Estenose mitral grave como evolução a longo prazo de miotomia/miectomia septal cirúrgica

Abstract

258 ment and are indicated for more aggressive therapies, such as myotomy-myectomy-septal resection, dual-chamber pacemaker implantation, alcohol injection in the septal artery, defibrillator implantation (used in cases at high risk for sudden death), and even heart transplantation 3,4 .Mitral stenosis is usually of rheumatic origin, occurring mainly among women (approximately 66% of the cases), but in rare cases, it may be congenital 7 . Pure or predominant mitral stenosis occurs in approximately 40% of all patients with rheumatic heart disease 7 . The clinical findings are extremely varied and have a significant relation with the degree of valvular impairment. These findings may vary from the mere presence of some clinical signs without symptoms until the presence of pulmonary edema, atrial arrhythmias, hemoptysis, and right ventricular failure 7 .Until the present time, however, from the pathophysiological point of view, no cases of an association of myotomy-myectomyseptal resection and the appearance of long-term mitral stenosis have been reported in the scientific literature.We report the case of a 67-year-old female, who, 18 years after undergoing myotomy-myectomy-septal resection for correction of asymmetric septal hypertrophic cardiomyopathy, had symptoms of severe mitral stenosis. The patient presented to the Instituto do Coração (InCor) of the Hospital das Clínicas of the FMUSP for appropriate clinical assessment, being then referred for surgery. Case reportWe report the case of a 67-year-old female of mixed heritage, born in the city of Montes Claros, in the state of Minas Gerais, and coming from the city of Belo Horizonte, in the state of Minas Gerais, who complained of progressive dyspnea for 1 year, which was lately triggered by minimum exertion (New York Heart Association functional class III). The patient reported, as personal antecedents, systemic arterial hypertension and dyslipidemia, in addition to ischemic stroke in 1995, with no sequelae.In 1985, after undergoing complementary examinations, asymmetric septal hypertrophic cardiomyopathy and pulmonary hypertension were diagnosed. On that occasion, the patient had progressive dyspnea and dizziness but denied any history of rheumatic disease. Myotomy-myectomy-septal resection was indicated and performed through an aortotomy. The anatomicopathological study of the left ventricular fragments removed during the surgery showed hypertrophic cardiomyocytes and areas of disarrangement and Hypertrophic cardiomyopathy, also known as idiopathic hypertrophic subaortic stenosis or hypertrophic obstructive cardiomyopathy, is a disease classically characterized by nondilated left ventricular hypertrophy in the absence of any other cause of increase in myocardial mass 1-4 . Its incidence in the general population ranges from 0.02% to 5% 1,5 . In approximately half of the cases, hypertrophic cardiomyopathy is a genetic disease, with a dominant autosomal transmission and variable expression; in the remaining cases, it may result from new mutations or recessive ...