Guías de práctica clínica de la Sociedad Española de Cardiología en valvulopatías
ABSTRACT Valvular heart diseases, which continue to be a major cause of morbidity and mortality world wide, have undergone radical changes since the first valve prostheses were implanted 40 years ago. These changes have been the result of both scientific progress and improved standard of living in developed countries. The availability of penicillin to treat streptococcal pharyngitis and less crowded living conditions have now made rheumatic fever uncommon in these countries. However, other forms of valve impairment have appeared over the past several years. The etiology of some of these valvular diseases remains obscure (e. g. myxomatous mitral valve); others, such as the senile type of calcific aortic valve stenosis, seem to be the price to be paid for the extension of life expectancy. With regard to diagnosis, echocardiography has constituted a formidable tool for visualizing anatomic valve changes, interpreting complex hemodynamic derangements, and evaluating repercussion on the left ventricle. In addition, the iteration of this non-invasive examination has allowed a much better understanding of the natural history of non-severe valvular disease and therefore of the precise timing for surgical intervention, without awaiting, in most cases, the appearance of advanced symptomatology. This has also been possible because of the great advances in cardiac surgery which can be summarised as: a) the improvement in extracorporeal circulation and myocardial preservation techniques; b) the greatly improved biologic and mechanic valve substitutes; c) the introduction of imaginative mitral valve repair procedures, and d) the use of intraoperative transesophageal echocardiography to assess the adequacy of valve repair. At the same time, percutaneous catheter balloon valvuloplasty has emerged as a valid alternative to mitral surgical commissurotomy for mitral stenosis. All these changes, and many more that can not be described in this brief summary, make a review of the management of patients with valve heart disease appropriate.
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ABSTRACT: IntroductionDynamic intraventricular gradients (DIG) after valve replacement in severe aortic stenosis have been reported, although the incidence of DIG and clinical signs are still poorly understood.AimTo evaluate the incidence of DIG)and determine risk factors and associated morbimortality. Patients and method. One hundred nine consecutive patients with severe aortic valve stenosis undergoing valve replacement were studied prospectively by echocardiography to detect the postoperative appearance of DIG, defined as a maximum flow velocity ≥ 2.5 m/s.ResultsSixteen patients (14.9%) developed postoperative DIG. Significant differences between the patients with or without DIG were found for ventricular diameter (left end-diastolic ventricular diameter (LEDVD) 43.2 vs. 47.7 mm, respectively, p < 0.001; left end-systolic ventricular diameter (LESVD) 21 vs. 29 mm, p < 0.001); left ventricular mass index (165 vs. 193 g/m2, p < 0.05); mean aortic valve gradient (68 vs. 59 mmHg, p < 0.01),; ejection fraction (73 vs. 61%, p < 0.001). No significant differences were found with respect to ventricular wall thicknesses (septal 16.3 vs. 15.7; posterior 14.37 vs. 14.62), the presence of aortic insufficiency, or other postoperative factors (anemia, inotropic agents, etc.).ConclusionsDIG after aortic valve replacement to treat severe stenosis is not unusual (15%). DIG is usually found at a midventricular location, close to the septum. In patients with postoperative DIG the most common associated factors were small LEDVD, high ejection fractions and ratios of intraventricular septal to posterior wall ratios, high valve gradients and small left ventricular masses. Preoperative echocardiography can identify patients with a higher risk of developing DIG after aortic valve replacement.Revista Espa de Cardiologia 01/2002; 55(2):127–134. DOI:10.1016/S0300-8932(02)76572-X · 3.34 Impact Factor
Medicine - Programa de Formación Médica Continuada Acreditado 01/2001; 8(46):2461–2463. DOI:10.1016/S0304-5412(01)70463-5
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ABSTRACT: Objective To analyze the immediate results and the clinical evolution of a group of fertile age women with rheumatic mitral stenosis, in whom percutaneous ballon mitral valvuloplasty was performed before or during pregnancy. Patients and method Eighty-one women with mitral stenosis, submitted to ballon mitral vavuloplasty, were studied. They were divided into three groups, according to their desire of no further pregnancies (group A; n = 19), pregnancy during the follow-up (group B; n = 23) or valvuloplasty was performed during pregnancy (group C; n = 39). Patients from group B and C were controlled during pregnancy, childbirth and puerperium, and the newborns of women in group C were followed from birth to the age of 5 years. Results Mortality in the three groups was null and the incidence of miscarriage was 2 (8.6%) in group B and 3 (9.1%) in group C. Normal delivery was predominant in group B and delivery by caesarean was predominant in group B. Success was immediate in all the cases The procedure was repeated in 3 women due to restenosis. The media valvar area rase from 0.93 to 2.05 cm2 in group A, from 1.28 to 2.04 cm2 in group B and from 0.84 to 2.14 cm2 in group C (intergroup p = NS). The functional class improved in the three groups of patients. Conclusion Percutaneous ballon mitral valvuloplasty is an effective, efficient method for the treatment of rheumatic mitral stenosis during pregnancy, after organogenesis, or at any time in a woman's life, as long as it is indicated according to clinical and echocardiographic evaluation criteria.Revista Espa de Cardiologia 01/2001; 54(5):573–579. DOI:10.1016/S0300-8932(01)76359-2 · 3.34 Impact Factor