Pablo M. A Pomerantzeff; José G Azevedo; Miguel Ratti; Álvaro V Moraes; Marisa Amato; Max Grinberg; Ana C Monteiro; Luiz B Puig; Noedir A. G Stolf; Geraldo Verginelli; Adib D Jatene
DOI: 10.1590/S0102-76381991000200001
RESUMO
Foram estudados no pós-operatório tardio 39 pacientes submetidos a plástica da valva mitral por insuficiência ou dupla lesão. A idade média dos pacientes foi de 30,5 anos com desvio padrão de 17,2 anos sendo 24 (61,50%) pacientes do sexo feminino e 15 (38,50%) do sexo masculino. Foram realizadas 21 anuloplastias com anel de Carpentier, com tira posterior, cinco anuloplastias tipo Merendino, e uma anuloplastia tipo Kay. Não houve óbito imediato neste grupo de pacientes. Vinte e três (58,97%) pacientes apresentavam em sua história sintomas relacionados a febre reumática, 12 (30,76%) pacientes com etiologia não definida e quatro (10,25%) com degeneração mucóide. O tempo de evolução foi de 1497 meses/pacientes, com média de 38,39 meses e desvio padrão de 16,08 meses. No período de pós-operatório tardio 34 (87,74%) pacientes estavam em classe funcional I (NYHA) sendo que ocorreram dois (5,12%) óbitos tardios e dois (5,12%) pacientes foram reoperados. As taxas linearizadas dos eventos reoperação e tromboembolismo foram respectivamente de 1,6% e 0,8% por paciente/ano. A estimativa da função de sobrevida é de 94,87%. Na avaliação ecocardiográfica comparando-se os valores pré e pós-operatórios encontramos diminuição significativa do diâmetro diastólico do ventrículo esquerdo (p = 0.0001), do diâmetro sistólico do ventrículo esquerdo (p = 0.0001), e do diâmetro do átrio esquerdo (p = 0.0001). O estudo ecodopplercardiográfico pós-operatório demonstrou não haver alteração da área valvar ao esforço. A análise dos dados permite concluir que os pacientes submetidos a plástica da valva mitral apresentam estimativa de sobrevida e evolução clínica satisfatórias.ABSTRACT
Thirty-nine patientes with mitral insufficiency or mitral stenosis and incompetence submitted to valvular repair were evaluated in the late postoperative period. Mean age of the patients was 30.5 years, with standard deviation of 17.2 years. Twenty-four patients were females (61.5%) and 15 (38.5%) males. Twenty-one Carpentier ring annuloplasties, 12 repair with a posterior sling, five Merendino type annuloplasties and one Kay type annuloplasty were performed. Twenty-three (58.97%) patients presented symptons related to rheumatic fever disease, 12 (30.76%) had no definite etiology and four (10.25%) presented mucoid degeneration occurred in this series. Evolution time was 1497 months/standard (meam 38.39 months and Standard deviation of 16.08 months). In the late postoperative period 34 (87.74%) patients were in NYHA functional class I. Two late deaths (5.12%) occurred, and two (5.12%) patients were reoperated on. Linearilized rates of the reoperation and thromboembolism events were 1.6% and 0.8% per patient/year, respectively. Estimated survival rate was 94.87%. Echocardiographic evaluation of the pre and postoperative values demonstrated significant decrease of the left ventricular diastolic diameter (p = 0.0001), of the left ventricular systolic diameter (p = 0.0001) of the left venticular systolic diameter (p = 0.0001) and of the left atrial diameter (p = 0.0001). The postoperative Doppler echocardiograpfic studies demonstrated absence of valvular area changes at effort. It was possible to conclude that patients submitted to mitral valve repair benefited from higher survival rates and satisfactory clinical evolution.REFERÊNCIAS
1. ABBASSI, A. S.; ALLEN, M. W.; DECRISFOFARD, D.; UN GAR, I. - Detection and estimation ot the degree of mitral regurgitation by rangegated pulsed Doppler echocardiography. Circulation, 61: 143-147, 1980. [MedLine]
2. ACAR, J.; CARAMANIAN, M.; PERRAULT, M.; LUXEREAU, P.; ARNAUD, J. C. - Les insuffisances mitrales par ruptures de cordages d'origine degenerative. Arch. Mal. Coeur, 61: 1724-1737, 1968.
3. ADEBO, O. A. & ROSS, T. K. - Conservative sugery for mitral valve disease: clinical and echocardiographic analyis of results. Thorax, 38: 565-571, 1983. [MedLine]
4. ANGELL, W. W.; OURY, J. H.; SHAH, P. - A comparison of replacement and reconstriction in patients with mitral regurgitation. J. Thorac. cardiovasc. Surg., 93: 665-674, 1987. [MedLine]
5. ANGER, L. E.; PATE, J. W.; LAWYER, G.; FITCH, C. W.; SHERMAN, P. H. - Prosthetic mitral valve replacement in children. J. Pediatr., 70: 577-585, 1967. [MedLine]
6. ANTUNES, M. J.; COLSEN, P. R.; KINSLEY, R. H. - Mitral valvuloplasty: a learning curve. Circulation, 68 (Supl. 2): 1179-1175, 1983.
7. ANTUNES, M. J.; MAGALHÃES, M. P.; COLSEN, P. R.; KINSLEY, R. H. - Valvuloplasty for rheumatic mitral valve disease: a surgical challenge. J. Thorac. Cardiovasc. Surg., 94: 44-56, 1987. [MedLine]
8. ARMISTEAD, S. H.; MACFARLAND, R.; LANE, I.; PANETH, M. - Mitral valve surgery in infants and children. J. Cardiovasc. Surg., 24: 144-149, 1983.
9. BAYLEY, C. P.; JAMISON, W. L.; BAKST, A. E.; BOLTON, H. E.; NICHOLS, H. T.; GEMEINHARDT, W. - The surgical correction of mitral insufficiency by the use of pericardial grafts. J. Thorac. Surg., 28: 551-603, 1954. [MedLine]
10. BERNARD, R. - Fundamentals of Biostatistics. Boston, PWS Publishers, 2. ed. 1986, p. 140-246.
11. BLACKSTONE, E. H. & KIRKLIN, J. W. - Death and other time related events after valve replacement. Circulation, 72: 753-767, 1985. [MedLine]
12. BODMAR, E.; HABERMAN, S., WAIN, W. H. - Compative method for actuarial analysis of cardiac valve replacements. Br. Heart J., 42: 541-552, 1979. [MedLine]
14. BORKON, A. M.; SOULE, L.; REITZ, B. A.; GOTT, V. L.; GARDNER, T. J. - Five year follow-up after valve replacement with the St. Jude Medical valve in infants, and children. Circulation, 74 (Supl. 1): 110-115, 1986.
15. BRAUNWALD, E. - História. In: Tratado de medicina Cardiovascular 2. ed. São Paulo. Roca, 1987. Cap. 1, p. 3-13.
16. CARPENTIER, A. - La valvuloplastie reconstitutive: une nouvelle tehnique de valvuloplastie mitrale. Presse Med., 77: 251-253, 1969. [MedLine]
17. CARPENTIER, A.; BRANCHINI, B.; COURT, J. C.; ASFAOU, E.; VILLANI, M.; DELOCHE, A.; RELLAND, J.; D'ALLAINES, C. L.; BLONDEAU. Ph.; PIWNICA, A.; PERENZAN, L.; BROM, G. - Congenital malformations of the mitral valve in children: pathology and surgical treatment. J. Thorac. Cardiovasc. Surg., 72: 865-866, 1976.
18. CARPENTIER, A.; CHAUVAUD, S.; FABIANI, J. N.; DELOCHE, A.; RELLAND, J.; LESSANA, A.; D'ALLAINES, CI.; BLONDEAU, Ph.; PIWNICA, A.; DUBOST, Ch. - Reconctructive surgery of mitral valve incompetence: ten-year appraisal. J. Thorac. Cardiovasc. Surg., 79: 338-348, 1980. [MedLine]
19. CARPENTIER, A.; DELOCHE, A.; DAUPATAIN, J.; SOYER, R.; BLONDEAU, P.; PIWNICA, A.; DUBOST, Ch.; McGOON, D. C. - A new reconstructive operation for correction of mitral and tricuspid insufficiency. J. Thorac. Cardiovasc. Surg., 61: 1-13, 1971. [MedLine]
20. CARPENTIER, A.; RELLAND, J.; DELOCHE, A. P.; PIWNICA, A.; CHAUVAUD, S.; DUBOST, C. - Conservative management of the prolapsed mitral valve. Ann. Thorac. Surg., 26: 294-302, 1978. [MedLine]
21. CHAFFIN, J. S. - Mitral valve replacement: a nine-year follow-up of risks and survivals. Ann. Thorac. Surg., 27: 312-319, 1978.
22. CHARLESWORTH, D. C.; WEISEL, R. D.; BAIRD, R. J.; SWLLY, H. E. - Assessment of mitral and tricuspid competence after valvuloplasty. Ann. Thorac. Surg., 35: 105-107, 1983. [MedLine]
23. CHAUVAND, S.; PERIER, P.; TOUATI, G.; RELLAND, J.; KARA, S. M.; BENOMAR, M.; CARPENTIER, A. - Long-term results of valve repair in children with acquired mitral valve incompetence. Circulation, 74 (Supl. 1): 104-109, 1986.
24. CHAUX, A.; CZER, L. S. C.; MATLOFF, J. M.; DEROBERTIS, M. A.; STEWART, M. E.; BATEMAN, T. M.; KASS, R. M.; LEE, M. E.; GRAY, R. J. - The St. Jude Medical bileaflet valve prosthesis. J. Thorac. Cardiovasc. Surg., 88: 706-717, 1984. [MedLine]
25. COBBS Jr., B. W.; HATCHER Jr., C. R.; CRAVER, J. M.; JONES, E. L.; SWELL, C. W. - Transverse midventricular disruption after mitral valve replacement. Am. Heart. J., 99: 33-49, 1980.
26. COSGROVE, D. M. - Mitral valve prolapse: surgical management. In: BOUPOLAS, H.; WOOLEY, C. F. - Mitral valve prolapse and the mitral valve prolapse syndrome. Mount Kisco, Futura Publishing Co, 1988, cap. 19, p. 345-374.
27. COSGROVE, D. M.; CHAVEZ, A. M.; LYTLE, B. W.; GILL, C. C.; STEWART, R. W.; TAYLOR, P. C.; GOORMASTIC, M.; BORSH, J. A.; LOOP, F. D. - Results of mitral valve reconstruction. Circulation, 74 (Supl. 1): 82-87, 1986.
28. DAVACHI, F.; MOLLER, J. H.; EDWARDS, J. E. - Diseases of the mitral valve in infancy. Circulation, 53: 565-579, 1971.
29. DAVID, T. E.; KOMEDA, M.; POLLICK, C.; BURNS, R. J. - Mitral valve annuloplasty: the effect of the type on left ventricular function. Ann. Thorac. Surg., 47: 524-528, 1989.
30. DAVILA, J. C.; MATTSON Jr., W. W.; O'NEILL, T. J. E.; GLOVER, R. P. - A method for the surgical correction of mitral insufficiency. Surg. Ginecol. Obstet., 98: 407-412, 1954.
31. DEL CASTILHO, J. M.; MORAES SOBRINHO, O. H.; VASCONCELOS, P. F.; RESENDE, C.A.; ARIÊ, S.; GALIANO, N.; ARMELIN, E. - Aspectos ecocardiográficos das próteses de dura-máter. Arq. Bras. Cardiol., 37: 181-187, 1981. [MedLine]
32. DUBOST, C. - Evaluation of surgery for mitral valve disease. Am. Heart J., 82: 143-148, 1971. [MedLine]
33. DURAN, C. G.; REVUELTA, J. M.; GAITE, L. I.; ALONSO, C.; FLEITAS, M. G. - Stability of mitral reconstructive-surgery at 10-12 years for predominantly rheumatic valvular disease. Circulation. 78: 91-96, 1988.
34. ELLIS Jr, F. H.; FRYE, R. L.; McGOON, D. C. - Results of reconstrutive operations for mitral insufficiency due to ruptured chordae tendineae. Surgery, 59: 165-172, 1966. [MedLine]
35. FEIGENBAUN, H.; POPP, R. L. ; WOLFF, S. B.; TROY, B. L.; POMBO, J. F.; HAINE, C. L.; DODGE, H.T. - Ultrasound measurements of the left ventricle. Arch. Intern. Med., 129: 461-467, 1972. [MedLine]
36. FEIGENBAUM, H.; WOLFE, S. B.; POPP, R. L.; HAINE, C. L.; DOUGE, H. T. - Correlation of ultrasound with angiocardiography in measuring left ventricular diastolic volume. Am. J. Cardiol.. 23: 111-114, 1969.
37. FORTUIN, N. J.; HOOD Jr, W. P.; SHERMAN, M. E.; CRAISE, E. - Determination of left ventricular volumes by ultrasound. Circulation, 54: 575-584, 1971.
38. FRATER, R. W. M. - Aggressive attempts at mitral valve plasty: is there a mice? In: BONDNAR, E. (ed.) Surgery for heart valve disease. 1990, p. 147-153.
39. FRATER, R. W. M.; GABBAY, S.; SHOIRE, D.; FACTOR, S.; STROM, J. - Reproducible replacement of elongated or ruptured mitral valve chordar. Ann. Thorac. Surg., 35: 14-20, 1983.
40. GALLER, M.; KRONZON, I.; SLATER, J.; LIGHTY Jr., F. W.; POLITZER, F.; COLVIN, S.; SOEBCER, F. - Long-term follow-up after mitral valve reconstruction: incidence of pos-toperative left ventricular outflow obstruction. Circulation, 74(Supl. 1): 99-103, 1986.
41. GALLOWAY, A. C.; COLVIN, S. B.; BAUMANN, F. G.; GROSSI, E. A.; RIBAKOVE, G. H.; HARTY, S.; SPENCER, F. C. - A comparison of mitral valve reconstruction with mitral valve replacement: intermediate - term results. Ann. Thorac. Surg., 47: 655-622, 1989.
42. GIBSON, D. G. - Estimation of left ventricular size by echocardiography. Br. Heart. J., 35: 128-134, 1973. [MedLine]
43. GOLDMAN, M. E.; MINDICH, B. P.; TEICHOOLZ, L. E.; BURGESS, N.; STAVILLE, K.; FUTER, V. - Intraoperative contrast echocardiography to evaluate mitral valve operations. J. Am. Coll. Cardiol., 4: 1035-1040, 1984. [MedLine]
44. GOLDMAN, M. E.; MORA, F.; GUARINO, T.; FUSTER, V.; MINDICH, B. P. - Mitral valvuloplasty is superior to valve replacement for preservation of left ventricular function; an intraoperative two-dimensional echocardiographic study. J. Am. Coll. Cardiol., 10: 568-575, 1987. [MedLine]
45. GREGORI Jr., F.; TAKEDA, R. T.; SILVA, S.S.; FAÇANHA, L. A.; RIBEIRO, J. A.; AQUINO, W. F.; SHIGUERU, S.; GOIS, L. E.; SIQUEIRA, J. E.; KRELING, P. A.; GOULART, M. P.; FABIANO, M.; GRULAN, A. I.; MIGUITA, L. C.; CANESIN, O. - Sete anos de experiência com plastia de valva mitral. Arq. Bras. Cardiol., 47: 269-274, 1986. [MedLine]
46. GROSMAN, W. - Profiles in valvular heart disease In: Cardiac, catheterization and angiopgraphy. 3. ed. 1986, p. 359-381.
47. GRUNKEMEIER, G. L. - Statistical analysis of prothetic valve series. In: RABAGO, G. L. & COOLEY, D. A. Heart valve replacement. 1987, p. 2-26.
48. GRUNKEMEIER, G. L. & STARR, A. - Actuarial analysis of surgical results: ratinale and method. Ann. Thorac. Surg., 24: 404-408, 1977. [MedLine]
49. GUVENDIK, L.; COBANOGLU, A.; DAVIS, N. R.; FESSLER, C. L.; STARR, A. - Valve replacement in children under 14 years of age: a review of 22 years of experience. Eur. J. Cardio-Thorac. Surg., 3: 229-234, 1989.
50. HANANIA, G.; DELOCHE, A.; MARCANTONI, J. P.; GERBAUX, A. - Resultats à moyen terme de I'annuloplastie mitrale reconstrutive de Carpentier. Arch. Mal Coeur., 66: 1297-1309, 1973.
51. HANSEN, D. E.; CAHILL, P. D.; DERBY, G. C.; MILLER, D. C. - Relative contributions of the anterior and posterior mitral chordae tendineae to canine global left ventricular systolic function. J. Thorac. Cardiovasc. Surg., 93: 45-55, 1987. [MedLine]
52. HARKEN, D. H.; BLACK, H.; ELLIS, L. B.; DEXTER, L. - The surgical correction of mitral insufficiency. J. Thorac. Surg., 28: 604-627, 1954.
53. HATLE, L. & ANGELSEN, B. - Dopplerultrasound in cardiology. Philadelphia, LEA & FEBIGER, 1985, p. 97-292.
54. HATLE, L.; ANGELSEN, B.; TROMSDAL, A. - Noninvasive assessment of atrioventricular pressure half-time Doppler ultrasound. Circulation, 60: 1096-1104, 1979. [MedLine]
55. HESSEL, E. A.; KENNEDY, J. W.; MERENDINO, K. A. - A reappraisal of nonprosthetic reconstructive surgery of mitral regurgitation based on an analysis of early and late results. J. Thorac. Cardiovasc. Surg., 52: 193-206, 1966. [MedLine]
56. SIHARA, T.; FERRANS, W. J.; JONES, M.; CABIN, H. S.; ROBERTS, W. C. - Calcific deposits developing in a bovine pericardial bioprosthetic valve 3 days after implantation. Circulation, 63: 718-728, 1981.
57. HAHN, D. R.; STERN, A. M.; SIGMANN, J. M.; KIRSH, M. M. - Longterm resuls of mitral insufficiency in children. J. Thorac. Cardiovasc. Surg., 53: 1-6, 1967. [MedLine]
58. KARASIK, A.; HALPERIN, Z.; LEWIS, B. S.; GEFT, I. L.; BORMAN, J. B.; GOTSMAN, M. S. - Echocardiogram left ventricular function in aortic and mitral incompetence and the effect of valve replacement. Israel J. Med. Sci., 13: 1171-1181, 1977.
59. KAY, G. L.; KAY, J. H.; ZUBIATE, P.; YOKOYAMA, T.; MENDEZ, M. - Mitral valve repair for mitral regurgitation secondary to coronary artery disease. Circulation, 74 (Supl. 1): 88-98, 1986.
60. KENNEDY, J. W.; DOCES, J. G.; STEWART, D. K. - Left ventricular function before and following surgical treatment of mitral valve disease. Am. Heart J., 97: 592-598, 1979. [MedLine]
61. KENNY, J.; COHN, L.; CHEMIN, R.; COLLINS, J. J.; PLAPPERT, M.; SUTTON, M. G. St. J. - Doppler echocardiograph ic evaluation of ring mitral valvuloplasty for pure mitral regurgitation. Am. J. Cardiol., 59: 341-345, 1987. [MedLine]
62. KREINDEL, M. S.; SCHIFNONE, W. A.; LEVER, H. M.; COSGROVE, D. - Systolic anterior motion of the mitral valve after Carpentier ring valvuloplasty for mitral valve prolapse. Am. J. Cardiol., 57: 408-412, 1986. [MedLine]
63. LAM, J. H. C.; RANGANATHAM, N.; WIGLE, E. D.; SILVER, M. D. - Morphology of the human mitral valve. Circulation, 51: 449-458, 1970.
64. LESSANA, A.; ESCORSIN, M.; ROMANO, M.; ADES, F.; VERGON, W.; RENZONI, D.; MENOZZO, C. C.; MONDUCCI, I. - Transposition of posterior leaflet for treatment of ruptured main chordae of the anterior mitral leaflet. J. Thorac. Cardiovasc. Surg., 89: 804-806, 1985. [MedLine]
65. LESSANA, A.; VIET, T. T.; ADES, F.; KARA, S. M.; AMEUR, A.; RUFFENACH, A.; UERIN, F.; HERREMAN, F.; DEGEORGES, M.; FRATER, R. W. M. - Mitral reconstructive operations: a series of 130 consecutive cases. J. Thorac. Cardiovasc. Surg., 86: 553-561, 1983. [MedLine]
66. LEWIS, J. F.; KVO, L. C.; NELSON, J. G.; LIMACHER, M. C.; QUINONES, M. A. - Pulsed Doppler echocardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window. Circulation, 70: 425-431, 1984. [MedLine]
67. LEWIS, R. P. & SASNDLER, H. - Relationship between changes in left ventricular dimensions and the ejection fraction in man. Circulation, 54: 58-557, 1987.
68. LILLEHEI, C. W.; GOTT, V. L.; DEWALL, R. A.; VARCO, R. L. - Surgical correction of pure mitral insufficiency by annuloplasty under direct vision. Lancet, 77: 406-409, 1957.
69. McGOON, D. C. - Repair of mitral insufficiency due to ruptured chordae tendinea. J. Thorac. Cardiovasc. Surg., 39: 357-362, 1960.
70. MYATAKE, K.; KINOSHITA, N.; NAGATA, S.; BEPPUS, S.; PARK, Y. D.; SAKAKIBARA, H.; NMURA, Y. - Intracardiac flow pattern in mitral regurgitation studied with combined use of the ultrasonic pulsed Doppler technique and cross-sctional echocardiography. Am. J. Cardiol, 45: 155-162, 1980. [MedLine]
71. NANDA, N. C. - Atlas of color Doppler echocardiography. Philadelphia, Lea & Febiger, 1989, cap. 3, p. 46-110.
72. NICHOLS, H. T. - Mitral insufficiency treatment by polar cross0fusion of the mitral, annulus fibrosus. J. Thorac. Cardiovasc. Surg., 33: 102-122, 1957.
73. NILI, M.; SALOMON, J.; HALEVI, A.; SCHUCHMAN, E.; LEVY, M. J. - Left ventricular rupture after mitral valve replacement. Scand. J. Thorac. Cardiovasc. Surg., 15: 235-238, 1981. [MedLine]
74. OURY, J. H.; PETERSON, K. L.; FOLKERTH, T. L.; DAILY, P. O. - Mitral valve replacement versus reconstruction: an analysis of indications and results of mitral valve procedures in a consecutive sries of 80 patients. J. Thorac. Cardiovasc. Surg., 73: 825-835, 1977. [MedLine]
75. PENTHER, P. - Traitement chirurgical pour annuloplastie des insuffisances mitrales: résultat a long-terme. Presse Med., 77: 1885-1886, 1969. [MedLine]
76. PERLOFF, J. K. & ROBERTS, W. C. - The mitral apparatus: functional anatomy of mitral regurgitation. Circulation, 56: 227-239, 1972.
77. PERRY, L. W.; MIDGLEY, F. M.; GALIOTO Jr., F. M.; SHAPIRD, S. R.; RUCKMAN, R. N.; SCOTT, L P. - Two-dimensional echocardiographic evaluation of mitral bioprosthetic function in infants and children. Am. Heart J., 102: 1022-1028, 1981. [MedLine]
78. PINSON, C. W.; COBANOGLU, A.; METZDORFF, M. A. - Late surgical results for ischemic mitral regurgitation: role of regurgitation. J. Thoracic. Cardiovasc. Surg., 88 (Supl. 5, Parte 1): 663-672, 1984.
79. POMERANTZEFF, P. M. A.; AMATO, M.; STOLF, N. A. G.; MARCIAL, M. B.; GRINBERG, M.; PILEGGI, F.; VERGINELLI, G.; JATENE, A. D. - Experiência com plástica de valva mitral. Arc. Bras. Cardiol., 45 (Supl. 1): 156, 1985. (Resumo).
80. POMERANTZEFF. P. M. A.; PIERACCIANI, G.; PUIG, L. B.; FONTES, R. D. - Insuficiência mitral. In: Clínica cirúrgica Alípio Corrêa Neto. 4. ed. São Paulo, Sarvier, 1988. Cap. 81, p. 719-731.
81. POMERANTZEFF, P. M. A.; STOLF, N. A. G.; AMATO, M.; MORETTI, M.; GRINBERG, M.; MORAES, A. V.; CAMARANO, G.; AULER Jr., J. O. C.; VERGINELLI, G.; JATENE, A. D. - Plástica de valva mitral (PVM): experiência do InCor. Arq. Bras. Cardiol, 49 (Supl. 1): 161, 1987. (Resumo). [MedLine]
82. POMERANTZEFF, P. M. A.; ZERBINI, E. J.; VERGINELLI, J.; JANETE, A. D. - Valve replacement in the Heart Institute, University of São Paulo, Brasil. Ann. Thorac. Surg., 48: 541-544, 1989.
83. PUIG, L. B.; VERGINELLI, G.; SOSA, E. A.; ROMA, L. S. L.; GARGIA, D. P.; CONCEIÇÃO, A. N.; ZERBINI, E. J.; PILEGGI, F. - Avaliação hemodinmica da valva de dura-máter mitral e tricúspide. Arq. Bras. Cardiol., 29: 297-301, 1976. [MedLine]
84. QUINOMES. M. A. - Doppler evaluation of right sided lesions and pulmonary hypertension In: NANDA, N. C. (ed.) Doppler echocardiography. New York, Igaku-Shoin, 1985. Cap. 13, p. 262-292.
85. RADFORD, M. J.; JOHNSON, R. A.; BUCKLEY, M. J.; DAGGETT, W. M.; LEINBAC, R. C.; GOLD, H. K. - Survival following mitral valve replacement for mitral regurgitation due to coronary artery disease. Circulation, 60 (Supl. 1): 39-47, 1979. [MedLine]
86. RANGANATHAN, N.; LAM, J. H. C.; WIGLE, E. D.; SILVER, M. D. - Morphology of the human mitral valve. Circulation, 51: 459-467, 1970.
87. RAPAPORT, E. - Natural history of aortic and mitral valve disase. Am. J. Cardiol., 45: 221-227, 1975.
88. REED, G. E.; POOLEY, R. W.; MOGGIO, R. A. - Durability of measured mitral annuloplasty: seventeen-year study. J. Thorac. Cardiovasc. Surg., 79: 31-35, 1980.
89. ROBERTS, W. C. & MORROW, A. G. - Causes of early postoperative death following cardiac valve replacement: clinical pathologic correlations in 64 patients studied at necropsy. J. Thorac. Cardiovasc. Surg., 54: 422-437, 1967. [MedLine]
90. SAND, M. E.; NAFTEL, D. C.; BLACKSTONE, E. H.; KIRKLIN, J. W.: KARP, R. B. - A comparison of repair and replacement for mitral valve incompetence. J. Thorac. Cardiovasc. Surg., 94: 208-219, 1987. [MedLine]
91. SAS, Institute Inc.; SAS/STAT - Guide personal computers, version 6, Edition Cary, NC: SAS Institute Inc., 1987.
92. SCHOEN, F. J.; TSAO, J. W.; LEVY, R. J. - Calcification of bovine pericardium used in cardiac valve bioprotheses: implantations for the mechanisms of bioprosthetic tissue mineralization. Am. J. Pathol., 123: 134-145. [MedLine]
93. SHERRID, M. V.; CLARK, R. D.; COHN, K. - Echocardiography analysus of left atrial size before and after operation in mitral valve disease. Am. J. Cardiol., 43: 171-178, 1979. [MedLine]
94. SHORE, D. F.; GABBAY, S.; YELLIN, E. L.; FRATER, R. W. M. - Degenerative changes in glutaraledehyde preserved pericardium used for the experimental replacement of anterior chordal of mitral valve. J. Cardiovasc. Surg., 24: 132-137, 1983.
95. SHORE, D. F.; WONG, P.; PANETH, M. - Valve repair versus replacement in the surgical management of ruptured chordial. A post-operative echocardiographic assessment of mitral valve function. J. Cardiovasc. Surg, 23: 378-382, 1982.
96. SHORE, D. F.; WONG, P.; PENETH, M.; BUCKLEI, M. J. - Results of mitral valvuloplasty with a suture pication technique. J. Thorac. Cardiovasc. Surg., 79: 349-357, 1980. [MedLine]
97. SIGGAARD-ANDERSEN, O. - Blood acid-base alignment nomogram-scales for pH, pC002, base excess of whole blood of different hemoglobin cncentrations plasma bicarbonate and plasma total -C02. Scand. J. Clin. Lab. Invest., 15: 211, 1963. [MedLine]
98. SPENCER, F. C.; COLVIN, S. B.; CULLIFORD, A. T.; ISON, O. W. - Experience with the Carpentier technique of mitral valve reconstruction in 103 patients (1980-1985). J. Thorac. Cardiovasc. Surg., 90: 341-350, 1985. [MedLine]
99. SUTTON, M. G. Sr. J.; TRAILL, T. A.; GHAFOUR, A. S.; BROWN, D. J.; GBSON, D. G. - Echocardiographic assessment of left ventricular filling after mitral valve surgery. Br. Heart J., 39: 1283-1291, 1977. [MedLine]
100. SYRACUSE, D. C.; BOWMAN Jr., Fº.; MALM. J. R. - Prosthetic valve reoperations: factors influencing early and late survival. J. Thorac. Cardiovasc. Surg., 77: 346-353, 1979.
101. UPTON, M. T. & GIBSON, D. G. - The study of left ventricular function from digitized echocardiograms. Prog. Cardiovasc. Dis., 20: 359-384, 1978. [MedLine]
102. WANN. L. S.; FEIGENBAUM, H.; WEYMAN, A. E.; DILLON, J. C. - Cross-sectional echocardiography detection of rheumatic mitral regurgitation. J. Cardiol, 41: 1258-1264, 1978.
103. WEINSTEIN. I. R.; MARBARGER, J. P.; PÉREZ, J. E. - Ultrasonic assessment of the St. Jude prosthetic valve: M mode, two-dimensional, and Doppler echocardiography. Circulation, 68: 897-905, 1983. [MedLine]
104. WILLIAMS, G. A. & LABOVITZ, A. J. - Doppler hemodynamic evaluation of prosthetic (Starr-Edwards and Bjürk-Shiley) and bioprosthetic (Hancok and Carpentier-Edwards) cardiac valves. Am. J. Cardiol., f56: 325-332, 1985.
105. WONG, C. Y. H. & SPIOTNITZ, H. M. - Systolic and diastolic properties of the human left ventricle during valve replacement for chronic mitral regurgitation. Am. J. Cardiol., 47: 40-50, 1981. [MedLine]
106. YACOUB, M.; HALIM, M.; RADLEY-SMITH, R.; McKAY, R.; NIJVELD, A.; TOWERS, M. - Surgical treatment of mitral regurgiration caused by floppy valves: repair vesus replacement. Circulation, 64 (Supl. 2): 210-216, 1981.
107. YANG, S. S.; BENTIVOGLIO, L. G.; MARANHÃO, V.; GOLDBERG, H. - Assessment of ventricular funcition. In: From cardiac catheterization data to hemodynamic parameters. 3. ed. Philadelphia, F. A. Daris Company, 1988. Cap. 10, p. 189-255.
108. ZWENG, T. N.; BLUETT, M. K.; MOSCA, R.; CALLOW, L. B.; BOVE, E. L. - Mitral valve replacement in the first 5 years of life. Ann. Thorac. Surg., 47: 720-724, 1989. [MedLine]