ABSTRACT
INTRODUCTION AND OBJECTIVE: Mitral stenosis (MS) is one of the most frequently observed valvular heart lesions in developing countries and is due to different etiologies. The effects of anticoagulation in different types of left atrial appendage (LAA) are unknown. The current study aimed to determine the resolution of LAA thrombus on transesophageal echocardiography (TEE) after three months of optimal anticoagulation in patients with different types of LAA at baseline cardiac computed tomography of patients with severe MS. METHODS: This prospective cohort study observed the frequency of LAA thrombus resolution after three months of anticoagulation therapy in patients with severe MS. The response rate in different morphologies of LAA and locations was also assessed. Thrombus resolution after three months of warfarin therapy was assessed on repeat TEE. RESULTS: A total of 88 patients were included, mean age 37.95±11.87 years. Repeat TEE showed thrombus resolution in only 27.3% of patients. The rate of thrombus resolution was 8/12 (66.7%), 4/28 (14.3%), 8/36 (22.2%), and 4/12 (33.3%) for patients with cactus, cauliflower, chicken wing, and windsock LAA type, respectively. The resolution rate was 0/12 (0%), 4/44 (9.1%), and 20/32 (62.5%) for patients with thrombus in the base, body, and tip of the LAA, respectively. CONCLUSION: The cactus type of LAA morphology and thrombus at the LAA tip responded well to three months of anticoagulation, however, patients with thrombus in the LAA base and body and cauliflower and chicken wing morphology were non-responders and could benefit from early referral for surgical management.
ABSTRACT
OBJECTIVE: Spontaneous echo contrast (SEC) is the appearance of swirling, smoke-like echoes in the left atrium (LA) and is accepted as an independent predictor of thromboembolic risk. There is an established relationship between the inflammatory state and the prothrombotic state. Therefore, we investigated the relationship between the Systemic Immune Inflammation Index (SII), a new inflammation parameter introduced recently, and SEC in patients with mitral stenosis (MS). MATERIAL AND METHODS: A total of 262 patients who underwent percutaneous mitral valvuloplasty (PMBV) for MS were included in this study. The patients were divided into two groups: patients with MS complicated by SEC and patients with MS without SEC, based on whether SEC occurred in the LA. RESULTS: There were 79 patients (mean age 47.1 ± 6.6, 30.3% male gender) in the SEC (+) group, while there were 183 patients (mean age 46.4 ± 8.6, 29.5% male gender) in the SEC (-) group. In multivariate analysis, high levels of SII were an independent risk factor for SEC in patients with MS (OR: 1.001, 95% confidence interval (CI): 1.000-1.001, p<0.001) together with high levels of C-reactive protein (OR: 1.145, 95% CI: 1.027-1.277, p=0.014). The receiver operating characteristics (ROC) curve analysis showed that at a cutoff value of 547.6 for SII to predict SEC with 74.6% sensitivity and 77.6% specificity (area under ROC curve=0.736 (95% CI: 0.668-0.805), p<0.001). CONCLUSION: Our study showed that the SII levels were independently associated with SEC in patients with MS.
Subject(s)
Mitral Valve Stenosis , Humans , Male , Female , Mitral Valve Stenosis/diagnostic imaging , Mitral Valve Stenosis/complications , Heart Atria/diagnostic imaging , Inflammation , C-Reactive Protein , Risk Factors , Echocardiography, TransesophagealABSTRACT
Protein-losing enteropathy is one of the most feared complications of the Fontan circulation. The diagnosis of protein-losing enteropathy in this setting should prompt a thorough investigation for the presence of a treatable hemodynamic impairment. In this report, we describe a complete reversal of protein-losing enteropathy following percutaneous enlargement of a restrictive atrial septal defect in a patient with a fenestrated lateral tunnel Fontan and severe mitral stenosis.
Subject(s)
Fontan Procedure , Heart Septal Defects, Atrial , Protein-Losing Enteropathies , Heart Septal Defects, Atrial/surgery , Hemodynamics , Humans , Postoperative Complications , Protein-Losing Enteropathies/etiologyABSTRACT
Resumo Fundamentos: Os mecanismos subjacentes pelos quais a doença cardíaca reumática (DCR) levam à disfunção valvar grave não são totalmente compreendidos. Objetivo: O presente estudo avaliou as alterações histopatológicas nas valvas mitrais (VM) buscando uma associação entre o padrão de disfunção valvar predominante e os achados histopatológicos. Métodos: Em 40 pacientes submetidos à troca da VM devido a DCR e em 20 controles submetidos a transplante cardíaco, foram analisados os aspectos histológicos da VM excisada. Dados clínicos e ecocardiográficos também foram coletados. As análises histológicas foram realizadas usando coloração com hematoxilina-eosina. Determinou-se inflamação, fibrose, neoangiogênese, calcificação e metaplasia adiposa. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados: A idade média dos pacientes com DCR foi de 53±13 anos, sendo 36 (90%) do sexo feminino, enquanto a idade média dos controles foi de 50±12 anos, semelhante aos casos, sendo a maioria do sexo masculino (70%). O endocárdio valvar reumático apresentou espessura maior que os controles (1,3±0,5 mm versus 0,90±0,4 mm, p=0,003, respectivamente), e infiltrado inflamatório mais intenso no endocárdio (78% versus 36%; p=0,004), com predominância de células mononucleares. Ocorreu fibrose moderada a acentuada mais frequentemente em válvulas reumáticas do que em válvulas controle (100% vs. 29%; p<0,001). Ocorreu calcificação em 35% das valvas reumáticas, principalmente entre as valvas estenóticas, associada à área valvar mitral (p=0,003). Conclusões: Apesar do intenso grau de fibrose, o processo inflamatório permanece ativo na valva mitral reumática, mesmo em doença tardia com disfunção valvar. A calcificação predominou em valvas estenóticas e em pacientes com disfunção ventricular direita.
Abstract Background: The underlying mechanisms by which rheumatic heart disease (RHD) lead to severe valve dysfunction are not completely understood. Objective: The present study evaluated the histopathological changes in mitral valves (MV) seeking an association between the pattern of predominant valvular dysfunction and histopathological findings. Methods: In 40 patients who underwent MV replacement due to RHD, and in 20 controls that underwent heart transplant, histological aspects of the excised MV were analyzed. Clinical and echocardiographic data were also collected. Histological analyses were performed using hematoxylin-eosin staining. Inflammation, fibrosis, neoangiogenesis, calcification and adipose metaplasia were determined. A p value<0.05 was considered to be statistically significant. Results: The mean age of RHD patients was 53±13 years, 36 (90%) were female, whereas the mean age of controls was 50±12 years, similar to the cases, with the majority of males (70%). The rheumatic valve endocardium presented greater thickness than the controls (1.3±0.5 mm versus 0.90±0.4 mm, p=0.003, respectively), and a more intense inflammatory infiltrate in the endocardium (78% versus 36%; p=0.004), with predominance of mononuclear cells. Moderate to marked fibrosis occurred more frequently in rheumatic valves than in control valves (100% vs. 29%; p<0.001). Calcification occurred in 35% of rheumatic valves, especially among stenotic valves, which was associated with the mitral valve area (p=0.003). Conclusions: Despite intense degree of fibrosis, the inflammatory process remains active in the rheumatic mitral valve, even at late disease with valve dysfunction. Calcification predominated in stenotic valves and in patients with right ventricular dysfunction.
Subject(s)
Humans , Male , Female , Adult , Aged , Rheumatic Heart Disease/diagnostic imaging , Calcinosis/diagnostic imaging , Mitral Valve Insufficiency , Mitral Valve Stenosis/diagnostic imaging , Middle Aged , Mitral Valve/diagnostic imagingABSTRACT
Resumen: Las cardiopatías complican 4% de los embarazos y 60% son por valvulopatías reumáticas; la más común es la estenosis mitral. Por esta razón, reportamos el caso de una puérpera en apariencia sana con embarazo normoevolutivo que debutó con falla cardiaca derecha. Se integró el diagnóstico de estenosis mitral grave por enfermedad reumática, la cual se estabilizó de manera precoz para realizar de forma externa corrección quirúrgica. Aunque en la actualidad la prevalencia de enfermedades reumáticas ha disminuido, la estenosis mitral sigue siendo la valvulopatía más común en las embarazadas y es una entidad potencialmente mortal si no se lleva el control adecuado.
Abstract: Heart disease complicates 4% of pregnancies, and rheumatic valve diseases make up 60% of these cases. The most common one is mitral stenosis. We present the case of a healthy puerperal woman with a non-complicated pregnancy who begin with pulmonary edema and acute heart failure. She was diagnosed with severe mitral stenosis with rheumatoid etiology, which was stabilized for external surgical correction. Although the prevalence of rheumatoid diseases has decreased, mitral stenosis remains the most common valve disease in pregnant women and is life-threatening without proper control.
Resumo: As cardiopatias complicam 4% das gestações e 60% são decorrentes de valvopatias reumáticas, sendo a mais comum a estenose mitral. Por esse motivo, relatamos o caso de uma puérpera aparentemente saudável com gestação normoevolutiva, que debutou com insuficiência cardíaca direita, integrando o diagnóstico de estenose mitral grave por doença reumática, que se estabilizou precocemente para realizar correção cirúrgica externa. Embora atualmente a prevalência de doenças reumáticas tenha diminuído, a estenose mitral ainda é a doença valvular mais comum em mulheres grávidas e é uma entidade potencialmente fatal se não for adequadamente controlada.
ABSTRACT
Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease. We report the case of a 57-year-old-woman with significant MS and permanent AF, in New York Heart Association functional class II, who despite adequate oral anticoagulation with acenocoumarol, presented several clinical episodes of systemic thromboembolism in the last four years. It was decided to perform a combined percutaneous procedure, including both PMV and percutaneous LAA closure with the Amplatzer Cardiac Plug device. No significant acute complications occurred and the patient was discharged on indefinite treatment with acenocoumarol associated with aspirin 100 mg/d for three months. After a one-year follow-up, there have been no new embolic episodes or other complications.
Subject(s)
Atrial Appendage/surgery , Atrial Fibrillation/drug therapy , Atrial Fibrillation/surgery , Mitral Valve Stenosis/surgery , Septal Occluder Device , Thromboembolism/prevention & control , Acenocoumarol/therapeutic use , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Cardiac Surgical Procedures , Combined Modality Therapy/methods , Female , Humans , Middle Aged , Mitral Valve Stenosis/complications , Mitral Valve Stenosis/diagnostic imaging , Thromboembolism/etiology , Treatment OutcomeABSTRACT
The authors report the case of a 53-year-old man, with a long-standing history of mild mitral stenosis, admitted for worsening fatigue. Transthoracic echocardiography (limited by poor image quality) showed mitral annular calcification, leaflets that were difficult to visualize and an estimated mitral valve area of 1.8 cm(2) by the pressure half-time method. However, elevated mean transmitral and right ventricle/right atrium gradients were identified (39 and 117 mmHg, respectively). This puzzling discrepancy in the echocardiographic findings prompted investigation by transesophageal echocardiography, which revealed an echogenic structure adjacent to the mitral annulus, causing severe obstruction (effective orifice area 0.7 cm(2)). The suspicion of supravalvular mitral ring was confirmed during surgery. Following ring resection and mitral valve replacement there was significant improvement in the patient's clinical condition and normalization of the left atrium/left ventricle gradient. Supravalvular mitral ring is an unusual cause of congenital mitral stenosis, characterized by an abnormal ridge of connective tissue on the atrial side of the mitral valve, which often obstructs mitral valve inflow. Few cases have been reported, most of them in children with concomitant congenital abnormalities. Diagnosis of a supravalvular mitral ring is challenging, since it is very difficult to visualize in most diagnostic tests. It was the combination of clinical and various echocardiographic findings that led us to suspect this very rare condition, enabling appropriate treatment, with excellent long-term results.
Subject(s)
Mitral Valve Stenosis/diagnosis , Mitral Valve Stenosis/etiology , Mitral Valve/abnormalities , Diagnostic Errors , Humans , Male , Middle Aged , Mitral Valve/surgeryABSTRACT
AIM: The aim of this study was to determine the early and long-term results of percutaneous balloon mitral valvotomy (PBMV) in patients with Wilkins score (WS) between 9 and 11. METHODS: We performed a retrospective review of clinical records of patients with rheumatic mitral stenosis who underwent PBMV between November 1991 and March 2008. Follow-up was obtained by telephone interview and/or clinical records. The procedure was considered unsuccessful when post-procedure mitral valve area was <1.5 cm(2). RESULTS: We analyzed 124 patients, 108 (87.1%) of them women. Mean age at the time of repair was 46 ± 11 years and mean follow-up time was 10 ± 4 years. Before the procedure, 100 patients (80.6%) had WS ≤ 8 and 24 (19.4%) were in the "gray zone" (>8 and <11). Patients with WS ≤ 8 and patients in the gray zone had similar ages at first intervention (45 ± 11 vs. 49 ± 11 years; p=0.095) and follow-up time (10 ± 4 vs. 11 ± 5 years; p=0.55). There were no differences between groups in gender (women: 86% vs. 92%; p=0.735), or in baseline echocardiographic measurements (mitral valve area by planimetry 1.0 cm(2) [P25-P75: 0.9-1.1] vs. 0.9 [P25-P75: 0.8-1.2], p=0.514; pulmonary artery systolic pressure 53 mmHg [P25-P75: 45-63] vs. 50 [P25-P75: 44-54], p=0.823]; left atrial diameter >55 mm [16.5% vs. 13.6%, p=1.00]; mitral regurgitation [46.5% vs. 37.5%, p=0.428]) or baseline transmitral gradient (13 mmHg [P25-P75: 10-19] vs. 13 mmHg [P25-P75: 7-20]). Improvements in mitral valve area by planimetry and in hemodynamic gradient were similar in the two groups (0.91 ± 0.39 cm(2) vs. 0.84 ± 0.44 cm(2), p=0.55; 8.8 ± 5.3 mmHg vs. 7.3 ± 5.9 mmHg, p=0.275, respectively). There were no significant differences in major complications or success rates (4.0 vs. 12.5 p=0.131; 89.9% vs. 95.8%, p=0.69) or in need for urgent surgery or future reintervention (2.0 vs. 8.3%, p=0.168; 22% vs. 27.3%, p=0.594). In-hospital mortality occurred only in patients in the WS gray zone (2 [8.3%] vs. 0%, p=0.04), one death (4.2% vs. 0%, p=0.194) possibly being related to a higher WS (secondary to stroke) and the other as a consequence of peripheral vascular complication. Improvements in NYHA functional class soon after the procedure and during follow-up were similar in the two groups. Total mortality was similar in the two groups (3.1 vs. 8.7%, p=0.244). CONCLUSIONS: PBMV was a safe and effective procedure in patients in the WS gray zone. Optimal results can be achieved in these patients if they are carefully selected and operated at experienced centers.
Subject(s)
Balloon Valvuloplasty , Mitral Valve Stenosis/classification , Mitral Valve Stenosis/surgery , Patient Selection , Severity of Illness Index , Balloon Valvuloplasty/methods , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Fundamentos: A técnica do balão único é de mais baixo custo e tem resultados semelhantes à de Inoue. Objetivos: Analisar a evolução da valvoplastia mitral com balão único Balt e fatores de risco para óbito e eventos maiores (óbito, nova valvoplastia mitral por balão ou cirurgia valvar mitral). Métodos: O balão único foi usado em 256 procedimentos, com diâmetro máximo de 25 mm em5 (1,9 %) e de 30 mm em 251 (98,1 %) procedimentos. O período médio de seguimento foi 55±33 meses. Resultados: Encontrou-se no grupo do balão único: média de idade 38,0±12,6 anos; escore ecocardiográfico 7,2±1,5 pontos; escore ecocardiográfico >8, 32 (12,5 %);sexo feminino, 222 (86,7 %); ritmo sinusal, 215 (84,0 %); sobrevida no seguimento de 245 (95,7 %) e sobrevida livre de eventos maiores, 211 (83,4 %). Na análise multivariada predisseram independentemente óbito: idade ³50 anos e escore ecocardiográfico >8 e eventos maiores: área valvar mitral pós-procedimento <1,50 cm2; comissurotomia prévia e sexo masculino; e com sete variáveis predisseram independentemente óbito: idade ≥50 anos, escore ecocardiográfico >8 e cirurgiamitral na evolução. Conclusões: Predisseram óbito e/ou eventos maiores: idade ≥50 anos, escore ecocardiográfico >8,área valvar mitral pós-procedimento <1,50 cm2, comissurotomia prévia, sexo masculino e cirurgia mitral na evolução.
Background: The single ballon (SB) technique is a low-cost option with outcomes similar to the Inoue ballon. Objectives: To analyze the long term outcomes of SB Balt mitral valvuloplasty with risk factors for death and major events (death, further mitral ballon valvuloplasty, or mitralvalve surgery) Methods: The single ballon was used in 256 procedures, with maximum balloon diameters of 25 mm for 5 (1.9%) procedures and 30 mm for 251 (98.1%)procedures. The mean follow-up period was 55+-33 months. Results: The single balloon group presented: age38.0±12.6 years, echocardiographic score 7.2±1.5points, echocardiographic score >8.32 (12.5 %), female 222(86.7 %), sinus rhythm 215 (84.0 %), survival for 245(95.7 %) at the end of the follow-up period and survival with no major events for 211 (17.6 %). In a multivariate analysis, the independent death prediction factors were: age ≥50 years and echocardiographic score >8; major events: post-procedure <1.5 cm2 mitral valve area, prior commisurotomy and male; the seven independent death prediction variables were: age ≥50years, echocardiographic score >8 and mitral valve surgery during the follow-up period. Conclusions: Death or major event predictors were: age ≥50 years, echocardiographic score >8, post-procedure mitral valve area <1.50 cm2, prior commisurotomy, male and mitral valve surgery during the follow-up period.
Subject(s)
Humans , Male , Female , Mitral Valve Stenosis/surgery , Risk Factors , Balloon Valvuloplasty/methods , Balloon Valvuloplasty , Multivariate Analysis , Echocardiography/methods , EchocardiographyABSTRACT
Relata-se o caso de gestante admitida na 23.ª semana de gestação com cardiopatia classe funcional IV pela NewYork Heart Association por estenose mitral reumática. Submeteu-se ao tratamento com betabloqueador e, na 29.ª semana de gestação, à valvoplastia pela técnica do duplo balão. Imediatamente após o procedimento, manifestou hemiparesia à esquerda e teve trabalho de parto prematuro, inibido com indometacina. A ressonância magnética decrânio mostrou infarto das artérias cerebral média e anterior direita. O tratamento instituído foi ácido acetilsalicílico eheparina, que se manteve até a 36.ª semana de gestação. O parto vaginal ocorreu com 37 semanas de gestação, eo recém-nascido, com 2.500 g de peso, tinha ânus anterior ectópico e luxação congênita das articulações coxofemorais.A paciente persiste com sequela leve da isquemia vascular cerebral e com remissão da insuficiência cardíaca,e o concepto evoluiu satisfatoriamente.
A case of a 23rd gestational week patient with the New York Heart Association functional class IV rheumatic mitral stenosis cardiopathy is reported. She was submitted to beta-blocker treatment and, at the 29th week, to double-balloon valvuloplasty technique. Immediately after the procedure she developed left sided hemiparesis and early labor, which was inhibited with indometacin. Cranial magnetic ressonance showed right middle and anterior cerebral artery infarction. Treatment was initiated with acetilsalicilic acid and heparin and held until the 36th week. Vaginal labor occurred at 37 weeks of gestation. The newborn weighted 2,500 g and presented with anterior ectopic anus and congenital hip luxation. The patient remains with mild stroke sequelae and the infant has developed satisfactorily.
Subject(s)
Humans , Pregnancy , Adult , Stroke , Angioplasty, Balloon , Mitral Valve Stenosis , Pregnancy , Brain IschemiaSubject(s)
Humans , Female , Adult , Mitral Valve Stenosis , Myxoma/surgery , Myxoma/complications , Myxoma/therapy , Heart Neoplasms/epidemiology , Oligosymptomatic DiseasesABSTRACT
PURPOSE: To study the short-term results, complication and in-hospital follow-up of 268 percutaneous mitral balloon valvuloplasty (PMBV) procedures performed with the low-profile monofoil balloon (LPMB) technique from 1990 to 1995. METHODS: A single 30mm balloon diameter was used in 247 (92.9) procedures, a single 25mm balloon diameter in 9 (3.3), a single 25mm balloon followed by a single 30mm balloon diameter in 7 (2.6) and in 5 procedures a balloon was not used. The mean age group was 36 +/- 12 years. Two hundred nineteen (81.7) procedures were performed in women (mean age 36 +/- 12 years) and 49 (18.3) in men (mean age, 35 +/- 14 years) (p = 0.78). Patients were in functional class II (NYHA) in 39 (14.5), class III in 198 (73.9) and class IV in 31 (11.6). Patients were in sinus rhythm in 228 (85.1) procedures and in atrial fibrillation in 40 (14.9). The echocardiographic score ranged from 4 to 14 (mean 7.2 +/- 1.5). RESULTS: There were 256 complete procedures, 249 of which were successful (mitral valve area (MVA) > or = 1.5cm2 after PMBV). Echocardiographic calculated MVA before PMBV was 0.9 +/- 0.2cm2. Hemodynamic calculated MVA before PMBV was 0.9 +/- 0.2cm2 and after was 2.0 +/- 0.4cm2 (p < 0.000001). Mean pulmonary artery pressure decreased from 40 +/- 15mmHg to 28 +/- 10mmHg (p < 0.000001) and mitral mean gradient from 20 +/- 7mmHg to 5 +/- 4mmHg (p < 0.000001). In the 256 complete procedures mitral valve (MV) was competent in 214 and there was 1+ mitral regurgitation (MR) in 42. After PMBV, MV was competent in 166 and there was 1+ MR in 68, 2+ in 16, 3+ in 5 and 4+ MR in 1. There were complications in 14 (5.2) procedures, severe MR in 6 (3 or 4+), stroke in 2 and cardiac tamponade in 6. Two patients died during emergency cardiac surgery after left ventricular perforation and 1 after stroke. CONCLUSION: PMBV with the LPMB was an effective procedure with a high success rate and a low rate of complications as the more usual double-balloon and Inoue balloon techniques.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Catheterization , Mitral Valve Stenosis , Catheterization , Echocardiography , Treatment Outcome , Analysis of Variance , HemodynamicsABSTRACT
PURPOSE--To study characteristics of the natural history of mitral stenosis (MS) in patients that have no correlation between mitral valve areas (MVA) and symptoms. METHODS--We studied 18 patients with MS, that presented no correlation between MVA and functional class (FC), 16 (89) were female and two (11) men, with age ranging from 16 to 54 (mean 33) years. Patients assigned to group A (8 cases) had FC III and MVA > or = 1.5 cm2 and group B (10 cases) FC I/II and MVA < 1.1 cm2. FC and MVA at the start (initial time-It) and after 12 months or before surgical correction (SC) or percutaneous mitral balloon valvuloplasty (PBV) (final time-Ft) were compared. All patients with predict O2 uptake (PRED VO2) at It were evaluated. RESULTS--Five (63) patients of group A, that maintained MVA > or = 1.5 cm2, changed to FC I/II but three (38) needed a SC or PBV (2 with lesser MVA at Ft). At group B, six (60) patients needed SC or PBV. CONCLUSION--MS patients with MVA > or = 1.5 and FC III, providing MVA do not decrease, improves their FC, becoming it more compatible with MVA PRED VO2. The cases of group B presented the greatest probability of needing SC or PVB.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Mitral Valve Stenosis , Catheterization , Functional Residual Capacity , Electrocardiography , Mitral Valve Stenosis , PrognosisABSTRACT
Objetivo - Avaliar a eficácia a longo prazo da valvoplastia mitral por cateter pela técnica do duplo baläo (VMC2B). Métodos - Sessenta e oito pacientes (76 por cento do sexo feminino), com média etária de 32 (15-69) anos, foram submetidos, consecutivamente, a VMC2B e realizaram avaliaçäo clínico-ecodopplercardiográfico no 12§ mês de acompanhamento (PO12M). Os critérios de seleçäo foram: sintomas de hipertensäo veno-capilar pulmonar, ausência de outra cardiopatia de indicaçäo cirúrgica, escore ecocardiográfico adequado, ausência de trombos intracavitários e insuficiência mitral (IM) no máximo discreta. Foram divididos em dois grupos: grupo A - composto por 7 (11 por cento) pacientes que apresentaram eventos cardíacos neste período e grupo B - composto por 61 pacientes que completaram o período de estudo sem eventos cardíacos. Näo havia diferença significativa entre os grupos em relaçäo aos dados demográficos, classe funcional (CF) e ao escore ecocardiográfico. Resultados - No grupo A, 3 pacientes apresentaram IM grave, em um caso houve insucesso e outro apresentou reestenose. Houve 2 óbitos näo relacionados ao procedimento. No grupo B, os resultados hemodinâmicos comparativos pré e imediatamente após (POI) VMC2B mostraram melhroa significativa, exceto em relaçäo ao índice cardíaco. Houve aumento do grau de IM em 17 (28 por cento) pacientes, tornando-se moderado em dois. A variaçäo da área valvar mitral (AVM) entre o PRÉ x POS x PO12M mostrou, comparando-se AVM no POI e PO12M, reduçäo significativa. Dois (3 por cento) pacientes com reduçäo >50 por cento do ganho inicial, 33 (54 por cento) entre 10 e 50 por cento e 26 (42 por cento) aquém de 10 por cento näo tiveram comprometimento da CF permanecendo em CF I/II. Conclusäo - A VMC2B é método atrativo para tratamento de estenose mitral em pacientes sintomáticos selecionados, com baixo índice de complicaçöes, melhora sintomática imediata que manteve-se a longo prazo apesar de reduçäo da AVM
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Catheterization , Mitral Valve Stenosis/therapy , Follow-Up Studies , Mitral Valve Stenosis/physiopathology , HemodynamicsABSTRACT
PURPOSE--To present immediate results of percutaneous mitral valvuloplasty (PVM) with Inoue balloon for the treatment of mitral stenosis. METHODS--One hundred and twelve consecutive patients mean age 31.26 +/- 9.5 years, 82 per cent females, the majority in functional class III/IV (69 per cent ) underwent percutaneous mitral valvuloplasty (PVM) with Inoue balloon. The procedure was undertaken by the transseptal technique. RESULTS--PMV achieved significant reduction in mean left atrial pressure pre 24.57 +/- 5.37 post 12.36 +/- 4.82, mitral gradient pre 15.31 +/- 4.28 post 3.48 +/- 2.09 and increased mitral valve area pre 0.88 +/- 0.12 post 2.0 +/- 0.28 (P < 0.001). An increase of at least 25 per cent of the mitral valve area with a final result greater than 1.5 cm2 was obtained in 96 per cent of the cases. Cardiac tamponade occurred in five cases (4.4 per cent ). In 4 a successful treatment was accomplished in the catheterization laboratory. Significant mitral regurgitation was seen in one case (0.9 per cent ) and there was one death (0.9 per cent ). CONCLUSION--The results of this series attest to the effectiveness of the PMV with Inoue balloon in selected cases of mitral stenosis
Objetivo - Analisar os resultados imediatos em portadores de estenose da válvala mitral, submetidos a valvuloplastia com cateter-balão de Inoue. Métodos - Cento e doze pacientes consecutivos, com idade média de 31,26±9,5 anos, 82% do sexo feminino, a maioria em classe funcional III e IV (69%), foram submetidos a valvuloplastia mitral por balão (VMB). Os casos foram selecionados pelo escore ecocardiográfico proposto por Wilkins. O procedimento foi realizado por via transeptal segundo a técnica de Inoue. Resultados - Após VMB foi observada significativa redução da pressão média do átrio esquerdo pré 24,57±5,37/ pós 12,36±4,82, do gradiente transvalvar mitral pré 15,31±4,28/ pós 3,48±2,09 e aumento significativo da área valvar mitral (AVM) média pré 0,88±0,12/pós 2,0±0,28 (P<0,001). O sucesso definido como aumento pelo menos de 25% da AVM com resultado final maior que 1,5cm2 na ausência de insuficiência mitral significativa (3/4+), cirurgia de emergência ou óbito, foi alcançado em 96% dos casos. Como complicações, ocorreram 5 tamponamentos cardíacos (TC), 4 deles tratados na sala de hemodinâmica com sucesso; 1 paciente desenvolveu insuficiência mitral importante (3/4+), sendo operado eletivamente; ocorreu 1 óbito, devido a TC seguido de embolia pulmonar. Conclusão - Os resultados observados nesta série, comprovam a efetividade e segurança da técnica de valvuloplastia com cateter-balão Inoue, em casos selecionados de portadores de estenose mitra
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Catheterization , Mitral Valve Stenosis/therapy , Retrospective Studies , Treatment OutcomeABSTRACT
Objetivo - Analisar os reultados da valvoplastia mitral por cateter-baläo (VMCB) em pacientes de alto risco operatório. Métodos - Vinte (12// pacientes dentre 172 comsecutivos submetidos a VMCB foram considerados de alto risco operatório. Dezessete (85//) eram mulheres e a média etária de 43(18-69) anos. Treze (65//) encontravam-se em edema agudo dos pulmöes (3 gestantes, 2 com acidente vascular cerebral (AVC) prévio, 1 com tromboembolismo pulmonar e outro com insuficiência renal crônica) e 7 (35//) em classe funcional (CF) III (2 com insuficiência coronariana crônica, 2 com obesidade maligna, 1 com neoplasia de pulmäo, 1 com caquexia cardíaca e outro com AVC prévio). Realizaram VMCB pela técnica transeptal sendo utilizado duplo baläo em 10(45//), baläo Inoue em 5(25//), monofoíl em 3(15//) e bifoil em 2(10//) pacientes. Resultados - Dezessete (85//) pacientes com sucesso e 2 (10//) com melhora clínica expressiva. Os resultados hemodinâmicos pré x pós-VMCB foram: pressäo de átrio esquerdo (PAE) em mmHg 28,2 ñ 10,0 x 15,2 ñ 9,2 (n = 20) (p < 0,001); gradiente transvalvar mitral médio (G) em mmHg 21,2 ñ 10,7 x 10,7 ñ 6,7 (n = 18) ( , 0,001); área valvar mitral (AVM) em cm² 0,73 ñ 0,6 (n = 11) (p < 0,001); pressäo média de artéria pulmonar em mmHg 52,0 ñ 18,2 x 40,1 ñ 14,7 (n = 18) (p < 0,001); índice cardíaco em L/min/m² 2,1 ñ 0,4 x 2,5 ñ 0,6 (n = 14) (p < 0,001). No ecocardiograma os resultados comparativos pré, pós e após 6 meses da VMCB foram: área valvar mitral (cm²) 1,06 ñ 0,39 x 1,92 ñ 0,51 x 1,65 ñ 0,5 e gradientes transvalvar mitral (mmHg) 13,8 ñ 4,7 x 7,3 ñ 3,6 x 7,3 ñ 4,4. Houve 2 óbitos imediatos (tromboembolismo pulmonar e falência de multiplos órgäos) e 1 extra-hospitalar. As complicaçöes foram: 2(10//) pacientes com complicaçöes neurológicas, 1(5//) com comunicaçäo interatrial e outro com perfuraçäo da átrio direito (5//). Conclusäo - A VMCB oferece alternativa ao tratamento cirurgico em pacientes considerados de alto risco operatório e manutençäo do sucesso em seis meses de seguimento
Purpose - To evaluate percutaneous mitral balloon valvuloplasty (PMBV) in surgical high risk patients. Methods - Twenty (12%) patients out of 172 submitted to a PMBV were considered high surgical risk cases; 17 (85%) were women and mean age was 43 (18- 69). Thirteen (65%) were in acute pulmonary edema (3 were pregnant, 2 had previous cerebrovascular event, 1 had pulmonar thromboembolism and other had chronic renal failure), and 7 (35%) were in functional class (CF) III (2 had coronary artery disease, 2 severe obesity, 1 pulmonar neoplasy, 1 cardiac cachexia and one with previous cerebrovascular event). All patients underwent PMBV through transeptal technique. Double balloon was used in 10 (50%) patients; Inoue balloon in 5 (25%), monofoil in 3 (15%) and bifoil in 2 (10%). Results - Seventeen (85%) obtained success and 2 (10%) had clinical improvement. The hemodinamic results pre versus post-PMBV showed: left atrium pressure (LAP) mmHg 28.2±10,0 x 15.2±9.2 (n=20) (p<0.001), mitral mediam gradient (G) mmHg 21.2±10.7 x 10.7±.7 (n=18)(p<0.001), mitral valve area (MVA) cm2 0.73±0.3 x 1.73±0.6 (n=11) (p<0.001), pulmonary artery pressure mmHg 52.0±18.2 x 40.1±14.7 (n=18) (p<0.001) and cardiac index L/min/m2 2.1±0.4 x 2.5±0.6(n=14) (p<0.001). Comparative echocardiography results pre, post and 6 months after PMBV showed: MVA 1.06±0.39 x 1.92±0.51 x 1.65±0.5 and G 13.8±4.7 x 7.3±3.6 x 7.3±4.4. There were two immediate deaths (pulmonary thromboembolism and multiple organs failure) and other after hospital discharge. The complications were: 2 (10%) patients with neurological complications, 1 (5%) atrial septal deffect and other right atrium perforation (5%). Conclusion - PMBV offers an alternative to surgical treatment in high risk surgical patients and the results are maintained in the 6 month follow-up
Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Adolescent , Adult , Middle Aged , Catheterization , Mitral Valve Stenosis/therapy , Echocardiography, Doppler , Risk Factors , Follow-Up Studies , Mitral Valve Stenosis/physiopathology , Evaluation StudyABSTRACT
Objetivo - Avaliar os resultados da valvoplastia mitral por cateter baläo (VMCB) a curto e a médio prazos. Métodos - Cento e quatro procedimentos em 103 pacientes, 89 (87%) mulheres e média etária de 33 anos. O diagnóstico foi estenose mitral (EM) em 95 (91%), reestenose mitral em 7 (7%) e bioprótese estenótica em 2(2%). Doze pacientes (10%) estavam em classe funcional (CF) II (NYHA), 73 (70%) em CF III e 19 (18%) em CF IV. Noventa e três (89%) estavam em ritmo sinusal, 10 (10%) em fibrilaçäo atrial e 1 (1%) em ritmo funcional. Em 99% dos casos a técnica empregada foi transeptal. Resultados hemodinâmicos comparativos entre pré X pós VMCB imediato foram: área valvar mitral (cm2) 0,75 ñ 0,27 x 1,68 ñ 0m48 (p < 0,0001), gradiente AE-VE médio (mmHg) 19,52 ñ 8,03 x 5,44 ñ 4,38 p < 0,0001); pressäo média de AE (mmHg) 24,72 ñ 8,76 x 9,63 ñ 6,11 (p < 0,0001); índice cardíaco (L/min/m*) 2,55 ñ 0,69 x 2,92 ñ 0,77 (p < 0,0001); pressäo média de AP (mmHg) 40,17 ñ 16,52 x 25,65 ñ 13,77 (p < 0,0001). Ao ecocardiograma os resultados comparativos entre pré-VMCB, pós-VMCB, controle de 6 meses e 12 meses pós-VMCB foram respectivamente: área valvar mitral (cm*) 0,89 ñ 0,23 x 1,87 ñ 0,41 x 1,72 ñ 0,43 x 1,64 ñ 0,44 e gradiente transvalvar mitral (mmHg) 13,12 ñ 4,66 x 6,44 ñ 2,93 x 7,72 ñ 3,24 x 8,30 ñ 4,17. Houve um óbito imediato pós-VMCB em paciente portadora de tromboembolismo pulmonar, 4 (4%) pacientes com insuficiência mitral importante (1 óbito no pós-operatório imediato) e 2 pacientes com reestenose mitral. Conclusäo - A VMCB mostra-se método eficaz e seguro ocorrendo persistência de bons resultados no período de 1 ano de acompanhamento
Purpose - To evaluate percutaneous mitral balloon valvuloplasty (PMBV) results immediately and one yearfollow-up. Methods - One hundred andfour procedures in 103 patients, 89 (87%) were women and mean age was 33. Ninety five (91%) had mitral stenosis, 7 (7%) mitral restenosis and 2 (2%) stenotic bioprosthesis. Twelve (10%) patients were in functional class (FC) II (NYHA), 73 (70%) in FC III and 19 (18%) in FC IV. Ninety three (89%) were in sinusal rhythm, 10 (10%) had atrialfibrilation and 1 (1%) junctional rhythm. In 99% cases the transeptal access was used. Results - The comparative haemodinamic results late x immediately after-PMBV were mitral valve area (cm2) 0.75 ± 0.27 x 1.68 ±0.48 (p < 0.0001), gradiente AE-VE average (mmHg) 19.52 ± 8.03 x 5.44 ± 4.38 (p < 0.0001); average pressure AE (mmHg) 24.72 ± 8.76 x 9.63 ± 6.11 (p < 0.0001), cardiac inde x (L/ min/m2) 2.55 ± 0.69 x 2.92 ± 0.77 (p < 0.0001); average pressure PA (mmHg) 40.17 ± 16.52 x 25.65 ± 13.77 (p < 0.0001). The echocardiography results pré-PMBV, post-PMBV, 6 and 12 months after PMBV were respectively: mitral valve area (cm2) 0.89 ± 0.23 x 1.87 ± 0.41 x 1.72 ± 0.43 x 1.64 ± 0.44 and mitral transvalvar gradient (mmHg) 13.12 ± 4.66 x 6.44 ± 2.93 x 7.72 ± 3.24 x 8.30 ± 4.17. There was one death immediately after-PMBV in a patient with pulmonar thromboembolism. Four (4%) had severe mitral regurgitation and went to surgery (1 death). There were 2 mitral reestenosis. Conclusion - For selected patients PMBVis a safe method and the good results are maintained in 1 year follow-up
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Catheterization , Mitral Valve Stenosis/therapy , Catheterization/adverse effects , Follow-Up Studies , Evaluation Study , HemodynamicsABSTRACT
Objetivo - Estudar a evoluçäo clínica de portadoras de estenose mitral no ciclo gravídico-puerperal que iniciaram a gravidez em classe funcional (CF) I/II. Métodos - Noventa e três mulheres, divididas em três grupos: Grupo GE - 30 gestantes portadoras de estenose mitral com média de idade de 27,9 anos. 26(86,7%) apresentavam sobrecarga atrial esquerda e nove (30%) ventricular direita no eletrocardiograma. A área valvar mitral ao ecodopplercardiograma variou entre 0,7 a 1,9 (1,26) cm*. Grupo GN - 32 gestantes näo cardiopatas, com média de idade de 25,5 anos com eletrocardiograma e área valvar mitral ao ecodopplercardiograma normais. Grupo EM - 31 portadoras de estenose mitral, näo grávidas com média de idade de 25 anos. Dezenove (61,3%) apresentavam sobrecarga atrial esquerda e quatro (13%) sobrecarga ventricular direita no eletrocardiograma. A área valvar mitral variou entre 0,50 a 1,80 (média = 1,19) cm*. Em cada consulta foram anotados os dados sobre CF e complicaçöes. As complicaçöes investigadas foram congestäo pulmonar, endocardite infecciosa, arritmia cardíaca e tromboembolismo. Resultados - Vinte e seis (86,7%) pacientes do grupo GE modificaram a CF: 16 evoluíram para CF III e 10 para IV, no grupo GN, 18 (56,2%) pacientes evoluíram de CF I para II no decorrer da gestaçäo e no grupo EM, cinco (16%) evoluíram da CF I/II para III durante o estudo. Arritmia cardíaca, endocardite infecciosa näo foram registradas. Fenômeno tromboembólico foi identificado em um (3,2%) caso no grupo EM. Näo houve mortalidade. Conclusäo - A grande maioria das gestantes portadoras de estenose mitral, que iniciaram a gravidez em CF I/II evoluíram para CF III/IV, no decorrer da gestaçäo. Medidas como repouso, farmacoterapia e avalvoplastia por cateter-baläo contribuíram, na totalidade dos casos, para o termo da gestaçäo e ausência de mortalidade
Purpose The clinical evolution of women with mitral stenosis was studied during pregnancy, delivery and puerperium in inicial function (FCJ class I/II. Methods Ninety-three women were divided in three groups. Group GE Pregnant women with mitral stenosis (n = 30, mean age 28 years); 26 (86.7%) patients had electrocardiographic signs of left atrial enlargement and nine (30%) had signs of right ventricular hypertrophy. The mitral valvar area was between 0.7 and 1.9 (mean = 1.26) cm2 at echod opplercardiogram, Group GM Normal pregnant women (n = 32; aged 25.4 years), the electrocardiogram and echodopplercardiogram were normal. Group EM - non pregnant patients, with mitral stenosis (n = 31.33 years); 19 (61,3%) had left atrial enlargement andfour (13%) had right ventricular hypertrophy. The mitral valvar area between 0.50 and 1.80 (mean = 1.19) cm2. The variables analyzed were FC and occurrence of the following complications. infective endocarditis, cardiac arrhythmias and thromboembolism. Results In GE group, 26 (86,7%) patients worsened the FC during gestation, 16 to FC III and 10 to FC IV. In GN group, 18 (56,2% ) patients changed from FC I to FC II during the gestation and in EM group 5 (16,2%) patients changed from FC I/II to III during the study. Cardiac arrhythmias and infective endocarditis were not observed; thromboembolic event was registered in one (3.2%) patients from EM group. There were no death in all groups. Conclusion The large majority of pregnant with mitral stenosis that started pregnancy in FC I/II worsened to FC III/IV during gestation. Medical treatment and eventually balloon valvuloplasty were successfull measure to allow a full-term gestation without mortality
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Middle Aged , Mitral Valve Stenosis/physiopathology , Pregnancy Complications, Cardiovascular/physiopathology , Catheterization , Prospective Studies , Postpartum Period/physiology , Mitral Valve Stenosis/drug therapy , Mitral Valve Stenosis/therapy , Heart RateABSTRACT
Objetivo - Avaliar a valvoplastia mitral por duplo cateter-baläo como técnica alternativa näo cirúrgica para tratamento da estenose mitral reumática. Método - Duzentos pacientes foram submetidos ao procedimento, sendo 86,5% do sexo feminino, com idade média de 35,2 anos. Oitenta e um por cento estavam em classes funcionais III e IV (NYHA), e 4% exibiam ritmo de fibrilaçäo atrial. Quatro por cento foram submetidos à comissurotomia cirurgica prévia e 7% eram gestantes. Utilizou-se a técnica de dilataçäo com duplo cateter-baläo, após punçäo septal esquerda. Resultados - O procedimento foi realizado com sucesso em 89% dos pacientes. A área valvar mitral aumentou de 0,91 ñ 0,27 para 2,10 ñ 0,47 cm*, p < 0,001; ocorreu reduçäo do gradiente transvalvar mitral de 20,86 ñ 6,16 para 4,26 ñ 3,13 mmHg, p < 0,001; as pressöes do átrio esquerdo e do tronco da artéria pulmonar reduziram de 25,90 ñ 7,10 para 12,10 ñ 9,0 mmHg e de 36,47 ñ 12,93 para 24,56 ñ 9,98 mmHg, p < 0,001, respectivamente. Dos 21 casos com insucesso, em 19 ocorreram dificuldades com a técnica transeptal. Em 12, constataram-se graus distintos de derrame pericárdico, dos quais 6 exibiram sinais de tamponamento cardíaco. Os 21 casos foram operados, ocorrendo 1 óbito. O refluxo mitral aparece em 50 casos e aumentou em 8. Quinze destes casos, exibiram descompensaçäo clínica, dos quais 10 foram operados, 3 estäo sob controle clínico e 2 faleceram tardiamente. Conclusäo - A valvoplastia mitral pelo duplo cateter-baläo é técnica segura, com bons resultados, constituindo-se me procedimento terapêutico alternativo näo cirúrgico da estenose mitral
Purpose - To study the immediate clinical, echocardiographic and hemodynamic results Of 200 patients who underwent percutaneous mitral balloon valvotomy (PMV) with double balloon technique. Methods - Two hundred patients were submitted to PVM for treatment of congestive heart failure secondary to severe mitral stenosis, between August 1987 to July 1991. Their mean age was 35.2 years, and 86.5% were female patients: 81% of them was in functional class, New York Heart Association (NYHAJ III or IV; 4% was in atrial fibrilation and 4% had previous surgical commissurotomy. Results - PMV was successfully performed in 89% of the patients. The mitral valve area, by pressure half time method, increased from 0.91 ± 0.27 to 2.10 ± 0.47 cm2, p < 0.001; the mean mitral gradient decreased from 20,86 ± 6.16 to 4.26 ± 3.13 mmHg, p < 0.001; the left atrium and mean pulmonary artery pressure decreased from 22.3 ± 7.1 to 11.9 ± 8.3 and 36.47 ± 12.93 to 24.56 ± 9.98 mmHg, p < 0.001, respectively. Complications related to transeptal technique occurred in 12 patients, which resulted in cardiac tamponade in 5 and death in 1. In 19 patients the punction of the atrial septum could not be performed. Mitral regurgitation (MR) immediately after PMV appeared 1 + or more grade in 50 patients, increased in 8 patients and remained unchanged in 11 patients. Ten patients needed mitral valve replacement in the first 48h after PMV, for treatment of severe MR. Conclusion - PMV prod uces excellent immediate results and can be considered an alternative to surgery for the relief of mitral stenosis