Marisa Campos Moraes Amato

Prognóstico da estenose valvar aórtica assintomática pelo teste de esforço

PURPOSE: To evaluate the exercise test as a prognostic factor for asymptomatic patients with aortic valve stenosis. METHODS: During 60 months 70 patients with aortic valve area <1cm2 without any other heart lesion were studied. The patients underwent Dopplerechocardiograms exercise tests (considered positive in the presence of electrocardiographic changes or symptoms) and clinical follow-up in order to determine the onset of symptoms or sudden death. RESULTS: The event-free probability was 50% after 16 months of follow-up. There was no relationship between the occurence of events and the sex or to the transvalvar gradient. However, there was a statistically significant association between the incidence of events (p= 0.0124), valvar area (p= 0.0003) and exercise test results (p= 0.0001). CONCLUSION: Patients with significant aortic stenosis even without symptoms, have a low survival rate and the exercise test is a good prognostic factor during follow-up.PURPOSE to evaluate the exercise test as a prognostic factor for asymptomatic patients with aortic valve stenosis. METHODS During 60 months 70 patients with aortic valve area < or = 1 cm2 without any other heart lesion were studied. The patients underwent Dopplerechocardiograms exercise tests (considered positive in the presence of electrocardiographic changes or symptoms) and clinical follow-up in order to determine the onset of symptoms or sudden death. RESULTS The event-free probability was 50% after 16 months of follow-up. There was no relationship between the occurrence of events and the sex or to the transvalvar gradient. However, there was a statistically significant association between the incidence of events (p = 0.0124), valvar area (p = 0.0003) and exercise test results (p = 0.0001). CONCLUSION Patients with significant aortic stenosis even without symptoms, have a low survival rate and the exercise test is a good prognostic factor during follow-up.

Plástica da valva mitral em pacientes consecutivos: como é a evolução tardia?: avaliação clínica e ecocardiográfica

Thirty-nine patientes with mitral insufficiency or mitral stenosis and incompetence submitted to valvular repair were evaluated in the late postoperative period. Mean age of the patients was 30.5 years, with standard deviation of 17.2 years. Twenty-four patients were females (61.5%) and 15 (38.5%) males. Twenty-one Carpentier ring annuloplasties, 12 repair with a posterior sling, five Merendino type annuloplasties and one Kay type annuloplasty were performed. Twenty-three (58.97%) patients presented symptons related to rheumatic fever disease, 12 (30.76%) had no definite etiology and four (10.25%) presented mucoid degeneration occurred in this series. Evolution time was 1497 months/standard (meam 38.39 months and Standard deviation of 16.08 months). In the late postoperative period 34 (87.74%) patients were in NYHA functional class I. Two late deaths (5.12%) occurred, and two (5.12%) patients were reoperated on. Linearilized rates of the reoperation and thromboembolism events were 1.6% and 0.8% per patient/year, respectively. Estimated survival rate was 94.87%. Echocardiographic evaluation of the pre and postoperative values demonstrated significant decrease of the left ventricular diastolic diameter (p = 0.0001), of the left ventricular systolic diameter (p = 0.0001) of the left venticular systolic diameter (p = 0.0001) and of the left atrial diameter (p = 0.0001). The postoperative Doppler echocardiograpfic studies demonstrated absence of valvular area changes at effort. It was possible to conclude that patients submitted to mitral valve repair benefited from higher survival rates and satisfactory clinical evolution.

Aneurisma subanular mitral: correção cirúrgica

Submitral left ventricular aneurysm is a poorly known entity in our country; it has been described mainly in the southern and western African black populations. It appears to be related to a ventricular wall weakness in the area of implantation of the posterior mitral valve leaflet. A 20-year-old white man was admitted with complaints of dyspnea and palpitation. On admission he was in NYH A class IV. After medical treatment the cardiac area was very enlarged and there was a systolic murmur +++/++++. The twodimensional echocardiography as well as the angiocardiography revealed annular submitral left ventricular aneurysm associated with severe mitral regurgitation. He was operated upon on October 20, 1986. We closed the neck of the aneurysm with a pericardial patch. The mitral valve was replaced due to a severe distortion. The patient is well, six years after the surgery.