RESUMO
Congenital clefts of the mitral valve without an associated atrioventricular canal defect are rare, and they may cause mitral insufficiency that requires surgical correction. Repair is typically by direct suture; however, if the cleft is especially wide, the use of this technique may distort the valve leaflet and cause poor coaptation with valvular insufficiency.Herein, we present the case of a 39-year-old woman who had severe mitral valve insufficiency secondary to a wide isolated cleft of the anterior mitral leaflet. The valve was reconstructed with an autologous pericardial patch supported by polytetrafluoroethylene neochordae and an implanted annuloplasty ring. Echocardiographic examination 1 year postoperatively showed excellent competence of the mitral valve and good coaptation of the leaflets. To our knowledge, this is the 1st report that describes the use of artificial neochordae to support an autologous pericardial patch in the repair of a cleft in the anterior mitral valve leaflet.
Assuntos
Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Pericárdio/transplante , Adulto , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Valva Mitral/anormalidades , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Desenho de Prótese , Índice de Gravidade de Doença , Técnicas de Sutura , Transplante Autólogo , Resultado do TratamentoRESUMO
Chronic obstructive pulmonary disease and obesity are major causes of morbidity and mortality worldwide and, according to current data, the global burden of these conditions will increase further. Obesity plays a major role in the development of the metabolic syndrome and has been identified as an important risk factor for chronic diseases such as type 2 diabetes mellitus and cardiovascular disease. Adiposity is associated with insulin resistance even over relatively normal ranges of body fatness. There is strong evidence that altered adipose tissue function plays a crucial role in the pathogenesis of obesity-related insulin resistance and type 2 diabetes, as has recently been reviewed. Obesity is linked to respiratory diseases such as obstructive sleep apnea syndrome and obesity hypoventilation syndrome and accumulating evidence suggests an association between obesity and asthma. A potential link between obesity and COPD is also increasingly recognized although little data is known about the mechanisms underlying this association. The inflammatory and metabolic profile differs between obese with COPD and normo or underweight with COPD in part due to dysfunction of adipose tissue.