Objective: To describe the mitral annuloplasty technique either in isolation or associated with posterior quadrantectomy and to analyze the immediate and late results in young patients. Method: Between February 1986 and February 2001, 790 mitral procedures were performed in our Institution including 41 annuloplasties in patients with ages ranging from 1 to 20 years old (Mean age = 9.7 years). 51.7% were males. The main etiologies were rheumatic disease (92.6%) and myxomatous degeneration (7.4%). Twenty-two (53.6%) patients were preoperatively in functional class III (NYHA) and 19 (46.4%) in class IV (NYHA), some in course of rheumatic fever aggravated by malnutrition. The technique employed was concentric mitral annuloplasty either in isolation or associated to posterior quadrantectomy. The follow-up ranged from 7 months to 15 years. Results: The in hospital mortality was 2.4%. All patients were discharged without mitral regurgitation. Two patients coursed with mitral stenosis (after 4 and 11 years) and replacement was needed. Two patients coursed with aortic insufficiency (after 12 and 18 months) and died after aortic valve replacement, contributing to a 5% late mortality. Conclusion: In conclusion, mitral annuloplasty without a prosthesis in isolation or associated to posterior quadrantectomy is a safe and easily reproducible especially in young patients.
Abstract:The case of a 49-year-old man who suffered a car accident responsible for several chest injuries including fractures of the left ribs, large subcutaneous emphysema and left hemopneumothorax arrived in shock in the Emergency Room of the Real Hospital Português de Beneficência in Pernambuco (RHPBPE). He was hospitalized for 30 days including some time in the intensive care unit and but did not show signs of diastolic murmur or heart failure. He was submitted to an echocardiography examination that diagnosed slight aortic incompetence, good left ventricular function and was discharged after clinical improvement. Three months later he started to feel symptoms of heart failure and returned to cardiac Emergency Room of the same Hospital. He repeated transthoracic and transesophageal echocardiography examinations presenting severe aortic incompetence due to leaflet disruption, rupture of atrial septum with enlargement of the right cardiac chambers and poor left ventricular function. He underwent surgical treatment of these lesions, with direct approach of the atrial septum and the aortic valve was replaced with a mechanical prosthesis, with a good result.Descriptors: Heart injuries. Wounds and injuries, heart. Aortic valve, surgery. Heart septum, surgery. ResumoPaciente do sexo masculino, 49 anos, atendido na Emergência do Real Hospital Português de Beneficência (RHPBPE), após acidente automobilístico, apresentando dispnéia, fraturas de múltiplos arcos costais, enfisema subcutâneo extenso e hidropneumotórax à esquerda e fratura da clavícula direita. Submetido inicialmente à drenagem torácica subaquática à esquerda e traqueostomia, tendo sido mantido em respiração controlada no respirador de volume na Unidade de Terapia Intensiva. Recebeu alta após um mês da admissão com ecocardiograma transtorácico que mostrava insuficiência aórtica e insuficiência mitral leve, com leve Bras Cir Cardiovasc 2003; 18(2): 181-185 Rev REVISION ARTICLETratamento cirúrgico de ruptura traumática da valva aórtica e do septo interatrial, após traumatismo fechado do tórax: revisão da literatura e apresentação de um caso raro 182
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