Edison Carvalho Sandoval Peixoto

Percutaneous Mitral Balloon Valvotomy. Long-term Outcome and Assessment of Risk Factors for Death and Major Events

OBJECTIVE To identify the factors that predict death and combined events, (death, new mitral balloon valvotomy, or mitral valve surgery) in long-term follow-up of patients undergoing percutaneous mitral balloon valvotomy. METHODS Follow-up was 49.0+/-31.0 (1 to 122) months. Techniques used were the single-balloon (84.4%), Inoue-balloon (13.8%), and double-balloon techniques (1.7%). RESULTS Included in the study were 289 patients 38.0+/-12.6 years of age (range, 13 to 83). Before the procedure, 244 patients had echocardiographic score < or = 8, and 45 patients had score > 8. Females comprised 85%, and 84% patients were in sinus rhythm. During follow-up, survival of the total group was 95.5%, that of the group with < or = 8 was 98.0%, finally that of the group with scores > 8 was 82.2% (P < 0.0001), whereas combined event-free survival was 83.4%, 86.1%, and 68.9%, respectively (P < 0.0001). In the multivariate analysis, the factors that predicted long-term death were a preprocedure echocardiographic score > 8 and the presence of severe valvular mitral regurgitation during the procedure. The events that predicted combined events were a previous history of mitral valvular commissurotomy and atrial fibrillation and the presence of severe mitral valvular regurgitation during the procedure, and postprocedure mitral valvular area < 1.5 m2 (failure). CONCLUSION Percutaneous mitral balloon valvotomy is an effective procedure, and over 2/3 of the patients were event-free at the end of follow-up. Survival in the group was high, even higher in the group with lower echocardiographic scores.

Balão único versus balão de Inoue na valvoplastia mitral percutânea por balão. Resultados imediatos e complicações

PURPOSE: To assess short-term results and complications of percutaneous mitral balloon valvuloplasty (PMBV) performed with Inoue balloon (IB) and single low profile balloon (SB). METHODS: We performed 390 PMBV procedures, 29 with IB and 337 with SB . There were no differences in age, sex, echocardiographic score distribution and echocardiographic mitral valve area (MVA). RESULTS: We performed 29 complete procedures with IB and 330 of 337 in SB group. Comparing IB and pre and pos-PMBV data we obtained: mean pulmonary artery pressure (MPAP) 36±15 and 39±14mmHg, p=0.2033, mean mitral gradient 17±6 and 20±7mmHg, p=0.0396 and MVA 0.9±0.2 and 0.9±0.2cm2, p=0.8043 and pos-PMBV: MPAP 25±8 and 28±10mmHg, p=0.2881, gradient 5±3 and 5±4mmHg, p=0.2778 and MVA 2.2±0.2 and 2.0±0.4cm2, p=0.0362. Mitral valve (MV) was competent in 26 patients in IB and in 280 in SB group and we had +/4 mitral regurgitation in 3 patients in IB and in 57 in SB group (p=0.3591) pre-PMBV respectively and pos-PMBV there was also no difference in MV competence (p=0.7439). CONCLUSION: Both techniques were effective. Hemodynamic data were also similar although MVA was greater in IB group after PMBV.

Influence of the echocardiographic score and not of the previous surgical mitral commissurotomy on the outcome of percutaneous mitral balloon valvuloplasty

OBJECTIVE To evaluate prior mitral surgical commissurotomy and echocardiographic score influence on the outcomes and complications of percutaneous mitral balloon valvuloplasty. METHODS We performed 459 complete mitral valvuloplasty procedures. Four hundred thirteen were primary valvuloplasty and 46 were in patients who had undergone prior surgical commissurotomy. The prior commissurotomy group was older, had higher echo scores, and a tendency toward a higher percentage of atrial fibrillation. RESULTS When the groups were compared with each other, no differences were found in pre- and postprocedure mean pulmonary artery pressure, mean mitral gradient, mitral valve area, and mitral regurgitation. Because we found no significant differences, we subdivided the entire group based on echo scores, those with echo scores < or =8 and those with echo scores >8 the mitral valve area being higher in the < or =8 echo score group 2.06+/-0.42 versus 1.90+/-0.40 cm2 (p=0.0090) in the >8 echo score group. CONCLUSION Dividing the groups based on echo score revealed that the higher echo score group had smaller mitral valve areas postvalvuloplasty.

Influência do sexo na evolução imediata e a médio prazo após a intervenção coronariana percutânea primária e análise dos fatores independentes de risco para óbito ou eventos

OBJECTIVE Determine gender-related differences and risk factors for death and events, both in-hospital and at six-month evolution, of patients admitted within the first twelve hours of ST-segment elevation acute myocardial infarction and who underwent primary percutaneous coronary intervention. METHODS Between July 1998 and December 2000, 199 consecutive patients were enrolled in the study, with elevation myocardial infarction and without cardiogenic shock, outcome, in-hospital and six-month progression were studied. RESULTS Clinical characteristics were similar in both groups, except that women were older than men (67.04 +/- 11.53 x 59.70 +/- 10.88, p < 0.0001). In-hospital mortality was higher among women (9.1% x 1.5%, p = 0.0171), as was the incidence of major events (12.1% x 3.0%, p = 0.0026). The difference in mortality rates remained the same at six months (12.1% x 1.5%, p = 0.0026). The multivariate analysis predicted death: female gender and an age over eighty years, and major events and/or stable angina multivessel: disease and severe ventricular dysfunction. CONCLUSION Female gender and an age over eighty years were independent predictors of mortality, six months of patients who had undergone primary percutaneous intervention.

Trombólise intra-arterial associada a angioplastia adjunta na fase aguda do acidente vascular cerebral isquêmico

BACKGROUND: Early reperfusion of an occluded artery responsible for an acute ischemic stroke is associated to the salvage of the hypoperfused zone adjacent to the central ischemic area. Our objective was to analyze the efficacy of intra-arterial thrombolysis in reestablishing flow in the treated vessel during the acute phase of ischemic stroke in a retrospective series of patients and evaluate the degree of disability using the modified Rankin scale (mRS) in a minimum follow-up period of three months, identifying prognostic variables. METHODS: Series of 30 patients with acute ischemic stroke [time from the onset of symptoms and beginning of thrombolysis (Δt) 18 (P = 0.01), advanced age (P = 0.01) and higher doses of recombinant tissue plasminogen activator (rt-PA) (P = 0.08). CONCLUSIONS: Intra-arterial thrombolysis in the acute phase of ischemic stroke and associated to adjunct intracranial angioplasty has proven to be an effective method with a high percentage of complete recanalization and favorable outcome in appropriately selected patients.

[Balloon valvuloplasty outcome of a group previously submitted to mitral percutaneous or surgical valve repair versus first-time valvuloplasty patients. Evolution of the group previously submitted to valve repair procedures].

OBJECTIVE To evaluate 501 procedures of mitral balloon valvuloplasty and the differences among the group already submitted the prior surgical or balloon valvuloplasty, with 59 procedures and the group without previous intervention, with 442 procedures. METHODS It was used the single balloon in 403, Inoue balloon in 89 and a double balloon in six, with no difference between the 2 groups (p=0.6610). RESULTS The prior surgical or balloon valvuloplasty group was older, with higher echo score and higher atrial fibrillation rate and of its 59 patients, 48 had been submitted only to mitral surgical commissurotomy, 8 only to mitral balloon valvuloplasty and 3 to surgical commissurotomy and after submitted to balloon valvuloplasty because of restenosis. In prior surgical or balloon valvuloplasty and mitral balloon valvuloplasty without previous intervention groups pre valvuloplasty there were respectively: echo mitral valve area 0.99+/-0.21 and 0.94+/-0.21 cm2 (p=0.0802) and mitral valve area (Gorlin) 0.94+/-0.18 and 0.91+/-0.21 cm2 (p=0.2518) and post mitral valvuloplasty 1.95+/-0.44 and 2.05+/-0.42 cm2 (p=0.1059). CONCLUSIONS The hemodynamic and angiographic outcome of the prior surgical or balloon valvuloplasty group were similar to the group without previous intervention. The evolution was satisfactory in the prior valvuloplasty subgroup with long-term follow-up.

CRT-700.55 Inoue Balloon Versus Single Balt Balloon Technique In Percutaneous Mitral Balloon Valvuloplasty: Results, In-hospital Evolution and Cost

To compare the results, in-hospital evolution and cost of 468 percutaneous mitral balloon valvuloplasties (PMBV) wiith Inoue balloon (IB) and single Balt balloon (SBB). Inoue group (IG) with 73 procedures and Balt group (BG) with 395. Performed between 06/1987 and 12/1999. Mean age of IG was 37.1

CRT-700.47 Long-term Follow-up of Percutaneous Mitral Valvuloplasty With Single Balloon Technique: Survival and Event-free Survival

Mitral balloon valvuloplasty with Inoue balloon is the worldwide accepted procedure technique. The aims of this study is to evaluate the long-term follow-up (FU) of mitral balloon valvuloplasty (MBV) with Balt single balloon (BSB) technique and to determine independent predictors of survival and

CRT-400.23 Long-term follow-up of Percutaneous Mitral Valvuloplasty With Inoue Versus Balt Single Balloon in Mitral Stenosis

This study aimed to demonstrate that mitral balloon valvuloplasty (MBV) with the Balt single balloon (BSB) has similar outcome and long-term follow-up (FU) than MBV performed with the Inoue worldwire accepted technique. From 1987 to 2013 a total of 526 procedures were performed, being 312 with a FU

CRT-200.80 Primary Percutaneous Coronary Intervention in Diabetic Patients. Independents Predicitors of Survival and Event-free Survival

Some studies showed that diabetic patients (D) group (DG) had a worse outcome when compared to nondiabetic (ND) patients group (NDG), after primary percutaneous coronary intervention (PCI). The objectives were to compare mortality and major coronary events (MACE) at 30 days and 1 year of DG and NDG