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1.
EuroIntervention ; 15(17): 1506-1513, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-31929100

RESUMO

AIMS: The aim of our study was to compare the impact of implantation of a balloon-expandable transcatheter valve into the inferior vena cava (CAVI) on exercise capacity with optimal medical therapy (OMT) in patients with severe tricuspid regurgitation (TR) and high surgical risk. METHODS AND RESULTS: Twenty-eight patients were randomised to OMT (n=14) or CAVI (n=14). The primary endpoint was maximal oxygen uptake at the three-month follow-up. Secondary endpoints included six-minute walk test, NYHA class, NT-proBNP levels, right heart function, unscheduled heart failure hospitalisation, and quality of life as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients underwent follow-up examinations one, three, six, and twelve months after randomisation. Maximal oxygen uptake did not change significantly in either group after three months and there was no difference between the OMT and CAVI groups (-0.1±1.8 ml∙kg-1∙min-1 vs -1.0±1.6 ml∙kg-1∙min-1, p=0.4995). Compared to baseline, CAVI improved NYHA class, dyspnoea, and quality of life after three months. However, there were no statistically significant differences in the secondary endpoints between the groups. Four periprocedural complications occurred after CAVI, resulting in open heart surgery. Four patients in the OMT group and eight patients (including four after conversion to surgery) in the CAVI group died from right heart failure, sepsis or haemorrhage. CONCLUSIONS: CAVI did not result in a superior functional outcome compared to OMT. Due to an unexpectedly high rate of valve dislocations, the study was stopped for safety reasons.


Assuntos
Cateterismo Cardíaco/métodos , Cateterismo Venoso Central/métodos , Insuficiência Cardíaca/complicações , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Tricúspide/cirurgia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Causas de Morte , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Minnesota/epidemiologia , Desenho de Prótese , Qualidade de Vida , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/epidemiologia , Veia Cava Inferior/fisiopatologia
2.
Am J Forensic Med Pathol ; 41(1): 40-41, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31929320

RESUMO

The deceased was a 44-year-old male who was treated for a suspected Ebstein's anomaly observed using transthoracic echocardiogram. He was found dead in his bed at home. Autopsy revealed that the septal tricuspid leaflet was intact; however, a large anterior tricuspid leaflet cleft and right atrioventricular cavity dilation were observed. Pathological examination revealed a normal tricuspid valve, except for the presence of a cleft with local fibrosis of the left ventricle papillary muscle and hemosiderin-containing macrophages at both lungs. There were no other abnormalities that may have led to death. It was concluded that he died a cardiac death based on the right heart overload associated with the anterior tricuspid leaflet cleft. This case indicates the possibility that the anterior tricuspid leaflet cleft can cause death and also highlights the necessity of a detailed autopsy to accurately diagnose the cause of death.


Assuntos
Valva Tricúspide/anormalidades , Valva Tricúspide/patologia , Adulto , Proteína C-Reativa/análise , Diagnóstico Diferencial , Anomalia de Ebstein/diagnóstico , Fibrose , Patologia Legal , Insuficiência Cardíaca/etiologia , Ventrículos do Coração/patologia , Hemossiderina/metabolismo , Humanos , Pulmão/metabolismo , Macrófagos/metabolismo , Masculino , Peptídeo Natriurético Encefálico/sangue , Músculos Papilares/patologia , Fragmentos de Peptídeos/sangue , Insuficiência da Valva Tricúspide/complicações
3.
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
4.
Ann Saudi Med ; 39(6): 422-425, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31804135

RESUMO

BACKGROUND: Early surgical management of complete atrioventricular (AV) canal defect is the optimal treatment option. Since the published evidence on outcomes is inconclusive, we retrospectively studied the outcomes of patients in our institution. OBJECTIVE: Study outcomes of complete AV canal repair. DESIGN: Retrospective, descriptive. SETTINGS: Single institute. PATIENTS AND METHODS: Medical records of patients under 2 years of age who underwent complete AV canal repair from January 2004 to December 2014 were retrospectively reviewed. MAIN OUTCOME MEASURES: Pre- and postoperative morbidity and mortality. SAMPLE SIZE: 140 patients. RESULT: The median (IQR) age at the time of surgery was 5.4 (3.9-8.2) months. Down syndrome was diagnosed in 98 (70%) of patients. AV valve regurgitation was found preoperatively in 129 (92%) and postoperatively in 135 (96%) patients. There was a significant association between preoperative pulmonary hypertension and the development of pulmonary hypertension in the postoperative period ( P=.04). Thirty-three patients needed reoperation. Arrhythmia was found in 19 patients, 16 of whom required pacemaker insertion. Seven patients died (5%). CONCLUSION: The presence of preoperative and postoperative AV valve regurgitation was common in this cohort but did not significantly affect patient survival. Our findings suggest an acceptable outcome for repair of complete AV septal defect with few complications postoperatively. LIMITATION: Retrospective in single institute. CONFLICT OF INTEREST: None.


Assuntos
Defeitos dos Septos Cardíacos/cirurgia , Fatores Etários , Feminino , Defeitos dos Septos Cardíacos/complicações , Defeitos dos Septos Cardíacos/mortalidade , Humanos , Lactente , Recém-Nascido , Masculino , Insuficiência da Valva Mitral/complicações , Estudos Retrospectivos , Resultado do Tratamento , Insuficiência da Valva Tricúspide/complicações
6.
J Card Surg ; 34(10): 1123-1126, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31374583

RESUMO

Primary cardiac tumors are very rare and generally benign. The most common type, cardiac rhabdomyoma, comprises 45% to 75% of primary cardiac tumors. Cardiac rhabdomyoma is a rare benign tumor that commonly presents with tuberous sclerosis. We present a case of an infant with multifocal cardiac rhabdomyomas with an atrial septal defect and tricuspid insufficiency and no sign of tuberous sclerosis. She was successfully treated with an operation, the treatment plan included mass resection, tricuspid annuloplasty, and closure of the patent foramen ovale. The right atrial lesion was resected entirely, while the lobulated lesion in the right ventricle was resected as two pieces. There was no evidence of recurrence 1 year after the surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/diagnóstico , Comunicação Interatrial/cirurgia , Rabdomioma/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Diagnóstico Diferencial , Ecocardiografia , Feminino , Seguimentos , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico , Ventrículos do Coração , Humanos , Lactente , Imagem Cinética por Ressonância Magnética , Rabdomioma/complicações , Rabdomioma/diagnóstico , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico
8.
Herz ; 44(6): 491-501, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312873

RESUMO

Pulmonary hypertension (PH) is an important contributor to morbidity and mortality in patients with left-sided heart disease, including valvular heart disease. In this context, elevated left atrial pressure primarily leads to the development of post-capillary PH. Despite the fact that repair of left-sided valvular heart disease by surgical or interventional approaches will improve PH, recent studies have highlighted that PH (pre- or post-interventional) remains an important predictor of long-term outcome. Here, we review the current knowledge on PH in valvular heart disease taking into account new hemodynamic PH definitions, and the distinction between post- and pre-capillary components of PH. A specific focus is on the precise characterization of hemodynamics and cardiopulmonary interaction, and on potential strategies for the management of residual PH after mitral or aortic valve interventions. In addition, we highlight the clinical significance of tricuspid regurgitation, which may occur as a primary condition or as a consequence of PH and right heart dilatation (functional). In this context, proper patient selection for potential tricuspid valve interventions is crucial. Finally, the article highlights gaps in evidence, and points toward future perspectives.


Assuntos
Doenças das Valvas Cardíacas , Hipertensão Pulmonar , Insuficiência da Valva Tricúspide , Doenças das Valvas Cardíacas/complicações , Hemodinâmica , Humanos , Hipertensão Pulmonar/complicações , Valva Tricúspide , Insuficiência da Valva Tricúspide/complicações
9.
Innovations (Phila) ; 14(5): 412-418, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31337249

RESUMO

OBJECTIVE: The aim of this study was to evaluate whether the addition of concomitant tricuspid valve surgery (TVS) negatively impacted operative outcomes of minimally invasive mitral valve surgery (MIMVS). METHODS: Patients undergoing MIMVS via a port-access right minithoracotomy between 2002 and 2014 at a single institution were reviewed. Patients were primarily stratified by those undergoing isolated MIMVS versus MIMVS+TVS. Propensity-matched cohorts were generated. Operative outcomes were compared between the propensity-matched cohorts and included operative mortality, complications, and length of hospital stay. RESULTS: A total of 1,158 patients underwent MIMVS via port-access right minithoracotomy. The majority of cases were elective (93%; n = 1,071) and 148 (13%) underwent concomitant MIMVS + TVS. Patients undergoing MIMVS + TVS were at higher risk at baseline. After propensity-matching, there were 119 isolated MIMVS and 119 MIMVS + TVS patients that were well matched with respect to all baseline variables. Cardiopulmonary bypass (148 ± 54 minutes versus 175 ± 54 minutes, P < 0.001) and aortic occlusion times (105 ± 36 minutes versus 128 ± 40 minutes, P < 0.001) were longer in the MIMVS + TVS group. Operative mortality was comparable (3% isolated MIMVS versus 4% for MIMVS + TVS; P = 0.73). Permanent pacemakers were required less frequently in the isolated MIMVS group (1% versus 6%; P = 0.03). All other complication rates were similar. Median length of hospital stay (7 versus 8 days; P = 0.13) and discharge-to-home rates (89% versus 94%; P = 0.15) were comparable. CONCLUSIONS: Despite longer operative times, minimally invasive TVS performed concomitantly with MIMVS has similar operative outcomes with the exception of a higher pacemaker rate when compared with isolated MIMVS.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Valva Tricúspide/cirurgia , Idoso , Anuloplastia da Valva Cardíaca/mortalidade , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Insuficiência da Valva Mitral/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/cirurgia
10.
Kyobu Geka ; 72(8): 587-590, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31353349

RESUMO

Dextrocardia is a rare condition frequently associated with multiple and complex cardiovascular abnormalities. A 66-year-old woman, who had been diagnosed with dextrocardia at young age, was referred to our hospital with complaint of increasing dyspnea. Severe mitral regurgitation, moderate tricuspid regurgitation, and atrial fibrillation were detected. The multi detector-row computed tomography(MDCT) revealed absence of the inferior vena cava, and the hepatic vein connected directly with the right atrium. The venous cannulae were inserted into the superior vena cava directly and into the hepatic vein from the right atrium. Mitral valve repair, tricuspid valve repair, and maze procedure were successfully performed. MDCT is useful for detecting abnormality of vena cava in a cases of dextrocardia.


Assuntos
Dextrocardia , Insuficiência da Valva Mitral , Insuficiência da Valva Tricúspide , Idoso , Dextrocardia/complicações , Feminino , Humanos , Valva Mitral , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Tricúspide/complicações , Veia Cava Inferior
11.
BMJ Case Rep ; 12(6)2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31253659

RESUMO

Hypereosinophilic syndrome (HES) is a rare systemic condition, defined as a persistently elevated eosinophil count associated with end organ damage and the absence of a primary cause. Cardiac involvement occurs in about 50% of patients with HES. Myocardial infiltration results in endomyocardial fibrosis, valve dysfunction and mural thrombus. The atrioventricular valves are almost always involved, resulting in regurgitation due to leaflet restriction, most commonly affecting the posterior mitral valve leaflet. Surgical management remains challenging in patients with HES with limited data on the choice of valve surgery. We describe the case of a 17-year-old woman with HES complicated by congestive cardiac failure secondary to severe mitral and tricuspid regurgitation. Because of refractory heart failure despite medical therapy, surgical mitral and tricuspid valve repair was performed, and an excellent 24-month outcome was achieved. We believe this is the first report of double valve repair in this rare condition.


Assuntos
Insuficiência Cardíaca/etiologia , Síndrome Hipereosinofílica/complicações , Insuficiência da Valva Mitral/complicações , Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/complicações , Valva Tricúspide/cirurgia , Adolescente , Ecocardiografia/métodos , Feminino , Insuficiência Cardíaca/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/cirurgia
12.
Heart Surg Forum ; 22(3): E262-E268, 2019 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-31237555

RESUMO

BACKGROUND: The operative indications for severe tricuspid insufficiency in patients undergoing left-sided valvular surgery are well defined; however, for mild and moderate insufficiency, the findings are still controversial. In this study, we aimed to document the prognostic parameters for progression of tricuspid insufficiency in patients undergoing left-sided valvular surgery. METHODS: 135 patients undergoing mitral valve ± coronary bypass surgery were retrospectively examined. Patients with simultaneous tricuspid valve surgery were excluded. Demographic, clinical, and laboratory findings were recorded and the relationship with progression of tricuspid insufficiency was studied. RESULTS: Valvular pathology was rheumatic in origin in 72.6% of patients. Tricuspid insufficiency was progressed in 69 (51.1%) of patients, while it did not change in 66 (48.9%) patients. Echocardiographic parameters recorded during follow-up revealed that left ventricular end-diastolic diameter decreased, while there was no significant change in right ventricular end-diastolic diameter. Tricuspid insufficiency was directly related with right ventricular end-diastolic diameter (P < .05), while no relationship was documented with left ventricular end-diastolic diameter. There was a statistically significant correlation between postoperative progression of tricuspid insufficiency and left atrial diameter; however, no relationship was documented with age, sex, valvular disease etiology, comorbidities, or preoperative atrial fibrillation. Risk factor analysis revealed that left atrial diameter was the only prognostic factor. CONCLUSION: The indications for mild and moderate tricuspid insufficiency are still not clear for patients undergoing left-sided valvular surgery. In this study, we documented that left atrial dilatation was a prognostic factor for progression of postoperative tricuspid insufficiency. In this group of patients, presence of left atrial dilatation may be an indication for tricuspid valve intervention.


Assuntos
Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/cirurgia , Adulto , Idoso , Ponte de Artéria Coronária , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Seleção de Pacientes , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Valva Tricúspide/cirurgia
13.
J Cardiothorac Surg ; 14(1): 106, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31186038

RESUMO

BACKGROUND: Partial atrioventricular canal defects (PAVC) are preferred to be repaired when diagnosed and before an operation would interfere with school. There were rare previous studies about partial atrioventricular canal defect operations in adult patients. In this single-center retrospective study, we mean to review the mid-term follow-up outcomes of late diagnosed and repaired partial atrioventricular canal defects in adult patients. METHODS: 46 adult partial atrioventricular canal defect patients who underwent operation in West China Medical Center from 2009 to 2017 were included. Required data were obtained from operation notes, patient charts and the outpatient records. RESULTS: Among 46 patients, 10(21.7%)were male and mean age at operation was 37.6 ± 12.4 years. 11 patients had prior arrythmia, including 8 atrial fibrillations, 2 atrioventricular blocks and 1 left bundle branch block. There were 41 patients with tricuspid valve regurgitation and 22 underwent tricuspid valvuloplasty. All the patients had mitral regurgitation. 6 patients with valve incrassation and shrinkage underwent mitral valve replacement, and the rest underwent mitral repair surgery. There was one early death post operation and no more mortalities in the following follow-up years. According to the follow-up outcomes, heart function of the patients recovered significantly, dilation of atriums and ventricles, except for left atriums, were reversed to a large extent and all but one patients' tricuspid valve regurgitations were reduced to mild and below. 4(8.7%) patients underwent reoperation and the main reasons were arrythmia and recurrent severe mitral valve regurgitation. CONCLUSION: Partial atrioventricular canal defect repair in adult patients can achieve good results. Compared with the results of patients underwent operations in preschool years, though delayed surgery timing seems to bring more preoperative complications and influences heart function, the mortality and reoperation rate are excellent.


Assuntos
Comunicação Interventricular/cirurgia , Adulto , Arritmias Cardíacas/complicações , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , China , Diagnóstico Tardio , Feminino , Seguimentos , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/cirurgia
14.
Surg Technol Int ; 34: 321-329, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31037717

RESUMO

Tricuspid valve regurgitation is generally functional in nature due to right-sided dysfunction in the setting of left-sided concomitant cardiac disease or pulmonary hypertension. Patients living with tricuspid regurgitation often experience numerous limitations as a result of right-sided heart failure symptoms. Patients with significant tricuspid disease, whether native, repaired, or replaced valve, often present with significant symptoms but may not be ideal candidates for operation or, eventually, reoperation. Transcatheter techniques to either repair or replace the tricuspid valve are a burgeoning frontier in structural cardiac interventions. Anatomical challenges include the large and asymmetrical annulus, paucity of calcification, adjacency of the right coronary artery system, and fragility of the valve tissue. Current approaches under investigation in feasibility and early phase clinical trials include edge-to-edge repair, coaptation enhancement, annuloplasty, heterotopic caval valve implantation, and percutaneous tricuspid valve replacement. Although there are limitations to the currently available transcatheter options for the patients, the initial data demonstrate the relative safety of using existing devices with good results and functional improvement. Hopefully, the emerging interest into interventional therapy of tricuspid valve disease will bring back the "forgotten valve" into the conscience of the cardiological and surgical community. This review intends to summarize the current strategies and evidences in transcatheter tricuspid valve intervention and enlightening new avenues for future clinical studies.


Assuntos
Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Insuficiência Cardíaca/etiologia , Próteses Valvulares Cardíacas , Humanos , Insuficiência da Valva Tricúspide/complicações
15.
Ann Vasc Surg ; 60: 477.e1-477.e6, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075472

RESUMO

Pulsating varicose veins are a rare clinical finding and are mainly derived from tricuspid regurgitation or right heart failure. The precise causes and optimal treatment of this phenomenon have been poorly recorded in the literature. Here, we describe a 56-year-old woman who presented to our medical center with bilateral varicose veins, heaviness, and edema in her lower limbs. The duplex revealed an arterial-like pulsating flow in the superficial and deep veins of the lower extremities, in addition to severe tricuspid regurgitation. Symptoms improved after the patient was given compression therapy using elastic stockings. In this article, we also review six other cases from the literature and discuss the therapies that would be reasonable in some conditions.


Assuntos
Extremidade Inferior/irrigação sanguínea , Insuficiência da Valva Tricúspide/complicações , Varizes/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Fluxo Pulsátil , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Meias de Compressão , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Varizes/terapia
17.
BMJ Case Rep ; 12(4)2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31023735

RESUMO

Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease beyond the age of 3 months. Complete heart block (CHB) is rare but a serious sequalae post-repair of TOF. We present a case of an 18-month-old child who developed late CHB after around 1 year of the corrective surgery of the congenital anomaly. On the regular follow-up visit, the patient assessment was unremarkable. However, there was bradycardia, 55 beats/min. The ECG showed complete atrioventricular dissociation. Echocardiogram was done and demonstrated severe tricuspid regurgitation (TR). The patient required a permanent pacemaker and he is currently well. We are presenting this case as a late unexpected CHB, with a possibility of progressive right-side dilatation as a contributing factor to CHB due to severe TR.


Assuntos
Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/cirurgia , Tetralogia de Fallot/complicações , Assistência ao Convalescente , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Ecocardiografia/métodos , Eletrocardiografia , Humanos , Lactente , Masculino , Marca-Passo Artificial , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Fatores Desencadeantes , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/cirurgia , Resultado do Tratamento , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem
20.
Pediatr Blood Cancer ; 66(7): e27717, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30907497

RESUMO

Elevated tricuspid valve regurgitation jet velocity (TRV ≥ 2.5 m/s) is associated with mortality among adults with sickle cell disease (SCD), but correlative biomarkers are not studied according to treatment exposure or genotypes. To investigate the associations between biomarkers and TRV elevation, we examined the relationship between TRV and hemolytic, inflammatory, and cardiac biomarkers, stratified by disease-modifying treatments and SCD genotype. In total, 294 participants with SCD (mean age, 11.0 ± 3.7 years) and 49 hereditary spherocytosis (HS; mean age, 22.9 ± 19.75 years) were included for comparison and enrolled. TRV was elevated in 30.7% of children with SCD overall: 18.8% in HbSC/HbSß+ -thalassemia, 28.9% in untreated HbSS/HbSß0 -thalassemia, 34.2% in HbSS/HbSß0 -thalassemia hydroxyurea-treated, and 57% in HbSS/HbSß0 -thalassemia chronic transfusion treated. TRV was elevated in 10.7% and 27.8% in HS children and adults, respectively. In children with SCD, elevated TRV was correlated with hemoglobin (odds ratio [OR] = 0.78, P = 0.004), lactate dehydrogenase (LDH; OR = 2.52, P = 0.005), and N-terminal pro-brain natriuretic peptide (NT-pro BNP; OR = 1.003, P = 0.004). In multivariable logistic regression, adjusting for genotype, sex, hemolytic index, and treatment, hemoglobin concentration remained the only significant variable associated with elevated TRV in untreated HbSS/HbSß0 -thalassemia participants. TRV was not associated with inflammatory markers, other markers of hemolysis, or NT-pro BNP in untreated HbSS/HbSß0 -thalassemia. Neither hemoglobin nor LDH was associated with TRV in HbSC/HbSß+ -thalassemia. These results suggest that elevated TRV is influenced by the degree of anemia, possibly reflecting sickling as part of the disease pathophysiology. Prospective studies should monitor hemoglobin concentration as children with SCD age into adulthood, prompting initiation of TRV screening and monitoring.


Assuntos
Anemia Falciforme , Insuficiência da Valva Tricúspide , Talassemia beta , Adolescente , Anemia Falciforme/complicações , Anemia Falciforme/tratamento farmacológico , Anemia Falciforme/epidemiologia , Anemia Falciforme/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prevalência , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/tratamento farmacológico , Insuficiência da Valva Tricúspide/epidemiologia , Insuficiência da Valva Tricúspide/fisiopatologia , Talassemia beta/complicações , Talassemia beta/tratamento farmacológico , Talassemia beta/epidemiologia , Talassemia beta/fisiopatologia
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