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Van Hecke M, Langenaeken T, Rega F, Roskams T, Meuris B. Validation of large animal models in mechanical valve research: a histologic comparison. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae070. [PMID: 38637938 PMCID: PMC11078892 DOI: 10.1093/icvts/ivae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/15/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Mechanical valves still require life-long anticoagulation. Preclinical animal testing is a crucial step in the assessment of valves; however, the chosen animal model should be carefully considered, and a well-controlled animal model of mechanical valve thrombosis has not been established yet. In this study, a histopathologic comparison was performed to evaluate the representativity of pigs and sheep as large animal models in bileaflet mechanical valve thrombosis research. METHODS 10 pigs and 8 sheep were implanted with a bileaflet mechanical valve in pulmonary position. During follow-up, no anticoagulative therapy was administered. Pigs were sacrificed between 14 and 38 days for explantation and assessment of the valve. Sheep were sacrificed between 71 and 155 days. Thrombus samples were processed and (immuno)histochemical stainings were applied. A pathologist evaluated the samples morphologically and semiquantitatively and compared these samples to available slides from 3 human patients who underwent redo surgery for acute bileaflet mechanical valve thrombosis, caused by insufficient anticoagulation. RESULTS All pigs showed macroscopically evident thrombi on the mechanical valve surface at sacrifice. In contrast, none of the sheep showed any sign of thrombus formation. Histology showed a high fibrin content in thrombi of both human and porcine cases (3/3 vs 8/10). Porcine thrombi showed more cellular organization (0/3 vs 6/10), more calcification (0/3 vs 9/10) and more endothelialization (0/3 vs 6/10). Inflammatory cells were present in all samples and were considered physiological. CONCLUSIONS Contrary to sheep, pigs develop thrombi on their mechanical valves in the short-term if no anticoagulation is administered. Histologic comparison of human and porcine thrombi shows comparable findings. The pig model might serve interestingly for further research on valve thrombosis, if it shows not to be an overly aggressive model.
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Affiliation(s)
- Manon Van Hecke
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Langenaeken
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tania Roskams
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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2
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Mousa A, Arshad H, Kakhktsyan T, Rashid MH, Patel J, Desai H. Prosthetic Aortic Valve Obstruction With Pannus Formation, an Approach for Diagnosis and Management: A Case Report. Cureus 2023; 15:e40416. [PMID: 37456415 PMCID: PMC10348070 DOI: 10.7759/cureus.40416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Mechanical valve obstructions are critical medical and surgical emergencies that require immediate attention when patients present with new complaints and exhibit signs such as the onset of murmurs or the disappearance of mechanical valve clicks. Obstructions can arise from various causes, including pannus formation, thrombus, vegetations, or subvalvular tissue growth. While pannus formations have been previously reported for the mitral valve, they are less commonly observed in the aortic valve, and several hypotheses have been proposed to understand pannus formation. Accurate diagnosis relies on imaging techniques such as echocardiography and fluoroscopy, and surgical intervention is considered the optimal treatment approach. Here, we present the case of a 69-year-old female who had previously undergone aortic valve replacement and subsequently developed progressive dyspnea, fatigue, and a new onset murmur. Imaging modalities revealed a closed leaflet and a high transvalvular gradient over the valve. The patient underwent a prosthetic redo valve replacement, and post-surgery, she was discharged home without complications.
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Affiliation(s)
- Aliaa Mousa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Hassaan Arshad
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Tigran Kakhktsyan
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Muhammad Humayoun Rashid
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
- Internal Medicine, Nishtar Medical University, Multan, PAK
| | - Jigar Patel
- Cardiovascular Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Harit Desai
- Cardiovascular Medicine, Capital Health Regional Medical Center, Trenton, USA
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3
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Kim K, Kim DY, Seo J, Cho I, Shim CY, Hong GR, Ha JW. The ratio of measured and reference effective orifice areas for discriminating prosthetic aortic valve obstruction. Eur Heart J Cardiovasc Imaging 2023; 24:232-240. [PMID: 36315445 DOI: 10.1093/ehjci/jeac206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/20/2022] [Accepted: 09/24/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS We aimed to evaluate the efficacy of the measured effective orifice area (EOA)/reference EOA ratio in discriminating mechanical prosthetic aortic valve (PAV) obstruction. METHODS AND RESULTS This is a retrospective study of 193 mechanical PAV patients with an elevated mean transprosthetic pressure gradient (PG) over 20 mmHg or peak velocity over 3 m/s. Of those, 143 patients were objectively proven PAV obstruction with cardiac computed tomography or surgical inspection. The EOA was measured using the continuity equation, and the reference EOA values were obtained from previous guidelines. The measured/reference EOA ratio was significantly lower in the obstruction group (0.63 ± 0.18 vs. 0.86 ± 0.17; P < 0.001). The EOA ratio added incremental value for discriminating obstruction from the conventional parameters recommended in the guidelines. Receiver operating characteristic curve analysis revealed that the measured/reference EOA ratio discriminated PAV obstruction from those without obstruction [area under the curve (AUC), 0.840; 95% confidence interval, 0.783-0.898; P < 0.001]. A cutoff of 0.71 had 73.4% sensitivity and 82.0% specificity. The novel diagnostic algorithm adding the EOA ratio had similar accuracy to previous guideline algorithms, including reference EOA, and conventional Doppler parameters (AUC, 0.763 vs. 0.731; P = 0.309). In patients with a large PAV (≥23 mm), the novel algorithm had higher accuracy than the previous algorithm (AUC, 0.788 vs. 0.642; P = 0.019). CONCLUSION The ratio of measured/reference EOA adds incremental value over conventional Doppler parameters and might be helpful for distinguishing PAV obstruction.
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Affiliation(s)
- Kyu Kim
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Dae-Young Kim
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Jiwon Seo
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
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Levy G, Palacio D. Cardiac gated multidetector computed tomography (MDCT) to determine valvular leaflet thrombosis and leaflet restriction. J Card Surg 2022; 37:4172-4177. [PMID: 36198144 DOI: 10.1111/jocs.17001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 01/06/2023]
Abstract
The evaluation of patients following aortic valve replacement has evolved, with multiple imaging modalities available that complement each other and permit better and prompt delineation of specific structural or functional valve complications. Multidetector computed tomography (MDCT) is one of the diagnostic modalities with significant technologic advancements that have made possible to evaluate high detail of the moving heart. The ability to deliver three-dimensional and multiplanar dynamic imaging with fine detail has demonstrated the technique is well suited to investigate valve complications. In this review article, we focus on some of the most contributing roles of MDCT in the diagnosis of complications associated with valvular pathology.
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Affiliation(s)
- Gal Levy
- Division of Cardiovascular and Thoracic Surgery, UTMB Galveston, Galveston, Texas, USA
| | - Diana Palacio
- Department of Radiology, UTMB Galveson, Galveson, Texas, USA
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5
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Ahn Y, Koo HJ, Kang JW, Yang DH. Tricuspid Valve Imaging and Right Ventricular Function Analysis Using Cardiac CT and MRI. Korean J Radiol 2021; 22:1946-1963. [PMID: 34668349 PMCID: PMC8628151 DOI: 10.3348/kjr.2020.1507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022] Open
Abstract
Cardiac computed tomography (CT) and cardiac magnetic resonance imaging (CMR) can reveal the detailed anatomy and function of the tricuspid valve and right ventricle (RV). Quantification of tricuspid regurgitation (TR) and analysis of RV function have prognostic implications. With the recently available transcatheter treatment options for diseases of the tricuspid valve, evaluation of the tricuspid valve using CT and CMR has become important in terms of patient selection and procedural guidance. Moreover, CT enables post-procedural investigation of the causes of valve dysfunction, such as pannus or thrombus. This review describes the anatomy of the tricuspid valve and CT and CMR imaging protocols for right heart evaluation, including RV function and TR analyses. We also demonstrate the pre-procedural planning for transcatheter treatment of TR and imaging of postoperative complications using CT.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Jinno T, Kato Y, Yamauchi H, Date Y, Sasaki K, Shimizu A, Kiyama H, Koyanagi T. Pannus-related left main trunk ostial stenosis after aortic valve replacement. Gen Thorac Cardiovasc Surg 2021; 69:1511-1514. [PMID: 34510334 DOI: 10.1007/s11748-021-01704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
A 34-year-old woman was hospitalized with shortness of breath and chest tightness and pain. She had undergone aortic valve replacement for aortic stenosis at the age of 18 years. Transthoracic echocardiography showed left ventricular asynergy and a high aortic valve pressure gradient. Thus, structural valve deterioration was diagnosed. Coronary computed tomography and coronary angiography revealed left main trunk ostial stenosis that had caused acute anteroseptal myocardial infarction. Urgent surgery revealed pannus formation around the prosthetic valve and covering the ostium of the left main trunk. A Bentall procedure and coronary artery bypass grafting were performed. The postoperative course was uneventful.
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Affiliation(s)
- Taiyo Jinno
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayama, Saitama, 350-1305, Japan.
| | - Yasuyuki Kato
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayama, Saitama, 350-1305, Japan
| | - Hidetaka Yamauchi
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayama, Saitama, 350-1305, Japan
| | - Yusuke Date
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayama, Saitama, 350-1305, Japan
| | - Kenichi Sasaki
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayama, Saitama, 350-1305, Japan
| | - Atsushi Shimizu
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayama, Saitama, 350-1305, Japan
| | - Hiroshi Kiyama
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayama, Saitama, 350-1305, Japan
| | - Toshiya Koyanagi
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayama, Saitama, 350-1305, Japan
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7
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Ronderos R, Politi MT, Mahia MC, Castro MF, Sciancalepore A, Cueva Torres F, Kuschnir P, de la Paz Ricapito M, Vrancic JM, Camporrotondo M, Piccinini F, Navia D. Hemodynamically significant prosthesis-patient mismatch can be predicted and is associated with early prosthetic valve dysfunction in aortic bioprosthesis. Echocardiography 2021; 38:814-824. [PMID: 33991141 DOI: 10.1111/echo.15068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/07/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To evaluate the accuracy of predicted prosthesis-patient mismatch (PPM) regarding actual PPM measured postoperatively. To assess the association between PPM and prosthetic valve dysfunction. METHODS Retrospective cohort study including adult patients after aortic valve replacement surgery with a biological prosthesis. Predicted PPM status was determined using mean reference effective orifice area indexed to total body surface (iEOA), without considering reference standard deviations. Postoperative PPM status was determined by measuring iEOA within the first 60 postoperative days. Prosthetic valve dysfunction was defined as thrombosis, pannus, valve degeneration, and/or disruption. RESULTS 205 patients were enrolled between January 2003 and June 2017: predicted PPM was absent in 52 patients (25.4%), moderate in 137 patients (66.8%), and severe in 16 patients (7.8%). After surgery, the actual postoperative iEOA was measured: 53 (25.9%) did not have PPM, 73 had moderate PPM (35.6%), and 79 had severe PPM (38.5%). Predicted PPM identified the presence of hemodynamically significant actual postoperative PPM (OR = 2.56; 95%CI 1.30-5.05; P = .006), though not its degree of severity. Prosthetic valve dysfunction was more frequent among patients with hemodynamically significant PPM (53.9% vs. 11.3%; P < .001), compared to those without PPM. The association between PPM and prosthetic valve dysfunction was maintained after adjusting for gender, age, and ever-smoking (OR = 9.03; P < .001). The incidence of thrombosis or pannus was also nonsignificantly higher in patients with moderate or severe PPM. CONCLUSIONS Predicted PPM identifies the presence, possibly not the severity, of actual postoperative PPM. Moderate or severe PPM is associated with prosthetic valve dysfunction. Actual postoperative prosthesis-patient mismatch measured within 60 postoperative days showed a distinctive hemodynamic profile and presented a stronger association with prosthetic valve dysfunction than predicted prosthesis-patient mismatch. A. Echocardiographic follow-up in patients according to the actual postoperative PPM measured within 60 postoperative days. B. Prediction of prosthetic valve dysfunction based on preoperative predicted PPM or on actual postoperative PPM within 60 postoperative days. PPM: prosthesis-patient mismatch. OR: Odds ratio.
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Affiliation(s)
- Ricardo Ronderos
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - María Teresa Politi
- Laboratorio de Estadística Aplicada a las Ciencias de la Salud (LEACS), Departamento de Toxicología y Farmacología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Mariana Cecilia Mahia
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - María Florencia Castro
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Agustina Sciancalepore
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Franklin Cueva Torres
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Paola Kuschnir
- Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Juan Mariano Vrancic
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Mariano Camporrotondo
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Piccinini
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Navia
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
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8
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Choi JW, Hwang HY, Lee Y, Sohn SH, Kim KH, Kim KB, Ahn H. Incidence and Risk Factors of Pannus after Mechanical Aortic Valve Replacement. Thorac Cardiovasc Surg 2021; 70:182-188. [PMID: 33940657 DOI: 10.1055/s-0041-1727152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study was conducted to evaluate the occurrence rate and risk factors of subaortic pannus (SAP) after bileaflet mechanical aortic valve (AV) replacement. METHODS Between 1990 and 2014, 862 patients underwent primary AV replacement with bileaflet mechanical prosthesis. SAP was defined as (1) gradual increase in mean pressure gradient through mechanical AV without any evidence of motion limitation of the leaflets on echocardiography and (2) AV mean pressure gradient >40 mm Hg or AV peak velocity >4 m/s on echocardiography, and (3) any visible subaortic tissue ingrowth beneath the mechanical AV on echocardiography or computed tomography. Clinical and echocardiographic follow-up durations were 13.8 ± 8.0 and 10.7 ± 7.9 years, respectively. RESULTS Mean age was 51.1 ± 12.1 years and concomitant surgeries were performed in 503 patients (58.4%). Overall survival at 10 and 20 years was 84.2 and 67.1%, respectively. SAP occurred in 33 patients, and in only 2 patients during the first 10 years after surgery. The cumulative incidence of SAP formation at 10, 20, and 25 years were 0.3, 5.0, and 9.9%, respectively. The Fine and Gray model demonstrated that small prosthetic valve size (hazard ratio [HR] [95% confidence interval, CI] = 0.738 [0.575-0.946]), young age (HR [95% CI] = 0.944 [0.909-0.981]), and concomitant mitral valve replacement (MVR) (HR [95% CI] = 3.863 [1.358-10.988]) were significant risk factors for the SAP formation. CONCLUSIONS SAP occurred gradually over time with 10- and 20-year cumulative incidence of 0.3 and 5.0%, respectively. Young age, small prosthetic valve size, and concomitant MVR were risk factors for SAP formation. Therefore, we recommend efforts to select large prostheses for young patients requiring concomitant MVR.
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Affiliation(s)
- Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Jongno-gu, Seoul, the Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Jongno-gu, Seoul, the Republic of Korea
| | - Yeiwon Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Jongno-gu, Seoul, the Republic of Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Jongno-gu, Seoul, the Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Jongno-gu, Seoul, the Republic of Korea
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Jongno-gu, Seoul, the Republic of Korea
| | - Hyuk Ahn
- Seoul Veterans Hospital, Gangdong-gu, Seoul, the Republic of Korea
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9
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Tod TJ, Gohres RA, Torky M, Wright GA, Lamberigts M, Flameng W, Meuris B. Influence of Tissue Technology on Pannus Formation on Bioprosthetic Heart Valves. Cardiovasc Eng Technol 2021; 12:418-425. [PMID: 33880722 DOI: 10.1007/s13239-021-00530-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Bioprosthetic heart valves have several modes of failure. Tissue degeneration and calcification are the major modes of failure with the highest focus of attention, however pannus formation can also be problematic. We studied the effect of a new tissue technology with the absence of any glutaraldehyde-based storage solution and a stable aldehyde capping process on pannus formation. METHODS Using a juvenile sheep model of mitral valve replacement, valves with the new tissue technology were compared to control valves with contemporary bovine pericardial tissue, regarding pannus formation. Valves were implanted for either a 5- or 8-month period. Explanted valves were examined macroscopically and histologically. Histological observations were made by an independent pathologist, blinded to group identity. RESULTS Pannus area measured macroscopically on the test valves was significantly lower than the pannus on the control tissue. This was confirmed on the histological samples, where the total pannus overgrowth was significantly lower in the test group compared to the control. CONCLUSION The new tissue technology leads to less pannus formation. This may beneficially influence both short- and long-term valve behavior of bioprosthetic valves.
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Affiliation(s)
- Tara J Tod
- Tissue Research, Edwards Lifesciences, Irvine, CA, USA
| | | | - Mohammed Torky
- Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Marie Lamberigts
- Cardiac Surgery, Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.
| | - Willem Flameng
- Cardiac Surgery, Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Cardiac Surgery, Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
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10
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Proper Orthogonal Decomposition Analysis of the Flow Downstream of a Dysfunctional Bileaflet Mechanical Aortic Valve. Cardiovasc Eng Technol 2021; 12:286-299. [PMID: 33469847 DOI: 10.1007/s13239-021-00519-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/02/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Aortic valve replacement remains the only viable solution for symptomatic patients with severe aortic valve stenosis. Despite their improved design and long history of successful operation, bileaflet mechanical heart valves are still associated with post-operative complications leading to valve dysfunction. Thus, the flow dynamics can be highly disturbed downstream of the dysfunctional valve. METHODS In this in vitro study, the flow dynamics downstream of healthy and dysfunctional bileaflet mechanical heart valves have been investigated using particle image velocimetry measurements. Proper orthogonal decomposition of the velocity field has been performed in order to explore the coherent flow features in the ascending aorta in the presence of a dysfunctional bileaflet mechanical heart valve. RESULTS The ability of proper orthogonal decomposition derived metrics to differentiate between heathy and dysfunctional cases is reported. Moreover, reduced-order modeling using proper orthogonal decomposition is thoroughly investigated not only for the velocity field but also for higher order flow characteristics such as time average wall shear stress, oscillatory shear index and viscous energy dissipation. CONCLUSION Considering these results, proper orthogonal decomposition can provide a rapid binary classifier to evaluate if the bileaflet mechanical valve deviates from its normal operating conditions. Moreover, the study shows that the size of the reduced-order model depends on which flow parameter is required to be reconstructed.
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11
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Raju SN, Shaw M, Pandey NN, Sharma A, Kumar S. Imaging evaluation using computed tomography after ascending aortic graft repair. Asian Cardiovasc Thorac Ann 2020; 29:132-142. [PMID: 32957798 DOI: 10.1177/0218492320960331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prosthetic aortic graft repair is employed in the management of various conditions such as annuloaortic ectasia, ascending aortic aneurysm, type A aortic dissection, and aortic root abscess. Correct interpretation of post-surgical prosthetic graft complications requires familiarity with the expected normal cross-sectional imaging appearance as well knowledge of additional surgical materials used in the repair, which could influence the imaging appearance. Multiple life-threatening complications of a prosthetic ascending aortic graft can be seen in the aorta and vicinity of the operative field. Complications can arise from involvement of the prosthetic aortic graft per se or secondary involvement of the coronary arteries, mediastinum, and sternotomy site. The optimal imaging protocol using multidetector computed tomography allows accurate interpretation of the expected benign postoperative changes as well as complications associated with the prosthetic graft, and differentiation of true complications from their mimickers. This review focuses on the normal imaging appearance of a prosthetic aortic graft on multidetector computed tomography, and imaging evaluation of multiple post-surgical complications that could arise after repair of the ascending aorta and the aortic valve.
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Affiliation(s)
- Sreenivasa Narayana Raju
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Shaw
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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12
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Kostyunin AE, Yuzhalin AE, Rezvova MA, Ovcharenko EA, Glushkova TV, Kutikhin AG. Degeneration of Bioprosthetic Heart Valves: Update 2020. J Am Heart Assoc 2020; 9:e018506. [PMID: 32954917 PMCID: PMC7792365 DOI: 10.1161/jaha.120.018506] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The implantation of bioprosthetic heart valves (BHVs) is increasingly becoming the treatment of choice in patients requiring heart valve replacement surgery. Unlike mechanical heart valves, BHVs are less thrombogenic and exhibit superior hemodynamic properties. However, BHVs are prone to structural valve degeneration (SVD), an unavoidable condition limiting graft durability. Mechanisms underlying SVD are incompletely understood, and early concepts suggesting the purely degenerative nature of this process are now considered oversimplified. Recent studies implicate the host immune response as a major modality of SVD pathogenesis, manifested by a combination of processes phenocopying the long‐term transplant rejection, atherosclerosis, and calcification of native aortic valves. In this review, we summarize and critically analyze relevant studies on (1) SVD triggers and pathogenesis, (2) current approaches to protect BHVs from calcification, (3) obtaining low immunogenic BHV tissue from genetically modified animals, and (4) potential strategies for SVD prevention in the clinical setting.
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Affiliation(s)
- Alexander E Kostyunin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Arseniy E Yuzhalin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation.,Department of Molecular and Cellular Oncology The University of Texas MD Anderson Cancer Center Houston TX
| | - Maria A Rezvova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Evgeniy A Ovcharenko
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Tatiana V Glushkova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Anton G Kutikhin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
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Cui H, Zhang L, Wei S, Jiang S. Early clinical outcomes of simple pannus removal for mechanical aortic valve stenosis. J Cardiothorac Surg 2019; 14:203. [PMID: 31775823 PMCID: PMC6880563 DOI: 10.1186/s13019-019-1022-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This study aimed to confirm the safety and feasibility of simple pannus removal in patients with mechanical aortic valve dysfunction for pannus overgrowth by evaluating its early clinical outcomes. METHODS From March 2015 to April 2019, 24 consecutive patients with mechanical aortic valve dysfunction due to subaortic pannus underwent reoperation. In 12 patients the repeat aortic valve replacement (AVR) was performed, and 12 received the simple pannus removal to preserve the previously implanted prosthesis. RESULTS There was only 1 in-hospital death in simple pannus removal group. Significant differences were obtained between procedures in cardiopulmonary bypass (CPB) and aortic cross-clamp time (128.7 vs 179.7 and 74.2 vs 132.7 mins, respectively, P < 0.05). The C-reactive protein (CRP) in simple pannus removal group was lower on the first day (0.13 ± 0.09 vs 0.31 ± 0.22 mg/dl, P < 0.05) and continued to be lower within 1 week after operation. There was no significant difference between procedures in aortic transvalvular peak velocity and transvalvular mean pressure gradient (TMPG) (2.6 ± 0.4 vs 2.5 ± 0.4 m/s and 13.2 ± 3.6 vs 11.6 ± 2.6 mmHg, respectively, P > 0.05) in echocardiography 1 week after operation. In addition, the aortic transvalvular peak velocity and TMPG in echocardiography 1 week after operation in pannus removal group between the repeat and initial surgery were not statistically significant (2.6 ± 0.4 vs. 2.5 ± 0.3 m/s, 13.2 ± 3.6 vs. 13.0 ± 3.5 mmHg, P > 0.05). CONCLUSIONS Simple pannus removal was a safe and effective procedure with satisfied early clinical outcomes for pannus overgrowth in mechanical aortic valve. However, further randomized and long-term follow-up studies were warranted to determine the clinical effects of the simple aortic pannus removal.
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Affiliation(s)
- Huimin Cui
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lin Zhang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shixiong Wei
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shengli Jiang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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14
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Nam K, Suh YJ, Han K, Park SJ, Kim YJ, Choi BW. Value of Computed Tomography Radiomic Features for Differentiation of Periprosthetic Mass in Patients With Suspected Prosthetic Valve Obstruction. Circ Cardiovasc Imaging 2019; 12:e009496. [DOI: 10.1161/circimaging.119.009496] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background:
We aimed to determine whether quantitative computed tomography radiomic features can aid in differentiating between the causes of prosthetic valve obstruction (PVO) in patients who had undergone prosthetic valve replacement.
Methods:
This retrospective study included 39 periprosthetic masses in 34 patients who underwent cardiac computed tomography scan from January 2014 to August 2017 and were clinically suspected as PVO. The cause of PVO was assessed by redo-surgery and follow-up imaging as standard reference, and classified as pannus, thrombus, or vegetation. Visual analysis was performed to assess the possible cause of PVO on axial and valve-dedicated views. Computed tomography radiomic analysis of periprosthetic masses was performed and radiomic features were extracted. The advantage of radiomic score compared with visual analysis for differentiation of pannus from other abnormalities was assessed.
Results:
Of 39 masses, there were 20 cases of pannus, 11 of thrombus, and 8 of vegetation on final diagnosis. The radiomic score was significantly higher in the pannus group compared with nonpannus group (mean, −0.156±0.422 versus −0.883±0.474;
P
<0.001). The area under the curve of radiomic score for diagnosis of pannus was 0.876 (95% CI, 0.731–0.960). Combination of radiomic score and visual analysis showed a better performance for the differentiation of pannus than visual analysis alone.
Conclusions:
Compared with visual analysis, computed tomography radiomic features may have added value for differentiating pannus from thrombus or vegetation in patients with suspected PVO.
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Affiliation(s)
- Kyungsun Nam
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (K.N., Y.J.S., K.H., Y.J.K., B.W.C.)
| | - Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (K.N., Y.J.S., K.H., Y.J.K., B.W.C.)
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (K.N., Y.J.S., K.H., Y.J.K., B.W.C.)
| | - Sang Joon Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University, Korea (S.J.P.)
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (K.N., Y.J.S., K.H., Y.J.K., B.W.C.)
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (K.N., Y.J.S., K.H., Y.J.K., B.W.C.)
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15
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Darwish A, Di Labbio G, Saleh W, Smadi O, Kadem L. Experimental investigation of the flow downstream of a dysfunctional bileaflet mechanical aortic valve. Artif Organs 2019; 43:E249-E263. [DOI: 10.1111/aor.13483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/26/2019] [Accepted: 04/29/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Ahmed Darwish
- Laboratory of Cardiovascular Fluid Dynamics, Mechanical, Industrial and Aerospace Engineering Concordia University Montreal Quebec Canada
| | - Giuseppe Di Labbio
- Laboratory of Cardiovascular Fluid Dynamics, Mechanical, Industrial and Aerospace Engineering Concordia University Montreal Quebec Canada
| | - Wael Saleh
- Laboratory of Cardiovascular Fluid Dynamics, Mechanical, Industrial and Aerospace Engineering Concordia University Montreal Quebec Canada
| | - Othman Smadi
- Department of Biomedical Engineering Hashemite University Zarqa Jordan
| | - Lyes Kadem
- Laboratory of Cardiovascular Fluid Dynamics, Mechanical, Industrial and Aerospace Engineering Concordia University Montreal Quebec Canada
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16
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Silbiger JJ, Lee S, Christia P, Perk G. Mechanisms, pathophysiology, and diagnostic imaging of left ventricular outflow tract obstruction following mitral valve surgery and transcatheter mitral valve replacement. Echocardiography 2019; 36:1165-1172. [DOI: 10.1111/echo.14370] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/06/2019] [Accepted: 05/07/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Samantha Lee
- Icahn School of Medicine at Mount Sinai New York New York
| | | | - Gila Perk
- Icahn School of Medicine at Mount Sinai New York New York
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17
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Hernández-Ramírez JM, Abad C, Singh M, González-Hernández L. Trombosis precoz seguida de pannus precoz en una prótesis mecánica en posición mitral. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2016.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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18
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Xu Y, Ye X, Li Z, Zhao Q. Aorta-atria-septum combined incision for aortic valve re-replacement. J Thorac Dis 2018; 10:E285-E288. [PMID: 29850170 DOI: 10.21037/jtd.2018.04.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This case report illustrates a patient who underwent supra-annular mechanical aortic valve replacement then suffered from prosthesis dysfunction, increasing pressure gradient with aortic valve. She was successfully underwent aortic valve re-replacement, sub-annular pannus removing and aortic annulus enlargement procedures through combined cardiac incision passing through aortic root, right atrium (RA), and upper atrial septum. This incision provides optimal visual operative field and simplifies dissection.
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Affiliation(s)
- Yiwei Xu
- Department of Cardiac Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiaofeng Ye
- Department of Cardiac Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhaolong Li
- Department of Cardiac Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qiang Zhao
- Department of Cardiac Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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19
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The clinical significance of perivalvular pannus in prosthetic mitral valves: Can cardiac CT be helpful? Int J Cardiol 2017; 249:344-348. [DOI: 10.1016/j.ijcard.2017.09.169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/12/2017] [Accepted: 09/18/2017] [Indexed: 11/20/2022]
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20
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Abstract
PURPOSE OF REVIEW In this review, we examine the central role of echocardiography in the diagnosis, prognosis, and management of infective endocarditis (IE). RECENT FINDINGS 2D transthoracic echocardiography (TTE) and transesophageal echocardiography TEE have complementary roles and are unequivocally the mainstay of diagnostic imaging in IE. The advent of 3D and multiplanar imaging have greatly enhanced the ability of the imager to evaluate cardiac structure and function. Technologic advances in 3D imaging allow for the reconstruction of realistic anatomic images that in turn have positively impacted IE-related surgical planning and intervention. CT and metabolic imaging appear to be emerging as promising ancillary diagnostic tools that could be deployed in select scenarios to circumvent some of the limitations of echocardiography. Our review summarizes the indispensable and central role of various echocardiographic modalities in the management of infective endocarditis. The complementary role of 2D TTE and TEE are discussed and areas where 3D TEE offers incremental value highlighted. An algorithm summarizing a contemporary approach to the workup of endocarditis is provided and major societal guidelines for timing of surgery are reviewed.
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21
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Aladmawi MA, Pragliola C, Vriz O, Galzerano D. Use of multidetector-row computed tomography scan to detect pannus formation in prosthetic mechanical aortic valves. J Thorac Dis 2017; 9:S343-S348. [PMID: 28540078 DOI: 10.21037/jtd.2017.04.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Obstruction of a mechanical aortic valve by pannus formation at the subvalvular level is a major long-term complication of aortic valve replacement (AVR). In fact, pannus is sometime difficult to differentiate from patient-prosthesis mismatch or valve thrombosis. In most cases cine-angiography and echocardiography, either transthoracic or transesophageal, cannot correctly visualize the complication when the leaflets show a normal mobility. Recent technological refinements made this difficult diagnosis possible by ECG-gated computed tomography (CT) scan which shows adequate images in 90% of the cases and can differentiate pannus from fresh and organized thrombus.
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Affiliation(s)
- Mohamed A Aladmawi
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Claudio Pragliola
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Domenico Galzerano
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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22
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Chambers JB. The echocardiography of replacement heart valves. Echo Res Pract 2016; 3:R35-R43. [PMID: 27600454 PMCID: PMC5076569 DOI: 10.1530/erp-16-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 11/08/2022] Open
Abstract
This is a practical description of how replacement valves are assessed using echocardiography. Normal transthoracic appearances including normal variants are described. The problem of differentiating normal function, patient-prosthesis mismatch and pathological obstruction in aortic replacement valves with high gradients is discussed. Obstruction and abnormal regurgitation is described for valves in the aortic, mitral and right-sided positions and when to use echocardiography in suspected infective endocarditis. The roles of transoesophageal and stress echocardiography are described and finally when other imaging techniques may be useful.
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23
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Chambers JB, Myerson SG, Rajani R, Morgan-Hughes GJ, Dweck MR. Multimodality imaging in heart valve disease. Open Heart 2016; 3:e000330. [PMID: 26977308 PMCID: PMC4785435 DOI: 10.1136/openhrt-2015-000330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/19/2015] [Accepted: 12/05/2015] [Indexed: 11/30/2022] Open
Abstract
In patients with heart valve disease, echocardiography is the mainstay for diagnosis, assessment and serial surveillance. However, other modalities, notably cardiac MRI and CT, are used if echocardiographic imaging is suboptimal but can also give complementary information to improve assessment of the valve lesion and cardiac compensation to aid the timing of surgery and determine risk. This statement discusses the way these imaging techniques are currently integrated to improve care beyond what is possible with echocardiography alone.
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Affiliation(s)
- John B Chambers
- Department of Adult Echocardiography , Guy's and St Thomas Hospitals , London , UK
| | - Saul G Myerson
- Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital , Oxford , UK
| | - Ronak Rajani
- Department of Cardiac CT , Guy's and St Thomas Hospitals , London , UK
| | | | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK
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24
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Kasahara H, Inoue Y, Suzuki S. Recurrent infarctions due to a dome-shaped pannus above the mitral valve prosthesis. J Thorac Dis 2016; 8:E130-2. [PMID: 26904241 DOI: 10.3978/j.issn.2072-1439.2016.01.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This report describes a unique case of a 56-year-old female who suffered from recurrent stroke after double mechanical valve replacement. During the four years after the surgery, she remained in normal sinus rhythm, received adequate anticoagulation therapy, and no apparent left atrial thrombus was detected. She underwent redo surgery to prevent further stroke after fourth instance of cerebral infarction. Intraoperative findings revealed a 'dome-shaped' pannus formation covering the sewing ring of the mitral prosthesis circumferentially, probably leading to clot formation and repeated infarctions. She has been stroke free for three years after pannus resection.
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Affiliation(s)
- Hirofumi Kasahara
- 1 Department of Cardiovascular Surgery, National Hospital Organization Saitama Hospital, Wako, Japan ; 2 Department of Cardiovascular Surgery, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Yoshito Inoue
- 1 Department of Cardiovascular Surgery, National Hospital Organization Saitama Hospital, Wako, Japan ; 2 Department of Cardiovascular Surgery, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Satoru Suzuki
- 1 Department of Cardiovascular Surgery, National Hospital Organization Saitama Hospital, Wako, Japan ; 2 Department of Cardiovascular Surgery, Hiratsuka City Hospital, Hiratsuka, Japan
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25
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Ma WG, Hou B, Abdurusul A, Gong DX, Tang Y, Chang Q, Xu JP, Sun HS. Dysfunction of mechanical heart valve prosthesis: experience with surgical management in 48 patients. J Thorac Dis 2016; 7:2321-9. [PMID: 26793354 DOI: 10.3978/j.issn.2072-1439.2015.12.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Dysfunction of mechanical heart valve prostheses is an unusual but potentially lethal complication after mechanical prosthetic valve replacement. We seek to report our experience with mechanical valve dysfunction regarding etiology, surgical techniques and early outcomes. METHODS Clinical data of 48 patients with mechanical valve dysfunction surgically treated between October 1996 and June 2011 were analyzed. RESULTS Mean age was 43.7±10.9 years and 34 were female (70.8%). The median interval from primary valve implantation to dysfunction was 44.5 months (range, 1 hour to 20 years). There were 21 emergent and 27 elective reoperations. The etiology was thrombosis in 19 cases (39.6%), pannus in 12 (25%), thrombosis and pannus in 11 (22.9%), improper disc orientation in 2 (4.1%), missing leaflet in 1 (2.1%), excessively long knot end in 1 (2.1%), endogenous factor in 1 (2.1%) and unidentified in 1 (2.1%). Surgical procedure was mechanical valve replacement in 37 cases (77.1%), bioprosthetic valve replacement in 7 (14.9%), disc rotation in 2 (4.2%) and excision of excessive knot end in 1 (2.1%). Early deaths occurred in 7 patients (14.6%), due to low cardiac output in 3 (6.3%), multi-organ failure in 2 (4.2%) and refractory ventricular fibrillation in 2 (4.2%). Complications occurred in 10 patients (20.8%). CONCLUSIONS Surgical management of mechanical valve dysfunction is associated with significant mortality and morbidity. Earlier identification and prompt reoperation are vital to achieving better clinical outcomes. The high incidence of thrombosis in this series highlights the need for adequate anticoagulation and regular follow-up after mechanical valve replacement.
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Affiliation(s)
- Wei-Guo Ma
- 1 Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China ; 2 Department of Cardiothoracic Surgery, First Hospital of Kashgar Prefecture, Shinjang 844000, China
| | - Bin Hou
- 1 Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China ; 2 Department of Cardiothoracic Surgery, First Hospital of Kashgar Prefecture, Shinjang 844000, China
| | - Adiljan Abdurusul
- 1 Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China ; 2 Department of Cardiothoracic Surgery, First Hospital of Kashgar Prefecture, Shinjang 844000, China
| | - Ding-Xu Gong
- 1 Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China ; 2 Department of Cardiothoracic Surgery, First Hospital of Kashgar Prefecture, Shinjang 844000, China
| | - Yue Tang
- 1 Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China ; 2 Department of Cardiothoracic Surgery, First Hospital of Kashgar Prefecture, Shinjang 844000, China
| | - Qian Chang
- 1 Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China ; 2 Department of Cardiothoracic Surgery, First Hospital of Kashgar Prefecture, Shinjang 844000, China
| | - Jian-Ping Xu
- 1 Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China ; 2 Department of Cardiothoracic Surgery, First Hospital of Kashgar Prefecture, Shinjang 844000, China
| | - Han-Song Sun
- 1 Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China ; 2 Department of Cardiothoracic Surgery, First Hospital of Kashgar Prefecture, Shinjang 844000, China
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Yasutake H, Sugano Y, Ikeda Y, Ohara T, Hasegawa T, Kanzaki H, Anzai T. First Case Report of the Antemortem Diagnosis of Nonbacterial Thrombotic Endocarditis of a Mechanical Prosthetic Valve. Intern Med 2016; 55:255-7. [PMID: 26831019 DOI: 10.2169/internalmedicine.55.5470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 67-year-old man with a history of aortic mechanical valve replacement exhibited an abnormal mass on the sewing ring of the prosthesis on echocardiography. Despite receiving strong anticoagulation, he developed acute cerebral infarction due to the formation of emboli resulting from the thrombus and underwent urgent re-aortic valve replacement. Based on the microscopic findings of the resected mass, he was finally diagnosed as having nonbacterial thrombotic endocarditis (NBTE) of the mechanical prosthetic valve, which was thought to be associated with colorectal cancer. We herein report the first known case of an antemortem diagnosis of NBTE on a mechanical heart valve.
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Affiliation(s)
- Hideki Yasutake
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
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27
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Salamon J, Munoz-Mendoza J, Liebelt JJ, Taub CC. Mechanical valve obstruction: Review of diagnostic and treatment strategies. World J Cardiol 2015; 7:875-881. [PMID: 26730292 PMCID: PMC4691813 DOI: 10.4330/wjc.v7.i12.875] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/22/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
Prosthetic valve obstruction (PVO) is a rare but feared complication of mechanical valve replacement. Diagnostic evaluation should focus on differentiating prosthetic valve thrombosis (PVT) from pannus formation, as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient’s symptoms, valve location, degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively, pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology, epidemiology, diagnostic approach and treatment options for aortic and mitral valve PVO.
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28
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Hirota M, Isomura T, Yoshida M, Katsumata C, Ito F, Watanabe M. Subvalvular Pannus Overgrowth after Mosaic Bioprosthesis Implantation in the Aortic Position. Ann Thorac Cardiovasc Surg 2015; 22:108-11. [PMID: 26633541 DOI: 10.5761/atcs.oa.15-00293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Although pannus overgrowth by itself was not the pathology of structural valve deterioration (SVD), it might be related to reoperation for SVD of the bioprostheses. METHODS We retrospectively reviewed patients undergoing reoperation for SVD after implantation of the third-generation Mosaic aortic bioprosthesis and macroscopic appearance of the explanted valves was examined to detect the presence of pannus. RESULTS There were 10 patients and the age for the initial aortic valve replacement was 72 ± 10 years old. The duration of durability was 9.9 ± 2.0 years. Deteriorated valve presented stenosis (valvular area of 0.96 ± 0.20 cm(2); pressure gradient of 60 ± 23 mmHg). Coexisting regurgitant flow was detected in two cases. Macroscopically, subvalvular pannus overgrowth was detected in 8 cases (80%). The proportion of overgrowth from the annulus was almost even and pannus overgrowth created subvalvular membrane, which restricted the area especially for each commissure. In contrast, opening and mobility of each leaflet was not severely limited and pannus overgrowth would restrict the area, especially for each commissure. In other two cases with regurgitation, tear of the leaflet on the stent strut was detected and mild calcification of each leaflet restricted opening. CONCLUSION In patients with the Mosaic aortic bioprosthesis, pannus overgrowth was the major cause for reoperation.
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Affiliation(s)
- Masanori Hirota
- Department of Cardiovascular Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
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30
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Sixty-Four–Section Cardiac Computed Tomography in Mechanical Prosthetic Heart Valve Dysfunction. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003246. [DOI: 10.1161/circimaging.115.003246] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Suh YJ, Kim YJ, Hong YJ, Lee HJ, Hur J, Im DJ, Kim YJ, Choi BW. Measurement of Opening and Closing Angles of Aortic Valve Prostheses In Vivo Using Dual-Source Computed Tomography: Comparison with Those of Manufacturers' in 10 Different Types. Korean J Radiol 2015; 16:1012-23. [PMID: 26356549 PMCID: PMC4559772 DOI: 10.3348/kjr.2015.16.5.1012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/26/2015] [Indexed: 11/15/2022] Open
Abstract
Objective The aims of this study were to compare opening and closing angles of normally functioning mechanical aortic valves measured on dual-source computed tomography (CT) with the manufacturers' values and to compare CT-measured opening angles according to valve function. Materials and Methods A total of 140 patients with 10 different types of mechanical aortic valves, who underwent dual-source cardiac CT, were included. Opening and closing angles were measured on CT images. Agreement between angles in normally functioning valves and the manufacturer values was assessed using the interclass coefficient and the Bland-Altman method. CT-measured opening angles were compared between normal functioning valves and suspected dysfunctioning valves. Results The CT-measured opening angles of normally functioning valves and manufacturers' values showed excellent agreement for seven valve types (intraclass coefficient [ICC], 0.977; 95% confidence interval [CI], 0.962-0.987). The mean differences in opening angles between the CT measurements and the manufacturers' values were 1.2° in seven types of valves, 11.0° in On-X valves, and 15.5° in ATS valves. The manufacturers' closing angles and those measured by CT showed excellent agreement for all valve types (ICC, 0.953; 95% CI, 0.920-0.972). Among valves with suspected dysfunction, those with limitation of motion (LOM) and an increased pressure gradient (PG) had smaller opening angles than those with LOM only (p < 0.05). Conclusion Dual-source cardiac CT accurately measures opening and closing angles in most types of mechanical aortic valves, compared with the manufacturers' values. Opening angles on CT differ according to the type of valve dysfunction and a decreased opening angle may suggest an elevated PG.
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Affiliation(s)
- Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jin Hur
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yun Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
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Suh YJ, Kim YJ, Lee S, Hong YJ, Lee HJ, Hur J, Choi BW, Chang BC. Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve. Int J Cardiovasc Imaging 2015; 31:1271-80. [DOI: 10.1007/s10554-015-0683-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
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Theodoridis K, Tudorache I, Calistru A, Cebotari S, Meyer T, Sarikouch S, Bara C, Brehm R, Haverich A, Hilfiker A. Successful matrix guided tissue regeneration of decellularized pulmonary heart valve allografts in elderly sheep. Biomaterials 2015; 52:221-8. [PMID: 25818428 DOI: 10.1016/j.biomaterials.2015.02.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/25/2015] [Accepted: 02/01/2015] [Indexed: 11/25/2022]
Abstract
In vivo repopulation of decellularized allografts with recipient cells leads to a positive remodeling of the graft matrix in juvenile sheep. In light of the increasing number of heart valve replacements among older patients (>65 years), this study focused on the potential for matrix-guided tissue regeneration in elderly sheep. Pulmonary valve replacement was performed in seven-year old sheep using decellularized (DV), decellularized and CCN1-coated (RV), or decellularized and in vitro reendothelialized pulmonary allografts (REV) (n=6, each group). CCN1 coating was applied to support re-endothelialization. In vitro re-endothelialization was conducted with endothelial-like cells derived from peripheral blood. Echocardiograms of all grafts showed adequate graft function after implantation and at explantation 3 or 6 months later. All explants were macroscopically free of thrombi at explantation, and revealed repopulation of the allografts on the adventitial side of valvular walls and proximal in the cusps. Engrafted cells expressed vimentin, sm α-actin, and myosin heavy chain 2, while luminal cell lining was positive for vWF and eNOS. Cellular repopulation of valvular matrix demonstrates the capacity for matrix-guided regeneration even in elderly sheep but is not improved by in vitro endothelialization, confirming the suitability of decellularized matrix for heart valve replacement in older individuals.
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Affiliation(s)
- Karolina Theodoridis
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexandru Calistru
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tanja Meyer
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Bara
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ralph Brehm
- Institute of Anatomy, University of Veterinary Medicine Hannover, Germany
| | - Axel Haverich
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andres Hilfiker
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover, Germany; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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Abstract
OBJECTIVE The purpose of this article is to review the utility of ECG-gated MDCT in evaluating postsurgical findings in aortic and mitral valves. Normal and pathologic findings after aortic and mitral valve corrective surgery are shown in correlation with the findings of the traditionally used imaging modalities echocardiography and fluoroscopy to assist in accurate noninvasive anatomic and dynamic evaluation of postsurgical valvular abnormalities. CONCLUSION Because of its superior spatial and adequate temporal resolution, ECG-gated MDCT has emerged as a robust diagnostic tool in the evaluation and treatment of patients with postsurgical valvular abnormalities.
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Antunes MJ. Requiem for a good mechanical heart valve: Farewell to the Medtronic Hall valve. J Thorac Cardiovasc Surg 2015; 149:1492-4. [PMID: 25752373 DOI: 10.1016/j.jtcvs.2015.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 01/27/2015] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Manuel J Antunes
- Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal.
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Moon J, Hoashi T, Kagisaki K, Kurosaki K, Shiraishi I, Ichikawa H. Clinical Outcomes of Mitral Valve Replacement With the 16-mm ATS Advanced Performance Valve in Neonates and Infants. Ann Thorac Surg 2015; 99:653-9. [DOI: 10.1016/j.athoracsur.2014.09.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/31/2014] [Accepted: 09/12/2014] [Indexed: 11/29/2022]
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Arnáiz-García ME, González-Santos JM, Bueno-Codoñer ME, López-Rodríguez J, Dalmau-Sorlí MJ, Arévalo-Abascal A, Arribas-Jiménez A, Diego-Nieto A, Rodríguez-Collado J, Rodríguez-López JM. Perivalvular pannus and valve thrombosis: Two concurrent mechanisms of mechanical valve prosthesis dysfunction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2014.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Arnáiz-García ME, González-Santos JM, Bueno-Codoñer ME, López-Rodríguez J, Dalmau-Sorlí MJ, Arévalo-Abascal A, Arribas-Jiménez A, Diego-Nieto A, Rodríguez-Collado J, Rodríguez-López JM. Perivalvular pannus and valve thrombosis: Two concurrent mechanisms of mechanical valve prosthesis dysfunction. Rev Port Cardiol 2015; 34:141.e1-3. [DOI: 10.1016/j.repc.2014.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022] Open
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Arnáiz-García ME, González-Santos JM, Arévalo-Abascal A, Bueno-Codoñer M, Dalmau-Sorlí MJ, López-Rodríquez J, Arribas-Jiménez A. [Subvalvular pannus as cause of late mismatch after aortic valve replacement]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:168-9. [PMID: 25577550 DOI: 10.1016/j.acmx.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/09/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
| | | | - Adolfo Arévalo-Abascal
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - María Bueno-Codoñer
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - María José Dalmau-Sorlí
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Javier López-Rodríquez
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
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Minakata K, Tanaka S, Okawa Y, Kaneko T, Okonogi S, Usui A, Abe T, Tamura N, Yanagi S, Sakata R. Twenty-Year Outcome of Aortic Valve Replacement With St. Jude Medical Mechanical Valves in Japanese Patients. Circ J 2015; 79:2380-8. [DOI: 10.1253/circj.cj-15-0793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Shiro Tanaka
- Kyoto University Graduate School of Public Health
| | - Yohei Okawa
- Cardiovascular Center Hokkaido Ohno Hospital
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41
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Evaluation of advancing the standard valve dysfunction by multidetector-row CT. J Artif Organs 2014; 17:162-8. [DOI: 10.1007/s10047-013-0751-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
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Furukawa H, Tanemoto K. Redo Valve Surgery—Current Status and Future Perspectives. Ann Thorac Cardiovasc Surg 2014; 20:267-75. [DOI: 10.5761/atcs.ra.13-00380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Choi JH, Choi JH, Song S, Lee MY. Intermittent, non cyclic severe mechanical aortic valve regurgitation. J Cardiovasc Ultrasound 2013; 21:189-91. [PMID: 24459568 PMCID: PMC3894372 DOI: 10.4250/jcu.2013.21.4.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 08/23/2013] [Accepted: 11/12/2013] [Indexed: 11/29/2022] Open
Abstract
Mechanical aortic prosthesis dysfunction can result from thrombosis or pannus formation. We describe an unusual case of intermittent, non cyclic mechanical aortic prosthesis dysfunction due to pannus formation with thrombus in the absence of systolic restriction of disk excursion, that presented with intermittent severe aortic regurgitation.
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Affiliation(s)
- Jong Hyun Choi
- Division of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Jung Hyun Choi
- Division of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Seunghwan Song
- Division of Cardiac Surgery, Pusan National University Hospital, Busan, Korea
| | - Myung-Yong Lee
- Division of Cardiology, Dankook University College of Medicine, Cheonan, Korea
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A rare case of two mechanisms of prosthetic valve dysfunction in the same patient. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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45
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[A rare case of two mechanisms of prosthetic valve dysfunction in the same patient]. Rev Port Cardiol 2013; 32:1037-41. [PMID: 24280075 DOI: 10.1016/j.repc.2013.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 06/12/2013] [Accepted: 06/25/2013] [Indexed: 11/21/2022] Open
Abstract
Prosthetic valve dysfunction is a significant clinical event. Determining its etiological mechanism and severity can be difficult. The authors present the case of a 50-year-old man, with two mechanical valve prostheses in aortic and mitral positions, hospitalized for decompensated heart failure. He had a long history of rheumatic multivalvular disease and had undergone three heart surgeries. On admission, investigation led to a diagnosis of severe dysfunction of both mechanical prostheses with different etiologies and mechanisms: pannus formation in the prosthetic aortic valve and intermittent dysfunction of the mitral prosthesis due to interference of a ruptured chorda tendinea in closure of the disks. The patient was reoperated, leading to significant improvement in functional class.
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46
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Koene BM, Soliman Hamad MA, Bouma W, Mariani MA, Peels KC, van Dantzig JM, van Straten AH. Can postoperative mean transprosthetic pressure gradient predict survival after aortic valve replacement? Clin Res Cardiol 2013; 103:133-40. [PMID: 24136290 PMCID: PMC3904035 DOI: 10.1007/s00392-013-0629-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 10/02/2013] [Indexed: 11/30/2022]
Abstract
Background In this study, we sought to determine the effect of the mean transprosthetic pressure gradient (TPG), measured at 6 weeks after aortic valve replacement (AVR) or AVR with coronary artery bypass grafting (CABG) on late all-cause mortality. Methods Between January 1998 and March 2012, 2,276 patients (mean age 68 ± 11 years) underwent TPG analysis at 6 weeks after AVR (n = 1,318) or AVR with CABG (n = 958) at a single institution. Mean TPG was 11.6 ± 7.8 mmHg and median TPG 11 mmHg. Based on the TPG, the patients were split into three groups: patients with a low TPG (<10 mmHg), patients with a medium TPG (10–19 mmHg) and patients with a high TPG (≥20 mmHg). Cox proportional-hazard regression analysis was used to determine univariate predictors and multivariate independent predictors of late mortality. Results Overall survival for the entire group at 1, 3, 5, and 10 years was 97, 93, 87 and 67 %, respectively. There was no significant difference in long-term survival between patients with a low, medium or high TPG (p = 0.258). Independent predictors of late mortality included age, diabetes, peripheral vascular disease, renal dysfunction, chronic obstructive pulmonary disease, a history of a cerebrovascular accident and cardiopulmonary bypass time. Prosthesis–patient mismatch (PPM), severe PPM and TPG measured at 6 weeks postoperatively were not significantly associated with late mortality. Conclusions TPG measured at 6 weeks after AVR or AVR with CABG is not an independent predictor of all-cause late mortality and there is no significant difference in long-term survival between patients with a low, medium or high TPG.
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Affiliation(s)
- Bart M Koene
- Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602 ZA, Eindhoven, The Netherlands,
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47
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Al-Alao B, Simoniuk U, Heron B, Parissis H. Rapid pannus formation after few months of obstructing aortic mechanical prosthesis. Gen Thorac Cardiovasc Surg 2013; 63:613-5. [PMID: 24065460 DOI: 10.1007/s11748-013-0319-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/07/2013] [Indexed: 01/23/2023]
Abstract
We report a rare case of a prosthetic aortic valve obstruction due to pannus formation only 3 months following aortic and mitral valve replacement. Fragments of asymmetrical pannus formation affected one of the leaflets of the bi-leaflet mechanical valve; the leaflet appeared immobile due to pannus ingrowth into the mechanical skeleton resulting in encroachment of the leaflet, which in turn became immobile. The patient successfully underwent emergency redo-aortic valve replacement.
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Affiliation(s)
- Bassel Al-Alao
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK.
| | - Urszula Simoniuk
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Brian Heron
- Department of Pathology, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Haralabos Parissis
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK.
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48
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Ellensen VS, Andersen KS, Vitale N, Davidsen ES, Segadal L, Haaverstad R. Acute obstruction by Pannus in patients with aortic medtronic-hall valves: 30 years of experience. Ann Thorac Surg 2013; 96:2123-8. [PMID: 24070701 DOI: 10.1016/j.athoracsur.2013.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/21/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Acute dysfunction of mechanical aortic valve prostheses is a life-threatening adverse event. Pannus overgrowth, which is fibroelastic hyperplasia originating from the periannular area, is one cause of dysfunction. The aim of this study was to determine the annual incidence of readmittance resulting from acute obstruction caused by pannus during 30 years of observation in patients with Medtronic-Hall aortic valve prostheses and to analyze the risk factors associated with pannus development. METHODS From 1982 to 2004, 1,187 patients in our department underwent aortic valve replacement with Medtronic-Hall mechanical monoleaflet valve prostheses. As of December 31, 2012, 27 of these patients (2.3%) had presented with acute valve dysfunction caused by pannus obstruction. RESULTS The annual incidence of pannus was 0.7 per 1,000. The median time from the primary operation to prosthetic dysfunction was 11.1 years (range, 1.2 to 26.8 years). Of the 20 patients who underwent reoperation, 2 died. Seven patients died before reoperation. Women had a higher risk for the development of obstructing pannus, and patients with pannus obstruction were younger. Valve size was not an independent risk factor. CONCLUSIONS Women and younger patients are at higher risk for pannus development. When acute dysfunction by pannus is suspected in a mechanical aortic valve, an immediate echocardiogram and an emergency aortic valve replacement should be carried out because of the potential of a fatal outcome.
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Affiliation(s)
- Vegard Skalstad Ellensen
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
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49
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Tanis W, Habets J, van den Brink RBA, Symersky P, Budde RPJ, Chamuleau SAJ. Differentiation of thrombus from pannus as the cause of acquired mechanical prosthetic heart valve obstruction by non-invasive imaging: a review of the literature. Eur Heart J Cardiovasc Imaging 2013; 15:119-29. [DOI: 10.1093/ehjci/jet127] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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50
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Pham N, Zaitoun H, Mohammed TL, DeLaPena-Almaguer E, Martinez F, Novaro GM, Kirsch J. Complications of Aortic Valve Surgery: Manifestations at CT and MR Imaging. Radiographics 2012; 32:1873-92. [DOI: 10.1148/rg.327115735] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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