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Mitral stenosis (MS) is a progressive situation caused by obstruction of blood flow across the mitral valve from the left atrium to the left ventricle. It is one of the most common valvular heart lesions found during pregnancy. The chances of significant maternal and fetal morbidity and mortality are more in the case of severe MS. Balloon mitral valvuloplasty (BMV) is a life-saving procedure in pregnancy instead of surgical correction. We are presenting the case of a 24-week pregnant woman with severe MS. She developed pulmonary edema and had undergone successful BMV which allowed her to tolerate her pregnancy decently. It leads to a decrease in the left atrial pressure as well as pulmonary arterial pressure. The patient underwent normal delivery uneventfully. Antibiotics were used with proper consultation and the patient was treated conservatively with excellent maternal and fetal outcomes. BMV is turns out to be a life-saving therapy for severe MS complicated by pulmonary edema.
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@#Objective To investigate the predictive value of right atrial myocardial fibrosis in the prognosis of isolated tricuspid regurgitation surgery after left heart valve surgery. Methods The patients who underwent tricuspid valvuloplasty by the same operator in Guangdong Provincial People's Hospital from April 2016 to August 2021 due to long-term isolated severe tricuspid regurgitation after left heart valve surgery were included in the study. According to the degree of right atrial myocardial fibrosis, the patients were divided into three groups: a mild group, a moderate group, and a severe group. The clinical data of these patients were compared and analyzed. Results A total of 75 patients were enrolled, including 16 males and 59 females with an average age of 57.0±8.4 years. There were 30 patients in the mild group, 29 patients in the moderate group and 16 patients in the severe group. In terms of the preoperative data, there were statistical differences in cardiac function grade, right atrial diameter, tricuspid incompetence area among the three groups (P<0.05). In terms of the postoperative data, there were statistical differences among the three groups in the cardiopulmonary bypass time, mechanical ventilation time, ICU monitoring time, complication rate and mortality (P<0.05). Further pairwise comparison showed that, compared with the mild group, the severe group had longer mechanical ventilation time (P=0.024), longer ICU monitoring time (P=0.003) and higher incidence of postoperative complications (P=0.024), while the moderate group had no statistical difference in all aspects (P>0.05); compared with the moderate group, the severe group had longer ICU monitoring time (P=0.021) and higher incidence of complications (P=0.006). Conclusion The early outcome of tricuspid valvuloplasty in patients with isolated tricuspid regurgitation after left heart valve surgery with severe right atrial myocardial fibrosis is worse than that in the patients with mild and moderate fibrosis, suggesting that the degree of myocardial fibrosis in the right atrium can be a predictor of the effect of tricuspid regurgitation surgery and a judgement indicator of the surgery timing.
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Objective:To analyze the short and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases.Methods:A total of 26 children with aortic valve diseases (stenosis or regurgitation) who underwent aortic valvuloplasty with autopericardium in Fuwai Central China Cardiovascular Hospital from September 2017 to June 2021 were retrospectively analyzed.The short-term and mid-term follow-up data were collected.The maximum aortic valve pressure gradient, subaortic regurgitation area, left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were compared before and after operation.Paired t test was used to analyze the short-term and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases. Results:All 26 cases were successfully operated, and there were no deaths and serious complications during the follow-up period of (22.96±6.45) months.There was a significant difference between the preoperative and postoperative maximum aortic valve pressure gradient at 1 month ( t=7.85, P<0.05), 6 months ( t=6.43, P<0.05), 1 year ( t=6.16, P<0.05) and 2 years postoperatively ( t=4.22, P<0.05) in children with aortic stenosis or that combined with mild-to-moderate closure.The follow-up data of 9 children with simple aortic stenosis showed that there was a significant difference between the preoperative (8.87±3.57) cm 2 and postoperative aortic regurgitation area at 1 month ( t=6.85, P<0.05), 6 months ( t=5.13, P<0.05), 1 year ( t=6.62, P<0.05) and 2 years postoperatively ( t=5.41, P<0.05). The LVEDV of 26 children was significantly lower at 6 months[(63.54±27.61) mL], 1 year [(53.61±20.20) mL] and 2 years postoperatively [(64.39±17.78) mL] compared with that of preoperative level[(89.42±45.89) mL]( t=3.89, 4.67, 3.58, all P<0.05). The left ventricular pressure and volume decreased, the enlarged heart was narrowed down, and the geometry of the heart was restored.The LVEF of 26 patients also from (61.65±9.67)% before surgery increased to (67.88±4.69)% 6 months after surgery( t=3.68, P<0.05), and increased to (68.62±4.46)% 1 year after surgery( t=4.01, P<0.05), and increased to (67.55±3.09)% 2 years after operation( t=3.01, P<0.05), and the heart function was improved. Conclusions:Aortic valvuloplasty with autopericardium presents an effective short and mid-term efficacy on children with aortic valve diseases, which prevents or delays the aortic valve replacement.
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Neonatal Marfan syndrome is the most severe form of Marfan syndrome usually showing critical cardio-respiratory symptoms from the neonatal period or early infancy. We report a boy with this syndrome who presented with heart failure at 3 months of age and was referred to our department at 6 months old after intense medical treatment. He had enophthalmos, funnel chest, arachnodactyly, and Steinberg's thumb sign, but had no family history of Marfan syndrome or other cardiac diseases. Left ventricular dilatation, severe mitral regurgitation and moderate tricuspid regurgitation were noted on echocardiography. Mitral valvuloplasty and tricuspid annuloplasty were performed, and the regurgitation improved to trivial and mild level, respectively. However, rapid exacerbation of mitral regurgitation occurred, and the patient fell into circulatory collapse which needed circulatory support with extracorporeal membrane oxygenator (ECMO) on 18th postoperative day. In the emergency operation, the previous surgical procedures on the mitral valve were intact and we thought that rapid progression of the mitral annular dilatation and valve expansion to be the cause of exacerbation. Mitral valve replacement (Regent® 21 mm aortic) was performed, and the cardiac function improved, but ECMO was still needed because of the depressed respiratory function. Furthermore, tricuspid regurgitation due to annular dilatation and valve expansion was aggravated rapidly which needed tricuspid valve replacement (ATS® 20 mm mitral) 9 days after the mitral valve replacement. ECMO was ceased on the 37th day and the patient was extubated on 71st day. He was discharged from the hospital 5 months after the first operation. One year has passed after discharge, and he is doing well with anticoagulation. In the treatment of neonatal Marfan syndrome, surgical procedure for valve repair is still controversial and it should be remembered that rapid exacerbation of the atrioventricular valve can occur even after satisfactory valve repair and there should be no hesitation regarding surgical intervention when needed.
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ABSTRACT Introduction: Aortic valve bioprostheses ring fracture in valve-in-valve procedures has shown low complication rates and presents as an option in the treatment of patients at high risk for conventional surgery, avoiding high transvalvular gradients, which are associated with increased mortality. Some prostheses available in the market cannot be fractured. In an ex vivo test, the possibility of ring fracture of aortic valve bioprostheses produced in Brazil when submitted to radial force application using a high-pressure non-compliant balloon was evaluated. Methods: One unit of each aortic valve bioprosthesis model, sizes 19 and 21 mm, produced by Brazilian companies (Braile Biomédica, Cardioprótese, and Labcor), was used. In the experiment, a non-compliant high-pressure balloon (Atlas®-Gold), 1 mm larger than the external diameter of the prosthesis, was positioned inside the valve annulus and inflated gradually aiming to fracture the prosthesis. Fracture pressures and photographic and radiological images of the prostheses before and after test were recorded. Results: All prostheses were fractured. In the models with metal ring, the fracture pressures were between 23 and 25 atm. In the other prostheses, the rupture occurred between 10 and 13 atm. No deformations in the structure were observed, which could potentially damage the aortic root. Conclusion: All the Brazilian prostheses evaluated were fractured, although the presence of a metal ring in the prosthesis framework increases the pressure required for fracture. The information obtained helps in the planning of valve-in-valve procedures in patients with aortic valve bioprostheses.
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Objective:To summarize the clinical data of mitral valve surgery completed in a single surgical team in one year, to discuss the etiologic characteristics, methods, results and early postoperative outcomes of mitral valvuloplasty surgeries, and to analyze the epidemiologic trends of mitral valve diseases admitted to the hospital.Methods:A total of 209 mitral valve surgeries completed by the same surgeon in the single surgical team at the Cardiovascular Surgery, First Medical Center, Chinese PLA General Hospital, from January 2021 to December 2021 were retrospectively analyzed. Mitral valve surgery accounted for 53.6% of all surgeries in this team during the same period. There were 100 cases(47.8%) in males and 109 cases(52.2%) in females, aged 11-85 years old, with a mean of(53.5±15.2) years old. There were 121 cases(57.9%) of NYHA class Ⅱ and 88 cases(42.1%) of class Ⅲ/Ⅳ.Results:Of the 152 mitral valvuloplasty surgeries, 117(77%) were performed with a totally Thoracoscopic approach. Annuloplasty rings were applied in 145 cases(95.4%), including semi-rigid closed Physio II annuloplasty rings in 118 cases(81.4%), Gore-Tex artificial chordae were applied in 89 cases(58.6%) for a total of 145, leaflet repair in 15 cases(9.9%), edge-to-edge repair in 2 cases(1.3%), commissure suture in 34 cases(22.4%), and chordae tendineae and papillary muscle splitting in 15 cases(9.9%). The repair rate of degenerative mitral valve disease was 100%, and the repair rate of rheumatic mitral valve disease was 48.1%. The echocardiogram was received about one week after surgery, and there was no or trace regurgitation in 91 cases(59.9%), mild in 58 cases(38.2%), and moderate in 3 cases(2.0%). There were 2 cases(1.3%) of all-cause death.Conclusion:Degenerative mitral valve disease have become the leading cause of mitral valve disease in our center, and the proportion of rheumatic mitral valve disease has decreased. Degenerative mitral valve disease has a very high repair rate, and rheumatic mitral valve disease has a relatively low repair rate due to its special pathologic and anatomic characteristics. Most mitral valvuloplasty procedure can be performed in a totally thoracoscopic approach. The application of a mitral valvuloplasty ring combined with Gore-Tex artificial chordae by an experienced surgeon can achieve reliable repair results.
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Objective:To summarize the experience and effect of mitral valvuloplasty in the treatment of mitral valve disease in infants.Methods:The clinical data of 140 infants with mitral valve disease from June 2010 to June 2020 were retrospectively analyzed. There were 62 males and 78 females, with body weight of(6.4±1.4)kg and age of(196.6±80.1)days. Among them, 131 cases were moderately or above mitral insufficiency, and 9 cases were mitral stenosis. The perioperative and follow-up clinical data were recorded, and the therapeutic effect and prognostic factors of mitral valve plastic surgery were analyzed.Results:All 140 children were received surgery of mitral valve repair under cardiopulmonary bypass. Cardiopulmonary bypass time was(79.1±41.9)min, aortic cross clamp time was(46.8±20.0)min, 7(5%)early death. Mechanical ventilation time was(74.2±149.8)h. After surgery, mild mitral regurgitation was found in 48 cases, mild-moderate regurgitation in 53 cases, moderate regurgitation in 32 cases, moderate-severe regurgitation in 6 cases, severe regurgitation in 1 case, with no mitral stenosis. During the follow-up period of 6-126 months, 3 cases died in the long term, and 11 cases were reoperated. Freedom from >moderate mitral regurgitation at 5 years after surgery was 81.2%. Longer cardiopulmonary bypass time and postoperative mitral regurgitation were risk factors for death and moderate or above regurgitation at the follow-up.Conclusion:Mitral valvuloplasty can effectively treat the mitral regurgitation and stenosis in infants. The prognosis of children with short cardiopulmonary bypass time and good valve plastic effect is better. For infants with Carpentier type I, good shaping effect can be achieved by mitral annuloplasty alone, while for type Ⅱ and type Ⅲ, treatment should be tailored to deal with the problems at all levels of the valve, and additional annuloplasty should be performed.
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Objective:To explore the value of current indications for fetal pulmonary valvuloplasty (FPV) by summarizing the postnatal diagnosis, treatment, and prognosis of fetuses with pulmonary atresia with intact ventricular septum (PA/IVS) and right ventricular hypoplasia (RVH).Methods:This prospective study was conducted at the Heart Center of Women and Children's Hospital, Qingdao University from September 2018 to March 2021, which included pregnant women who were (1) with fetal PA/IVS and RVH; (2) unable to receive FPV due to fetal position or gestational age despite the indications; (3) given integrated pre- and postnatal management. Prenatal fetal echocardiography assessment, postnatal diagnosis, treatment, and follow-up were summarized using Wilcoxon matched-pair signed-rank test.Results:A total of 35 singleton pregnant women were diagnosed with fetal PA/IVS and RVH by ultrasonic cardiogram and admitted during the study period. Among the 28 fetuses meeting the FPV indications, 18 underwent FPV, while the other 10 did not due to inappropriate fetal position or gestational age. After excluding four terminated pregnancies, the rest six cases were enrolled. The median gestational age at the initial prenatal fetal echocardiography diagnosis was 28.9 weeks (28.3-30.4 weeks). Compared with the initial evaluation, the fetal right ventricular to left ventricular length/diameter ratio [0.8 (0.6-0.9) vs 0.6 (0.5-0.8)] and tricuspid regurgitation velocity [4.7 m/s (3.2-5.1 m/s) vs 4.1 m/s (3.3-4.8 m/s)] were increased, while tricuspid valve Z value [－0.8(－1.6-0.8) vs 0.4 (－0.3-1.9)] and single-ventricular predictive score [0.5 (0.0-2.0) vs 2.0 (1.0-3.0)] were decreased when re-evaluated six weeks later ( T were－2.21, 2.00,－2.20, and 2.00; all P<0.05). All of the six fetuses were born alive with a median gestational age of 38.9 weeks (37.3-40.1 weeks). The median weight was 3 425 g (3 100-4 160) g after being transferred to cardiac intensive care unit. The median age was 12.5 d (0.0-20.0 d) at the first surgical intervention. The median follow-up duration was 15 months (11.8-18.5 months). At initial diagnosis, the single-ventricular predictive score was 1-2 points in four fetuses, and =3 points in two fetuses. There was no death during follow-up. Four patients achieved anatomical biventricular circulation, one achieved clinical biventricular circulation, and one still needed further follow-up, with single-ventricular predictive score at initial diagnosis of 1-3, 3, and 2 points, respectively. Conclusions:The prognosis is good in fetuses with PA/IVS and RVH who have FPV indications but do not receive intrauterine intervention, which suggests that the current FPV indications may be too broad, and a more suitable FPV indication need to be further explored given the difficulty of implementing FPV.
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SUMMARY BACKGROUND: Percutaneous mitral balloon valvuloplasty and mitral valve replacement have been the treatment options for mitral stenosis for several years, however, studies that compare these two modalities are very rare in the literature. ObjectIve: In this article, we aim to investigate the comparison of clinical results of percutaneous mitral balloon valvuloplasty and mitral valve replacement. Methods: 527 patients with rheumatic mitral stenosis, treated with percutaneous mitral balloon valvuloplasty or mitral valve replacement (276 patients with percutaneous mitral balloon valvuloplasty and 251 patients with mitral valve replacement) from 1991 to 2012 were evaluated. The demographic characteristics, clinical, echocardiographic and catheterization data of patients were evaluated retrospectively. The results of early and late clinical follow-up of patients after percutaneous mitral balloon valvuloplasty and mitral valve replacement were also evaluated. Results: The mean follow-up time of the percutaneous mitral balloon valvuloplasty group was 4.7 years and, for the mitral valve replacement-group, it was 5.45 years. The hospital stay of the percutaneous mitral balloon valvuloplasty group was shorter than that of the mitral valve replacement group (2.02 days vs 10.62 days, p<0.001). The hospital mortality rate of percutaneous mitral balloon valvuloplasty and mitral valve replacement were 0% and 2% respectively (p=0.024). In the percutaneous mitral balloon valvuloplasty group, early postprocedural success rate was 92.1%. The event-free survival of percutaneous mitral balloon valvuloplasty and mitral valve replacement was found to be similar. While reintervention was higher in percutaneous mitral balloon valvuloplasty-group (p<0.001), mortality rate was higher in mitral valve replacement-group (p<0.001). Conclusion: Percutaneous mitral balloon valvuloplasty seems to be more advantageous than mitral valve replacement due to low mortality rates, easy application of the procedure and no need for general anesthesia.
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Humans , Balloon Valvuloplasty , Mitral Valve Stenosis/surgery , Mitral Valve Stenosis/diagnostic imaging , Retrospective Studies , Follow-Up Studies , Mitral Valve/surgery , Mitral Valve/diagnostic imagingABSTRACT
Objective:To compare the results of surgical valvuloplasty and balloon dilation in patients with aortic stenosis (AS) at our center.Methods:We retrospectively reviewed the clinical data of children diagnosed with AS, underwent aortic repair or balloon dilation from January 2008 to December 2019. Seeking to analyze the early and long-term valvular function, evaluate mortality and freedom from reoperation by Kaplan- Meier method and figure out the risk factors by logistic regression. Results:There were 116 patients having received surgical valvuloplasty (SAV) and 64 having received balloon dilation (BD). There were no significant differences between two groups respect to median age, weight, preoperative peek gradient, aortic insufficient degree, left ventricular ejection fraction left ventricular end-diastolic dimension Z-score and aortic anulus diameter Z-score ( P>0.05). SAV achieved better gradient reduction and freedom from reoperation than did BD. The mean follow-up time was (5.2±3.1) years in SAV and (4.5±2.1) years in BD. Survival at 10 year was comparable between 2 groups ( P=0.51). Freedom from reoperation at 10 years was 59.6% in SAV and 49.7% in BD respectively ( P=0.01). Multivariate analysis revealed that BD contributed to subsequent reoperation ( P=0.05). Conclusion:SAV and BD both significantly relieved aortic stenosis and obtained good survival benefit. SAV yielded better gradient reduction and lower reoperation risk. BD might increase the hazard of reoperation.
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Objective:Reported our experience of 100 consecutive cases of thoracoscopic mitral valvuloplasty in the early period.Methods:Between September 2017 and December 2019, 100 consecutive cases of thoracoscopic mitral valvuloplasty had been completed in our institution. There were 56 males and 44 females. The mean age was(49.2±14.7) years old, ranging from 15 to 75 years old.The safety and feasibility of this technique was evaluated by its early clinical outcomes.Results:Mitral valve(MV) repair techniques included leaflet folding in 5 cases, cleft suture in 10, commissuroplasty in 15, edge to edge in 1, artificial chordae implantation in 76 cases with mean of(2.5±1.6)(1-4) pairs, and prosthetic annuloplasty in all cases. Intraoperative transoesophageal echocardiography(TEE) revealed no mitral regurgitation(MR) in 95 cases and a mild in 2 cases with all coaptation length more than 5 mm. The rest 3 cases with moderate or more MR were successfully reconstructed after being blocked again. The mean cardiopulmonary bypass(CPB) time was(164.4±51.0 )min and aortic clamping time was(119.7 ± 39.1) min, and the latest 10 cases were(140.2±45.3 )min and(96.3±25.4) min, the difference was statistically significant( P<0.05). There was one operative death for avulsion of left atrial suture after operation and 2 intraoperative re-exploration for bleeding. Severe MR was observed in 2 patients 3 months after operation, and mitral valve replacement(MVR) was performed through median sternotomy. Conclusion:Totally thoracoscopic mitral valvuloplasty is technically feasible, safe, effective and reproducible in clinical practice after crossing the learning curve. The short-term effect is satisfactory, however, further randomized and long-term follow-up studies are warranted to determine its clinical effects.
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@#Objective To report the short-term outcomes of a standardized, simplified and reproducible strategy of mitral valvuloplasty (MVP), which was focused on leaflet foldoplasty and anatomic anomalies of congenital mitral regurgitation (MR). Methods Consecutive 74 patients who underwent MVP by our standardized strategy in our institution from 2016 to 2018 were included retrospectively. There were 30 males and 44 females with a median age of 18.5 (6-146) months and weight of 15.4 (7-51) kg. Results Anatomic anomalies of MR included: (1) subvalvular apparatus: 72 (97.3%) patients with mal-connected chordae tendineae, 31 (41.9%) with absent chordae tendineae and 14 (18.9%) with fused or dysplastic papillary muscle; (2) leaflet: 10 (13.5%) patients with cleft of anterior leaflet, 61 (82.4%) with leaflet prolapse including 56 (91.8%) with anterior leaflet prolapse; (3) annulus: 71 (95.9%) patients with annular dilatation. Leaflet foldoplasty was performed in 61 (82.4%) patients with leaflet prolapse. All patients were successfully discharged and 4 (5.4%) patients were with moderate MR. The follow-up time was 22.0 (9.1-41.8) months. During the follow-up period, 3 patients had moderate MR and 1 patient had reoperation for severe MR. All patients were in normal cardiac function with a mean left ventricular ejection fraction of 66.0%±6.1%. In addition, the mean left ventricular end-diastolic dimension was 31.8±6.0 mm, which was significant smaller than that before the operation (t=6.090, P<0.000 1). Conclusion The standardized leaflet foldoplasty with resection of mal-connected chordae tendineae and posterior annuloplasty technique is safe and feasible with favorable short-term outcomes in MR patients.
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@#Objective To explore the clinical effect of mitral valvuloplasty on children with Barlow disease combined with moderate to severe or severe mitral regurgitation. Methods The clinical data of 10 patients with Barlow disease combined with moderate to severe or severe mitral regurgitation in Fuwai Hospital from January 2014 to August 2019 were analyzed retrospectively, including 3 males and 7 females, with a mean age of 8.7±7.9 years. Echocardiography before and during the operation confirmed that the mitral valve leaflets were long and swinging, the valve leaflets and the opposite edge protruded into the left atrium and were higher than the level of the mitral valve rings, the mitral valve rings were dilated, the papillary muscles and tendons were long, and the pathological changes after the operation showed mucoid degenertion of the valve leaflets and tendons, and some fibrous foci hyperplasia. Mitral valve repair included implantation of artificial valve ring, implantation of artificial tendon, posterior leaflets sliding, partial resection of posterior leaflets (excluding sliding), valve leaflets folding, tendon folding, papillary muscle splitting and annular valve contraction (excluding artificial valve ring implantation). The technique of mitral valve repair, early clinical results and follow-up echocardiographic data were analyzed. Results All the patients successfully completed the mitral valve repair. The mean time of aortic occlusion was 73.2±17.4 min, and cardiopulmonary bypass time was 99.5±19.8 min. At the same time, 4 patients received tricuspid valve repair and 1 funnel chest correction. There was no reoperation in perioperative period. The 1-year and 5-year survival rates were 100.0% and 100.0%, respectively. The incidence of below moderate mitral regurgitation was 90.0% at postoperative 1 year and 72.0% at postoperative 5 years. Conclusion For the young children who have Barlow disease and mitral regurgitation, considering the characteristics of heavy lesions, small operation space, and the need to meet the growth and development of valve, it is suggested to adopt the surgical techniques different from those of older children, such as valve ring retraction and tendon folding, if necessary, to adopt "edge to edge" suture, which can shorten aortic occlusion time and achieve good early effects, and its long-term effects still need further follow-up observation. Mitral valvuloplasty technique for Barlow disease similar to that of adults can be used in older children, including implantation of artificial valve ring and implantation of artificial tendon, etc.
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RESUMEN Introducción: La estenosis aórtica es relativamente frecuente en niños. El objetivo de este trabajo fue de caracterizar los resultados y la evolución de esta patología luego del manejo quirúrgico y percutáneo. Material y Métodos: Estudio retrospectivo de pacientes de cero a 19 años, tratados de estenosis aórtica subvalvular, valvular y supravalvular, en el Hospital de Clínicas, entre 1998 y 2019. Fueron excluidos los casos asociados a otras lesiones congénitas. Resultados: Fueron tratados 20 pacientes, edad de 3 días a 17 años, predominio masculino (80%). La estenosis fue valvular en 65% de los casos, subvalvular 20%, supravalvular 5% y múltiple en 10%. El 61% de los valvulares recibió tratamiento percutáneo, y los demás valvuloplastia quirúrgica. En el seguimiento, la tasa libre de reintervención fue de 47% a 10 años; el 50% de ellos tiene insuficiencia valvular aórtica moderada a severa. De los 13 casos de estenosis valvular, tratados percutánea o quirúrgicamente, 4 están aguardando recambio valvular. De 4 pacientes con estenosis subvalvular, 3 tienen insuficiencia aórtica leve, y gradiente medio de 20 mmHg. De dos pacientes con estenosis supravalvular, uno quedó con estenosis residual importante. En cuanto a clase funcional, todos los pacientes se encuentran en grados 1 y 2 de la escala de NYHA. No se presentaron complicaciones inmediatas en los sometidos a procedimientos percutáneos o quirúrgicos. Fallecieron dos pacientes (10.5%). Conclusiones: La estenosis aórtica afecta principalmente la región valvular, y el tratamiento tanto quirúrgico como percutáneo permiten aliviar la obstrucción hasta el momento de un reemplazo valvular.
ABSTRACT Introduction: Aortic stenosis is relatively common in children. The objective of this study was to characterize the results and clinical course of this pathology after surgical and percutaneous management. Material and methods: This was a retrospective study of patients aged 0 to 19 years, treated for subvalvular, valvular, and supravalvular aortic stenosis, at Hospital de Clínicas, between 1998 and 2019. Cases associated with other congenital lesions were excluded. Results: Twenty patients were treated, age from 3 days to 17 years, male predominance (80%). The stenosis was valvular in 65% of the cases, subvalvular 20%, supravalvular 5% and multiple in 10%. 61% of the valve recipients received percutaneous treatment, and the other surgical valvuloplasty. At follow-up, the free reoperation rate was 47% at 10 years; 50% of them have moderate to severe aortic valve regurgitation. Of the 13 cases of valve stenosis, treated percutaneously or surgically, 4 are awaiting valve replacement. Of 4 patients with subvalvular stenosis, 3 have mild aortic regurgitation and a mean gradient of 20 mmHg. Of two patients with supravalvular stenosis, one was left with significant residual stenosis. Regarding functional class, all patients are in grades 1 and 2 of the NYHA scale. There were no immediate complications in those undergoing percutaneous or surgical procedures. Two patients (10.5%) died. Conclusions: Aortic stenosis mainly affects the valve region, and both surgical and percutaneous treatment allow the obstruction to be relieved until the time of valve replacement.
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RESUMEN Introducción: La valvuloplastia mitral percutánea con balón actualmente es el primer procedimiento terapéutico que se contempla en el mundo desarrollado para los pacientes con estenosis mitral reumática e indicación para ello, y se realiza en el Cardiocentro de Santiago de Cuba desde julio de 2008. Objetivos: Describir los resultados de la valvuloplastia mitral percutánea con balón en los pacientes estudiados. Método: Se realizó un estudio observacional y descriptivo, unicéntrico, que incluyó a 91 pacientes tratados mediante este procedimiento en el Cardiocentro de Santiago de Cuba, desde julio de 2008 hasta junio de 2019. Se evaluaron variables clínico-epidemiológicas, ecocardiográficas y hemodinámicas, así como el resultado inmediato del procedimiento. Resultados: Predominaron los pacientes jóvenes (60,4% entre 15-44 años), del sexo femenino (86,8%), con antecedentes de fiebre reumática (48,4%), en clase funcional III (64,8%) de la NYHA (New York Heart Association) y en ritmo sinusal (86,8%). Se logró un aumento promedio del área valvular de más del doble (0,99 vs. 2,12 cm2) del valor inicial y una reducción de la presión auricular mayor de 50% (25,0 vs.11, 76 mmHg), lo que permitió evaluar de satisfactorio el tratamiento en el 95,6% de los pacientes. Se identificó una asociación significativa (Prueba de Fisher ≤ 0,05) entre la puntuación de Wilkins ≤ 8 y el resultado satisfactorio del procedimiento. Conclusiones: Los resultados de la aplicación de la valvuloplastia mitral percutánea con balón en el centro fueron satisfactorios y congruentes con los referidos nacional e internacionalmente.
ABSTRACT Introduction: Percutaneous balloon mitral valvuloplasty has flourished as a mainstream therapy (mostly in developed countries) for treating patients with medical indication and those suffering from rheumatic mitral stenosis. This procedure is performed at the Cardiocentro in Santiago de Cuba since July 2008. Objectives: To describe the results of percutaneous balloon mitral valvuloplasty in the study participants. Methods: A descriptive, single-centered and observational study including 91 patients treated by this procedure was conducted at the Cardiocentro in Santiago de Cuba from July 2008 to June 2019. Clinical/epidemiological, echocardiographic and hemodynamic variables were assessed, as well as immediate procedure outcomes. Results: Young individuals (60.4% between 15-44 years), female (86.8%), with a history of rheumatic fever (48.4%), NYHA (New York Heart Association) functional class III (64.8%) and sinus rhythm (86.8%) predominated. An average increase in valve area of over double (0.99 vs. 2.12 cm2) the initial value and a reduction in atrial pressure of more than 50% (25 vs. 11.76 mmHg) was achieved; thus evidencing that the treatment was effective in 95.6% of the patients. A significant association (Fisher Test ≤ 0.05) was identified between Wilkins score ≤ 8 and satisfactory outcome of the procedure. Conclusions: The results of percutaneous balloon mitral valvuloplasty in the medical center were successful and consistent with those achieved nationally and internationally.
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Rheumatic Fever , Balloon Valvuloplasty , Mitral Valve StenosisABSTRACT
This study is aimed to delineate readers with an overview of percutaneous balloon pulmonary valvuloplasty (PBPV) of pulmonary valve stenosis (PVS) and highlighting outcome based on influential and recent studies. It has been four decades since Kan et al first introduce PBPV. Since then, PBPV has recognized as a gold standard therapy for PVS of all ages. Nowadays, PBPV is practiced for a broad range of indication such as PVS, PV dysplasia and pulmonary atresia. Typically, PBPV is recommended when gradient across the PV is >50 mmHg. The procedure involves the placement of one or more balloon catheters across the stenotic PV with the guidance of a guidewire; thereafter, inflation of the balloons is done by pressure, thus producing valvotomy. Nowadays, PBPV is done by echocardiographic guidance, but previously, it was done by fluoroscopic guidance. The main disadvantage of fluoroscopy was the radiation injury of patients. The recently recommended balloon/annulus ratio is 1.2 to 1.25. Following the procedure, the dramatic reduction of pressure gradient, free motion of the PV leaflets with less doming, the rise of cardiac output have been noted, whereas complications may occur but are unusual and minimal. Significant predictors of restenosis include balloon/annulus ratio <1.2 and immediate post-PBPV gradient ≥30 mmHg. Only a few percentages of patients needed repeat PBPV. Long-term follow-up results are surprisingly excellent. In conclusion, it is our opinion that PBPV is equally successful in patients of all ages, while worldwide recognized studies prove the safety, feasibility, and effectiveness. However, for early detection of any complication, life-long clinical follow-up is mandatory.
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Resumen: Introducción: la estenosis aórtica severa es una enfermedad frecuente, y la sustitución valvular es el único tratamiento eficaz. La valvuloplastia aórtica percutánea (VAP) tiene beneficios transitorios y su indicación está restringida a pacientes inestables como terapia puente o paliativa. A nivel nacional existe escasa evidencia sobre los resultados de esta técnica. Objetivo: determinar la indicación, eficacia, complicaciones y mortalidad de las VAP realizadas en nuestro centro entre enero de 2006 y setiembre de 2018. Secundariamente, determinar la terapia definitiva aplicada y el tiempo transcurrido hasta la misma. Método: estudio retrospectivo y descriptivo. Incluyó los pacientes a los que se le realizó VAP en el período. Se revisaron las historias clínicas para extracción de variables. Las variables cualitativas se presentan en valor absoluto y porcentaje; cuantitativas en mediana e intervalo intercuartilo. Se utilizó prueba de Wilcoxon para variables dependientes, tomando p<0,05 como nivel de significación. Para sobrevida se realizaron curvas de Kaplan-Meier. Protocolo aprobado por el Comité de Ética institucional. Resultados: 28 casos; 17 (60,7%) mujeres; la mediana de edad fue de 79,5 años (IQ 73-85,5). El objetivo de la VAP fue: puente a la decisión en 11 casos (39,2%), al tratamiento definitivo en 12 (42,8%) y paliativo en 5 (18%). La VAP fue considerada exitosa en 57,1% de los casos. Las indicaciones más frecuentes fueron: insuficiencia cardíaca refractaria en 10 casos (35,7%) y shock cardiogénico en 9 (32,1%). Diecinueve pacientes fallecieron (67,8%). La sobrevida fue 59 días (IQ 5-412). Seis pacientes recibieron tratamiento definitivo (cuatro recibieron implante valvular percutáneo y dos cirugía cardíaca). El tiempo de la VAP al implante percutáneo fue 233 días y 47 días a la cirugía abierta. Conclusiones: las indicaciones más frecuentes de la VAP fueron puente a tratamiento definitivo y decisión. La VAP fue exitosa en más del 50% de los casos. Las complicaciones mayores marcaron el pronóstico. La mortalidad fue elevada en el seguimiento. Un número reducido accedió al tratamiento definitivo (predominando el implante percutáneo).
Summary: Introduction: severe aortic stenosis is frequent and valve replacement is the only effective treatment. Percutaneous aortic valvuloplasty has transient benefits, and its indication is restricted to unstable patients as a bridge to other treatment or palliative therapy. In our country, there is a few evidence of this technique. Objective: to determine the indication, efficacy, complications and mortality of percutaneous aortic valvuloplasty performed in our center between January 2006 - September 2018. Secondarily, to determine which was the definitive therapy and it´s delay. Method: retrospective and descriptive study. All patients who received valvuloplasty during the study period were included. Clinical histories were reviewed. Qualitative variables were presented in absolute value and percentage; the quantitative ones, in median and interquartile interval. Wilcoxon test was applied to dependent variables, p <0.05. Kaplan Meier curves were performed to analize survival. Protocol was approved by ethics committee. Results: 28 cases. 17 (60.7%) were female. Average age was 79.5 years (IQ 73-85.5). The objective of percutaneous aortic valvuloplasty was bridge therapy to decision in 11 cases (39.2%), bridge to definitive treatment in 12 (42.8%) and palliative in 5 (18%). The most frequent indications were: refractory heart failure in 10 cases (35.7%) and cardiogenic shock in 9 (32.1%). Valvuloplasty was successful in 57.1% of cases. 19 patients died (67.8%). The median survival was 59 days (IQ 5-412). 6 patients received definitive treatment (4 percutaneous implantation and 2 open cardiac surgery). The time from percutaneous aortic valvuloplasty to percutaneous aortic valve implantation was 233 days and 47 days to open surgery. Conclusions: the most frequent indications for percutaneous aortic valvuloplasty were bridge therapy to definitive treatment and decision. Percutaneous aortic valvuloplasty was successful in more than 50% of cases. Major complications determined the prognosis. Mortality was high at follow-up. A small number acceded to definitive treatment (predominantly percutaneous implantation).
Resumo: Introdução: a estenose aórtica grave é frequente, a substituição valvar é o único tratamento efetivo. A valvoplastia aórtica percutânea tem resultados transitórios, sua indicação é restrita a pacientes instáveis como ponte ou terapia paliativa. Em nível nacional, há poucas evidências. Objetivo: determinar a indicação, eficácia, complicações e mortalidade das valvoplastias aórticas percutâneas realizadas em nosso centro entre janeiro de 2006 a setembro de 2018. Determinar secundariamente a terapia definitiva e o tempo até ela. Método: estudo retrospetivo, descritivo. Todos os pacientes que receberam valvuloplastia aórtica percutânea durante o período do estudo foram incluídas. Histórias clínicas foram revisadas. As variáveis qualitativas são apresentadas em valor absoluto e percentagem; os quantitativos em intervalo mediano e interquartil. O teste de Wilcoxon foi utilizado para variáveis dependentes, p <0,05. Para sobrevivência, as curvas de Kaplan Meier foram realizadas. Protocolo aprobado pelo comitê de ética. Resultados: 28 casos. 17 (60,7%) eram mulheres e a idade média foi de 79,5 anos (QI 73-85,5). O objectivo da valvoplastia foi ponte para decisão terapêutica em 11 casos (39,2%), ponte para tratamento definitivo em 12 casos (42,8%) e paliativo em 5 casos (18%). As indicações mais frequentes foram: insuficiência cardíaca refratária em 10 casos (35,7%) e choque cardiogênico em 9 casos (32,1%). A valvuloplastia foi bem sucedida em 57.1% dos casos. 19 pacientes morreram (67,8%). A mediana de sobrevivência é de 59 dias (IQ 5-412). 6 pacientes receberam tratamento definitivo (4 implantes percutâneos e 2 por cirurgia cardíaca aberta). A mediana do tempo de valvoplastia aórtica percutânea para implante de valva aórtica percutânea foi de 233 dias e cirurgia aberta de 47 dias. Conclusões: as indicações mais frequentes para valvoplastia aórtica percutânea foram a terapia ponte para tratamento e para decisão definitiva. A valvoplastia aórtica percutânea foi bem sucedida em mais de 50%. As complicações principais marcaram o prognóstico. A mortalidade foi alta no follow-up. Um pequeno número concordou com o tratamento definitivo (predominantemente implante percutâneo).
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@#Objective To compare the efficacy and safety of mitral valvuloplasty via minimally invasive approach with those of mitral valvuloplasty via traditional median sternotomy. Methods A total of 1 221 patients undergoing mitral valvuloplasty from January 2015 to August 2018 in Guangdong Provincial People's Hospital were analyzed retrospectively, including 721 males and 500 females, with an average age of 47.2±15.1 years. According to the different surgical methods, they were divided into a study group (n=654), who received mitral valvuloplasty via the totally thoracoscopic approach, and a control group (n=567), who received mitral valvuloplasty via traditional median sternotomy. Clinical data, surgical results, and perioperative outcomes of the two groups were compared. Results There was no significant difference in preoperative general data between the two groups (P>0.05). Compared with the control group, the study group had longer cardiopulmonary bypass time and aortic cross-clamping time (146.7±42.4 min vs. 122.7±30.6 min, 96.2±32.7 min vs. 78.3±23.8 min, both P=0.000), and shorter total operation time (227.4±55.3 min vs. 238.1±56.4 min, P=0.001). There was no significant difference in the incidence of secondary cross-clamping and mitral valve replacement between the two groups (3.7% vs. 2.6%, P=0.312; 1.7% vs. 1.4%, P=0.690). The blood transfusion rate and the incidence of respiratory tract infection and postoperative poor wound healing were lower (13.0% vs. 24.5%, 2.1%vs. 18.0%, 1.5% vs. 5.3%, all P=0.000) and the postoperative hospital stay was shorter (6.2±4.4 d vs. 11.5±8.8 d, P=0.000) in the study group. There was no significant difference in hospitalization expense between the two groups (95 847.9±31 322.0 yuan vs. 99 673.1±47 930.3 yuan, P=0.149). Within 30 d after surgery, 1 patient died in the study group and 4 patients died in the control group. Before discharge, there were 4 and 5 patients with severe mitral valve regurgitation in the study group and the control group, respectively. Conclusion Compared with mitral valvuloplasty via traditional median sternotomy, minimally invasive mitral valvuloplasty is superior in shortening operation time and postoperative hospital stay, lowering blood transfusion rate, and reducing postoperative complications, which can achieve better clinical outcomes.
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@#To analyze the mid-long-term outcomes of surgical balloon valvuloplasty (SBV) for right ventricular decompression in the treatment of pulmonary atresia with intact ventricular septum (PA/IVS). Methods Clinical data of consecutive 91 patients who were diagnosed with PA/IVS and underwent SBV in our institution from January 2005 to December 2017 were retrospectively analyzed, including 52 (57.1%) males and 39 (42.9%) females. The median age was 3 months (1 d, 24 months) and the median weight was 4.1 (2.5, 12.0) kg. Results The SBV was performed in all patients, and 62 of whom received other simultaneous surgeries, including ligation of patent ductus arteriosus (PDA, 33 patients), ligation of PDA with modified Blalock-Taussig shunt (23 patients), ligation of PDA with bidirectional Glenn shunt (6 patients). There was no early postoperative death. The median follow-up time was 8.8 (2.5, 13.4) years, 4 patients were lost. There were 7 (8.0%) deaths and 1 (1.1%) patient with a re-SBV for pulmonary stenosis. The one and a half ventricular repair was performed in 5 (5.7%) patients and Fontan procedure in 2 (2.3%) patients. In addition, the mean Z-value of tricuspid valve annulus was −1.7±1.5, which was significant bigger than that before the operation (t=5.587, P<0.001). Conclusion SBV via right ventricular outflow tract for right ventricular decompression in the treatment of PA/IVS is safe and reliable. The majority of patients can receive biventricular repair instead of single ventricular palliation by SBV with individually customized shunt.
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@#Objective To compare short- and medium-term effects of Leonardo da Vinci robot-assisted and traditional mitral valvuloplasty. Methods We conducted a retrospective analysis of 74 patients who underwent mitral valvuloplasty in our hospital from January 2015 to March 2017. The patients were divided into two groups according to the mode of operation: a da Vinci group (n=29, 13 males, 16 females at an average age of 52 years) and a routine group (n=45, 18 males, 27 females at an average age of 53 years). The perioperative data of patients in the two groups were compared and analyzed. Results There was no significant difference in sex, age, weight, height, body mass index (BMI), cardiac function (NYHA), hypertension, diabetes, postoperative blood transfusion and postoperative complications between the two groups (P>0.05). The tracheal intubation time, ICU retention time, hospital stay time, blood loss and postoperative drainage in the da Vinci group were shorter or less than those in the routine group (P<0.05). The operation time, cardiopulmonary bypass time and aortic clamping time in the da Vinci group were longer than those in the routine group (P<0.05). Different surgical procedures had no significant effect on left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation (MR) 3 years after operation. There was no interaction between the mode of operation and the time of follow-up. There was no significant difference in echocardiographic evaluation in the same period (P>0.05). Conclusion Da Vinci operation shortens the rehabilitation process of patients compared with traditional surgery. For short- and medium-term follow-up results, there is no difference between Leonardo da Vinci and traditional mitral valve surgeries, and the clinical effect of da Vinci robot-assisted mitral valvuloplasty is satisfactory, which is worthy of further clinical promotion.