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2.
Int Heart J ; 60(4): 796-804, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308329

RESUMO

The benefits of concomitant mitral valve procedure (MVP) for treating moderate chronic ischemic mitral regurgitation (IMR) during coronary artery bypass grafting (CABG) have not been clearly established. This study aimed to determine the incidence of moderate or more residual mitral regurgitation (MR) following CABG plus MVP for moderate chronic IMR, and to evaluate the impacts of concomitant MVP vs. CABG alone on clinical outcomes based on propensity-matched data.All eligible patients were entered into either the MVP group (CABG plus MVP, n = 184) or CABG group (CABG alone, n = 162). Moderate or more residual MR rate was investigated, and in-hospital and follow-up outcomes between the groups were compared after matching.Moderate or more residual MR rate was 11.4% at 1 year and 22.9% at 2 years after CABG plus MVP, respectively. Patients in the MVP group as compared with the CABG group had significantly lower moderate or more residual MR rates at various postoperative time points (all P < 0.001). Grouping was not an independent risk factor for in-hospital adverse events in multivariate logistic regression analysis. Also, grouping was a significant variable related to moderate or more residual MR rate and NYHA class III-IV at the latest follow-up in Cox regression analysis (HR = 0.391, 95% CI 0.114-0.628; HR = 0.419, 95% CI 0.233-0.819, respectively).Concomitant MVP as compared with CABG alone for treating moderate chronic IMR was associated with a reduction in moderate or more residual MR rate and an improvement in NYHA functional status, with no increase in in-hospital adverse events or follow-up death.


Assuntos
Ponte de Artéria Coronária/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/complicações , Valva Mitral/cirurgia , Isquemia Miocárdica/cirurgia , Idoso , China/epidemiologia , Doença Crônica , Angiografia Coronária , Ecocardiografia Doppler , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
3.
Isr Med Assoc J ; 5(21): 308-313, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140220

RESUMO

BACKGROUND: The MitraClip procedure is becoming an acceptable alternative for high-risk patients with mitral regurgitation (MR) due to functional (FMR) or degenerative (DMR) disease and suitable mitral anatomy. OBJECTIVES: To evaluate the results of MitraClip at our institute in carefully selected patients. METHODS: We conducted a retrospective analysis of medical records and echocardiography data from January 2012 to December 2017. RESULTS: A total of 39 MitraClip procedures in 37 patients (aged 75 ± 12 years, 9 women) was performed. Twenty-four patients presented with FMR, 12 with DMR, and 1 with combined pathology. One-day post-procedure MR was moderate to low in 86.1% of patients, with immediate device success in 88.8%. MR at 1 year was moderate to low in 79% at 1 year. Survival at 1 year was 86% and at 2 years 69.4%. Peri-procedural (< 1 week) death and MitraClip failure occurred in one and three patients, respectively. New York Heart Association score improved to class 1 or 2 in 37% of patients at 1 year vs. one patient at baseline. Post-procedural systolic pulmonary pressure was reduced from 53 (range 48-65) to 43 (range 36-52) mmHg at 1 month with a subsequent plateau at follow-up, to 41 (34-57) mmHg at 6 months, and to 47 (38-50) at 12 months. CONCLUSIONS: MitraClip in severe MR resulted in modest improvement in functional status and pulmonary pressure with a small risk of immediate procedural complications. Outcomes are encouraging considering the natural course of MR and the risks of surgical intervention.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Valva Mitral , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia/métodos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/cirurgia , Avaliação de Resultados (Cuidados de Saúde) , Desempenho Físico Funcional , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Desenho de Prótese , Pressão Propulsora Pulmonar , Risco Ajustado , Índice de Gravidade de Doença , Análise de Sobrevida
4.
Int Heart J ; 60(3): 768-771, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31019171

RESUMO

A 91-year-old woman was admitted to our hospital for treatment of congestive heart failure with severe aortic stenosis. After admission, she developed a high fever due to pneumonia and worsened heart failure. We could not perform transcatheter aortic valve implantation (TAVI) because of active infection; therefore, retrograde balloon aortic valvuloplasty (BAV) was urgently performed. A complete atrioventricular block and severe functional mitral regurgitation appeared suddenly after BAV in the absence of mechanical disorders. Her condition improved after several days in our intensive care unit. Pacemaker implantation and TAVI were then performed, and the patient was discharged from our hospital. MR could sometimes exacerbate after BAV in clinical practice; therefore, we set out to report this case.


Assuntos
Estenose da Valva Aórtica/complicações , Bloqueio Atrioventricular/diagnóstico , Valvuloplastia com Balão/efeitos adversos , Insuficiência da Valva Mitral/diagnóstico , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/terapia , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Feminino , Humanos , Insuficiência da Valva Mitral/etiologia , Marca-Passo Artificial/normas , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
5.
J Vet Intern Med ; 33(3): 1446-1455, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30938891

RESUMO

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


Assuntos
Insuficiência da Valva Aórtica/veterinária , Pressão Sanguínea/fisiologia , Doenças dos Cavalos/diagnóstico , Insuficiência da Valva Mitral/veterinária , Animais , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/diagnóstico por imagem , Ecocardiografia/veterinária , Feminino , Doenças dos Cavalos/diagnóstico por imagem , Cavalos , Masculino , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/diagnóstico por imagem , Estudos Retrospectivos
6.
Swiss Med Wkly ; 149: w20023, 2019 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-30852836

RESUMO

Mitral regurgitation is a highly prevalent condition among elderly patients, affecting almost 10% of the general population aged 75 and older. Left untreated, severe mitral regurgitation results in high mortality and frequent hospitalisation for treatment of heart failure. Surgical treatment remains the first-line therapy for symptomatic, severe mitral regurgitation , especially for patients presenting with a primary aetiology. However, a high proportion of patients with mitral regurgitation are turned down for open-heart surgery, mainly due to advanced age, diminished left ventricular function and comorbidities. Thus, percutaneous treatment options have been recently developed as an alternative. In this article, we will review transcatheter interventional techniques at the level of the mitral valve, including implantation technique, indications and clinical results.


Assuntos
Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Comorbidade , Humanos , Insuficiência da Valva Mitral/classificação , Suíça , Resultado do Tratamento , Função Ventricular Esquerda
7.
BMC Infect Dis ; 19(1): 102, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704409

RESUMO

BACKGROUND: Infective endocarditis (IE) is defined as endocarditis caused by microorganisms (bacteria or fungi) involving either the heart or great vessels. The clinical course of IE can be complicated by cardiac dysfunction and bacterial embolization to virtually any organ. Staphylococcus aureus and viridans group streptococci are the most common causative organisms, whereas group A Streptococcus (GAS) is less common. Although some GAS serotypes have been associated with severe disease, there are few reports of IE associated with GAS serotypes. Here, we report two cases of GAS endocarditis and review the associated literature. CASE PRESENTATIONS: Patient 1 was a previously healthy 14-year-old girl who developed bacteremia and disseminated intravascular coagulation secondary to left foot cellulitis. She was administered intravenous antibiotics. Two of three blood cultures grew Streptococcus pyogenes (T6 M6, emm6.104). Three days later, a new systolic ejection murmur was heard and echocardiography showed mitral regurgitation with mitral valve vegetation. Because of the resultant severity of the mitral regurgitation, she underwent mitral valve repair after 10 weeks of antibiotic treatment. Patient 2 was a 17-month old boy who presented with a fever. He had a history of spontaneous closure of a ventricular septal defect (VSD). He was started on intravenous antibiotics for possible bacteremia. Two consecutive blood cultures with an interval of more than 12 h grew S. pyogenes (T4 M4, emm4.0). Five days later, echocardiography showed vegetation on a membranous ventricular septal aneurysm. The patient responded well to antibiotics, and recovered fully with no complications. CONCLUSIONS: Although both patients developed GAS endocarditis, patient 1 did not have any predisposing conditions for IE, and patient 2 had a only a low-risk predisposing condition, a VSD that had closed spontaneously at five months of age. We found twelve reports in the literature of GAS endocarditis with information on serotypes. All patients in these reports had GAS endocarditis caused by serotypes generally associated with milder infections, but no specific risk trends were identified. A greater accumulation of cases is necessary to more clearly elucidate the association between GAS IE and specific serotypes.


Assuntos
Endocardite Bacteriana/diagnóstico , Insuficiência da Valva Mitral/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação , Adolescente , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Lactente , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/tratamento farmacológico , Insuficiência da Valva Mitral/microbiologia , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia
9.
Kyobu Geka ; 72(2): 99-103, 2019 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-30772873

RESUMO

Left sinus of Valsalva aneurysm(SVAn)is a very rare clinical entity. We present a 68-year-old female with left SVAn, 5 cm in diameter, compressing the left main coronary artery and causing antero-septal asynergy. She also had massive pericardial effusion, moderate to severe(grade Ⅲ)aortic regurgitation, and mitral regurgitation. One month after pericardial drainage, the patient successfully underwent composite graft replacement of the aortic root, reimplantation of the right coronary artery and suture closure of thin friable left main trunk(LMT)orifice, as well as double coronary artery bypass grafting with bilateral internal mammary arteries to the left anterior descending artery and the diagonal branch. Mitral valve repair was also performed. She recovered uneventfully and remains asymptomatic at 2 years after surgery. To our knowledge, only 13 cases undergoing open heart surgery for left SVAn have been reported in Japan.


Assuntos
Aneurisma Aórtico/complicações , Tamponamento Cardíaco/etiologia , Isquemia Miocárdica/etiologia , Seio Aórtico , Idoso , Aneurisma Aórtico/patologia , Aneurisma Aórtico/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/cirurgia , Tamponamento Cardíaco/terapia , Constrição Patológica/etiologia , Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Drenagem , Feminino , Humanos , Japão , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/cirurgia , Reimplante
10.
Int Heart J ; 60(2): 474-476, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30626769

RESUMO

Simultaneous left and right-sided native valve infective endocarditis (IE) is rare. Staphylococcus aureus was the predominant organism for bilateral IE. Shunt diseases are common risk factors of both-sided IE. Streptococcus anginosus (S. anginosus) is usually associated with pyogenic infections, but rarely a cause of IE. Here we present an extremely rare case of simultaneous left and right-sided native valve IE affecting the mitral and tricuspid valves caused by S. anginosus in an adult patient that has not been reported in the literature previously, particularly without the most frequent predisposing factors of IE. A 66-year-old man was admitted due to generalized fatigue, chills, malaise, and intermittent fevers for 1 year. A grade III-IV/VI systolic murmur at the mitral area and a III/VI systolic murmur at the tricuspid area were noted on physical examination. Laboratory evaluation revealed an elevated erythrocyte sedimentation rate and C-reactive protein level, and high fasting blood glucose. Blood culture was positive for S. anginosus. Echocardiography revealed vegetations in both sides of the heart: a large mitral valve vegetation with severe mitral regurgitation, as well as another vegetation on the tricuspid valve with moderate regurgitation. The case highlights a rare pathogen of both-sided IE, a rare presentation of S. anginosus infection, and several points worthy of note in echocardiography of IE.


Assuntos
Anti-Infecciosos/administração & dosagem , Ecocardiografia Transesofagiana/métodos , Ecocardiografia/métodos , Endocardite Bacteriana , Insuficiência da Valva Mitral , Valva Mitral , Infecções Estreptocócicas , Streptococcus anginosus/isolamento & purificação , Insuficiência da Valva Tricúspide , Valva Tricúspide , Adulto , Idoso , Hemocultura/métodos , Sedimentação Sanguínea , Proteína C-Reativa/análise , Anuloplastia da Valva Cardíaca/métodos , Endocardite Bacteriana/sangue , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/fisiopatologia , Endocardite Bacteriana/terapia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/microbiologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Exame Físico/métodos , Infecções Estreptocócicas/sangue , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/fisiopatologia , Infecções Estreptocócicas/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/microbiologia , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgia
11.
Mayo Clin Proc ; 94(1): 66-73, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30611455

RESUMO

OBJECTIVES: To assess the frequency and implications of mitral valve (MV) surgery at the time of septal myectomy (SM) for hypertrophic cardiomyopathy (HCM) in a national cohort. PATIENTS AND METHODS: The National Inpatient Sample (NIS) was used to analyze surgical outcomes in patients with HCM undergoing SM from January 1, 2003, through December 31, 2014. Univariate analyses were used to compare patients undergoing SM with vs without concomitant procedures, and logistic regression was used to determine factors associated with prolonged length of stay (LOS) and in-hospital mortality. Numeric values of 10 or less were not reported per NIS data use agreements. RESULTS: The national cohort included 1174 adults with a primary diagnosis of HCM undergoing SM. Overall mean ± SD age was 54.4±14.5 years, and 45% of patients (n=529) were male. Isolated SM was performed in 67% (n=786), and the remainder had concomitant cardiac procedures, most frequently MV repair/replacement (22%, n=257). Median LOS was increased in those with concomitant MV surgery, 7 days, compared with isolated SM, 6 days (P<.001). Overall hospital mortality was 2.9% (n=34) and was lowest in those undergoing isolated SM (<1%; P<.001). In otherwise isolated SM, MV replacement increased likelihood of in-hospital death (odds ratio, 12.0; 95% CI, 3.9-36.5; P<.001) on a univariate basis. CONCLUSION: Intervention on the MV is more common nationally than in specialized centers, and the addition of MV replacement and other concomitant cardiac procedures was associated with increased rates of hospital mortality and LOS compared with patients undergoing isolated SM. These results suggest that concomitant MV intervention is associated with increased risk.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adolescente , Adulto , Idoso , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Septos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
12.
Mayo Clin Proc ; 94(1): 89-102, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30611459

RESUMO

Recent innovations and advancements in 3-dimensional (3D) echocardiography allow for better understanding of anatomic relationships and improve communication with the interventional cardiologist for guidance of catheter-based interventions. The mitral valve lends itself best for imaging with transesophageal echocardiography (TEE). Consequently, the role of 3D TEE in guiding catheter-based mitral interventions has been evolving rapidly. Although several publications have reported on the advantages and role of 3D TEE in guiding one or more of the steps involved in percutaneous mitral valve repair using the MitraClip, none offer a comprehensive and practical user-friendly guide. This review article provides the reader with practical intraprocedural tips on use of 3D TEE to guide all relevant steps involved in the procedure including how to acquire the images needed and what to look for.


Assuntos
Cateterismo Cardíaco/métodos , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Guias de Prática Clínica como Assunto
13.
ESC Heart Fail ; 6(1): 222-227, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30620449

RESUMO

Herein, we report the case of a 67-year-old woman who was admitted to our hospital because of dyspnoea and oedema of the lower extremities. Transthoracic echocardiography revealed severe tricuspid and mitral regurgitation, and the leaflets of the tricuspid valve were found to be rigid and almost immobile. The plasma concentrations of serotonin and chromogranin A were elevated, and hence, suspicion for carcinoid heart disease was raised. In addition to the diagnostic workup and medical and surgical treatment, we analysed levels of novel cardiovascular biomarkers throughout the entire follow-up by means of enzyme-linked immunosorbent assay. A dopa positron emission tomography (DOPA-PET) was conducted and showed a neoplasm in the terminal ileum. Tricuspid valve replacement, mitral valve repair, and a closure of the patent foramen ovale (PFO) were conducted. Two months later, hemicolectomy and liver segment resection were performed. The tumour was resected, and the diagnosis of a neuroendocrine tumour (NET) was confirmed. Throughout the follow-up, we observed a decrease in the plasma levels of novel biomarkers [e.g. interleukin-8 (IL-8), soluble suppression of tumorigenicity-2 (sST2), and heart-type fatty acid-binding protein (H-FABP)] over the follow-up period. In our case, carcinoid heart disease resulted in a severe tricuspid regurgitation as commonly seen in these patients. Moreover, a pre-existent mitral regurgitation was likely aggravated by fibrotic remodelling, because a PFO has led to a right-to-left shunt and might have caused left heart involvement. As IL-8 was associated with adverse outcomes in patients with NETs, and sST2 and H-FABP were associated with adverse outcomes in patients with heart failure previously, these biomarkers could aid in the risk stratification of patients with NET.


Assuntos
Biomarcadores Tumorais/sangue , Doença Cardíaca Carcinoide/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência da Valva Mitral/complicações , Idoso , Doença Cardíaca Carcinoide/sangue , Doença Cardíaca Carcinoide/cirurgia , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia , Ensaio de Imunoadsorção Enzimática , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Insuficiência da Valva Mitral/diagnóstico , Tomografia por Emissão de Pósitrons
14.
Eur J Heart Fail ; 21(2): 196-204, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30549159

RESUMO

AIMS: To explore whether left ventricular reverse remodelling (LVRR) is a predictor of outcomes in patients with functional mitral regurgitation (FMR) undergoing MitraClip procedure. METHODS AND RESULTS: We analysed 184 consecutive patients with FMR who underwent successful MitraClip procedure. LVRR was defined as a reduction in left ventricular end-systolic volume ≥ 10% from baseline to 6 months. LVRR was observed in 79 (42.9%) patients. Compared with non-LVRR, LVRR patients were more likely to be females, less likely to have an ischaemic aetiology of mitral regurgitation or a prior (<6 months) heart failure (HF) hospitalization, and had smaller left ventricular dimensions. New York Heart Association class improved from baseline up to 1-year follow-up in both groups. Higher rates of overall survival (87.3% vs. 75.2%, P = 0.039), freedom from HF hospitalization (77.2% vs. 60%, P = 0.020), and freedom from the composite endpoint (cardiovascular mortality or HF hospitalization) (74.7% vs. 55.2%; P = 0.012) were observed in LVRR vs. non-LVRR patients at 2-year follow-up. LVRR was associated with a significant reduction of the adjusted relative risk of mortality, HF hospitalization and composite endpoint [hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.20-0.96, P = 0.040; HR 0.55; 95% CI 0.32-0.97, P = 0.038; and HR 0.54; 95% CI 0.32-0.92, P = 0.023, respectively]. Female gender, absence of diabetes, freedom from prior HF hospitalization, non-ischaemic aetiology of mitral regurgitation, and left ventricular end-diastolic diameter < 75 mm were found to be independent predictors of LVRR. CONCLUSIONS: Left ventricular reverse remodelling is associated with better long-term outcomes in patients with FMR successfully treated with MitraClip. A careful patient selection may be useful as specific baseline features predict favourable left ventricular remodelling. [Correction added on 17 January 2019, after online publication: the preceding sentence has been changed.].


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Ventrículos do Coração/fisiopatologia , Insuficiência da Valva Mitral/fisiopatologia , Sistema de Registros , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular/fisiologia , Idoso , Ecocardiografia , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Prognóstico , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Clin Physiol Funct Imaging ; 39(3): 209-214, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30589484

RESUMO

INTRODUCTION: ST elevation myocardial infarction (STEMI) is one of the main causes of congestive heart failure (CHF). The main symptom of CHF is exercise tolerance impairment. The aim of the study was to evaluate the prevalence and risk factors for impaired exercise tolerance in patients after STEMI. METHODS AND RESULTS: A total of 84 patients with STEMI were analysed in the study. Cardiopulmonary exercise test (CPET) was performed 6 months after STEMI. Impaired exercise tolerance defined as peak VO2 < 84% predicted for age and sex was present in 49 (58%) patients and was connected with lack of abciximab administration (91.4 versus 69%, P = 0·02) and the presence of mitral regurgitation (47 versus 23%, P = 0·02). In univariate analysis, the troponin I level at admission (OR 1·89, P = 0·047), the use of abciximab (OR 0·21, P = 0·03), the presence of mitral regurgitation (OR 2·98, P = 0·03) and NT-proBNP concentration (OR 2·17, P = 0·021) were related to impaired exercise tolerance. The best multivariate model for predicting impaired exercise tolerance included mitral regurgitation and lack of abciximab administration. CONCLUSIONS: Impaired exercise tolerance after STEMI is common. Mitral regurgitation and lack of abciximab administration are the best predicting factors of impaired exercise tolerance after STEMI.


Assuntos
Aptidão Cardiorrespiratória , Teste de Esforço , Tolerância ao Exercício , Insuficiência Cardíaca/diagnóstico , Insuficiência da Valva Mitral/diagnóstico , Intervenção Coronária Percutânea , Abciximab/uso terapêutico , Idoso , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/fisiopatologia , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Polônia/epidemiologia , Valor Preditivo dos Testes , Prevalência , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
16.
Indian Heart J ; 70(6): 836-842, 2018 Nov - Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30580853

RESUMO

BACKGROUND: Percutaneous balloon mitral valvuloplasty (PBMV) can be complicated with significant mitral regurgitation (MR). We performed a pilot, prospective study to evaluate the role of three dimensional transesophageal echocardiography (3D-TEE) in the prediction of MR after PBMV through mitral valve quantification (MVQ). METHODS: Between October 2014 and October 2016, 37 patients with rheumatic, moderate-to-severe mitral stenosis, referred to the Cath lab of Bab Alshearia University hospitals for PBMV, were divided into two age and sex matched groups. Group I included 25 patients without significant MR following PBMV [vena contract area (VCA) <0.4cm2], while group II included 12 patients with significant MR after PBMV [VCA ≥0.4cm2]. Both groups were comparable in terms of TEE data, Wilkins score for favorability of PBMV and baseline hemodynamics. RESULTS: Data from MVQ showed that both groups were comparable (p>0.05) in terms of MV annulus quantification (Anteroposterior diameter, annular sphericity, 3D area and height), MV scallops (A1, A2, A3, P1, P2 and P3) areas, as well as A1 and A2 tenting volumes. However, we recorded significant differences between the two groups as regard total MV, A2, P2 and P3 tenting volumes (p<0.05) and tenting height (p=0.03), as well as A2, A3 and P2 prolapse volumes (p<0.05). Moreover, our data showed a significant difference between both groups in terms of MV coaptation heights (p=0.01), but not in anterior coaptation length (p=0.13). CONCLUSION: Mitral valve quantification through 3D-TEE is a simple automated method, easily applicable to patients before PBMV. Moreover, MVQ-derived data, such as MV scallops' tenting and prolapse volumes, coaptation heights, and exposed and total A2 lengths may predict the possibility of significant MR after PBMV.


Assuntos
Valvuloplastia com Balão/efeitos adversos , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Insuficiência da Valva Mitral/diagnóstico , Estenose da Valva Mitral/cirurgia , Valva Mitral/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Adulto , Egito/epidemiologia , Feminino , Humanos , Incidência , Masculino , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/etiologia , Valor Preditivo dos Testes , Índice de Gravidade de Doença
17.
Am J Case Rep ; 19: 1467-1473, 2018 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-30531674

RESUMO

BACKGROUND Infective endocarditis is prevalent worldwide and the modified Duke criteria have been used universally to diagnose this condition. However, making the correct diagnosis is rather difficult because the clinical presentation and findings of blood tests are non-specific. CASE REPORT A 70-year-old female complaining of dyspnea for 5 days with acute mitral regurgitation was transferred to our hospital. She had acute heart and respiratory failure and disseminated intravascular coagulation. Although infective endocarditis was suspected, repeated blood cultures and transesophageal echocardiography could not reveal any findings of infective endocarditis. Because the etiology of her condition was not determined by various examinations, mitral annuloplasty was required to treat her mitral regurgitation, and was performed for definitive diagnosis and treatment revealing the presence of vegetation on the mitral valve. Enterococcus faecalis was detected by cultures of the mitral valve and blood after the surgery. CONCLUSIONS It can be very difficult to diagnose infective endocarditis correctly, especially when a case fails to fulfill the modified Duke criteria. In such a case, only cardiac surgery might enable us to make an accurate diagnosis and save a patient's life.


Assuntos
Coagulação Intravascular Disseminada/complicações , Endocardite Bacteriana/diagnóstico , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas/diagnóstico , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/diagnóstico , Doença Aguda , Idoso , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/terapia , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia
18.
J Med Case Rep ; 12(1): 372, 2018 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-30558652

RESUMO

BACKGROUND: Transcatheter aortic valve replacement is indicated for severe symptomatic aortic stenosis in patients who have a very high or prohibitive surgical risk as assessed pre-procedurally by the Society of Thoracic Surgery Risk Score, EuroSCORE (II), frailty testing, and other predictors. When combined with another left ventricular outflow tract obstruction, careful consideration must be taken prior to proceeding with transcatheter aortic valve replacement because an additional masked left ventricular outflow tract pathology can lead to challenging hemodynamics in the peri-deployment phase, as reported in this case. CASE PRESENTATION: A 56-year-old Caucasian man with multiple comorbidities and severe aortic stenosis underwent transcatheter aortic valve replacement under monitored anesthesia care. During the deployment phase, he developed dyspnea that progressed to pulmonary edema requiring emergent conversion to general anesthesia, orotracheal intubation, acute respiratory distress syndrome-type ventilation, and vasopressor medications. Intraoperative transesophageal echocardiography was performed and hypertrophic obstructive cardiomyopathy with systolic anterior motion of the mitral valve was discovered as an underlying pathology, undetected on preoperative imaging. After treatment with beta blockers, fluid resuscitation, and alpha-1 agonists, he stabilized and was eventually discharged from our hospital without any lasting sequelae. CONCLUSIONS: Patients with aortic stenosis most often develop symmetric hypertrophy; however, a small subset has asymmetric septal hypertrophy leading to left ventricular outflow tract obstruction. In cases of severe aortic stenosis, however, evidence of left ventricular outflow tract obstruction via both symptoms and echocardiographic findings may be minimized due to extremely high afterload on the left ventricle. Diagnosing a left ventricular outflow tract obstruction as the cause of hemodynamic instability during transcatheter aortic valve replacement, in the absence of abnormal findings on echocardiogram preoperatively, requires a high index of clinical suspicion. The management of acute onset left ventricular outflow tract obstruction intraoperatively consists primarily of medical therapy, including rate control, adequate volume resuscitation, and avoidance of inotropes. With persistently elevated gradients, interventional treatments may be considered.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Estenose da Valva Aórtica/cirurgia , Cardiomiopatia Hipertrófica/diagnóstico , Complicações Intraoperatórias/diagnóstico , Insuficiência da Valva Mitral/diagnóstico , Substituição da Valva Aórtica Transcateter , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica/terapia , Ecocardiografia Transesofagiana , Hidratação , Humanos , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , Resultado do Tratamento
19.
Artigo em Inglês | MEDLINE | ID: mdl-30549514

RESUMO

Papillary muscle rupture is a rare complication after myocardial infarction and almost all cases occur in the mitral valve papillary muscle. Tricuspid regurgitation development after right ventricular myocardial infarction caused by papillary muscle rupture is extremely rare.  In this video tutorial we present a 70-year-old man with massive tricuspid regurgitation caused by papillary muscle rupture after percutaneous stenting of the right coronary artery. We performed tricuspid valve repair with reimplanted papillary muscle in situ using neither artificial chordae nor a prosthetic valve. There are no previous case reports of this surgical repair technique.


Assuntos
Ruptura Cardíaca/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Músculos Papilares/cirurgia , Intervenção Coronária Percutânea/métodos , Idoso , Angiografia Coronária , Ecocardiografia , Ruptura Cardíaca/diagnóstico , Ruptura Cardíaca/etiologia , Humanos , Masculino , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Músculos Papilares/diagnóstico por imagem
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