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JTCVS Open Dec 2023Mitral valve repair for bileaflet prolapse can be complex, involving multiple chords or resection. The Alfieri technique for bileaflet disease is simple but may be...
OBJECTIVE
Mitral valve repair for bileaflet prolapse can be complex, involving multiple chords or resection. The Alfieri technique for bileaflet disease is simple but may be associated with mitral stenosis or recurrent mitral regurgitation. Outcomes of patients with bileaflet prolapse undergoing mitral valve repair using the Alfieri versus conventional chord/resection techniques were compared.
METHODS
Adults undergoing mitral valve repair for bileaflet prolapse for degenerative disease from 2017 to 2023 were stratified by repair technique. Outcomes including operative mortality and echocardiogram data were compared. Time to event analysis was used to characterize freedom from recurrent mitral regurgitation (moderate or greater mitral regurgitation).
RESULTS
Among 188 patients with bileaflet prolapse, 37% (70) were repaired with the Alfieri and the remaining patients were repaired with chords/resection. Compared with chords/resection, patients undergoing the Alfieri had shorter cardiopulmonary bypass and crossclamp times. Operative mortality (0% [0/70] vs 2% [2/118], = .27) was similar between both techniques. The mean mitral gradient was low and similar for the Alfieri versus chords/resection (3 vs 3, = .34). Development of recurrent mitral regurgitation at 2 years, incorporating the competing risk of death and mitral reintervention, was 4.3% (95% CI, 1.5%-9.3%) for the Alfieri technique and 5.8% (95% CI, 2.2%-11.8%) for chord/resection ( = .83).
CONCLUSIONS
Both the Alfieri and chord/resection techniques had low rates of recurrent mitral regurgitation at 2 years. The mitral valve gradient was low and similar regardless of technique; thus, those who received the Alfieri technique did not have an increased rate of mitral stenosis. The Alfieri may be an underused technique for bileaflet prolapse.
PubMed: 38204703
DOI: 10.1016/j.xjon.2023.10.005 -
Advanced Biomedical Research 2023In this case, a 44-year-old pregnant woman at a gestational age of 28 weeks and 6 days with symptoms of cold, shortness of breath, and cough since a week ago. She had...
In this case, a 44-year-old pregnant woman at a gestational age of 28 weeks and 6 days with symptoms of cold, shortness of breath, and cough since a week ago. She had received remdesivir ampoule, Tamiflu tablet, meropenem and linezolid, and dexamethasone. She received oxygen through a 14-liter reservoir bag mask and hydrocortisone, heparin, and ceftriaxone. Nine hours after hospitalization, the patient suffered a cardiorespiratory arrest, resuscitation was performed, and the patient was intubated. Emergency cesarean section was done in the intensive care unit. Finally, the patient suffered a cardiorespiratory arrest, prop was placed for the patient, and evidence of severe Mitral stenosis and right ventricle dilation were observed. The cardiopulmonary resuscitation operation continued for an hour, but unfortunately the patient died. So, it is important to be careful about influenza during pregnancy and in the case of heart failure symptoms, it is necessary to consider the presence of underlying mitral stenosis.
PubMed: 38192899
DOI: 10.4103/abr.abr_104_23 -
JACC. Case Reports Nov 2023Frail patients with severe calcific mitral stenosis have few treatment options. We present a novel case successfully treated with a left-atrial-to-coronary-sinus shunt....
Frail patients with severe calcific mitral stenosis have few treatment options. We present a novel case successfully treated with a left-atrial-to-coronary-sinus shunt. However, the patient's symptoms returned, and, at surgery, the shunt was found to be occluded and associated with left atrial and ventricular fibrosis and calcification. ().
PubMed: 38094177
DOI: 10.1016/j.jaccas.2023.102039 -
Journal of Clinical Medicine Jul 2023The aim of the present review is to highlight the strengths and limitations of echocardiographic parameters and scores employed to predict favorable outcome in complex... (Review)
Review
Echocardiographic Parameters for Risk Prediction in Borderline Right Ventricle: Review with Special Emphasis on Pulmonary Atresia with Intact Ventricular Septum and Critical Pulmonary Stenosis.
The aim of the present review is to highlight the strengths and limitations of echocardiographic parameters and scores employed to predict favorable outcome in complex congenital heart diseases (CHDs) with borderline right ventricle (RV), with a focus on pulmonary atresia with intact ventricular septum and critical pulmonary stenosis (PAIVS/CPS). A systematic search in the National Library of Medicine using Medical Subject Headings and free-text terms including echocardiography, CHD, and scores, was performed. The search was refined by adding keywords "PAIVS/CPS", Ebstein's anomaly, and unbalanced atrioventricular septal defect with left dominance. A total of 22 studies were selected for final analysis; 12 of them were focused on parameters to predict biventricular repair (BVR)/pulmonary blood flow augmentation in PAIVS/CPS. All of these studies presented numerical (the limited sample size) and methodological limitations (retrospective design, poor definition of inclusion/exclusion criteria, variability in the definition of outcomes, differences in adopted surgical and interventional strategies). There was heterogeneity in the echocardiographic parameters employed and cut-off values proposed, with difficultly in establishing which one should be recommended. Easy scores such as TV/MV (tricuspid/mitral valve) and RV/LV (right/left ventricle) ratios were proven to have a good prognostic accuracy; however, the data were very limited (only two studies with <40 subjects). In larger studies, RV end-diastolic area and a higher degree of tricuspid regurgitation were also proven as accurate predictors of successful BVR. These measures, however, may be either operator and/or load/pressure dependent. TV Z-scores have been proposed by several authors, but old and heterogenous nomograms sources have been employed, thus producing discordant results. In summary, we provide a review of the currently available echocardiographic parameters for risk prediction in CHDs with a diminutive RV that may serve as a guide for use in clinical practice.
PubMed: 37510714
DOI: 10.3390/jcm12144599 -
Medicina (Kaunas, Lithuania) Oct 2023: The main cause of morbidity and mortality in hemodialysis patients is cardiovascular disease, which is quite common. The main objective of our study was to investigate... (Observational Study)
Observational Study
: The main cause of morbidity and mortality in hemodialysis patients is cardiovascular disease, which is quite common. The main objective of our study was to investigate the relationship between oxidative stress, inflammation, and vascular and valvular calcifications in hemodialysis patients. : This observational study had 54 hemodialysis patients, with an average age of 60.46 ± 13.18 years. Cardiovascular ultrasound was used to detect and/or measure aortic and mitral valve calcifications, carotid and femoral atheroma plaques, and common carotid intima-media thickness. The aortic calcification score was determined using a lateral abdomen plain radiograph. The inflammatory, oxidative, metabolic, and dietary statuses, as well as demographic characteristics, were identified. : There were significant correlations between the levels of IL-6 and carotid plaque number ( = 0.003), fibrinogen level and aortic valve calcifications ( = 0.05), intima-media thickness ( = 0.0007), carotid plaque number ( = 0.035), femoral plaque number ( = 0.00014), and aortic calcifications score ( = 0.0079). Aortic annulus calcifications ( = 0.03) and intima-media thickness ( = 0.038) were adversely linked with TNF-α. Nutrition parameters were negatively correlated with atherosclerosis markers: number of carotid plaques with albumin ( = 0.013), body mass index ( = 0.039), and triglycerides ( = 0.021); number of femoral plaques with phosphorus (0.013), aortic calcifications score with albumin ( = 0.051), intima-media thickness with LDL-cholesterol ( = 0.042). Age and the quantity of carotid plaques, femoral plaques, and aortic calcifications were linked with each other ( = 0.0022, 0.00011, and 0.036, respectively). Aortic annulus calcifications ( = 0.011), aortic valve calcifications ( = 0.023), and mitral valve calcifications ( = 0.018) were all associated with an increased risk of death. : Imaging measures of atherosclerosis are adversely connected with dietary status and positively correlated with markers of inflammation and risk of mortality.
Topics: Humans; Middle Aged; Aged; Carotid Intima-Media Thickness; Atherosclerosis; Inflammation; Aortic Valve Stenosis; Heart Valve Diseases; Renal Dialysis; Albumins; Risk Factors
PubMed: 37893519
DOI: 10.3390/medicina59101801 -
The Journal of Invasive Cardiology Jun 2024Quantification of invasive hemodynamics and mitral annular calcification-related mitral stenosis remains underexplored in patients exposed to chest radiation. We sought...
Quantification of invasive hemodynamics and mitral annular calcification-related mitral stenosis remains underexplored in patients exposed to chest radiation. We sought to explore invasive hemodynamic parameters via transseptal catheterization in patients with and without chest radiation who had a diagnosis of mitral annular calcification-related mitral stenosis. After excluding patients with more than moderate mitral regurgitation, we found that there was no difference in mitral valve area on hemodynamic testing in patients with and without radiation with an elevated baseline transmitral gradient on transthoracic echocardiography in the setting of mitral annular calcification-related mitral stenosis. There was a higher transmitral gradient and left atrial pressure in patients with prior radiation consistent with left atrial noncompliance, suggesting that treatment mitral valve stenosis may not relieve symptoms in this cohort of patients.
PubMed: 38870446
DOI: 10.25270/jic/24.00120 -
SAGE Open Medical Case Reports 2023Mitral facies is a classical feature of chronic mitral stenosis (MS) that commonly associated with low cardiac output and pulmonary hypertension. A 44-year-old woman...
Mitral facies is a classical feature of chronic mitral stenosis (MS) that commonly associated with low cardiac output and pulmonary hypertension. A 44-year-old woman presented with 10-year history of refractory right heart failure. We noted distinctive malar rash appearance on her face known as "mitral facies." An echocardiogram revealed severe MS and other significant valve involvement with typical characteristics of rheumatic valvular heart disease. Doppler measurement showed decreased cardiac output and severe pulmonary hypertension in this patient. The mitral facies could be an alarming sign of a more severe and advanced form of MS. It also can be a marker of impaired cardiac output and concomitant severe pulmonary hypertension.
PubMed: 37719638
DOI: 10.1177/2050313X231200965 -
Journal of Chest Surgery Jun 2024Calcification of the mitral valve annulus is common in patients on dialysis. The growing number of individuals receiving dialysis has been accompanied by an increase in...
Calcification of the mitral valve annulus is common in patients on dialysis. The growing number of individuals receiving dialysis has been accompanied by an increase in cases necessitating surgical intervention for mitral valve annulus calcification. In this report, we present a severe case characterized by bulky calcification of the mitral annulus, which was managed with mechanical mitral valve replacement. A 61-year-old man on dialysis presented with chest pain upon exertion that had persisted for 3 months. Cardiac echocardiography revealed severe mitral stenosis and regurgitation, accompanied by cardiac dysfunction. During surgery, an ultrasonic aspiration system was employed to remove the calcification of the mitral valve annulus to the necessary extent. Subsequently, a mechanical mitral valve was sutured into the supra-annular position. To address the regurgitation, the area surrounding the valve was sewn to the wall of the left atrium. Postoperative assessments indicated an absence of perivalvular leak and demonstrated improved cardiac function. The patient was discharged on postoperative day 22. We describe a successful mitral mechanical valve replacement in a case of extensive circumferential mitral annular calcification. Even with severe calcification extending into the left ventricular myocardium, we were able to minimize the decalcification process. This approach enabled the performance of mitral mechanical valve replacement in a high-risk patient on dialysis, thus expanding the possibilities for cardiac surgery.
PubMed: 38835208
DOI: 10.5090/jcs.24.017 -
Turk Gogus Kalp Damar Cerrahisi Dergisi Jan 2024This study aimed to outline the valvular changes following heart transplantation and describe the management options to address these conditions. (Review)
Review
BACKGROUND
This study aimed to outline the valvular changes following heart transplantation and describe the management options to address these conditions.
METHODS
A literature search using EMBASE, MEDLINE, and PubMed databases was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in this study. Clinical studies involving patients who had their first heart transplant and articles that mentioned management for valvular heart disease were included. Treatment options were grouped into four categories: cardiac surgery other than retransplant and valve surgery, valve replacement and repairs, nonsurgical interventions, and conservative management.
RESULTS
Nine hundred and three (6.56%) patients out of 13,757 patients (10,529 males, 3,228 females; mean age: 60.3±10.4 years; range, 20 to 83 years) undergoing heart transplantation were identified with valvular disease affecting one or more valves. The mean interval between the transplant and the diagnosis of valve disease was 11.31±6.95 years. The most common valvular heart disease was tricuspid regurgitation, with 796 (94.09%) occurrences, followed by mitral regurgitation (n=22, 2.6%), aortic regurgitation (n=14, 1.65%), aortic stenosis (n=11, 1.3%), and mitral stenosis (n=3, 0.35%). Additionally, the number of surgical valve replacement and repairs (n=89) was higher than nonsurgical interventions (n=20).
CONCLUSION
Acquired valvular heart diseases after cardiac transplantation are an infrequent clinical presentation that can cause valvular changes in the recipient. According to the extracted data, there is no sole superior management option, and more research is needed in this area.
PubMed: 38545365
DOI: 10.5606/tgkdc.dergisi.2024.25631 -
Brazilian Journal of Cardiovascular... Oct 2023To assess actual data on the safety, effectiveness, and hemodynamic performance of Bovine Pericardium Organic Valvular Bioprosthesis (BVP). (Clinical Trial)
Clinical Trial Observational Study
OBJECTIVE
To assess actual data on the safety, effectiveness, and hemodynamic performance of Bovine Pericardium Organic Valvular Bioprosthesis (BVP).
METHODS
The BIOPRO Trial is an observational, retrospective, non-comparative, non-randomized, and multicenter study. We collected data from 903 patients with symptomatic, moderate, or severe valve disease who underwent BVP implants in the timeframe from 2013 to 2020 at three Brazilian institutions. Death, valve-related adverse events (AEs), functional recovery, and hemodynamic performance were evaluated at the hospital, at discharge, and six months and one year later. Primary analysis compared late (> 30 days after implant) linearized rates of valve-related AEs, such as thromboembolism, valve thrombosis, major hemorrhage, major paravalvular leak, and endocarditis, following objective performance criteria (OPC). Analysis was performed to include at least 400 valve-years for each valve position (aortic and mitral) for complete comparisons to OPC. Kaplan-Meier survival and major adverse cardiovascular and cerebrovascular event analyses were also performed.
RESULTS
This retrospective study analyzed follow-up data collected from 903 patients (834.2 late patient-years) who have undergone surgery for 455 isolated aortic valve replacement (50.4%), 382 isolated mitral valve replacement (42.3%), and 66 combined valve replacement or other intervention (7.3%). The linearized rates of valve-related AEs were < 2 × OPC. One-year survival rates were 95.1% and 92.7% for aortic and mitral valve replacement, respectively. This study demonstrated an improvement in the New York Heart Association classification from baseline and hemodynamic performance within an expected range.
CONCLUSION
According to this analysis, BVP meets world standards for safety and clinical efficacy.
Topics: Animals; Cattle; Humans; Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Pericardium; Postoperative Complications; Prosthesis Design; Retrospective Studies; Treatment Outcome
PubMed: 37797247
DOI: 10.21470/1678-9741-2023-0015