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1.
Rev. urug. cardiol ; 36(3): e405, 2021. ilus, graf, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1367044

ABSTRACT

Desde que Edward Heyde vislumbró en 1958 una misteriosa asociación entre estenosis aórtica y hemorragia digestiva han transcurrido seis décadas y se ha suscitado no poca controversia. En la época en que fue propuesta, el estatus técnico y metodológico de la ciencia médica y una interpretación sesgada de su idea original impidieron obtener un sustento estadístico y fisiopatológico que le otorgara un amplio reconocimiento como entidad clínica individual. Los avances en varias disciplinas permitieron demostrar que su frecuencia de presentación excede el efecto del azar, además de esclarecer con precisión y elegancia sus mecanismos fisiopatológicos. Su consolidación como síndrome nos revela una verdadera encrucijada entre la cardiología, la gastroenterología, la hematología y el laboratorio, especialidades involucradas tanto en su proceso de comprensión como en su manejo práctico en la actualidad. Sin embargo, a pesar de tener una incidencia no desdeñable y adquirir un papel central en la conducción clínica de la estenosis aórtica, esta entidad parece haber pasado de ser resistida a relativamente ignorada. Con el objetivo de contribuir a su visibilidad, la presente revisión ofrece un panorama integral sobre el tema, incluyendo una perspectiva histórica de los principales aportes en pos de su conocimiento y un abordaje en profundidad de sus mecanismos, las claves de su detección clínica y su impacto en el manejo de la estenosis aórtica y otras entidades con fisiopatología afín.


Since Edward Heyde perceived in 1958 a mysterious association between aortic stenosis and gastrointestinal bleeding, six decades have passed and no little controversy has arisen. At the time it was proposed, the technical and methodological status of medical science and a biased interpretation of his original idea prevented obtaining a statistical and pathophysiological support that would grant it wide recognition as and individual clinical entity. Advances in several disciplines allowed to demonstrate that its frequency of presentation exceeds the effect of chance, besides clarifying with precision and elegance its pathophysiological mechanisms. Its consolidation as a syndrome reveals a true crossroads between Cardiology, Gastroenterology, Hematology and Laboratory, specialties involved both in its understanding process and in its practical management today. However, despite having a not negligible incidence and acquiring a central role in the clinical conduction of aortic stenosis, this entity seems to have gone from being resisted to relatively ignored. With the objective of contributing to its visibility, this review offers a comprehensive overview of the subject, covering the main historical contributions to its knowledge and approaching in depth its mechanisms, the keys to its clinical detection and its impact on the management of aortic stenosis and other entities with related pathophysiology.


Desde que Edward Heyde imaginou em 1958 uma misteriosa associação entre estenose aórtica e hemorragia gastrointestinal, seis décadas se passaram e não houve pouca controvérsia. Na época em que foi levantada, o estado técnico e metodológico da ciência médica e uma interpretação tendenciosa de sua ideia original impediram a construção de um apoio estatístico e fisiopatológico que lhe concederia amplo reconhecimento como entidade clínica individual. Avanços em diversas disciplinas permitiram demonstrar que sua frequência de apresentação excede o efeito do acaso, além de esclarecer com precisão e elegância seus mecanismos fisiopatológicos. Sua consolidação como síndrome revela uma verdadeira encruzilhada entre Cardiologia, Gastroenterologia, Hematologia e Laboratório, especialidades envolvidas tanto em seu processo de compreensão quanto em sua gestão prática hoje. No entanto, apesar de ter uma incidência não desprezível e adquirir um papel central no manejo clínico da estenose aórtica, esta entidade parece ter passado de resistida para relativamente ignorada. Com o intuto de contribuir para sua visibilidade, esta revisão oferece um panorama abrangente do tema, revendo as principais contribuições históricas ao seu conhecimento e abordando em profundidade seus mecanismos, as chaves para sua detecção clínica e seu impacto na gestão da estenose aórtica e outras entidades com fisiopatologia relacionada.


Subject(s)
Humans , Aortic Valve Stenosis/complications , Angiodysplasia/complications , Gastrointestinal Hemorrhage/etiology , Aortic Valve Stenosis/surgery , von Willebrand Diseases/complications , Angiodysplasia/etiology , Angiodysplasia/therapy , Heart Valve Prosthesis Implantation , Gastrointestinal Hemorrhage/therapy
2.
Revista Digital de Postgrado ; 9(1): e194, 2020. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1095043

ABSTRACT

El implante valvular aórtico transcatéter, es un procedimiento cardiovascular de mínima invasión y una alternativa frente a la intervención convencional, en insuficiencia aórtica severa. En este trabajo se realiza una revisión de las complicaciones y la sobrevida, en pacientes sometidos a TAVI, frente a remplazo aórtico tradicional. Para ello se realizó una investigación documental con información entre los años 2010-2018. El implante valvular aórtico transcatéter debe efectuarse vía transfemoral o transapical, con una válvula Core o Sapien XT, según la necesidad del individuo, para evitar la regurgitación para valvular. Con este implante disminuyen las complicaciones y se remodela el ventrículo izquierdo; reduciendo la disnea y mejorando el pronóstico vida y la tasa de mortalidad en comparación con otros métodos(AU)


The transcatheter aortic valve implant is a minimally invasive cardiovascular procedure and, an alternative to conventional intervention in severe aortic insufficiency. In this work, a review of complications and survival is performed in patients undergoing TAVI, compared to traditional aortic replacement. For this, a documentary investigation was carried out with information between the years 2010-2018. The transcatheter aortic valve implant should be performed transfemorally or transapically, with a Core or Sapien XT valve, depending on the individual's need, to avoid regurgitation to valvulate. With this implant the complications decrease and the left ventricle is remodeled; reducing breathlessness and improving the life prognosis and mortality rate compared to other methods(AU)


Subject(s)
Humans , Aortic Valve Insufficiency/diagnosis , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/complications , Radiography, Thoracic/methods , Transcatheter Aortic Valve Replacement/methods , Surgical Clearance , Angiography/methods , Cardiac Catheterization , Survival Rate , Retrospective Studies
3.
Arq. bras. cardiol ; 113(6): 1104-1111, Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055057

ABSTRACT

Abstract Background: Chronic kidney disease (CKD) is frequently present in patients with aortic valve disease. Decreased kidney perfusion as a consequence of reduced cardiac output may contribute to renal dysfunction in this setting. Objective: Given the potential reversibility of kidney hypoperfusion after valve repair, this study aimed to analyze the impact of percutaneous transcatheter aortic valve implantation (TAVI) on kidney function. Methods: We performed a retrospective analysis of 233 consecutive patients who underwent TAVI in a single center between November 2008 and May 2016. We assessed three groups according to their baseline estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2): Group 1 with eGFR ≥ 60; Group 2 with 30 ≤ eGFR < 60; and Group 3 with eGFR < 30. We analyzed the eGFR one month and one year after TAVI in these three groups, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula to calculate it. Results: Patients from Group 1 had a progressive decline in eGFR one year after the TAVI procedure (p < 0.001 vs. pre-TAVI). In Group 2 patients, the mean eGFR increased one month after TAVI and continued to grow after one year (p = 0.001 vs. pre-TAVI). The same occurred in Group 3, with the mean eGFR increasing from 24.4 ± 5.1 mL/min/1.73 m2 before TAVI to 38.4 ± 18.8 mL/min/1.73 m2 one year after TAVI (p = 0.012). Conclusions: For patients with moderate-to-severe CKD, kidney function improved one year after the TAVI procedure. This outcome is probably due to better kidney perfusion post-procedure. We believe that when evaluating patients that might need TAVI, this 'reversibility of CKD effect' should be considered.


Resumo Fundamento: Pacientes com doença valvar aórtica frequentemente apresentam doença renal crônica (DRC). Diminuição da perfusão renal como consequência da redução do débito cardíaco pode contribuir para a disfunção renal neste cenário. Objetivo: Dado o potencial de reversibilidade da hipoperfusão renal após o reparo valvar, este estudo teve o objetivo de analisar o impacto do implante percutâneo de válvula aórtica (TAVI - transcatheter aortic valve implantation) na função renal. Métodos: Foi realizada uma análise retrospectiva de 233 pacientes consecutivos submetidos ao TAVI em um único centro, entre novembro de 2008 e maio de 2016. Três grupos foram avaliados de acordo com a taxa de filtração glomerular estimada (TFGe) basal (mL/min/1,73 m2): Grupo 1 com TFGe ≥ 60; Grupo 2 com 30 ≤ TFGe < 60; e Grupo 3 com TFGe < 30. O TFGe foi analisado nestes três grupos um mês e um ano após o TAVI e calculado usando a fórmula do Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Resultados: Os pacientes do Grupo 1 tiveram um declínio progressivo da TFGe um ano após o procedimento TAVI (p < 0,001 vs. pré-TAVI). Nos pacientes do Grupo 2, a média da TFGe aumentou um mês depois do TAVI e continuou crescendo depois de um ano (p = 0,001 vs. pré-TAVI). O mesmo ocorreu no Grupo 3, com a média da TFGe subindo de 24,4 ± 5,1 mL/min/1,73 m2 antes do TAVI para 38,4 ± 18,8 mL/min/1,73 m2 um ano após o TAVI (p = 0,012). Conclusões: Em pacientes com DRC moderada a grave, a função renal melhorou um ano após o procedimento TAVI. Este resultado é provavelmente devido à melhora da perfusão renal pós-procedimento. Acredita-se que, ao avaliar pacientes que possam precisar de TAVI, este 'efeito de reversibilidade da DRC' deva ser considerado.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Aortic Valve Stenosis/surgery , Renal Insufficiency, Chronic/rehabilitation , Transcatheter Aortic Valve Replacement/methods , Aortic Valve Stenosis/complications , Comorbidity , Retrospective Studies , Risk Factors , Renal Insufficiency, Chronic/etiology , Transcatheter Aortic Valve Replacement/statistics & numerical data , Glomerular Filtration Rate
4.
Int. j. cardiovasc. sci. (Impr.) ; 32(5): 492-504, Sept-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040093

ABSTRACT

Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for high-risk or non-operable patients with severe symptomatic aortic stenosis. Atrioventricular conduction disturbances requiring permanent pacemaker (PPM) are a common and clinically important complication. Objectives: To evaluate the incidence of conduction disorders (CDs) after TAVI and the need for subsequent PPM implantation. To identify the predictors of postoperative PPM implantation. Methods: Retrospective study. All patients who underwent TAVI in a public hospital from December/2011 to June/2016 were included. Multivariate analysis was conducted to establish the predictor of permanent pacemaker implantation. Survival curves were constructed by the Kaplan-Meyer method. Statistically significant variables were those with p value < 0.05. Results: 64 patients with AS underwent TAVI. Eleven patients were excluded. TAVI induced a new CD in 40 (77%) of the remaining 53 patients. The most common new CDs were 3rd degree AV block (32%) and left bundle branch block (30%). Sixteen patients (30,2%) underwent PPM implantation during the index hospitalization. On univariate analysis the risk factors for PPM implantation were CoreValve® use (OR: 1,76; P = 0,005), larger prosthesis implantation (P = 0,015), presence of a QRS ≥ 120 ms (OR: 5,62; P = 0,012), and 1st degree AV block (OR: 13; P = 0.008). On multivariate analysis the presence of 1st degree AV block predicted the need for PPM. Conclusion: TAVI induced CDs requiring PPM in 30% of the patients. The presence of 1st degree AV block predicted the need for PPM


Subject(s)
Humans , Male , Female , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/therapy , Pacemaker, Artificial , Bundle-Branch Block , Transcatheter Aortic Valve Replacement/methods , Aortic Valve , Stroke Volume , Echocardiography/methods , Statistical Analysis , Multivariate Analysis , Retrospective Studies , Risk Factors , Atrioventricular Block
8.
Arch. cardiol. Méx ; 87(2): 108-115, Apr.-Jun. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-887504

ABSTRACT

Resumen: Objetivo: La prevalencia de calcificación valvular aórtica (CVA) tiene influencia importante de la etnia y se desconoce en población mexicana. Nuestro objetivo fue investigar la prevalencia de CVA y sus asociaciones con factores de riesgo cardiovascular y calcificación arterial coronaria (CAC). Método: En 1,267 sujetos (53% mujeres) sin enfermedad coronaria conocida y con edad de 35 a 75 años, la CVA y la CAC se evaluaron mediante tomografía computada multidetector, utilizando el método de Agatston. Los factores de riesgo cardiovascular se documentaron en todos los participantes. Las asociaciones de CVA con CAC y factores de riesgo se estimaron usando el análisis de regresión logística múltiple. Resultados: La prevalencia global de CVA y CAC fue del 19.89% y del 26.5%, respectivamente. Ambas condiciones aumentaron con la edad y se encontraron con mayor frecuencia en hombres (25.5 y 37.1%, respectivamente) que en mujeres (14.9 y 13%, respectivamente). La CVA se observó en únicamente el 8.5% de los sujetos sin CAC, mientras que en aquellos con CAC 1-99, 100-399 y > 400 unidades Agatston, las prevalencias fueron del 36.8, 56.8 y 84%, respectivamente. El análisis de regresión logística múltiple ajustado por edad, género, obesidad, inactividad física, hipertensión, dislipidemia y valores altos de insulina, mostró que la presencia de CAC (RM [IC95%]: 3.23 [2.26-4.60]), obesidad (1.94 [1.35-2.79]), género masculino (1.44 [1.01-2.05]) y edad (1.08 [1.03-1.10]), fueron predictores independientes y significativos de la CVA. Conclusiones: La prevalencia de CVA es alta y se asocia significativamente con factores de riesgo aterosclerótico y CAC en población mexicana.


Abstract: Objetive: The prevalence of aortic valve calcification (AVC), strongly influenced by ethnicity, is unknown in Mexican population. The aim of this study was to investigate the prevalence of AVC and its associations with cardiovascular risk factors and coronary artery calcification (CAC), in Mexican subjects. Methods: In 1,267 subjects (53% women) without known coronary heart disease, aged 35 to 75 years, AVC and CAC were assessed by multidetector-computed tomography using the Agatston score. Cardiovascular risk factors were documented in all participants. The associations of AVC with CAC and risk factors were assessed by multivariable logistic regression analyses. Results: The overall prevalence of AVC and CAC was 19.89% and 26.5%, respectively. AVC and CAC increased with age and were found more frequently in men (25.5% and 37.1%, respectively) than in women (14.9% and 13.0%, respectively). AVC was observed in only 8.5% of subjects wit-hout CAC, while those with CAC 1-99, 100-399, and > 400 Agatston units had AVC prevalences of 36.8%, 56.8%, and 84.0%, respectively. The multivariable logistic regression analyses, adjusted for age, gender, obesity, physical inactivity, hypertension, dyslipidemia and high insulin levels, showed that the presence of CAC (OR [CI95%]: 3.23 [2.26-4.60]), obesity (1.94 [1.35-2.79]), male gender (1.44 [1.01-2.05]) and age (1.08 [1.03-1.10]), were significant independent predictors of AVC. Conclusion: Prevalence of AVC is high and significantly associated with atherosclerotic risk factors and CAC in this Mexican population.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aortic Valve/pathology , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/epidemiology , Coronary Artery Disease/complications , Calcinosis/complications , Calcinosis/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors , Mexico/epidemiology
9.
Arch. endocrinol. metab. (Online) ; 60(6): 582-586, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-827786

ABSTRACT

ABSTRACT Objective The current study was aimed at analyzing sarcoplasmic reticulum Ca2+ ATPase (Serca2) and ryanodine receptor type 2 (Ryr2) gene expression in rats subjected to surgery that induced HF and were subsequently treated with T4 using physiological doses. Materials and methods HF was induced in 18 male Wistar rats by clipping the ascending thoracic aorta to generate aortic stenosis (HFS group), while the control group (9-sham) underwent thoracotomy. After 21 weeks, the HFS group was subdivided into two subgroups. One group (9 Wistar rats) with HF received 1.0 µg of T4/100 g of body weight for five consecutive days (HFS/T4); the other group (9 Wistar rats) received isotonic saline solution (HFS/S). The animals were sacrificed after this treatment and examined for signs of HF. Samples from the left ventricles of these animals were analyzed by RT-qPCR for the expression of Serca2 and Ryr2 genes. Results Rats with HF developed euthyroid sick syndrome (ESS) and treatment with T4 restored the T3 values to the Sham level and increased Serca2 and Ryr2 gene expression, thereby demonstrating a possible benefit of T4 treatment for heart function in ESS associated with HF. Conclusion The T4 treatment can potentially normalize the levels of T3 as well elevated Serca2 and Ryr2 gene expression in the myocardium in heart failure rats with euthyroid sick syndrome.


Subject(s)
Animals , Male , Thyroxine/administration & dosage , Euthyroid Sick Syndromes/drug therapy , Ryanodine Receptor Calcium Release Channel/drug effects , Aortic Valve Stenosis/complications , Thyroxine/therapeutic use , Triiodothyronine/drug effects , Euthyroid Sick Syndromes/complications , Euthyroid Sick Syndromes/genetics , RNA, Messenger/metabolism , Gene Expression/drug effects , Rats, Wistar , Ryanodine Receptor Calcium Release Channel/genetics , Models, Animal , Sarcoplasmic Reticulum Calcium-Transporting ATPases/drug effects , Sarcoplasmic Reticulum Calcium-Transporting ATPases/genetics , Heart Failure/complications
10.
Rev. bras. anestesiol ; 66(1): 82-85, Jan.-Feb. 2016. tab
Article in Portuguese | LILACS | ID: lil-773478

ABSTRACT

BACKGROUND AND OBJECTIVES: Aortic stenosis increases perioperative morbidity and mortality, perioperative invasive monitoring is advised for patients with an aortic valve area <1.0 cm2 or a mean aortic valve gradient >30 mm Hg and it is important to avoid hypotension and arrhythmias. We report the anaesthetic management with continuous spinal anaesthesia and minimally invasive haemodynamic monitoring of two patients with severe aortic stenosis undergoing surgical hip repair. CASE REPORT: Two women with severe aortic stenosis were scheduled for hip fracture repair. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring was used for anaesthetic management of both. Surgery was performed successfully after two consecutive doses of 2 mg of isobaric bupivacaine 0.5% in one of them and four consecutive doses in the other. Haemodynamic conditions remained stable throughout the intervention. Vital signs and haemodynamic parameters remained stable throughout the two interventions. CONCLUSION: Our report illustrates the use of continuous spinal anaesthesia with minimally invasive haemodynamic monitoring as a valid alternative to general or epidural anaesthesia in two patients with severe aortic stenosis who are undergoing lower limb surgery. However, controlled clinical trials would be required to establish that this technique is safe and effective in these type or patients.


JUSTIFICATIVA E OBJETIVOS: A estenose aórtica aumenta a morbidade e mortalidade no período perioperatório. A monitoração invasiva no perioperatório é recomendada para pacientes com área valvar <1,0 cm2 ou gradiente médio >30 mm Hg, além de ser importante evitar a hipotensão e arritmias. Relatamos o manejo anestésico com o uso de raquianestesia contínua e monitoração hemodinâmica minimamente invasiva em duas pacientes com estenose aórtica grave, submetidas à cirurgia de reparação do quadril. RELATO DE CASO: Duas pacientes com estenose aórtica grave foram programadas para cirurgia de reparação de fratura de quadril. Raquianestesia contínua com monitoração hemodinâmica minimamente invasiva foi usada para o manejo anestésico de ambas as pacientes. A cirurgia foi realizada com sucesso após duas doses consecutivas de 2 mg de bupivacaína isobárica a 0,5% em uma das pacientes e quatro doses consecutivas na outra. As condições hemodinâmicas permaneceram estáveis durante a intervenção. Os sinais vitais e parâmetros hemodinâmicos permaneceram estáveis durante as duas intervenções. CONCLUSÃO: Nosso relato descreve o uso da raquianestesia contínua com monitoração hemodinâmica minimamente invasiva como uma alternativa válida para a anestesia geral ou peridural em duas pacientes com estenose aórtica grave, submetidas à cirurgia de membro inferior. Contudo, ensaios clínicos controlados são necessários para estabelecer que a técnica é segura e eficaz nesse tipo de pacientes.


Subject(s)
Humans , Female , Aged , Aged, 80 and over , Aortic Valve Stenosis/complications , Bupivacaine/administration & dosage , Hip Fractures/surgery , Anesthesia, Spinal/methods , Aortic Valve Stenosis/pathology , Severity of Illness Index , Monitoring, Intraoperative/methods , Hemodynamics
11.
Rev. Assoc. Med. Bras. (1992) ; 61(1): 58-60, Jan-Feb/2015. tab
Article in English | LILACS | ID: lil-744724

ABSTRACT

Introduction: valve disease is an important cause of heart failure. There is a direct relationship between valve deterioration and the patient’s inflammatory status and cytokines: interleukin-6, interleukin-1, tumor necrosis factor, and C-reactive protein, involved in this major state of inflammation. Objective: to report a series of cases of valve replacement, using a bioprosthetic or mechanical valve, and the inflammatory profile of them. Methods: patients older than 18 years and with bioprosthetic or mechanical valve placed for a minimum of 6 months and maximum of 2 years were included. In addition to the demographic characteristics of each patient, inflammatory markers were measured and a comparison was made of echocardiographic results before (based on medical records) and after surgery. A total of 46 patients were enrolled, 23 with mechanical valve and 23 with bioprosthetic valve. Results: of the 46 patients, 20 presented complete data were included, 12 with bioprosthetic and 8 with mechanical valve. There was no difference between types of prosthesis or implant site for the values of inflammatory markers although they were all above reference range. Discussion: patients undergoing aortic mechanical valve implant benefited more than those undergoing bioprosthetic implant and both with much better results than those of valve replacements performed on mitral valve. In short, there was no difference in relation to inflammatory biomarkers. .


Introdução: doença valvar é importante causa de insuficiência cardíaca. Existe relação direta entre a deterioração valvar e o estado inflamatório do paciente, sendo as citocinas interleucina-6, interleucina-1, fator de necrose tumoral e a proteína C reativa as principais envolvidas nesse estado de estimulação. Objetivo: relatar uma série de casos de troca valvar, bioprótese ou mecânica e seu perfil inflamatório. Métodos: pacientes maiores de 18 anos e portadores de bioprótese ou protética mecânica, com período mínimo de 6 meses e máximo de 2 anos, foram incluídos. Além das características demográficas de cada paciente, colheram-se os marcadores inflamatórios e comparou-se o ecocardiograma conforme registro de prontuário antes e depois da cirurgia. Um total de 46 pacientes foi incluído, tendo sido 23 com valva mecânica e 23 de bioprótese. Resultados: dos 46 pacientes, chegamos ao total de 20 pacientes com dados completos, sendo 12 com bioprótese e 8 com protética mecânica. Não houve diferença entre tipo de prótese ou local de implante para os valores dos marcadores inflamatórios, contudo, na média, seus valores estavam aumentados. Discussão: pacientes submetidos ao implante de valva protética mecânica aórtica beneficiaram-se mais do que os submetidos ao implante de bioprótese e ambos com resultado bem superior às trocas realizadas na valva mitral. Não houve diferença em relação aos biomarcadores inflamatórios. .


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Aortic Valve Stenosis/surgery , C-Reactive Protein/metabolism , Heart Valve Prosthesis Implantation , Heart Failure/surgery , /blood , Mitral Valve/surgery , Tumor Necrosis Factor-alpha/blood , Aortic Valve Stenosis/complications , Bioprosthesis , Biomarkers/blood , Heart Valve Prosthesis , Heart Failure/etiology , Prosthesis Design
12.
Anest. analg. reanim ; 26(2): 4-4, dic. 2013.
Article in Spanish | LILACS | ID: lil-754090

ABSTRACT

Presentamos el caso de una paciente de 42 años, portadora de válvula mecánica mitral y aórtica, que cursando el tercer trimestre de gestación sufre una disfunción crítica de la prótesis aórtica. Es asistida por el servicio de anestesiología del Hospitalde Clínicas, en este contexto para realizar una cesárea de urgencia. Se analiza en este trabajo el manejo anestesiológico de la gestante con una estenosis aórtica severa por trombosis valvular, sometida a una cirugía cesárea de urgencia. Se realiza una revisión que contempla la técnica anestésica a realizar comparando la anestesia regional versus anestesia general; consideraciones en las técnicas de bloqueo central en pacientes en tratamiento con antifibrinolíticos y antiacoagulantes; monitorización a realizar; relevancia del ecocardiograma transtorácico en el perioperatorio, como otro monitor fundamental para evaluar estado hemodinámico de la paciente; elección de drogas anestésicas que nos brindan mayor seguridad en este tipo de pacientes, con la menor repercusión sobre el feto y su evolución post operatoria. Conclusiones: El manejo anestesiológico de gestantes portadoras de estenosis aórtica crítica sometida a cirugía cesárea es un desafío. La creación de un equipo multidisciplinario, la posibilidad de contar con la monitorización adecuada, y el uso de fármacos que permiten mantener la hemodinamia materna con escasa repercusión sobre el feto permitieron llegar a un resultado exitoso en este caso...


Subject(s)
Humans , Adult , Female , Pregnancy , Young Adult , Anesthesia, Endotracheal , Cesarean Section/adverse effects , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/physiopathology , Aortic Valve Stenosis/mortality , Heart Valve Prosthesis/adverse effects , Thrombosis/complications
13.
Rev. bras. cardiol. invasiva ; 21(2): 103-108, abr.-jun. 2013. tab
Article in Portuguese | SES-SP, LILACS, SES-SP | ID: lil-681941

ABSTRACT

INTRODUÇÃO: A incidência de refluxo paraprotético (RPP) parece maior entre os pacientes submetidos a implante de prótese aórtica transcateter e sua potencial associação com aumento da mortalidade tardia tem suscitado preocupação na comunidade científica. Nosso objetivo foi avaliar a incidência e o impacto clínico e estabelecer preditores do RPP em nossa casuística. MÉTODOS: Entre julho de 2009 e fevereiro de 2013, 112 pacientes foram submetidos a implante de prótese aórtica transcateter. O grau do RPP pós-procedimento foi avaliado segundo os critérios do VARC 2. Dividiu-se a população em grupo RPP ausente/RPP discreto e grupo RPP moderado/RPP grave. RESULTADOS: A média da idade foi de 82,5 ± 3,9 anos, 58,9% eram do sexo feminino e o EuroSCORE logístico foi de 23,6 ± 13,4. Houve queda do gradiente sistólico médio (54,7 ± 15,3 mmHg vs. 11,7 ± 4 mmHg; P < 0,01) e ganho da área valvar aórtica (0,66 ± 0,15 cm² vs. 1,8 ± 0,3 cm²; P < 0,01). Ao final do procedimento, 46,4% não apresentaram RPP, e RRP discreto ou moderado foi observado em 42% e 11,6% dos pacientes. Nenhum paciente apresentou RPP grave. A análise multivariada identificou sexo masculino [odds ratio (OR) 5,85, intervalo de confiança (IC] 1,29-26,7; P = 0,022), valvoplastia aórtica percutânea prévia (OR 18,44, IC 2,30-147,85; P = 0,006), fração de ejeção < 35% (OR 4,160, IC 1,014-17,064; P = 0,048) e presença de hipertensão pulmonar grave (OR 7,649, IC 1,86-31,51; P = 0,005) como preditores independentes de RPP moderado/grave. CONCLUSÕES: A incidência de RPP moderado/grave foi baixa e comparável à de outras casuísticas. Sexo masculino, antecedente de valvoplastia aórtica percutânea prévia, presença de hipertensão pulmonar grave e disfunção ventricular esquerda grave foram preditores independentes dessa complicação.


BACKGROUND: The incidence of paravalvular aortic regurgitation (PAR) seems higher among patients submitted to transcatheter aortic valve implantation and its potential association with an increased late mortality has raised concerns in the scientific community. Our objective was to evaluate the incidence and clinical impact of PAR and establish PAR predictors in our patient population. METHODS: Between July/2009 and February/2013, 112 patients were submitted to transcatheter aortic valve implantation. The degree of PAR after the procedure was assessed according to the VARC 2 criteria. The population was divided into no/mild PAR group and moderate/severe PAR group. RESULTS: Mean age was 82.5 ± 3.9 years, 58.9% were female and the logistic EuroSCORE was 23.6 ± 13.4. There was a decrease in the mean systolic gradient (54.7 ± 15.3 mmHg vs 11.7 ± 4 mmHg; P < 0.01) and a gain in the aortic valve area (0.66 ± 0.15 cm² vs 1.8 ± 0.3 cm²; P < 0.01). At the end of the procedure 46.4% did not have PAR, and mild or moderate PAR was observed in 42% and 11.6% of the patients. No patient presented severe PAR. Multivariate analysis identified male gender [odds ratio (OR) 5.85, confidence interval (CI] 1.29-26.7; P = 0.022), previous percutaneous aortic val­vuloplasty (OR 18.44, CI 2.30-147.85; P = 0.006), ejection fraction < 35% (OR 4.160, CI 1.014-17.064; P = 0.048) and the presence of severe pulmonary hypertension (OR 7.649, CI 1.86-31.51; P = 0.005) as independent predictors of moderate/severe PAR. CONCLUSIONS: The incidence of moderate/severe PAR was low and comparable to other studies. Male gender, history of prior percutaneous aortic valvuloplasty, presence of severe pulmonary hypertension and severe left ventricular dysfunction were independent predictors of this complication.


Subject(s)
Humans , Cardiac Catheters , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/diagnosis , Heart Valve Prosthesis Implantation/mortality , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/diagnosis , Echocardiography, Transesophageal/methods , Echocardiography, Transesophageal , Retrospective Studies
14.
Rev. bras. ecocardiogr. imagem cardiovasc ; 26(2): 115-120, abr.-jun. 2013. ilus, mapas
Article in Portuguese | LILACS | ID: lil-678706

ABSTRACT

A eficácia do tratamento de tumores como linfoma Hodgkin e o câncer de mama com o uso da radioterapia reduziu, significativamente, a morbidade e mortalidade desses pacientes. Todavia, com o aumento da sobrevida, as complicações cardiovasculares, entre elas, as lesões valvares começaram a surgir, anos ou até décadas após a radioterapia. O acompanhamento com o ecodopplercardiograma, após a radioterapia, é indispensável como medida de detecção precoce e acompanhamento evolutivo, devido ao seu baixo custo e fácil acesso. O objetivo deste estudo é relatar quatro casos de pacientes que desenvolveram lesão valvar aórtica após radioterapia.


Treatment efficacy of tumors like Hodgkin’s Lymphoma and breast cancer with the use of radiotherapy has significantly reduced morbidity and mortality of these patients. However, with the increase of survival, cardiovascular complication, e.g., valvar lesions has arisen years to decades after the end of radiotherapy. The following with echocardiography after radiotherapy is an essential step in early detection and following, because of low cost and easy access. The aim of this paper is to report four cases of patients that developed aortic valvar lesion after radiotherapy.


Subject(s)
Humans , Male , Female , Middle Aged , Heart Valve Diseases/complications , Echocardiography, Doppler/methods , Aortic Valve Stenosis/complications , Heart Neoplasms/complications , Radiotherapy/adverse effects , Cardiac Catheterization/methods , Cardiac Catheterization , Myocardial Revascularization/methods , Myocardial Revascularization
18.
Article in English | WPRIM | ID: wpr-219665

ABSTRACT

Isolated left ventricular (LV) apical hypoplasia is a rare congenital cardiac anomaly which is not accompanied by other cardiac abnormalities, with the exception of two cases. We report a case of a 33-year-old male patient with isolated LV apical hypoplasia combined with infundibular pulmonary stenosis and aortic stenosis. We review a literature focusing on the characteristic magnetic resonance features and combined cardiac abnormalities.


Subject(s)
Adult , Aortic Valve Stenosis/complications , Diagnosis, Differential , Echocardiography , Electrocardiography , Humans , Hypoplastic Left Heart Syndrome/complications , Magnetic Resonance Imaging, Cine , Male , Pulmonary Valve Stenosis/complications
19.
Rev. bras. cardiol. invasiva ; 21(3): 221-226, 2013. graf, tab
Article in Portuguese | LILACS | ID: lil-690652

ABSTRACT

INTRODUÇÃO: A valvuloplastia aórtica por cateter balão (VAB) é utilizada como estratégia paliativa em pacientes inelegíveis tanto para troca valvar cirúrgica quanto para implante valvar aórtico transcateter, ou como ponte para essas modalidades de tratamento. Não se sabe o impacto terapêutico da VAB quando realizada como medida de salvamento para pacientes em condições clínicas extremas (in extremis). MÉTODOS: Foram analisados pacientes com estenose aórtica grave de etiologia degenerativa submetidos à VAB entre julho de 2008 e janeiro de 2013. Os pacientes foram divididos entre o grupo in extremis (definido pela presença de duas ou mais das seguintes disfunções orgânicas: ventilação mecânica, instabilidade hemodinâmica, terapia renal dialítica, coagulopatia ou disfunção hepática graves) e o grupo controle, que incluiu os demais pacientes. RESULTADOS: Um total de 19 pacientes realizaram VAB no período. A condição clínica in extremis esteve presente em 42,1%. Os pacientes do grupo in extremis tiveram EUROSCORE II mais elevado (41,1 ± 24,7 vs. 15,9 ± 14,0; P = 0,01) e fração de ejeção do VE mais baixa que o grupo controle (33,9 ± 17,3% vs. 49,0 ± 12,5%; P = 0,04). Nenhum paciente do grupo in extremis sobreviveu ao período intra-hospitalar, enquanto que, no grupo controle, a mortalidade foi de 27,3% (P < 0,01). CONCLUSÕES: Para o tratamento de pacientes com estenose aórtica grave de etiologia degenerativa, a VAB tem resultado desfavorável quando indicada para pacientes com duas ou mais disfunções orgânicas, ou seja, em condição clínica in extremis.


BACKGROUND: Balloon aortic valvuloplasty (BAV) is used as a palliative strategy in patients who are not eligible for valve replacement surgery, transcatheter aortic valve implantation, or as a bridge to these treatment modalities. The impact of BAV as a salvage procedure for patients in extreme clinical conditions (in extremis) is unknown. METHODS: Patients with severe degenerative aortic stenosis undergoing BAV between July 2008 and January 2013 were evaluated. Patients were divided into the in-extremis group (defined by the presence of two or more of the following organ dysfunctions: mechanical ventilation, hemodynamic instability, dialysis, coagulopathy or severe hepatic dysfunction) and the control group, which included the remaining patients. RESULTS: A total of 19 patients underwent BAV. The clinical condition in-extremis was present in 42.1% of them. Patients from the in-extremis group had a higher EUROSCORE II (41.1 ± 24.7 vs. 15.9 ± 14.0; P = 0.001) and LV ejection fraction lower than the control group (33.9 ± 17.3% vs. 49.0 ± 12.5; P = 0.04). None of the patients in the in-extremis group survived past the hospitalization period, whereas the control group mortality was 27.3% (P < 0.01). CONCLUSIONS: BAV has an unfavorable result in patients with severe degenerative aortic stenosis with two or more organ dysfunctions, that is, patients in extremis.


Subject(s)
Humans , Male , Female , Aged , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/mortality , Heart Valve Prosthesis Implantation , Balloon Valvuloplasty/instrumentation , Data Analysis/analysis , Echocardiography/methods , Risk Factors
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