RESUMEN
OBJECTIVE: Patients with acute type A aortic dissection demonstrate a wide range of aortic insufficiency. Outcomes after valve resuspension and root repair are not well studied in the long term. We evaluated the long-term effects of preoperative aortic insufficiency in patients undergoing emergency root-preserving surgery for acute type A aortic dissection. METHODS: From 2002 to 2017, 558 of 776 patients with acute type A aortic dissection underwent native aortic valve resuspension and root reconstruction. Patients were stratified into 4 groups by preoperative aortic insufficiency grade (n = 539): aortic insufficiency less than 2+ (n = 348), aortic insufficiency = 2+ (n = 72), aortic insufficiency = 3+ (n = 49), and aortic insufficiency = 4+ (n = 70). Multivariable ordinal longitudinal mixed effects and multi-state transition models were used to assess risk factors for recurrent aortic insufficiency. RESULTS: The prevalence of cardiogenic shock in patients presenting with preoperative aortic insufficiency less than 2+, 2+, 3+, and 4+ was 53 of 348 (15.2%), 12 of 72 (16.7%), 10 of 49 (20.4%), and 24 of 70 (34.3%), respectively (P = .002). Postoperatively, 94.0% of patients had aortic insufficiency 1+ or less at discharge. Operative mortality was 34 of 348 (9.8%), 10 of 72 (13.9%), 6 of 49 (12.2%), and 12 of 70 (17.1%) (P = .303). In an ordinal mixed effects model, preoperative aortic insufficiency was associated with more severe postoperative aortic insufficiency. The multi-state transition model demonstrated that severe aortic insufficiency was associated with progression from no to mild aortic insufficiency (hazard ratio, 2.14; 95% confidence interval, 1.35-3.38), and progression from mild to moderate aortic insufficiency (hazard ratio, 5.70; 95% confidence interval, 1.88-17.30). CONCLUSIONS: Preoperative aortic insufficiency is an important predictor of recurrent aortic insufficiency in patients undergoing valve resuspension with root reconstruction for emergency acute type A aortic dissection repair. Increased echocardiographic surveillance for recurrent aortic insufficiency may be warranted in this cohort.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/epidemiología , Complicaciones Posoperatorias/epidemiología , Anciano , Aorta/cirugía , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/mortalidad , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/efectos adversos , Tratamientos Conservadores del Órgano/mortalidad , Reoperación/mortalidad , Estudios RetrospectivosRESUMEN
OBJECTIVES: To determine the presence of and periprocedural changes caused by aortic regurgitation (AR) in patients supported with an Impella (Abiomed, Danvers, MA) left ventricular assist device. DESIGN: Retrospective. SETTING: Tertiary academic medical center. PARTICIPANTS: Patients who underwent insertion of an Impella device at Allegheny General Hospital from January 2015 to December 2018. INTERVENTIONS: Analysis of patient electronic medical records. MEASUREMENTS AND MAIN RESULTS: Demographic information; comorbidities; duration of support; and the presence and severity of AR pre-procedure and post-procedure, as reported by echocardiography, were analyzed. The electronic medical records of 69 patients were included in the present study. Before placement of the Impella device, 25 (35%) patients showed detectable AR, with 18 (26%) showing mild AR and 7 (10%) showing moderate AR. After the removal of the Impella device, AR remained steady or increased in 61 patients. Fifteen patients (22%) demonstrated mild AR, 6 (8.7%) demonstrated moderate AR, and 2 (2.9%) demonstrated severe AR. An increase in severity of AR was noted in 9 patients (14.7%), and 52 patients (85%) had no change in the severity of AR. The duration of support with the Impella device, demographic variables, and comorbidities were not associated with a statistically significant risk for increased severity of post-procedural AR in multiple multivariable logistic regression analyses. CONCLUSIONS: The presented data suggest that after Impella device support, a significant proportion of patients may show evidence of increased AR. Additional studies are needed to understand the etiology and significance of this observation.
Asunto(s)
Insuficiencia de la Válvula Aórtica , Corazón Auxiliar , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/epidemiología , Insuficiencia de la Válvula Aórtica/cirugía , Corazón Auxiliar/efectos adversos , Humanos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Abstract Background: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results: A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.
Resumo Fundamento: O implante de válvula aórtica por cateter tornou-se uma opção para pacientes com doença valvar aórtica de elevado risco cirúrgico. Objetivo: Avaliar os resultados dos seguimentos intra-hospitalar e de até 1 ano do implante de válvula aórtica por cateter. Métodos: Estudo de coorte prospectiva de casos de implante de válvula aórtica por cateter entre julho de 2009 e fevereiro de 2015. Análise de variáveis clínicas e do procedimento, correlacionando com mortalidade intra-hospitalar e de 1 ano. Resultados: Foram submetidos ao implante 136 pacientes, com média de idade de 83 (80-87) anos, sendo 49% mulheres, 131 (96,3%) deles com estenose aórtica, um (0,7%) com insuficiência aórtica e quatro (2,9%) com disfunção de prótese. A classe funcional da NYHA foi III ou IV em 129 (94,8%) casos. A área valvar inicial foi 0,67 ± 0,17 cm2 e o gradiente ventrículo esquerdo-aorta médio de 47,3 ± 18,2 mmHg, com STS de 9,3% (4,8%-22,3%). As próteses implantadas eram autoexpansíveis em 97% dos casos. A mortalidade peroperatória em 1,5% dos casos; em 30 dias em 5,9%; intra-hospitalar em 8,1%; e após 1 ano em 15,5% dos casos. A hemotransfusão (risco relativo de 54; p = 0,0003) e a hipertensão arterial pulmonar (risco relativo de 5,3; p = 0,036) foram preditoras de mortalidade hospitalar; e a proteína C-reativa pico (risco relativo de 1,8; p = 0,013) e a hemotransfusão (risco relativo de 8,3; p = 0,0009) de mortalidade em 1 ano. Aos 30 dias, 97% dos pacientes estavam em classe NYHA I/II e, em 1 ano, o número chegou a 96%. Conclusão: O implante de válvula aórtica por cateter foi realizado com alto índice de sucesso e baixa mortalidade. A hemotransfusão associou-se com maior mortalidade hospitalar e de 1 ano. Proteína C-reativa pico se associou com a mortalidade de 1 ano.
Asunto(s)
Humanos , Masculino , Femenino , Anciano de 80 o más Años , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Mortalidad Hospitalaria , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Insuficiencia de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/epidemiología , Complicaciones Posoperatorias/mortalidad , Factores de Tiempo , Brasil/epidemiología , Métodos EpidemiológicosRESUMEN
BACKGROUND: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. OBJECTIVE: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. METHODS: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. RESULTS: A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. CONCLUSION: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.
Asunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Mortalidad Hospitalaria , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Anciano de 80 o más Años , Insuficiencia de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/epidemiología , Brasil/epidemiología , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/mortalidad , Factores de TiempoRESUMEN
BACKGROUND: Previous studies indicate that compared with physical examination, Doppler echocardiography identifies a larger number of cases of rheumatic heart disease in apparently healthy individuals. OBJECTIVES: To determine the prevalence of rheumatic heart disease among students in a public school of Belo Horizonte by clinical evaluation and Doppler echocardiography. METHODS: This was a cross-sectional study conducted with 267 randomly selected school students aged between 6 and 16 years. students underwent anamnesis and physical examination with the purpose of establishing criteria for the diagnosis of rheumatic fever. They were all subjected to Doppler echocardiography using a portable machine. Those who exhibited nonphysiological mitral regurgitation (MR) and/or aortic regurgitation (AR) were referred to the Doppler echocardiography laboratory of the Hospital das Clínicas of the Universidade Federal of Minas Gerais (HC-UFMG) to undergo a second Doppler echocardiography examination. According to the findings, the cases of rheumatic heart disease were classified as definitive, probable, or possible. RESULTS: Of the 267 students, 1 (0.37%) had a clinical history compatible with the diagnosis of acute rheumatic fever (ARF) and portable Doppler echocardiography indicated nonphysiological MR and/or AR in 25 (9.4%). Of these, 16 (6%) underwent Doppler echocardiography at HC-UFMG. The results showed definitive rheumatic heart disease in 1 student, probable rheumatic heart disease in 3 students, and possible rheumatic heart disease in 1 student. CONCLUSION: In the population under study, the prevalence of cases compatible with rheumatic involvement was 5 times higher on Doppler echocardiography (18.7/1000; 95% CI 6.9/1000-41.0/1000) than on clinical evaluation (3.7/1000-95% CI).
Asunto(s)
Cardiopatía Reumática/epidemiología , Adolescente , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/epidemiología , Brasil/epidemiología , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/epidemiología , Prevalencia , Sector Público , Cardiopatía Reumática/diagnóstico por imagen , Instituciones Académicas , Ultrasonografía DopplerRESUMEN
Background: Previous studies indicate that compared with physical examination, Doppler echocardiography identifies a larger number of cases of rheumatic heart disease in apparently healthy individuals. Objectives: To determine the prevalence of rheumatic heart disease among students in a public school of Belo Horizonte by clinical evaluation and Doppler echocardiography. Methods: This was a cross-sectional study conducted with 267 randomly selected school students aged between 6 and 16 years. students underwent anamnesis and physical examination with the purpose of establishing criteria for the diagnosis of rheumatic fever. They were all subjected to Doppler echocardiography using a portable machine. Those who exhibited nonphysiological mitral regurgitation (MR) and/or aortic regurgitation (AR) were referred to the Doppler echocardiography laboratory of the Hospital das Clínicas of the Universidade Federal of Minas Gerais (HC-UFMG) to undergo a second Doppler echocardiography examination. According to the findings, the cases of rheumatic heart disease were classified as definitive, probable, or possible. Results: Of the 267 students, 1 (0.37%) had a clinical history compatible with the diagnosis of acute rheumatic fever (ARF) and portable Doppler echocardiography indicated nonphysiological MR and/or AR in 25 (9.4%). Of these, 16 (6%) underwent Doppler echocardiography at HC-UFMG. The results showed definitive rheumatic heart disease in 1 student, probable rheumatic heart disease in 3 students, and possible rheumatic heart disease in 1 student. Conclusion: In the population under study, the prevalence of cases compatible with rheumatic involvement was 5 times higher on Doppler echocardiography (18.7/1000; 95% CI 6.9/1000-41.0/1000) than on clinical evaluation (3.7/1000-95% CI). .
Fundamento: Estudos indicam que o Doppler ecocardiograma possibilita a identificação de um maior número de casos de valvopatia reumática, quando comparado ao exame clínico, em indivíduos aparentemente saudáveis. Objetivos: Determinar a prevalência de valvopatia sugestiva de envolvimento reumático segundo as avaliações clínicas e Doppler ecardiográficas em alunos de escola pública de Belo Horizonte. Métodos: Estudo transversal realizado com 267 escolares entre 6 e 16 anos, selecionados de forma aleatória. Os alunos foram submetidos à anamnese e exame físico com o objetivo de estabelecer critérios prévios para o diagnóstico de febre reumática. Todos realizaram o estudo Doppler ecocardiográfico com o emprego de um aparelho portátil. Aqueles que apresentaram regurgitação valvar mitral (RM) e ou aórtica (RAo) sugestiva de não fisiológica foram encaminhados ao laboratório de Doppler ecocardiografia do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) para a realização de novo estudo. Conforme os achados, os casos de valvopatia reumática foram classificados em definitiva, provável e possível. Resultados: Dos 267 escolares, um (0,37%) apresentou história compatível com o diagnóstico de febre reumática aguda (FRA), 25 (9,4%) apresentaram RM e/ou RAo consideradas não fisiológicas ao Doppler ecocardiograma portátil. Destes, 16 (6%) realizaram Doppler ecocardiograma no HC-UFMG, sendo evidenciadas: valvopatia reumática definitiva em um escolar; valvopatia reumática provável em três; valvopatia reumática possível em um escolar. Conclusão: Na população estudada a prevalência de casos compatíveis com envolvimento reumático foi cinco vezes maior ...
Asunto(s)
Adolescente , Niño , Femenino , Humanos , Masculino , Cardiopatía Reumática/epidemiología , Insuficiencia de la Válvula Aórtica/epidemiología , Insuficiencia de la Válvula Aórtica , Brasil/epidemiología , Estudios Transversales , Insuficiencia de la Válvula Mitral/epidemiología , Insuficiencia de la Válvula Mitral , Prevalencia , Sector Público , Cardiopatía Reumática , Instituciones Académicas , Ultrasonografía DopplerRESUMEN
BACKGROUND: Although advanced age is considered a risk factor for several diseases, the impact of gender on age-associated cardiovascular diseases, such as atherosclerotic processes and valvular diseases, remains not completely clarified. The present study was designed to assess aortic valve morphology and function and vascular damage in elderly using the apolipoprotein E knockout (ApoE KO) mouse. Our hypothesis was that advanced age-related cardiovascular changes are aggravated in atherosclerotic male mice. METHODS: The grade (0 to 4) of aortic regurgitation was evaluated through angiography. In addition, vascular lipid deposition and senescence were evaluated through histochemical analyses in aged male and female ApoE KO mice, and the results were compared to wild-type C57BL/6J (C57) mice. RESULTS: Aortic regurgitation was observed in 92% of the male ApoE KO mice and 100% of the male C57 mice. Comparatively, in age-matched female ApoE KO and C57 mice, aortic regurgitation was observed in a proportion of 58% and 53%, respectively. Histological analysis of the aorta showed an outward (positive) remodeling in ApoE KO mice (female: 1.86 ± 0.15; male: 1.89 ± 0.68) using C57 groups as reference values. Histochemical evaluation of the aorta showed lipid deposition and vascular senescence only in the ApoE KO group, which were more pronounced in male mice. CONCLUSION: The data show that male gender contributes to the progression of aortic regurgitation and that hypercholesterolemia and male gender additively contribute to the occurrence of lipid deposition and vascular senescence in elderly mice.
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Envejecimiento/patología , Enfermedades de la Aorta/patología , Insuficiencia de la Válvula Aórtica/patología , Válvula Aórtica/patología , Aterosclerosis/patología , Aterosclerosis/fisiopatología , Caracteres Sexuales , Envejecimiento/sangre , Envejecimiento/metabolismo , Angiografía , Animales , Aorta/metabolismo , Aorta/patología , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/epidemiología , Enfermedades de la Aorta/metabolismo , Insuficiencia de la Válvula Aórtica/sangre , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/epidemiología , Apolipoproteínas E/genética , Aterosclerosis/sangre , Progresión de la Enfermedad , Femenino , Hipercolesterolemia/sangre , Hipercolesterolemia/genética , Hipercolesterolemia/metabolismo , Hipercolesterolemia/patología , Metabolismo de los Lípidos/genética , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Distribución Aleatoria , Índice de Severidad de la EnfermedadAsunto(s)
Humanos , Insuficiencia de la Válvula Aórtica/epidemiología , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/fisiopatología , Aortografía , Diagnóstico Diferencial , Diagnóstico por Imagen , Insuficiencia de la Válvula Aórtica/clasificación , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/terapiaRESUMEN
OBJECTIVE: To compare the efficacy of injections of 1.2 million units of benzathine penicillin G given every 3 weeks versus every 4 weeks for secondary prevention of rheumatic fever, based on the long-term outcome of patients receiving such prophylaxis. METHODS: A total of 249 consecutive patients with rheumatic fever, randomly assigned to either a 3-week or a 4-week regimen, were examined every 3 to 6 months, and followed for 794 and 775 patient-years, respectively. RESULTS: Compliance with each regimen was comparable: 83 (66.9%) of 124 patients in the 3-week group versus 92 (73.6%) of 125 patients in the 4-week group stayed in the program (p > 0.05). Streptococcal infections occurred less frequently in those receiving the 3-week regimen: 7.5 versus 12.6 per 100 patient-years (p < 0.01). Prophylaxis failed in 2 patients receiving the 3-week regimen and in 10 receiving the 4-week regimen (0.25 and 1.29 per 100 patient-years respectively; p = 0.015). Serum penicillin levels were adequate (> or = 0.02 micrograms/ml) in 100 (56%) of 179 samples obtained 21 days after penicillin injection in the 3-week regimen, and in 51 (33%) of 155 samples obtained 28 days after injection in the 4-week regimen (p < 0.01). Of 71 patients with mitral regurgitation in the 3-week regimen, 47 (66%) no longer had the murmur; of 87 patients in the 4-week regimen, 40 (46%) no longer had the murmur (p < 0.05). CONCLUSIONS: This 12-year controlled study indicates that the outcome of patients with rheumatic fever is better with a 3-week than with a 4-week penicillin prophylaxis regimen. Greater emphasis and more widespread use of the 3-week regimen should be recommended.
Asunto(s)
Penicilina G Benzatina/uso terapéutico , Fiebre Reumática/prevención & control , Cardiopatía Reumática/prevención & control , Adolescente , Adulto , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/epidemiología , Insuficiencia de la Válvula Aórtica/prevención & control , Niño , Preescolar , Esquema de Medicación , Femenino , Estudios de Seguimiento , Soplos Cardíacos/epidemiología , Soplos Cardíacos/etiología , Soplos Cardíacos/prevención & control , Humanos , Masculino , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/epidemiología , Insuficiencia de la Válvula Mitral/prevención & control , Cooperación del Paciente , Penicilina G Benzatina/sangre , Estudios Prospectivos , Recurrencia , Inducción de Remisión , Fiebre Reumática/complicaciones , Fiebre Reumática/epidemiología , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/epidemiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
We report our 8-year experience with the resurgence of acute rheumatic fever during the years 1985 through 1992. The records of 274 confirmed cases referred to Primary Children's Medical Center were reviewed. The clinical features including the presence of the Jones criteria, demographic data, preceding streptococcal infection, and the use of echocardiographic studies were tabulated and assessed. Patients came predominantly (84%) from middle-class families with access to medical care. Only 46 patients (17%) sought medical attention for a preceding sore throat. Carditis evident by auscultation was the dominant major manifestation in 68% of the cases. Echocardiography demonstrated mitral regurgitation that was not audible in 15 (47%) of 32 patients who had only polyarthritis at onset and in 30 (57%) of the 53 who had pure chorea. The incidence of acute rheumatic fever has been declining since the peak of the outbreak in 1985 but is continuing in the intermountain area at rates comparable to those of the 1960s.
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Brotes de Enfermedades , Insuficiencia de la Válvula Mitral/epidemiología , Fiebre Reumática/epidemiología , Cardiopatía Reumática/epidemiología , Enfermedad Aguda , Adolescente , Insuficiencia de la Válvula Aórtica/epidemiología , Artritis/epidemiología , Artritis/etiología , Niño , Preescolar , Ecocardiografía Doppler , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Cardiopatía Reumática/diagnóstico , Estados Unidos/epidemiologíaRESUMEN
Long-term morbidity and mortality were evaluated in the 21 survivors of a cohort of 51 consecutive infants with severe aortic valve stenosis who underwent surgical treatment in the first 3 months of life during the period from 1958 to 1988. The 21 early survivors have been followed up from 3 to 27 years (median 7.5 years). There have been two late deaths: one at age 13 year from bacterial endocarditis and the other at age 14 years after dislodgment of a prosthetic valve. The calculated 10-year actuarial survival for this group is 100%, with a 15-year actuarial survival of 75% (standard error 15%). Seven repeat operations have been performed in six patients: Three had persistent stenosis and a repeat valvotomy was performed in two of them, aged 2 years and 15 years. The other underwent placement of a conduit from the left ventricle to the descending aorta at 2 years of age. Replacement of the aortic valve has been performed in four patients because of severe valvular insufficiency 13 to 27 years after the initial operation. One of these had required a repeat valvotomy at the age of 15 years. The calculated actuarial freedom from reoperation at 10 years is 90% (standard error 6%) and at 15 years, 67% (standard error 15%). Aortic insufficiency was progressive throughout the period of follow-up. No patient had more than moderate aortic insufficiency 3 to 5 years after the initial valvotomy, whereas aortic insufficiency was severe in five of the eight patients followed up for 11 or more years. Progression of aortic insufficiency and the need for reoperation were not related to the age at initial valvotomy. Survivors of surgical aortic valvotomy in early infancy have a relatively good long-term prognosis and a high freedom from reoperation in the period leading to adolescence. Aortic insufficiency in these patients is progressive, and valve replacement eventually may be required.
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Estenosis de la Válvula Aórtica/cirugía , Análisis Actuarial , Insuficiencia de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Complicaciones Posoperatorias/epidemiología , Pronóstico , Reoperación/estadística & datos numéricos , Análisis de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
This study analyzes the prevalence of coronary artery disease (CAD) among patients with rheumatic valvular heart disease (VHD) in Chile. Coronary angiography was performed in all patients referred to cardiac catheterization with VHD who were over age 50 years and who had angina or ECG signs of ischemia. A total of 100 patients entered the study. Significant CAD (greater than 50% obstruction) was found in 14% of the cases: 7% in patients with mitral valve disease (MVD), 18% in aortic valve disease (AVD), and 21% in combined mitral and aortic valve disease (MAVD). Angina was present in 14% of the patients with MVD, 63% with AVD, and 53% with MAVD. Only 57% of patients with CAD had angina pectoris; 20% with angina had CAD. Hemodynamic parameters and left ventricular ejection fraction were not correlated with the presence or absence of CAD. We conclude that in patients with valvular heart disease, the incidence of CAD is lower in Chile than previously reported in the English literature. We confirmed the fact that angina is often not associated with CAD, and that CAD is often present in the absence of angina.