RESUMO
BACKGROUND: From August 1993 to May 1994, 20 patients (mean age, 43 years) with atrial fibrillation underwent the maze operation without cryoablation. Ten patients had mitral stenosis, 5 had mitral insufficiency, and 5 had a mixed mitral lesion. The mean left atrial diameter as measured on echocardiograms was 6.1 cm. The cause was rheumatic in 17 patients (85%) and degenerative in 3 (15%). Seven patients had had previous episodes of thromboembolism. METHODS: Mitral valvuloplasty was performed on 7 patients, mitral commissurotomy on 4, and mitral valve replacement on 9. Thrombi were found in the left atrium of 7 patients and also in the right atrium in 2. The mean cross-clamp time was 73 minutes (range, 52 to 108 minutes). RESULTS: Patients were discharged from the hospital in good condition. Hemodynamic studies and Doppler echocardiograms showed significant reduction in the left atrial diameter (mean diameter, 4.9 cm; p < 0.01) in 18 patients. The two-channel Holter monitor showed sinus rhythm in 15 patients, atrial ectopic rhythm in 4, and atrial fibrillation in 1. Eleven patients (55%) experienced atrial fibrillation (9 in the first 3 months postoperatively), which was reversed with quinidine. Ninety percent of patients had development of an effective, synchronous, atrial systole. Six to 15 months postoperatively (average follow-up, 10 months), all patients were in functional class I, and 18 were not on a regimen of antiarrhythmic medication. CONCLUSIONS: This simplification of the maze operation has been demonstrated to be an effective alternative for the treatment of chronic atrial fibrillation.
Assuntos
Fibrilação Atrial/cirurgia , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Adolescente , Adulto , Idoso , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/métodos , Doença Crônica , Criocirurgia , Ecocardiografia Doppler , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/fisiopatologiaRESUMO
From October 1987 to March 1993, 105 patients were studied who have undergone valvuloplasty with an open ring. They ranged from 5 to 79 years (mean 30); 33 (31.4%) were under 16. All patients had mitral insufficiency, alone in 62 (59.0%) and associated with mitral stenosis (double mitral lesion) in 43 (41.0%). In the majority of the cases, the aetiology was rheumatic (78.1%); active in 10 (9.5%) patients. Three patients (2.9%) were in class II, 42 (40.0%) in class III, 57 (54.3%) in class IV and 3 (2.9%) in class V. Ten patients (9.5%) had isolated ring implantation while the remaining underwent associated procedures on the leaflets, chordae and papillary muscles. There were two (1.9%) hospital deaths, and six patients (5.7%) had to be reoperated. On the 30th (mean) postoperative day, 75 (71.4%) patients were reevaluated by catheterization, echo Doppler or both to confirm the effectiveness of the techniques employed. The mitral valve was functioning normally or with mitral regurgitation + in 63 (84.0%) patients, mitral regurgitation + + in 2 (2.7%), mitral regurgitation + + + in 5 (6.7%), mitral stenosis + in 4 (5.3%), and mitral stenosis + + in 1 (1.3%) patient. The results were therefore considered excellent in 63 (84.0%) patients with either normal mitral valve or mitral regurgitation +, good in 6 (8.0%) patients with mitral regurgitation + + and/or mitral stenosis +, and poor in 6 (8.0%) patients with mitral regurgitation + + + and/or mitral stenosis + +. Two deaths (1.9%) occurred within the first 7 months of follow-up. Patients were evaluated clinically 1-67 months postoperatively (mean 27):90 (85.7%) were in class I, 4 (3.8%) in class II, 4 (3.8%) in class III and 1 (1.0%) in class IV.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Cardiopatia Reumática/cirurgia , Análise Atuarial , Adulto , Cordas Tendinosas/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/mortalidade , Estenose da Valva Mitral/mortalidade , Desenho de Prótese , Cardiopatia Reumática/mortalidade , Fatores de TempoRESUMO
No período de fevereiro de 1979 a março de 1986 foram submetidos a cerclagem do TP 40 pacientes portadores de cardiopatias congênitas com hiperfluxo pulmonar, insuficiência cardíaca e hipodesenvolvimento ponderal. Vinte e três pacientes eram do sexo masculino e 17 do feminino com idade média de 6 meses (20 dias a 17 meses). Foram as seguintes as malformaçöes: CIV (22 casos), AVC total (6), DSVD (2), TA (2), TGVB (3), AT (2), VU (1) e cardiopatia complexa (2 casos). A cerclagem foi relizada com controle de pressäo do TP de tal forma a reduzí-la de 50% nos acianóticos e de 40% nos cianóticos. Dois pacientes (5%) faleceram no pós-operatório imediato, sendo um em bloqueo A-V total (AVC, 1, 7 kg, 20 dias de idade) e outro em septicemia, 20 dias após a cirurgia (CIV). Um óbito tardio ocorreu por broncopneumonia. Os demais pacientes evoluíram satisfatoriamente, com resoluçäo da ICC e ganho de peso em média 400g por mês (peso pré: média 4 kg, peso pós: média 7,5 kg). Treze pacientes foram reestudados hemodinamicamente, em média 21 meses após a cerclagem. A relaçäo FP/FS reduziu de 2,7 para 0,92, ao mesmo tempo em que houve diminuiçäo também na relaçäo PSAP/PSAo de 0,73 para 0,28. Nestes pacientes houve uma melhora clínica observada pela diminuiçäo do déficit ponderal de 38 por cento, para 20 por cento. Treze pacientes, foram submetidos a correçäo total em média 21 meses após a cerclagem, com dois óbitos hospitalares, sendo um imediato e outro por intoxicaçäo digitálica, 1 mês após a cirurgia. Analisando-se, separadamente, os 6 casos de AVCT, em todos predominava o shunt e näo o refluxo valvar. Houve um óbito imediato e 5 pacientes foram reestudados hemodinamicamente. Observou-se reduçäo importante nas pressöes pulmonares e no fluxo arterial pulmonar. Estes pacientes foram reoperados para correçäo total, com boa evoluçäo