RESUMO
From March 1986 to January 1993, we performed percutaneous balloon mitral commissurotomy (PBMC) in ninety-one patients with rheumatic mitral stenosis, two of them during pregnancy. The gestational age at the time of valvotomy was thirty and twenty-seven weeks respectively. Balloon Inoue technique in both cases resulted in improvement in mitral valve area (0.8 vs 1.6 and 0.7 vs 1.9 cm2) and in mean mitral gradient (19 vs 4 and 12 vs 0 mm Hg) immediately after dilation, without residual atrial septal defect or mitral insufficiency. There were no complications. The estimated radiation exposure to the fetus was of 6.4 minutes of fluoroscopy and 6 seconds of angiography. To limit of X-ray irradiation, we used color Doppler echocardiography during dilatation in both cases. The subsequent course of gestation was uncomplicated and normal babies were delivered in both cases. Fetus protection against ionising radiation was assured by lead mantles. In the follow-up the mitral valve area was 1.7 and 2.1 cm2, 15 and 4 months later respectively. PBMC can be performed safely during pregnancy and is effective in increasing the valvular area and relieving symptoms. It offers an excellent alternative for the pregnant patients, with severe mitral stenosis. The risk to the fetus appears lower than previous reports of surgical commissurotomy performed during pregnancy.
Assuntos
Cateterismo/métodos , Estenose da Valva Mitral/terapia , Complicações Cardiovasculares na Gravidez/terapia , Cardiopatia Reumática/terapia , Adulto , Feminino , Hemodinâmica , Humanos , Valva Mitral , Estenose da Valva Mitral/diagnóstico , Estenose da Valva Mitral/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Indução de Remissão , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/fisiopatologiaRESUMO
Thirty patients admitted to the ICCU with a first myocardial infarction (MI) of any localization, with left ventricular dysfunction revealed by echo-Doppler ejection fraction (EF) < 40%, where randomly divided in three groups of ten: GROUP 1 who was treated with captopril 25 mg orally between the 5th and 7th day post MI, and sustained until the end of the study. GROUP 2 received nifedipine, 10 mg capsules t.i.d. also started between days 5 and 7 post MI. GROUP 3 as a control group was treated conventionally, according to the ICCU routine. The treatment was maintained during 12 months. All patients had a second echo-Doppler at the 5th day post MI to confirm the EF criteria. Also left ventricular end-systolic and end-diastolic diameters were measured. At the 5th day post MI and before the drug administration, a low level treadmill stress test was performed in all patients. Subsequently a maximal stress test (Bruce protocol) was done at the first month and at 6 and 12 months of the study. The results showed a significant increase EF in patients of GROUP 1 from an average basal value of 38 +/- 2 to 54 +/- 5 at six months (p < 0.01) and to 60 +/- 3 at 12 months (p < 0.005). The increments observed in patients of GROUP 2 and 3 were more modest; only the 12 month value in GROUP 3, from a basal figure of 41 +/- 3 to 50 +/- 4, had a p < 0.05.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Captopril/administração & dosagem , Hipertrofia Ventricular Esquerda/prevenção & controle , Infarto do Miocárdio/complicações , Adulto , Idoso , Tolerância ao Exercício/efeitos dos fármacos , Feminino , Seguimentos , Hemodinâmica/efeitos dos fármacos , Humanos , Hipertrofia Ventricular Esquerda/epidemiologia , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Nifedipino/administração & dosagem , Fatores de TempoRESUMO
UNLABELLED: In order to know the normal ranges of the maximum velocity and the pressure half-time between normal functioning tricuspid prostheses and malfunctioning tricuspid prostheses due to obstruction, we studied 25 patients with tricuspid prostheses (11 mechanical and 14 biological); they were divided in 2 groups: group I: 14 patients without clinical evidence of malfunction and; group II: 11 patients with malfunction due to obstruction confirmed by catheterization, surgery and/or necropsy. The peak gradient was estimated by the modified Bernoulli equation and the prosthetic valve area by the pressure halftime method. RESULTS: the mean peak velocity in group I was 147 +/- 18 cm/sec versus 165 +/- 16 cm/sec (p NS) in group II. The mean pressure half-time in group I was 124 +/- 20 msec versus 355 +/- 48 msec (p less than 0.001) in group II. CONCLUSIONS: 1. A pressure half-time greater than 200 msec is very suggestive of malfunction due to obstruction (p less than 0.001). 2. There are normo-functioning tricuspid prostheses with prolonged pressure half-time, and the values that divides these groups from those with malfunction is small: 199 and 244 msec, that is why we suggest that every patient has to have his her own echocardiographic control in the immediate postoperative period.