Heart Valve Diseases/surgery

ABCIC

Case Report

Trivalvular Endocarditis: A Rare Multivalvular Condition

Renata Della Giustina et al. Maurício Felippi de Sá Marchi Marcelo Moser Fiamoncini Eduardo Zanghelini Mazon … Maurício Pais Bussoletto Altair Fiamoncini

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ABC

Editorial

The Double-Orifice Technique in Mitral Valve Repair: 35 Years of History

Pablo Maria Alberto Pomerantzeff et al. Carlos Manuel de Almeida Brandão Arlindo Riso Fabio Biscegli Jatene

The advantages of mitral valve repair are lower morbidity and mortality, reduced risk of thromboembolism and endocarditis, improved survival, and better preservation of left ventricular function. The most common cause of degenerative mitral regurgitation is a myxomatous valve with segmental prolapse of the posterior leaflet, a lesion that can be corrected by classical techniques such as quadrangular resection, but other lesions may require more complex surgical techniques, for instance, correction of anterior leaflet prolapse or Barlow disease. Mitral valve repair in rheumatic patients is still a challenge.

In December 1984, Adib Domingos Jatene MD, PhD performed the first “duplication of the mitral orifice”, in a female patient with mitral insufficiency due to rupture of anterior leaflet chordae (). The technique restored mitral competence by anchoring the free edge of the prolapsing leaflets to the corresponding free edge of the opposing leaflet with a 5-0 polypropylene stitch reinforced with pledgets. The patient presented good immediate and long-term evolution.

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IJCS

Original Article

Prevalence of Frailty in Patients Undergoing Cardiac Valve Surgery: Comparison of Frailty Tools

Gabriela Harada et al. Monique Carvalho Andrade Julia Nobrega Brito Caio de Assis Moura Tavares … Flávio Tarasoutchi Pablo Maria Alberto Pomerantzeff Luiz Bortolotto Maria Ignez Zanetti Feltrim

Abstract

Background

There is no consensus among tools for assessing frailty.

Objective

To evaluate the prevalence of frailty according to different tools in patients referred for elective valve cardiac surgery.

Methods

This is a cross-sectional study. All patients were ≥ 18 years of age, clinically stable. The following patients were excluded: those unable to perform the tests because of physical, cognitive, or neurological limitations; those requiring non elective/emergency procedures or hemodynamic instability. During the preoperative cardiology visit, frailty was assessed by the Short Physical Performance Battery (SPPB), the Frailty Deficit Index (FDI), handgrip strength, and gait speed 3m. For the entire analysis, the statistical significance was set at 5%.

Results

Our cohort consisted of 258 subjects. From the total cohort, 201 were ≤ 70 years of age (77.9%), the predominant etiology according to rheumatic disease (50.7% vs 8.8%; p=0.000) with double mitral lesion (24.9% vs 0%; p=0.000). Frailty was present in 32.9% according SPPB, 29.1% with reduced muscular strength. and 8.9% with FDI. Handgrip strength was weaker in elderly patients (26.7 vs 23.6; p=0.051) and gait speed was lower in the younger group, in which 36% were considered frail (36% vs 14%; p=0.002). Variables associated with frailty were age ≥ 70 years, female gender, aortic stenosis, and regurgitation.

Conclusion

Frailty in adult patients who will have elective heart valve surgery is present even in the younger groups, although the older group with comorbidities are more frail. Frailty was more clearly shown by the SPPB than by the FDI and handgrip tests.

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ABC

Research Letter

Porcine Valve Bioprosthesis: a Legacy from Mario Vrandecic

Erika Correa Vrandecic et al. Ektor Correa Vrandecic Bayard Gontijo Filho Rossana Dall’Orto Elias … Braulio Roberto Gonçalves Marinho Couto Marcus Vinicius Bolivar Malachias

Heart valve disease currently occupies the spotlight in cardiovascular medicine due to recent advances in imaging techniques and emerging therapeutic possibilities, attracting the attention of physicians, researchers, device manufacturers, and investors. Brazil has a prominent international role in the history and technological development of prosthetic heart valves used to treat this disease.

The first worldwide implantation of a commercially available porcine valve bioprosthesis occurred in October 1968. About half a century later, in September 2019, passes on the physician and scientist Mario Vrandecic, creator of the only heart valve bioprosthesis made from porcine tissue produced in Brazil and approved by the United States (US) Food and Drug Administration (FDA), globally used for decades in the treatment of heart valve disease.

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IJCS

Editorial

Biological and Mechanical Heart Valves Under a New Spotlight: Paradigm Shift and New State of the Art

Domingo Marcolino Braile et al. Idiberto José Zotarelli Filho

With the growth in life expectancy observed in recent decades in Brazil and worldwide, implantation of cardiac valve prostheses has been one of the recommended procedures for patients with valve diseases. In Brazil, this approach is the second most performed surgery among highly complex cardiovascular procedures. According to DATASUS, between January 2008 and May 2018, 900 implants were performed.

The 2017 European Society of Cardiology / European Association for Cardio-Thoracic Surgery (ESC/EACTS3) guidelines established that the choice between a mechanical (MV) and biological valve (BV) in adults is primarily determined by estimating the risk of bleeding related to anticoagulation, thromboembolism, and the risk of structural deterioration of BV, considering the patient’s lifestyle and preferences. This risk/benefit ratio of MV and BV led the US and European guidelines to recommend the use of prostheses in patients under 60 years of age. Nevertheless, the use of BV has increased significantly in all age groups in recent decades.

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Image

Extensive Myocardial Calcification in a Heart Transplant Patient

Sasha B. C. P. Duarte et al. Sandrigo Mangini Monica S. Avila Marcelo L. Montemor Fernando Bacal

A 33-year-old female patient underwent heart transplantation (Tx) for valvular heart disease, where the surgical procedure was uneventful. Post-Tx, she developed with acute graft dysfunction, acute renal failure (ARF) requiring dialysis and septic shock. Bloodstream infection confirmed by treatment for carbapenemase-producing Klebsiella pneumoniae. Non-contrast-enhanced computed tomography (CT) of the chest and abdomen was done for investigation of the infectious focus and distention of the abdomen and melena, with extensive left ventricular myocardial calcification (MC) not previously found in CT (, and ). A diagnosis of cytomegalovirus (CMV) infection was also confirmed by upper digestive endoscopy findings with diffuse gastroduodenal ulcers and quantitative detection of positive CMV DNA, and the patient received ganciclovir. The patient became refractory to treatment and died.

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ABC

Original Article

Paravalvular Regurgitation: Clinical Outcomes in Surgical and Percutaneous Treatments

Carlos Passos Pinheiro et al. Daniele Rezek Eduardo Paiva Costa Edvagner Sergio Leite de Carvalho … Freddy Antonio Brito Moscoso Percy Richard Chavez Taborga Andreia Dias Jeronimo Alexandre Antonio Cunha Abizaid Auristela Isabel de Oliveira Ramos

Abstract

Background:

Paravalvular regurgitation (paravalvular leak) is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair.

Objectives:

To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure.

Methods:

This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure.

Results:

The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases), with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57) and a higher mortality rate (0% vs. 20%, p = 0.08). A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08).

Conclusion:

Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk.

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Original Article

Spectrum of cardiac lesions associated with Isolated Cleft Mitral Valve and their impact on therapeutic choices

Ayoub El hammiri et al. Abdenasser Drighil Sanaa Benhaourech

Abstract

Background:

Isolated cleft mitral valve (ICMV) may occur alone or in association with other congenital heart lesions. The aim of this study was to describe the profile of cardiac lesions associated with ICMV and their potential impact on therapeutic management.

Methods:

We conducted a descriptive study with data retrieved from the Congenital Heart Disease (CHD) single-center registry of our institution, including patients with ICMV registered between December 2008 and November 2014.

Results:

Among 2177 patients retrieved from the CHD registry, 22 (1%) had ICMV. Median age at diagnosis was 5 years (6 days to 36 years). Nine patients (40.9%) had Down syndrome. Seventeen patients (77.3%) had associated lesions, including 11 (64.7%) with accessory chordae in the left ventricular outflow tract (LVOT) with no obstruction, 15 (88.2%) had ventricular septal defect (VSD), three had secundum atrial septal defect, and four had patent ductus arteriosus. Thirteen patients (59.1%) required surgical repair. The decision to proceed with surgery was mainly based on the severity of the associated lesion in eight patients (61.5%) and on the severity of the mitral regurgitation in four patients (30.8%). In one patient, surgery was decided based on the severity of both the associated lesion and mitral regurgitation.

Conclusion:

Our study shows that ICMV is rare and strongly associated with Down syndrome. The most common associated cardiac abnormalities were VSD and accessory chordae in the LVOT. We conclude that cardiac lesions associated with ICMV are of major interest, since in this study patients with cardiac lesions were diagnosed earlier. The decision to operate on these patients must take into account the severity of both mitral regurgitation and associated cardiac lesions.

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Arteriovenous and Intercoronary Fistulae Presenting as Heart Failure in an Adult

Emmanouil Petrou et al. Chrysafios Girasis

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Original Article

Age, Creatinine and Ejection Fraction Score in Brazil: Comparison with InsCor and the EuroSCORE

Omar Asdrúbal Vilca Mejía et al. Bruna La Regina Matrangolo David Provenzale Titinger Leandro Batisti de Faria … Luís Roberto Palma Dallan Filomena Regina Barbosa Galas Luiz Augusto Ferreira Lisboa Luís Alberto Oliveira Dallan Fabio Biscegli Jatene

Abstract

Background:

Risk scores for cardiac surgery cannot continue to be neglected.

Objective:

To assess the performance of “Age, Creatinine and Ejection Fraction Score” (ACEF Score) to predict mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery, and to compare it to other scores.

Methods:

A prospective cohort study was carried out with the database of a Brazilian tertiary care center. A total of 2,565 patients submitted to elective surgeries between May 2007 and July 2009 were assessed. For a more detailed analysis, the ACEF Score performance was compared to the InsCor’s and EuroSCORE’s performance through correlation, calibration and discrimination tests.

Results:

Patients were stratified into mild, moderate and severe for all models. Calibration was inadequate for ACEF Score (p = 0.046) and adequate for InsCor (p = 0.460) and EuroSCORE (p = 0.750). As for discrimination, the area under the ROC curve was questionable for the ACEF Score (0.625) and adequate for InsCor (0.744) and EuroSCORE (0.763).

Conclusion:

Although simple to use and practical, the ACEF Score, unlike InsCor and EuroSCORE, was not accurate for predicting mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery in a Brazilian tertiary care center. (Arq Bras Cardiol. 2015; [online].ahead print, PP.0-0)

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