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Khalil A, Stone D, Dysart J, Taqatqa A. Bicuspid Aortic Valve Function and Aortopathy on Presentation and Progression in Children: Does Sex Difference Have Any Implications? Pediatr Cardiol 2024:10.1007/s00246-024-03574-x. [PMID: 38987442 DOI: 10.1007/s00246-024-03574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart defect. It can be accompanied by aortic regurgitation or stenosis with aortopathies. Studies in adults showed a sex difference, but there are limited number of reports in the pediatric population. To evaluate the difference in bicuspid aortic valve morphology and functionality between sexes, and the presence and progression of aortopathies, a retrospective chart review study was performed at a tertiary referral care center in the Midwest. In our study, we analyzed a cohort of 476 pediatric patients diagnosed with BAV who presented between January 2007 and February 2018. During the follow-up period spanning 2 to 10 years, male patients (n = 314, 66%) had larger aortic valve annulus (AVA) and sinus of Valsalva (SOV) at the time of initial presentation with more likelihood for progression. In the subgroup analysis, the larger SOV in males was observed in isolated BAV patients without genetic syndromes or cardiac malformations, and there were no significant differences between both sexes in the ascending aorta dimension, valve functionality, valve morphology, and the need for intervention in any of the studied groups. As such, these findings may alter the follow-up focus and frequency for patients with BAV, particularly before adulthood, and warrant further studies.
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Affiliation(s)
- Ahmad Khalil
- Pediatric Cardiology, Karl and Patricia Betz Congenital Heart Center, Corewell Health Helen DeVos Children's Hospital, 25 Michigan St NE, Suite 4200, Grand Rapids, MI, 49503-2559, USA.
- Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing and Grand Rapids, MI, USA.
| | - David Stone
- Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing and Grand Rapids, MI, USA
- Corewell Health Helen DeVos Children's Hospital Children's Heart Center, East Lansing, MI, USA
| | - John Dysart
- Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing and Grand Rapids, MI, USA
- Corewell Health Helen DeVos Children's Hospital Children's Heart Center, East Lansing, MI, USA
| | - Anas Taqatqa
- Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing and Grand Rapids, MI, USA
- Corewell Health Helen DeVos Children's Hospital Children's Heart Center, East Lansing, MI, USA
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2
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Schiavone WA, Majdalany DS. The Value of the Electrocardiogram in Adult Congenital Heart Disease. J Pers Med 2024; 14:367. [PMID: 38672995 PMCID: PMC11051035 DOI: 10.3390/jpm14040367] [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: 02/23/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
The electrocardiogram is the first test that is undertaken when evaluating a patient's heart. Diagnosing congenital heart disease in an adult (ACHD) can be facilitated by knowing the classical electrocardiographic (EKG) findings. These EKG findings often result from the congenital defect that prevents a part of the cardiac conduction system from occupying its normal anatomic position. When these classical EKG findings are not present, the clinician should consider alternate diagnoses. As the patient with congenital heart disease ages, with native anatomy or after surgical or device repair, the EKG can be used to assess the patient's status and to decide if and when treatment requires adjustment. This is because the electrocardiogram (EKG) can diagnose the hypertrophy or enlargement in a cardiac chamber that results from the congenital defect or anomaly and can diagnose an arrhythmia that might compromise an otherwise stable anatomy. While ACHD often involves intracardiac shunting, in many cases the abnormality only involves cardiac electrical conduction block or ventricular repolarization. These life-threatening diseases can be diagnosed with an EKG. This review will demonstrate and explain how the EKG can be used to diagnose and follow adults with congenital heart disease. When coupled with history and physical examination, the value of the EKG in ACHD will be apparent. A diagnosis can then be made or a differential diagnosis proposed, before an imaging study is ordered.
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Affiliation(s)
| | - David S. Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
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Burns J, Ganigara M, Cerise JE, Hayes DA. Fetal echocardiographic features associated with bicuspid aortic valve. Cardiol Young 2024; 34:50-55. [PMID: 37171064 DOI: 10.1017/s1047951123000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Prenatal diagnosis of bicuspid aortic valve is challenging. Bicuspid aortic valve is often associated with aortic dilation. METHODS Fetuses with postnatally confirmed bicuspid aortic valve were gestational age-matched with normal controls. Complex lesions were excluded. Aortic valve and arch measurements by two blinded investigators were compared. RESULTS We identified 27 cases and 27 controls. Estimated fetal weight percentile was lower in cases than controls. Seven cases had one or more significant lesions including perimembranous ventricular septal defects (n = 2), isolated annular hypoplasia (n = 2), and/or arch hypoplasia/coarctation (n = 4). Fetuses with bicuspid aortic valves had significantly smaller median z-scores of the aortic annulus (-1.60 versus -0.53, p < 0.001) and root (-1.10 versus -0.53, p = 0.040), and larger ratios of root to annulus (1.32 versus 1.21, p < 0.001), sinotubular junction to annulus (1.07 versus 0.99, p < 0.001), ascending aorta to annulus (1.29 versus 1.18, p < 0.001), and transverse aorta to annulus (1.04 versus 0.96, p = 0.023). Leaflets were "doming" in 11 cases (41%) and 0 controls (p = 0.010), "thickened" in 10 cases (37%) and 0 controls (p = 0.002). We noted similar findings in the subgroup without significant additional cardiac defects. CONCLUSIONS The appearance of doming or thickened aortic valve leaflets on fetal echocardiogram is associated with bicuspid aortic valve. Compared to controls, fetuses with bicuspid aortic valve had smaller aortic annulus sizes (possibly related to smaller fetal size) without proportionally smaller aortic measurements, resulting in larger aortic dimension to annulus ratios. Despite inherent challenges of diagnosing bicuspid aortic valve prenatally, these findings may increase suspicion and prompt appropriate postnatal follow-up.
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Affiliation(s)
- Joseph Burns
- Division of Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | | | - Jane E Cerise
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Denise A Hayes
- Division of Pediatric Cardiology, Cohen Children's Medical Center Northwell Health, New Hyde Park, NY, USA
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Alpert JS. Bicuspid Aortic Valve Disease - Evolving Concepts with Clinical Relevance. Am J Med 2023; 136:1053-1054. [PMID: 36707013 DOI: 10.1016/j.amjmed.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Joseph S Alpert
- Editor in Chief,The American Journal of Medicine; University of Arizona School of Medicine, Tucson.
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You YJ, Ko SM. Computed Tomography and Magnetic Resonance Imaging Findings of Bicuspid Aortic Valve and Related Abnormalities of the Heart and Thoracic Aorta. Korean J Radiol 2023; 24:960-973. [PMID: 37724590 PMCID: PMC10550744 DOI: 10.3348/kjr.2023.0312] [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: 01/30/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 09/21/2023] Open
Abstract
The bicuspid aortic valve (BAV) is the most common congenital cardiovascular malformation. Patients with BAV are at higher risk of other congenital cardiovascular malformations and valvular dysfunction, including aortic stenosis/regurgitation and infective endocarditis. BAV may also be related to aortic wall abnormalities such as aortic dilatation, aneurysm, and dissection. The morphology of the BAV varies with the presence and position of the raphe and is associated with the type of valvular dysfunction and aortopathy. Therefore, accurate diagnosis and effective treatment at an early stage are essential to prevent complications in patients with BAV. This pictorial essay highlights the characteristics of BAV and its related congenital cardiovascular malformations, valvular dysfunction, aortopathy, and other rare cardiac complications using multimodal imaging.
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Affiliation(s)
- You Jin You
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Min Ko
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Ren S, Wen Y, Ma G, Miao Q. Native bicuspid aortic valve thrombus in a patient with an ascending aorta aneurysm: A case report. Heliyon 2023; 9:e18463. [PMID: 37534009 PMCID: PMC10391927 DOI: 10.1016/j.heliyon.2023.e18463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
Thrombus formation on a well-conserved bicuspid aortic valve is rare. We encountered a patient with organized thrombus formation on a native bicuspid aortic valve without calcification or stenosis, which was found occasionally during an elective operation for ascending aorta replacement surgery. The location of the thrombus was just at the orifice of left coronary artery, which produced the atherosclerosis-like symptoms such like exertional chest tightness and dyspnea. And these are no apparent predisposing causes of thrombosis could be ascertained postoperatively. The patient is in excellent condition 6 months after the operation. The lesson we learned from our case is that when the patient's symptom can't correspond with his or her diagnosis, we should ask more questions, evaluate the patient thoroughly and make the differential diagnosis as possible as we can. And the surgery can be performed aggressively when patient's symptoms cannot be figured out by physical examination, not only for pathologic confirmation but also for the prevention of life-threatening complications that can caused by either condition.
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Affiliation(s)
- Shuofang Ren
- Corresponding author. Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
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Sopek Merkaš I, Lakušić N, Predrijevac M, Štambuk K, Hrabak Paar M. Bicuspid aortic valve with associated aortopathy, significant left ventricular hypertrophy or concomitant hypertrophic cardiomyopathy: A diagnostic and therapeutic challenge. World J Clin Cases 2023; 11:4251-4257. [PMID: 37449224 PMCID: PMC10336990 DOI: 10.12998/wjcc.v11.i18.4251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/26/2023] Open
Abstract
Due to its prevalence of 0.5% to 2% in the general population, with a 75% predominance among men, bicuspid aortic valve is the most common congenital heart defect. It is frequently accompanied by other cardiac congenital anomalies, and clinical presentation can vary significantly, with stenosis being the most common manifestation, often resulting in mild to moderate concentric hypertrophy of the left ventricle. Echocardiography is the primary diagnostic modality utilized for establishing the diagnosis, and it is often the sole diagnostic tool relied upon by clinicians. However, due to the heterogeneous clinical presentation and possible associated anomalies (which are often overlooked in clinical practice), it is necessary to employ various diagnostic methods and persist in finding the accurate diagnosis if multiple inconsistencies exist. By employing this approach, we can effectively manage these patients and provide them with appropriate treatment. Through a clinical case from our practice, we provide an overview of the literature on bicuspid aortic valve with aortophaty and the possible association with hypertrophic cardiomyopathy, diagnostic methods, and treatment options. This review article highlights the critical significance of achieving an accurate diagnosis in patients with bicuspid aortic valve and significant left ventricular hypertrophy. It is crucial to exclude other possible causes of left ventricular outflow tract obstruction, such as sub- or supra-aortic obstructions, and hypertrophic cardiomyopathy.
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Affiliation(s)
- Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
| | - Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Mladen Predrijevac
- Department of Cardiovascular Surgery, Magdalena Clinic for Cardiovascular Diseases, Krapinske Toplice 49217, Croatia
| | - Krešimir Štambuk
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Cardiology, Magdalena Clinic for Cardiovascular Diseases, Krapinske Toplice 49217, Croatia
| | - Maja Hrabak Paar
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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Phillips T, Kisling A, Gallagher R. A soldier's return to duty after minimally invasive correction of complex congenital cardiovascular disease. Clin Case Rep 2023; 11:e6963. [PMID: 36814712 PMCID: PMC9939580 DOI: 10.1002/ccr3.6963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
We report a case of incidental detection of severe aortic coarctation, severe secundum atrial septal defect, and bicuspid aortic valve in an active-duty military service member. A single complex minimally invasive procedure successfully corrected his coarctation and atrial septal defect allowing this patient to continue military service.
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Affiliation(s)
- Tarin Phillips
- Department of CardiologyWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Adam Kisling
- Department of CardiologyWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Robert Gallagher
- Department of CardiologyWalter Reed National Military Medical CenterBethesdaMarylandUSA
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Biofabrication of Sodium Alginate Hydrogel Scaffolds for Heart Valve Tissue Engineering. Int J Mol Sci 2022; 23:ijms23158567. [PMID: 35955704 PMCID: PMC9368972 DOI: 10.3390/ijms23158567] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022] Open
Abstract
Every year, thousands of aortic valve replacements must take place due to valve diseases. Tissue-engineered heart valves represent promising valve substitutes with remodeling, regeneration, and growth capabilities. However, the accurate reproduction of the complex three-dimensional (3D) anatomy of the aortic valve remains a challenge for current biofabrication methods. We present a novel technique for rapid fabrication of native-like tricuspid aortic valve scaffolds made of an alginate-based hydrogel. Using this technique, a sodium alginate hydrogel formulation is injected into a mold produced using a custom-made sugar glass 3D printer. The mold is then dissolved using a custom-made dissolving module, revealing the aortic valve scaffold. To assess the reproducibility of the technique, three scaffolds were thoroughly compared. CT (computed tomography) scans showed that the scaffolds respect the complex native geometry with minimal variations. The scaffolds were then tested in a cardiac bioreactor specially designed to reproduce physiological flow and pressure (aortic and ventricular) conditions. The flow and pressure profiles were similar to the physiological ones for the three valve scaffolds, with small variabilities. These early results establish the functional repeatability of this new biofabrication method and suggest its application for rapid fabrication of ready-to-use cell-seeded sodium alginate scaffolds for heart valve tissue engineering.
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Szöcs K, Toprak B, Schön G, Rybczynski M, Brinken T, Mahlmann A, Girdauskas E, Blankenberg S, von Kodolitsch Y. Concomitant cardiovascular malformations in isolated bicuspid aortic valve disease: a retrospective cross-sectional study and meta-analysis. Cardiovasc Diagn Ther 2022; 12:400-414. [PMID: 36033227 PMCID: PMC9412207 DOI: 10.21037/cdt-22-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/21/2022] [Indexed: 11/22/2022]
Abstract
Background Congenital bicuspid aortic valve affects up to 2% of the general population. It occurs in complex congenital heart defects or in syndromes such as Turner, Marfan, or Loeys-Dietz. However, the majority of bicuspid aortic valves are considered to manifest as isolated malformations. Methods We aimed to assess retrospectively associated cardiovascular malformations in 200 individuals with bicuspid aortic valve considered to occur as an isolated manifestation. All individuals underwent transthoracic echocardiography, 164 thoracoabdominal tomographic imaging, and 84 coronary artery imaging. In addition, we also performed a meta-analysis of data from the literature to assess the occurrence of associate malformations. Results In our retrospective cross-sectional study collective, the mean age was 45±15 years, 154 (77%) individuals were male. Anatomy of bicuspid aortic valve according to Schaefer was type 1 in 142 (71%), type 2 in 35 (18%), type 3 in 2 (1%), unicuspid in 6 (3%), and unclassified in 15 (8%) individuals. Coarctation of the aorta had 4.2% of individuals, 3.6% had coronary anomalies. No individual had a patent ductus arteriosus, 0.5% had atrial and ventricular septal defect each, 1.5% mitral valve prolapse. No individual had a tricuspid valve prolapse. Our meta-analysis identified in cohorts with isolated bicuspid aortic valve 11.8% (95% CI: 7.7–16.0%) individuals with aortic coarctation, 3.7% (95% CI: 1.2–6.1%) with coronary anomalies, 3.3% (95% CI: 0.0–6.7%) with patent ductus arteriosus, 5.9% (95% CI: 1.3–10.5%) with ventricular septal defect and 1.6% (95% CI: 1.1–2.1%) with mitral valve prolapse. Conclusions Individuals with isolated bicuspid aortic valve may exhibit a variety of associated cardiovascular malformations and therefore screening for associated malformations may be warranted.
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Affiliation(s)
- Katalin Szöcs
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Betül Toprak
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Meike Rybczynski
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tatjana Brinken
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrian Mahlmann
- University Centre for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Center for Vascular Medicine, Clinic for Angiology, St. Josefs-Hospital, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany
| | - Evaldas Girdauskas
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Yskert von Kodolitsch
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Adeniyi A, Abadir S, Douglass P, Brown C. Late Complication of Quadricuspid Aortic Valve: Early Moderate to Severe Aortic Regurgitation. Cureus 2022; 14:e27312. [PMID: 36043006 PMCID: PMC9410703 DOI: 10.7759/cureus.27312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
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Majmundar M, Kumar A, Doshi R, Shariff M, Krishnaswamy A, Reed GW, Brockett J, Lahorra JA, Svensson LG, Puri R, Kapadia SR, Kalra A. Early outcomes of transcatheter versus surgical aortic valve implantation in patients with bicuspid aortic valve stenosis. EUROINTERVENTION 2022; 18:23-32. [PMID: 35019840 PMCID: PMC9909453 DOI: 10.4244/eij-d-21-00757] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Limited information is available on outcomes in patients with bicuspid aortic valve (BAV) stenosis undergoing transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR), as pivotal randomised trials excluded patients with BAV pathology due to anatomic complexity. AIMS The aim of the study was to compare early outcomes between TAVI and SAVR in patients with BAV stenosis. METHODS We queried the Nationwide Readmission Database (NRD) between 2016 and 2018 to identify adults who underwent TAVI or SAVR for BAV stenosis. The study's primary outcome was in-hospital mortality. Secondary outcomes were 30-day and six-month major adverse cardiovascular events (MACE). We matched both cohorts using propensity score matching, and applied logistic and Cox-proportional hazard regression to compute the odds ratio (OR), the hazard ratio (HR), and the 95% confidence interval (CI). RESULTS Out of 17,068 patients with BAV stenosis, 1,629 (9.5%) patients underwent TAVI and 15,439 (90.5%) underwent SAVR. After propensity score matching (PSM), we found 1,393 matched pairs. Of the matched pairs, 848 had complete six-month follow-ups. In the PSM cohort, TAVI was associated with reduced in-hospital mortality (0.7% vs 1.8%, OR: 0.35, 95% CI: 0.13-0.93; p=0.035), and a similar rate of MACE at 30 days (1% vs 1.5%, OR: 0.65, 95% CI: 0.27-1.58; p=0.343) and at six months (4.2% vs 4.9%, HR 0.86, 95% CI: 0.44-1.69; p=0.674), compared with SAVR. CONCLUSIONS In the propensity score-matched cohort, TAVI was associated with reduced odds of in-hospital mortality and a similar risk of 30-day and six-month MACE, supporting the feasibility of TAVI in BAV patients without a need for concurrent aortic root repair.
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Affiliation(s)
- Monil Majmundar
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA,Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ashish Kumar
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA,Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Rajkumar Doshi
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
| | | | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grant W. Reed
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Brockett
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA,Department of Thoracic & Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph A. Lahorra
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA,Department of Thoracic & Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lars G. Svensson
- Department of Thoracic & Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 224 W Exchange St, Suite 225, Akron, Ohio 44302, USA
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Rizzi S, Ragazzini S, Pesce M. Engineering Efforts to Refine Compatibility and Duration of Aortic Valve Replacements: An Overview of Previous Expectations and New Promises. Front Cardiovasc Med 2022; 9:863136. [PMID: 35509271 PMCID: PMC9058060 DOI: 10.3389/fcvm.2022.863136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/28/2022] [Indexed: 01/18/2023] Open
Abstract
The absence of pharmacological treatments to reduce or retard the progression of cardiac valve diseases makes replacement with artificial prostheses (mechanical or bio-prosthetic) essential. Given the increasing incidence of cardiac valve pathologies, there is always a more stringent need for valve replacements that offer enhanced performance and durability. Unfortunately, surgical valve replacement with mechanical or biological substitutes still leads to disadvantages over time. In fact, mechanical valves require a lifetime anticoagulation therapy that leads to a rise in thromboembolic complications, while biological valves are still manufactured with non-living tissue, consisting of aldehyde-treated xenograft material (e.g., bovine pericardium) whose integration into the host fails in the mid- to long-term due to unresolved issues regarding immune-compatibility. While various solutions to these shortcomings are currently under scrutiny, the possibility to implant fully biologically compatible valve replacements remains elusive, at least for large-scale deployment. In this regard, the failure in translation of most of the designed tissue engineered heart valves (TEHVs) to a viable clinical solution has played a major role. In this review, we present a comprehensive overview of the TEHVs developed until now, and critically analyze their strengths and limitations emerging from basic research and clinical trials. Starting from these aspects, we will also discuss strategies currently under investigation to produce valve replacements endowed with a true ability to self-repair, remodel and regenerate. We will discuss these new developments not only considering the scientific/technical framework inherent to the design of novel valve prostheses, but also economical and regulatory aspects, which may be crucial for the success of these novel designs.
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Affiliation(s)
- Stefano Rizzi
- Tissue Engineering Unit, Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milan, Italy
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
- Stefano Rizzi
| | - Sara Ragazzini
- Tissue Engineering Unit, Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milan, Italy
| | - Maurizio Pesce
- Tissue Engineering Unit, Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milan, Italy
- *Correspondence: Maurizio Pesce
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Sophocleous F, Bône A, Shearn AIU, Forte MNV, Bruse JL, Caputo M, Biglino G. Feasibility of a longitudinal statistical atlas model to study aortic growth in congenital heart disease. Comput Biol Med 2022; 144:105326. [PMID: 35245697 DOI: 10.1016/j.compbiomed.2022.105326] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 12/12/2022]
Abstract
Studying anatomical shape progression over time is of utmost importance to refine our understanding of clinically relevant processes. These include vascular remodeling, such as aortic dilation, which is particularly important in some congenital heart defects (CHD). A novel methodological framework for three-dimensional shape analysis has been applied for the first time in a CHD scenario, i.e., bicuspid aortic valve (BAV) disease, the most common CHD. Three-dimensional aortic shapes (n = 94) reconstructed from cardiovascular magnetic resonance imaging (MRI) data as surface meshes represented the input for a longitudinal atlas model, using multiple scans over time (n = 2-4 per patient). This model relies on diffeomorphism transformations in the absence of point-to-point correspondence, and on the right combination of initialization, estimation and registration parameters. We computed the shape trajectory of an average disease progression in our cohort, as well as time-dependent parameters, geometric variations and the average shape of the population. Results cover a spatiotemporal spectrum of visual and numerical information that can be further used to run clinical associations. This proof-of-concept study demonstrates the feasibility of applying advanced statistical shape models to track disease progression and stratify patients with CHD.
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Affiliation(s)
- Froso Sophocleous
- Bristol Medical School, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | - Alexandre Bône
- ARAMIS Lab, ICM, Inserm U1127, CNRS UMR 7225, Sorbonne University, Inria, Paris, France
| | - Andrew I U Shearn
- Bristol Medical School, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | | | - Jan L Bruse
- Vicomtech Foundation, Basque Research and Technology Alliance BRTA, Mikeletegi 57, 20009, Donostia-San Sebastián, Spain
| | - Massimo Caputo
- Bristol Medical School, Faculty of Life Sciences, University of Bristol, Bristol, UK; Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Giovanni Biglino
- Bristol Medical School, Faculty of Life Sciences, University of Bristol, Bristol, UK; Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; National Heart and Lung Institute, Imperial College London, London, UK.
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15
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Mohammadi K, Akrami M, Mirtajaddini M. A heart in a heart: a case report of spontaneous flail of bicuspid aortic valve. J Med Case Rep 2021; 15:614. [PMID: 34961549 PMCID: PMC8712105 DOI: 10.1186/s13256-021-03211-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Aortic regurgitation is attributed to congenital and acquired abnormalities of the aortic valve or aortic valve supporting structures. The most common cause of aortic regurgitation is atherosclerotic degeneration of the valve, especially in the presence of a bicuspid aortic valve. Case summary A 25-year-old Persian man with no past medical history, developed dyspnea since 1 week before his first visit to the physician. He was an active person up to this time, and had no history of trauma or chest pain. Transthoracic echocardiography showed severe aortic regurgitation in the context of flail bicuspid aortic valve, with no evidence of endocarditis. Laboratory tests including blood cultures were negative for infection. The patient underwent aortic valve replacement and the diagnosis was confirmed at time of surgery. Conclusion This case represents noninfective and nontraumatic spontaneous flail of bicuspid aortic valve. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-021-03211-8.
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Affiliation(s)
- Khadije Mohammadi
- Cardiovascular Research Center, Shafa Hospital, Kerman University of Medical Sciences, Shafa Avenue, Kerman, Iran.
| | - Mahsa Akrami
- Cardiovascular Research Center, Shafa Hospital, Kerman University of Medical Sciences, Shafa Avenue, Kerman, Iran
| | - Marzieh Mirtajaddini
- Cardiovascular Research Center, Shafa Hospital, Kerman University of Medical Sciences, Shafa Avenue, Kerman, Iran.,Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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16
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Nijs J, Vangelder B, Tanaka K, Gelsomino S, Van Loo I, La Meir M, Maessen J, Kietselaer BL. Geometric characteristics of bicuspid aortic valves. JTCVS Tech 2021; 10:200-215. [PMID: 34977726 PMCID: PMC8691778 DOI: 10.1016/j.xjtc.2021.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/19/2021] [Indexed: 12/01/2022] Open
Abstract
Objective We studied the coaptation angles α and β in bicuspid aortic valve geometry from computed tomography scan images. Methods In 45 patients, we calculated the coaptation angle α (the angle between the nonfused commissures crossing the center of coaptation), angle β (between the nonfused commissures crossing the center of the reference circle), angles γ1 and γ2 and ε1 and ε2 (angle between the nonfused commissures and the coaptation point at the raphe or the perfect midpoint, respectively), the length of the raphe, the absolute and relative sinuses' surfaces (relative to the perfect circle and the percentage exceeding the ideal circle). Spearman correlation was employed to investigate the associations among all parameters. Results The coaptation angles α and β were significantly different (P < .001). We found a significant correlation of α with the length of the raphe (P = .008), whereas β was dependent on the position of the commissures. Both γ1 and γ2 (P = .04), or ε1 and ε2 (P < .001) significantly differed from each other and ε2 was the most constant angle, although its size geometrically depends on β. The noncoronary was the largest sinus, and β was the primary determinant of its increased size in bicuspid aortic valves with righ/left fusion pattern. Conclusions The coaptation angle α is influenced by the length of the raphe, whereas angle β is dependent on the position of the commissures. The position of the raphe can vary and is not always situated in the middle of the free edge. The position of the right/non commissure is variable, whereas the right/left commissure is more fixed.
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Affiliation(s)
- Jan Nijs
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
- Department of Cardiac Surgery, Brussels Center for Aortic and Cardiovascular Connective Tissue Diseases, University Hospital Brussels, Brussels, Belgium
- Address for reprints: Jan Nijs, MD, Department of Cardiac Surgery, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium.
| | - Babs Vangelder
- Cardiology Division, Department of Cardiology, University Hospital Brussels, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Cardiac Surgery, Brussels Center for Aortic and Cardiovascular Connective Tissue Diseases, University Hospital Brussels, Brussels, Belgium
- Cardio-Radiology Division, Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Sandro Gelsomino
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
- Cardiothoracic Surgery Division, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ines Van Loo
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
- Cardiothoracic Surgery Division, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos Maessen
- Cardiothoracic Surgery Division, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiothoracic Surgery Division, Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bas L.J.H. Kietselaer
- Cardiology Division, Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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17
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Bartoli-Leonard F, Zimmer J, Aikawa E. Innate and adaptive immunity: the understudied driving force of heart valve disease. Cardiovasc Res 2021; 117:2506-2524. [PMID: 34432007 PMCID: PMC8783388 DOI: 10.1093/cvr/cvab273] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Indexed: 12/18/2022] Open
Abstract
Calcific aortic valve disease (CAVD), and its clinical manifestation that is calcific aortic valve stenosis, is the leading cause for valve disease within the developed world, with no current pharmacological treatment available to delay or halt its progression. Characterized by progressive fibrotic remodelling and subsequent pathogenic mineralization of the valve leaflets, valve disease affects 2.5% of the western population, thus highlighting the need for urgent intervention. Whilst the pathobiology of valve disease is complex, involving genetic factors, lipid infiltration, and oxidative damage, the immune system is now being accepted to play a crucial role in pathogenesis and disease continuation. No longer considered a passive degenerative disease, CAVD is understood to be an active inflammatory process, involving a multitude of pro-inflammatory mechanisms, with both the adaptive and the innate immune system underpinning these complex mechanisms. Within the valve, 15% of cells evolve from haemopoietic origin, and this number greatly expands following inflammation, as macrophages, T lymphocytes, B lymphocytes, and innate immune cells infiltrate the valve, promoting further inflammation. Whether chronic immune infiltration or pathogenic clonal expansion of immune cells within the valve or a combination of the two is responsible for disease progression, it is clear that greater understanding of the immune systems role in valve disease is required to inform future treatment strategies for control of CAVD development.
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Affiliation(s)
- Francesca Bartoli-Leonard
- Division of Cardiovascular Medicine, Department of Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jonas Zimmer
- Division of Cardiovascular Medicine, Department of Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Elena Aikawa
- Division of Cardiovascular Medicine, Department of Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Cardiovascular Medicine, Department of Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Human Pathology, Sechenov First Moscow State Medical University, Moscow, Russia
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18
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Kosger P, Akin T, Kiztanir H, Ucar B. Arterial Stiffness and Left Ventricular Myocardial Function in Children with a Well-Functioning Bicuspid Aortic Valve. Arq Bras Cardiol 2021; 117:1126-1133. [PMID: 34550169 PMCID: PMC8757143 DOI: 10.36660/abc.20200657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 01/20/2021] [Indexed: 12/04/2022] Open
Abstract
Fundamento: A rigidez arterial é um importante preditor de aortopatia e remodelamento miocárdico em pacientes com válvula aórtica bicúspide, podendo estar aumentada na infância. Objetivo: Avaliar a rigidez arterial e a função miocárdica do ventrículo esquerdo em crianças com válvula aórtica bicúspide funcional. Métodos: Quarenta e quatro crianças com válvula aórtica bicúspide e 41 pares saudáveis com válvula aórtica tricúspide foram incluídos neste estudo caso-controle. Foram obtidos os diâmetros e os escores-z relacionados da raiz aórtica e da aorta ascendente. Quanto à função miocárdica do ventrículo esquerdo, juntamente com as velocidades de fluxo mitral e parâmetros do Modo M, as velocidades miocárdicas e os intervalos de tempo foram avaliados com Doppler tecidual. A análise da onda de pulso foi realizada por aparelho oscilométrico (Mobil-o-Graph). Um valor de p<0,05 foi considerado significativo. Resultados: O índice da massa ventricular esquerda, a velocidade A do fluxo mitral, o diâmetro e o escore z da aorta ascendente e o índice de desempenho miocárdico estavam significativamente maiores nos pacientes (p = 0,04, p = 0,02, p = 0,04, p <0,001 e p <0,001 respectivamente). O índice de desempenho miocárdico correlacionou-se positivamente com o diâmetro da aorta ascendente e a velocidade A (r=0,272; p=0,01, r=356; p=0,001, respectivamente). A análise multivariada revelou que o índice de desempenho miocárdico estava relacionado ao diâmetro da aorta ascendente (p = 0,01). O índice de aumento e a velocidade da onda de pulso foram semelhantes entre os grupos (p> 0,05). Conclusão: De acordo com a análise da onda de pulso oscilométrico, as crianças com válvula aórtica bicúspide funcional apresentam rigidez arterial semelhante a seus pares saudáveis. O diâmetro da aorta ascendente foi estabelecido como preditor independente da função miocárdica do ventrículo esquerdo. A rigidez arterial pode não ser um fator de risco grave em pacientes pediátricos sem dilatação acentuada da aorta ascendente.
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Affiliation(s)
- Pelin Kosger
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Pediatric Cardiology, Eskisehir - Turquia
| | - Tugcem Akin
- Eskisehir State Hospital, Pediatric Cardiology Clinic, Eskisehir - Turquia
| | - Hikmet Kiztanir
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Pediatric Cardiology, Eskisehir - Turquia
| | - Birsen Ucar
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Pediatric Cardiology, Eskisehir - Turquia
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19
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Dolmaci OB, Driessen AHG, Klautz RJM, Poelmann R, Lindeman JHN, Grewal N. Comparative evaluation of coronary disease burden: bicuspid valve disease is not atheroprotective. Open Heart 2021; 8:openhrt-2021-001772. [PMID: 34497063 PMCID: PMC8438949 DOI: 10.1136/openhrt-2021-001772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/30/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Bicuspid aortic valve (BAV) has been associated with less atherosclerosis as compared with tricuspid aortic valve (TAV) patients. It, however, remains unclear whether this reflects the older age of TAV patients and/or accumulation of atherosclerotic risk factors or that the BAV phenotype is atheroprotective. Therefore, we compared the atherosclerotic disease burden of BAV and TAV patients, with that of the general (age-matched) population. METHODS The prevalence of coronary artery disease (CAD) and CAD risk factors in BAV and TAV patients who underwent aortic valve surgery were compared with the Dutch general practitioners registry data. BAV (n=454) and TAV (n=1101) patients were divided into four groups: BAV with aortic valve stenosis (BAV-AoS), BAV with aortic valve regurgitation (BAV-AR), TAV with AoS (TAV-AoS) and TAV with AR (TAV-AR). The atherosclerotic disease burden of each group was compared with that of the corresponding age cohort for the general population. RESULTS CAD risk factors hypertension and hypercholesterolaemia were more prevalent in the surgery groups than the age-matched general population (all p<0.001). All BAVs (BAV-AoS and BAV-AR) and TAV-AR had a similar incidence of CAD history as compared to the age-matched general populations (p=0.689, p=0.325 and p=0.617 respectively), whereas TAV-AoS had a higher incidence (21.6% versus 14.9% in the age-matched general population, p<0.001). CONCLUSIONS Stenotic TAV disease is part of the atherosclerotic disease spectrum, while regurgitant TAV and all BAVs are not. Although the prevalence of cardiovascular risk factors is higher in all BAV patients, the prevalence of CAD is similar to the general population.
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Affiliation(s)
- Onur Baris Dolmaci
- Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Robert J M Klautz
- Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Robert Poelmann
- Animal Sciences and Health, Leiden University Institute of Biology, Leiden, The Netherlands
| | - Jan H N Lindeman
- Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nimrat Grewal
- Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands .,Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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20
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Schiavone WA. Straight back syndrome as a clue to diagnosing asymptomatic congenital valvular heart disease and limiting the risk of weightlifting. J Osteopath Med 2021; 121:135-140. [PMID: 33567078 DOI: 10.1515/jom-2020-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although both are initially asymptomatic, mitral valve prolapse/myxomatous mitral valve disease (MVP/MMVD) and bicuspid aortic valve (BAV), with its associated aortic disease, are currently the two most common congenital valvular heart diseases. Severe mitral regurgitation due to rupture of chordae tendineae (CTR) prompts surgery for MVP/MMVD. Surgery for BAV is performed for severe aortic stenosis and/or regurgitation, often with management of root and/or ascending aortic enlargement. There may be an association between straight back syndrome (SBS) and MVP/MMVD, which may be a key to earlier diagnosis. Other associations link weightlifting with ascending aortic enlargement and with CTR, where the common theme is blood pressure elevation. As the number of people with fitness center memberships continues to increase, this potentially exposes more undiagnosed individuals with MVP/MMVD or BAV to risk from weightlifting. Challenges include making the public aware of this risk and preparing the osteopathic physician to recognize patients at risk through a structured history-taking and targeted cardiovascular examination.
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Affiliation(s)
- William A Schiavone
- Cardiologist, retired from Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA
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21
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Biological knowledge-slanted random forest approach for the classification of calcified aortic valve stenosis. BioData Min 2021; 14:35. [PMID: 34301292 PMCID: PMC8305490 DOI: 10.1186/s13040-021-00269-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background Calcific aortic valve stenosis (CAVS) is a fatal disease and there is no pharmacological treatment to prevent the progression of CAVS. This study aims to identify genes potentially implicated with CAVS in patients with congenital bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in comparison with patients having normal valves, using a knowledge-slanted random forest (RF). Results This study implemented a knowledge-slanted random forest (RF) using information extracted from a protein-protein interactions network to rank genes in order to modify their selection probability to draw the candidate split-variables. A total of 15,191 genes were assessed in 19 valves with CAVS (BAV, n = 10; TAV, n = 9) and 8 normal valves. The performance of the model was evaluated using accuracy, sensitivity, and specificity to discriminate cases with CAVS. A comparison with conventional RF was also performed. The performance of this proposed approach reported improved accuracy in comparison with conventional RF to classify cases separately with BAV and TAV (Slanted RF: 59.3% versus 40.7%). When patients with BAV and TAV were grouped against patients with normal valves, the addition of prior biological information was not relevant with an accuracy of 92.6%. Conclusion The knowledge-slanted RF approach reflected prior biological knowledge, leading to better precision in distinguishing between cases with BAV, TAV, and normal valves. The results of this study suggest that the integration of biological knowledge can be useful during difficult classification tasks. Supplementary Information The online version contains supplementary material available at 10.1186/s13040-021-00269-4.
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22
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Çelik M, Milojevic M, Durko AP, Oei FBS, Bogers AJJC, Mahtab EAF. Differences in baseline characteristics and outcomes of bicuspid and tricuspid aortic valves in surgical aortic valve replacement. Eur J Cardiothorac Surg 2021; 59:1191-1199. [PMID: 33496318 DOI: 10.1093/ejcts/ezaa474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/14/2020] [Accepted: 11/26/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients with bicuspid aortic valve (BAV) comprise a substantial portion of patients undergoing surgical aortic valve replacement (SAVR). Our goal was to quantify the prevalence of BAV in the current SAVR ± coronary artery bypass grafting (CABG) population, assess differences in cardiovascular risk profiles and assess differences in long-term survival in patients with BAV compared to patients with tricuspid aortic valve (TAV). METHODS Patients who underwent SAVR with or without concomitant CABG and who had a surgical report denoting the relevant valvular anatomy were eligible and included. Prevalence, predictors and outcomes for patients with BAV were analysed and compared to those patients with TAV. Matched patients with BAV and TAV were compared using a propensity score matching strategy and an age matching strategy. RESULTS A total of 3723 patients, 3145 of whom (mean age 66.6 ± 11.4 years; 37.4% women) had an operative report describing their aortic valvular morphology, underwent SAVR ± CABG between 1987 and 2016. The overall prevalence of patients with BAV was 19.3% (607). Patients with BAV were younger than patients with TAV (60.6 ± 12.1 vs 68.0 ± 10.7, respectively). In the age-matched cohort, patients with BAV were less likely to have comorbidities, among others diabetes (P = 0.001), hypertension (P < 0.001) and hypercholesterolaemia (P = 0.003), compared to patients with TAV. Twenty-year survival following the index procedure was higher in patients with BAV (14.8%) compared to those with TAV (12.9%) in the age-matched cohort (P = 0.015). CONCLUSIONS Substantial differences in the cardiovascular risk profile exist in patients with BAV and TAV. Long-term survival after SAVR in patients with BAV is satisfactory.
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Affiliation(s)
- Mevlüt Çelik
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Frans B S Oei
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Edris A F Mahtab
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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23
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Diz OM, Toro R, Cesar S, Gomez O, Sarquella-Brugada G, Campuzano O. Personalized Genetic Diagnosis of Congenital Heart Defects in Newborns. J Pers Med 2021; 11:562. [PMID: 34208491 PMCID: PMC8235407 DOI: 10.3390/jpm11060562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 12/26/2022] Open
Abstract
Congenital heart disease is a group of pathologies characterized by structural malformations of the heart or great vessels. These alterations occur during the embryonic period and are the most frequently observed severe congenital malformations, the main cause of neonatal mortality due to malformation, and the second most frequent congenital malformations overall after malformations of the central nervous system. The severity of different types of congenital heart disease varies depending on the combination of associated anatomical defects. The causes of these malformations are usually considered multifactorial, but genetic variants play a key role. Currently, use of high-throughput genetic technologies allows identification of pathogenic aneuploidies, deletions/duplications of large segments, as well as rare single nucleotide variants. The high incidence of congenital heart disease as well as the associated complications makes it necessary to establish a diagnosis as early as possible to adopt the most appropriate measures in a personalized approach. In this review, we provide an exhaustive update of the genetic bases of the most frequent congenital heart diseases as well as other syndromes associated with congenital heart defects, and how genetic data can be translated to clinical practice in a personalized approach.
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Affiliation(s)
- Olga María Diz
- UGC Laboratorios, Hospital Universitario Puerta del Mar, 11009 Cadiz, Spain;
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08950 Barcelona, Spain
| | - Rocio Toro
- Medicine Department, School of Medicine, Cádiz University, 11519 Cadiz, Spain;
| | - Sergi Cesar
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain;
| | - Olga Gomez
- Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08950 Barcelona, Spain;
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
| | - Georgia Sarquella-Brugada
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain;
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
| | - Oscar Campuzano
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08950 Barcelona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
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24
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Tandon I, Quinn KP, Balachandran K. Label-Free Multiphoton Microscopy for the Detection and Monitoring of Calcific Aortic Valve Disease. Front Cardiovasc Med 2021; 8:688513. [PMID: 34179147 PMCID: PMC8226007 DOI: 10.3389/fcvm.2021.688513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
Calcific aortic valve disease (CAVD) is the most common valvular heart disease. CAVD results in a considerable socio-economic burden, especially considering the aging population in Europe and North America. The only treatment standard is surgical valve replacement as early diagnostic, mitigation, and drug strategies remain underdeveloped. Novel diagnostic techniques and biomarkers for early detection and monitoring of CAVD progression are thus a pressing need. Additionally, non-destructive tools are required for longitudinal in vitro and in vivo assessment of CAVD initiation and progression that can be translated into clinical practice in the future. Multiphoton microscopy (MPM) facilitates label-free and non-destructive imaging to obtain quantitative, optical biomarkers that have been shown to correlate with key events during CAVD progression. MPM can also be used to obtain spatiotemporal readouts of metabolic changes that occur in the cells. While cellular metabolism has been extensively explored for various cardiovascular disorders like atherosclerosis, hypertension, and heart failure, and has shown potential in elucidating key pathophysiological processes in heart valve diseases, it has yet to gain traction in the study of CAVD. Furthermore, MPM also provides structural, functional, and metabolic readouts that have the potential to correlate with key pathophysiological events in CAVD progression. This review outlines the applicability of MPM and its derived quantitative metrics for the detection and monitoring of early CAVD progression. The review will further focus on the MPM-detectable metabolic biomarkers that correlate with key biological events during valve pathogenesis and their potential role in assessing CAVD pathophysiology.
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Affiliation(s)
- Ishita Tandon
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, United States
| | - Kyle P Quinn
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, United States
| | - Kartik Balachandran
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, United States
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25
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Dolmaci OB, Legué J, Lindeman JHN, Driessen AHG, Klautz RJM, Van Brakel TJ, Siebelink HMJ, Mertens BJA, Poelmann RE, Gittenberger-de Groot AC, Grewal N. Extent of Coronary Artery Disease in Patients With Stenotic Bicuspid Versus Tricuspid Aortic Valves. J Am Heart Assoc 2021; 10:e020080. [PMID: 34075785 PMCID: PMC8477872 DOI: 10.1161/jaha.120.020080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, which is often complicated by aortic valve stenosis (AoS). In tricuspid aortic valve (TAV), AoS strongly associates with coronary artery disease (CAD) with common pathophysiological factors. Yet, it remains unclear whether AoS in patients with BAV is also associated with CAD. This study investigated the association between the aortic valve morphological features and the extent of CAD. Methods and Results A single-center study was performed, including all patients who underwent an aortic valve replacement attributable to AoS between 2006 and 2019. Coronary sclerosis was graded on preoperative coronary angiographies using the coronary artery greater even than scoring method, which divides the coronaries in 28 segments and scores nonobstructive (20%-49% sclerosis) and obstructive coronary sclerosis (>49% sclerosis) in each segment. Multivariate analyses were performed, controlling for age, sex, and CAD risk factors. A total of 1296 patients (931 TAV and 365 BAV) were included, resulting in 548 matched patients. Patients with TAV exhibited more CAD risk factors (odds ratio [OR], 2.66; 95% CI, 1.79-3.96; P<0.001). Patients with BAV had lower coronary artery greater even than 20 (1.61±2.35 versus 3.60±2.79) and coronary artery greater even than 50 (1.24±2.43 versus 3.37±3.49) scores (P<0.001), even after correcting for CAD risk factors (P<0.001). Patients with TAV more often needed concomitant coronary revascularization (OR, 3.50; 95% CI, 2.42-5.06; P<0.001). Conclusions Patients with BAV who are undergoing surgery for AoS carry a lower cardiovascular risk profile, correlating with less coronary sclerosis and a lower incidence of concomitant coronary revascularization compared with patients with TAV.
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Affiliation(s)
- Onur B Dolmaci
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands.,Department of Cardiothoracic Surgery Amsterdam University Medical Center the Netherlands
| | - Juno Legué
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands
| | - Jan H N Lindeman
- Department of Vascular Surgery Leiden University Medical Center the Netherlands
| | - Antoine H G Driessen
- Department of Cardiothoracic Surgery Amsterdam University Medical Center the Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands.,Department of Cardiothoracic Surgery Amsterdam University Medical Center the Netherlands
| | - Thomas J Van Brakel
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands
| | | | - Bart J A Mertens
- Biomedical Data Science Biostatistics Section Leiden University Medical Center the Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health Leiden University the Netherlands
| | | | - Nimrat Grewal
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands
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26
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Q Fever Endocarditis: A Review of Local and all Reported Cases in the Literature. Heart Lung Circ 2021; 30:1509-1515. [PMID: 34052129 DOI: 10.1016/j.hlc.2021.04.022] [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: 10/20/2020] [Revised: 03/22/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Q fever endocarditis by Coxiella burnetii is rare and presents a diagnostic challenge. With limited data available, the aim of this study was to review all reported cases together with unpublished local cases to understand risk factor profiles, diagnostic methods, clinical features, treatments and outcomes. METHODS A search of the PubMed database using the term 'Q fever endocarditis' identified cases between 1950-2019. Included cases had positive polymerase chain reaction testing, valve culture or serology. Separately, to identify local cases meeting our criteria we queried the Western Australian Health Open Patient Administration System at two local hospitals for the ICD-10-AM diagnosis code A78 between 2013-2019. RESULTS We identified 181 cases from 31 publications and four local cases to create a combined series of 185 cases. The majority 141 (76%) were male and only 11% had normal cardiac valves. Most (72%) of patients had a history of contact with animals or travel. Nearly all (98%) cases had positive serology and over half (56%) had surgery performed. Overall mortality was 17%, and mortality for native valve endocarditis and prosthetic valve endocarditis was 12% and 3% respectively. No patients treated with doxycycline and hydroxychloroquine died. Mortality prior to 1999 was 28%, compared with 5% for more recent cases. CONCLUSION Serological diagnosis is key in Q fever endocarditis and possible risk factors exist such as male gender, pre-existing valvular conditions and contact with animals or travel. Native valve endocarditis and treatment with drugs other than doxycycline and hydroxychloroquine increase the risk of death.
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27
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Abstract
Aortic stenosis (AS) remains one of the most common forms of valve disease, with significant impact on patient survival. The disease is characterized by left ventricular outflow obstruction and encompasses a series of stenotic lesions starting from the left ventricular outflow tract to the descending aorta. Obstructions may be subvalvar, valvar, or supravalvar and can be present at birth (congenital) or acquired later in life. Bicuspid aortic valve, whereby the aortic valve forms with two instead of three cusps, is the most common cause of AS in younger patients due to primary anatomic narrowing of the valve. In addition, the secondary onset of premature calcification, likely induced by altered hemodynamics, further obstructs left ventricular outflow in bicuspid aortic valve patients. In adults, degenerative AS involves progressive calcification of an anatomically normal, tricuspid aortic valve and is attributed to lifelong exposure to multifactoral risk factors and physiological wear-and-tear that negatively impacts valve structure-function relationships. AS continues to be the most frequent valvular disease that requires intervention, and aortic valve replacement is the standard treatment for patients with severe or symptomatic AS. While the positive impacts of surgical interventions are well documented, the financial burden, the potential need for repeated procedures, and operative risks are substantial. In addition, the clinical management of asymptomatic patients remains controversial. Therefore, there is a critical need to develop alternative approaches to prevent the progression of left ventricular outflow obstruction, especially in valvar lesions. This review summarizes our current understandings of AS cause; beginning with developmental origins of congenital valve disease, and leading into the multifactorial nature of AS in the adult population.
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Affiliation(s)
- Punashi Dutta
- The Herma Heart Institute, Section of Pediatric Cardiology, Children's Wisconsin, Milwaukee, WI (P.D., J.F.J., H.K., J.L.).,Department of Pediatrics, Medical College of Wisconsin, Milwaukee (P.D., J.F.J., J.L.)
| | - Jeanne F James
- The Herma Heart Institute, Section of Pediatric Cardiology, Children's Wisconsin, Milwaukee, WI (P.D., J.F.J., H.K., J.L.).,Department of Pediatrics, Medical College of Wisconsin, Milwaukee (P.D., J.F.J., J.L.)
| | - Hail Kazik
- The Herma Heart Institute, Section of Pediatric Cardiology, Children's Wisconsin, Milwaukee, WI (P.D., J.F.J., H.K., J.L.).,Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee (H.K.)
| | - Joy Lincoln
- The Herma Heart Institute, Section of Pediatric Cardiology, Children's Wisconsin, Milwaukee, WI (P.D., J.F.J., H.K., J.L.).,Department of Pediatrics, Medical College of Wisconsin, Milwaukee (P.D., J.F.J., J.L.)
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28
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Carlos T, Freitas AA, Alves PM, Martins R, Gonçalves L. Aortic strain in bicuspid aortic valve: an analysis. Int J Cardiovasc Imaging 2021; 37:2399-2408. [PMID: 33818697 DOI: 10.1007/s10554-021-02215-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/03/2021] [Indexed: 11/25/2022]
Abstract
Bicuspid aortic valve (BAV) is monitored by transthoracic echocardiography and computed tomography (CT) angiography. However, it does not have any early marker of disease progression. This study evaluated speckle-tracking echocardiography (STE) aortic and left ventricular (LV) strain prognostic values, their discriminative power, and their correlation with the degree of valvular regurgitation. We conducted a retrospective analysis of a prospectively enrolled cohort of 45 diagnosed with BAV and 20 gender and age matched controls. We performed 2D-STE aortic and LV strain analysis of the selected population. The cohort was followed-up during a median period of 19.9 months (IQR 12.9-25.2), and outcomes (hospital admission for heart failure (HF), aortic valve replacement (AVR), and death) were determined. The mean patient age was 46.6 ± 15.5 years and 80 % were male. LV indexed volumes and aortic diameter were higher in BAV patients. LV global longitudinal strain (GLS) was impaired (p < 0.001) and aortic GLS was significantly augmented (p = 0.027) in BAV patients. Aortic global circumferential strain (GCS) did not vary between groups. Aortic diameter was the best parameter related to BAV (AUC 0.92) and aortic GLS was best correlated with significant AR (AUC 0.76). AVR was the only outcome observed and its only predictor was indexed LV end-diastolic volume. BAV had impaired LV-GLS values. Aortic GLS was abnormally augmented in BAV patients, which might reflect higher aortic diameters that distorted strain calculations. STE aortic strain is related to AR but does not appear to be a reliable predictor of surgery in BAV patients, at 19 months.
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Affiliation(s)
- Tomás Carlos
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - André Azul Freitas
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal
| | - Patrícia Marques Alves
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal. .,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal.
| | - Rui Martins
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal
| | - Lino Gonçalves
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal
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29
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Pepe G, Giusti B, Colonna S, Fugazzaro MP, Sticchi E, De Cario R, Kura A, Pratelli E, Melchiorre D, Nistri S. When should a rare inherited connective tissue disorder be suspected in bicuspid aortic valve by primary-care internists and cardiologists? Proposal of a score. Intern Emerg Med 2021; 16:609-615. [PMID: 32949381 PMCID: PMC8049921 DOI: 10.1007/s11739-020-02458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
Size threshold for aortic surgery in bicuspid aortic valve (BAV) is debated. Connective tissue disorders (CTDs) are claimed as a clinical turning point, suggesting early surgery in BAV patients with CTD. Thus, we aimed at developing a score to detect high risk of carrying CTDs in consecutive BAVs from primary care. Ninety-eight BAVs without ectopia lentis or personal/family history of aortic dissection were studied at the Marfan syndrome Tuscany Referral Center. Findings were compared with those detected in 84 Marfan patients matched for sex and age. We selected traits with high statistical difference between MFS and BAV easily obtainable by cardiologists and primary-care internists: mitral valve prolapse, myopia ≥ 3DO, pectus carenatum, pes planus, wrist and thumb signs, and difference between aortic size at root and ascending aorta ≥ 4 mm. Clustering of ≥ 3 of these manifestations were more frequent in Marfan patients than in BAVs (71.4% vs 6.1%, p < 0.0001) resulting into an Odds Ratio to be affected by MFS of 38.3 (95% confidence intervals 14.8-99.3, p < 0.0001). We propose a score assembling simple clinical and echocardiographic variables resulting in an appropriate referral pattern of BAVs from a primary-care setting to a tertiary center to evaluate the presence of a potential, major CTD.
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Affiliation(s)
- Guglielmina Pepe
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Viale Gaetano Pieraccini, 50139, Florence, Italy.
- Research and Innovation Center for Marfan Syndrome and Related Disorders, Careggi Hospital, Florence, Italy.
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Florence, Italy.
| | - Betti Giusti
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Viale Gaetano Pieraccini, 50139, Florence, Italy
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Florence, Italy
- Atherothrombotic Diseases Tuscany Referral Center, Careggi Hospital, Florence, Italy
| | - Stefania Colonna
- Outpatient Cardiology Unit, Health District 1 ULSS 6, Vigonza and Carmignano di Brenta, Padua, Italy
| | | | - Elena Sticchi
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Viale Gaetano Pieraccini, 50139, Florence, Italy
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Florence, Italy
- Atherothrombotic Diseases Tuscany Referral Center, Careggi Hospital, Florence, Italy
| | - Rosina De Cario
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Viale Gaetano Pieraccini, 50139, Florence, Italy
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Florence, Italy
- Atherothrombotic Diseases Tuscany Referral Center, Careggi Hospital, Florence, Italy
| | - Ada Kura
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Viale Gaetano Pieraccini, 50139, Florence, Italy
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Florence, Italy
- Atherothrombotic Diseases Tuscany Referral Center, Careggi Hospital, Florence, Italy
| | - Elisa Pratelli
- Specialization in Physical and Rehabilitation Medicine, Recovery and Rehabilitation Agency, Careggi Hospital, Florence, Italy
| | - Daniela Melchiorre
- Department of Experimental and Clinical Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Stefano Nistri
- Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Italy
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30
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Cave DGW, Panayiotou H, Bissell MM. Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve Disease-A Systematic Review of the Literature. Front Cardiovasc Med 2021; 8:629227. [PMID: 33842561 PMCID: PMC8024488 DOI: 10.3389/fcvm.2021.629227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/02/2021] [Indexed: 11/25/2022] Open
Abstract
Bicuspid aortic valve (BAV) disease presents a unique management challenge both pre- and post-operatively. 4D flow MRI offers multiple tools for the assessment of the thoracic aorta in aortic valve disease. In particular, its assessment of flow patterns and wall shear stress have led to new understandings around the mechanisms of aneurysm development in BAV disease. Novel parameters have now been developed that have the potential to predict pathological aortic dilatation and may help to risk stratify BAV patients in future. This systematic review analyses the current 4D flow MRI literature after aortic valve and/or ascending aortic replacement in bicuspid aortic valve disease. 4D flow MRI has also identified distinct challenges posed by this cohort at the time of valve replacement compared to standard management of tri-leaflet disorders, and may help tailor the type and timing of replacement. Eccentric pathological flow patterns seen after bioprosthetic valve implantation, but not with mechanical prostheses, might be an important future consideration in intervention planning. 4D flow MRI also has promising potential in supporting the development of artificial valve prostheses and aortic conduits with more physiological flow patterns.
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Affiliation(s)
- Daniel G W Cave
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Hannah Panayiotou
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
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31
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Surgical Aortic Valve Replacement with Concomitant Aortic Surgery in Patients with Purely Bicuspid Aortic Valve and Associated Aortopathy. J Cardiovasc Dev Dis 2021; 8:jcdd8020016. [PMID: 33578656 PMCID: PMC7916373 DOI: 10.3390/jcdd8020016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
The bicuspid aortic valve (BAV) is the most common congenital cardiac malformation associated with aortopathy. The current study provides surgical clinical data on the patient characteristics and long-term survival of this less common adult purely BAV population undergoing surgical aortic valve replacement (SAVR) with concomitant aortic surgery. Adult patients with purely BAV who underwent SAVR and concomitant aortic surgery were included. Prevalence, predictors of survival, and outcomes for this patient population were analyzed. A total of 48 patients (mean age 58.7 ± 13.2 years, 33% female) with purely BAV underwent SAVR and concomitant aortic surgery between 1987 and 2016. The majority (62%) of the patients had pure aortic stenosis (AS). A total of 12 patients died. Survival was 92%, 73%, and 69% at 1, 5, and 20 years of follow-up. At 15 years of follow-up, the survival was close to that of the Dutch population, with a relative survival of 77%. Adult patients with a purely bicuspid aortic valve morphology undergoing SAVR and concomitant aortic root and/or ascending aorta present with excellent survival.
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32
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Abstract
Congenital heart disease is the most common congenital defect observed in newborns. Within the spectrum of congenital heart disease are left‐sided obstructive lesions (LSOLs), which include hypoplastic left heart syndrome, aortic stenosis, bicuspid aortic valve, coarctation of the aorta, and interrupted aortic arch. These defects can arise in isolation or as a component of a defined syndrome; however, nonsyndromic defects are often observed in multiple family members and associated with high sibling recurrence risk. This clear evidence for a heritable basis has driven a lengthy search for disease‐causing variants that has uncovered both rare and common variants in genes that, when perturbed in cardiac development, can result in LSOLs. Despite advancements in genetic sequencing platforms and broadening use of exome sequencing, the currently accepted LSOL‐associated genes explain only 10% to 20% of patients. Further, the combinatorial effects of common and rare variants as a cause of LSOLs are emerging. In this review, we highlight the genes and variants associated with the different LSOLs and discuss the strengths and weaknesses of the present genetic associations. Furthermore, we discuss the research avenues needed to bridge the gaps in our current understanding of the genetic basis of nonsyndromic congenital heart disease.
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Affiliation(s)
- Lauren E Parker
- Division of Cardiology Department of Pediatrics Duke University School of Medicine Durham NC
| | - Andrew P Landstrom
- Division of Cardiology Department of Pediatrics Duke University School of Medicine Durham NC.,Department of Cell Biology Duke University School of Medicine Durham NC
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33
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Taghizadeh B, Ghavami L, Derakhshankhah H, Zangene E, Razmi M, Jaymand M, Zarrintaj P, Zarghami N, Jaafari MR, Moallem Shahri M, Moghaddasian A, Tayebi L, Izadi Z. Biomaterials in Valvular Heart Diseases. Front Bioeng Biotechnol 2020; 8:529244. [PMID: 33425862 PMCID: PMC7793990 DOI: 10.3389/fbioe.2020.529244] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 11/16/2020] [Indexed: 01/07/2023] Open
Abstract
Valvular heart disease (VHD) occurs as the result of valvular malfunction, which can greatly reduce patient's quality of life and if left untreated may lead to death. Different treatment regiments are available for management of this defect, which can be helpful in reducing the symptoms. The global commitment to reduce VHD-related mortality rates has enhanced the need for new therapeutic approaches. During the past decade, development of innovative pharmacological and surgical approaches have dramatically improved the quality of life for VHD patients, yet the search for low cost, more effective, and less invasive approaches is ongoing. The gold standard approach for VHD management is to replace or repair the injured valvular tissue with natural or synthetic biomaterials. Application of these biomaterials for cardiac valve regeneration and repair holds a great promise for treatment of this type of heart disease. The focus of the present review is the current use of different types of biomaterials in treatment of valvular heart diseases.
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Affiliation(s)
- Bita Taghizadeh
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Laleh Ghavami
- Laboratory of Biophysics and Molecular Biology, Department of Biophysics, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Hossein Derakhshankhah
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ehsan Zangene
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Mahdieh Razmi
- Department of Biochemistry, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Mehdi Jaymand
- Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Payam Zarrintaj
- Polymer Engineering Department, Faculty of Engineering, Urmia University, Urmia, Iran
| | - Nosratollah Zarghami
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Reza Jaafari
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Matin Moallem Shahri
- Cardiology Department, Taleghani Trauma Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, WI, United States
| | - Zhila Izadi
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Regenerative Medicine, Cell Science Research Center, Academic Center for Education, Culture and Research (ACECR), Royan Institute for Stem Cell Biology and Technology, Tehran, Iran
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34
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Update on Bicuspid Aortic Valve Syndrome: Patient Selection and Therapies in 2020. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00850-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Sudhakar D, Kamran H, Chen N, Mims M, Hamzeh I. A Sticky Situation: Aortic Valve Thrombus in Patient with Antiphospholipid Antibody Syndrome and Immune Thrombocytopenia. Am J Med 2020; 133:e393-e395. [PMID: 31987800 DOI: 10.1016/j.amjmed.2019.12.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Nan Chen
- Baylor College of Medicine, Houston, Tex
| | - Martha Mims
- Baylor College of Medicine, Houston, Tex; Ben Taub Hospital, Houston, Tex
| | - Ihab Hamzeh
- Baylor College of Medicine, Houston, Tex; Ben Taub Hospital, Houston, Tex
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36
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Debiec R, Hamby SE, Jones PD, Coolman S, Asiani M, Kharodia S, Skinner GJ, Samani NJ, Webb TR, Bolger A. Novel loss of function mutation in NOTCH1 in a family with bicuspid aortic valve, ventricular septal defect, thoracic aortic aneurysm, and aortic valve stenosis. Mol Genet Genomic Med 2020; 8:e1437. [PMID: 32720365 PMCID: PMC7549557 DOI: 10.1002/mgg3.1437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background Bicuspid aortic valve is the most common congenital valvular heart defect in the general population. BAV is associated with significant morbidity due to valve failure, formation of thoracic aortic aneurysm, and increased risk of infective endocarditis and aortic dissection. Loss of function mutations in NOTCH1 (OMIM 190198) has previously been associated with congenital heart disease involving the aortic valve, left ventricle outflow tract, and mitral valve that segregates in affected pedigrees as an autosomal dominant trait with variable expressivity. Methods We performed whole‐exome sequencing in four members of a three‐generational family (three affected and one unaffected subject) with clinical phenotypes including aortic valve stenosis, thoracic aortic aneurysm, and ventricular septal defect. Results We identified 16 potentially damaging genetic variants (one stop variant, one splice variant, and 14 missense variants) cosegregating with the phenotype. Of these variants, the nonsense mutation (p.Tyr291*) in NOTCH1 was the most deleterious variant identified and the most likely variant causing the disease. Conclusion Inactivating NOTCH1 mutations are a rare cause of familial heart disease involving predominantly left ventricular outflow tract lesions and characterized by the heterogeneity of clinical phenotype.
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Affiliation(s)
- Radoslaw Debiec
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Stephen E Hamby
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Peter D Jones
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Sue Coolman
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Manish Asiani
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Shireen Kharodia
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gregory J Skinner
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Tom R Webb
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Aidan Bolger
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.,East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
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37
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Bons LR, Geenen LW, van den Hoven AT, Dik WA, van den Bosch AE, Duijnhouwer AL, Siebelink HMJ, Budde RPJ, Boersma E, Wessels MW, van de Laar IMBH, DeRuiter MC, Goumans MJ, Loeys BL, Roos-Hesselink JW. Blood biomarkers in patients with bicuspid aortic valve disease. J Cardiol 2020; 76:287-294. [PMID: 32265086 DOI: 10.1016/j.jjcc.2020.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/10/2020] [Accepted: 02/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with a bicuspid aortic valve (BAV) are at risk of developing valve deterioration and aortic dilatation. We aimed to investigate whether blood biomarkers are associated with disease stage in patients with BAV. METHODS Serum levels of high sensitivity C-reactive protein (hsCRP), high sensitivity troponin T (hsTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and total transforming growth factor-beta 1 (TGF-ß1) were measured in adult BAV patients with valve dysfunction or aortic pathology. Age-matched general population controls were included for TGFß-1 measurements. Correlation analyses and multivariable linear regression were used to determine the association between (2log-transformed) biomarker levels and aortic valve regurgitation, aortic valve stenosis, aortic dilatation, or left ventricular function. RESULTS hsCRP and hsTnT were measured in the total group of 183 patients (median age 34 years, 25th-75th percentile 23-46), NT-proBNP in 162 patients, and TGF-ß1 beta in 108 patients. Elevated levels of NT-proBNP were found in 20% of the BAV patients, elevated hsTnT in 6%, and elevated hsCRP in 7%. Higher hsTnT levels were independently associated with aortic regurgitation [odds ratio per doubling (OR2log) 1.34, 95% CI 1.01;1.76] and higher NT-proBNP levels with aortic valve maximal velocity (ß2log 0.17, 95%CI 0.07;0.28) and aortic regurgitation (OR2log 1.41, 95%CI 1.11;1.79). Both BAV patients with (9.9 ± 2.7 ng/mL) and without aortic dilatation (10.4 ± 2.9 ng/mL) showed lower TGF-ß1 levels compared to general population controls (n = 85, 11.8 ± 3.2 ng/mL). CONCLUSIONS Higher NT-proBNP and hsTNT levels were associated with aortic valve disease in BAV patients. TGF-ß1 levels were lower in BAV patients than in the general population, and not related to aortic dilatation. Longitudinal data are needed to further investigate the prognostic value of biomarkers in these patients.
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Affiliation(s)
- Lidia R Bons
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laurie W Geenen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem A Dik
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Clinical Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marja W Wessels
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid M B H van de Laar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marie-José Goumans
- Department of Cell and Chemical Biology, Laboratory for Cardiovascular Cell Biology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bart L Loeys
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands; Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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38
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Gupta SK, Kumari S, Singh S, Barthwal MK, Singh SK, Thum T. Non-coding RNAs: Regulators of valvular calcification. J Mol Cell Cardiol 2020; 142:14-23. [PMID: 32247640 DOI: 10.1016/j.yjmcc.2020.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
There is currently a growing global burden of valvular heart diseases due to aging populations and changing lifestyles. Valvular heart diseases mainly include the malfunctioning of aortic and mitral valves and are characterized by extensive tissue remodeling, which includes calcification, endothelial dysfunction, and endothelial-mesenchymal transition. These valvular remodeling processes are known to be regulated by protein-coding genes as well as non-coding genes. Here, we have summarized studies highlighting the non-coding RNA mediated regulation of valvular tissue remodeling and their potential therapeutic benefits. Additionally, studies investigating the diagnostic capability of circulating non-coding RNA molecules in valvular diseases are also summarized. Overall, of the various candidates, several studies have highlighted miR-214 and miR-204 as central regulators of valvular calcification.
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Affiliation(s)
- Shashi Kumar Gupta
- Pharmacology Division, CSIR-Central Drug Research Institute, Lucknow, India.
| | - Sunaina Kumari
- Pharmacology Division, CSIR-Central Drug Research Institute, Lucknow, India
| | - Sandhya Singh
- Pharmacology Division, CSIR-Central Drug Research Institute, Lucknow, India
| | | | - Sushil Kumar Singh
- Department of Cardiovascular & Thoracic Surgery, King George Medical University, Lucknow, India
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany
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39
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Fulmer D, Toomer K, Guo L, Moore K, Glover J, Moore R, Stairley R, Lobo G, Zuo X, Dang Y, Su Y, Fogelgren B, Gerard P, Chung D, Heydarpour M, Mukherjee R, Body SC, Norris RA, Lipschutz JH. Defects in the Exocyst-Cilia Machinery Cause Bicuspid Aortic Valve Disease and Aortic Stenosis. Circulation 2019; 140:1331-1341. [PMID: 31387361 DOI: 10.1161/circulationaha.119.038376] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) disease is a congenital defect that affects 0.5% to 1.2% of the population and is associated with comorbidities including ascending aortic dilation and calcific aortic valve stenosis. To date, although a few causal genes have been identified, the genetic basis for the vast majority of BAV cases remains unknown, likely pointing to complex genetic heterogeneity underlying this phenotype. Identifying genetic pathways versus individual gene variants may provide an avenue for uncovering additional BAV causes and consequent comorbidities. METHODS We performed genome-wide association Discovery and Replication Studies using cohorts of 2131 patients with BAV and 2728 control patients, respectively, which identified primary cilia genes as associated with the BAV phenotype. Genome-wide association study hits were prioritized based on P value and validated through in vivo loss of function and rescue experiments, 3-dimensional immunohistochemistry, histology, and morphometric analyses during aortic valve morphogenesis and in aged animals in multiple species. Consequences of these genetic perturbations on cilia-dependent pathways were analyzed by Western and immunohistochemistry analyses, and assessment of aortic valve and cardiac function were determined by echocardiography. RESULTS Genome-wide association study hits revealed an association between BAV and genetic variation in human primary cilia. The most associated single-nucleotide polymorphisms were identified in or near genes that are important in regulating ciliogenesis through the exocyst, a shuttling complex that chaperones cilia cargo to the membrane. Genetic dismantling of the exocyst resulted in impaired ciliogenesis, disrupted ciliogenic signaling and a spectrum of cardiac defects in zebrafish, and aortic valve defects including BAV, valvular stenosis, and valvular calcification in murine models. CONCLUSIONS These data support the exocyst as required for normal ciliogenesis during aortic valve morphogenesis and implicate disruption of ciliogenesis and its downstream pathways as contributory to BAV and associated comorbidities in humans.
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Affiliation(s)
- Diana Fulmer
- Departments of Medicine (D.F., G.L., X.Z., Y.D., Y.S., R.A.N., J.H.L.), Medical University of South Carolina, Charleston.,Regenerative Medicine and Cell Biology (D.F., K.T., L.G., K.M., J.G., R. Moore, R.S., R.A.N.), Medical University of South Carolina, Charleston
| | - Katelynn Toomer
- Regenerative Medicine and Cell Biology (D.F., K.T., L.G., K.M., J.G., R. Moore, R.S., R.A.N.), Medical University of South Carolina, Charleston
| | - Lilong Guo
- Regenerative Medicine and Cell Biology (D.F., K.T., L.G., K.M., J.G., R. Moore, R.S., R.A.N.), Medical University of South Carolina, Charleston
| | - Kelsey Moore
- Regenerative Medicine and Cell Biology (D.F., K.T., L.G., K.M., J.G., R. Moore, R.S., R.A.N.), Medical University of South Carolina, Charleston
| | - Janiece Glover
- Regenerative Medicine and Cell Biology (D.F., K.T., L.G., K.M., J.G., R. Moore, R.S., R.A.N.), Medical University of South Carolina, Charleston
| | - Reece Moore
- Regenerative Medicine and Cell Biology (D.F., K.T., L.G., K.M., J.G., R. Moore, R.S., R.A.N.), Medical University of South Carolina, Charleston
| | - Rebecca Stairley
- Regenerative Medicine and Cell Biology (D.F., K.T., L.G., K.M., J.G., R. Moore, R.S., R.A.N.), Medical University of South Carolina, Charleston
| | - Glenn Lobo
- Departments of Medicine (D.F., G.L., X.Z., Y.D., Y.S., R.A.N., J.H.L.), Medical University of South Carolina, Charleston.,Ophthalmology (G.L.), Medical University of South Carolina, Charleston
| | - Xiaofeng Zuo
- Departments of Medicine (D.F., G.L., X.Z., Y.D., Y.S., R.A.N., J.H.L.), Medical University of South Carolina, Charleston
| | - Yujing Dang
- Departments of Medicine (D.F., G.L., X.Z., Y.D., Y.S., R.A.N., J.H.L.), Medical University of South Carolina, Charleston
| | - Yanhui Su
- Departments of Medicine (D.F., G.L., X.Z., Y.D., Y.S., R.A.N., J.H.L.), Medical University of South Carolina, Charleston
| | - Ben Fogelgren
- Department of Anatomy, Biochemistry, and Physiology, University of Hawaii at Manoa, Honolulu (B.F.)
| | - Patrick Gerard
- Department of Mathematical Sciences, Clemson University, SC (P.G.)
| | - Dongjun Chung
- Public Health Sciences (D.C.), Medical University of South Carolina, Charleston
| | - Mahyar Heydarpour
- Department of Anesthesiology, Brigham and Women's Hospital (M.H.), Harvard Medical School, Boston, MA
| | - Rupak Mukherjee
- Surgery (R. Mukherjee), Medical University of South Carolina, Charleston.,Departments of Research (R. Mukherjee), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Simon C Body
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (S.C.B.), Harvard Medical School, Boston, MA
| | - Russell A Norris
- Departments of Medicine (D.F., G.L., X.Z., Y.D., Y.S., R.A.N., J.H.L.), Medical University of South Carolina, Charleston.,Regenerative Medicine and Cell Biology (D.F., K.T., L.G., K.M., J.G., R. Moore, R.S., R.A.N.), Medical University of South Carolina, Charleston
| | - Joshua H Lipschutz
- Departments of Medicine (D.F., G.L., X.Z., Y.D., Y.S., R.A.N., J.H.L.), Medical University of South Carolina, Charleston.,Medicine (J.H.L.), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
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40
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Howard C, Picca L, Smith T, Sharif M, Bashir M, Harky A. The bicuspid aortic valve: Is it an immunological disease process? J Card Surg 2019; 34:482-494. [PMID: 31012137 DOI: 10.1111/jocs.14050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 01/03/2023]
Abstract
Bicuspid aortic valves (BAVs) are the most common congenital cardiac condition and are characterized by a structural abnormality whereby the aortic valve is composed of two leaflets instead of being trileaflet. It is linked to an increased risk for a variety of complications of the aorta, many with an immunological pathogenesis. The aim of this study is to review and analyze the literature regarding immunological processes involving BAVs, associated common pathologies, and their incidence in the population. This study will also examine current trends in surgical and therapeutic approaches to treatment and discuss the future direction of BAV treatment.
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Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Leonardo Picca
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tristan Smith
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Monira Sharif
- Department of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Mohamad Bashir
- Department of Emergency Medicine and Surgery, Macclesfield General Hospital, Macclesfield, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
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41
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Bojko M, Eisen H, Mather P, Vallabhajosyula P. Delayed aneurysmal complication of bicuspid aortic valve disease after heart transplantation. J Thorac Cardiovasc Surg 2019; 158:e185-e186. [PMID: 30979419 DOI: 10.1016/j.jtcvs.2019.02.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/07/2019] [Accepted: 02/24/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Markian Bojko
- College of Medicine, Drexel University, Philadelphia, Pa
| | - Howard Eisen
- Division of Cardiology, Pennsylvania State University College of Medicine, University Park, Pa
| | - Paul Mather
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pa
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42
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Sophocleous F, Biffi B, Milano EG, Bruse J, Caputo M, Rajakaruna C, Schievano S, Emanueli C, Bucciarelli-Ducci C, Biglino G. Aortic morphological variability in patients with bicuspid aortic valve and aortic coarctation. Eur J Cardiothorac Surg 2019; 55:704-713. [PMID: 30380029 PMCID: PMC6459283 DOI: 10.1093/ejcts/ezy339] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/10/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Benedetta Biffi
- Institute of Cardiovascular Science, University College London, London, UK
| | - Elena Giulia Milano
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK.,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jan Bruse
- Vicomtech-IK4, Data Intelligence for Energy and Industrial Processes, Donostia/San Sebastián, Spain
| | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Cha Rajakaruna
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Costanza Emanueli
- Bristol Medical School, University of Bristol, Bristol, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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43
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Mimler T, Nebert C, Eichmair E, Winter B, Aschacher T, Stelzmueller ME, Andreas M, Ehrlich M, Laufer G, Messner B. Extracellular matrix in ascending aortic aneurysms and dissections - What we learn from decellularization and scanning electron microscopy. PLoS One 2019; 14:e0213794. [PMID: 30883576 PMCID: PMC6422325 DOI: 10.1371/journal.pone.0213794] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/28/2019] [Indexed: 01/24/2023] Open
Abstract
Pathological impairment of elastic fiber and other extracellular matrix (ECM) components are described for the aortic media of ascending thoracic aortic aneurysms (aTAA) but the exact pathological impairment of the structure and its degree still needs further investigations. To evaluate the quantity and quality of elastic fiber sheets and other ECM structures (e.g. collagen), cells were removed from different types of aneurysmal tissues (tricuspid aortic valve [TAV] associated-, bicuspid aortic valve [BAV] associated-aneurysmal tissue and acute aortic dissections [AAD]) using 2.5% sodium hydroxide (NaOH) and compared to decellularized control aortic tissue. Likewise, native tissue has been analysed. To evaluate the 2D- (histological evaluation, fluorescence- and auto-fluorescence based staining methods) and the 3D structure (scanning electron microscopic [SEM] examination) of the medial layer we first analysed for a successful decellularization. After proving for successful decellularization, we quantified the amount of elastic fiber sheets, elastin and other ECM components including collagen. Aside from clearly visible focal elastic fiber loss in TAV-aTAA tissue, decellularization resulted in reduction of elastic fiber auto-fluorescence properties, which is perhaps an indication from a disease-related qualitative impairment of elastic fibers, visible only after contact with the alkaline solution. Likewise, the loss of collagen amount in BAV-aTAA and TAV-aTAA tissue (compared to non-decellularized tissue) after contact with NaOH indicates a prior disease-associated impairment of collagen. Although the amount of ECM was not changed in type A dissection tissue, detailed electron microscopic evaluation revealed changes in ECM quality, which worsened after contact with alkaline solution but were not visible after histological analyses. Apart from the improved observation of the samples using electron microscopy, contact of aneurysmal and dissected tissue with the alkaline decellularization solution revealed potential disease related changes in ECM quality which can partly be connected to already published data, but have to be proven by further studies.
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Affiliation(s)
- Teresa Mimler
- Department of Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Clemens Nebert
- Department of Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Eva Eichmair
- Department of Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Birgitta Winter
- Department of Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Thomas Aschacher
- Department of Surgery, Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Martin Andreas
- Department of Surgery, Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marek Ehrlich
- Department of Surgery, Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Surgery, Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Barbara Messner
- Department of Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Vienna, Austria
- * E-mail:
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44
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Toufan Tabrizi M, Rahimi Asl R, Nazarnia S, Pourafkari L. Evaluation of relationship between bicuspid aortic valve phenotype with valve dysfunction and associated aortopathy. J Cardiovasc Thorac Res 2019; 10:236-242. [PMID: 30680084 PMCID: PMC6335981 DOI: 10.15171/jcvtr.2018.41] [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: 09/02/2018] [Accepted: 09/30/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: Morphology of bicuspid aortic valve (BAV) may have implication in the associated pathologies including aortic stenosis (AS), aortic insufficiency (AI) and aortic dilation. The aim of this study is to investigate the frequency and patterns of valvular dysfunction and aortopathy associated with different phenotypes of BAV in a referral center in northwest of Iran. Methods: In this prospective study patients who presented to our echocardiography lab between January 2014 and December 2015 and were diagnosed with BAV were assessed. Frequency of various BAV phenotypes and their association with valvular dysfunction and aortopathy was evaluated. A P value less than 0.05 was considered statistically significant. Results: The average age of the study patients was 40±16 years, with predominance of male sex (72%). Patients with anteroposteriorly located BAV (BAV-AP) phenotype constituted majority of our cases with prevalence of 62.7%, while 37.3% of cases had right-left (BAV-RL) located valves. BAV-RL patients when compared to BAV-AP patients had higher frequencies of dilated aortic arch (25% vs. 4.3%, P < 0.001), AS (56.3% vs. 31.4%, P < 0.001), mass or vegetation on aortic valve (14.3 vs. 6.4%, P = 0.023) and lower frequencies of dilated aortic root (42.9% vs. 57.4%, P = 0.01), aortic insufficiency (68.8% vs. 79.8%, P = 0.034) and co-arctation of aorta (3.6% vs. 11.7%, P = 0.01). Conclusion: There seems to be a relationship between various BAV phenotypes, and frequency and pattern of aortic valve dysfunction and aortopathy. These findings suggest that examining leaflet morphology in BAV might help in risk stratification of these patients.
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Affiliation(s)
| | - Roghaieh Rahimi Asl
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheyla Nazarnia
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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45
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Abstract
Valvular heart dysfunction (VHD) affects up to 7% of adults up to age 44 year, whereas up to 13% of individuals older than 75 years are affected. The broad term of valvular heart disease includes dysfunction of one or more of the 4 heart valves, including the pulmonary valve, tricuspid valve, mitral valve, or aortic valve. Specifically the more frequent anomalies, implication, assessment, and treatment that will be described more extensively include aortic regurgitation, aortic stenosis, mitral regurgitation, or tricuspid regurgitation. The most prevalent cause of valvular heart disease stems from calcification and stiffening of the valve leaflets contributing to stenosis.
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Affiliation(s)
- Susan Lee
- School of Nursing, Louisiana State University Health, 1900 Gravier Street, Room 328, New Orleans, LA 70112, USA.
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46
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Williams A, Awadalla M. Three cusps are better than two: bicuspid aortic valve and implications for military service. BMJ Mil Health 2018; 166:167-170. [PMID: 30429296 DOI: 10.1136/jramc-2018-001002] [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: 06/21/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/03/2022]
Abstract
Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation. It is an aortopathy and is associated with other congenital heart disease. Although there is no mortality increase with BAV, the natural history increases the risk of aortic valve disease, aortic dilatation and infective endocarditis over the time frame of a full military career. Military service theoretically increases the risk of aortic dilatation and endocarditis in BAV. Conversely, there are some who have BAV who would not suffer any complications during their military career. Currently, potential UK Army recruits undergo personal/family history and physical examination plus an ECG and, although this goes beyond American Heart Association guidelines, it does not screen specifically for BAV. This would necessitate a transthoracic echo for each potential recruit but would be a considerable increase in resources-both time and financial. In addition to the recruitment medical, military personnel undergo frequent medicals, which could identify those who develop significant valvular disease. Those with mild valve disease are at lowest risk of complication. Those with aortic dilatation only remain a concern.
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Affiliation(s)
| | - M Awadalla
- Cardiology Department, Royal Gwent Hospital, Newport, UK
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47
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Sticchi E, De Cario R, Magi A, Giglio S, Provenzano A, Nistri S, Pepe G, Giusti B. Bicuspid Aortic Valve: Role of Multiple Gene Variants in Influencing the Clinical Phenotype. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8386123. [PMID: 30255099 PMCID: PMC6145047 DOI: 10.1155/2018/8386123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/20/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
Abstract
Background. Bicuspid aortic valve (BAV) is a common congenital heart defect with increased prevalence of aortic dilatation and dissection. BAV has an autosomal dominant pattern of inheritance with reduced penetrance and variable expressivity. BAV has been described as an isolated trait or associated with other clinical manifestations in syndromic conditions. Identification of a syndromic condition in a BAV patient is clinically relevant in order to personalize indication to aortic surgery. We aimed to point out how genetic diagnosis by next-generation sequencing (NGS) can improve management of a patient with complex BAV clinical picture. Methods and Results. We describe a 45-year-old Caucasian male with BAV, thoracic aortic root and ascending aorta dilatation, and connective features evocative but inconclusive for clinical diagnosis of Marfan syndrome (MFS). Targeted (91 genes) NGS was used. Proband genetic variants were investigated in first-degree relatives. Proband carried 5 rare variants in 4 genes: FBN1(p.Asn542Ser and p.Lys2460Arg), NOTCH1(p.Val1739Met), LTBP1(p.Arg1330Gln), and TGFBR3(p.Arg423Trp). The two FBN1 variants were inherited in cis by the mother, showing systemic features evocative of MFS, but with a milder phenotype than that observed in the proband. Careful clinical observation along with the presence of the FBN1 variants allowed diagnosis of MFS in the proband and in his mother. NOTCH1 variant was found in mother and brother, not exhibiting BAV, thus not definitely supporting/excluding association with BAV. Interestingly, the proband, his brother and father, all showing root dilatation, and his sister, with upper range aortic root dimension, were carriers of a TGFBR3 variant. LTBP1 might also modulate the vascular phenotype. Conclusions. Our results underline the usefulness of NGS together with family evaluation in diagnosis of patients with monogenic traits and overlapping clinical manifestations due to contribution of the same genes and/or presence of comorbidities determined by different genes.
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Affiliation(s)
- Elena Sticchi
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Florence, Italy
- Excellence Centre for Research, Transfer and High Education for the Development of De Novo Therapies (DENOTHE), University of Florence, Florence, Italy
| | - Rosina De Cario
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
| | - Alberto Magi
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
| | - Sabrina Giglio
- Department of Biomedical Experimental and Clinical Sciences 'Mario Serio', University of Florence, Italy
- Medical Genetic Unit, Meyer Children's University Hospital, Florence, Italy
| | - Aldesia Provenzano
- Department of Biomedical Experimental and Clinical Sciences 'Mario Serio', University of Florence, Italy
| | - Stefano Nistri
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Italy
| | - Guglielmina Pepe
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Florence, Italy
- Excellence Centre for Research, Transfer and High Education for the Development of De Novo Therapies (DENOTHE), University of Florence, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Florence, Italy
- Excellence Centre for Research, Transfer and High Education for the Development of De Novo Therapies (DENOTHE), University of Florence, Florence, Italy
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48
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Krizhanovskii C, Franco-Cereceda A. Diabetes, Incretin Therapy and Thoracic Aortic Aneurysm - What Does the Evidence Show? Curr Vasc Pharmacol 2018; 17:432-439. [PMID: 30156160 DOI: 10.2174/1570161116666180828155622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/18/2022]
Abstract
Epidemiological evidence supports a reduced prevalence of Thoracic Aortic Aneurysm (TAA) and Abdominal Aortic Aneurysm (AAA) in patients with Diabetes (DM). The mechanisms underlying this negative association are unknown. Some studies support that hyperglycemia has effects on the Extracellular Matrix (ECM), resulting in collagen cross-links and altered proteolytic activity, which ultimately counteracts aneurysm formation. However, recent experimental research indicates that incretin- based anti-diabetic therapy and Glucagon-Like Peptide-1 (GLP-1) may reduce the formation of TAA. GLP-1 is a peptide hormone, released from intestinal L-cells in response to hormonal, neural and nutrient stimuli. In addition to potentiation of meal-stimulated insulin secretion, GLP-1 signaling exerts numerous pleiotropic effects on various tissues, including protective effects on the myocardium and vascular endothelium. Recent studies also report protective effects of GLP-1 based therapy on the formation of aneurysms in animal models and direct effects of GLP-1 signaling on the molecular mechanisms suggested to influence TAA formation, including inflammation, proteolytic activity and collagen composition. In this narrative review, we present the available evidence for effects of GLP-1 on experimental aneurysm development and discuss the potential role of GLP-1 in aneurysm formation based on available data from pre-clinical and clinical studies.
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Affiliation(s)
- Camilla Krizhanovskii
- Sodertalje Hospital, Department of Internal Medicine, SE-152 86 Sodertalje, Sweden.,Sodertalje Hospital, Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Sodertalje Hospital, Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
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Cheng CL, Chang HH, Huang PJ, Wang WC, Lin SY. Echocardiographic manifestations and chemical composition of stenotic bicuspid aortic valves. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:80. [PMID: 29869720 DOI: 10.1007/s10856-018-6087-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
Bicuspid aortic valve (BAV) is an inherited form of heart disease with only two aortic valve leaflets via a disorder of cardiac valvulogenesis. We investigated the in vivo echocardiographic features of cardiac morphology in patients with BAV and the ex vivo compositional components of all the excised BAV leaflets isolated from BAV patients. Three BAV patients were randomly selected. All patients underwent 2D transthoracic echocardiography (TTE) with a Doppler ultrasound tool. The compositional components of each respective BAV leaflet for all the excised BAVs were determined by a portable fiber-optic Raman spectroscopy. Preoperative TTE revealed the thickened and calcified BAV leaflets, and stenotic aortic flow for all BAV patients. These BAV patients exhibited severe aortic stenosis (AS) by the lower values of aortic valve area (AVA) index. One patient showed a more significant left ventricle hypertrophy, whereas two patients exhibited a significant aortic regurgitation (AR). In addition, three different Raman spectral patterns were summed up from 121 randomized Raman determinations for all the excised BAV leaflets. The main calcified deposition in each BAV leaflet was formed by large amounts of calcium hydroxyapatite and type-B carbonate apatite (Raman bands at 960 and 1070 cm-1). The calcified BAV leaflets were composed of different compositional components such as calcium hydroxyapatite, type-B carbonate apatite, lipids, proteins, cholesterol and β-carotene. The rare NL subtype of type 1 BAV morphotype was found in one patient, but two patients had the purely BAV morphotype with two equal-sized leaflets.
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Affiliation(s)
- Ching-Li Cheng
- Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan
| | - Hsiao-Huang Chang
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Jung Huang
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Chen Wang
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shan-Yang Lin
- Department of Biotechnology and Pharmaceutical Technology, Yuanpei University of Medical Technology, Hsin Chu, Taiwan.
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50
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Left Ventricle Outflow Obstruction by Reverse-Oriented Tricuspid Semilunar Valve-Like Endocardial Duplicatures. Case Rep Cardiol 2018; 2018:2403806. [PMID: 29854471 PMCID: PMC5964581 DOI: 10.1155/2018/2403806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/04/2018] [Indexed: 11/18/2022] Open
Abstract
A 57-year-old female had a history of hypertension disease, and one year before her death, her ECG showed signs of left ventricle hypertrophy. She died with signs of heart failure with pulmonary edema development. At autopsy, there was left ventricle hypertrophy (wall thickness: 21 mm). In the left ventricle outflow channel, 15 mm below the aortic valve on the muscular wall, there were three white 1-1.5 mm thick membranous semilunar valve-like structures with the sizes of 9, 7, and 5 mm, with concavities opened into the left ventricle, reducing the outflow area by 21.5%. These structures were hanging on the regular muscular ventricular wall, without any visible fibrous anchoring structure and without formation of commissures, and were composed of fine collagen and elastic fibers. Gross anatomy as well as histological structure was different from the subaortic membrane. The reported accessory reverse-oriented tricuspid semilunar valve-like structure is an unusual finding of a structure in the left ventricular outflow tract, to which we could not find an analogy in the available literature.
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