The Journal Of Heart Valve Disease[JOURNAL]
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200 papers
Impact of Tricuspid Valve Regurgitation on Early Outcomes after Transcatheter Aortic Valve Replacement.
Barvalia M, Tayal R, Cohen M … +5 more , Miguel Amor M, Tcharnaia L, Chen C, Russo M, Haik B
J Heart Valve Dis · 2017 Jul · PMID 29302936
BACKGROUND AND AIM OF THE STUDY: Tricuspid valve regurgitation (TR) is often not taken into consideration in the prognostication of patients undergoing transcatheter aortic valve replacement (TAVR). Accordingly, its impa...
BACKGROUND AND AIM OF THE STUDY: Tricuspid valve regurgitation (TR) is often not taken into consideration in the prognostication of patients undergoing transcatheter aortic valve replacement (TAVR). Accordingly, its impact on such patients remains relatively poorly defined. The study aim was to explore the effect of TR and parameters of right ventricular (RV) function on outcomes in patients undergoing TAVR. METHODS: Baseline demographic and echocardiographic data were collected for 460 consecutive patients undergoing TAVR at the authors' institution between 2012 and 2015. A retrospective analysis was performed to determine the association of TR with all-cause mortality in these patients. The primary endpoint was 30-day rate of all-cause mortality and/or hospital re-admission. RESULTS: Among 460 patients included in the study analysis there were 25 deaths and 40 re-admissions. Univariate analysis showed that a higher Society of Thoracic Surgeons (STS) score, severe preoperative mitral and tricuspid regurgitation were associated with statistically significant higher 30-day mortality and/or re-admission rates. On multivariate analysis, STS score (OR 1.07, 95% CI 1.012-1.126), moderate TR (OR 3.24, 95% CI 1.52-6.87) and severe TR (OR 2.5, 95% CI 1.04-6.04) were identified as significant independent predictors of all-cause mortality. CONCLUSIONS: The severity of TR is a strong independent parameter predictive of death at 30 days. Therefore, parameters of RV function such as TR should be incorporated into predictive models for patients undergoing TAVR.
Outcomes of Surgery for Severe Aortic Regurgitation with Systolic Left Ventricular Dysfunction.
Bruno P, Cammertoni F, Rosenhek R … +5 more , Mazza A, Nesta M, Burzotta F, D'Amario D, Massetti M
J Heart Valve Dis · 2017 Jul · PMID 29302935
BACKGROUND AND AIM OF THE STUDY: Management of patients with aortic regurgitation (AR) and severe impairment of left ventricular (LV) function characterized by an ejection fraction (EF) ≤35% is challenging. Conflicting r...
BACKGROUND AND AIM OF THE STUDY: Management of patients with aortic regurgitation (AR) and severe impairment of left ventricular (LV) function characterized by an ejection fraction (EF) ≤35% is challenging. Conflicting results regarding perioperative and long-term survival of these patients have been reported. The study aim was to compare in-hospital outcomes and long-term survival of patients with AR and severe LV dysfunction versus moderate dysfunction (35% <EF <50%) versus preserved LV function (EF ≥50%). METHODS: Between January 2006 and December 2013, a retrospective review was conducted of 119 consecutive patients with severe isolated AR who underwent aortic valve replacement at our institution. Overall, 17 patients (14%) had severe LV dysfunction, 26 (22%) had moderate LV dysfunction, and 76 (64%) had a preserved LV function. RESULTS: Patients with severely depressed EF were older and more severely symptomatic according to NYHA classification. Operative mortality was 0% in all groups. At a median echocardiographic follow up of 21 months, a statistically significant reverse remodelling of the left ventricle and an improvement in EF of the low-EF group were found. Survival for the overall population was 98.3%, 80.7% and 48.1% at one, five, and nine years, respectively. Long-term postoperative survival was not affected by baseline EF (p = 0.635), but age >70 years and NYHA class III/IV symptoms were predictive of survival. CONCLUSIONS: In-hospital and long-term survival was similar in patients with severe LV dysfunction and with preserved or moderately reduced LV function. Positive reverse LV remodelling and improved LV function was evident at the two-year echocardiographic follow up in these patients, who should not be denied aortic valve surgery.
Impact of Patient-Specific Material Properties on Aneurysm Wall Stress: Finite Element Study.
Wang Z, Xuan Y, Guccione JM … +2 more , Tseng EE, Ge L
J Heart Valve Dis · 2018 · PMID 34789967
BACKGROUND: Finite element analysis (FEA) can be used to determine ascending thoracic aortic aneurysm (aTAA) wall stress as a potential biomechanical predictor of dissection. FEA is dependent upon zero-pressure three-dim...
BACKGROUND: Finite element analysis (FEA) can be used to determine ascending thoracic aortic aneurysm (aTAA) wall stress as a potential biomechanical predictor of dissection. FEA is dependent upon zero-pressure three-dimensional geometry, patient-specific material properties, wall thickness, and hemodynamic loading conditions. Unfortunately, determining material properties on unoperated patients using non-invasive means is challenging; and we have previously demonstrated significant material property differences among aTAA patients. Our study objective was to determine the impact of patient-specific material properties on aTAA wall stress. Using FEA, we investigated if patient-specific wall stress could be reasonably predicted using population-averaged material properties, which would greatly simplify dissection prediction. METHODS: ATAA patients (n=15) with both computed tomography (CT) imaging and surgical aTAA specimens were recruited. Patient-specific aTAA CT geometries were meshed and pre-stress geometries determined as previously described. Patient-specific material properties were derived from biaxial stretch testing of aTAA tissue and incorporated into a fiber-enforced hyper-elastic model, while group-averaged material properties were estimated using mean values of each parameter. Population-averaged material properties were also calculated from literature and studied. Wall stress distribution and its magnitude were determined using LS-DYNA FEA software. Peak and averaged stresses and stress distributions were compared between patient-specific and both group- and population-averaged material property models. RESULTS: Patient-specific material properties had minimal influence on either peak or averaged wall stress compared to use of group- or population-averaged material properties. Stress distribution was also nearly superimposed among models with patient-specific vs. group- or population-averaged material properties and provided similar prediction of sites most prone to rupture. CONCLUSIONS: FEA using population-averaged material properties likely provides reliable stress prediction to indicate sites most prone to rupture. Population-averaged material properties may be reliably used in computational models to assess wall stress and significantly simplify risk prediction of aTAA dissection.
Iatrogenic Lutembacher Syndrome after Percutaneous Mitral Commissurotomy.
Karamitsos TD, Nikolaidou C, Koutsakis A … +3 more , Anastasiadis K, Karvounis C, Hadjimiltiades S
J Heart Valve Dis · 2017 May · PMID 29092127
Atrial septal defects (ASDs) are common immediately after percutaneous mitral commissurotomy (PMC). They are usually small, hemodynamically insignificant, and tend to decrease or disappear within 6 to 12 months. Herein,...
Atrial septal defects (ASDs) are common immediately after percutaneous mitral commissurotomy (PMC). They are usually small, hemodynamically insignificant, and tend to decrease or disappear within 6 to 12 months. Herein, a case is described of persistent ASD in a patient with mitral valve stenosis who had undergone successful PMC three years previously. The patient had signs and symptoms of right heart failure and severe tricuspid regurgitation (TR) with borderline right ventricular systolic function on echocardiography, in addition to the ASD. Cardiac magnetic resonance (CMR) imaging played a significant role in decision-making by clarifying the anatomy of the ASD and severity of the shunt, measuring right ventricular systolic function, and providing absolute quantification for TR. The right ventricular systolic function was normal on CMR, rendering the patient suitable for surgical treatment. Persistent iatrogenic ASDs have become an increasingly common finding after invasive procedures requiring trans-septal puncture and the manipulation of catheters. Multimodality imaging can provide significant aid in the management of patients with valvular heart disease complicated by iatrogenic shunts.
Prosthetic Aortic Valve Endocarditis Without Evidence of Vegetation.
Katchi T, Cooper HA, Yandrapalli SS … +5 more , Khera S, Fallon J, Spielvogel D, Aronow WS, Panza JA
J Heart Valve Dis · 2017 May · PMID 29092126
Despite significant technological advances, the diagnosis of infective endocarditis (IE) remains a major challenge, and the condition continues to be associated with significant morbidity and mortality. Valvular vegetati...
Despite significant technological advances, the diagnosis of infective endocarditis (IE) remains a major challenge, and the condition continues to be associated with significant morbidity and mortality. Valvular vegetations have long been the diagnostic and pathologic hallmarks of IE. However, IE can be diagnosed even in the absence of vegetations using the modified Duke criteria. Vegetation-negative endocarditis is rare, and to the present authors' knowledge no cases of septic emboli in the absence of valvular vegetations have been reported. Herein is reported a case of prosthetic aortic valve endocarditis associated with both clinical and radiologic evidence of septic emboli, but in the absence of vegetations on both repeated transesophageal echocardiography and pathologic evaluation. This case highlights the importance of maintaining a high clinical suspicion and a low threshold for the surgical replacement of a possibly infected valve, in patients that meet other clinical criteria for IE, even in the absence of detectable valvular vegetations.
Significant Drop in Right Atrial Pressure Does Not Influence Fractional Flow Reserve Coronary Assessment.
Scarsini R, Pesarini G, Castriota F … +2 more , Vassanelli C, Ribichini F
J Heart Valve Dis · 2017 May · PMID 29092125
The effect of a highly elevated level of right atrial filling pressure on fractional flow reserve (FFR) measurement remains unclear. Transcatheter tricuspid valve intervention, a recently introduced option for inoperable...
The effect of a highly elevated level of right atrial filling pressure on fractional flow reserve (FFR) measurement remains unclear. Transcatheter tricuspid valve intervention, a recently introduced option for inoperable or high-risk patients, represents a unique model of in-vivo physiology to investigate the eventual influence of central venous pressure on coronary FFR measurements. The case is reported of a patient with a degenerated tricuspid surgical bioprosthesis who underwent transcatheter tricuspid valve-in-valve replacement and concomitant coronary functional assessment with FFR. In an experimental model, the significant fall in right atrial pressure did not influence FFR measurements in the presence of angiographically proven mild coronary artery disease.
Post-Coital Acute Rupture of a Fenestrated Aortic Valve.
Roumy A, Jeanrenaud X, Pretre R … +1 more , Kirsch M
J Heart Valve Dis · 2017 May · PMID 29092124
Fenestrated aortic valve is a frequent condition which is, for most of the time, asymptomatic and generally has no influence on aortic valve competence. However, aortic valve regurgitation could occur, especially in the...
Fenestrated aortic valve is a frequent condition which is, for most of the time, asymptomatic and generally has no influence on aortic valve competence. However, aortic valve regurgitation could occur, especially in the case of fibrous strand rupture. In this situation, acute aortic regurgitation is poorly tolerated and requires urgent surgical correction. Herein is presented the case of a 70-year-old patient who was admitted as an emergency for acute heart failure after coital exertion. Echocardiography revealed severe acute aortic regurgitation due to leaflet prolapse. Intraoperative inspection of the valve showed a strand rupture of the isolated fenestration.
Bileaflet Foldoplasty in Barlows Disease.
Khalpey Z, Rawashdeh B, Kazui T … +1 more , Lick S
J Heart Valve Dis · 2017 May · PMID 29092123
Mitral valve repair is a feasible and preferable option for the treatment of Barlow's disease. Complex valve repair techniques, in contrast, often lead to increased cross-clamp times and low cardiac output syndrome. A si...
Mitral valve repair is a feasible and preferable option for the treatment of Barlow's disease. Complex valve repair techniques, in contrast, often lead to increased cross-clamp times and low cardiac output syndrome. A simple, fast, and reproducible foldoplasty technique to reduce anterior and posterior mitral leaflet heights may improve coaptation and reduce mitral regurgitation. Accordingly, herein are described minimally invasive, successful trans-septal and robotic approaches for a bileaflet foldoplasty technique in two patients with Barlow's disease.
Treatment of Prosthetic Valve Thrombosis with Bolus Dose Tenecteplase: An Experience from a Developing Country.
Kumar Jha R, Bansal S, S Issar H … +2 more , Chaudhary M, Sharma S
J Heart Valve Dis · 2017 May · PMID 29092122
BACKGROUND AND AIM OF THE STUDY: Prosthetic valve thrombosis (PVT) in metallic prosthetic cardiac valves is not an uncommon condition, and has high mortality and morbidity. Although surgery is the traditional choice for...
BACKGROUND AND AIM OF THE STUDY: Prosthetic valve thrombosis (PVT) in metallic prosthetic cardiac valves is not an uncommon condition, and has high mortality and morbidity. Although surgery is the traditional choice for PVT therapy, thrombolysis with newer agents has achieved good success rates. Many studies described in the western literature have used tissue plasminogen activators, while studies from developing countries have been largely based on the use of streptokinase and urokinase. Data regarding the use of newer agents such as tenecteplase are scant. Hence, the study aim was to evaluate the safety and efficacy of tenecteplase in left-sided PVT. METHODS AND RESULTS: Between 2013 and 2016, a total of 18 patients with PVT was treated with a 40 mg bolus dose of tenecteplase. Significantly, one patient was a pregnant lady in whom a lower dose (25 mg) was successfully and safely used. Thrombolysis was followed by enoxaparin and oral anticoagulation in patients, all of whom had complete lysis of thrombus and clinical improvement. CONCLUSIONS: Tenecteplase is an effective and excellent therapeutic agent for PVT, with a good safety margin. Its safe use in pregnancy points to a possible optional therapy, but this requires confirmation.
Obstructive Thrombosis of Left-Sided Mechanical Heart Valves: Clinical Profile and Thrombolytic Therapy.
Chandrakasu A, Jayachandran A, Gopinath Nayar P … +4 more , Meyyappan C, Narayan G, Basha Abdul Bari A, Johnson Samuel P
J Heart Valve Dis · 2017 May · PMID 29092121
BACKGROUND AND AIM OF THE STUDY: Thrombosis of a mechanical prosthetic heart valve is a potentially life-threatening complication associated with a high mortality. Although thrombolytic therapy has been considered highly...
BACKGROUND AND AIM OF THE STUDY: Thrombosis of a mechanical prosthetic heart valve is a potentially life-threatening complication associated with a high mortality. Although thrombolytic therapy has been considered highly beneficial in this situation, very few studies have been conducted to monitor the effectiveness of such thrombolytic therapy among Asian populations. Hence, the study aim was to evaluate the clinical profile, efficacy and safety of the thrombolytic agent streptokinase (SK) in patients with obstructive thrombosis of a left-sided mechanical heart valve. METHODS: Patients (n = 30) with left-sided mechanical heart valve thrombosis (LSMHVT) who had been managed with SK during the past four years were included in this retrospective study. Clinical features such as presenting symptoms based on NYHA functional class, prosthetic valve position, oral anticoagulant compliance, International Normalized Ratio (INR) and imaging methods including fluoroscopy, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were evaluated. In addition, the effectiveness and complications of SK were analyzed. RESULTS: The majority of patients presented with advanced NYHA class (III and IV, each 40%). Obstructive thromboses were observed at the mitral prosthesis in 70% of cases, at the aortic prosthesis in 27%, and at both valves in 3%. All patients underwent TTE, but fluoroscopy was used more often than TEE. Despite compliance with oral anticoagulation therapy, a sub-therapeutic INR was observed in 40% of cases at the time of presentation. Overall, thrombolysis was successful in 80% of patients using intravenous SK, with 100% success in patients in NYHA classes I-III and 42% for NYHA class IV. Moreover, embolic complications occurred in only a small number of patients. CONCLUSIONS: In patients with obstructive thrombosis of LSMHVT, intravenous SK was effective and should be considered as first choice in patients in NYHA classes I-III, and as an acceptable alternative in those in NYHA class IV.
Immunologic Responses in Biological and Mechanical Valve Prostheses: Inflammation and Functionality Are Not Always Related.
Rodriguez-Hernandez A, Elena Soto M, Vargas-Barron J … +7 more , Marquez R, Bojalil-Parra R, Perez-Torres I, Luis Salas-Pacheco J, Jimenez-Rojas V, Antonio Arias-Godinez J, Guarner-Lans V
J Heart Valve Dis · 2017 May · PMID 29092120
BACKGROUND AND AIM OF THE STUDY: The aim of this retrospective study was to evaluate the inflammatory response in patients with aortic and/or mitral prostheses, and to correlate the level of inflammatory markers with pro...
BACKGROUND AND AIM OF THE STUDY: The aim of this retrospective study was to evaluate the inflammatory response in patients with aortic and/or mitral prostheses, and to correlate the level of inflammatory markers with prosthesis functionality. METHODS: A total of 48 patients with biological or mechanical prostheses was included in the study, in which levels of tumor necrosis factor-alpha (TNFα), interleukin (IL)-1, -4, and -6, interferon-gamma (IFNγ), osteopontin (OPN), intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), endothelin-1 and C-reactive protein were analyzed. Functionality of the prosthesis was evaluated using transthoracic echocardiography at three years after surgery. RESULTS: The mean period from the date of surgery was seven years. High levels of IL-1 were found in patients with mechanical prostheses compared to those with bioprostheses (p = 0.04). Patients with aortic bioprostheses and stenosis had higher levels of OPN and endothelin-1, those with aortic mechanical prostheses with stenosis had increased levels of matrix metalloproteinase (MMP)-9, OPN and ICAM, and those with aortic mechanical leakage had increased levels of MMP-1 and endothelin-1. In mitral bioprostheses with leakage of endothelin-1, ICAM and MMP-9 levels were increased, while in mechanical prostheses with leakage there were increases of ICAM and endothelin-1. Tricuspid bioprostheses with double lesions had increased levels of OPN and endothelin-1. CONCLUSIONS: Valvular dysfunction was similar across the types of prosthesis material. IL-1 was increased in subjects with mechanical prostheses independently of dysfunction, while in biological prostheses there were increases in OPN and endothelin-1, and these were related to valvular dysfunction. Given that in the analysis of durability and functionality there were no significant differences between biological and mechanical prostheses, biological prostheses may represent the first treatment option in patients with low economic resources, the elderly, and even young patients.
miR-92a: A Novel Potential Biomarker of Rapid Aortic Valve Calcification.
Nader J, Metzinger-Le Meuth V, Maitrias P … +5 more , Humbert JR, Brigant B, Tribouilloy C, Metzinger L, Caus T
J Heart Valve Dis · 2017 May · PMID 29092119
BACKGROUND AND AIM OF THE STUDY: The study aim was to compare the tissular expression of microRNAs (miRs) in bicuspid and tricuspid valves, and to evaluate their use as potential novel biomarkers of aortic valve calcific...
BACKGROUND AND AIM OF THE STUDY: The study aim was to compare the tissular expression of microRNAs (miRs) in bicuspid and tricuspid valves, and to evaluate their use as potential novel biomarkers of aortic valve calcification in bicuspid valves. METHODS: A prospective single-center observational study was conducted on stenotic bicuspid and tricuspid human aortic valves. According to their potential role in valve vascular and valvular calcification, a decision was taken to include miR- 92a, miR-141, and miR-223 in this analysis. A real-time quantitative polymerase chain reaction was used to measure the expression of each miR, using U6 and Cel-miR-39 as endogenous and exogenous gene controls, respectively. RESULTS: Among a total of 47 human calcified aortic valves collected, 30 (63.8%) were tricuspid valves. The mean preoperative transvalvular gradient was 50.8 mmHg (range: 37-89 mmHg), with no significant difference between bicuspid and tricuspid valves (50 mmHg versus 51.2 mmHg; p = 0.729). The mean aortic valve area was 0.79 cm2 (range: 0.33-1.3 cm2), again with no significant difference between the two groups (p = 0.34). The level of miR-92a expression was twofold higher in bicuspid valves compared to tricuspid valves (0.38 versus 0.17; p = 0.016), but no significant difference in miR-141 and miR-223 expression was observed between the two groups (p = 0.68 and p = 0.35, respectively). A positive correlation was observed between miR-92a expression and mean preoperative transvalvular gradient (r = 0.3257, p = 0.04). CONCLUSIONS: miR-92a is overexpressed in calcified bicuspid aortic valves, and may serve as a potential biomarker of rapid aortic valve calcification. Further studies based on these results may be designed to correlate the relative expression of miR-92a in the serum with its tissular expression in AS.
Carcinoid Valve Disease: A Case Report and Review.
Heikali D, Chang N, Tabibiazar R
J Heart Valve Dis · 2017 May · PMID 29092118
In patients with carcinoid syndrome, the development of carcinoid valve disease typically carries an unfavorable prognosis. We present the case of a patient with significant valvular dysfunction secondary to carcinoid va...
In patients with carcinoid syndrome, the development of carcinoid valve disease typically carries an unfavorable prognosis. We present the case of a patient with significant valvular dysfunction secondary to carcinoid valve disease. Valve replacement surgery was complicated by the development of prosthetic valve degeneration, ultimately requiring percutaneous valve implantation in a valve-in-valve fashion. The technical details of the case, as well as a review of carcinoid valve disease, including its pathophysiology, clinical manifestations, diagnostic features and management considerations, are presented.
A Staged Approach of Proximal Left Anterior Descending Coronary Artery Percutaneous Intervention Followed by Minimally Invasive Valve Surgery.
Pineda AM, Mihos CG, Rodriguez-Escudero JP … +3 more , Lamelas J, Beohar N, Santana O
J Heart Valve Dis · 2017 May · PMID 29092117
BACKGROUND AND AIM OF THE STUDY: A subset of patients requiring coronary revascularization of the proximal left anterior descending coronary artery (LAD) and valve surgery may benefit from a staged approach, rather than...
BACKGROUND AND AIM OF THE STUDY: A subset of patients requiring coronary revascularization of the proximal left anterior descending coronary artery (LAD) and valve surgery may benefit from a staged approach, rather than combined median sternotomy coronary artery bypass graft (CABG) and valve surgery. METHODS: A retrospective evaluation was made of the outcomes of patients with significant proximal LAD and valvular heart disease undergoing a staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) at the authors' institution between February 2009 and April 2014. A Kaplan-Meier analysis was performed to estimate mid-term survival. RESULTS: A total of 68 consecutive patients (mean age 75.2 ± 8.9 years) was identified. PCI was performed for one- or two-vessel disease in 76.5% and 23.5% of the patients, respectively. Within a median of 39 days (IQR 11-62 days), 91.2% of patients underwent primary MIVS, and 8.8% underwent re-operative MIVS, of which 58 (85.3%) were single-valve and 10 (14.7%) were double-valve operations. At the time of surgery, 72.1% of the patients were receiving dual anti-platelet therapy. The 30-day mortality was 2.9%. At a mean follow up of 26 ± 16 months, 7.4% of the patients had a non-target vessel acute coronary syndrome, and the survival rate was 88.2%. CONCLUSIONS: Among a select group of patients with proximal LAD and valvular disease, a staged approach of PCI followed by MIVS can be safely performed for primary or re-operative surgery, with excellent mid-term outcomes.
Unexpected Problems of Antithrombotic Therapy with An Unusual Side Effect of Vitamin K Antagonists after Mitral Valve Replacement.
Marchandot B, Messas N, Jesel L … +5 more , Trinh A, Kibler M, Reydel A, Ohlmann P, Morel O
J Heart Valve Dis · 2017 May · PMID 29092116
Except for bleeding complications, vitamin K antagonists (VKAs) are known to have few undesirable side effects. Herein is presented the case of a 45-year-old woman in whom liver damage was induced by fluindione and warfa...
Except for bleeding complications, vitamin K antagonists (VKAs) are known to have few undesirable side effects. Herein is presented the case of a 45-year-old woman in whom liver damage was induced by fluindione and warfarin after mitral valve replacement. Hepatotoxicity is a rare complication of VKAs, both in the French National and Drug Safety registry and the medical literature. A diagnosis of VKA-induced drug damage was confirmed by the absence of other etiologies, the chronological sequence, recurrence after re-exposure to VKA, and rapid improvements after discontinuation of the drug. Despite possible cross-reactions between VKAs, the re-introduction of acenocoumarol was successfully achieved, with no recurrence of biological disturbances.
Cardiac Amyloidosis Associated with Enlargement and Functional Impairment of the Mitral Annulus: Insights from the Three-Dimensional Speckle Tracking Echocardiographic MAGYAR-Path Study.
Nemes A, Földeák D, Kormányos Á … +4 more , Domsik P, Kalapos A, Borbényi Z, Forster T
J Heart Valve Dis · 2017 May · PMID 29092115
BACKGROUND AND AIM OF THE STUDY: Cardiac amyloidosis (CA) is a rare condition characterized by the extracellular deposition of amyloidogenic proteins in the heart. The aim of the present study was to compare the size and...
BACKGROUND AND AIM OF THE STUDY: Cardiac amyloidosis (CA) is a rare condition characterized by the extracellular deposition of amyloidogenic proteins in the heart. The aim of the present study was to compare the size and function of the mitral annulus (MA) between CA patients and age- and gender-matched controls, using three-dimensional speckle-tracking echocardiography (3-D STE). METHODS: The study included 17 patients (mean age 64.2 ± 9.8 years) with CA, whose results were compared to 26 age- and gender-matched healthy controls (mean age 59.0 ± 8.2 years). Complete two-dimensional (2-D) Doppler echocardiography and 3-D STE were performed in all cases. RESULTS: Significantly enlarged end-diastolic and end-systolic MA diameters (3.09 ± 0.56 cm versus 2.70 ± 0.37 cm, p = 0.01 and 2.71 ± 0.68 cm versus 1.87 ± 0.31 cm, p <0.001) and MA area (11.22 ± 3.56 cm2 versus 8.60 ± 1.92 cm2, p = 0.004 and 8.57 ± 3.35 cm2 versus 4.55 ± 1.05 cm2, p <0.001) were demonstrated in CA. MA fractional area change (24.10 ± 13.97% versus 46.06 ± 14.37%, p <0.001) and MA fractional shortening (12.92 ± 9.55% versus 30.98 ± 11.65%, p <0.001) were also impaired in CA patients as compared to matched controls. CONCLUSIONS: CA is associated with MA enlargement and functional impairment represented by MA fractional shortening and MA fractional area change, as assessed using 3-D STE.
Remodeling Mitral Annuloplasty Ring Concept with Preserved Dynamics of Annular Height.
Skov SN, Røpcke DM, Tjørnild MJ … +6 more , Ilkjær C, Rasmussen J, Nygaard H, M Hasenkam J, Jensen MO, Nielsen SL
J Heart Valve Dis · 2017 May · PMID 29092114
BACKGROUND AND AIM OF THE STUDY: The configuration of the native annulus changes from nearly flat in the diastolic phase to saddle-shaped in the systolic phase. The present study was conducted to test a novel remodeling...
BACKGROUND AND AIM OF THE STUDY: The configuration of the native annulus changes from nearly flat in the diastolic phase to saddle-shaped in the systolic phase. The present study was conducted to test a novel remodeling annuloplasty ring with built-in septal-lateral fixation and commissural axial flexibility so as to maintain the change in annular saddle shape. The study aim was to evaluate the in-vivo biomechanical performance of the novel annuloplasty ring, compared with the native valve and a semi-rigid and rigid annuloplasty ring. METHODS: All measurements were performed in vivo using a porcine model. A total of 28 pigs (bodyweight ca. 80 kg) were randomized to four groups: (i) with no ring; (ii) with a novel remodeling ring; (iii) with a semi-rigid ring (Physio I Ring, Edwards Lifesciences); and (iv) with a rigid ring (Classic Annuloplasty Ring, Edwards Lifesciences). Force measurements were performed using a dedicated transducer to determine remodeling capacity of the annuloplasty rings. Geometric parameters were measured by implanting sonomicrometry crystals along the mitral annulus. RESULTS: All ring groups significantly restricted the cyclic change of the mitral annulus compared with the 'no-ring' group. The change and maximum value of the annular height were maintained for the novel ring but were significantly decreased for the rigid and semi-rigid rings compared with the 'no-ring' group. Mitral annular force measurements confirmed that the overall remodeling capacity of the novel ring was comparable with the conventional ring groups, and significantly higher in the septal-lateral direction compared to the semi-rigid ring. CONCLUSIONS: In-vivo geometry and force measurements indicated that the intended design features of the new device were successfully provided. The novel ring concept with remodeling properties, combined with the advantages of a flexible annuloplasty ring, is unique. The maintenance of annular saddle shape and cyclic change in annular height may be an important step towards improved mitral valve repair.
Progression of Tricuspid Regurgitation after Mitral Valve Replacement for Rheumatic Heart Disease.
Q Tri HH, Vinh PN
J Heart Valve Dis · 2017 May · PMID 29092113
BACKGROUND AND AIM OF THE STUDY: Progression of tricuspid regurgitation (TR) may occur after mitral valve replacement (MVR). The study aim was to define the independent predictors for new severe TR after MVR to treat rhe...
BACKGROUND AND AIM OF THE STUDY: Progression of tricuspid regurgitation (TR) may occur after mitral valve replacement (MVR). The study aim was to define the independent predictors for new severe TR after MVR to treat rheumatic heart disease. METHODS: A total of 413 patients (177 men, 236 women; mean age 40.9 ± 9.2 years) with rheumatic heart disease undergoing MVR without concomitant tricuspid valve repair at the authors' institute between 1995 and 2005, who did not have preoperative severe TR, were followed for at least one year postoperatively. Survival without severe TR was estimated using the Kaplan-Meier method. Independent predictors for new severe TR were identified using multiple Cox regression analysis. RESULTS: During a median follow up of 13 years there were two late deaths, and 46 patients (11.1%) had new severe TR. Survival without severe TR was 88.0 ± 1.7% at 10 years. Independent predictors for new severe TR were preoperative moderate TR (HR 2.401; p = 0.008) and atrial fibrillation (AF) (HR 2.119; p = 0.018). At the most recent follow up, furosemide was used in 23.9% patients with and 7.3% patients without new severe TR (p = 0.001). Patients with new severe TR had larger right ventricles and higher pulmonary artery pressures on echocardiography. CONCLUSIONS: Among patients with rheumatic heart disease undergoing MVR without concomitant tricuspid valve repair, independent predictors for new severe TR were preoperative moderate TR and AF. New severe TR was associated with increased furosemide use.
Early Activation of Growth Pathways in Mitral Leaflets Exposed to Aortic Regurgitation: New Insights from an Animal Model.
Marsit O, Royer O, Drolet MC … +6 more , Arsenault M, Couet J, Morin S, Levine RA, Pibarot P, Beaudoin J
J Heart Valve Dis · 2017 May · PMID 29092112
BACKGROUND AND AIM OF THE STUDY: Mitral leaflet enlargement in patients with chronic aortic regurgitation (AR) has been identified as an adaptive mechanism potentially able to prevent functional mitral regurgitation (FMR...
BACKGROUND AND AIM OF THE STUDY: Mitral leaflet enlargement in patients with chronic aortic regurgitation (AR) has been identified as an adaptive mechanism potentially able to prevent functional mitral regurgitation (FMR) in response to left ventricular (LV) dilatation. The timing of valve enlargement is not known, and the related mechanisms are largely unexplored. METHODS: AR was induced in 58 rats, and another 54 were used as sham controls. Animals were euthanized at different time points after AR creation (48 h, one week, and three months), and AR severity, FMR and LV dilatation were assessed using echocardiography. Mitral valves were harvested to document the reactivation of embryonic growth pathways. RESULTS: AR animals had increased LV dimensions and mitral annulus size. No animal developed FMR. No change in leaflet length or thickness was seen at 48 h; however, anterior mitral leaflets were longer and thicker in AR animals at one week and three months. Molecular changes were present early (at 48 h and at one week), with positive staining for transforming growth factor-b1 (TGF-b1), Alpha-smooth muscle actin (α-SMA) and matrix metalloproteinase-2 (MMP-2), which suggested active matrix remodeling. Increased gene expression for collagen 1, TGF-β1, α-SMA and MMP-2 was found in the mitral valve at 48 h and at one week, but after three months their expression had returned to normal. CONCLUSIONS: This model of AR induces active expansion and thickening of the mitral leaflets. Growth signals are expressed acutely, but not at three months, which suggests that most of this enlargement occurs at an early stage. The stimulation of valvular growth could represent a new strategy for the prevention of FMR.
Prevalence of Bicuspid Aortic Valve in Chinese Patients with Aortic Valve Disease: A Systematic Review.
Wang X, Wang W
J Heart Valve Dis · 2017 May · PMID 29092111
BACKGROUND AND AIM OF THE STUDY: The aim of this systematic review was to assess the incidence of bicuspid aortic valve (BAV) in Chinese patients with aortic valve disease. METHODS: Articles published between January 200...
BACKGROUND AND AIM OF THE STUDY: The aim of this systematic review was to assess the incidence of bicuspid aortic valve (BAV) in Chinese patients with aortic valve disease. METHODS: Articles published between January 2000 and January 2015 were retrieved, and those reporting numbers of BAVs were selected. Data relating to congenital BAV and rheumatic lesions with functional BAV that were available for analysis were also collected. RESULTS: A total of 4,070 articles (3,538 in Chinese, 532 in English) was retrieved, among which 3,954 were excluded and 116 were selected. Ultimately, 20 articles remained for further analysis, and these revealed that the prevalence of confirmed BAVs in aortic valves was 10.92% (133/1,218). The long-term follow up survival rate of patients undergoing surgical procedures to treat BAVs ranged from 76.7% to 91.7%. CONCLUSIONS: The prevalence of BAVs in aortic valve disease remains high among the Chinese population. Rheumatic lesions with functional BAV have frequently been described in the Chinese population. More epidemiological data are required to better characterize and understand aortic valve disease, especially in the context of transcatheter aortic valve implantation.
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