2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31217211

RESUMO

There are nine published reports of trileaflet mitral valves globally. As such their implication on health outcomes and associations with other disease is uncertain. This case describes a 62-year-old man presenting with exertional dyspnoea and hypertension. It describes an early misdiagnosis of hypertrophic cardiomyopathy and highlights that clinicians should be alerted in cases of very high left ventricular outflow gradients in the presence of eccentric mitral regurgitation (MR). Here the MR was caused by a rare congenital deformity whereby a deep cleft in the posterior leaflet resulted in a tricuspid appearance. We present the natural disease course of a trileaflet mitral valve and without intervention over 13 years from symptom onset to the development of severe MR.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia , Ventrículos do Coração/patologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Cateterismo Cardíaco , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica/cirurgia , Dispneia , Implante de Prótese de Valva Cardíaca , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento
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