RESUMEN
OBJECTIVE: To analyze late clinical evolution after surgical treatment of children, with reparative and reconstructive techniques without annular support. METHODS: We evaluated 21 patients operated upon between 1975 and 1998. Age 4.67+/-3.44 years; 47.6% girls; mitral insufficiency 57.1% (12 cases), stenosis 28.6% (6 cases), and double lesion 14.3% (3 cases). The perfusion 43.10+/-9.50 min, and ischemia time were 29.40+/-10.50 min. The average clinical follow-up in mitral insufficiency was 41.52+/-53.61 months. In the stenosis group (4 patients) was 46.39+/-32.02 months, and in the double lesion group (3 patients), 39.41+/-37.5 months. The echocardiographic follow-up was in mitral insufficiency 37.17+/-39.51 months, stenosis 42.61+/-30.59 months, and in the double lesion 39.41+/-37.51 months. RESULTS: Operative mortality was 9.5% (2 cases). No late deaths occurred. In the group with mitral insufficiency, 10 (83.3%) patients were asymptomatic (p=0.04). The majority with mild reflux (p=0.002). In the follow-up of the stenosis group, all were in functional class I (NYHA); and the mean transvalve gradient varied between 8 and 12 mmHg, average of 10.7 mmHg. In the double lesion group, 1 patient was reoperated at 43 months. No endocarditis or thromboembolism were reported. CONCLUSION: Mitral stenosis repair has worse late results, related to the valve abnormalities and associated lesions. The correction of mitral insufficiency without annular support showed good long-term results.
Asunto(s)
Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Adolescente , Niño , Preescolar , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Válvula Mitral/anomalías , Insuficiencia de la Válvula Mitral/congénito , Estenosis de la Válvula Mitral/congénito , Factores de Tiempo , Resultado del TratamientoRESUMEN
Mitral valve repair may be performed without ring support with advantages related to results and complications. The objective of this study was to analyze the long-term clinical results following surgical repair and reconstruction without the use of rings in cases of congenital mitral lesions in children less than 12 years of age. Twenty-one patients who had undergone surgery during the period from 1975 to 1998 were evaluated. The mean age was 4.6 +/- 3.4 years. Females represented 47.6% of the total. Mitral regurgitation was present in 57.1% (12 patients), stenosis in 28.6% (6 patients), and the mixed lesion group represented 14.3% (3 patients). Perfusion time was 43.1 +/- 9.5 minutes and ischemic time 29.4 +/- 10.5 minutes. Follow-up time was 41.5 +/- 53.6 months for the regurgitation group, 46.3 +/- 32.0 months for the stenosis group, and 39.41 +/- 37.51 months for the mixed lesion group. Echocardiographical follow-up time was 37.17 +/- 39.51 months for the regurgitation group, 42.61 +/- 30.59 months for the stenosis group, and 39.41 +/- 37.51 months for the mixed lesion group. Operative mortality was 9.5% (two cases). There were no late deaths. In the regurgitation group, 10 patients (83.3%) were asymptomatic (p = 0.004). In the echocardiographical follow-up, most of the patients had minimal regurgitation. In the clinical follow-up of the stenosis group all patients were in functional class I (NYHA). The mean transvalvular gradient measured by echocardiography was from 8 to 12 mmHg with a mean gradient of 10.7 mmHg. In the mixed lesion group there was one reoperation at postoperative month 43. There were no cases of endocarditis or thromboembolism. Mitral valve repair in congenital lesions is associated with good late results. The majority of cases in the regurgitation group remain asymptomatic and do not require reoperation. Rings or annular support are not necessary in such cases. Satisfactory repair is more difficult to achieve in cases of mitral stenosis due to valvular abnormalities and the seriousness of the associated lesions.
Asunto(s)
Insuficiencia de la Válvula Mitral/congénito , Estenosis de la Válvula Mitral/congénito , Válvula Mitral/anomalías , Niño , Preescolar , Ecocardiografía , Femenino , Humanos , Lactante , Masculino , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/mortalidad , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/mortalidad , Estenosis de la Válvula Mitral/cirugía , Factores de TiempoRESUMEN
INTRODUÇÇO: A correçäo cirúrgica da estenose aórtica resulta em reduçäo significativa do gradiente pressórico transvalvar, sendo acompanhada por regressäo da hipertrofia ventricular esquerda(HVE). A intensidade e a rapidez dessa regressäo tem sido objeto de avaliaçöes. A associaçäo de valvoplastia aórtica e regressäo imediata da HVE é relatada em poucos estudos. MÉTODOS: Foram estudados, prospectivamente, 11 pacientes submetidos à valvoplastia em estenose aórtica, utilizando-se ecocardiografia imediatamente antes da cirurgia e no período pós-operatório precoce (6,1 + ou - 0,9 dias). RESULTADOS: A espessura septal variou de 12,10 + ou - 1,66mm para 11,36 + ou - 1,12mm (reduçäo de 6,1 por cento) (NS) enquanto a espessura parietal variou 4,4 por cento (de 11,70 + ou - 1,41 mm para 11,18 + ou - 1,16mm) (NS). A fraçäo de ejeçöo apresentou uma variaçäo de 62,02 + ou - 18,59 por cento para 62,50 + ou - 11,74 por cento (NS). A massa ventricular esquerda variou em 6,7 por cento ( de 277,65 + ou - 114,80 g passou para 258,93 + ou - 92,38 g) (NS). O gradiente transvalvular médio regrediu de 53,6 + ou -10,3 mmHg para 23,0 + ou - 9,1mmHg, ou seja, 57 por cento (p<0.001). CONCLUSÕES: A valvoplastia alivia o gradiente pressórico aórtico satisfatoriamente e a regressäo da HVE tende a se iniciar logo após, porém ainda näo é significativa no período pós-operatório imediato
Asunto(s)
Humanos , Persona de Mediana Edad , Masculino , Femenino , Estenosis de la Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas , Hipertrofia Ventricular Izquierda/cirugía , Periodo Posoperatorio , Estudios ProspectivosRESUMEN
BACKGROUND: Relief of gradient is followed by myocardial mass reduction in aortic stenosis. Its degree and speed are under evaluation. Aortic valve repair in calcified aortic stenosis is less well studied than replacement. METHODS: We evaluated left ventricular hypertrophy reduction by echocardiogram in 11 patients immediately after valve repair in aortic stenosis at a mean of 6.1 +/- 0.9 days post operative. RESULTS: Septal width was 12.10 +/- 1.66 mm pre and 11.36 +/- 1.12 mm post operative, 6,1% reduction (NS). Parietal width varied 4.4% from 11.70+/-1.41 mm to 11.18 +/- 1,16 mm (NS). Ejection fraction went from 62.02+/-18.59% to 62.50+/-11. 74% (NS). Left ventricular mass varied 6.7%, from 277.65+/-114.80g to 258.93+/- 92.38 g (NS). Mean transvalvar gradient reduced 57%, from 53.56+/-10.30 to 23.0+/-9.1 mmHg (P<0.001). CONCLUSION: Aortic valve repair reduces gradients adequately and left ventricular hypertrophy shows a trend to regression soon after aortic repair, but is not yet significant in the first post-operatively week.