RESUMO
While left ventricular (LV) restrictive filling pattern is an ominous echocardiographic finding in thalassaemia major (TM), the prognostic significance of right ventricular (RV) diastolic function in patients with TM has not been thoroughly investigated. We studied 45 TM asymptomatic transfusion-dependent patients with normal LV systolic function by Doppler echocardiography. The 15-year cumulative survival rate was 34% in patients with RV restrictive filling pattern (RFP) and 82% in patients with RV non-RFP (log-rank = 10.41, p = 0.0013). Doppler estimation of RV filling pattern is very important in evaluating the prognosis of TM patients and should be performed routinely and using a standardised followup protocol.
Assuntos
Diástole/fisiologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita/fisiologia , Talassemia beta/fisiopatologia , Adulto , Morte Súbita Cardíaca/epidemiologia , Ecocardiografia Doppler , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Prognóstico , Disfunção Ventricular Direita/mortalidade , Talassemia beta/mortalidadeRESUMO
INTRODUCTION: The incidence of percutaneous closure of secundum atrial septal defects (ASD) and patent foramen ovale (PFO), which has become an established therapy, is constantly increasing. In this study, which is the first in the Greek literature, we present the immediate and mid-term results from this intervention in our center. METHODS: From April 2004 to April 2008, 103 patients underwent percutaneous closure of an ASD or PFO using Amplatzer closure devices. Thirty were male, the mean age was 37 +/- 15.5 years, and the mean follow-up period 21.7 +/- 14.8 months. The procedure was successful in 102 of the above patients; 69 (mean age 36.3 years +/- 17.1, 81% female) underwent secundum ASD closure, while 33 patients (mean age 39.1 +/- 10.5 years, 16 female and 17 male) underwent percutaneous closure of a PFO due to cryptogenic stroke. RESULTS: There were no major complications during the procedure (death, device embolization or need for immediate cardiac surgery). There were minor complications in 8 (7.7%) patients (bleeding at the puncture site, transient ST elevation in the inferior leads, multiple atrial and ventricular ectopics). The transient ST elevation in the inferior leads appeared in 5 patients (5%) and was probably due to air embolization. This transient complication completely resolved within 3 minutes. During the follow-up period, no patient had a major complication (cardiac rupture, device embolization, thrombus formation, thromboembolism or infective endocarditis). Most importantly, in the patients who underwent PFO closure there were no recurrences of cryptogenic stroke during the follow-up period (24.3 +/- 14.5 months). CONCLUSIONS: This study shows that using Amplatzer closure devices for atrial septal communications is both safe and effective, with sustained results over a maximum follow-up period of four years. Appropriate patient selection, as well as accurate device sizing fitting the dimensions of the defect, are important factors for the success and the safety of the method.
Assuntos
Forame Oval Patente/cirurgia , Comunicação Interatrial/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Dispositivo para Oclusão Septal , Adulto , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Forame Oval Patente/diagnóstico por imagem , Grécia , Comunicação Interatrial/diagnóstico por imagem , Humanos , Incidência , Masculino , Desenho de Prótese , Fatores de Tempo , Resultado do TratamentoAssuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Complicações Pós-Operatórias , Falha de Prótese/etiologia , Reoperação/métodos , Idoso , Ecocardiografia Tridimensional/métodos , Feminino , Fluoroscopia/métodos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Resultado do TratamentoRESUMO
Dilatation of the pulmonary autograft after the Ross procedure is a possible complication, necessitating aortic valve replacement. We present a case of a patient who developed pulmonary autograft dilatation and was treated successfully with valve-sparing aortic root reimplantation with a Valsalva graft.
Assuntos
Aneurisma/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Valva Pulmonar/transplante , Adolescente , Aneurisma/etiologia , Estenose da Valva Aórtica/cirurgia , Dilatação Patológica , Humanos , Masculino , Valva Pulmonar/patologia , Reimplante , Transplante AutólogoRESUMO
INTRODUCTION: The Ross procedure is a safe alternative option for aortic valve replacement in selected patients. Here we present the medium-term results of our experience with this procedure. METHODS: Between December 1998 and January 2004, 21 patients (16 male, 5 female, mean age 42 years) underwent aortic valve replacement using the Ross operation. Indications for operation were aortic stenosis in 5 patients, aortic regurgitation in 5 patients, aortic stenosis and regurgitation in 9 patients, acute septic endocarditis of a native aortic valve in 1 patient and of a mechanical aortic valve in 1 patient. The root replacement technique was used in 17 patients (81%) and the subcoronary insertion technique in 4 patients (19%). RESULTS: Hospital mortality was 4.7% (1 patient) and late mortality is zero. Mean follow up duration was 4 years (range 1-6 years). On follow up all of the patients were in New York Heart Association class I. One patient developed neo-aortic root dilatation (5.1 cm) with mild neo-aortic valve regurgitation and underwent a modified David I procedure using a Valsalva graft. None of the patients had a gradient of more than 10 mmHg through the pulmonary autograft. Sixteen patients had no aortic insufficiency, while mild aortic regurgitation developed in three patients. Pulmonary valve regurgitation developed in 11 patients (range 8-75 mmHg) but only one patient (75 mmHg) developed significant asymptomatic stenosis. CONCLUSIONS: Our experience with the Ross procedure suggests that aortic root replacement with a pulmonary autograft can be performed safely in adult patients. Pulmonary homograft degeneration requiring reintervention might be a rare complication.
Assuntos
Valva Aórtica/transplante , Doenças das Valvas Cardíacas/cirurgia , Valva Pulmonar/transplante , Adolescente , Adulto , Feminino , Seguimentos , Doenças das Valvas Cardíacas/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Transplante Autólogo , Transplante Homólogo , Resultado do TratamentoRESUMO
BACKGROUND: The present study evaluated the prognostic significance of Doppler-demonstrated left ventricular (LV) restrictive filling pattern (RFP) in patients with thalassaemia major (TM), which carries an adverse cardiovascular prognosis. METHODS AND RESULTS: The study group comprised 45 asymptomatic transfusion-dependent patients with TM and normal LV systolic function. All patients were chelated with desferrioxamine. They were regularly evaluated by clinical and Doppler-echocardiographic studies throughout the 15-year follow-up period. The patients were categorized into 2 groups according to baseline data: those with LVRFP and those with LV non-RFP. The incidence of cardiac death in both groups was analyzed. The impact of chelation therapy on the ventricular filling pattern and survival was also examined. Nineteen patients (42.2%) had LVRFP and 26 (57.8%) had LV non-RFP. During follow-up 11 patients died from cardiac causes; 8 of them (72.8%) initially had LVRFP and 3 (27.2%) had LV non-RFP. LVRFP was significantly associated with mortality (p=0.018). Poor compliance with chelation therapy was significantly associated with LVRFP (p=0.007) and cardiac mortality (p=0.003). CONCLUSIONS: LVRFP is an important predictor of cardiac mortality in patients with TM. Poor compliance with chelation therapy was significantly associated with both a RFP (p=0.007) and cardiac mortality (p=0.003).