array:23 [
  "pii" => "S2174204917302118"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2017.07.002"
  "estado" => "S300"
  "fechaPublicacion" => "2017-07-01"
  "aid" => "1024"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "prv"
  "cita" => "Rev Port Cardiol. 2017;36:579-81"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1333
    "formatos" => array:3 [
      "EPUB" => 131
      "HTML" => 912
      "PDF" => 290
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:19 [
      "pii" => "S0870255117304274"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2017.06.001"
      "estado" => "S300"
      "fechaPublicacion" => "2017-07-01"
      "aid" => "1024"
      "documento" => "simple-article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "prv"
      "cita" => "Rev Port Cardiol. 2017;36:579-81"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1947
        "formatos" => array:3 [
          "EPUB" => 185
          "HTML" => 1348
          "PDF" => 414
        ]
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Artigo Recomendado Do M&#234;s</span>"
        "titulo" => "Coment&#225;rio a &#171;Perfis de fluxo e <span class="elsevierStyleItalic">stress</span> a&#243;rtico em doentes com v&#225;lvula a&#243;rtica bic&#250;spide &#8211; v&#225;lvulas normofuncionantes e com altera&#231;&#227;o da fun&#231;&#227;o&#187;"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "579"
            "paginaFinal" => "581"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Comment on &#8220;Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency&#8221;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Jos&#233; Fragata"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Jos&#233;"
                "apellidos" => "Fragata"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S2174204917302118"
          "doi" => "10.1016/j.repce.2017.07.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302118?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117304274?idApp=UINPBA00004E"
      "url" => "/08702551/0000003600000078/v1_201707241250/S0870255117304274/v1_201707241250/pt/main.assets"
    ]
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204917301691"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2016.12.017"
    "estado" => "S300"
    "fechaPublicacion" => "2017-07-01"
    "aid" => "1033"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Rev Port Cardiol. 2017;36:577-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2335
      "formatos" => array:3 [
        "EPUB" => 152
        "HTML" => 1738
        "PDF" => 445
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "The era of the novel oral anticoagulants in Portugal"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "577"
          "paginaFinal" => "578"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "A era dos novos anticoagulantes orais em Portugal"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1117
              "Ancho" => 3375
              "Tamanyo" => 237085
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Numbers of packages and defined daily doses of oral anticoagulants prescribed in Portugal&#46; DDDs&#58; defined daily doses&#59; NOACs&#58; new oral anticoagulants&#59; OACs&#58; oral anticoagulants&#59; VKAs&#58; vitamin K antagonists&#46; Source&#58; INFARMED&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Daniel Caldeira, Joaquim J&#46; Ferreira, Fausto J&#46; Pinto"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Daniel"
              "apellidos" => "Caldeira"
            ]
            1 => array:2 [
              "nombre" => "Joaquim J&#46;"
              "apellidos" => "Ferreira"
            ]
            2 => array:2 [
              "nombre" => "Fausto J&#46;"
              "apellidos" => "Pinto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255116304486"
        "doi" => "10.1016/j.repc.2016.12.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116304486?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301691?idApp=UINPBA00004E"
    "url" => "/21742049/0000003600000078/v1_201707290050/S2174204917301691/v1_201707290050/en/main.assets"
  ]
  "pt" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Artigo Recomendado Do M&#234;s</span>"
    "titulo" => "Coment&#225;rio a &#171;Perfis de fluxo e <span class="elsevierStyleItalic">stress</span> a&#243;rtico em doentes com v&#225;lvula a&#243;rtica bic&#250;spide &#8211; v&#225;lvulas normofuncionantes e com altera&#231;&#227;o da fun&#231;&#227;o&#187;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "579"
        "paginaFinal" => "581"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Jos&#233; Fragata"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Jos&#233;"
            "apellidos" => "Fragata"
            "email" => array:1 [
              0 => "jigfragata&#64;gmail&#46;com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Membro do Corpo Redatorial da Revista Portuguesa de Cardiologia"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Comment on &#8220;Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency&#8221;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Abstract</span><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Objectives&#58;</span> Bicuspid aortic valve&#44; characterized by valve malformation and risk for aortopathy&#44; displays profound alteration in systolic aortic outflow and wall shear stress distribution&#46; The present study performed 4&#8208;dimensional flow magnetic resonance imaging in patients with bicuspid aortic valve with right&#8208;left cusp fusion&#44; focusing on the impact of valve function on hemodynamic status within the ascending aorta&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Methods&#58;</span> Four&#8208;dimensional flow magnetic resonance imaging was performed in 50 subjects with right&#8208;left bicuspid aortic valve and 15 age&#8208; and aortic size&#8208;matched controls with tricuspid aortic valve&#46; Patients with bicuspid aortic valve were categorized into 3 groups according to their aortic valve function as follows&#58; bicuspid aortic valve with no more than mild aortic valve dysfunction &#40;bicuspid aortic valve control&#44; n &#61; 20&#41;&#44; bicuspid aortic valve with severe aortic insufficiency &#40;n &#61; 15&#41;&#44; and bicuspid aortic valve with severe aortic stenosis &#40;n &#61; 15&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Results&#58;</span> All patients with right&#8208;left bicuspid aortic valve exhibited peak wall shear stress at the right&#8208;anterior position of the ascending aorta &#40;bicuspid aortic valve vs trileaflet aortic valve at the right&#8208;anterior position&#58; 0&#46;91 &#177; 0&#46;23<span class="elsevierStyleHsp" style=""></span>N&#47;m<span class="elsevierStyleSup">2</span> vs 0&#46;43 &#177; 0&#46;12<span class="elsevierStyleHsp" style=""></span>N&#47;m<span class="elsevierStyleSup">2</span>&#44; P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; with no distinct alteration between bicuspid aortic valve with severe aortic insufficiency and bicuspid aortic valve with severe aortic stenosis&#46; The predominance of dilatation involving the tubular ascending aorta &#40;82&#37;&#44; type 2 aortopathy&#41; persisted&#44; with or without valve dysfunction&#46; Compared with bicuspid aortic valve control subjects&#44; the bicuspid aortic valve with severe aortic insufficiency group displayed universally elevated wall shear stress &#40;0&#46;75 &#177;0&#46;12<span class="elsevierStyleHsp" style=""></span>N&#47;m<span class="elsevierStyleSup">2</span> vs 0&#46;57 &#177; 0&#46;09<span class="elsevierStyleHsp" style=""></span>N&#47;m<span class="elsevierStyleSup">2</span>&#44; P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41; in the ascending aorta&#44; which was associated with elevated cardiac stroke volume &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; The bicuspid aortic valve with severe aortic stenosis group showed elevated flow eccentricity in the form of significantly increased standard deviation of circumferential wall shear stress&#44; which correlated with markedly increased peak aortic valve velocity &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Conclusions&#58;</span> The location of peak aortic wall shear stress and type of aortopathy remained homogeneous among patients with right&#8208;left bicuspid aortic valve irrespective of valve dysfunction&#46; Severe aortic insufficiency or stenosis resulted in further elevated aortic wall shear stress and exaggerated flow eccentricity &#40;J Thorac Cardiovasc Surg 2017&#59;153&#58;1263&#8208;72&#41;&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Coment&#225;rio</span><p id="par0005" class="elsevierStylePara elsevierViewall">&#171;<span class="elsevierStyleItalic">form follows function&#46;&#46;</span>&#46;&#187;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Entre muitos outros poss&#237;veis&#44; selecionei este artigo&#44; por Shan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#44; porque tenta dar resposta a um problema que cardiologistas e cirurgi&#245;es card&#237;acos encontram com frequ&#234;ncia crescente &#8211; a necessidade de fazer substituir&#44; ou n&#227;o&#44; a aorta ascendente no contexto de bicuspidia a&#243;rtica&#46; A import&#226;ncia do tema e do artigo em apre&#231;o motivou&#44; ali&#225;s&#44; dois coment&#225;rios editoriais a acompanh&#225;&#8208;lo&#44; um por David Tirone<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> e outro por Mohamad Alkhouli<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#44; editoriais cuja leitura tamb&#233;m recomendo&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Numa v&#225;lvula a&#243;rtica&#44; de base estruturalmente tric&#250;spide&#44; as altera&#231;&#245;es mantidas do fluxo transvalvular&#44; num contexto de estenose&#44; ou mesmo de insufici&#234;ncia a&#243;rtica&#44; determinam dilata&#231;&#227;o da aorta ascendente&#46; Esta dilata&#231;&#227;o dita &#171;p&#243;s&#8208;esten&#243;tica&#187; dever&#225; ser corrigida aquando da substitui&#231;&#227;o valvular&#44; por substitui&#231;&#227;o da aorta ascendente no mesmo tempo&#44; de acordo com as <span class="elsevierStyleItalic">guidelines</span> atuais&#46; A maior parte dos cirurgi&#245;es substitui hoje a aorta ascendente&#44; independentemente do substrato valvular existente&#44; sempre que o calibre da aorta ultrapassa claramente os 50<span class="elsevierStyleHsp" style=""></span>mm&#46; No entanto&#44; Gaudino<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> demonstrou numa s&#233;rie de 93 doentes com v&#225;lvulas a&#243;rticas de base normal tric&#250;spide&#44; mas com estenose e dilata&#231;&#227;o concomitante da aorta ascendente&#44; &#40;entre 50&#8208;59<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; que a substitui&#231;&#227;o da aorta n&#227;o seria necess&#225;ria dado que&#44; ao fim de mais de 15 anos volvidos ap&#243;s a substitui&#231;&#227;o valvular&#44; o di&#226;metro a&#243;rtico n&#227;o ter&#225; variado&#44; nem houve necessidade de uma qualquer interven&#231;&#227;o sobre a aorta ascendente&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se a necessidade de substitui&#231;&#227;o da aorta ascendente dilatada poder&#225; ser&#44; eventualmente&#44; discutida em presen&#231;a de uma v&#225;lvula tric&#250;spide&#44; j&#225; na bicuspidia a&#243;rtica existe evid&#234;ncia sustentada para essa necessidade<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A bicuspidia a&#243;rtica &#233; a cardiopatia cong&#233;nita mais frequente&#44; com uma preval&#234;ncia na popula&#231;&#227;o de cerca de 1&#44;3&#37;&#44; sendo que a dilata&#231;&#227;o da aorta ocorrer&#225; em percentagens vari&#225;veis ao longo da vida&#44; entre 20&#8208;84&#37; dos casos&#46; Com efeito&#44; a bicuspidia a&#243;rtica representa um espectro de les&#245;es podendo envolver a v&#225;lvula&#44; a raiz da aorta&#44; a aorta ascendente e o segmento proximal do arco&#44; e com fen&#243;tipos de express&#227;o muito diferentes&#46; O mecanismo de dilata&#231;&#227;o a&#243;rtica ser&#225; multifatorial&#58; haver&#225; fundamentalmente raz&#245;es hemodin&#226;micas baseadas no perfil do fluxo e no <span class="elsevierStyleItalic">stress</span> a&#243;rtico&#44; relacionados com a bicuspidia de base e&#47;ou com a disfun&#231;&#227;o valvular normalmente associada<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#44; mas parece hoje dif&#237;cil de negar o papel da anomalia gen&#233;tica<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Todos temos encontrado&#44; no largo espectro da bicuspidia a&#243;rtica&#44; doentes com fun&#231;&#227;o valvular preservada por muitos anos e sem dilata&#231;&#227;o da aorta&#44; outros com v&#225;lvula normofuncionante e com aorta dilatada &#8211; este talvez o grupo de decis&#227;o mais incerta&#44; outros ainda com les&#227;o valvular com&#44; ou sem&#44; dilata&#231;&#227;o a&#243;rtica&#46; Causas hemodin&#226;micas e a varia&#231;&#227;o gen&#233;tica parecem&#44; assim&#44; influenciar multifatorialmente&#44; e de modo diferente&#44; esta larga varia&#231;&#227;o fenot&#237;pica&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Independentemente do mecanismo parecer&#225; hoje razo&#225;vel&#44; na bicuspidia com les&#227;o valvular funcional associada e dilata&#231;&#227;o a&#243;rtica&#44; substituir a aorta ascendente para calibres iguais ou superiores a 50<span class="elsevierStyleHsp" style=""></span>mm&#46; Menos definido ser&#225; o que fazer para calibres inferiores a 50<span class="elsevierStyleHsp" style=""></span>mm&#44; sobretudo em presen&#231;a de v&#225;lvulas a&#243;rticas bic&#250;spides normofuncionantes&#44; em que a indica&#231;&#227;o cir&#250;rgica prim&#225;ria &#233; a substitui&#231;&#227;o da aorta ascendente por risco de rutura&#63; O artigo por Shan<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#44; que passaremos agora a comentar&#44; avalia o perfil dos fluxos a&#243;rticos e o <span class="elsevierStyleItalic">shear stress</span> na parede da aorta&#44; em doentes com v&#225;lvulas a&#243;rticas tric&#250;spides e em grupos homog&#233;neos de doentes com v&#225;lvulas bic&#250;spides &#40;com fus&#227;o das cuspes esquerda e direita&#41; e aorta ascendente moderadamente dilatada &#40;40<span class="elsevierStyleHsp" style=""></span>mm&#41; &#8211; normofuncionantes&#44; com estenose e com insufici&#234;ncia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">No estudo&#44; utilizou a resson&#226;ncia magn&#233;tica nuclear &#40;&#91;RMN&#93; <span class="elsevierStyleItalic">full volume&#44; flow sensitive</span>&#41; &#8211; 4<span class="elsevierStyleHsp" style=""></span>D<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#44; tendo verificado que&#58; nas v&#225;lvulas tric&#250;spides sem les&#227;o o fluxo era normal&#44; central e coesivo&#59; nas v&#225;lvulas bic&#250;spides normofuncionantes&#44; o fluxo era exc&#234;ntrico e com trajetos helicoidais a estender&#8208;se pela vertente a&#243;rtica anterior&#8208;direita at&#233; &#224; origem do arco a&#243;rtico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Este perfil acentuava&#8208;se marcadamente &#40;aumento do <span class="elsevierStyleItalic">shear stress</span>&#41; em presen&#231;a de estenose ou de insufici&#234;ncia &#40;sem diferen&#231;a para qualquer destas&#41;&#46; No entanto&#44; na insufici&#234;ncia o <span class="elsevierStyleItalic">shear stress</span> mostrou&#8208;se ainda maior&#44; talvez pelo aumento do volume sist&#243;lico devido &#224; regurgita&#231;&#227;o&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A dilata&#231;&#227;o da aorta ascendente foi prevalente em 82&#37; das v&#225;lvulas bic&#250;spides&#44; independente da presen&#231;a&#44; ou n&#227;o&#44; de les&#227;o valvular&#46; A fragilidade a&#243;rtica cong&#233;nita&#44; devida ao gen&#243;tipo de <span class="elsevierStyleItalic">deficit</span> de fibrilina e associada a um perfil de maior <span class="elsevierStyleItalic">stress</span> hemodin&#226;mico&#44; que &#233; intr&#237;nseco &#224; bicuspidia&#44; condicionam a muito prevalente dilata&#231;&#227;o da aorta&#46; Resta&#44; contudo&#44; explicar a extrema varia&#231;&#227;o&#44; que faz com que nuns doentes o processo ocorra ainda na inf&#226;ncia e&#44; noutros&#44; na vida adulta ou na maturidade&#46; Esta varia&#231;&#227;o talvez se deva &#224; diferente penetra&#231;&#227;o gen&#233;tica e a discrepantes perfis hemodin&#226;micos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O que o artigo por Shan<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> nos ensina de novo &#233; que&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">comparando v&#225;lvulas a&#243;rticas tric&#250;spides e bic&#250;spides&#44; sem disfun&#231;&#227;o valvular&#44; o <span class="elsevierStyleItalic">shear stress</span> induzido pelo fluxo &#233; claramente superior nas bic&#250;spides &#8211; uma caracter&#237;stica inerente &#224; bicuspidia a&#243;rtica&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">na bic&#250;spidia a&#243;rtica&#44; o <span class="elsevierStyleItalic">shear stress</span> na parede anterior&#8208;direita da aorta est&#225; muito aumentado&#44; independentemente da coexist&#234;ncia&#44; ou n&#227;o&#44; de disfun&#231;&#227;o valvular&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">o perfil dos fluxos na bicuspidia a&#243;rtica&#44; com estenose ou insufici&#234;ncia&#44; &#233; diferente e o <span class="elsevierStyleItalic">stress</span> mural &#233; maior&#59; particularmente na insufici&#234;ncia valvular&#44; est&#225; aumentado difusamente face ao fluxo acrescido&#44; e na estenose o aumento &#233; focal e mais dirigido para a parede anterodireita&#46; Esta diferen&#231;a poder&#225; ter impactos distintos sobre a parede a&#243;rtica&#44; &#224; dist&#226;ncia&#44; levando a tipos de dilata&#231;&#227;o a&#243;rtica diferentes&#59;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">finalmente&#44; poder&#8208;se &#225; inferir que&#44; em caso de repara&#231;&#227;o valvular a&#243;rtica&#44; uma configura&#231;&#227;o tric&#250;spide proteger&#225; mais a aorta do que a preserva&#231;&#227;o da forma bic&#250;spide&#44; devendo estas idealmente contemplar uma geometria a 180&#176;&#44; visando obter fluxos mais laminares<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46;</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">At&#233; agora&#44; a substitui&#231;&#227;o profil&#225;tica da aorta era ditada exclusivamente pelo calibre e ritmo de expans&#227;o&#44; mas est&#225; aberto caminho para uma maior personaliza&#231;&#227;o na decis&#227;o&#44; no que concerne &#224; substitui&#231;&#227;o da aorta ascendente&#44; baseada tamb&#233;m no facto de existir&#44; ou n&#227;o&#44; uma les&#227;o valvular associada&#44; tratando&#8208;se de uma estenose ou&#44; mais prementemente e com maior controlo&#44; no caso de insufici&#234;ncia valvular&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">As <span class="elsevierStyleItalic">guidelines</span> hoje prevalentes para lidar com a dilata&#231;&#227;o da aorta ascendente associada &#224; bicuspidia a&#243;rtica com les&#227;o valvular significativa apontam para a sua substitui&#231;&#227;o no mesmo&#44; se o di&#226;metro for igual ou superior a 45<span class="elsevierStyleHsp" style=""></span>mm<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#44; se a v&#225;lvula bic&#250;spide &#233; normofuncionante parece razo&#225;vel esperar at&#233; que a aorta ascendente atinja pelo menos 50<span class="elsevierStyleHsp" style=""></span>mm&#44; isto na aus&#234;ncia de crescimento r&#225;pido ou de sintomas&#46; &#201; poss&#237;vel na maioria dos casos substituir a aorta&#44; preservando a v&#225;lvula a&#243;rtica&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A RMN 4<span class="elsevierStyleHsp" style=""></span>D parece ser um m&#233;todo &#250;til para avaliar os impactos do perfil de fluxo sobre a aorta&#44; e ajudar no seguimento e decis&#227;o&#44; agora personalizada&#44; do momento cir&#250;rgico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclus&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">As v&#225;lvulas a&#243;rticas bic&#250;spides &#40;mesmo as normofuncionantes&#41; est&#227;o associadas a um perfil anormal de fluxo&#44; com maior <span class="elsevierStyleItalic">stress</span> parietal a&#243;rtico&#46; Este perfil agrava&#8208;se em presen&#231;a de disfun&#231;&#227;o valvular&#44; particularmente na insufici&#234;ncia&#46; Estas considera&#231;&#245;es devem ser tidas em conta no estabelecer do momento da interven&#231;&#227;o para substitui&#231;&#227;o da aorta em contexto de bicuspidia a&#243;rtica&#44; que pode agora passar a ser individualizada&#44; e n&#227;o s&#243; baseada no di&#226;metro&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflito de interesses</span><p id="par0100" class="elsevierStylePara elsevierViewall">O autor declara n&#227;o haver conflito de interesses&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:5 [
        0 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Coment&#225;rio"
        ]
        2 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Conclus&#227;o"
        ]
        3 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflito de interesses"
        ]
        4 => array:1 [
          "titulo" => "Bibliografia"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">J Thorac Cardiovasc Surg&#46;&#160;2017 Jun&#59;153&#40;6&#41;&#58;1263&#8208;1272&#46;e1&#46; doi&#58; 10&#46;1016&#47;j&#46;jtcvs&#46;2016&#46;12&#46;059&#46; Epub 2017 Feb 10&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "e1"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aortic shear stress in bicuspid aortic valve in patients with stenosis and insufficiency"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Y&#46; Shan"
                            1 => "J&#46; Li"
                            2 => "Y&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thoracic Cardiovasc Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "153"
                        "paginaInicial" => "1263"
                        "paginaFinal" => "1272"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Form follows function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46;E&#46; David"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2017.02.046"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "153"
                        "paginaInicial" => "1261"
                        "paginaFinal" => "1262"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28351478"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The sheer stress of deciding when to replace the aorta in bicuspid valve disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Alkhouli"
                            1 => "J&#46;S&#46; Rankin"
                            2 => "J&#46;D&#46; Mills"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2017.03.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2017"
                        "volumen" => "153"
                        "paginaInicial" => "1273"
                        "paginaFinal" => "1274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28377120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aortic expansion rate in patients with dilated post&#8208;stenotic ascending aorta submitted only to aortic valve replacement long&#8208;term follow&#8208;up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Gaudino"
                            1 => "A&#46; Anselmi"
                            2 => "M&#46; Morelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2011.03.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2011"
                        "volumen" => "58"
                        "paginaInicial" => "581"
                        "paginaFinal" => "584"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21798419"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Borger"
                            1 => "M&#46; Preston"
                            2 => "J&#46; Ivanov"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2004.07.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2004"
                        "volumen" => "128"
                        "paginaInicial" => "677"
                        "paginaFinal" => "683"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15514594"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New insights in the association between bicuspid aortic valve phenotype&#44; aortic configuration and valve haemodynamics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46;H&#46; Sievers"
                            1 => "U&#46; Stierle"
                            2 => "R&#46;M&#46; Hachmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ejcts/ezv087"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "49"
                        "paginaInicial" => "439"
                        "paginaFinal" => "446"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25787670"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bicuspid aortic valve is heritable"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Cripe"
                            1 => "G&#46; Andelfinger"
                            2 => "L&#46;J&#46; Martin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2004.03.050"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2004"
                        "volumen" => "44"
                        "paginaInicial" => "138"
                        "paginaFinal" => "143"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15234422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bicuspid aortic valve&#58; four&#8208;dimensional MR evaluation of ascending aortic systolic flow patterns"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;D&#46; Hope"
                            1 => "T&#46;A&#46; Hope"
                            2 => "A&#46;K&#46; Meadows"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.09091437"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology&#46;"
                        "fecha" => "2010"
                        "volumen" => "255"
                        "paginaInicial" => "53"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20308444"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Greater asymmetric wall shear stress in Sievers&#8217; type 1&#47;LR compared with 0&#47;LAT bicuspid aortic valves after valve&#8208;sparing aortic root replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;H&#46; Stephens"
                            1 => "T&#46;A&#46; Hope"
                            2 => "F&#46;A&#46; Kari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2015.04.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "150"
                        "paginaInicial" => "59"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25956338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2014 AHA&#47;ACC guideline for the management of patients with valvular heart disease&#58; a report of the American College of Cardiology&#47;American Heart Association Task Force on Practice Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;A&#46; Nishimura"
                            1 => "C&#46;M&#46; Otto"
                            2 => "R&#46;O&#46; Bonow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2014.05.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "148"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "e132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24939033"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/21742049/0000003600000078/v1_201707290050/S2174204917302118/v1_201707290050/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9913"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Recommended article of the month"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000078/v1_201707290050/S2174204917302118/v1_201707290050/pt/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302118?idApp=UINPBA00004E"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Artigo Recomendado Do Mês
Comentário a «Perfis de fluxo e stress aórtico em doentes com válvula aórtica bicúspide – válvulas normofuncionantes e com alteração da função»
Comment on “Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency”
José Fragata
Membro do Corpo Redatorial da Revista Portuguesa de Cardiologia
Read
4298
Times
was read the article
1521
Total PDF
2777
Total HTML
Share statistics
 array:23 [
  "pii" => "S2174204917302118"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2017.07.002"
  "estado" => "S300"
  "fechaPublicacion" => "2017-07-01"
  "aid" => "1024"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "prv"
  "cita" => "Rev Port Cardiol. 2017;36:579-81"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1333
    "formatos" => array:3 [
      "EPUB" => 131
      "HTML" => 912
      "PDF" => 290
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:19 [
      "pii" => "S0870255117304274"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2017.06.001"
      "estado" => "S300"
      "fechaPublicacion" => "2017-07-01"
      "aid" => "1024"
      "documento" => "simple-article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "prv"
      "cita" => "Rev Port Cardiol. 2017;36:579-81"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1947
        "formatos" => array:3 [
          "EPUB" => 185
          "HTML" => 1348
          "PDF" => 414
        ]
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Artigo Recomendado Do M&#234;s</span>"
        "titulo" => "Coment&#225;rio a &#171;Perfis de fluxo e <span class="elsevierStyleItalic">stress</span> a&#243;rtico em doentes com v&#225;lvula a&#243;rtica bic&#250;spide &#8211; v&#225;lvulas normofuncionantes e com altera&#231;&#227;o da fun&#231;&#227;o&#187;"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "579"
            "paginaFinal" => "581"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Comment on &#8220;Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency&#8221;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Jos&#233; Fragata"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Jos&#233;"
                "apellidos" => "Fragata"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S2174204917302118"
          "doi" => "10.1016/j.repce.2017.07.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302118?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117304274?idApp=UINPBA00004E"
      "url" => "/08702551/0000003600000078/v1_201707241250/S0870255117304274/v1_201707241250/pt/main.assets"
    ]
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204917301691"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2016.12.017"
    "estado" => "S300"
    "fechaPublicacion" => "2017-07-01"
    "aid" => "1033"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Rev Port Cardiol. 2017;36:577-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2335
      "formatos" => array:3 [
        "EPUB" => 152
        "HTML" => 1738
        "PDF" => 445
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "The era of the novel oral anticoagulants in Portugal"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "577"
          "paginaFinal" => "578"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "A era dos novos anticoagulantes orais em Portugal"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1117
              "Ancho" => 3375
              "Tamanyo" => 237085
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Numbers of packages and defined daily doses of oral anticoagulants prescribed in Portugal&#46; DDDs&#58; defined daily doses&#59; NOACs&#58; new oral anticoagulants&#59; OACs&#58; oral anticoagulants&#59; VKAs&#58; vitamin K antagonists&#46; Source&#58; INFARMED&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Daniel Caldeira, Joaquim J&#46; Ferreira, Fausto J&#46; Pinto"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Daniel"
              "apellidos" => "Caldeira"
            ]
            1 => array:2 [
              "nombre" => "Joaquim J&#46;"
              "apellidos" => "Ferreira"
            ]
            2 => array:2 [
              "nombre" => "Fausto J&#46;"
              "apellidos" => "Pinto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255116304486"
        "doi" => "10.1016/j.repc.2016.12.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116304486?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301691?idApp=UINPBA00004E"
    "url" => "/21742049/0000003600000078/v1_201707290050/S2174204917301691/v1_201707290050/en/main.assets"
  ]
  "pt" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Artigo Recomendado Do M&#234;s</span>"
    "titulo" => "Coment&#225;rio a &#171;Perfis de fluxo e <span class="elsevierStyleItalic">stress</span> a&#243;rtico em doentes com v&#225;lvula a&#243;rtica bic&#250;spide &#8211; v&#225;lvulas normofuncionantes e com altera&#231;&#227;o da fun&#231;&#227;o&#187;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "579"
        "paginaFinal" => "581"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Jos&#233; Fragata"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Jos&#233;"
            "apellidos" => "Fragata"
            "email" => array:1 [
              0 => "jigfragata&#64;gmail&#46;com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Membro do Corpo Redatorial da Revista Portuguesa de Cardiologia"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Comment on &#8220;Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency&#8221;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Abstract</span><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Objectives&#58;</span> Bicuspid aortic valve&#44; characterized by valve malformation and risk for aortopathy&#44; displays profound alteration in systolic aortic outflow and wall shear stress distribution&#46; The present study performed 4&#8208;dimensional flow magnetic resonance imaging in patients with bicuspid aortic valve with right&#8208;left cusp fusion&#44; focusing on the impact of valve function on hemodynamic status within the ascending aorta&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Methods&#58;</span> Four&#8208;dimensional flow magnetic resonance imaging was performed in 50 subjects with right&#8208;left bicuspid aortic valve and 15 age&#8208; and aortic size&#8208;matched controls with tricuspid aortic valve&#46; Patients with bicuspid aortic valve were categorized into 3 groups according to their aortic valve function as follows&#58; bicuspid aortic valve with no more than mild aortic valve dysfunction &#40;bicuspid aortic valve control&#44; n &#61; 20&#41;&#44; bicuspid aortic valve with severe aortic insufficiency &#40;n &#61; 15&#41;&#44; and bicuspid aortic valve with severe aortic stenosis &#40;n &#61; 15&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Results&#58;</span> All patients with right&#8208;left bicuspid aortic valve exhibited peak wall shear stress at the right&#8208;anterior position of the ascending aorta &#40;bicuspid aortic valve vs trileaflet aortic valve at the right&#8208;anterior position&#58; 0&#46;91 &#177; 0&#46;23<span class="elsevierStyleHsp" style=""></span>N&#47;m<span class="elsevierStyleSup">2</span> vs 0&#46;43 &#177; 0&#46;12<span class="elsevierStyleHsp" style=""></span>N&#47;m<span class="elsevierStyleSup">2</span>&#44; P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; with no distinct alteration between bicuspid aortic valve with severe aortic insufficiency and bicuspid aortic valve with severe aortic stenosis&#46; The predominance of dilatation involving the tubular ascending aorta &#40;82&#37;&#44; type 2 aortopathy&#41; persisted&#44; with or without valve dysfunction&#46; Compared with bicuspid aortic valve control subjects&#44; the bicuspid aortic valve with severe aortic insufficiency group displayed universally elevated wall shear stress &#40;0&#46;75 &#177;0&#46;12<span class="elsevierStyleHsp" style=""></span>N&#47;m<span class="elsevierStyleSup">2</span> vs 0&#46;57 &#177; 0&#46;09<span class="elsevierStyleHsp" style=""></span>N&#47;m<span class="elsevierStyleSup">2</span>&#44; P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41; in the ascending aorta&#44; which was associated with elevated cardiac stroke volume &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; The bicuspid aortic valve with severe aortic stenosis group showed elevated flow eccentricity in the form of significantly increased standard deviation of circumferential wall shear stress&#44; which correlated with markedly increased peak aortic valve velocity &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Conclusions&#58;</span> The location of peak aortic wall shear stress and type of aortopathy remained homogeneous among patients with right&#8208;left bicuspid aortic valve irrespective of valve dysfunction&#46; Severe aortic insufficiency or stenosis resulted in further elevated aortic wall shear stress and exaggerated flow eccentricity &#40;J Thorac Cardiovasc Surg 2017&#59;153&#58;1263&#8208;72&#41;&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Coment&#225;rio</span><p id="par0005" class="elsevierStylePara elsevierViewall">&#171;<span class="elsevierStyleItalic">form follows function&#46;&#46;</span>&#46;&#187;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Entre muitos outros poss&#237;veis&#44; selecionei este artigo&#44; por Shan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#44; porque tenta dar resposta a um problema que cardiologistas e cirurgi&#245;es card&#237;acos encontram com frequ&#234;ncia crescente &#8211; a necessidade de fazer substituir&#44; ou n&#227;o&#44; a aorta ascendente no contexto de bicuspidia a&#243;rtica&#46; A import&#226;ncia do tema e do artigo em apre&#231;o motivou&#44; ali&#225;s&#44; dois coment&#225;rios editoriais a acompanh&#225;&#8208;lo&#44; um por David Tirone<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> e outro por Mohamad Alkhouli<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#44; editoriais cuja leitura tamb&#233;m recomendo&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Numa v&#225;lvula a&#243;rtica&#44; de base estruturalmente tric&#250;spide&#44; as altera&#231;&#245;es mantidas do fluxo transvalvular&#44; num contexto de estenose&#44; ou mesmo de insufici&#234;ncia a&#243;rtica&#44; determinam dilata&#231;&#227;o da aorta ascendente&#46; Esta dilata&#231;&#227;o dita &#171;p&#243;s&#8208;esten&#243;tica&#187; dever&#225; ser corrigida aquando da substitui&#231;&#227;o valvular&#44; por substitui&#231;&#227;o da aorta ascendente no mesmo tempo&#44; de acordo com as <span class="elsevierStyleItalic">guidelines</span> atuais&#46; A maior parte dos cirurgi&#245;es substitui hoje a aorta ascendente&#44; independentemente do substrato valvular existente&#44; sempre que o calibre da aorta ultrapassa claramente os 50<span class="elsevierStyleHsp" style=""></span>mm&#46; No entanto&#44; Gaudino<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> demonstrou numa s&#233;rie de 93 doentes com v&#225;lvulas a&#243;rticas de base normal tric&#250;spide&#44; mas com estenose e dilata&#231;&#227;o concomitante da aorta ascendente&#44; &#40;entre 50&#8208;59<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; que a substitui&#231;&#227;o da aorta n&#227;o seria necess&#225;ria dado que&#44; ao fim de mais de 15 anos volvidos ap&#243;s a substitui&#231;&#227;o valvular&#44; o di&#226;metro a&#243;rtico n&#227;o ter&#225; variado&#44; nem houve necessidade de uma qualquer interven&#231;&#227;o sobre a aorta ascendente&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se a necessidade de substitui&#231;&#227;o da aorta ascendente dilatada poder&#225; ser&#44; eventualmente&#44; discutida em presen&#231;a de uma v&#225;lvula tric&#250;spide&#44; j&#225; na bicuspidia a&#243;rtica existe evid&#234;ncia sustentada para essa necessidade<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A bicuspidia a&#243;rtica &#233; a cardiopatia cong&#233;nita mais frequente&#44; com uma preval&#234;ncia na popula&#231;&#227;o de cerca de 1&#44;3&#37;&#44; sendo que a dilata&#231;&#227;o da aorta ocorrer&#225; em percentagens vari&#225;veis ao longo da vida&#44; entre 20&#8208;84&#37; dos casos&#46; Com efeito&#44; a bicuspidia a&#243;rtica representa um espectro de les&#245;es podendo envolver a v&#225;lvula&#44; a raiz da aorta&#44; a aorta ascendente e o segmento proximal do arco&#44; e com fen&#243;tipos de express&#227;o muito diferentes&#46; O mecanismo de dilata&#231;&#227;o a&#243;rtica ser&#225; multifatorial&#58; haver&#225; fundamentalmente raz&#245;es hemodin&#226;micas baseadas no perfil do fluxo e no <span class="elsevierStyleItalic">stress</span> a&#243;rtico&#44; relacionados com a bicuspidia de base e&#47;ou com a disfun&#231;&#227;o valvular normalmente associada<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#44; mas parece hoje dif&#237;cil de negar o papel da anomalia gen&#233;tica<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Todos temos encontrado&#44; no largo espectro da bicuspidia a&#243;rtica&#44; doentes com fun&#231;&#227;o valvular preservada por muitos anos e sem dilata&#231;&#227;o da aorta&#44; outros com v&#225;lvula normofuncionante e com aorta dilatada &#8211; este talvez o grupo de decis&#227;o mais incerta&#44; outros ainda com les&#227;o valvular com&#44; ou sem&#44; dilata&#231;&#227;o a&#243;rtica&#46; Causas hemodin&#226;micas e a varia&#231;&#227;o gen&#233;tica parecem&#44; assim&#44; influenciar multifatorialmente&#44; e de modo diferente&#44; esta larga varia&#231;&#227;o fenot&#237;pica&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Independentemente do mecanismo parecer&#225; hoje razo&#225;vel&#44; na bicuspidia com les&#227;o valvular funcional associada e dilata&#231;&#227;o a&#243;rtica&#44; substituir a aorta ascendente para calibres iguais ou superiores a 50<span class="elsevierStyleHsp" style=""></span>mm&#46; Menos definido ser&#225; o que fazer para calibres inferiores a 50<span class="elsevierStyleHsp" style=""></span>mm&#44; sobretudo em presen&#231;a de v&#225;lvulas a&#243;rticas bic&#250;spides normofuncionantes&#44; em que a indica&#231;&#227;o cir&#250;rgica prim&#225;ria &#233; a substitui&#231;&#227;o da aorta ascendente por risco de rutura&#63; O artigo por Shan<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#44; que passaremos agora a comentar&#44; avalia o perfil dos fluxos a&#243;rticos e o <span class="elsevierStyleItalic">shear stress</span> na parede da aorta&#44; em doentes com v&#225;lvulas a&#243;rticas tric&#250;spides e em grupos homog&#233;neos de doentes com v&#225;lvulas bic&#250;spides &#40;com fus&#227;o das cuspes esquerda e direita&#41; e aorta ascendente moderadamente dilatada &#40;40<span class="elsevierStyleHsp" style=""></span>mm&#41; &#8211; normofuncionantes&#44; com estenose e com insufici&#234;ncia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">No estudo&#44; utilizou a resson&#226;ncia magn&#233;tica nuclear &#40;&#91;RMN&#93; <span class="elsevierStyleItalic">full volume&#44; flow sensitive</span>&#41; &#8211; 4<span class="elsevierStyleHsp" style=""></span>D<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#44; tendo verificado que&#58; nas v&#225;lvulas tric&#250;spides sem les&#227;o o fluxo era normal&#44; central e coesivo&#59; nas v&#225;lvulas bic&#250;spides normofuncionantes&#44; o fluxo era exc&#234;ntrico e com trajetos helicoidais a estender&#8208;se pela vertente a&#243;rtica anterior&#8208;direita at&#233; &#224; origem do arco a&#243;rtico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Este perfil acentuava&#8208;se marcadamente &#40;aumento do <span class="elsevierStyleItalic">shear stress</span>&#41; em presen&#231;a de estenose ou de insufici&#234;ncia &#40;sem diferen&#231;a para qualquer destas&#41;&#46; No entanto&#44; na insufici&#234;ncia o <span class="elsevierStyleItalic">shear stress</span> mostrou&#8208;se ainda maior&#44; talvez pelo aumento do volume sist&#243;lico devido &#224; regurgita&#231;&#227;o&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A dilata&#231;&#227;o da aorta ascendente foi prevalente em 82&#37; das v&#225;lvulas bic&#250;spides&#44; independente da presen&#231;a&#44; ou n&#227;o&#44; de les&#227;o valvular&#46; A fragilidade a&#243;rtica cong&#233;nita&#44; devida ao gen&#243;tipo de <span class="elsevierStyleItalic">deficit</span> de fibrilina e associada a um perfil de maior <span class="elsevierStyleItalic">stress</span> hemodin&#226;mico&#44; que &#233; intr&#237;nseco &#224; bicuspidia&#44; condicionam a muito prevalente dilata&#231;&#227;o da aorta&#46; Resta&#44; contudo&#44; explicar a extrema varia&#231;&#227;o&#44; que faz com que nuns doentes o processo ocorra ainda na inf&#226;ncia e&#44; noutros&#44; na vida adulta ou na maturidade&#46; Esta varia&#231;&#227;o talvez se deva &#224; diferente penetra&#231;&#227;o gen&#233;tica e a discrepantes perfis hemodin&#226;micos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O que o artigo por Shan<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> nos ensina de novo &#233; que&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">comparando v&#225;lvulas a&#243;rticas tric&#250;spides e bic&#250;spides&#44; sem disfun&#231;&#227;o valvular&#44; o <span class="elsevierStyleItalic">shear stress</span> induzido pelo fluxo &#233; claramente superior nas bic&#250;spides &#8211; uma caracter&#237;stica inerente &#224; bicuspidia a&#243;rtica&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">na bic&#250;spidia a&#243;rtica&#44; o <span class="elsevierStyleItalic">shear stress</span> na parede anterior&#8208;direita da aorta est&#225; muito aumentado&#44; independentemente da coexist&#234;ncia&#44; ou n&#227;o&#44; de disfun&#231;&#227;o valvular&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">o perfil dos fluxos na bicuspidia a&#243;rtica&#44; com estenose ou insufici&#234;ncia&#44; &#233; diferente e o <span class="elsevierStyleItalic">stress</span> mural &#233; maior&#59; particularmente na insufici&#234;ncia valvular&#44; est&#225; aumentado difusamente face ao fluxo acrescido&#44; e na estenose o aumento &#233; focal e mais dirigido para a parede anterodireita&#46; Esta diferen&#231;a poder&#225; ter impactos distintos sobre a parede a&#243;rtica&#44; &#224; dist&#226;ncia&#44; levando a tipos de dilata&#231;&#227;o a&#243;rtica diferentes&#59;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">finalmente&#44; poder&#8208;se &#225; inferir que&#44; em caso de repara&#231;&#227;o valvular a&#243;rtica&#44; uma configura&#231;&#227;o tric&#250;spide proteger&#225; mais a aorta do que a preserva&#231;&#227;o da forma bic&#250;spide&#44; devendo estas idealmente contemplar uma geometria a 180&#176;&#44; visando obter fluxos mais laminares<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46;</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">At&#233; agora&#44; a substitui&#231;&#227;o profil&#225;tica da aorta era ditada exclusivamente pelo calibre e ritmo de expans&#227;o&#44; mas est&#225; aberto caminho para uma maior personaliza&#231;&#227;o na decis&#227;o&#44; no que concerne &#224; substitui&#231;&#227;o da aorta ascendente&#44; baseada tamb&#233;m no facto de existir&#44; ou n&#227;o&#44; uma les&#227;o valvular associada&#44; tratando&#8208;se de uma estenose ou&#44; mais prementemente e com maior controlo&#44; no caso de insufici&#234;ncia valvular&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">As <span class="elsevierStyleItalic">guidelines</span> hoje prevalentes para lidar com a dilata&#231;&#227;o da aorta ascendente associada &#224; bicuspidia a&#243;rtica com les&#227;o valvular significativa apontam para a sua substitui&#231;&#227;o no mesmo&#44; se o di&#226;metro for igual ou superior a 45<span class="elsevierStyleHsp" style=""></span>mm<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#44; se a v&#225;lvula bic&#250;spide &#233; normofuncionante parece razo&#225;vel esperar at&#233; que a aorta ascendente atinja pelo menos 50<span class="elsevierStyleHsp" style=""></span>mm&#44; isto na aus&#234;ncia de crescimento r&#225;pido ou de sintomas&#46; &#201; poss&#237;vel na maioria dos casos substituir a aorta&#44; preservando a v&#225;lvula a&#243;rtica&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A RMN 4<span class="elsevierStyleHsp" style=""></span>D parece ser um m&#233;todo &#250;til para avaliar os impactos do perfil de fluxo sobre a aorta&#44; e ajudar no seguimento e decis&#227;o&#44; agora personalizada&#44; do momento cir&#250;rgico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclus&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">As v&#225;lvulas a&#243;rticas bic&#250;spides &#40;mesmo as normofuncionantes&#41; est&#227;o associadas a um perfil anormal de fluxo&#44; com maior <span class="elsevierStyleItalic">stress</span> parietal a&#243;rtico&#46; Este perfil agrava&#8208;se em presen&#231;a de disfun&#231;&#227;o valvular&#44; particularmente na insufici&#234;ncia&#46; Estas considera&#231;&#245;es devem ser tidas em conta no estabelecer do momento da interven&#231;&#227;o para substitui&#231;&#227;o da aorta em contexto de bicuspidia a&#243;rtica&#44; que pode agora passar a ser individualizada&#44; e n&#227;o s&#243; baseada no di&#226;metro&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflito de interesses</span><p id="par0100" class="elsevierStylePara elsevierViewall">O autor declara n&#227;o haver conflito de interesses&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:5 [
        0 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Coment&#225;rio"
        ]
        2 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Conclus&#227;o"
        ]
        3 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflito de interesses"
        ]
        4 => array:1 [
          "titulo" => "Bibliografia"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">J Thorac Cardiovasc Surg&#46;&#160;2017 Jun&#59;153&#40;6&#41;&#58;1263&#8208;1272&#46;e1&#46; doi&#58; 10&#46;1016&#47;j&#46;jtcvs&#46;2016&#46;12&#46;059&#46; Epub 2017 Feb 10&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "e1"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aortic shear stress in bicuspid aortic valve in patients with stenosis and insufficiency"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Y&#46; Shan"
                            1 => "J&#46; Li"
                            2 => "Y&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thoracic Cardiovasc Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "153"
                        "paginaInicial" => "1263"
                        "paginaFinal" => "1272"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Form follows function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46;E&#46; David"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2017.02.046"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2017"
                        "volumen" => "153"
                        "paginaInicial" => "1261"
                        "paginaFinal" => "1262"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28351478"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The sheer stress of deciding when to replace the aorta in bicuspid valve disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Alkhouli"
                            1 => "J&#46;S&#46; Rankin"
                            2 => "J&#46;D&#46; Mills"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2017.03.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2017"
                        "volumen" => "153"
                        "paginaInicial" => "1273"
                        "paginaFinal" => "1274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28377120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aortic expansion rate in patients with dilated post&#8208;stenotic ascending aorta submitted only to aortic valve replacement long&#8208;term follow&#8208;up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Gaudino"
                            1 => "A&#46; Anselmi"
                            2 => "M&#46; Morelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2011.03.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2011"
                        "volumen" => "58"
                        "paginaInicial" => "581"
                        "paginaFinal" => "584"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21798419"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Borger"
                            1 => "M&#46; Preston"
                            2 => "J&#46; Ivanov"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2004.07.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2004"
                        "volumen" => "128"
                        "paginaInicial" => "677"
                        "paginaFinal" => "683"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15514594"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New insights in the association between bicuspid aortic valve phenotype&#44; aortic configuration and valve haemodynamics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46;H&#46; Sievers"
                            1 => "U&#46; Stierle"
                            2 => "R&#46;M&#46; Hachmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ejcts/ezv087"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "49"
                        "paginaInicial" => "439"
                        "paginaFinal" => "446"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25787670"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bicuspid aortic valve is heritable"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Cripe"
                            1 => "G&#46; Andelfinger"
                            2 => "L&#46;J&#46; Martin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2004.03.050"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2004"
                        "volumen" => "44"
                        "paginaInicial" => "138"
                        "paginaFinal" => "143"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15234422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bicuspid aortic valve&#58; four&#8208;dimensional MR evaluation of ascending aortic systolic flow patterns"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;D&#46; Hope"
                            1 => "T&#46;A&#46; Hope"
                            2 => "A&#46;K&#46; Meadows"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.09091437"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology&#46;"
                        "fecha" => "2010"
                        "volumen" => "255"
                        "paginaInicial" => "53"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20308444"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Greater asymmetric wall shear stress in Sievers&#8217; type 1&#47;LR compared with 0&#47;LAT bicuspid aortic valves after valve&#8208;sparing aortic root replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;H&#46; Stephens"
                            1 => "T&#46;A&#46; Hope"
                            2 => "F&#46;A&#46; Kari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2015.04.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "150"
                        "paginaInicial" => "59"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25956338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2014 AHA&#47;ACC guideline for the management of patients with valvular heart disease&#58; a report of the American College of Cardiology&#47;American Heart Association Task Force on Practice Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;A&#46; Nishimura"
                            1 => "C&#46;M&#46; Otto"
                            2 => "R&#46;O&#46; Bonow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2014.05.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2014"
                        "volumen" => "148"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "e132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24939033"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/21742049/0000003600000078/v1_201707290050/S2174204917302118/v1_201707290050/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9913"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Recommended article of the month"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000078/v1_201707290050/S2174204917302118/v1_201707290050/pt/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302118?idApp=UINPBA00004E"
]
Article information
ISSN: 21742049
Original language: Portuguese
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 8 7 15
2024 October 40 30 70
2024 September 47 23 70
2024 August 44 26 70
2024 July 55 26 81
2024 June 37 26 63
2024 May 42 20 62
2024 April 42 27 69
2024 March 68 26 94
2024 February 36 17 53
2024 January 23 23 46
2023 December 28 22 50
2023 November 37 23 60
2023 October 47 16 63
2023 September 26 23 49
2023 August 30 17 47
2023 July 25 14 39
2023 June 20 12 32
2023 May 43 30 73
2023 April 21 1 22
2023 March 29 20 49
2023 February 23 14 37
2023 January 22 16 38
2022 December 35 21 56
2022 November 33 20 53
2022 October 34 24 58
2022 September 18 37 55
2022 August 25 22 47
2022 July 23 33 56
2022 June 26 25 51
2022 May 20 22 42
2022 April 34 41 75
2022 March 29 40 69
2022 February 25 35 60
2022 January 24 28 52
2021 December 35 25 60
2021 November 33 27 60
2021 October 40 40 80
2021 September 22 19 41
2021 August 28 33 61
2021 July 15 21 36
2021 June 29 26 55
2021 May 34 41 75
2021 April 90 44 134
2021 March 54 23 77
2021 February 44 18 62
2021 January 40 14 54
2020 December 29 17 46
2020 November 22 8 30
2020 October 22 17 39
2020 September 34 11 45
2020 August 24 7 31
2020 July 30 2 32
2020 June 32 6 38
2020 May 26 6 32
2020 April 34 8 42
2020 March 23 10 33
2020 February 39 11 50
2020 January 28 4 32
2019 December 16 9 25
2019 November 17 3 20
2019 October 26 8 34
2019 September 13 8 21
2019 August 27 6 33
2019 July 21 8 29
2019 June 18 10 28
2019 May 24 12 36
2019 April 14 13 27
2019 March 27 10 37
2019 February 24 6 30
2019 January 22 7 29
2018 December 41 12 53
2018 November 38 5 43
2018 October 51 10 61
2018 September 31 11 42
2018 August 11 14 25
2018 July 9 5 14
2018 June 18 2 20
2018 May 27 3 30
2018 April 33 8 41
2018 March 54 12 66
2018 February 19 3 22
2018 January 39 7 46
2017 December 71 7 78
2017 November 30 21 51
2017 October 32 15 47
2017 September 38 20 58
2017 August 59 20 79
2017 July 1 1 2
Show all

Follow this link to access the full text of the article

Idiomas
Revista Portuguesa de Cardiologia (English edition)
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.