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JTCVS Techniques Dec 2023
PubMed: 38152198
DOI: 10.1016/j.xjtc.2023.09.002 -
Annals of Cardiothoracic Surgery May 2024The Y-incision/rectangular patch aortic annular enlargement (Y-incision AAE) is our go-to technique for aortic annular/root enlargement at the University of Michigan for...
The Y-incision/rectangular patch aortic annular enlargement (Y-incision AAE) is our go-to technique for aortic annular/root enlargement at the University of Michigan for its simplicity and effectiveness. A complete aortotomy is used for first-time surgical aortic valve replacements (SAVRs), and a partial aortotomy is frequently used in reoperative SAVR. The Y-incision is made through the left-non commissure, underneath the aortic annulus to the left and right fibrous trigones. A rectangular patch is sewn to the aorto-mitral curtain from the left fibrous trigone to the right fibrous trigone and transitioned to the aortic annulus on both sides. The enlarged aortic annulus/root is sized with the valve-shape end of the sizer, and the largest size that can touch all three nadirs of the aortic annulus with one strut facing the left-right commissure is chosen. The non-pledgetted valve sutures are placed in a non-everting suture fashion on the aortic annulus, and inside-outside-inside on the patch. The sutures at the nadir of the non-coronary sinus and left coronary sinus are tied first. The proximal ascending aorta is enlarged with a posterior longitudinal aortotomy, and the distal end of the patch is trimmed to a triangular shape to facilitate the closure of the aortotomy with the "Roof" technique. In the 142 consecutives cases, the median size of prosthetic valve used was 29 and upsizing was 3-4 valve sizes. Outcomes included one death, one stroke, two pacemaker implantations for complete heart block including one case of aortic valve endocarditis with Gerbode fistula, and no reoperation for post-operative bleeding. The median aortic valve mean gradient was 7 mmHg and aortic valve area was 2.4 cm two years after SAVR. The median left ventricular mass index regression was 41% in 12-24 months in patients with moderate/severe aortic stenosis.
PubMed: 38841092
DOI: 10.21037/acs-2023-aae-0151 -
Cells Jul 2023This review discusses the evolving topic of atrial cardiomyopathy concerning valvular heart disease. The pathogenesis of atrial cardiomyopathy involves multiple factors,... (Review)
Review
This review discusses the evolving topic of atrial cardiomyopathy concerning valvular heart disease. The pathogenesis of atrial cardiomyopathy involves multiple factors, such as valvular disease leading to atrial structural and functional remodeling due to pressure and volume overload. Atrial enlargement and dysfunction can trigger atrial tachyarrhythmia. The complex interaction between valvular disease and atrial cardiomyopathy creates a vicious cycle of aggravating atrial enlargement, dysfunction, and valvular disease severity. Furthermore, atrial remodeling and arrhythmia can predispose to atrial thrombus formation and stroke. The underlying pathomechanism of atrial myopathy involves molecular, cellular, and subcellular alterations resulting in chronic inflammation, atrial fibrosis, and electrophysiological changes. Atrial dysfunction has emerged as an essential determinant of outcomes in valvular disease and heart failure. Despite its predictive value, the detection of atrial fibrosis and dysfunction is challenging and is not included in the clinical routine. Transthoracic echocardiography and cardiac magnetic resonance imaging are the main diagnostic tools for atrial cardiomyopathy. Recently published data have revealed that both left atrial volumes and functional parameters are independent predictors of cardiovascular events in valvular disease. The integration of atrial function assessment in clinical practice might help in early cardiovascular risk estimation, promoting early therapeutic intervention in valvular disease.
Topics: Humans; Atrial Fibrillation; Heart Valve Diseases; Cardiomyopathies; Heart Failure; Fibrosis; Molecular Biology
PubMed: 37443830
DOI: 10.3390/cells12131796 -
Heart Failure Reviews Jan 2024Cardiac amyloidosis (CA) is an underdiagnosed condition caused by the deposition of misfolded proteins, namely immunoglobulin light chains and transthyretin, in the... (Review)
Review
Cardiac amyloidosis (CA) is an underdiagnosed condition caused by the deposition of misfolded proteins, namely immunoglobulin light chains and transthyretin, in the extracellular spaces of the heart. Any cardiovascular structure can be affected by amyloid infiltration, including the valves. Amyloid accumulation within the cardiac valves may lead to their structural and functional impairment, with a profound impact on patients' prognosis and quality of life. The most common forms of valvular disease in CA are aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR). CA and AS share similar risk factors, disease mechanisms, and remodeling patterns, which make their diagnosis particularly challenging. Patients with both CA and AS experience worse outcomes than CA or AS alone, and transcatheter aortic valve replacement may represent a useful therapeutic strategy in this population. Data on MR and TR are quite limited and mainly coming from case reports or small series. This review paper will summarize our current understanding on the epidemiology, disease mechanisms, echocardiographic features, clinical implications, and therapeutic options of AS, MR, and TR in patients with CA.
Topics: Humans; Quality of Life; Heart Valve Diseases; Mitral Valve Insufficiency; Tricuspid Valve Insufficiency; Aortic Valve Stenosis; Amyloidosis
PubMed: 37735319
DOI: 10.1007/s10741-023-10350-1 -
Journal of Cardiovascular Development... May 2024Mitral stenosis (MS) poses significant challenges in diagnosis and management due to its varied etiologies, such as rheumatic mitral stenosis (RMS) and degenerative... (Review)
Review
Mitral stenosis (MS) poses significant challenges in diagnosis and management due to its varied etiologies, such as rheumatic mitral stenosis (RMS) and degenerative mitral stenosis (DMS). While rheumatic fever-induced RMS has declined in prevalence, DMS is rising with aging populations and comorbidities. Starting from a complex clinical case of DMS, the aim of this paper is to review the literature on mitral stenosis by analyzing the available tools and the differences in terms of diagnosis and treatment for rheumatic and degenerative stenosis. Emerging transcatheter techniques, such as transcatheter mitral valve replacement (TMVR) and lithotripsy-facilitated percutaneous mitral commissurotomy (PMC), represent promising alternatives for DMS patients deemed unfit for surgery. In particular, intravascular lithotripsy (IVL) has shown potential in facilitating percutaneous interventions by fracturing calcific deposits and enabling subsequent interventions. However, larger prospective studies are warranted to validate these findings and establish IVL's role in DMS management. To further enhance this technique, research could focus on investigating the long-term outcomes and durability of mitral lithotripsy, as well as exploring its potential in combination with PMC or TMVR.
PubMed: 38786975
DOI: 10.3390/jcdd11050153 -
Frontiers in Cardiovascular Medicine 2023The accurate etiology of mitral valve aneurysm (MVA) formation is not completely understood, and the most effective management approach for this condition remains...
BACKGROUND
The accurate etiology of mitral valve aneurysm (MVA) formation is not completely understood, and the most effective management approach for this condition remains controversial.
METHODS
We retrospectively analyzed 20 MVA patients who underwent either surgical interventions or conservative follow-ups at the Zhongnan Hospital of Wuhan University between 2017 and 2021. We examined their clinical, echocardiographic, and surgical records and tracked their long-term outcomes.
RESULTS
Of the 20 patients, 12 were diagnosed with MVA using transthoracic echocardiography, seven required additional transesophageal echocardiography for a more definitive diagnosis, and one child was diagnosed during surgery. In all these patients, the MVAs were detected in the anterior mitral leaflet. We found that 15 patients (75%) were associated with infective endocarditis (IE), whereas the remaining patients were associated with bicuspid aortic valve and moderate aortic regurgitation (AR) and mild aortic stenosis (5%), congenital heart disease (5%), elderly calcified valvular disease (5%), mitral valve prolapse (5%), and unknown reasons (5%). Of the 17 patients who underwent hospital surgical interventions, two died due to severe cardiac events. The remaining 15 patients had successful surgeries and were followed up for an average of 13.0 ± 1.8 months. We observed an improvement in their New York Heart Association functional class and mitral regurgitation and AR degrees (value < 0.001). During follow-up, only one infant had an increased left ventricular end-diastolic diameter and left ventricular end-systolic diameter, whereas the remaining 14 patients had decreased values ( < 0.001). In addition, none of the three conservatively managed patients experienced disease progression during the 7-24 months of follow-up.
CONCLUSIONS
We recommend using echocardiography as a highly sensitive method for MVA diagnosis. Although most cases are associated with IE or AR, certain cases still require further study to determine their causes. A prompt diagnosis of MVA in patients using echocardiography can aid in its timely management.
PubMed: 37692047
DOI: 10.3389/fcvm.2023.1233926