Objective: Mitral valve repair in rheumatic patients is still a challenge. The aim of this study is to assess the results of mitral valve repair in rheumatic patients with rheumatic mitral insufficiency.Methods: 330 patients with rheumatic mitral insufficiency who had undergone mitral valve repair in the Heart Institute HC-FMUSP were assessed retrospectively, between 1985 and 2005. The mean age was 26.9 ± 15.4 years and 57.6% were female. On preoperative assessment, 39.5% of patients were in NYHA functional class IV. The most common techniques for repair employed were bovine pericardial strip annuloplasty in 48.4% patients and Carpentier ring annuloplasty in 22.6%. Shortening of chordae (20%) and papillary muscle splitting (17.8%) were the most common associated techniques performed. Tricuspid valve repair (26.7%) and aortic valve replacement (27.2%) were the most common associated procedures.Results: The hospital mortality was 0.9% (three patients), two of them children with active rheumatic fever. Linearized rates of thromboembolism, endocarditis, reoperation and late death were 0.2%, 0.2%, 3.5% and 0.5% patients-year, respectively. Actuarial survival in 20 years was 86.4 ± 6.6%.

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Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica Particulate emboli capture by an intra-aortic filter device during aortic valve replacement Abstract Objective: This study aims to analyze the embolic activity in patients with calcified aortic stenosis who underwent aortic valve replacement using intra-aortic filtration with an EMBOL-X® System device (Edwards Lifesciences Inc., Mountain View, CA, USA).Methods: From January 2007 to July 2007, 13 consecutive patients with calcified aortic stenosis, who underwent isolated aortic valve replacement using intra-aortic filtration by an EMBOL-X® System for 5 minutes after aortic clamp release, were evaluated. Mean patient age was 63.7 years (range 34 to 79 years) and 61.5% were female. The mean bypass time was 60.2 ± 7.5 minutes (range 45 to 72 minutes) and the mean cross-clamp time was 50 ± 7.5 minutes (range 35 to 63 minutes). Following removal, each filter was fixed in formalin and analyzed macroscopically with the captured fragments being counted. Histological examinations of the captured material were performed.Results: There were no strokes or gross neurological events. There were no cases of postoperative renal failure." No deaths were reported during hospitalization. Particulate emboli were found in five (38.5%) of the filters. On histological analysis of the particulate emboli captured, two (40%) contained fibrin, two (40%) presented conjunctive tissue, one (20%) contained red blood cells and in two it was not possible to determine the nature of the particulates captured. Conclusion:The EMBOL-X® System device was effective in particulate emboli capture in aortic valve replacement surgery of patients with calcified aortic stenosis. Descriptors INTRODUCTIONStrokes are the third leading cause of death in developed countries and the main cause of physical disability [1]. Over the last few years, neurological lesions during heart surgery have received special attention from surgeons. About 3.8% of patients submitted to coronary artery bypass grafting and up to 10% of those who undergo aortic valve replacement suffer strokes [3,4].Neurological events are associated to substantial increases in mortality, hospitalization and costs over the medium and long terms. Much effort has been spent to minimize the risks of these complications. Although the causes of neurological complications are multifactorial, age and atherosclerosis have been identified as the main risk factors [5,6].Studies have evaluated the capacity and safety of intraaortic filters to capture fragments released in the intraoperative period of patients undergoing CABG. The results not only demonstrated the safety of the device but also its capacity to capture fragments in the intra-operative period and the histological composition of the fragments (predominantly of atheromatous origin), as well as identifying that aortic de-clamping was the moment of greatest risk [5].However specific studies to evaluate the use of this device in patients...