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Article in English | WPRIM | ID: wpr-928972


OBJECTIVES@#Type 2 diabetes (T2DM) is a common comorbidity in patients with degenerative aortic stenosis (AS).As a key item of the American Society of Thoracic Surgeons (STS) score, it has a vital impact on the clinical prognosis of traditional thoracic surgery. T2DM has an adverse effect on the morbidity and mortality of cardiovascular diseases. At the same time, studies have shown that T2DM are associated with myocardial hypertrophy and remodeling, decreased left ventricular function, and worsening heart failure symptoms in the AS patients. Transcatheter aortic valve replacement (TAVR) as an interventional method to replace the aortic valve has better safety for middle and high risk patients in surgery, but the impact of T2DM on the clinical outcome of TAVR in AS patients is not clear.By analyzing the clinical and image characteristics of patients with AS and T2DM who received TAVR treatment, so as to explore the effect of T2DM on the perioperative complications and prognosis of TAVR.@*METHODS@#A total of 100 consecutive patients with severe AS, who underwent TAVR treatment and were followed up for more than 1 month, were selectedin the Second Xiangya Hospital of Central South University from January 2016 to December 2020.Among them, 5 patients who were treated with TAVR due to simple severe aortic regurgitation were not included, therefore a total of 95 patients with severe aortic stenosis were enrolled in this study.The age of the patients was (72.7±4.8) years old, and there were 58 males (61.1%), and the patients with moderate or above aortic regurgitation had 30 cases (31.6%). The patients were divided into a diabetic group and a non-diabetic group according to whether they were combined with T2DM.There was no statistical difference in age, gender, body mass index (BMI), STS score, and New York Heart Association (NYHA) cardiac function classification between the 2 groups (all P>0.05). The primary end point was defined as a composite event consisting of all-cause death and stroke one month after surgery, and the secondary end point was defined as TAVR-related complications immediately after surgery and one month after surgery.The preoperative clinical data, cardiac ultrasound data, CT data, postoperative medication and the incidence of each endpoint event were compared between the 2 groups.The predictive model of adverse events was constructed by single factor and multivariate logistic regression.@*RESULTS@#Compared with the non-diabetic group, the diabetic group had high blood pressure and chronic renal insufficiency.There was no significant difference in preoperative ultrasound echocardiography between the 2 groups. Preoperative CT evaluation found that the anatomical structure of the aortic root in the diabetic group was smaller than that in the non-diabetic group, and there was no significant difference in the incidence of bicuspid aortic valve between the 2 groups (all P<0.05). In terms of postoperative medication, the use of statins in the diabetes group was significantly higher than that in the non-diabetic group. In the diabetes group, 6 patients (37.5%) received insulin therapy, and 9 patients (56.3%) received oral medication alone.Univariate logistic regression analysis showed that the all-cause death and stroke compound events was increased in the diabetes group in 30 days after TAVR (OR=6.86; 95% CI: 2.14 to 21.79; P<0.01). Heart disease (OR=2.80; 95% CI: 0.99 to 7.88; P<0.05) and chronic renal insufficiency (OR=3.75; 95% CI: 1.24 to 11.34; P<0.05) were also risk factors for all-cause death and stroke compound events.In a multivariate analysis, after adjusting for age, gender, BMI, comorbidities, N-terminal pro-B type natriuretic peptide (NT-proBNP), total calcification score, ejection fraction, and degree of aortic regurgitation, T2DM was still a risk factor for all-cause death and stroke compound events in 30 days after TAVR (OR=12.68; 95% CI: 1.76 to 91.41; P<0.05).@*CONCLUSIONS@#T2DM is a risk factor for short-term poor prognosis in patients with symptomatic severe AS after TAVR treatment. T2DM should play an important role in the future construction of the TAVR surgical risk assessment system, but the conclusions still need to be further verified by long-term follow-up of large-scale clinical studies.

Aged , Aortic Valve/surgery , Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Diabetes Mellitus, Type 2/complications , Female , Humans , Male , Renal Insufficiency, Chronic/complications , Risk Factors , Severity of Illness Index , Stroke , Transcatheter Aortic Valve Replacement/methods , Treatment Outcome , United States
Rev. bras. cir. cardiovasc ; 36(6): 807-816, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1351668


Abstract Introduction: The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge. Methods: This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR). Results: A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse. Conclusion: We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.

Humans , Aged , Aortic Valve Insufficiency/surgery , Aortic Valve Insufficiency/complications , Aortic Valve Prolapse/surgery , Aortic Valve Prolapse/complications , Aortic Valve Prolapse/diagnostic imaging , Heart Septal Defects, Ventricular/surgery , Heart Septal Defects, Ventricular/complications , Prolapse , Syndrome , Retrospective Studies , Treatment Outcome
Rev. bras. cir. cardiovasc ; 36(2): 192-200, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1251087


Abstract Introduction: Valve-reimplantation and remodelling techniques used in aortic reconstruction provide successful early, mid, and long-term results. We present our early and late-term experience with 110 patients with aortic regurgitation (AR) who underwent aortic valve repair (AVr) or valve-sparing aortic root surgeries (VSARS) due to aortic dissection or aortic aneurysm. Methods: Nine hundred eighty-two patients who underwent aneurysm or dissection surgery and aortic valve surgery between April 1997 and January 2017 were analysed using the patient database. A total of 110 patients with AR who underwent AVr or VSARS due to aortic dissection or aortic aneurysm were included in the study. Results: In the postoperative period, a decrease was observed in AR compared to the preoperative period (P<0.001); there was an increase in postoperative ejection fraction (EF) compared to the preoperative values (P<0.005) and a significant decrease in postoperative left ventricle diameters compared to the preoperative values (P<0.001). Kaplan-Meier analysis revealed one, two, four, and five-year freedom from moderate-severe AR as 95%, 91%, 87%, and 70%, respectively. Freedom from reoperation in one, two, and five years were 97.9%, 93.6%, and 81%, respectively. Eight patients (7.4%) underwent AVr during follow-up. Out of the remaining 100 patients, 13 (12%) had minimum AR, 52 (48%) had 1st-2nd degree AR, and 35 (32%) had 2nd-3rd degree AR during follow-up. Conclusion: For the purpose of maintaining the native valve tissue, preserving the EF and the left ventricular end-diastolic diameter, valve-sparing surgeries should be preferred for appropriate patients.

Aortic Aneurysm/surgery , Aortic Aneurysm/complications , Aortic Valve Insufficiency/surgery , Aneurysm, Dissecting/surgery , Aortic Valve/surgery , Reoperation , Retrospective Studies , Follow-Up Studies , Treatment Outcome
Rev. bras. cir. cardiovasc ; 36(1): 130-132, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155797


Abstract Aortic valve endocarditis can lead to secondary involvement of aorto-mitral curtain and the adjacent anterior mitral leaflet (AML). The secondary damage to AML is often caused by the infected jet of aortic regurgitation hitting the ventricular surface of the mitral leaflet, or by the pronounced bacterial vegetation that prolapses from the aortic valve into the left ventricular outflow tract. This is called 'kissing lesion'. We describe a patient with infective endocarditis of the aortic valve causing perforation of both noncoronary cusp of aortic valve and the AML, which is rare.

Humans , Aortic Valve Insufficiency/surgery , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/diagnostic imaging , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnostic imaging , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency
Rev. cuba. med. gen. integr ; 36(4): e1324, tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156489


Introducción: El síndrome de Noonan es una enfermedad congénita con una incidencia de 1:1000-2500 recién nacidos vivos. Se encuentra subdiagnosticada en nuestro medio debido a la variabilidad clínica, lo cual no permite un adecuado control y seguimiento para detectar complicaciones consecuentes a los defectos cardiovasculares congénitos. En Perú no existen reportes de casos sobre el síndrome de Noonan y sus complicaciones. Objetivo: Discutir la importancia del examen clínico para su adecuado diagnóstico a partir de las características del síndrome de Noonan en un adulto. Caso clínico: Presentamos el caso de un varón de 33 años con síndrome de Noonan, endocarditis infecciosa e insuficiencia aórtica severa. Conclusiones: Se resalta la importancia del examen físico y el uso de criterios diagnósticos para realizar el diagnóstico del síndrome de Noonan(AU)

Introduction: Noonan syndrome is a congenital disease with an incidence of 1: 1000-2500 live newborns. Due to its clinical variability, it is underdiagnosed in our setting, which does not allow adequate control and follow-up to detect complications resulting from congenital cardiovascular defects. In Peru, there are no case reports on Noonan syndrome and its complications. Objective: To discuss the importance of clinical examination for adequate diagnosis of Noonan syndrome, based on the characteristics of the disease in an adult. Clinical case: We present the case of a 33-year-old male patient with Noonan syndrome, infective endocarditis, and severe aortic regurgitation. Conclusions: The importance of physical examination and the use of diagnostic criteria to diagnose Noonan syndrome are highlighted(AU)

Humans , Male , Adult , Aortic Valve Insufficiency/surgery , Endocarditis/diagnosis , Noonan Syndrome/complications , Noonan Syndrome/genetics , Noonan Syndrome/epidemiology , Peru
Rev. bras. cir. cardiovasc ; 35(4): 573-576, July-Aug. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137288


Abstract Left sinus of Valsalva aneurysm (SVA) is a very infrequent clinical entity. Valsalva aneurysms are often asymptomatic in right and non-coronary sinuses and the diagnosis is often incidental. A left SVA which presents with exertional chest pain due to compression of left coronary system arteries is extremely rare. In this case, we present a successful surgical repair of left SVA without aortic regurgitation or myocardial infarction in a 59-year-old male patient.

Humans , Male , Middle Aged , Aortic Aneurysm/surgery , Aortic Aneurysm/complications , Aortic Aneurysm/diagnostic imaging , Sinus of Valsalva/surgery , Sinus of Valsalva/diagnostic imaging , Aortic Valve Insufficiency/surgery , Aortic Valve Insufficiency/diagnostic imaging , Chest Pain/etiology , Myocardial Infarction
Arch. cardiol. Méx ; 90(2): 108-115, Apr.-Jun. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131018


Abstract Background: Paravalvular leak (PVL) is a frequent and important complication after surgical valvular replacement that can cause heart failure and hemolytic anemia and is associated with poor clinical outcomes. Surgical reoperation has been the standard treatment, but it is associated with high morbidity and mortality. Transcatheter closure is a therapeutic alternative. The aim of the present study is to analyze the feasibility and the short- and medium-term outcomes of the transcatheter closure of PVLs. Methods: Single-center registry of consecutive patients with post-surgical PVLs that underwent transcatheter closure, between January 2006 and December 2016. Efficacy and safety results were analyzed during the procedure and at 6-month follow-up. Results: Twenty-one PVLs (15 mitral, 5 aortic, and 1 tricuspid) were closure during 20 procedures. In the initial echocardiography, 91% of the leaks were severe. The most used device was the Amplatzer Vascular Plug III® in 10 procedures (50%). The three-dimensional transesophageal echocardiography was used in 70% of cases. The device was successfully implanted in 95% of cases, a regurgitation reduction ≥ 1 grade was achieved in 95% of the cases, and the clinical success was 79%. Six-month survival was 100%; however, three cases required valvular surgery (15%). Conclusions: Transcatheter closure of PVLs is a feasible and safe procedure with high rates of technical, echocardiographic, and clinical success in the short and medium term. It is an adequate therapeutic alternative, mainly in high surgical risk patients and multiples comorbidities.

Resumen Introducción: La fuga paravalvular es una complicación frecuente e importante posterior al reemplazo valvular quirúrgico que puede ocasionar insuficiencia cardiaca, anemia hemolítica y se relaciona con malos resultados clínicos. La reintervención quirúrgica ha sido el tratamiento habitual, pero se acompaña de alta morbimortalidad. El cierre transcatéter es una alternativa terapéutica. El objetivo del presente estudio es analizar la factibilidad y los resultados a corto y mediano plazo del cierre transcatéter de fugas paravalvulares con dispositivos oclusores. Métodos: Registro unicéntrico de una serie consecutiva de pacientes con fugas paravalvulares posquirúrgicas que fueron cerradas vía transcatéter con dispositivos oclusores, entre enero del 2006 y diciembre del 2016. Se analizaron los resultados de eficacia y seguridad durante el procedimiento y a seis meses. Resultados: Se trataron 21 fugas paravalvulares (15 mitrales, 5 aórticas y 1 tricuspídea) durante 20 procedimientos. El 91% de las fugas fue grave en la ecocardiografía inicial. El dispositivo utilizado con más frecuencia fue el Amplatzer Vascular Plug III® en 10 procedimientos (50%). Se utilizó ecocardiografía transesofágica tridimensional en 70% de los casos. Se logró implantar el dispositivo con éxito en el 95% de los casos; se consiguió una reducción ≥ 1 del grado de regurgitación en el 95% de las veces y se alcanzó el éxito clínico en el 79%. A seis meses la supervivencia fue del 100%; sin embargo, tres casos requirieron cirugía valvular (15%). Conclusiones: El cierre transcatéter de fugas paravalvulares es un procedimiento factible, seguro y con tasas elevadas de éxito técnico, ecocardiográfico y clínico a corto y mediano plazo. Es una alternativa terapéutica adecuada, en particular en pacientes considerados de alto riesgo quirúrgico y múltiples comorbilidades.

Humans , Male , Female , Adult , Middle Aged , Aortic Valve Insufficiency/surgery , Tricuspid Valve Insufficiency/surgery , Cardiac Catheterization/methods , Mitral Valve Insufficiency/surgery , Time Factors , Prosthesis Failure , Heart Valve Prosthesis , Registries , Follow-Up Studies , Treatment Outcome , Echocardiography, Transesophageal , Echocardiography, Three-Dimensional , Septal Occluder Device
Rev. bras. cir. cardiovasc ; 34(6): 659-666, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057493


Abstract Objective: To evaluate the changes of the mitral valve geometrics and the degrees of moderate mitral regurgitation (MR) in patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS). Methods: A retrospective analysis study of intraoperative transesophageal echocardiography (TEE) and postoperative transthoracic echocardiography (TTE) was performed in 49 patients diagnosed with pure AS combined with moderate MR, who underwent AVR from January 2013 to December 2017. TEE was used to evaluate the direct geometric changes of the mechanical effects on mitral annulus after AVR. TTE was used to evaluate the changes of MR after operation. All patients underwent TTE during the midterm follow-up. The mean follow-up time was 40.21 months. Results: All of the 49 patients had moderate MR. Anterolateral-posteromedial diameter, anterior-posterior diameter, and mitral annular area were significantly reduced after AVR, while no significant changes were found in the intraoperative left ventricular loading conditions before and after AVR. The degree of mitral valve regurgitation, left ventricular size, left atrial size, left ventricular end-diastolic volume, and left ventricular to aortic pressure gradient were significantly reduced before discharge, and midterm follow-up showed good results. Conclusion: This study supports the belief that aortic outflow tract obstruction and an actual mechanical compression of the anterior mitral annulus after AVR would cause reduction in MR. Ventricular remodeling would also cause reduction in MR with time going on. Patients with AS, especially young patients with moderate MR, were most likely to benefit from AVR in early time.

Humans , Male , Female , Adult , Middle Aged , Aged , Aortic Valve/surgery , Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Mitral Valve Insufficiency/surgery , Postoperative Period , Severity of Illness Index , Heart Valve Prosthesis , Retrospective Studies , Echocardiography, Transesophageal , Heart Valve Prosthesis Implantation/methods , Heart Ventricles/surgery , Mitral Valve/surgery
Rev. bras. cir. cardiovasc ; 34(3): 344-351, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013473


Abstract Objectives: To compare the advantages and disadvantages of perventricular and percutaneous procedures for treating isolated ventricular septal defect (VSD). Methods: A total of 572 patients with isolated VSD were selected in our hospital between January 2015 and December 2016. The patients' median age and weight were five years (1-26 years) and 29 kg (9-55 kg), respectively. The median diameter of VSD was 6.0 mm (5-10 mm). Patients were divided into two groups. In group A, perventricular device closure was performed in 427 patients; in group B, 145 patients underwent percutaneous device closure. Results: Four hundred twelve patients in group A and 135 patients in group B underwent successful closure. The total occlusion rate was 98.5% (immediately) and 99.5% (3-month follow-up) in group A, which were not significantly different from those in group B (97.7% and 100%, respectively). Patients in group A had longer intensive care unit (ICU) stay than those in group B, but patients in group B experienced significantly longer operative times than those in group A. The follow-up period ranged from 8 months to 1.5 year (median, 1 year). During the follow-up period, late-onset complete atrioventricular block occurred in two patients. No other serious complications were noted in the remaining patients. Conclusion: Both procedures are safe and effective treatments for isolated VSD. The percutaneous procedure has obvious advantages of shorter ICU stay and less trauma than the perventricular procedure. However, the perventricular procedure is simpler to execute, results in a shorter operative time, and avoids X-ray exposure.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Septal Occluder Device/standards , Heart Septal Defects, Ventricular/surgery , Aortic Valve Insufficiency/surgery , Time Factors , Angiography/methods , Echocardiography/methods , Retrospective Studies , Treatment Outcome , Statistics, Nonparametric , Equipment Design , Atrioventricular Block/surgery , Operative Time , Heart Septal Defects, Ventricular/diagnostic imaging , Cardiac Surgical Procedures/instrumentation , Cardiac Surgical Procedures/methods , Length of Stay
Rev. chil. cardiol ; 37(3): 206-211, dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-978002


Resumen: La insuficiencia aórtica severa aguda (IASA) constituye una emergencia quirúrgica; sus principales causas son la endocarditis infecciosa y la disección aórtica. Existen tres hallazgos ecocardiográficos distintivos de dicha patología, que ayudan al diagnóstico y manejo que son: el cierre prematuro de la válvula mitral (CPVM), la insuficiencia mitral diastólica (IMD) y la apertura prematura de la válvula aórtica (APVA). Estos elementos reflejan el severo aumento de la presión de fin de diástole del ventrículo izquierdo (PFDVI) y, si bien son específicos, no son únicos de dicha patología. A continuación, se reporta el caso de un paciente con IASA. Hombre de 36 años, sin antecedentes, consulta por estado infeccioso asociado a insuficiencia cardíaca aguda. Ingresa en shock cardiogénico y la ecocardiografía muestra: ventrículo izquierdo severamente dilatado con función sistólica conservada, dilatación leve de la aurícula izquierda y una endocarditis de válvula aórtica trivalvar asociado a insuficiencia severa. Se identifica, además, la presencia de CPVM y de IMD hallazgos que evidenciaban la severidad de la lesión y lo agudo de la presentación. Se realizó un recambio valvular aórtico de urgencia con una prótesis biológica con buena evolución postoperatoria.

Abstracts: Severe acute aortic regurgitation (SAAR) constitutes a surgical emergency. Its main causes are infective endocarditis and aortic dissection. Three echocardiographic hallmarks aid in its diagnosis and management, namely: premature opening of the aortic valve (POAV), premature mitral valve closure (PMVC) and diastolic mitral regurgitation (DMR), findings that reflect the great increase in left ventricular end-diastolic pressure. Also, these findings are distinctive but not unique to SAAR. We report a 36-year-old male, without past medical history that refers three weeks of malaise, fever and heart failure. At the emergency department, the patient evolved to cardiogenic shock being admitted to the coronary unit. A transthoracic and transesophageal echocardiography revealed a severely dilated left ventricle with normal systolic function, a mild left atrium enlargement and endocarditis of a trileaflet aortic valve with severe regurgitation. Furthermore, PMVC and DMR were identified, findings that portrayed the severe and acute presentation of the disease. A surgical aortic valve replacement was performed uneventfully, and the patient discharged in good conditions.

Humans , Male , Adult , Aortic Valve Insufficiency/diagnostic imaging , Echocardiography/methods , Aortic Valve Insufficiency/surgery , Acute Disease , Heart Valve Prosthesis Implantation , Heart Valve Diseases/diagnostic imaging , Mitral Valve/surgery , Mitral Valve/diagnostic imaging
Rev. chil. cardiol ; 37(3): 212-213, dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-1042596


Resumen: Recientemente, Sepúlveda et al. publicaron en la Revista Chilena de Cardiología(1) el caso clínico de una mujer de 60 años con una válvula aórtica cuadricúspide, diagnosticada por ecocardiografía transtorácica y transesofágica, no operada, con una extensa revisión de la literatura respectiva. En esta oportunidad, nosotros presentamos los hallazgos intraoperatorios en un hombre de 72 años operado por una insuficiencia aórtica severa secundaria a una válvula aórtica cuadricúspide no diagnosticada preoperatoriamente.

Abstracts: Recently, Sepúlveda et al. published in Revista Chilena de Cardiología1 the clinical case of a 60-year-old woman with quadricuspid aortic valve diagnosed by transthoracic and transesophageal echocardiography not operated on, including an extensive review of the literature. We present the intraoperative findings of a 72-year-old man with severe aortic insufficiency and a quadricuspide aortic valve, not preoperatively diagnosed.

Humans , Male , Aged , Aortic Valve/abnormalities , Aortic Valve/surgery , Aortic Valve Insufficiency/surgery , Aortic Valve Insufficiency/etiology
Rev. bras. cir. cardiovasc ; 33(6): 573-578, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-977481


Abstract Introduction: The aim of this study is to investigate the change in the dimension of sinus of Valsalva in patients who underwent supracoronary ascending aorta replacement with aortic valve replacement. Methods: A total of 81 patients who underwent supracoronary ascending aorta replacement with aortic valve replacement were included. Ten of 81 patients died during the follow-up. The patients were divided into three groups according to the aortic valve diseases. Group I (n=17) included patients with bicuspid valves, group II (n=30) included patients with stenotic degenerative valves, and patients with aortic regurgitation constituted group III (n=24). In preoperative and follow-up periods, the sinus of Valsalva diameter of the patients was evaluated by echocardiographic examination. The mean age was 54.1±15.1 years. Twenty-eight (34.6%) patients were female and 12 (14.8%) patients were in New York Heart Association functional class III. Results: There was no early mortality. Late mortality was developed in 10 (12.4%) patients, 8 (9.9%) due to non-cardiac reasons. Late follow-up was obtained in 71 patients with a mean of 60±30.1 months postoperatively. During follow-up, the increase in the diameter of the sinus of Valsalva was significant in Group I (P<0.01), while in Group II and III it was insignificant (P>0.05). Conclusion: To avoid the risks associated with sinus of Valsalva dilatation, it is reasonable to replace the sinus of Valsalva in the setting of aortic valve replacement and ascending aorta replacement for bicuspid aortic valve with a dilated ascending aorta and relatively normal sinuses of Valsalva in young patients.

Humans , Male , Female , Middle Aged , Aortic Valve/abnormalities , Aortic Valve/surgery , Sinus of Valsalva/surgery , Heart Valve Prosthesis Implantation/methods , Heart Defects, Congenital/surgery , Heart Valve Diseases/surgery , Mitral Valve/surgery , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/surgery , Aortic Valve Insufficiency/diagnostic imaging , Sinus of Valsalva/diagnostic imaging , Echocardiography , Retrospective Studies , Age Factors , Heart Valve Prosthesis Implantation/mortality , Heart Defects, Congenital/mortality , Heart Defects, Congenital/diagnostic imaging , Heart Valve Diseases/mortality , Heart Valve Diseases/diagnostic imaging , Mitral Valve/diagnostic imaging
Clinics ; 72(4): 207-212, Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-840070


OBJECTIVES: The effect of performing aortic valve repair in combination with valve-sparing operation on the length of time for which patients are free from reoperation is unclear. The objective of this study was to determine if the performance of aortic valve repair during valve-sparing operation modified the freedom from reoperation time. METHODS: From January 2003 to July 2014, 78 patients with a mean age of 49±15 years underwent valve-sparing operation. Sixty-eight percent of these patients were male. Twenty-two (28%) aortic valve repair procedures were performed in this patient population. In the aortic valve repair + valve-sparing operation group, 77.3% of patients had moderate/severe aortic insufficiency, while in the valve-sparing operation group, 58.6% of patients had moderate/severe aortic insufficiency (ns = not significant). Additionally, 13.6% of patients in the aortic valve repair + valve-sparing operation group had functional class III/IV, while 14.2% of patients in the valve-sparing operation group had functional class III/IV (ns). RESULTS: The in-hospital and late mortality rates, for the aortic valve repair + valve-sparing operation and valve-sparing operation groups were similar, as they were 4.5% and 3.6%; and 0% and 1.8%, respectively. In the aortic valve repair + valve-sparing operation group, 0% of patients presented moderate/severe aortic insufficiency during late follow-up, while in the valve-sparing operation group, 14.2% of patients presented with moderate/severe aortic insufficiency during this period (ns). In the aortic valve repair + valve-sparing operation group, 5.3% of patients presented with functional class III/IV, while in the valve-sparing operation group, 4.2% of patients presented with functional class III/IV (ns). In the aortic valve repair + valve-sparing operation group, 0% of patients required reoperation, while in the valve-sparing operation group, 3.6% of patients required reoperation over a mean follow-up period of 1621±1156 days (75 patients). CONCLUSION: Valve-sparing operation is a safe and long-lasting procedure and performance of aortic valve repair when necessary does not increase risk of reoperation on the aortic valve.

Humans , Male , Female , Adult , Middle Aged , Aged , Aortic Valve/surgery , Heart Valve Diseases/surgery , Operative Time , Organ Sparing Treatments , Reconstructive Surgical Procedures/methods , Reoperation , Aortic Valve Insufficiency/mortality , Aortic Valve Insufficiency/surgery , Follow-Up Studies , Heart Valve Diseases/mortality , Reconstructive Surgical Procedures/statistics & numerical data , Reoperation/statistics & numerical data , Replantation/methods , Replantation/mortality , Survival Rate , Time Factors , Treatment Outcome
Rev. bras. cir. cardiovasc ; 32(1): 49-52, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-1042027


Abstract Scientific progress shall ultimately boost the current acceptance level for conservative aortic valve surgery. The present text aimed to report the 23-year long-term follow-up of one patient operated with bovine pericardium cusp extension. Growing confidence in the efficacy of the operation will allow a more expeditious indication for surgical treatment, as is already the case in mitral valve repair. This change of attitude will certainly make it possible for patients to be sent for operation in mild aortic valve regurgitation. The present report reinforces the concept and highlights the impression that the aortic valvoplasty, independent of the progressive bovine pericardium degeneration, may positively change the natural history of the aortic valve insufficiency.

Humans , Animals , Female , Middle Aged , Aortic Valve/surgery , Aortic Valve Insufficiency/surgery , Pericardium/transplantation , Aortic Valve/pathology , Bioprosthesis , Cattle , Echocardiography, Doppler , Heart Valve Prosthesis Implantation , Electrocardiography
Rev. chil. cardiol ; 36(1): 41-45, 2017. ilus
Article in Spanish | LILACS | ID: biblio-844308


An 84-year man with prior coronary artery bypass surgery and endovascular repair of an abdominal aortic aneurysm developed congestive heart failu-re. He had calcific aortic valve disease with severe regurgitation. A #29 Edwards-Sapien aortic valve via trans-apical approach was implanted with the patient connected to extra corporeal circulation. The patient recovered successfully and remained in functional class II 8 months after hospital dis-charge.

Humans , Male , Aged, 80 and over , Aortic Valve Insufficiency/surgery , Extracorporeal Membrane Oxygenation , Heart Valve Prosthesis Implantation/methods
Arq. bras. cardiol ; 107(1): 55-62, July 2016. tab, graf
Article in English | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: lil-792497


Abstract Background: Paravalvular regurgitation (paravalvular leak) is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair. Objectives: To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure. Methods: This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure. Results: The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases), with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57) and a higher mortality rate (0% vs. 20%, p = 0.08). A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08). Conclusion: Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk.

Resumo Fundamento: Regurgitação ou escape paravalvar é uma complicação grave e incomum associada ao implante de prótese valvar. Estudos mostram incidência de 3% a 6% com repercussão hemodinâmica. Existem poucos estudos na literatura que comparam as abordagens cirúrgica e percutânea para sua correção. Objetivos: Comparar as abordagens cirúrgica e percutânea de correção da regurgitação paravalvar quanto a desfechos clínicos durante a internação e após 1 ano do procedimento. Métodos: Este é um estudo retrospectivo, descritivo e observacional, que incluiu 35 pacientes com escape paravalvar acompanhados no Instituto Dante Pazzanese de Cardiologia entre janeiro de 2011 e dezembro de 2013 e que necessitaram de correção. Os pacientes foram divididos de acordo com o tratamento estabelecido e acompanhados por um período 1 ano após o procedimento. Resultados: O grupo submetido ao tratamento percutâneo foi considerado como de maior risco para complicações por apresentar pacientes mais idosos, com maior prevalência de diabetes, maior quantidade de cirurgias valvares prévias e menor valor médio de clearance de creatinina. Durante a evolução intra-hospitalar, observou-se grande número de complicações nos dois grupos (74,3% dos casos), sem diferença estatística nos desfechos analisados. Após 1 ano, o grupo percutâneo teve maior número de reintervenções (8,7% vs. 20%, p = 0,57) e mortalidade maior (0% vs. 20%, p = 0,08). Uma alta incidência de escape residual mitral foi verificada após procedimento percutâneo (8,7% vs. 50%, p = 0,08). Conclusão: A cirurgia é o tratamento de escolha da regurgitação paravalvar. A abordagem percutânea pode ser uma alternativa para os pacientes com risco cirúrgico elevado.

Humans , Male , Female , Adult , Middle Aged , Aged , Aortic Valve Insufficiency/surgery , Aortic Valve Insufficiency/etiology , Heart Valve Prosthesis Implantation/adverse effects , Percutaneous Coronary Intervention/methods , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/etiology , Aortic Valve/surgery , Aortic Valve Insufficiency/mortality , Postoperative Complications/surgery , Postoperative Complications/mortality , Reoperation , Time Factors , Bioprosthesis/adverse effects , Heart Valve Prosthesis/adverse effects , Retrospective Studies , Risk Factors , Treatment Outcome , Echocardiography, Transesophageal , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis Implantation/mortality , Therapeutic Occlusion/methods , Therapeutic Occlusion/mortality , Percutaneous Coronary Intervention/mortality , Hospitalization , Mitral Valve/surgery , Mitral Valve Insufficiency/mortality