ABSTRACT
OBJECTIVE: It has been described that prevalence of patent foramen ovale (PFO) declines with age. Our hypothesis was that persistent high pressures in the left atria (LA), may facilitate closure of PFO and age would not play a role. METHODS AND RESULTS: The prevalence of PFO was studied in 201 consecutive patients with suspicion of cardioembolic stroke by contrast transoesophageal echocardiography. Left ventricular end-diastolic pressures (LVEDP) were estimated non-invasively by transthoracic echocardiography. Patients with normal diastolic function (DF) or with diastolic dysfunction (DD) stage I were considered as having normal LVEDP whereas patients with DD stage II or III as having elevated LVEDP. Prevalence of PFO was 42.8% and it was smaller in patients with elevated LVEDP than in patients with normal LVEDP (21.2% vs. 51.7%, P < 0.01). There was a smaller prevalence of PFO in patients with DD stage II than in patients with DD stage I or normal DF (25% vs. 51 and 54%, both P < 0.05). Size of the LA was larger in patients without PFO [34.73 ml/m2 (24.14-40.84ml/m2) vs. 27.86 ml/m2 (21.37-34.68 ml/m2), P < 0.05]. Mean age was 64.2 years (57.38-75.77) with no difference between patients with PFO and without PFO. In multivariate analysis Eustachian valve, atrial septal aneurysm, elevated LVEDP and large LA remained significantly associated (P < 0.05) with PFO. CONCLUSION: Elevated LVEDP and enlargement of LA are negatively associated with PFO. The higher the LVEDP, the lower the prevalence of PFO. Age is not associated with PFO.
Subject(s)
Echocardiography, Doppler, Color/methods , Foramen Ovale, Patent/epidemiology , Foramen Ovale/physiology , Recovery of Function , Ventricular Pressure/physiology , Aged , Diastole , Disease Progression , Female , Follow-Up Studies , Foramen Ovale/diagnostic imaging , Foramen Ovale, Patent/diagnostic imaging , Foramen Ovale, Patent/physiopathology , Germany/epidemiology , Humans , Male , Middle Aged , PrevalenceSubject(s)
Femoral Neoplasms/diagnosis , Heart Neoplasms/diagnosis , Heart Neoplasms/secondary , Organometallic Compounds , Organophosphorus Compounds , Osteosarcoma/diagnosis , Osteosarcoma/secondary , Adult , Echocardiography, Three-Dimensional , Female , Humans , Radiopharmaceuticals , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methodsABSTRACT
Introducción Los dos grandes registros multicéntricos de cirugía cardíaca realizados en la Argentina, CONAREC y ESMUCICA, datan de más de 10 años. Considerando los avances médicos y quirúrgicos de la última década, surgió la necesidad de realizar un nuevo registro nacional, prospectivo y multicéntrico para conocer las características, la evolución, las complicaciones y los predictores de mortalidad de los pacientes sometidos a cirugía cardíaca. Objetivos Conocer el perfil epidemiológico, la modalidad quirúrgica y la evolución posoperatoria de los pacientes sometidos a cirugía cardíaca en la Argentina. Material y métodos Registro prospectivo, consecutivo y multicéntrico realizado en 49 centros cardioquirúrgicos de la República Argentina por residentes de cardiología. Se analizaron las características y la evolución de 2.553 pacientes sometidos a cirugía cardíaca entre septiembre de 2007 y octubre de 2008: 1.465 (57,4%) a cirugía coronaria, 359 (14,1%) a reemplazo valvular aórtico, 169 (6,6%) a cirugía valvular mitral, 312 (12,2%) a cirugía combinada coronariovalvular y 248 (9,7%) a otros procedimientos. Resultados Hubo predominio de hombres (74,9%); la edad promedio fue de 63 ± 11 años. La prevalencia de diabetes fue del 24,9%, la de hipertensión del 76,3% y la de insuficiencia cardíaca del 17%. La disfunción ventricular moderada a grave prequirúrgica fue del 23,8% y el 19,8% de las cirugías fueron no programadas. En las cirugías coronarias, el 41,9% de ellas se realizaron sin circulación extracorpórea y se empleó puente mamario en el 89%. El 81,7% de las cirugías mitrales se indicaron por insuficiencia y el 62,6% de las aórticas, por estenosis. En estas cirugías se emplearon válvulas mecánicas en el 58% de los casos. La mediana de internación fue de 6 días. Se presentaron complicaciones mayores en el 31,7% (del 25% en coronarios al 49,36% en combinados) y la mortalidad global fue del 7,7% (del 4,3% en coronarios al 13,4% en combinados). Conclusiones Este registro muestra la realidad de la cirugía cardíaca en centros con residencia o concurrencia de cardiología. Comparadas con cifras de registros nacionales previos, la mortalidad y las complicaciones mayores han disminuido, pero continúan siendo elevadas.
Background The CONAREC and the ESMUCICA studies are the largest multicenter registries performed in Argentina more than 10 years ago. The clinical and surgical advances achieved during the last decade have obliged us to carry out a new national, prospective and multicenter registry to become aware of the characteristics, outcomes, complications and predictors of mortality of patients undergoing cardiac surgery. Objectives To recognize the epidemiologic profile, surgical approach and postoperative outcomes of patients undergoing cardiac surgery in Argentina. Material and Methods This is a prospective, consecutive and multicenter registry performed by residents in Cardiology in 49 centers with cardiovascular surgery facilities. A total of 2553 patients undergoing cardiac surgery were included between September 2007 and October 2008, distributed as follows: coronary artery bypass graft surgery, 1465 patients (57.4%); aortic valve replacement, 359 (14.1%); mitral valve surgery, 169 (6.6%); combined procedure (revascularization-valve surgery), 312 (12.2%); other procedures, 248 (9.7%). Results There were more men (74.9%) than women; mean age was 63±11 years. The prevalence of diabetes was 24.9%, of hypertension 76.3% and of heart failure 17%. Preoperative moderate to severe left ventricular dysfunction was 23.8%, and 19.8% of surgeries were done on an urgent or emergency basis. A 41.9% of coronary artery bypass graft surgeries were done without cardiopulmonary bypass and a mammary artery bypass graft was used in 89%. Mitral valve surgery was indicated due to mitral regurgitation in 81.7% of cases and 63.6% of aortic valve surgeries were due to aortic valve stenosis. Mechanical heart valve prostheses were used in 58% of cases. Patients were hospitalized for a median of 6 days. Major complications occurred in 31.7% of cases (25% in revascularization surgeries and 49.36% in combined procedures) and global mortality was 7.7% (4.3% and 49.36%, respectively). Conclusions This registry demonstrates the real facts in cardiovascular surgery in centers with cardiovascular residents in Cardiology. Mortality and major complications are lower than those reported by previous registers, yet they are still high.
