RESUMEN
BACKGROUND: Surgical pulmonary veins isolation (PVI) is done to restore sinus rhythm (SR) in patients with chronic permanent atrial fibrillation (CPAF) and mitral valve disease. Here we compare the efficacy of electrical block lines performed with radiofrequency (RF) compared with conventional surgery. METHODS: Randomized trial of 22 patients with CPAF and indication for mitral valve surgery. Ten patients underwent conventional surgery (SURG) and 12 RF. To prove the efficacy of the blockage lines, epicardial pacemaker wires were placed in the isolated pulmonary veins region (IPVR) and right atria (RA). RESULTS: There were no differences in the baseline data among the groups. All patients remained in SR during the immediate postoperative period. Block lines were tested in patients who remained in SR during the following days (eight in SURG and nine in RF). The median value of thresholds to conduct the stimulus of IPVR for the RA was 18 mA in SURG and 3 mA in RF (P < 0.022). Eight SURG patients and seven RF patients (P < 0.38) remained in SR at hospital discharge. Eleven RF patients and one SURG required amiodarone to maintain SR (P < 0.001). The incidence of recurrent atrial fibrillation (AF) in the follow-up was 10.7/100 patients/year in the SURG group versus 73.1/100 patients/year in the RF group (P = 0.009). CONCLUSIONS: PVI by SURG formed more effective block lines than RF. SR at hospital discharge was similar among the groups, but more amiodarone was used in RF. During follow-up, incidence of recurrent AF was higher in the RF group.
Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Enfermedades de las Válvulas Cardíacas/cirugía , Válvula Mitral/cirugía , Venas Pulmonares/cirugía , Anciano , Amiodarona/uso terapéutico , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Enfermedad Crónica , Femenino , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Resultado del TratamientoRESUMEN
BACKGROUND: Chronic atrial fibrillation (AF) due to mitral valve disease has been successfully treated by surgery. We performed a study to evaluate the effectiveness of a surgical method of simple pulmonary vein isolation (PVI) without radiofrequency or cryoablation in the restoration of sinus rhythm in a group of patients. METHODS: Fifteen patients were operated on for mitral valve disease and chronic AF. The technique consists basically of a circumferential incision excluding the pulmonary vein ostia from the left atrium. RESULTS: Sinus rhythm was achieved in 92.3% of the patients at 6-month follow-up. Echocardiograms 2 months after surgery showed a mean decrease of 1.1 cm in left atrial size. Effective atrial ejection was reestablished in all patients in whom sinus rhythm was achieved (mean LA ejection fraction 41% +/- 14%). Twenty-four hour Holter recordings did not show episodes of paroxysmal atrial fibrillation in any patients. Four patients had isolated episodes of ventricular ectopic beats. Stress electrocardiograms showed mean maximal ventricular response was 64% +/- 11% and 73% +/- 9% of predicted value at 2 and 6 months, respectively. All patients had improved NYHA functional class after surgery; 74% of patients were in NYHA functional class I at 6 months compared with 13.3% preoperatively. CONCLUSIONS: Pulmonary vein isolation without the use of radiofrequency or cryoablation is effective in restoring sinus rhythm in patients with chronic AF secondary to mitral valve disease. Based on simple surgical incisions, this technique is more advantageous than others requiring additional instrumentation.
Asunto(s)
Fibrilación Atrial/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Venas Pulmonares/cirugía , Adulto , Anciano , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/etiología , Enfermedad Crónica , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/complicacionesRESUMEN
INTRODUÇÃO: Fibrilação atrial tem sido tratada pelo procedimento do Labirinto (Cox) e suas modificações. Há, no entanto, evidências de que o isolamento dos óstios das veias pulmonares ou exclusão do átrio esquerdo poderia ser eficaz para este fim. CASUÍSTICA E MÉTODOS: Avaliamos os resultados iniciais da técnica simplificada de isolamento cirúrgico dos óstios das veias pulmonares para tratar fibrilação atrial crônica em pacientes operados por lesão valvar mitral. Foram tratados 7 pacientes por esta técnica (grupo IVP) e comparados com série prévia de 57 casos submetidos a cirurgia do Labirinto (Cox 3). RESULTADOS: A idade média foi de 49 + ou - 8 anos vs 49 + ou -11 anos, (IVP vs. Cox3), sendo 71 por cento e 72 por cento (IVP vs. Cox 3) do sexo feminino. Dimensões do átrio esquerdo 5,5 + ou -0,7 cm vs. 6,0 + ou -1,1 cm (IVP vs. Cox 3). Fração de ejeção ventricular 63 + ou -10 por cento vs. 64 + ou -6 por cento (IVP vs. Cox 3). Tempo CEC 91 + ou -33 min vs. 104 + ou - 29 min (IVP vs. Cox 3). Tempo de isquemia 71 + ou - 23 min vs. 83 + ou - 26 min (IVP vs. Cox 3). Ritmo pós-operátório sinusal/atrial n(por cento): 6(86) vs. 46(80) (IVP vs. Cox 3). Ritmo marcapasso n(por cento):1 (14) vs. 4 (7) (IVP vs. Cox 3). Fibrilação atrial n( por cento): 0 vs. 7 (13) (IVP vs. Cox 3). CONCLUSÕES: Resultados iniciais mostram reversão a ritmo sinusal na maioria dos casos em ambos procedimentos e manutenção do ritmo a longo prazo. Foi iniciado estudo prospectivo randomizado para avaliar o IVP comparativamente ao procedimento Cox 3.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Procedimientos Quirúrgicos Cardíacos , Fibrilación Atrial/cirugía , Fibrilación Atrial/etiología , Válvula Mitral/patología , Válvula Mitral/cirugía , Enfermedad Crónica , Venas Pulmonares/cirugíaRESUMEN
Objetivo: relatar achados microbiológicos, histopatológicos, radiológicos e endoscópicos associados às observações clínicas de pacinetes portadores de sinusite fúngica. Materiais e métodos: foi realizada análise prospectiva de 829 casos compatíveis com sinusopatia crônica, através de tomografia computadorizada e endoscopia nasal, análises clínicas, laboratoriais, microbiológicas e histopatológicas, chegou-se ao diagnóstico de sinusite fúngica em 33 pacientes, os quais foram enquadrados em uma das seguintes classificações_ bola fúngica, sinusite fúngica alérgica, sinusite invasiva aguda (fulminante) ou sinusite indolente ou lentamente invasiva...