Navegando por Palavras-chave "Aortic valve"
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- ItemAcesso aberto (Open Access)Cirurgia de troca valvar em gestante(Sociedade Brasileira de Cirurgia Cardiovascular, 2007-12-01) Cunha, Claúdio Ribeiro Da; Santos, Paulo Cesar [UNIFESP]; Castineira, Carolina Pastorin; Pereira, Flávia Souza Fernandes; Sociedade Brasileira de Cirurgia Cardiovascular; Universidade Federal de Uberlândia; Universidade Federal de São Paulo (UNIFESP)We describe a woman with gestational age of 20 weeks, who was submitted to a complex procedure. She underwent replacement of the biological mitral and aortic valve, both by biological prosthesis, valvuloplasty of the tricuspid valve, as well as thrombectomy of the left atrium. Extracorporeal circulation (ECC) was used during 105 minutes. The patient was discharged from hospital in good health conditions and the newborn remained in the Neonatal Intensive Care Unit (NICU) in a stable state. This is a complex procedure with a high maternal and fetal mortality. Therefore, this is an important case regarding valve abnormalities treatment during pregnancy.
- ItemSomente MetadadadosDouble transapical aortic and mitral valve-in-valve implant: An alternative for high risk and multiple reoperative patients(Elsevier B.V., 2013-04-15) Gaia, Diego Felipe [UNIFESP]; Breda, João Roberto [UNIFESP]; Ferreira, Carolina Baeta Neves Duarte [UNIFESP]; Marcondes de Souza, Jose Augusto [UNIFESP]; Buffolo, Enio [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
- ItemAcesso aberto (Open Access)Efeitos das cardioplegias sangüíneas hipotérmica e normotérmica nos substratos intracelulares em pacientes com corações hipertróficos(Sociedade Brasileira de Cirurgia Cardiovascular, 2000-06-01) Gomes, Walter José [UNIFESP]; Ascione, Raimondo; Suleiman, M-saadeh; Bryan, Alan J.; Angelini, Gianni D.; Universidade Federal de São Paulo (UNIFESP); University of Bristol Bristol Heart Institute Department of Cardiac SurgeryOBJECTIVE: Warm intermittent blood cardioplegia has been shown to prevent the reperfusion damage seen when cold blood cardioplegia is used in patients undergoing coronary revascularization. Little is known on the effects of these two cardioplegic techniques on hypertrophic hearts. The aim of this study was to investigate the comparative effects of cold and warm antegrade blood cardioplegia in patients with aortic stenosis who underwent aortic valve replacement. MATERIAL AND METHODS: The intracellular concentration of substrates (ATP, lactate and amino acids) was measured in left ventricular biopsies taken from 20 patients undergoing aortic valve replacement in whom myocardial protection was achieved by hyperkalaemic intermittent warm (n=10) or cold (n=10) blood cardioplegia. Biopsies were taken 5 minutes after institution of cardiopulmonary bypass (control), after 30 minutes of ischaemic arrest and 20 minutes after reperfusion. RESULTS: There were no significant changes in the intracellular concentration of substrates in the samples collected during the time of ischaemic arrest when compared to control. Upon reperfusion however there was a significant fall in the ATP and amino acids regardless of the cardioplegia technique used. CONCLUSION: The data suggest that both cardioplegia techniques do not confer adequate myocardial protection in hypertrophic hearts.
- ItemAcesso aberto (Open Access)Experiência inicial da Universidade Federal de São Paulo no desenvolvimento e aplicação do implante valvar aórtico transcateter(Universidade Federal de São Paulo (UNIFESP), 2009-11-25) Santos, Diego Felipe Gaia dos [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The aortic valve replacement is a routine procedure, and involves replacement of the native valve/prosthesis. In most of the patients who undergo such procedure the risk is acceptable, but in some cases, such risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for aortic position implant. METHOD: After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median age was 75,5 years. Median Logistic EuroSCORE was 43,7%. Four patients presented with disfunctional bioprosthesis, remainig ones presented calcified aortic stenosis (peak transvalvular gradient 79,7 mmHg). After minithoracotomy and under echocardiograph and fluoroscopic control, a balloon catheter was placed on aortic position and inflated. After, a second balloon with valved endoprosthesis was positioned and released under high ventricular rate. Echocardiograph and angiograph controls were performed and the patients were referred to ICU. RESULTS: Implant was feasible in 13 cases. There were no intra-operative deaths. Mortality was 42%. Median peak transvalvular aortic gradient reduced to 25,0 mmHg, and left ventricular function improved in the first 7 post operative days. Paravalvular aortic regurgitation was mild and present in most cases. Platelet count significantly decreased after procedure, but returned to normal values after 30 days. CONCLUSION: The transapical implantation of catheter-mounted bioprosthesis was a feasible procedure. Technical details and learning curve require further discussion.
- ItemSomente MetadadadosFoto-desbridamento de válvulas aórticas calcificadas com laser de CO2(Universidade Federal de São Paulo (UNIFESP), 1987) Gomes, Walter José [UNIFESP]; Buffolo, Enio [UNIFESP]
- ItemAcesso aberto (Open Access)Implante de tubo valvulado bioprótese stentless em posição aórtica: estudo experimental em ovinos(Sociedade Brasileira de Cirurgia Cardiovascular, 2002-03-01) Santos, Paulo César [UNIFESP]; Gerola, Luís Roberto [UNIFESP]; Pessa, Clodualdo J.N. [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Casagrande, Ivan Sergio Joviano; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Labcor Centro de PesquisaINTRODUCTION: Often, studies on aortic prosthetic valves analyze their performance not at the primitive position, but using tricuspid and mitral ones or inserting it in the descending aortic area. Taking that into account, it would be relevant to observe results in those studies in which the conclusions are based on their original implantation. MATERIAL AND METHODS: Thirty young sheep, 28 males and 2 females, were operated on. Ages ranged 4.4 to 6.3 months and weights 25 to 37 Kg. Extra corporeal circulation (ECC) was applied to all the animals, always guided by the conventional criteria, that is to say, the arterial cannula was inserted in the thoracic aorta just past the arterious ducts and the venous cannulae, a single one, was placed in the right atrium. The operation was performed according to the principle of moderately low body temperature- 29ºC- and cold cristalloid cardioplegia, in the aortic root, to induce; but otherwise was utilized blood to the maintenance. Following with the technique proposed, the aortic valve of the animal heart was completely excised and finally implanted the valved tube stentless, not forgetting the refixation of the coronary main. The sheep were kept in clinical and laboratorial observation during thirty days in what was included a echocardiogram in the end. RESULTS: The results demonstrated 8 intraoperatory deaths (26.6%), and 6 during the following (27.7%). The mean time of ECC was 98 minutes. The dimension of the majority prothetics valves were 21 and 23. Only two valves evoluted with mild insufficiency, none denoted evidences of the endocarditis neither of leaflets perfuration, the mean fraction of ejection was 74%, the left ventricle had its wall preserved in all cases. CONCLUSION: This experimental model can certainly reproduce nearly the reality, confirming good parameters of prothetics stentless evaluation in the aortic position. And the sheep declared itself to be pleasant, which helps us its control during the whole study.
- ItemAcesso aberto (Open Access)Implante transapical de endoprótese valvada balão-expansível em posição aórtica sem circulação extracorpórea(Sociedade Brasileira de Cirurgia Cardiovascular, 2009-06-01) Gaia, Diego Felipe [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Souza, José Augusto Marcondes de [UNIFESP]; Guilhen, José Cícero Stocco [UNIFESP]; Telis, Andre [UNIFESP]; Fischer, Claudio Henrique [UNIFESP]; Ferreira, Carolina Baeta Neves Duarte [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The aortic valve replacement is a routine procedure, and involves replacement of the native valve/prosthesis. In most of the patients who undergo such procedure the risk is acceptable, but in some cases, such risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation without cardiopulmonary bypass (CPB) has been shown to be viable, with lower morbidity and mortality. The aim of this study was to develop a catheter-mounted aortic bioprosthesis for implantation without CPB. METHODS: After developing in animals, three patients with high EuroSCORE underwent implantation. Case 1: patients with bioprosthesis dysfunction; Case 2: severe aortic stenosis; Case 3: dysfunction of aortic bioprosthesis. After minithoracotomy and under echocardiographic and fluoroscopic control, a balloon catheter was placed on aortic position and inflated. After, a second balloon with valved endoprosthesis was positioned and released under high ventricular rate. Echocardiographic and angiographic controls were performed and the patients were referred to ICU. RESULTS: In the first case, implantation without CPB was possible with appropriate results. The patient evolved with improvement of ventricular function. After, this patient developed bronchopneumonia, tracheoesophageal fistula and died due to mediastinitis. Autopsy confirmed proper valve positioning and leaflets preservation. The second case showed the device migration after inflation of the balloon, with the need for urgent median sternotomy, CPB and conventional valve replacement. This patient evolved well and was discharged from the ICU on the 14th postoperative day without complications. This patient developed respiratory infection, septic shock and died on the 60th postoperative day. The patient from the third case underwent successful implantation. CONCLUSION: The off-pump transapical implantation of catheter-mounted bioprosthesis was shown to be a feasible procedure. Technical details and learning curve require further discussion.
- ItemAcesso aberto (Open Access)Implante transcateter de valva aórtica: resultados atuais do desenvolvimento e implante de um nova prótese brasileira(Sociedade Brasileira de Cirurgia Cardiovascular, 2011-09-01) Gaia, Diego Felipe [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Ferreira, Carolina Baeta Neves Duarte [UNIFESP]; Souza, José Augusto Marcondes de [UNIFESP]; Gimenes, Marcus Vinícius [UNIFESP]; Macedo, Murilo Teixeira [UNIFESP]; Martins, Márcio Rodrigo [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such risk can justify contraindication. Minimally invasive transcatheter aortic valve implantation has emerged as an alternative, with lower morbidity and mortality. The aim of this study was clinical, safety and efficacy assessment. METHODS: Thirty-three high risk patients underwent transcatheter balloon expandable aortic valve implantation. Mean Logistic EuroScore risk was 39.30% and STS score 30.28%. Eight patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis were implanted trough the ventricular apex under rapid ventricular pacing or hemorrhagic shock. Echocardiographic and angiographic controls were performed. RESULTS: Implant was feasible in 30 cases. Three conversions occured. There was only one case of operative death. Median transvalvular aortic gradient reduced from 43.58 mmHg to 10.54 mmHg. Left ventricular function improved in the first 7 postoperative days. Paravalvular aortic regurgitation was mild and present in 30.30%. One case presented major vascular complication and another one permanent pacemaker implant. One major stroke case occurred. Overall 30-day mortality was 18.18%. CONCLUSION: The transapical implantation of catheter mounted bioprosthesis is a safe procedure with acceptable midterm results. Long term follow-up with increased sample power is mandatory in order to access hemodynamic, life quality and survival
- ItemAcesso aberto (Open Access)Tratamento cirúrgico das valvopatias aórticas com bioprótese de pericárdio bovino sem suporte: resultados imediatos(Sociedade Brasileira de Cardiologia - SBC, 2006-07-01) Araújo, Wesley Ferreira de [UNIFESP]; Gerola, Luís Roberto [UNIFESP]; Kin, Hyoung C. [UNIFESP]; Pereira Filho, Armindo [UNIFESP]; Vargas, Guilherme Flora [UNIFESP]; Catani, Roberto [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To present the immediate results and assess the clinical and hemodynamic performance of stentless bovine pericardial bioprostheses in aortic position. METHODS: Twenty patients were operated who were indicated for surgery for valve replacement with biological prostesis. Eleven patients were male; sixteen had aortic stenosis; four, insufficiency; the mean age was 66.3 ± 8.8 years. The surgical technique used was subcoronary implant. Associated procedures were performed in five patients. Postoperative morbidity,mortality and hemodynamic performance were assessed on transthoracic echocardiogram. RESULTS: Mean time of cardiopulmonary bypass was 136.5 ± 24.41 minutes and mean anoxic time was 105.2 ± 21.62 minutes. Hospital mortality was 5% (one patient). Mean time of intensive care unit stay was 3.65 ± 3.23 days. Mean postoperatively transvalvular gradient was was 25.39 ± 7.82 mmHg. Left ventricle ejection fraction was 67 ± 13.49% preoperatively and 63.24 ± 16.06% postoperatively (p = 0.45). Eleven patients did not present any degree of valve regurgitation, eight presented mild regurgitation and one ,mild to moderate regurgitation. CONCLUSION: Stentless prostheses can be used for the surgical tratment of aortic valve diseases, with in hospital mortality and morbidity similar to the mortality and morbidity described in the literature for similar procedures, with satisfactory hemodynamic performance.