The Journal Of Heart Valve Disease[JOURNAL]
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200 papers
Clinical Significance of Greater Implantation Height with SAPIEN 3 Transcatheter Heart Valve.
Ramirez Del Val F, Hirji SA, Carreras ET … +10 more , Kolkailah AA, Chowdhury R, McGurk S, Lee J, Nyman CB, Shook DC, Sobieszczyk PS, Pelletier MP, Shah PB, Kaneko T
J Heart Valve Dis · 2018 Jan · PMID 30560594
BACKGROUND: A lower rate of permanent pacemaker (PPM) has been linked to a target aortic implantation height (AIH) >0.70, following transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve. Based on clinical...
BACKGROUND: A lower rate of permanent pacemaker (PPM) has been linked to a target aortic implantation height (AIH) >0.70, following transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve. Based on clinical experience, it was hypothesized that a higher AIH (≥0.85) would lower the rate of PPM implantation. METHODS: A total of 127 patients (66 females, 61 males; mean age 82 ± 8 years) underwent TAVR with the SAPIEN 3 valve between May 2015 and July 2016. AIH was defined as the proportion of the valve frame above the aortic annulus in the post-deployment aortogram. A target AIH (≥0.70) was achieved in 113 patients (89%). Cases were stratified into a High Implantation (HI) group (AIH ≥0.85; 33 patients) or a Standard Implantation (SI) group (AIH <0.85; 94 patients). RESULTS: The mean Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score of all patients was 6.4 ± 3.5%. Preoperative right bundle branch block (RBBB) was prevalent in 13% of SI patients, and in 18% of HI patients (p = 0.56). There were no significant differences in operative mortality (3.2% versus 0%), median length of stay (2 days versus 3 days) and incidence of moderate-to-severe paravalvular leak (3.2% versus 0%; all p >0.410) between SI and HI patients, respectively. Likewise, the incidence of new PPM did not differ between the two groups (12% in HI versus 13% in SI; p ≥0.99). The mean AIH was similar for patients with PPM implantation (0.80 ± 0.08) compared to those without (0.78 ± 0.06; p = 0.520). Preoperative RBBB was significantly associated with PPM implantation (odds ratio (OR) 10.1; p = 0.002), and patients who underwent PPM implantation had a higher operative mortality (12.5% versus 1%; p = 0.040). CONCLUSIONS: Among TAVR patients who received the SAPIEN 3 heart valve, a higher AIH (≥0.85) was not associated with a lower rate of PPM implantation or increased operative mortality. Prior RBBB was the only independent risk factor for new PPM implantation. Long-term follow up is crucial in determining the clinical significance of PPM implantation.
Average Aortic Valve Sclerosis Score Index as a Marker for Significant Coronary Artery Disease in Patients with Non-ST-Elevation Myocardial Infarction or Unstable Angina.
Nabati M, Favaedi M
J Heart Valve Dis · 2018 Jan · PMID 30560593
BACKGROUND: Previous studies have reported an association between aortic valve sclerosis (AVS) and coronary atherosclerosis. However, the threshold of sclerosis used to identify high-risk patients has not yet been determ...
BACKGROUND: Previous studies have reported an association between aortic valve sclerosis (AVS) and coronary atherosclerosis. However, the threshold of sclerosis used to identify high-risk patients has not yet been determined. METHODS: A total of 225 patients admitted with non- ST-elevation myocardial infarction (NSTEMI) or unstable angina was studied. Echocardiography was performed on all patients within 24 h of admission. Sclerosis scores were determined for each aortic cusp, and the average AVS score index (AVSSI) was calculated. The left ventricular ejection fraction (LVEF) and variables of left ventricular diastolic function and filling pressure, such as transmitral pulsed Doppler early diastolic velocities (E wave), early diastolic tissue Doppler mitral annular velocities (e'), and E/e', were also determined. These patients underwent coronary angiography, and SYNTAX scores were determined. RESULTS: Patients with an average AVSSI >1 were older, more hypertensive, and had higher rates of previous coronary artery bypass grafting. In addition, the prevalences of significant coronary artery disease (CAD) and three-vessel CAD were higher in these patients. Among the echocardiographic variables, LVEF and e' velocity were significantly lower and E/e' was significantly higher in patients with an AVSSI >1. These patients also had a higher prevalence of left ventricular hypertrophy, diastolic dysfunction, and ischemic mitral regurgitation than those with an average AVSSI ≤1. Regression analysis showed that AVS was independently associated with significant CAD and SYNTAX score. CONCLUSIONS: The average AVSSI may be a useful marker in the risk stratification of acute coronary syndrome patients, and is consistent with other high-risk echocardiographic variables, the presence of significant CAD, and more complex coronary artery lesions.
Sternal-Sparing Aortic Valve Replacement in a Patient with Osteogenesis Imperfecta: A Case Report.
Joshi P, Thakur S, Finn C … +1 more , Sadlier P
J Heart Valve Dis · 2017 Nov · PMID 30207130
The case described here is the first reported case of successful isolated aortic valve replacement (AVR) via a right anterior thoracotomy (RAT) in a patient with osteogenesis imperfecta (OI). The most common reported com...
The case described here is the first reported case of successful isolated aortic valve replacement (AVR) via a right anterior thoracotomy (RAT) in a patient with osteogenesis imperfecta (OI). The most common reported complication in patients with OI undergoing AVR or other cardiac surgery is bleeding and sternal complications. By using a RAT approach, it was possible to replace the aortic valve without major bleeding, transfusion, or sternal complications.
The Perceval Sutureless Valve in Aortic Root Reoperation.
Isbir S, Arsan S, Ak K … +1 more , Cobanoglu A
J Heart Valve Dis · 2017 Nov · PMID 30207129
The case is reported of a 62-year-old man with severe aortic regurgitation that was related to failed prior valve-sparing ascending aortic aneurysm repair, and who was successfully treated with a Perceval Sutureless valv...
The case is reported of a 62-year-old man with severe aortic regurgitation that was related to failed prior valve-sparing ascending aortic aneurysm repair, and who was successfully treated with a Perceval Sutureless valve.
Congenital Left Ventricular-Right Atrial Communication Gerbode-Type Defect.
Elsheshtawy M, Abdelghany M, Shani J … +1 more , Moscovits M
J Heart Valve Dis · 2017 Nov · PMID 30207128
Adult congenital heart diseases present a unique challenge in assessing right-sided cardiac chambers, where pressures can be mistakenly calculated using standard echocardiographic formulae. A challenging case is presente...
Adult congenital heart diseases present a unique challenge in assessing right-sided cardiac chambers, where pressures can be mistakenly calculated using standard echocardiographic formulae. A challenging case is presented of a combined inlet ventricular septal defect and ventriculo-atrial Gerbode defect. The diagnosis of such adult congenital heart diseases requires an in-depth understanding of cardiac pathophysiology and hemodynamics. Video 1: Transthoracic echocardiography. Apical four-chamber view, showing a large inlet VSD with bidirectional shunt (Eisenmenger syndrome). Video 2: Transthoracic echocardiography showing the Gerbode defect in a short-axis view.
The Modified Ross Procedure with Prosthetic Graft Wrap Does Not Prevent Autograft Failure.
Wang A, Ganapathi AM, Wang A … +1 more , Hughes GC
J Heart Valve Dis · 2017 Nov · PMID 30207127
The modified Ross procedure, which involves replacement of the aortic valve with a pulmonary autograft root supported within a Dacron tube graft, was developed with the goal of preventing late autograft dilatation and as...
The modified Ross procedure, which involves replacement of the aortic valve with a pulmonary autograft root supported within a Dacron tube graft, was developed with the goal of preventing late autograft dilatation and associated aortic insufficiency. The case is reported of an adult patient who had a bicuspid aortic valve (BAV), underwent a modified Ross procedure, and developed severe aortic insufficiency within one year and subsequently required reoperation for aortic valve replacement. While advances have been made to increase the success of the Ross procedure via modifications to prevent aortic root dilatation, no modifications have yet been devised to improve the ability of the pulmonary valve to withstand systemic aortic pressures. The Ross procedure has significant advantages for children, but the risks and benefits should be carefully considered in adults, especially in those with BAV.
Mitral Valve Malignant Primary Tumor as a Surgical Emergency: Case Report.
Gomez MD, Gomez-Sanchez M, Antonio Arias-Godinez J … +2 more , Jimenez-Becerra S, Herrera-Alarcon V
J Heart Valve Dis · 2017 Nov · PMID 30207126
Malignant primary tumors of the heart are among the most unusual forms of cancer. Cardiac malignancy accounts for about 20% of all primary cardiac tumors, with most arising from the atria and less frequently the ventricl...
Malignant primary tumors of the heart are among the most unusual forms of cancer. Cardiac malignancy accounts for about 20% of all primary cardiac tumors, with most arising from the atria and less frequently the ventricles; very unusual locations include the great vessels and the cardiac valves. A rare case is presented of a young female that arrived at the authors' emergency room in pulmonary edema and circulatory collapse secondary to a true tumor of the mitral leaflets that caused severe mitral valve stenosis. On pathological examination this proved to be a mitral leaflet angiosarcoma.
MitraClip® Implantation Under Cerebral Protection: A Case Report.
Pohl J, Luedike P, Alexander Jánosi R … +1 more , Rassaf T
J Heart Valve Dis · 2017 Nov · PMID 30207125
MitraClip® implantation is commonly used in patients with severe mitral regurgitation (MR) and who are at high risk for surgical mitral valve repair. The occurrence of stroke or transient ischemic attack is a potential c...
MitraClip® implantation is commonly used in patients with severe mitral regurgitation (MR) and who are at high risk for surgical mitral valve repair. The occurrence of stroke or transient ischemic attack is a potential complication in patients undergoing MitraClip implantation, and incidences of up to 2.6% have been reported. Herein is reported the case of an 84-year-old woman with severe MR and a thin filamentous structure at the rim of the left atrial appendage of unknown etiology. Due to a high surgical risk, the heart team decided to perform endovascular mitral valve repair using the MitraClip procedure. In order to prevent stroke, the implantation procedure was performed using a cerebral protection system.
Early Experience with the Latest-Generation Biological Prosthesis, the Trifecta GT.
Paredes F, Estigarribia Bernal A, Permanyer E … +5 more , Poncela J, Ysasi A, Herrero E, Maynar M, Llorens R
J Heart Valve Dis · 2017 Nov · PMID 30207124
BACKGROUND: The study aim was to assess the hemodynamic results and implantation technique for the latest-generation St. Jude Medical aortic valve bioprosthesis, the Trifecta™ GT, which was first marketed in 2016. METHOD...
BACKGROUND: The study aim was to assess the hemodynamic results and implantation technique for the latest-generation St. Jude Medical aortic valve bioprosthesis, the Trifecta™ GT, which was first marketed in 2016. METHODS: The first 100 patients (mean age 74.59 ± 7.41 years) undergoing aortic valve replacement (AVR) with the Trifecta GT, whether associated or not with other procedures, were included and assessed. All patients underwent a baseline ultrasound scan prior to hospital discharge to monitor postoperative gradients and the presence of periprosthetic leakage. RESULTS: The predominant valvular heart disease was aortic stenosis (85%). An isolated AVR was required in 43% of patients. The prosthesis sizes used were 19, 21, 23, 25, and 27 mm. The overall hospital mortality was 5%; all deaths occurred in patients with associated surgeries. Peak gradients measured prior to hospital discharge ranged from 17.95 mmHg to 10.95 mmHg for 19 mm and 27 mm prostheses, respectively; mean gradients were 9.94 and 6.18 mmHg for 19 mm and 27 mm prostheses, respectively. Neither implant-related complications nor significant periprosthetic leakages were recorded. CONCLUSIONS: Based on experience with patients, the Trifecta GT demonstrated an excellent hemodynamic performance after implantation, which involved a simple and safe technique. Further long-term studies to determine the durability of the prosthesis are required.
Red Cell Distribution Width as a Prognostic Marker in Patients Undergoing Valve Surgery.
Duchnowski P, Hryniewiecki T, Stokłosa P … +2 more , Kuśmierczyk M, Szymański P
J Heart Valve Dis · 2017 Nov · PMID 30207123
BACKGROUND: Numerous studies have shown that elevated red cell distribution width (RDW) is associated with poor outcomes in patients with cardiovascular diseases such as acute myocardial infarction, stroke, and chronic h...
BACKGROUND: Numerous studies have shown that elevated red cell distribution width (RDW) is associated with poor outcomes in patients with cardiovascular diseases such as acute myocardial infarction, stroke, and chronic heart failure. The prognostic utility of RDW in patients with valvular disease undergoing heart valve surgery is unknown. METHODS: A prospective study was conducted on a group of consecutive patients with hemodynamically significant valvular heart disease that underwent elective valvular surgery. The preoperative complete blood count, data on risk factors, course of operations and the postoperative period were assessed. The primary and secondary endpoints were 30-day mortality and any major adverse event within 30 days. The data were analyzed with Kaplan-Meier survival curves, regression analyses, and receiver operator characteristic (ROC) curves. RESULTS: The study group included 500 consecutive patients who underwent replacement or repair of the valve/valves. Sixteen patients died during the follow up period. On multivariate analysis, creatinine (p = 0.04), red blood cell (RBC) count (p = 0.005) and RDW (p = 0.02) were each associated with an increased risk of death. The composite endpoint occurred in 208 patients. On multivariate analysis, chronic kidney disease (p = 0.003), raised pulmonary blood pressure (p = 0.02) and RDW (p = 0.001) remained independent predictors of the secondary endpoint. The preoperative RDW in patients with valvular disease undergoing valve surgery, combined with EuroSCORE II, predicted 30-day mortality significantly better than did EuroSCORE II alone. CONCLUSIONS: An elevated RDW is associated with a worse outcome following valve surgery. The predictive ability of the RDW, when assessed by the area under the ROC curve, improved the predictive ability of the EuroSCORE II calculator.
Antiplatelet Therapy for Long-Term Management of Patients with Mechanical Aortic Prostheses.
Garcia Rinaldi R, Rodriguez-Acosta J, Bermúdez D … +3 more , Galera Á, Quinones S, Quinones J
J Heart Valve Dis · 2017 Nov · PMID 30207122
BACKGROUND: A mechanical aortic prosthesis (MAP) may cause platelet activation secondary to shear forces, and the release of adenosine diphosphate (ADP). This platelet-mediated event may lead to arterial embolism. Tradit...
BACKGROUND: A mechanical aortic prosthesis (MAP) may cause platelet activation secondary to shear forces, and the release of adenosine diphosphate (ADP). This platelet-mediated event may lead to arterial embolism. Traditionally, warfarin has been used to treat such cases, although this anticoagulant has no inhibitory effects on platelets. The study aim was to determine if antiplatelet agents could prevent thromboembolic events in patients with a MAP. METHODS: Since 2001, a total of 265 patients (average age 64.5 ± 12.0 years), each of whom received a MAP with or without additional aortic surgery, was followed at the authors' institution. Patients received a loading dose of clopidogrel or prasugrel + asprin 325 mg and tested for platelet inhibition. The maintenance dose was 75 mg clopidogrel or 10 mg prasugrel + 81 mg aspirin. Platelet reactivity was tested, using two different methods, after one month and at six-month intervals thereafter. RESULTS: The average follow up was 47.3 ± 44.3 months; total follow up was 11,688.8 months [974 patient-years (pt-yr)]. Over a 16-year period 51 patients died, primarily from myocardial infarction. Twelve patients had strokes (1.2%/pt-yr); of these patients, 10 had discontinued the antiplatelet medication (and were receiving warfarin). One patient was nonresponsive to clopidrogel and another (a compliant patient) was never tested. Strokes were not observed in compliant patients who responded to antiplatelet agents. Thirteen patients had gastrointestinal bleeding, four required transfusion, and three died due to cerebral aneurysms. CONCLUSIONS: Platelet-mediated thromboembolism following MAP installation can be treated with antiplatelet agents. The 16-year results of the present study suggested that antiplatelet agents can reduce thromboembolic events in patients with MAP. Strokes can be prevented in patients with MAP if treated with the correct antiplatelet agent, if the patient responds to the agent employed and is strictly compliant.
Frequency and Clinical Significance of Right Atrial Embryonic Remnants Involvement in Infective Endocarditis.
Cresti A, Baratta P, De Sensi F … +3 more , D'Aiello I, Costoli A, Limbruno U
J Heart Valve Dis · 2017 Nov · PMID 30207121
BACKGROUND: The involvement of atrial embryonic remnants in infective endocarditis (IE) has seldom been reported. The study aim was to evaluate the prevalence of vegetations on right atrial embryonic remnants (RAER) in p...
BACKGROUND: The involvement of atrial embryonic remnants in infective endocarditis (IE) has seldom been reported. The study aim was to evaluate the prevalence of vegetations on right atrial embryonic remnants (RAER) in patients with a definitive diagnosis of IE. METHODS: Since 1998, all consecutive patients with suspected IE were referred to the authors' institution to undergo transesophageal echocardiography (TEE). Patients with a high probability of IE but with a negative result underwent a further TEE examination within 10 days. The involvement of RAER was investigated systematically. RESULTS: Among a total of 585 patients evaluated, definitive criteria for IE were present in 210 (35.9%). Right-sided IE was detected in 33 patients (15%); these included 21 infections on the tricuspid valve (65%), 10 cases of intracardiac electronic device infection (29%), one infection on the Thebesian valve (3%), and one on the pulmonary valve (3%). The incidence of right-sided IE was 0.84 per 100,000 population per year. RAER involvement was detected in five patients (15% of right-sided endocarditis), representing 2.5% of the complete IE series. The incidence of RAER endocarditis was 0.13 new cases per 100,000 population per year. The Eustachian and Thebesian valves were involved in four cases. Two patients presented with pulmonary embolism and died in hospital. Transthoracic echocardiography (TTE) allowed the detection of RAER vegetations in two cases. CONCLUSIONS: Although the prevalence of embryonic remnants involvement in IE is underestimated, it may carry an important embolic risk if undetected. As TTE demonstrated only a low sensitivity in the diagnosis of embryonic remnant involvement, TEE should be performed systematically and RAER involvement carefully sought. TEE is recommended in all patients with a high clinical suspicion of right-sided IE. Video 1: Mid-esophageal TEE view. Multiple vegetations attached onto the pacemaker leads (broken arrow) and on the Eustachian valve (solid arrow). Video 2: Mid-esophageal TEE view. A vegetation attached onto the tricuspid valve (broken arrow) and on the Eustachian valve (solid arrow).
Clinicopathological Spectrum of Mitral Valve Myxoma.
Aguilar C, Espinoza D, Segura P … +1 more , Donet JA
J Heart Valve Dis · 2017 Nov · PMID 30207120
Cardiac myxomas are the most common primary tumors of the heart. Although these tumors have been reported in all cardiac chambers, myxomas arising from heart valves are extremely rare. Here, the details are described of...
Cardiac myxomas are the most common primary tumors of the heart. Although these tumors have been reported in all cardiac chambers, myxomas arising from heart valves are extremely rare. Here, the details are described of a patient with mitral valve myxoma, and a review is provided of 99 cases reported in the literature. Mitral valve myxomas most often occur in middle-aged patients, with a slight female predominance. Most of the tumors arise in an isolated fashion on the atrial side of the anterior mitral valve leaflet. Embolic events were the most frequent manifestation, followed by obstructive symptoms. Unlike atrial wall myxomas, these tumors have a lower incidence of constitutional manifestations. Tumor resection with valve preservation is the usual method of surgical treatment in isolated tumors, while most patients with multiple valve myxomas underwent valve replacement. Mitral valve myxomas should be considered in the differential diagnosis of mitral valve tumors, with an awareness of a relatively high risk of embolic events. This location should not raise suspicion for a heritable myxoma syndrome. Prompt surgical resection is warranted to reduce complications.
Mitral Valve Repair for Mitral Regurgitation with Congenital Anomalies of the Papillary Muscles.
Takeshita M, Arai H, Mizuno T … +2 more , Oi K, Yashima M
J Heart Valve Dis · 2017 Nov · PMID 30207119
BACKGROUND: True parachute mitral valve and parachute-like asymmetric mitral valve are associated with congenital anomalies of the papillary muscles, which involves an abnormal anatomy of the papillary muscles and chorda...
BACKGROUND: True parachute mitral valve and parachute-like asymmetric mitral valve are associated with congenital anomalies of the papillary muscles, which involves an abnormal anatomy of the papillary muscles and chordae. METHODS: Two patients are described with mitral valve regurgitation and papillary muscle anomalies. Mitral valve repair using artificial chordae reconstruction and ring annuloplasty was attempted in both cases. RESULTS: The first patient had a true parachute mitral valve, while the second patient had a parachute-like asymmetric mitral valve. In both patients, widespread leaflet prolapse induced mitral valve regurgitation, and the anterior mitral leaflet was thickened because of long-term regurgitation. Mitral valve repair using artificial chordae reconstruction and ring annuloplasty were successfully performed. At midterm follow up the patients did not experience any progression of significant regurgitation or stenosis. CONCLUSIONS: Mitral valve repair using artificial chordae reconstruction combined with ring annuloplasty is effective for treating regurgitant parachute mitral valve in adults.
Characterization of Effective Orifice Areas of Mitral Prosthetic Heart Valves: An In-Vitro Study.
Evin M, Magne J, Grieve SM … +2 more , Rieu R, Pibarot P
J Heart Valve Dis · 2017 Nov · PMID 30207118
BACKGROUND: Reference values of hemodynamic parameters for the assessment of prosthetic heart valves are necessary, and ideally need to be provided by entities independent of the valve manufacturers. Thus, the study aim...
BACKGROUND: Reference values of hemodynamic parameters for the assessment of prosthetic heart valves are necessary, and ideally need to be provided by entities independent of the valve manufacturers. Thus, the study aim was to provide, in vitro, normal reference values of the effective orifice area (EOA) for different models and sizes of mitral prosthetic valve, and to assess the determinants of EOA and mean transvalvular pressure gradient (mTPG). METHODS: Four models of mechanical prostheses were tested (one mono-leaflet, three bi-leaflet) and four models of bioprostheses (two bovine pericardial, two porcine) on a double-activation pulsed duplicator that was specifically designed and optimized for assessing the hemodynamic performance of mitral prosthetic valves. The hemodynamic conditions were standardized and included for bioprostheses: two mitral flow volumes, three mean aortic pressures, two heart rates, and three E/A ratios. The EOAs were measured with Doppler echocardiography, using the same method (continuity equation) as was used in the clinical setting. Overestimation in term of EOA was defined according to guidelines as >0.25 cm2. RESULTS: EOA reference values were recorded. For mono-leaflet prostheses (Medtronic Hall 7700, size 25 to 31 mm) 2.29 and 3.49; for bi-leaflet prostheses (St. Jude Medical Master and Master HP, sizes 25 to 33 mm and On-X valve, sizes 27-29 mm) 1.34 and 4.74 cm2; for porcine bioprostheses (Medtronic Mosaic CINCH, sizes 25 to 31 mm and St. Jude Epic 100, sizes 25 to 33 mm) 1.35 and 3.56 cm2; for bovine pericardial bioprosthetic valves (Edwards Perimount 6900P and Magna Ease 7300, sizes 25 to 33 mm) 1.67 and 2.36 cm2. There were some discrepancies between the normal reference EOAs measured compared to those provided by the prosthesis manufacturers, or in published reports. The bioprosthetic EOAs were shown to be smaller than the manufacturers' values in 32% of valves (by an average of 0.57 ± 0.28 cm2) versus in 7% of valves when compared to values reported elsewhere (by an average of 0.43 ± 0.17 cm2). The relationship between EOA and internal orifice area (IOA) varied according to the type of prosthesis. The EOA was close to the IOA in mechanical valves (regression slopes 0.87-0.99) but was much smaller than the IOA in bioprosthetic valves (slopes 0.25-0.30). The EOA was influenced by prosthesis diameter, prosthesis stent diameter and height, while the mTPG was influenced by EOA and heart rate. CONCLUSIONS: The present study has provided normal reference values of EOAs for several frequently used mitral prostheses. This information may be helpful for identifying and quantifying prosthetic valve dysfunction and prosthesis-patient mismatch.
Prevalence and Doppler Echocardiographic Characteristics of Normally Functioning Mitral Prostheses with Mean Gradient ≥10 mmHg.
House CM, Moriarty KA, Nelson WB
J Heart Valve Dis · 2017 Nov · PMID 30207117
BACKGROUND: The study aim was to determine the prevalence of normally functioning mitral prostheses with mean gradient ≥10 mmHg, and to identify the characteristics and echocardiographic variables that might be useful to...
BACKGROUND: The study aim was to determine the prevalence of normally functioning mitral prostheses with mean gradient ≥10 mmHg, and to identify the characteristics and echocardiographic variables that might be useful to distinguish normal function from dysfunction. METHODS: A total of 56 consecutive patients with a prosthetic mitral valve and mean gradient ≥10 mmHg was retrospectively identified. Nineteen patients without subsequent imaging confirming normal prosthesis function or dysfunction were excluded; hence, 37 patients were classified as obstruction, insufficiency, or normal prosthesis (high-gradient; NPHG). A comparison group of 25 patients with a mean transprosthetic gradient of ≤5 mmHg (low-gradient group) was also identified. RESULTS: Of the 37 patients, seven (19%) had obstruction, 10 (27%) had significant valvular or perivalvular insufficiency, and 20 (54%) were deemed NPHG. NPHG patients had a similar net atrioventricular compliance (Cn) to those with obstruction and insufficiency, which was significantly lower than the low-gradient group. The cardiac index (CI) was significantly higher in the NPHG group (3.4 ± 0.9 l/min/m2) compared to all other groups (p = 0.001). Receiver operator characteristic curves showed that the indexed effective orifice area (EOAi), effective orifice area (EOA) and velocity-time integral ratio distinguished NPHG from abnormal prosthesis function in patients with mean gradients ≥10 mmHg (area under curve = 0.92, 0.86, and 0.82, respectively). CONCLUSIONS: The study data suggested that a plurality of individuals with a mean transprosthetic mitral gradient ≥10 mmHg will be found to have a normally functioning prosthesis. Most of these patients will have a small EOAi, a reduced Cn, and a relatively increased CI.
Long-Term Follow Up After Successful Percutaneous Balloon Mitral Valvuloplasty.
Rodrigues I, Branco L, Patrício L … +5 more , Bernardes L, Abreu J, Cacela D, Galrinho A, Ferreira R
J Heart Valve Dis · 2017 Nov · PMID 30207116
BACKGROUND: Percutaneous balloon mitral valvuloplasty (PMV) is the cornerstone of rheumatic mitral stenosis treatment in suitable patients. Previous studies have reported low rates of technical failure and few major comp...
BACKGROUND: Percutaneous balloon mitral valvuloplasty (PMV) is the cornerstone of rheumatic mitral stenosis treatment in suitable patients. Previous studies have reported low rates of technical failure and few major complications, with good long-term results after successful PMV. The study aim was to assess the very long-term outcome in patients after PMV performed at a single tertiary center. METHODS: Between 1991 and 2010, a total of 213 consecutive patients underwent PMV at the authors' center. The criteria used to define successful procedure were post-procedural mitral valve area ≥1.5 cm2 and mitral regurgitation less than grade III, without in-hospital major cardiac or cerebrovascular events. The primary endpoint evaluated during the follow up period was the occurrence of cardiovascular death and need for mitral reintervention (percutaneous or surgical). Kaplan-Meier curves were generated to determine event rates, and predictors of major cardiac events in patients with successful PMV were determined using Cox regression analysis. RESULTS: A total of 190 patients (89%) underwent a successful PMV; 88% of these are currently being followed up at the authors' center. During a mean follow up of 11.2 ± 7.3 years, at least one major adverse cardiac event occurred in 25.1% of patients (6.6% all-cause death, 6.6% repeated PMV, 21% required mitral valve surgery). Cumulative event-free survival at 20 years was 54.7 ± 6.3%. On univariate analysis, the echocardiographic score [hazard ratio (HR) = 1.25 (1.00-1.70), p <0.05], left atrial diameter [HR = 1.06 (1.01-1.11), p <0.05] and mean mitral valve gradient soon after the procedure [HR = 1.25 (1.02-1.55), p <0.05] were predictors of events. On multivariate analysis, the echocardiographic mitral valve score before PMV was the only independent predictor of primary outcome [HR=1.75 (1.16-2.64), p<0.01]. CONCLUSIONS: Up to 20 years after successful PMV, a sizeable proportion of patients remained event-free, which confirmed the late efficacy of PMV. Among the present patient cohort, echocardiographic score before PMV was the only independent predictor of long term events.
Survival Advantage of MitraClip® Over Medical Treatment in Patients with Mitral Regurgitation: A Meta-Analysis.
Benito-González T, Estévez-Loureiro R, Iglesias-Gárriz I … +11 more , Gualis J, Pérez de Prado A, Garrote C, Swaans MJ, S Van der Heyden JA, Feldman T, Giannini C, Alonso D, Rodriguez-Santamarta M, Castaño M, Fernández-Vázquez F
J Heart Valve Dis · 2017 Nov · PMID 30207115
BACKGROUND: The MitraClip® system is a percutaneous treatment for mitral regurgitation (MR) that has shown promising results in patients who are inoperable or at high risk for mitral surgery. Data on the efficacy of the...
BACKGROUND: The MitraClip® system is a percutaneous treatment for mitral regurgitation (MR) that has shown promising results in patients who are inoperable or at high risk for mitral surgery. Data on the efficacy of the system over optimal medical therapy, above all in patients with functional MR, are scarce. The study aim was to assess the effect of MitraClip on the survival of patients with moderate/severe or severe MR compared to medical therapy, using meta-analytical techniques. METHODS: Independently, reviewers searched electronically for relevant articles based on predefined criteria and end-points. Only articles with a comparison between MitraClip and conservative therapy were included. Standard meta-analysis techniques were used. The primary outcomes were 30-day and one-year mortalities. RESULTS: Five observational reports were included that enrolled a total of 1,271 patients: 720 patients underwent percutaneous mitral valve repair (PMVR) with the MitraClip device, and 551 were managed conservatively. A total of 49 all-cause mortality events was reported at 30 days: 3.05% (22/720) in the PMVR arm, and 4.90% (27/510) in the conservative group, with no significant differences in all-cause mortality (OR 0.64; 95% CI 0.36-1.14). A total of 269 all-cause mortality events at one year was reported: 15.14% (109/720) in the PMVR arm, and 29.04% (160/551) in the conservative group. A significant difference favoring PMVR with the MitraClip system over medical therapy alone was observed (OR 0.44; 95% CI 0.30-0.64, p <0.0001). Neither significance between study heterogeneity (p = 0.18) nor publication bias was detected (p = 0.3). CONCLUSIONS: PMVR with the MitraClip system may be associated with an improvement in one-year survival compared to stand-alone medical management.
Cardioembolic Stroke from an Atrial Myxoma in a Pediatric Patient: A Case Report and Review of the Literature.
Aldajani AA, Mudhry MA, Mir A … +1 more , Albaradie RS
J Heart Valve Dis · 2017 Nov · PMID 30207114
Cardioembolic stroke is an uncommon phenomenon in pediatric patients. Although the heart is the usual source of the condition, cardiac myxomas are still considered to be a rare cause in children. The case is presented of...
Cardioembolic stroke is an uncommon phenomenon in pediatric patients. Although the heart is the usual source of the condition, cardiac myxomas are still considered to be a rare cause in children. The case is presented of a 13-year-old, right-handed Saudi boy who showed right-sided weakness for 30 h prior to hospital admission that involved the face, arm, and leg, with slurred speech. The patient had been discharged previously from a local hospital, without active management. An examination showed decreased strength on the right side, with hyperreflexia and an up-going plantar response. The work-up included magnetic resonance imaging, which demonstrated multiple bilateral acute infarcts involving mainly the left cerebellum and a small focus in the right cerebellum. Transthoracic echocardiography demonstrated a left atrial mass measuring 1.9 cm × 2.4 cm, attached to the septum. The mass was resected after anticoagulation, and histopathology confirmed a benign myxoma. This case of cardioembolic stroke was the first to be identified in a pediatric patient in Saudi Arabia, and may easily have been missed. Brain imaging and echocardiography should be performed as soon as possible in such patients in order to guide patient management.
Long-Term Results after Modified Bentall Operation in 200 Patients.
Katselis C, Samanidis G, Papasotiriou A … +5 more , Kriaras I, Antoniou T, Khoury M, Michalis A, Perreas K
J Heart Valve Dis · 2017 Nov · PMID 30207113
BACKGROUND: Composite graft replacement of the aortic root is the treatment of choice for an array of aortic root pathologies, such as annuloaortic ectasia, Marfan syndrome and acute or chronic aortic dissection type A....
BACKGROUND: Composite graft replacement of the aortic root is the treatment of choice for an array of aortic root pathologies, such as annuloaortic ectasia, Marfan syndrome and acute or chronic aortic dissection type A. In this retrospective study of the authors' aortic surgery database, an exploration was made of factors related to early and long-term morbidity and mortality of patients who underwent this procedure. METHODS: Between 2000 and 2009, a total of 200 consecutive patients (male:female ratio 4:1; mean age 56.2 ± 11.66 years) underwent the modified Bentall operation at the authors' institution, with a composite graft (mechanical valve) being used to correct aortic root pathology. All preoperative, perioperative and postoperative data, as well as long-term follow up data, were retrieved from the authors' aortic surgery database. RESULTS: Preoperative characteristics of the patients included elective and emergency operations (83.1% and 15.9%, respectively). Intraoperative and 30-day mortalities were 2% and 3.5%, respectively, while the rate of postoperative cerebrovascular events was 1.5%. Long-term survival at a mean follow up of 110 months for the elective and emergency groups was 88.6% and 71.9%, respectively (p = 0.007). Moreover, during the same period new cerebrovascular events were observed in 5.8% of cases. Predictive factors for late survival were type of surgery (elective versus emergency; p = 0.023), conduit size (≤23 mm versus >23 mm; p = 0.053) , age >65 years (p = 0.001), intensive care unit stay (days; p <0.001) and postoperative creatinine level (p = 0.002). Survival rates at one, three, five and 10 years postoperatively were 93.5%, 92.5%, 91.5% and 85.9%, respectively. CONCLUSIONS: Patients who underwent the modified Bentall operation presented with minimal major adverse effects and demonstrated a good long-term survival.
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