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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
ABC., imagem cardiovasc ; 34(3)2021. ilus, graf
Article in Portuguese | LILACS | ID: biblio-1292127


Resumo Historicamente, o papel do ecocardiograma de estresse físico no manejo da cardiomiopatia hipertrófica tem sido negligenciado na prática clínica, de acordo com a análise das diretrizes do American College of Cardiology/ American Heart Association de 2002, que recomendavam cautela no uso dessa metodologia, em portadores de cardiomiopatia hipertrófica, devido ao risco de possível ocorrência tanto de arritmia cardíaca, como de colapso hemodinâmico no esforço. Atualmente, o estresse físico na cardiomiopatia hipertrófica integra a avaliação rotineira de pacientes sintomáticos com ou sem gradiente da via de saída do ventrículo esquerdo < 50 mmHg, em repouso. Para este grupo, é um método seguro e confiável para medir o gradiente da via de saída do ventrículo esquerdo durante o esforço e sólido diferenciador de pacientes com cardiomiopatia hipertrófica não obstrutivos (gradiente ausente, tanto em repouso quanto no esforço) daqueles com gradientes lábeis (gradiente ausente no repouso e presente no esforço). Portanto, na avaliação da cardiomiopatia hipertrófica, o estresse físico é igualmente útil na quantificação do grau de regurgitação mitral, nas alterações da contratilidade segmentar do ventrículo esquerdo e na avaliação da função diastólica do ventrículo esquerdo, diante do esforço, sendo capaz de predizer o futuro desenvolvimento de sintomas de insuficiência cardíaca. O método é também importante na determinação das diferentes estratégias de tratamento para cada paciente, desde a miomectomia cirúrgica ou a ablação septal alcoólica, para aqueles com gradiente lábil, com sintomas limitantes e refratários ao tratamento medicamentoso versus transplante cardíaco para aqueles sem gradiente.(AU)

Humans , Male , Adult , Middle Aged , Atrial Fibrillation/complications , Hypertrophy, Left Ventricular/congenital , Cardiomyopathy, Hypertrophic, Familial , Heart Failure/complications , Mitral Valve , Stress, Physiological , Vibration/adverse effects , Magnetic Resonance Spectroscopy/methods , Ergometry/methods , Death, Sudden, Cardiac/etiology , Echocardiography, Stress/methods , Electrocardiography/methods , Ablation Techniques
Rev. bras. cir. cardiovasc ; 35(6): 994-998, Nov.-Dec. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1143997


Abstract We compared the mortality rates of two surgical techniques for correction of atrioventricular disjunction in 10 out of 720 patients who underwent mitral valve replacement from 2005 to 2012. In group I, the mitral annulus was fixed with bovine pericardial strips; in group II, a 'patch' of bovine pericardium was sutured and extended from the base of the lateral and medial papillary muscles, covered the posterior wall of the left ventricle, went through the posterior mitral annulus, and ended in the posterior wall of the left atrium adjacent to the mitral ring. The group II technique showed a lower mortality.

Humans , Animals , Atrioventricular Node/surgery , Mitral Valve/surgery , Mitral Valve Insufficiency , Papillary Muscles/surgery , Pericardium/transplantation , Tricuspid Valve , Cattle
Acta méd. colomb ; 45(4): 29-33, Oct.-Dec. 2020. tab
Article in English | LILACS, COLNAL | ID: biblio-1278138


Abstract Infectious endocarditis (IE) is a multisystemic disease caused by an infection, generally bacterial, of the endocardial surface. Its incidence is three to nine cases per 100,000 persons. Objective: to characterize the patients with a diagnosis of infectious endocarditis seen at the Hospital Universitario San Rafael de Tunja. Materials and methods: a descriptive observational study. Patients seen at the Hospital Uni versitario San Rafael de Tunja between January 1, 2010 and January 1, 2019. Sociodemographic, clinical, paraclinical, imaging, treatment and outcome variables were gathered. Results: a total of 87 persons with a confirmed diagnosis of infectious endocarditis were seen. The average age was 38.77 years, with an SD ± 13.32 years. Leukocytosis was seen in 90%, neutrophilia in 85%, lymphocytosis in 3%, thrombocytopenia in 4%, elevated serum CRP in 85%, transaminitis in 45%, hyponatremia in 2% and hypernatremia in 4%. All patients received antibiotic treatment; only 23% required surgery. Conclusions: this case series found similar clinical and microbiological characteristics to those reported in other national and international studies. Males were affected more often than females, with the main etiological agent being Staphylococcus aureus. Fever and infectious vasculitis signs were the main clinical manifestations, most often affecting the mitral valve.

Resumen La endocarditis infecciosa (EI) es una enfermedad multisistémica que resulta de una infección, generalmente bacteriana, de la superficie endocárdica. Su incidencia es de tres a nueve casos por cada 100 000 personas. Objetivo: realizar una caracterización de los pacientes atendidos en el Hospital Universitario San Rafael de Tunja con diagnóstico de endocarditis infecciosa. Material y métodos: estudio observacional descriptivo. Pacientes atendidos en el Hospital Universitario San Rafael de Tunja entre el 1°. de enero del 2010 a 1°. de enero del 2019. Se tomaron variables sociodemográficas, clínicas, paraclínicas, imagenológicos, terapéuticas y de desenlaces. Resultados: en total se atendieron 87 personas que presentaron diagnóstico confirmado de endocarditis infecciosa. La edad promedio fue 38.77 años con una DE ± 13.32 años. Se observó leucocitosis en 90%, neutrofilia en 85%, linfocitosis en 3%, trombocitopenia en 4%, aumento de los valores séricos de PCR en 85%, transaminitis en 45%, hiponatremia en 2% e hipernatremia en 4%. Todos los pacientes recibieron manejo antibiótico, tan solo 23% requi rieron manejo quirúrgico. Conclusiones: en esta serie de casos se encontraron características clínicas y microbiológicas similares a lo reportado en otras investigaciones nacionales e internacionales. Afectando con mayor frecuencia a personas del sexo masculino, siendo el principal agente causal el Staphylococcus aureus, el agente causal. La fiebre y los signos de vasculitis infecciosa fueron las principales manifestacio nes clínicas, afectado con mayor frecuencia la válvula mitral.

Humans , Male , Adult , Aged , Endocarditis , Diagnostic Imaging , Bacteremia , Heart Valves , Mitral Valve
Rev. bras. cir. cardiovasc ; 35(4): 555-564, July-Aug. 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1137313


Abstract Objective: To examine the current literature behind the evolution of mitral valve surgery techniques and their impact on patient outcomes. Methods: An electronic literature search among major databases was performed (PubMed, Embase, Scopus, Cochrane, and Google scholar). All the relevant articles were screened and identified to be included in this narrative review. The main outcomes were postoperative morbidity, length of in-hospital stay, and long-term mortality. Results: Minimally invasive and robot-assisted approach to mitral valve repair and replacements has shown great potential in improving surgical outcomes when compared against traditional midline sternotomy. Selected patients can benefit from percutaneous mitral valve surgery; however, more evidence is required to ascertain its long-term outcomes. Conclusion: Current evidence suggests that robotic and minimal invasive mitral valve surgeries are increasing in practice with satisfactory perioperative and mortality rates. However, long-term data is yet to be published to support current practice.

Humans , Cardiac Surgical Procedures , Mitral Valve Insufficiency , Treatment Outcome , Mitral Valve/surgery
Rev. colomb. cardiol ; 27(4): 319-323, jul.-ago. 2020. graf
Article in English | LILACS, COLNAL | ID: biblio-1289232


Abstract Mitral valve aneurysm is a rare and uncommon complication of infective endocarditis leading to a weakened mitral tissue. The most feared mitral valve aneurysm's complications are: perforation and severe mitral regurgitation. Multiple mechanisms have been suggested to explain the development of mitral valve aneurysm in aortic infective endocarditis including: local extension of the infection, the mitral kissing vegetation and aortic regurgitation. We report the case of a 29-year-old man who had infective endocarditis of a native aortic valve and the sub-aortic diaphragm complicated by a perforated mitral valve aneurysm diagnosed only by transesophageal echocardiogram. The patient had no sign of heart failure. We hypothesized that all those mechanisms lead to the developing of the mitral valve aneurysm in this case, but also the presence of the diaphragm favored the spread of the infection.

Resumen Una de las complicaciones poco comunes e inusuales de la endocarditis infecciosa son los aneurismas de la válvula mitral. Las complicaciones más temidas de estos últimos son la perforación y la insuficiencia mitral severa. Diferentes mecanismos pueden explicar el desarrollo de dicha insuficiencia en el contexto de una endocarditis infecciosa, incluyendo una extensión local, una vegetación sobre la válvula mitral y una insuficiencia aórtica. Nuestro caso clínico es el de un joven de 29 años diagnosticado de endocarditis infecciosa sobre su válvula aortica nativa con un diafragma subaortico complicado con un aneurisma de la válvula mitral perforado. El paciente no presentaba signos de insuficiencia cardíaca. Hemos supuesto que todos los mecanismos que hemos evocado anteriormente han llevado al desarrollo de dicho aneurisma, junto con la presencia del diafragma, elemento en favor de la diseminación de la infección.

Humans , Male , Adult , Elements , Endocarditis/complications , Aneurysm , Mitral Valve , Aortic Valve , Aortic Valve Insufficiency , Mitral Valve Insufficiency
Rev. cir. (Impr.) ; 72(3): 231-235, jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1115547


Resumen Introducción: La disección de la aurícula izquierda es una complicación infrecuente, pero potencialmente fatal de la cirugía cardíaca. Es frecuentemente asociada a cirugías de la válvula mitral, tanto su reparación el reemplazo, con una incidencia de 0,16%. Sin embargo, otros procedimientos como intervenciones percutáneas también presentan este riesgo. Objetivos: Presentar la resolución quirúrgica de un caso de disección de aurícula izquierda y aportar a la casuística nacional. Materiales y Método: Registro clínico, imagenológico y fotográfico del episodio clínico. Resultados: Una paciente que fue sometida a ablación por radiofrecuencia por vía retrógrada, y cursa durante el periodo postintervencional con insuficiencia cardíaca y su estudio identifica una disección auricular. Se realiza reparación del anillo mitral, plastía del aparato subvalvular y parche de pericardio, la paciente presenta evolución clínica y ecográfica favorable. Discusión: El tratamiento de esta entidad debe analizarse caso a caso, ya que la etiología relacionada a procedimientos percutáneos es diferente a la causada por cirugía valvular mitral. Conclusión: La reparación de una disección auricular con parche es una buena alternativa de tratamiento en estos casos.

Introduction: Left atrial dissection is an infrequent but potentially fatal complication of cardiac surgery. It is frequently associated with mitral valve surgery, both its repair and replacement, with an incidence of 0.16%. However, other procedures such as percutaneous interventions can also be predisposing factors. Objectives: To report the surgical resolution of a left atrial dissection case and contribute to the national casuistry. Materials and Method: Clinical, imaging and photographic record of the clinical episode. Results: A patient who underwent retrograde radiofrequency ablation during the post-interventional period with heart failure and whose study identifies an atrial dissection. Mitral ring repair, subvalvular apparatus repair and pericardial patch was performed, the patient evolves with favorable clinical and sonographic evolution. Discussion: The treatment of this entity should be analyzed case by case, the etiology related to percutaneous procedures is different to that caused by mitral valve surgery and this should be considered when choosing a therapeutic option. Conclusion: Repairing an atrial dissection with a patch is a good alternative in these cases.

Humans , Female , Middle Aged , Aneurysm, Dissecting/surgery , Aneurysm, Dissecting/diagnostic imaging , Postoperative Complications/etiology , Rare Diseases , Cardiac Surgical Procedures/adverse effects , Mitral Valve/surgery
Int. j. morphol ; 38(3): 596-601, June 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1098293


Las valvas cardíacas y especialmente la valva atrioventricular izquierda (VAVI) ha sido considerada por largo tiempo, como una estructura pasiva. Sin embargo, han surgido nuevas teorías que reconocen a esta estructura como una "valva viva", con un funcionamiento de mayor autonomía y dinámico. En esta línea, existen estudios en donde se ha concluido que la ausencia de tejidos contráctiles en una valva, generan ondulaciones no fisiológicas. Por el contrario, se ha señalado la presencia de tejido contráctil en la valva, lo que refleja una activación ondulante. Basado en lo anterior, el objetivo del presente estudio fue determinar la presencia de fibras musculares cardíacas en las cúspides de la VAVI. Se utilizaron 12 cúspides, 6 anteriores y 6 posteriores, de 7 cadáveres adultos (4) y lactantes (3) de distintas edades, sin patologías cardíacas. Las muestras pertenecían a la Facultad de Medicina de la Universidad Estadual de Ciencias da Saúde de Alagoas, Maceió, Brasil. Estas muestras fueron tratadas con procesamiento histológico de rutina. Los hallazgos morfológicos a un aumento de 4x mostraron células musculares que fueron visibles principalmente por el lado atrial en la totalidad de las cúspides, tanto inmersas en el tejido conectivo denso del anillo fibroso como en el tejido conectivo laxo. Al verificar la naturaleza de las fibras con un aumento mayor (100x), se detectaron estrías transversales en todas las muestras estudiadas, lo cual afirma la presencia de fibras musculares estríadas cardíacas en la VAVI. Los resultados obtenidos aportan al conocimiento de la microestructura y tejido contráctil de las cúspides de la VAVI. Por lo tanto, resulta de gran relevancia seguir profundizando en los conocimientos morfológicos de la VAVI, para sentar una base sólida sobre la microestructura contráctil en los diferentes estadíos del ser humano.

Cardiac valves and particularly, the left atrioventricular valve (LAVV) have long been considered passive structures. Nonetheless, there are more recent hypothesis that recognize this structure as a "living valve", with greater autonomy and dynamic function. Along these lines, some studies have concluded that the absence of contractile tissues in a valve, generates non-physiological undulations. In contrast, the presence of contractile tissue in the valve has been reported, reflecting a waving activation. Based on the above, the objective of the present study was to determine the presence of cardiac muscle fibers in the cusps of the LAVV. 12 cusps, 6 anterior and 6 posterior. Therefore, 7 adult (4) and lactating (3) bodies of different ages without cardiac pathologies were used. The samples belonged to the Faculty of Medicine of the Universidade de Ciencias da Saude de Alagos, Maceió, Brazil. The samples were treated with routine histological processing. Morphological findings at an increase of 4x showed muscle cells that were visible mainly from the atrial side in all the cusps, both immersed in the dense connective tissue of the fibrous ring and in loose connective tissue. Transverse striations were detected in all samples studied, when verifying the nature of the fibers with greater increase (100x), confirming the presence of cardiac striated muscle fibers in the LAVV. The results obtained contribute to the knowledge of the microstructure and contractile tissue of the LAVV cusps. Therefore it is relevant to further morphological knowledge of this valve, in order to build a solid foundation on the contractile microstructure in the different stages of the human development.

Humans , Male , Female , Infant , Adult , Mitral Valve/anatomy & histology , Cadaver , Heart/anatomy & histology
Rev. colomb. cardiol ; 27(2): 84-89, mar.-abr. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1138760


Abstract Background: percutaneous transmitral commissurotomy has become an ideal treatment option for mitral stenosis due to its less adverse events and more favorable outcomes. Patients improve symptomatically after percutaneous transmitral commissurotomy but we have minimal available data about the quality of life after percutaneous transmitral commissurotomy. Objective: to assess the quality of life after percutaneous transmitral commissurotomy through WHOQol scoring covering different aspects of life, to determine its correlation with a net gain in mitral valve area (MVA) and to ascertain its association with gender. Methods: it was a prospective cohort study carried out for a period of 15 months. A total of 100 patients with mitral stenosis who had successful percutaneous transmitral commissurotomy done were enrolled in the study. Among the total included, 4 patients were lost to follow up and data were collected from 96 patients. Quality of life was assessed before the procedure, at 1 month and 3 months follow up after percutaneous transmitral commissurotomy using WHOQol scoring questionnaire. Results: among 96 patients, 64 (67%) were females and 32 (33%) were males. WHOQol scoring improved significantly after percutaneous transmitral commissurotomy from 32.8±8.9 to 54.6±11.2 and 62.8± 9.7, after one month and 3 months respectively. There was a significant association between net gain of MVA and WHOQol scoring with an R value of 0.46 and p value of 0.03. There was no difference in group comparison of all the six domains between male and female patients. Conclusion: successful percutaneous transmitral commissurotomy improves the quality of life in mitral stenosis patients regardless of their gender and has a positive correlation with a net gain in mitral valve area.

Resumen Antecedentes: La comisurotomía mitral percutánea se ha convertido en una opción terapéutica ideal para la estenosis mitral, debido a efectos menos adversos y a resultados más favorables. Los pacientes mejoran sintomáticamente tras la realización de esta técnica, aunque se dispone de escasos datos acerca de la calidad de vida tras su puesta en práctica. Objetivo: Evaluar la calidad de vida tras la comisurotomía mitral percutánea mediante la puntuación WHOQol, que cubre diferentes aspectos de la vida, para determinar su correlación con la ganancia neta del área valvular mitral (AVM), y determinar su asociación con el sexo. Métodos: Estudio prospectivo de cohorte durante un periodo de 15 meses, en el que se incluyeron 100 pacientes con estenosis mitral a quienes se les practicó con éxito comisurotomía mitral percutánea. De entre el total incluido, se perdieron 4 pacientes durante el estudio, por lo que se recolectaron datos de los 96 pacientes restantes. La calidad de vida se evaluó antes del procedimiento, y transcurridos un mes y tres meses de seguimiento, utilizando el cuestionario de puntuación WHOQol. Resultados: De los 96 pacientes, 64 (67%) eran mujeres y 32 (33%) varones. La puntuación WHOQol mejoró considerablemente tras la realización de la comisurotomía mitral percutánea, con valores de 32,8±8,9 a 54,6±11,2 y 62,8± 9,7, transcurridos uno y 3 meses, respectivamente. Se produjo una asociación significativa entre la ganancia neta de AVM y la puntuación WHOQol, con un valor R de 0,46 y un valor p de 0,03. No se produjo diferencia alguna en cuanto a la comparación grupal de los seis dominios entre varones y mujeres. Conclusión: La comisurotomía mitral percutánea exitosa mejora la calidad de vida de los pacientes de estenosis mitral, independientemente del sexo, y tiene una correlación positiva con la ganancia neta del área valvular mitral.

Humans , Male , Female , Quality of Life , Mitral Valve Stenosis , Surveys and Questionnaires , Gender Identity , Mitral Valve
Pesqui. vet. bras ; 40(3): 188-196, Mar. 2020. tab, ilus
Article in English | ID: biblio-1135608


The present study evaluated the volume and function of the left atrium by two-dimensional echocardiographic feature-tracking imaging (2D-FTI) and Simpson's monoplanar modeling in dogs with asymptomatic degenerative mitral valve disease (DMVD). The study consisted of 80 dogs that were divided into the following three groups: Group 1, 21 dogs (A); Group 2, 30 dogs (B1) and Group 3, 29 dogs (B2). The variable strain (contraction phase) was significantly lower in Group 3 than in Group 1 (12.92±4.54 x 16.69±5.74, p=0.014), and significant differences in the contraction strain index (CSI) were observed between all of the groups that were evaluated (1 = 46.82±8.10, 2 = 39.88±8.03, 3 = 35.25±5.64, p<0.0001). The atrial diastolic volume index (AdVi) that was measured by 2D-FTI was significantly higher in Group 3 than in Group 1 (1.31±0.95 x 0.96±0.31, p=0.038), and the atrial cardiac index (ACI) was also higher in Group 3 than in Group 1 (102.38±80.18 x 78.19±33.38, p=0.030). Atrial function was assessed by Simpson's monoplanar method, which demonstrated an increase in the left atrial systolic volume, while the contractile function decreased with an increasing disease severity (Group 1 0.21±0.06; Group 2 0.25±0.06; Group 3 0.32±0.08, p<0.0001). The intraobserver and interobserver assessments showed low to moderate variability; most of the values for the coefficient of variation for the variables that were analysed with each method were below 25%. Thus, DMVD was determined to cause an alteration in atrial function, especially in the contraction phase, and even in asymptomatic animals, and the methods of 2D-FTI echocardiography and Simpson's monoplanar evaluation are sensitive and early methods for the detection of left atrial dysfunction.(AU)

O presente estudo avaliou o volume e a função atrial esquerda obtidos por meio da ecocardiografia bidimensional feature tracking (2D-FTI) e pelo método monoplanar de Simpson em cães saudáveis e cães com DMVD assintomáticos. Foram avaliados 80 cães distribuídos em três grupos: Grupo 1, 21 cães (classe A); Grupo 2, 30 cães (classe B1) e Grupo 3, 29 cães (classe B2). A variável strain (fase de contração) foi significativamente menor no Grupo 3 que no Grupo 1 (12,92±4,54 x 16,69±5,74, p=0,014) e para a variável índice de strain de contração (CSI), houve diferença estatística entre todos os grupos avaliados (1 = 46,82±8,10; 2 = 39,88±8,03; 3 = 35,25±5,64, p<0,0001). O índice de volume diastólico atrial (iVdA) mensurado por meio do 2D-FTI foi significativamente maior no Grupo 3 que no Grupo 1 (1,31±0,95 x 0,96±0,31, p=0,038), assim como para o índice cardíaco atrial (iCA) também foi maior no Grupo 3 (102,38±80,18 x 78,19±33,38, p=0,030). A função atrial avaliada pelo método monoplanar de Simpson demonstrou um aumento do volume atrial esquerdo e do volume sistólico do átrio esquerdo, enquanto que a função contrátil diminuiu com o aumento da gravidade da doença (Grupo 1 0,21±0,06; Grupo 2 0,25±0,06; Grupo 3 0,32±0,08; p<0,0001). A avaliação intraobservador e interobservador, demonstrou variabilidade baixa a moderada, uma vez que a maioria dos valores de coeficiente de variação se concentraram abaixo de 25% para as variáveis analisadas em ambos os métodos. Dessa forma, conclui-se que a DMVD causa alteração na função atrial, principalmente na fase de contração, mesmo em animais assintomáticos e que a ecocardiografia 2D-FTI e o método monoplanar de Simpson são métodos sensíveis e precoces na detecção da disfunção atrial esquerda.(AU)

Animals , Dogs , Atrial Function, Left , Electrophysiologic Techniques, Cardiac/veterinary , Heart Valve Diseases/veterinary , Mitral Valve/diagnostic imaging , Echocardiography/methods , Echocardiography/veterinary
Rev. bras. cir. cardiovasc ; 35(1): 120-122, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092477


Abstract Caseous calcification of the mitral annulus (CCMA) is known to be a rare variant of mitral annulus calcification, a chronic and degenerative process of the mitral valve fibrous ring. It usually carries a benign prognosis. The following case demonstrates a huge mitral annulus caseoma that complicated with severe mitral regurgitation and was treated with a successful surgery. The common consensus on the optimal management of CCMA is conservative medical management and avoiding unnecessary surgery. Therewithal, the current indications for surgical intervention include mitral valve dysfunction, strokes and uncertain diagnosis. Aggressive debridement, risk of left ventricular perforation and exposure of caseous debris to the systemic blood flow may increase the risk of a standard mitral valve surgery. Mitral valve replacement should be preferred compared with mitral valve repair.

Humans , Cardiac Surgical Procedures , Mitral Valve Insufficiency/surgery , Calcinosis , Mitral Valve
Article in Chinese | WPRIM | ID: wpr-880779


OBJECTIVE@#To compare the mid- and long-term outcomes of patients receiving mitral valve replacement through robotically assisted and conventional median sternotomy approach.@*METHODS@#The data of 47 patients who underwent da Vinci robotic mitral valve replacement in our hospital between January, 2007 and December, 2015 were collected retrospectively (robotic group). From a total of 286 patients undergoing mitral valve replacement through the median thoracotomy approach between March, 2002 and June, 2014, 47 patients were selected as the median sternotomy group for matching with the robotic group at a 1:1 ratio. The perioperative data and follow-up data of the patients were collected, and the quality of life (QOL) of the patients at 30 days and 6 months was evaluated using the Quality of Life Short Form Survey (SF-12). The time of returning to work postoperatively and the patients' satisfaction with the surgical incision were compared between the two groups.@*RESULTS@#All the patients in both groups completed mitral valve replacement successfully, and no death occurred during the operation. In the robotic group, only one patient experienced postoperative complication (pleural effusion); in median sternotomy group, one patient received a secondary thoracotomy for management of bleeding resulting from excessive postoperative drainage, and one patient died of septic shock after the operation. The volume of postoperative drainage, postoperative monitoring time, ventilation time, and postoperative hospital stay were significantly smaller or shorter in the robotic group than in the thoracotomy group (@*CONCLUSIONS@#Robotically assisted mitral valve replacement is safe and reliable. Compared with the median sternotomy approach, the robotic approach is less invasive and promotes faster postoperative recovery of the patients, who have better satisfaction with the quality of life and wound recovery.

COVID-19/drug therapy , Humans , Mitral Valve/surgery , Quality of Life , Retrospective Studies , Robotic Surgical Procedures , Sternotomy , Thoracotomy , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-826344


Infective endocarditis is a microbial infection of the endocardium and can easily affect heart valve.Its characteristic lesion is vegetation formation,and the shedding of vegetation results in arterial embolism and ischemic necrosis of corresponding tissues and organs.A case of infective endocarditis with multiple extracardiac complications was described in this article.The characteristic ultrasound finding was the vegetation formation in anterior mitral valve.CT and MRI scans revealed involvements in multiple organs and blood vessels,which were manifested as splenic infarction,renal infarction,cerebral infarction,splenic aneurysm,superior mesenteric artery aneurysms,renal artery aneurysms,and distal segment stenosis and occlusion of right middle cerebral artery.

Embolism , Endocarditis , Endocarditis, Bacterial , Humans , Infarction , Mitral Valve
Rev. bras. cir. cardiovasc ; 35(2): 185-190, 2020. tab, graf
Article in English | LILACS | ID: biblio-1101468


Abstract Objective: To compare the in-hospital outcomes of a right-sided anterolateral minithoracotomy with those of median sternotomy in patients who received a mitral valve replacement (MVR) because of rheumatic mitral valve stenosis (RMS). Methods: This is a retrospective analysis of 128 patients (34% male) with RMS between 2011 and 2015. The median age was 53 years (45; 56). The mean ejection fraction was 58.4±6.3%. All the subjects were divided into two groups - Group 1 contained 78 patients who underwent MVR via minithoracotomy (MT-MVR), while Group 2 contained 50 patients who underwent MVR via median sternotomy (S-MVR). Results: In the MT-MVR group, a mechanical prosthesis was implanted in 72% of cases, while it was implanted in 90% of cases in the S-MVR group (P=0.01). The duration of myocardial ischemia was similar (MT-MVR, 77±24 min; S-MVR, 70±18 min) (P=0.09). However, the cardiopulmonary bypass time was lower in the S-MVR group than in the MT-MVR group (99±24 min and 119±34 min, respectively) (P≤0.001). There was no difference in the duration of mechanical ventilation, intensive care unit stay, and hospitalization period. Postoperative blood loss was lower in the MT-MVR group (P≤0.001) than in the S-MVR group. There are no statistically significant differences in postoperative complications (superficial wound infection, stroke, delirium, pericardial tamponade, pleural puncture, acute kidney insufficiency, and implantation of pacemaker). The overall in-hospital mortality was 3.9% (P=0.6) Conclusion: The minimally invasive approach for RMS is feasible and has an excellent cosmetic effect without increasing the risk of surgical complications.

Humans , Male , Female , Middle Aged , Heart Valve Prosthesis Implantation , Mitral Valve Stenosis/surgery , Stroke Volume , Thoracotomy , Retrospective Studies , Ventricular Function, Left , Treatment Outcome , Mitral Valve
Clinics ; 75: e2428, 2020. tab, graf
Article in English | LILACS | ID: biblio-1142784


OBJECTIVES: The aim of this study was to analyze mitral annulus (MA) dynamics using cardiac magnetic resonance (CMR) in patients with degenerative mitral insufficiency who underwent mitral valve repair (MVR). METHODS: Mitral valve imaging was performed by CMR in twenty-nine patients with degenerative mitral insufficiency who underwent MVR between July 2014 and August 2016, with quadrangular resection of the posterior leaflet without ring annuloplasty. They were prospectively followed up from the preoperative period up to 2 years postoperatively. RESULTS: We observed a significant reduction in all measurements of the MA after surgery. The mean systolic circumference of the MA was reduced from 13.28±1.95 cm to 11.50±1.59 cm, and the diastolic circumference was reduced from 12.51±2.01 cm to 10.66±2.09 cm in the immediate postoperative period, measures that remained stable 2 years after MVR (p<0.001). The mean maximum area of the MA was significantly reduced from 14.34±4.03 to 10.45±3.17 cm2 when comparing the immediate postoperative period and the 2 year follow-up (p<0.001). The same occurred with the mean minimum area of the MA, which was reduced from 12.53±3.68 cm2 to 9.23±2.84 cm2 in the same period, and this reduction was greater in the antero-posterior diameter than in the mid-lateral diameter. The mobility of the MA was preserved after surgery, ranging between 19.6% and 25.7% at 2-year follow-up. CONCLUSION: We observed a significant reduction in the MA size after MVR, with preservation of the MA mobility at the 2-year follow-up.

Humans , Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnostic imaging , Magnetic Resonance Spectroscopy , Follow-Up Studies , Treatment Outcome , Diastole , Mitral Valve/surgery , Mitral Valve/diagnostic imaging