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3.
Kyobu Geka ; 72(9): 690-693, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31506410

RESUMO

A 79-year-old womam presented with severe aortic stenosis (AS) and aorto-iliac occlusive disease (AIOD). The distal end of her abdominal aorta was occluded with severe calcification. Simultaneous Y-grafting of the terminal abdominal aorta and transcatheter aortic valve implantation (TAVI) using the left limb of a Y-shaped artificial graft as an access route were planned. After proximal and distal anastomoses of the abdominal aorta and the right common iliac artery(CIA) using the Y-shaped artificial graft, TAVI was performed through the left limb of the artificial graft. The technique was similar to that used for transfemoral TAVI. Subsequently, the left limb of the graft was anastomosed to the left CIA. The patient's postoperative course was unremarkable, without heart failure or lower limb ischemia. This option serves as an effective access route for TAVI in patients with AIOD.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica , Feminino , Humanos , Artéria Ilíaca
4.
Kyobu Geka ; 72(9): 694-697, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31506411

RESUMO

An 89-year-old female was admitted with progressive dyspnea. She had history of old myocardial infarction. Echocardiography revealed severe aortic valve stenosis (AS) with bicuspid aortic valve (BAV). Computed tomography (CT) detected an ascending aortic aneurysm and a left ventricular apex aneurysm. CT confirmed the BAV with severe calcification and tight horizontal angulation. We scheduled transfemoral transcatheter aortic valve replacement (TAVR). While careful wire manipulation, the valve was successfully implanted. BAV is frequently associated with dilation of the ascending aorta. The coexistence of an ascending aortic aneurysm would indicate surgery in order to be able to treat both lesions simultaneously and to avoid catastrophic stent-related complications, such as prosthesis dislodgment and aneurysm rupture. In the present case, there was also risk of left ventricular rupture due to wire manipulation. The horizontal aorta also complicates accurate positioning of the prosthesis during TAVR. This case highlights TAVR for AS with complicated anatomy.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Valva Aórtica , Feminino , Humanos , Resultado do Tratamento
12.
Methodist Debakey Cardiovasc J ; 15(2): 122-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384375

RESUMO

Right ventricular outflow tract (RVOT) dysfunction is common following surgical repair of tetralogy of Fallot and other forms of complex congenital heart disease. This results in pulmonary stenosis or regurgitation and may ultimately lead to RV failure and dysrhythmias. Transcatheter valve technologies are now available to treat certain patients with RVOT dysfunction. Current devices include the Medtronic Melody valve and the Edwards Lifesciences SAPIEN XT. Although these valves are approved for use in dysfunctional circumferential RVOT conduits, they are increasingly being used off label for nonconduit outflow tracts. Procedural complications include but are not limited to conduit rupture and coronary compression. Longer-term complications include stent fracture and endocarditis. Outcomes with these valves have demonstrated durable relief of stenosis and regurgitation. The Medtronic Harmony valve and the Alterra Prestent from Edwards Lifesciences are investigational devices that are intended to treat the patulous RVOT that is too large to accommodate currently available valves. This review will focus on current indications to treat RVOT dysfunction, existing transcatheter valve technologies, and investigational devices undergoing clinical trials. Hopefully, within the not-too-distant future, transcatheter pulmonary valve implantation will be feasible in the vast majority of patients with RVOT dysfunction following surgical repair of congenital heart disease.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Tetralogia de Fallot/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/fisiopatologia , Fatores de Risco , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia
13.
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
14.
Medicine (Baltimore) ; 98(35): e16903, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464922

RESUMO

Staphylococcus aureus prosthetic valve endocarditis (SAPVE) has a poor prognosis. There are no large series that accurately describe this entity.This is a retrospective observational study on a prospective cohort from 3 Spanish reference hospitals for cardiac surgery, including 78 definitive episodes of left SAPVE between 1996 and 2016.Fifty percent had a Charlson Index score >5; 53% were health care-related. Twenty percent did not present fever. Complications at diagnosis included: severe heart failure (HF, 29%), septic shock (SS, 17.9%), central nervous system abnormalities (19%), septic metastasis (4%). Hemorrhagic stroke was not higher in anticoagulated patients. Twenty-seven percent were methicilin-resistant SA (MRSA). Fifteen of 31 had positive valve culture; it was related to surgery within first 24 hours. At diagnosis, 69% had vegetation (>10 mm in 75%), 21.8% perianular extension, and 20% prosthetic dehiscence. Forty-eight percent had persistent bacteremia, related to nonsurgical treatment. Perianular extension progressed in 18%. Surgery was performed in 35 episodes (12 with stroke). Eleven uncomplicated episodes were managed with medical therapy, 8 survived. In-hospital mortality was 55%, higher in episodes with hemorrhagic stroke (77.8% vs 52.2%, odds ratio 3.2 [0.62-16.55]). Early SAPVE was nosocomial (92%), presented as severe HF (54%), patients were diagnosed and operated on early, 38% died. In intermediate SAPVE (9 weeks-1 year) diagnosis was delayed (24%), patients presented with constitutional syndrome (18%), renal failure (41%), and underwent surgery >72 hours after indication; 53% died. Late SAPVE (>1 year) was related with health care, diagnosis delay, and 60% of deceases.Left SAPVE frequently affected patients with comorbidity and health care contact. Complications at diagnosis and absence of fever were frequent. Presence of MRSA was high. Positive valve culture was related to early surgery. Paravalvular extension was frequent; vegetations were large, but its absence at diagnosis was common. Some uncomplicated SAPVE episodes were safety treated with medical therapy. Surgery was feasible in patients with stroke. Mortality was high. There were differences in some clinical characteristics and in evolution according to the time elapsed from valve replacement. Prognosis was better in early SAPVE.


Assuntos
Endocardite Bacteriana/epidemiologia , Próteses Valvulares Cardíacas/microbiologia , Infecções Relacionadas à Prótese/epidemiologia , Infecções Estafilocócicas/epidemiologia , Idoso , Comorbidade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Gerenciamento Clínico , Endocardite Bacteriana/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Espanha/epidemiologia , Infecções Estafilocócicas/etiologia , Análise de Sobrevida , Tempo para o Tratamento
15.
Braz J Cardiovasc Surg ; 34(3): 318-326, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310471

RESUMO

OBJECTIVES: This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI). METHODS: Databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin American and Caribbean Literature on Health Sciences [LILACS], and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm2/m2 and 0.65 cm2/m2 and as severe if iEOA ≤ 0.65 cm2/m2. RESULTS: The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P=0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P=0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P=0.001). CONCLUSION: The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.


Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Humanos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Falha de Tratamento
16.
Braz J Cardiovasc Surg ; 34(3): 361-365, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310476

RESUMO

Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is an issue that has been overlooked (not to say neglected). Cardiac surgeons must bear in mind that this is a real problem that we must tackle. The purpose of this paper is to be a wake-up call to the surgical community by giving a brief overview of what PPM is, its incidence and impact on the outcomes. We also discuss the increasing role played by imaging for predicting and assessing PPM after SAVR (with which surgeons must become more acquainted) and, finally, we present some options to avoid PPM after the surgical procedure.


Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/mortalidade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/mortalidade , Falha de Tratamento
17.
Int Heart J ; 60(4): 986-989, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308324

RESUMO

So far, there is still controversy regarding the optimal prosthetic valve for patients with active infective valve endocarditis with annular abscess. Here, we report the case of a 65-year-old woman who was diagnosed with infective endocarditis associated with extensive annular abscess. The patient underwent debridement of the abscess cavity followed by aortic valve replacement using a Solo Smart (SS) stentless bioprosthesis. Postoperative recovery was uneventful, with no signs of recurrent infection. Since the SS valve is designed for supra-annular and subcoronary implantation, it is considered to be an alternative to conventional prosthetic valves in patients with infective endocarditis with aortic annular abscess.


Assuntos
Abscesso/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Infecções Estreptocócicas/cirurgia , Abscesso/diagnóstico , Abscesso/microbiologia , Idoso , Valva Aórtica/microbiologia , Endocardite/diagnóstico , Feminino , Próteses Valvulares Cardíacas , Humanos , Desenho de Prótese , Infecções Estreptocócicas/diagnóstico , Streptococcus/isolamento & purificação
18.
Kyobu Geka ; 72(6): 463-465, 2019 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-31268022

RESUMO

A 45-year-old female was admitted to our hospital due to severe aortic stenosis. Transthoracic and transesophageal echocardiography indicated the aortic valve was bicuspid, but we confirmed that the aortic valve was unicuspid by intraoperative finding. There was 1 open commissure between the left coronary cusp and the noncoronary cusp position. Aortic valve replacement was performed with a mechanical valve, and the postoperative course was uneventful. We report a very rare case of unicuspid aortic valve replacement.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Aórtica , Estenose da Valva Aórtica/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade
19.
Kyobu Geka ; 72(8): 630-633, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31353358

RESUMO

An 80-year-old woman was incidentally found to have a cardiac tumor on the aortic valve by echocardiography. Papillary fibroelastoma(PFE) was strongly suspected, and urgent operation was performed to prevent embolism. Two tumors were identified arising from the left and right cusps with wide stalks, and aortic valve replacement was performed. By pathological examination, the tumors were diagnosed as PFEs. A small tumor was also found on the non-coronary cusp, which was considered as possible PFE or Lambl's excrescence. In the case of multiple PFEs on one valve, valve replacement, instead of simple excision of tumors, should be considered.


Assuntos
Fibroma , Neoplasias Cardíacas , Doenças das Valvas Cardíacas/etiologia , Próteses Valvulares Cardíacas , Idoso de 80 Anos ou mais , Valva Aórtica , Ecocardiografia , Feminino , Fibroma/complicações , Neoplasias Cardíacas/complicações , Humanos
20.
Rev Assoc Med Bras (1992) ; 65(6): 818-824, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340310

RESUMO

BACKGROUND: The use of the 3D printer in complex cardiac surgery planning. OBJECTIVES: To analyze the use and benefits of 3D printing in heart valve surgery through a systematic review of the literature. METHODS: This systematic review was reported following the Preferred Reporting Items for Systematic Review and registered in the Prospero (International Prospective Register of Systematic Reviews) database under the number CRD42017059034. We used the following databases: PubMed, EMBASE, Scopus, Web of Science and Lilacs. We included articles about the keywords "Heart Valves", "Heart Valve Prosthesis Implantation", "Heart Valve Prosthesis", "Printing, Three-Dimensional", and related entry terms. Two reviewers independently conducted data extraction and a third reviewer solved disagreements. All tables used for data extraction are available at a separate website. We used the Cochrane Collaboration tool to assess the risk of bias of the studies included. RESULTS: We identified 301 articles and 13 case reports and case series that met the inclusion criteria. Our studies included 34 patients aged from 3 months to 94 years. CONCLUSIONS: Up to the present time, there are no studies including a considerable number of patients. A 3D-printed model produced based on the patient enables the surgeon to plan the surgical procedure and choose the best material, size, format, and thickness to be used. This planning leads to reduced surgery time, exposure, and consequently, lower risk of infection.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Impressão Tridimensional , Feminino , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Impressão Tridimensional/instrumentação , Reprodutibilidade dos Testes , Resultado do Tratamento
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