Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 275-293).

In vitro and in vivo models were proposed to evaluate the effects of ischemic mitral regurgitation and surgical repair on the function and mechanics of the heart’s mitral valve. In specific aim 1, a novel transducer was developed to measure the radially directed forces that may act on devices implanted to the mitral annulus. In an ovine model, radial forces were found to statistically increase with left ventricular pressure and were reduced in the setting of ischemic mitral regurgitation. In specific aim 2, the suture forces required to constrain true-sized and undersized annuloplasty rings to the mitral annulus of ovine animals was evaluated. Suture forces were observed to be larger on the anterior aspect of the rings and were elevated with annular undersizing. In specific aim 3, an in vitro simulator’s ability to mimic healthy and ischemic mitral regurgitation ovine mitral valve function was evaluated. After understanding the accuracy of the model, the in vitro ischemic mitral regurgitation model was used to evaluate the progressive effects of annuloplasty on strut and intermediary chordal tethering. The generated data and knowledge will contribute to the development of more durable devices and techniques to assess the significant clinical burden known as ischemic mitral regurgitation.

The purpose of this scientific work was to evaluate safety and efficacy of treatment of atrial fibrillation using monopolar radiofrequency ablation electrodes in patients who undergo mitral valve surgical correction using incisions of atrial septum (trans-septal and superior septal approaches). More than 80% of the patients are free of atrial fibrillation one year after the operation and 76% of these patients do not use anti-arrhythmic drugs. During the final visit of follow-up it was recorded that 71.5% of the patients remained free of atrial fibrillation and flutter. The maze procedure increases duration of cardiopulmonary by-pas for 16 ± 3 min, only. The baseline and surgical correction data in groups of patients of trans-septal and superior septal approaches did not differ. The method of mitral valve correction (implantation of mitral valve prosthesis or plasty of the valve) had no statistically significant influence on the results of atrial fibrillation treatment. The factors influencing the efficacy of the treatment include higher class of heart failure and larger longitudinal measurement of the left atrium found on echoscopy using M-mode. Combined therapy of secondary atrial tachycardia and atypical atrial flutter (by means of anti-arrhythmic drugs, trans-oesophageal stimulation and per-catheter ablation) enables to improve the results of maze procedure. The superior septal approach should be used in complicated operations as using this incision it is more convenient... [to full text] / Šio mokslinio darbo tikslas buvo įvertinti efektyvumą bei saugumą gydant prieširdžių virpėjimą, naudojant elektrofiziologinius RD abliacijos unipolinius elektrodinius kateterius pacientams, kuriems mitralinio vožtuvo ydą koreguojančios operacijos atliekamos per prieširdžių pertvaros(tarprieširdinės ir viršutinio pertvaros) pjūvius. Atlikus šią operaciją – po 1 metų >80% pacientų neturi prieširdžių virpėjimo/plazdėjimo, iš jų 76% nevartoja antiaritminių vaistų. Galutinio sekimo metu fiksuota, kad išliko 71,5% pacientų be prieširdžių virpėjimo ir plazdėjimo. Labirinto procedūra prailgina tik 16 ± 3 min dirbtinės kraujotakos laiką. Išeities ir operacinių parametrų atžvilgiu tarprieširdinės ir viršutinio pertvaros pjūvių grupės nesiskyrė. Mitralinio vožtuvo ydos korekcijos pobūdis – protezavimas ar plastika - statistiškai patikimai neturėjo PV gydymo rezultams. Gydymo efektyvumui įtakos turi: didesnė širdies nepakankamumo funkcinė klasė ir kairiojo prieširdžio išilginis dydis nustatytas echoskopiškai M - režimu. Pooperacinių antrinių prieširdinių tachikardijų ir atipinių prieširdžių plazdėjimo kombinuota (taikant antiaritminius vaistus, perstemplinę stimuliaciją ir perkateterinę radiodažnuminę abliacija) terapija leidžia pagerinti labirinto procedūros rezultatus. Viršutinis pertvaros pjūvis naudotinas sudėtingose operacijose, taip galima lengviau apžiūrėti mitralinį vožtuvą ir koreguoti mitralinę ydą.

In der hier vorliegenden Arbeit sollen die Ergebnisse einer endokardialen Kryoablation in Kombination mit einer minimal-invasiven Mitralklappenoperation bezogen auf unterschiedliche Vorhofflimmerformen ausgewertet werden. Hierzu wurden prospektiv gesammelte Daten von 732 Patienten analysiert, die zwischen 2002 und 2009 eine minimal-invasive Mitralklappenoperation mit zusätzlicher Kryoablation zur Behandlung von Vorhofflimmern (VHF) am Herzzentrum Leipzig erhielten. Insgesamt 84% der Patienten erhielten vor der Krankenhausentlassung ein 24-Stunden-Langzeit-EKG. Während jährlicher Telefongespräche wurden die Folgemedikation sowie die klinischen Symptome der Patienten abgefragt und einmalig die Lebensqualität mittels des SF-12 Fragebogens und des AFSS-Fragebogens evaluiert. Zur Beurteilung des Herzrhythmus wurde das letzte vorliegende EKG oder sofern vorhanden, ein 24h-LZ-EKG vom Hausarzt oder zuweisenden Kardiologen ausgewertet. Die Gesamtmortalität im Krankenhaus lag bei 1,5% ohne einen Unterschied zwischen Patienten mit paroxysmalem und lang-persistierendem VHF. Bedeutende Risikofaktoren für Hospitalsterblichkeit waren ein fortgeschrittenes Alter, eine präoperative Ejektionsfraktion von weniger als 50%, ein höherer CHADS2-Score sowie Angina-pectoris-Beschwerden. Das Gesamtüberleben tendierte nach einem, drei sowie fünf Jahren bei Patienten mit lang-persistierendem VHF zu schlechteren Ergebnissen (93,8%/91,4/86,1%) verglichen mit Patienten, welche ein paroxysmales VHF hatten (96,6%/93,6%/90,7%). Nach 12 Monaten waren 90,8±1,1% der gesamten Patientenkohorte frei von einem erneuten VHF, nach drei Jahren 72,5% und nach fünf Jahren 48,9%. Auch hier zeigten die Patienten mit einem lang-persistierenden VHF nach 5 Jahren schlechtere Ergebnisse (60,2% vs. 43%). In der hier präsentierten Studie konnten als bedeutende Risikofaktoren für ein Wiederauftreten von VHF im Langzeitverlauf ein präoperativ erhöhter Kreatininwert und grenzwertig signifikant ein VHF im Langzeit-EKG vor Krankenhausentlassung dargestellt werden. Die Rate an kardialen und zerebralen Komplikationen (MACCE) in der Langzeitbeobachtung war mit 26,3% in beiden Patientengruppen ähnlich und auch vergleichbar mit den Ergebnissen anderer Zentren bzw. Studien. Es konnte gezeigt werden, dass Patienten mit einem stabilen SR in der Nachbeobachtung eine wesentlich niedrigere MACCE-Rate aufwiesen (38,0% vs. 20,9%). Die Schlaganfallrate insgesamt lag sehr niedrig (1,9%), wobei auch hier die Patienten mit einem stabilen SR deutlich besser abschnitten (3,9% vs. 1,0%). Die Lebensqualität und die subjektiven Beschwerden durch das VHF waren bei beiden Patientengruppen (paroxysmal vs. lang persistierend) vergleichbar. Auch hier zeigte sich, dass Patienten mit erfolgreicher Wiederherstellung des SR einen deutlichen Gewinn an Lebensqualität aufwiesen. Insgesamt waren die Morbidität und Mortalität nach einem minimal-invasiven Mitralklappeneingriff niedrig. Diese Studie unterstützt die Hypothese, dass die Kryoablation eine sichere und effektive Methode ist, VHF bei Patienten während einer Mitralklappenoperation simultan zu abladieren. Da die Mitralklappenchirurgie allein mit nur einer geringen Rate an Konversionen in den SR verbunden ist und die endokardiale Kryoablation ein sicheres Verfahren darstellt, sollte diese Option bei jedem VHF-Patienten, der sich einer Mitralklappenoperation unterzieht, erwogen werden.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, 2003. / Bibliyografya var.

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (p. 123-133).

Background. Barlow’s mitral valve (MV) disease re- mains a surgical challenge. We compared short- and medium-term outcomes of neochordal (“loop”) versus edge-to-edge (“Alfieri”) minimally invasive MV repair in patients with Barlow’s disease. Methods. From January 2009 to April 2014, 123 consecutive patients with Barlow’s disease (defined as bileaflet billowing or prolapse [or both], excessive leaflet tissue, and annular dilatation with or without calcifica- tion) underwent minimally invasive MV operations for severe mitral regurgitation (MR) at our institution. Three patients (2.4%) underwent MV replacement during the study period and were excluded from subsequent anal- ysis. The loop MV repair technique was used in 68 pa- tients (55.3%) and an edge-to-edge repair was performed in 44 patients (35.8%). Patients who underwent a combi- nation of these 2 techniques (n [ 8 [6.5%]) were excluded. The median age was 48 years, and 62.5% of patients were men. Concomitant procedures included closure of a patent foramen ovale or atrial septal defect (n [ 19), tricuspid valve repair (n [ 5), and atrial fibril- lation ablation (n [ 15). Follow-up was performed 24.7 ± 17 months postoperatively and was 98% complete. Results. No deaths occurred perioperatively or during follow-up. Aortic cross-clamp time (64.1 ± 17.6 minutes versus 95.9 ± 29.5 minutes) and cardiopulmonary bypass (CPB) time (110.0 ± 24.2 minutes versus 146.4 ± 39.1 mi- nutes) were significantly shorter (p < 0.001) in patients who received edge-to-edge repair. Although patients who underwent edge-to-edge repair received a larger annulo- plasty ring (38.6 ± 1.5 mm versus 35.8 ± 2.7 mm; p < 0.001), the early postoperative resting mean gradients were higher(3.3±1.2mmHgversus2.6±1.2mmHg;p[ 0.007) and the mitral orifice area tended to be smaller in this group (2.8 ± 0.7 cm2 versus 3.0 ± 0.7 cm2; p [ 0.06). The amount of residual MR was similar between groups (0.3 ± 0.6 versus 0.6 ± 1.0 for edge-to-edge versus loop procedures, respectively; p [ 0.08). More than mild MR requiring early MV reoperation was present in 3 patients who underwent loop procedures (4.4%) and in no patients who had edge-to-edge procedures (p [ 0.51). During follow-up, 2 patients (1 in each group) required MV replacement for severe MR. The 4-year freedom from MV reoperation was 92.8% ± 5.0% in the Alfieri group compared with 90.9% ± 4.6% in the loop group (p [ 0.94). Conclusions. Minimally invasive MV repair can be accomplished with excellent early and medium-term outcomes in patients with Barlow’s disease. The edge- to-edge (Alfieri) repair can be performed with reduced operative times when compared with the loop technique, but it results in mildly increased transvalvular gradients and mildly decreased valve opening areas without any difference in residual MR.

Made available in DSpace on 2014-06-11T19:23:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-27Bitstream added on 2014-06-13T19:30:22Z : No. of bitstreams: 1 franco_rp_me_jabo.pdf: 1325167 bytes, checksum: c0d65b611313afe6bf052d1a43166362 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A endocardiose da válvula mitral é uma cardiopatia de alta incidência na clínica médica de pequenos animais, com maior acometimento de cães idosos e de raças de pequeno porte. Realizou-se então um estudo para avaliar clinicamente a utilização do maleato de enalapril, furosemida, espironolactona e suas associações, em cães com endocardiose de válvula mitral classes funcionais Ib e II, antes e após a terapêutica implantada. Para isso, utilizaram-se 36 animais portadores desta afecção, distribuídos em quatro grupos, conforme as classes funcionais de ICC, com terapêutica específica implantada durante 56 dias em cada grupo estudado. Animais portadores da classe funcional Ib foram distribuídos em dois grupos, com o primeiro recebendo furosemida (n=8) e o outro maleato de enalapril (n=8). Igualmente, distribuíram-se os animais da classe funcional II, com um grupo recebendo maleato de enalapril e furosemida (n=10) e o segundo, enalapril associado à espironolactona e furosemida (n=10). Todos os grupos foram avaliados em quatro momentos (T0, T14, T28 e T56 dias) quanto aos parâmetros e sinais clínicos, exames hematológicos e bioquímico-séricos, que incluíram enzima conversora da angiotensina (ECA) e aldosterona; avaliações radiográficas, eletrocardiográficas, ecodopplercardiográficas e da pressão arterial. Os resultados demonstraram uma redução dos sinais clínicos nos animais classe II, com a estabilização dos parâmetros em ambos os grupos. As avaliações hematológica e bioquímico sérica não revelaram alterações significativas nas classes estudadas, mas uma redução significativa dos valores de ECA e aldosterona foram observadas nos grupos que receberam enalapril como terapêutica. Ao exame radiográfico observou-se redução dos valores de VHS e, ao eletrocardiograma as variáveis onda Pms e Complexo QRSms apresentaram diminuições significativas... / The endocardiosis of mitral valve is a high incidence of heart disease in the medical clinic for small animals, with the involvement of older dogs and small breeds. This is a clinical study to evaluate the use of the enalapril maleate, furosemide, spironolactone and their associations in dogs with mitral valve endocardiosis of class Ib and II, before and after therapy implanted. It was used 36 animals with this endocardiosis, divided into four groups according to class of congestive heart failure, implanted with a specific therapy for 56 days in each group. The animals classified in class Ib was divided into two groups, with the first receiving furosemide (n = 8) and the other of maleate of enalapril (n = 8). It is also divided the animals of Class II, with a group of receiving maleate of enalapril and furosemide (n = 10) and second, enalapril combined with spironolactone and furosemide (n = 10). Every groups were available in four moments (T0, T14, T28, e T56 days) as to clinical parameters, symptoms, serum biochemical and hematological tests, which included the angiotensin converting enzyme (ACE) and aldosterone; radiographic evaluations ECG, Dopplerechocardiography and blood pressure. The results showed a reduction of clinical signs in animals Class II, with stabilization of physiological parameters in both groups. The serum biochemical and hematological evaluation showed no significant changes in the classes studied, but a significant reduction of the values of ACE and Aldosterone were seen in the groups receiving enalapril as therapy. By radiographic examination, we observed a reduction of the values of VHS, and the variables Pms wave and QRSms Complex in electrocardiogram showed significant variations in groups of Class II. The absence of variations in blood pressure was observed in both groups. But the Dopplerechocardiogram showed a ventricular remodeling with a significant decrease... (Complete abstract click electronic access below)

Orientador: Aparecido Antonio Camacho / Banca: Áureo evangelista Santana / Banca: Wagner Luís Ferreira / Resumo: A endocardiose da válvula mitral é uma cardiopatia de alta incidência na clínica médica de pequenos animais, com maior acometimento de cães idosos e de raças de pequeno porte. Realizou-se então um estudo para avaliar clinicamente a utilização do maleato de enalapril, furosemida, espironolactona e suas associações, em cães com endocardiose de válvula mitral classes funcionais Ib e II, antes e após a terapêutica implantada. Para isso, utilizaram-se 36 animais portadores desta afecção, distribuídos em quatro grupos, conforme as classes funcionais de ICC, com terapêutica específica implantada durante 56 dias em cada grupo estudado. Animais portadores da classe funcional Ib foram distribuídos em dois grupos, com o primeiro recebendo furosemida (n=8) e o outro maleato de enalapril (n=8). Igualmente, distribuíram-se os animais da classe funcional II, com um grupo recebendo maleato de enalapril e furosemida (n=10) e o segundo, enalapril associado à espironolactona e furosemida (n=10). Todos os grupos foram avaliados em quatro momentos (T0, T14, T28 e T56 dias) quanto aos parâmetros e sinais clínicos, exames hematológicos e bioquímico-séricos, que incluíram enzima conversora da angiotensina (ECA) e aldosterona; avaliações radiográficas, eletrocardiográficas, ecodopplercardiográficas e da pressão arterial. Os resultados demonstraram uma redução dos sinais clínicos nos animais classe II, com a estabilização dos parâmetros em ambos os grupos. As avaliações hematológica e bioquímico sérica não revelaram alterações significativas nas classes estudadas, mas uma redução significativa dos valores de ECA e aldosterona foram observadas nos grupos que receberam enalapril como terapêutica. Ao exame radiográfico observou-se redução dos valores de VHS e, ao eletrocardiograma as variáveis onda Pms e Complexo QRSms apresentaram diminuições significativas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The endocardiosis of mitral valve is a high incidence of heart disease in the medical clinic for small animals, with the involvement of older dogs and small breeds. This is a clinical study to evaluate the use of the enalapril maleate, furosemide, spironolactone and their associations in dogs with mitral valve endocardiosis of class Ib and II, before and after therapy implanted. It was used 36 animals with this endocardiosis, divided into four groups according to class of congestive heart failure, implanted with a specific therapy for 56 days in each group. The animals classified in class Ib was divided into two groups, with the first receiving furosemide (n = 8) and the other of maleate of enalapril (n = 8). It is also divided the animals of Class II, with a group of receiving maleate of enalapril and furosemide (n = 10) and second, enalapril combined with spironolactone and furosemide (n = 10). Every groups were available in four moments (T0, T14, T28, e T56 days) as to clinical parameters, symptoms, serum biochemical and hematological tests, which included the angiotensin converting enzyme (ACE) and aldosterone; radiographic evaluations ECG, Dopplerechocardiography and blood pressure. The results showed a reduction of clinical signs in animals Class II, with stabilization of physiological parameters in both groups. The serum biochemical and hematological evaluation showed no significant changes in the classes studied, but a significant reduction of the values of ACE and Aldosterone were seen in the groups receiving enalapril as therapy. By radiographic examination, we observed a reduction of the values of VHS, and the variables Pms wave and QRSms Complex in electrocardiogram showed significant variations in groups of Class II. The absence of variations in blood pressure was observed in both groups. But the Dopplerechocardiogram showed a ventricular remodeling with a significant decrease... (Complete abstract click electronic access below) / Mestre

O RDW é um índice hematológico utilizado para avaliação quantitativa da anisocitose eritrocitária, sendo útil na diferenciação das causas de quadros anêmicos. Atualmente, na medicina humana, o RDW tem sido considerado como um importante fator prognóstico em quadros de ICC, mesmo na ausência de anemia. A CRP é considerada a principal proteína de fase aguda sendo amplamente utilizada como marcadora de inflamação. O objetivo deste estudo foi determinar se há diferença nos valores do RDW e da concentração da CRP em cães com DVDCM com e sem ICC, bem como nos diferentes estágios (A, B1, B2, C e D) da doença, segundo a classificação da ACVIM, comparados a cães de raças predispostas, mas sem a doença cardíaca, e associações entre as variáveis. Esta pesquisa constituiu um estudo clínico observacional prospectivo transversal de caráter exploratório, realizada em cães com DVDCM. Para tal, foram selecionados 141 cães, de até 20kg, machos e fêmeas. O grupo com ICC e sem ICC apresentaram menor número de hemácias, hemoglobina e hematócrito em relação ao grupo controle (P&lt;0,001). O índice RDW não diferiu entre os grupos estudados quando foram alocados quanto ao estadiamento ACVIM (P&#61; 0,25), quanto à presença de ICC (P&#61; 0,146), ou de remodelamento cardíaco (P&#61;0,078). Quanto à CRP, os grupos C e D (C: 2.251 ng/dL, 962,05-5.292,5 ng/dL e D: 3.628,4 ng/dL, 4.1592,3-6.254,5 ng/dL) apresentaram concentração maior que o grupo controle (1.685,5 ng/dL, 1.045,45-3.795,5 ng/dL). Quanto ao estadiamento da DVDCM os grupos diferiram entre si (P&#61;0,014) porém, não foi possível identificar quais grupos apresentaram diferença. O grupo com ICC (2.939,7-1.304,25-5.908,8 ng/dL) apresentou maior concentração de CRP em relação ao grupo controle (1.685 ng/dL, 1.1015,45-3.795,5 ng/dL) (P&#61;0,03). O grupo com remodelamento (4.916,66&plusmn;6.102,14) apresentou maior concentração de CRP em relação ao grupo sem remodelamento (2.510,67&plusmn;3,26) (P&#61;0,009). Houve correlação positiva fraca entre CRP e número total de leucócitos (r&#61;0,197; P&#61;0,019). Conclui-se que apesar de não ter sido detectada diferença significativa para o RDW houve tendência a valores maiores nos cães com remodelamento comparados aos sem remodelamento. A concentração de CRP foi maior nos cães com remodelamento cardíaco em relação àqueles sem remodelamento e nos cães com ICC em relação aos cães sem ICC e àqueles de raças predispostas, mas sem alterações cardíacas. A dosagem sérica de CRP juntamente com outros marcadores e exames complementares já utilizados rotineiramente, poderá ser útil na avaliação e acompanhamento de pacientes portadores de DVDCM / RDW is a hematological index used for anisocytosis quantitative assesment, and useful to diferenciate anemic states. In human medicine, it has been considered an important prognostic factor in heart failure (HF), even in the absence of anemia. CRP is considered the main acute phase protein, and it is widely used as a marker of inflammation. An exploratory prospective cross sectional study was conducted aiming to determine whether there is a difference in RDW and CRP concentration in dogs with chronic degenerative mitral valve disease (CDMVD) with and without HF, presence of remodeling, as well as between the different disease stages (A, B1, B2, C e D - ACVIM), compared to dogs of predisposed breeds, but without heart disease. For this study, 141 dogs, up to 20kg, males and females were distributed in groups in order to achieve the main golas. Dogs with and without HF presented smaller number of red blood cells, hemoglobin and hematocrit compared to control group (P&lt;0.001). RDW was not diferente between groups for CDMVD stages (P&#61; 0.25), regarding HF presence (P&#61; 0.146), or cardiac remodeling (P&#61;0.078). Groups C and D (C: 2,251 ng/dL, 962.05-5,292.5 ng/dL e D: 3,628.4 ng/dL, 4,1592.3-6,254.5 ng/dL) presented higher CRP concentration compared to control (1,685.5 ng/dL, 1,045.45-3,795.5 ng/dL). There was a difference in CRP concentration between groups, however, it was not possible to identify the differing groups (P&#61;0.014). CRP concentration was higher in HF group (2,939.7-1,304.25-5,908.8 ng/dL) compared to control (1,685 ng/dL, 1,1015.45-3,795.5 ng/dL) (P&#61;0.03). CRP concentration was higher in cardiac remodeling group (4,916.66&plusmn;6,102.14) in relation to the group without remodeling (2,510.67&plusmn;3.26) (P&#61;0.009). There was a weak positive correlation between CRP and total leucocyte count (r&#61;0.197; P&#61;0.019). We conclude that although we could not identify a significative difference for RDW, there was a tendency to increased values in dogs with cardiac remodeling. CRP concentration was higher in cardiac remodeling group and in HF group compared to control. CRP serum together with other markers and auxiliary exames already routinely used may provide useful information for assessment and follow up of dogs with CDMVD