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The American Surgeon Feb 2022Dr Nina Braunwald is celebrated for her work as the first female cardiothoracic surgeon and her key role in the design and implementation of the first prosthetic mitral...
Dr Nina Braunwald is celebrated for her work as the first female cardiothoracic surgeon and her key role in the design and implementation of the first prosthetic mitral valve. She began her residency at Bellevue Hospital in 1952, a time in the United States where the scope of women's work was limited. Once her training took her to the National Institutes of Health (NIH), her historic flexible leaflet valve was developed and Dr Braunwald paved an innovative step toward the advanced prostheses of today. Afterward, she was recognized by the American Board of Thoracic Surgery in 1963. Her extensive research and educational passion for cardiothoracic surgery led to numerous publications, a leadership role with the NIH, and associate professorship at University of California San Diego and Harvard; leaving behind a significant legacy to be memorialized in awards and fellowships to women in academic cardiac surgery. Her work inspired continued evolution of the prosthetic valve and countless women to pursue surgery as a career before passing away in 1992, leaving behind a new generation of women surgeons. Despite her successful career, she was never promoted to full professor by her academic institutions.
Topics: Boston; California; Heart Valve Prosthesis; History, 20th Century; Humans; Mitral Valve; National Institutes of Health (U.S.); Physicians, Women; Prosthesis Design; Thoracic Surgery; United States
PubMed: 33381976
DOI: 10.1177/0003134820982575 -
Radiographics : a Review Publication of... 2019Replacement with a prosthetic heart valve (PHV) remains the definitive surgical procedure for management of severe cardiac valve disease. PHV dysfunction is uncommon but... (Review)
Review
Replacement with a prosthetic heart valve (PHV) remains the definitive surgical procedure for management of severe cardiac valve disease. PHV dysfunction is uncommon but can be a life-threatening condition. The broad hemodynamic and pathophysiologic manifestations of PHV dysfunction are stenosis, regurgitation, and a stuck leaflet. Specific structural abnormalities that cause PHV dysfunction include prosthetic valve-patient mismatch, structural failure, valve calcification, dehiscence, paravalvular leak, infective endocarditis, abscess, pseudoaneurysm, abnormal connections, thrombus, hypoattenuating leaflet thickening, and pannus. Multiple imaging modalities are available for evaluating a PHV and its dysfunction. Transthoracic echocardiography is often the first-line imaging modality, with additional modalities such as transesophageal echocardiography, CT, MRI, cine fluoroscopy, and nuclear medicine used for further characterization and establishing a specific cause. The authors review PHVs and the role of imaging modalities in evaluation of PHV dysfunction and illustrate the imaging appearances of different complications. RSNA, 2019.
Topics: Aortic Dissection; Aneurysm, False; Bioprosthesis; Calcinosis; Cineradiography; Constriction, Pathologic; Echocardiography; Endocarditis; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Magnetic Resonance Imaging; Multimodal Imaging; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Single Photon Emission Computed Tomography Computed Tomography; Surgical Wound Dehiscence
PubMed: 31150303
DOI: 10.1148/rg.2019180177 -
Kyobu Geka. the Japanese Journal of... Apr 2023Prosthetic valve endocarditis is a fatal complication after valve replacement surgery. Early surgical intervention is recommended for patients who suffer from...
Prosthetic valve endocarditis is a fatal complication after valve replacement surgery. Early surgical intervention is recommended for patients who suffer from complications such as heart failure, valve dysfunction, and abscesses. In the present study, we evaluated the clinical characteristics of 18 patients who underwent surgery for prosthetic valve endocarditis at our institution between December 1990 and August 2022, and examined the appropriateness of the timing and method of surgery, and whether there was improvement in cardiac function. Guidelines-based surgical intervention resulted in improved survival and improved cardiac function in the early and late postoperative period.
Topics: Humans; Endocarditis, Bacterial; Heart Valve Prosthesis; Prosthesis-Related Infections; Endocarditis; Reoperation; Treatment Outcome; Aortic Valve
PubMed: 36997175
DOI: No ID Found -
Journal of Internal Medicine Sep 2022Prosthetic valve endocarditis (PVE) is a feared complication after heart valve surgery. Studies on differences in bacteriology in various types of PVE are limited.
BACKGROUND
Prosthetic valve endocarditis (PVE) is a feared complication after heart valve surgery. Studies on differences in bacteriology in various types of PVE are limited.
OBJECTIVES
This study aimed to investigate the microbiology of PVE depending on the type of prosthetic valve and timing of diagnosis.
METHODS
A retrospective study based on the Swedish Registry on Infective Endocarditis focusing on PVE was conducted. The cohort was divided into mechanical and bioprosthetic valves; into endocarditis localization in the aortic, mitral, or tricuspid valve; and into early and late PVE. The microbiology in these groups was compared. Predictors of Staphylococcus aureus as the cause of PVE were examined by multivariable logistic regression.
RESULTS
A total of 780 episodes of PVE in 749 patients were compared regarding the distribution of causative microbiological agents. The most common agents included alpha-hemolytic streptococci (29%), S. aureus (22%), enterococci (14%), coagulase-negative staphylococci (CoNS) (12%), and Cutibacterium acnes (6%). S. aureus was more commonly found on mechanical valves compared to bioprosthetic ones (36% vs. 17%, p < 0.001) whereas alpha-hemolytic streptococci, enterococci, and CoNS were more common on bioprosthetic valves. There were no significant differences in the microbiology of PVE affecting mitral or aortic valves or in cases of early and late PVE. Predictors for S. aureus as the cause of PVE were end-stage renal disease, intravenous drug use, mechanical valve, and tricuspid localization of endocarditis.
CONCLUSIONS
The type of prosthetic heart valve is associated with the causative pathogen. Patients with mechanical valves are more likely to have PVE caused by S. aureus.
Topics: Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Prosthesis-Related Infections; Registries; Retrospective Studies; Staphylococcus aureus
PubMed: 35373870
DOI: 10.1111/joim.13491 -
Circulation. Cardiovascular Imaging Apr 2024Heart valve replacement has steadily increased over the past decades due to improved surgical mortality, an aging population, and the increasing use of transcatheter... (Review)
Review
Heart valve replacement has steadily increased over the past decades due to improved surgical mortality, an aging population, and the increasing use of transcatheter valve technology. With these developments, prosthetic valve complications, including prosthetic valve endocarditis, are increasingly encountered. In this review, we aim to characterize the manifestations of prosthetic valve endocarditis using representative case studies from our institution to highlight the advances and contributions of modern multimodality imaging techniques.
Topics: Humans; Aged; Endocarditis, Bacterial; Heart Valve Prosthesis; Endocarditis; Heart Valve Prosthesis Implantation; Multimodal Imaging; Prosthesis-Related Infections
PubMed: 38626096
DOI: 10.1161/CIRCIMAGING.123.016435 -
Journal of Nuclear Cardiology :... Oct 2017
Topics: Endocarditis; Fluorodeoxyglucose F18; Heart Valve Prosthesis; Humans; Positron Emission Tomography Computed Tomography; Prosthesis-Related Infections; Radiopharmaceuticals
PubMed: 28560560
DOI: 10.1007/s12350-017-0938-4 -
Current Cardiology Reviews 2023Prosthetic valve endocarditis can be difficult to diagnose and cause significant morbidity and mortality, especially when no culture data are available to guide therapy....
BACKGROUND
Prosthetic valve endocarditis can be difficult to diagnose and cause significant morbidity and mortality, especially when no culture data are available to guide therapy. Transthoracic and transesophageal echocardiograms, the studies of choice for initial endocarditis evaluation, can be less reliable due to artifact and post-surgical changes. Some less common forms of endocarditis may be difficult to culture and, due to their fastidious nature, may delay the identification of causative organisms. Given the lack of directed antimicrobial treatment, culturenegative prosthetic valve endocarditis is specifically difficult. A wide differential diagnosis is critical to make a timely diagnosis and initiate treatment.
CASE PRESENTATION
We present a case of a patient presenting with dyspnea which was found to have culture-negative endocarditis requiring mitral and aortic valve replacement that ultimately was complicated with culture-negative prosthetic valve endocarditis. Identifying a culprit organism made appropriate and timely antimicrobial treatment difficult, ultimately resulting in the patient dying from endocarditis complications.
CONCLUSION
A high index of suspicion is needed when managing infective endocarditis, especially when prosthetic valves are involved. Diagnostic accuracy of cultures and echocardiography may be reduced when dealing with prosthetic valve endocarditis; thus, alternative methods of diagnosis may be required to make a timely diagnosis of causative organisms.
Topics: Humans; Endocarditis, Bacterial; Heart Valve Prosthesis; Aortic Valve; Echocardiography; Anti-Infective Agents
PubMed: 37055889
DOI: 10.2174/1573403X19666230411151214 -
Nederlands Tijdschrift Voor Geneeskunde Feb 2022We report on three patients with infective endocarditis, which differ greatly in clinical manifestations. Infective endocarditis (IE) is defined by, a mostly bacterial,...
We report on three patients with infective endocarditis, which differ greatly in clinical manifestations. Infective endocarditis (IE) is defined by, a mostly bacterial, infection of a native or prosthetic heart valve, the endocardial surface or a cardiac device. It is a rare condition, but it's incidence is increasing because of an increased incidence of elderly patients with chronic disease and cardiac devices. IE is heterogeneous in aetiology, clinical manifestations, and course. It can involve almost any organ system. The presentation often remains subtle and varies with nonspecific symptoms ranging from a mild infection to septic shock and multiorgan failure. IE remains a highly mortal disease, since the diagnosis is missed often. A thorough anamnesis and physical examination can be helpful. Blood cultures prior to antibiotics and echocardiography are key diagnostic steps if there's a clinical suspicion of IE.
Topics: Aged; Anti-Bacterial Agents; Echocardiography; Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans
PubMed: 35129893
DOI: No ID Found -
The Canadian Journal of Cardiology Jul 2021Surgical replacement remains the primary option to treat the rapidly growing number of patients with severe valvular heart disease. Although current valve... (Review)
Review
Surgical replacement remains the primary option to treat the rapidly growing number of patients with severe valvular heart disease. Although current valve replacements-mechanical, bioprosthetic, and cryopreserved homograft valves-enhance survival and quality of life for many patients, the ideal prosthetic heart valve that is abundantly available, immunocompatible, and capable of growth, self-repair, and life-long performance has yet to be developed. These features are essential for pediatric patients with congenital defects, children and young adult patients with rheumatic fever, and active adult patients with valve disease. Heart valve tissue engineering promises to address these needs by providing living valve replacements that function similarly to their native counterparts. This is best evidenced by the long-term clinical success of decellularised pulmonary and aortic homografts, but the supply of homografts cannot meet the demand for replacement valves. A more abundant and consistent source of replacement valves may come from cellularised valves grown in vitro or acellular off-the-shelf biomaterial/tissue constructs that recellularise in situ, but neither tissue engineering approach has yet achieved long-term success in preclinical testing. Beyond the technical challenges, heart valve tissue engineering faces logistical, economic, and regulatory challenges. In this review, we summarise recent progress in heart valve tissue engineering, highlight important outcomes from preclinical and clinical testing, and discuss challenges and future directions toward clinical translation.
Topics: Biocompatible Materials; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Long Term Adverse Effects; Materials Testing; Tissue Engineering; Translational Research, Biomedical
PubMed: 33839245
DOI: 10.1016/j.cjca.2021.03.022 -
Journal of Thrombosis and Thrombolysis Apr 2023Since the beginning of the SARS-CoV-2 (COVID-19) pandemic, correlation of venous thromboembolism (VTE) and COVID-19 infection has been well established. Increased... (Review)
Review
Since the beginning of the SARS-CoV-2 (COVID-19) pandemic, correlation of venous thromboembolism (VTE) and COVID-19 infection has been well established. Increased inflammatory response in the setting of COVID-19 infection is associated with VTE and hypercoagulability. Venous and arterial thrombotic events in COVID-19 infection have been well documented; however, few cases have been reported involving cardiac valve prostheses. In this review, we present a total of eight cases involving COVID-19-related prosthetic valve thrombosis (PVT), as identified in a systematic review. These eight cases describe valve position (mitral versus aortic) and prosthesis type (bioprosthetic versus mechanical), and all cases demonstrate incidents of PVT associated with simultaneous or recent COVID-19 infection. None of these eight cases display obvious non-adherence to anticoagulation; five of the cases occurred greater than three years after the most recent valve replacement. Our review offers insights into PVT in COVID-19 infected patients including an indication for increased monitoring in the peri-infectious period. We explore valve thrombosis as a mechanism for prosthetic valve failure. We describe potential differences in antithrombotic strategies that may offer added antithrombotic protection during COVID-19 infection. With the growing population of valve replacement patients and recurring COVID-19 infection surges, it is imperative to explore relationships between COVID-19 and PVT.
Topics: Humans; Fibrinolytic Agents; Venous Thromboembolism; COVID-19; SARS-CoV-2; Heart Valve Diseases; Heart Valve Prosthesis; Thrombosis; Aortic Valve
PubMed: 36528721
DOI: 10.1007/s11239-022-02746-x