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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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25. Interventional Cardiology
26. Cardiovascular Surgery
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Intraoperative transesophageal and postoperative echocardiography in mitral valve surgery: the right match?
Session:
Posters 3 - Écran 9 - Imagiologia Cardiovascular
Speaker:
Patrícia M. Alves
Congress:
CPC 2019
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Patrícia M. Alves; Ana Vera Marinho; Carlos Branco; Ana Valdez Ramalho; Maria João Maldonado; Gonçalo Freitas Coutinho; David Prieto; Lino Gonçalves; Pedro Engrácia Antunes
Abstract
<p><strong>BACKGROUND:</strong> Intraoperative transesophageal echocardiography (iTEE) has an important role in diagnosing post-cardiopulmonary bypass (CPB) results of mitral valve (MV) replacement and repair. Intraoperative Doppler features may be dissimilar from those measured in the postoperative follow-up period due to a different hemodynamic status. We aimed to evaluate iTTE Doppler flow profile after mitral valve replacement and repair and compare with the postoperative transthoracic echocardiography (post-TTE).</p> <p><strong>METHODS:</strong> We conducted a prospective, observational study of 76 patients that underwent mitral valve surgery from December 2017 to October 2018. iTEE was performed in the post-CBP period, with Doppler evaluation [mean pressure gradient (MPG) and functional area]. Patients were re-evaluated with TTE, 72 hours after surgery (post-TTE). iTEE and post-TTE Doppler values were compared and correlated. Preoperative TTE (pre-TTE) parameters were also determined.</p> <p><strong>RESULTS:</strong> The mean age was 59 ± 18 years and 55% were female. The prevalence of severe mitral regurgitation (MR) was 77.6% and severe mitral stenosis (MS) 23.7%. In 5.3% cases there was both severe mitral regurgitation and stenosis. Etiology of MR was rheumatic in 25% cases, degenerative in 61%, endocarditis in 5% and secondary in 8.5%. Etiology in MS was rheumatic in all cases. Globally, mitral valve repair was performed in 71% cases (83% for MR and 15% for MS) and replacement in 29% (64% for MR and 46% for MS). Left ventricular ejection fraction (LVEF), LV end-diastolic diameter (LVDD), systolic pulmonary artery pressure (sPAP), right ventricular diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) assessed in pre-TTE and post-TTE, as also MPG and functional area in post-TTE and iTEE are depicted on table 1. There was a higher numerical difference in iTEE <em>vs</em> post-TTE MPG values in mechanical valves (n=5) (3.5±1.2 to 5.2±1.6 mmHg, difference of 1.65±2.4 mmHg), than in biological valves (n=17) (3.1±1.1 to 3.9±1.5 mmHg, difference of 0.8±1.7 mmHg). Globally, iTEE-derived MPG and functional area were strongly correlated with their post-TTE values (r<sup>2</sup> 0.7 and 0.8, p<0.001).</p> <p><strong>CONCLUSIONS:</strong> iTEE Doppler parameters were strongly correlated with postoperative TTE parameters, with minimal differences: postoperative MPG were +0.4±1 mmHg higher in MV repair and +1.0±1.8 mmHg in MV replacement. There was a global improvement in sPAP, although LVEF was slightly reduced in the postoperative evaluation. Our study demonstrates the usefulness of iTEE and its importance in stablishing possible reference values for postoperative follow-up.</p>
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