Objective: In a population of patients undergoing cardiac surgery for rheumatic mitral valve disease, evaluate the impact of preoperative PH on early surgical mortality. Methods: This is a prospective cohort carried out from January 1, 2017 to December 30, 2020. All patients over 18 years of age who underwent cardiac surgery to correct rheumatic mitral valve disease with functional tricuspid regurgitation in an echocardiogram performed up to 6 months before surgery were included. Systolic pulmonary artery pressure (sPAP) value was also defined by preoperative echocardiogram evaluation. The primary outcome was surgical mortality. Results: 144 patients were included. The mean age was 46.2 (±12.3) years with 107 (74.3%) female individuals, the median left ventricular ejection fraction was 61.0% (55 - 67) and sPAP was 55.0 mmHg (46 - 74), with 45 (31.3%) individuals with right ventricular dysfunction. The predominant valve disease was mitral stenosis (74.3%). The prevalence of severe tricuspid regurgitation was 47.2%. The total in-hospital mortality was 15 (10.4%) individuals. sPAP was independently associated with early surgical death RR 1.04 (1.01 – 1.07), p = 0.003. To determine a sPAP cut-off that indicates higher mortality and help decision making in clinical practice, we performed an analysis through the ROC curve (area 0.70, p=0.012). The estimated value of 73.5mmHg has the highest accuracy in our model for predicting early mortality. Conclusion: In patients with rheumatic heart disease who will undergo mitral valve surgery, pulmonary hypertension is associated with higher early mortality. Values above 73.5 mmHg predict higher risk and, in this part of the population, additional measures to control intraoperative and immediate postoperative pulmonary hypertension should be considered.

Background: Left atrial (LA) volume indexing for body surface area (BSA) may underestimate LA size in obese and overweight people. Since LA volume is a risk marker for some cardiovascular events, it is suggested that indexing for height would be an alternative more apropriated method. The aims of this study were to find normal and the best cutoff values for LA volume indexed for height in our population. Methods: Echocardiograms from 2018 to 2021 were reviewed and patients without known cardiac disease and completely normal echocardiograms that had the left atrial volume (LAvol) measured by biplane Simpson’s method were included. LAvol was indexed by BSA (ml/m²), by height (LAvol/m), by height raised to exponent 2.7 (ml/ m2.7) and by height squared (ml/h²). Results: A total of 545 patients, 50.5 ± 13.4 y., 335 females (61,5%) were analyzed. There were 145 normal weight (26.6%), 215 overweight (39.4%), 154 obese (28.3%) and 31 low weight (5.7%) patients. To estabilish normal values we included only the normal weight group and considered normal values from 2SD below to 2SD above the mean. Mean and normal values were: LAvol/h 26.0 ±4.5, 17 – 30 ml/m, LAvol/ht² 16 ± 2.8, 10.4 - 21.6 ml/ ht² and LAvol/ht2.7 11.4 ± 2.2, 7.0 - 15.8 ml/m2.7. The normal LAvol/ht2.7 differed between male and female (11.4 ± 2.4 and 12.8 ± 2.6, p = 0.000). LA diameter, LAvol, LAvol/h, LAvol/h² and LAvol/ht2.7 increased progressively from low-weight, normal weight, overweight and obese patients (p= 0.0000), but not LAvol/BSA. When indexing LAvol for height, for height² and for height2.7 20.8%, 22.7% and 21.4% of the obese patients, respectively, were reclassified as enlarged LA, and 7.4%, 8.8% and 8.4% of the overweight patients as well. Using ROC curve analysis, LAvol/h² had the highest AUC ant the best predictive value to identify LA enlargement and LAvol/BSA the worst one. Conclusions: normal values for LAvol indexed for height by three different methods are described in normal individuals. We reinforce that LAvol indexation for BSA underestimates LA size in obese and overweight patients and in these groups, specially, indexing for height² is probably the best method to evaluate LAvol.

Background: Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) patients with left bundle branch block (LBBB). However, the benefits of CRT in patients with previous pacing are still uncertain. The aim is to compare the short-term mortality between upgrade and De novo-CRT implantation.Methods: Prospective cohort study that included HF patients indicated for CRT with left ventricular ejection fraction (LVEF) of less than 35%. Data were collected to investigate mortality predictors after 1 year. The overall survival was calculated by the Kaplan-Meier method and multivariate analysis using Cox's regression model was performed. A value of p<0.05 was considered as significant.Results: 93 patients were evaluated with a mean follow-up of 1.0±0.6year. Of these, 22 (23.7%) were upgraded from right ventricular pacing. Chagas Disease (CD) was the most prevalent cause of HF with 29 (31.2%) individuals. LVEF at 6 months increased after CRT: 24,0%±7.8 to 30.3%±11.5, p=0.007, and there was no difference between upgraded patients and De novo CRT, p=0.26. Overall mortality at 1-year was 30.1% (28 patients). In univariate analysis, CD and upgraded therapy were associated with high mortality,

Introduction Observational studies differ on the impact of performing tricuspid repair on surgical mortality. Some studies demonstrate increased surgical mortality related to right ventricular failure and circulatory shock, while there are other studies that evidence improvement in quality of life and signs of right heart failure in the long time. Objective To evaluate the impact on surgical mortality of concomitant tricuspid annuloplasty in patients undergoing cardiac surgery for rheumatic mitral valve disease, who have moderate to severe tricuspid regurgitation. Methods This is a prospective cohort from January 1, 2017 to December 30, 2020. All patients over 18 years of age who underwent cardiac surgery to correct rheumatic mitral valve disease with moderate to significant tricuspid regurgitation were included. The primary outcome was 30-days mortality. Results 165 patients were included, 98 (59.4%) underwent tricuspid valve annuloplasty. The mean age was 46, 5 (±12) years, the median of Euroscore II was 2,33%. The 30-days mortality was 17 (10.3%) and there was no difference between the groups submitted or not to tricuspid repair: 12 (12.2%) versus 5 (7.5%); p=0.44, respectively. In the multivariate analysis involving seven variables with a potential prediction of death in 30 days, tricuspid repair had no association with death, RR 2,4 (0,5 – 8,3); p=0.27. Conclusion In patients with rheumatic heart disease undergoing cardiac surgery for rheumatic mitral valve disease, perform tricuspid annuloplasty in individuals who had moderate to severe tricuspid insufficiency was not associated with increased surgical mortality. FUNDunding Acknowledgement Type of funding sources: None.