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1.
Heart Lung Circ ; 28(9): 1436-1446, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266726

RESUMO

Multivalvular heart disease (MVD) is a highly prevalent condition causing significant morbidity and mortality. The complex haemodynamic interactions between coexisting valve lesions makes the diagnosis and treatment challenging. Current guidelines may not be adequate for managing the varying clinical scenarios of MVD and, therefore, the expertise of a multidisciplinary Heart Valve Team is of paramount importance. The indications for intervention should be based on a global assessment of the consequences of the multiple valve lesions after a careful estimation of the added surgical risk of combined procedures, the long-term risk of morbidity and mortality associated with multiple valve prostheses and the risk of reoperation if less-than-severe valve lesions are left untreated at the time of first evaluation. Echocardiography plays an important role in assessing patients and, as a general rule, an accurate echo diagnosis needs to combine different measurements. The emerging transcatheter valve therapies should be considered an option for high risk patients. More data on the natural history of MVD and the impact of intervention on outcome are required to better define the optimal management strategy.


Assuntos
Ecocardiografia , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valvas Cardíacas , Hemodinâmica , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/cirurgia , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Valvas Cardíacas/cirurgia , Humanos
3.
Anatol J Cardiol ; 21(4): 214-221, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30930449

RESUMO

OBJECTIVE: To compare the accuracy and reasons for disagreement of two-dimensional (2D) and three-dimensional (3D) echocardiography findings in the assessment of the atrioventricular valve complex in patients with atrioventricular septal defect. METHODS: A total of 20 children (mean age 8 months) with atrioventricular septal defect were enrolled prospectively into this study. The accuracy of and the reasons for disagreement in the assessment of the atrioventricular valve features were analyzed between 2D and 3D echocardiography and surgical findings. RESULTS: We found that in assessing the Rastelli type and the extension of the inferior leaflet into the right ventricle, 3D echocardiography was more accurate compared to 2D echocardiography. In all other features, 2D and 3D echocardiography showed similar accuracy. A significant reason for inaccuracy by both echo modalities was that the technique itself could not visualize the feature, although the image quality was considered to be adequate. In most cases, where it was not possible to visualize the atrioventricular feature by 2D, it was possible by 3D, and vice versa. CONCLUSION: The accuracy of 2D and 3D echocardiography and understanding the potential reasons for disagreements in assessing the atrioventricular valve complex with 2D and 3D can guide the use of those two techniques when combining them in the clinical practice.


Assuntos
Defeitos dos Septos Cardíacos/diagnóstico por imagem , Valvas Cardíacas/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Ecocardiografia , Ecocardiografia Tridimensional , Feminino , Defeitos dos Septos Cardíacos/fisiopatologia , Valvas Cardíacas/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes
4.
Ann Thorac Cardiovasc Surg ; 25(4): 192-199, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-30867384

RESUMO

PURPOSE: We want to share our experience of Sorin Bicarbon prosthesis (SBP) after 19 years follow-up. METHODS: Retrospective study of 1377 patients who had replaced with SBP from May 1998 to December 2008 at Ho Chi Minh Heart Institute, Viet Nam. RESULTS: Male patients was 42%, mean age was 40.2 ± 11.8 years. Atrial fibrillation was 43.5%. The main cause of valvular disease was rheumatic fever (89.8%). Isolated mitral valve replacement (MVR): 54% (744), isolated aortic valve replacement (AVR): 18% (247), double valve replacement (DVR): 26% (359), and 27 AVR plus mitral repair. 30-day mortality for all was 1.5%. Mean time of follow-up was 153 ± 53.1 months with total follow-up time was 17563 patients-years. 2.5% lost of follow-up. Late death was 77 cases. Redo for all causes was 59 cases. 19 years survival was 88.8 ± 1.8%. 19 years freedom of redo was 76.4 ± 4.7%. Linearized rate of all valve thrombosis, embolism, severe bleeding, endocarditis, and pannus were 0.31%, 0.28%, 0.267%, 0.068%, and 0.165% patient-years, respectively. CONCLUSIONS: SBP had shown very good results in long term and still have a reliable mechanical valve.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valvas Cardíacas/cirurgia , Desenho de Prótese , Cardiopatia Reumática/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , 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 , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Recuperação de Função Fisiológica , Reoperação , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/mortalidade , Cardiopatia Reumática/fisiopatologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Heart Fail Clin ; 15(2): 219-227, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30832813

RESUMO

Secondary regurgitation caused by the remodeling and dysfunction of the left or right heart chamber may complicate heart failure, worsening both symptoms and prognosis. Outcome studies have shown that patients' prognosis worsened as the severity of secondary regurgitation increases. Imaging and more specifically echocardiography plays a central role for diagnosis and serial assessment of secondary regurgitation as well as for timing the intervention and guiding the procedure.


Assuntos
Insuficiência Cardíaca/complicações , Doenças das Valvas Cardíacas/etiologia , Ecocardiografia/métodos , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Hemodinâmica/fisiologia , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Prognóstico , Remodelação Ventricular
6.
Circ Cardiovasc Imaging ; 12(2): e007928, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30704283

RESUMO

BACKGROUND: The 2012 World Heart Federation Criteria are the current gold standard for the diagnosis of latent rheumatic heart disease (RHD). Because data and experience using these criteria have grown, there is opportunity to simplify and develop outcome prediction tools. We aimed to develop a simple echocardiographic score applicable for RHD screening with potential to predict disease progression. METHODS: This study included 3 cohorts used for score derivation (n=9501), score validation (n=7312), and assessment of outcomes prediction (n=227). In the derivation cohort, variables independently associated with definite RHD were assigned point values proportional to their regression coefficients. The sum of these values was stratified into low (0-6), intermediate (7-9), and high (≥10) risk. RESULTS: Five components were selected for score development, including mitral valve anterior leaflet thickening, excessive leaflet tip motion, and regurgitation jet length ≥2 cm, and aortic valve focal thickening and any regurgitation. The score showed optimal discrimination and calibration for RHD diagnosis in the derivation and validation cohorts (C statistic, 0.998 and 0.994, respectively), with good discrimination for predicting disease progression (C statistic, 0.811). Progression-free survival rate in the low-risk children at 1-, 2-, and 3-year follow-up was 100%, 100%, and 93%, respectively, compared with 90%, 60%, and 47% in high-risk group. The point-based score was strongly associated with disease progression (hazard ratio, 1.270; 95% CI, 1.188-1.358; P<0.001). CONCLUSIONS: This simplified score, based on components of the World Heart Federation criteria, is highly accurate to recognize definite RHD and provides the first tool for risk stratification, assigning children with latent RHD to low, intermediate, or high risk based on echocardiographic features at diagnosis.


Assuntos
Técnicas de Apoio para a Decisão , Ecocardiografia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/diagnóstico por imagem , Programas de Rastreamento/métodos , Cardiopatia Reumática/diagnóstico por imagem , Bases de Dados Factuais , Progressão da Doença , Doenças das Valvas Cardíacas/fisiopatologia , Valvas Cardíacas/fisiopatologia , Humanos , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Cardiopatia Reumática/fisiopatologia , Medição de Risco , Fatores de Risco
7.
Radiology ; 290(1): 70-78, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30375924

RESUMO

Purpose To compare four-dimensional flow MRI with automated valve tracking to manual valve tracking in patients with acquired or congenital heart disease and healthy volunteers. Materials and Methods In this retrospective study, data were collected from 114 patients and 46 volunteers who underwent four-dimensional flow MRI at 1.5 T or 3.0 T from 2006 through 2017. Among the 114 patients, 33 had acquired and 81 had congenital heart disease (median age, 17 years; interquartile range [IQR], 13-49 years), 51 (45%) were women, and 63 (55%) were men. Among the 46 volunteers (median age, 28 years; IQR, 22-36 years), there were 19 (41%) women and 27 (59%) men. Two orthogonal cine views of each valve were used for valve tracking. Wilcoxon signed-rank test was used to compare analysis times, net forward volumes (NFVs), and regurgitant fractions. Intra- and interobserver variability was tested by using intraclass correlation coefficients (ICCs). Results Analysis time was shorter for automated versus manual tracking (all patients, 14 minutes [IQR, 12-15 minutes] vs 25 minutes [IQR, 20-25 minutes]; P < .001). Although overall differences in NFV and regurgitant fraction were comparable between both methods, NFV variation over four valves was smaller for automated versus manual tracking (all patients, 4.9% [IQR, 3.3%-6.7%] vs 9.8% [IQR, 5.1%-14.7%], respectively; P < .001). Regurgitation severity was discordant for seven pulmonary valves, 22 mitral valves, and 21 tricuspid valves. Intra- and interobserver agreement for automated tracking was excellent for NFV assessment (intra- and interobserver, ICC ≥ 0.99) and strong to excellent for regurgitant fraction assessment (intraobserver, ICC ≥ 0.94; interobserver, ICC ≥ 0.89). Conclusion Automated valve tracking reduces analysis time and improves reliability of valvular flow quantification with four-dimensional flow MRI in patients with acquired or congenital heart disease and in healthy volunteers. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by François in this issue.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Imageamento Tridimensional/métodos , Imagem Cinética por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Criança , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
8.
Diagn Interv Imaging ; 100(2): 109-116, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30527913

RESUMO

PURPOSE: The purpose of this study was to compare non-invasive high-spatial-resolution postmortem cardiac magnetic resonance imaging (MRI) and autopsy findings for evaluating the septal insertion of atrioventricular valves in fetuses. MATERIALS AND METHODS: Five fetal heart specimens including two normal hearts, one heart with complete atrioventricular septal defect (AVSD) and two hearts with linear insertion of atrioventricular valves (LIAVV; gestational age 17 to 34 weeks) were studied with cardiac MRI using a 4.7 T MRI scanner without sample preparation. Three (3D) and two-dimensional (2D) turbo-RARE (rapid imaging with refocused echoes) sequences in four-chamber and left-ventricular long-axis planes were obtained with a minimal isotropic/in-plane resolution of 156µm. Nonparametric tests were performed to compare the distance between insertions of medial leaflets of the atrioventricular valves and the inlet/outlet distance ratio between MRI and autopsy findings in normal, complete AVSD and with linear insertion of atrioventricular valves (LIAVV) fetal hearts. RESULTS: Despite apparent differences between LIAVV/normal hearts, no significant differences were found between differential insertion of medial leaflets and inlet/outlet distance ratios with both techniques. Very good to excellent reliability between both techniques was found for differential insertion (ICC: 87.2%; 95% CI: -21.7%, 99.1%) (P=0.963) and inlet/outlet distance ratio (ICC 98.3%; 95%CI: 85.2%, 99.8%) (P=0.537) measurements. CONCLUSION: Postmortem cardiac MRI could replace autopsy for assessing normal or abnormal septal insertion of atrioventricular valves in fetuses without requiring specific preparation of the heart.


Assuntos
Feto/anormalidades , Feto/diagnóstico por imagem , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Valvas Cardíacas/anormalidades , Valvas Cardíacas/diagnóstico por imagem , Imagem por Ressonância Magnética , Cadáver , Estudos de Viabilidade , Humanos , Imagem por Ressonância Magnética/métodos
9.
Clin Res Cardiol ; 108(2): 194-202, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30083858

RESUMO

PURPOSE: Calcification of aortic valve and mitral annulus is associated with cardiovascular risk factors, morbidity and mortality. Assessment of cardiac calcification with echocardiography is feasible, however, only few structured scoring systems have been established so far with limited prognostic data. This study aimed to evaluate an echocardiographic calcification score (echo-CCS) in patients with low/intermediate cardiovascular risk. METHODS: Digitally stored echocardiography studies of 151 patients (median age 64, 49.7% male) from February 2008 to December 2009 were retrospectively reviewed for calcifications of the aortic valve, aortic root, mitral annulus, papillary muscles and ventricular septum. A calcification score ranging from 0 to 5 was assigned to every patient and its relation to computed tomography calcium score, coronary stenosis and ESC SCORE was assessed. Follow-up data were collected from 149 patients (98.7%) with a median of 6.2 years. Logistic regression and Kaplan-Meier analysis were performed to assess the association of the echo-CCS with significant coronary artery disease (≥ 50% stenosis) and risk for cardiac events and all-cause mortality. RESULTS: An association of the echo-CCS with the ESC SCORE (ρ = 0.5; p < 0.001) and a good correlation of the echo-CCS with the Agatston score (ρ = 0.73; p < 0.001) can be observed. Univariate regressions revealed that echo-CCS is a significant predictor for cardiac events [OR = 5.1 (CI: 1.7-15.0); p = 0.003], coronary intervention [OR = 2.8 (CI: 1.3-5.7); p = 0.006], hospitalisation for cardiac symptoms [OR = 2.0 (CI: 1.2-3.4); p = 0.007], all-cause mortality [OR = 2.6 (CI: 1.3-5.5); p = 0.01] and significant CAD [OR = 3.2 (CI: 1.9-5.4); p < 0.001]. CONCLUSIONS: We demonstrated the prevalence of an easily obtainable, radiation-free calcification score in patients with low/intermediate cardiovascular risk. The strong association with CT-calcium scoring may evoke its potential as an alternative method in CV risk assessment.


Assuntos
Calcinose/diagnóstico , Doenças Cardiovasculares/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ecocardiografia/métodos , Valvas Cardíacas/diagnóstico por imagem , Medição de Risco , Calcinose/epidemiologia , Doenças Cardiovasculares/epidemiologia , Causas de Morte/tendências , Estudos de Viabilidade , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
10.
J Cardiothorac Vasc Anesth ; 33(1): 118-133, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30174265

RESUMO

OBJECTIVE: The authors sought to assess for the presence of practice variation in the use of intraoperative transesophageal echocardiography (TEE) for open cardiac valve surgery. DESIGN: This study was a retrospective cohort analysis. SETTING: The administrative claims data used for this investigation were multi-institutional and a representative sample of commercially insured patients in the United States between 2010 and 2015. PARTICIPANTS: The cohort consisted of adult patients, aged 18 years or older, undergoing open mitral valve (MV) or aortic valve (AV) surgery. INTERVENTIONS: This was an observational analysis without interventions. MEASUREMENTS AND MAIN RESULTS: Of 19,386 valve surgeries, 12,313 (64%) underwent AV replacement, 6,192 (32%) underwent MV repair or replacement, and 881 (<5%) underwent both MV and AV surgery. The overall rate of intraoperative TEE was 82% (95% confidence interval [CI]: 81%-82%), less frequently observed in AV procedures compared to MV or combined MV-AV procedures (80% v 85%, p < 0.001). Rates of intraoperative TEE claims varied markedly across U.S. states. After adjustment, the relative odds of an intraoperative TEE claim ranged across states from 0.26 (Louisiana, 95% CI: 0.18-0.36; p < 0.001) to 2.10 (North Carolina, 95% CI: 1.57-2.82; p < 0.001). CONCLUSION: Among adult patients undergoing open AV or MV surgery in the United States, 82% had a claim for an intraoperative TEE with marked variability across U.S. states. Increasing adherence to intraoperative TEE guidelines for valve surgery may represent an unrecognized opportunity to improve the quality of cardiac surgical care.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana/normas , Fidelidade a Diretrizes , Doenças das Valvas Cardíacas/cirurgia , Valvas Cardíacas/diagnóstico por imagem , Monitorização Intraoperatória/métodos , Padrões de Prática Médica , Idoso , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico , Próteses Valvulares Cardíacas , Valvas Cardíacas/cirurgia , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
11.
Radiol Clin North Am ; 57(1): 141-164, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30454810

RESUMO

Valvular heart disease is a common clinical problem. Although echocardiography is the standard technique for the noninvasive evaluation of the valves, cardiac CT has evolved to become a useful tool in the evaluation of the cardiac structures as well. Importantly, CT allows for improved quantification of valvular calcification due to its superior spatial resolution. It may improve the detection of small valvular or perivalvular pathology or the characterization of valvular masses and vegetations. This review describes the assessment of normal and diseased heart valves by cardiac CT and discusses its strengths and weaknesses.


Assuntos
Doenças das Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Técnicas de Imagem de Sincronização Cardíaca , Meios de Contraste , Doenças das Valvas Cardíacas/cirurgia , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador
13.
Rev Port Cardiol ; 37(12): 981-986, 2018 12.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30528564

RESUMO

INTRODUCTION: Papillary fibroelastoma (PFE) is a rare primary benign tumor of cardiac origin that predominantly affects the cardiac valves. Although most patients are asymptomatic, serious complications may result given their propensity for embolization. Advances in imaging technology have enabled earlier detection and more accurate characterization of these tumors. We report a case series, describing clinical presentation, treatment and outcome. METHODS: Institutional records of a tertiary center between 1997 and 2015 were reviewed for all patients diagnosed with PFE treated surgically and confirmed histologically. Demographic and clinical characteristics, echocardiography findings and treatment modalities were analyzed and recurrence at follow-up was studied. RESULTS: A total of 26 patients (69% male), aged 54±18 years, had a PFE. Clinically, PFE presented with neurologic deficits in eight cases and was asymptomatic in 65.4%. The mitral valve surface was the predominant tumor location (53.8%), followed by the aortic valve (34.6%). Tumor size ranged between 3 mm and 22 mm, 26.9% had a pedicle and 42.4% were mobile. All patients were treated successfully by complete resection, isolated in 88.5% and with valve repair in three cases. No other cardiac procedure was performed concomitantly and there were no major postoperative complications. Median follow-up was 61±49 months and no tumor recurrence or embolic events were documented. CONCLUSIONS: Fibroelastomas are generally small, single and detected by chance during routine imaging exams. Complete surgical resection of the tumor has an excellent prognosis and appears to be a good strategy.


Assuntos
Neoplasias Cardíacas , Papiloma , Adulto , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/patologia , Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Papiloma/diagnóstico por imagem , Papiloma/patologia , Papiloma/cirurgia , Estudos Retrospectivos , Adulto Jovem
14.
Echocardiography ; 35(12): 1974-1981, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30431175

RESUMO

BACKGROUND: Nonagenarians (NON) are a growing segment of the population and have a high prevalence of cardiac disease. Many findings encountered on their echocardiograms are also found in younger individuals with valvular or myocardial disease. Therefore, the purpose of this study was to describe this distinct echocardiographic phenotype. METHODS: We identified our study population by querying our echo database to identify unique septuagenarians (SEPT) and nonagenarians (NON) who underwent a transthoracic echocardiogram (TTE) from January 1, 2010 to December 31, 2014. Exclusion criteria were LVEF < 50%, any akinetic wall segment, aortic stenosis, moderate-severe AR and/or severe MR, coronary revascularization within 60 days of study echo, and prior valve surgery. RESULTS: The mean age of SEPT was 73.0 ± 2.0 and NON was 92.0 ± 2.1 (P < 0.001). There was no gender difference between groups. NON had significantly smaller LV end-diastolic diameters than SEPT (41.6 ± 5.7 mm vs 48.0 ± 7.0 mm, P < 0.001). NON had a greater relative wall thickness (0.51 ± 0.10 vs 0.40 ± 0.08, P < 0.001) and more frequently had concentric remodeling or hypertrophy. NON had higher E/Ea ratios and estimated LA pressures (P < 0.01). 48% of NON had moderate-severe mitral annular calcification compared to 25.0% of SEPT (P < 0.01). CONCLUSIONS: Herein, we provide the first comprehensive echocardiographic description of 'presbycardia'; concentric LVH, asymmetric septal hypertrophy, mitral and aortic valve calcification, and increased epicardial fat thickness. This pattern of findings may be increasingly seen as the population ages.


Assuntos
Ecocardiografia Doppler/métodos , Doenças das Valvas Cardíacas/fisiopatologia , Valvas Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular , Idoso , Idoso de 80 Anos ou mais , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Estudos Retrospectivos
16.
Braz J Cardiovasc Surg ; 33(4): 398-403, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30184038

RESUMO

INTRODUCTION: Carcinoid heart disease most frequently involves the tricuspid or, more rarely, the pulmonary valve and presents with right heart failure as 5-HT is metabolized by the lung. Left-sided valve involvement is quite rare. We describe our experience of 3 patients presenting with heart failure secondary to carcinoid heart disease affecting all four cardiac valves. There are only four previous isolated case reports in the literature. METHODS: All three patients underwent quadruple valve replacement during a single operation. Right ventricular outflow tract reconstruction with a pericardial patch was performed in all patients. For 24 hours prior to surgery, all patients received intravenous octreotide, which continued in intensive care for at least 24 hours. RESULTS: Mean cross-clamp and bypass times were 175 (range 164-197 minutes) and 210 (range 195-229 minutes) minutes, respectively. Mean intensive treatment unit (ITU) and inpatient stays were 2.3 (range 2-3 days) and 12 (range 9-16 days) days, respectively. One patient was reopened for bleeding 4 hours postoperatively from a ventricular pacing wire site. None required a permanent pacemaker postoperatively. There were no other complications in any patient. The quality of life was excellent at 6-16 months clinic follow-up as they were in NYHA 1. Postoperative echocardiography showed no paravalvular leaks and well-functioning prostheses in all cases. CONCLUSION: Surgery to replace all four valves is feasible with excellent medium-term survival and a very low rate of complications. Patients with carcinoid heart disease should always be considered for surgery irrespective of the extent of valvular involvement.


Assuntos
Doença Cardíaca Carcinoide/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Bioprótese , Doença Cardíaca Carcinoide/diagnóstico por imagem , Ecocardiografia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Próteses Valvulares Cardíacas , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/cirurgia , Humanos , Índice de Gravidade de Doença
17.
J Magn Reson Imaging ; 48(2): 318-329, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30134000

RESUMO

The most common types of left-sided valvular heart disease (VHD) in the Western world are aortic valve stenosis, aortic valve regurgitation, and mitral valve regurgitation. Comprehensive clinical evaluation entails both hemodynamic analysis and structural as well as functional characterization of the left ventricle. Cardiac magnetic resonance imaging (MRI) is an established diagnostic modality for assessment of left-sided VHD and is progressively gaining ground in modern-day clinical practice. Detailed flow visualization and quantification of flow-related biomarkers in VHD can be obtained using 4D flow MRI, an imaging technique capable of measuring blood flow in three orthogonal directions over time. In addition, recent MRI sequences enable myocardial tissue characterization and strain analysis. In this review we discuss the emerging potential of state-of-the-art MRI including 4D flow MRI, tissue mapping, and strain quantification for the diagnosis and prognosis of left-sided VHD. LEVEL OF EVIDENCE: 1 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2018. J. MAGN. RESON. IMAGING 2018;48:318-329.


Assuntos
Doenças das Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Coração/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Insuficiência da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Biomarcadores , Ecocardiografia , Hemodinâmica , Humanos , Imageamento Tridimensional/métodos , Cinética , Insuficiência da Valva Mitral/diagnóstico por imagem , Prognóstico , Resistência ao Cisalhamento , Estresse Mecânico
19.
JACC Cardiovasc Imaging ; 11(12): 1920-1922, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30121263
20.
Circulation ; 138(14): 1412-1427, 2018 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-30018167

RESUMO

BACKGROUND: 18F-Fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) was recently introduced as a new tool for the diagnosis of prosthetic heart valve endocarditis (PVE). Previous studies reporting a modest diagnostic accuracy may have been hampered by unstandardized image acquisition and assessment, and several confounders, as well. The aim of this study was to improve the diagnostic performance of FDG PET/CT in patients in whom PVE was suspected by identifying and excluding possible confounders, using both visual and standardized quantitative assessments. METHODS: In this multicenter study, 160 patients with a prosthetic heart valve (median age, 62 years [43-73]; 68% male; 82 mechanical valves; 62 biological; 9 transcatheter aortic valve replacements; 7 other) who underwent FDG PET/CT for suspicion of PVE, and 77 patients with a PV (median age, 73 years [65-77]; 71% male; 26 mechanical valves; 45 biological; 6 transcatheter aortic valve replacements) who underwent FDG PET/CT for other indications (negative control group), were retrospectively included. Their scans were reassessed by 2 independent observers blinded to all clinical data, both visually and quantitatively on available European Association of Nuclear Medicine Research Ltd-standardized reconstructions. Confounders were identified by use of a logistic regression model and subsequently excluded. RESULTS: Visual assessment of FDG PET/CT had a sensitivity/specificity/positive predictive value/negative predictive value for PVE of 74%/91%/89%/78%, respectively. Low inflammatory activity (C-reactive protein <40 mg/L) at the time of imaging and use of surgical adhesives during prosthetic heart valve implantation were significant confounders, whereas recent valve implantation was not. After the exclusion of patients with significant confounders, diagnostic performance values of the visual assessment increased to 91%/95%/95%/91%. As a semiquantitative measure of FDG uptake, a European Association of Nuclear Medicine Research Ltd-standardized uptake value ratio of ≥2.0 was a 100% sensitive and 91% specific predictor of PVE. CONCLUSIONS: Both visual and quantitative assessments of FDG PET/CT have a high diagnostic accuracy in patients in whom PVE is suspected. FDG PET/CT should be implemented early in the diagnostic workup to prevent the negative confounding effects of low inflammatory activity (eg, attributable to prolonged antibiotic therapy). Recent valve implantation was not a significant predictor of false-positive interpretations, but surgical adhesives used during implantation were.


Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas/efeitos adversos , Valvas Cardíacas/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Adulto , Idoso , Endocardite Bacteriana/microbiologia , Feminino , Valvas Cardíacas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/microbiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
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