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2.
Medicine (Baltimore) ; 99(2): e18651, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914049

RESUMO

RATIONALE: Heart-valve replacement is one of the main surgical methods for various heart-valve diseases. Warfarin is the only oral anticoagulant used for thrombosis prevention after heart-valve replacement. However, warfarin has a narrow therapeutic window, large differences in efficacy between individuals, and can be affected by drugs, food and disease status. PATIENT CONCERNS: We used the Hamberg model to develop an anticoagulation regimen for a 10-month-old Chinese male after mitral-valve replacement. DIAGNOSES: Echocardiography revealed mitral malformation with severe regurgitation, patent foramen ovale, thickening of the left ventricular wall, enlargement of the left atrium, and the overall systolic function of the left ventricle was lower than normal. INTERVENTIONS: First, the patient was treated with Mitral valvuloplasty plus temporary implantation of a pacing wire. Since this was inadequate, he underwent mitral-valve replacement. Then, we used the Hamberg model to develop an anticoagulation regimen. OUTCOMES: After discharge from hospital, the pharmacist provided anticoagulation management for this pediatric patient using an "Online Anticoagulation Clinic" (OAC). Point-of-care testing could be employed by the boy's mother at home to obtain the International Normalized Ratio. His time to response was 89.6% during the 6 months after hospital discharge, and adverse reactions such as bleeding or thrombosis did not occur. LESSONS: This is the first time the Hamberg model has been employed to design anticoagulation therapy for an Asian infant. His anticoagulation therapy may be managed using the OAC.


Assuntos
Anticoagulantes/administração & dosagem , Cálculos da Dosagem de Medicamento , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Tromboembolia/prevenção & controle , Grupo com Ancestrais do Continente Asiático , Humanos , Lactente , Coeficiente Internacional Normatizado , Masculino , Sistemas Automatizados de Assistência Junto ao Leito
4.
Kyobu Geka ; 73(1): 4-8, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31956243

RESUMO

According to the current guideline, early surgery is recommended in patients with infective endocarditis (IE). On the other hand, mitral valve plasty (MVP) became the preferred surgical option in patients with IE, because of its benefits in the preservation of left ventricular function and prevention of recurrence of infection. Feasibility of MVP is an important issue in surgical strategy, however, it might be associated with the timing of the operation:feasibility of MVP might be higher in healed IE than active IE, although there had been no clear evidence in previous studies. In order to develop scoring system to predict feasibility of MVP in patients with active IE, we have introduced "severity score".Severity score defined as the sum of valvular score which evaluates the extensiveness of the valvular destruction, and technical score which evaluates the complexity and durability of the repair. Probability of feasible MVP was high in severity score≤7 points and low in severity score≥9 points. MVP is basically selected in patients with severity score of 8 points, taking the benefit of patients and risks of longterm durability into consideration. We believe that severity score is valuable and reproducible scoring system in surgical decision making.


Assuntos
Endocardite Bacteriana , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Endocardite Bacteriana/cirurgia , Humanos , Valva Mitral
5.
Kyobu Geka ; 73(1): 9-13, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31956244

RESUMO

Persistent atrial fibrillation sometimes causes atrial enlargement. In such patients, regurgitation of mitral valve and tricuspid valve would be developed due to the enlargement of annulus of the atrio-ventricular valves. This mechanism of the mitral regurgitation is recently recognized as the atriogenic tethering of the posterior leaflet. Annuloplasty with ring is essential for the surgery in all patients. In the patients with giant left atrium, the annulus is tremendously enlarged. In such patients, we applied patch-augmentation of the posterior leaflet with autologous pericardial patch. Tricuspid annular dilatation is co-existed in these patients, so tricuspid annuloplasty should be done simultaneously. There is no guideline for the treatment of this pathology, so the indication for surgery should be argued.


Assuntos
Fibrilação Atrial , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Átrios do Coração , Humanos , Valva Mitral
6.
Kyobu Geka ; 73(1): 22-27, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31956246

RESUMO

Functional mitral stenosis after mitral valve repair for degenerative mitral regurgitation( DMR) is an evolving concept. Mitral annuloplasty devices stabilize the mitral annulus, reduce leaflet stress and increase leaflet coaptation, which leads to improvement of repair durability at the cost of dynamic and physiological annular movement and diastolic annular area. An elevation in rest and peak transmitral gradient has been observed in some patients with annuloplasty devices, and this elevation may associate with worse prognosis as late atrial fibrillation or lower functional capacity after surgery. In this review, we summarize the current reports describing functional mitral stenosis after mitral valve repair for DMR.


Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Estenose da Valva Mitral , Humanos , Valva Mitral , Estenose da Valva Mitral/cirurgia , Prognóstico
7.
Kyobu Geka ; 73(1): 28-33, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31956247

RESUMO

BACKGROUND: Carpentier's techniques for degenerative posterior mitral leaflet (PML) prolapse have been established with excellent long-term results reported. However, residual mitral regurgitation( MR) occasionally occurs even after a straightforward repair, though the involved mechanisms are not fully understood. We sought to identify specific preoperative echocardiographic findings associated with residual MR after a PML repair. METHODS AND RESULTS: We retrospectively studied 117 consecutive patients who underwent a primary mitral valve repair for isolated PML prolapse including a preoperative three-dimensional ransesophageal echocardiography( 3D-TEE) examination. Eleven had residual MR after the initial repair, of whom 7 required a corrective second pump run, 4 underwent conversion to mitral valve replacement, and 1 developed moderate MR within 1 month. Their preoperative parameters were compared with those of 105 patients who had an uneventful mitral valve repair. There were no hospital deaths. Multivariate analysis identified preoperative anterior mitral leaflet (AML) tethering angle as a significant predictor for residual MR [odds ratio (OR) 6.82, 95% confidence interval (CI) 1.8~33.8, p=0.0049]. Receiver operator characteristics curve analysis revealed a cut-off value of 24.3°( area under the curve 0.77), indicating that AML angle predicts residual MR. In multivariate regression analysis, smaller anteroposterior mitral annular diameter( p<0.001) and lower left ventricular ejection fraction( p=0.002) were significantly associated with higher AML angle, while left ventricular and left atrial dimension had no significant correlation. CONCLUSIONS: AML tethering in cases of PML prolapse has an adverse impact on early results following mitral valve repair. The findings of preoperative 3D-TEE are important for consideration of a careful surgical strategy.


Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Humanos , Valva Mitral , Prolapso , Estudos Retrospectivos , Resultado do Tratamento
8.
Mymensingh Med J ; 29(1): 97-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915343

RESUMO

This study was aimed to compare the long-term outcomes and survival rate among mitral valve replacement using thoracotomy and standard median sternotomy in a single surgeon's practice. Total 250 patients were evaluated; Group I (n=65) patients had anterolateral thoracotomy and Group II (n=185) had standard median sternotomy for valve replacement. Mean age was 25.1±5 years in Group I and 41.8±10.5 years in Group II. Female was predominant in Group I. Total operative time and bypass time was statistically significant in Group I (235.5±25.8 minutes; 84.2±12.75 minutes) in contrast to Group II (203.8±15.5 minutes; 71.5±10.5 minutes). Incision scar was not visible in females in Group I but full incision scar was visible in Group II. Post-operative ICU stay duration was significant high in Group II. Though, wound infection incidence was 0% in Group I; however, 9.73% patient had wound infection in Group II. Only 1.62% patient developed unstable sternum in Group II. Most of the patients from both study group were in regular follow up and 1-year mortality rate was 4.62% and 5.94% in Group I and Group II respectively. Mitral valve replacement through a right anterolateral thoracotomy is easy and safe to perform; while getting maximum benefits for the patients. Besides satisfactory cosmetic outcome especially in female, this approach provides better exposure to mitral apparatus even in patients with small left atrium, cost effectiveness, less duration of hospital stays and absence of the risk for unstable sternum.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Esternotomia/métodos , Esterno/cirurgia , Toracotomia/métodos , Adulto , Bangladesh/epidemiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Doenças das Valvas Cardíacas/mortalidade , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
11.
Khirurgiia (Mosk) ; (12): 121-125, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825352

RESUMO

Minimally invasive approach in mitral valve surgery has been applied since the late 1990s. Considerable experience of mini-thoracotomy in cardiac surgery has been gained over this period. Stages of the development of minimally invasive cardiac surgery are reviewed in the article. Features of mitral valve surgery through right-sided mini-thoracotomy are discussed. Surgical outcomes of these procedures are reported considering data of various cardiac surgery centers. Moreover, the authors determined indications and limitations of this technique.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Toracotomia/métodos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
14.
J Cardiothorac Surg ; 14(1): 185, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684992

RESUMO

BACKGROUND: Cardiac radiofrequency ablation is a popular treatment for arrhythmias. However, it does have some complications, some of which are severe, even fatally. And there were limited reports on cardiac internal perforation after radiofrequency catheter ablation (RFCA) that required a surgical repair. CASE PRESENTATION: A 47-year-old male was admitted to our hospital due to chest congestion for 4 months. He received a radiofrequency catheter ablation (RFCA) 9 months prior to admission. On admission, an echocardiogram showed an abnormal perforation between the left ventricle and the left atrium with moderate mitral valve regurgitation. We therefore performed a mitral valve replacement (MVR) and fixed the abnormal atrial-ventricular breakage via median sternotomy. CONCLUSIONS: Cardiac perforation is a severe complication of cardiac RFCA, operators should be extremely cautious to minimize radiofrequency associated perforations. Such a challenging and complex procedure should be deliberately considered by doctors and patients before implementation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Traumatismos Cardíacos/diagnóstico , Ecocardiografia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Complicações Pós-Operatórias
15.
Kyobu Geka ; 72(12): 969-973, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701905

RESUMO

This is a 3-case report of mitral valve replacement (MVR) with an On-X mechanical valve followed up to 10 years. Case 1(64-year-old man) and case 2 (66-year-old woman) experienced traffic accident and traumatic event, respectively, in their chronic phase after MVR. Case 1 had multiple bone fractures of the bilateral lower limbs, which was followed by systemic infection and pyogenic spondylitis. He needed long-term antibiotics therapy for more than 4 years. Case 2 fell down at home and severely hit her head, which resulted in a traumatic subarachnoid hemorrhage. She was in a deep coma, and needed discontinuation of anticoagulation therapy for 4 weeks. Case1, 2, and 3(54-year-old man) are doing well in New York Heart Association functional class I without any valve-related thromboembolic or hemorrhagic events at 10, 9 and 8 years after MVR, respectively. On-X valve performance has also been found well maintained in all cases by echocardiography, even after traumatic accident or discontinuation of anticoagulation in Case 1 and 2. In this report, the On-X mechanical valve demonstrated good midterm result of its valve performance in the mitral position and its potential advantages in antithrombogenicity.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Mitral , Tromboembolia , Idoso , Anticoagulantes , Valva Aórtica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Kyobu Geka ; 72(12): 1005-1008, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701912

RESUMO

A 70-years old man was referred to our department for acute heart failure due to post myocardial infarction papillary muscle rupture. We planned emergent surgery, but he refused blood transfusion because of religious reason( Jehovah's Witness). Therefore, we chose medical therapy using intra-aortic balloon pumping and catecholamine. He was also treated with subcutaneous erythropoietin and intravenous iron supplement to increase preoperative hemoglobin. One month later, we decided to undergo mitral valve repair because he was stabilized with medical treatment. The patient underwent mitral valve repair with artificial chordae through median sternotomy. The mitral valve A3 prolapse was caused by posterior papillary muscle rupture. No blood transfusion was given and postoperative course was uneventful. We experienced successful mitral repair for post infarction papillary muscle rupture in a Jehova's Witnessess patient.


Assuntos
Ruptura Cardíaca Pós-Infarto , Testemunhas de Jeová , Insuficiência da Valva Mitral , Idoso , Ruptura Cardíaca Pós-Infarto/cirurgia , Humanos , Masculino , Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Infarto do Miocárdio , Músculos Papilares
17.
Tex Heart Inst J ; 46(3): 195-198, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708702

RESUMO

The MitraClip system can be used to control regurgitant blood flow in patients with mitral regurgitation who cannot tolerate open surgery to replace the mitral valve. Technical limitations make the right femoral vein the standard access point for placing the MitraClip. However, this route is not always suitable. We present the case of an 85-year-old woman in whom we successfully used a left-sided approach for inserting a MitraClip because her right femoral vein was occluded. This apparently novel left femoral approach merits consideration as an option for device insertion when right femoral vein access is precluded.


Assuntos
Cateterismo Cardíaco/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Veia Femoral , Fluoroscopia , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Resultado do Tratamento
18.
Braz J Cardiovasc Surg ; 34(5): 525-534, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719006

RESUMO

OBJECTIVE: To evaluate the factors impacting on the conversion to sinus rhythm and on the postoperative rhythm findings in the six-month follow-up period of a mitral valve surgery combined with cryoablation Cox-Maze III procedure, in patients with atrial fibrillation. METHODS: In this study, we evaluated 80 patients who underwent structural valve disease surgery in combination with cryoablation. Indications for the surgical procedures were determined in the patients according to the presence of rheumatic or non-rheumatic structural disorders in the mitral valve as evaluated by echocardiography. Cox-Maze III procedure and left atrial appendix closure were applied. RESULTS: The results of receiver operating characteristics analysis indicated that the rate of conversion to the sinus rhythm was significantly higher in patients with left atrial diameters ≥ 45.5 mm and with ejection fraction (EF) ≥ 48.5%. However, the statistical differences disappeared in the sixth month. Thromboembolic (TE) events were seen only in three patients in the early period and no more TE events occurred in the six-month follow-up period. CONCLUSION: The EF and the preoperative left atrial diameter were determined to be the factors impacting on the conversion to sinus rhythm in patients who underwent mitral valve surgery in combination with cryoablation. Mitral valve surgery in combination with ablation for atrial fibrillation does not affect mortality and morbidity in the experienced health centers; however, it remains controversial whether it will provide additional health benefits to the patients compared to those who underwent only mitral valve surgery.


Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Criocirurgia/métodos , Frequência Cardíaca/fisiologia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Adulto , Fibrilação Atrial/prevenção & controle , Eletrocardiografia , Feminino , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Fatores de Tempo , Resultado do Tratamento
19.
Braz J Cardiovasc Surg ; 34(5): 535-541, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719007

RESUMO

INTRODUCTION: Metabolic syndrome (MetS) is defined as an association between diabetes, hypertension, obesity and dyslipidemia and an increased risk of cardiovascular disease. Mitral annular calcification (MAC) is associated with several cardiovascular disorders, including coronary artery disease, atrial fibrillation (AF), heart failure, ischemic stroke and increased mortality. The CHA2DS2-VASc score is used to estimate thromboembolic risk in AF. However, the association among MAC, MetS and thromboembolic risk is unknown and was evaluated in the current study. METHODS: The study group consisted of 94 patients with MAC and 86 patients with MetS. Patients were divided into two groups: those with and those without MAC. RESULTS: Patients with MAC had a higher MetS rate (P<0.001). In patients with MAC, the CHA2DS2-VASc scores and the rate of cerebrovascular accident and AF were significantly higher compared to those without MAC (P<0.001, for both parameters). The results of the multivariate regression analysis showed that history of smoking, presence of MetS and high CHA2DS2-VASc scores were associated with the development of MAC. ROC curve analyses showed that CHA2DS2-VASc scores were significant predictors for MAC (C-statistic: 0.78; 95% CI: 0.706-0.855, P<0.001). Correlation analysis indicated that MAC was positively correlated with the presence of MetS and CHA2DS2-VASc score (P=0.001, r=0.264; P<0.001, r=0.490). CONCLUSION: We have shown that CHA2DS2-VASc score and presence of MetS rates were significantly higher in patients with MAC compared without MAC. Presence of MAC was correlated with CHA2DS2-VASc score, presence of MetS, AF and left atrial diameter and negatively correlated with left ventricular ejection fraction.


Assuntos
Calcinose/complicações , Doenças das Valvas Cardíacas/complicações , Síndrome Metabólica/complicações , Valva Mitral , Tromboembolia/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Calcinose/fisiopatologia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Tromboembolia/fisiopatologia
20.
Braz J Cardiovasc Surg ; 34(5): 615-617, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719013

RESUMO

We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any immunosuppressive event) and needed to undergo valve replacement.


Assuntos
Endocardite Bacteriana/cirurgia , Infecções por Bactérias Gram-Negativas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Stenotrophomonas maltophilia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Pessoa de Meia-Idade , Choque Séptico/etiologia
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