Avaliação do remodelamento do átrio esquerdo após valvuloplastia mitral percutânea em pacientes com estenose mitral reumática através do ecocardiograma tridimensional

Abstract

Introduction: Rheumatic fever (RF) is still the leading cause of heart valve disease in Brazil and is responsible for significant morbidity and mortality Rheumatic mitral stenosis (MS) results in severe pressure overload of the left atrium (LA). The secondary atrial remodeling generates LA dysfunction, blood stasis, high incidence of atrial fibrillation (AF), thrombus formation and systemic embolism. The aim of this study is to evaluate the AE function by threedimensional echocardiography (ECO3D) in patients with or without AF before and after percutaneous balloon mitral valvuloplasty (PMV). Methods: A total of 84 MS patients referred for PMV were included between March / 2010 and July / 2014. The research was conducted at the Hospital das Clínicas, and echocardiograms performed in the hospital echocardiography sector. Volumes and LA function were measured by ECO3D before, 48 hours after the PMV, and with one year of followup. Results: The decrease in left atrial maximum volume was mean (SD) 55.5 ± 23.1 ml / m², to 53.5 ± 29.7 ml / m² after 48 hours after the procedure (p = 0.147), to 50.5 ± 24.6 ml / m² at 1 year follow-up (p = 0.011). The fraction of emptying increased from 20.4 ± 10.1% 28.7 ± 11.4% after 48 hours of the procedure (p <0.001) and to 32.6 ± 13.3% at 1 year follow-up (p = 0.003). In patients with AF and the LA emptying fraction was 13.8 ± 7.5% at baseline, 21 ± 9.3% 48 hours of the procedure (p = 0.039) and 20.8 ± 8.7% following (p = 0.946). Age, presence of AF at baseline, and postprocedural mitral mean gradient were identified as the most significant predictors of late LA function. Conclusions: The LA features a reverse remodeling after PMV. This remodeling is higher immediately after the procedure, but continued to occur in the coming months. In patients with AF that remodeling also occurs, though to a lesser extent and the improvement over the months after the procedure is not significant.