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ORIGINAL ARTICLE

Aortic valve insufficiency in chronic aortic dissection

Ricardo BeyrutiI; Noedir A. G StolfII; Luiz Felipe P MoreiraII; Paulo M Pêgo-FernandesII; Charles MadyII; Adib D JateneII

DOI: 10.1590/S0102-76381993000200005

ABSTRACT

From January 1980 to December 1989, 48 consecutive patients with chronic aortic dissection and aortic valve insufficiency underwent operation. They were analyzed in 2 groups (24 patients each) to evaluate the late clinical and echocardiography outcome of those in whom the aortic valve was preserved (Group A) compared with those having valve replacement (Group B). The overall preoperative characteristics of the two groups were similar except for the age (Group A 47.9 ± 10.8 versus Group B 40.2 ± 9.5 years, p=0.03). In the preoperative echocardiographic evaluation, Group B patients had significantly higher aortic root and left ventricle systolic and diastolic diameters (p<0.03), and aortic insufficiency grade (p=0.02). The hospital mortality was 12.5% in Group A and 4.2% in Group B and the seven years actuarial survival rate was respectively 75.7% ± 9.8% and 82.7% ± 7.9%. Postoperatively there was, in both groups, a significant improvement in all clinical parameters evaluated (dyspnea, chest pain, arterial hypertension, aortic insufficiency murmurs (p<0.001). There was also a marked reduction in the aortic root and left ventricle diameters in all patients compared to preoperative values (p<0.05) without statistical difference between the groups. Echocardiographic mild aortic insufficiency remained in 20% of the patients in whom the valve was preserved, without long term hemodynamic or clinical repercussion. Hence, we conclude that aortic insufficiency in chronic dissection can be equally treated with both techniques. Aortic valve preservation should, whenever possible, be attempted and considered as the procedure of choice.

RESUMO

Com o objetivo de avaliar os resultados clínicos e ecocardiográficos tardios obtidos com a correção da insuficiência aórtica decorrente da dissecção crônica da aorta proximal, foram estudados 48 pacientes consecutivos operados entre janeiro de 1980 e dezembro de 1989, separados em 2 grupos de 24 pacientes cada. Grupo A - pacientes nos quais a valva aórtica foi preservada pela "resuspensão comissural"; Grupo B - pacientes nos quais a valva aórtica foi substituída. Na avaliação ecocardiográfica pré-operatória, os pacientes do Grupo B apresentavam grau de insuficiência aórtica, diâmetros ventriculares (sistólico e diastólico) e da aorta ascendente significativamente maiores do que os do Grupo A (p=0,03), sendo comparáveis nos demais parâmetros. A mortalidade hospitalar foi 12,5% no Grupo A e de 4,17% no Grupo B e a sobrevida aos 7 anos, respectivamente, 75,75% ± 9,82% e 82,72% ± 7,87% (NS). A avaliação clínica mostrou que, no pós-operatório, houve melhora significativa (p<0,001) e semelhante dos parâmetros nos dois grupos. A comparação ecocardiográfica pré e pós-operatória tardia mostrou, da mesma forma, redução importante dos diâmetros sistólico e diastólico do ventrículo esquerdo e no diâmetro da aorta (p<0,05), mantendo-se inalteradas as frações de encurtamento e de ejeção ventriculares nos pacientes dos dois grupos. Nos pacientes do Grupo A, entretanto, houve persistência de insuficiência aórtica residual (p=0,03). Os autores concluem que, com as duas técnicas empregadas, o tratamento cirúrgico da dissecção da aorta ascendente com insuficiência aórtica associada permite sobrevida imediata e tardia satisfatórias e nítida melhora funcional. Nos pacientes do Grupo A, a insuficiência aórtica residual detectada à ecocardiografia não produziu sintomas ou repercussão hemodinâmica tardios e, desta forma, preconizam a preservação da valva, sempre que tecnicamente possível.
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