Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.719
Filtrar
1.
Zhonghua Er Ke Za Zhi ; 59(4): 294-298, 2021 Apr 02.
Artigo em Chinês | MEDLINE | ID: mdl-33775048

RESUMO

Objective: To analyze the clinical characteristics and treatment of tricuspid valve prolapse caused by chordal rupture complicated with persistent pulmonary hypertension in neonates. Methods: The clinical data of a male neonate with tricuspid valve prolapse complicated with persistent pulmonary hypertension admitted to the Neonatal Intensive Care Unit of Children's Hospital of Hebei Province in November 2018 was analyzed retrospectively. Related literature up to September 2020 was searched with the strategy of "(neonate OR newborn) AND (tricuspid valve prolapse) AND (rupture OR necrosis) AND (papillary muscle OR chordae tendineae) AND (pulmonary hypertension)" in Wanfang, CNKI and PubMed database in Chinese and English. The characteristics of the disease were summarized. Results: A male full-term neonate was admitted due to presenting severe cyanosis for 9 hours. He was born by caesarean section and presented severe cyanosis and dyspnea at 10 min of ages, unresponsive to the positive airway pressure resuscitation. After 9 hours of mechanical ventilation, there was no improvement. Thus he was transferred to Children's Hospital of Hebei Province. On admission, the initial blood gas analysis showed an arterial partial pressure of oxygen of 22.5 mmHg (1 mmHg=0.133 kPa). The echocardiography revealed prolapsed anterior leaflet of tricuspid valve, severe tricuspid regurgitation (TR) and pulmonary artery hypertension, and right to left shunt via a patent foramen ovale. The arterial duct was closed. The chest X-ray was normal. The boy was treated with nitric oxide, milrinone, and continued mechanical ventilation initially. Addition of prostacyclin analog (treprostinil) on day 3 led to significant improvement of pulmonary blood flow, oxygenation, and stabilization, so that the extracorporeal membrane oxygenation therapy was avoided. At 11 months after birth, the boy underwent cardiac surgery. At surgery, the rupture of chordal tendineae in anterior leaflet of tricuspid valve was found. Tricuspid annuloplasty, valvuloplasty and repair of patent foramen ovale were successfully performed. The follow-up echocardiogram at postoperative 3 months showed only mild tricuspid insufficiency. The boy was well at last follow-up at 22 months of age with normal cognitive skill development. According to literature, 20 cases of papillary muscle or chordae tendineae rupture in neonates had been reported in 12 English papers. Among the total 21 neonates, there were 12 male infants and only one premature infant with gestational age of 33 weeks. They presented with profound cyanosis soon after birth. All of them received endotracheal intubation and mechanical ventilation. Other treatments included inhalation of nitric oxide, intravenous milrinone, vasoactive drugs, diuretics and prostacyclin, etc. Extracorporeal membrane oxygenation (ECMO) was used in 6 infants as a bridge to surgical treatment. Two cases reported earlier death of cardiopulmonary failure without operation and the rest 19 survived after surgery. The followed surgery or autopsy revealed that all of them had tricuspid valve prolapse, rupture of papillary muscle or chordae tendineae. Conclusions: The severe TR resulting from rupture of papillary muscle or chordate tendineae in neonates is rare and could cause severe hypoxemia. Early recognition, adequate cardiopulmonary support to stabilize the hemodynamic status and timely surgery can significantly reduce the mortality.


Assuntos
Hipertensão Pulmonar , Valva Tricúspide , Cesárea , Criança , Cordas Tendinosas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia
3.
BMJ Case Rep ; 14(2)2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33574044

RESUMO

A 75-year-old was treated for prostate adenocarcinoma with brachytherapy in September 2018. A routine follow-up chest radiograph 3 months later revealed a metallic object of the same dimensions as a brachytherapy pellet located in the right ventricle. Further imaging showed the brachtherapy pellet was located in the anterobasal right ventricular endocardium close to the tricuspid valve. Frequent asymptomatic premature ventricular contractions were observed with likely origin from the left ventricular outflow tract, an area remote from the site of the pellet. The patient remains asymptomatic and subsequent imaging shows that the position of the pellet has not changed.


Assuntos
Adenocarcinoma/radioterapia , Braquiterapia/efeitos adversos , Braquiterapia/instrumentação , Migração de Corpo Estranho/patologia , Neoplasias da Próstata/radioterapia , Valva Tricúspide/patologia , Adenocarcinoma/diagnóstico por imagem , Idoso , Braquiterapia/métodos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Eletrocardiografia , Humanos , Imageamento Tridimensional , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia
4.
Elife ; 92020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320094

RESUMO

Over 1.6 million Americans suffer from significant tricuspid valve leakage. In most cases this leakage is designated as secondary. Thus, valve dysfunction is assumed to be due to valve-extrinsic factors. We challenge this paradigm and hypothesize that the tricuspid valve maladapts in those patients rendering the valve at least partially culpable for its dysfunction. As a first step in testing this hypothesis, we set out to demonstrate that the tricuspid valve maladapts in disease. To this end, we induced biventricular heart failure in sheep that developed tricuspid valve leakage. In the anterior leaflets of those animals, we investigated maladaptation on multiple scales. We demonstrated alterations on the protein and cell-level, leading to tissue growth, thickening, and stiffening. These data provide a new perspective on a poorly understood, yet highly prevalent disease. Our findings may motivate novel therapy options for many currently untreated patients with leaky tricuspid valves.


Assuntos
Matriz Extracelular/metabolismo , Insuficiência Cardíaca/complicações , Hemodinâmica , Insuficiência da Valva Tricúspide/etiologia , Valva Tricúspide/metabolismo , Função Ventricular Esquerda , Função Ventricular Direita , Adaptação Fisiológica , Animais , Modelos Animais de Doenças , Metabolismo Energético , Matriz Extracelular/genética , Matriz Extracelular/patologia , Colágenos Fibrilares/genética , Colágenos Fibrilares/metabolismo , Regulação da Expressão Gênica , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Masculino , Carneiro Doméstico , Transdução de Sinais , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/metabolismo , Insuficiência da Valva Tricúspide/fisiopatologia
5.
J Vis Exp ; (161)2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32804160

RESUMO

Heart conditions in which the tricuspid valve (TV) faces either increased volume or pressure stressors are associated with premature valve failure. Mechanistic studies to improve our understanding of the underlying pathophysiology responsible for the development of premature TV failure are lacking. Due to the inability to conduct these studies in humans, an animal model is required. In this manuscript, we describe the protocols for a novel chronic recovery infant piglet heart model for the study of changes in the TV when placed under combined volume and pressure stress. In this model, volume loading of the right ventricle and the TV is achieved through the disruption of the pulmonary valve. Then pressure loading is accomplished through the placement of a pulmonary artery band. The success of this model is assessed at four weeks post intervention surgery through echocardiography, intracardiac pressure measurement, and pathologic examination of the heart specimens.


Assuntos
Ventrículos do Coração/fisiopatologia , Valva Tricúspide/fisiopatologia , Anestesia , Animais , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Hemodinâmica , Imageamento Tridimensional , Masculino , Modelos Animais , Tamanho do Órgão , Pressão , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Valva Pulmonar/fisiopatologia , Valva Pulmonar/cirurgia , Suínos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia
6.
Am J Cardiol ; 132: 119-125, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32741538

RESUMO

It is well known that some patients present with "more than severe" tricuspid regurgitation (TR). We aimed to assess the prognosis of these very severe TR patients. We defined very severe TR using 3 simple echocardiographic parameters: a coaptation gap≥10mm, a laminar TR flow and a systolic reversal of the hepatic vein flow. We included 259 consecutive patients (76 ± 13 years; 46% men) with moderate-to-severe TR (n = 114) and severe TR (n = 145). The primary end point was the combination of hospitalisation for right heart failure (RHF) and cardiovascular mortality. Median follow-up was 24(7 to 47) months. In patients with severe TR, 52 (36%) met the definition of very severe TR. These patients were younger, had more history of RHF and were more frequently treated with loop diuretics than those with moderate-to-severe TR (all p < 0.001). Four-year event-free survival rates were 68 ± 5%, for moderate-to-severe TR, 48 ± 6% for severe TR and only 35 ± 7% for very-severe TR (p < 0.001). On multivariable analysis, after adjustment for outcome predictors including age, comorbidity, RHF, TR etiology, left and right ventricular dysfunction, and tricuspid valve surgery, patients with very severe TR had a worsened prognosis than those with moderate-to-severe TR (Adjusted Hazard Ratio [95% Confidence Interval] = 2.43 [1.18 to 5.53]; p = 0.002) and than those with severe TR (Adjusted Hazard Ratio [95% Confidence Interval] = 2.23 [1.06 to 5.56]; p = 0.015). In conclusion, very severe TR is frequent in patients with severe TR, corresponds to a more advanced stage of the disease and is associated with poor outcomes. Therefore, the use of a 5-grade classification of TR severity is justified in routine clinical practice. (ID-RCB: 2017-A03233-50).


Assuntos
Ecocardiografia Doppler/métodos , Insuficiência da Valva Tricúspide/classificação , Valva Tricúspide/diagnóstico por imagem , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Insuficiência da Valva Tricúspide/diagnóstico
7.
BMC Infect Dis ; 20(1): 476, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631238

RESUMO

BACKGROUND: Blood culture-negative endocarditis (BCNE) is diagnosed in 2-7% of patients with infective endocarditis (IE) and recent antibiotic use is a known risk factor. Altered mental status may be a presenting symptom. Besides empiric antibiotics, intravenous anticoagulation using heparin may have a role in the management of such patients. CASE PRESENTATION: A 23-year-old male patient was referred to our center with fever, altered mental status and abnormal gait. Neurologic examination revealed Wernicke's aphasia. Cardiac auscultation revealed systolic murmur at the left sternal border. ECG (electrocardiogram) was unremarkable. Brain MRI showed multiple cerebellar lesions. Transthoracic echocardiography (TTE) demonstrated three large masses on the right ventricle (RV), tricuspid valve (TV), and anterior mitral valve (MV) leaflet. Blood cultures (three sets) were negative. Intravenous heparin therapy was administered. After 48 h, the second TTE demonstrated that one valvular lesion disappeared and the other two lesions showed a significant decrease in size. The patient's neurological symptoms resolved gradually. Further workup for collagen vascular disorders did not show any abnormality. CONCLUSION: BCNE should be considered in patients with fever and neurologic manifestations. TTE should be performed to detect valvular abnormalities. Intravenous heparin could be used in such patients when TTE demonstrate valvular vegetations.


Assuntos
Anticoagulantes/uso terapêutico , Afasia de Wernicke/tratamento farmacológico , Hemocultura , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Heparina/uso terapêutico , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anticoagulantes/administração & dosagem , Afasia de Wernicke/microbiologia , Endocardite Bacteriana/sangue , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Heparina/administração & dosagem , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/patologia , Adulto Jovem
8.
J Cardiothorac Surg ; 15(1): 152, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600335

RESUMO

BACKGROUND: Congenitally corrected transposition of great arteries (CCTGA) is caused by atrioventricular and ventriculoarterial discordance. Cases of CCTGA with spontaneous chordae rupture of tricuspid valve have not been reported before. CASE PRESENTATION: Here we diagnosed a 38-year-old man, who was found CCTGA 14 years ago, as spontaneous chordae rupture by real-time three dimentional transesophageal echocardiography (RT-3D-TEE). The present case is the first report to describe a CCTGA patient combine with spontaneous chordae rupture in tricuspid valve. After tricuspid valve replacement, the patient was uneventful after 6 years' follow-up. CONCLUSION: We reported a rare case with spontaneous chordae rupture of tricuspid valve in a CCTGA patient and explored its etiology here. RT-3D-TEE is an important supplement to 2-dimentional transthoracic echocardiography and can provide more accurate detections in tricuspid valve diseases in CCTGA.


Assuntos
Cordas Tendinosas/patologia , Transposição Congênita Corrigida de Grandes Artérias/complicações , Ruptura Espontânea/complicações , Insuficiência da Valva Tricúspide/etiologia , Prolapso da Valva Tricúspide/complicações , Adulto , Cordas Tendinosas/diagnóstico por imagem , Ecocardiografia , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Ruptura Espontânea/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia
9.
Pediatr Cardiol ; 41(6): 1206-1211, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32488510

RESUMO

Non-invasive evaluation of right ventricular (RV) systolic function in neonates with pulmonary hypertension (PH) with traditional metrics including RV fractional area change (FAC) and tricuspid annular systolic plane excursion (TAPSE) has improved outcomes. Apical three-chamber (3C) RV-FAC, a novel tripartite assessment of the RV, has recently been described in healthy infants. We assess the utility of 3C RV-FAC and biplane RV-FAC in delayed transitioning and neonatal PH. Echocardiograms for 22 normal infants and 22 infants with PH were retrospectively analyzed for RV systolic function indices including four chamber (4C), 3C, and biplane RV-FAC, TAPSE, Tei index, and RV systolic excursion velocity (S'). 4C, 3C, and biplane RV-FAC correlated with PH severity and was decreased in neonates with PH compared to normal neonates (biplane RV-FAC 31.7 ± 13.4% vs. 41 .9 ± 4.7%, p = 0.002). TAPSE was significantly decreased in neonates with PH, but did not correlate with PH severity. Other RV systolic function metrics were not significantly different between normal neonates and neonates with PH. 3C RV-FAC and biplane RV-FAC are lower in neonates with PH. 3C and biplane RV-FAC may allow for improved assessment of global RV systolic dysfunction in newborns with delayed transitioning or PH compared to the commonly used regional methods.


Assuntos
Hipertensão Pulmonar/fisiopatologia , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Ecocardiografia/métodos , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Recém-Nascido , Masculino , Estudos Retrospectivos , Sístole , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia
10.
Cardiovasc J Afr ; 31(4): 217-220, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32490507

RESUMO

The use of peripherally inserted central catheters (PICCs) has expanded substantially for drug delivery in clinical practice in recent years. However, PICC lines expose patients to potential complications associated with an increasing incidence of infective endocarditis. We herein report a case of a 57-year-old woman who was diagnosed with tricuspid valve endocarditis by echocardiography. The most probable cause was direct injury to the tricuspid valve by the tip of a PICC line with excessive length in the right heart. The vegetation disappeared with conservative treatment after removal of the PICC line. Clinicians must maintain vigilance against any suspected PICC-related infection in febrile patients with a PICC line. For echocardiographers, precise evaluation of the position of the PICC tip and the detection of endocarditis is important to devise the optimal clinical strategy.


Assuntos
Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Cateteres de Demora/efeitos adversos , Endocardite/etiologia , Traumatismos Cardíacos/etiologia , Valva Tricúspide/lesões , Antibacterianos/uso terapêutico , Tratamento Conservador , Remoção de Dispositivo , Endocardite/diagnóstico por imagem , Endocardite/terapia , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/terapia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem
12.
J Cardiovasc Magn Reson ; 22(1): 33, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32404159

RESUMO

BACKGROUND: 3D-time resolved flow (4DF) cardiovascular magnetic resonance (CMR) with retrospective analysis of atrioventricular valve regurgitation (AVVR) allows for internal validation by multiple direct and indirect methods. Limited data exist on direct measurement of AVVR by 4DF CMR in pediatric congenital heart disease (CHD). We aimed to validate direct measurement of the AVVR jet as accurate and reliable compared to the volumetric method (clinical standard by 2D CMR) and as a superior method of internal validation than the annular inflow method. METHODS: We identified 44 consecutive patients with diverse CHD referred for evaluation of AVVR by CMR. 1.5 T or 3 T scanners, intravenous contrast, and a combination of parallel imaging and compressed sensing were used. Four methods of measuring AVVR volume (RVol) were used: volumetric method (VOL; the clinical standard) = stroke volume by 2D balanced steady-state free precession - semilunar valve forward flow (SLFF); annular inflow method (AIM) = atrioventricular valve forward flow [AVFF] - semilunar valve net flow (SLNF); and direct measurement (JET). AVFF was measured using static and retrospective valve tracking planes. SLFF, SLNF, AVFF, and JET were measured by 4DF phase contrast. Regurgitant fraction was calculated as [RVol/(RVol+SLNF)]× 100. Statistical methods included Spearman, Wilcoxon rank sum test/Student paired t-test, Bland Altman analysis, and intra-class coefficient (ICC), where appropriate. RESULTS: Regurgitant fraction by JET strongly correlated with the indirect methods (VOL and AIM) (ρ = 0.73-0.80, p < 0.001) and was similar to VOL with a median difference (interquartile range) of - 1.5% (- 8.3-7.2%; p = 0.624). VOL had weaker correlations with AIM and JET (ρ = 0.69-0.73, p < 0.001). AIM underestimated RF by 3.6-6.9% compared to VOL and JET, p < 0.03. Intra- and inter- observer reliability were excellent for all methods (ICC 0.94-0.99). The mean (±standard deviation) inter-observer difference for VOL was 2.4% (±5.1%), p < 0.05. CONCLUSIONS: In a diverse cohort of pediatric CHD, measurement of AVVR using JET is accurate and reliable to VOL and is a superior method of internal validation compared to AIM. This study supports use of 4DF CMR for measurement of AVVR, obviating need for expert prospective prescription during image acquisition by 2D CMR.


Assuntos
Cardiopatias Congênitas/diagnóstico por imagem , Hemodinâmica , Interpretação de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Insuficiência da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/fisiopatologia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/fisiopatologia , Adulto Jovem
16.
J Card Surg ; 35(6): 1383-1386, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32349171

RESUMO

Dextrocardia with situs solitus is a rare congenital anomaly, often associated with intra- or extracardiac malformations. A clear understanding of the spatial orientation of the chambers of the heart for planning surgical approach, is imperative. Access to the right side of the heart, especially for repair of the tricuspid valve can be challenging. We describe a case of dextrocardia, situs solitus, inlet ventricular septal defect (VSD) with iatrogenic tricuspid regurgitation (TR) in an adult patient, highlighting the surgical aspects essential for a successful outcome.


Assuntos
Anormalidades Múltiplas/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Dextrocardia/cirurgia , Comunicação Interventricular/cirurgia , Situs Inversus/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Dextrocardia/diagnóstico por imagem , Diagnóstico por Imagem , Feminino , Comunicação Interventricular/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Doença Iatrogênica , Situs Inversus/diagnóstico por imagem , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Adulto Jovem
17.
J Card Surg ; 35(6): 1371-1374, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32333436

RESUMO

Surgical management of patients affected by structural valve deterioration of bioprostheses in tricuspid valve position represents a challenge. Furthermore, transcatheter valve-in-valve implantation (TVIVI) recently emerged as an interesting option in high-risk surgical patients. When surgery is performed, replacement of the dysfunctional tricuspid bioprosthesis could be a difficult procedure due to the risk of heart rupture during the prosthesis removal. Herein we report the case of a 52-year-old female patient in which a transcatheter TVIVI was successfully performed under direct vision as a bailout strategy due to the impossibility of bioprosthesis removal.


Assuntos
Bioprótese/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Falha de Prótese , Toracotomia/métodos , Valva Tricúspide/cirurgia , Endocardite/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Reoperação , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem
18.
Int J Cardiovasc Imaging ; 36(6): 1077-1084, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32200479

RESUMO

Functional tricuspid regurgitation (FTR) is defined as abnormal systolic tricuspid leakage with normal valve structures, and its prognostic role and management in patients with left-heart valve disease is well known. Due to paucity of data on FTR in patients with ischemic heart disease, the aim of our prospective study was to compare the prognostic effect of FTR between patients with moderate FTR and those with less-than-moderate FTR undergoing isolated coronary artery bypass graft (CABG) surgery. This prospective cohort study included all the patients who were candidate for isolated CABG and were referred for preoperative transthoracic echocardiography between April 2018 and November 2018. Patients were categorized into two groups: less-than-moderate FTR and moderate FTR. The endpoints of the study were the prognostic effect of FTR on short-term mortality and morbidities as a composite endpoint, as well as length of hospitalization, length of intensive care unit (ICU) stay, and ventilation time. Of a total of 410 patients, 363 patients (mean age = 62.4 years, 63.7% men) entered our final analysis. Logistic regression analysis demonstrated that composite endpoints of short-term mortality and morbidities was not significantly different between the two groups, but moderate FTR had a statistically significant effect on length of hospitalization (P = 0.002) and the ventilation time (P = 0.048). This effect, however, did not persist after adjustments for probable known confounders. Our study indicated no significant prognostic effect for preoperative FTR versus less-than-moderate FTR on short-term mortality and morbidities, as well as length of hospitalization, length of ICU stay, and the ventilation time.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Tempo de Internação , Insuficiência da Valva Tricúspide/fisiopatologia , Valva Tricúspide/fisiopatologia , Idoso , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/mortalidade
20.
Open Heart ; 7(1): e001227, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32206317

RESUMO

Objectives: Tricuspid valve disease is increasingly encountered, but surgery is rarely performed in isolation, in part because of a reported higher operative risk than other single-valve operations. Although guidelines recommend valve repair, there is sparse literature for the optimal surgical approach in isolated tricuspid valve disease. We performed a meta-analysis examining outcomes of isolated tricuspid valve repair versus replacement. Methods: We searched Pubmed, Embase, Scopus and Cochrane from January 1980 to June 2019 for studies reporting outcomes of both isolated tricuspid valve repair and replacement, excluding congenital tricuspid aetiologies. Data were extracted and pooled using random-effects models and Review Manager 5.3 software. Results: There were 811 article abstracts screened, from which 52 full-text articles reviewed and 16 studies included, totalling 6808 repairs and 8261 replacements. Mean age ranged from 36 to 68 years and females made up 24%-92% of these studies. Pooled operative mortality rates and odds ratios (95% confidence intervals) for isolated tricuspid repair and replacement surgery were 8.4% vs 9.9%, 0.80 (0.64 to 1.00). Tricuspid repair was also associated with lower in-hospital acute renal failure 12.4% vs 15.6%, 0.82 (0.72 to 0.93) and pacemaker implantation 9.4% vs 21.0%, 0.37 (0.24 to 0.58), but higher stroke rate 1.5% vs 0.9%, 1.63 (1.10 to 2.41). There were no differences in rates of prolonged ventilation, mediastinitis, return to operating room or late mortality. Conclusion: Isolated tricuspid valve repair was associated with significantly reduced in-hospital mortality, renal failure and pacemaker implantation compared with replacement and is therefore recommended where feasible for isolated tricuspid valve disease, although its higher stroke rate warrants further research.


Assuntos
Anuloplastia da Valva Cardíaca , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Valva Tricúspide/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anuloplastia da Valva Cardíaca/efeitos adversos , Anuloplastia da Valva Cardíaca/mortalidade , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...