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Valvuloplastía Aórtica con balón como puente para reemplazo valvular aórtico percutáneo o quirúrgico en el manejo de la estenosis aórtica severa Percutaneous aortic balloon valvuloplasty as a bridge to aortic valve replacement in severe aortic stenosis
Gabriel Maluenda,Itsik Ben-Dor,Israel Barbash,Dani Dvir
Revista Chilena de Cardiología , 2012,
Abstract: Introducción: La incorporación del reemplazo valvular aórtico percutáneo (RVAP) ha 'revivido' el uso de la valvuloplastía Aórtica con balón (VAB) para el tratamiento de la estenosis Aórtica (EA) severa sintomática. Objetivos: Determinar la tasa de éxito y complicaciones después de VAB y los resultados clínicos como terapia única versus VAB como puente para RVA quirúrgico o percutáneo. Métodos: La cohorte quedó compuesta por 472 pacientes que fueron sometidos a 538 VAB. En el grupo I, VAB se usó como terapia única, n=387(81.9%), y grupo II, VAB como puente, n=85(18.1%, n=65 a RVAP, n=20 RVA quirúrgico). VAB exitosa fue definida como una reducción >40% en gradiente aórtico medio y/o incremento en área valvular aórtica >40%. Resultados: Los grupos I y grupo II fueron comparables en cuanto a edad (81.7±8.3 vs. 83.2±10.9 a os, p=0.18), o STS score (13.1±6.2 vs. 12.4±6.4, p=0.4), o Euroscore logístico (45.4±22.3 vs. 46.9±21.8, p=0.43). El incremento medio en el área valvular Aórtica fue de 0.39±0.25 cm2 en el grupo I y 0.42±0.26 cm2 en el grupo II, p=0.33. El descenso en la gradiente media fue de 24.1±13.1 mmHg en el grupo I y de 27.1±13.8 mmHg en el grupo II, p=0.06. La VAB no fue exitosa en 81 casos (15%). Por análisis multivariado se comprobó que la repetición de VAB era el correlato más potente para VAB no exitosa (HR 4.34[95%, IC 2.2-8.3], p<0.001). La mortalidad alejada fue de 55.2.% (214 pacientes) en el grupo I y de 22.3% (n=19) en grupo II, p<0.001. No hubo diferencias en muerte intra-procedimiento, n=6 (2%) vs. n=5 (2%), o accidente cerebro vascular, n=7 (2.3%) vs n=4(1.6%). Conclusión: En pacientes de alto riesgo con EA severa y contraindicación temporal para RVA quirúrgico/ percutáneo, la VAB puede ser usada como puente para una intervención definitiva con buen resultado a mediano plazo. Background: the recent introduction of percutaneous aortic valve replacement (PAVR) has become a stimulus to perform percutaneous aortic balloon valvu-loplasty (PABV) in patients with severe symptomatic aortic stenosis (AS) as a bridge to valve replacement (AVR) Aim: to determine success rates and clinical results of PABV alone vs those obtained with PABV followed by either surgical or percutaneous AVR. Method: 472 patients with severe AS underwent a total of 538 PABV procedures. 378 (82%) were treated with PABV alone (Group I). In Group II, 85 patients (18%) had PABV followed by either PAVR (n=65) or surgical AVR (n=20). A successful PABV was defined as >40% reduction in mean aortic valve pressure gradient or >40% increase in aortic valve area Results: Groups I an
Percutaneous approaches in valvular heart diseases  [cached]
Mustafa Ayd?n,Ali ?etiner
Anadolu Kardiyoloji Dergisi , 2009,
Abstract: Valvular heart diseases still continue to be an important health problem. Surgical replacement of cardiac valves keeps a widely used treatment method for the present. However, the efficiency of minimal invasive and percutaneous methods targeted to repair and replacement of the diseased valves has been searched for nowadays. The first clinical experiences and early stage outcomes on the applicability of these methods are encouraging. Nevertheless, it should be kept in mind that percutaneous valvular interventions are at their development stages. Long term confidence and efficiency studies of these treatment modalities are needed. The present review emphasizes the studies on percutaneous techniques initiated in the treatment of valvular heart diseases.
Edema pulmonar refractario secundario a estenosis valvular aórtica severa - valvuloplastia aórtica como terapia puente a cirugía: Presentación de un caso Refractory pulmonary edema secondary to severe aortic valvular stenosis - aortic valvuloplasty as bridge therapy to surgery
Santiago Salazar,Franklin Hanna,Aminta Capasso,Miguel Madero
Revista Colombiana de Cardiología , 2009,
Abstract: La estenosis valvular aórtica es una entidad progresiva, que cuando es severa y produce síntomas, tiene un pronóstico sombrío que afecta de forma adversa la sobrevida. En estos casos el tratamiento de elección es la cirugía de cambio valvular, la cual, bajo determinadas circunstancias clínicas, puede ser de muy alto riesgo, y obliga así a considerar alternativas de manejo menos agresivas que permitan solucionar el problema. Se muestra el caso de un hombre de 65 a os, con estenosis valvular aórtica severa, quien desarrolló edema pulmonar refractario al manejo médico, que se resolvió mediante valvuloplastia aórtica, como terapia puente a cirugía. Aortic valve stenosis is a progressive disease; when it is severe and symptomatic has a bleak prognosis that affects adversely the patient survival. In these cases, the treatment of choice is valve replacement surgery that under certain circumstances can bear a huge risk that forces the physician to consider less aggressive management alternatives to solve the problem. The case of a 65 years old male with severe aortic valve stenosis is reported. He developed pulmonary edema refractory to medical treatment that was solved by aortic valvuloplasty as bridge therapy to surgery.
Retroca valvular
Pomerantzeff, Pablo M. A;Abreu, Mário César S. de;Amato, Marisa;Moretti, Miguel;Auler Júnior, José Otávio C;Grinberg, Max;Tarasoutchi, Flávio;Mansur, Alfredo;Dias, Altamiro Ribeiro;Bittencourt, Delmont;Stolf, Noedir A. G;Verginelli, Geraldo;Jatene, Adib D;
Revista Brasileira de Cirurgia Cardiovascular , 1987, DOI: 10.1590/S0102-76381987000300005
Abstract: replacement of valvular prosthesis is an increasingly frequent procedure in heart surgery. better results are attained with the observation of correct indication and improved surgical technique. in the period of january 1984 to june 1986, 145 patients were submitted to prosthesis replacement, at our institution. these patients received a total of 157 prostheses and 4 had their starr-edwards valve ball replaced due to ball variance. six patients were submitted to a third valvular replacement in the mitral position, withouth deaths. nine patients had a third valvular replacement in the aortic position with 1 death in the immediate postoperative period. rupture or calcification of the dura mater leaflets were the main reason for the indication of prosthetic replacement. in the mitral position 41 patients presented rupture of the leaflets and 19 showed calcification. in the aortic position 32 bioprostheses underwent rupture and 12, calcification. bio-prostheses were utilized in the majority of cases of replace the dysfunctioning prostheses. porcine bioprostheses were implanted in 63 cases and bovine pericardial bioprostheses, in 35. immediate mortality was 8.3% (12 patients); low cardiac output was the main cause of death. the most frequent immediate complications were low cardiac output, arrhythmias and bleeding. in the preoperative period 90% of the patients were in functional classes iii and iv (nyha). after the replacement, 89% of the aortics and 82% of the mitral were in functional classes i an ii.
Cardiac Valvular Inflammatory Pseudotumor
Pradeep Vaideeswar, Anil M Patwardhan, Pragati A Sathe
Journal of Cardiothoracic Surgery , 2008, DOI: 10.1186/1749-8090-3-53
Abstract: Diseases of the heart valves cut across all age groups, race and geographic locations to form a significant cause of morbidity and mortality. These deformities may be congenital or acquired, as a result of developmental, post-inflammatory and degenerative changes. In our country, owing to high prevalence of rheumatic heart disease [1], the etiology in most valvular dysfunctions (stenosis and/or regurgitation) is attributed to rheumatic heart disease, unless proved otherwise. This is largely true in most instances, but there do exist occasions, where a "rheumatic "assumption is erroneous. We present a rare case of inflammatory pseudotumor, manifesting as a granulomatous valvulitis, producing chronic mitral and aortic regurgitation in a 62 years old lady.A 62-year-old woman presented to our Cardiovascular & Thoracic Center with complaints of breathlessness and palpitation. The dyspnea (grade II), present for the past eight years, had progressed in six months to grades III/IV. She had had past hospital admissions for similar complaints. A secundum atrial septal defect had been closed in the year 1990. She was advised valve replacement for rheumatic valvular heart disease. Routine hematological and biochemical investigations had been normal. Two-dimensional echocardiography showed severe mitral and moderate aortic, regurgitation. The pulmonary arterial pressure was 80 mm Hg. She was taken up for mitral and aortic valve replacements. The anterior mitral leaflet was thick and fleshy while the posterior leaflet was thin. There was no significant sub-valvular pathology. The anterior leaflet and the medial scallop of the posterior leaflet were excised and the valve was replaced by Carbomedics mechanical valve (27 mm). The right and non-coronary cusps of the aortic valve showed similar thickening. The cusps were excised and the valve replaced by a St. Jude's mechanical valve (19 mm). During surgery, there was inadvertent tear of the superior caval vein, which was sutured and
Unique type of isolated cardiac valvular amyloidosis
Shehzad Iqbal, Salma Reehana, David Lawrence
Journal of Cardiothoracic Surgery , 2006, DOI: 10.1186/1749-8090-1-38
Abstract: A 72 years old gentleman underwent urgent aortic valve replacement. Intraoperatively, a lesion was found attached to the inferior surface of his bicuspid aortic valve.Histopathology examination of the valve revealed that the lesion contained amyloid deposits, identified as AL amyloidosis. The serum amyloid A protein (SAP) scan was normal and showed no evidence of systemic amyloidosis. The ECG and echocardiogram were not consistent with cardiac amyloidosis.Two major types of cardiac amyloidosis have been described in literature: primary-myelomatous type (occurs with systemic amyolidosis), and senile type(s). Recently, a localised cardiac dystrophic valvular amyloidosis has been described. In all previously reported cases, there was a strong association of localised valvular amyloidosis with calcific deposits.Ours is a unique case which differs from the previously reported cases of localised valvular amyloidosis. In this case, the lesion was not associated with any scar tissue. Also there was no calcific deposit found. This may well be a yet unknown type of isolated valvular amyloidosis.Amyloid deposition in heart is a common occurrence in systemic amyloidosis. But localised valvular amyloid deposits are very uncommon. It was only in 1922 that the cases of valvular amyloidosis were reported [1]. Then in 1980, Goffin et al reported another type of valvular amyloidosis, which he called the 'dystrophic valvular amyloidosis'. We report a case of aortic valve amyloidosis which is different from the previously described isolated valvular amyloidosis.A 72 year old gentleman was admitted with shortness of breath and palpitations via accident & emergency department. He was found to be in atrial fibrillation and in left ventricular failure. He was a hypertensive diabetic with poorly controlled blood sugar. Examination revealed an ejection systolic murmur. His left ventricular failure was treated with diuretics. Transthoracic echocardiography showed a stenotic bicuspid aortic va
Valvular heart disease in patients undergoing chronic hemodialysis  [PDF]
Loncar Daniela,Tabakovic Mithat,Mulic-Bacic Suada,Hadzovic Djani
Cardiologia Croatica , 2013,
Abstract: Valvular heart disease is a common phenomenon in patients undergoing chronic hemodialysis. Abnormalities include valvular and annular thickening and calcification of any of the heart valves, causing regurgitation and/or stenosis. Valvular thickening or sclerosis in patients undergoing chronic dialysis treatment usually affects the aortic and mitral valve. Aortic valve calcification is recorded in up to a half of hemodialyzed patients, occurring from 10 to 20 years earlier than in the general population. Valvular regurgitation occurs mostly in mitral, tricuspid and less commonly in aortic valve. The aim of the article was to determine the incidence of valvular heart disease in asymptomatic patients undergoing chronic dialysis.The analysis involves a total of 50 patients, of whom 35 (70%) are treated by hemodialysis and 15 (30%) by continuous ambulatory peritoneal dialysis. Valvular thickening or sclerosis was diagnosed in 20 (40%) patients. Sclerosis of mitral cusps was diagnosed in 9 (18%) patients and sclerosis of aortic cusps was diagnosed in 11 (22%) patients. Heart valve calcifications were diagnosed in 12 (31%) patients. Mild aortic stenosis was present in 3 (6%) patients. Mitral regurgitation was diagnosed in 38 (76%) patients, aortic regurgitation in 14 (28%), and tricuspid regurgitation in 24 (48%) patients.The evaluation of the valve apparatus for all patients undergoing chronic dialysis program requires echocardiographic examination that is to be performed, considering the high prevalence of valvular heart diseases.
Valvular heart disease associated with coronary artery disease  [cached]
Aylin Y?ld?r?r
Anadolu Kardiyoloji Dergisi , 2009,
Abstract: Nowadays, age-related degenerative etiologies have largely replaced the rheumatic ones and as a natural result of this etiologic change, coronary artery disease has become associated with valvular heart disease to a greater extent. Degenerative aortic valve disease has an important pathophysiological similarity to atherosclerosis and is the leader in this association. There is a general consensus that severely stenotic aortic valve should be replaced during bypass surgery for severe coronary artery disease. For moderate degree aortic stenosis, aortic valve replacement is usually performed during coronary bypass surgery. Ischemic mitral regurgitation has recently received great attention from both diagnostic and therapeutic points of view. Ischemic mitral regurgitation significantly alters the prognosis of the patient with coronary artery disease. Severe ischemic mitral regurgitation should be corrected during coronary bypass surgery and mitral valve repair should be preferred to valve replacement. For moderate degree ischemic mitral regurgitation, many authors prefer valve surgery with coronary bypass surgery. In this review, the main characteristics of patients with coronary artery disease accompanying valvular heart disease and the therapeutic options based on individual valve pathology are discussed.
Valvular and perivalvular involvement in patients with chronic kidney disease
Neelavathi Senkottaiyan,Saad Hafidh,Farrin A Manian,Martin A Alpert,
Neelavathi Senkottaiyan
,Saad Hafidh,Farrin A. Manian,Martin A. Alpert

老年心脏病学杂志(英文版) , 2005,
Abstract: Mitral annular calcification (MAC) and aortic valve calcification (AVC) are the most common valvular and perivalvular abnormalities in patients with chronic kidney disease (CKD). Both MAC and AVC occur at a younger age in CKD patients than in the general population. AVC progresses to aortic stenosis and mild aortic stenosis progresses to severe aortic stenosis at a more rapid rate in patients with CKD than in the general population. The use of calcium-free phosphate binders in such patients may reduce the calcium burden in valvular and perivalvular structures and retard the rate of progression of aortic stenosis. Despite high rates of morbidity and mortality, the prognosis associated with valve surgery in patients with CKD is better than without valve surgery. Infective endocarditis remains an important complication of CKD, particularly in those treated with hemodialysis.
The preoperative assessment of patients with valvular heart disease as a comorbidity  [PDF]
Markovi? Dejan,Jankovi? Radmilo,Kova?evi?-Kosti? Nata?a,Velinovi? Milo?
Acta Chirurgica Iugoslavica , 2011, DOI: 10.2298/aci1102031m
Abstract: In patients with valvular heart disease planned for any type of surgery preoperative evaluation and preparation are especially important for a successfull outcome of the surgery. Preoperative preparation and intraoperative treatment of patients with valvular heart disease are different depending on the type of valvular disease: aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation or mitral valve prolapse. In this paper we have outlined the criteria for evaluating the severity of valvular disease, given that the risk in surgery is proportional to the degree of valvular disease. Also, given that the risk in surgery is also directly proportional to the type and extent of non cardiac surgery, it will be presented recommendations for intraoperative monitoring, with the purpose of evaluating patient’s hemodynamic state, as well as recommendations for perioperative treatment of hypotension, tachycardia, and other hemodynamic disturbances. In the paper we will separately discuss bacterial endocarditis profilaxys which can occur after the surgery of patients with valvular disease. Since the patients with valvular disease, and especially the ones with implanted prosthetic valve or heart arrhythmia, are usually on oral anticoagulation therapy, it will be given recommendations for treatment of patients on oral anticoagulation therapy as part of preoperative preparations.
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