ABSTRACT
A substituição cirúrgica da valva aórtica é o tratamento de eleição para pacientes com estenose aórtica sintomática acentuada. Entretanto, o risco cirúrgico aumenta expressivamente com o avançar da idade e com a associação de comorbidades. Nessa situação clínica, o implante por cateter de bioprótese valvar aórtica deve ser considerado uma alternativa terapêutica válida e eficaz. O propósito deste Consenso é oferecer uma revisão crítica do conjunto de evidências e dos avanços mais recentes relacionados ao implante por cateter de bioprótese valvar aórtica e sumarizaro estado da arte atual, com o intuito de melhor guiar a tomada de decisão terapêutica. A seleção dos pacientes para o implante por cateter de prótese valvar aórtica deve obedecer aos seguintes critérios: 1) presença de estenose valvar aórtica acentuada, sintomática, definida como orifício valvar aórtico com área < 1 cm² (ou < 0,6 cm²/m²); 2) idade > 75 anos e alta probabilidade de morbidade e mortalidade cirúrgicas pela presença de comorbidades; e 3) presença de condição anatômica e morfológica favorável para o procedimento por cateter. As evidências científicas atuais indicam que esse procedimento melhora os sintomas e reduz a mortalidade de pacientes com estenose aórtica e com contraindicação cirúrgica, quando comparado ao tratamento conservador. Adicionalmente, em pacientes com estenose aórtica acentuada e alto risco cirúrgico, o implante por cateter apresenta-se como alternativa terapêutica eficaz, capaz de alterar o curso natural da doença deforma equivalente ao tratamento cirúrgico convencional.
Surgical replacement of the aortic valve is the therapy of choice for patients with severe symptomatic aortic stenosis.However, surgical risk increases significantly with age and with the association of comorbidities. In this clinical context, transcatheter aortic-valve implantation must be consideredas a valid and effective therapeutic alternative. The purpose of this Consensus is to provide a critical review of all the evidence and recent advances related to transcatheter aortic valveimplantation and summarize the current state of the art, in order to better guide therapeutic decision-making. Patient selection for transcatheter aortic-valve implantation must meet the following criteria: 1) presence of severe symptomatic aortic valve stenosis, defined as aortic valve orifice area < 1 cm² (or < 0.6 cm²/m²); 2) age > 75 years and a high probability of surgical morbidity and mortality due to pre-existing comorbidities; and 3) the presence of anatomical and morphological conditions favorable for transcatheter interventions. Current scientific evidence indicates that thisprocedure improves symptoms and reduces mortality in patients with aortic stenosis who were not suitable candidates for surgery, as compared to standard therapy. Additionally, inpatients with severe aortic stenosis and high surgical risk, transcatheter aortic-valve implantation is an alternative effective treatment, able to alter the natural course of disease in a manner equivalent to conventional surgical treatment.
Subject(s)
Humans , Catheters , Bioprosthesis , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/complications , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis Implantation , Risk FactorsABSTRACT
The patient is a male with risk factors for coronary artery disease, who was referred for cardiac catheterization after acute myocardial infarction in the inferior wall. The patient underwent transluminal coronary angioplasty in the right coronary artery with successful stent implantation
Subject(s)
Humans , Male , Middle Aged , Aorta, Thoracic/abnormalities , Coronary Artery Disease/etiology , Coronary Vessel Anomalies/complications , Angioplasty, Balloon, Coronary , Coronary Artery Disease/therapy , Coronary Vessel Anomalies/therapy , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Risk Factors , StentsABSTRACT
Aneurysm of the left main coronary artery is a rare angiographic finding, with few cases described in the international literature. We report the case of a 42-year-old male with a previous history of acute myocardial infarction, whose coronariography indicated triple vessel coronary disease and an aneurysm of the left main coronary artery. A review of the etiology, clinical aspects, and surgical management of coronary arterial aneurysm is presented