Avaliaçäo da reduçäo de gradientes pressóricos e da hipertrofia ventricular após valvoplastia cirúrgica na estenose aórtica / Left ventricular hypertrophy regression immediately after aortic valve repair

INTRODUÇÇO: A correçäo cirúrgica da estenose aórtica resulta em reduçäo significativa do gradiente pressórico transvalvar, sendo acompanhada por regressäo da hipertrofia ventricular esquerda(HVE). A intensidade e a rapidez dessa regressäo tem sido objeto de avaliaçöes. A associaçäo de valvoplastia aórtica e regressäo imediata da HVE é relatada em poucos estudos. MÉTODOS: Foram estudados, prospectivamente, 11 pacientes submetidos à valvoplastia em estenose aórtica, utilizando-se ecocardiografia imediatamente antes da cirurgia e no período pós-operatório precoce (6,1 + ou - 0,9 dias). RESULTADOS: A espessura septal variou de 12,10 + ou - 1,66mm para 11,36 + ou - 1,12mm (reduçäo de 6,1 por cento) (NS) enquanto a espessura parietal variou 4,4 por cento (de 11,70 + ou - 1,41 mm para 11,18 + ou - 1,16mm) (NS). A fraçäo de ejeçöo apresentou uma variaçäo de 62,02 + ou - 18,59 por cento para 62,50 + ou - 11,74 por cento (NS). A massa ventricular esquerda variou em 6,7 por cento ( de 277,65 + ou - 114,80 g passou para 258,93 + ou - 92,38 g) (NS). O gradiente transvalvular médio regrediu de 53,6 + ou -10,3 mmHg para 23,0 + ou - 9,1mmHg, ou seja, 57 por cento (p<0.001). CONCLUSÕES: A valvoplastia alivia o gradiente pressórico aórtico satisfatoriamente e a regressäo da HVE tende a se iniciar logo após, porém ainda näo é significativa no período pós-operatório imediato

[Reduction of pressure gradients and of ventricular hypertrophy after surgical valvoplasty in aortic stenosis]. / Avaliação da redução de gradientes pressóricos e da hipertrofia ventricular após valvoplastia cirúrgica na estenose aórtica.

BACKGROUND: Relief of gradient is followed by myocardial mass reduction in aortic stenosis. Its degree and speed are under evaluation. Aortic valve repair in calcified aortic stenosis is less well studied than replacement. METHODS: We evaluated left ventricular hypertrophy reduction by echocardiogram in 11 patients immediately after valve repair in aortic stenosis at a mean of 6.1 +/- 0.9 days post operative. RESULTS: Septal width was 12.10 +/- 1.66 mm pre and 11.36 +/- 1.12 mm post operative, 6,1% reduction (NS). Parietal width varied 4.4% from 11.70+/-1.41 mm to 11.18 +/- 1,16 mm (NS). Ejection fraction went from 62.02+/-18.59% to 62.50+/-11. 74% (NS). Left ventricular mass varied 6.7%, from 277.65+/-114.80g to 258.93+/- 92.38 g (NS). Mean transvalvar gradient reduced 57%, from 53.56+/-10.30 to 23.0+/-9.1 mmHg (P<0.001). CONCLUSION: Aortic valve repair reduces gradients adequately and left ventricular hypertrophy shows a trend to regression soon after aortic repair, but is not yet significant in the first post-operatively week.

Predictive factors for persistence of atrial fibrillation after mitral valve operation.

BACKGROUND: The majority of patients operated on for mitral valve disease with chronic atrial fibrillation (AF) do not recover sinus rhythm with conventional postoperative treatment. The maze procedure may be used in these circumstances. To define the precise indications for the maze procedure, it would be necessary to identify those patients based on preoperative factors. METHODS: A retrospective study was undertaken on 100 consecutive patients operated on for mitral valve disease in chronic AF. The return to sinus rhythm was analyzed with relation to age, gender, AF duration, left atrial size, left ventricular ejection fraction, lesion type, valve procedure, associated procedures, and reoperation. RESULTS: At late follow-up (more than 1 year) 26 (26%) patients presented sinus rhythm and 74 (74%) remained in AF. Statistical single parametric analysis demonstrated that mitral stenosis was a risk factor for maintaining AF, whereas regurgitation was more associated to sinus rhythm recovery. There was no relation with the other parameters with return to sinus rhythm. It should be noted, however, that 96% of this series had AF for more than 6 months preoperatively. CONCLUSIONS: The majority of patients with mitral valve disease remain in AF and this may justify the association of maze procedure. Pure regurgitation may be a single predictor for return to sinus rhythm after mitral valve operation in chronic AF.