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1.
Methodist Debakey Cardiovasc J ; 15(2): 149-151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384379

RESUMO

Patients with advanced valvular disease may be at high or prohibitive risk for surgical management. We describe a patient with previous mitral and tricuspid valve repair and recurrent admissions for New York Heart Association Class IV heart failure symptoms due to severe mitral stenosis and severe tricuspid regurgitation. Due to her comorbidities and two previous sternotomies, the patient was at high risk for surgery. We performed a simultaneous transfemoral mitral and tricuspid valve-in-ring implantation. This is the first report of its kind using a Sapien 3 valve (Edwards Lifesciences).


Assuntos
Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Cateterismo Cardíaco/métodos , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/etiologia , Estenose da Valva Mitral/fisiopatologia , Desenho de Prótese , Recuperação de Função Fisiológica , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/fisiopatologia
2.
J Cardiothorac Surg ; 14(1): 102, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174558

RESUMO

BACKGROUND: Mitral valve replacement with the total leaflet preservation technique can yield good results; however, its development is limited by patient-valve mismatch. Therefore, we compared the efficacies of the modified total leaflet preservation technique, posterior leaflet preservation technique, and no leaflet preservation technique in mitral valve replacement. METHODS: Clinical records and echocardiographic data of 180 patients who underwent mitral valve replacement for rheumatic mitral valve disease between 2009 and 2017 were analysed retrospectively to summarise the operative experience and short-term (six months) results. The patients were divided into three groups: group A (n = 62), treated with the modified total leaflet preservation technique; group B (n = 80), treated with the posterior leaflet preservation technique; and group C (n = 38), treated with the no leaflet preservation technique. RESULTS: No significant difference in the preoperative clinical data was noted between the groups (p > 0.05). The clamp and recovery times of group A were longer (p < 0.05) and shorter (p < 0.05), respectively, than those of groups B and C. The postoperative left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left ventricular ejection fraction of group A were significantly better than those of groups B and C. The incidence of low cardiac output syndrome in group A was lower than that in group C (p < 0.05). There was no postoperative left ventricular posterior wall rupture or mechanical valve dysfunction in group A. CONCLUSIONS: The short-term results of the modified total leaflet preservation technique were better than those of the other techniques. This technique is also suitable for patients with rheumatic mitral valve stenosis.


Assuntos
Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Tratamentos com Preservação do Órgão/métodos , Cardiopatia Reumática/cirurgia , Adulto , Ecocardiografia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/fisiopatologia , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/fisiopatologia , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
3.
J Cardiothorac Surg ; 14(1): 108, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196216

RESUMO

BACKGROUND: Mitral valve repair with the use of an annuloplasty ring is the procedure of choice in patients with significant mitral regurgitation (MR) due to floppy mitral valve (FMV)/mitral valve prolapse (MVP). The mitral annular size, shape and motion may vary substantially among patients and thus, commercially available rings may not be suitable for each individual patient. METHODS: A "personalized ring" (PR) was easily constructed in the operating room using a Dacron sheet and titanium ligating clips to custom fit to each individual mitral annulus shape and size. There were 127 patients with severe MR due to FMV/MVP that underwent mitral valve repair surgery; 58 patients received a PR and 69 patients received a commercial Carpentier-Edwards Physio II ring. The patient records were retrospectively analysed. RESULTS: There were no surgical deaths. In-hospital length-of-stay and blood transfusions were not statistically different between the two groups. Mitral valve area was greater (p < 0.05) in the PR group (3.78 ± 0.22) compared to the Physio II ring group (3.13 ± 0.21). Mitral annular area changed from systole to diastole by 14.35% ± 3.28% in the PR group and did not change in the Physio II ring group (p < 0.05). Systolic anterior motion (SAM) of the mitral valve occurred in 2 patients with the Physio II ring and no patients with the PR. Up to 8 years follow-up, all patients in both groups were alive with NYHA functional class I-II symptoms and mild or less MR. CONCLUSIONS: The PR is suitable for all patients with significant MR due to FMV/MVP who require MV repair. The precise fit of the PR to the mitral annulus better preserves valve area and sphincter function of the mitral annulus, prevents SAM and provides excellent short and long-term results.


Assuntos
Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Desenho de Prótese , Adulto , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/fisiopatologia , Estudos Retrospectivos , Sístole
6.
Int J Cardiovasc Imaging ; 35(9): 1597-1604, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30972528

RESUMO

For patients with asymptomatic mitral regurgitation (MR), the criteria identifying the groups at higher-risk and their clinical outcome are still uncertain. Therefore, in these patients, optimal time of surgery remains controversial. The purpose of this study was to compare left atrial (LA) strain to other echocardiographic left ventricular (LV) and LA parameters for the prediction of cardiovascular outcomes in patients with moderate asymptomatic MR. We enrolled 395 patients with primary degenerative moderate asymptomatic MR. Exclusion criteria were: history of atrial fibrillation, myocardial infarction, heart failure, cardiac surgery or heart transplantation, severe MR, mitral valve surgery during follow-up. Patients were prospectively followed for 3.5 ± 1.6 years for the development of cardiovascular events i.e. atrial fibrillation, stroke/transient ischaemic attack, acute heart failure, cardiovascular death. Of 276 patients (mean age 66 ± 8 years) who met eligibility criteria, 108 patients had 141 new events. Patients who developed cardiovascular events presented reduced global peak atrial longitudinal strain (PALS), reduced LA emptying fraction, larger LA volume indexed and lower LV strain at baseline (p < 0.0001). With receiving operating characteristics (ROC) curve analysis, global PALS < 35% showed the greatest predictive performance (AUC global PALS: 0.87). Bland-Altman analysis demonstrated good intra- and interobserver agreement with small bias and Kaplan-Meier analysis showed a graded association between PALS and event-free-survival rates. Speckle tracking imaging could provide a useful index, global PALS, to estimate LA function in asymptomatic moderate MR in order to optimize timing of surgery before the development of irreversible myocardial dysfunction.


Assuntos
Função do Átrio Esquerdo , Ecocardiografia Doppler , Insuficiência da Valva Mitral/diagnóstico por imagem , Idoso , Doenças Assintomáticas , Fenômenos Biomecânicos , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Variações Dependentes do Observador , Seleção de Pacientes , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
7.
Medicine (Baltimore) ; 98(17): e14969, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027050

RESUMO

To summary the impact of off-pump coronary artery bypass grafting (CABG) only on patients with moderate ischemic mitral regurgitation and survival.We retrospectively analyzed 109 patients with coronary artery disease (CAD) complicated by moderate mitral regurgitation, from January, 2008 to December, 2014, in the Department of Cardiovascular Surgery at the No. 2 Hospital of Jilin University undergoing off pump CABG only. Preoperative clinical characteristics, complications after surgery, and outcome (survivor or death) were assessed. We observed the degree of mitral valve regurgitation, left ventricular ejection fraction (LVEF), left ventricular and left atrial size, left ventricular end-diastolic volume (LVEDV) preoperative, and New York Heart Association (NYHA) functional class, postoperative 10 days before discharge, and 6 months and longer after surgery. The statistical data were processed by SPSS 19 software with computer; statistical significant difference with P < .05.Overall in-hospital mortality was 2.75% (3 patients). Patients had lower mean LVEF in the postoperative compared with the preoperative period, but all the patients had higher LVEF since 6 months than preoperative period (P < .001). Compared with the preoperative dates, postoperative valvular regurgitation, left ventricular and atrial size and LVEDV postoperative 10 days before discharge, 6 months and more longer after surgery reduced significantly (P < .001). Rapid atrial fibrillation occurred in 19 cases during perioperative and returned to normal before discharge. The symptom of angina was disappeared in all patients before discharge. The mean follow-up time was 60.16 ±â€Š17.98 months (range 36-96 months). Two patients died of major adverse cardiac events including heart failure and ventricular fibrillation. Three patients died of lung cancer, and 2 patients died of stroke during the longer follow-up.Off-pump CABG can be performed safely in patients with CAD complicated by moderate mitral regurgitation. The efficacy of CABG only is well demonstrated by the significant improvement of LVEF and NYHA functional class, and by the decrease of left ventricular and atrial size, LVEDV, and mitral regurgitation grade.


Assuntos
Ponte de Artéria Coronária , Isquemia/cirurgia , Insuficiência da Valva Mitral/cirurgia , Idoso , Feminino , Humanos , Isquemia/mortalidade , Isquemia/patologia , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/patologia , Insuficiência da Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Função Ventricular Esquerda
8.
Ann Thorac Surg ; 108(1): 90-97, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30836099

RESUMO

BACKGROUND: Neochordoplasty is an important repair technique, but optimal anchoring position is unknown. Although typically anchored at papillary muscles, new percutaneous devices anchor the neochordae at or near the ventricular apex, which may have an effect on chordal forces and the long-term durability of the repair. METHODS: Porcine mitral valves (n = 6) were mounted in a left heart simulator that generates physiologic pressure and flow through the valves, and chordal forces were measured with Fiber Bragg Grating strain gauge sensors. Isolated mitral regurgitation was induced by cutting P2 primary chordae, and the regurgitant valve was repaired with polytetrafluoroethylene neochord with apical anchoring, followed by papillary muscle fixation for comparison. In both situations, the neochord was anchored to a customized force-sensing post positioned to mimic the relevant in vivo placement. RESULTS: Echocardiographic and hemodynamic data confirmed that the repairs restored physiologic hemodynamics. Forces on the chordae and neochord were lower for papillary fixation than for the apical fixation (p = 0.003). In addition, the maximum rate of change of force on the chordae and neochordae was higher for apical fixation than for papillary fixation (p = 0.028). CONCLUSIONS: Apical neochord anchoring results in effective repair of mitral regurgitation, albeit with somewhat higher forces on the chordae and neochord suture, as well as an increased rate of loading on the neochord compared with the papillary muscle fixation. These results may guide strategies to reduce stresses on neochordae as well as aid optimal patient selection.


Assuntos
Cordas Tendinosas/cirurgia , Insuficiência da Valva Mitral/cirurgia , Animais , Fenômenos Biomecânicos , Cordas Tendinosas/fisiologia , Ecocardiografia , Hemodinâmica , Insuficiência da Valva Mitral/fisiopatologia , Músculos Papilares/cirurgia , Suínos
9.
Vet J ; 245: 7-11, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30819428

RESUMO

The purpose of this study was to clarify how alacepril in amounts greater than those recommended on the product labeling approved by drug regulatory agencies affects left atrial pressure (LAP) and central aortic pressure in dogs with experimentally induced mitral valve regurgitation (MR). Six healthy Beagle dogs were surgically induced for MR and received alacepril at either 1.5mg/kg/12-h (3.0mg/kg/day) or 3.0mg/kg/12-h (6.0mg/kg/day) per one administration for seven days. After a four-week washout period, another dosage was administrated as a crossover study. Dogs were randomised to receive 3.0mg/kg/day or 6.0mg/kg/day first. LAP and central systolic (SAP), mean (MAP), and diastolic (DAP) aortic pressure were measured for 24-h before and during the administration of alacepril. The earliest decreases in SAP, MAP, and DAP with 6.0mg/kg/day were observed on days 4, 4, and 5, respectively. With 3.0mg/kg/day, the earliest decrease in DAP was observed on day 7. The maximum LAP was decreased on days 5 and 7 with 6.0mg/kg/day. The mean LAP was decreased on day 7 with 6.0mg/kg/day. In conclusion, the administration of alacepril at 6.0mg/kg/day reduced the LAP and central aortic pressure within several days.


Assuntos
Pressão Arterial/efeitos dos fármacos , Pressão Atrial/efeitos dos fármacos , Captopril/análogos & derivados , Doenças do Cão/tratamento farmacológico , Insuficiência da Valva Mitral/tratamento farmacológico , Insuficiência da Valva Mitral/veterinária , Inibidores da Enzima Conversora de Angiotensina , Animais , Função do Átrio Esquerdo/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Captopril/administração & dosagem , Estudos Cross-Over , Doenças do Cão/fisiopatologia , Cães , Feminino , Masculino , Insuficiência da Valva Mitral/fisiopatologia
10.
Cardiovasc Pathol ; 40: 32-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30836303

RESUMO

BACKGROUND: The mechanism by which atrial fibrosis leads to the production and maintenance of atrial fibrillation (AF) is unclear. Myocardial biopsies, which have often been used in previous studies, are taken from a single site and do not always reflect the overall condition of atrial fibrosis. AIMS: The aim of this study was to investigate the location of fibrosis in the atria induced by mitral regurgitation (MR) and its effect on atrial electrophysiology and vulnerability to AF. METHODS: Nineteen pigs were divided into three groups. The control group (n=6) underwent a sham operation, and the experimental groups underwent an MR induction operation and were observed for 3 (n=7) or 6 (n=6) months. All the animals were tested for vulnerability to AF. Then, the atria were divided into 12 regions: 6 in the left atrium (LA) and 6 in the right atrium (RA). The conduction velocities (CVs) and effective refractory periods (ERPs) in different regions were examined by electroanatomic mapping, and fibrosis in different regions was examined by Masson staining. RESULTS: With the duration of MR, fibrosis (3.11% ±â€¯0.08% in the control group, 5.85% ±â€¯0.42% in the 3-month group and 8.17% ±â€¯0.23% in the 6-month group, P<.001), vulnerability to AF (0/6 in the control group, 2/7 in the 3-month group and 5/6 in the 6-month group, P<.05) and the effective refractory period (220.1±1.1 ms in the control group, 244.4±1.4 ms in the 3-month group and 289.0±8.9 ms in the 6-month group, P<.001) were increased, while the conduction velocity (1.39±0.16 m/s in the control group, 1.04±0.05 m/s in the 3-month group and 0.89±0.02 m/s in the 6-month group, P<.001) was reduced. These pathophysiological changes were not uniform in different regions of the atria (3.83% ±â€¯0.25% in right atrial fibrosis vs 8.22% ±â€¯0.83% in left atrial fibrosis, P<.001; 5.09% ±â€¯0.34% in the right atrium vs 11.76% ±â€¯0.52% in the left atrium, P<.001). A negative correlation was identified between fibrosis and conduction velocity (P<.001 in the 3-month and 6-month groups), but no correlation was found between fibrosis and the effective refractory period (P=.829 in the 3-month group and P=.093 in the 6-month group). Susceptibility to AF was associated with the dispersion of atrial fibrosis (P=.023). CONCLUSIONS: With the duration of MR, atrial fibrosis increased, and the degree of increase was not uniform among different areas of the atria. The dispersion of atrial fibrosis may contribute to increased susceptibility to AF by influencing the conduction velocity rather than the effective refractory period.


Assuntos
Potenciais de Ação , Fibrilação Atrial/etiologia , Remodelamento Atrial , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Insuficiência da Valva Mitral/complicações , Animais , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Modelos Animais de Doenças , Fibrose , Átrios do Coração/patologia , Masculino , Insuficiência da Valva Mitral/patologia , Insuficiência da Valva Mitral/fisiopatologia , Período Refratário Eletrofisiológico , Fatores de Risco , Suínos , Porco Miniatura , Fatores de Tempo
11.
BMJ Case Rep ; 12(2)2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30755426
12.
Biomed Res Int ; 2019: 2437105, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30756081

RESUMO

Objectives: This study aims to correlate subclinical echocardiographic features with the clinical, laboratory, and therapeutic profiles of the patients to characterize risks for systemic lupus erythematosus (SLE) cardiac diseases. Methods: The study included 59 SLE patients. Demographic data, disease characteristics, and current therapies were recorded, and the anthropometric measurements and routine laboratory tests were performed. The disease activity by the SLE Disease Activity Index-2K (SLEDAI2K) and the presence of metabolic syndrome (MetS) were assessed. Two-dimensional echocardiography was performed. Results: The mean age of the patients was 31.3 ± 10.5 years, and the disease duration was 5.18 ± 4.1 years. 86.4% of the patients were females. Cardiac presentations by echocardiography were mainly mitral regurgitation (33.9%), tricuspid regurgitation (32.2%), mitral thickening (18.6%), aortic thickening (13.6%), pericardial effusion (13.6%), and pulmonary hypertension (8.5%) in order of frequency. The frequency of different echocardiographic findings with respect to other clinical phenotypes showed peaks with renal disease, MetS, and leukopenia. Components of MetS (triglycerides, high systolic blood pressure) and avascular necrosis were significant predictors for pericardial diseases (OR=1.011 CI 95% 1-1.022, p=0.046, OR=1.157 CI 95% 1.025-1.307, p=0.018, and OR=74.78 CI 95% 2.52-2215.76, p=0.013, respectively), and it is likely that hydroxychloroquine was protective against them. Age of the patients was a significant predictor for tricuspid regurgitation (OR=1.063 CI 95% 1.004-1.126, p=0.036). Mucosal ulcers were negative predictors for mitral thickening and regurgitation (OR=0.2 CI 95% 0.059-0.673, p=0.009). The use of corticosteroids appeared to protect against a number of valve lesions especially tricuspid regurgitation (OR=0.299 CI 95% 0.088-1.019, p=0.054). Conclusion: This study highlighted different echocardiographic features and identified clinical predictors of different cardiac pathologies aiming to determine patients at risk and improve the prognosis of SLE cardiac diseases.


Assuntos
Doenças das Valvas Cardíacas/metabolismo , Lúpus Eritematoso Sistêmico/metabolismo , Síndrome Metabólica/metabolismo , Insuficiência da Valva Mitral/metabolismo , Adulto , Contagem de Células Sanguíneas , Sedimentação Sanguínea , Colesterol/sangue , Ecocardiografia Doppler , Feminino , Coração/diagnóstico por imagem , Coração/fisiopatologia , Doenças das Valvas Cardíacas/sangue , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/fisiopatologia , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/complicações , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/sangue , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/fisiopatologia , Derrame Pericárdico/sangue , Derrame Pericárdico/complicações , Derrame Pericárdico/fisiopatologia , Triglicerídeos/sangue , Ácido Úrico/sangue
13.
Ann Thorac Surg ; 108(1): 81-88, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30710521

RESUMO

BACKGROUND: Heart failure with reduced ejection fraction due to a post-infarction anteroseptal aneurysm carries a poor prognosis. Patients with refractory heart failure may be considered for advanced surgery, including left ventricular assist device implantation, heart transplantation and left ventricular reconstruction. The aim of this study was to evaluate outcomes after an integrated approach of left ventricular reconstruction with concomitant procedures (mitral/tricuspid valve repair, coronary revascularization), and assess risk factors for event-free survival, focusing on left ventricular geometry/function and presence of functional mitral regurgitation (MR). METHODS: A total of 159 consecutive heart failure patients who underwent left ventricular reconstruction between 2002 and 2011 were included. Mid-term echocardiographic and long-term clinical outcomes were evaluated. Preoperative risk factors were correlated to event-free survival (freedom from mortality, left ventricular assist device implantation, and heart transplantation). RESULTS: Mid-term echocardiography demonstrated decreased indexed left ventricular end-systolic volumes (89 ± 42 mL/m2 preoperatively; 51 ± 18 at mid-term, p < 0.001), and absence of MR ≥ grade 2. Event-free survival was 83% ± 3% at 1-year, 68% ± 4% at 5-year, and 46% ± 4% at 10-year follow-up. Preoperative wall motion score index (WMSI; hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.7-5.8, p < 0.001) and presence of MR ≥ grade 2 (HR 1.9, 95% CI 1.1-3.1, p = 0.014) were independently associated with adverse event-free survival. CONCLUSIONS: Event-free survival is favorable in patients with WMSI < 2.5 and significantly worse when WMSI is ≥ 2.5. In both groups, the presence of preoperative MR ≥ grade 2 negatively affects event-free survival, despite successful correction of MR. Risk stratification by preoperative WMSI and MR grade supports the Heart team in choosing the optimal surgical strategy for patients with refractory heart failure.


Assuntos
Insuficiência Cardíaca/cirurgia , Ventrículos do Coração/cirurgia , Insuficiência da Valva Mitral/fisiopatologia , Idoso , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
14.
Echocardiography ; 36(1): 164-169, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30620100

RESUMO

Recent studies lend credibility to the notion that lone atrial fibrillation (AF) can cause functional mitral regurgitation (MR), commonly referred to as atrial functional MR (AF-MR). The conventional view holds that left atrial enlargement associated with AF causes annular dilatation which gradually moves the mitral valve leaflets apart resulting in inadequate coaptation and regurgitation. Recent findings, however, suggest that AF-MR is not solely related to left atrial remodeling, but that important structural and functional abnormalities of the left ventricle also play a role in its pathogenesis.


Assuntos
Fibrilação Atrial/complicações , Remodelamento Atrial/fisiologia , Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Ecocardiografia Doppler em Cores/métodos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Ventrículos do Coração/patologia , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia
15.
J Cardiovasc Med (Hagerstown) ; 20(3): 137-144, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30601192

RESUMO

AIMS: We sought to analyze the early and follow-up results of minimally invasive video-assisted mitral valve repair. With particular focus on degenerative disease, results were stratified according to type of lesion, strategy of repair and surgical technique. METHODS: We retrospectively built a database over 241 patients who received mitral repair for severe regurgitation through right minithoracotomy in the 2009-17 period. Cause was degenerative in 92.1%, restrictive in 5.8% and mixed in the remainders. Clinical and echocardiographic follow-up (98.7% complete, average duration 2.9 years ±â€Š1.4) was obtained through contact of in-house and territorial cardiologists. Recurrent mitral regurgitation at follow-up was defined as being at least mild-to-moderate (2+). RESULTS: Operative mortality was 1.7%, and related to the technique in one case. Five-year actuarial survival was 95% ±â€Š2; there was no valve-related death and one reoperation. At follow-up, we observed eight cases of 2+ regurgitation and one instance of 4+ regurgitation (4-year actuarial freedom: 92% ±â€Š4). Freedom from recurrent regurgitation was significantly lower in the 'restrictive' subgroup vs. the 'degenerative' subgroup (P = 0.02); no statistically significant difference in freedom from recurrence was observed among patients who received mitral repair using a 'resect' vs. 'nonresection' strategy (P = 0.46), and in those who received the Totally Endoscopic technique (endoaortic balloon occlusion, no costal spreading) vs. controls (external aortic clamp, costal spreading) (P = 0.98). CONCLUSION: Durability of minimally invasive mitral repair is optimal. Nonresection repair techniques are at least noninferior to previous approaches based on leaflet resection.


Assuntos
Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Toracotomia/métodos , Cirurgia Vídeoassistida/métodos , Idoso , Bases de Dados Factuais , Ecocardiografia , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , 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/mortalidade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Toracotomia/efeitos adversos , Toracotomia/mortalidade , Fatores de Tempo , Resultado do Tratamento , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/mortalidade
16.
J Cardiovasc Surg (Torino) ; 60(3): 406-412, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30698368

RESUMO

BACKGROUND: The feasibility and safety of robotic mitral valve repair has been proven in several studies but the mid-term to long-term outcomes are unclear. We aim to summarize our surgical experience with robotic mitral valve repair and demonstrate the follow-up results out to 7 years. METHODS: From 2007 to 2014, 110 consecutive patients underwent robotic mitral valve repair with da Vinci Surgical System (Intuitive Surgical, USA) in our center. The operative data were collected, and patients were echocardiographically followed regularly up to 7 years. RESULTS: The patients' average age was 45±13 (14 to 70) years with male to female ratio of 2.3:1. Mitral regurgitation (95.5%) or stenosis (4.5%) was diagnosed. The triangular or quadrangular resection was the most performed type of repair (63.3%). Nitinol U-clips (58.1%), running suture (31.1%), and Cor-Knot™ suture device (LSI Solutions, Victor, NY) (10.8%) were used to secure the annuloplasty ring. All cases were performed by the same surgeon. One case of conversion to sternotomy was noted. The mean CPB time was 121±34.3 (range, 70 to 152) minutes, and the mean cross-clamp time was 82.6±25.3 (range, 47 to 122) minutes. After surgery, one death (0.91%) and two cases of transient neurocognitive defect (1.82%) occurred. Three cases of early failure of repair that required reoperation (2.73%) were noticed. All patients were successfully followed for a median of 4.1 (range, 1 month to 7 years) years and 94.5% had freedom of re-operation. CONCLUSIONS: Robotic mitral valve repair is a safe and effective procedure with excellent mid-term outcomes.


Assuntos
Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos , Adolescente , Adulto , Idoso , Feminino , 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 , Hemodinâmica , 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 , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/mortalidade , Estenose da Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/mortalidade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Arch Cardiovasc Dis ; 112(2): 95-103, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30600216

RESUMO

BACKGROUND: Surgical treatment of secondary mitral regurgitation (SMR) is controversial. AIM: To analyse outcome after undersizing annuloplasty (UA) and mitral valve replacement (MVR). METHODS: Consecutive patients operated on for severe SMR, with left ventricular ejection fraction (LVEF)<40% and refractory CHF, were included. Endpoints were in-hospital mortality, mid-term cardiovascular (CV) mortality, evolution of LV variables and recurrence of mitral regurgitation (MR). RESULTS: 59 patients were included (mean age 65±10 years, preoperative LVEF 36±6%; effective regurgitant orifice [ERO] 41±17 mm2), 41 with ischaemic disease: 12 underwent UA and 47 underwent MVR; only eight had concomitant coronary revascularization. In-hospital mortality was 3.3% (8.3% in UA group; 2.1% in MVR group). Eight-year CV mortality was 39±13% (40±18% in UA group; 27±10% in MVR group). Older age (hazard ratio 1.14, 95% confidence interval 1.07 to 1.22; P<0.001) and LV end-systolic diameter (hazard ratio 1.18, 95% confidence interval 1.09 to 1.27; P<0.001) independently predicted CV mortality. LVEF did not change between the preoperative and follow-up transthoracic echocardiograms in the MVR group (36±6% vs. 35±10%; P=0.6) or the UA group (36±5% vs. 31±12%; P=0.09). Conversely, LV end-diastolic diameter decreased significantly in the MVR group (64±8m to 59±9mm; P=0.002), but not in the UA group (61±7m to 64±10mm; P=0.2). Recurrence of significant MR occurred in 81% of patients in the UA group (mean postoperative ERO 19±6 mm2) versus none in the MVR group. CONCLUSIONS: Surgical treatment of SMR can be performed with acceptable operative risk and mid-term survival in severe heart failure, even if there is no indication for revascularization. MVR is associated with significant reverse remodelling, and UA with prohibitive risk of MR recurrence.


Assuntos
Insuficiência Cardíaca/complicações , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Ecocardiografia , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Desenho de Prótese , Recuperação de Função Fisiológica , Recidiva , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
18.
Comput Methods Biomech Biomed Engin ; 22(3): 288-303, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30596526

RESUMO

The aim of this study is to simulate the Mitral Regurgitation (MR) disease progression from mild to severe intensity. A Fluid Structure Interaction (FSI) model was developed to extract the hemodynamic parameters of blood flow in mitral regurgitation (MR) during systole. A two-dimensional (2D) geometry of the mitral valve was built based on the data resulting from Magnetic Resonance Imaging (MRI) dimensional measurements. The leaflets were assumed to be elastic. Using COMSOL software, the hemodynamic parameters of blood flow including velocity, pressure, and Von Mises stress contours were obtained by moving arbitrary Lagrange-Euler mesh. The results were obtained for normal and MR cases. They showed the effects of the abnormal distance between the leaflets on the amount of returned flow. Furthermore, the deformation of the leaflets was measured during systole. The results were found to be consistent with the relevant literature.


Assuntos
Circulação Coronária , Hemodinâmica/fisiologia , Hemorreologia , Insuficiência da Valva Mitral/fisiopatologia , Velocidade do Fluxo Sanguíneo , Humanos , Masculino , Valva Mitral/fisiopatologia , Modelos Cardiovasculares , Pressão , Estresse Mecânico , Sístole/fisiologia , Adulto Jovem
19.
Am J Cardiol ; 123(1): 75-83, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30539749

RESUMO

Functional mitral regurgitation (FMR) is common in heart failure (HF), and negatively impacts prognosis. Cardiac resynchronization therapy (CRT) can improve FMR, but the long-term changes in and impact of FMR after CRT are still unclear. The present study investigated the prevalence, evolution and impact on mortality of FMR before and after CRT in patients with HF. A total of 1,313 patients (66 ± 11 years, 77% male, 59% ischemic heart disease) treated with CRT were evaluated. Patients were divided into 4 groups of FMR according to the evolution at 6 months after CRT: no or mild FMR at baseline which remained unchanged at 6 months (grade 0-1 FMR unchanged, n = 609 [51%]), no or mild FMR which worsened to moderate to severe (grade 0-1 FMR worsened, n = 66 [6%)]), moderate to severe FMR which improved to no or mild (grade 2-4 improved, n = 209 [18%]), and moderate to severe FMR which remained unchanged (grade 2-4 unchanged, n = 309 [26%]). Over a mean follow-up of 51 ± 38 months, 297 (25%) patients died. Those with baseline FMR grade 0-1 which remained unchanged at 6-month follow-up, as well as baseline FMR grade 2-4 which improved, had lower mortality rates than patients with 6-month FMR grade 2-4 regardless of baseline FMR grade (p <0.001). Baseline FMR grade 2-4 that remained unchanged at 6-month follow-up was associated with increased mortality, independent of the clinical and left ventricular volumetric responses to CRT (hazard ratio, 1.77; 95% confidence interval, 1.41-2.22, p <0.001). In conclusion, moderate to severe FMR at baseline which remains unchanged at 6 months after CRT implantation is strongly associated with long-term mortality in patients with HF.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Insuficiência da Valva Mitral/fisiopatologia , Idoso , Ecocardiografia , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/mortalidade , Prevalência , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
20.
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
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