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1.
Int J Mol Sci ; 22(6)2021 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-33806852

RESUMO

Cardiovascular malformations and diseases are common but complex and often not yet fully understood. To better understand the effects of structural and microstructural changes of the heart and the vasculature on their proper functioning, a detailed characterization of the microstructure is crucial. In vivo imaging approaches are noninvasive and allow visualizing the heart and the vasculature in 3D. However, their spatial image resolution is often too limited for microstructural analyses, and hence, ex vivo imaging is preferred for this purpose. Ex vivo X-ray microfocus computed tomography (microCT) is a rapidly emerging high-resolution 3D structural imaging technique often used for the assessment of calcified tissues. Contrast-enhanced microCT (CE-CT) or phase-contrast microCT (PC-CT) improve this technique by additionally allowing the distinction of different low X-ray-absorbing soft tissues. In this review, we present the strengths of ex vivo microCT, CE-CT and PC-CT for quantitative 3D imaging of the structure and/or microstructure of the heart, the vasculature and their substructures in healthy and diseased state. We also discuss their current limitations, mainly with regard to the contrasting methods and the tissue preparation.


Assuntos
Sistema Cardiovascular/diagnóstico por imagem , Microtomografia por Raio-X/métodos , Animais , Biomarcadores , Vasos Sanguíneos/diagnóstico por imagem , Vasos Sanguíneos/metabolismo , Anormalidades Cardiovasculares/diagnóstico por imagem , Sistema Cardiovascular/patologia , Meios de Contraste , Coração/anatomia & histologia , Coração/diagnóstico por imagem , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/patologia , Humanos , Imageamento Tridimensional/métodos , Miocárdio/metabolismo
2.
Cardiovasc Pathol ; 50: 107276, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32866636

RESUMO

The constituents of normal cardiac valves as well as those involved by active and/or chronic processes have been detailed previously, however minor attention has been provided toward mature adipocytes within valves and correlation with other histologic, clinical, and echocardiographic data. The literature also contains a paucity of investigations examining the presence of a particular form of degenerative change of mature adipocytes termed membranous fat necrosis. We retrospectively reviewed the histologic findings of 1042 native cardiac valves which included identification of the presence of adipocytes and membranous fat necrosis within them, as well as correlation with other histopathologic features, and clinical and echocardiographic findings. Notable observations included that membranous fat necrosis was only present in valves with adipocytes, adipocytes and membranous fat necrosis were seen in older patients, and that Caucasians made up a greater proportion of patients while African Americans made up a lower proportion of patients when valves were found with adipocytes and membranous fat necrosis. Aortic valves contained adipocytes and membranous fat necrosis at a greater rate than compared to other valves, and aortic valves with adipocytes and membranous fat necrosis were more commonly tricuspid (as opposed to bicuspid) and with larger aortic valve area and lower peak and mean gradients. Further investigation is required to determine potential physiologic and/or pathologic consequence of their presence.


Assuntos
Adipócitos/patologia , Necrose Gordurosa , Doenças das Valvas Cardíacas/patologia , Valvas Cardíacas/patologia , Idoso , Autopsia , Bases de Dados Factuais , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Methodist Debakey Cardiovasc J ; 16(2): 86-96, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670468

RESUMO

Of the 100,000-plus valve surgeries performed each year in the United States, up to 6% of those develop complications from prosthetic valve dysfunction. Prosthetic valve dysfunction (PVD) can be life threatening and often challenging to diagnose. In this review, we discuss the prevalence and incidence of PVD, explore its different etiologies, and assess the role of multimodality imaging with an emphasis on cardiac multidetector computed tomography (MDCT) for evaluating patients with PVD. We also investigate the utility of MDCT in preprocedural planning for transcatheter devices and redo surgical planning and discuss management strategies for patients with PVD.


Assuntos
Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valvas Cardíacas/cirurgia , Tomografia Computadorizada Multidetectores , Complicações Pós-Operatórias/diagnóstico por imagem , Falha de Prótese , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Humanos , Incidência , Imagem Multimodal , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Valor Preditivo dos Testes , Prevalência , Reoperação , Fatores de Risco , Resultado do Tratamento
5.
Circ Cardiovasc Imaging ; 13(6): e010600, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32507019

RESUMO

Background Infective endocarditis (IE) remains a difficult to diagnose condition associated with high mortality. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has recently emerged as another IE imaging modality, although diagnostic accuracy varies across observational studies and types of IE. This meta-analysis assessed the diagnostic performance of 18F-FDG PET/CT for IE and its subtypes. Methods We searched Pubmed, Cochrane, and Embase from January 1980 to September 2019 for studies reporting both sensitivity and specificity of 18F-FDG PET/CT for IE. Meta-Disc 1.4 was used to pool data for all cases of IE and its subgroups of native valve IE, prosthetic valve IE, and cardiac implantable electronic devices IE. Results We screened 2566 records from the search, assessed 52 full-text articles, and included 26 studies totaling 1358 patients (509 IE cases). Pooled sensitivity and specificity (95% CI, inconsistency I-square statistic) were 0.74 (0.70-0.77, 71.5%) and 0.88 (0.86-0.91, 78.5%) for all cases of endocarditis. Corresponding parameters for native valve IE were sensitivity 0.31 (0.21-0.41, 29.4%) and specificity 0.98 (0.95-0.99, 34.4%); for prosthetic valve IE: sensitivity 0.86 (0.81-0.89, 60.0%) and specificity 0.84 (0.79-0.88, 75.2%); and for cardiac implantable electronic devices IE: sensitivity 0.72 (0.61-0.81, 76.2%) and specificity 0.83 (0.75-0.89, 83.6%). Pooled sensitivities and specificities were higher for the 17 studies since 2015 than the 9 studies published before 2015. Conclusions 18F-FDG PET/CT had high specificity for all IE subtypes; however, sensitivity was markedly lower for native valve IE than prosthetic valve IE and cardiac implantable electronic devices IE. It is, therefore, a useful adjunct modality for assessing endocarditis, especially in the challenging scenarios of prosthetic valve IE and cardiac implantable electronic devices IE, with improving performance over time, related to advances in 18F-FDG PET/CT techniques.


Assuntos
Endocardite/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Valvas Cardíacas/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Desfibriladores Implantáveis/efeitos adversos , Endocardite/etiologia , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Valor Preditivo dos Testes , Prognóstico , Infecções Relacionadas à Prótese/etiologia , Reprodutibilidade dos Testes , Fatores de Risco
6.
Int. j. morphol ; 38(3): 726-730, June 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1098312

RESUMO

Determination of age represents one of the most important aspects in forensic identification. Through aging, changes can occur in morphological structures of the heart valves. The objective is to examine the relationship between the dimensions of the rigth atrioventricular (tricuspid), pulmonary, left atrioventricular (mitral), and aortic valves and age at death. Sixty fresh human hearts were obtained from Department of Anatomy and Department of Forensic Medicine, Faculty of medicine, Chiang Mai University, Thailand. The age of individuals was between 20-90 years. We investigated the morphometric parameters of the valves were taken including: valve circumference, length, the height and area of each leaflet. All parameters were measured by using specific image analysis software. The correlation test and predictive equation were established. The positive correlation between the circumference, area of posterior leaflet, height of anterior leaflet, and area of anterior leaflet of the rigth atrioventricular valve were found. The left atrioventricular valve showed correlation with age in circumference, length and area of posterior leaflet. For the pulmonary and aortic valves, there were correlated between circumference at sinotubular junction and leaflet sizes in almost leaflets. The circumference at sinotubular junction of the pulmonary valve was highest significantly correlation with age (r=0.693). The predictive equation was age = -3.659+0.652(Circumference at sinotubular junction of the pulmonary valve) with standard error of ± 14.7 years. Additional knowledge of morphometric features in human heart valves and its relationship with age could be used as age indicator in forensic field.


La determinación de la edad representa uno de los aspectos más importantes en la identificación forense. Pueden ocurrir cambios a través del envejecimiento, en las estructuras morfológicas de las válvulas cardíacas. El objetivo de este estudio fue examinar la relación entre las dimensiones de las valvas atrioventricular derecha (tricúspide), pulmonar, atrioventricular izquierda (mitral) y aórtica, y la edad en relación a la muerte. Se obtuvieron sesenta corazones humanos frescos del Departamento de Anatomía y el Departamento de Medicina Forense de la Facultad de Medicina de la Universidad de Chiang Mai, Tailandia. La edad de las personas fluctuaba entre los 20 y 90 años. Investigamos los parámetros morfométricos de las valvas analizadas, incluyendo: circunferencia de la valva, longitud, altura y área de cada valva. Todos los parámetros se midieron utilizando un software de análisis de imagen específico. Se estableció la prueba de correlación y la ecuación predictiva. Se encontró la correlación positiva entre la circunferencia, el área de la valvula posterior, la altura de la valvula anterior y el área de la valvula anterior de la valva atrioventricular derecha. La valva atrioventricular izquierda mostró correlación con la edad en la circunferencia, longitud y área de la valvula posterior. Para las valvas pulmonar y aórtica, se correlacionó entre la circunferencia en la unión sinotubular y el tamaño de las válvulas. La circunferencia en la unión sinotubular de la valva pulmonar fue la mayor correlación significativa con la edad (r = 0,693). La ecuación predictiva fue edad = -3,659 + 0,652 (circunferencia en la unión sinotubular de la valva pulmonar) con error estándar de ± 14,7 años. El conocimiento adicional de las características morfométricas en las valvas cardíacas humanas y su relación con la edad podría usarse como indicador de edad en el campo forense.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Envelhecimento/fisiologia , Medicina Legal/métodos , Valvas Cardíacas/anatomia & histologia , Valvas Cardíacas/diagnóstico por imagem , Tailândia , Cadáver
7.
J Cardiothorac Surg ; 15(1): 59, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295626

RESUMO

BACKGROUND: Uniatrial biventricular connection (UBC) is a rare cardiovascular anomaly characterized by absence of one atrioventricular connection and drainage of the other atrium via a solitary atrioventricular valve into both ventricles. The absent atrioventricular connection may affect either the left or right atrium. Because of the absence of one atrioventricular connection hearts with UBC have been classified among functionally univentricular hearts requiring palliative treatment according to the Fontan principle. AIMS/OBJECTIVE: We report two further patients with UBC. In one of these patients careful echocardiographic examination of the atrioventricular junction in early infancy revealed the possibility of biventricular repair based on the favorable anatomy of the atrioventricular valve and balanced ventricles in the presence of an inlet ventricular septal defect (VSD). CASE PRESENTATIONS: Both patients presented in the neonatal period for evaluation of complex congenital heart disease. The anatomy of the atrioventricular valves in our patients was indistinguishable from atrioventricular septal defects exhibiting the morphology of a common valve with superior and inferior bridging leaflets. The common atrioventricular valve was connected exclusively to the right atrium draining into both ventricles while the left atrium drained into the right atrium via a secundum atrial septal defect. In one of our patients biventricular repair with good longterm-result was performed by reseptation of the atria, patch repair of the VSD and septation of the atrioventricular valve. The second patient underwent univentricular palliation according to the Fontan principle. DISCUSSION/CONCLUSION: The echocardiographic findings in our patients suggest that at least some patients with UBC represent a variant of atrioventricular septal defects associated with extreme ventriculoatrial malalignment resulting in fusion of the deviated primary atrial septum with the lateral aspect of the atrioventricular junction. This offers the option of septation of the common atrioventricular valve and biventricular repair in patients with adequate size of both ventricles. Exact echocardiographic analysis of the morphology of the atrioventricular valve is essential to distinguish these patients with a morphologically common atrioventricular valve in early infancy from other variants of absent atrioventricular connection and to select those who are suitable for biventricular repair.


Assuntos
Defeitos dos Septos Cardíacos/cirurgia , Valvas Cardíacas/anormalidades , Criança , Pré-Escolar , Ecocardiografia , Feminino , Átrios do Coração/anormalidades , Átrios do Coração/cirurgia , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Valvas Cardíacas/diagnóstico por imagem , Ventrículos do Coração/anormalidades , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Lactente , Recém-Nascido
8.
Methodist Debakey Cardiovasc J ; 16(1): 61-64, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32280420

RESUMO

Williams-Beuren syndrome is a multisystem genetic disorder associated with cardiovascular abnormalities, the most common of which is some variation of arterial stenosis. We describe a case of Williams-Beuren syndrome with multiple cardiovascular structural and arterial abnormalities and demonstrate the unique role of cardiac computed tomography in diagnosis.


Assuntos
Aortografia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Valvas Cardíacas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Síndrome de Williams/diagnóstico por imagem , Diagnóstico Diferencial , Valvas Cardíacas/anormalidades , Valvas Cardíacas/fisiopatologia , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Síndrome de Williams/fisiopatologia
9.
Cardiovasc Pathol ; 47: 107210, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142924

RESUMO

Nonbacterial thrombotic endocarditis is a form of a thrombotic angiopathy involving the endothelial lined endocardial surfaces of the heart which includes valves and the chamber walls. Underlying etiologies for nonbacterial thrombotic endocarditis include autoimmune diseases, hypercoagulable states, in the setting of certain malignant neoplasms, and physical injury. The pathogenesis for these processes is that of primary endothelial injury resulting in a thrombotic angiopathy. We present a patient with heart failure being evaluated before hematopoietic stem cell transplantation who had previously been provided with chemotherapy and whose cardiac magnetic resonance imaging reveals findings suggestive of amyloidosis. A subsequent endomyocardial biopsy instead showed nonbacterial thrombotic endocarditis characterized by the endocardium with fibromyxoid thickening and overlying fresh fibrin. This case highlights histopathologic findings of chemotherapy-associated nonbacterial thrombotic endocarditis involving the right ventricle wall of the endocardium, therefore expanding the radiological differential in patients with cardiac magnetic resonance imaging findings suggestive of amyloidosis.


Assuntos
Amiloidose/patologia , Antineoplásicos/efeitos adversos , Endocardite não Infecciosa/induzido quimicamente , Cardiopatias/patologia , Valvas Cardíacas/efeitos dos fármacos , Trombose/induzido quimicamente , Amiloidose/diagnóstico por imagem , Biópsia , Cardiotoxicidade , Diagnóstico Diferencial , Endocardite não Infecciosa/diagnóstico por imagem , Endocardite não Infecciosa/patologia , Cardiopatias/diagnóstico por imagem , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Trombose/diagnóstico por imagem , Trombose/patologia
10.
Int J Cardiovasc Imaging ; 36(3): 403-413, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31902093

RESUMO

The role of two dimensional (2D) echocardiography (ECHO) for the diagnosis and clinical decision making in infective endocarditis (IE) has been extensively studied and described in the medical literature. Some reports have demonstrated the incremental value of three dimensional (3D) transesophageal (TE) ECHO in the setting of IE. However, a systematic review focusing on the role of 3D imaging is lacking. In this manuscript, we examine the role of 3D TE ECHO in the diagnosis of IE. IE is a challenging disease in which 2D transthoracic (TT) and TE ECHO have complementary roles and are unequivocally the mainstay of diagnostic imaging. Still, 2D imaging has important limitations. Technological advances in 3D imaging allow for the reconstruction of real-time anatomical images of cardiac structure and function. 3D imaging has emerged as a diagnostic technique that overcame some of the limitations of 2D ECHO. Currently, both transthoracic and transesophageal echocardiography transducers are able to generate 3D images. However, 3D TE ECHO provides images of a higher quality in comparison to 3D TT ECHO, and is the best echocardiographic modality able to allow for a detailed anatomical imaging. 3D TE ECHO may represent the key adjunctive echocardiographic technique being able to positively impact on IE-related surgical planning and intervention and to facilitate the interaction between the surgeon and the imaging specialist. Importantly, 3D TE ECHO is not the recommended initial modality of choice for the diagnosis of IE; however, in highly specialized centers, it has become an important complementary technique when advanced surgical planning is required. Furthermore, anatomical imaging has become the link between the different techniques that play a role in IE imaging. In fact, both computed tomography and magnetic resonance allow three dimensional reconstruction. An important future goal should allow for the fusion among various imaging modalities. Our review highlights the role of 3D TE ECHO in IE imaging and emphasize where it offers incremental value.


Assuntos
Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Valvas Cardíacas/diagnóstico por imagem , Endocardite/fisiopatologia , Endocardite/terapia , Valvas Cardíacas/fisiopatologia , Humanos , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes
11.
Asian Cardiovasc Thorac Ann ; 28(7): 431-443, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31752500

RESUMO

Due to the prevalence of rheumatic heart disease in the developing world, mechanical heart valves in the younger patient population remain the prostheses of choice if repair is not feasible. Despite their durability, mechanical valves are burdened by coagulation and thromboembolism. Modern design tools can be utilized during the design process of mechanical valves, which allow a more systematic design approach and more detailed analysis of the blood flow through and around valves. These tools include computer-aided design, manufacturing, and engineering, such as computational fluid dynamics and finite element analysis, modern manufacturing techniques such as additive manufacturing, and sophisticated in-vitro and in-vivo tests. Following this systematic approach, a poppet valve was redesigned and the results demonstrate the benefits of the method. More organized flow patterns and fewer complex fluid structures were observed. The alternative trileaflet valve design has also been identified as a potential solution and, if a similar design approach is adopted, it could lead to the development of an improved mechanical heart valve in the future. It is imperative that researchers in developing countries continue their search for a mechanical heart valve with a reduced thromboembolic risk, requiring less or no anticoagulation.


Assuntos
Países em Desenvolvimento , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valvas Cardíacas/cirurgia , Desenho de Prótese , Cardiopatia Reumática/cirurgia , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Desenho Assistido por Computador , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Hemodinâmica , Humanos , Modelos Cardiovasculares , Recuperação de Função Fisiológica , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/fisiopatologia , Fatores de Risco , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Resultado do Tratamento
13.
Semin Thorac Cardiovasc Surg ; 32(1): 140-142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31520731

RESUMO

We describe an asymptomatic 7-year-old boy who was taken to the operating room for repair of a subaortic membrane and possible Gerbode's defect. He was found to have a double outlet right atrium associated with an accessory atrioventricular valve in addition to a small atrial septal defect and subaortic membrane. Regurgitant flow through this accessory valve led to the left ventricle to right atrial shunt that was seen on preoperative ECHO. The atrial septal defect was repaired and a baffle was used to isolate blood flow across the accessory valve from the left atrium to the left ventricle. The patient was discharged on postoperative day 4 and has been doing well 2 years postoperatively.


Assuntos
Anormalidades Múltiplas , Procedimentos Cirúrgicos Cardíacos , Estenose Subaórtica Fixa/cirurgia , Átrios do Coração/cirurgia , Cardiopatias Congênitas/cirurgia , Comunicação Interatrial/cirurgia , Valvas Cardíacas/cirurgia , Hemodinâmica , Doenças Assintomáticas , Criança , Estenose Subaórtica Fixa/diagnóstico por imagem , Estenose Subaórtica Fixa/fisiopatologia , Átrios do Coração/anormalidades , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Valvas Cardíacas/anormalidades , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Recuperação de Função Fisiológica , Resultado do Tratamento
14.
Thorac Cardiovasc Surg ; 68(2): 99-106, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30021241

RESUMO

BACKGROUND: The management of patients with mechanical heart valves remains a major concern in populations with limited resources and medical facilities. This study reports the clinical outcomes of patients who underwent mechanical valve implantation in a sub-Saharan center over an 8-year period. METHODS: A total of 291 mechanical valves were implanted in 233 patients in our institution between February 2008 and June 2016. A total of 117 patients underwent mitral valve replacement (MVR, 50.2%), 57 had aortic valve replacement (AVR, 24.4%), and 59 underwent both AVR and MVR (double valve replacement [DVR], 25.7%). The mean age at surgery was 27.6 ± 13.4 years (range, 7-62 years). Rheumatic etiology was found in 80.6% of the patients. Hospital mortality, late deaths, and valve-related events were reviewed at follow-up (839 patient-years, range: 1-9.4 years, complete in 93%). RESULTS: The 30-day mortality was 4.7% (11/233). The overall survival at 1 and 6 years for the whole cohort was 88.8 ± 2.1% and 78.7 ± 3.3%, respectively. The 6-year survival for AVR, MVR, and DVR was 89.3 ± 4.8%, 73.2 ± 5.4%, and 79.3 ± 5.8%, respectively (p = 0.15). The freedom from neurologic events and anticoagulation-related bleeding at 6 years was 93.1 ± 2.1% and 78.9 ± 3.7%, respectively. No patient had reoperation at follow-up. No case of prosthetic valve thrombosis was identified. Eight full-term pregnancies were reported. CONCLUSION: This preliminary experience reports acceptable midterm results after mechanical heart valve implantation in our region. Both accurate surgical evaluation and strategies, either financial or social, facilitating patient's education and medical assistance are crucial to ensure good results. Long-term follow-up and further studies comparing current nonthrombogenic options are warranted to draw reliable conclusions.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valvas Cardíacas/cirurgia , Adolescente , Adulto , Camarões , Criança , 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 , Gravidez , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
Thorac Cardiovasc Surg ; 68(2): 148-157, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-29739021

RESUMO

OBJECTIVE: Paravalvular leak (PVL) after valve replacement remains clinically challenging. Percutaneous closure is an effective therapy for patients with PVLs because reoperation is associated with high rates of morbidity and mortality. The purpose of this study was to retrospectively compare the clinical outcome of transcatheter closure and surgical repair in patients with a PVL. METHODS: From January 2000 to May 2016, 131 patients with PVL were treated at three major medical centers in China. Perioperative characteristics and outcomes of the procedure were reviewed. RESULTS: Sixty-eight (51.9%) patients with PVLs were treated with percutaneous transcatheter closure (group I). The procedure was successful in 67 (98%) with no hospital deaths. Sixty-three (48.1%) patients with PVLs had a reoperation (group II). Five of the surgical patients had a third open-heart operation for residual regurgitation, and one underwent successful percutaneous closure. Six patients died in the hospital postoperatively. All patients in group II but only 11 in group I needed perioperative blood transfusions. The procedural time and hospital stay after the procedure were significantly shorter in group I than in group II. At the 1-year follow-up, cardiac function improved by ≥ 1 New York Heart Association functional class in 55 (82%) patients in group I and in 39 (68%) patients in group II. CONCLUSIONS: Transcatheter closure was shown to be a safe, effective therapeutic option in patients with PVL. It was associated with a lower hospital mortality rate, shorter procedural time, and fewer blood transfusions than surgical treatment in selected patients.


Assuntos
Cateterismo Cardíaco , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Valvas Cardíacas/cirurgia , Complicações Cognitivas Pós-Operatórias/cirurgia , Adulto , Idoso , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , China , 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/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Cognitivas Pós-Operatórias/diagnóstico por imagem , Complicações Cognitivas Pós-Operatórias/mortalidade , Complicações Cognitivas Pós-Operatórias/fisiopatologia , Recuperação de Função Fisiológica , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
16.
Ann Thorac Surg ; 109(5): 1426-1432, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31630767

RESUMO

BACKGROUND: Fueled by the burgeoning opioid epidemic, valve surgeries for substance use disorder-related infective endocarditis (SUD-IE) are increasing. The impact of substance use disorder on postvalve replacement morbidity needs further investigation. METHODS: We queried The Society of Thoracic Surgeons Adult Cardiac Surgery Database for all valve surgeries for infective endocarditis at Tufts Medical Center (2002-2016) and collected demographic and disease-related data, including timing of mortality subclassified as short-term (<6 months including operative), midterm (6 months to 5 years), and extended-term (>5 years). Patients with documentation of illicit drug use before the operation were considered to have SUD-IE. Deaths were confirmed through review of medical record and matching with the Massachusetts Vital Statistics Database. We performed univariate and multivariate proportional hazard regressions examining the impact of substance use disorder mortality in people who received a valve replacement. RESULTS: In the cohort of 228 patients, 80 (35%) had SUD-IE. Eight-six people (38%) died, and overall mortality was higher in people with SUD-IE compared with non-SUD-IE (48% vs 32%, P = .025). SUD-IE was associated with a higher risk of overall mortality (adjusted hazard ratio, 2.41; 95% confidence interval, 1.38-4.20; P = .002). Although the difference between short-term or extended-term mortality was not significant, SUD-IE was associated with increased frequency of midterm mortality (53% vs 31%, P = .003). CONCLUSIONS: Our data reflect high rates of postvalve surgery morbidity and mortality in people with SUD-IE at a tertiary care center. The midterm postoperative period is a vulnerable period for people with SUD-IE worthy of further investigation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Endocardite/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valvas Cardíacas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Idoso , Ecocardiografia Transesofagiana , Endocardite/complicações , Endocardite/epidemiologia , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/etiologia , Valvas Cardíacas/diagnóstico por imagem , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
17.
Thorac Cardiovasc Surg ; 68(2): 107-113, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30218992

RESUMO

OBJECTIVES: The increasing proportion of elderly patients in cardiac surgery poses additional challenges for the clinical management and leads to a higher operative risk due to multiple comorbidities of these patients. We reviewed the outcome of patients who were 75 years and older and underwent complex multiple valve surgery at our institution. METHODS: A retrospective review was performed to identify patients who were 75 years and older and underwent multiple valve surgery between January 2011 and May 2016 at our institution. Patients were assigned to one out of four subgroups: combined aortic and mitral valve surgery (group AM), aortic and tricuspid valve surgery (group AT), mitral and tricuspid valve surgery (group MT), and aortic, mitral, and tricuspid valve surgery (group AMT). RESULTS: A total of 311 patients underwent multiple valve surgery, of whom 119 (38.3%) were 75 years and older (median: 78 [25th-75th quartile: 76-80]). The estimated operative mortality (EuroSCORE II) in the overall cohort was 10.7%. The observed 30-day mortality was 4.2% (7% in group AM, 0% in group AT, 2.2% in group MT, 3.8% in group AMT; p = 0.685). Main complications were reexplorative surgery in 16%, adverse cerebrovascular events in 6.7%, prolonged mechanical ventilation in 10.1%, renal replacement therapy in 15.1%, nosocomial pneumonia in 15.1%, and pacemaker implantation in 18.5%. CONCLUSIONS: This study demonstrates the feasibility of complex multiple valve surgery in elderly patients. The observed perioperative mortality was lower than predicted. However, we observed a substantial rate of adverse events; therefore, careful patient selection is required in this high-risk patient population.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Valvas Cardíacas/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/fisiopatologia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Sci Rep ; 9(1): 18560, 2019 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-31811244

RESUMO

Bioprosthetic heart valves (BHVs) are commonly used as heart valve replacements but they are prone to fatigue failure; estimating their remaining life directly from medical images is difficult. Analyzing the valve performance can provide better guidance for personalized valve design. However, such analyses are often computationally intensive. In this work, we introduce the concept of deep learning (DL) based finite element analysis (DLFEA) to learn the deformation biomechanics of bioprosthetic aortic valves directly from simulations. The proposed DL framework can eliminate the time-consuming biomechanics simulations, while predicting valve deformations with the same fidelity. We present statistical results that demonstrate the high performance of the DLFEA framework and the applicability of the framework to predict bioprosthetic aortic valve deformations. With further development, such a tool can provide fast decision support for designing surgical bioprosthetic aortic valves. Ultimately, this framework could be extended to other BHVs and improve patient care.


Assuntos
Bioprótese/efeitos adversos , Desenho Assistido por Computador , Aprendizado Profundo , Próteses Valvulares Cardíacas/efeitos adversos , Desenho de Prótese/métodos , Fenômenos Biomecânicos , Técnicas de Apoio para a Decisão , Estudos de Viabilidade , Análise de Elementos Finitos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Modelos Cardiovasculares , Falha de Prótese , Tomografia Computadorizada por Raios X
19.
Rev Port Cardiol ; 38(9): 675.e1-675.e5, 2019 09.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31806283

RESUMO

Technical advances in health care have improved patient survival and quality of life, but are not devoid of complications. We present the case of a 74-year-old woman with a history of hypertensive heart disease with preserved systolic function, atrial fibrillation and dyslipidemia. She had a DDDR pacemaker implanted in 2005 due to symptomatic complete atrioventricular block. The patient reported progressive fatigue, weakness, ascites with abdominal discomfort, and lower limb edema, accompanied by non-specific hepatic cholestasis on biochemical testing. Abdominal ultrasound revealed homogeneous hepatomegaly and dilatation of the inferior vena cava and upper hepatic veins, suggestive of congestive hepatopathy. Echocardiography revealed tricuspid regurgitation progressively worsening over the previous four years and dilatation and progressive dysfunction of the right ventricle, with preserved left ventricular function. The transesophageal echocardiogram revealed severe tricuspid regurgitation with flail septal leaflet and marked dilatation of the tricuspid annulus due to mechanical interference of the pacemaker lead, which was adhering to the septal leaflet. Minimally invasive surgical treatment was performed with partial resection of the leaflet, placement of a tricuspid annuloplasty ring and replacement of the pacemaker lead. Regression of the congestive symptoms was observed, and the postoperative echocardiogram showed the tricuspid annuloplasty ring with no evidence of stenosis and only slightly dilated right chambers with moderate pulmonary hypertension. Six months after the procedure, the patient suffered an acute neurological event and died.


Assuntos
Insuficiência Cardíaca , Valvas Cardíacas , Marca-Passo Artificial/efeitos adversos , Idoso , Anuloplastia da Valva Cardíaca , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/lesões , Valvas Cardíacas/cirurgia , Humanos , Doença Iatrogênica
20.
G Ital Cardiol (Rome) ; 20(12): 722-735, 2019 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-31834296

RESUMO

Three-dimensional echocardiography (3DE) represents one of the most innovative advances in cardiovascular imaging over the last 20 years. Recent technological developments have fueled the full implementation of 3DE in clinical practice and expanded its impact on patient diagnosis, management, and prognosis. One of the most important clinical applications of transthoracic 3DE has been the quantitation of cardiac chamber volumes and function. The main limitations affecting two-dimensional echocardiography calculations of chamber volumes (i.e. geometric assumptions about cardiac chamber shape and view foreshortening) are overcome by 3DE that allows an actual measurement of their volumes. Transesophageal 3DE has been applied mainly to assess the anatomy and function of heart valves, congenital defects and masses in the beating heart. As reparative cardiac surgery and transcatheter procedures have become more and more popular to treat structural heart disease, transesophageal 3DE has become not only one of the main imaging modalities for procedure planning but also for intra-procedural guidance and assessment of procedural results. New image rendering modalities such as 3D printing, holographic display, and fusion of 3DE images with other radiological or nuclear modalities will further expand the clinical applications and indications of 3DE.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Tridimensional/métodos , Cardiopatias/diagnóstico por imagem , Ecocardiografia/métodos , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Valvas Cardíacas/diagnóstico por imagem , Humanos
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