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Basnet K, Bhattarai SR, Shah S, Joshi A, Sah SK, Gami R, Khanal R. Rheumatic Heart Disease among Patients with Valvular Heart Disease Admitted to the In-patient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:419-424. [PMID: 35633232 PMCID: PMC9252223 DOI: 10.31729/jnma.7457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/03/2022] [Indexed: 11/02/2022] Open
Abstract
Introduction Valvular heart disease continues to cause significant morbidity and mortality around the world, with rheumatic heart disease accounting for the bulk of cases in developing nations. The aim of this study is to find out the prevalence of rheumatic heart disease among patients with valvular heart disease admitted to the in-patient department of a tertiary care centre. Methods A descriptive cross-sectional study was conducted from December, 2018 to December, 2020 at a tertiary care centre after receiving ethical approval from the Institutional Review [Reference number: 395 (6-11) e2 077/078]. Patients of age ≥18 years presenting with valvular manifestations of any disease diagnosed by transthoracic echocardiography were included and patients other than Nepalese nationals were excluded. Convenience sampling was done and a sample size of 327 was taken. Data were collected, entered and analyzed using the Statistical Package for the Social Sciences version 22.0. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results Among 327 patients, the prevalence of rheumatic heart disease was found to be 237 (72.47%) (67.63-77.31 at 95% Confidence Interval). Conclusions The prevalence of rheumatic heart disease was similar to the other similar studies conducted in similar settings. Keywords epidemiology; prevalence; rheumatic heart disease.
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Affiliation(s)
- Kriti Basnet
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Shreeyash Raj Bhattarai
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Sangam Shah
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Amir Joshi
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Sanjit Kumar Sah
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Roshan Gami
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Rajaram Khanal
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Centre, Maharajgunj, Kathmandu, Nepal
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Nishi H, Takahashi S, Ohta K, Takamoto M, Shigeishi H, Go S, Obayashi T, Yoshioka Y, Konishi M, Shimizu Y, Yano K, Miyagawa T, Kakimoto N, Ohge H, Kawaguchi H, Kurihara H. Effects of perioperative oral care on postoperative inflammation following heart valve surgery. Oral Dis 2020; 27:1542-1550. [PMID: 33067895 DOI: 10.1111/odi.13682] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/12/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Whether oral health care during the perioperative period can lead to a better outcome after heart valve surgery has not been adequately elucidated. We examined the effects of perioperative oral care on postoperative inflammation response in patients who underwent heart valve surgery. MATERIALS AND METHODS In this retrospective cohort study, 223 patients scheduled for single valve heart surgery were divided into the oral care, who underwent professional teeth cleaning or scaling within 3 days prior to surgery, and also following surgery at least twice a week (n = 111), and non-oral care (n = 112) groups. After propensity score matching, records of both groups (80:80) were examined after surgery to evaluate inflammation markers (white blood cell count [WBC], neutrophil/white blood cell ratio [NWR], C-reactive protein [CRP] level, body temperature [BT]). RESULTS WBC, NWR, CRP level, and BT were increased in both groups the day following surgery. Thereafter, CRP level, WBC, NWR, and BT on various days after surgery in the oral care group showed greater decreases as compared to the non-oral care group. CONCLUSIONS Perioperative oral health care can decrease postoperative inflammation in patients undergoing heart valve surgery and may be important to ensure a better outcome in those patients.
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Affiliation(s)
- Hiromi Nishi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Kouji Ohta
- Department of Public Oral Health, Program of Oral Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Megumi Takamoto
- Department of Dentistry and Oral Surgery, Shinshu University Hospital, Nagano, Japan
| | - Hideo Shigeishi
- Department of Public Oral Health, Program of Oral Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Seimei Go
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Taiji Obayashi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - Yukio Yoshioka
- Department of Molecular Oral Medicine and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaru Konishi
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshitaka Shimizu
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kanako Yano
- Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Tsuyoshi Miyagawa
- Center for Integrated Medical Research, Hiroshima University Hospital, Japan
| | - Naoya Kakimoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Hiroki Ohge
- Department of Infectious diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroyuki Kawaguchi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidemi Kurihara
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Martinsson A, Li X, Zöller B, Andell P, Andersson C, Sundquist K, Smith JG. Familial Aggregation of Aortic Valvular Stenosis: A Nationwide Study of Sibling Risk. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.117.001742. [PMID: 29242201 DOI: 10.1161/circgenetics.117.001742] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 10/20/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Aortic valvular stenosis (AS) is the most common cause of cardiac valvular replacement surgery. During the last century, the pathogenesis of AS has undergone transitions in developed countries, from rheumatic heart disease to a degenerative calcific pathogenesis. Although a familial component has been described for a subset of cases with a bicuspid valve, data are limited on the overall familial aggregation of this disease. METHODS AND RESULTS Contemporary information on 6 117 263 Swedish siblings, of which 13 442 had a clinical diagnosis of AS, was collected from the nationwide Swedish Multi-Generation Register and the National Patient Register. A total of 4.8% of AS cases had a sibling history of AS. Having at least 1 sibling with AS was associated with a hazard ratio of 3.41 (95% confidence interval, 2.23-5.21) to be diagnosed with AS in an adjusted model. Individuals with >1 sibling with AS had an exceptionally high risk (hazard ratio, 32.84) but were uncommon (34 siblings from 11 sibships). In contrast, spouses of subjects with AS were only slightly more likely to be diagnosed with AS compared with subjects without spousal AS (hazard ratio 1.16 for husbands and 1.18 for wives). CONCLUSIONS A sibling history of clinically diagnosed AS was associated with increased risk of AS. Spouses of patients with AS only had a modest risk increase, suggesting that shared adult environmental factors contribute less to the development of AS than genetic factors.
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Affiliation(s)
- Andreas Martinsson
- From the Department of Cardiology, Clinical Sciences (A.M., P.A., J.G.S.) and Center for Primary Health Care Research (X.L., B.Z., K.S.), Lund University, Sweden; Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.); Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C.A.); and Department of Family Medicine and Community Health and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (K.S.).
| | - Xinjun Li
- From the Department of Cardiology, Clinical Sciences (A.M., P.A., J.G.S.) and Center for Primary Health Care Research (X.L., B.Z., K.S.), Lund University, Sweden; Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.); Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C.A.); and Department of Family Medicine and Community Health and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (K.S.)
| | - Bengt Zöller
- From the Department of Cardiology, Clinical Sciences (A.M., P.A., J.G.S.) and Center for Primary Health Care Research (X.L., B.Z., K.S.), Lund University, Sweden; Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.); Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C.A.); and Department of Family Medicine and Community Health and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (K.S.)
| | - Pontus Andell
- From the Department of Cardiology, Clinical Sciences (A.M., P.A., J.G.S.) and Center for Primary Health Care Research (X.L., B.Z., K.S.), Lund University, Sweden; Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.); Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C.A.); and Department of Family Medicine and Community Health and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (K.S.)
| | - Charlotte Andersson
- From the Department of Cardiology, Clinical Sciences (A.M., P.A., J.G.S.) and Center for Primary Health Care Research (X.L., B.Z., K.S.), Lund University, Sweden; Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.); Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C.A.); and Department of Family Medicine and Community Health and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (K.S.)
| | - Kristina Sundquist
- From the Department of Cardiology, Clinical Sciences (A.M., P.A., J.G.S.) and Center for Primary Health Care Research (X.L., B.Z., K.S.), Lund University, Sweden; Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.); Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C.A.); and Department of Family Medicine and Community Health and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (K.S.)
| | - J Gustav Smith
- From the Department of Cardiology, Clinical Sciences (A.M., P.A., J.G.S.) and Center for Primary Health Care Research (X.L., B.Z., K.S.), Lund University, Sweden; Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.); Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C.A.); and Department of Family Medicine and Community Health and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (K.S.)
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Perrucci GL, Zanobini M, Gripari P, Songia P, Alshaikh B, Tremoli E, Poggio P. Pathophysiology of Aortic Stenosis and Mitral Regurgitation. Compr Physiol 2017. [PMID: 28640443 DOI: 10.1002/cphy.c160020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The global impact of the spectrum of valve diseases is a crucial, fast-growing, and underrecognized health problem. The most prevalent valve diseases, requiring surgical intervention, are represented by calcific and degenerative processes occurring in heart valves, in particular, aortic and mitral valve. Due to the increasing elderly population, these pathologies will gain weight in the global health burden. The two most common valve diseases are aortic valve stenosis (AVS) and mitral valve regurgitation (MR). AVS is the most commonly encountered valve disease nowadays and affects almost 5% of elderly population. In particular, AVS poses a great challenge due to the multiple comorbidities and frailty of this patient subset. MR is also a common valve pathology and has an estimated prevalence of 3% in the general population, affecting more than 176 million people worldwide. This review will focus on pathophysiological changes in both these valve diseases, starting from the description of the anatomical aspects of normal valve, highlighting all the main cellular and molecular features involved in the pathological progression and cardiac consequences. This review also evaluates the main approaches in clinical management of these valve diseases, taking into account of the main published clinical guidelines. © 2017 American Physiological Society. Compr Physiol 7:799-818, 2017.
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Affiliation(s)
- Gianluca L Perrucci
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Paola Songia
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Paolo Poggio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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MEKHDIEVA K, BLYAKHMAN F. IMPACT OF LEFT VENTRICULAR FALSE TENDONS ON YOUNG ATHLETES’ CARDIOVASCULAR ADAPTATION TO EXERCISE LOADS. J MECH MED BIOL 2017. [DOI: 10.1142/s021951941750066x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
False tendons (FT) are additional chord-like structures in left ventricle (LV) cavity considered as a phenotypic feature of the connective tissue dysplasia (CTD) syndrome. The search for a range of heart adaptability to exercise loads of young athletes with FT in LV is the aim of the proposed study. Sixty six members of student basketball and indoor soccer teams (mean age: 19.8[Formula: see text][Formula: see text][Formula: see text]3.9 years) underwent treadmill stress-test and heart ultrasound transthoracic examination. Further, image processing to perform the tendons mapping within LV 3D-reconstructed model was applied. The number of FT located in different parts of LV varied from 1 to 6 units per LV. Based on the comparative and correlation analyses of data obtained, we found that the more the number of FT per LV, the less is a range of the heart adaptation to increased exercise loads. In accordance with the results of two-way multivariate analysis of variance, we concluded that the FT, located in basal and median LV zones, connecting interventricular septum and posterior-lateral parts of LV wall mainly affect the ability of the heart to adapt to exercise loads. Therefore, athletes with certain number and types of FT in the LV critically need individual prescription for exercise loads.
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Affiliation(s)
- K. MEKHDIEVA
- Sports and Health Technologies Laboratory, Institute of Physical Education, Sports and Youth Policy, Ural Federal University, Yekaterinburg 620078, Russian Federation
| | - F. BLYAKHMAN
- Biomedical Physics Department, Ural State Medical University, Yekaterinburg 620028, Russian Federation
- Physics Department, Ural Federal University, Yekaterinburg 620083, Russian Federation
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Lu Q, Pei Y, Wu H, Wang Z, Zaiping J. Transcatheter aortic valve implantation with balloon-expandable valve: early experience from China. Braz J Cardiovasc Surg 2016; 30:425-32. [PMID: 27163416 PMCID: PMC4614925 DOI: 10.5935/1678-9741.20150054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/02/2015] [Indexed: 11/24/2022] Open
Abstract
Objective The aim of the current study was to evaluate the early experience of the
application of transcatheter aortic valve implantation with the
balloon-expandable system in China. The transcatheter aortic valve
implantation technology has been widely used for patients with inoperable
severe aortic stenosis in the developed world. The application of
transcatheter aortic valve implantation is still in the early stages of
testing in China, particularly for the balloon-expandable valve
procedure. Methods This was a retrospective study. All patients undergoing transcatheter aortic
valve implantation with balloon-expandable system in our hospital between
2011 and 2014 were included. Edwards SAPIEN XT Transcatheter Heart Valve was
used. The improvement of valve and heart function was evaluated as well as
30-day mortality and major complications according to the VARC-2
definition. Results A total of 10 transcatheter aortic valve implantation procedures with the
balloon-expandable system were performed in our hospital, of which 9 were
transfemoral and 1 was transapical. The median age was 76 years, and the
median STS score and Logistic EuroSCORE (%) were 8.9 and 16.2. The
implantation was successfully conducted in all patients, only 2 patients had
mild paravalvular leak. There was no second valve implantation. Moreover, no
30-day mortality or complications was reported. Following the transcatheter
aortic valve implantation procedure, the heart and valve functions had
improved significantly. During the follow-up period of 3-34 months, one
patient died of lung cancer 13 months after the operation. Conclusion This early experience has provided preliminary evidence for the safety and
efficacy of transcatheter aortic valve implantation procedure with the
balloon-expandable system in the developing world with an increasing aging
population.
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Affiliation(s)
- Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, China
| | - Yifei Pei
- Department of Cardiology, Shanghai Changhai Hospital, China
| | - Hong Wu
- Department of Cardiology, Shanghai Changhai Hospital, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Shanghai Changzheng Hospital, China
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7
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Vermeer-de Bondt PE, Schoffelen T, Vanrolleghem AM, Isken LD, van Deuren M, Sturkenboom MCJM, Timen A. Coverage of the 2011 Q fever vaccination campaign in the Netherlands, using retrospective population-based prevalence estimation of cardiovascular risk-conditions for chronic Q fever. PLoS One 2015; 10:e0123570. [PMID: 25909712 PMCID: PMC4409345 DOI: 10.1371/journal.pone.0123570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/05/2015] [Indexed: 11/18/2022] Open
Abstract
Background In 2011, a unique Q fever vaccination campaign targeted people at risk for chronic Q fever in the southeast of the Netherlands. General practitioners referred patients with defined cardiovascular risk-conditions (age >15 years). Prevalence rates of those risk-conditions were lacking, standing in the way of adequate planning and coverage estimation. We aimed to obtain prevalence rates retrospectively in order to estimate coverage of the Q fever vaccination campaign. Methods With broad search terms for these predefined risk-conditions, we extracted patient-records from a large longitudinal general-practice research-database in the Netherlands (IPCI-database). After validation of these records, obtained prevalence rates (stratified for age and sex) extrapolated to the Q fever high-incidence area population, gave an approximation of the size of the targeted patient-group. Coverage calculation addressed people actually screened by a pre-vaccination Q fever skin test and serology (coverage) and patients referred by their general practitioners (adjusted-coverage) in the 2011 campaign. Results Our prevalence estimate of any risk-condition was 3.1% (lower-upper limits 2.9-3.3%). For heart valve defects, aorta aneurysm/prosthesis, congenital anomalies and endocarditis, prevalence was 2.4%, 0.6%, 0.4% and 0.1%, respectively. Estimated number of eligible people in the Q fever high-incidence area was 11,724 (10,965-12,532). With 1330 people screened for vaccination, coverage of the vaccination campaign was 11%. For referred people, the adjusted coverage was 18%. Coverage was lowest among the very-old and highest for people aged 50–70 years. Conclusion The estimated coverage of the vaccination campaign was limited. This should be interpreted in the light of the complexity of this target-group with much co-morbidity, and of the vaccine that required invasive pre-vaccination screening. Calculation of prevalence rates of risk-conditions based on the IPCI-database was feasible. This procedure proved an efficient tool for future use, when prevalence estimates for policy, implementation or surveillance of subgroup-vaccination or other health-care interventions are needed.
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Affiliation(s)
- Patricia E. Vermeer-de Bondt
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
- * E-mail:
| | - Teske Schoffelen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ann M. Vanrolleghem
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Leslie D. Isken
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Marcel van Deuren
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Aura Timen
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
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Abstract
OBJECTIVE To review the risk of pergolide associated cardiac valvulopathy in patients with Parkinson's disease. DATA SOURCES MEDLINE, Embase, and the Cochrane Library. Reference lists were reviewed and librarians were consulted to identify additional trials. STUDY SELECTION All studies and case reports in the English literature on pergolide and cardiac valvulopathy. DATA EXTRACTION Demographics of patients, study duration, dose and duration of pergolide use, echocardiogram results, length of follow-up, and clinical outcome. RESULTS Twenty-two published articles were identified. There were no randomized controlled trials. Follow-up time varied between a few months and four years. Three case reports and four studies (three case control and one observational) assessed 246 patients. Evidence for valvulopathy was found in all studies. Variable methods were used to assess the degree of valvular regurgitation making comparisons between studies difficult. Little clinical correlation is available for echocardiogram results. Variable improvement was shown in the few patients in whom the drug was stopped. There is insufficient data to determine whether dose and duration or other comorbities have an effect on the risk of developing cardiac valvulopathy. CONCLUSION Pergolide therapy is associated with an increased risk of developing cardiac valvulopathy but the true incidence and importance of this remains unknown. Further prospective studies are needed with standardized assessments of echocardiograms.
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Affiliation(s)
- Cindy Zadikoff
- Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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Boudoulas KD, Ravi Y, Garcia D, Saini U, Sofowora GG, Gumina RJ, Sai-Sudhakar CB. Type of Valvular Heart Disease Requiring Surgery in the 21st Century: Mortality and Length-of-Stay Related to Surgery. Open Cardiovasc Med J 2013; 7:104-9. [PMID: 24339838 PMCID: PMC3856389 DOI: 10.2174/1874192420130902001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/20/2013] [Accepted: 08/26/2013] [Indexed: 12/31/2022] Open
Abstract
Aim: While the incidence of rheumatic heart disease has declined dramatically over the last half-century, the number of valve surgeries has not changed. This study was undertaken to define the most common type of valvular heart disease requiring surgery today, and determine in-hospital surgical mortality and length-of-stay (LOS) for isolated aortic or mitral valve surgery in a United States tertiary-care hospital. Methods: Patients with valve surgery between January 2002 to June 2008 at The Ohio State University Medical Center were studied. Patients only with isolated aortic or mitral valve surgery were analyzed. Results: From 915 patients undergoing at least aortic or mitral valve surgery, the majority had concomitant cardiac proce-dures mostly coronary artery bypass grafting (CABG); only 340 patients had isolated aortic (n=204) or mitral (n=136) valve surgery. In-hospital surgical mortality for mitral regurgitation (n=119), aortic stenosis (n=151), aortic insufficiency (n=53) and mitral stenosis (n=17) was 2.5% (replacement 3.4%; repair 1.6%), 3.9%, 5.6% and 5.8%, respectively (p=NS). Median LOS for aortic insufficiency, aortic stenosis, mitral regurgitation, and mitral stenosis was 7, 8, 9 (replacement 11.5; repair 7) and 11 days, respectively (p<0.05 for group). In-hospital surgical mortality for single valve surgery plus CABG was 10.2% (p<0.005 compared to single valve surgery).
Conclusions: Aortic stenosis and mitral regurgitation are the most common valvular lesions requiring surgery today. Surgery for isolated aortic or mitral valve disease has low in-hospital mortality with modest LOS. Concomitant CABG with valve surgery increases mortality substantially. Hospital analysis is needed to monitor quality and stimulate improvement among Institutions.
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Pagel PS, Zundel MT. An echogenic object in the left atrium: a consequence of end-stage renal disease? J Cardiothorac Vasc Anesth 2013; 27:1429-31. [PMID: 23540354 DOI: 10.1053/j.jvca.2012.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Golda A, Jurecka A, Opoka-Winiarska V, Tylki-Szymańska A. Mucopolysaccharidosis type VI: a cardiologist's guide to diagnosis and treatment. Int J Cardiol 2012; 167:1-10. [PMID: 22704873 DOI: 10.1016/j.ijcard.2012.05.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 05/25/2012] [Accepted: 05/27/2012] [Indexed: 11/28/2022]
Abstract
Mucopolysaccharidosis type VI (MPS VI, Maroteaux-Lamy syndrome) is an inborn error of metabolism, with incidences at birth ranging from 1 in 1.5 million to 1 in 43,000 live births. This disorder is rarely considered when evaluating patients with common populational cardiovascular diseases. A significant number of MPS VI patients, however, do present cardiovascular disease and MPS VI should be considered as a potential differential diagnosis for other cardiovascular disorders. This article reviews the clinical features, diagnostic tests and treatment options for MPS VI. Although MPS VI affects many organs and systems of the human body this review focuses on MPS VI diseases of the heart and vessels. The most characteristic cardiac presentation of MPS VI is valvular disease, but heart failure, pulmonary hypertension, cardiomyopathy, fibroelastosis and cardiac conduction system disorders may also occur. Cardiovascular disease in MPS VI patients may emerge silently. An early diagnosis is difficult due to joint stiffness, respiratory system involvement or skeletal malformations that limit exercise capacity and mask the underlining heart failure. This article is supposed to serve as a very practical reference for cardiologists who may come across MPS VI in their daily practices. A greater awareness of cardiovascular manifestations of MPS VI among cardiologists can help to reduce misdiagnosis and promote early detection of this inborn disorder and aid the implementation of adequate therapy at the earliest stage possible which is crucial for its efficacy.
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Affiliation(s)
- Adam Golda
- Department of Cardiology, Gliwice General Hospital, Gliwice, Poland
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Orton EC, Lacerda CMR, MacLea HB. Signaling pathways in mitral valve degeneration. J Vet Cardiol 2012; 14:7-17. [PMID: 22364692 DOI: 10.1016/j.jvc.2011.12.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 12/08/2011] [Indexed: 01/22/2023]
Abstract
Heart valves exhibit a highly-conserved stratified structure exquisitely designed to counter biomechanical forces delivered over a lifetime. Heart valve structure and competence is maintained by heart valve cells through a process of continuous turnover extracellular matrix (ECM). Degenerative (myxomatous) mitral valve disease (DMVD) is an important disease associated with aging in both dogs and humans. DMVD is increasingly regarded as a disease with identifiable signaling mechanisms that control key genes associated with regulation and dysregulation of ECM homeostasis. Initiating stimuli for these signaling pathways have not been fully elucidated but likely include both mechanical and chemical stimuli. Signaling pathways implicated in DMVD include serotonin, transforming growth factor β (TGFβ), and heart valve developmental pathways. High circulating serotonin (carcinoid syndrome) and serotoninergic drugs are known to cause valvulopathy that shares pathologic features with DMVD. Recent evidence supports a local serotonin signaling mechanism, possibly triggered by high tensile loading on heart valves. Serotonin initiates TGFβ signaling, which in turn has been strongly implicated in canine DMVD. Recent evidence suggests that degenerative aortic and mitral valve disease may involve pathologic processes that mimic osteogenesis and chondrogenesis, respectively. These processes may be mediated by developmental pathways shared by heart valves, bone, and cartilage. These pathways include bone morphogenic protein (BMP) and Wnt signaling. Other signaling pathways implicated in heart valve disease include Notch, nitric oxide, and angiotensin II. Ultimately, increased understanding of signaling mechanisms could point to therapeutic strategies aimed at slowing or halting disease progression.
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Affiliation(s)
- E Christopher Orton
- Department of Clinical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, CO 80523-1678, USA.
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14
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Lacerda CMR, Kisiday J, Johnson B, Orton EC. Local serotonin mediates cyclic strain-induced phenotype transformation, matrix degradation, and glycosaminoglycan synthesis in cultured sheep mitral valves. Am J Physiol Heart Circ Physiol 2012; 302:H1983-90. [PMID: 22345569 DOI: 10.1152/ajpheart.00987.2011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study addressed the following questions: 1) Does cyclic tensile strain induce protein expression patterns consistent with myxomatous degeneration in mitral valves? 2) Does cyclic strain induce local serotonin synthesis in mitral valves? 3) Are cyclic strain-induced myxomatous protein expression patterns in mitral valves dependent on local serotonin? Cultured sheep mitral valve leaflets were subjected to 0, 10, 20, and 30% cyclic strain for 24 and 72 h. Protein levels of activated myofibroblast phenotype markers, α-smooth muscle actin (α-SMA) and nonmuscle embryonic myosin (SMemb); matrix catabolic enzymes, matrix metalloprotease (MMP) 1 and 13, and cathepsin K; and sulfated glycosaminoglycan (GAG) content in mitral valves increased with increased cyclic strain. Serotonin was present in the serum-free media of cultured mitral valves and concentrations increased with cyclic strain. Expression of the serotonin synthetic enzyme tryptophan hydroxylase 1 (TPH1) increased in strained mitral valves. Pharmacologic inhibition of the serotonin 2B/2C receptor or TPH1 diminished expression of phenotype markers (α-SMA and SMemb) and matrix catabolic enzyme (MMP1, MMP13, and cathepsin K) expression in 10- and 30%-strained mitral valves. These results provide first evidence that mitral valves synthesize serotonin locally. The results further demonstrate that tensile loading modulates local serotonin synthesis, expression of effector proteins associated with mitral valve degeneration, and GAG synthesis. Inhibition of serotonin diminishes strain-mediated protein expression patterns. These findings implicate serotonin and tensile loading in mitral degeneration, functionally link the pathogeneses of serotoninergic (carcinoid, drug-induced) and degenerative mitral valve disease, and have therapeutic implications.
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Affiliation(s)
- Carla M R Lacerda
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523-1678, USA.
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15
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Echocardiographic evaluation of left ventricular outflow tract hemodynamics in healthy children with anomalous left ventricular band. Int J Cardiol 2011; 152:262-5. [DOI: 10.1016/j.ijcard.2011.07.099] [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: 07/27/2011] [Accepted: 07/29/2011] [Indexed: 11/18/2022]
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16
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Ramakrishna H, Feinglass N, Augoustides JG. Clinical Update in Cardiac Imaging Including Echocardiography. J Cardiothorac Vasc Anesth 2010; 24:371-8. [DOI: 10.1053/j.jvca.2009.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Indexed: 01/07/2023]
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17
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Zakkar M, Patni R, Punjabi PP. Mitral valve regurgitation and 3D echocardiography. Future Cardiol 2010; 6:231-42. [DOI: 10.2217/fca.09.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The mitral valve is a complex, dynamic and functional apparatus that can be altered by a wide range of disorders leading to stenosis or regurgitation. Surgical management of mitral valve disease may be difficult. Planned intervention may not always be feasible when the surgeon is faced with complex pathology that cannot be assessed fully by conventional 2D echocardiography. Transthoracic and transesophageal 3D echocardiography can provide a more reliable functional and anatomical assessment of the different valve components and evaluation of its geometry, which can aid the surgeon in planning a more suitable surgical intervention and improve outcomes. Although 3D echocardiography is a new technology, it has proven to be an important modality for the accurate assessment of valvular heart disease and in the future, it promises to be an essential part in the routine assessment of cardiovascular patients.
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Affiliation(s)
- Mustafa Zakkar
- Department of Cardiothoracic surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | - Ravi Patni
- Department of Cardiothoracic surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | - Prakash P Punjabi
- Department of Cardiothoracic surgery, Imperial College NHS Trust, Hammersmith Hospital, Du Cane Road London, W12 0HS, UK
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Hervier B, Wastiaux H, Freour T, Masseau A, Corvec S, Armingeat T, Hamidou M. Granulomatose pseudosarcoïdosique révélant une syphilis tertiaire. Rev Med Interne 2009; 30:806-8. [DOI: 10.1016/j.revmed.2009.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 10/23/2008] [Accepted: 01/02/2009] [Indexed: 10/21/2022]
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19
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John A, Robinson DA, Markan S, Nicolosi AC, Pagel PS. A patient with chronic hemodialysis-dependent end-stage renal disease presenting with mild dyspnea on exertion and a harsh systolic murmur. J Cardiothorac Vasc Anesth 2008; 23:253-5. [PMID: 18834768 DOI: 10.1053/j.jvca.2007.09.011] [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: 08/15/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Abie John
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
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20
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Donnelly KB. Cardiac Valvular Pathology: Comparative Pathology and Animal Models of Acquired Cardiac Valvular Diseases. Toxicol Pathol 2008; 36:204-17. [DOI: 10.1177/0192623307312707] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent voluntary withdrawal of the ergoline-derivative Alzheimers’ drug Pergolide (Permax) resulting from demonstrated risk of cardiac valve injury illustrates the increased importance of valve injury in pharmaceutical toxicology. Following the 2001 landmark discovery of cardiac valve injury associated with the widely prescribed anti-obesity drug combination fenfluramine-phentermine, and subsequent withdrawal, the need to understand and assess cardiac valve biology and pathology both preclinically and clinically has been accentuated. Unique aspects of the developmental biology, anatomy, and physiology of cardiac valves compared to main cardiac tissue have been discovered, and key elements of the pathophysiology of various valvular injury mechanisms have been described. Although general clinical cardiac valvular disease in humans has been well characterized, animal modeling of valvular injury has proved to be difficult and undersubscribed. Additionally, both the preclinical, pharmaceutical, toxicologic assessment of valvular injury and the understanding of species-comparative valvular pathology have been limited. As discoveries and awareness grows, the purpose of this paper is to review the structure and function of cardiac valves, mechanisms, and outcomes of the common acquired human cardiac valve diseases, including those that are drug-related; to summarize comparative laboratory animal valvular pathology; and to review the literature of contemporary animal models of valvular injury.
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Affiliation(s)
- Kevin B. Donnelly
- Lilly Research Laboratories, Eli Lilly and Co., Greenfield, Indiana, USA
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21
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Waller ER, Siatkowski RM, Pardo G. Abnormal Eye Movements Due to Radiographically Silent Ischaemia as a Presenting Sign of Antiphospholipid Syndrome. Neuroophthalmology 2008. [DOI: 10.1080/01658100801952558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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22
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Togashi M, Tamura K, Nitta T, Ishizaki M, Sugisaki Y, Fukuda Y. Role of matrix metalloproteinases and their tissue inhibitor of metalloproteinases in myxomatous change of cardiac floppy valves. Pathol Int 2007; 57:251-9. [PMID: 17493172 DOI: 10.1111/j.1440-1827.2007.02096.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To clarify the underlying cause of myxomatous changes in cardiac floppy valves, the expression of the matrix metalloproteinases (MMP) and the tissue inhibitors of metalloproteinases (TIMP) was investigated in cardiac valves. Valves were obtained from nine patients with floppy valves, from 13 patients with other valvular disease types, and from four patients with normal valves. Immunohistochemical analyses for MMP-2, MMP-9, TIMP-1, and TIMP-2, and gelatin zymography for MMP-2 and MMP-9 were performed. Compared with the spongiosa of normal valves, the myxomatous area of floppy valves had stronger immunohistochemical reaction to MMP-2 and MMP-9, and weaker reaction to TIMP-2. Activated MMP-2 and MMP-9 were detected in eight out of nine cases of floppy valves. Activated MMP-2 was detected at low levels in two cases of normal valves showing mild expansion of the spongiosa without macroscopic floppiness. The ratio of active/total MMP-2 and MMP-9 increased in floppy valves compared with normal valves. These results suggest that the imbalance between MMP and TIMP and the increased activity of MMP-2 and MMP-9 may correlate with myxomatous changes observed in floppy valves. Valves with a slight myxomatous change and activated MMP-2 may develop into floppy valves with increases in the activity of MMP.
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Affiliation(s)
- Mayuko Togashi
- Department of Analytic Human Pathology, Nippon Medical School, and Division of Surgical Pathology, Nippon Medical School Hospital, Tokyo, Japan
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Klinkner DB, Densmore JC, Kaul S, Noll L, Lim HJ, Weihrauch D, Pritchard KA, Oldham KT, Sander TL. Endothelium-derived microparticles inhibit human cardiac valve endothelial cell function. Shock 2006; 25:575-80. [PMID: 16721264 DOI: 10.1097/01.shk.0000209558.69575.80] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Elevated numbers of endothelium-derived microparticles (EMPs) in the circulation are found in a variety of critical illnesses. EMPs have been associated with vascular dysfunction, including thrombotic complications and loss of normal vascular reactivity, common responses associated with cardiac valve injury. However, the exact mechanisms of this dysfunction and the potential impact on cardiac endothelium are unknown. We hypothesize that pathologic levels of circulating EMPs negatively regulate proliferation and migration of valvular endothelial cells (ECs), leading to downstream endothelial dysfunction. EMPs were generated from plasminogen activation inhibitor 1-stimulated human umbilical vein endothelial cells (HUVECs). Human mitral valve endothelial cells (HMVECs) were isolated and characterized by platelet endothelial cell-derived adhesion molecule-1 (PECAM-1, or CD31) and von Willebrand factor immunocytochemistry. HMVECs were treated with increasing EMP doses, and then, the effects of EMPs on growth factor-induced proliferation and migration were tested. Proliferation was assessed by H-thymidine incorporation. EC migration was assayed by photographing microtubules of HMVECs and HUVECs in fibrin gel incubated with EMPs +/- growth factors for 48 h. The EMP effects on non-valve HUVECs were tested in parallel. EMPs inhibited HMVEC proliferation at high doses but stimulated HUVEC proliferation at all doses. In HMVECs, EMPs inhibited basic fibroblast growth factor- and vascular endothelial growth factor-induced proliferation and migration. Taken together, these data suggest EMPs regulate valvular EC proliferation in a dose-dependent manner and, furthermore, modulate growth factor signaling in ECs. These results implicate EMPs as a possible source of downstream EC dysfunction in disease states. EMPs may play a role in valvular leaflet injury in human disease by inhibiting normal growth and repair of endothelium.
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Affiliation(s)
- Denise B Klinkner
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin and Children's Research Institute, Milwaukee, WI 53226, USA
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