ABSTRACT
BACKGROUND: Aortic valve prosthesis with adequate hemodynamic performance should allow more complete left ventricular mass regression and normalize left ventricular function. This possibly affects long-term prognosis after aortic valve replacement. OBJECTIVE: Assessment of hemodynamic performance of pulmonary autograft in the aortic position and the regression of left ventricular mass after the Ross procedure. METHODS: Between May 1995 and March 1996, 45 patients with mean age of 27.1 years underwent a Ross procedure. Doppler echocardiography and cardiac catheterization were performed on all patients before hospital discharge to evaluate the hemodynamic performance of auto- and homografts, as well as to evaluate left ventricular mass and function. Fourteen patients with follow-up longer than six months were submitted to dobutamine stress echocardiography to study the hemodynamic performance of auto- and homografts during exercise. RESULTS: Hospital mortality was 6%. After a mean follow-up of 12.8 months (1-23 months) there was one late sudden death. No valve-related event was observed during this period. Immediate and late hemodynamic performance of the pulmonary autografts were normal with an average mean gradient of 1.8 +/- 0.6 mmHg and an average maximum instantaneous gradient of 2.9 +/- 0.9 mmHg. Valvular insufficiency was insignificant. Even during exercise, gradients did not increase significantly with an average mean gradient of 4.3 +/- 2.5 mmHg and an average maximum gradient of 10.4 +/- 6.1 mmHg. Homografts used for right ventricular reconstruction showed excellent immediate hemodynamic performance. However, at late follow-up an increase in flow speed was observed with an average to mean gradient of 10 +/- 7.1 mmHg at rest and 26 +/- 13.2 mmHg during exercise. Left ventricular mass index was normal at rest and during exercise in the majority of patients. CONCLUSION: Given the normal hemodynamic function of pulmonary autografts, the reduction of ventricular mass and normalization of left ventricular function, in addition to the excellent late follow-up of the patients, the Ross procedure is considered the operation of choice for young patients requiring aortic valve replacement.
Subject(s)
Aortic Valve/surgery , Heart Valve Diseases/surgery , Pulmonary Veins/transplantation , Tissue Transplantation/methods , Adolescent , Adult , Age Factors , Child , Echocardiography, Doppler , Electrocardiography , Exercise Test , Female , Follow-Up Studies , Graft Survival , Heart Valve Diseases/diagnosis , Hemodynamics/physiology , Humans , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Severity of Illness Index , Survival Rate , Tissue Transplantation/mortality , Transplantation, Autologous , Treatment OutcomeABSTRACT
Un nuevo monitor automático oscilométrico y noinvasivo de la presión arterial está disponible en el Brasil. El aparato fue evaluado comparando los datos de la presión arterial media con la medida simultánea de la presión arterial por el método directo de cateterización de la arteria radial concectada al manómetro de mercurio. Fueron estudiados 21 niños divididos en dos grupos: grupo 1, constituido por 10 niños con peso menor de 10K, con edad entre 1 mes y 1 año. Grupo 2, constituído por 11 niños con más de 10 Kg, con edad encima de 1 año y 6 meses. El coeficiente de correlación entre las medidas tomadas en los dos grupos fue de r = 0.85 (p < 0,01) para el grupo 1 y r = 0,88 (p < 0,001) para el grupo 2. Se concluyó que las presiones medias fornecidas por el aparato se correlacionan bien con la medida directa de la presión arterial, siendo un instrumento útil para monitorizar presión arterial en niños
Subject(s)
Infant , Child, Preschool , Child , Humans , Male , Female , Anesthesia , Heart Defects, Congenital/surgery , Blood Pressure Determination/methods , Monitoring, Physiologic/instrumentationSubject(s)
Endomyocardial Fibrosis/surgery , Adolescent , Adult , Endocarditis, Bacterial/complications , Endomyocardial Fibrosis/complications , Endomyocardial Fibrosis/pathology , Female , Heart Ventricles/diagnostic imaging , Humans , Middle Aged , Multicenter Studies as Topic , Prognosis , Radiography , Retrospective StudiesSubject(s)
Aortic Valve/surgery , Heart Valve Prosthesis , Thromboembolism/etiology , Actuarial Analysis , Adolescent , Adult , Aged , Anticoagulants/therapeutic use , Female , Humans , Male , Middle Aged , PrognosisSubject(s)
Heart Defects, Congenital/surgery , Palliative Care , Pulmonary Artery/surgery , Subclavian Artery/surgery , Child , Child, Preschool , Evaluation Studies as Topic , Humans , Infant , Infant, Newborn , Pulmonary Valve Insufficiency/surgery , Pulmonary Valve Stenosis/surgery , Tetralogy of Fallot/surgery , Transposition of Great Vessels/surgeryABSTRACT
Contribuindo para esclarecer o valor da dilatacao transluminal percutanea (DTP) de lesoes estenosantes das arterias coronarias e tambem para esclarecer a posicao da revascularizacao cirurgica em relacao a essa nova tecnica, os autores analisam a experiencia com 17 pacientes, submetidos a DTP no periodo de setembro de 1979 a dezembro de 1980. Em 9 casos os resultados foram considerados satisfatorios.Houve 2 casos de deslocamento da placa e disseccao da arteria e outro ocorreu espasmo apos o procedimento. Em 5 pacientes nao foi possivel ultrapassar a lesao para posicionar o balao. Tanto os casos complicados como aqueles em que a lesao nao foi ultrapassada foram levados a revascularizacao direta por ponte de veia safena. Um dos pacientes operados por complicacao pulmonar morreu. Considerando que so foram submetidos a DTP pacientes com indicacao cirurgica, admitimos que a tentativa de DTP nao compromete os resultados da eventual cirurgia
