Showing papers by "Manuel J. Antunes published in 1996"

Advances in surgical treatment of acquired valve disease.

Abstract: After the first two decades of constant improvements in valve prostheses, no major advance has occurred since the mid 1980s. Hence, valve replacement remained the exchange of one disease for another. With minor and, for the most part, statistically nonsignificant variations, the spectrum of late valve-related complications remained unaltered and the few series published in the year under review brought no additional information of relevance. By contrast, in the past few years there has been a growing enthusiasm for the use of allografts, stentless porcine bioprostheses, and pulmonary autografts. Not only was there a surge of interest in the allografts as aortic valve substitutes, but in the past year there have also been several reports of use for whole or partial mitral or tricuspid valve replacement. On the other hand, stentless bioprostheses are also gaining increasing acceptance, and all major manufacturers of heart valve prostheses have models for use in different situations and with different techniques. Finally, the Ross operation is now being performed around the world. Despite these advances, valve repair still merits the preference of many surgeons. Mitral valvuloplasty preserves left ventricular function much better than valve replacement. By contrast, the results of aortic valve repair look much less impressive. Lastly, this work focuses on recent reports on special aspects of surgery for native or prosthetic valve endocarditis, especially with the use of allografts or autografts; on the results of valve surgery in elderly patients, a fast growing group; and on the controversial issues of anticoagulation in patients with artificial valves.

Traumatic aortic valve insufficiency

Abstract: The traumatic aortic valvular insufficiency (TAVI), through less frequent after a non-penetrating thoracic traumatism, is a serious entity with a very reserved prognosis. So it must be suspected in every patients with signs or symptoms of de novo heart failure post-traumatism. The transthoracic echocardiography and eventually transesophageal echocardiography have a fundamental role in the confirmation of the diagnosis. The clinical picture of traumatic aortic regurgitation is quickly evolutionary and the non efficacy of medical therapy has placed the valvular substitution surgery as the best succeeded treatment. With the advent of the aortic valve repairing surgery some TAVI cases has been submitted to this procedure. Nevertheless, the development of residual aortic regurgitation in these situations, usually requiring later valvular replacement surgery, make the aortic valvuloplasty a controversial surgical technique. The AA describe a recent clinical case of aortic regurgitation after a non-penetrant thoracic traumatism, discussing the aspects connected with physiopathology, diagnosis and therapy. The singularity of this case was based on the fact that the initial clinical diagnosis had been prejudiced by the context of a polytraumatism and there had been a time free of symptoms between the traumatism and the beginning of the symptomatology of left ventricular failure. Even though the identification of the problem allowed an intensive treatment of this serious situation that ended with the replacement of the aortic valve by mechanical aortic prosthesis, with the patient's total recovery.