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2.
PLoS One ; 15(7): e0236265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697799

RESUMO

AIMS: The preprocedural assessment of outcomes and patients' prognosis after interventional therapy of functional MR (FMR) is uncertain. Therefore, we aim to develop an easy-to-handle scoring system for adequate prediction of individual outcomes in patients with FMR after the interventional treatment. MATERIALS AND METHODS: We retrospectively used medical data of patients with symptomatic FMR, who underwent transcatheter mitral valve repair (TMVR) from January 2014 to August 2016 in our heart center. All patients had the mean follow-up of 18 months. All clinical and echocardiographic data originate from the "Bonner Mitral Valve Register Database". RESULTS: We included 105 patients (76,7±8,8 years, 50,6% female) with symptomatic (NYHA functional class>II) moderate-to-severe or severe FMR at surgical high-risk. We modified the MIDA-Score for degenerative MR (DMR) according to the varying underlying pathomechanisms of FMR, called as "The modified MIDA Score". We found all-cause mortality of 7% within 18 months after the procedure. 34,1% of our cohort was rehospitalized; 90% of those were due to cardiovascular causes. The modified MIDA score was found to be a strong predictor for mortality and rehospitalization in patients with FMR (AUC: 0,89) and superior to the other conventional scoring systems in prediction of mortality (The modified MIDA-Score: AUC: 0,8, EuroSCORE II: AUC: 0,57, STS-Score: AUC: 0,51). The logistic regression analysis showed the modified MIDA score > 9 points to be the strongest predictor for mortality and rehospitalization after TMVR (OR: 3,35, p = 0,011). CONCLUSION: The modified MIDA score was found to be a promising, easy-to-handle, elementary scoring system for adequate prediction of individual postinterventional prognosis in patients with FMR undergoing TMVR. Further evaluation and validation of this novel scoring system in prospective multicentric studies with a large number of patients is warranted.


Assuntos
Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Insuficiência da Valva Mitral/cirurgia , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/mortalidade , Readmissão do Paciente/estatística & dados numéricos , Período Pré-Operatório , Prognóstico , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
3.
Heart Fail Clin ; 16(2): 211-219, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32143765

RESUMO

Acute mitral regurgitation is an uncommon, challenging disease that requires emergent care and proper management. To evaluate its etiology, echocardiography is essential. However, echocardiography findings in these patients are often different from that of chronic mitral regurgitation owing to the acute elevation of left atrial and pulmonary artery pressure derived from the small left ventricle and atrium with low compliance. Although surgical correction is usually required owing to the hemodynamic instability, many patients are considered to be at high surgical risk. Transcatheter mitral valve repair using MitraClip (Abbott Vascular, Santa Clara, CA) may be a solution as a bail-out therapy.


Assuntos
Cateterismo Cardíaco/métodos , Ecocardiografia/métodos , Serviços Médicos de Emergência/métodos , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Doença Aguda , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Ventrículos do Coração/fisiopatologia , Humanos , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Risco Ajustado/métodos
4.
Ann Thorac Surg ; 110(2): 670-675, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32199821

RESUMO

PURPOSE: In children with a mitral annulus too small to accommodate traditional prostheses, surgical implantation of stent-based valves is a promising option. However no reliable preoperative methods exist to guide patient selection, device sizing, and positioning. We describe a novel methodology to visualize and quantify device fit in 3-dimensional echocardiogram (3DE)-derived heart models. DESCRIPTION: Heart models were created from existing preoperative 3DEs using custom software. Valve models were virtually implanted into the models, and both device fit and left ventricular outflow tract (LVOT) area were quantified. EVALUATION: The 3DEs of 3 patients who underwent Melody valve placement in the mitral position were retrospectively modeled: 1 with LVOT obstruction, 1 with perivalvar leak, and 1 without complications. In all cases 2-dimensional measurements underestimated 3D annular dimensions, and the patient with clinical LVOT obstruction had the lowest predicted LVOT area-to-aortic area ratio (0.5). CONCLUSIONS: 3DE-based preoperative modeling of surgical implantation of stent-based valves in the mitral position may improve quantification of mitral valve dimensions and inform risk stratification for potential LVOT obstruction.


Assuntos
Cateterismo Cardíaco/métodos , Ecocardiografia Tridimensional/métodos , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Feminino , Humanos , Lactente , Masculino , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Desenho de Prótese , Estudos Retrospectivos
5.
Ann Thorac Surg ; 110(1): e59-e61, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32199828

RESUMO

Mitral valve annuloplasty has been the gold standard for treatment of functional mitral valve regurgitation. However, annuloplasty for functional mitral regurgitation may cause augmented posterior leaflet tethering, which results in functional anterior prolapse. Herein we added papillary muscle heads focalization for such patients. All separated papillary muscle heads are sutured together, and the roots of chordae at each papillary muscle are unifocalized on both sides. Stitches are positioned at the same distances from corresponding leaflet edges to adjust the height of leaflet edges in each segment. This is a simple and effective technique to correct for functional anterior prolapse after annuloplasty.


Assuntos
Cordas Tendinosas/cirurgia , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Músculos Papilares/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico
6.
Am Heart J ; 222: 73-82, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32018204

RESUMO

BACKGROUND: Underweight and obesity represent classical risk factors for adverse outcome in patients treated for cardiovascular disease. AIMS: The current analysis examines the impact of underweight, overweight and obesity on intra-hospital, short and long-term outcomes in patients treated by MitraClip therapy. METHODS AND RESULTS: From August 2010 until July 2013, 799 patients (age 75.3 ±â€¯8.6 years, male gender 60.7%, median logistic EuroSCORE 20% [12; 31], functional mitral regurgitation (MR): 69.3%) were prospectively enrolled into the multicenter German Transcatheter Mitral Valve Interventions registry. Patients were stratified according to body mass index (BMI) into 4 groups: BMI <20 kg/m2 (underweight), BMI 20.0 to <25.0 kg/m2 (normal weight, reference group), BMI 25.0 to <30.0 kg/m2 (overweight) and BMI ≥30 kg/m2 (obese). Significant increased rates of procedural failure, transfusion/bleeding, sepsis or multiorgan failure and low cardiac output failure were found for underweight patients only. Kaplan-Meier survival curves demonstrated inferior survival for underweight patients, but comparable outcomes for all other patients (global log rank test, P < .01). Multivariable Cox-regression analysis (adjusted for age, gender, creatinine ≥1.5 mg/dL, diabetes, left ventricular ejection fraction <30% and chronic obstructive pulmonary disease) confirmed underweight (as compared to normal weight) as an independent risk factor of death (hazard ratio [HR]: 1.58, 95% confidence interval (CI): 1.01-2.46, P = .044) and overweight as protective against death (HR: 0.71; 95%-CI: 0.55-0.93; P = .011). CONCLUSIONS: Compared to other weight groups, underweight patients undergoing MitraClip implantation are exposed to increased rates of procedural failure, bleeding and low cardiac output as well as increased short- and long-term mortality rates and should therefore be carefully discussed in the heart-team.


Assuntos
Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Magreza/complicações , Ecocardiografia , Seguimentos , Alemanha/epidemiologia , Mortalidade Hospitalar/tendências , Incidência , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
8.
Ann Thorac Surg ; 110(2): 517-522, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31962113

RESUMO

BACKGROUND: Surgical repair of primary mitral regurgitation (MR) is considered an indicator of quality performance. Therefore, accurate data reporting is critical for quality assessment. During an institutional quality review, MR etiology could not be determined in 40% of operations in The Society of Thoracic Surgeons database entries, and therefore our true repair rate could not be reliably ascertained. Therefore, we reviewed all source documents and echocardiograms to assess our true disease etiology and repair rate. METHODS: Source records and echocardiograms of all operations performed in a single health care system for a 1-year period were reviewed by an experienced mitral valve surgeon, an echocardiographic core laboratory, and a data manager. Disease etiology and operation were compared with data previously entered in the database by post hoc chart abstraction. RESULTS: In all, 314 isolated mitral valve operations were performed. The MR was originally classified as primary, 163 (52%); secondary, 22 (7%); rheumatic, 37 (12%); endocarditis, 24 (8%); other, 33 (10%); and unknown, 35 (11%). Reported repair rate for primary MR was 142 of 163 (87.1%). After review, etiology was determined to be primary, 177 (56%); secondary, 33 (11%); rheumatic, 61 (20%); endocarditis, 25 (8%); and others, 18 (5%)-resulting in a change of classification in 99 of 314 patients (31.5%) and a true repair rate for primary MR of 165 of 177 (93.2%). CONCLUSIONS: Source document and imaging review of mitral valve surgery revealed significant discordance with post hoc chart abstraction methods. A more detailed data entry methodology is necessary to accurately report the true disease etiology and repair rates for primary MR.


Assuntos
Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Insuficiência da Valva Mitral/classificação , Valva Mitral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Sociedades Médicas , Cirurgia Torácica , Bases de Dados Factuais , Ecocardiografia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Texas/epidemiologia , Resultado do Tratamento
9.
Can J Vet Res ; 84(1): 67-73, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31949330

RESUMO

This study was designed to evaluate the antioxidative status of serum by measuring its total antioxidant capacity, as well as the antioxidant enzyme activity (superoxide dismutase, catalase, and glutathione reductase), in dogs with various stages of degenerative mitral valve disease (DMVD) compared to healthy controls. In total, 71 client-owned dogs in different stages of DMVD, which included healthy controls, took part in the study. Following an anamnesis, clinical examination, standard transthoracic echocardiograpic examination, chest X-ray, complete blood (cell) count, and serum biochemistry, dogs were divided into 2 study groups. Blood was drawn from each dog once at the time of presentation and selected antioxidant parameters were measured using commercially available assay kits. The activity of superoxide dismutase gradually decreased in the more advanced stages of DMVD, while the activity of catalase was significantly higher in the group of dogs with asymptomatic DMVD compared to healthy controls and dogs with symptomatic DMVD. No significant changes were noted in total antioxidant capacity and the activity of glutathione reductase. Results suggested that DMVD has a significant impact on the activity of superoxide dismutase and catalase in the serum of the tested dogs. Knowledge of changes in the activity of antioxidative enzymes may warrant further studies, possibly to evaluate the potential role of compounds with antioxidative properties in the clinical outcome of dogs with DMVD.


Assuntos
Antioxidantes/metabolismo , Catalase/sangue , Doenças do Cão/enzimologia , Glutationa Redutase/sangue , Insuficiência da Valva Mitral/veterinária , Superóxido Dismutase/sangue , Análise de Variância , Animais , Contagem de Células Sanguíneas/veterinária , Análise Química do Sangue/veterinária , Estudos de Casos e Controles , Doenças do Cão/sangue , Doenças do Cão/diagnóstico , Cães , Ecocardiografia/veterinária , Feminino , Insuficiência Cardíaca/enzimologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/veterinária , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Insuficiência da Valva Mitral/sangue , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/enzimologia
10.
Ann Thorac Surg ; 109(3): 794-801, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31472142

RESUMO

BACKGROUND: Mitral valve repair (MVr) for severe, degenerative mitral regurgitation is the gold standard, because medical management carries poor prognosis. However, despite clear benefit of MVr, many eligible patients are untreated. This study investigated whether MVr restores patients to normal life expectancy, at any age of operation, by comparing long-term survival of patients after MVr with the life expectancy of the general United States population. METHODS: This retrospective study investigated 1011 patients with degenerative mitral regurgitation who underwent isolated MVr between 2003 and 2017. Parametric distribution analysis was applied to long-term post-MVr mortality data, and Weibull probability plots provided the best-fit distribution by Anderson-Darling Goodness-of-Fit testing. Confidence intervals of the estimated distribution were used to compare additional life expectancy after MVr to the general US population across multiple decades of life. Patients after MVr were categorized by age into decade (range, 20-89 years). RESULTS: The life expectancy of patients after MVr matched the life expectancy of the general US population at any age between 40 and 89 years. Lower-bound one-sided 95% confidence intervals for additional life expectancy were not appreciably different from corresponding median additional life expectancy of the general population. There were few deaths in the 20- to 39-year-old group, limiting predictability, but survival also appeared normative. CONCLUSIONS: These findings suggest that degenerative MVr restores anticipated life expectancy to that of the general population, regardless of age. Although our findings underscore the importance of repair for degenerative mitral disease, larger studies with longer term follow-up are needed to reinforce this finding, particularly for younger patients.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Expectativa de Vida/tendências , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Adulto Jovem
11.
Am J Cardiol ; 125(2): 236-243, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31767121

RESUMO

Right-sided heart failure (RHF) after left ventricular assist device implantation is a significant cause of morbidity and mortality. Although multiple predictors of early RHF have been described, information on late RHF is scarce. The aim of this study was to identify predictors of late RHF in left ventricular assist device patients. A retrospective analysis of all adult patients who underwent HeartWare-ventricular assist device implantation as a bridge to transplantation in a single-centre was performed. Late RHF was defined as RHF requiring rehospitalization after 30 days of implantation. A total of 16 (10.3%) patients from 156 implantations developed late RHF. Median time to late RHF onset was 182.5 (interquartile range 105 to 618) days. Patients developing late RHF were older at surgery. A significantly higher rate of moderate or severe tricuspid regurgitation before implantation was found in patients presenting with late RHF (81.2% vs 33.5%; p <0.001). Several echocardiographic parameters at discharge postimplant, such as significant mitral regurgitation, demonstrated a strong association with late RHF. A multivariate Cox regression analysis revealed that significant preoperative tricuspid regurgitation was the strongest predictor of late RHF (hazard ratio 5.50, 95% confidence interval [1.34 to 22.58]; p = 0.02). Significant mitral regurgitation postimplantation and older age also significantly predicted late RHF. In conclusion, preoperative significant tricuspid regurgitation and mitral regurgitation after implantation predict the occurrence of late RHF.


Assuntos
Insuficiência Cardíaca/etiologia , Ventrículos do Coração/diagnóstico por imagem , Coração Auxiliar , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Tricúspide/complicações , Função Ventricular Direita/fisiologia , Progressão da Doença , Ecocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/fisiopatologia , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/fisiopatologia
12.
Nat Rev Cardiol ; 17(5): 298-312, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31819230

RESUMO

Mitral regurgitation (MR) is a common valvular heart disease and is the second most frequent indication for heart valve surgery in Western countries. Echocardiography is the recommended first-line test for the assessment of valvular heart disease, but cardiovascular magnetic resonance imaging (CMR) provides complementary information, especially for assessing MR severity and to plan the timing of intervention. As new CMR techniques for the assessment of MR have arisen, standardizing CMR protocols for research and clinical studies has become important in order to optimize diagnostic utility and support the wider use of CMR for the clinical assessment of MR. In this Consensus Statement, we provide a detailed description of the current evidence on the use of CMR for MR assessment, highlight its current clinical utility, and recommend a standardized CMR protocol and report for MR assessment.


Assuntos
Imagem Cinética por Ressonância Magnética/métodos , Insuficiência da Valva Mitral/diagnóstico , Valva Mitral/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Humanos , Insuficiência da Valva Mitral/fisiopatologia , Índice de Gravidade de Doença
14.
Ann Thorac Surg ; 110(1): e15-e17, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31863759

RESUMO

Left ventricular outflow tract obstruction (LVOTO) can be caused by multiple factors. One of the rare causes of LVOTO is preserved anterior mitral valve leaflet and chordal apparatus after mitral valve replacement. We describe a case of a patient with worsening chronic congestive heart failure secondary to LVOTO from systolic anterior motion of residual native anterior mitral leaflet. In this patient, LVOTO was surgically corrected by excision of anterior leaflet and chordal apparatus through the aortic root.


Assuntos
Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Complicações Pós-Operatórias , Obstrução do Fluxo Ventricular Externo/etiologia , Ecocardiografia Transesofagiana , Feminino , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Obstrução do Fluxo Ventricular Externo/diagnóstico
15.
Am J Cardiol ; 125(4): 652-657, 2020 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-31870493

RESUMO

Mitral arcade is a rare entity that is mostly reported in pediatric patients. We present the first 2 adult cases of mitral arcade in combination with tricuspid dysplasia, left ventricular noncompaction, and short-chain acyl-CoA deficiency in 2 brothers. We examined clinical and echocardiographic data on 2 brothers with a combination of short-chain acyl-CoA deficiency, mitral arcade, tricuspid dysplasia, and left ventricular noncompaction (LVNC), highlighting their clinical course and outcomes. Two-dimensional and 3-dimensional transthoracic echocardiography revealed direct attachment of the papillary muscles to the mitral leaflets, namely mitral arcade, as well as mild mitral regurgitation along with LVNC and tricuspid dysplasia. Over the past 7 years, both brothers have remained asymptomatic with excellent exercise capacity (13 and 10 metabolic equivalents (METS), respectively). Mitral and tricuspid regurgitation remain mild with unchanged left ventricular function (ejection fraction: 65% and 59%). In conclusion, we highlight 2 cases with a constellation of pathology including short-chain acyl-CoA deficiency, mitral arcade, tricuspid dysplasia, and LVNC, which has never been described before.


Assuntos
Acil Coenzima A/deficiência , Cardiopatias Congênitas/diagnóstico , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Tricúspide/diagnóstico , Adolescente , Criança , Ecocardiografia , Eletrocardiografia , Humanos , Imagem por Ressonância Magnética , Masculino
16.
Medicine (Baltimore) ; 98(48): e18156, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770258

RESUMO

RATIONALE: Streptococcus anginosus mostly colonizes the digestive and genitourinary system, including the oropharyngeal region. It commonly causes invasive pyogenic infection, but less likely causes infective endocarditis (IE). PATIENT CONCERNS: An 18-year-old woman who had an underlying mitral valve prolapse without mitral regurgitation presented to our hospital with low-grade fever, left leg weakness, and left abdominal pain. She was diagnosed with brain infarction and microabscess as well as IE. The patient totally recovered after the 6-week course of intravenous antibiotics. DIAGNOSIS: Brain magnetic resonance imaging revealed brain infarction and microabscess. Abdominal computed tomography revealed splenic and left renal infarction. Three sets of blood culture were positive for S anginosus. Transthoracic echocardiogram identified mitral valve prolapse with moderate eccentric mitral valve regurgitation, and a 0.3 × 0.6-cm vegetation was found on the left mitral valve. All of these results meet the modified Duke criteria. INTERVENTIONS: The abdominal pain and left leg weakness were improving after 2 weeks of intravenous antibiotics treatment. No neurological sequelae were noted after completing the 6-week course of medical treatment. OUTCOMES: The patient was successfully treated and discharged after completing the 6-week intravenous antibiotics treatment. LESSONS: IE should be considered in young patients with native valve disease who have prolonged fever. Though S anginosus commonly causes invasive pyogenic infection, patients with native valve disease should be checked for IE.


Assuntos
Antibacterianos/administração & dosagem , Abscesso Encefálico , Infarto Encefálico , Endocardite , Prolapso da Valva Mitral , Infecções Estreptocócicas , Streptococcus anginosus/isolamento & purificação , Administração Intravenosa , Adolescente , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Ecocardiografia/métodos , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Feminino , Humanos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Recuperação de Função Fisiológica , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(48): e18169, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770266

RESUMO

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


Assuntos
Aneurisma Aórtico , Insuficiência da Valva Aórtica , Dispneia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral , Valva Mitral , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/fisiopatologia , Aneurisma Aórtico/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Dispneia/diagnóstico , Dispneia/etiologia , Dispneia/fisiopatologia , Ecocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/fisiopatologia , Resultado do Tratamento
18.
Cardiovasc Ultrasound ; 17(1): 28, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752893

RESUMO

BACKGROUND: The search for reliable cardiac functional parameters is crucial in patients with mitral regurgitation (MR). In the Italian arm of the European Registry of MR, we compared the ability of global longitudinal strain (GLS) and left ventricular (LV) ejection fraction (LVEF) to detect cardiac damage in MR. METHODS: Five hundred four consecutive patients with MR underwent a complete echo-Doppler exam. A total of 431, 53 and 20 patients had degenerative, secondary and mixed MR, respectively. The main echocardiographic parameters, including LV and left atrial (LA) size measurements, pulmonary artery systolic pressure (PASP) and GLS were compared between patients with mild MR (n = 392) vs. moderate to severe MR (n = 112). RESULTS: LVEF and GLS were related one another in the pooled population, and separately in patients with mild and moderate/severe MR (all p < 0.0001). However, a certain number of patients were above the upper or below the lower limits of the 95% confidence interval (CI) of the normal relation in the pooled population and in patients with mild MR. Only 2 patients were below the 95% CI in moderate to severe MR. After adjusting for confounders by separate multivariate models, LVEF and GLS were independently associated with LV and left atrial size in the pooled population and in mild and moderate/severe MR. GLS, but not LVEF, was also independently associated with PASP in patients with mild and moderate to severe MR. CONCLUSIONS: Both LVEF and GLS are independently associated with LV and LA size, but only GLS is related to pulmonary arterial pressure. GLS is a powerful hallmark of cardiac damage in MR.


Assuntos
Ecocardiografia Doppler/métodos , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Valva Mitral/diagnóstico por imagem , Contração Miocárdica/fisiologia , Volume Sistólico/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Função Ventricular Esquerda/fisiologia , Adulto Jovem
19.
J Cardiothorac Surg ; 14(1): 204, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775814

RESUMO

BACKGROUND: Mitral valve aneurysm (MVA) is a saccular outpouching of the mitral leaflet which expands on systole and collapses during diastole. The case of MVA was first described in 1729 by Morand. It is one of the rare entities with a reported incidence of only 0.2-0.29% and no such case reported in Pakistan before. CASE PRESENTATION: A 51 year old female presented with dyspnea and chest pain for 3 months. Upon investigating, trans-esophageal echocardiography (TEE) revealed thickened anterior mitral valve leaflet with rolled up margins, forming an aneurysm, with severe mitral regurgitation. Subsequently, the valve was evaluated intra-operatively for repair but eventually had to be excised and then successfully replaced with a bioprosthetic valve. CONCLUSIONS: TEE is an excellent technique to confirm the diagnosis of a mitral valve leaflet aneurysm, and depending upon the severity of the defect, valve repair can be attempted but replacement becomes the most suitable treatment modality, once repair is deemed impossible. We hereby report a rare case, where timely diagnosis, appropriate surgical intervention and regular post-operative follow up helped in achieving good prognosis of this rare entity.


Assuntos
Aneurisma Cardíaco/cirurgia , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/etiologia , Valva Mitral/cirurgia , Feminino , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/diagnóstico , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia
20.
J Cardiothorac Surg ; 14(1): 205, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775821

RESUMO

BACKGROUND: Good mid-term durability of mitral valve repair of bileaflet lesions has been reported; however, patients may develop failure during follow-up. This study assessed late outcomes and mechanisms of failure associated with mitral valve repair of bileaflet lesions. METHODS: Fifty-six patients (mean age 67 ± 12 years) underwent mitral valve repair of bileaflet lesions due to degenerative disease in 2011-2018. Mitral annuloplasty was added to all procedures except for 1 patient with annular calcification. Mitral valve lesions were identified by surgical inspection. Mean clinical and echocardiography follow-up occurred at 2.7 ± 2.1 and 2.5 ± 1.9 years, respectively. RESULTS: Additional mitral valve repair techniques involved triangular resection (n = 15 patients), quadrangular resection with sliding plasty (n = 12), neochordoplasty (n = 52), and commissural plication (n = 26). Prolapse of ≥2 anterior and posterior leaflet scallops occurred in 22 (39%) and 30 (54%) patients, respectively. During follow-up, 10 (17.8%) patients developed moderate or severe mitral regurgitation. Whereas prolapse or tethering was observed early after neochordoplasty or quadrangular resection, recurrent regurgitation occurred late after commissural repair. Five-year freedom from recurrent moderate or severe mitral regurgitation rates was 71.1 ± 11.0%. CONCLUSIONS: Seventeen percent of patients developed recurrent mitral regurgitation during follow-up. Repair failure in the early phase occurred owing to aggressive resection of the posterior mitral leaflet or maladjustment of the artificial neochordae. Recurrent mitral regurgitation might occur in the late phase even after acceptable commissural repair. A sequential approach may be useful to improve the quality of mitral valve repair in bileaflet lesions.


Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/patologia , Prolapso da Valva Mitral/diagnóstico , Prolapso da Valva Mitral/patologia , Recidiva , Resultado do Tratamento
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