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BMJ Case Reports Feb 2016This report describes a case of Campylobacter fetus prosthetic valve infective endocarditis and discusses the subsequent management. Although C. fetus has a tropism for...
This report describes a case of Campylobacter fetus prosthetic valve infective endocarditis and discusses the subsequent management. Although C. fetus has a tropism for vascular endothelium, infective endocarditis has rarely been reported. In this patient, despite initial optimal antimicrobial therapy, valve replacement was ultimately required due to ongoing infectious emboli to the brain in the setting of evidence of vegetation enlargement on echocardiogram. The prosthetic valve was replaced, the patient completed a 6-week course of parenteral antibiotics after surgical intervention and he made a full recovery with no long-term neurological sequelae. This case highlights the fact that despite the relatively low prevalence of C. fetus endocarditis, it is associated with a high degree of mortality and valve replacement is often indicated.
Topics: Aged; Anti-Bacterial Agents; Campylobacter Infections; Campylobacter fetus; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male
PubMed: 26917729
DOI: 10.1136/bcr-2015-212928 -
Heart (British Cardiac Society) Mar 2019Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area... (Review)
Review
Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm/m following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10-15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.
Topics: Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Heart Valve Prosthesis; Humans; Prosthesis Design; Prosthesis Failure
PubMed: 30846522
DOI: 10.1136/heartjnl-2018-313515 -
The Journal of Thoracic and... Apr 2023Intrinsic risk of infection of cryopreserved allograft aortic root replacements remains poorly understood despite their long history of use. The objective of this study...
OBJECTIVE
Intrinsic risk of infection of cryopreserved allograft aortic root replacements remains poorly understood despite their long history of use. The objective of this study was to determine this intrinsic risk of allograft infection and its risk factors when allografts are implanted for both nonendocarditis indications and infective endocarditis.
METHODS
From January 1987 to January 2017, 2042 patients received 2110 allograft aortic valves at a quaternary medical center, 1124 (53%) for nonendocarditis indications and 986 (47%) for endocarditis indications (670 [68%] prosthetic valve endocarditis). Staphylococcus aureus caused 193 of 949 cases of endocarditis (20%), 71 (7.3%) in persons who injected drugs. Periodic surveillance and cross-sectional follow-up achieved 85% of possible follow-up time. The primary end point was allograft infection in patients with nonendocarditis and endocarditis indications. Risk factors were identified by hazard function decomposition and machine learning.
RESULTS
During follow-up, 30 allografts (26 explanted) became infected in patients in the nonendocarditis group and 49 (41 explanted) in patients with endocarditis. At 20 years, the probability of allograft infection was 5.6% in patients in the nonendocarditis group and 14% in patients with endocarditis. Risk factors for allograft infection in patients in the nonendocarditis group were younger patient age and older donor age. Risk factors for allograft infection in patients with endocarditis were earlier implant year, injection drug use, and younger age. In patients with endocarditis, 18% of allograft infections were caused by the original organism.
CONCLUSIONS
The low infection rates, both in patients without and with endocarditis, support continued use of allografts in the modern era, in particular for the treatment of invasive endocarditis of the aortic root.
Topics: Humans; Endocarditis, Bacterial; Cross-Sectional Studies; Heart Valve Prosthesis; Endocarditis; Allografts
PubMed: 34366128
DOI: 10.1016/j.jtcvs.2021.04.086 -
Cardiovascular Intervention and... Oct 2022Prosthesis-patient mismatch (PPM), first described in 1978, occurs when a prosthetic valve functions normally, but has an effective orifice area that is too small... (Review)
Review
Prosthesis-patient mismatch (PPM), first described in 1978, occurs when a prosthetic valve functions normally, but has an effective orifice area that is too small relative to the patient's body surface area. It results in residual left ventricular afterload and higher transvalvular pressure gradient, which has been considered to impair prognosis. PPM following surgical aortic replacement is reportedly associated with worse clinical outcomes, such as high mortality. However, the impact of PPM on clinical outcomes after transcatheter aortic valve implantation (TAVI) remains unclear. There is conflicting evidence on the impact of PPM following TAVI due to differences across studies in terms of follow-up period, methods, patient populations, and type of bioprosthetic valve. The present review summarizes the most recent evidence on PPM after TAVI.
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prosthesis Design; Risk Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35708855
DOI: 10.1007/s12928-022-00865-z -
Current Cardiology Reports Jun 2015The specific flow pattern and imaging features of prosthetic heart valves poses major challenges for the Doppler echocardiographic assessment of prosthetic valve... (Review)
Review
The specific flow pattern and imaging features of prosthetic heart valves poses major challenges for the Doppler echocardiographic assessment of prosthetic valve structure and function. A comprehensive approach that integrates several semi-quantitative and quantitative parameters obtained from multiple views is key to appropriately detect and quantitate prosthetic valve dysfunction and complications. In patients with prosthetic valves, and particularly in those with mitral prostheses, transesophageal echocardiography is often required to confirm and/or complement information obtained by transthoracic echocardiography. Three-dimensional echocardiography may provide incremental information for the identification of the underlying etiology of prosthetic valve stenosis or regurgitation. Transcatheter aortic valve implantation has rapidly expanded in the past 10 years and paravalvular regurgitation is frequent following this procedure. Given that paravalvular regurgitant jets are often multiple, irregular, and eccentric, the grading of this type of regurgitation is particularly challenging and requires an integrative multiwindow, multiplane, multiparametric approach.
Topics: Constriction, Pathologic; Echocardiography; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Prosthesis Failure; Thrombosis; Treatment Outcome
PubMed: 26003146
DOI: 10.1007/s11886-015-0602-z -
Gaceta Medica de Mexico 2022Heart valve bioprostheses are the gold standard for aortic valve surgical replacement in selected patients.
INTRODUCTION
Heart valve bioprostheses are the gold standard for aortic valve surgical replacement in selected patients.
OBJECTIVE
To evaluate the safety and efficacy of the National Institute of Cardiology (INC) bioprosthetic heart valve in humans.
METHODS
Single-center study that included 341 patients who underwent single surgical aortic valve replacement with INC heart valve.
RESULTS
318 implants were performed de novo (93%) and 23 as redo surgery (7%); STS scores were 1.4 and 1.8%, and follow-up was for 42 and 46 months, respectively. There were no differences in clinical complications or pacemaker implantation rate. Both groups maintained a normal LVEF. Overall improvement in functional class was observed, with worsening only in two patients of the de novo group. INC prosthesis dysfunction requiring surgical reintervention was observed in eight patients (4.65%) of the de novo group vs. one patient in the redo group.
CONCLUSIONS
The INC heart valve is efficacious and safe, and is associated with a low rate of complications and functional class improvement during long-term follow-up. Prospective, comparative studies of this valve are required.
Topics: Humans; Heart Valve Prosthesis Implantation; Prospective Studies; Aortic Valve; Heart Valve Prosthesis; Prosthesis Failure; Cardiology; Treatment Outcome; Aortic Valve Stenosis; Reoperation
PubMed: 36657112
DOI: 10.24875/GMM.M22000715 -
Mymensingh Medical Journal : MMJ Jul 2022Mechanical prosthetic valve thrombosis is a serious complication which necessitates immediate intervention. The presenting signs and symptoms of this illness are...
Mechanical prosthetic valve thrombosis is a serious complication which necessitates immediate intervention. The presenting signs and symptoms of this illness are somewhat variable, but physical examination and trans-esophageal-echocardiography enable rapid diagnosis. Valve replacement or thrombolysis in the correct hospital setting must be performed to avoid life-threatening complication without delay. But it is not proven entirely which therapy is superior. For any given patient, the risks of thrombolytic therapy, including bleeding, systemic embolism and failure to restore valvular function, must be weighed against the risks of surgical intervention. In spite of aggressive therapy, morbidity and mortality from prosthetic valve thrombosis and its treatment are not less indeed. This report describes the case of a woman with aortic prosthetic valves who presents with heart failure and evidence of severe prosthetic aortic valve dysfunction after a period of suboptimal anticoagulation.
Topics: Aortic Valve; Female; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Thrombolytic Therapy; Thrombosis
PubMed: 35780379
DOI: No ID Found -
JACC. Cardiovascular Interventions Feb 2015The aim of this review is to describe the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis (PVE) after transcatheter valve... (Review)
Review
OBJECTIVES
The aim of this review is to describe the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis (PVE) after transcatheter valve replacement (TVR).
BACKGROUND
Very few data exist on PVE after TVR.
METHODS
Studies published between 2000 and 2013 regarding PVE in patients with transcatheter aortic valve replacement (TAVR) or transcatheter pulmonary valve replacement (TPVR) were identified through a systematic electronic search.
RESULTS
A total of 28 publications describing 60 patients (32 TAVRs, 28 TPVRs) were identified. Most TAVR patients (66% male, 80 ± 7 years of age) had a very high-risk profile (mean logistic EuroSCORE: 30.4 ± 14.0%). In TPVR patients (90% male, 19 ± 6 years of age), PVE was more frequent in the stenotic conduit/valve (61%). The median time between TVR and infective endocarditis was 5 months (interquartile range: 2 to 9 months). Typical microorganisms were mostly found with a higher incidence of enterococci after TAVR (34.4%), and Staphylococcus aureus after TPVR (29.4%). As many as 60% of the TAVR-PVE patients were managed medically despite related complications such as local extension, embolism, and heart failure in more than 50% of patients. The valve explantation rate was 57% and 23% in balloon- and self-expandable valves, respectively. In-hospital mortality for TAVR-PVE was 34.4%. Most TPVR-PVE patients (75%) were managed surgically, and in-hospital mortality was 7.1%.
CONCLUSIONS
Most cases of PVE post-TVR involved male patients, with a very high-risk profile (TAVR) or underlying stenotic conduit/valve (TPVR). Typical, but different, microorganisms of PVE were involved in one-half of the TAVR and TPVR cases. Most TPVR-PVE patients were managed surgically as opposed to TAVR patients, and the mortality rate was high, especially in the TAVR cohort.
Topics: Endocarditis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Incidence; Pulmonary Valve; Risk Factors; Transcatheter Aortic Valve Replacement
PubMed: 25700757
DOI: 10.1016/j.jcin.2014.09.013 -
Journal of Medical Engineering &... Jan 2021Mechanical Heart Valves (MHVs) are known for their excellent lifespan and feasibly are the most reliable and stable valves amongst all prosthetic valves. Successful...
Mechanical Heart Valves (MHVs) are known for their excellent lifespan and feasibly are the most reliable and stable valves amongst all prosthetic valves. Successful bileaflet MHVs such as the St. Jude Medical (SJM) are known for providing central blood flow and minimal pressure drop across the valve. However, due to their non-physiological flow conditions, they still suffer from hemodynamic complications, that is, red blood cell (RBC) lysis and/or thrombogenicity, to date. Our hypothesis is that the design of MHVs can be improved so that their hemodynamics can be comparable to those of tissue valves. In this study, a new concept for the design of MHVs is proposed. To accomplish this, we identified the major design limitations of bileaflet MHVs, such as the gold standard SJM valve as well as the believed contributing factors to their thrombogenicity. We developed a novel design architecture for bileaflet MHVs that addressed these limitations, and from it, the Apex Valve (AV). Our experimental assessment of the AV found that its hemodynamics were closer to that of a bioprosthetic valve than of a bileaflet MHV. This design has been filed as a US Provisional Patent.
Topics: Heart Valve Prosthesis; Heart Valves; Hemodynamics; Models, Cardiovascular; Prosthesis Design
PubMed: 33448912
DOI: 10.1080/03091902.2020.1853835 -
The Journal of Thoracic and... Apr 2022
Topics: Heart Valve Prosthesis; Humans; Mitral Valve
PubMed: 34535269
DOI: 10.1016/j.jtcvs.2021.08.060