RESUMO
Aortic valve replacement can produce dramatic benefit in the setting of symptomatic aortic stenosis. The potential for morbidity and mortality associated with thoracotomy, cardiopulmonary bypass, and aortotomy has fostered a search for alternatives. Early experience with transcatheter endovascular aortic valve implantation demonstrated feasibility and efficacy, but the procedure was difficult to reproduce. However, equipment, techniques, and experience have evolved rapidly. Balloon-expandable and self-expanding prostheses and percutaneous femoral artery and open left ventricular apical access have found favor, each with potential advantages and disadvantages. Procedural success rates and clinical outcomes continue to improve. Current studies suggest that morbidity and mortality rates of percutaneous aortic valve implantations are much better in comparison to conventional surgery in selected high-risk patients. On November 11, 2008, in the Gottsegen György Hungarian Institute of Cardiology we performed the first two successful percutaneous aortic valve implantations in Central and Eastern Europe, following a more than one-year preparation period. After seven days the patients were discharged in very good conditions.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Cateterismo , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/fisiopatologia , Humanos , Hungria , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Seleção de Pacientes , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Vasovagal syncope or common faint is the most frequent form of syncopes. With regard to the different involvement of the efferent mechanisms, several forms of the neurally mediated syncope syndromes are recognized. The authors present a case of mixed type vasovagal syncope, diagnosed by tilt table testing. The efferent mechanisms of syncope included Wenckebach type atrioventricular block due to increased vagal tone, and sympathetic withdrawal, reflected by sudden drop in the blood pressure. The significance and interrelationship of these factors are discussed.
