1
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Salman J, Franz M, Aburahma K, de Manna ND, Tavil S, Ali-Hasan-Al-Saegh S, Ius F, Boethig D, Zubarevich A, Schmack B, Kaufeld T, Popov AF, Ruhparwar A, Weymann A. Hypothermic Ventricular Fibrillation in Redo Minimally Invasive Mitral Valve Surgery: A Promising Solution for a Surgical Challenge. J Clin Med 2024; 13:4269. [PMID: 39064309 PMCID: PMC11277611 DOI: 10.3390/jcm13144269] [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: 06/06/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Minimally invasive mitral valve surgery (MIMVS) is a treatment for severe mitral valve pathologies. In redo cases, especially after coronary artery bypass grafting (CABG) surgery with patent mammary bypass grafts, establishing aortic clamping followed by antegrade cardioplegia application might be challenging. Here, we present the outcome of hypothermic ventricular fibrillation as an alternative to conventional cardioprotection. Methods: Patients who underwent MIMVS either received hypothermic ventricular fibrillation (study group, n = 48) or antegrade cardioprotection (control group, n = 840) and were observed for 30 postoperative days. Data were retrospectively analyzed and collected from January 2011 until December 2022. Results: Patients in the study group had a higher preoperative prevalence of renal insufficiency (p = 0.001), extracardiac arteriopathy (p = 0.001), insulin-dependent diabetes mellitus (p = 0.001) and chronic lung disease (p = 0.036). Furthermore, they had a longer surgery time and a lower repair rate (p < 0.001). No difference, however, was seen in postoperative incidences of stroke (p = 0.26), myocardial infarction (p = 1) and mitral valve re-operation (p = 1) as well as 30-day mortality (p = 0.1) and postoperative mitral valve insufficiency or stenosis. Conclusions: The patients who underwent redo MIMVS with hypothermic ventricular fibrillation did not have worse outcomes or more serious adverse events compared to the patients who received routine conventional cardioprotection. Therefore, the use of hypothermic ventricular fibrillation appears to be a promising cardioprotective technique in this challenging patient population requiring redo MIMVS.
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Affiliation(s)
| | | | | | | | | | - Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany; (J.S.); (B.S.); (A.W.)
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2
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Franz M, Aburahma K, Ius F, Ali-Hasan-Al-Saegh S, Boethig D, Hertel N, Zubarevich A, Kaufeld T, Ruhparwar A, Weymann A, Salman J. Minimally Invasive Surgery through Right Mini-Thoracotomy for Mitral Valve Infective Endocarditis: Contraindicated or Safely Possible? J Clin Med 2024; 13:4182. [PMID: 39064222 PMCID: PMC11278371 DOI: 10.3390/jcm13144182] [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: 06/05/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Mitral valve infective endocarditis (IE) still has a high mortality. Minimally invasive mitral valve surgery (MIMVS) is technically more challenging, especially in patients with endocarditis. Here, we compare the early postoperative outcome of patients with endocarditis and other indications for MIMVS. Methods: Two groups were formed, one consisting of patients who underwent surgery because of mitral valve endocarditis (IE group: n = 75) and the other group consisting of patients who had another indication for MIMVS (non-IE group: n = 862). Patients were observed for 30 postoperative days. Data were retrospectively reviewed and collected from January 2011 to September 2023. Results: Patients from the IE group were younger (60 vs. 68 years; p < 0.001) and had a higher preoperative history of stroke (26% vs. 6%; p < 0.001) with neurological symptoms (26% vs. 9%; p < 0.001). No difference was seen in overall surgery time (211 vs. 206 min; p = 0.71), time on cardiopulmonary bypass (137 vs. 137 min; p = 0.42) and aortic clamping time (76 vs. 78 min; p = 0.42). Concerning postoperative data, the IE group had a higher requirement of erythrocyte transfusion (2 vs. 0; p = 0.041). But no difference was seen in the need for a mitral valve redo procedure, bleeding, postoperative stroke, cerebral bleeding, new-onset dialysis, overall intubation time, sepsis, pacemaker implantation, wound healing disorders and 30-day mortality. Conclusions: Minimally invasive mitral valve surgery in patients with mitral valve endocarditis is feasible and safe. Infective endocarditis should not be considered as a contraindication for MIMVS.
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Affiliation(s)
| | | | | | - Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.W.); (J.S.)
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3
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Pino PG, Madeo A, Lucà F, Ceravolo R, di Fusco SA, Benedetto FA, Bisignani G, Oliva F, Colivicchi F, Gulizia MM, Gelsomino S. Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks. J Clin Med 2023; 12:jcm12072522. [PMID: 37048605 PMCID: PMC10094963 DOI: 10.3390/jcm12072522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this important diagnostic tool still needs to be wholly appreciated in clinical practice. This review aims at explaining how, why, and when performing RT3DE is useful in clinical practice.
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Affiliation(s)
- Paolo G. Pino
- Former Cardiology Department, San Camillo Forlanini Hospital, 00151 Roma, Italy
| | - Andrea Madeo
- Cardiology Department, Ferrari Hospital, 87012 Castrovillari, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Roberto Ceravolo
- Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia, Italy
| | | | - Francesco Antonio Benedetto
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | | | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | - Furio Colivicchi
- Cardiology Department, San Filippo Neri Hospital, 00135 Rome, Italy
| | | | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University, 6211 LK Maastrich, The Netherlands
- Correspondence:
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4
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Franz M, De Manna ND, Schulz S, Ius F, Haverich A, Cebotari S, Tudorache I, Salman J. Minimally Invasive Mitral Valve Surgery in the Elderly. Thorac Cardiovasc Surg 2023. [PMID: 36858067 DOI: 10.1055/s-0043-1762940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND The minimally invasive mitral valve procedure warrants minimal surgical trauma and might influence the postoperative course positively, especially in old patients. In this retrospective study, we reviewed our experience in minimally invasive mitral valve surgery (miMVS) in patients aged ≥ 75 years. METHODS In this retrospective cohort study, based on propensity score matching, we compared patients aged ≥75 years with patients aged <75 years who underwent miMVS. The primary endpoint was 30-day mortality. Secondary endpoints were myocardial infarction, stroke, and renal failure. RESULTS Between January 2011 and February 2021, 761 patients underwent miMVS at our institution. After propensity score matching, a study group (≥75 years, n = 189) and a control group (<75 years, n = 189) were formed. Preoperatively patients ≥75 years more often suffered from NYHA III heart failure (60 vs. 46%; p = 0.013). Their valves were more often frequently replaced (48 vs. 32%; p < 0.001), and their postoperative ventilation time was longer (13 hours vs. 11 hours; p < 0.001). There were no statistically significant differences regarding postoperative stroke (3 vs. 0.6%; p = 0.16), myocardial infarction (0 vs. 1%; p = 0.32), renal insufficiency with new dialysis (5 vs. 4%; p = 0.62), and 30-day mortality (4 vs. 2%; p = 0.56). CONCLUSION miMVS results in satisfactory early postoperative outcomes in elderly patients.
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Affiliation(s)
- Maximilian Franz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nunzio Davide De Manna
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital, Udine, Italy
| | - Saskia Schulz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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5
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Subramani S. Comparison between 2D and 3D echocardiography for quantitative assessment of mitral regurgitation: Current status. Ann Card Anaesth 2022; 25:198-199. [PMID: 35417968 PMCID: PMC9244269 DOI: 10.4103/aca.aca_238_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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6
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Franke B, Brüning J, Yevtushenko P, Dreger H, Brand A, Juri B, Unbehaun A, Kempfert J, Sündermann S, Lembcke A, Solowjowa N, Kelle S, Falk V, Kuehne T, Goubergrits L, Schafstedde M. Computed Tomography-Based Assessment of Transvalvular Pressure Gradient in Aortic Stenosis. Front Cardiovasc Med 2021; 8:706628. [PMID: 34568450 PMCID: PMC8457381 DOI: 10.3389/fcvm.2021.706628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/09/2021] [Indexed: 01/07/2023] Open
Abstract
Background: In patients with aortic stenosis, computed tomography (CT) provides important information about cardiovascular anatomy for treatment planning but is limited in determining relevant hemodynamic parameters such as the transvalvular pressure gradient (TPG). Purpose: In the present study, we aimed to validate a reduced-order model method for assessing TPG in aortic stenosis using CT data. Methods: TPGCT was calculated using a reduced-order model requiring the patient-specific peak-systolic aortic flow rate (Q) and the aortic valve area (AVA). AVA was determined by segmentation of the aortic valve leaflets, whereas Q was quantified based on volumetric assessment of the left ventricle. For validation, invasively measured TPGcatheter was calculated from pressure measurements in the left ventricle and the ascending aorta. Altogether, 84 data sets of patients with aortic stenosis were used to compare TPGCT against TPGcatheter. Results: TPGcatheter and TPGCT were 50.6 ± 28.0 and 48.0 ± 26 mmHg, respectively (p = 0.56). A Bland–Altman analysis revealed good agreement between both methods with a mean difference in TPG of 2.6 mmHg and a standard deviation of 19.3 mmHg. Both methods showed good correlation with r = 0.72 (p < 0.001). Conclusions: The presented CT-based method allows assessment of TPG in patients with aortic stenosis, extending the current capabilities of cardiac CT for diagnosis and treatment planning.
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Affiliation(s)
- Benedikt Franke
- Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Brüning
- Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pavlo Yevtushenko
- Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Henryk Dreger
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Brand
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Juri
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Unbehaun
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Simon Sündermann
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Alexander Lembcke
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Titus Kuehne
- Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
| | - Marie Schafstedde
- Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Charité - Universitätsmedizin Berlin, Berlin, Germany
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7
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Automatic Assessment of Mitral Regurgitation Severity Using the Mask R-CNN Algorithm with Color Doppler Echocardiography Images. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:2602688. [PMID: 34552659 PMCID: PMC8452404 DOI: 10.1155/2021/2602688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
Accurate assessment of mitral regurgitation (MR) severity is critical in clinical diagnosis and treatment. No single echocardiographic method has been recommended for MR quantification thus far. We sought to define the feasibility and accuracy of the mask regions with a convolutional neural network (Mask R-CNN) algorithm in the automatic qualitative evaluation of MR using color Doppler echocardiography images. The authors collected 1132 cases of MR from hospital A and 295 cases of MR from hospital B and divided them into the following four types according to the 2017 American Society of Echocardiography (ASE) guidelines: grade I (mild), grade II (moderate), grade III (moderate), and grade IV (severe). Both grade II and grade III are moderate. After image marking with the LabelMe software, a method using the Mask R-CNN algorithm based on deep learning (DL) was used to evaluate MR severity. We used the data from hospital A to build the artificial intelligence (AI) model and conduct internal verification, and we used the data from hospital B for external verification. According to severity, the accuracy of classification was 0.90, 0.89, and 0.91 for mild, moderate, and severe MR, respectively. The Macro F1 and Micro F1 coefficients were 0.91 and 0.92, respectively. According to grading, the accuracy of classification was 0.90, 0.87, 0.81, and 0.91 for grade I, grade II, grade III, and grade IV, respectively. The Macro F1 and Micro F1 coefficients were 0.89 and 0.89, respectively. Automatic assessment of MR severity is feasible with the Mask R-CNN algorithm and color Doppler electrocardiography images collected in accordance with the 2017 ASE guidelines, and the model demonstrates reasonable performance and provides reliable qualitative results for MR severity.
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8
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Cormican DS, Drennen Z, Sonny A, Crowley JC, Gil IJN, Ramakrishna H. Functional Mitral Regurgitation in Heart Failure: Analysis of the ESC Multidisciplinary Heart-Team Position Statement and Review of Current Guidelines. J Cardiothorac Vasc Anesth 2021; 36:3357-3364. [PMID: 34607763 DOI: 10.1053/j.jvca.2021.09.004] [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: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel S Cormican
- Department of Anesthesiology, Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Zachary Drennen
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Abraham Sonny
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Jerome C Crowley
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Iván J Núñez Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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9
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van Buuren F, Gati S, Sharma S, Papadakis M, Adami PE, Niebauer J, Pelliccia A, Rudolph V, Börjesson M, Carre F, Solberg E, Heidbuchel H, Caselli S, Corrado D, Serratosa L, Biffi A, Pressler A, Schmied C, Panhuyzen-Goedkoop NM, Rasmussen HK, La Gerche A, Faber L, Bogunovic N, D'Ascenzi F, Mellwig KP. Athletes with valvular heart disease and competitive sports: a position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2021; 28:1569-1578. [PMID: 33846742 DOI: 10.1093/eurjpc/zwab058] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/18/2022]
Abstract
This article provides an overview of the recommendations from the Sports Cardiology section of the European Association of Preventive Cardiology on sports participation in individuals with valvular heart disease (VHD). The aim of these recommendations is to encourage regular physical activity including sports participation, with reasonable precaution to ensure a high level of safety for all affected individuals. Valvular heart disease is usually an age-related degenerative process, predominantly affecting individuals in their fifth decade and onwards. However, there is an increasing group of younger individuals with valvular defects. The diagnosis of cardiac disorders during routine cardiac examination often raises questions about on-going participation in competitive sport with a high dynamic or static component and the level of permissible physical effort during recreational exercise. Although the natural history of several valvular diseases has been reported in the general population, little is known about the potential influence of chronic intensive physical activity on valve function, left ventricular remodelling pulmonary artery pressure, and risk of arrhythmia. Due to the sparsity of data on the effects of exercise on VHD, the present document is largely based on clinical experience and expert opinion.
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Affiliation(s)
- Frank van Buuren
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Catholic Hospital Southwestfalia, St. Martinus Hospital Olpe, Germany
| | - Sabiha Gati
- National Heart and Lung Institute, Imperial College, London, UK.,Department of Cardiology, Royal Brompton Hospital, London, SW3 6NP, UK
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group, St. George's, University of London, UK
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St. George's, University of London, UK
| | - Paolo Emilio Adami
- Cardiovascular Medicine Center Zurich, Hirslanden Klinik im Park, Zurich Switzerland
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Antonio Pelliccia
- Cardiovascular Medicine Center Zurich, Hirslanden Klinik im Park, Zurich Switzerland
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Institute of Medicine; Center for Health and Performance, Gothenburg University.,Department of Medicine, Sahlgrenzska University Hospital/Östra, Gothenburg, Sweden
| | - Francois Carre
- Sport Medicine Department, Rennes University Hospital, LTSI INSERM UMR 1099, France
| | - Erik Solberg
- Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Hein Heidbuchel
- Antwerp University and University Hospital, Cardiology, Antwerp, Belgium
| | - Stefano Caselli
- Cardiovascular Medicine Center Zurich, Hirslanden Klinik im Park, Zurich Switzerland.,Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - Luis Serratosa
- Hospital Universitario Quironsalud Madrid, Spain.,Ripoll y De Prado Sport Clinic, FIFA Medical Centre of Excellence, Madrid, Spain
| | - Alessandro Biffi
- Cardiovascular Medicine Center Zurich, Hirslanden Klinik im Park, Zurich Switzerland
| | - Axel Pressler
- Centre for General, Sports and Preventive Cardiology, Munich, Germany.,Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Germany
| | - Christian Schmied
- Kardiologisches Ambulatorium, Sportmedizin/Sportkardiologie, University Heart Center, Zurich, Switzerland
| | | | | | | | - Lothar Faber
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Nikola Bogunovic
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Klaus Peter Mellwig
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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10
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Van Praet KM, Kempfert J, Jacobs S, Stamm C, Akansel S, Kofler M, Sündermann SH, Nazari Shafti TZ, Jakobs K, Holzendorf S, Unbehaun A, Falk V. Mitral valve surgery: current status and future prospects of the minimally invasive approach. Expert Rev Med Devices 2021; 18:245-260. [PMID: 33624569 DOI: 10.1080/17434440.2021.1894925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: During the past five years the approach to procedural planning, operative techniques and perfusion strategies for minimally invasive mitral valve surgery (MIMVS) has evolved. With the goal to provide a maximum of patient safety the procedure has been modified according to individual patient characteristics and is largely based on preoperative imaging.Areas covered: In this review article we describe the important factors in image based therapy planning and simulation, different access strategies, the operative key-steps, a rationale use of devices, and highlight a few future developments in the field of MIMVS. Published studies were identified through pearl growing, citation chasing, a search of PubMed using the systematic review methods filter, and the authors' topic knowledge.Expert opinion: With the help of expert teams including surgeons specialized in mitral repair, anesthesiologists and perfusionists a broad spectrum of mitral valve pathologies and related pathologies can be treated with excellent functional outcomes. Avoiding procedure related complications is the key for success for any MIMVS program.
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Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Christof Stamm
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Serdar Akansel
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timo Z Nazari Shafti
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Katharina Jakobs
- Institute for Anesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Stefan Holzendorf
- Department of Perfusion, German Heart Center Berlin, Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Department of Health Sciences, ETH Zürich, Translational Cardiovascular Technologies, Switzerland
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11
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Abdelaziz HMM, Tawfik AM, Abd-Elsamad AA, Sakr SA, Algamal AM. Cardiac magnetic resonance imaging for assessment of mitral stenosis before and after percutaneous balloon valvuloplasty in comparison to two- and three-dimensional echocardiography. Acta Radiol 2020; 61:1176-1185. [PMID: 31937108 DOI: 10.1177/0284185119897368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The experience with cardiac magnetic resonance (CMR) in mitral stenosis (MS) is limited in contrast to mitral regurgitation. PURPOSE To compare CMR versus 2D and 3D transthoracic (TTE) and 3D transesophgeal (TEE) echocardiography in assessment of rheumatic MS before and after percutaneous balloon mitral valvuloplasty (PBMV). MATERIAL AND METHODS Twenty consecutive symptomatic patients with MS were evaluated prospectively and independently by CMR, TTE, and TEE pre-PBMV, and by CMR and TTE post-PBMV. Mitral valve area (MVA) was assessed by CMR planimetry, TTE and TEE planimetry, and pressure half time (PHT). Further assessment included trans-mitral velocity, mitral regurgitation (MR), and left atrial (LA) volume. RESULTS PBMV was successful in 18 patients and failed in two patients (one with MVA <1.5 cm2, one developed severe MR). Pre-PBMV and MVA by CMR, 2D TTE, biplane, 3D TTE, 3D TEE, and PHT were 1.16, 1.16, 1.10, 1.02, 1.05, and 0.99 cm2, respectively. Post-PBMV, a significant increase in MVA was observed (2.15, 2.06, 2.07, 2.04, and 2.03 cm2, respectively). High agreement was observed between CMR and echocardiography before and after PBMV, except for PHT method. CMR significantly underestimated trans-mitral velocity and gradients compared to echocardiography (P<0.001). Before PBMV, mild MR was observed in 11, 12, and 19 patients by 2D TTE, 3D TTE, and CMR. After PBMV, MR was observed in all patients (19 mild, one severe) by all modalities. Echocardiography significantly underestimated LA volume compared to CMR (P<0.001). LA volume decreased significantly after PBMV (P<0.001). CONCLUSION CMR provides comprehensive assessment of several parameters in MS patients before and after intervention. Agreement with echocardiography is acceptable.
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Affiliation(s)
- Hanaa MM Abdelaziz
- Department of Cardiovascular Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed M Tawfik
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ayman A Abd-Elsamad
- Department of Cardiovascular Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sherif A Sakr
- Department of Cardiovascular Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Abdulsalam M Algamal
- Department of Cardiovascular Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Grand D, Navrazhina K, Frew JW. A Scoping Review of Non-invasive Imaging Modalities in Dermatological Disease: Potential Novel Biomarkers in Hidradenitis Suppurativa. Front Med (Lausanne) 2019; 6:253. [PMID: 31781567 PMCID: PMC6851050 DOI: 10.3389/fmed.2019.00253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/21/2019] [Indexed: 01/01/2023] Open
Abstract
Background: The development of imaging-based biomarkers has the potential to overcome major challenges in the accurate and reproducible assessment of disease severity and response to novel therapies in Hidradenitis Suppurativa (HS). Understanding the advantages and limitations of existing non-invasive imaging modalities in dermatological disease will aid in the development of hypotheses and inform the design of future studies. Methods: A scoping review was performed using Medline, Embase, Web of Science Databases and evaluation of "gray literature" until June 30, 2019. Citations were examined according to pre-defined inclusion and exclusion criteria. Citations were reviewed by two independent reviewers. Narrative Synthesis was used to summarize data, structured by imaging modality. Results: Non-invasive imaging modalities, such as ultrasound, MRI, RCM, EIS, OCT, and MIT, were identified. Only ultrasound, MRI and MIT have been used in HS. Image modalities vary in image depth, resolution, cost, accessibility and correlation with known aspects of disease activity in HS. Discussion and Conclusion: The benefits and limitations of each imaging modality are products of cost, accessibility, validity and reliability. An additional hurdle to the development of image-based biomarkers in HS is a lack of established analytical benchmarks that can be correlated with existing biological, inflammatory and clinical parameters. This review has identified potential imaging biomarkers, as well as relevant analytical benchmarks that reflect the presence or absence of disease. Further investigation work is needed to analytically and clinically validate these imaging variables in order to identify potential imaging biomarkers in HS.
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Affiliation(s)
- David Grand
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, United States.,Albert Einstein College of Medicine, Bronx, NY, United States
| | - Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, United States.,Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, Weill Cornell University, New York, NY, United States
| | - John W Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, United States
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Abstract
Functional mitral regurgitation (FMR) in the setting of left ventricular (LV) dysfunction and heart failure portends a poor prognosis. Guideline-directed medical therapy remains the cornerstone of initial treatment, with emphasis placed on treatment of the underlying LV dysfunction, as FMR is a secondary phenomenon and a disease due to LV remodeling. Surgical correction of FMR is controversial because it typically does not address the underlying mechanism and etiology of the condition. However, new, minimally invasive transcatheter therapies, in particular the MitraClip system, have shown promise in the treatment of FMR in selected patients. This review will summarize the pathophysiology underlying FMR, the prognosis of patients with heart failure and FMR, and the various medical and procedural treatment options currently available and under investigation.
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Muacevic A, Adler JR. Initial Experience of Transthoracic Echocardiography at a Newly Operational Satellite Center in Hyderabad, Pakistan. Cureus 2019; 11:e5735. [PMID: 31723496 PMCID: PMC6825457 DOI: 10.7759/cureus.5735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Transthoracic echocardiography (TTE) is the primary noninvasive imaging modality for quantitative and qualitative evaluation of cardiac anatomy and function. The Hyderabad satellite center of National Institute of Cardiovascular Diseases (NICVD), Pakistan has recently started its operations, including TTE; therefore, it is imperative to assess the initial experience for the process improvement of the center. Therefore, the aim of this clinical audit was to review our initial experience of TTE at this newly operational satellite center. Methods In this clinical audit, we reviewed the records of patient undergone TTE at the echocardiography department of NICVD Hyderabad satellite center from May 2018 to October 2018. Demographic characteristics, clinical history, indications for the TTE, and echocardiographic diagnoses were reviewed. Results A total of 2,177 TTE procedures were performed during the study period of six months out of which 68.7% (1,496) were performed in male patients. Mean age of the patients was 50.83 ± 12.44 years with 48.2% (1,050) patients above 50 years of age. The most frequent indication for the procedure was cardiomyopathy, 54.1% (1,177), among other indications, native valve regurgitation was in 49.8% (1,085), ischemic heart disease in 23.2% (504), heart murmurs in 17.3% (377), cardiac masses in 14.3% (312), pericardial disease in 8.5% (184), pulmonary disease in 7.3% (160), infective endocarditis in 6.4% (139), aortic and major disease in 6.3% (138), and native valve stenosis in 5.4% (177) of the patients. Procedures were performed before coronary artery revascularization in 2.2% (47) and for prosthetic valve assessment in 1.7% (38) patients. The TTE was normal in 36.6% (796) patients, while the most frequent diagnosis was cardiomyopathy, 53.8% (1,172), among the other TTE findings valvular heart disease was in 21.8% (475), ischemic heart disease (IHD) in 21.6% (470), pericardial disease in 8.0% (175), and congenital heart disease (CHD) in 1.4% (30) patients. Conclusion This clinical audit showed the effective use of TTE as a noninvasive imaging modality for quantitative and qualitative evaluation of cardiac anatomy and function at a newly operational satellite center of a resource-limited country with normal TTE findings in only 36.6% of the patients.
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Chew PG, Dobson LE, Garg P, Fairbairn TA, Musa TA, Uddin A, Swoboda PP, Foley JR, Fent GJ, Brown LAE, Onciul S, Plein S, Blackman DJ, Greenwood JP. CMR quantitation of change in mitral regurgitation following transcatheter aortic valve replacement (TAVR): impact on left ventricular reverse remodeling and outcome. Int J Cardiovasc Imaging 2018; 35:161-170. [PMID: 30182320 PMCID: PMC6373302 DOI: 10.1007/s10554-018-1441-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022]
Abstract
Current echocardiographic data reporting the impact of concomitant mitral regurgitation (MR) on outcome in patients who undergo transcatheter aortic valve replacement (TAVR) are conflicting. Using cardiovascular magnetic resonance (CMR) imaging, this study aimed to assess the impact of MR severity on cardiac reverse remodeling and patient outcome. 85 patients undergoing TAVR with CMR pre- and 6 m post-TAVR were evaluated. The CMR protocol included cines for left (LV) and right ventricular (RV) volumes, flow assessment, and myocardial scar assessment by late gadolinium enhancement (LGE). Patients were dichotomised according to CMR severity of MR fraction at baseline (‘non-significant’ vs ‘significant’) and followed up for a median duration of 3 years. Forty-two (49%) patients had ‘significant MR’ at baseline; they had similar LV and RV size and function compared to the ‘non-significant MR’ group but had greater LV mass at baseline. In those with significant MR at baseline, 77% (n = 32) had a reduction in MR post-TAVR, moving them into the ‘non-significant’ category at 6-months, with an overall reduction in MR fraction from 34 to 17% (p < 0.001). Improvement in MR was not associated with more favourable cardiac reverse remodeling when compared with the ‘non-improvers’. Significant MR at baseline was not associated with increased mortality at follow-up. Significant MR is common in patients undergoing TAVR and improves in the majority post-procedure. Improvement in MR was not associated with more favourable LV reverse remodeling and baseline MR severity was not associated with mortality.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Tarique A Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - James R Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Louise A E Brown
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Sebastian Onciul
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK.
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