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Cian Nazzetta D, De Sousa LCG, Rosa VEE, Tessari FC, Pessoa RS, Lipari LFVP, Fernandes JRC, Lopes MP, De Santis ASAL, Spina GS, Pires LJNT, Sampaio RO, Tarasoutchi F. Long-term prognostic impact of pulmonary vascular resistance in patients with rheumatic mitral stenosis undergoing percutaneous mitral balloon valvuloplasty. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) has a well-known impact on the prognosis of patients with rheumatic mitral stenosis (MS). Some patients can present pre-capillary PH, defined as a pulmonary vascular resistance (PVR) ≥3.0 woods, and there is few data regarding the prognostic value of invasive measures of PVR in this context.
Purpose
To assess the impact of PVR on the long-term outcomes of patients with rheumatic MS undergoing percutaneous mitral balloon valvuloplasty (PMBV).
Methods
Unicentric, retrospective study, including patients with rheumatic MS undergoing PMBV from 2016 to 2020. All patients underwent clinical and laboratorial evaluation, and transthoracic echocardiogram before and after the procedure. During PMBV, transesophageal echocardiogram and hemodynamic measures were performed. The composite endpoint included death, reintervention and persistent NYHA FC III–IV in long-term follow-up.
Results
58 patients were included with a median age of 50.5 [42–60.5] years and 82.8% were female. Most important comorbidities were hypertension (55.2%), previous valvular intervention (22.4%), diabetes (20.7%), atrial fibrillation (18%), previous stroke/transient ischemic attack (3.4%), coronary artery disease (1.7%). Median mitral valve area was 1.2 [0.9–1.3] cm2, mean transmitral gradient was 8 [6–12] mmHg and pulmonary artery systolic pressure (PASP) was 42 [35–51] mmHg. Pre-procedure hemodynamic right atrium pressure (RAP) was 8 [6–10] mmHg, pulmonary artery mean pressure (mPAP) was 26 [21–31] mmHg, pulmonary capillary pressure (PCP) was 18 [15–22] mmHg and PVR was 2.15 [1.5–3.46] mmHg/min. Thirty-five (60.3%) patients underwent 1 balloon dilation, 10 (17.2%) 2 dilations, 3 (5.3%) 3 dilations and 1 (1.7%) 4 dilations. Only 1 (1.7%) case need conversion to open surgery. Post-procedure hemodynamic Δ mPAP was 4 [1–8] mmHg, Δ PCP was 5 [2–7] mmHg and Δ PVR was 0.03 [−0.072–0.99] mmHg/min. Median follow-up was 32.9 [20.2–43] months. Need for reintervention (surgery or PMBV) was 6.9%, mortality during follow-up was 1.7% and the composite endpoint occurred in 13 (22.4%) patients. By univariate analysis, echocardiographic PSAP (HR: 1.069, 95% CI 1.010–1.130, p=0.021), RAP (HR: 1.267, 95% CI 1.028–1.562, p=0.027), Δ hemodynamic PASP (HR: 0.927, 95% CI 0.866–0.991, p=0.026) and moderate or severe tricuspid regurgitation (HR: 6.318, 95% CI 1.734–23.023, p=0.005) were associated with the composite endpoint. By multivariate analysis adjusted by RVP, RAP (HR: 1.626, 95% CI 1.005–2.630, p=0.047) was the only independent predictor of the composite endpoint. The RAP cutoff found through the Youden index was 9.5 mmhg (Figure 1).
Conclusion
In patients with severe MS undergoing PMBV, RAP measurement in cardiac catheterization was the only independent predictor of combined outcome of death, reintervention and persistent NYHA FC III–IV in long-term follow-up. PVR had no impact on long-term outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Cian Nazzetta
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - L C G De Sousa
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - V E E Rosa
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - F C Tessari
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - R S Pessoa
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - L F V P Lipari
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - J R C Fernandes
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - M P Lopes
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - A S A L De Santis
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - G S Spina
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - L J N T Pires
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - R O Sampaio
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
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2
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Nicz P, Freire AFD, Filippini FB, Kanhouche G, Accorsi TAD, Ribeiro HB, Liberato G, Nomura CH, Cassar RS, Vieira ML, Mathias Jr W, Pomerantzeff PMA, Tarasoutchi F, Abizaid A, De Brito Jr FS. Transcatheter aortic valve implantation without contrast media technique in chronic kidney disease population – pilot study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Acute Kidney Injury (AKI) is frequently observed after Transcatheter aortic valve implantation (TAVI), with rates ranging from 3% to 50%. In the Brazilian TAVI Registry, the incidence of AKI following TAVI was 18%, with 4.5% requiring dialysis. Its occurrence is associated with an increase in 3-fold all-cause and cardiac death. Since AKI is related to the volume of contrast media, avoiding contrast during TAVI procedure is advisable, especially in chronic kidney disease (CKD) patients.
Purpose
The aims of the proposed study are to: (1) evaluate the feasibility and safety of a zero-contrast technique for CKD patients undergoing TAVI and (2) define the role of each of the non-contrast imaging modalities in the preoperative assessment for TAVI and (3) evaluate the incidence of AKI post-TAVI in this population.
Methods
Patients with severe symptomatic aortic stenosis (AS) and CKD stage ≥3a where evaluated for TAVI with four preoperative exams: transesophageal echocardiogram (TEE), cardiac magnetic resonance, contrast and noncontrast computed tomography (MDCT) and aortoiliac co2 angiography. After safety measures of transfemoral (TF) viability and aortic valve favorable anatomy, patients were submitted to TF-TAVI with self-expandable Evolut R/Pro. The contrast MDCT was blinded to the operators and it is checked before the procedure, at a safety checkpoint, to exclude high-risk conditions not detected by non-contrast methods. During the procedure, another safety checkpoint was accomplished. Clinical and echocardiographic outcomes were assessed at 30 days.
Results
Between december 2020 to december 2021, a total of 25 patients underwent TF TAVI with zero-contrast technique. Mean age of 79.9±6.1 years, 52% male, 18 patients (72%) NYHA functional class III or IV, mean STS-PROM 3.0±1.5%, 12% had severe systolic dysfunction (left ventricle ejection fraction <35%) and mean creatinine clearance of 49.1±7 mL/min. Self-expandable Evolut R was implanted in 80% of patients and Evolut Pro in 20% of them, the most frequent THV size was 29 mm (52%) and the mean implant depth was 6 mm in fluoroscopy and 4.5 mm in TEE. The mean procedural time was 138±56 minutes, with a median radiation dose of 6.6 mGy/cm2 [IQR, 2–6 mGy]. Definitive pacemaker was implanted in 17% of patients and AKI was seen in 6 patients (24%), with stage I (20%), stage II (4%) and no case needed hemodialysis. At 30 days, 84% were at functional class I, there was no death, one embolization requiring a second valve and the rate of device success (VARC-2) was 92%.
Conclusion
The proposed pilot study for transfemoral TAVI in CKD population with zero contrast technique was safe, with promising results and similar rates of success and complication, compared with the conventional TAVI approach.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): MedtronicAngiodroid
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Affiliation(s)
- P Nicz
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - A F D Freire
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - F B Filippini
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - G Kanhouche
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - T A D Accorsi
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - G Liberato
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - C H Nomura
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - R S Cassar
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - M L Vieira
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - W Mathias Jr
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - P M A Pomerantzeff
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - A Abizaid
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - F S De Brito Jr
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
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3
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Lopes MP, Emer Egypto Rosa V, Palma JH, Fernandes JRC, De Santis ASAL, Spina GS, Abizaid AC, De Brito Jr FS, Tarasoutchi F, Sampaio RO, Ribeiro HB. Valve-in-valve procedure for bioprosthesis dysfunction in rheumatic patients: a new procedure for an old disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bioprosthetic heart valve has a limited durability and lower long-term performance especially in rheumatic patients. The standard treatment for degenerated bioprosthesis involves redo open-heart surgery, which is associated with significant morbidity and mortality, particularly in high-risk patients. Minimally invasive procedures, as valve-in-valve (ViV) implantation, may offer an attractive therapy alternative.
Methods
The aim of this study was to evaluate the characteristics and short-term post-procedure data of rheumatic and non-rheumatic patients undergoing aortic, mitral or tricuspid ViV procedure.
Results
Single centre data-base analysis study, with prospective data collection, during the period of May 2015 to September 2020. Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9% vs 43.2%, respectively; p=0.004) and atrial fibrillation (82.6% vs 45.9%, respectively; p<0.001). There were no statistical difference regarding number of previous surgeries (2 [3–1] vs 1 [2–1], respectively; p=0.103). There was a tendency towards higher 30-day mortality in rheumatic patients (21.7% vs 5.4%, respectively; p=0.057) and device success rate was low, but similar between groups (78.3% vs 72.0%, respectively; p=0.710). Transapical access rate was also higher in rheumatic group (92.6% vs 70.3%, respectively; p=0.008);
Conclusion
Rheumatic patients tend to have a higher mortality when undergoing ViV procedures, although not statistically significant. Rheumatic patients underwent a greater number of previous valve surgeries than reported in literature, and also had high rate of transapical ViV procedure, which may have contributed to higher 30-day mortality and a lower device success rate.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M P Lopes
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - J H Palma
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - J R C Fernandes
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - A S A L De Santis
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - G S Spina
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - A C Abizaid
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - F S De Brito Jr
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - R O Sampaio
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
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4
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Emer Egypto Rosa V, Lopes MP, Spina GS, Soares Jr J, Salazar D, Romero CE, Lottemberg MP, De Santis A, Pires LJNT, Goncalves LFT, Fernandes JRC, Sampaio RO, Tarasoutchi F. Rheumatic myocarditis: a poorly recognized etiology of left ventricular dysfunction in valvular heart disease patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure is present in about 10% of patients with acute rheumatic fever (RF), and several studies showed that cardiac decompensation in RF results primary from valvular disease, and not due to primary myocarditis. However, literature is scarce in this topic and a recent case series showed that recurrent RF could cause ventricular dysfunction even in the absence of valvular heart disease.
Purpose
To evaluate clinical, laboratory and echocardiographic profile of rheumatic fever patients with confirmed myocarditis diagnosis using Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) or Gallium-67 cardiac scintigraphy.
Methods
Clinical, laboratory and imaging characteristics of 25 consecutive patients with diagnosis of myocarditis, using 18F-FDG PET/CT or gallium-67 cardiac scintigraphy (Figure 1A and 1B, respectively), and RF reactivation according to revised Jones Criteria, were evaluated. Patients underwent 3 sequential echocardiograms: (1) baseline, (2) during myocarditis and (3) post- corticosteroid treatment, and were divided according to the presence (Group 1) or absence (Group 2) of reduced left ventricular ejection fraction (LVEF) during myocarditis episode.
Results
Median age was 42 (17–51) years, 64% had more than 40 years and 64% were women. Comparing patients in Group 1 (n=16) with Group 2 (n=9), there was no demographic, echocardiographic or laboratory difference between groups, except for NYHA III/IV heart failure (Group 1: 100.0% versus Group 2: 50.0%; p=0.012) and LVEF (30 [25–37] versus 56 [49–62] %, respectively; p<0.001), as expected. Group 1 patients had significant reduction of LVEF during carditis with further improvement after treatment (Figure 1C). There was no correlation between LVEF and valvular dysfunction during myocarditis. Of all patients, 19 (76%) underwent 18F-FDG PET/CT, with positive scan in 68.4% and 21 (84%) underwent Gallium-67 cardiac scintigraphy, with positive uptake in 95.2%, both with no difference between groups.
Conclusion
Myocarditis due to rheumatic fever reactivation can cause left ventricular dysfunction despite of valvular disease, and is reversible after corticosteroid treatment.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - M P Lopes
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - G S Spina
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - J Soares Jr
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - D Salazar
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - C E Romero
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - M P Lottemberg
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - A De Santis
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - L J N T Pires
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - L F T Goncalves
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - J R C Fernandes
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - R O Sampaio
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
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5
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Kirschbaum MR, Devido MS, Azeka E, Demarchi LMMF, Santos JS, Pinto DVR, Hajjar LA, Tarasoutchi F, Park M, Avila WS. COVID-19 in pregnant women with heart diseases. Adverse maternal and fetal outcomes. Case series from InCor registry of Pregnancy and Heart Disease. Eur Heart J 2021. [PMCID: PMC8574523 DOI: 10.1093/eurheartj/ehab724.2890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Heart disease is the leading non-obstetric cause of maternal death during pregnancy. In this field, the emergence of pandemic COVID-19 has caused the worst-case scenario considering that pregnant women are more susceptible to viral infections, and preexisting cardiac disease is the most prevalent co-morbidity among COVID-19 deaths. Purpose To assess the maternal and fetal outcomes of COVID-19 during pregnancy of women with heart diseases. Methods During the year 2020, among 82 pregnant women with heart disease followed consecutively at the Instituto do Coração-InCor, seven of them with an average age of 33.2 years had COVID-19 during their pregnancies. The underlying heart diseases were rheumatic valve disease (5 pt), congenital heart disease (1 pt) and one case with acute myocarditis, without preexisting cardiopathy. The prescription (antibiotics, inotropes, corticosteroids and others) used was according to the clinical conditions required for each patient, however subcutaneous or intravenous heparin was used in all patients. Results Only one case had an uneventful maternal-fetal course, the other six women required hospitalization / ICU for an average of 25.3 days, including the need for mechanical ventilation in two of them. Serious complications were related to respiratory failure (ADRS), recurrent atrial flutter with hemodynamic instability, acute pulmonary edema, and cardiogenic shock associated with sepsis which caused two maternal deaths. There were two emergency mitral valve interventional, percutaneous balloon valvuloplasty and valve bioprosthesis replacement, respectively. There were five premature births with an average gestational age of 34.2 weeks of gestation, which resulted in one stillbirth. Pathological findings of three placental and the six-months follow-up of the babies did not confirm vertical transmission of COVID-19. Conclusions The uncertain evolution given of the overlapping complications of three conditions – COVID-19, pregnancy, and heart disease – implies an increased risk for women with heart diseases of childbearing age, for whom pregnancy should be discouraged and planned after vaccination FUNDunding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- M R Kirschbaum
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - M S Devido
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E Azeka
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - L M M F Demarchi
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J S Santos
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D V R Pinto
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - L A Hajjar
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - M Park
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - W S Avila
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
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6
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Fukui M, Annabi MS, Rosa VEE, Ribeiro HB, Tarasoutchi F, Shelbert EB, Bergler-Klein J, Mascherbauer J, Rochitte CE, Pibarot P, Cavalcante JL. Impact of left ventricular fibrosis and longitudinal systolic strain on outcomes in low gradient aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The clinical utility of comprehensive cardiac magnetic resonance (CMR) for the assessment of myocardial structure and function remains unknown in patients with low gradient (LG) aortic stenosis (AS).
Purpose
This study sought to compare CMR characteristics of myocardial structure and function according to different flow / gradient patterns of AS: classical low flow LG (LFLG); paradoxical LFLG; normal flow LG; and high gradient, and to evaluate their impact on the outcomes of these patients.
Methods
International multicentric prospective study included 147 patients with LG moderate to severe AS and 18 patients with high gradient severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE).
Results
Patients with classical LFLG (n=90) had more LV adverse remodeling and impaired longitudinal function including higher ECV, and higher LGE and volume, and worst LVGLS, compared to other patterns of AS. Over a median follow-up of 2-years, 43 deaths and 48 composite outcomes of death or heart failure hospitalization occurred in LG AS patients. As LVGLS or ECV worsened, risks of adverse events also increased (per tertile of LVGLS: HR [95% CI] for mortality, 1.50 [1.02–2.20]; p=0.04; HR [95% CI] for composite outcome, 1.45 [1.01–2.09]; p<0.05) (per tertile of ECV: HR [95% CI] for mortality, 1.63 [1.07–2.49]; p=0.02; HR [95% CI] for composite outcome, 1.54 [1.02–2.33]; p=0.04). LGE presence was also associated with higher mortality (HR [95% CI], 2.27 [1.01–5.11]; p<0.05) and risk of the composite outcome (HR [95% CI], 3.00 [1.16–7.73]; p=0.02). The risk of all-cause death and of the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV and LGE) (Figure) with and without adjustment for age, true severe AS, classical LFLG, and aortic valve replacement as a time-varying covariate.
Conclusions
In this international multicentric study of LG AS, comprehensive CMR assessment of myocardial structure and function provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M S Annabi
- University Institute of Cardiology and Respirology of Quebec (IUCPQ), Quebec, Canada
| | - V E E Rosa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - E B Shelbert
- University of Pittsburgh, Pittsburgh, United States of America
| | - J Bergler-Klein
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | | | - C E Rochitte
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - P Pibarot
- University Institute of Cardiology and Respirology of Quebec (IUCPQ), Quebec, Canada
| | - J L Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
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7
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Lopes M, Campos CM, Rosa VEE, Sampaio RO, Morais TC, Brito FS, Vieira MLC, Mathias W, Medeiros HNAA, Santis ASAL, Rochitte CE, Ribeiro MH, Santos LM, Abizaid A, Tarasoutchi F. Multimodality imaging and systemic biomarkers in classical low-flow low-gradient aortic stenosis: key findings for cardiac remodeling evaluation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Elevated levels of troponin I (hsTnT) and B-type natriuretic peptide (BNP) have been related with poor prognosis in patients with LFLG-AS. Biomarkers are less expensive, more practical and more accessible than imaging tests, so their use can be an alternative to imaging in the evaluation of patients with LFLG-AS.
Purpose
The aim of the present study is to assess multimodality imaging findings according to systemic biomarkers (i.e. hsTnT and BNP) in Low-Flow, Low-Gradient Aortic Stenosis (LFLG-AS) and reduced left ventricular ejection fraction (LVEF) patients.
Methods
Prospective study with LFLG-AS patients (LVEF <50%, aortic valve area ≤1,0 cm2 and mean gradient <40 mmHg) that underwent hsTNnT, BNP, cardiac magnetic resonance (CMR) with T1 mapping and 2 dimensional echocardiogram (2DEcho). All patients also underwent dobutamine stress echocardiogram to define aortic stenosis severity. Patients were divided into 3 groups according to BNP and hsTnT levels: Group 1: BNP and hsTnT levels below median (BNP <395 pg/ml and TnI-Ultra <0.042 ng/ml); Group 2: BNP or hsTnT higher than median; and Group 3: both hsTnT and BNP higher than median.
Results
49 patients with LFLG-AS were included (Group 1: 17 patients, Group 2: 14 patients and Group 3: 18 patients). Clinical characteristics (including risk scores) were not able to stratify these groups. Patients with elevation of both biomarkers had lower valvuloarterial impedance (P=0.03), lower LVEF (P=0.02), less moderate/severe mitral (P=0.01) and tricuspid regurgitation (P<0.01) by 2DEcho. CMR identified a progressive increase (from Group 1 to 3) of right and left chamber volumes; reduction in right and left ejection fraction and a marked increase in myocardial fibrosis assessed by extracellular volume (ECV) and indexed extracellular volume (iECV) (Figure 1).
Conclusion
Higher levels of BNP and hsTnT in LFLG-AS patients were associated with worse multi-modality imaging parameters and can be a surrogate of cardiac remodeling.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): No funding
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Affiliation(s)
- M.A.A.A.M.L Lopes
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - C M Campos
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - V E E Rosa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - R O Sampaio
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - T C Morais
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F S Brito
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M L C Vieira
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - W Mathias
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | | | - A S A L Santis
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - C E Rochitte
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M H Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L M Santos
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - A Abizaid
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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8
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Van Nieuwkerk A, Santos R, Regueiro A, Tchetche D, Barbanti M, D'Onofrio A, Ribichini F, Ten F, Tarasoutchi F, Orvin K, Pagnesi M, Ghattas A, Mehran R, Henriques J, Delewi R. Obesity paradox in 12,381 patients undergoing transfemoral transcatheter aortic valve implantation: from the CENTER-collaboration. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve implantation (TAVI) is a well-established treatment for symptomatic aortic valve stenosis. The majority of patients treated are overweight or obese. Obesity has traditionally been linked to reduced survival and worse cardiovascular outcomes. However, an “obesity paradox” has been described in some diseases, with improved survival of obese patients after invasive and surgical procedures.
Methods
The CENTER-collaboration included data from 10 registries or clinical trials of patients undergoing transfemoral TAVI from 2007 to 2018. Patients were divided in four groups according to body mass index (BMI): underweight: BMI <18.5 kg/m2, normal weight: BMI 18.5 to 24.9 kg/m2, overweight: BMI 25 to 29.9 kg/m2, and obese: BMI ≥30 kg/m2. The primary endpoints of this analysis were differences in 30-day all-cause mortality and stroke after TAVI.
Results
Of the 12,381 patients analysed, 2% (n=205) were underweight, 29% (n=3552) had normal weight, 44% (n=5460) were overweight and 25% (n=3140) obese. Older patients had lower BMI (median of 84 years for underweight and 81 years for obese patients, p<0.001). Cardiovascular risk factors such as hypertension, diabetes mellitus and dyslipidaemia increased progressively with increase of BMI category. As to clinical outcomes, there were no differences for stroke rates across BMI groups. In-hospital mortality was highest in patients who were underweight, namely 8.4%, compared to normal weight, overweight and obese patients (6.2%, 4.3% and 4.6% respectively, p<0.001) as was 30-day mortality (9.8% compared to 6.9%, 5.3% and 5.2% respectively, p=0.001). On the other hand, extremely obese patients (BMI ≥40.0 kg/m2) also had worse prognosis, with a 30-day mortality of 7.6%.
Conclusions
In this global analysis of more than 12 000 patients undergoing transfemoral TAVI, overweight and obese patients had better in-hospital and 30-day survival than normal weight patients, confirming the obesity paradox. There was an inverted J-shaped relationship of body mass index with prognosis, with higher mortality rates for underweight and extremely obese patients.
Mortality and stroke per BMI category
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Dutch Heart Foundation; Netherlands Organisation for Health Research and Development
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Affiliation(s)
- A Van Nieuwkerk
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - R.B Santos
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - A Regueiro
- Barcelona Hospital Clinic, Servicio de Cardiologia, Barcelona, Spain
| | | | - M Barbanti
- AOU Policlinico - Vittorio Emanuele, Division of Cardiology, Catania, Italy
| | - A D'Onofrio
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - F Ribichini
- University of Verona, Division of Cardiology, Department of Medicine, Verona, Italy
| | - F Ten
- Hospital Universitario y Politecnico La Fe, Servicio de Cardiologia, Valencia, Spain
| | - F Tarasoutchi
- Sao Paulo University Medical School, Heart Institute, Sao Paulo, Brazil
| | - K Orvin
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - M Pagnesi
- San Raffaele Scientific Institute, Interventional Cardiology Unit, Milan, Italy
| | | | - R Mehran
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - J.P.S Henriques
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - R Delewi
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
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9
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Lemes MVS, Bacelar AC, Rosa VEE, Caixeta AM, Lemos PA, Ribeiro HB, Almeida BO, Mariani J, Campos CAHM, Tarasoutchi F, Franken M, Brito FS. P929Predictors of renal function improvement in patients with chronic kidney disease undergoing TAVR. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Chronic kidney disease (CKD) is common among patients undergoing transcatheter aortic valve replacement (TAVR). The prognosis of CKD on TAVR outcomes has been previously documented. However, there is a paucity of data about predictors of renal function improvement and its clinical relevance.
Purpose
To determine predictors of renal function improvement after TAVR among patients with CKD.
Methods
Prospective study, analyzing 819 patients from 22 centers with symptomatic severe aortic stenosis included in the Brazilian TAVR Registry between 2008 and 2015. CKD was defined as estimated glomerular filtration rate (eGFR) <60mg/dL, and patients without CKD were excluded. Groups were divided according to variation of eGFR between baseline and 7 days after TAVR: improvement (increase >10% in eGFR) in 197 (34.1%) patients, worsening (decrease >10% in eGFR) in 203 (35.2%), and stable (neither criteria) in 177 (30.7%). Logistic regression analysis was used to identify predictors of renal function improvement. One-year outcomes were determined as Kaplan-Meier survival curves.
Results
CKD was present in 577 (70%) patients. The mean age was 81.9±6.8 years, 56.2% were male, 31.7% had diabetes and 74.5% had hypertension. The mean STS score was 10.6±7.9%, the mean EuroSCORE II were 21.8±15.2% and the preferable access site was transfemoral (93.4%). The mean eGFR was 37.3±12.5 ml/min in the improvement group (IG), 39.6±11.7 ml/min in the stable group (SG) and 40.2±12.3 ml/min in the worsening group (WG), with significant statistical difference between IG and WG (p=0.044). There was no difference related to contrast midia volume between the 3 groups. In the multivariate analysis, coronary artery disease (OR: 0.69; 95% CI 0.48–0.98; p=0.039) and baseline eGFR (OR: 0.98; 95% CI 0.97–1.00; p=0.039) were associated with improvement in renal function. There was no significant difference in 1-year all-cause mortality between IG and SG (15.4 vs 9.5%, log rank p=0.141) (Figure 1A). However, the WG had higher mortality compared with the IG (29.3 vs 15.4%, log rank p<0,001) (Figure 1B).
Figure 1
Conclusion
Improvement in renal function after TAVR was frequently found among patients with CKD. The absence of coronary artery disease and lower baseline eGFR were independent predictors of improvement in renal function. Although the IG had lower 1-year all-cause mortality compared to WG, no difference were observed related to SG.
Acknowledgement/Funding
SBHCI
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Affiliation(s)
- M V S Lemes
- Hospital Israelita Albert Einstein and Heart Institute of University of Sao Paulo, Brazil, Sao Paulo, Brazil
| | - A C Bacelar
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - V E E Rosa
- Hospital Israelita Albert Einstein and Heart Institute of University of Sao Paulo, Brazil, Sao Paulo, Brazil
| | - A M Caixeta
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - P A Lemos
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - B O Almeida
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - J Mariani
- Hospital Israelita Albert Einstein and Heart Institute of University of Sao Paulo, Brazil, Sao Paulo, Brazil
| | - C A H M Campos
- Hospital Israelita Albert Einstein and Heart Institute of University of Sao Paulo, Brazil, Sao Paulo, Brazil
| | - F Tarasoutchi
- Hospital Israelita Albert Einstein and Heart Institute of University of Sao Paulo, Brazil, Sao Paulo, Brazil
| | - M Franken
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - F S Brito
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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10
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Emer Egypto Rosa V, Ribeiro HB, Samapio RO, Morais TC, Rosa MEE, De Santis ASAL, Fernandes JRC, Spina GS, Vieira MLC, Pomerantzeff PMA, Rochitte CE, Mathias Jr W, Tarasoutchi F. P6483Predictors of contractile reserve on dobutamine stress echocardiography in patients with classical low-flow, low-gradient aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is a lack of information on factors that influence contractile reserve (CR) on dobutamine stress echocardiography (DSE) in patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS).
Purpose
This study sought to evaluate the predictors of CR in patients with LFLG-AS.
Methods
Prospective study including 43 consecutive LFLG-AS patients (aortic valve area [AVA] ≤1.0 cm2, mean transaortic gradient <40 mmHg, left ventricular ejection fraction [LVEF] <50%) with true severe aortic stenosis. All patients underwent dobutamine stress echocardiography and T1-mapping cardiac magnetic resonance (CMR). CR was defined as an increase ≥20% in the left ventricular stroke volume at peak stress. Patients with pseudo-severe aortic stenosis were excluded.
Results
All of the patients in the study had degenerative aortic stenosis, with a median age of 67 [60–74] years, most of them being male (83.7%). A high prevalence of comorbidities was found, highlighted by diabetes (42%), hypertension (70%), atrial fibrillation (25%) and coronary artery disease (38%). Mean transaortic gradient was 25 [20–33] mmHg, AVA was 0.88 [0.68–0.95] cm2, LVEF was 35 [28–43]% and 32.6% had moderate/severe functional mitral regurgitation. CMR myocardium extracellular volume fraction (ECV) was 28.8 [26.3–33.0] %, indexed ECV was 35.4 [25.0–41.2] ml/m2, 32.6% had positive transmural delayed-enhancement images and 25.6% had positive mesocardial delayed-enhancement images. On DSE, 30 patients (69.7%) had CR and 13 patients (30.3%) had no CR. Global longitudinal strain was 10 [7–12] %, Δ indexed flow rate was 25 [3–38] ml/m2.seg and Δ mean gradient was 10 [3–16] mmHg. By multivariate analysis, moderate/severe functional mitral regurgitation (HR 0.122, 95% CI 0.020–0.759, p=0.024) and AVA (HR 0.606, 95% CI 0.396–0.925, p=0.020 [for each increase of 0.05 cm2]) were the only factors associated with CR. ECV, indexed ECV and positive transmural or mesocardial delayed-enhancement images were not associated with CR in the univariate analysis.
Conclusions
In our study, the absence of moderate/severe functional mitral regurgitation and AVA were predictors of CR on DSE in patients with LFLG-AS. As AVA was smaller in patients with CR, our finding contradicts the hypothesis that more severe aortic stenosis could also contribute to the lack of CR. Other possible factors that are surrogate of myocardium fibrosis, as ECV, indexed ECV and positive delayed-enhancement images, were not associated with the absence of CR.
Acknowledgement/Funding
FAPESP
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Affiliation(s)
- V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - R O Samapio
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - T C Morais
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - M E E Rosa
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - A S A L De Santis
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - J R C Fernandes
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - G S Spina
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - M L C Vieira
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - P M A Pomerantzeff
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - C E Rochitte
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - W Mathias Jr
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
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11
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Emer Egypto Rosa V, Echeverri D, Sztejfman M, Jaikel LAG, Dager A, Abud M, Charry P, Chauvet AA, Tarasoutchi F, Cura F, Ribeiro HB. P2273Predictors of short- and mid-term outcomes after TAVR in low-flow, low-gradient aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is a lack of data on outcomes in classical (C-LFLG) and paradoxical low-flow, low-gradient aortic stenosis (P-LFLG) patients undergoing TAVR.
Purpose
We aim to compare baseline characteristic and procedural outcomes between C-LFLG, P-LFLG and high-gradient aortic stenosis (HG-AS) patients undergoing TAVR.
Methods
Patients included in the Transcatheter RegistrY of aorTic valve biOprosthesis in Latin-AMerica (TRYTOM Registry) were divided in 3 groups: 1) HG-AS: mean transaortic gradient (MG) ≥40 mmHg; 2) P-LFLG: MG <40 mmHg and left ventricular ejection fraction (LVEF) ≥50%; 3) C-LFLG: MG <40 mmHg and LVEF <50%. The outcomes were evaluated at 30-days and 1-year and were classified according to definitions of the VARC-2.
Results
1040 patients were included, 677 (65%) classified as HG-AS, 223 (21%) as P-LFLG and 140 (14%) as C-LFLG. Median follow-up was 16 months (range 0–109). There were baseline differences between HG-AS, P-LFLG and C-LFLG regarding age (80±7 vs 80±5 vs 78±8 years, respectively; p=0.017), NYHA FC III and IV (61.0 vs 72.6 vs 83.6%, respectively; p<0.001), coronary artery disease (44.1 vs 47.1 vs 57.9%, respectively; p=0.012), EuroSCORE II (7.2±6.3 vs 7.5±5.0 vs 12.9±10.4%, respectively; p<0.001), LVEF (56±11 vs 61±7 vs 32±9%, respectively; p<0.001), MG (53±13 vs 30±6 vs 27±7 mmHg, respectively; p<0.001), aortic valve area (0.65±0.16 vs 0.74±0.15 vs 0.70±0.16 cm2, respectively; p<0.001) and creatinine (1.2±0.7 vs 1.1±0.5 vs 1.5±1.3 mg/dl, respectively; p<0.001). Despite these significant baseline differences, we found similar outcomes after TAVR between HG-AS, P-LFLG and C-LFLG regarding device success (89.8 vs 95.1 vs 90.7%, respectively; p=0.057), in-hospital mortality (6.1 vs 5.9 vs 11.8%, respectively; p=0.144) and all other VARC-2 major outcomes, including major bleeding, major vascular complication and disabling stroke. In addition, female sex (OR 2.13, 95% CI 1.16–3.92, p=0.014), LVEF (OR 1.02, 95% CI 1.00–1.04, p=0.039) and MG (OR 0.97, 95% CI 0.95–0.99, p=0.004) were the only predictor of device success by multivariate analysis. Furthermore, 1-year mortality was similar among the groups (9.5 vs 8.3 vs 14.3%, respectively; p=0.358; Figure 1), and by multivariate analysis, diabetes (HR 2.44, 95% CI 1.10–5.41, p=0.028), creatinine (HR 1.65, 95% CI 1.17–2.33, p=0.004), conversion to general anesthesia (HR 7.93, 95% CI 2.08–30.20, p=0.002) and post-procedure disabling stroke (HR 12.84, 95% CI 3.09–53.40, p<0.001) predicted increased 1-year mortality, irrespective on the LVEF and MG.
Conclusions
Apart from baseline differences, TAVR in P-LFLG and C-LFLG was feasible and with similar clinical outcomes when compared to HG-AS. Mid-term mortality rates was associated with diabetes, creatinine and procedure complications.
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Affiliation(s)
- V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | | | | | | | - A Dager
- Angiografia de Occidente, Cali, Colombia
| | - M Abud
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - P Charry
- Hospital Universitario Mayor de Mederi, Bogota, Colombia
| | - A A Chauvet
- Regional Hospital 1st of October, Mexico City, Mexico
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - F Cura
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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12
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Avila Samuel W, Lobo CG, Abreu SB, Rossi EG, Bortolotto MR, Testa CB, Tarasoutchi F, Hajjar LA. P5451Pregnancy and heart valve prostheses: maternal and fetal outcomes. comparative study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- W Avila Samuel
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C G Lobo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - S B Abreu
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Rossi
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - M R Bortolotto
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C B Testa
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - L A Hajjar
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
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13
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Emer Egypto Rosa V, Ribeiro HB, Sampaio RO, Morais TC, Rosa MEE, De Santis ASAL, Fernandes JRC, Vieira MLC, Pomerantzeff PMA, Rochitte CE, Mathias Jr W, Tarasoutchi F. P5455Impact of interstitial myocardial fibrosis measured by T1-mapping cardiac magnetic resonance on post-operative cardiac remodeling in patients with classical low-flow, low-gradient aortic stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - R O Sampaio
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - T C Morais
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - M E E Rosa
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - A S A L De Santis
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - J R C Fernandes
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - M L C Vieira
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - P M A Pomerantzeff
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - C E Rochitte
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - W Mathias Jr
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
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Emer Egypto Rosa V, Campos CM, Jatene T, Carvalho LAF, Siqueira DA, Lemos PA, Sao Thiago LEK, Esteves V, Tarasoutchi F, De Brito Jr FS. P6309Impact of low-flow, low-gradient aortic stenosis in short- and long-term follow-up after TAVI: Insights from the Brazilian TAVI Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - C M Campos
- Heart Institute of the University of Sao Paulo (InCor) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - T Jatene
- Anis Rassi Hospital, Goiania, Brazil
| | | | - D A Siqueira
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - P A Lemos
- Heart Institute of the University of Sao Paulo (InCor) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - V Esteves
- Hospital Brasil – Rede D'Or, São Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - F S De Brito Jr
- Heart Institute of the University of Sao Paulo (InCor) and Hospital Sírio-Libanês, São Paulo, Brazil
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15
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Camargo R, Siciliano R, Paixao M, Soeiro A, Soares Jr J, Felicio M, Strabelli T, Buchpiguel C, Alavi A, Tonello L, Mansur A, Tarasoutchi F, Oliveira Jr M, Meneghetti J. 4775Diagnostic value of Positron emission tomography (PET/CT) in native and prosthetic infective endocarditis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tarasoutchi F, Montera MW, Ramos AIO, Sampaio RO, Rosa VEE, Accorsi TAD, Lopes ASSA, Fernandes JRC, Pires LJT, Spina GS, Vieira MLC, Lavitola PL, Bignoto TC, Togna DJD, Mesquita ET, Esteves WAM, Atik FA, Colafranceschi AS, Moisés VA, Kiyose AT, Pomerantzeff PMA, Lemos PA, Brito Jr. FS, Clara W, Brandão CMA, Poffo R, Simões R, Rassi S, Leães PE, Mourilhe-Rocha R, Pena JLB, Jatene FB, Barbosa MM, Souza Neto JD, Saraiva JFK. ATUALIZAÇÃO DAS DIRETRIZES BRASILEIRAS DE VALVOPATIAS: ABORDAGEM DAS LESÕES ANATOMICAMENTE IMPORTANTES. Arq Bras Cardiol 2017. [DOI: 10.5935/abc.20180007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Pomerantzeff PA, Steffen SP, Brandao CMDA, Lapenna GA, Tarasoutchi F, Jatene FB. 308 * SURGICAL THROMBECTOMY OF MECHANICAL VALVE THROMBOSIS. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gonzalez MM, Timerman S, Gianotto-Oliveira R, Polastri TF, Canesin MF, Schimidt A, Siqueira AW, Pispico A, Longo A, Pieri A, Reis A, Tanaka ACS, Santos AM, Quilici AP, Ribeiro ACL, Barreto ACP, Pazin-Filho A, Timerman A, Machado CA, Franchin Neto C, Miranda CH, Medeiros CR, Malaque CMS, Bernoche C, Gonçalves DM, Sant'Ana DG, Osawa EA, Peixoto E, Arfelli E, Evaristo EF, Azeka E, Gomes EP, Wen FH, Ferreira FG, Lima FG, Mattos FR, Galas FG, Marques FRB, Tarasoutchi F, Mancuso FJN, Freitas GR, Feitosa-Filho GS, Barbosa GC, Giovanini GR, Miotto HC, Guimarães HP, Andrade JP, Oliveira-Filho J, Fernandes JG, Moraes Junior JBMX, Carvalho JJF, Ramires JAF, Cavalini JF, Teles JMM, Lopes JL, Lopes LNGD, Piegas LS, Hajjar LA, Brunório L, Dallan LAP, Cardoso LF, Rabelo MMN, Almeida MFB, Souza MFS, Favarato MH, Pavão MLRC, Shimoda MS, Oliveira Junior MT, Miura N, Filgueiras Filho NM, Pontes-Neto OM, Pinheiro PAPC, Farsky OS, Lopes RD, Silva RCG, Kalil Filho R, Gonçalves RM, Gagliardi RJ, Guinsburg R, Lisak S, Araújo S, Martins SCO, Lage SG, Franchi SM, Shimoda T, Accorsi TD, Barral TCN, Machado TAO, Scudeler TL, Lima VC, Guimarães VA, Sallai VS, Xavier WS, Nazima W, Sako YK. [First guidelines of the Brazilian Society of Cardiology on Cardiopulmonary Resuscitation and Cardiovascular Emergency Care]. Arq Bras Cardiol 2014; 101:1-221. [PMID: 24030145 DOI: 10.5935/abc.2013s006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pesaro AEP, Katz M, Pereira C, Correa AG, Fava AN, Franken M, Nunes ACB, Forlenza LM, Tarasoutchi F, Makdisse MR. Serial brain natriuretic peptide strongly predicts in-hospital mortality in patients with acute myocardial infarction. Crit Care 2013. [PMCID: PMC3890911 DOI: 10.1186/cc12622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lorga Filho AM, Azmus AD, Soeiro AM, Quadros AS, Avezum Junior A, Marques AC, Franci A, Manica ALL, Volschan A, De Paola AAV, Greco AIL, ACN F, Sousa ACS, Pesaro AEP, Simão AF, Lopes ASSA, Timerman A, Ramos AIO, Alves BR, Caramelli B, Mendes BA, Polanczyk CA, Montenegro CEL, Barbosa CJDG, Serrano Junior CV, Melo CCL, Pinho C, Moreira DAR, Calderaro D, Gualandro DM, Armaganijan D, Machado Neto EA, Bocchi EA, Paiva EF, Stefanini E, D’Amico E, Evaristo EF, Silva EER, Fernandes F, Brito Junior FS, Bacal F, Ganem F, Gomes FLT, Mattos FR, Moraes Neto FR, Tarasoutchi F, Darrieux FCC, Feitosa GS, Fenelon G, Morais GR, Correa Filho H, Castro I, Gonçalves Junior I, Atié J, Souza Neto JD, Ferreira JFM, Nicolau JC, Faria Neto JR, Annichino-Bizzacchi JM, Zimerman LI, Piegas LS, Pires LJT, Baracioli LM, Silva LB, Mattos LAP, Lisboa LAF, Magalhães LPM, Lopes MACQ, Montera MW, Figueiredo MJO, Malachias MVB, Gaz MVB, Andrade MD, Bacellar MSC, Barbosa MR, Clausell NO, Dutra OP, Coelho OR, Yu PC, Lavítola PL, Lemos Neto PA, Andrade PB, Farsky PS, Franco RA, Kalil RAK, Lopes RD, Esporcatte R, Heinisch RH, Kalil Filho R, Giraldez RRCV, Alves RC, Leite REGS, Gagliardi RJ, Ramos RF, Montenegro ST, Accorsi TAD, Jardim TSV, Scudeler TL, Moisés VA, Portal VL. Diretrizes Brasileiras de Antiagregantes Plaquetários e Anticoagulantes em Cardiologia. Arq Bras Cardiol 2013; 101:1-95. [DOI: 10.5935/abc.2013s009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tarasoutchi F, Montera MW, Grinberg M, Barbosa MR, Piñeiro DJ, Sánchez CRM, Barbosa MM. Diretriz Brasileira de Valvopatias - SBC 2011/ I Diretriz Interamericana de Valvopatias - SIAC 2011. Arq Bras Cardiol 2011; 97:1-67. [DOI: 10.1590/s0066-782x2011002000001] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Fernandes JL, Sampaio RO, Brandão CM, Cardoso LF, Tarasoutchi F, Pomerantzeff P, Auler JO, Grinberg M. Improvement of cardiac hemodynamics with inhaled nitric oxide after surgery in patients with mitral stenosis and severe pulmonary hypertension. Crit Care 2005. [PMCID: PMC4097462 DOI: 10.1186/cc3555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Timerman S, Moretti M, Marques F, Ramos R, Mesquita E, Stefanini E, Gun C, Tarasoutchi F, Paiva E, Ferreira D, Timerman A. Crit Care 2005; 9:P309. [DOI: 10.1186/cc3372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kopel L, Tarasoutchi F, Medeiros C, Carvalho RT, Grinberg M, Lage SG. Arterial distensibility as a possible compensatory mechanism in chronic aortic insufficiency. Arq Bras Cardiol 2001; 77:258-65. [PMID: 11562688 DOI: 10.1590/s0066-782x2001000900006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate elastic properties of conduit arteries in asymptomatic patients who have severe chronic aortic regurgitation. METHODS Twelve healthy volunteers aged 30+/-1 years (control group) and 14 asymptomatic patients with severe aortic regurgitation aged 29+/-2 years and left ventricular ejection fraction of 0.61+/-0.02 (radioisotope ventriculography) were studied. High-resolution ultrasonography was performed to measure the systolic and diastolic diameters of the common carotid artery. Simultaneous measurement of blood pressure enabled the calculation of arterial compliance and distensibility. RESULTS No differences were observed between patients with aortic regurgitation and the control group concerning age, sex, body surface, and mean blood pressure. Pulse pressure was significantly higher in the aortic regurgitation group compared with that in the control group (78+/-3 versus 48+/-1mmHg, P<0.01). Arterial compliance and distensibility were significantly greater in the aortic regurgitation group compared with that in the control group (11.0+/-0.8 versus 8.1+/-0.7 10(-10) N-1 m4, P=0.01 e and 39.3+/-2.6 versus 31.1+/-2.0 10(-6) N-1 m2, P=0.02, respectively). CONCLUSION Patients with chronic aortic regurgitation have increased arterial distensibility. Greater vascular compliance, to lessen the impact of systolic volume ejected into conduit arteries, represents a compensatory mechanism in left ventricular and arterial system coupling.
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Affiliation(s)
- L Kopel
- Heart Institute, Clínicas Hospital, FM, University of São Paulo, Brazil
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Dias AR, Dias RR, Gaiotto F, Lima J, Cerqueira FM, Grinberg M, Sampaio R, de Lara Lavitola P, Elias N, Tarasoutchi F, Cardoso LF, Stolf NA. Mini-sternotomy for the treatment of aortic valve lesions. Arq Bras Cardiol 2001; 77:221-8. [PMID: 11562684 DOI: 10.1590/s0066-782x2001000900002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare inverted-L mini-sternotomy performed above the sternal furcula with conventional sternotomy in patients with aortic valve diseases who undergo surgical treatment. METHODS We operated upon 30 patients who had aortic valve lesions that had clinical and hemodynamic findings. All patients underwent inverted-L sternotomy, which extended from above the manubrium of the sternum to the 3rd right intercostal space, without opening the pleural cavity. Their ages ranged from 32 to 76 years, and 18 were males and 12 were females. We used negative pressure in a venous 1/4-inch cannula, and the patients were maintained in Trendelemburg's position. Twenty-seven patients received bioprostheses with diameters ranging from 23 to 29mm. Three patients underwent only removal of the calcifications of the aortic valve leaflets and aortic commissurotomy. RESULTS The mean duration of anoxic cardiac arrest was 63.11min. Access was considered good in all patients. One death was due to pulmonary and renal problems not related to the incision. All patients had a better recovery in the intensive care unit, got out of bed sooner, coughed more easily, and performed prophylactic physiotherapeutic maneuvers for respiratory problems more easily and with less pain in the incision. Early ambulation was more easily carried out by all patients. CONCLUSION Mini-sternotomy proved to be better than the conventional sternotomy because it provided more comfort for the patients in the early postoperative period, with less pain and greater desire for early ambulation and all its inherent advantages.
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Affiliation(s)
- A R Dias
- Instituto do Coração, Hospital das Clínicas, FM, USP, Sao Paulo, Brazil
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Pomerantzeff PM, Brandão CM, Faber CM, Grinberg M, Cardoso LF, Tarasoutchi F, Stolf NA, Verginelli G, Jatene AD. Mitral valve repair in rheumatic patients. Heart Surg Forum 2001; 3:273-6. [PMID: 11178286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND There is controversy regarding the role of reparative techniques for rheumatic-mitral valve disease. We have analyzed the late results of mitral valve repair in a group of patients with rheumatic mitral valve insufficiency. METHODS From March 1980 to December 1997, 201 patients with rheumatic fever underwent mitral valve repair at the Heart Institute, Hospital das Clínicas, Medical School, University of São Paulo. The mean age of patients was 26.9 +/- 15.4 years, with 59.7% of the patients being female. Other diagnoses were present in 67.7% of patients; the most common was tricuspid regurgitation (31.3%). Mitral valve repair techniques included: 1) Carpentier ring annuloplasty in 75 patients (37.3%); 2) posterior annuloplasty with bovine patch in 68 patients (33.8%); 3) posterior segmental annuloplasty in 16 patients (7.9%); 4) quadrangular resection of the posterior leaflet with ring plication in 11 patients (5.5%); 5) partial resection of the anterior leaflet in 6 patients (3%); 6) De Vega's annuloplasty in 6 patients (3%); 7) Kay's annuloplasty in 5 patients (2.5%); 8) Reed's annuloplasty in 4 patients (2%); and 9) miscellaneous techniques in 10 patients (4.9%). Combined techniques were used in 94 patients (46.8%), the most frequent of which was chordal shortening (48 patients, 23.9%). Other non-mitral cardiac procedures were performed in 113 patients (56.2%). Actuarial survival and event-free curves (Kaplan-Meier method) were compared by linear regression analysis. RESULTS The in-hospital mortality rate was 2.0% (four patients). The causes of death were multiorgan failure in two patients and low cardiac output in the other two patients. In the late postoperative period, 83.9% of the patients were in New York Heart Association (NYHA) functional class 1. The actuarial survival was 93.9% +/- 1.9% at a mean of 125 months. Twenty-three patients were reoperated in the postoperative period at a mean interval of 35.7 months. Survival free from reoperation was 43.3% +/- 13.7% at 125 months. When analyzing the patients according to age, actuarial survival was 91.3% +/- 3.8% in the group of patients younger than 16 years (Group 1), compared with 95.6% +/- 2.7% in the group older than 16 years (Group 2), with a statistically significant difference of p < 0.0001. Survival free from reoperation was 50.8% +/- 16.9% in Group 1 and 47.0% +/- 14.9% in Group 2 (p < 0.0001). CONCLUSIONS Late results obtained with mitral valve repair for rheumatic mitral valve insufficiency were satisfactory and exceeded those reported for mitral valve replacement in the same population.
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Affiliation(s)
- P M Pomerantzeff
- Heart Institute, Hospital das Clínicas, Medical School, University of São Paulo, Brazil
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Pomerantzeff PM, Brandao CM, Cauduro P, Puig LB, Grinberg M, Tarasoutchi F, Cardoso LF, Lerner A, Stolf NA, Verginelli G, Jatene AD. Fisics-Incor bovine pericardial bioprostheses: 15 year results. Heart Surg Forum 2001; 1:130-5. [PMID: 11276451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND From March 1982 to December 1995, 2,607 Fisics-Incor bovine pericardial bioprostheses were implanted in 2,259 patients. Mean age was 47.2 +/- 17.5 years, and 55% were male. Rheumatic fever was present in 1,301 (45.7%) patients. METHODS One thousand and seventy-three aortic valve replacements, 1,085 mitral replacements, 27 tricuspid replacements, 195 mitral-aortic replacements, and 16 other combined valve replacements were carried out. Combined procedures were performed in 788 (32.9%) patients, the most frequent being tricuspid valve repair (9.2%) and coronary artery bypass grafting (7.7%). RESULTS Hospital mortality was 8.6% (194 patients), 8.6% for the mitral group, 4.7% for the aortic group, and 12.8% for double-valve replacements. The linear rates for calcification, thromboembolism, rupture, leak and endocarditis were, respectively, 1.1%, 0.2%, 0.9%, 0.1% and 0.5% patient-year. The actuarial survival curve was 56.7 +/- 5.4% in 15 years. Survival free from endocarditis was 91.92%, survival free from thromboembolism was 95 +/- 1.7%, survival free from rupture was 43.7 +/- 9.8%, survival free from leak was 98.9 +/- 4.5%, and survival free from calcification was 48.8 +/- 7.9% in 15 years. In the late postoperative period, 1,614 (80.6%) patients were in New York Heart Association functional Class I. CONCLUSIONS We conclude that the results with the Fisics-Incor bovine pericardial prostheses were satisfactory in our group of patients.
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Affiliation(s)
- P M Pomerantzeff
- Heart Institute, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, Brazil
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Jatene MB, Marcial MB, Tarasoutchi F, Cardoso RA, Pomerantzeff P, Jatene AD. Influence of the maze procedure on the treatment of rheumatic atrial fibrillation - evaluation of rhythm control and clinical outcome in a comparative study. Eur J Cardiothorac Surg 2000; 17:117-24. [PMID: 10731646 DOI: 10.1016/s1010-7940(00)00326-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of the maze procedure on the treatment of rheumatic atrial fibrillation in patients with mitral valve disease. METHODS Fifty-five patients (mean age 51 years; 47 females) with rheumatic mitral valve disease and associated atrial fibrillation in New York Heart Association functional class III or IV, preoperatively, were operated upon. Thirty-five had double dysfunction, 19 had stenosis, and one had mitral regurgitation. None had other associated heart diseases or previous operations. The patients were divided into two groups: GI, 20 patients were treated for mitral valve disease with associated maze procedure; GII, 35 patients were treated for mitral valve disease without the maze procedure. The preoperative echocardiogram showed a left atrial diameter in GI of 5.35 mm and in GII of 5.57 mm (P=0.779). The groups were considered clinically similar (P=0.759). Cardiopulmonary bypass was used in all patients. The mitral valve was replaced with a biological prosthesis in 24 patients and repaired in 31 patients. RESULTS Three hospital deaths occurred, one in GI, two in GII. After cardiopulmonary bypass, 37.1% of patients in GII remained in atrial fibrillation. All patients in GI recovered regular rhythm (P<0.0001). In the ICU, atrial fibrillation was detected in 80% of patients in GII and maintained in 76.4% in a mean follow-up period of 38.5 months. In GI, atrial fibrillation occurred in 20% of patients in the ICU and maintained in 5.3% in 41 months of mean follow-up (P=0.0001). None of the patients in GI and 20.6% of patients in GII had a thromboembolic episode 1-63 months after the operation (P=0.041). Four late deaths occurred (two in each group), two being due to progression of valvular disease, one after an episode of pulmonary infection and one with no cardiac cause. CONCLUSION The maze procedure is effective in treating atrial fibrillation in patients with rheumatic mitral valve disease. The results are sustained in the mid-term follow-up period, preventing postoperative thromboembolic episodes, and with acceptable morbidity and mortality.
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Affiliation(s)
- M B Jatene
- InCor-Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
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Tarasoutchi F, Grinberg M, Filho JP, Izaki M, Cardoso LF, Pomerantezeff P, Nuschbacher A, da Luz PL. Symptoms, left ventricular function, and timing of valve replacement surgery in patients with aortic regurgitation. Am Heart J 1999; 138:477-85. [PMID: 10467198 DOI: 10.1016/s0002-8703(99)70150-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Because cardiac decompensation is subtle, the best time to perform aortic valve replacement surgery may be difficult to determine. We investigated the relation of symptoms to left ventricular (LV) function and the timing of valve replacement in patients with aortic regurgitation (AR) of largely rheumatic origin. METHODS Sixty-eight initially asymptomatic patients (mean age 29 years) with severe chronic AR were monitored for 36 months. Assessments included baseline and yearly echocardiograms and radioisotope ventriculography (resting and exercise) and clinical examinations every 6 months. RESULTS Forty-seven patients (69%) remained asymptomatic and 21 (31%) had symptoms develop after 24 to 36 months. Compared with symptomatic patients, asymptomatic patients had significantly (P <.05) lower baseline LV end-diastolic diameter, end-systolic diameter, end-systolic stress, and volume/mass ratio but greater shortening fraction and ejection fraction (EF) at rest. These variables remained stable without statistically significant change until surgical correction in symptomatic patients. Percent variation of EF from rest to exercise increased in patients who remained asymptomatic (EF 2.8% +/- 10.6%) but decreased in those who became symptomatic (EF -4.2% +/- 13%; P <.05). Twenty symptomatic patients (New York Heart Association class III/IV, angina and/or syncope) had valve replacement surgery, after which all were in New York Heart Association class I/II and had significant decreases of LV end-diastolic and end-systolic diameters and an increase on percent variation of EF from rest to exercise (P <.0001). CONCLUSIONS Development of symptoms did not correlate with change in any ventricular function indexes. Surgery on appearance of symptoms restored LV function to near normal.
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Affiliation(s)
- F Tarasoutchi
- Heart Institute, School of Medicine, University of São Paulo, SP, Brazil
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Pomerantzeff PM, Brandão CM, Rossi EG, Cardoso L, Tarasoutchi F, Grinberg M, Stolf NA, Puig LB, Verginelli G, Jatene AD. Mitral valve repair. Quadrangular resection of the posterior leaflet in patients with myxomatous degeneration. Arq Bras Cardiol 1999; 73:273-80. [PMID: 10752166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To analyze the immediate and late results of mitral valve repair with quadrangular resection of the posterior leaflet without the use of a prosthetic ring annuloplasty. METHODS Using this technique, 118 patients with mitral valve prolapse who underwent mitral repair from January '84 through December '96 were studied. Age ranged from 30 to 86 (mean = 59.1 +/- 11.8) years and 62.7% were males. An associated surgery was performed in 22% of the patients, and coronary artery bypass graft was the most frequently performed surgery (15 patients--12.7%). In 20 (16.9%) patients other associated techniques of mitral valve repair were used and shortening of elongated chordae tendineae was the most frequent one (6 patients). RESULTS Immediate mortality was 0.9% (one patient). Long-term rates for thromboembolism, endocarditis, reoperation and death in the late postoperative period were 0.4%, 0.4%, 1.7% and 2.2% patients/year, respectively. The actuarial curve of survival was 83.8 +/- 8.6% over 12 years; survival free from re-operation was 91.8 +/- 4.3%, free from endocarditis was 99.2 +/- 0.8% and free from thromboembolism was 99.2 +/- 0.8%. In the late postoperative period, 93.8% of the patients were in functional class 1 (NYHA), with a complete follow-up in 89.7% of the patients. CONCLUSION Patients with mitral valve prolapse who undergo mitral valve repair using this technique have a satisfactory prognosis over 12 years.
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Affiliation(s)
- P M Pomerantzeff
- Instituto do Coração of the Hospital das Clínicas, FMUSP, Brazil
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Cardoso LF, Rati MA, Pomerantzeff PM, Medeiros CC, Tarasoutchi F, Rossi EG, Avila WS, Grinberg M. [Comparison between percutaneous balloon valvuloplasty and open commissurotomy for mitral stenosis]. Arq Bras Cardiol 1998; 70:415-21. [PMID: 9713084 DOI: 10.1590/s0066-782x1998000600007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To compare immediate and late (12 months) follow-up of clinical and Doppler echocardiographic results between percutaneous mitral balloon valvuloplasty and open commissurotomy in a prospective and randomized trial. METHODS Eighty eight symptomatic patients with severe mitral stenosis and favorable anatomy were randomized in a prospective trial comparing the two procedures. All patients were submitted to clinical and Doppler echocardiographic evaluation before the procedures and immediate and twelve months thereafter. RESULTS Mean mitral gradient (mmHg) decreased from 12.2 +/- 5.8 to 5.80 +/- 2.7 (p < 0.001) in commissurotomy group (CG) and from 11.7 +/- 6.1 to 5.0 +/- 2.4 (p < 0.001) in the balloon valvuloplasty group (VG). Mitral valve are (cm2) increased from 0.98 +/- 0.21 to 2.52 +/- 0.46 in CG and from 1.05 +/- 0.25 to 2.18 +/- 0.40 in VG (p < 0.001). In both groups there was a slight decrease in mitral valve area at 12 month follow-up. There was no death in either group. One patient in the VG had moderate mitral regurgitation and underwent surgery. At the 12 month follow-up, all patients in CG and 97.7% of patients in VG were in New York Heart Association functional class I or II. CONCLUSION Both procedures were safe and showed similar immediate improvement in mitral gradient and functional class. Mitral valve area had a greater increase immediately after commissurotomy, however, there was a significantly greater reduction in the CG after 12 months of follow-up, when compared to balloon valvuloplasty. In both groups, mitral gradient remained reduced and most patients did not change functional class during the follow-up.
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Affiliation(s)
- L F Cardoso
- Instituto do Coração, Hospital das Clínicas, FMUSP
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Pomerantzeff PM, Tarasoutchi F, de Brito Júnior FS, Munhoz AM, Cardoso LF, Brandão CM, Grinberg M, Stolf NA, Bellotti G, Pileggi F, Jatene AD. [Results of aortic stenosis surgery in patients with severe ventricular dysfunction]. Arq Bras Cardiol 1996; 67:375-8. [PMID: 9246823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To study the short and long term clinical course of patients with severe aortic stenosis after surgical treatment of the valvular lesion. METHODS Thirty survivors among 31 consecutive patients with severe left ventricular dysfunction (LVD) due to aortic stenosis (AS) were submitted to clinical and echocardiographic follow-up during a mean of 30 months after surgical treatment of the valvular lesion. Twenty five (83.3%) patients were male with a mean age of 50 years (25 to 74). Before operation the following parameters were obtained: diastolic left ventricular diameter (DLVD), shortening fraction (SF), left ventricular ejection fraction (LVEF), aortic valve area (AVA), left ventricular-aortic pressure gradient (PG) and NYHA functional class (FC). During the follow up, after the surgical procedure, FC, DLVD, LVEF and SF could be analysed and compared with previous data. RESULTS A significant rise in SF (p = 0.001) and LVEF (p = 0.0001), as well as a decrease in DLVD (p = 0.001) were observed in the follow up. Symptoms lessened in severity in the majority of patients. Three of our patients died with progressive LVD and heart failure, after at least 36 months of follow-up. These results indicate that when operation is carried out in patients with AS and left ventricular failure, a significant improvement in left ventricular function and in symptoms takes place. Although the risk of surgical treatment is increased in this group of patients, LVD should not be considered a contraindication to the procedure. CONCLUSION The left ventricular dysfunction is not a contraindiction for the surgical treatment of the aortic stenosis.
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Cardoso LF, Grinberg M, Patrício M, Neves Rati MA, Medeiros CC, Tarasoutchi F, Avila WS, Rossi EG, Bellotti G. [Comparative study between inoue single balloon and double balloon in percutaneous mitral valvuloplasty. Immediate results and after 1 year follow-up]. Arq Bras Cardiol 1996; 66:213-6. [PMID: 8935686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To compare early and 12 months results of mitral stenosis (MS) correction by percutaneous balloon valvuloplasty (PMBV) using Inoue's single-balloon or double balloon techniques. METHODS We submitted 139 consecutive patients to PMBV using Inoue single-balloon (n = 56, GI) or the double balloon technique (n = 83, GII). The two groups were similar, in: age, sex, functional class (FC), echocardiographic (ECHO) score, mitral valve area (MVA), and gradient (G) or presence of regurgitation. Clinical and ECHO data were compared before (PRE), immediately after (POI) and one year following the procedure (PO12M). RESULTS PMBV was successfully performed in 53 (95%) patients of GI and in 79 (96%) of GII. Statistical analyses showed that the groups were similar at POI but different at PO12M (p < 0.002). ECHO immediately after PMBV showed that: MVA increased from 0.99 +/- 0.23 to 2.01 +/- 0.44cm2 (p < 0.001) in GI and from 0.94 +/- 0.23 to 2.09 +/- 0.35cm2 (p < 0.001) in GII and G decreased from 11.58 +/- 5.02 to 5.16 +/- 2.23mmHg (p < 0.001) in GI and from 12.48 +/- 4.89 to 5.96 +/- 3.21mmHg (p < 0.001) in GII. After one year 36 (64%) patients in GI and 62 (74%) in GII underwent an ECHO study. A comparison between immediate and one year follow-up results showed that MVA decreased from 2.01 +/- 0.4 to 2.00 +/- 0.3cm2 (NS) in GI and from 2.09 +/- 0.3 to 1.74 +/- 0.4cm2 (p < 0.001) in GII and G decreased from 5.16 +/- 2.2 to 5.50 +/- 2.9mmHg (NS) in GI and from 5.96 +/- 3.2 to 8.61 +/- 4.8mmHg (p < 0.001) in GII. There was therefore a sustained improvement of MVA and G after one year in GI and a significant decrease in MVA and G in GII. The FC after one year was similar and satisfactory in both groups. CONCLUSION Both techniques are equally effective in relieving MS immediately after PMBV, but after one year, despite similar FC, Inoue-balloon technique seems to be superior to maintain MVA and G.
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Affiliation(s)
- L F Cardoso
- Instituto do Coração do Hospital da Clínicas-FMUSP, São Paulo, SP
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35
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Tarasoutchi F, Grinberg M, Parga Filho J, Cardoso LF, Izaki M, Pomerantzeff P, Lunardi W, Meneghetti C, da Luz PL, Bellotti G. [Postoperative course of left ventricular function in aortic insufficiency]. Arq Bras Cardiol 1995; 65:147-52. [PMID: 8554491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To analyze the follow-up of left ventricular function (LVF) after surgical correction of severe chronic aortic insufficiency (AI). METHODS Twenty-one out of 68 patients with AI, initially asymptomatic and that developed symptoms during the follow-up period of 24-36 months, were studied. Relationship between symptoms and LVF by echocardiogram and radioisotopic ventriculography at rest and in isotonic exercise were studied. Three clinical moments (CM) were assumed: CM-0- at the beginning of the study, when all patients were asymptomatic; CM-1- manifestation of the symptoms during 24-36 months; CM-2- corresponding to the late post-operative period of 8 months of 20 out of 21 patients (one refused the surgery). The analysis did not show any significant differences between the mean values of all echocardiographic variables (diastolic and systolic diameters, shortening fraction, final systolic stress, volume-mass ratio, contractility index) and the ejection fraction of the left ventricle (EF) obtained by the radioisotope ventriculography at rest and, including exercise, between clinical moments 0 and 1. RESULTS In the CM-2, involution was verified for functional class I/II in all cases and absence of expressive complications or immediate or late postoperative mortality. Comparison between CM-2 and 0 showed expressive regression of the diameters at rest in the postoperative period and with significant improvement in the means mainly the percentual variation of the EF and total time of effort. CONCLUSION Symptoms assembled patients with more advanced eccentric hypertrophy and did not coincide with any immediate change in findings studied at rest and at exercise. It represented a point of reference for surgical indication compatible with late postoperative involution of chronic adaptation of AI.
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Tarasoutchi F, Grinberg M, Scarabucci M, Cardoso LF, Cavalheiro Filho C, Rached RA, Pomerantzeff P, da Luz PL, Bellotti G. [Preoperative erythrocytopheresis in a patient with SC hemoglobinopathy and mitral stenosis]. Arq Bras Cardiol 1995; 64:463-4. [PMID: 8526778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Hemoglobinopathies are associated with thrombotic complications, when exposed to cardiopulmonary bypass. A 54-year old, black woman with hemoglobinopathy SC and severe mitral stenosis was submitted to eritrocytopheresis 48 hours before mitral commissurotomy surgery. The therapeutic determined appearance of the percentual hemoglobin A of 68% with reduction the hemoglobin S of 48% to 15% and the hemoglobin C of 51% to 17%. No complications occurred during postoperative period. To best of our knowledge, that is the first report about application the eritrocytopheresis in the pre operative extra corporeal circulation care in surgical treatment of patients with chronic rheumatic heart disease and hemoglobinopathy SC.
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Affiliation(s)
- F Tarasoutchi
- Instituto do Coração do Hospital das Clínicas - FMUSP, São Paulo
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37
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Tarasoutchi F, Grinberg M. [++Chronic aortic insufficiency. Physiopathological and clinical peculiarities]. Arq Bras Cardiol 1995; 64:417-8. [PMID: 8526769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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38
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Tarasoutchi F, Grinberg M, Parga Filho J, Cardoso LF, Izaki M, Lavítola P, Cardoso RH, da Luz PL, Bellotti G. [The relationship between left ventricular function and the precipitation of symptoms in severe chronic aortic insufficiency]. Arq Bras Cardiol 1995; 64:301-9. [PMID: 7495386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To study the relationship between symptoms and left ventricular function in 68 patients with severe chronic aortic regurgitation using echocardiogram and radionuclide left ventriculography at rest. METHODS Three stages of natural history are assumed: the 1st, at the beginning of the study, when all patients were asymptomatic (clinical stage 0); the 2nd, at the end of 36 month persistence of asymptomatic (clinical stage 1), consisting of 45 patients (group AA); the 3rd, on occasion of manifestation of the symptoms during this period of time (clinical stage 2), consisting of 21 patients (group AS-PRE), with two fatalities not related to valvopathy. RESULTS The comparison between the groups resulted in similarities in the mean ages, mean time of knowledge of the disease, predominance of males and rheumatic etiology. The profile analysis showed that the significant initial differences between the average of all echocardiographic variables (diastolic diameter, systolic diameter, shortening fraction, final systolic stress, volume-mass ratio, contractility index) and of the ejection fraction of the left ventricle obtained by the radionuclide ventriculography at rest, remained during the study. CONCLUSION Development of symptoms grouped patients with more advanced excentric hypertrophy, did not coincide with any immediate change in the laboratory markers studied at rest and it was used as a referential for surgical therapy.
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Affiliation(s)
- F Tarasoutchi
- Instituto do Coração do Hospital das Clínicas, FMUSP
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39
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Ayres CV, Cardoso LF, Grinberg M, Rati MA, Medeiros CC, Tarasoutchi F, Avila WS, Rossi EG, Bellotti G. [Mitral stenosis correction by double catheter-balloon valvuloplasty technique]. Arq Bras Cardiol 1995; 64:27-31. [PMID: 7669007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate long-term efficacy of double balloon percutaneous mitral valvuloplasty technique (PMV2B). METHODS Sixty-eight patients (76% female), mean-age 32 (15-69) years who had been submitted to PMV2B, that completed clinical and echodopplercardiographic one year follow-up (PO12M). Admission criteria were: exertional dyspnoea, no thromboembolism antecedent up to three months before the procedure, absence of other cardiac disease requiring correction, an admissible echodopplercardiographic score, absence of intracavitary thrombus and mitral regurgitation absent or minor. RESULTS The patients were divided in two groups: group A of 7 (11%) patients that have a cardiac event in this period, and group B of 61 patients that completed the follow-up without a cardiac event. In group A three patients have had a severe mitral regurgitation, one case was unsuccessful and other one had a re-stenosis. There were two deaths, not related to the intervention. In group B, haemodynamic results before and immediately after PMV2B (POI) showed a significant improvement, except in relation to cardiac index. There was an increase in the grade of mitral regurgitation in 17 (28%) patients and in two cases this regurgitation became moderate. The mitral valvar area (MVA) variation between PRE x POI x PO12M presented, comparing MVA between POI and PO12M, a significant reduction. Two (3%) patients with a reduction greater than 50% of the initial increase, 33 (54%) between 10 and 50% and 26 (42%) less that 10% remained in functional class I/II. CONCLUSION PMV2B is an attractive treatment to select symptomatic mitral stenosis patients, with a low incidence of complications, symptomatic effective improvement that was maintained in one year follow-up, although there was a reduction in MVA.
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Affiliation(s)
- C V Ayres
- Instituto do Coração do Hospital das Clínicas-FMUSP
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40
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Tarasoutchi F, Grinberg M, Wu TC, Filho CC, Rached RA, Cardoso LF, Pomerantzeff PM, Estevez Filho A, da Luz PL, Bellotti G. [Chronic rheumatic cardiopathy in a patient with of hemophilia successfully treated with surgery]. Arq Bras Cardiol 1994; 63:389-91. [PMID: 7611917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A 52 year-old man, with rheumatic cardiopathy and hemophilia was admitted to the hospital for aortic valve replacement and mitral valve commisurotomy. He had a history of allergic reaction to cryoprecipitate, and to undergo to the cardiac surgery, the ideal level of factor VIII was estimated to be 100%. To reach this level he first received 2,500UI of the factor VIII:C increasing the factor VIII:C level from 20 to 58%. During the surgery he received an additional dose of 1,500UI of factor VIII plus 3,500,000UI of aprotinin (Trasylol), which was started at the beginning of the anaesthesia and maintained during the surgical procedure, increasing the factor VIII level to 220%. The patient was discharged 11 days after the surgery without any hemorrhagic complication.
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Cardoso LF, Grinberg M, Vieira ML, Lopes NH, Tarasoutchi F, Lourenço Filho DD, Bellotti G. [Aneurysms of the left and non coronary sinus of Valsalva associated to mitral and aortic rheumatic valves and obstructive coronary disease]. Arq Bras Cardiol 1994; 63:303-5. [PMID: 7771949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A 30 years old, male, patient with rare multiple aneurysms of sinus of Valsalva associated to mitral and aortic regurgitation and total occlusion of circumflex artery had the clinical diagnosis made accidentally. The multiple aneurysms were detected by transesophageal echodopplercardiography and hemodynamic study. The diagnosis were confirmed at surgery and the patient underwent correction of the aneurysms through the use of pericardial patches and mitral and aortic valve replacement.
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Affiliation(s)
- L F Cardoso
- Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo
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42
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Tarasoutchi F, Grinberg M, Barreto Filho JA, Vasconcelos JT, Cardoso LF, Lunardi W, Mansur A, Pomerantzeff P, da Luz PL, Bellotti G. [Acquired ventricular septal defect during infective endocarditis]. Arq Bras Cardiol 1994; 63:203-5. [PMID: 7778992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We studied five patients with acquired ventricular septal defect during the course of an infective endocarditis. All patients were male and had a previous aortic valve disease associated with an aortic ring abscess. Clinical examination was useful for the diagnosis of 4 cases, emphasizing the following findings: systolic murmur and/or left paraesternal thrill and right-heart failure. Incidence of congestive heart failure was 60%, while 40% of all patients died during the in-hospital course. No specific etiologic agent was detected. Therefore, acquired ventricular septal defect should be suspected in patients with infective endocarditis of the aortic valve that evolve with a systolic murmur and/or paraesternal thrill and right-heart failure. Immediate surgical treatment is mandatory in these cases.
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Affiliation(s)
- F Tarasoutchi
- Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo
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Lunardi W, Grinberg M, Scaff M, Antelmi I, Mutarelli E, Kajita LJ, Esteves A, Tarasoutchi F, Cardoso LF, Rossi E. [Neurological events in infective endocarditis]. Arq Bras Cardiol 1993; 61:349-55. [PMID: 8204070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The study of frequency, modalities and course of neurological complications of infective endocarditis (IE), as well as the current indication and value of supplementary examinations. METHODS Sixty-three patients with IE, 39 with native valve and 24 with valvar prosthesis, were prospectively studied; the mean age was 42 years and 45 (71.4%) were males. Two groups were formed: A) 41 patients without neurological events and B) 22 patients who presented 28 neurological events before or during hospitalization: ischemic cerebrovascular accident 20, hemorrhagic cerebrovascular accident 2, meningeal hemorrhage 2, meningitis 2, brain abscess 1 and seizure 1. All patients were submitted to neurological clinical examination; 57 computerized tomographies of the cranium, 28 arteriographies and 32 cerebrospinal fluid analysis were performed. RESULTS The incidence of neurological events corresponded to 34.92% of IE patients, with a clear predominance (85.71%) of vascular as compared to infectious manifestations. Mortality was 2.32 times higher in group B patients (22.73% x 9.76%), albeit p = 0.256, and was not related to staphylococcal etiology. The neurological events were not related to sex, age and presence of valvar prosthesis. The presence of neurological complications was greater (p = 0.047) in patients with simultaneous infections in two valves (mitral and aortic) and also (p = 0.00884) in those with IE in prosthesis implanted for less than three months. All supplementary neurological examinations in group A were normal. CONCLUSION 1) Occurrence of neurological events is a factor which influences the prognosis of IE; 2) supplementary neurological examinations did not reveal subclinical neurological complications; 3) neurological complications were significantly more frequent in patients with simultaneous mitral and aortic valve IE; 4) IE in prosthesis implanted for less than 3 months has a greater probability to develop a neurological picture as compared to IE in prosthesis implanted for more than 3 months.
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Affiliation(s)
- W Lunardi
- Instituto do Coração do Hospital das Clínicas, FMUSP
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44
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Cardoso LF, Grinberg M, Ratti MA, de Magalhães LP, Antelmi I, Medeiros CC, Tarasoutchi F, Rossi EG, Avila WS, Bellotti G. [Comparison between the use of unifoil double balloon and bifoil balloon in successful mitral valvuloplasty by balloon catheter]. Arq Bras Cardiol 1993; 61:87-91. [PMID: 8297227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To compare immediate and long term results balloon mitral valvuloplasty (BMV) using double balloon or bifoil balloon. METHODS One hundred and thirteen consecutive cases of BMV used aleatory double balloon (group DB--55 cases) or bifoil balloon (group BF--16 cases). Patients were similar regarding to age, sex, valvopaty etiology, functional class and echocardiographic score. Seventy one (63%) patients achieved 12 months follow-up. RESULTS In group DB there were 2 (4%) insuccess, 2 (4%) cardiac tamponade and 2 (4%) deaths, 91% patients had immediate criteria of success. Mitral valve area (MVA) increased from 0.8 to 1.69cm2 and mitral gradient (G) by echodopplercardiographic (ECHO) decreased from 17.9 to 4.8mmHg. Three (5%) patients developed severe mitral regurgitation (MR) and needed surgical intervention. At follow-up 2 (4%) developed mitral restenosis. MVA estimated by ECHO study after one year follow-up was inferior to 1.15cm2 in 15 (32%) cases, between 1.5 and 2.0cm2 in 17 (37%) and superior to 2.0cm2 in 14 (31%). In group BF there were 2 (12.5%) insuccess, 4 (25%) developed severe MR occurring 1 death immediate post-operative mitral valve replacement. Among 14 (87%) success cases, MVA increased from 0.8 to 1.89cm2 and G decreased from 18 to 6.4mmHg. Lately 2 (12.5%) needed surgical intervention because significative MR. At 12th month follow-up the ECHO study showed that in one (10%) case MVA was < 1.5cm2, and in 3 (27%) cases was between 1.5 and 2.0cm2. CONCLUSION There were similar good results in both groups, however group DB had more restenosis, cardiac tamponade and vascular complications and group BF had more severe MR.
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Affiliation(s)
- L F Cardoso
- Instituto do Coração do Hospital das Clínicas-FMUSP
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Cardoso LF, Grinberg M, Ayres CV, Rati MA, Medeiros CC, Tarasoutchi F, Sant'Anna FM, Bellotti G. [Mitral catheter-balloon valvuloplasty in surgical high risk patients]. Arq Bras Cardiol 1993; 60:301-5. [PMID: 8311744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
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 pulmonary 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 pulmonary neoplasia, 1 cardiac cachexia and one with previous cerebrovascular event). All patients underwent PMBV through transseptal technique. Double balloon was used in 10 (50%) patients; Inoue balloon in 5 (25%), mono-foil in 3 (15%) and bi-foil in 2 (10%). RESULTS Seventeen (85%) obtained success and 2 (10%) had clinical improvement. The hemodynamic 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 medium gradient (G) mmHg 21.2 +/- 10.7 x 10.7 +/- 6.7 (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 defect 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.
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Affiliation(s)
- L F Cardoso
- Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo
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Lavítola PDL, Dallan LA, Tarasoutchi F, Grinberg M, da Luz PL, Pileggi F, Jatene AD. [Valvular surgical treatment concurrent with myocardial revascularization]. Arq Bras Cardiol 1992; 59:441-6. [PMID: 1341867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To study the morbidity and mortality due to valvar surgical treatment performed concomitantly to myocardial revascularization. METHODS From 1650 patients submitted to mitral or aortic valve surgical treatment, 103 (6.24%) had it associated to myocardial revascularization. Coronary insufficiency was associated to aortic valvar lesion in 66 (64.0%) patients, group I, with mean age of 62.3 +/- 8 years; and in 37 (35.9%) patients with mitral valve lesion, group II, with mean age of 57.8 +/- 5.8 years. Diagnosis was based upon the anamnesis, physical examination and confirmed by cine-coronarographic findings. RESULTS I-Complications at the immediate postoperative; a) mortality 11 (10.6%) patients, 6 (9.09%) from group I: by low cardiac output 3, uncontrolled arrhythmia 1, mediastinitis 1; acute infarction with cardiogenic shock 1, and 5 (134.5%) of group II: uncontrolled hemorrhage 2, sudden death 1, saphenous vein graft occlusion, respiratory insufficiency and sepsis 2; b) controlled intercurrences that increased the time of hospitalization: mental disorder 5 patients; CVA 7, diabetes decompensation 2, worsening of chronic renal insufficiency 1, upper level digestive hemorrhage 1 and respiratory insufficiency 3 patients. II-late postoperative complications of 77 (83.6%) patients which could be followed up during a period of 60 months: 1) mortality: 3 (3.89%) patients; 2 due to cardiomyopathy and 1 by acute myocardial infarction; 2) late evolution-functional capacity III (NYHA) by cardiomyopathy 6; I/II 68 patients; mild angina 6 patients, 2 underwent revascularization at the end of final 36-42 months. CONCLUSION The clinical improvement and mortality indexes statistically similar to the isolate surgical acts stimulate us to keep up with such associate procedures.
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Souza AJ, Tarasoutchi F, Cardoso LF, Pommerantzeff PM, Grinberg M. [Aortic dissection associated with systemic lupus erythematosus]. Arq Bras Cardiol 1992; 59:127-30. [PMID: 1341157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 33-year-old female patient, with a 4-year history of hypertension plus a 3-year history of systemic lupus erythematosus, who had been taking high dosages of corticosteroids, has shown repetitive respiratory infections and congestive heart failure for the past 8 months. Angiocardiography confirmed the diagnosis of aortic insufficiency with aneurysmatic dilation of Valsalva's posterior sinus, ascending aorta of normal diameter and normal coronary arteries. Aortic dissection causing aortic insufficiency due to collapse of aortic leaflets was spotted during the surgery and was corrected by a bovine pericardial tube and suspension of aortic valve. The postoperative (PO) period was complicated by left-sided seizures followed by left hemiparesis and respiratory infection. She was discharged on the 25th PO day with mild left hemiparesis and in functional class I (NYHA), using medicines. We emphasize the need to consider the diagnosis of aortic dissection in patients with systemic lupus erythematosus and aortic insufficiency, specially in those who have a history of systemic arterial hypertension and long-term corticosteroid therapy.
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Affiliation(s)
- A J Souza
- Instituto do Coração, Hospital das Clínicas, FMUSP
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48
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Cardoso LF, Ratti MA, Grinberg M, Medeiros CC, Tarasoutchi F, Rossi EG, Avila WS, Pomerantzeff PM, de Moraes AV, Arie S. [Mitral valvuloplasty by balloon catheter. Early results and one-year follow-up]. Arq Bras Cardiol 1992; 58:445-51. [PMID: 1340723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To evaluate percutaneous mitral balloon valvuloplasty (PMBV) results immediately and one year follow-up. METHODS One hundred and four 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 atrial fibrillation and 1 (1%) junctional rhythm. In 99% cases the transseptal access was used. RESULTS The comparative haemodynamic results late x immediately after-PMBV were mitral valve area (cm2) 0.75 +/- 0.27 x 1.68 +/- 0.48 (p < 0.0001), gradient 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 index (L/min/m2) 2.55 +/- 0.69 x 2.92 x 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 pulmonary thromboembolism. Four (4%) had severe mitral regurgitation and went to surgery (1 death). There were 2 mitral reestenosis. CONCLUSION For selected patients PMBV is a safe method and the good results are maintained in 1 year follow-up.
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Affiliation(s)
- L F Cardoso
- Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo
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49
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Grinberg M, Tarasoutchi F, Bellotti G. [What does the "day before" mean in aortic insufficiency?]. Arq Bras Cardiol 1992; 58:165-7. [PMID: 1340193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- M Grinberg
- Instituto do Coração do Hospital das Clínicas, FMUSP
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Werner K, Tarasoutchi F, Lunardi W, Mariño JC, Grinberg M, Bellotti G, Jatene AD. Mycotic aneurysm of the celiac trunk and superior mesenteric artery in a case of infective endocarditis. J Cardiovasc Surg (Torino) 1991; 32:380-3. [PMID: 2055940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mycotic aneurysms of the celiac artery are extremely rare, and in our review of the literature we found that in only one case was it due to infective endocarditis. In our case a 19-year-old female patient with culture-negative infective endocarditis presented with pain in the epigastric area. A celiac artery aneurysm was diagnosed by ultrasonography and confirmed on CT scan and angiography, which also demonstrated an associated aneurysm of the superior mesenteric artery. Since excellent collateral circulation was present, simple ligation of the two aneurysms was performed. The patient presented no major complications in the postoperative course.
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Affiliation(s)
- K Werner
- Heart Institute, University of São Paulo, Brazil
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