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1.
Rev Med Suisse ; 11(464): 537-42, 2015 Mar 04.
Artigo em Francês | MEDLINE | ID: mdl-25924247

RESUMO

Percutaneous approaches to mitral valve disease consist in modifications of existing surgical techniques, aiming to replicate the favourable outcomes of surgery, with less procedure-related risk, due to their less invasive nature. While some of these techniques are clearly indicated for the management of certain valve diseases, other appear as possible alternatives to surgery among patients deemed at high-risk or considered inoperable, or are still under clinical investigation. Major development of these percutaneous approaches is expected within the future, thus hopefully allowing treatment of a larger proportion of patients with mitral valve disease.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Desenho de Prótese
2.
Ann Cardiol Angeiol (Paris) ; 71(1): 41-52, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34274113

RESUMO

Heart failure (HF) has high event rates, mortality, and is challenging to manage in clinical practice. Clinical management is complicated by complex therapeutic strategies in a population with a high prevalence of comorbidity and general frailty. In the last four years, an abundance of research has become available to support multidisciplinary management of heart failure from within the hospital through to discharge and primary care as well as supporting diagnosis and comorbidity management. Within the hospital setting, recent evidence supports sacubitril-valsartan combination in frail, deteriorating or de novo patients with LVEF≤40%. Furthermore, new strategies such as SGLT2 inhibitors and vericiguat provide further benefit for patients with decompensating HF. Studies with tafamidis report major clinical benefits specifically for patients with ATTR cardiac amyloidosis, a remaining underdiagnosed and undertreated disease. New evidence for medical interventions supports his bundle pacing to reduce QRS width and improve haemodynamics as well as ICD defibrillation for non-ischemic cardiomyopathy. The Mitraclip reduces hospitalisations and mortality in patients with symptomatic, secondary mitral regurgitation and ablation reduces mortality and hospitalisations in patients with paroxysmal and persistent atrial fibrillation. In end-stage HF, the 2018 French Heart Allocation policy should improve access to heart transplants for stable, ambulatory patients and, mechanical circulatory support should be considered to avoid deteriorating on the waiting list. In the community, new evidence supports that improving discharge education, treatment and patient support improves outcomes. The authors believe that this review fills the gap between the guidelines and clinical practice and provides practical recommendations to improve HF management.


Assuntos
Insuficiência Cardíaca , Alta do Paciente , Aminobutiratos , Compostos de Bifenilo , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Hospitalização , Hospitais , Humanos
3.
Sci Rep ; 8(1): 13019, 2018 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-30158670

RESUMO

Mutations in the TGFßR2 gene have been associated with a life threatening risk of aortic dissection but no arrhythmic death has been previously reported. Two young females carrying a TGFßR2 mutation, initially diagnosed as Marfan syndrome or Loeys Dietz syndrome, presented sudden death with autopsy ruling out dissection. The ECGs of the 2 Sudden Cardiac Deaths revealed profound ventricular repolarization abnormalities with a sinusoidal T-U morphology associated with normal left ventricular ejection fraction. These data strongly suggest sudden cardiac arrhythmic deaths and prompted us to systematically study the repolarization pattern in the patients with TGFßR2 mutations. ECG findings from 58 mutation carriers patients (TGFßR2 group) were compared with those of 46 non-affected first degree relatives (control group). TGFßR2 mutation was associated with ventricular repolarization abnormalities in 47% of patients (p < 0.001 vs. controls), including a 19.6 ms (95%CI 8.7; 30.5) QTc interval prolongation compared to the non-affected first degree relatives (p < 0.001), higher prevalence of abnormal U waves (16% vs. 2%), and sinusoidal T-U morphology (10% vs. 0%). TGFßR2 mutations can be associated with abnormal ventricular repolarization pattern, longer QT interval than non-carrier relatives and an increased risk for sudden death.


Assuntos
Arritmias Cardíacas/complicações , Arritmias Cardíacas/genética , Morte Súbita Cardíaca/etiologia , Mutação , Receptor do Fator de Crescimento Transformador beta Tipo II/genética , Adolescente , Eletrocardiografia , Feminino , Humanos , Adulto Jovem
4.
Eur Heart J Cardiovasc Imaging ; 18(10): 1163-1169, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-27625364

RESUMO

AIMS: So far, a total of five patients with eclipsed mitral regurgitation (MR) have been reported in the literature by three different teams. The aim of this article was to detail clinical and echocardiographic characteristics, and outcome of patients presenting eclipsed MR. METHODS AND RESULTS: We defined eclipsed MR as spontaneous appearance, at rest, from 1 min to the next of an acute restriction in the motion of mitral leaflets preventing coaptation and leading to massive MR in patients with normal left ventricular end-diastolic diameter, left ventricular ejection fraction >45%, and baseline MR ≤2. Spontaneous regression occurred within 30 min, and no obvious trigger such as acute hypertension, new-onset arrhythmia, or myocardial ischaemia is present. Clinical data, ECG, echocardiographic data, surgery report, and follow-up status of six patients with eclipsed MR are reported: all were post-menopausal women with median age of 74 [57-80] years presenting hypertension (4/6), chronic kidney disease (5/6), or chronic anaemia (4/6). Five out of six patients experienced acute pulmonary oedema requiring hospitalization and underwent mitral valve replacement because of heart failure recurrence. Two patients died in the first days after surgery while the three others are free of symptoms at, respectively, 56, 18, and 10 months follow-up. CONCLUSION: Eclipsed MR is a clinical and echocardiographic syndrome responsible for heart failure with preserved EF. It is presently underdiagnosed and should be evoked in cases of recurrent acute pulmonary oedema without obvious trigger, in particular in patients presenting discordant evaluation of MR severity over time.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/métodos , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/terapia , Prognóstico , Doenças Raras , Recidiva , Estudos Retrospectivos , Medição de Risco , Estudos de Amostragem , Índice de Gravidade de Doença , Taxa de Sobrevida
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