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Alomari M, El-Sayed Ahmed MM, Ali M, Wadiwala IJ, Pham SM, Sareyyupoglu B. Quadricuspid Aortic Valve: Imaging, Diagnosis, and Prognosis. Tex Heart Inst J 2024; 51:e238256. [PMID: 38686682 DOI: 10.14503/thij-23-8256] [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] [Indexed: 05/02/2024]
Abstract
Quadricuspid aortic valve is a rare congenital cardiac anomaly with an incidence of 0.008% to 0.043%. Its clinical course varies depending on cusp anatomy, function, and associated cardiac malformations. It frequently progresses to aortic valve regurgitation that may require surgical valve replacement. Detection has shifted from incidental discovery during autopsies or cardiac surgeries in the early 20th century to various cardiac imaging methods in recent decades. In addition to contributing to the literature, this report supports the use of transesophageal echocardiography more liberally to detect aortic valve abnormalities. The case presents a 48-year-old female patient with an incidentally discovered quadricuspid aortic valve.
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Affiliation(s)
- Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
- Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Mostafa Ali
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ishaq J Wadiwala
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
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Halaby RN, Bruce CG, Yildirim DK, Uzun D, Rogers T, Khan JM, Jaimes AE, Grant LP, Babaliaros VC, Greenbaum AB, Lederman RJ. TABERNACL: Temporary Hemodynamic Stabilization In Vivo. Circ Cardiovasc Interv 2024; 17:e013898. [PMID: 38533653 PMCID: PMC11097944 DOI: 10.1161/circinterventions.123.013898] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/02/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Acute aortic regurgitation is life-threatening with few nonsurgical options for immediate stabilization. We propose Trans-Aortic Balloon to Ease Regurgitation Applying Counter-Pulsation (TABERNACL), a simple, on-table temporary valve using commercially available equipment to temporize acute severe aortic regurgitation. METHODS We hypothesize that an appropriately sized commercial balloon dilatation catheter-straddling the aortic annulus and connected to a counterpulsation console-can serve as a temporizing valve to restore hemodynamic stability in acute aortic regurgitation. We performed benchtop testing of valvuloplasty, angioplasty, and sizing balloons as counterpulsation balloons. TABERNACL was assessed in vivo in a porcine model of acute aortic regurgitation (n=8). We also tested a static undersized, continuously inflated transvalvular balloon as a spacer intended physically to obstruct the regurgitant orifice. RESULTS Benchtop testing identified that Tyshak II and PTS sizing (NuMed Braun) balloon catheters performed adequately as temporary valves (ie, complete inflation and deflation with each cycle) and resisted fatigue, in contrast to others. When TABERNACL was used in the acute severe regurgitation animals, there was immediate hemodynamic improvement, with a significant 35% increase in diastolic aortic pressure by 16 mm Hg ([95% CI, 7-25] P=0.0056), 34% reduction in left ventricular end-diastolic pressure by -7 mm Hg ([95% CI, -10 to -5] P=0.0006), improvement in the aortic diastolic index by 0.28 ([95% CI, 0.18-0.39] P=0.0009), and reversal of electrocardiographic myocardial ischemia. As an alternative, static balloon inflation across the aortic valve stabilized regurgitation hemodynamics at the expense of a new aortic gradient and caused excessive ectopy from balloon movement in the left ventricular outflow tract. CONCLUSIONS TABERNACL improves hemodynamics and reduces coronary ischemia by electrocardiography in animals with acute severe aortic regurgitation. TABERNACL valves obstruct the diastolic regurgitant orifice without systolic obstruction. This may prove a lifesaving bridge to definitive valve replacement therapy.
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Affiliation(s)
- Rim N. Halaby
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
| | - Christopher G. Bruce
- Department of Cardiology, Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (C.G.B., V.C.B., A.B.G.)
| | - D. Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
| | - Dogangun Uzun
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
| | - Toby Rogers
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC (T.R.)
| | - Jaffar M. Khan
- Department of Cardiology, St. Francis Hospital, Roslyn, NY (J.M.K.)
| | - Andi E. Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
| | - Laurie P. Grant
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
| | - Vasilis C. Babaliaros
- Department of Cardiology, Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (C.G.B., V.C.B., A.B.G.)
| | - Adam B. Greenbaum
- Department of Cardiology, Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (C.G.B., V.C.B., A.B.G.)
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
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Awlad Thani S, Al Jamei SM, Al Azri KN, Al Alawi K, Al Shabibi S. Native Aortic Valve Infective Endocarditis Secondary to Community-Acquired Methicillin-Resistant Staphylococcus aureus: A Case Report and Literature Review. Cureus 2024; 16:e55341. [PMID: 38559539 PMCID: PMC10981920 DOI: 10.7759/cureus.55341] [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] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Infective endocarditis (IE) refers to a microbial infection affecting either a heart valve or endocardium, resulting in tissue damage and the formation of vegetation. Native aortic valve endocarditis in children is rare and is associated with serious complications related to valvular insufficiency and systemic embolizations. As reports about community-acquired methicillin-resistant Staphylococcus aureus (MRSA) native aortic valve endocarditis in children are very scarce, we report this case along with a literature review about its complications and management. Here, we report the case of a seven-month-old infant who was previously healthy and presented with signs and symptoms of shock and systemic embolizations secondary to native aortic valve IE. His blood culture showed MRSA. He developed aortic valve insufficiency heart failure and multiorgan septic emboli that progressed to fatal refractory multiorgan failure. The management of complicated aortic valve endocarditis in children is challenging and needs a multidisciplinary team approach and prompt intervention.
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Panama G, Martinez A, Yavari M, Geunwon Kim A, Abela G. A Case of Gemella morbillorum Causing Multi-valvular Endocarditis. Cureus 2024; 16:e53716. [PMID: 38455816 PMCID: PMC10918293 DOI: 10.7759/cureus.53716] [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] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
This is the case of a 31-year-old man with no significant past medical history who presented to the emergency department experiencing persistent fevers, chills, and malaise for the past 2-3 weeks. During this period, he had multiple urgent care visits for possible left-sided otitis media which was treated with short a course of Augmentin. While on antibiotics his symptoms would improve, but they would reappear once he had finished treatment. The patient also had significant dental carries with a chronic right molar infection. At the emergency department, blood cultures grew two out of two Gemella morbillorum. Transthoracic echocardiography showed a 1 cm x 0.5 cm mobile density on the left coronary cusp of the aortic valve with moderate-severe aortic insufficiency. The patient was started on empiric IV vancomycin. Further workup revealed that the source of infection was dental carries. While proceeding with a transesophageal echocardiogram, the patient went into flash pulmonary edema requiring ICU admission. Imaging revealed an elongated 1.7 cm x 0.6 cm vegetation attached to the base of the left coronary cusp on the left ventricular outflow tract side with severe aortic regurgitation and a small 0.8 cm x 0.8 cm vegetation on the atrial side of the anterior mitral leaflet at A2 associated with mitral leaflet perforation with severe mitral regurgitation. Oral surgery removed the infected teeth. Cardiothoracic surgery performed open heart valve replacement which revealed a completely destroyed aortic valve, droplet vegetation, and destruction of the mitral valve leading to mechanical valve replacement. The patient received a two-week course of gentamycin while in the ICU with meropenem. Once sensitivities were back, he was switched to IV penicillin therapy for a total of six weeks.
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Affiliation(s)
- Gabriel Panama
- Department of Internal Medicine, Michigan State University, East Lansing, USA
| | - Adolfo Martinez
- Department of Internal Medicine, Michigan State University, East Lansing, USA
| | - Majid Yavari
- Department of Internal Medicine, Michigan State University, East Lansing, USA
| | - Andrew Geunwon Kim
- Department of Internal Medicine, Michigan State University, East Lansing, USA
| | - George Abela
- Department of Cardiology, Michigan State University, East Lansing, USA
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Lin Y, Xie L, Zhang Z, He J, Dai X, Chen L, Chen M. Mid-term outcomes of total neointima implantation in surgical repair of acute type A aortic dissection. J Clin Hypertens (Greenwich) 2024; 26:155-165. [PMID: 38214206 PMCID: PMC10857477 DOI: 10.1111/jch.14762] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/13/2024]
Abstract
Total neointima implantation (patch neointima technique + triple-branched stent graft placement) has been performed in proximal aortic repair for acute type A aortic dissection (ATAAD) for more than 10 years at a center. However, there is no report on the mid-term outcomes with a control group of the surgical procedure. Consequently, the authors aimed to evaluate the safety and efficacy of this technique in this study. Patients who underwent the total neointima implantation were classified as Group A, and those who underwent the conventional aortic root reconstruction with the "sandwich" technique and the total aortic arch replacement were classified as Group B. Furthermore, the authors described the preoperative characteristics, operative data, and patient outcomes. Group A patients experienced a shorter surgery duration, lower volumes of perioperative bleeding, and fewer red blood cell transfusions. The incidence of neurological complications was significantly reduced in Group A. All patients maintained a normal range of proximal aortic sizes after surgery. Kaplan-Meier analysis revealed no significant differences between the patients in the two groups regarding cumulative mortality and the incidence of moderate-to-severe aortic insufficiency. In well-selected patients, total neointima implantation is an alternative procedure for the surgical repair of ATAAD.
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Affiliation(s)
- Yong Lin
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianPR China
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
| | - Lin‐feng Xie
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianPR China
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
| | - Zhao‐feng Zhang
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianPR China
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
| | - Jian He
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianPR China
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
| | - Xiao‐fu Dai
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianPR China
| | - Liang‐wan Chen
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianPR China
- Fujian Provincial Center for Cardiovascular MedicineFuzhouFujianPR China
| | - Mei‐fang Chen
- Department of Cardiovascular SurgeryFujian Medical University Union HospitalFuzhouFujianPR China
- Key Laboratory of Cardio‐Thoracic Surgery (Fujian Medical University)Fujian Province UniversityFuzhouFujianPR China
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Singu S, Chory R, Singu VK, Pursley M, Harris G. Bicuspid Aortic Valve Endocarditis Caused by Streptococcus sanguinis: A Case Report. Cureus 2024; 16:e52488. [PMID: 38371036 PMCID: PMC10870037 DOI: 10.7759/cureus.52488] [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] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Antibiotic prophylaxis prior to dental work in bicuspid aortic valve (BAV) patients is currently a matter of debate. The American Dental Association does not require those with native BAV to receive antibiotic prophylaxis prior to dental work as BAV is considered an "intermediate" risk for infective endocarditis (IE). We present the case of a 63-year-old male, with a medical history of BAV, who acquired Streptococcus sanguinis IE after a routine dental cleaning four months prior to initial onset of symptoms. He exhibited new-onset and severe aortic regurgitation at presentation, requiring urgent aortic valve replacement to restore valve function. BAV patients are at high risk of IE, emphasizing the need for prophylactic antibiotics in dental cleaning as well as invasive dental procedures in those with BAV.
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Affiliation(s)
- Sravani Singu
- Internal Medicine, Thomas Hospital, Infirmary Health, Fairhope, USA
| | - Robert Chory
- Internal Medicine, Thomas Hospital, Infirmary Health, Fairhope, USA
| | - Vamsi K Singu
- Neuroscience, Thomas Hospital, Infirmary Health, Fairhope, USA
- Neuroscience, University of Alabama at Birmingham, Birmingham, USA
| | - Michael Pursley
- Cardiovascular Disease, Thomas Hospital, Infirmary Health, Fairhope, USA
| | - Glenn Harris
- Cardiovascular Disease, Thomas Hospital, Infirmary Health, Fairhope, USA
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Alotabi RA, Alamri OZ, Alenezi SE, Suliman I. The Ross Procedure in a Case of Baraitser-Winter Syndrome: A Case Report. Cureus 2024; 16:e52331. [PMID: 38361693 PMCID: PMC10866739 DOI: 10.7759/cureus.52331] [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] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Baraitser-Winter syndrome (BRWS) is a rare genetic disorder caused by mutations in the ACTB and ACTG1 genes. It is characterized by intellectual disability, physical malformations, and dysmorphic craniofacial features. Additionally, cardiovascular abnormalities may also be present. We present a case of a 15-year-old boy with BRWS associated with congenital bicuspid aortic valve and severe aortic insufficiency which was managed successfully with Ross procedure.
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Affiliation(s)
- Raghad A Alotabi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Orjowan Z Alamri
- Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Shahad E Alenezi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Ihab Suliman
- Cardiology, King Abdulaziz Medical City, King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, SAU
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8
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Ozawa K, Kuwaki K, Furuya H, Yamaguchi M, Yamamoto A. Surgical Management of Giant Unruptured Left Sinus of Valsalva Aneurysm With Severe Aortic Regurgitation. Tex Heart Inst J 2023; 50:e238134. [PMID: 37824588 PMCID: PMC10658150 DOI: 10.14503/thij-23-8134] [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] [Indexed: 10/14/2023]
Abstract
Left sinus of Valsalva aneurysms are extremely rare. Concomitant aortic valve regurgitation is a comorbidity in this pathology. This case report summarizes successful surgical treatment with aortic root replacement with a modified Bentall procedure in a 49-year-old female patient who had an unruptured huge left sinus of Valsalva aneurysm with severe aortic valve regurgitation. The intraoperative assessment showed severe adhesion between the left main trunk of the coronary artery and the left sinus of Valsalva aneurysm, and meticulous adhesion detachment was required.
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Affiliation(s)
- Keisuke Ozawa
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji City, Tokyo, Japan
| | - Kenji Kuwaki
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji City, Tokyo, Japan
| | - Hidekazu Furuya
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji City, Tokyo, Japan
| | - Masaomi Yamaguchi
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji City, Tokyo, Japan
| | - Akiyoshi Yamamoto
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji City, Tokyo, Japan
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Dutta M, Patel RK, Basile EJ, Belaunzaran MA. Aortic Valve Replacement: A Case of Aortic Valve Insufficiency Secondary to Infective Endocarditis. Cureus 2023; 15:e46628. [PMID: 37937026 PMCID: PMC10626977 DOI: 10.7759/cureus.46628] [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] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
Acute aortic valve insufficiency (AAVI) is a pathologic medical condition that has a presentation on a spectrum of severity and is attributable to numerous etiologies. Most often, it is caused by infective endocarditis, which depending on the patient's clinical status may require treatment with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). This case presents a patient with acute aortic valve insufficiency secondary to infective endocarditis, requiring intervention. Further, it also provides real-time use of the general guidelines used in the determination of SAVR vs. TAVR candidacy. This case will further help providers in the cardiology realm to identify this presentation and increase comfort in referring to existing guidelines, as well as highlight where the current guidelines appear limited.
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Affiliation(s)
- Mudit Dutta
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Rushi K Patel
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Eric J Basile
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Miguel A Belaunzaran
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
- Medical School, Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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Michelena HI, Anand V, Enriquez-Sarano M, Pellikka PA. Correspondence on 'Prevalence of pulmonary hypertension in aortic regurgitation and its influence on outcomes' by Ratwatte et al. Heart 2023; 109:1574. [PMID: 37657915 DOI: 10.1136/heartjnl-2023-323347] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Affiliation(s)
- Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Uehara H, Okuyama M, Oe Y, Yoshimura T, Gunji T. Tertiary Cardiovascular Syphilis Presenting as Aortic Regurgitation, Aortitis, Thrombus, and Coronary Artery Occlusion, Requiring Percutaneous Coronary Intervention. Am J Case Rep 2023; 24:e941070. [PMID: 37735866 PMCID: PMC10519639 DOI: 10.12659/ajcr.941070] [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: 05/11/2023] [Revised: 08/07/2023] [Accepted: 08/02/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Heart failure is caused by coronary artery disease, valvular disease, and arrhythmias and is highly treatable with recent technology. However, the incidence of syphilis is increasing worldwide. This case report describes tertiary cardiovascular syphilis, accompanied by aortic regurgitation, syphilitic aortitis complicated by thrombus of the ascending aorta, and coronary artery occlusion, requiring percutaneous coronary artery intervention. CASE REPORT A 51-year-old Japanese man with no significant medical history was admitted to the hospital for worsening shortness of breath on exertion. On physical examination, there was no edema in either lower leg. Chest X-rays showed an enlarged heart and pulmonary congestion, and echocardiography showed a left ventricular ejection fraction of 18%, with full circumferential wall motion impairment. Heart failure was diagnosed, and the patient was found to have severe coronary artery disease and aortic regurgitation. He underwent percutaneous coronary intervention (PCI) for his coronary artery occlusion and was treated with medications for heart failure. Two months later, his condition improved, and PCI was performed for the revascularization of the remaining coronary artery. After PCI was completed, the patient was evaluated for vasculitis. The aortic wall lesion was likely a result of non-active syphilitic aortitis, and the results of serological tests of syphilis were positive. Therefore, we concluded that the diagnosis was cardiovascular syphilis. CONCLUSIONS This case report has highlighted the need for clinicians to be aware of the cardiovascular findings in syphilis, including syphilitic aortitis, particularly at this time, when the global incidence of syphilis is increasing.
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12
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Ono M, Kawasaki T, Koie H, Kondo H, Shibuya H, Hayashi T, Horikita T. Aortic valve insufficiency caused by a hypoplastic aortic valve in a calf. J Vet Med Sci 2023; 85:1010-1014. [PMID: 37532587 PMCID: PMC10539828 DOI: 10.1292/jvms.23-0139] [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] [Indexed: 08/04/2023] Open
Abstract
A 1-month-old crossbred calf was referred for examination due to marked systolic heart murmurs and poor growth. The heart murmur was most audible on the right side of the cranial thorax. Cardiomegaly was evident on chest radiography, and echocardiography demonstrated aortic regurgitation and decreased fractional shortening. Cardiomegaly, aortic root dilation and cardiac displacement were confirmed by computed tomography. At necropsy, the heart was enlarged, and all three aortic valve leaflets were irregularly shaped. In calves with chronic aortic insufficiency, remodeling displacement of the heart and aorta causes changes in the location and timing of heart murmurs. Therefore, aortic insufficiency cannot be ruled out when a systolic heart murmur can be observed in the right chest wall.
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Affiliation(s)
- Mamiko Ono
- Laboratory of Large Animal Clinical Sciences, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Kanagawa, Japan
| | - Teppei Kawasaki
- Laboratory of Large Animal Clinical Sciences, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Kanagawa, Japan
| | - Hiroshi Koie
- Laboratory of Veterinary Physiology, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Kanagawa, Japan
| | - Hirotaka Kondo
- Laboratory of Veterinary Pathology, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Kanagawa, Japan
| | - Hisashi Shibuya
- Laboratory of Veterinary Pathology, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Kanagawa, Japan
| | - Tetsuya Hayashi
- North Veterinary Clinical Center, Chiba Prefectural Federated Agricultural Mutual Aid Association, Chiba, Japan
| | - Tetsuya Horikita
- Laboratory of Large Animal Clinical Sciences, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Kanagawa, Japan
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13
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Yang Y, Xiao B, Feng X, Chen Y, Wang Q, Fang J, Zhou P, Wei X, Cheng L. Identification of hub genes and key signaling pathways by weighted gene co-expression network analysis for human aortic stenosis and insufficiency. Front Cardiovasc Med 2023; 10:857578. [PMID: 37621558 PMCID: PMC10445149 DOI: 10.3389/fcvm.2023.857578] [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: 01/18/2022] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Background Human aortic valve stenosis (AS) and insufficiency (AI) are common diseases in aging population. Identifying the molecular regulatory networks of AS and AI is expected to offer novel perspectives for AS and AI treatment. Methods Highly correlated modules with the progression of AS and AI were identified by weighted genes co-expression network analysis (WGCNA). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed by the clusterProfiler program package. Differentially expressed genes (DEGs) were identified by the DESeqDataSetFromMatrix function of the DESeq2 program package. The protein-protein interaction (PPI) network analyses were implemented using the STRING online tool and visualized with Cytoscape software. The DEGs in AS and AI groups were overlapped with the top 30 genes with highest connectivity to screen out ten hub genes. The ten hub genes were verified by analyzing the data in high throughput RNA-sequencing dataset and real-time PCR assay using AS and AI aortic valve samples. Results By WGCNA algorithm, 302 highly correlated genes with the degree of AS, degree of AI, and heart failure were identified from highly correlated modules. GO analyses showed that highly correlated genes had close relationship with collagen fibril organization, extracellular matrix organization and extracellular structure organization. KEGG analyses also manifested that protein digestion and absorption, and glutathione metabolism were probably involved in AS and AI pathological courses. Moreover, DEGs were picked out for 302 highly correlated genes in AS and AI groups relative to the normal control group. The PPI network analyses indicated the connectivity among these highly correlated genes. Finally, ten hub genes (CD74, COL1A1, TXNRD1, CCND1, COL5A1, SERPINH1, BCL6, ITGA10, FOS, and JUNB) in AS and AI were found out and verified. Conclusion Our study may provide the underlying molecular targets for the mechanism research, diagnosis, and treatment of AS and AI in the future.
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Affiliation(s)
- Yang Yang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of OrganTransplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
- Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Bing Xiao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, China
| | - Xin Feng
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Chen
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qunhui Wang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Fang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Zhou
- Institute of OrganTransplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
- Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Cheng
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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14
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Syed A, Durham L, Melamed J, Pearson PJ. Subclinical Aortic Insufficiency Causing Cardiogenic Shock Years After Impella Placement. Cureus 2023; 15:e43699. [PMID: 37724224 PMCID: PMC10505493 DOI: 10.7759/cureus.43699] [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] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
A 28-year-old male with atrial fibrillation and thyrotoxicosis-induced heart failure underwent multiple interventions, including extracorporeal membrane oxygenation (ECMO), multiple valve repair/replacement, and Impella placement/removal. However, after a period of three years, the patient developed progressive aortic insufficiency (AI), which was attributed to damage caused by the prolonged use of the Impella device. The discussion highlights the importance of adhering to manufacturer guidelines for device use and emphasizes the need for careful examination during placement to minimize potential complications.
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Affiliation(s)
- Ali Syed
- School of Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Lucian Durham
- Cardiac Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Joshua Melamed
- Thoracic Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Paul J Pearson
- Cardiac Surgery, Medical College of Wisconsin, Milwaukee, USA
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15
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Mohammed F, Gubitosa JC, Huffman TR, Abdul-Waheed M, Rafeedheen R. A Case of Cardiac Arrest Due to Transcatheter Aortic Valve Infolding. Cureus 2023; 15:e43847. [PMID: 37736431 PMCID: PMC10510568 DOI: 10.7759/cureus.43847] [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] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Prosthetic valvular infolding during transcatheter aortic valve implantation (TAVI) is an under-recognized yet significant complication that can occur. Here, we describe the case of a 61-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) and low-flow, low-gradient severe aortic valve stenosis of a bicuspid aortic valve who presented to undergo TAVI. During the procedure, repositioning of the valve resulted in prosthetic valvular infolding and resultant severe aortic regurgitation (AR), culminating in cardiac arrest. Swift balloon valvuloplasty corrected the valve geometry and eliminated any AR, allowing hemodynamic recovery and completion of the procedure. Our case and review highlight methods, both angiographic and echocardiographic, to recognize prosthetic valvular infolding the moment it presents, as well as strategies to correct the infolding with minimal detriment to the patient.
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Affiliation(s)
- Fawaz Mohammed
- Internal Medicine, University of Kentucky College of Medicine, Bowling Green, USA
| | - James C Gubitosa
- Cardiology, University of Kentucky College of Medicine, Bowling Green, USA
| | - Travis R Huffman
- Cardiology, University of Kentucky College of Medicine, Bowling Green, USA
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16
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Taduru SS, Ramakrishnan M, Pamulapati H. Successful Transcatheter Aortic Valve Replacement in an Elderly Patient with Calcified Bicuspid Aortic Valve with Calcified Raphe: A Case Report. Cureus 2023; 15:e41850. [PMID: 37583742 PMCID: PMC10423847 DOI: 10.7759/cureus.41850] [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] [Accepted: 07/13/2023] [Indexed: 08/17/2023] Open
Abstract
At present, transcatheter aortic valve replacement (TAVR) is not only used in high-surgical-risk patients with aortic stenosis (AS), but its use has also been extended to low-risk patients, resulting in its increasing utilization in patients with bicuspid aortic valve (BAV). BAV however presents unique challenges for TAVR due to its distinct valvular anatomy, and surgical aortic valve replacement (SAVR) remains the primary recommended method of aortic valve replacement in patients with BAV. Nonetheless, observational data have been quickly accumulating regarding the successful use of TAVR in BAV. Here, we present a case of a 73-year-old female who presented with heart failure symptoms and was found to have severe AS and BAV with calcified raphe (Sievers 1a). Due to her age and complicated medical history, including coronary artery disease and chronic kidney disease, she was considered to be at intermediate surgical risk (Society of Thoracic Surgeons (STS) score 5.4%) and underwent TAVR with the successful deployment of a 29 mm Edwards SAPIEN valve (Edwards Lifesciences, California, USA). A post-procedure echocardiogram confirmed the appropriate placement of the prosthesis without any valvular or paravalvular regurgitation. This case, therefore, adds to the growing body of evidence regarding the use of TAVR in patients with BAV despite anatomical challenges.
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Affiliation(s)
- Siva Sagar Taduru
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Madhuri Ramakrishnan
- Nephrology, Hays Medical Center, Hays, USA
- Nephrology, University of Kansas Medical Center, Kansas City, USA
| | - Hema Pamulapati
- Cardiovascular Disease, University of Kansas Medical Center, Kansas City, USA
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17
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Niu K, Torres Velez M, Lin Y. Left Atrial Myxoma With Aortic Insufficiency Leading to Cerebrovascular Accident. Cureus 2023; 15:e39048. [PMID: 37378170 PMCID: PMC10291998 DOI: 10.7759/cureus.39048] [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] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
Primary cardiac tumors are extremely rare and can lead to significant neurologic symptoms if not diagnosed and treated appropriately. Cardiac myxomas represent the most common subtype of cardiac tumors and are typically located on the left side of the heart and, when diagnosed appropriately with echocardiography, are typically treated with surgical excision. Simultaneous presentation of myxoma and valvular insufficiency is rare and under-documented. This is a rare case of a patient with a left atrial myxoma and aortic insufficiency leading to cerebrovascular symptoms.
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Affiliation(s)
- Kevyn Niu
- Internal Medicine, Blake Medical Center, Bradenton, USA
| | | | - Yizhi Lin
- Internal Medicine, Blake Medical Center, Bradenton, USA
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18
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Khatun N, Kaliounji A, Alkoutami SS, Francois J, John S. Quadricuspid Aortic Valve: An Incidental Finding in an Elderly Man. Cureus 2023; 15:e39536. [PMID: 37366439 PMCID: PMC10290899 DOI: 10.7759/cureus.39536] [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] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Quadricuspid aortic valve (QAV) is a very rare congenital abnormality. Here, we present a rare case of QAV incidentally noted in a patient at an advanced age during transthoracic echocardiography (TTE). A 73-year-old man with a history of hypertension, hyperlipidemia, diabetes, and treated prostate cancer was admitted to the hospital with palpitations. An electrocardiogram (ECG) showed T-wave inversion in V5-V6, with initial troponin levels mildly elevated. Acute coronary syndrome was ruled out by serial ECGs that were unchanged, and troponins downtrended. TTE showed a rare and incidental finding of type A QAV with four equal cusps with mild aortic regurgitation.
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Affiliation(s)
- Nazima Khatun
- Internal Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Aboud Kaliounji
- Internal Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Sami S Alkoutami
- Internal Medicine, St. George's University School of Medicine, St. George's, USA
| | - Jonathan Francois
- Cardiology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Sabu John
- Cardiology, Kings County Hospital Center, Brooklyn, USA
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19
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Vuong S, Hollingworth A. Challenges of Managing Non-rheumatic Aortic Valve Disorder in a Genetically Susceptible Woman. Cureus 2023; 15:e37998. [PMID: 37252476 PMCID: PMC10209652 DOI: 10.7759/cureus.37998] [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] [Accepted: 04/22/2023] [Indexed: 05/31/2023] Open
Abstract
In this case report, we investigated the potential link between SMAD3/transforming growth factor β (TGF-β) pathway dysregulation and aortic valvular disease. We report a middle-aged female, heterozygous for the R18W novel variant of the SMAD3 gene, with a history of an aortic valve disorder and three aortic valve replacements in a span of 15 years. The patient neither has a history of congenital connective tissue disorders nor any known congenital valvular defects. The patient had genetic testing for thoracic aortic aneurysm and dissection (TAAD)/Marfan syndrome/related disorders. She was found to be heterozygous for the p.Arg18Trp (R18W) protein variant of the SMAD3 gene (chromosome position 15:67430416), coding DNA c.52 C>T. Members of the transforming growth factor β (TGF-β) family and their downstream signaling proteins, including SMAD, are important for establishing proper embryogenic development and maintaining adult tissue homeostasis. Investigating the disturbances within the TGF-β signaling pathways may provide insightful knowledge of how genetic factors can cause structural and functional valvular defects.
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Affiliation(s)
- Stephanie Vuong
- MSIII, Midwestern University Arizona College of Osteopathic Medicine, Glendale, USA
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20
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Velders BJJ, Vriesendorp MD, De Lind Van Wijngaarden RAF, Rao V, Reardon MJ, Shrestha M, Chu MWA, Sabik JF, Liu F, Klautz RJM. Perioperative care differences of surgical aortic valve replacement between North America and Europe. Heart 2023:heartjnl-2023-322350. [PMID: 36963820 DOI: 10.1136/heartjnl-2023-322350] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/27/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To describe differences between North America and Europe in the perioperative management of patients undergoing surgical aortic valve replacement (SAVR). METHODS Patients with moderate or greater aortic stenosis or regurgitation requiring SAVR were enrolled in a prospective observational cohort evaluating the safety and efficacy of a new stented bioprosthesis at 25 centres in North America (Canada and the USA) and 13 centres in Europe (Germany, the Netherlands, France, the UK, Switzerland and Italy). While all patients underwent implantation with the same bioprosthetic model, perioperative management was left to the discretion of participating centres. Perioperative care was described in detail including outcomes up to 1-year follow-up. RESULTS Among 1118 patients, 643 (58%) were implanted in North America, and 475 (42%) were implanted in Europe. Patients in Europe were older, had a lower body mass index, less bicuspid disease and worse degree of aortic stenosis at baseline. In Europe, anticoagulant therapy at discharge was more aggressive, whereas length of stay was longer, and discharges directly to home were less common. Rehospitalisation risk was lower in Europe at 30 days (8.5% vs 15.9%) but converged at 1-year follow-up (26.5% vs 28.1%). Within continents, there were major differences between individual countries concerning perioperative management. CONCLUSION Contemporary perioperative management of SAVR patients varies between North America and Europe in patient selection, procedural techniques, antithrombotic regimen and discharge management. Furthermore, rehospitalisation differed largely between continents and countries. Hence, geographical setting must be considered during design and interpretation of trials on SAVR. TRIAL REGISTRATION NUMBER NCT02088554.
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Affiliation(s)
- Bart J J Velders
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Vivek Rao
- Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Malakh Shrestha
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael W A Chu
- Department of Cardiothoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Fang Liu
- Department of Biostatistics, Medtronic, Mounds View, Minnesota, USA
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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21
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Pires LT, Rosa VEE, Morais TC, Bello JHSM, Fernandes JRC, de Santis A, Lopes MP, Gutierrez PS, Rochitte CE, Nomura CH, Pomerantzeff PMA, Sampaio RO, Tarasoutchi F. Postoperative myocardial fibrosis assessment in aortic valvular heart diseases-a cardiovascular magnetic resonance study. Eur Heart J Cardiovasc Imaging 2023:7080717. [PMID: 36935401 PMCID: PMC10284053 DOI: 10.1093/ehjci/jead041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/10/2023] [Accepted: 02/09/2023] [Indexed: 03/21/2023] Open
Abstract
AIMS Left ventricular remodelling occurs during the chronic course of aortic regurgitation (AR) and aortic stenosis (AS), leading to myocardial hypertrophy and fibrosis. Several studies have shown that extracellular volume fraction (ECV) and indexed extracellular volume (iECV) are important surrogate markers of diffuse myocardial fibrosis (MF). Postoperative data on these cardiovascular magnetic resonance (CMR) extracellular expansion parameters for either AS or AR are scarce. This study aimed to demonstrate the postoperative changes that occur in diffuse MF, and the influence of preoperative MF on the reversal of LV remodelling, in patients with AR or AS. METHODS AND RESULTS Patients with severe AR or AS and indications for surgery were prospectively enrolled. Patients underwent pre- and postoperative CMR, and ECV and iECV were quantified. Data from 99 patients were analysed (32 with AR and 67 with AS). After surgery, the left ventricle mass index decreased in both groups (AR: 110 vs. 91 g/m2; AS: 86 vs. 68 g/m2, both P < 0.001). The late gadolinium enhancement fraction (AR: preoperative 1.9% vs. postoperative 1.7%, P = 0.575; AS: preoperative 2.4% vs. postoperative 2.4%, P = 0.615) and late gadolinium enhancement mass (AR: preoperative 3.8 g vs. postoperative 2.5 g, P = 0.635; AS: preoperative 3.4 g vs. postoperative 3.5 g, P = 0.575) remained stable in both groups. Preoperative iECV and ECV were greater in the AR group (iECV: 30 mL/m2 vs. 22 mL/m2, P = 0.001; ECV: 28.4% vs. 27.2%, P = 0.048). Indexed extracellular volume decreased after surgery in both groups (AR: 30-26.5 mL/m2, AS: 22-18.2 mL/m2, both P < 0.001); it was still greater in the AR group (AR: 26.5 mL/m2 vs. AS: 18.2 mL/m2, P < 0.001). Postoperative ECV remained stable in the AR group (preoperative 28.4% vs. postoperative 29.9%; P = 0.617) and increased in the AS group (preoperative 27.2% vs. postoperative 28.6%; P = 0.033). CONCLUSION Patients with both AR or AS presented reduction in iECV after surgery, unfolding the reversible nature of diffuse MF. In contrast to patients with AS, those with AR developed postoperative iECV regression with stable ECV, suggesting a balanced reduction in both intracellular and extracellular myocardial components.
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Affiliation(s)
- Lucas T Pires
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vitor E E Rosa
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Thamara C Morais
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Joao R C Fernandes
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Antonio de Santis
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mariana P Lopes
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Paulo S Gutierrez
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos E Rochitte
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cesar H Nomura
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Pablo M A Pomerantzeff
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roney O Sampaio
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flávio Tarasoutchi
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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22
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Patel KP, Baumbach A. Future of transcatheter aortic valve implantation: where do we go from here? Heart 2023; 109:564-571. [PMID: 36631145 DOI: 10.1136/heartjnl-2022-321575] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Kush P Patel
- Structural Heart Intervention Department, Barts Heart Centre, London, UK.,Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andreas Baumbach
- Barts Heart Centre, Barts Health NHS Trust, London, UK .,Cardiology, Queen Mary University of London, London, UK
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23
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Malahfji M, Kitkungvan D, Senapati A, Nguyen DT, El-Tallawi C, Tayal B, Debs D, Crudo V, Graviss EA, Reardon MJ, Quinones M, Zoghbi WA, Shah DJ. Differences in Myocardial Remodeling and Tissue Characteristics in Chronic Isolated Aortic and Mitral Regurgitation. Circ Cardiovasc Imaging 2023; 16:e014684. [PMID: 36880378 DOI: 10.1161/circimaging.122.014684] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND The left ventricular hemodynamic load differs between aortic regurgitation (AR) and primary mitral regurgitation (MR). We used cardiac magnetic resonance to compare left ventricular remodeling patterns, systemic forward stroke volume, and tissue characteristics between patients with isolated AR and isolated MR. METHODS We assessed remodeling parameters across the spectrum of regurgitant volume. Left ventricular volumes and mass were compared against normal values for age and sex. We calculated forward stroke volume (planimetered left ventricular stroke volume-regurgitant volume) and derived a cardiac magnetic resonance-based systemic cardiac index. We assessed symptom status according to remodeling patterns. We also evaluated the prevalence of myocardial scarring using late gadolinium enhancement imaging, and the extent of interstitial expansion via extracellular volume fraction. RESULTS We studied 664 patients (240 AR, 424 primary MR), median age of 60.7 (49.5-69.9) years. AR led to more pronounced increases in ventricular volume and mass compared with MR across the spectrum of regurgitant volume (P<0.001). In ≥moderate regurgitation, AR patients had a higher prevalence of eccentric hypertrophy (58.3% versus 17.5% in MR; P<0.001), whereas MR patients had normal geometry (56.7%) followed by myocardial thinning with low mass/volume ratio (18.4%). The patterns of eccentric hypertrophy and myocardial thinning were more common in symptomatic AR and MR patients (P<0.001). Systemic cardiac index remained unchanged across the spectrum of AR, whereas it progressively declined with increasing MR volume. Patients with MR had a higher prevalence of myocardial scarring and higher extracellular volume with increasing regurgitant volume (P value for trend <0.001), whereas they were unchanged across the spectrum of AR (P=0.24 and 0.42, respectively). CONCLUSIONS Cardiac magnetic resonance identified significant heterogeneity in remodeling patterns and tissue characteristics at matched degrees of AR and MR. Further research is needed to examine if these differences impact reverse remodeling and clinical outcomes after intervention.
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Affiliation(s)
- Maan Malahfji
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Danai Kitkungvan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
- Division of Cardiology, Department of Internal Medicine, University of Texas McGovern School of Medicine, Houston (D.K.)
| | - Alpana Senapati
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
- Intermountain Medical Center, Salt Lake City, UT (A.S.)
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, TX (D.T.N., E.A.G.)
| | - Carlos El-Tallawi
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Bhupendar Tayal
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Dany Debs
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Valentina Crudo
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, TX (D.T.N., E.A.G.)
| | - Michael J Reardon
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Miguel Quinones
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - William A Zoghbi
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Dipan J Shah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
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24
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Stoica S, Beard C, Takkenberg JJM, Mokhles MM, Turner M, Pepper J, Hopewell-Kelly N, Benedetto U, Nashef SAM, El-Hamamsy I, Skillington P, Glauber M, De Paulis R, Tseng E, Meuris B, Sitges M, Delgado V, Krane M, Kostolny M, Pufulete M. Formal consensus study on surgery to replace the aortic valve in adults aged 18-60 years. Heart 2023; 109:857-865. [PMID: 36849232 DOI: 10.1136/heartjnl-2022-321740] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/12/2022] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE There is uncertainty about surgical procedures for adult patients aged 18-60 years undergoing aortic valve replacement (AVR). Options include conventional AVR (mechanical, mAVR; tissue, tAVR), the pulmonary autograft (Ross) and aortic valve neocuspidisation (Ozaki). Transcatheter treatment may be an option for selected patients. We used formal consensus methodology to make recommendations about the suitability of each procedure. METHODS A working group, supported by a patient advisory group, developed a list of clinical scenarios across seven domains (anatomy, presentation, cardiac/non-cardiac comorbidities, concurrent treatments, lifestyle, preferences). A consensus group of 12 clinicians rated the appropriateness of each surgical procedure for each scenario on a 9-point Likert scale on two separate occasions (before and after a 1-day meeting). RESULTS There was a consensus that each procedure was appropriate (A) or inappropriate (I) for all clinical scenarios as follows: mAVR: total 76% (57% A, 19% I); tAVR: total 68% (68% A, 0% I); Ross: total 66% (39% A, 27% I); Ozaki: total 31% (3% A, 28% I). The remainder of percentages to 100% reflects the degree of uncertainty. There was a consensus that transcatheter aortic valve implantation is appropriate for 5 of 68 (7%) of all clinical scenarios (including frailty, prohibitive surgical risk and very limited life span). CONCLUSIONS Evidence-based expert opinion emerging from a formal consensus process indicates that besides conventional AVR options, there is a high degree of certainty about the suitability of the Ross procedure in patients aged 18-60 years. Future clinical guidelines should include the option of the Ross procedure in aortic prosthetic valve selection.
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Affiliation(s)
- Serban Stoica
- Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK
| | - Chloe Beard
- Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Mostafa M Mokhles
- Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark Turner
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - John Pepper
- Surgery, Royal Brompton Hospital, London, UK
| | - Noreen Hopewell-Kelly
- Health and Social Sciences, University of the West of England-Frenchay Campus, Bristol, UK
| | | | - Samer A M Nashef
- Cardiac Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | - Elaine Tseng
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Bart Meuris
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Marta Sitges
- Cardiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Markus Krane
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Martin Kostolny
- Cardiothoracic Unit, Great Ormond Street Hospital and Institute of Cardiovascular Science, University College London, London, UK
| | - Maria Pufulete
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
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25
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Abstract
Mixed aortic stenosis (AS) and aortic regurgitation (AR) is the most frequent concomitant valve disease worldwide and represents a heterogeneous population ranging from mild AS with severe AR to mild AR with severe AS. About 6.8% of patients with at least moderate AS will also have moderate or greater AR, and 17.9% of patients with at least moderate AR will suffer from moderate or greater AS. Interest in mixed AS/AR has increased, with studies demonstrating that patients with moderate mixed AS/AR have similar outcomes to those with isolated severe AS. The diagnosis and quantification of mixed AS/AR severity are predominantly echocardiography-based, but the combined lesions lead to significant limitations in the assessment. Aortic valve peak velocity is the best parameter to evaluate the combined haemodynamic impact of both lesions, with a peak velocity greater than 4.0 m/s suggesting severe mixed AS/AR. Moreover, symptoms, increased left ventricular wall thickness and filling pressures, and abnormal left ventricular global longitudinal strain likely identify high-risk patients who may benefit from closer follow-up. Although guidelines recommend interventions based on the predominant lesion, some patients could potentially benefit from earlier intervention. Once a patient is deemed to require intervention, for patients receiving transcatheter valves, the presence of mixed AS/AR could confer benefit to those at high risk of paravalvular leak. Overall, the current approach of managing patients based on the dominant lesion might be too reductionist and a more holistic approach including biomarkers and multimodality imaging cardiac remodelling and inflammation data might be more appropriate.
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Affiliation(s)
- Rashmi Nedadur
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Belzile
- Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Farrell
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Wendy Tsang
- Division of Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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26
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Deja MA. Aortic valve cusp prolapse before and after valve-sparing aortic root replacement. Heart 2022; 109:8-9. [PMID: 36371662 DOI: 10.1136/heartjnl-2022-321390] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Marek A Deja
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
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27
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Ehrlich T, Hagendorff A, Abeln K, Froede L, Giebels C, Schäfers HJ. Aortic cusp abnormalities in patients with trileaflet aortic valve and root aneurysm. Heart 2022; 109:55-62. [PMID: 35803710 DOI: 10.1136/heartjnl-2022-320905] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The frequency of concomitant cusp pathology in aortic root aneurysm with or without aortic regurgitation is not well known, and the sensitivity and specificity of two-dimensional trans-oesophageal echocardiography (2D TEE) in its detection has not yet been specified. OBJECTIVES We analysed the type and frequency of concomitant cusp alterations in root aneurysm referred for surgery. Sensitivity and specificity of 2D TEE in detecting these alterations were determined. METHODS In 582 patients (age 56.8±15.4 years, 453 male) with trileaflet aortic valves undergoing root replacement for regurgitation (n=347) or aneurysm (n=235), details of valve morphology were analysed. In a subcohort (n=281), intraoperative TEEs were analysed retrospectively and correlated with the intraoperative findings. RESULTS Any cusp pathology was present in 90.9% (prolapse: n=473; retraction: n=30; calcification: n=14; fenestration: n=12), morphologically normal cusps were seen in only 52 patients (8.93%). Valve-sparing surgery was performed in 525 (90.2%) instances, composite replacement in 57 (9.8%). Preoperative TEE correctly identified any postroot repair prolapse in 70.6% and any retraction in 85%. The sensitivity of TEE in detecting any prolapse was 68.6% (specificity of 79.5%). The sensitivity was highest for the right cusp and intermediate for the non-coronary. CONCLUSIONS Cusp prolapse is frequent in root aneurysm and trileaflet aortic valves. Prolapse is underdiagnosed by 2D TEE in many cases because pre-existent stretching of cusp tissue is masked by the geometric effects of root dilatation.
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Affiliation(s)
- Tristan Ehrlich
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | | | - Karen Abeln
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Lennart Froede
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Christian Giebels
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
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28
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Tung M, Nah G, Tang J, Marcus G, Delling FN. Valvular disease burden in the modern era of percutaneous and surgical interventions: the UK Biobank. Open Heart 2022; 9:e002039. [PMID: 36104095 PMCID: PMC9476134 DOI: 10.1136/openhrt-2022-002039] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The burden of valvular heart disease (VHD) has increased significantly among ageing populations, yet remains poorly understood in the present-day context of percutaneous and surgical interventions. OBJECTIVE To define the incidence, clinical correlates and associated mortality of VHD in the UK Biobank cohort. METHODS We interrogated data collected in the UK Biobank between 1 January 2000 and 30 June 2020. VHD incidence was determined using International Classification of Disease-10 codes for aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis, mitral regurgitation (MR) and mitral valve prolapse. We calculated HRs for incident VHD and all-cause mortality. Clinical correlates of VHD included demographics, coronary artery disease, heart failure and atrial fibrillation. Surgical and percutaneous interventions for mitral and aortic VHD were considered time-dependent variables. RESULTS Among 486 187 participants, the incidence of any VHD was 16 per 10 000 person-years, with highest rates for MR (8.2), AS (7.2) and AR (5.0). Age, heart failure, coronary artery disease and atrial fibrillation were significantly associated with all types of VHD. In our adjusted model, aortic and mitral VHD had an increased risk of all-cause death compared with no VHD (HR 1.62, 95% CI 1.44 to 1.82, p<0.001 and HR 1.25, 95% CI 1.09 to 1.44, p=0.002 for aortic and mitral VHD, respectively). CONCLUSION VHD continues to constitute a significant public health burden, with MR and AS being the most common. Age and cardiac comorbidities remain strong risk factors for VHD. In the modern era of percutaneous and surgical interventions, mortality associated with VHD remains high.
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Affiliation(s)
- Monica Tung
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gregory Nah
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Janet Tang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Greg Marcus
- Department of Medicine (Cardiovascular Division), University of California San Francisco, San Francisco, California, USA
| | - Francesca N Delling
- Department of Medicine (Cardiovascular Division), University of California San Francisco, San Francisco, California, USA
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29
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Affiliation(s)
- Tirone David
- Surgery, Toronto General Hospital, Toronto, Ontario, Canada
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30
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Geirsson A, Owen CH, Binford RS, Voeller RK, Burke CR, McNeil JD, Wei LM, Badhwar V, Rankin JS. Aortic valve repair for isolated right coronary leaflet prolapse. JTCVS Tech 2022; 13:26-30. [PMID: 35711222 PMCID: PMC9196763 DOI: 10.1016/j.xjtc.2022.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Isolated right coronary leaflet prolapse is a common cause of nonaneurysmal aortic insufficiency, but can rarely occur in patients with proximal aortic aneurysms. Standardized techniques for routine autologous repair of this disorder are presented. Methods Most aortic valve leaflet prolapse is isolated to the right coronary leaflet, with hypertension and annular dilatation being contributory. Echocardiographically, a posteriorly eccentric aortic insufficiency jet together with "fracture" of the right leaflet tip are diagnostic. Primary repair includes internal geometric ring annuloplasty to downsize and reshape the annulus, together with central plication of the prolapsing leaflet. Thickened, scarred, or retracted noduli are released using an ultrasonic aspirator. The goal is to achieve equivalent coaptation heights of ≥8 mm for all 3 leaflets. Results Three videos of 6 cases are provided to illustrate these techniques. In the first, 3 patients are shown with classic isolated right leaflet prolapse. In the second and third videos, alternative pathologies are presented for contrast. Applying the reconstructive approaches of geometric ring annuloplasty, leaflet plication, and ultrasonic nodular release, excellent early and late repair outcomes are obtainable in most patients. Conclusions The combination of aortic ring annuloplasty, central leaflet plication, and ultrasonic nodular release allows routine and standardized repair of right coronary leaflet prolapse, either isolated or concomitant with aneurysm surgery.
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Affiliation(s)
- Arnar Geirsson
- Department of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn
| | | | | | - Rochus K. Voeller
- Department of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minn
| | | | | | - Lawrence M. Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J. Scott Rankin
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
- Address for reprints: J. Scott Rankin, MD, 1 Medical Center Drive, Morgantown, WV 26506.
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31
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Affiliation(s)
- Jay Voit
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Christopher R Burke
- Department of Cardiac Surgery, University of Washington, Seattle, Washington, USA
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32
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Olsthoorn JR, Goossens EAC, Lam K, Tonino PAL, van Dantzig JM. Aortic Valve Insufficiency as a Late Complication After Impella Device Implantation. JACC Cardiovasc Interv 2022; 15:e91-3. [PMID: 35367172 DOI: 10.1016/j.jcin.2022.01.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/22/2022]
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33
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Anderson RH. Correspondence on 'The personalized external aortic root support procedure: interesting niche or ready for prime time?' by Burke et al. Heart 2022; 108:744. [PMID: 35264418 DOI: 10.1136/heartjnl-2021-320555] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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34
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Campisi S, Habougit C, Guichard JB. Acute aortic valve dysfunction in a woman with livedo racemosa and memory impairment. Heart 2021; 108:110-156. [PMID: 34937800 DOI: 10.1136/heartjnl-2021-319542] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/05/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Salvatore Campisi
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Cyril Habougit
- Department of Anatomopathology, University Hospital of Saint-Etienne, Saint-Etienne, France
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35
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Zhang Y, Verdecia J, Mgbemena O, Ravi M, Sands M. Bartonella Endocarditis: A Missed Diagnosis in Medical Practice. Cureus 2021; 13:e19309. [PMID: 34900484 PMCID: PMC8647862 DOI: 10.7759/cureus.19309] [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] [Accepted: 11/06/2021] [Indexed: 11/17/2022] Open
Abstract
Here, we present the case of a 52-year-old patient who presented with fever, chills, and weight loss. Further workup revealed Bartonella endocarditis of the aortic valve. After six weeks of antibiotics, a follow-up transthoracic echocardiogram showed a decrease in the size of vegetation. Serologic testing based on epidemiologic history should be obtained for the workup of blood culture-negative endocarditis.
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Affiliation(s)
- Yixin Zhang
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Jorge Verdecia
- Infectious Disease, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Okechukwu Mgbemena
- Cardiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Malleswari Ravi
- Infectious Disease, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Michael Sands
- Infectious Disease, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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36
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Koren O, Patel V, Kaewkes D, Koseki K, Chakravarty T, Nakamura M, Wen C, Naami R, Makkar RR. Transcatheter Aortic Valve Replacement for Bicuspid Aortic Insufficiency After Valve-Sparing Aortic Root Replacement. JACC Case Rep 2021; 3:1798-1802. [PMID: 34917957 PMCID: PMC8642721 DOI: 10.1016/j.jaccas.2021.07.018] [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: 04/28/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 01/07/2023]
Abstract
Bicuspid aortic insufficiency (BAI) patients with root aneurysm often require aortic valve and root replacement in a composite procedure. The valve-sparing root replacement (VSARR) procedure is aimed at preserving the native valve when possible. This case highlights a successful transcatheter aortic valve replacement procedure in a BAI patient previously treated with VSARR. (Level of Difficulty: Intermediate.)
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Key Words
- AI, aortic insufficiency
- BAI, bicuspid aortic insufficiency
- BAV, bicuspid aortic valve
- David procedure
- EOA, effective orifice area
- LVOT, left ventricular outflow tract
- SOV, sinus of Valsalva
- TAVR, transcatheter aortic valve replacement
- THV, transcatheter heart valve
- TTE, transthoracic echocardiography
- VSARR, valve-sparing aortic root replacement
- aortic aneurysm
- aortic valve insufficiency
- bicuspid aortic valve disease
- transcatheter aortic valve replacement
- valve-sparing aortic replacement
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Affiliation(s)
- Ofir Koren
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA.,Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Vivek Patel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Danon Kaewkes
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA.,Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Keita Koseki
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA.,Department of Cardiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Tarun Chakravarty
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Mamoo Nakamura
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Cheng Wen
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Robert Naami
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
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37
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He S, Huynh CA, Deng Y, Markan S, Nguyen A. Bicuspid Aortic Valve in Pregnancy Complicated by Aortic Valve Vegetation, Aortic Root Abscess, and Aortic Insufficiency. Cureus 2021; 13:e20209. [PMID: 35004029 PMCID: PMC8730475 DOI: 10.7759/cureus.20209] [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] [Accepted: 12/06/2021] [Indexed: 11/30/2022] Open
Abstract
A 39-year-old patient presented to our Labor and Delivery unit with fever and nausea in the context of recent bacteriuria. She was found to be in sepsis due to an incidental bicuspid aortic valve (BAV) complicated by aortic valvular vegetations, severe aortic insufficiency, and aortic root abscess, requiring an emergent cesarean section. Three days after delivery, the patient successfully underwent a mechanical aortic valve replacement and root reconstruction. In this case report, medical, surgical, and anesthetic management of parturient patients with BAV are discussed. The management of this congenital valvulopathy and vasculopathy is complicated by the extensive hemodynamic and cardiovascular derangements that occur during pregnancy.
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Affiliation(s)
- Shan He
- Anesthesiology, Baylor College of Medicine, Houston, USA
| | | | - Yi Deng
- Anesthesiology, Baylor College of Medicine, Houston, USA
| | - Sandeep Markan
- Anesthesiology, Baylor College of Medicine, Houston, USA
| | - Anvinh Nguyen
- Anesthesiology, Baylor College of Medicine, Houston, USA
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38
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Bhasin D, Kumar R, Gupta P. Man with an ejection systolic murmur. Heart 2021; 107:1955-2006. [PMID: 34824157 DOI: 10.1136/heartjnl-2021-319841] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Dinkar Bhasin
- Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Rahul Kumar
- Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Preeti Gupta
- Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
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39
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Guo X, Song R, Chen Y. Severe aortic regurgitation and heart failure. Heart 2021; 107:1874-1924. [PMID: 34764203 DOI: 10.1136/heartjnl-2021-319612] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Xinli Guo
- Department of Cardiology, Sichuan University, Chengdu, China
| | - Rizhen Song
- Department of Cardiology, Sichuan University, Chengdu, China
| | - Yucheng Chen
- Department of Cardiology, Sichuan University, Chengdu, China
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40
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Verbrugge FH, Reddy YNV, Eleid MF, Lin G, Burkhoff D, Borlaug BA. Mild aortic valve disease and the diastolic pressure-volume relationship in heart failure with preserved ejection fraction. Open Heart 2021; 8:openhrt-2021-001701. [PMID: 34670831 PMCID: PMC8529988 DOI: 10.1136/openhrt-2021-001701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/24/2021] [Indexed: 01/04/2023] Open
Abstract
Objective Mild aortic valve stenosis (AS) and aortic valve (AV) sclerosis are associated with diastolic dysfunction and increased mortality in the general population. This study specifically investigated the impact of mild AV disease in heart failure with preserved ejection fraction (HFpEF). Methods Consecutive patients hospitalised with HFpEF (n=370) underwent assessment of cardiac structure and function and long-term clinical follow-up. Results In the study cohort, 111 had mild AS (30%), 104 AV sclerosis (28%) and 155 a non-calcified AV (42%). Mild-to-moderate AV regurgitation (AR) was present in 64 (17%). Compared with patients with a normal AV, those with AV disease were older, with worse renal function and more atrial fibrillation. E/e′ increased from non-calcified AV to AV sclerosis to mild AS (13.8 (10.8–16.8) vs 15.0 (10.9–20.0) vs 18.0 (12.7–23.3), respectively; p<0.001)). Left ventricular diastolic pressure–volume relationships were shifted leftwards in patients with AS and AV sclerosis, but not influenced by AR. The left ventricular end-diastolic volume normalised at 20 mm Hg was 117±34 mL, 106±30 mL and 112±30 mL in non-calcified AV, AV sclerosis and mild AS, respectively (p=0.023), while 112±32 mL in mild-to-moderate AR. Over 30 months (IQR, 8–61 months), 247 patients died (67%). The presence of mild AV disease was associated with increased mortality, but this was no longer significant after adjusting for age and sex. Conclusions Low-grade AV disease is common among patients hospitalised for HFpEF and is associated with older age, atrial arrhythmia, renal dysfunction, higher left heart filling pressures and increased left ventricular chamber stiffness.
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Affiliation(s)
- Frederik H Verbrugge
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Centre for Cardiovascular Diseases, University Hospital Brussels, Brussels, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Yogesh N V Reddy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Grace Lin
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York City, New York, USA
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Granath C, Mohamed SA, Olsson C, Grattan M, Mertens L, Franco-Cereceda A, Björck HM. Valve disease and aortopathy associations of bicuspid aortic valve phenotypes differ between men and women. Open Heart 2021; 8:openhrt-2021-001857. [PMID: 34670833 PMCID: PMC8529975 DOI: 10.1136/openhrt-2021-001857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 12/30/2022] Open
Abstract
Objective Determine whether associations between bicuspid aortic valve (BAV) phenotypes, valve disease and aortopathy differ between sexes. Methods 1045 patients with BAV (76.0% men, n=794) from two surgical centres were included in this cross-sectional study. Valve phenotype was classified intraoperatively as right–left (RL), right-non-coronary (RN), left-non-coronary (LN) or 2-sinus BAV. Echocardiography was used to determine type and degree of valve disease, and aortic dimensions. Aortic dilatation was defined as diameter ≥4.5 cm. Results RL was the most common phenotype (73.6%), followed by RN (16.2%), 2-sinus BAV (9.2%) and LN (1.1%), with no difference in phenotype distribution between men and women (p=0.634). Aortic valve insufficiency (AI) prevalence differed significantly with valve phenotype in men (p=0.047), with RL and LN having the highest prevalence (34.1% and 44.0%, respectively). In women, RN had a higher proportion of AI than RL (21.3% vs 7.3%, p=0.017). Men with RL had larger root dimensions, in particular at the sinus (mean difference 0.24 cm compared with RN, p=0.002). Men with 2-sinus BAV had the highest prevalence of root phenotype dilatation (7.0%, other phenotypes ≤2.3%, p=0.031), whereas women with 2-sinus BAV did not have root dilatation and smaller sinus dimensions (mean difference: 0.35 cm compared with RL, p=0.021). Aortic root segments were larger in men with AI compared with aortic stenosis (sinus mean difference: 0.40 cm, p<0.001). The difference was even larger in women (mean difference: 0.78 cm, p<0.001), and women with AI also had larger tubular segments (mean difference: 0.61 cm, p=0.001). Conclusions There are significant sex differences in clinical associations of BAV phenotypes, which should be considered in further studies on the role of phenotypes in individualised patient management.
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Affiliation(s)
- Carl Granath
- Department of Molecular Medicine and Surgery, Section of Cardiothoracic Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Salah A Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lubeck, Germany
| | - Christian Olsson
- Department of Molecular Medicine and Surgery, Section of Cardiothoracic Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Grattan
- Department of Paediatrics, LHSC Children's Hospital, University of Western Ontario, London, Ontario, Canada.,Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Luc Mertens
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Section of Cardiothoracic Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna M Björck
- Department of Medicine, Cardiovascular Medicine Unit, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Sharma GK, Mir WAY, Kovacs D, Ibrahim Z, Benatar D, Khosla S, Gaire S, Shrestha DB. Outlet Ventricular Septal Defect in an Elderly Male. Cureus 2021; 13:e17127. [PMID: 34532169 PMCID: PMC8434814 DOI: 10.7759/cureus.17127] [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] [Accepted: 08/12/2021] [Indexed: 11/05/2022] Open
Abstract
Ventricular septal defect (VSD) is the most common congenital cardiac anomaly in children and the second most common congenital cardiac anomaly in adults. The hemodynamic compromise associated with VSD is due to the shunt formation created by the abnormal communication between the right and left ventricles. While 85%-90% of small VSDs close spontaneously during the first year of life, some do not close spontaneously. If spontaneous closure does not occur during childhood, a VSD may persist into adulthood and may first be recognized after the development of a complication. We present a case of outlet VSD with secondary aortic insufficiency due to the prolapse of the aortic valve leaflet, especially in the right coronary cusp (RCC) sparing the left coronary cusp. RCC prolapse is an important finding in outlet VSD as the prolapse has the potential to cause permanent aortic insufficiency and closure is indicated regardless of the size of VSD.
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Affiliation(s)
- Gaurav K Sharma
- Cardiology, Rosalind Franklin University of Medicine and Science, Chicago, USA
| | | | - Daniela Kovacs
- Cardiology, Rosalind Franklin University of Medicine and Science, Chicago, USA
| | - Zeina Ibrahim
- Cardiology, Rosalind Franklin University of Medicine and Science, Chicago, USA
| | - Daniel Benatar
- Cardiology, Rosalind Franklin University of Medicine and Science, Chicago, USA
| | - Sandeep Khosla
- Cardiology, Rosalind Franklin University of Medicine and Science, Chicago, USA
| | - Suman Gaire
- Department of Emergency Medicine, Palpa Hospital, Palpa, NPL
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Papakonstantinou NA, Kogerakis N, Kantidakis G, Athanasopoulos G, Stavridis GT. A modern approach to aortic valve insufficiency: Aortic root restoration via HAART 300 internal annuloplasty ring. J Card Surg 2021; 36:4189-4195. [PMID: 34448500 DOI: 10.1111/jocs.15947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/14/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY HAART 300 is an internal geometric annuloplasty ring. The safety and efficacy of this novel device in aortic valve (AV) repair in a single referral center are reported. METHODS Twenty patients with trileaflet AV insufficiency with ascending aorta and/or aortic root enlargement were included. Subannular implantation was performed to correct annular dilatation, whereas concomitant leaflet repair was performed whenever required. All but two patients also received ascending aorta replacement, whereas selective sinus replacement was performed in all but five patients. RESULTS Follow-up was for a maximum of 3.8 years and a mean of 2.2 years. Mean age was 54.2 years old. Moderate to severe preoperative AV insufficiency was noted in 75% of patients, whereas 70% of them had an ascending aorta over 45 mm. One patient was lost from follow-up. Overall mortality as well as major complication rates were zero. Early postoperatively, no more than mild AV regurgitation was detected, whereas only one patient appeared with moderate AV regurgitation during our 2.2-year follow-up. New York Heart Association class was also significantly lower compared to preoperative values and valve gradients remained low at last follow-up. CONCLUSIONS Geometric ring annuloplasty is a safe and effective valve sparing approach to deal with AV insufficiency contributing to overall root reconstruction. Short-term results are excellent rendering this easily reproducible and versatile method very attractive.
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Affiliation(s)
- Nikolaos A Papakonstantinou
- 3rd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece.,2nd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Nektarios Kogerakis
- 2nd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Georgios Kantidakis
- 3rd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
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44
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Shad R, Kaiser AD, Kong S, Fong R, Quach N, Bowles C, Kasinpila P, Shudo Y, Teuteberg J, Woo YJ, Marsden AL, Hiesinger W. Patient-Specific Computational Fluid Dynamics Reveal Localized Flow Patterns Predictive of Post-Left Ventricular Assist Device Aortic Incompetence. Circ Heart Fail 2021; 14:e008034. [PMID: 34139862 PMCID: PMC8292193 DOI: 10.1161/circheartfailure.120.008034] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Progressive aortic valve disease has remained a persistent cause of concern in patients with left ventricular assist devices. Aortic incompetence (AI) is a known predictor of both mortality and readmissions in this patient population and remains a challenging clinical problem. METHODS Ten left ventricular assist device patients with de novo aortic regurgitation and 19 control left ventricular assist device patients were identified. Three-dimensional models of patients' aortas were created from their computed tomography scans, following which large-scale patient-specific computational fluid dynamics simulations were performed with physiologically accurate boundary conditions using the SimVascular flow solver. RESULTS The spatial distributions of time-averaged wall shear stress and oscillatory shear index show no significant differences in the aortic root in patients with and without AI (mean difference, 0.67 dyne/cm2 [95% CI, -0.51 to 1.85]; P=0.23). Oscillatory shear index was also not significantly different between both groups of patients (mean difference, 0.03 [95% CI, -0.07 to 0.019]; P=0.22). The localized wall shear stress on the leaflet tips was significantly higher in the AI group than the non-AI group (1.62 versus 1.35 dyne/cm2; mean difference [95% CI, 0.15-0.39]; P<0.001), whereas oscillatory shear index was not significantly different between both groups (95% CI, -0.009 to 0.001; P=0.17). CONCLUSIONS Computational fluid dynamics serves a unique role in studying the hemodynamic features in left ventricular assist device patients where 4-dimensional magnetic resonance imaging remains unfeasible. Contrary to the widely accepted notions of highly disturbed flow, in this study, we demonstrate that the aortic root is a region of relatively stagnant flow. We further identified localized hemodynamic features in the aortic root that challenge our understanding of how AI develops in this patient population.
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Affiliation(s)
- Rohan Shad
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Alexander D. Kaiser
- Institute for Computational and Mathematical Engineering, Stanford University
- Department of Pediatrics (Cardiology), Stanford University
| | - Sandra Kong
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Robyn Fong
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Nicolas Quach
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Cayley Bowles
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Patpilai Kasinpila
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Jeffrey Teuteberg
- Department of Medicine (Cardiovascular Medicine), Stanford University
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Alison L. Marsden
- Department of Bioengineering, Stanford University
- Institute for Computational and Mathematical Engineering, Stanford University
- Department of Pediatrics (Cardiology), Stanford University
| | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
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45
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Huded CP, Allen KB, Chhatriwalla AK. Counterpoint: challenges and limitations of transcatheter aortic valve implantation for aortic regurgitation. Heart 2021; 107:1942-1945. [PMID: 33863760 DOI: 10.1136/heartjnl-2020-318682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/15/2021] [Revised: 03/19/2021] [Accepted: 04/04/2021] [Indexed: 11/04/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) for isolated aortic regurgitation (AR) comprises <1.0% of all TAVI procedures performed in the USA. In this manuscript, we review the challenges, evidence and future directions of TAVI for isolated AR. There are no randomised clinical trials or mid-term data evaluating TAVI for isolated AR, and no commercially available devices are approved for this indication. Challenges in performing TAVI for isolated AR as opposed to aortic stenosis (AS) include: lack of a calcified anchoring zone for valve deployment, large and dynamic size of the aortic annulus and high stroke volume (during systole) and regurgitant volume (during diastole) across the aortic annulus during each cardiac cycle. Observational studies have shown that outcomes of TAVI for AR are worse than outcomes of TAVI for AS. However, newer generation TAVI devices may perform better than older generation devices in patients with AR. Two emerging valves (the JenaValve and the J-Valve) are designed with mechanisms to anchor in a non-calcified annulus, and these valves have shown promise for AR. Data on these devices are limited, and clinical investigation is ongoing. Randomised clinical trials are needed to establish TAVI as a safe and effective treatment for isolated AR.
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Affiliation(s)
- Chetan P Huded
- Department of Cardiology, Saint Luke's Hospital, Kansas City, Missouri, USA
| | - Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Hospital, Kansas City, Missouri, USA
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Butcher SC, Fortuni F, Kong W, Vollema EM, Prevedello F, Perry R, Ng ACT, Poh KK, Almeida AG, González-Gómez A, Shen M, Yeo TC, Shanks M, Popescu BA, Galian-Gay L, Fijalkowski M, Liang M, Tay E, Ajmone Marsan N, Selvanayagam JB, Pinto FJ, Zamorano J, Pibarot P, Evangelista A, Bax JJ, Delgado V. Prognostic implications of left atrial dilation in aortic regurgitation due to bicuspid aortic valve. Heart 2021; 108:137-144. [PMID: 33833069 DOI: 10.1136/heartjnl-2020-318907] [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: 01/03/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the prognostic value of left atrial volume index (LAVI) in patients with moderate to severe aortic regurgitation (AR) and bicuspid aortic valve (BAV). METHODS 554 individuals (45 (IQR 33-57) years, 80% male) with BAV and moderate or severe AR were selected from an international, multicentre registry. The association between LAVI and the combined endpoint of all-cause mortality or aortic valve surgery was investigated with Cox proportional hazard regression analyses. RESULTS Dilated LAVI was observed in 181 (32.7%) patients. The mean indexed aortic annulus, sinus of Valsalva, sinotubular junction and ascending aorta diameters were 13.0±2.0 mm/m2, 19.4±3.7 mm/m2, 16.5±3.8 mm/m2 and 20.4±4.5 mm/m2, respectively. After a median follow-up of 23 (4-82) months, 272 patients underwent aortic valve surgery (89%) or died (11%). When compared with patients with normal LAVI (<35 mL/m2), those with a dilated LAVI (≥35 mL/m2) had significantly higher rates of aortic valve surgery or mortality (43% and 60% vs 23% and 36%, at 1 and 5 years of follow-up, respectively, p<0.001). Dilated LAVI was independently associated with reduced event-free survival (HR=1.450, 95% CI 1.085 to 1.938, p=0.012) after adjustment for LV ejection fraction, aortic root diameter, LV end-diastolic diameter and LV end-systolic diameter. CONCLUSIONS In this large, multicentre registry of patients with BAV and moderate to severe AR, left atrial dilation was independently associated with reduced event-free survival. The role of this parameter for the risk stratification of individuals with significant AR merits further investigation.
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Affiliation(s)
- Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - William Kong
- Department of Cardiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - E Mara Vollema
- Department of Cardiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Francesca Prevedello
- Department of Cardiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,Division of Cardiology, West Vicenza General Hospitals, Arzignano (Vicenza), Italy
| | - Rebecca Perry
- Department of Cardiovascular Medicine, Flinders University, Flinders Medical Centre, Bedford Park, Adelaide, Australia.,University of South Australia, Allied Health and Human Performance, Adelaide, South Australia, Australia
| | - Arnold Chin Tse Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Kian Keong Poh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ana G Almeida
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte (CHULN), CCUL, Universidade de Lisboa, Lisboa, Portugal
| | | | - Mylène Shen
- Department of Cardiology, Québec Heart and Lung Institute, Laval University, Québec, Quebec, Canada
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Miriam Shanks
- Division of Cardiology, University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila" - Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebro'n, Barcelona, Spain
| | - Marcin Fijalkowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michael Liang
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore.,Department of Cardiology, Khoo Teck Puat Hospital, Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Joseph B Selvanayagam
- Department of Cardiovascular Medicine, Flinders University, Flinders Medical Centre, Bedford Park, Adelaide, Australia
| | - Fausto J Pinto
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte (CHULN), CCUL, Universidade de Lisboa, Lisboa, Portugal
| | - José Zamorano
- Department of Cardiology, Hospital Universitario Ramo'n y Cajal, Madrid, Spain
| | - Philippe Pibarot
- Department of Cardiology, Québec Heart and Lung Institute, Laval University, Québec, Quebec, Canada
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebro'n, Barcelona, Spain
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland; Heart Center, Turku University Hospital, Turku, Finland, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
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Jahangiri M. Survival after surgical aortic valve replacement in patients with bicuspid aortic valve disease. Heart 2021; 107:1113-1114. [PMID: 33795380 DOI: 10.1136/heartjnl-2021-319088] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Marjan Jahangiri
- Cardiac Surgery, St George's Hospital and Medical School, London, UK
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48
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Brescia AA, Deeb GM, Sang SLW, Tanaka D, Grossman PM, Sukul D, He C, Theurer PF, Clark M, Shannon FL, Chetcuti SJ, Fukuhara S. Surgical Explantation of Transcatheter Aortic Valve Bioprostheses: A Statewide Experience. Circ Cardiovasc Interv 2021; 14:e009927. [PMID: 33719506 DOI: 10.1161/circinterventions.120.009927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Alexander A Brescia
- Department of Cardiac Surgery (A.A.B., G.M.D., S.F.), University of Michigan, Ann Arbor
| | - G Michael Deeb
- Department of Cardiac Surgery (A.A.B., G.M.D., S.F.), University of Michigan, Ann Arbor.,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Stephane Leung Wai Sang
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.).,Spectrum Health Medical Group, Cardiothoracic Surgery, Grand Rapids, MI (S.L.W.S.)
| | - Daizo Tanaka
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.).,Henry Ford Hospital Division of Cardiac Surgery, Detroit, MI (D.T.)
| | - P Michael Grossman
- Department of Internal Medicine (P.M.G., D.S., S.J.C.), University of Michigan, Ann Arbor.,Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, MI (P.M.G., D.S., S.J.C.)
| | - Devraj Sukul
- Department of Internal Medicine (P.M.G., D.S., S.J.C.), University of Michigan, Ann Arbor.,Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, MI (P.M.G., D.S., S.J.C.)
| | - Chang He
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Patricia F Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Melissa Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Francis L Shannon
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.).,Division of Cardiovascular Surgery, Beaumont Health, Royal Oak, MI (F.L.S.)
| | - Stanley J Chetcuti
- Department of Internal Medicine (P.M.G., D.S., S.J.C.), University of Michigan, Ann Arbor.,Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, MI (P.M.G., D.S., S.J.C.)
| | - Shinichi Fukuhara
- Department of Cardiac Surgery (A.A.B., G.M.D., S.F.), University of Michigan, Ann Arbor.,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
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49
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Glaser N, Jackson V, Eriksson P, Sartipy U, Franco-Cereceda A. Relative survival after aortic valve surgery in patients with bicuspid aortic valves. Heart 2021; 107:1167-1172. [PMID: 33622679 PMCID: PMC8257557 DOI: 10.1136/heartjnl-2020-318733] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES The objective of this cohort study was to analyse long-term relative survival in patients with bicuspid aortic valve (BAV) who underwent aortic valve surgery. METHODS We studied 865 patients with BAVs who participated in three prospective cohort studies of elective, open-heart, aortic valve surgery at the Karolinska University Hospital, Stockholm, Sweden, between 2007 and 2020. The expected survival for the age, sex and calendar year-matched general Swedish population was obtained from the Human Mortality Database. The Ederer II method was used to calculate relative survival, which was used as an estimate of cause-specific survival. RESULTS No differences were found in the observed versus expected survival at 1, 5, 10 or 12 years: 99%, 94%, 83% and 76% vs 99%, 93%, 84% and 80%, respectively. The relative survival at 1, 5, 10 and 12 years was 100% (95% CI 99% to 100%), 101% (95% CI 99% to 103%), 99% (95% CI 95% to 103%) and 95% (95% CI 87% to 102%), respectively. The relative survival at the end of follow-up tended to be lower for women than men (86% vs 95%). The mean follow-up was 6.3 years (maximum 13.3 years). CONCLUSIONS The survival of patients with BAV following aortic valve surgery was excellent and similar to that of the general population. Our results suggest that the timing of surgery according to current guidelines is correct and provide robust long-term survival rates, as well as important information about the natural history of BAV in patients following aortic valve surgery.
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Affiliation(s)
- Natalie Glaser
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden .,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Jackson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per Eriksson
- Cardiovascular Medicine Unit, Centre for Molecular Medicine, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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50
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Abstract
Objective: To evaluate the evidence for common therapeutic controversies in the medical management of valvular heart disease (VHD). Data Sources: A literature search of PubMed (inception to December 2020) was performed using the terms angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and aortic stenosis (AS); and adrenergic β-antagonists and aortic valve regurgitation (AR) or mitral stenosis (MS). Study Selection and Data Extraction: Randomized controlled trials (RCTs) and meta-analyses conducted in humans and published in English that reported ≥1 clinical outcome were included. Data Synthesis: Nine articles were included: 3 RCTs and 1 meta-analysis for ACE inhibitors/ARBs in AS, 1 RCT for β-blockers in AR, and 4 RCTs for β-blockers in MS. Evidence suggests that ACE inhibitors/ARBs do not increase the risk of adverse outcomes in patients with AS but may delay valve replacement. β-Blockers do not appear to worsen outcomes in patients with chronic AR and may improve left-ventricular function in patients with a reduced ejection fraction. β-Blockers do not improve and may actually worsen exercise tolerance in patients with MS in sinus rhythm. Relevance to Patient Care and Clinical Practice: ACE inhibitors/ARBs and β-blockers can likely be safely used in patients with AS or AR, respectively, who have a compelling indication. There is insufficient evidence to recommend routine use of β-blockers in patients with MS without atrial fibrillation. Conclusions: Common beliefs about the medical treatment of VHD are not supported by high-quality data. There remains a need for larger-scale RCTs in the medical management of VHD.
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Affiliation(s)
- Arden R Barry
- University of British Columbia, Vancouver, BC, Canada.,Chilliwack General Hospital, Lower Mainland Pharmacy Services, Chilliwack, BC, Canada
| | - Erica H Z Wang
- St Paul's Hospital, Lower Mainland Pharmacy Services, Vancouver, BC, Canada
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