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Biomedical subjects

Max Grinberg

Publications and source records attributed to Max Grinberg.

34 records · Page 2Linked to original sources
PubMed2004

Comparison of open commissurotomy and balloon valvuloplasty in mitral stenosis. A five-year follow-up.

OBJECTIVE: To compare clinical and laboratory data in patients with mitral stenosis undergoing open commissurotomy or balloon valvuloplasty, who were followed up for 5 years. METHODS: Eighty-one patients were prospectively assessed prior to the procedure (PRE) and immediately after the procedure, in the immediate postoperative period (IPO), and followed up yearly for 5 years (PO12M, PO24M, PO36M, PO48M, and PO60M). They were randomized into the following 2 groups: GC (group undergoing open commissurotomy): 37 patients (32.4 +/- 7.2 years; 89.2% females); and GV (group undergoing balloon valvuloplasty): 44 patients (32.9 +/- 9.5 years; 90.9% females). The patients' assessment comprised the following items: functional class, occurrence of events, electrocardiography, and Doppler echocardiography. RESULTS: A significant improvement in functional class occurred in most patients. Three patients in GC and in GV were in functional class III in PO60M. No difference in the mitral gradient was observed between the groups. A difference in the mean mitral valve areas was observed between the groups during the entire evaluation. No patients died. In regard to the IPO of GC, 3 patients had moderate mitral insufficiency (MI), and 3 had bleeding (1 was reoperated upon). In the IPO of GV, 4 patients had moderate MI, 1 had severe MI, 2 had cardiac tamponade, and 1 patient required surgery due to severe MI. Over 60 months, 9 GV patients evolved to moderate or severe MI, while 6 GC patients evolved to moderate or severe MI, and 2 other GC patients required surgery due to double mitral dysfunction. CONCLUSION: The rate of success in open mitral commissurotomy and balloon mitral valvuloplasty was 100%, and the rate of complications was low. During follow-up, a mild elevation in mitral gradient and a drop in mitral valve area were observed in both groups.

Adult↗
PubMed2004

[Valve replacement with chordal preservation and valvuloplasty for chronic mitral insufficiency].

OBJECTIVE: To compare, from the clinical and laboratory points of view, 3 groups of patients undergoing surgical treatment for isolated chronic mitral insufficiency. One group underwent valvuloplasty, and the other 2 groups underwent mitral valve replacement with different techniques for chordal preservation. METHODS: Twenty-eight patients with a mean age of 54.1 years, no coronary or multivalvular disease, and no reoperation, underwent surgery as follows: 9 underwent valvuloplasty; 10 underwent mitral valve replacement with chordal preservation in both leaflets; and 9 underwent mitral valve replacement with chordal preservation only in the posterior leaflet. Clinical, Doppler echocardiographic, and radionuclide ventriculographic assessments were performed until the 6th month of follow-up. RESULTS: At the end, 88.8% of the patients were in functional class I. One died due to intracranial hemorrhage during anticoagulant treatment. The left ventricular diastolic diameter (P<0.0001) and end-diastolic volume (P<0.0001) decreased in the 3 groups. Only the patients undergoing valvuloplasty had a decrease in systolic diameter (P=0.0003) and in end-systolic volume (P=0.0040), with no change in the ejection fraction (P=0.5586). The patients undergoing mitral valve replacement had a similar drop in ejection fraction (P=0.0001 and P=0.0296). CONCLUSION: The 3 surgical techniques used provided clinical improvement. Patients undergoing valvuloplasty had better preservation of ventricular function. No significant difference was observed in cardiac performance between the 2 groups undergoing mitral valve replacement with chordal preservation within a 6-month follow-up.

Adolescent↗
PubMed2004

Late evolution of mitral commissurotomy in patients with low echocardiographic score.

OBJECTIVE: The purpose of this study was to analyze the late results with open mitral commissurotomy in patients with low echocardiographic scores and to identify variables influencing these late results. METHODS: We studied 50 patients who underwent open mitral commissurotomy due to rheumatic mitral stenosis at the Heart Institute University of São Paulo Medical School. Enrolled patients had a Wilkins echocardiographic score <or=9 and a mean mitral valve area (MVA) of 0.94+/-0.19 cm(2). Patients underwent clinical, electrocardiographic, and echocardiographic evaluations preoperatively, immediate postoperatively, at 6 months, at 12 months, and then annually for 11 years. RESULTS: There was no hospital mortality. During 383.58 patient/years of follow-up, there were two late deaths, one related to valve disease. Actuarial survival was 94.3+/-4.0% at 11 years. The linearized reoperation rate was 1.3% patient/year, and the linearized thromboembolism rate was 0.8% patient/year. No patients developed endocarditis. The mean MVA was 2.50+/-0.44 cm(2) during the immediate postoperative period, decreasing to 1.74+/-0.4 cm(2) over 60 months (P<0.01). Although it was 1.40+/-0.24 cm(2) at 132 months, variations observed after 60 months were not significant. In regard to MVA, patients with higher echocardiographic scores had worse late results than patients with low scores (P=0.002). Neither the grade of subvalvular apparatus involvement nor MVAs during the preoperative and immediate postoperative periods significantly influenced the late evolution of MVAs. CONCLUSIONS: Open mitral commissurotomy produces satisfactory results in patients with low echocardiographic scores.

Adult↗
PubMed2003

Ten-year clinical laboratory follow-up after application of a symptom-based therapeutic strategy to patients with severe chronic aortic regurgitation of predominant rheumatic etiology.

OBJECTIVES: This study was designed to assess the feasibility and the long-term results of a symptom-based strategy of aortic valve replacement in a Brazilian population with predominant rheumatic etiology. BACKGROUND: Optimal criteria for valve replacement in aortic regurgitation (AR) are still not entirely clear. The appearance of symptoms is an indication for surgery, but may be associated with myocardial damage. Although cardiac imaging data have provided a safer guide for such decisions, the use of symptom-based surgical indication has not been validated and might conceivably be better in populations with predominant rheumatic etiology and younger age. METHODS: Echocardiography and rest-exercise radionuclide ventriculography were performed in 75 patients with severe AR, age 28 +/- 9 years, over a period of 10 +/- 0.69 years. Thirty-seven patients developed symptoms and underwent aortic valve replacement surgery within six months. Thirty-eight patients remained asymptomatic and were managed medically. RESULTS: Survival was 100% in asymptomatic patients and 82% in symptomatic. Surgical treatment caused marked ventricular remodeling, with ventricular diameter involution and an improvement of rest-exercise ejection fraction percent variation. Multivariate analysis showed that the probability of developing symptoms within 10 years was 58% for a patient with a left ventricular end-diastolic diameter > or =70 mm and 76% for a patient with left ventricular end-systolic (LVESD) > or =50 mm. Logistic regression identified LVESD and age as the most predictive and specific, but not sensitive, indicators of symptom development. CONCLUSIONS: Application of a standardized therapeutic strategy to patients with severe AR and predominant rheumatic etiology resulted in 90.6% survival after 10 years of follow-up.

Adult↗
PubMed2003

Pregnancy in patients with heart disease: experience with 1,000 cases.

BACKGROUND: Previously, the high maternal mortality in cardiac patients who became pregnant prompted the assertion: Women with an abnormal heart should not become pregnant. This long-standing notion needs to be revised today. HYPOTHESIS: The study was undertaken to ascertain the experience with a large series of pregnant women with cardiac disease cared for in the same referral center. METHODS: From 1989 to 1999, 1,000 pregnant women with heart disease were followed by the same clinical and obstetric team. The cardiac diseases included rheumatic heart disease (55.7%), congenital heart disease (19.1%), Chagas' disease (8.5%), cardiac arrhythmias (5.1%), cardiomyopathies (4.3%), and others (7.3%). RESULTS: Of the pregnant women studied, 765 (76.5%) experienced no cardiovascular events during the study; 235 (23.5%) patients had the following cardiovascular complications: congestive heart failure (12.3%), cardiac arrhythmias (6%), thromboembolism (1.9%), angina (1.4%), hypoxemia (0.7%), infective endocarditis (0.5%), and other complications (0.7%). Clinical treatment allowed adequate management in 161 (68.8%) patients; however, 46 (19.6%) patients underwent interventional procedures because of refractory complications. The general maternal mortality rate was 2.7%. Of the 915 (91.5%) infants who were discharged, 119 (13%) were premature. CONCLUSION: Pregnancy in women with heart disease is still associated with considerable morbidity and mortality rates, which strongly correlate to maternal underlying disease. Strict prenatal care and early risk stratification during gestation are fundamental measures to improve the prognosis of pregnancy in women with heart disease.

Adolescent↗
PubMed2003

Duration of symptoms in patients with infective endocarditis.

Despite progress in the management of infective endocarditis, delays in diagnosis or prior antimicrobial treatment may adversely influence the symptom duration and outcome. The duration of symptoms in patients with infective endocarditis was studied in 683 cases among 653 patients with 703 episodes of the disease; patients were hospitalized within 10 days of symptom onset in 169 (24.7%) cases. Antimicrobial therapy before hospital admission was administered to 257 (36.5%) patients. Overall mortality was 25.6%. Symptom duration was longer when antimicrobials were administered before diagnosis (58.8+/-78.1 vs. 44.8+/-54.9 days), when vegetations were detected on echocardiogram (53.5+/-68.2 vs. 38.8+/-47.3) and among patients admitted before 1990 (42.3+/-67.1 vs. 54.2+/-62.4 days). Symptom duration was shorter in patients with prosthetic valve endocarditis (26.8+/-34.2 vs. 59.3+/-71.6 days). In 54 (26.5%) episodes of prosthetic valve endocarditis, patients had symptoms for more than 30 days. Staphylococcus aureus was the most frequent agent among patients with symptoms up to 10 days (41.2%) and Streptococcus among those with symptoms over 20 days (53.9%). Symptom duration did not significantly differ in regard to medical (51.3+/-69.2 days) or surgical (46.7+/-55.7 days) treatment. Mortality increased as symptom duration decreased and was highest for patients who experienced symptoms for less than 10 days (36.1%). In some patients medical care may be delivered relatively late in the course of infective endocarditis. Administration of antibiotics previous to hospital admission increased duration of symptoms, and cardiac valve prosthesis, staphylococcal infection and death were associated with more acute disease.

Adolescent↗
PubMed2002

Comparison between percutaneous balloon valvuloplasty and open commissurotomy for mitral stenosis. A prospective and randomized study.

Eighty patients with tight and pliable mitral stenosis were randomized in a prospective trial comparing percutaneous balloon valvuloplasty and open commissurotomy. Mitral valve area increased significantly in both groups immediately after the procedures. However, a decrease in mitral valve area occurred in both groups at 6, 12 and 24 months during the follow-up. There was no death in either group. Two patients had significant mitral regurgitation after percutaneous balloon valvuloplasty. After 24 months, all patients in the commissurotomy group and 97.4% of the patients in the balloon valvuloplasty group were in New York Heart Association functional class I or II.

Adolescent↗
PubMed2002

Pregnancy and peripartum cardiomyopathy. A comparative and prospective study.

OBJECTIVE: To assess pregnancy outcome in women with peripartum cardiomyopathy and to compare it with idiopathic cardiomyopathy. METHODS: Twenty-six pregnant women, aged 28.4+/-6.1 years, with dilated cardiomyopathy were followed. Eighteen patients had peripartum cardiomyopathy [11 with persistent left ventricular systolic dysfunction (EF=45.2+/-2) and 7 with recovered ventricular function (EF=62.3+/-3.6)]. The 8 remaining patients had idiopathic cardiomyopathy (EF= 43.5+/-4.1). During the prenatal period, limited physical activity and a low-sodium diet were recommended, and hospitalization was recommended when complications occurred. RESULTS: Of the 26 patients, 11 (42.3%) had a normal delivery; 9(35.5%) had cardiac complications, 6 (22.2%) had obstetric complications. Two patients (7.7%) died. Two preterm pregnancies occurred, with 26 health newborns (2 sets of twins). Two miscarriages took place. The cardiac complication rate during pregnancy was lower (p<0.009) in the peripartum cardiomyopathy group without ventricular dysfunction and greater (p=0.01) in the idiopathic group when compared with the peripartum group with ventricular dysfunction. Changes in left ventricular ejection fraction were not observed (p<0.05) in the postpartum period, when compared with that during pregnancy in the 3 groups. CONCLUSION: Pregnancy in patients with dilated cardiomyopathy is associated with maternal morbidity. Left ventricular function is a prognostic factor and must be the most parameter when counseling patients with peripartum cardiomyopathy about a new pregnancy.

Adolescent↗
PubMed2002

Influence of pregnancy after bioprosthetic valve replacement in young women: a prospective five-year study.

BACKGROUND AND AIMS OF THE STUDY: Prosthetic heart valve placement in young women does not normally prevent successful pregnancy, though either thrombosis in mechanical prostheses or degeneration in biological prostheses may cause risks for both mother and fetus. Although pericardial prostheses avoid the risks of anticoagulation therapy, it has been suggested that pregnancy accelerates structural degeneration in bioprostheses. The study aim was to assess the influence of pregnancy on five-year outcome after pericardial bioprosthesis replacement. METHODS: A total of 85 women was studied prospectively over five years from prosthesis implantation, using annual clinical and echocardiographic investigations. Women were allocated to two groups based on pregnancy occurring during follow up: 48 patients (56%; group A) became pregnant, and 37 (44%; group B) did not. RESULTS: At five-year follow up, the clinical events occurred in 29 patients (34.1%): 11 (22.9%) women in group A (mean (+/-SE) linearized rate 3.6+/-0.24%/patient-year (pt-yr)), and 18 (45.6%) in group B (linearized rate 8.6+/-0.30%/pt-yr). Probability of freedom from clinical events was higher (p = 0.0096) in group A (77.9+/-6.1 versus 51.3+/-8.2%). Structural bioprosthesis degeneration, thrombosis or infective endocarditis occurred in 13 patients (27.1%) in group A (linearized rate 2.75+/-0.20%/pt-yr) and 11 (29.7%) in group B (linearized rate 2.5+/-0.18%/pt-yr). Probability of structural bioprosthesis degeneration (e.g. stenosis, calcification or rupture) did not differ (p = 0.6440) between groups (85.4+/-5.1 versus 89.5+/-5.1%), even after age-adjusted analysis (p = 0.3112). CONCLUSION: Structural changes found at five years after bioprosthesis placement may be attributed to the natural course of the bioprosthesis, and independent of any occurrence of pregnancy.

Adolescent↗
PubMedDate not supplied

Risk factor analysis of hospital mortality in patients with endocarditis with ring abscess.

BACKGROUND: Endocarditis associated with ring abscess is a pathology with high morbidity and mortality. AIM OF THE STUDY: The purpose of this study was to analyze hospital mortality risk factors in patients with ring abscess due to endocarditis. METHODS: From January 1982 to December 2000, 104 patients underwent surgical intervention at the Heart Institute of the University of São Paulo Medical School for valve endocarditis with ring abscess. The age ranged from 6 years to 73 years, with an average of 40.3 years and 72.1% were male. According to NYHA functional class (FC), 12 (11.5%) were in FC II, 62 (59.6%) in FC III, and 30 (28.9%) in FC IV. Seventy-seven (74.0%) patients had endocarditis on a bioprosthesis, 58 (55.8%) in the aortic position and 19 (18.3%) in the mitral position. Twenty-nine (26.9%) patients had atrioventricular blockage prior to the operation. Univariate analysis was performed comparing variables and hospital mortality with a level of significance of 5%. Multivariate analysis was performed by logistic regression. RESULTS: The hospital mortality was 19.2% (20 patients). Univariate analysis showed that atrioventricular blockage, age, and prosthetic valve endocarditis significantly influenced hospital mortality. Multivariate analysis identified atrioventricular blockage as an independent predictor of hospital mortality. CONCLUSIONS: Preoperative atrioventricular blockage is an independent risk factor for hospital mortality in the surgical treatment of endocarditis with ring abscess.

Abscess↗