Asunto(s)
Insuficiencia de la Válvula Aórtica , Anuloplastia de la Válvula Cardíaca , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Humanos , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/cirugía , Válvula Mitral/cirugía , Resultado del TratamientoRESUMEN
Abstract Background: Right valve diseases are not benign, the tricuspid regurgitation has a significant impact on morbidity and mortality of patients. Objectives: This study aimed to report the short-term results of tricuspid annuloplasty using the De Vega technique modified by Manuel Antunes. Methods: A descriptive-analytical study was performed to evaluate the results of the tricuspid valvuloplasty performed at the Instituto de Medicina Integral Professor Fernando Figueira between 2012 and 2017. Data were collected by reviewing charts and databases of the Department of Cardiology and Cardiovascular Surgery of the institution. Those with rheumatic diseases or infective endocarditis with tricuspid valve involvement, or reoperation of the tricuspid valve were excluded. Student's t-test and McNemar's were used for statistical analysis. A p-value < 0.05 was considered statistically significant. Results: A total of 87 patients were studied, most of them were women (56.3%). The most associated heart valve diseases were mitral regurgitation (27.6%) and aortic regurgitation (20.7%). There was a significant decrease in the degree of tricuspid regurgitation in the postoperative period, with 83.3% of patients with none or mild regurgitation and only 1.1% with severe regurgitation (p = 0.0077). Conclusions: In the current study, tricuspid valve annuloplasty using the modified De Vega technique was shown to be effective in the short term. Further studies are needed to evaluate the long-term results.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Insuficiencia de la Válvula Tricúspide/cirugía , Anuloplastia de la Válvula Cardíaca/métodos , Periodo Posoperatorio , Insuficiencia de la Válvula Tricúspide/fisiopatología , Epidemiología DescriptivaRESUMEN
Isolated aortic valve repair is an alternative to aortic valve replacement in patients with severe aortic regurgitation. It reduces the risk of prosthesis-related complications, such as thromboembolism and endocarditis, and there is no need for long-term oral anticoagulation. However, repair techniques are technically demanding, especially in bicuspid aortic valves.
Asunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Anuloplastia de la Válvula Cardíaca/métodos , Enfermedades de las Válvulas Cardíacas/cirugía , Adulto , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/etiología , Enfermedad de la Válvula Aórtica Bicúspide , Enfermedades de las Válvulas Cardíacas/complicaciones , Humanos , MasculinoRESUMEN
In cases of aortic valve disease, prosthetic valves have been increasingly used for valve replacement, however, there are inherent problems with prostheses, and their quality in the so-called Third World countries is lower in comparison to new-generation models, which leads to shorter durability. Recently, transcatheter aortic valve replacement has been explored as a less invasive option for patients with high-risk surgical profile. In this scenario, aortic valve neocuspidization (AVNeo) has emerged as another option, which can be applied to a wide spectrum of aortic valve diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. Spurred on by the last publications, we went on to write an overview of the current practice of state-of-the-art AVNeo and its results.
Asunto(s)
Válvula Aórtica/cirugía , Anuloplastia de la Válvula Cardíaca/métodos , Glutaral/uso terapéutico , Enfermedades de las Válvulas Cardíacas/cirugía , Pericardio/trasplante , Trasplante Autólogo/métodos , Humanos , Reoperación , Resultado del TratamientoRESUMEN
Abstract In cases of aortic valve disease, prosthetic valves have been increasingly used for valve replacement, however, there are inherent problems with prostheses, and their quality in the so-called Third World countries is lower in comparison to new-generation models, which leads to shorter durability. Recently, transcatheter aortic valve replacement has been explored as a less invasive option for patients with high-risk surgical profile. In this scenario, aortic valve neocuspidization (AVNeo) has emerged as another option, which can be applied to a wide spectrum of aortic valve diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. Spurred on by the last publications, we went on to write an overview of the current practice of state-of-the-art AVNeo and its results.
Asunto(s)
Humanos , Válvula Aórtica/cirugía , Pericardio/trasplante , Trasplante Autólogo/métodos , Glutaral/uso terapéutico , Anuloplastia de la Válvula Cardíaca/métodos , Enfermedades de las Válvulas Cardíacas/cirugía , Reoperación , Resultado del TratamientoRESUMEN
Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.
O traumatismo cardíaco é comum em acidentes com veículos automotores. Uma mulher com 50 anos de idade foi transportada para nosso hospital após sofrer múltiplos traumatismos em um acidente de automóvel quando dirigia em alta velocidade. Após admissão à unidade de terapia intensiva, uma ultrassonografia cardíaca revelou ruptura traumática de músculo papilar da valva tricúspide e forame oval patente, enquanto se observou, no exame físico, o sinal de Lancisi. Foi realizado tratamento cirúrgico com anuloplastia da valva e fechamento do forame oval patente; durante o ato cirúrgico, diagnosticou-se ruptura oculta do átrio direito.
Asunto(s)
Foramen Oval Permeable/etiología , Atrios Cardíacos/cirugía , Músculos Papilares/lesiones , Válvula Tricúspide/lesiones , Accidentes de Tránsito , Anuloplastia de la Válvula Cardíaca/métodos , Femenino , Foramen Oval Permeable/diagnóstico , Foramen Oval Permeable/cirugía , Atrios Cardíacos/lesiones , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/etiología , Lesiones Cardíacas/cirugía , Humanos , Persona de Mediana Edad , Músculos Papilares/cirugía , Válvula Tricúspide/cirugíaRESUMEN
RESUMO O traumatismo cardíaco é comum em acidentes com veículos automotores. Uma mulher com 50 anos de idade foi transportada para nosso hospital após sofrer múltiplos traumatismos em um acidente de automóvel quando dirigia em alta velocidade. Após admissão à unidade de terapia intensiva, uma ultrassonografia cardíaca revelou ruptura traumática de músculo papilar da valva tricúspide e forame oval patente, enquanto se observou, no exame físico, o sinal de Lancisi. Foi realizado tratamento cirúrgico com anuloplastia da valva e fechamento do forame oval patente; durante o ato cirúrgico, diagnosticou-se ruptura oculta do átrio direito.
ABSTRACT Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.
Asunto(s)
Humanos , Femenino , Músculos Papilares/lesiones , Válvula Tricúspide/lesiones , Foramen Oval Permeable/etiología , Atrios Cardíacos/cirugía , Músculos Papilares/cirugía , Válvula Tricúspide/cirugía , Accidentes de Tránsito , Foramen Oval Permeable/cirugía , Foramen Oval Permeable/diagnóstico , Anuloplastia de la Válvula Cardíaca/métodos , Atrios Cardíacos/lesiones , Lesiones Cardíacas/cirugía , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/etiología , Persona de Mediana EdadRESUMEN
OBJECTIVE: Ebstein's anomaly remains a relatively ignored disease. Lying in the 'No Man's land' between congenital and valve surgeons, it largely remains inadequately studied. We report our short-term results of treating it as a 'one and a half ventricle heart' and propose that the true tricuspid annulus (TTA) 'Z' score be used as an objective criterion for estimation of 'functional' right ventricle (RV). METHODS: 22 consecutive patients undergoing surgery for Ebstein's anomaly were studied. Echocardiography was performed to assess the type and severity of the disease, tricuspid annular dimension and its 'Z' score. Patients were operated by a modification of the cone repair, with addition of annuloplasty, bidirectional cavopulmonary shunt (BCPS) and right reduction atrioplasty to provide a comprehensive repair. TTA 'Z' score was correlated later with postplication indexed residual RV volume. RESULTS: There was one (4.5%) early and no late postoperative death. There was a significant reduction in tricuspid regurgitation grading (3.40±0.65 to 1.22±0.42, P<0.001). Residual RV volume reduced to 71.96±3.8% of the expected volume and there was a significant negative correlation (rho -0.83) between TTA 'Z' score and indexed residual RV volume. During the follow-up of 20.54±7.62 months, the functional class improved from 2.59±0.7 to 1.34±0.52 (P<0.001). CONCLUSION: In Ebstein's anomaly, a higher TTA 'Z' score correlates with a lower postplication indexed residual RV volume. Hence, a complete trileaflet repair with offloading of RV by BCPS (when the TTA 'Z' score is >2) is recommended. The short-term outcomes of our technique are promising.
Asunto(s)
Anuloplastia de la Válvula Cardíaca/métodos , Anomalía de Ebstein/cirugía , Procedimiento de Fontan/métodos , Ventrículos Cardíacos/cirugía , Válvula Tricúspide/cirugía , Adolescente , Adulto , Anuloplastia de la Válvula Cardíaca/mortalidad , Niño , Preescolar , Anomalía de Ebstein/diagnóstico por imagen , Anomalía de Ebstein/mortalidad , Ecocardiografía , Femenino , Estudios de Seguimiento , Procedimiento de Fontan/mortalidad , Ventrículos Cardíacos/fisiopatología , Humanos , Lactante , Masculino , Ilustración Médica , Complicaciones Posoperatorias , Recuperación de la Función , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Adulto JovenRESUMEN
A fístula aorto-atrial direita é uma comunicação anômala, que representa uma grave e infrequente complicação da endocardite infecciosa. Neste estudo, relata-se o caso de um paciente de 53 anos, do sexo masculino, com histórico evolutivo patológico de endocardite infecciosa e acometimento de valva aórtica. Sob imagem de ecocardiograma, demonstrou-se abscesso perivalvar aórtico, estendendo-se à parede atrial direita, com necessidade de abordagem cirúrgica. Foram realizados a anuloplastia valvar aórtica e implante de valva mecânica. Após 1 mês de evolução pós-cirúrgica, realizou-se novo ecocardiograma, que acusou shunt de débito da raiz da aorta para o átrio direito. A conduta diante do caso foi discutida entre equipe clínica e cirúrgica, visando a possíveis falhas na terapêutica inicial. (AU)
Right aorto-atrial fistula is an anomalous communication that represents a serious and infrequent complication of infective endocarditis. This study reports the case of a 53-year-old male patient, with a pathological evolutionary history of infective endocarditis and aortic valve involvement. The echocardiogram shows an aortic perivalvar abscess extending to the right atrial wall, requiring a surgical approach. Aortic valve annuloplasty and mechanical valve implantation were performed. After a month of post-surgical evolution, a new echocardiogram was performed, which showed aortic root to right atrium shunt. The behavior in this case was discussed between the clinical and surgical teams, aiming at possible failures in the initial therapy. (AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Fístula Vascular/etiología , Endocarditis Bacteriana/complicaciones , Ecocardiografía , Fístula Vascular/diagnóstico por imagen , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Anuloplastia de la Válvula Cardíaca/efectos adversos , Antibacterianos/uso terapéuticoRESUMEN
Abstract Objective: Ebstein's anomaly remains a relatively ignored disease. Lying in the 'No Man's land' between congenital and valve surgeons, it largely remains inadequately studied. We report our short-term results of treating it as a 'one and a half ventricle heart' and propose that the true tricuspid annulus (TTA) 'Z' score be used as an objective criterion for estimation of 'functional' right ventricle (RV). Methods: 22 consecutive patients undergoing surgery for Ebstein's anomaly were studied. Echocardiography was performed to assess the type and severity of the disease, tricuspid annular dimension and its 'Z' score. Patients were operated by a modification of the cone repair, with addition of annuloplasty, bidirectional cavopulmonary shunt (BCPS) and right reduction atrioplasty to provide a comprehensive repair. TTA 'Z' score was correlated later with postplication indexed residual RV volume. Results: There was one (4.5%) early and no late postoperative death. There was a significant reduction in tricuspid regurgitation grading (3.40±0.65 to 1.22±0.42, P<0.001). Residual RV volume reduced to 71.96±3.8% of the expected volume and there was a significant negative correlation (rho −0.83) between TTA 'Z' score and indexed residual RV volume. During the follow-up of 20.54±7.62 months, the functional class improved from 2.59±0.7 to 1.34±0.52 (P<0.001). Conclusion: In Ebstein's anomaly, a higher TTA 'Z' score correlates with a lower postplication indexed residual RV volume. Hence, a complete trileaflet repair with offloading of RV by BCPS (when the TTA 'Z' score is >2) is recommended. The short-term outcomes of our technique are promising.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Adulto Joven , Válvula Tricúspide/cirugía , Procedimiento de Fontan/métodos , Anomalía de Ebstein/cirugía , Anuloplastia de la Válvula Cardíaca/métodos , Ventrículos Cardíacos/cirugía , Complicaciones Posoperatorias , Válvula Tricúspide/diagnóstico por imagen , Ecocardiografía , Estudios de Seguimiento , Procedimiento de Fontan/mortalidad , Recuperación de la Función , Anomalía de Ebstein/mortalidad , Anomalía de Ebstein/diagnóstico por imagen , Anuloplastia de la Válvula Cardíaca/mortalidad , Ventrículos Cardíacos/fisiopatología , Ilustración MédicaRESUMEN
Resumen Antecedentes la reparación de la insuficiencia tricuspídea funcional está indicada en casos de insuficiencia cardíaca, generalmente, asociada a enfermedades de las válvulas cardíacas izquierdas y en algunos casos de enfermedad coronaria o cardiopatías congénitas. Objetivo : evaluar los resultados a largo plazo de la reparación tricuspídea en pacientes operados en la región centro sur de Chile. Pacientes y métodos : estudio retrospectivo de registros clínicos y operatorios en 114 pacientes con edad promedio 57.8 (DE 13) años (72 mujeres) sometidos a reparación tricuspídea asociada a otros procedimientos quirúrgicos entre 2009 y 2017. Resultados : la etiología de la insuficiencia tricuspídea fue debida a enfermedad reumática inactiva en 45% y a endocarditis infecciosa en 2.6%. 63% estaban en fibrilación auricular y 75% en capacidad funcional NYHC III. 15.8% tenían cirugía valvular cardíaca previa. El ecocardiograma mostró insuficiencia severa en 56% de los casos y había hipertensión pulmonar severa en 39.5%. La cirugía consistió en la implantación de un anillo semi-rígido en forma concomitante a reemplazo o reparación de lesión valvular mitral, reemplazo valvular aórtico, cierre de comunicación interauricular, cirugía coronaria o resección de tumor intra cardíaco. La mortalidad post operatoria global fue 16%, debido a falla multisistémica en 6%, insuficiencia cardíaca en 5% y hemorragia cerebral en 4.3%. El seguimiento promedio fue 78.8 (DS 7.2) meses. La supervivencia actuarial fue 74% a los 60 y 68% a los 96 meses. Conclusión : La cirugía de reparación de la insuficiencia tricuspídea moderada o severa, asociada a otras enfermedades cardíacas provee una buena recuperación sintomática, con excelente sobrevida alejada.
Abstract Background : Surgery for functional tricuspid valve insufficiency is indicated in cases of congestive heart failure usually associated to left heart valve diseases or as a concomitant surgery for other causes such as congenital or coronary disease. Aim : To assess and report the long-term results of tricuspid valve repair in adult patients in a regional cardiac surgery center in south Chile. Patients and Methods : Retrospective review of clinical and operative records of 114 patients aged 57.8 +/- 13 years (72 women) subjected to tricuspid reparative surgery concomitant with other cardiac procedures between 2009 to 2017. Results : In 45% of cases etiology was due to inactive rheumatic disease and 2.6% was due to endocarditis. 63% presented with atrial fibrillation and 75% were in NYHC CFIII. 15.8% had a previous cardiac valve surgery. Preoperative echocardiography showed severe tricuspid insufficiency in 56% of cases and pulmonary hypertension was severe in 39.5%. In all cases tricuspid repair was performed through the insertion of a semi rigid ring as a concomitant procedure for mitral repair/replacement in most cases, aortic valve replacement, surgical closure of an ASD, CABG surgery and the resection of cardiac tumors. Overall postoperative mortality was 16% due to multi-organic dysfunction in 6%, cardiac failure in 5% and cerebral hemorrhage in 4.3%. Mean long term follow up was 78.8+/- 7.2 months. Actuarial survival was 74% at 60 and 68% at 96 months. Conclusion: Surgical tricuspid valve repair for moderate to severe tricuspid insufficiency isolated or associated to other cardiac diseases provides a good symptomatic recovery, with an excellent long term survival.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Insuficiencia de la Válvula Tricúspide/cirugía , Anuloplastia de la Válvula Cardíaca/métodos , Factores de Tiempo , Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/mortalidad , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Ecocardiografía , Análisis de Supervivencia , Estudios Retrospectivos , Estudios de Seguimiento , Causas de Muerte , Resultado del Tratamiento , Anuloplastia de la Válvula Cardíaca/mortalidadAsunto(s)
Fibroma/cirugía , Neoplasias Cardíacas/cirugía , Estenosis de la Válvula Mitral/cirugía , Músculos Papilares , Procedimientos Quirúrgicos Cardíacos/métodos , Anuloplastia de la Válvula Cardíaca/métodos , Ecocardiografía , Ecocardiografía Transesofágica , Femenino , Fibroma/diagnóstico por imagen , Fibroma/patología , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/patología , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Persona de Mediana Edad , Estenosis de la Válvula Mitral/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Válvula Tricúspide/cirugíaRESUMEN
This case illustrates an unusual and fatal complication after endovascular treatment of type B aortic dissection and highlights the role of echocardiography in the early diagnosis of complications. In this case, a patient with previous diagnosis of chronic type B aortic dissection and moderate aortic regurgitation underwent endovascular repair of the proximal descending aorta and conservative surgical correction of the aortic valve. On early postoperative, a transesophageal echocardiogram and aortic angiotomography demonstrated proximal endoleak by contrast extravasation around the proximal graft attachment site, causing compression of the stent in its middle portion, resulting in narrowing with reduced cross-sectional area.
Asunto(s)
Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/etiología , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/etiología , Anuloplastia de la Válvula Cardíaca/efectos adversos , Ecocardiografía/métodos , Procedimientos Endovasculares/efectos adversos , Terapia Combinada/métodos , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana EdadAsunto(s)
Válvula Aórtica/cirugía , Anuloplastia de la Válvula Cardíaca/efectos adversos , Puente Cardiopulmonar/efectos adversos , Inhibidores Enzimáticos/uso terapéutico , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Azul de Metileno/uso terapéutico , Válvula Mitral/cirugía , Óxido Nítrico Sintasa/antagonistas & inhibidores , Vasoplejía/tratamiento farmacológico , Humanos , MasculinoRESUMEN
OBJECTIVES: Dabigatran is a direct thrombin inhibitor shown to be an effective alternative to warfarin in patients with non-valvular atrial fibrillation (AF). We evaluated the use of dabigatran in patients with bioprosthetic mitral and/or aortic valve replacement and AF. METHODS: We selected 34 and randomized 27 patients in a 1:1 ratio to receive dabigatran or warfarin. The primary endpoint was the presence of a new intracardiac thrombus at 90 days, by transesophageal echocardiogram (TEE). Secondary endpoints included the development of dense spontaneous echo contrast (SEC) and incidence of stroke (ischemic or hemorrhagic), myocardium infarction, valve thrombosis and peripheral embolic events. RESULTS: The trial was terminated prematurely because of low enrollment. There were 27 patients in total: 15 patients placed in the dabigatran group and 12 in the warfarin group. After 90 days, one patient (8.3 %) in the warfarin group and none in the dabigatran group had developed a new intracardiac thrombus. In the dabigatran group, two patients (13.3 %) developed dense SEC versus one patient (8.3 %) in the warfarin group. In the warfarin group, one patient (8.3 %) presented ischemic stroke, and none did in the dabigatran group. We observed no cases of hemorrhagic stroke, valve thrombosis, embolic events or myocardial infarction in either group throughout the study. However, one patient (6.7 %) in the dabigatran group had a fully recovered transient ischemic attack and one patient in the warfarin group died of heart failure. CONCLUSIONS: The use of dabigatran appears to be similar to warfarin in preventing the formation of intracardiac thrombus. TRIAL REGISTRATION: Clinicaltrials.gov NCT01868243.
Asunto(s)
Antitrombinas/uso terapéutico , Dabigatrán/uso terapéutico , Cardiopatías/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Warfarina/uso terapéutico , Adolescente , Adulto , Antitrombinas/administración & dosificación , Antitrombinas/efectos adversos , Fibrilación Atrial/tratamiento farmacológico , Bioprótesis , Anuloplastia de la Válvula Cardíaca , Dabigatrán/administración & dosificación , Dabigatrán/efectos adversos , Femenino , Cardiopatías/fisiopatología , Cardiopatías/terapia , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Trombosis/fisiopatología , Trombosis/terapia , Resultado del Tratamiento , Warfarina/administración & dosificación , Warfarina/efectos adversos , Adulto JovenRESUMEN
PURPOSE OF REVIEW: Fetal aortic valvuloplasty is intended to alter the natural history of aortic stenosis evolving to hypoplastic left heart syndrome. The most recently reported data and advances on this procedure were reviewed. RECENT FINDINGS: The highlights of the latest experience are the advances in further understanding of the prenatal and postnatal natural history of this disease, and the way in which fetal aortic valvuloplasty impacts on it, the identification of new predictors of biventricular outcome, and the report of postnatal survival of intervened patients. Recently reported short-term and middle-term results are encouraging. Experimental research on procedural aspects is ongoing, with no definite results. Multicenter studies are also ongoing. SUMMARY: In recent years, there have been advances in the understanding of the prenatal and postnatal process of aortic stenosis evolving to hypoplastic left heart syndrome and the effects of fetal aortic valvuloplasty, as well as the need of adequate postnatal therapeutic strategies for these patients. Procedural aspects are being studied with animal models, but still need far more experience before human application. Long-term results are still to be discovered, and multicenter studies may provide a new perspective. Continuing research is mandatory so that ultimately fetal heart intervention finds its place among the therapeutic resources for congenital heart disease.