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Song Y, Kim KT, Park SJ, Kim HR, Yoo JS, Kang PJ, Jung SH, Chung CH, Kim JB, Kim HJ. Mechanical versus Bioprosthetic Aortic Valve Replacement in Patients Aged 50 to 70 Years. J Chest Surg 2024; 57:242-251. [PMID: 38472122 DOI: 10.5090/jcs.23.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/31/2023] [Accepted: 01/15/2024] [Indexed: 03/14/2024] Open
Abstract
Background This study compared the outcomes of surgical aortic valve replacement (AVR) in patients aged 50 to 70 years based on the type of prosthetic valve used. Methods We compared patients who underwent mechanical AVR to those who underwent bioprosthetic AVR at our institution between January 2000 and March 2019. Competing risk analysis and the inverse probability of treatment weighting (IPTW) method based on propensity score were employed for comparisons. Results A total of 1,580 patients (984 patients with mechanical AVR; 596 patients with bioprosthetic AVR) were enrolled. There was no significant difference in early mortality between the mechanical AVR and bioprosthetic AVR groups (0.9% vs. 1.7%, p=0.177). After IPTW adjustment, the risk of all-cause mortality was significantly higher in the bioprosthetic AVR group than in the mechanical AVR group (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.07-1.80; p=0.014). Competing risk analysis revealed lower risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28-0.67; p<0.001) and anticoagulation- related bleeding (sHR, 0.35; 95% CI, 0.23-0.53; p<0.001) in the bioprosthetic AVR group. Conversely, the risk of aortic valve (AV) reintervention was higher in the bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17-11.93; p<0.001). Conclusion Among patients aged 50 to 70 years who underwent surgical AVR, those receiving mechanical valves showed better survival than those with bioprosthetic valves. The mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding, while the bioprosthetic AVR group showed a higher risk of AV reintervention.
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Affiliation(s)
- Youngkwan Song
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Jin Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil Je Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Manokaran P, Krishnasamy S, Aman RRABR, Teoh VWY, Loch A. Aortic root pseudoaneurysm: a case report and literature review. Indian J Thorac Cardiovasc Surg 2024; 40:68-77. [PMID: 38125320 PMCID: PMC10728390 DOI: 10.1007/s12055-023-01580-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 12/23/2023] Open
Abstract
Pseudoaneurysms of the aortic root are rare. A case of prosthetic aortic valve infection progressing from a confined intramural abscess to a ruptured abscess communicating with the aorta and forming a large pseudoaneurysm is described. Additionally, data from all cases and case series, published between 2000 and 2021, was analyzed. A PUBMED search for the keywords "aortic root mycotic aneurysm," "aortic root abscess AND infective endocarditis," and "aortic root mycotic aneurysm AND infective endocarditis" yielded 152 publications (with 157 cases described): Aortic pseudoaneurysm is more common in males (80.9%, n = 127). Mean age is 51 years (4 months-84 years). The most common symptom is fever (68.5%, n = 102). Mean time until diagnosis is 27.2 days. Embolic complications are present in 17.8% (n = 28) at diagnosis. Most cases are due to valvular infections (n = 72 cases, 45.9%). Prior cardiac surgery is documented in 49.0% (n = 77). The mean time interval for developing aortic root abscess following heart surgery is 32.2 months. 22.3% (n = 35) are immunocompromised. Aetiological agents were Staphylococcus sp. (34.1%, n = 47) and Streptococcus sp. (23.2%, n = 32). Mean antimicrobial therapy lasts 58.5 days. Outcome with surgery is superior to medical treatment: overall inpatient mortality 18.5% (n = 27); with surgery 12.2% (n = 15 out of 123 patients), with only medical management 47.8% (n = 11 out of 23 patients). In conclusion, aortic root pseudoaneurysm occurs most commonly in middle-aged male patients. History of prior aortic procedures is commonly present. Correct diagnosis hinges on detailed history, transoesophageal echocardiography, and computed tomography (CT) aorta. Surgery is the preferred therapeutic option. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01580-x.
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Affiliation(s)
| | - Sivakumar Krishnasamy
- Department of Surgery/Cardiothoracic, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Alexander Loch
- Department of Medicine/Cardiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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3
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Gressens SB, Souhail B, Pilmis B, Lourtet-Hascoët J, Podglajen I, Fiore A, Fihman V, Mainardi JL, Lepeule R, Lebeaux D, Dubert M. Prognosis of prosthetic valve infective endocarditis due to Streptococcus spp., a retrospective multi-site study to assess the impact of antibiotic treatment duration. Eur J Clin Microbiol Infect Dis 2024; 43:95-104. [PMID: 37964043 DOI: 10.1007/s10096-023-04705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE The duration of antibiotic treatment for prosthetic valve endocarditis caused by Streptococcus spp. is largely based on clinical observations and expert opinion rather than empirical studies. Here we assess the impact of a shorter antibiotic duration. OBJECTIVES To assess the impact of antibiotic treatment duration for streptococcal prosthetic valve endocarditis on 12-month mortality as well as subsequent morbidity resulting in additional cardiac surgical interventions, and rates of relapse and reinfection. METHODS This retrospective multisite (N= 3) study examines two decades of data on patients with streptococcal prosthetic valve endocarditis receiving either 4 or 6 weeks of antibiotics. Overall mortality, relapse, and reinfection rates were also assessed for the entire available follow-up period. RESULTS The sample includes 121 patients (median age 72 years, IQR [53; 81]). The majority (74%, 89/121) received a ß-lactam antibiotic combined with aminoglycoside in 74% (89/121, median bi-therapy 5 days [1; 14]). Twenty-eight patients underwent surgery guided by ESC-guidelines (23%). The 12-month mortality rate was not significantly affected by antibiotic duration (4/40, 10% in the 4-week group vs 3/81, 3.7% in the 6-week group, p=0.34) or aminoglycoside usage (p=0.1). Similarly, there were no significant differences between the 2 treatment groups for secondary surgical procedures (7/40 vs 21/81, p=0.42), relapse or reinfection (1/40 vs 2/81 and 2/40 vs 5/81 respectively). CONCLUSIONS Our study found no increased adverse outcomes associated with a 4-week antibiotic duration compared to the recommended 6-week regimen. Further randomized trials are needed to ascertain the optimal duration of treatment for streptococcal endocarditis.
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Affiliation(s)
- S B Gressens
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France.
| | - B Souhail
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité Transversale de traitement des Infections, Assistance Publique - Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
| | - B Pilmis
- Service de Microbiologie, Unité Mobile d'Infectiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - J Lourtet-Hascoët
- Service de Microbiologie, Unité Mobile d'Infectiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - I Podglajen
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - A Fiore
- Service de Chirurgie Cardiaque, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 94000, Créteil, France
| | - V Fihman
- EA 7380 Dynamyc, EnvA, Université-Paris-Est-Créteil, Créteil, France
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité de Bactériologie - Hygiène, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - J L Mainardi
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - R Lepeule
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité Transversale de traitement des Infections, Assistance Publique - Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
- EA 7380 Dynamyc, EnvA, Université-Paris-Est-Créteil, Créteil, France
| | - D Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - M Dubert
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
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Plata-Corona JC, González-Ortiz A, García-Cárdenas M, Espinola-Zavaleta N, Alexanderson-Rosas E, Carvajal-Juárez I. Role of molecular imaging in the diagnosis of prosthetic aortic valve endocarditis by Bacillus licheniformis: a case report. Eur Heart J Case Rep 2023; 7:ytad425. [PMID: 38426048 PMCID: PMC10903176 DOI: 10.1093/ehjcr/ytad425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 03/02/2024]
Abstract
Background Infective endocarditis is a challenging diagnosis that usually requires cardiovascular image confirmation as part of the approach. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is an imaging technique more sensible for the diagnosis of prosthetic valve endocarditis (PVE) when echocardiography is inconclusive. Case summary We present the case of a 35-year-old man who had a previous Bentall-De Bono procedure 4 years prior that included biological, national institute of cardiology (INC)-type, locally manufactured aortic valve replacement and woven Dacron tube graft implantation in the ascending aorta. He was admitted because of dyspnoea, oedema, fever, and syncope. A complete auriculoventricular blockade was diagnosed, requiring cardiac pacing. Also, infective endocarditis (IE) was suspected. Blood cultures showed the isolation of Bacillus licheniformis. Transthoracic echocardiography, transoesophageal echocardiography, and CT angiography were inconclusive for IE. Treatment was initiated with intravenous (IV) antibiotic therapy, and an extensive protocol for IE, including molecular imaging modalities, was ordered. 99mTc-Ubiquicidin scintigraphy was acquired without abnormal findings. Images of 18F-FDG-PET/CT revealed abnormally intense heterogeneous uptake in the prosthetic aortic annulus in a classic pattern. Applying the modified 2015 Duke criteria for PET/CT, PVE was confirmed. Discussion Although the other imaging modalities were negative, the high clinical suspicion made it mandatory to continue the study protocol, remarking on the utility of 18F-FDG-PET/CT on patients categorized as having 'possible' endocarditis, as in our patient.
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Affiliation(s)
| | - Araceli González-Ortiz
- Clinical Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Mauricio García-Cárdenas
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C. 14080, Mexico
| | - Nilda Espinola-Zavaleta
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C. 14080, Mexico
- Echocardiography Department, ABC Medical Center, I.A.P., Mexico City, Mexico
| | - Erick Alexanderson-Rosas
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C. 14080, Mexico
- PET/CT Unit, Autonomous National University of Mexico (UNAM), Mexico City, Mexico
- Department of Physiology, Faculty of Medicine, Autonomous National University of Mexico (UNAM), Mexico City, Mexico
| | - Isabel Carvajal-Juárez
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C. 14080, Mexico
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Amirghofran AA, Salimi M, Kamran H, Bazrafshan H, Navaei MR, Shokrollahi A, Nirooei E, Edraki M, Amoozgar H, Ajami G, Arabi H. Long-term outcomes of the classic Konno-Rastan procedure in paediatric and adult patients: impact of aortic annulus size on patient outcomes. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad151. [PMID: 37665750 DOI: 10.1093/icvts/ivad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/14/2023] [Accepted: 09/02/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES The classic Konno-Rastan procedure may yield different outcomes regarding aortic annulus diameters ≤15 mm and larger. Focusing on the effect of the diameter of the aortic annulus, we described the long-term outcomes of our patients. METHODS The outcomes of paediatric and adult patients who underwent surgery from 2000 to 2021 were studied retrospectively. The patient population was divided into 2 groups with aortic annulus diameters ≤15 mm and >15, and the outcomes were compared between the 2 groups. RESULTS A total of 48 patients, with a mean age of 12.24 ± 9.42 years (2-53 years) and a median follow-up duration of 8 years (7 months to 20 years) with an IQR of 5.5, were enrolled. The mean peak instantaneous pressure gradient was 78.97 ± 25.29 mmHg, which decreased to 21.43 mmHg (P-value = 0.012). The maximum left ventricular outflow tract gradient at the last follow-up was 28.21 mmHg, with the exception of 1 case with a gradient of 68.45 mmHg. The mean diameter of the aortic annulus was 15.34 ± 3.87 mm (8-23 mm), and the mean prosthetic valve size was 20.31 mm, which was 5 mm (33%) larger than the native annulus diameter. The overall mortality rate was 6.3%, with 1 death in the hospital and 2 in the first year after the surgery. The major complication rate, including mortality, heart block and reintervention, was higher in patients with ≤15 mm annulus (P-value = 0.028.) However, there was no difference between the 2 groups in follow-up. Four (8%) late cardiac reoperations were performed, none of which were related to our surgeries. CONCLUSIONS Kono-Rastan surgery for patients with aortic valve diameter of ≤15 mm can be performed with acceptable long-term outcomes.
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Affiliation(s)
| | - Maryam Salimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali Shokrollahi
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Nirooei
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Edraki
- Pediatric Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Amoozgar
- Pediatric Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Ajami
- Pediatric Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Arabi
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Alsoufi B. The Konno-Rastan procedure in children and young adults: efficiency versus effectiveness. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad171. [PMID: 37847656 PMCID: PMC10599977 DOI: 10.1093/icvts/ivad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/16/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Norton Children’s Hospital, Louisville, KY, USA
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7
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Sanchez-Nadales A, Cedeño J, Sonnino A, Sarkar A, Igbinomwanhia E, Asher CR, Xu B. Utility of Intracardiac Echocardiography for Infective Endocarditis and Cardiovascular Device-Related Endocarditis: A Contemporary Systematic Review. Curr Probl Cardiol 2023:101791. [PMID: 37172870 DOI: 10.1016/j.cpcardiol.2023.101791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
The diagnosis of infective endocarditis (IE) can pose a significant challenge, particularly in cases of prosthetic valve endocarditis (PVE) or cardiac device-related endocarditis (CDIE) (1). While echocardiography remains a crucial diagnostic tool for identifying IE, including PVE and CDIE, there are certain circumstances where transesophageal echocardiography (TEE) may not be conclusive or practically feasible (2). Recently, intracardiac echocardiography (ICE) has emerged as a promising alternative for diagnosing IE and evaluating intracardiac infections, especially in cases where transthoracic echocardiography (TTE) has not been revealing, and TEE has been contraindicated. Furthermore, ICE has been found to be useful in guiding transvenous lead extractions in infected implantable cardiac devices (3). This systematic review aims to comprehensively explore the various applications of ICE in the diagnosis of IE and assess its efficacy in comparison to traditional diagnostic methods.
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Affiliation(s)
| | - Juan Cedeño
- Department of Internal Medicine, Cleveland Clinic Florida, Weston FL, 33321.
| | - Alice Sonnino
- Department of Internal Medicine, Cleveland Clinic Florida, Weston FL, 33321.
| | - Abdulla Sarkar
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston FL, 33321.
| | - Efehi Igbinomwanhia
- Department of Cardiovascular Disease, MetroHealth System, Cleveland, OH, 44109, USA.
| | - Craig R Asher
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston FL, 33321.
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195.
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8
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Abdelghani M, Abdelfattah M, Diab AM, Elsheikh H, Elabbady MEM. Computed tomography vs. cinefluoroscopy for the assessment of mechanical prosthetic valve leaflet motion. Heart Vessels 2023; 38:599-605. [PMID: 36301342 DOI: 10.1007/s00380-022-02193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022]
Abstract
Evaluation of mechanical prosthetic valve function is based on echocardiography, but adequate assessment of leaflet motion is limited by acoustic shadowing. Cinefluoroscopy is a standard method to assess leaflet motion, while computed tomography (CT) has been suggested as an alternative. We sought to compare the feasibility of leaflet motion assessment by cinefluoroscopy vs. CT. In 35 prospectively enrolled patients, leaflet motion was assessed in 43 bileaflet mechanical prostheses (29 mitral and 14 aortic) by cinefluoroscopy and non-contrast CT. Assessment was considered feasible when the 'in profile' projection (with the radiographic beam parallel to both the valve ring plane and the tilting axis of discs) could be achieved. Overall feasibility of fluoroscopic assessment was 74% (mitral, 66% vs. aortic, 93%; p = 0.071), while feasibility of CT assessment was 100% (p = 0.003). Among prostheses with unfeasible fluoroscopic assessment, CT suggested an extreme C-arm angulation to achieve the "in profile" projection (RAO: 76.0 ± 5.8°, LAO: 122.7 ± 32.5°, CRA: 51.4 ± 16.0°, CAU: 57.0 ± 18.2°). Among prostheses with feasible assessment by both techniques, fluoroscopy and CT yielded similar opening and closing angles (intraclass correlation coefficient, 0.959-0.998) with lower irradiation with CT as compared with fluoroscopy (26.2[21.1-29.3] vs. 289[179-358] mGy, p < 0.001). While CT scan took 8.7 ± 0.5 s, fluoroscopy required 2.64 ± 1.56 min to achieve and record the "in profile" projection. Non-contrast CT provides a higher feasibility and a quicker evaluation of mechanical prosthetic valve leaflet motion with less irradiation than fluoroscopy, especially in mitral valve position.
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Affiliation(s)
- Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Cairo, Egypt.
- Cardiology Department, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Benjamin SR, Thankachen R, Mallampatti S, Kuruvila KT. Tetralogy of Fallot with absent pulmonary valve in an adult. Indian J Thorac Cardiovasc Surg 2023; 39:198-200. [PMID: 36785604 PMCID: PMC9918637 DOI: 10.1007/s12055-022-01407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 10/14/2022] Open
Abstract
Absent pulmonary valve syndrome (APVS) is seen in around 3 to 6% of tetralogy of Fallot (TOF) patients. They present in the neonatal or infantile period with respiratory compromise, cardiac failure, or cyanosis. They rarely survive into adulthood with only few reports published in literature so far. In this report, we present an adult patient with TOF and APVS, who underwent a successful repair with prosthetic valve implantation.
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Affiliation(s)
- Santhosh Regini Benjamin
- The Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Roy Thankachen
- The Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Sameer Mallampatti
- The Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
| | - Korah Thomas Kuruvila
- The Department of Cardiothoracic Surgery, The Christian Medical College (CMC Hospital), Vellore, 632004 Tamil Nadu India
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10
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Bansal A, Ananthasubramaniam K. Cardiovascular positron emission tomography: established and emerging role in cardiovascular diseases. Heart Fail Rev 2023; 28:387-405. [PMID: 36129644 DOI: 10.1007/s10741-022-10270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/26/2022]
Abstract
Cardiac positron emission tomography (PET) imaging has established themselves firmly as excellent and reliable functional imaging modalities in assessment of the spectrum of coronary artery disease. With the explosion of technology advances and the dream of flow quantification now a reality, the value of PET is now well realized. Cardiac PET has proved itself as precise imaging modality that provides functional imaging of the heart in addition to anatomical imaging. It has established itself as one of the best available techniques for evaluation of myocardial viability. Hybrid PET/computed tomography provides simultaneous integration of coronary anatomy and function with myocardial perfusion and metabolism, thereby improving characterization of the dysfunctional area and chronic coronary artery disease. The availability of quantitative myocardial blood flow evaluation with PET provides additional prognostic information and increases diagnostic accuracy in the management of patients with coronary artery disease. Hybrid imaging seems to hold immense potential in optimizing management of cardiovascular diseases and furthering clinical research.
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Affiliation(s)
- Amit Bansal
- UHS Wilson Medical Center, Johnson City, NY, USA
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Kiuchi N, Seino Y, Yamamoto M, Katagiri S, Takagi S, Nomura T, Suzuki T. Postoperative prosthetic mitral valve occlusion due to left atrial thrombus during veno-arterial extracorporeal membrane oxygenation: a case report. JA Clin Rep 2022; 8:93. [PMID: 36471130 PMCID: PMC9723070 DOI: 10.1186/s40981-022-00586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anticoagulation using heparin is generally used to prevent thrombus formation during mechanical circulatory support, such as veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, during the early period following cardiac surgery, anticoagulation becomes more difficult due to the greater risk of critical bleeding complications. CASE PRESENTATION A 71-year-old man presented with acute prosthetic valve occlusion caused by left atrial thrombus formation and bioprosthetic valve thrombosis during peripheral VA-ECMO following mitral valve replacement (MVR) despite continuous heparin administration and loading of antiplatelet agents. The VA-ECMO flow rate decreased 10 h after the intensive care unit (ICU) admission after MVR. Exploratory transesophageal echocardiography (TEE) examination revealed a left atrial thrombus, prosthetic valve obstruction by the thrombus, and an intrapericardial hematoma. CONCLUSIONS Intracardiac thrombus formation might occur during VA-ECMO despite appropriate anticoagulation and loading of antiplatelet agents. Exploratory TEE examination was helpful in the detection of intra-atrial thrombus formation after cardiac surgery and surgical decision-making.
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Affiliation(s)
- Naoto Kiuchi
- grid.260969.20000 0001 2149 8846Department of Anesthesiology, Nihon University School of Medicine, 30-1 Kamicho Oyaguchi, Itabashi-ku, Tokyo, Japan
| | - Yusuke Seino
- grid.410818.40000 0001 0720 6587Department of Intensive Care Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan ,grid.412764.20000 0004 0372 3116Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Japan
| | - Mai Yamamoto
- grid.260969.20000 0001 2149 8846Department of Anesthesiology, Nihon University School of Medicine, 30-1 Kamicho Oyaguchi, Itabashi-ku, Tokyo, Japan
| | - Seidai Katagiri
- grid.260969.20000 0001 2149 8846Department of Anesthesiology, Nihon University School of Medicine, 30-1 Kamicho Oyaguchi, Itabashi-ku, Tokyo, Japan
| | - Shunichi Takagi
- grid.260969.20000 0001 2149 8846Department of Anesthesiology, Nihon University School of Medicine, 30-1 Kamicho Oyaguchi, Itabashi-ku, Tokyo, Japan
| | - Takeshi Nomura
- grid.410818.40000 0001 0720 6587Department of Intensive Care Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Takahiro Suzuki
- grid.260969.20000 0001 2149 8846Department of Anesthesiology, Nihon University School of Medicine, 30-1 Kamicho Oyaguchi, Itabashi-ku, Tokyo, Japan
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12
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Takami Y, Hoshino N, Ishikawa H, Akita K, Sakurai Y, Amano K, Izawa H, Takagi Y. Thrombosed stuck mitral valve during advanced mechanical circulatory support for post-cardiotomy shock. J Cardiol Cases 2022; 25:282-284. [PMID: 35582073 PMCID: PMC9091497 DOI: 10.1016/j.jccase.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/10/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022] Open
Abstract
We report a case of mechanical prosthetic mitral valve thrombosis in a 52-year-old woman with previous diagnosis of dilated cardiomyopathy, who was supported with advanced mechanical circulatory support after urgent mechanical mitral valve replacement (MVR) and tricuspid annuloplasty. Difficult weaning from cardiopulmonary bypass needed support with veno-arterial extracorporeal membranous oxygenation and Impella (Abiomed Inc, Danvers, MA, USA), so-called ECPELLA. Temporary discontinuation of heparin and massive blood transfusion were necessary due to four times of reoperation for bleeding during ECPELLA support. Poor recovery of cardiac function needed escalation from ECPELLA to extracorporeal biventricular assist device (ex-BiVAD) using two centrifugal pumps on Day 12. After gradual decrease in the left ventricular assist device flow, transesophageal echocardiography and fluoroscopic images revealed the stuck leaflets of the mitral prosthesis. Therefore, the patient underwent re-MVR with a bioprosthesis on Day 18, followed by continued assistance with ex-BiVAD. The patient was finally weaned from ex-BiVAD on Day 28 and was transferred to the referral hospital for rehabilitation. She was alive in good general condition at 2-year follow-up. It is important to balance the effects of anticoagulation on advanced mechanical circulatory support with ECPELLA, against the side effects of bleeding, especially in post-cardiotomy patients with bleeding tendency. .
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Affiliation(s)
- Yoshiyuki Takami
- Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naoki Hoshino
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Ishikawa
- Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyotoshi Akita
- Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yusuke Sakurai
- Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kentaro Amano
- Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yasushi Takagi
- Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
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13
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Tayama E, Saku K, Anegawa T, Oryoji A, Negoto S. Prosthetic cardiac valves: history and review of cardiac prostheses clinically available in Japan. Surg Today 2022; 52:521-531. [PMID: 34435247 DOI: 10.1007/s00595-021-02361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Abstract
Recently developed prosthetic valves are reliable and essential for the treatment of valvular heart disease. The mechanical valve evolved remarkably following the introduction of pyrolite carbon material, which enabled the creation of a bileaflet form incorporated with a pivot mechanism. The improved durability of the biological valve is attributed mainly to the development of a tissue fixation process and anti-calcification treatments. However, optimal antithrombogenicity and durability have not yet been achieved for either prosthetic valve type. To select the most suitable prosthetic valve for each individual patient from among the many clinically available prosthetic valves, it is necessary to have a thorough understanding of the characteristics of each valve.
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Affiliation(s)
- Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Tomoyuki Anegawa
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Atsunobu Oryoji
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Shinya Negoto
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
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14
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Idhrees M, Karthikeyan, Velayudhan B. A giant ascending aortic aneurysm in a patient with previous aortic valve replacement. Indian J Thorac Cardiovasc Surg 2022; 38:102-104. [PMID: 34898887 PMCID: PMC8630217 DOI: 10.1007/s12055-021-01246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/03/2023] Open
Abstract
A 64-year male presented with dyspnoea for 2 months. At age of 40 years, he underwent aortic valve replacement. Presently, his echocardiogram reveals a normal functioning prosthetic valve, moderate left ventricular dysfunction and a large ascending aortic aneurysm. A computer tomography aortogram shows a large ascending aortic aneurysm (maximum diameter: 12.2×13.5cm, length: 11.9cm). He underwent prosthetic valve-sparing aortic root replacement with hemiarch replacement. To our best of knowledge, this is the largest reported ascending aortic aneurysm among the Asian population.
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Affiliation(s)
- Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Sciences (SIMS Hospital), Chennai, India 600 026
| | - Karthikeyan
- Department of Radiology, SRM Institutes for Medical Sciences (SIMS Hospital), Chennai, India
| | - Bashi Velayudhan
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Sciences (SIMS Hospital), Chennai, India 600 026
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15
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Quiring R, Burke V. Escherichia coli prosthetic valve endocarditis from a non-genitourinary source. IDCases 2021; 26:e01329. [PMID: 34815936 PMCID: PMC8592857 DOI: 10.1016/j.idcr.2021.e01329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022] Open
Abstract
E. coli is an infrequent cause of infective endocarditis due to is limited ability to adhere to heart valves. There is a notable increase in the share of total cases of E. coli infective endocarditis due to prosthetic valve infections. There is an increased recognition of non-genitourinary sources of E. coli prosthetic valve endocarditis. The overall mortality rate is declining for E. coli prosthetic valve endocarditis cases.
Escherichia coli (E. coli) is a rare cause of infective endocarditis due to its lack of traditional virulence factors that promote endocardial adherence. Previous case reports of E. coli infective endocarditis demonstrate specific risk factors to include advanced age over 70, female sex, diabetes, immunosuppression, and intravascular or cardiac devices. Antecedent genitourinary infection is the most common source. We present a case of a 55-year-old Honduran man with a recent bioprosthetic mitral valve replacement and tricuspid valve repair who presented with one month of subjective fevers, night sweats, anorexia, and significant weight loss. After extensive work-up, the patient was diagnosed with E. coli infective endocarditis secondary to E. coli growth in blood cultures and a transesophageal echocardiogram (TEE) revealing a vegetation on his prosthetic mitral valve. An indolent gastrointestinal source was suspected to be the source of infection with imaging only notable for mild periappendiceal stranding concerning for a possible site of antecedent inflammation. He was treated with a 6-week course of ceftriaxone and gentamicin inpatient and then discharged on trimethoprim-sulfamethoxazole suppressive therapy with serial echocardiographic follow-up given the persistent small vegetation on repeat echocardiogram. Our case report and review of ten recent cases of prosthetic valve endocarditis described in the literature illustrates several common features of the epidemiology, presentation, and management of E. coli prosthetic valve endocarditis including more commonly reported non-genitourinary sources of bacteremia, a trend towards more frequent surgical interventions, and a declining mortality rate.
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Key Words
- AI, Aortic insufficiency
- AMI, Acute myocardial infarction
- AMK, Amikacin
- AMP, Ampicillin
- AV, Aortic valve
- AVR, Aoritc valve replacement
- CEF, Cefalexin
- CIP, Ciprofloxacin
- CTX, Ceftriaxone
- E. coli, Escherichia coli
- EF, Ejection Fraction
- Escherichia coli
- GENT, Gentamicin
- GI, Gastrointestinal
- GU, Genitourinary
- HACEK, Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae
- IE, Infective Endocarditis
- IMP, Imipenem
- Infective endocarditis
- M, Man
- MR, Mitral regurgitation
- MV, Mitral valve
- MVR, Mitral valve replacement
- OFL, Oflofloxacin
- PVE, Prosthetic valve endocarditis
- Prosthetic valve
- SD, Standard deviation
- SUL, Sulbactam
- TV, Tricuspid valve
- UTI, Urinary tract infections
- Unk, Unknown
- W, Woman
- WMA, Wall motion abnormalities Infective endocarditis
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Affiliation(s)
- Robert Quiring
- Louisiana State University Health Sciences Center School of Medicine, 2020 Gravier Street, New Orleans, LA 70112, USA
| | - Victoria Burke
- Louisiana State University Health Sciences Center School of Medicine, Department of Infectious Disease, 1542 Tulane Avenue Suite 331A, Box T4M-2, New Orleans, LA 70112, USA
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16
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Alabdely M, Alazmah M, Alamro B, Alabdaljabar MS, Halim M. A relapsed Pseudomonas stutzeri prosthetic valve endocarditis: a case report and review of the literature. J Med Case Rep 2021; 15:507. [PMID: 34627386 PMCID: PMC8502308 DOI: 10.1186/s13256-021-03084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pseudomonas stutzeri is a nonfluorescent denitrifying bacterium widely distributed in the environment, and it has also been isolated as an opportunistic pathogen from humans. It is a Gram-negative bacterium and a common inhabitant of soil and water. CASE PRESENTATION We report the case of a 51-year-old arab gentleman who has systemic lupus erythematous complicated by lupus nephritis and underwent renal transplantation twice. He underwent mitral valve replacement and 4 years later was diagnosed with prosthetic valve endocarditis caused by Pseudomonas stutzeri. CONCLUSIONS Literature review was conducted and revealed that this pathogen may be of a particular medical relevance in immunocompromised patients. Our case proves that early infection and relapse despite optimal antibiotics course are possible outcomes of Pseudomonas stutzeri endocarditis. To the best of our knowledge, this is the second case of fulminant early prosthetic valve endocarditis occurring only 1 month post-cardiac surgery with relapse despite a complete antibiotics course.
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Affiliation(s)
- Mayyadah Alabdely
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Mohammed Alazmah
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Bandar Alamro
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamad S Alabdaljabar
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Magid Halim
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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17
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Taamallah K, Hammami F, Gharsallah H, Koubaa M, Ben Jemaa M, Fehri W. Brucella Prosthetic Valve Endocarditis: A Systematic Review. J Saudi Heart Assoc 2021; 33:198-212. [PMID: 34447668 PMCID: PMC8366765 DOI: 10.37616/2212-5043.1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Brucella prosthetic valve endocarditis is a rare but a life-threatening complication of brucellosis. It remains a diagnostic challenge. Optimal treatment of Brucella prosthetic valve endocarditis is debated. Available data is limited to case reports or small case series. The purpose of this study was to systematically review all published cases of Brucella prosthetic valve endocarditis in the literature. Method A systematic review of PubMed database, Google, Google Scholar, and Scopus (From January 1974 to the present) for studies providing epidemiological, clinical and microbiological data as well as data on treatment and outcomes of Brucella prosthetic valve endocarditis was performed. Results A total of 51 reported cases were reviewed. Brucella melitensis (45%) and Brucella abortus (11.7%) were the most frequently isolated species. Most common type of prosthesis valve was mechanical prothesis (84.3%) and ten patients had double valve prosthesis (19.6%). Fever and dyspnea were present in 100% and 37.2% of the cases, respectively. The diagnosis was set with echocardiographic finding in 30 cases (93.7%), which revealed vegetation in 27 cases (84.3%). Most used antibiotics were rifampicin, doxycycline and aminoglycoside or cotrimoxazole. No deaths were noted in patients treated by combined medical and surgical treatment, but mortality was noted in 27.7% of the cases treated by antibiotics alone (p = 0.006). Conclusion This systematic review highlights diagnostic challenges and demonstrates that surgery improved outcome by reducing mortality in patients treated with the combined surgical and medical treatment option. Brucellosis should be considered in the differential diagnosis of prosthetic valve endocarditis in patients residing in or traveling to areas of endemicity.
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Affiliation(s)
- Karima Taamallah
- Cardiology Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Fatma Hammami
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Hédi Gharsallah
- Intensive Care Unit Department, Military Hospital of Tunis, Tunis, Tunisia
| | - Makram Koubaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Mounir Ben Jemaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Wafa Fehri
- Cardiology Department, Military Hospital of Tunis, Tunis, Tunisia
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18
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Ösken A, Ünal Dayı Ş, Özcan KS, Keskin M, Kemaloğlu Öz T, Poyraz E, Gürkan U, Akgöz H, Çam N. Speckle tracking echocardiography in severe patient-prosthesis mismatch. Herz 2021; 46:375-380. [PMID: 33687479 DOI: 10.1007/s00059-021-05031-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/06/2020] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although aortic valve replacement (AVR) when successfully performed boasts low mortality rates in selected patients, prosthesis-patient mismatch (PPM) can be found in the majority of these individuals. Limited research is available supporting the benefit of two-dimensional speckle tracking echocardiography (2D-STE) in patients with severe PPM. This study sought to assess myocardial strain using 2D-STE to determine the relationship between subclinical left ventricular (LV) dysfunction and aortic PPM in patients undergoing AVR with preserved LV ejection fraction. MATERIAL AND METHODS We retrospectively examined all consecutive patients with isolated AVR who presented to our center from 2005 to 2018. The data of 1086 patients were analyzed. Severe PPM was defined as an indexed effective orifice area of 0.65 cm2/m2 or less. As a result of the detailed assessment, 54 patients meeting the eligibility criteria were included in the study. Baseline data were collected and compared between the two groups of patients with severe PPM (n = 27) and those with normofunctional aortic prosthesis valve as a control group (n = 27). All patients underwent baseline echocardiography. Global longitudinal strain (GLS) and global circumferential strain (GCS) were evaluated by 2D-STE. RESULTS When compared with controls, patients with severe PPM had significantly decreased GLS (18.6 ± 2.9 vs. 21.4 ± 2.1; p < 0.01) and GCS (17.2 ± 3.6 vs. 21.7 ± 2.1; p < 0.01) values. CONCLUSION In addition to standard clinical and echocardiographic parameters, GLS and GCS suggest subclinical dysfunction and have incremental value in patients with severe PPM.
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Affiliation(s)
- Altuğ Ösken
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey. .,Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tibbiye cad. 13, Haydarpasa/Istanbul/Turkey, 34668, İstanbul, Turkey.
| | - Şennur Ünal Dayı
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kazım Serhan Özcan
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Tuğba Kemaloğlu Öz
- Department of Cardiology, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Esra Poyraz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Gürkan
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Haldun Akgöz
- Department of Cardiology, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Neşe Çam
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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19
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Jover E, Fagnano M, Cathery W, Slater S, Pisanu E, Gu Y, Avolio E, Bruno D, Baz-Lopez D, Faulkner A, Carrabba M, Angelini G, Madeddu P. Human adventitial pericytes provide a unique source of anti-calcific cells for cardiac valve engineering: Role of microRNA-132-3p. Free Radic Biol Med 2021; 165:137-151. [PMID: 33497799 DOI: 10.1016/j.freeradbiomed.2021.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Abstract
AIMS Tissue engineering aims to improve the longevity of prosthetic heart valves. However, the optimal cell source has yet to be determined. This study aimed to establish a mechanistic rationale supporting the suitability of human adventitial pericytes (APCs). METHODS AND RESULTS APCs were immunomagnetically sorted from saphenous vein leftovers of patients undergoing coronary artery bypass graft surgery and antigenically characterized for purity. Unlike bone marrow-derived mesenchymal stromal cells (BM-MSCs), APCs were resistant to calcification and delayed osteochondrogenic differentiation upon high phosphate (HP) induction, as assessed by cytochemistry and expression of osteogenic markers. Moreover, glycolysis was activated during osteogenic differentiation of BM-MSCs, whereas APCs showed no increase in glycolysis upon HP challenge. The microRNA-132-3p (miR-132), a known inhibitor of osteogenesis, was found constitutively expressed by APCs and upregulated following HP stimulation. The anti-calcific role of miR-132 was further corroborated by in silico analysis, luciferase assays in HEK293 cells, and transfecting APCs with miR-132 agomir and antagomir, followed by assessment of osteochondrogenic markers. Interestingly, treatment of swine cardiac valves with APC-derived conditioned medium conferred them with resistance to HP-induced osteogenesis, with this effect being negated when using the medium of miR-132-silenced APCs. Additionally, as an initial bioengineering step, APCs were successfully engrafted onto pericardium sheets, where they proliferated and promoted aortic endothelial cells attraction, a process mimicking valve endothelialization. CONCLUSIONS Human APCs are resistant to calcification compared with BM-MSCs and convey the anti-calcific phenotype to heart valves through miR-132. These findings may open new important avenues for prosthetic valve cellularization.
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Affiliation(s)
- Eva Jover
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom; Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.
| | - Marco Fagnano
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - William Cathery
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Sadie Slater
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Emanuela Pisanu
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Yue Gu
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Elisa Avolio
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Domenico Bruno
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Daniel Baz-Lopez
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Ashton Faulkner
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom; School of Biochemistry, University of Bristol, UK
| | - Michele Carrabba
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gianni Angelini
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Paolo Madeddu
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
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20
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Kiran GR, Chandrasekhar P, Mohammad Ali S. Clinical outcomes of patients with mitral prosthetic valve obstructive thrombosis treated with streptokinase or tenecteplase. Indian Heart J 2021; 73:365-8. [PMID: 34154758 DOI: 10.1016/j.ihj.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/04/2021] [Accepted: 02/14/2021] [Indexed: 11/23/2022] Open
Abstract
Agent of choice for thrombolytic therapy (TT) in prosthetic valve thrombosis (PVT) is unknown. 84 mitral obstructive-PVT episodes treated with TT (43: Tenecteplase; 41: Streptokinase) were included in this prospective study. The incidence of primary end-point (CCS: complete clinical success, defined as complete or partial hemodynamic success with no complications or surgery) was 84.5% with recurrent PVT as a sole predictor. Bleeding and embolic manifestations were noted in 8.3% and 4.7% of episodes respectively. Tenecteplase use was associated with lower complication rate and a mitral EOA of <0.74 cm2 at presentation predicts the need for extended thrombolysis (accuracy, 78.6%).
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21
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Trombara F, Bergonti M, Toscano O, Dalla Cia A, Assanelli EM, Polvani G, Bartorelli AL. Bloody tricuspid stenosis: case report of an uncommon cause of haemoptysis. Eur Heart J Case Rep 2021; 5:ytaa537. [PMID: 33598616 PMCID: PMC7873793 DOI: 10.1093/ehjcr/ytaa537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/18/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022]
Abstract
Background Haemoptysis is usually caused by pulmonary and infectious diseases. In few cases, it has a cardiac cause, such as pulmonary embolism or mitral valve stenosis. Haemoptysis may be an uncommon symptom of prosthetic valve dysfunction, being related to elevated right heart pressures. Case summary A 22-year-old woman from sub-Saharan Africa known for a triple valve replacement was hospitalized for dyspnoea and haemoptysis. A careful clinical evaluation excluded the most common causes of haemoptysis. Transthoracic echocardiogram showed normal biventricular function, normally functioning mechanical prosthetic aortic and mitral valves, and the biological tricuspid prosthesis showed an increased transvalvular gradient. Contrast chest computed tomography scan excluded pulmonary embolism and mechanical valve obstruction, but revealed marked systemic venous hypertension. Right heart catheterization confirmed increased right heart pressures and severe bioprosthetic tricuspid valve stenosis. The patient underwent a successful percutaneous tricuspid valve-in-valve replacement, with complete resolution of symptoms. Discussion The increase in venous pressures due to bioprosthetic tricuspid stenosis caused veno-venous shunts: blood from the lower body was drained into the superior vena cava via the azygos vein. Increased pressure in the latter affected pressure in bronchial veins and arteries, leading to haemoptysis. Cardiac surgical reinterventions are associated with worse outcomes and higher mortality rates. Management of a degenerated prosthetic tricuspid valve is challenging and requires a multidisciplinary assessment. Transcatheter tricuspid valve replacement is becoming a feasible option in patients with prosthetic dysfunction. Based on evidence to date, tricuspid valve-in-valve replacement appears to be a safe, feasible, and effective alternative in selected young patients.
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Affiliation(s)
- Filippo Trombara
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milan, Italy.,University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Marco Bergonti
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milan, Italy.,University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Olga Toscano
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milan, Italy.,University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | | | | | - Gianluca Polvani
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milan, Italy.,University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milan, Italy.,University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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22
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Ortiz Garcia JG, Nathan S, Brorson JR. Neurologic complications of implantable devices. Handb Clin Neurol 2021; 177:211-220. [PMID: 33632440 DOI: 10.1016/b978-0-12-819814-8.00019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Technologies for repairing cardiac structures or sustaining cardiac function with implantable devices have helped patients with an ever-expanding array of cardiac conditions. Patients are surviving and thriving with cardiac conditions that would formerly have been disabling or fatal. With the implantation of devices in the heart, however, comes the inevitable risk of neurological complications. This chapter focuses on devices implanted in the chambers or valves of the heart itself, including prosthetic heart valves, closure devices for patent foramen ovale, atrial appendage occluder devices, short-term implantable circulatory assist devices, and long-term ventricular assist devices, but excluding coronary artery stents or extracardiac devices. Further, it considers the procedural and postprocedural risks of the devices, leaving the discussion of clinical effectiveness of the devices to other chapters of this book.
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Affiliation(s)
- Jorge G Ortiz Garcia
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sandeep Nathan
- Section of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, IL, United States
| | - James R Brorson
- Department of Neurology, University of Chicago, Chicago, IL, United States.
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23
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Ulloa JH, Glickman M. Human trial using the novel bioprosthetic VenoValve in patients with chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord 2020; 9:938-944. [PMID: 33221526 DOI: 10.1016/j.jvsv.2020.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic venous insufficiency (CVI) is a disease characterized by failure of the venous valves that allow blood from the lower limbs to return to the heart. The more severe types of CVI (C4b-C6 disease) significantly influence patients' quality of life (QOL). The treatment options for CVI of the deep system are limited. The present study is the first-in-human study using a prosthetic venous valve, VenoValve, to initially evaluate patient outcomes. We evaluated the feasibility, initial safety, and performance outcomes of the VenoValve. METHODS Ten patients with C5-C6 CVI of the deep venous system secondary to postthrombotic syndrome had had a VenoValve surgically implanted into the femoral vein in Bogota, Colombia, under approval of the local ethics committee and Colombian National Food and Drug Surveillance Institute, national health care regulatory body, or the Colombian National Food and Drug Surveillance Agency. Follow-up examinations were conducted postoperatively at 2 and 14 days and then every 30 days for 6 months. The results of the assessments for adverse events, reflux time, disease severity (venous clinical severity scores), pain scores (visual analog scale), and QOL (VEINES-QOL/Sym [venous insufficiency epidemiological and economic study-QOL/symptoms] questionnaire) were documented. RESULTS Ten patients underwent successful implantation of the VenoValve into the femoral vein as outpatients (100% technical success rate). Of the 10 patients, 9 had undergone VenoValve placement under regional anesthesia and 1 under local anesthesia. Six patients had required bovine patch angioplasty of the vein. Four adverse events occurred, including one case of hematoma at the incision site that was aspirated, 2 cases of superficial wound infection in C6 patients treated with antibiotics, and 1 case of a bleeding complication due to warfarin anticoagulation. One patient's VenoValve had thrombosed at 5 months due to nontherapeutic anticoagulation. Improvements in all 5 patients who had reached the 6-month follow-up mark with the VenoValve were demonstrated during the study period by decreases in the venous clinical severity scores (61% decrease from baseline), visual analog scale for pain scores (57% decrease), and reflux time (40% decrease) and a statistically significant improvement in the VEINES-QOL/Sym questionnaire. The patient with the occluded VenoValve had experienced improvements in all areas except for the reflux time. The latter patient had shown improvement because her ulcer had nearly healed before the occurrence of the thrombosis. CONCLUSIONS The early results of the first-in-human trial using the VenoValve appear promising, with improvements in clinical outcomes and QOL. The VenoValve is the first prosthetic valve that has shown success at 6 months of follow-up. These findings offer insight for creating better outcomes for these highly disabled patients.
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Affiliation(s)
- Jorge H Ulloa
- Department of Surgery, Fundacion Santa Fe de Bogota, Universidad de Los Andes, Bogota, Colombia.
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24
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Kalçık M, Özkan M, Gündüz S, Gürsoy MO, Yesin M, Bayam E, Güner A, Kalkan S, Karakoyun S, Tanboğa Hİ. Normal reference values for mechanical mitral prosthetic valve inner diameters and areas assessed by two-dimensional and real-time three-dimensional transesophageal echocardiography. Int J Cardiovasc Imaging 2020; 37:547-557. [PMID: 33011903 DOI: 10.1007/s10554-020-02039-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
It was previously observed that two dimensional (2D) Doppler derived and real-time three-dimensional (RT-3D) directly measured valve areas were smaller than reported manufacturer sizes. It may be helpful to obtain the ranges of inner diameters (IDs) and the geometric orifice area (GOA) during evaluation of prosthetic mitral valves. In this study, we aimed to provide reference dimensional parameters of bileflet mitral mechanical prosthetic valves. Patients with recent mitral valve replacement were examined by 2D and RT-3D transesophageal echocardiography (TEE) in the early postoperative period when the presence of pannus overgrowth was unlikely. Measurements of 2D IDs, 3D hinge to hinge (HHD) and edge to edge diameters (EED) and 3D GOA were obtained and compared with reported manufacturer sizes and areas. This study enrolled 126 patients with mitral prosthetic valves (38 ATS, 42 Carbomedics, 46 St. Jude Medical, all bileaflet). The measured 2D and 3D IDs and GOA were significantly smaller than reported manufacturer sizes in the majority of the valve sizes. This RT-3D TEE-guided study provides ranges of reference values for directly measured IDs and GOA of the three most commonly used mechanical mitral prosthetic valve types for the first time in a relatively large series.
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Affiliation(s)
- Macit Kalçık
- Faculty of Medicine, Department of Cardiology, Hitit University, Buharaevler Mah. Buhara 25. Sok. No:1 /A Daire:22, Çorum, Turkey.
| | - Mehmet Özkan
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.,Division of Health Sciences, Ardahan University, Ardahan, Turkey
| | - Sabahattin Gündüz
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, Izmir Katip Çelebi University, Atatürk Training and Research Hospital, Izmir, Turkey
| | - Mahmut Yesin
- Faculty of Medicine, Department of Cardiology, Kars Kafkas University, Kars, Turkey
| | - Emrah Bayam
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semih Kalkan
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Karakoyun
- Faculty of Medicine, Department of Cardiology, Kars Kafkas University, Kars, Turkey
| | - Halil İbrahim Tanboğa
- Faculty of Medicine, Department of Cardiology, Nisantasi University, Istanbul, Turkey
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25
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Ozkaramanli Gur D, Baykiz D, Gur O, Alpsoy S, Akyuz A, Gurkan S. Evaluation of mechanical prosthetic valves: the role of three dimensional echocardiography in calculating effective orifice area in obese vs non-obese individuals. Int J Cardiovasc Imaging 2021; 37:215-27. [PMID: 32833185 DOI: 10.1007/s10554-020-01978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
Calculation of effective orifice area (EOA) is crucial for the evaluation of prosthetic valve (PV) function and there is lack of data on the best method, particularly in obese patients, in whom two-dimensional (2D) transthoracic echocardiography (TTE) is cumbersome. We sought to compare two methods of calculating EOA through Continuity equation; one using standard 2D-TTE and other three-dimensional (3D) stoke volume (SV), in patients with bileaflet mechanical PV stratified by body mass index (BMI). On conventional TTE, SV mas measured using standard 2D derived data and 3D derived SV in 38 aortic and 62 mitral PV patients who were referred for further evaluation for mild/moderate symptoms of dyspnea. Patients were categorized with regard to transprosthetic flow into 'normal-flow' and 'high-flow' groups and several echocardiographic data including 2D and 3D EOA were compared. Rates of obesity (BMI ≥ 30) were similar within high and normal flow groups of mitral and aortic PV patients. Correlation and agreement of 2D and 3D EOA was sought in patients with and without obesity. After identifying patients with possible severe obstruction, ROC analysis was carried out to identify whether 2D and 3D derived EOA could discriminate those with obstruction. There was good correlation and agreement between two methods in patients without obesity in both mitral and aortic PV. In obese individuals, however, there was no correlation between 2D and 3D EOA; in whom echocardiographic criteria showing severe obstruction revealed that 3D EOA measurements were more accurate. ROC analysis supported that 3D EOA performs better to identify patients with obstructive characteristics. In patients with bileaflet PV, measurement of EAO by 3D derived SV yields more accurate results irrespective of BMI.
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26
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Rodriguez-Nava G, Mohamed A, Yanez-Bello MA, Trelles-Garcia DP. Advances in medicine and positive natural selection: Prosthetic valve endocarditis due to biofilm producer Micrococcus luteus. IDCases 2020; 20:e00743. [PMID: 32195120 DOI: 10.1016/j.idcr.2020.e00743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022] Open
Abstract
Over the past years there has been a considerable increase in the use of aortic bioprostheses for treating aortic valve disease. With the increasing use of implanted medical devices, the incidence of prosthetic valve endocarditis has also increased. This is accompanied by a shift in the microbiology of infectious endocarditis. Micrococcus species are usually regarded as contaminants from skin and mucous membranes that rarely cause infectious diseases, however, they have the capacity to create biofilms from prosthetic materials and hence, to cause disease. We report the case of a 54-year-old woman who developed native valve infective endocarditis due to Micrococcus luteus. To our knowledge, only 18 cases of M. luteus prosthetic valve endocarditis have been described, none in the English literature.
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27
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Moussa Y, Moussa M, Chakra MA. Enterococcal prosthetic valve endocarditis secondary to transurethral prostatic resection. IDCases 2020; 19:e00708. [PMID: 32055442 PMCID: PMC7005459 DOI: 10.1016/j.idcr.2020.e00708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
Prosthetic valve endocarditis (PVE) is a catastrophic complication of cardiac valve replacement, associated with high mortality rates. Staphylococci (both Staphylococcus aureus and coagulase-negative Staphylococcui) are the most common cause of PVE. Diagnosis may often be difficult because of its complications and extracardiac manifestations. Positive blood and valve cultures are one of the most important diagnostic criteria for IE. Transesophageal echography should be performed without delay in all patients suspected to have PVE. As for treatment, according to the guidelines sensitive antimicrobials should be administered for 6 weeks. Surgery is recommended in case of PVE complicated by heart failure, severe prosthetic dysfunction, abscess or persistent fever. We present a case of PVE after transurethral resection of the prostate in a 63-year-old male patient with a history of mitral valve replacement. The patient was treated by appropriate antimicrobials for 6 weeks and recovered completely.
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Affiliation(s)
- Yasmin Moussa
- Clinic of Dermatology, Dr. Brinkmann, Schult & Samimi-Fard, Barbarastraße 15, 45964 Gladbeck, Germany
| | - Mohamed Moussa
- Head of Urology Department, Zahra Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Mohamed Abou Chakra
- Faculty of Medicine, Department of Urology, Lebanese University, Beirut, Lebanon
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28
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Russo A, Peghin M, Givone F, Ingani M, Graziano E, Bassetti M. Daptomycin-containing regimens for treatment of Gram-positive endocarditis. Int J Antimicrob Agents 2019; 54:423-434. [PMID: 31400470 DOI: 10.1016/j.ijantimicag.2019.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Infective endocarditis (IE) is a severe infection, and a leading cause of mortality and morbidity. Due to its favourable microbiological and pharmacological characteristics, daptomycin is routinely used in clinical practice for treating IE. METHODS A prospective study was conducted at a large tertiary-care hospital in Italy over an 8-year period (January 2010-January 2018) on all patients with native-valve endocarditis (NVE) or prosthetic-valve endocarditis (PVE) caused by Gram-positive bacteria. Patients with NVE and PVE treated with regimens that included daptomycin at different dosages (daptomycin-containing regimens, DCR) were compared with those treated with non-DCR. Primary endpoints of the study were 30-day mortality and clinical treatment failure. RESULTS During the study period, 327 patients with Gram-positive NVE (n = 224, 68.8%) or PVE (n = 103, 31.2%) were analysed. Eighty-four (37.5%) NVE patients were treated with daptomycin, alone (59.9%) or with other antimicrobials. Most PVE patients (n = 61, 58%) were treated with a DCR, which always consisted of daptomycin plus other drugs. Among PVE patients, treatment with a DCR was associated with lower 30-day mortality than treatment with a non-DCR (6.5% vs. 38%, P < 0.001). Among NVE patients treated with DCRs, risk factors for 30-day mortality were streptococcal infections, persistent bacteraemia, and standard-dose (4-6 mg/kg) rather than high-dose daptomycin therapy. Overall, surgical treatment of IE and DCR were associated with clinical success and 30-day survival. CONCLUSIONS Compared with non-DCRs, using single-drug or multiple-drug DCRs is associated with lower 30-day mortality in PVE, but with higher 30-day mortality in NVE at approved doses and in a subgroup of streptococcal IE.
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Affiliation(s)
- Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Maddalena Peghin
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Filippo Givone
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Martina Ingani
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Elena Graziano
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
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29
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Habu M, Kawasaki T, Yamano M, Kamitani T. Onset of new diastolic murmur as a sign of bio prosthetic valve dysfunction: A case report. J Cardiol Cases 2019; 19:157-60. [PMID: 31073348 DOI: 10.1016/j.jccase.2018.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/04/2018] [Accepted: 12/25/2018] [Indexed: 11/21/2022] Open
Abstract
The diagnosis of prosthetic valve dysfunction remains challenging because visualization is limited due to artifacts on echocardiography. We herein report a case of bioprosthetic valve dysfunction, in which cardiac auscultation was useful as an initial clue to the diagnosis. An 81-year-old man, who had undergone bioprosthetic aortic valve replacement due to aortic stenosis 10 years earlier, presented to the emergency department with chest discomfort. Cardiac auscultation revealed a newly developed diastolic murmur, although no diastolic murmurs were previously detected on auscultation or phonocardiography. There were no notable changes in electrocardiography, chest radiograph, laboratory tests, or echocardiography except for trivial aortic regurgitation. His hemodynamic status progressively deteriorated due to prosthetic valve dysfunction, which was later confirmed on echocardiography, and aortic valve re-replacement was semi-urgently performed with success. The diastolic murmurs disappeared after surgery. <Learning objective: This case once again highlights the importance of cardiac auscultation for diagnosis even with the use of advanced imaging technology.>.
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30
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Gagneux-Brunon A, Pouvaret A, Maillard N, Berthelot P, Lutz MF, Cazorla C, Tulane C, Fuzellier JF, Verhoeven PO, Frésard A, Duval X, Lucht F, Botelho-Nevers E. Acute kidney injury in infective endocarditis: A retrospective analysis. Med Mal Infect 2019; 49:527-533. [PMID: 30955847 DOI: 10.1016/j.medmal.2019.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 07/26/2018] [Accepted: 03/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with high case fatality in infective endocarditis (IE), but epidemiological data on the frequency of AKI during IE is scarce. We aimed to describe the frequency and risk factors for AKI during the course of IE using Kidney Disease: Improving Global Outcomes consensual criteria. METHODS Using the French hospital discharge database (French acronym PMSI), we retrospectively reviewed the charts of 112 patients presenting with a first episode of probable or definite IE between January 2010 and May 2015. RESULTS Seventy-seven patients (68.8%) developed AKI. In univariate analysis, risk factors for AKI were cardiac surgery for IE (n=29, 37.7% vs. n=4, 1.4%, P<0.0005), cardiac failure (n=29, 36.7% vs. n=1, 2.9%, P<0.0005), diabetes mellitus (n=14, 18.2% vs. n=1, 0.9%, P=0.034), and prosthetic valve IEs (n=24, 31.2% vs. n=4, 11.4%). No differences were observed for gentamicin exposure (n=57, 64% vs. n=32, 86.5%, P=0.286). Prosthetic valve IE, cardiac failure, and vancomycin exposure were independently associated with AKI with respective odds ratio of 5.49 (95% CI 1.92-17.9), 4.37 (95% CI 4.37-465.7), and 1.084 (1.084-16.2). Mean length of hospital stay was significantly longer in patients presenting with AKI than in controls (respectively 52.4±22.1 days vs. 39.6±12.6, P<0.005). CONCLUSION AKI is very frequent during IE, particularly in patients with prosthetic valve IE, cardiac failure, and those receiving vancomycin.
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Affiliation(s)
- A Gagneux-Brunon
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France.
| | - A Pouvaret
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - N Maillard
- EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; Department of Nephrology, Dialysis, Transplantation and Hypertension, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - P Berthelot
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; Laboratory of Microbiology and Hygiene, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; Infection Control Unit, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - M F Lutz
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France
| | - C Cazorla
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France
| | - C Tulane
- Department of Cardiology, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - J F Fuzellier
- Department of Cardiac Surgery, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - P O Verhoeven
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; Laboratory of Microbiology and Hygiene, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - A Frésard
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France
| | - X Duval
- Inserm 1425, Inserm U1137, Centre d'Investigation Clinique, Université Paris-Diderot, Hôpital Bichat, AP-HP, 75018 Paris, France
| | - F Lucht
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France
| | - E Botelho-Nevers
- Department of Infectious Diseases, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; EA 3064, GIMAP, Jean-Monnet University, University of Lyon, 42000 Saint-Etienne, France; CIC 1408 Inserm, 42055 Saint-Etienne, France
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31
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Ivanovic B, Trifunovic D, Matic S, Petrovic J, Sacic D, Tadic M. Prosthetic valve endocarditis - A trouble or a challenge? J Cardiol 2018; 73:126-133. [PMID: 30389305 DOI: 10.1016/j.jjcc.2018.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
Abstract
Prosthetic valve endocarditis (PVE) represents a rare and serious complication of valve replacement associated with high morbidity and mortality, which significantly differs from native valve endocarditis (NVE). There are two major problems: establishing diagnosis and treatment of PVE. Diagnosis in PVE is challenging and often requires several imaging methods besides standard microbiological analyzes. Transesophageal echocardiographic examination remains the widely used imaging technique in PVE diagnosis, but additional techniques such as computed tomography (CT) and 18F-fluodeoxyglucose positron emission tomography/CT are often necessary. Persistent fever, embolic complications, valve dehiscence, intracardial abscess, heart failure, as well as staphylococcal and fungal PVE require surgical treatment to avoid lethal outcome. The introduction of transcatheter valve implantations and devices significantly complicated the approach - diagnostic and therapeutic to PVE patients. Despite constantly increasing knowledge regarding pathogenesis and treatment of PVE, the optimal therapy remains a matter of debate. Additional studies are necessary to define therapeutic strategies for this potentially fatal complication.
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Affiliation(s)
| | | | - Snezana Matic
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - Jelena Petrovic
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - Dalila Sacic
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - Marijana Tadic
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany.
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32
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Halabi Z, Mocadie M, El Zein S, Kanj SS. Pseudomonas stutzeri prosthetic valve endocarditis: A case report and review of the literature. J Infect Public Health 2018; 12:434-437. [PMID: 30049610 DOI: 10.1016/j.jiph.2018.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/01/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022] Open
Abstract
We report a case of Pseudomonas stutzeri endocarditis in Lebanon. The patient had a recent history of prosthetic aortic valve replacement and presented to the emergency department with fever and chills. Transesophageal echocardiography confirmed the presence of a vegetation on the prosthetic valve and blood cultures yielded P. stutzeri. The patient was treated with surgery and antibiotics but deteriorated and passed away four days after admission. To our knowledge, this is the fifth case of P. stutzeri endocarditis reported in the literature, and the first case with early presentation and mortality.
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Affiliation(s)
- Zeina Halabi
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Michele Mocadie
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saeed El Zein
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.
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33
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Benatta NF, Batouche DD, Djazouli MA. [Anticoagulation's problematic during pregnancy in carriers of mechanical heart prosthesis]. Ann Cardiol Angeiol (Paris) 2018; 67:270-273. [PMID: 29909951 DOI: 10.1016/j.ancard.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/06/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The heart prosthesis pregnant women are becoming more frequent due to the persistence of rheumatic fever in the country sends developments. OBJECTIVE To propose management strategies from preconception to pregnancy and postpartum. MATERIALS AND METHODS Prospective study from 2009-2014 about parturientes followed in cardiology and maternity on center Hospitalo University Oran. RESULTS Thirty patients were followed, ejection fraction was equal to 60% in 29 cases. A single case of stenosis of the aortic prosthesis. Sixteen received low molecular weight heparins (LMWH) enoxaparine kind between 6 and 12 weeks, 13 received l'acenocoumarol (AVK) in the first quarter. One patient had been insufficient dose enoxaparine to 1/day and complicate ischemic stroke, abortion of a fetus of 16 weeks malformed in a mother who received acenoucoumarol (AVK) in the first quarter. Maternal mortality was null. DISCUSSION LMWHs were 100% effective in sufficient doses, the VKA and LMWH relay period was critical and should be done in a hospital setting. CONCLUSION Wearing a prosthetic valve is compatible with supervised pregnancy LMWHs were 100% effective, provided they were used in sufficient doses between 6-12 weeks of amenorrhea.
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Bade AS, Shaikh SSA, Khemani H, Singh G, Bansal NO. Thrombolysis Is an Effective and Safe Therapy in Stuck Mitral Valves With Delayed Presentation as Well as Hemodynamically Unstable Patients: A Single Centre Study. Cardiol Res 2018; 9:161-164. [PMID: 29904451 PMCID: PMC5997445 DOI: 10.14740/cr708w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background Thrombosis is a complication of prosthetic valves on oral anticoagulants which is associated with significant morbidity and mortality. A re-operation carries a substantial risk, with mortality rate from 10% to 15% in selected series, which may be 2- or 3-folds higher in critically ill patients. This study conducted in a tertiary care cardiology unit aimed to evaluate the effectiveness and safety of thrombolytic therapy in stuck mitral bileaflet heart valves. Methods As a prospective observational study, clinical symptoms and fluoroscopy were the mainstay in diagnosis of stuck mitral valve. Gradient across the valve by transthoracic echocardiography was used to monitor the therapy every 6 h. Fall of mean gradient more than 50% was considered as successful thrombolysis. And final results were again checked by fluoroscopy with documentation of improved leaflet movement. Results Totally we studied 34 patients. Patients receiving thrombolytic therapy with streptokinase achieved an overall 91.2% freedom from a repeat operation or major complications, a large subcutaneous hematoma occurred in one ( 2.9%), reoperation required in two due to failure of treatment (5.9%), allergic reaction in one (2.9%), one patient developed transient neurologic dysfunction (2.9%) and one patient died during therapy due to refractory cardiogenic shock(2.9%). All patients including those with delayed presentation (> 14 days) and hemodynamically unstable patients had good results similar to those who presented within 14 days and hemodynamically stable. Mortality was higher in unstable patients and reoperation was higher with delayed presentation. Conclusions Thrombolysis with streptokinase is highly successful and safe therapy in hemodynamically stable as well as unstable patients, or those with early or delayed presentation with stuck bileaflet mitral valves, especially in centers where round the clock cardiothoracic surgery backup is not available.
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Affiliation(s)
- Arun Shivajirao Bade
- Department of Cardiology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai India
| | | | - Hemant Khemani
- Department of Cardiology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai India
| | - Gurkirat Singh
- Department of Cardiology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai India
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Rotman OM, Kovarovic B, Sadasivan C, Gruberg L, Lieber BB, Bluestein D. Realistic Vascular Replicator for TAVR Procedures. Cardiovasc Eng Technol 2018; 9:339-350. [PMID: 29654509 DOI: 10.1007/s13239-018-0356-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an over-the-wire procedure for treatment of severe aortic stenosis (AS). TAVR valves are conventionally tested using simplified left heart simulators (LHS). While those provide baseline performance reliably, their aortic root geometries are far from the anatomical in situ configuration, often overestimating the valves' performance. We report on a novel benchtop patient-specific arterial replicator designed for testing TAVR and training interventional cardiologists in the procedure. The Replicator is an accurate model of the human upper body vasculature for training physicians in percutaneous interventions. It comprises of fully-automated Windkessel mechanism to recreate physiological flow conditions. Calcified aortic valve models were fabricated and incorporated into the Replicator, then tested for performing TAVR procedure by an experienced cardiologist using the Inovare valve. EOA, pressures, and angiograms were monitored pre- and post-TAVR. A St. Jude mechanical valve was tested as a reference that is less affected by the AS anatomy. Results in the Replicator of both valves were compared to the performance in a commercial ISO-compliant LHS. The AS anatomy in the Replicator resulted in a significant decrease of the TAVR valve performance relative to the simplified LHS, with EOA and transvalvular pressures comparable to clinical data. Minor change was seen in the mechanical valve performance. The Replicator showed to be an effective platform for TAVR testing. Unlike a simplified geometric anatomy LHS, it conservatively provides clinically-relevant outcomes and complement it. The Replicator can be most valuable for testing new valves under challenging patient anatomies, physicians training, and procedural planning.
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Affiliation(s)
- Oren M Rotman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA
| | - Chander Sadasivan
- Department of Neurological Surgery, Stony Brook University, Stony Brook, NY, 11794, USA.,Vascular Simulations LLC, Stony Brook, NY, 11790, USA
| | | | - Baruch B Lieber
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA.,Department of Neurological Surgery, Stony Brook University, Stony Brook, NY, 11794, USA.,Vascular Simulations LLC, Stony Brook, NY, 11790, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA.
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Pongratz P, Ebbers M, Geerdes-Fenge H, Reisinger EC. RE: 'Streptococcus pluranimalium: A novel human pathogen?'. Int J Surg Case Rep 2017; 41:493-494. [PMID: 29546024 PMCID: PMC5723267 DOI: 10.1016/j.ijscr.2017.10.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 12/26/2022] Open
Abstract
Streptococcus pluranimalium as a novel human pathogen has been reported by several authors in various contexts. In all reported cases in humans the microorganism was detected by the Vitek2®. The great advances with the introduction of new analytical techniques such as MALDI-TOF or 16S rRNA analysis enabled a more detailed discrimination of pathogens such as these nonhemolytic streptococci. In the cases of such similar gene sequences such techniques are absolutely essential to identify the exact strain for this highly conserved 16S rRNA gene. However, until now neither a sequence analysis of the 16S rRNA gene nor PCR nor MALDI-TOF techniques could define Streptococcus pluranimalium in humans. We conclude that according to our best present knowledge there exists no conclusive evidence for a human infection of Streptococcus pluranimalium even when using most advanced and exact identification techniques until now.
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Affiliation(s)
- Peter Pongratz
- Rostock University Medical Center, Division of Tropical Medicine and Infectious Diseases, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany.
| | - Meinolf Ebbers
- Rostock University Medical Center, Division of Tropical Medicine and Infectious Diseases, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Hilte Geerdes-Fenge
- Rostock University Medical Center, Division of Tropical Medicine and Infectious Diseases, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
| | - Emil C Reisinger
- Rostock University Medical Center, Division of Tropical Medicine and Infectious Diseases, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany
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Ino N, Masutani S, Tanikawa S, Iwamoto Y, Saiki H, Ishido H, Tamura M, Senzaki H. Effects of home prothrombin international ratio (PT-INR) management in children with mechanical prosthetic valves - Importance of individual correlations between laboratory and CoaguChek device PT-INRs. J Cardiol 2018; 71:187-91. [PMID: 29066099 DOI: 10.1016/j.jjcc.2017.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Warfarin administration is essential but requires difficult management and frequent clinic visits in patients with mechanical prosthetic atrioventricular valve replacement (MPAVVR). This study investigated how home prothrombin international ratio (PT-INR) monitoring with CoaguChek® (Roche Diagnostics, Basel, Switzerland) safely reduced clinic visits in children with MPAVVR. We also compared individual correlations between the CoaguChek and laboratory PT-INR. METHODS This study included four pediatric patients who started frequent warfarin home-monitoring after MPAVVR (three mitral valves and one tricuspid valve). We collected information regarding the number of outpatient clinic visits and measurements of PT-INR before and after starting home CoaguChek monitoring (each one year) from medical records. We also compared individual correlations between laboratory and CoaguChek PT-INR in three patients. RESULTS No major clinical events were encountered during the study period. The ratio of outpatient clinic visits in the second year to those in the first year was decreased in all patients (0.30-0.66). The ratio of the numbers of home measurements to all PT-INR measurements in the second year ranged from 0.55 to 0.64 indicating that CoaguChek home monitoring approximately halved the number of outpatient clinic visits. CoaguChek measurements tended to be slightly overestimated in two patients but were greatly underestimated in one patient. CONCLUSIONS CoaguChek home monitoring in children with MPAVVR reduced the number of their clinic visits without compromising the safety of warfarin management. Given considerable individual differences in correlations between CoaguChek and laboratory PT-INR, individual correlation needs to be identified to fairly interpret the CoaguChek PT-INR values.
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Cousin B, Guglielminotti J, Iung B, Montravers P. Retrospective study of anaesthetic management of pregnancy patients with mechanical heart valve prosthesis and anticoagulants. Anaesth Crit Care Pain Med 2017; 37:225-231. [PMID: 28927733 DOI: 10.1016/j.accpm.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/02/2017] [Accepted: 08/17/2017] [Indexed: 11/26/2022]
Abstract
Pregnancies among patients with a mechanical prosthetic valve and receiving anticoagulant medication are rare. Informations about their anesthetic management is poor. The objective of this study was to investigate the anaesthetic management of these patients in a reference medical centre as well as to identify possible ways for improvement. To this aim, the medical records of patients with a mechanical heart valve prosthesis having given birth at our center were analysed. In particular, the characteristics of patients and deliveries, the management of anticoagulation, as well as the type of anaesthesia performed, were collected and analysed. Eighteen cases were studied and compared to 36 controls. All studied cases were being administered anticoagulants. Five of these 8 patients delivered vaginally, one with epidural analgesia. Three of them have had a caesarean during labor, all under general anaesthesia. During the anticoagulation window, the teams had to perform an epidural in 3 (37%) of these 8 patients. Ten cases (55%) had a planned caesarean delivery, all performed under general anaesthesia. The anticoagulation interruption allowed spinal anaesthesia for 4 out of 10 caesarean delivery. The reoperation rate for secondary haemorrhage was significantly higher (P=0.0032) and the duration of the hospitalisation was extended (P<0.001). A context of anticoagulant overdose was identified in 60% of the bleeding cases. Progress can be made in the anaesthetic management of those patients by optimising the use of neuraxial anaesthesia and by improving the management of bleeding risk after delivery.
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Affiliation(s)
- Benoît Cousin
- Department of anaesthesia and intensive care, Bichat-Claude-Bernard University hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Jean Guglielminotti
- Department of anaesthesia and intensive care, Bichat-Claude-Bernard University hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Inserm, UMR 1137, IAME, 75018 Paris, France
| | - Bernard Iung
- Heart institute, Bichat-Claude-Bernard University hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - Philippe Montravers
- Department of anaesthesia and intensive care, Paris VII Sorbonne Cité university, Bichat-Claude-Bernard university hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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Hansen JW, Gadey G, Piemonte TC. Prosthetic mitral valve paravalvular leak: A problem that requires dexterity. Cardiovasc Revasc Med 2017; 19:126-132. [PMID: 28874307 DOI: 10.1016/j.carrev.2017.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
Prosthetic valve paravalvular leak (PVL) is a known and relatively common complication of surgical valve replacement, which may lead to significant morbidity. Patients with significant mitral valve replacement (MVR) PVL typically present with symptoms of heart failure and elevated filling pressures or with hemolytic anemia. Percutaneous closure of these leaks has become the preferred therapy. Percutaneous closure of MVR PVL can be technically challenging, given the anatomy of the approach (trans-septal, trans-apical), the level of associated comorbidities and the geographic location of the paravalvular defect. Steerable catheters offer a unique ability to position themselves coaxial to the PVL. The Dexterity catheter (Spirus Medical LLC, Bridgewater, MA, USA) is a semi-rigid steerable catheter used in our lab with the ability to articulate at two separate points on the distal tip and flex greater than 360 degrees. We present cases of surgical valves that developed PVL which underwent successful repair with a Dexterity catheter.
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Affiliation(s)
- James W Hansen
- Lahey Hospital and Medical Center, Burlington, MA, United States.
| | - Gautam Gadey
- Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Thomas C Piemonte
- Lahey Hospital and Medical Center, Burlington, MA, United States; Cardiosolutions Inc., West Bridgewater, MA, United States
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40
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Wang SC, Torosoff MT, Smith RP, Coates AD. Streptococcus pyogenes meningitis and endocarditis in a patient with prosthetic mitral valve. J Cardiol Cases 2017; 16:82-84. [PMID: 30279803 DOI: 10.1016/j.jccase.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/10/2017] [Accepted: 05/22/2017] [Indexed: 11/18/2022] Open
Abstract
Streptococcus pyogenes is commonly found in cutaneous and pharyngeal infections, but rarely causes meningitis and endocarditis. We report a 77-year-old male with history of prosthetic mitral valve, presenting with meningitis and endocarditis secondary to S. pyogenes. We aim to raise awareness among clinicians of rare infectious etiology as the cause of endocarditis and meningitis, and importance of prompt diagnosis in ensuring success of medical treatment and long-term survival. <Learning objective: Main learning objectives are: (1) Rare sources of infection should be considered in setting of endocarditis and meningitis. (2) In high-risk patients, transesophageal echocardiogram is indicated although initial transthoracic echocardiogram may not show classic vegetation.>.
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Affiliation(s)
- Stephani C Wang
- Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Mikhail T Torosoff
- Cardiology, Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Raymond P Smith
- Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Andrew D Coates
- Department of Medicine, Albany Medical Center, Albany, NY, USA
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Gnanenthiran SR, Liu EYT, Wilson M, Chung T, Gottlieb T. Prosthetic Valve Infective Endocarditis With Mycobacterium Fortuitum: Antibiotics Alone Can Be Curative. Heart Lung Circ 2017; 26:e86-e89. [PMID: 28688832 DOI: 10.1016/j.hlc.2017.05.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 11/19/2022]
Abstract
Rapidly growing non-tuberculous mycobacteria (RGM) are a rare, often fatal cause of infective endocarditis. Although surgery has been the cornerstone of RGM endocarditis therapy, we present the first documented adult case of Mycobacterium fortuitum endocarditis cured with antibiotic therapy.
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Affiliation(s)
- Sonali R Gnanenthiran
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Eunice Y T Liu
- Infectious Disease Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Michael Wilson
- Cardiothoracic Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Tommy Chung
- Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Thomas Gottlieb
- Infectious Disease Department, Concord Repatriation General Hospital, Sydney, NSW, Australia.
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Kataoka G, Asano R, Sato A, Tatsuishi W, Nakano K. Outcomes of prosthetic valve replacement in women of child-bearing age. Surg Today 2016; 47:755-761. [PMID: 27838861 DOI: 10.1007/s00595-016-1445-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The outcomes of pregnancy are more favorable for women with bioprostheses than for those with mechanical prostheses. However, bioprostheses are associated with a high reoperation rate in young women and it remains unclear whether these young women can give birth without any complications. We analyzed the outcomes of prosthetic valve replacement and investigated the effectiveness and problems associated with bioprostheses in women of child-bearing age in Japan. METHODS The subjects of this study were six consecutive young adult women aged under 40 years, who underwent prosthetic valve replacement between January 2007 and April 2016. RESULTS Bioprostheses were selected for four of these six women in consideration of their child-bearing age. Mechanical valves were selected for the other two women who underwent the Konno procedure and double valve replacement (AVR, MVR) in view of their high risk for reoperation. The cardiac operations, although without mortality or morbidity, were complex and some involved multi-time procedures. Three of the women with bioprostheses had uneventful term pregnancies. CONCLUSIONS These young women with bioprostheses were able to give birth safely; however, as multiple operations are often required, and bioprostheses may not be ideal for young women. Prosthetic valve selection for young women of child-bearing age requires adequate pregnancy counseling and long-term planning.
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Affiliation(s)
- Go Kataoka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan.
| | - Ryota Asano
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan
| | - Atsuhiko Sato
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan
| | - Wataru Tatsuishi
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan
| | - Kiyoharu Nakano
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan
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Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, Landeck BF, Maganti K, Michelena HI, Tolstrup K. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29:1-42. [PMID: 26765302 DOI: 10.1016/j.echo.2015.09.011] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
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Affiliation(s)
- Muhamed Saric
- New York University Langone Medical Center, New York, New York
| | | | - M Samir Arnaout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Farooq A Chaudhry
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Richard A Grimm
- Learner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Kirsten Tolstrup
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Sarrazin JF, Philippon F, Trottier M, Tessier M. Role of radionuclide imaging for diagnosis of device and prosthetic valve infections. World J Cardiol 2016; 8:534-546. [PMID: 27721936 PMCID: PMC5039355 DOI: 10.4330/wjc.v8.i9.534] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/14/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular implantable electronic device (CIED) infection and prosthetic valve endocarditis (PVE) remain a diagnostic challenge. Cardiac imaging plays an important role in the diagnosis and management of patients with CIED infection or PVE. Over the past few years, cardiac radionuclide imaging has gained a key role in the diagnosis of these patients, and in assessing the need for surgery, mainly in the most difficult cases. Both 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and radiolabelled white blood cell single-photon emission computed tomography/computed tomography (WBC SPECT/CT) have been studied in these situations. In their 2015 guidelines for the management of infective endocarditis, the European Society of Cardiology incorporated cardiac nuclear imaging as part of their diagnostic algorithm for PVE, but not CIED infection since the data were judged insufficient at the moment. This article reviews the actual knowledge and recent studies on the use of 18F-FDG PET/CT and WBC SPECT/CT in the context of CIED infection and PVE, and describes the technical aspects of cardiac radionuclide imaging. It also discusses their accepted and potential indications for the diagnosis and management of CIED infection and PVE, the limitations of these tests, and potential areas of future research.
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Ferraz RV, Andrade M, Silva F, Andrade P, Carvalho C, Torres JP, Almeida J, Sarmento A, Santos L. Chronic Q fever: A missed prosthetic valve endocarditis possibly for years. IDCases 2016; 6:55-57. [PMID: 27713859 PMCID: PMC5048103 DOI: 10.1016/j.idcr.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022] Open
Abstract
Chronic Coxiella burnetii endocarditis usually develops in people with underlying heart disease and accounts for 60–70% of chronic Q fever. Onset is generally insidious and manifestations are atypical. The authors report a case of Coxiella burnetii prosthetic valve endocarditis in a 53 years- old patient with recurrent mechanical valve dehiscence on mitral position. He lived in a rural area with sheep and goats on the surroundings. During a 9 year- period, he was submitted to three cardiac mitral valve surgeries two of which with no Q fever diagnosis suspicion. Diagnosis was based on a positive serology test (Indirect imunofluorescence). Treatment consisted in a combination of prolonged course of hydroxychloroquine plus doxycycline and surgical replacement of the mitral valve, with a favorable outcome. With this case report, the authors pretend to highlight the not always expected diagnosis of Q fever endocarditis. If not considered, Coxiella burnetii endocarditis may lead to multiple cardiac surgeries, greater morbidity and potentially death.
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Affiliation(s)
- Rita Veiga Ferraz
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - Marta Andrade
- Cardiothoracic Surgery Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Portugal
| | - Filipa Silva
- Internal Medicine Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Paulo Andrade
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - Cláudia Carvalho
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - José Pinheiro Torres
- Cardiothoracic Surgery Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Portugal
| | - Jorge Almeida
- Cardiothoracic Surgery Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Instituto de Inovação e Investigação em Saúde (I3S), Grupo de I&D em Nefrologia e Doenças Infeciosas, Instituto Nacional de Engenharia Biomédica (INEB), Porto, Portugal
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Nishioka N, Yamada A, Ujihira K, Iba Y, Maruyama R, Hatta E, Kurimoto Y, Nakanishi K. Outcomes of surgical aortic valve replacement using Carpentier-Edwards PERIMOUNT bioprosthesis series in elderly patients with severe aortic valve stenosis: a retrospective cohort study. Gen Thorac Cardiovasc Surg 2016; 64:728-734. [PMID: 27491542 DOI: 10.1007/s11748-016-0698-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We sought to compare the outcomes of Carpentier-Edwards PERIMOUNT (CEP), Magna and Magna Ease valves in Japanese elderly patients with severe aortic valve stenosis (AS). METHODS We retrospectively identified 136 patients (mean age 76.61 ± 5.5 years old) who had undergone isolated surgical aortic valve replacement (SAVR) using CEP, Magna, and Magna Ease valves at a single institution, from January 2001 to December 2013. We compared the valves according to their survival rates, freedom from major adverse cardiovascular and cerebrovascular events (MACCE), and durability and hemodynamic performance by echocardiographic data. RESULTS The thirty-day mortality after isolated SAVR in all the valve groups was "zero". The differences among the three groups in terms of survival rates, freedom from MACCE at 2 years, durability and hemodynamic performance of the valves by echocardiographic data was not statistically significant. CONCLUSION All CEP, Magna and Magna Ease valves seemed to be similarly useful in Japanese elderly patients with severe AS. Our data did not clearly support the superiority of one valve over another. A longer follow-up period might be necessary to compare the durability and hemodynamic performance of these valves with more certainty.
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Affiliation(s)
- Naritomo Nishioka
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan.
| | - Akira Yamada
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Kosuke Ujihira
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Ryushi Maruyama
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Eiichiro Hatta
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Katsuhiko Nakanishi
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
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Yu HP, Huang CH, Hou SM, Hsiung MC, Tsai SK, Yin WH. Percutaneous transcatheter closure of mitral paravalvular leak via transarterial retrograde approach. J Geriatr Cardiol 2015; 12:683-6. [PMID: 26788047 DOI: 10.11909/j.issn.1671-5411.2015.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Repeat surgery has usually been considered the first choice to solve paravalvular leaks of prosthetic valves, but it carries a high operative risk, a high mortality rate and an increased risk for re-leaks. Percutaneous closure of such defects is possible, and different approaches and devices are used for this purpose. For mitral paravalvular leaks, constructing an arterio-venous wire loop for delivering the closure device through an antegrade approach is the most commonly used technique. Transcatheter closure can also be performed through a transapical approach or retrograde transfemoral arterial approach. We present a case of 68-year-old man with a mitral paravalvular leak that was successfully closed using an Amplatzer® Duct Occluder II, via retrograde transfemoral arterial approach under three-dimensional transesophageal echocardiographic guidance, without the use of a wire loop. The initial attempt to cross the paravalvular defect was unsuccessful, but the obstacle was finally overcome by introducing complex interventional techniques.
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Scotten LN, Siegel R. Are anticoagulant independent mechanical valves within reach-fast prototype fabrication and in vitro testing of innovative bi-leaflet valve models. Ann Transl Med 2015; 3:197. [PMID: 26417581 DOI: 10.3978/j.issn.2305-5839.2015.08.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Exploration for causes of prosthetic valve thrombogenicity has frequently focused on forward or post-closure flow detail. In prior laboratory studies, we uncovered high amplitude flow velocities of short duration close to valve closure implying potential for substantial shear stress with subsequent initiation of blood coagulation pathways. This may be relevant to widely accepted clinical disparity between mechanical and tissue valves vis-à-vis thrombogenicity. With a series of prototype bi-leaflet mechanical valves, we attempt reduction of closure related velocities with the objective of identifying a prototype valve with thrombogenic potential similar to our tissue valve control. This iterative design approach may find application in preclinical assessment of valves for anticoagulation independence. METHODS Tested valves included: prototype mechanical bi-leaflet BVs (n=56), controls (n=2) and patented early prototype mechanicals (n=2) from other investigators. Pulsatile and quasi-steady flow systems were used for testing. Projected dynamic valve area (PDVA) was measured using previously described novel technology. Flow velocity over the open and closing periods was determined by volumetric flow rate/PDVA. For the closed valve interval, use was made of data obtained from quasi-steady back pressure/flow tests. Performance was ranked by a proposed thrombogenicity potential index (TPI) relative to tissue and mechanical control valves. RESULTS Optimization of the prototype valve designs lead to a 3-D printed model (BV3D). For the mitral/aortic site, BV3D has lower TPI (1.10/1.47) relative to the control mechanical valve (3.44/3.93) and similar to the control tissue valve (ideal TPI ≤1.0). CONCLUSIONS Using unique technology, rapid prototyping and thrombogenicity ranking, optimization of experimental valves for reduced thrombogenic potential was expedited and simplified. Innovative mechanical valve configurations were identified that merit consideration for further development which may bring the anti-coagulation independent mechanical valve within reach.
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Affiliation(s)
- Lawrence N Scotten
- 1 ViVitro Systems Inc. (VSI), Victoria, BC, Canada ; 2 Lake Oswego, OR, USA
| | - Rolland Siegel
- 1 ViVitro Systems Inc. (VSI), Victoria, BC, Canada ; 2 Lake Oswego, OR, USA
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Abstract
INTRODUCTION Infective endocarditis (IE) is a life-threatening illness with a high morbidity and mortality, and with a rise in incidence in patients with prosthetic valves and cardiac devices. Recently the Dutch guidelines of IE prophylaxis have been revised, limiting IE prophylaxis to the highest-risk population. The aim of the present study was to investigate the incidence of IE and its trend between 2008-2013 in a regional hospital in the Netherlands. METHODS This is an observational descriptive study of all patients who were admitted with IE to the Medical Center of Alkmaar (MCA) from 1 January 2008 to 31 December 2013. RESULTS A total of 89 patients with IE, including 7 patients (7.9 %) with a cardiac device IE (CDIE), were identified. In 2008 there were 8 patients with IE, this increased to 26 patients in 2013. Patients with a prosthetic valve IE increased from 25 % in 2008 to 34.6 % in 2013. This increase was not seen in patients with CDIE. CONCLUSION In the MCA we have observed an increase in patients with IE since 2010. This increase was in part attributable to prosthetic valve IE. A larger observational study is needed to investigate the increase of IE in the Netherlands.
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Affiliation(s)
- M M G Krul
- Department of Cardiology, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
| | - A B A Vonk
- Department of Cardiothoracic surgery, VU Medical Center, Amsterdam, The Netherlands
| | - J H Cornel
- Department of Cardiology, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
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Ercan E, Tengiz I, Turk U, Ozyurtlu F, Alioglu E. A new device for paravalvular leak closure. J Geriatr Cardiol 2015; 12:187-8. [PMID: 25870623 DOI: 10.11909/j.issn.1671-5411.2015.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 12/31/2014] [Accepted: 12/31/2014] [Indexed: 12/01/2022] Open
Abstract
Percutaneous closure of a prosthetic paravalvular leak (PVL) is a challenging procedure. Operators must use devices constructed for other applications. We present the use of a device which is specifically designed for PVL closure. To the best of our knowledge, there is no publication in MEDLINE reporting the use of the device.
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