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BMC Cardiovascular Disorders Apr 2022Large pulmonary valve perforation, which is rarely seen with infective endocarditis, general atrophy, or congenital fenestration, often leads to potentially fatal...
BACKGROUND
Large pulmonary valve perforation, which is rarely seen with infective endocarditis, general atrophy, or congenital fenestration, often leads to potentially fatal outcomes, including heart failure.
CASE PRESENTATION
Transthoracic and transesophageal echocardiographic evaluation of a 69-year-old woman revealed a severely eccentric pulmonary regurgitation with concomitant pulmonary valve stenosis, patent ductus arteriosus, patent foramen ovale, and pulmonary artery aneurysm. In the operation, a large perforation was found in the pulmonary valve leaflet. She underwent complicated surgery that involved closure of the congenital heart defects and replacement of a pulmonary valve with successful results. But the cause of her pulmonary valve perforation remained undetermined.
CONCLUSION
This case highlights two important points: the need for timely management of congenital heart disease and being aware of the possibility of pulmonary valve perforation, which in this case was indicated by an eccentric pulmonary regurgitant jet seen on echocardiography.
Topics: Aged; Echocardiography, Transesophageal; Endocarditis; Endocarditis, Bacterial; Female; Heart Defects, Congenital; Humans; Pulmonary Valve
PubMed: 35397515
DOI: 10.1186/s12872-022-02595-9 -
JACC. Cardiovascular Interventions Dec 2015
Topics: Aortic Valve Stenosis; Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve
PubMed: 26718515
DOI: 10.1016/j.jcin.2015.09.011 -
The Journal of Thoracic and... Nov 2016
Topics: Cardiac Surgical Procedures; Heart Defects, Congenital; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve
PubMed: 27637425
DOI: 10.1016/j.jtcvs.2016.07.031 -
Catheterization and Cardiovascular... Aug 2021We compared 5-year outcomes of transcatheter pulmonary valve (TPV) replacement with the Melody TPV in the post-approval study (PAS) and the investigational device...
OBJECTIVE
We compared 5-year outcomes of transcatheter pulmonary valve (TPV) replacement with the Melody TPV in the post-approval study (PAS) and the investigational device exemption (IDE) trial.
BACKGROUND
As a condition of approval of the Melody TPV after the IDE trial, the Food and Drug Administration required that a PAS be conducted to evaluate outcomes of TPV replacement in a "real-world" environment. The 5-year outcomes of the PAS have not been published, and the IDE and PAS trials have not been compared.
METHODS
The cohorts comprised all patients catheterized and implanted at 5 IDE sites and 10 PAS sites. Differences in trial protocols were detailed. Time-related outcomes and valve-related adverse events were compared between the two trials with Kaplan-Meier curves and log-rank testing.
RESULTS
167 patients (median age, 19 years) were catheterized and 150 underwent TPV replacement in the IDE trial; 121 were catheterized (median age, 17 years) and 100 implanted in the PAS. Freedom from hemodynamic dysfunction (p = .61) or any reintervention (p = .74) over time did not differ between trials. Freedom from stent fracture (p = .003) and transcatheter reintervention (p = .010) were longer in PAS, whereas freedom from explant (p = .020) and TPV endocarditis (p = .007) were shorter. Clinically important adverse events (AEs) were reported in 14% of PAS and 7.2% of IDE patients (p = .056); the incidence of any particular event was low in both.
CONCLUSIONS
Hemodynamic and time-related outcomes in the PAS and IDE trials were generally similar, confirming the effectiveness of the Melody TPV with real-world providers. There were few significant complications and limited power to identify important differences in AEs. The lack of major differences in outcomes between the two studies questions the usefulness of mandated costly post-approval studies as part of the regulatory process for Class III medical devices.
Topics: Adolescent; Adult; Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prosthesis Design; Pulmonary Valve; Pulmonary Valve Insufficiency; Treatment Outcome; Young Adult
PubMed: 33780150
DOI: 10.1002/ccd.29657 -
PloS One 2021In the last 25 years, numerous tissue engineered heart valve (TEHV) strategies have been studied in large animal models. To evaluate, qualify and summarize all available... (Meta-Analysis)
Meta-Analysis
In the last 25 years, numerous tissue engineered heart valve (TEHV) strategies have been studied in large animal models. To evaluate, qualify and summarize all available publications, we conducted a systematic review and meta-analysis. We identified 80 reports that studied TEHVs of synthetic or natural scaffolds in pulmonary position (n = 693 animals). We identified substantial heterogeneity in study designs, methods and outcomes. Most importantly, the quality assessment showed poor reporting in randomization and blinding strategies. Meta-analysis showed no differences in mortality and rate of valve regurgitation between different scaffolds or strategies. However, it revealed a higher transvalvular pressure gradient in synthetic scaffolds (11.6 mmHg; 95% CI, [7.31-15.89]) compared to natural scaffolds (4,67 mmHg; 95% CI, [3,94-5.39]; p = 0.003). These results should be interpreted with caution due to lack of a standardized control group, substantial study heterogeneity, and relatively low number of comparable studies in subgroup analyses. Based on this review, the most adequate scaffold model is still undefined. This review endorses that, to move the TEHV field forward and enable reliable comparisons, it is essential to define standardized methods and ways of reporting. This would greatly enhance the value of individual large animal studies.
Topics: Animals; Heart Valve Prosthesis; Models, Animal; Pulmonary Valve; Tissue Engineering
PubMed: 34610023
DOI: 10.1371/journal.pone.0258046 -
The American Journal of Case Reports Feb 2019BACKGROUND Infective endocarditis (IE) has a high mortality rate, even when treated with appropriate antibiotic therapy and surgical intervention. Right-sided...
BACKGROUND Infective endocarditis (IE) has a high mortality rate, even when treated with appropriate antibiotic therapy and surgical intervention. Right-sided endocarditis is in itself rare, with some studies reporting an incidence of 5-10%. The majority of these cases involve the tricuspid valve, and isolated pulmonary valve endocarditis (PVE) is an extremely rare entity affecting less than 2% of patients with infective endocarditis. Identification and early management are crucial to prevent long-term complications and reduce mortality. CASE REPORT We present a patient with a history of essential hypertension and no underlying valvular disease, who underwent dental cleaning and subsequently developed low-grade fever, myalgia, and malaise. This occurred during the flu season, and was initially diagnosed and treated as flu, without any improvement. The patient was later found to be bacteremic with S. mitis, with no identifiable source, and a normal transthoracic echocardiogram (TTE). He was later hospitalized, had a transesophageal echocardiogram, and was found to have a large pulmonic valve vegetation. CONCLUSIONS This case presents an interesting and rare finding of endocarditis, isolated to the pulmonic valve, in an otherwise healthy individual with no predisposing risk factors. The lack of peripheral stigmata, as well as an unremarkable initial outpatient TTE, made the diagnosis more difficult. It should also be noted that current guidelines do not specifically address right-sided endocarditis, and do not specify the role of surgical intervention.
Topics: Dental Prophylaxis; Echocardiography; Endocarditis, Bacterial; Humans; Male; Middle Aged; Pulmonary Valve; Streptococcal Infections; Streptococcus mitis
PubMed: 30713335
DOI: 10.12659/AJCR.913041 -
Journal of the American College of... Aug 2021
Topics: Endocarditis; Endocarditis, Bacterial; Humans; Pulmonary Valve
PubMed: 34353536
DOI: 10.1016/j.jacc.2021.05.043 -
Pulmonary Valve Replacement With a Trifecta Valve Is Associated With Reduced Transvalvular Gradient.The Annals of Thoracic Surgery Feb 2017Outcomes after surgical pulmonary valve replacement (PVR) in patients with congenital cardiac disease are limited by long-term valve deterioration, which may be hastened...
BACKGROUND
Outcomes after surgical pulmonary valve replacement (PVR) in patients with congenital cardiac disease are limited by long-term valve deterioration, which may be hastened by turbulent flow. The use of the Trifecta valve (St. Jude Medical, Little Canada, MN) at our institution (Duke University Medical Center, Durham, NC) appears to result in low postimplantation transvalvular gradients. This study was performed to compare the early transvalvular gradient associated with the Trifecta valve with that associated with two other valves commonly used for PVR.
METHODS
We performed a single institution review of patients undergoing PVR with the Perimount valve (Edwards Lifesciences, Irvine, CA), the Biocor valve (St. Jude Medical), or the Trifecta valve between November 1993 and January 2014. Multivariable linear regression modeling was used to determine the adjusted association between valve type and transvalvular gradient as determined by early postoperative echocardiography.
RESULTS
A total of 186 patients met study criteria; 54 (29%) received a Biocor valve, 87 (47%) received a Perimount valve, and 45 (24%) received a Trifecta valve. There were no baseline differences among the groups, but the peak transvalvular gradient was significantly decreased among patients with the Trifecta valve. After adjustment for age, valve size, patients' weight, and time to the assessment, as compared with the Trifecta valve, the Biocor valve was associated with a 57% higher peak valve gradient (p < 0.01), whereas the Perimount valve was associated with a 26% higher peak valve gradient (p = 0.04).
CONCLUSIONS
PVR for congenital heart disease with the Trifecta bioprosthetic valve is associated with a reduced early transvalvular gradient. This finding may be associated with reduced valve deterioration over time.
Topics: Adolescent; Adult; Bioprosthesis; Blood Flow Velocity; Child; Echocardiography; Female; Follow-Up Studies; Heart Defects, Congenital; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Prosthesis Design; Pulmonary Valve; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 27570156
DOI: 10.1016/j.athoracsur.2016.06.018 -
Interactive Cardiovascular and Thoracic... Jul 2022Given the anatomical variations of tetralogy of Fallot (TOF), different surgical techniques can be used to achieve correction. Transannular patches (TAPs) are the most...
OBJECTIVES
Given the anatomical variations of tetralogy of Fallot (TOF), different surgical techniques can be used to achieve correction. Transannular patches (TAPs) are the most commonly used technique; they are associated with right ventricular dysfunction, the incidence of which can be reduced through pulmonary valve preservation.
METHODS
Between January 2010 and July 2019, we performed 274 surgical corrections of tetralogy of Fallot at Fundación Cardioinfantil; 63 patients (23%) underwent repair with a TAP in addition to a pulmonary neovalve (Group I), 66 patients (24.1%) received a TAP without a pulmonary valve (Group II) and 145 patients (52.9%) had a repair with valve preservation (Group III). We analysed patient's characteristics before, during and after surgery at a 30-day follow-up.
RESULTS
We found that patients in Group III were older (P = 0.04). Group II had the lowest level of O2 saturation before surgery (82%, P = 0.001). Cardiopulmonary bypass and aortic cross-clamp times were longer in Group I (P < 0.001). Right ventricular dysfunction was less frequent in Group III (15.9%, P = 0.011). Severe residual pulmonary regurgitation was more common in Group II (21.9%, P = 0.001).
CONCLUSIONS
Preservation of the pulmonary valve is an important factor for immediate postoperative management of tetralogy of Fallot. Patients who were repaired with a TAP with or without a pulmonary neovalve had a higher incidence of right ventricular dysfunction than those with pulmonary valve preservation.
Topics: Follow-Up Studies; Humans; Infant; Pulmonary Valve; Pulmonary Valve Insufficiency; Retrospective Studies; Tetralogy of Fallot; Treatment Outcome; Ventricular Dysfunction, Right
PubMed: 35640540
DOI: 10.1093/icvts/ivac155 -
The Annals of Thoracic Surgery Sep 2012
Topics: Female; Humans; Male; Pulmonary Valve; Pulmonary Valve Insufficiency; Plastic Surgery Procedures; Recycling; Tetralogy of Fallot
PubMed: 22916749
DOI: 10.1016/j.athoracsur.2012.06.007