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European Heart Journal Open May 2024With the 2022 pulmonary hypertension (PH) definition, the mean pulmonary artery pressure (mPAP) threshold for any PH was lowered from ≥25 to >20 mmHg, and the...
AIMS
With the 2022 pulmonary hypertension (PH) definition, the mean pulmonary artery pressure (mPAP) threshold for any PH was lowered from ≥25 to >20 mmHg, and the pulmonary vascular resistance (PVR) value to differentiate between isolated post-capillary PH (IpcPH) and combined pre- and post-capillary PH (CpcPH) was reduced from >3 Wood units (WU) to >2 WU. We assessed the impact of this change in the PH definition in aortic stenosis (AS) patients undergoing aortic valve replacement (AVR).
METHODS AND RESULTS
Severe AS patients ( = 503) undergoing pre-AVR cardiac heart catheterization were classified according to both the 2015 and 2022 definitions. The post-AVR mortality [median follow-up 1348 (interquartile range 948-1885) days] was assessed. According to the 2015 definition, 219 (44% of the entire population) patients had PH: 63 (29%) CpcPH, 125 (57%) IpcPH, and 31 (14%) pre-capillary PH. According to the 2022 definition, 321 (+47%) patients were diagnosed with PH, and 156 patients (31%) were re-classified: 26 patients from no PH to IpcPH, 38 from no PH to pre-capillary PH, 38 from no PH to unclassified PH, 4 from pre-capillary PH to unclassified PH, and 50 from IpcPH to CpcPH (CpcPH: +79%). With both definitions, only the CpcPH patients displayed increased mortality (hazard ratios ≈ 4). Among the PH-defining haemodynamic components, PVR was the strongest predictor of death.
CONCLUSION
In severe AS, the application of the 2022 PH definition results in a substantially higher number of patients with any PH as well as CpcPH. With either definition, CpcPH patients have a significantly increased post-AVR mortality.
PubMed: 38812478
DOI: 10.1093/ehjopen/oeae037 -
Scientific Reports May 2024Partial heart transplantation (PHT) is a novel surgical approach that involves transplantation of only the part of the heart containing a valve. The rationale for this...
Partial heart transplantation (PHT) is a novel surgical approach that involves transplantation of only the part of the heart containing a valve. The rationale for this approach is to deliver growing heart valve implants that reduce the need for future re-operations in children. However, prior to clinical application of this approach, it was important to assess it in a preclinical model. To investigate PHT short-term outcomes and safety, we performed PHT in a piglet model. Yorkshire piglets (n = 14) were used for PHT of the pulmonary valve. Donor and recipient pairs were matched based on blood types. The piglets underwent PHT at an average age of 44 days (range 34-53). Post-operatively, the piglets were monitored for a period of two months. Of the 7 recipient piglets, one mortality occurred secondary to anesthesia complications while undergoing a routine echocardiogram on post-operative day 19. All piglets had appropriate weight gain and laboratory findings throughout the post-operative period indicating a general state of good health and rehabilitation after undergoing PHT. We conclude that PHT has good short-term survival in the swine model. PHT appears to be safe for clinical application.
Topics: Animals; Heart Transplantation; Swine; Pulmonary Valve; Models, Animal; Disease Models, Animal
PubMed: 38811656
DOI: 10.1038/s41598-024-63072-1 -
Case Reports in Critical Care 2024Acute hypoxemic respiratory failure from infective endocarditis with septic emboli has been attributed to the vicious cycle of tissue damage and inflammatory cytokine...
Acute hypoxemic respiratory failure from infective endocarditis with septic emboli has been attributed to the vicious cycle of tissue damage and inflammatory cytokine response. Spontaneous pneumothorax is a rare complication and can be a late-onset presentation despite appropriate antibiotic therapy. We present a rare case of bilateral spontaneous pneumothoraces in a patient with tricuspid valve endocarditis and septic pulmonary emboli. We suspect that the profound inflammatory response from two different bacterial pathogens and the peripheral location of the septic thrombosis are the basis of the development of bilateral pneumothorax development in our patient.
PubMed: 38808068
DOI: 10.1155/2024/3049691 -
Frontiers in Cardiovascular Medicine 2024Venus -valve™ (Venus Medtech, Hangzhou, China) is a self-expandable bioprosthetic valve that can be transcatheter-implanted in native right ventricular outflow tract...
BACKGROUND
Venus -valve™ (Venus Medtech, Hangzhou, China) is a self-expandable bioprosthetic valve that can be transcatheter-implanted in native right ventricular outflow tract (RVOT) patients. Valve implantation is technically challenging. Due to the implantation technique, left pulmonary artery (LPA) stents represent a relative contraindication to Venus -valve. In this case series, we describe our experience in implanting Venus -valve in patients with previous LPA stents and the use of holographic models to facilitate procedural planning.
METHODS AND RESULTS
From January to October 2023, 17 patients were scheduled for Venus -Valve implantation. 16/17 (94%) patients were successfully implanted. 3/16 (18.7%) patients underwent Venus -valve implantation with LPA stents. All patients underwent pre-operative CT scan. CT data set were employed to create three-dimensional (3D) holographic models (Artiness, Milan, Italy) of the entire heart, which were useful to plan valve implantation with a modified technique. Procedural success rate was 100%. No procedural complications occurred. All three patients presented good haemodynamic and angiographic results at discharge and follow-up visits.
CONCLUSION
This case-series underscores the feasibility of Venus -valve implantation in patients with previous LPA stents. The use of holographic models facilitated procedural planning in these challenging anatomical scenarios.
PubMed: 38803661
DOI: 10.3389/fcvm.2024.1378924 -
Structural Heart : the Journal of the... May 2024The interplay between the right ventricle and the pulmonary artery, known as right ventricular to pulmonary artery (RV-PA) coupling, is crucial for assessing right...
Invasive Assessment of Right Ventricular to Pulmonary Artery Coupling Improves 1-year Mortality Prediction After Transcatheter Aortic Valve Replacement and Anticipates the Persistence of Extra-Aortic Valve Cardiac Damage.
BACKGROUND
The interplay between the right ventricle and the pulmonary artery, known as right ventricular to pulmonary artery (RV-PA) coupling, is crucial for assessing right ventricular systolic function against the afterload from the pulmonary circulation. Pulmonary artery pressure levels are ideally measured by right heart catheterization. Yet, echocardiography represents the most utilized method for evaluating pulmonary artery pressure levels, albeit with limitations in accuracy. This study therefore aims to evaluate the prognostic significance of right ventricular to pulmonary artery (RV-PA) coupling expressed as tricuspid annular plane systolic excursion (TAPSE) related to systolic pulmonary artery pressure (sPAP) levels measured by right heart catheterization (TAPSE/sPAP) or estimated by transthoracic echocardiography (TAPSE/sPAP) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).
METHODS
Using data from a bicentric registry, this study compares TAPSE/sPAP vs. TAPSE/sPAP in predicting 1-year all-cause mortality after TAVR.
RESULTS
Among 333 patients with complete echocardiography and right heart catheterization data obtained before TAVR, their mean age was 79.8 ± 6.74 years, 39.6% were female, and general 1-year survival was 89.8%. sPAP and sPAP showed only moderate correlation (Pearson correlation coefficient : 0.53, value: <0.0001). TAPSE/sPAP was superior to TAPSE/sPAP in predicting 1-year all-cause mortality after TAVR (area under the curve: 0.662 vs. 0.569, value: 0.025). Patients with reduced TAPSE/sPAP levels (< 0.365 mm/mmHg) evidenced significantly lower 1-year survival rates than patients with preserved TAPSE/sPAP levels (81.8 vs. 93.6%, value: 0.001; hazard ratio for 1-year mortality: 3.09 [95% confidence interval: 1.55-6.17]). Echocardiographic follow-up data revealed that patients with reduced RV-PA coupling suffer from persistent right ventricular dysfunction (TAPSE: 16.6 ± 4.05 mm vs. 21.6 ± 4.81 mm in patients with preserved RV-PA coupling) and severe tricuspid regurgitation (diagnosed in 19.7 vs. 6.58% in patients with preserved RV-PA coupling).
CONCLUSIONS
RV-PA coupling expressed as TAPSE/sPAP can refine stratification of severe aortic stenosis patients into low-risk and high-risk cohorts for mortality after TAVR. Moreover, it can help to anticipate persistent extra-aortic valve cardiac damage, which will demand further treatment.
PubMed: 38799808
DOI: 10.1016/j.shj.2024.100282 -
Genes May 2024Brugada syndrome is a rare arrhythmogenic syndrome associated mainly with pathogenic variants in the gene. Right ventricle outflow tract fibrosis has been reported in...
Brugada syndrome is a rare arrhythmogenic syndrome associated mainly with pathogenic variants in the gene. Right ventricle outflow tract fibrosis has been reported in some cases of patients diagnosed with Brugada syndrome. Pulmonary atresia with an intact ventricular septum is characterized by the lack of a functional pulmonary valve, due to the underdevelopment of the right ventricle outflow tract. We report, for the first time, a 4-year-old boy with pulmonary atresia with an intact ventricular septum who harbored a pathogenic de novo variant in , and the ajmaline test unmasked a type-1 Brugada pattern. We suggest that deleterious variants in the gene could be implicated in pulmonary atresia with an intact ventricular septum embryogenesis, leading to overlapping phenotypes.
Topics: Humans; Pulmonary Atresia; Male; Brugada Syndrome; Child, Preschool; NAV1.5 Voltage-Gated Sodium Channel; Heart Defects, Congenital; Ventricular Septum
PubMed: 38790267
DOI: 10.3390/genes15050638 -
Journal of Cardiovascular Development... May 2024Collaborative multicenter research has significantly increased our understanding of fetal Ebstein anomaly, delineating risk factors for adverse outcomes as well as...
Collaborative multicenter research has significantly increased our understanding of fetal Ebstein anomaly, delineating risk factors for adverse outcomes as well as predictors of postnatal management. These data are incorporated into prenatal care and therapeutic strategies and inform family counseling and delivery planning to optimize care. This report details the translation of findings from multicenter studies into multidisciplinary prenatal care for a fetus with Ebstein anomaly, supraventricular tachycardia, and a circular shunt, including transplacental therapy to control arrhythmias and achieve ductal constriction, informed and coordinated delivery room management, and planned univentricular surgical palliation.
PubMed: 38786969
DOI: 10.3390/jcdd11050147 -
Journal of Cardiovascular Development... Apr 2024Surgical aortic valve replacement (SAVR) with a biological heart valve prosthesis (BHV) is often used as a treatment in elderly patients with symptomatic aortic valve...
Surgical aortic valve replacement (SAVR) with a biological heart valve prosthesis (BHV) is often used as a treatment in elderly patients with symptomatic aortic valve disease. This age group is also at risk for the development of dementia in the years following SAVR. The research question is "what are the predictors for the development of dementia?". In 1500 patients undergoing SAVR with or without an associated procedure, preoperative (demographic, cardiac and non-cardiac comorbid conditions), perioperative (associated procedures, cross-clamp and cardiopulmonary bypass time) and postoperative 30-day adverse events (bleeding, thromboembolism, heart failure, conduction defects, arrhythmias, delirium, renal and pulmonary complications) were investigated for their effect on the occurrence of dementia by univariate analyses. Significant factors were entered in a multivariate analysis. The sum of the individual follow-up of the patients was 10,182 patient-years, with a mean follow-up of 6.8 years. Data for the development of dementia could be obtained in 1233 of the 1406 patients who left the hospital alive. Dementia during long-term follow-up developed in 216/1233 (17.2%) of the patients at 70 ± 37 months. Development of dementia reduced the mean survival from 123 (119-128) to 109 (102-116) months ( < 0.001). Postoperative delirium was the dominant predictor (OR = 3.55 with a 95%CI of 2.41-4.93; < 0.00), followed by age > 80 years (2.38; 1.78-3.18; < 0.001); preoperative atrial fibrillation (1.47; 1.07-2.01; = 0.018); cardiopulmonary bypass time > 120 min (1.34; 1.02-1.78; = 0.039) and postoperative thromboembolism (1.94; 1.02-3.70; = 0.044). Postoperative delirium, as a marker for poor condition, and an age of 80 or more were the dominant predictors.
PubMed: 38786959
DOI: 10.3390/jcdd11050136 -
Biology Apr 2024Previous reports have shown that various oral pulmonary vasodilators are effective against canine pulmonary hypertension (PH). However, no studies have compared their...
Previous reports have shown that various oral pulmonary vasodilators are effective against canine pulmonary hypertension (PH). However, no studies have compared their hemodynamic effects. We aimed to compare the hemodynamic effects of 15 µg/kg beraprost sodium, 1.0 mg/kg sildenafil, and their combination, in dogs with experimentally induced mitral regurgitation. This experimental crossover study evaluated the hemodynamic and functional effects of oral pulmonary vasodilators by application of right-sided heart catheterization and echocardiography. Beraprost significantly decreased pulmonary and systemic vascular resistance. Additionally, beraprost increased right-ventricular stroke volume and left-ventricular cardiac output without worsening left-heart size and left-atrial pressure. The pulmonary vasodilatory effects of sildenafil were stronger, and its systemic vasodilatory effects were weaker than those of beraprost. However, sildenafil significantly increased the left-ventricular volume, left-atrial pressure indicator, and right-ventricular cardiac output. Combination therapy resulted in the strongest pulmonary and systemic vasodilating effects without worsening the left-heart size and left-atrial pressure indicators. Both beraprost and sildenafil were effective against canine PH; however, sildenafil was associated with the risk of worsening left-heart loading. Combination therapy with beraprost and sildenafil synergistically dilated pulmonary and systemic vessels, indicating a more potent treatment option for severe PH cases.
PubMed: 38785793
DOI: 10.3390/biology13050311 -
Scientific Reports May 2024There is limited data on the effect of socioeconomic status (SES) on transcatheter (TAVR) and surgical aortic valve replacement (SAVR) outcomes for aortic stenosis (AS)....
There is limited data on the effect of socioeconomic status (SES) on transcatheter (TAVR) and surgical aortic valve replacement (SAVR) outcomes for aortic stenosis (AS). This study conducted a population-based analysis to assess the influence of SES on valve replacement outcomes. Patients with AS undergoing TAVR or SAVR were identified in National Inpatient Sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients living in neighborhoods of income at the lowest and highest quartiles. Of 613,785 AS patients, 9.77% underwent TAVR and 10.13% had SAVR. These rates decline with lower neighborhood income levels, with TAVR/SAVR ratio also declining in lower-income areas. Excluding concomitant procedures, 58,064 patients received isolated TAVR (12,355 low-income and 15,212 high-income) and 43,694 underwent isolated SAVR (10,029 low-income and 10,811 high-income). Low-income patients, in both TAVR and SAVR, were younger but had more comorbid burden. For isolated TAVR, outcomes were similar across income groups. However, for isolated SAVR, low-income patients experienced higher in-hospital mortality (aOR = 1.44, p < 0.01), pulmonary (aOR = 1.13, p = 0.01), and renal complications (aOR = 1.14, p < 0.01). They also had more transfers, longer waits for operations, and extended hospital stays. Lower-income communities had reduced access to TAVR and SAVR, with TAVR accessibility being particularly limited. When given access to TAVR, patients from lower-income neighborhoods had mostly comparable outcomes. However, patients from low-income communities faced worse outcomes in SAVR, possibly due to delays in treatment. Ensuring equitable specialized healthcare resources including expanding TAVR access in economically disadvantaged communities is crucial.
Topics: Humans; Female; Male; Transcatheter Aortic Valve Replacement; Aged; Aortic Valve Stenosis; Aged, 80 and over; Healthcare Disparities; Inpatients; Heart Valve Prosthesis Implantation; United States; Hospital Mortality; Middle Aged; Socioeconomic Factors; Social Class; Aortic Valve; Treatment Outcome; Socioeconomic Disparities in Health
PubMed: 38783030
DOI: 10.1038/s41598-024-62797-3