1
|
Richardson M, Bonnet JP, Coulon C, Domanski O, Constans B, Estevez MG, Gautier S, Marsili L, Hamoud YO, Coisne A, Ridon H, Polge AS, Mouton S, Haddad Y, Juthier F, Moussa M, Vehier CM, Lemesle G, Schurtz G, Garabedian C, Jourdain M, Ninni S, Brigadeau F, Montaigne D, Lamblin N, Ghesquiere L. Management and outcomes of pregnant women with cardiovascular diseases in a cardio-obstetric team. Arch Cardiovasc Dis 2024:S1875-2136(24)00056-1. [PMID: 38644069 DOI: 10.1016/j.acvd.2024.02.009] [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: 12/12/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are currently the leading cause of maternal death in Western countries. Although multidisciplinary cardio-obstetric teams are recommended to improve the management of pregnant women with CVD, data supporting this approach are scarce. AIMS To describe the characteristics and outcomes of pregnant patients with CVD managed within the cardio-obstetric programme of a tertiary centre. METHODS We included every pregnant patient with history of CVD managed by our cardio-obstetric team between June 2017 and December 2019, and collected all major cardiovascular events (death, heart failure, acute coronary syndromes, stroke, endocarditis and aortic dissection) that occurred during pregnancy, peripartum and the following year. RESULTS We included 209 consecutive pregnancies in 202 patients. CVDs were predominantly valvular heart diseases (37.8%), rhythm disorders (26.8%), and adult congenital heart diseases (22.5%). Altogether, 47.4% were classified modified World Health Organization (mWHO)>II, 66.5% had CARdiac disease in PREGnancy score (CARPREG II)≥2 and 80 pregnancies (38.3%) were delivered by caesarean section. Major cardiovascular events occurred in 16 pregnancies (7.7%, 95% confidence interval [CI] 4.5-12.2) during pregnancy and in three others (1.5%, 95% CI 0.3-4.1) during 1-year follow-up. Most events (63.1%) occurred in the 16.3% of patients with unknown CVD before pregnancy. CONCLUSIONS The management of pregnant patients with CVD within a cardio-obstetric team seems encouraging as we found a relatively low rate of cardiovascular events compared to the high-risk profile of our population. However, most of the remaining events occurred in patients without cardiac monitoring before pregnancy.
Collapse
Affiliation(s)
- Marjorie Richardson
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France.
| | - Jean Philippe Bonnet
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Capucine Coulon
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Olivia Domanski
- Department of Paediatrics and Congenital Heart Diseases, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Benjamin Constans
- Department of Anaesthesia, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Max Gonzalez Estevez
- Department of Anaesthesia, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Sophie Gautier
- Department of Pharmacology, Lille University Hospital, Lille, France
| | - Luisa Marsili
- Department of Clinical Genetic, Lille University Hospital, Lille, France
| | - Yasmine Ould Hamoud
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Augustin Coisne
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Cardiovascular Research Foundation, New York, NY, USA; Inserm, U1011-EGID, Institut Pasteur de Lille, University of Lille, CHU de Lille, 59000 Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France
| | - Hélène Ridon
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Anne-Sophie Polge
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Stéphanie Mouton
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Yasmine Haddad
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Francis Juthier
- Faculté de médecine de Lille, université de Lille, Lille, France; Department of Surgery, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Inserm U1011, Institut Pasteur de Lille, Lille, France
| | - Mouhamed Moussa
- Department of Anaesthesia, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Claire Mounier Vehier
- Department of Vascular Medicine and Hypertension, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Gilles Lemesle
- Faculté de médecine de Lille, université de Lille, Lille, France; Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France; FACT (French Alliance for Cardiovascular Trial), Paris, France
| | - Guillaume Schurtz
- Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France
| | - Charles Garabedian
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; METRICS, ULR 2694, Assessment of Health Technologies and Medical Practices, Lille, France
| | - Mercedes Jourdain
- Faculté de médecine de Lille, université de Lille, Lille, France; Intensive Care Unit, CHU de Lille, Lille, France; Inserm U1190, Lille, France
| | - Sandro Ninni
- Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France; Department of Cardiology, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - François Brigadeau
- Department of Cardiology, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - David Montaigne
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Inserm, U1011-EGID, Institut Pasteur de Lille, University of Lille, CHU de Lille, 59000 Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France
| | - Nicolas Lamblin
- Faculté de médecine de Lille, université de Lille, Lille, France; Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France; Inserm U1167, Institut Pasteur de Lille, Lille, France
| | - Louise Ghesquiere
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; METRICS, ULR 2694, Assessment of Health Technologies and Medical Practices, Lille, France
| |
Collapse
|
2
|
Ryan JB. Who should get the last TAVI valve? Public versus private access to disruptive technologies in the Australian health care system. Med J Aust 2024; 220:231-233. [PMID: 38327243 DOI: 10.5694/mja2.52226] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Jonathon B Ryan
- University of New South Wales, Sydney, NSW
- Prince of Wales Hospital and Community Health Services, Sydney, NSW
- Prince of Wales Private Hospital, Sydney, NSW
- Eastern Heart Clinic, Sydney, NSW
| |
Collapse
|
3
|
Rheude T, Pellegrini C, Xhepa E, Joner M. [Update on the treatment of aortic valve stenosis in symptomatic and asymptomatic patients]. Herz 2024; 49:156-164. [PMID: 38240775 DOI: 10.1007/s00059-023-05229-8] [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] [Accepted: 11/22/2023] [Indexed: 03/07/2024]
Abstract
Aortic valve stenosis is one of the most frequent valvular heart diseases requiring treatment in industrialized countries. The symptom onset is associated with a significantly increased mortality, so that there is a clear indication for treatment in patients with severe, symptomatic aortic valve stenosis; however, data on the optimal treatment of patients with asymptomatic aortic valve stenosis are scarce. Smaller studies in the field of cardiac surgery suggest that early surgical valve replacement is superior to a conservative approach. For this reason, the results of additional adequately powered randomized trials are awaited with great interest. In this year numerous long-term results from randomized comparisons of the two available treatment options (surgical versus transcatheter aortic valve replacement) were published, which will further guide the heart team to find the best treatment approach for each individual.
Collapse
Affiliation(s)
- Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland.
- DZHK (Deutsches Zentrum für Herzkreislaufforschung), partner site Munich Heart Alliance, München, Deutschland.
| |
Collapse
|
4
|
Bozorgi A, Sadeghian S, Mehrabi Nasab E. Trans-apical catheter ablation of ventricular tachycardia in a patient with metallic aortic and mitral valves. J Cardiothorac Surg 2024; 19:12. [PMID: 38243315 PMCID: PMC10799356 DOI: 10.1186/s13019-024-02478-4] [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: 07/01/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024] Open
Abstract
We present a patient with a history of heart failure and metallic aortic and mitral valves surgeries, who required ablation for a drug-refractory left ventricular tachycardia. But the metallic valves prohibited the insertion of catheters via retrograde or via trans-septal approaches. Therefore, we decided to perform catheter ablation by direct left ventricle puncture through a minithoracotomy. The arrhythmia was successfully ablated via of trans-apical approach and did not recur at six months follow-up.
Collapse
Affiliation(s)
- Ali Bozorgi
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran.
| | - Saeed Sadeghian
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Entezar Mehrabi Nasab
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
- Department of Cardiology, School of Medicine, Valiasr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
5
|
Jia C, Zeng Y, Huang X, Yang H, Qu Y, Hu Y, Chen W, Yang X. Lifestyle patterns, genetic susceptibility, and risk of valvular heart disease: a prospective cohort study based on the UK Biobank. Eur J Prev Cardiol 2023; 30:1665-1673. [PMID: 37259902 DOI: 10.1093/eurjpc/zwad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
AIMS Genetic and lifestyle factors are both major contributors to valvular heart disease (VHD). However, it is still uncertain whether genetic susceptibility alters the association between lifestyle and VHD. We aimed to investigate the association between lifestyle and VHD in different genetic risk backgrounds. METHODS AND RESULTS A prospective cohort study was carried out on 499 341 participants without VHD at baseline. The assessment of lifestyle included smoking, alcohol consumption, diet, activity, and sleep. Genetic susceptibility was separately measured by polygenic risk scores (PRSs) and family history of cardiovascular disease (CVD). Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) between lifestyle and VHD, as well as aortic stenosis (AS). During a median follow-up of 10.8 years, 12 983 incident VHD cases were diagnosed (incidence rate 2.46 per 1000 person-years), including 3527 AS cases (incidence rate 0.66 per 1000 person-years). The risk of VHD and AS decreased with healthier lifestyles (P value for trend <0.001). Compared to individuals with a unhealthy lifestyle, the HRs of VHD in intermediate and healthy lifestyle groups were 0.81 (0.76-0.86) and 0.81 (0.76-0.87). The negative association between healthy lifestyle and VHD events was independent of genetic risk (P for interaction between healthy lifestyle scores and PRSs/family history of CVD was 0.723/0.763). Similar findings were obtained in analyses of AS, and a stronger negative association was found. CONCLUSION Our study reveals that adherence to a healthy lifestyle is significantly associated with a reduced risk of VHD especially AS, irrespective of genetic susceptibility. SUMMARY Based on a cohort of around 490 000 participants, the study investigated the association between lifestyle and VHD under different stratifications of genetic risk. The study found that a healthy lifestyle was associated with a lower risk of VHD, particularly AS, independent of genetic risk. Our findings suggest that advance interventions for lifestyle may be an effective way to reduce the global burden of VHD.
Collapse
Affiliation(s)
- Chenglin Jia
- Department of Cardiovascular Surgery, West China Biomedical Big Data Center and Med-X Center for Informatics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital/West China School of Medicine, and Key Laboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
| | - Yu Zeng
- Department of Cardiovascular Surgery and West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
- Med-X Center for Informatics, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
| | - Xuan Huang
- Department of Cardiovascular Surgery and West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
- Med-X Center for Informatics, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
| | - Huazhen Yang
- Department of Cardiovascular Surgery and West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
- Med-X Center for Informatics, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
| | - Yuanyuan Qu
- Department of Cardiovascular Surgery and West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
- Med-X Center for Informatics, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
| | - Yao Hu
- Department of Cardiovascular Surgery and West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
- Med-X Center for Informatics, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
| | - Wenwen Chen
- Department of Cardiovascular Surgery and West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
- Med-X Center for Informatics, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
| | - Xiaoyan Yang
- Department of Cardiovascular Surgery and West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
- Med-X Center for Informatics, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan 610041, China
| |
Collapse
|
6
|
Ling Y, Chen H, Zhu P, Li T, Xue B, Liu J. Minimally invasive valve surgery including patients of combined simultaneous surgery: a retrospective study. J Cardiothorac Surg 2023; 18:266. [PMID: 37777784 PMCID: PMC10541706 DOI: 10.1186/s13019-023-02361-8] [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: 04/09/2023] [Accepted: 09/02/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVE This study investigated the perioperative safety and advantages of performing a minimally invasive valve surgery (MIVS) and conducting a preliminary examination of the combined simultaneous surgery (CSS). METHODS A total of 29 patients (16 men and 13 women; mean age, 58.41 ± 13.08 years) who underwent MIVS at our center from July 2021 to March 2022 were selected. Among them, 16 patients underwent aortic valve surgery (AVS), 13 patients underwent mitral valve surgery (MVS), and four patients additionally underwent CSS. RESULTS The MIVS time ranged from 165 to 420 min, with a mean of 230.54 ± 54.61 min; the cardiopulmonary bypass (CPB) time ranged from 54 to 164 min, with a mean of 120.24 ± 25.98 min; the aortic cross-clamp (ACC) time ranged from 36 to 118 min, with a mean of 78.66 ± 21.01 min and an automatic heart resuscitating rate was 89.66%; the mean tracheal intubation time was 6.30 ± 3.87 h, and the median total postoperative drainage was 317.5 (35, 1470) ml. No difference was observed between preoperative and postoperative left ventricular ejection fraction (LVEF) (61.90% ± 6.28% vs. 60.21% ± 5.52%, P = 0.281). The difference in postoperative drainage (419.20 ml ± 377.20 ml vs. 588.75 ml ± 673.63 ml, P = .461), tracheal intubation time (6.66 h ± 4.27 h vs. 4.63 h ± 1.11 h, P = .359), intensive care unit (ICU) stay (3.96 ± 8.62 days vs. 2.00 ± 0.816 days, P = .658), and postoperative hospital stay (9.96 ± 8.45 days vs. 8.25 ± 1.26 days, P = .694) between MIVS and CSS was not significant. CONCLUSION MIVS in our center may be safe and effective. Additionally, CSS may be a feasible option that could be performed after a thorough preoperative evaluation and multidisciplinary discussion.
Collapse
Affiliation(s)
- Yun Ling
- Department of Cardiovascular Surgery, Shanghai East Hospital affiliated to Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200000, China
| | - Huaxin Chen
- Department of Anesthesiology, Hainan Hospital of Chinese PLA General Hospital, 80 Jianglin Rd, Sanya, 572013, China
| | - Pengxiong Zhu
- Department of Cardiovascular Surgery, Shanghai East Hospital affiliated to Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200000, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China.
| | - Bangde Xue
- Department of Cardiovascular Surgery, Shanghai East Hospital affiliated to Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200000, China.
| | - Jun Liu
- Department of Cardiovascular Surgery, Shanghai East Hospital affiliated to Tongji University School of Medicine, 150 Jimo Rd, Shanghai, 200000, China.
| |
Collapse
|
7
|
Kang M, Choi JW, Sohn SH, Hwang HY, Kim KH. Incidence of and Risk Factors for the Development of Significant Tricuspid Regurgitation after Isolated Aortic Valve Replacement. J Chest Surg 2023; 56:304-310. [PMID: 37248717 PMCID: PMC10480404 DOI: 10.5090/jcs.22.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/03/2023] [Accepted: 04/19/2023] [Indexed: 05/31/2023] Open
Abstract
Background The late progression of tricuspid regurgitation (TR) after mitral valve surgery is well known. However, few reports have described the progression of TR after aortic valve surgery. We investigated the incidence of and risk factors for the development of significant TR after isolated aortic valve replacement (AVR). Methods This study analyzed patients with less than moderate TR who underwent isolated AVR at Seoul National University Hospital from January 1990 to December 2018. Significant TR was defined as moderate or higher. Echocardiographic follow-up was performed in all patients. The Fine-Gray model was used to identify clinical risk factors for the development of significant TR. Results In total, 583 patients (61.7±14.2 years old) were included. Operative mortality occurred in 9 patients (1.5%), and the overall survival rates at 10, 20, and 25 years were 91.1%, 83.2%, and 78.9%, respectively. Sixteen patients (2.7%) developed significant TR during the follow-up period (13 moderate; 3 severe). The cumulative incidence of significant TR at 10, 20, and 25 years was 0.77%, 3.83%, and 6.42%, respectively. No patients underwent reoperation or reintervention of the tricuspid valve. Hemodialysis or peritoneal dialysis for chronic kidney disease (hazard ratio [HR], 5.188; 95% confidence interval [CI], 1.154-23.322) and preoperative mild TR (HR, 5.919; 95% CI, 2.059-17.017) were associated with the development of significant TR in the multivariable analysis. Conclusion TR progression after isolated AVR in patients with less than moderate TR is rare. Preoperative mild TR and hemodialysis or peritoneal dialysis for chronic kidney disease were significant risk factors for the development of TR.
Collapse
Affiliation(s)
- Minsang Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
8
|
Jameie M, Safarian Nematabad M, Mansouri P, Jalali A, Aghajani F, Lotfi-Tokaldany M, Aghajani H. The Impact of the COVID-19 Pandemic on Hospitalization Rates due to Prosthetic Valve Thrombosis. J Tehran Heart Cent 2023; 18:136-141. [PMID: 37637285 PMCID: PMC10459344 DOI: 10.18502/jthc.v18i2.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background Studies have shown a decline in the admission rates of various diseases during the COVID-19 pandemic. Prosthetic valve thrombosis (PVT) is a rare condition followed by surgical or transcatheter valvular interventions. Considering the lack of data on hospitalization rates due to PVT during the pandemic, this study evaluated the implications of the COVID-19 pandemic on PVT admissions and characteristics in a tertiary referral center. Methods Data from all the consecutive patients hospitalized due to PVT between February 2020 and February 2021 (the first year of the pandemic) were collected from medical records and compared clinically with the corresponding time before the pandemic (February 2019 through February 2020). Variables of interest included the number of hospitalization, patient and valve characteristics, diagnostic and management strategies, and in-hospital events. Results Forty patients (32.5% male, age: 54.0 [46.5-62.0 y] comprised the study population. We observed a considerable decline in hospitalization rates during the pandemic, from 31 to 9 patients. Admitted patients were 8 years younger, had a higher proportion of the New York Heart Association functional class III or IV symptoms (44.4% vs 22.6%), were more often treated with fibrinolysis (33.3% vs 22.6%) or surgical approaches (33.3% vs 22.6%), and were discharged 6 days sooner. Conclusion We described a reduction in PVT hospitalization. Patients presented with a higher proportion of severe dyspnea and had increased treatment with fibrinolysis/surgical approaches. These observations highlight the necessity of the active surveillance of patients with prosthetic valves by caregivers for timely diagnosis and appropriate management during the pandemic.
Collapse
Affiliation(s)
- Mana Jameie
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Safarian Nematabad
- Ali IbnAbitaleb Educational and Treatment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Pejman Mansouri
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Aghajani
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Lotfi-Tokaldany
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Sá MP, Van den Eynde J, Simonato M, Hirji S, Erten O, Jacquemyn X, Tasoudis P, Dokollari A, Sicouri S, Weymann A, Ruhparwar A, Arora R, Clavel MA, Pibarot P, Ramlawi B. Late outcomes of valve-in-valve transcatheter aortic valve implantation versus re-replacement: Meta-analysis of reconstructed time-to-event data. Int J Cardiol 2023; 370:112-121. [PMID: 36370873 DOI: 10.1016/j.ijcard.2022.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate all-cause mortality in ViV-TAVI versus redo SAVR in patients with failed bioprostheses. METHODS Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of non-randomized studies published by September 30, 2021. RESULTS Ten studies met our eligibility criteria and included a total of 3345 patients (1676 patients underwent ViV-TAVI and 1669 patients underwent redo SAVR). Pooling all the studies, ViV-TAVI showed a lower risk of all-cause mortality in the first 44 days [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.49-0.93, P = 0.017], with an HR reversal after 197 days favoring redo SAVR (HR 1.53; 95% CI 1.22-1.93; P < 0.001). Pooling only the matched populations (1143 pairs), ViV-TAVI showed a lower risk of all-cause mortality in the first 55 days [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.45-0.89, P < 0.001], with a reversal HR after 212 days favoring redo SAVR (HR 1.57; 95% CI 1.22-2.03; P < 0.001). The Cox regression model showed a statistically significant association of prosthesis-patient mismatch (PPM) with all-cause mortality during follow-up for ViV-TAVI (HR 1.03 per percentage increase in the study- and treatment arm-level proportion of PPM, 95% 1.02-1.05, P < 0.001). CONCLUSION ViV-TAVI is associated with a strong protective effect immediately after the procedure in comparison with redo SAVR, however, this initial advantage reverses over time and redo SAVR seems to be a protective factor for all-cause mortality after 6 months. Considering that these results are the fruit of pooling data from observational studies, they should be interpreted with caution and trials are warranted.
Collapse
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA.
| | | | | | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Alexander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Rakesh Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marie-Annick Clavel
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Philippe Pibarot
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| |
Collapse
|
10
|
Paul C, O'Brien J, Huffam S, Ridley D. Native valve infective endocarditis: a rare complication of rat bite fever caused by Streptobacillus moniliformis. Med J Aust 2022; 217:584-585. [PMID: 36379219 PMCID: PMC10099992 DOI: 10.5694/mja2.51775] [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] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Joseph O'Brien
- Barwon Health, Geelong, VIC.,Monash University, Melbourne, VIC
| | | | - Daryl Ridley
- Barwon Health, Geelong, VIC.,Deakin University, Geelong, VIC
| |
Collapse
|
11
|
Freixa X, Arzamendi D, Del Trigo M, Cepas-Guillén PL, Li P, Sanchis L, Barreiro M, Regueiro A, Baz JA, Asmarats L, Calvo F, Moñivas V, Meduiña I, Goicolea J, Sitges M, Estévez-Loureiro R. The TriClip system for edge-to-edge transcatheter tricuspid valve repair. A Spanish multicenter study. Rev Esp Cardiol (Engl Ed) 2022; 75:797-804. [PMID: 35288060 DOI: 10.1016/j.rec.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES In patients with tricuspid regurgitation (TR), edge-to-edge transcatheter tricuspid valve repair (TTVR) is the strategy with the highest penetration worldwide. A dedicated edge-to-edge TTVR system has recently become available in Europe. The present study describes the initial experience with the system in Spain. METHODS This multicenter study collected individual data from the centers accepted for the use of the novel system within an initial limited release. Between June 2020 and March 2021, all patients undergoing an edge-to-edge TTVR using the TriClip system in Spain were included in the study. The primary endpoint was the achievement of a TR reduction of at least 1 grade at discharge. RESULTS We included 34 patients. Most of them reported a previous history of atrial fibrillation (91%) and only 1 had a pacemaker lead. The primary endpoint (TR reduction of at least 1 grade at discharge) was met in all patients. Most of the patients required 1 (47%) or 2 clips (44%) with a clear predominance of XT (87%) over NT (13%). The location of the first clip was anteroseptal in >90% of the patients. Only 1 patient had a partial detachment, which was stabilized with additional clips in the same procedure. At discharge, TR severity was≤2 in 91% of patients. At 3 months, mortality was nil. Overall, 88% of patients were in New York Heart Association functional class≤2 and 80% had residual TR≤2. CONCLUSIONS Edge-to-edge TTVR seemed to be effective and safe with a sustained TR reduction at 3 months. Further studies will be needed to confirm our findings.
Collapse
Affiliation(s)
- Xavier Freixa
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Del Trigo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pedro Luis Cepas-Guillén
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Sanchis
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Manuel Barreiro
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Antonio Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Lluis Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fran Calvo
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Vanessa Moñivas
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Irene Meduiña
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Goicolea
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Marta Sitges
- Departamento de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | |
Collapse
|
12
|
Peters AS, Duggan JP, Trachiotis GD, Antevil JL. Epidemiology of Valvular Heart Disease. Surg Clin North Am 2022; 102:517-528. [PMID: 35671771 DOI: 10.1016/j.suc.2022.01.008] [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] [Indexed: 10/18/2022]
Abstract
Acquired diseases of the aortic and mitral valves are the most common cause of morbidity and mortality among Valvular heart diseases. Aortic stenosis (AS) is increasing in incidence in the United States (4,43 US), driven largely by an aging demographic. Aortic valve replacement is the only effective treatment of AS and has a dramatic mortality benefit. Mitral valve regurgitation (MR) is the most common form of valvular heart disease (VHD) in the US, whereby MR is most often the result of mitral valve prolapse; rheumatic heart disease (RHD) is a more common etiology of MR in underdeveloped countries. interventions for MR in the US are increasing.
Collapse
Affiliation(s)
- Alex S Peters
- Department of Surgery, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD 20814, USA
| | - John P Duggan
- Department of Surgery, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD 20814, USA
| | - Gregory D Trachiotis
- Division of Cardiology, Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, 50 Irving Street Northwest, Washington, DC 20422, USA; Department of Surgery, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037, USA
| | - Jared L Antevil
- Division of Cardiothoracic Surgery, Washington DC Veterans Affairs Medical Center, 50 Irving Street Northwest, Washington, DC 20422, USA.
| |
Collapse
|
13
|
Sadeghian H, Sadeghian A, Eslami B, Abbasi SH, Lotfi-Tokaldany M. Combined Aortic and Mitral Valve Stenosis in Mucopolysaccharidosis Syndrome Type I-S: A Report of a Rare Case. J Tehran Heart Cent 2022; 16:31-33. [PMID: 35082865 PMCID: PMC8728857 DOI: 10.18502/jthc.v16i1.6598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/26/2020] [Indexed: 12/02/2022] Open
Abstract
Mucopolysaccharidosis (MPS) syndrome is an inherited metabolic disorder. In more than half of the patients with MPS syndrome, heart valve involvement is reported; however, combined aortic and mitral valve stenosis in MPS syndrome type I-S is very rare. We describe a 39-year-old man with severe mitral and aortic valve stenosis due to MPS syndrome type I-S. Transthoracic and transesophageal echocardiography revealed severe thickening and calcification in the aortic and mitral valves with severe left ventricular hypertrophy. The coronary arteries were normal in angiography.
Collapse
Affiliation(s)
- Hakimeh Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Eslami
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hesameddin Abbasi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Bernard Lown Scholar in Cardiovascular Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | |
Collapse
|
14
|
Dumps C, Umrath V, Rupprecht B, Schimpf J, Benak J. [Intraoperative transesophageal echocardiography for emergency diagnostics in noncardiac surgery patients]. Anaesthesist 2021. [PMID: 34821955 DOI: 10.1007/s00101-021-01034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
Due to the development of compact and mobile devices, transesophageal echocardiography (TEE) is now being used as one important point-of-care diagnostic method in emergency rooms, intensive care units and operating rooms. In the first part of this advanced training series, general aspects of the examination method and the procedure as well as indications and contraindications were outlined. In addition, an overview of application areas beyond cardiac surgery in which TEE can be used to monitor the patient or to assist with the operative procedure was provided. In the second part, the main findings during intraoperative TEE in the event of hemodynamic instability or unexplained hypoxemia are presented. A shortened emergency examination as proposed by Reeves et al. is outlined. The article concludes with an outlook on semiautomatic interpretation software and computer-aided image acquisition.
Collapse
|
15
|
Kim C, Lee G, Oh H, Jeong G, Kim SW, Chun EJ, Kim YH, Lee JG, Yang DH. A deep learning-based automatic analysis of cardiovascular borders on chest radiographs of valvular heart disease: development/external validation. Eur Radiol 2021; 32:1558-1569. [PMID: 34647180 DOI: 10.1007/s00330-021-08296-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cardiovascular border (CB) analysis is the primary method for detecting and quantifying the severity of cardiovascular disease using posterior-anterior chest radiographs (CXRs). This study aimed to develop and validate a deep learning-based automatic CXR CB analysis algorithm (CB_auto) for diagnosing and quantitatively evaluating valvular heart disease (VHD). METHODS We developed CB_auto using 816 normal and 798 VHD CXRs. For validation, 640 normal and 542 VHD CXRs from three different hospitals and 132 CXRs from a public dataset were assigned. The reliability of the CB parameters determined by CB_auto was evaluated. To evaluate the differences between parameters determined by CB_auto and manual CB drawing (CB_hand), the absolute percentage measurement error (APE) was calculated. Pearson correlation coefficients were calculated between CB_hand and echocardiographic measurements. RESULTS CB parameters determined by CB_auto yielded excellent reliability (intraclass correlation coefficient > 0.98). The 95% limits of agreement for the cardiothoracic ratio were 0.00 ± 0.04% without systemic bias. The differences between parameters determined by CB_auto and CB_hand as defined by the APE were < 10% for all parameters except for carinal angle and left atrial appendage. In the public dataset, all CB parameters were successfully drawn in 124 of 132 CXRs (93.9%). All CB parameters were significantly greater in VHD than in normal controls (all p < 0.05). All CB parameters showed significant correlations (p < 0.05) with echocardiographic measurements. CONCLUSIONS The CB_auto system empowered by deep learning algorithm provided highly reliable CB measurements that could be useful not only in daily clinical practice but also for research purposes. KEY POINTS • A deep learning-based automatic CB analysis algorithm for diagnosing and quantitatively evaluating VHD using posterior-anterior chest radiographs was developed and validated. • Our algorithm (CB_auto) yielded comparable reliability to manual CB drawing (CB_hand) in terms of various CB measurement variables, as confirmed by external validation with datasets from three different hospitals and a public dataset. • All CB parameters were significantly different between VHD and normal control measurements, and echocardiographic measurements were significantly correlated with CB parameters measured from normal control and VHD CXRs.
Collapse
Affiliation(s)
- Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Korea
| | - Gaeun Lee
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Hongmin Oh
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyujun Jeong
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Won Kim
- Department of Cardiology, Korea University Ansan Hospital, Ansan, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul University Bundang Hospital, Seongnam, Korea
| | - Young-Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - June-Goo Lee
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
16
|
Yao JV, Joshi SB, Morgan JG, Lee MG. An unusual case of non-infective endocarditis in undiagnosed antiphospholipid syndrome. Med J Aust 2021; 215:311-312.e1. [PMID: 34494275 DOI: 10.5694/mja2.51246] [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] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 01/09/2023]
Affiliation(s)
| | - Subodh B Joshi
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Melissa Gy Lee
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| |
Collapse
|
17
|
You Y, Liu S, Wu Z, Chen D, Wang G, Chen G, Pan Y, Zheng X. Cardiac surgery under cardiopulmonary bypass in pregnancy: report of four cases. J Cardiothorac Surg 2021; 16:268. [PMID: 34563221 PMCID: PMC8467144 DOI: 10.1186/s13019-021-01650-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Open heart surgery during pregnancy is relatively rare at home and abroad, and there is a higher risk and probability of maternal and infant death. How to carry out heart valve replacement under cardiopulmonary bypass (CPB) under the premise of ensuring the safety of mother and child is the focus of attention at home and abroad. Case introduction We reported four cases of cardiac surgeries under CPB during pregnancy performed in our hospital from March 2020 to March 2021. Two of the patients continued their pregnancy after cardiac surgery under CPB. Three patients had infective endocarditis and the other one had an ascending aortic aneurysm. Three patients underwent heart valve placement with the mechanical mitral valve when the other one underwent Bentall surgery. The operations of four cases were all successful, and further follow-up evaluation of the pregnant women and fetuses showed no abnormalities. The patients' detailed information is shown in the following table. Conclusion Heart disease during pregnancy should be treated actively and proactively when the patient has obvious symptoms. Heart valve replacement under CPB will be the first choice, and this may become the primary surgical treatment for symptomatic heart disease during pregnancy.
Collapse
Affiliation(s)
- Youhao You
- Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shenghua Liu
- Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Zhaohong Wu
- Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dunjin Chen
- Obstetrics and Gynecology Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Gefei Wang
- Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Gangdong Chen
- Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Youguang Pan
- Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xing Zheng
- Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
18
|
Di Bella S, Campisciano G, Luzzati R, Di Domenico EG, Lovecchio A, Pappalardo A, Comar M, Gatti G. Bacterial colonization of explanted non-endocarditis cardiac valves: evidence and characterization of the valvular microbiome. Interact Cardiovasc Thorac Surg 2021; 32:457-459. [PMID: 33221915 DOI: 10.1093/icvts/ivaa285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/11/2020] [Accepted: 10/22/2020] [Indexed: 11/12/2022] Open
Abstract
Bacterial colonization has been already demonstrated in heart valve tissues of patients without cardiovascular infections. However, the evidence of a valvular microbiome is still scarce. The next-generation sequencing method was carried out on 34 specimens of aortic (n = 20) and mitral valves (n = 14) explanted from 34 patients having neither evidence nor history of infectious diseases, particularly infective endocarditis. While no bacteria were demonstrated using standard culture methods, bacterial deoxyribonucleic acid (DNA) sequences were found using next-generation sequencing in 15/34 (44%) cases. Escherichia coli was present in 6 specimens and was the most frequently identified bacterium. There was a trend towards a higher rate of bacterial DNA positivity in specimens of calcific valves than in those of non-calcific valves (10/17 vs 5/17, P = 0.17). Based on a quantitative test, E. coli accounted for 0.7% ± 1% in calcific valvular tissue and 0.3% ± 0.3% in non-calcific valvular tissue (P = 0.2), and for 11% ± 27% in the valvular tissue of diabetic patients and 0.3% ± 1% in the valvular tissue of non-diabetic patients (P = 0.08). Detection of bacterial DNA in non-endocarditis valvular tissues could be a relatively common finding. There could be an association between the valvular microbiome and certain models of valve degeneration and common metabolic disorders.
Collapse
Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Giuseppina Campisciano
- Laboratory of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health-IRCCS Burlo-Garofolo, Trieste, Italy
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Enea Gino Di Domenico
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute-IRCCS, Istituti Fisioterapici Ospitalieri, Rome, Italy
| | - Antonio Lovecchio
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Aniello Pappalardo
- Cardio-Thoracic and Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Manola Comar
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy.,Laboratory of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health-IRCCS Burlo-Garofolo, Trieste, Italy
| | - Giuseppe Gatti
- Cardio-Thoracic and Vascular Department, Trieste University Hospital, Trieste, Italy
| |
Collapse
|
19
|
Luo G, Pan SL, Wang KL, Wang DL, Sun Y, Xu Q, Chen TT. [Fetal cardiac intervention and perioperative management of fetus with hypoplastic right heart syndrome]. Zhonghua Fu Chan Ke Za Zhi 2021; 55:837-842. [PMID: 33355758 DOI: 10.3760/cma.j.cn112141-20200519-00425] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To summarize the experience of perioperative management strategy of fetal pulmonary valvuloplasty (FPV) for hypoplastic right heart syndrome (HRHS). Methods: In the retrospective study of perioperative data, 13 fetuses of HRHS were treated with FPV in Qingdao Women and Children's Hospital from July 2018 to June 2019. Results: (1) The evaluation indexes of the right ventricle in 13 fetuses before FPV: the mean ratio of tricuspid/mitral annulus, right/left ventricular length, pulmonary/aortic annulus, and tricuspid inflow time/cardiac cycle were 0.81±0.04, 0.56±0.14, 0.69±0.06, and 0.35±0.03, respectively. (2) All pregnant mothers underwent general anesthesia. The basic fetal heart rate was (156±12) beats per minutes before FPV, and 9 fetuses showed bradycardia during the operation, and recovered to normal after drug resuscitation. On the first day after FPV, two cases had bradycardia and pregnancy was terminated. The fluctuation of systolic blood pressure of pregnant mother was less than 20%, and there was no significant difference between preoperative and intraoperative pulse pressure [(36.0±5.6) vs (35.8±6.9) mmHg (1 mmHg=0.133 kPa); t=8.102, P=0.951]. (3) All cases of HRHS fetus successfully underwent FPV. The average gestational age was (27.3±0.8) weeks. The average operation time was (23.2±1.0) minutes. The ratio of tricuspid to mitral annulus (t=-2.513, P=0.022) and the ratio of right to left ventricular length (t=-3.373, P=0.003) were significantly improved at 6 weeks postoperatively. Ten fetuses were delivered, and there was no death after early intervention. (4) Of 13 pregnant women, 3 cases were nausea and vomiting on the day of FPV operation, the treatment of the symptoms was improved by tropisetron; one case had tolerable abdominal pain and improved without special treatment. Pregnant women had no major complications such as cardiac failure, abortion and death. (5) Chromosome karyotype analysis and microarray analysis of amniotic fluid was retained during the operation. No typical chromosome abnormality or other abnormal genetic diagnosis was found. Conclusions: FPV colud be used as an effective intervention measure to promote the development of right ventricle in HRHS fetuses. The scientific management of multidisciplinary professional technical team in perioperative period is particularly important to ensure the success of FPV and the safety of pregnant women and fetuses.
Collapse
Affiliation(s)
- G Luo
- Heart Center, Qingdao Women and Children's Hospital, Qingdao 266034, China
| | - S L Pan
- Heart Center, Qingdao Women and Children's Hospital, Qingdao 266034, China
| | - K L Wang
- Heart Center, Qingdao Women and Children's Hospital, Qingdao 266034, China
| | - D L Wang
- Department of Anesthesiology, Qingdao Women and Children's Hospital, Qingdao 266034, China
| | - Y Sun
- Department of Obstetrics, Qingdao Women and Children's Hospital, Qingdao 266034, China
| | - Q Xu
- Department of Obstetrics, Qingdao Women and Children's Hospital, Qingdao 266034, China
| | - T T Chen
- Department of Ultrasound, Qingdao Women and Children's Hospital, Qingdao 266034, China
| |
Collapse
|
20
|
Abstract
OBJECTIVE To explore the effectiveness and safety of golimumab in the treatment of severe/refractory cardiovascular Behcet syndrome (BS). METHODS We retrospectively analyzed the clinical data of nine patients diagnosed with severe/refractory cardiovascular BS and treated with golimumab from February 2018 to July 2020 in Peking Union Medical College Hospital. We analyzed levels of erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hsCRP), imaging findings, and the doses of glucocorticoids and immunosuppressive agents during the period of combined treatment with golimumab. RESULTS Nine patients were enrolled, including 8 males and 1 female, with a mean age and median course of (37.0±8.6) years and 120 (60, 132) months, respectively. Seven patients presented with severe aortic regurgitation combined with other cardiovascular involvement secondary to BS. Two patients presented with large vessel involvement, including multiple aneurysms and vein thrombosis. Prior to golimumab treatment, seven patients were treated with glucocorticoids and multiple immunosuppres-sants [with a median number of 3 (1, 3) types] while still experienced disease progression or elevated inflammation biomarkers during postoperative period. Eight patients with disease progression, uncontrolled inflammation and history of severe postoperative complications required effective and fast control of inflammation during perioperative period. One patient had adverse reaction with tocilizumab and switched to golimumab during perioperative period. The patients were treated with golimumab 50 mg every 4 weeks, along with concomitant treatment of glucocorticoid and immunosuppressants. After a median follow-up of (16.3±5.6) months, all the patients achieved clinical improvement. Vascular lesions were radiologically stable and no vascular progressive or newly-onset of vascular lesions was observed. The eight patients who experienced cardiac or vascular operations showed no evidence of postoperative complications. The ESR and hsCRP levels decreased significantly [16.5 (6.8, 52.5) mm/h vs. 4 (2, 7) mm/h, and 21.24 (0.93, 32.51) mg/L vs. 0.58 (0.37, 1.79) mg/L (P < 0.05), respectively]. The dose of prednisone was tapered from 35 (15, 60) mg/d to 10.0 (10.0, 12.5) mg/d. No prominent adverse reactions were observed. CONCLUSION Our study suggests that golimumab is effective in the treatment of severe/refractory cardiovascular BS. Combination immunosuppression therapy with golimumab contributes to control of inflammation, reduction of postoperative complications and tapering the dose of glucocorticoids or immunosuppressants.
Collapse
|
21
|
Abstract
BACKGROUND Echocardiography is the standard for the diagnosis of heart diseases. Nevertheless, thoracic X‑ray is a frequently used examination method, also for questions regarding the cardiac situation of patients. QUESTION How relevant is the conventional radiological assessment of heart disease? MATERIALS AND METHODS Long-known knowledge about pathophysiology of heart disease and its radiological correlation are discussed. RESULTS Knowledge of the normal anatomy of the heart is a basic prerequisite for the assessment of pathologies. For the question of heart disease, it is essential to also assess the pulmonary vascularization. The size of the entire heart and the individual cardiac cavities is assessed by direct and indirect signs, such as heart-lung ratio, cava triangle, vascular pedicle or the size of the aorta and of the main pulmonary artery. The most common cause of heart enlargement is valve disease, which shows various conventional radiological images. CONCLUSION Conventional thoracic radiography still plays a central role in the diagnosis of cardiopulmonary diseases and is an important diagnostic tool for quickly obtaining an overview of the patient's cardiopulmonary situation. The interplay between physiology and X‑ray symptoms is complex, so close attention should be paid not only to the heart anatomy and configuration, but also primarily to the pulmonary blood flow.
Collapse
Affiliation(s)
- Hanka Arndt
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - A Busse
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - F G Meinel
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| |
Collapse
|
22
|
Ren CL, Yao MH, Zhang L, Wang R, Jiang SL. [Surgical treatment of tricuspid valve disease due to permanent pacemaker lead]. Zhonghua Yi Xue Za Zhi 2020; 100:3147-3151. [PMID: 33142396 DOI: 10.3760/cma.j.cn112137-20200427-01345] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To summarize the etiology and surgical treatment experience of tricuspid valve disease due to permanent pacemaker lead. Methods: The medical records of 22 patients who underwent tricuspid valve operation for tricuspid valve disease due to permanent cardiac pacemaker lead from January 2008 to December 2017 were retrospectively reviewed. There were 12 males and 10 females, with a mean age of (62.6±12.1) years old (45-82 years old). All patients underwent tricuspid valve surgery via open thoracotomy under general anesthesia, including 8 patients through median thoracotomy approach, 4 patients through right mini-thoracotomy approach, and 10 patients with endoscopy-assisted and totally endoscopic technique. Moreover, 8 patients underwent tricuspid valve replacement, and 14 patients received tricuspid valve repair. Results: During the operation, 10 cases of severe tricuspid regurgitation were detected due to valve and subvalvular structures dysfunction involved in the pacing electrode, 7 cases showed tricuspid annulus dilation, and pacing electrode-related infective endocarditis were involved in the tricuspid valve of 5 cases. Compared with conventional median thoracotomy surgery, the amount of postoperative drainage fluid and hospitalization time after minimally invasive surgery (including right mini-thoracotomy and endoscopic surgery) were significantly reduced [281(120, 489) ml vs 368(180, 560) ml, P=0.02; 9.2(4.8, 14.5) d vs 11.2(6.3, 16.9) d, P=0.03]. Postoperative echocardiographic data showed that the size of the right atrium and ventricle in these patients was significantly reduced compared with preoperative data, and their cardiac function were normal. There was no difference of pacing electrode parameters between pre-and postoperative period. All 22 patients were cured and discharged, with no valve-and pacemaker-related complications. Conclusions: Patients with tricuspid valve disease due to permanent cardiac pacemaker lead should actively undergo surgery including tricuspid replacement or repair according to different etiologies, which exhibit satisfactory outcomes. Minimally invasive endoscopic tricuspid surgery is a new technique for the treatment of isolated tricuspid valve disease, with less surgical trauma and faster recovery.
Collapse
Affiliation(s)
- C L Ren
- Department of Cardiovascular Surgery, First Medical Center of PLA General Hospital, Beijing 100853, China
| | - M H Yao
- Department of Cardiovascular Surgery, First Medical Center of PLA General Hospital, Beijing 100853, China
| | - L Zhang
- Department of Cardiovascular Surgery, First Medical Center of PLA General Hospital, Beijing 100853, China
| | - R Wang
- Department of Cardiovascular Surgery, First Medical Center of PLA General Hospital, Beijing 100853, China
| | - S L Jiang
- Department of Cardiovascular Surgery, First Medical Center of PLA General Hospital, Beijing 100853, China
| |
Collapse
|
23
|
Nazarzadeh M, Pinho-Gomes AC, Bidel Z, Dehghan A, Canoy D, Hassaine A, Ayala Solares JR, Salimi-Khorshidi G, Smith GD, Otto CM, Rahimi K. Plasma lipids and risk of aortic valve stenosis: a Mendelian randomization study. Eur Heart J 2020; 41:3913-3920. [PMID: 32076698 PMCID: PMC7654932 DOI: 10.1093/eurheartj/ehaa070] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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: 07/10/2019] [Revised: 10/09/2019] [Accepted: 01/29/2020] [Indexed: 01/09/2023] Open
Abstract
AIMS Aortic valve stenosis is commonly considered a degenerative disorder with no recommended preventive intervention, with only valve replacement surgery or catheter intervention as treatment options. We sought to assess the causal association between exposure to lipid levels and risk of aortic stenosis. METHODS AND RESULTS Causality of association was assessed using two-sample Mendelian randomization framework through different statistical methods. We retrieved summary estimations of 157 genetic variants that have been shown to be associated with plasma lipid levels in the Global Lipids Genetics Consortium that included 188 577 participants, mostly European ancestry, and genetic association with aortic stenosis as the main outcome from a total of 432 173 participants in the UK Biobank. Secondary negative control outcomes included aortic regurgitation and mitral regurgitation. The odds ratio for developing aortic stenosis per unit increase in lipid parameter was 1.52 [95% confidence interval (CI) 1.22-1.90; per 0.98 mmol/L] for low density lipoprotein (LDL)-cholesterol, 1.03 (95% CI 0.80-1.31; per 0.41 mmol/L) for high density lipoprotein (HDL)-cholesterol, and 1.38 (95% CI 0.92-2.07; per 1 mmol/L) for triglycerides. There was no evidence of a causal association between any of the lipid parameters and aortic or mitral regurgitation. CONCLUSION Lifelong exposure to high LDL-cholesterol increases the risk of symptomatic aortic stenosis, suggesting that LDL-lowering treatment may be effective in its prevention.
Collapse
Affiliation(s)
- Milad Nazarzadeh
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
- The Collaboration Center of Meta-Analysis Research, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Zeinab Bidel
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
- The Collaboration Center of Meta-Analysis Research, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Abbas Dehghan
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Dexter Canoy
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Abdelaali Hassaine
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Jose Roberto Ayala Solares
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Gholamreza Salimi-Khorshidi
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | | | | | - Kazem Rahimi
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
24
|
Ninomiya R, Orii M, Fujiwara J, Yoshizawa M, Nakajima Y, Ishikawa Y, Kumagai A, Fusazaki T, Tashiro A, Kin H, Yoshioka K, Morino Y. Sex-Related Differences in Cardiac Remodeling and Reverse Remodeling After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis in a Japanese Population. Int Heart J 2020; 61:961-969. [PMID: 32921672 DOI: 10.1536/ihj.20-154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Left ventricular (LV) remodeling with aortic stenosis (AS) appears to differ according to sex, but reverse remodeling after transcatheter aortic valve implantation (TAVI) has not been elucidated in a Japanese population. This study aims to determine whether any sex-related differences in LV or reverse remodeling after TAVI exist in the context of severe AS.Of 208 patients who received TAVI for severe AS in our institution, 100 (men, 42; mean age, 83.0 ± 4.9 years) underwent transthoracic echocardiography before and 3 months after TAVI. Despite similar valvular gradients, women with severe AS had lower indexed LV mass (LVMi) than did men (152.3 ± 35.4 versus 173.2 ± 44.6 g/m2, P = 0.005), with smaller indexed LV end-diastolic (LVEDVi) (50.2 ± 13.3 versus 61.4 ± 20.7 mL/m2, P = 0.001) and end-systolic (LVESVi; 17.9 ± 8.7 versus 24.3 ± 13.8 mL/m2, P = 0.006) volumes. After TAVI, women (-6.0% ± 14.4%) had higher reduction in the rate of change of relative wall thickness (RWT) than did men (4.4% ± 19.0%, P = 0.003). Men (-8.9% ± 3.9%) had higher reduction in the rate of change of LVEDVi than did women (1.5% ± 3.3%, P = 0.045). Incidence of LV reverse remodeling defined as a reduction in LVESV of >15% was significantly higher in men (50%) than in women (26%, P = 0.013).In addition to sex differences in the pattern of LV remodeling with AS, reverse LV remodeling after TAVI also differed between sexes.
Collapse
Affiliation(s)
- Ryo Ninomiya
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Makoto Orii
- Department of Radiology, Iwate Medical University
| | - Jumpei Fujiwara
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Michiko Yoshizawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yoshifumi Nakajima
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yu Ishikawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Akiko Kumagai
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tetsuya Fusazaki
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Atsushi Tashiro
- Department of Laboratory of Medicine, Iwate Medical University
| | - Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University
| | | | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| |
Collapse
|
25
|
Chun SH, Suh YJ, Han K, Park SJ, Shim CY, Hong GR, Lee S, Lee SH, Kim YJ, Choi BW. Differentiation of left atrial appendage thrombus from circulatory stasis using cardiac CT radiomics in patients with valvular heart disease. Eur Radiol. 2020;. [PMID: 32812175 DOI: 10.1007/s00330-020-07173-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/19/2020] [Accepted: 08/10/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine whether quantitative radiomic features from cardiac CT could differentiate the left atrial appendage (LAA) thrombus from circulatory stasis in patients with valvular heart disease. METHODS Ninety-five consecutive patients with valvular heart disease and filling defects in LAA on two-phase cardiac CT from March 2016 to August 2018 were retrospectively enrolled and classified as having thrombus or stasis by transesophageal echocardiography or cardiac surgery. The ratio of Hounsfield units in the filling defects to those in the ascending aorta (AA) was calculated on early- and late-phase CT (LAA/AAE and LAA/AAL, respectively). Radiomic features were extracted from semi-automated three-dimensional segmentation of the filling defect on early-phase CT. The diagnostic ability of radiomic features for differentiating thrombus from stasis was assessed and compared to LAA/AAE and LAA/AAL by comparing the AUC of ROC curves. Diagnostic performances of CT attenuation ratios and radiomic features were validated with an independent validation set. RESULTS Thrombus was diagnosed in 25 cases and stasis in 70. Sixty-eight radiomic features were extracted. Values of 8 wavelet-transformed features were lower in thrombus than in stasis (p < 0.001). The AUC value of a radiomic feature, wavelet_LHL, for diagnosing thrombus was 0.78, which was higher than that of LAA/AAE (AUC = 0.54, p = 0.025) and similar to that of LAA/AAL (AUC = 0.76, p = 0.773). In the validation set, the AUC of wavelet_LHL was 0.71, which was higher than that of LAA/AAE (AUC = 0.57, p = 0.391) and similar to that of LAA/AAL (AUC = 0.75, p = 0.707). CONCLUSIONS Quantitative radiomic features from the early phase of cardiac CT may help diagnose LAA thrombus in patients with valvular heart disease. KEY POINTS • Wavelet-transformed grey-level non-uniformity values from radiomic analysis are significantly lower for LAA thrombus than for circulatory stasis. • Radiomic features may have an additional value for differentiating LAA thrombus from circulatory stasis when interpreting single-phase cardiac CT. • Radiomic features extracted from single-phase images may show similar diagnostic ability as conventional quantitative analysis from two-phase images.
Collapse
|
26
|
Sá MPBO, Zhigalov K, Cavalcanti LRP, Escorel Neto AC, Rayol SC, Weymann A, Ruhparwar A, Lima RC. Impact of Aortic Annulus Enlargement on the Outcomes of Aortic Valve Replacement: A Meta-analysis. Semin Thorac Cardiovasc Surg 2020; 33:316-325. [PMID: 32621964 DOI: 10.1053/j.semtcvs.2020.06.046] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 11/11/2022]
Abstract
We sought to evaluate the impact of surgical aortic annulus enlargement (ARE) on the perioperative outcomes of surgical aortic valve replacement. Databases were searched for articles published by October 2019 in order to carry out a systematic review followed by meta-analysis. Thirteen studies with 40,447 patients (aortic valve replacement [AVR] with aortic annulus enlargement [AAE]: 4686 patients; AVR without AAE: 35,761 patients) were included. The total rate of AAE was 11.6%, ranging from 4.1%-28.1%. The overall unadjusted odds ratio (OR) (95% confidence interval [CI]) for operative mortality showed a statistically significant difference between the groups, with higher risk in the "AVR with AAE" group (OR 1.388; 95% CI 1.049-1.836, P < 0.001), but not for isolated AVR+AAE (OR 1.341; 95% CI 0.920-1.956, P = 0.127) and also not in matched populations (OR 1.003; 95% CI 0.773-1.300, P = 0.984). The "AVR with AAE" group showed an overall lower risk of significant patient-prosthesis mismatch (PPM) (OR 0.567; 95% CI 0.376-0.854, P = 0.007) and a higher overall difference in means of indexed effective orifice area (iEOA) (random effect model: 0.058 cm2/m2; 95% CI 0.024-0.092, P < 0.001). The overall ORs for myocardial infarction, stroke, complete heart block/permanent pacemaker implantation and reoperation for bleeding showed no statistically significant difference between the groups. AAE is a useful adjunct to AVR, but the benefit of reduced PPM must be balanced against a possibly higher risk of perioperative mortality.
Collapse
Affiliation(s)
- Michel Pompeu B O Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite - FCM/ICB, Recife, Brazil.
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil
| | - Antonio C Escorel Neto
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil
| | - Sérgio C Rayol
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Ricardo C Lima
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite - FCM/ICB, Recife, Brazil
| |
Collapse
|
27
|
Wang J, Wang A, Cui Y, Wang C, Zhang J. Diagnosis and treatment of infective endocarditis in pregnancy: a case report. J Cardiothorac Surg 2020; 15:109. [PMID: 32448305 PMCID: PMC7245794 DOI: 10.1186/s13019-020-01147-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pregnancy with infective endocarditis (IE) is rare, but the fetal and maternal mortality rates of these pregnancies are very high, making IE a serious threat to the safety of pregnant women and their fetuses. Therefore, for pregnant women with recurrent fever, a detailed medical history and physical examination should be performed, echocardiography and blood culture should be carried out as soon as possible, multidisciplinary consultation should be implemented, and a diagnosis and treatment plan should be formulated right away, as this is key to saving the lives of mothers and infants. Case introduction A 30-year-old pregnant Chinese woman had IE at 26 weeks of gestation. After close monitoring and care until 31 weeks of gestation, she underwent a successful delivery, cardiac surgery, repair of the patent ductus arteriosus (PDA), mitral valvuloplasty (MVP) and removal of the vegetations. The operation was successful, and further follow-up evaluation showed no abnormality. Conclusion For the diagnosis and treatment of IE in pregnancy, it is of great importance to implement an individualized diagnosis and treatment plan in combination with close monitoring by echocardiography and to select the right time for cardiac surgery and termination of pregnancy.
Collapse
Affiliation(s)
- Jing Wang
- Department of Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Anlong Wang
- Department of Radiology, Zhejiang Provincial Integrated Chinese and Western Medicine Hospital, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Yong Cui
- Department of Cardiothoracic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, China
| | - Ceng Wang
- Department of Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Jian Zhang
- Department of Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, 310014, Zhejiang, China.
| |
Collapse
|
28
|
Nechwatal RM, Bestehorn K, Leuschner F, Hagendorff A, Guha M, Schlitt A. [Postacute care after transcatheter aortic valve implantation (TAVI)]. Herz 2020; 46:41-47. [PMID: 32313970 DOI: 10.1007/s00059-020-04915-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 07/30/2019] [Accepted: 03/19/2020] [Indexed: 11/26/2022]
Abstract
With increasing age valvular heart disease is among the most frequent diseases of the heart. Relevant valvular disease impairs not only the long-term prognosis but also physical resilience, activities of daily living and the quality of life. In cases of middle to high-grade symptomatic cardiac defects, valve replacement or valve reconstruction is still the surgical procedure of choice; however, in recent years the transcatheter percutaneous aortic valve replacement (TAVI) procedure has become more prominent for the most frequent defect, aortic valve stenosis. This article provides an overview of the aftercare and rehabilitation of patients following a TAVI intervention.
Collapse
Affiliation(s)
- Robert Michael Nechwatal
- Rehaklinik Heidelberg-Königstuhl, Fachklinik für Herz‑, Kreislauf‑, Gefäß‑, Lungen- und Bronchialerkrankungen, Kohlhof 6, 69117, Heidelberg, Deutschland.
| | - Kurt Bestehorn
- Institut für Klinische Pharmakologie, TU Dresden, Dresden, Deutschland
| | - Florian Leuschner
- Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Manju Guha
- Reha-Klinik am Sendesaal, Bremen, Deutschland
| | - Axel Schlitt
- Abteilung für Kardiologie und Diabetologie, Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg, Deutschland
- Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| |
Collapse
|
29
|
Abstract
Degenerative mitral regurgitation due to posterior leaflet prolapse is often associated with tissue redundancy in the leaflet height and free margin of the prolapsing segment. The butterfly technique has been introduced for focal resection to precisely control the leaflet height without annular plication. This technique is indicated for a high prolapsing leaflet, greater than 20 mm. With intraoperative measurement of leaflet heights and ink dot marking as a depth indicator, the butterfly technique can be safely performed in most high posterior leaflet prolapse cases, without increasing the risk of systolic anterior motion.
Collapse
Affiliation(s)
- Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| |
Collapse
|
30
|
Kim SH, Cha S, Kang S, Han K, Paik NJ, Kim WS. High prevalence of physical inactivity after heart valve surgery and its association with long-term mortality: A nationwide cohort study. Eur J Prev Cardiol 2020; 28:749-757. [PMID: 33611453 DOI: 10.1177/2047487320903877] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
AIMS Physical activity (PA) and systematic efforts, such as cardiac rehabilitation, are recommended by several national guidelines for those who have received heart valve surgery. However, only a few studies have demonstrated real-world situations, such as changes in the PA level after heart valve surgery, and their effects on long-term outcomes. We designed this study to investigate the changes in PA after heart valve surgery and their associations with mortality using nationwide representative data. METHODS This study was performed using the Korean National Health Insurance Service database. We included patients who received heart valve surgery from 2009 to 2015 and underwent regular health checkups before and after surgery. Subjects were grouped according to their PA level before and after the surgery. Information on all-cause mortality was obtained until 31 December 2016, with a maximum follow-up period of 5 years. RESULTS Of the 6587 subjects, 3258 (49.5%) were physically inactive after surgery. Among patients who were physically active (n = 3070), 1196 (39.0%) became inactive after surgery. The postoperative 'inactive' group showed higher mortality than the 'active' group (hazard ratio (HR): 1.41, 95% confidence interval (CI): 1.08-1.83). The 'inactive/inactive' group showed the highest risk of mortality (HR: 1.69, 95% CI: 1.19-2.40) compared with the 'active/active' group. CONCLUSIONS Insufficient PA level after heart valve surgery is associated with higher risk of mortality. However, maintaining sufficient PA after heart valve surgery may be challenging for many patients. Therefore, systematic efforts, such as cardiac rehabilitation, should be considered in those who received heart valve surgery.
Collapse
Affiliation(s)
- Sun-Hyung Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seongmin Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Gyeonggi Regional Cardiocerebrovascular Center, Seongnam, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Gyeonggi Regional Cardiocerebrovascular Center, Seongnam, Korea
| |
Collapse
|
31
|
Peper ES, Leopaldi AM, van Tuijl S, Coolen BF, Strijkers GJ, Baan J, Planken RN, de Weger A, Nederveen AJ, Marquering HA, van Ooij P. An isolated beating pig heart platform for a comprehensive evaluation of intracardiac blood flow with 4D flow MRI: a feasibility study. Eur Radiol Exp 2019; 3:40. [PMID: 31650367 PMCID: PMC6813403 DOI: 10.1186/s41747-019-0114-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/02/2019] [Indexed: 12/25/2022] Open
Abstract
Background Cardiac magnetic resonance imaging (MRI) in large animals is cumbersome for various reasons, including ethical considerations, costs of housing and maintenance, and need for anaesthesia. Our primary purpose was to show the feasibility of an isolated beating pig heart model for four-dimensional (4D) flow MRI for investigating intracardiac blood flow patterns and flow parameters using slaughterhouse side products. In addition, the feasibility of evaluating transcatheter aortic valve replacement (TAVR) in the model was investigated. Methods Seven slaughterhouse pig hearts were installed in the MRI-compatible isolated beating pig heart platform. First, Langendorff perfusion mode was established; then, the system switched to working mode, in which blood was actively pumped by the left ventricle. A pacemaker ensured a stable HR during 3-T MRI scanning. All hearts were submitted to human physiological conditions of cardiac output and stayed vital for several hours. Aortic flow was measured from which stroke volume, cardiac output, and regurgitation fraction were calculated. Results 4D flow MRI acquisitions were successfully conducted in all hearts. Stroke volume was 31 ± 6 mL (mean ± standard deviation), cardiac output 3.3 ± 0.9 L/min, and regurgitation fraction 16% ± 9%. With 4D flow, intracardiac and coronary flow patterns could be visualised in all hearts. In addition, we could study valve function and regurgitation in two hearts after TAVR. Conclusions The feasibility of 4D flow MRI in an isolated beating pig heart loaded to physiological conditions was demonstrated. The platform is promising for preclinical assessment of cardiac blood flow and function. Electronic supplementary material The online version of this article (10.1186/s41747-019-0114-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eva S Peper
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | - Bram F Coolen
- Department of Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Baan
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arend de Weger
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
32
|
Seeland U, Bauersachs J, Roos-Hesselink J, Regitz-Zagrosek V. [Update of the ESC guidelines 2018 on cardiovascular diseases during pregnancy : Most important facts]. Herz 2019; 43:710-718. [PMID: 30456631 DOI: 10.1007/s00059-018-4765-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Heart diseases are the most common cause of maternal death during pregnancy in Western countries. The current ESC guidelines 2018 for the management of cardiovascular diseases during pregnancy is a guide for any physician facing the challenge of caring for pregnant women with cardiovascular diseases. Among the new concepts compared to 2011, are recommendations to classify maternal risk due to the modified World Health Organization (mWHO) classification, introduction of the pregnancy heart team, guidance on assisted reproductive therapy, specific recommendations on anticoagulation for low-dose and high-dose requirements of vitamin K antagonists and the potential use of bromocriptine in peripartum cardiomyopathy. The Food and Drug Administration (FDA) categories A-D and X should no longer be used. Therefore, the table of drugs was completed with detailed information from animal and human studies on maternal and fetal risks. The new findings on specific heart diseases are presented in detail in the respective chapters.
Collapse
Affiliation(s)
- U Seeland
- Institut für Geschlechterforschung in der Medizin (GiM) und Center for Cardiovascular Research (CCR), Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115, Berlin, Deutschland. .,DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partnerseite Berlin, Berlin, Deutschland.
| | - J Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - J Roos-Hesselink
- Klinik für Kardiologie, Universitair Medisch Centrum Rotterdam, Rotterdam, Niederlande
| | - V Regitz-Zagrosek
- Institut für Geschlechterforschung in der Medizin (GiM) und Center for Cardiovascular Research (CCR), Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115, Berlin, Deutschland.,DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partnerseite Berlin, Berlin, Deutschland
| |
Collapse
|
33
|
Hong ZN, Huang JS, Huang LQ, Cao H, Chen Q. The effect of valve noise on the quality of life of patients after mechanical mitral valve replacement in a Chinese population. J Cardiothorac Surg 2019; 14:137. [PMID: 31324188 PMCID: PMC6642469 DOI: 10.1186/s13019-019-0956-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/15/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the effect of valve noise on the quality of life (QOL) in Chinese patients who underwent mechanical mitral valve replacement. Methods We enrolled a total of 103 patients who underwent mechanical mitral valve replacement (MVR, CM valve in 52 patients, SJM valve in 51 patients) from January 2016 to December 2016 in our institution and used the SF-36 as an instrument to assess patients’ QOL. Results Patients’ QOL improved over time. Patients who experienced disturbances due to valve noise had lower SF-36 scores in each scale, especially in general health, vitality, and mental health. Only 8.74% (n = 9) of patients complained of valve noise 1 year after the operation compared to 19.42% (n = 20) in the first month after the operation. The number of patients who experienced disturbances due to valve noise decreased over time, with a P value of 0.58. Logistic regression analysis showed that female patients those aged < 60 years old had a higher risk of experiencing disturbances due to valve noise. The valve type (CM vs SJM), body mass index (BMI) and valve size showed no significant differences in patients who experienced disturbances due to continuous valve noise. The SF-36 results were similar in the CM group and SJM group 1 year after the operation. Conclusions QOL evaluated by the SF-36 improved over time in Chinese patients who underwent mechanical MVR. Age less than 60 years and female sex were high risk factors for experiencing disturbances due to valve noise. CM and SJM mechanical valves demonstrated similar valve noise levels and impact on QOL in patients who experienced mechanical MVR.
Collapse
Affiliation(s)
- Zhi-Nuan Hong
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Jiang-Shan Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Li-Qin Huang
- Department of Public Health, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
| |
Collapse
|
34
|
Nelson AJ, Montarello NJ, Cosgrove CS, Roberts-Thomson RL, Delacroix S, Chokka RG, Montarello JK, Worthley SG. Transcatheter aortic valve implantation: a new standard of care. Med J Aust 2019; 209:136-141. [PMID: 30071816 DOI: 10.5694/mja17.01255] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/03/2018] [Indexed: 12/31/2022]
Abstract
Aortic stenosis is the most common valvular lesion requiring intervention and with an ageing population, its burden is likely to increase. Increasing comorbidity and a desire for less invasive treatment strategies has facilitated the expansion of percutaneous aortic valve therapies. Robust clinical trial data are now available to support the role of transcatheter aortic valve implantation (TAVI) in patients of prohibitive, high and now intermediate surgical risk. The introduction of a Medicare Benefits Schedule reimbursement is likely to see TAVI use grow exponentially in Australia over the next 5 years. Clinical trials evaluating low risk patients may be the final frontier to see TAVI become the standard of care for most patients with severe aortic stenosis.
Collapse
|
35
|
Pu JZ, Ke YT, Huang LJ, Zhao HL, Zhang C, Wu WH. [Feasibility and efficacy of percutaneous closure of paravalvuar leak in patients after heart valve replacement surgery using Amplatzer vascular plug Ⅲ]. Zhonghua Xin Xue Guan Bing Za Zhi 2019; 47:291-6. [PMID: 31060188 DOI: 10.3760/cma.j.issn.0253-3758.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the feasibility and efficacy of percutaneous closure of paravalvuar leak (PVL) in patients after heart valve replacement surgery using Amplatzer vascular plug Ⅲ (AVP Ⅲ). Methods: In this retrospective study, consecutive PVL patients after heart valve replacement surgery receiving percutaneous closure with AVP Ⅲ in Beijing Anzhen hospital between March 2017 and October 2018 (n=21) were enrolled.The preoperative and intraoperative data and short-and mid-term outcome results were analyzed. Results: Theage of patients in this cohort was (54.9±11.7) years, and there were 12 (57.1%) male patients. There were 8 patients (38.1%) post mitral valve replacement, 4 patients (19.0%) post aortic valve replacement and 9 patients (42.9%) post double valves replacements.There were 14 cases (66.7%) of mitral valve PVL,6 cases (28.6%) of aortic valve PVL, and 1 case (4.8%) of double valves PVL.Successful device deployment was accomplished in 18 defects from 17 PVL patients. Technical successful rate of mitral valve PVL closure and aortic valve PVL closure was 12/15 and 6/7,respectively. One patient received surgical repair due to procedure-induced femoral pseudoaneurysm.There were 17 cases of severe PVL and 1 case of moderate PVL before procedure, and there were 2 cases of moderate PVL, 6 cases mild PVL, and PVL disappeared in 10 cases after procedure (P<0.01 vs. pre-procedure). The follow-up time was (8.3±4.7) months. There were 10 cases (58.8%) of New York Heart Association (NYHA) function grade Ⅲ and 7 cases (41.2%) of NYHA function grade Ⅳ before procedure, and there were 12 cases of NYHA function grade Ⅰ(70.6%) and 5 cases (29.4%) of NYHA function grade Ⅱ post procedure (P<0.01). Post procedure, there was no displacement of the occluder and heart valve movement was not affected,and there was no new hemolysis or hemolysis worsening. Conclusion: Percutaneous closure of PVL in patients after heart valve replacement surgery with AVP Ⅲ is feasible, and associated with favorable short-and mid-term clinical outcomes.
Collapse
|
36
|
Xu Q, Liu X, Jiang J, He Y, Zhu Q, Gao F, Du F, He W, Cheng J, Kong M, Pu Z, Zhou Q, Gooley R, Wang J. Transcatheter aortic valve replacement in atypical valve anatomy using the Lotus valve : A Chinese single-center experience. Herz 2019; 46:63-70. [PMID: 30694372 PMCID: PMC7862532 DOI: 10.1007/s00059-018-4778-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/28/2018] [Accepted: 12/09/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the West, the safety and efficacy of the Lotus valve have been demonstrated; however, data in the Chinese population are still lacking. Few studies have compared the clinical outcomes of transcatheter aortic valve replacement (TAVR) with the Lotus valve in patients with bicuspid or tricuspid aortic valve stenosis. Our aim was to assess TAVR outcomes with the Lotus aortic valve in a Chinese patient cohort. METHODS In total, 23 symptomatic, high-surgical risk patients with severe aortic valve stenosis were enrolled. Among them, nine patients (39%) had bicuspid aortic valves, and three patients had a large annulus dimension. The Lotus valve was successfully implanted in all patients. To facilitate accurate positioning, partial re-sheathing was attempted in ten patients (43.5%), while one patient had a full retrieval. One-year clinical follow-up was completed in all patients. RESULTS There were no deaths, strokes, or major adverse cardiac and cerebrovascular events in 22 of the 23 patients at 30 days; the all-cause mortality rate at 1 year was 4.4% (1 of 23 patients). The mean aortic valve gradient decreased from 51.5 ± 8.8 mm Hg at baseline to 13.4 ± 4.9 mm Hg (p < 0.001) and the valve area increased from 0.6 ± 0.2 cm2 to 1.5 ± 0.4 cm2 (p < 0.001) at 30 days. Paravalvular leakage was absent or mild (22%), and no patient had severe paravalvular leakage. Six patients (26.1%) required a postprocedural pacemaker. There was no difference regarding the procedural and the 1‑year outcomes between patients with bicuspid and tricuspid aortic valve stenosis. CONCLUSION Our single-center experience demonstrated that the Lotus valve is feasible and effective for Chinese patients with aortic valve stenosis, including atypical cases with bicuspid aortic valves or large aortic annulus size.
Collapse
Affiliation(s)
- Q Xu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - X Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - J Jiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Y He
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Q Zhu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - F Gao
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - F Du
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - W He
- Department of Anesthesia, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - J Cheng
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - M Kong
- Department of Cardiac Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Z Pu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Q Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - R Gooley
- Monash Cardiovascular Research Centre, Monash University, Victoria, Clayton, Australia
| | - J Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China.
| |
Collapse
|
37
|
Firouzi A, Samiei N, Ahmadi S, Naderi N, Sadeghipour P, Sanati HR, Kashfi F, Sattarzadeh R, Hantoushzadeh S, Bayat M, Pourtaghi S, Nasiri M. Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis. J Tehran Heart Cent 2019; 14:12-17. [PMID: 31210765 PMCID: PMC6560256] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Mitral stenosis tends to worsen during pregnancy because of the increase in the cardiac output and the heart rate. In nonresponders to medical therapy, percutaneous transluminal mitral commissurotomy (PTMC) may be performed when there is a suitable valvular anatomy. In this study, we aimed to investigate the clinical and fetal outcomes of pregnant women with mitral stenosis who underwent PTMC. Methods: Thirty-one patients undergoing PTMC during pregnancy were enrolled in this study. The mitral valve area (MVA), the transmitral valve mean gradient (MVMG), and the severity of mitral regurgitation were assessed pre- and postprocedurally by transthoracic and transesophageal echocardiography. The radiation time was measured during the procedure. The patients were followed up during pregnancy, and the neonates were monitored for weight, height, the head circumference, the birth Apgar score, and the adverse effects of radiation for at least 12 months. Results: PTMC was successfully performed on 29 (93.5%) patients. No maternal death or pulmonary edema was reported. The mean MVA significantly increased (from 0.73±0.17 cm2 to 1.28±0.24 cm2; P<0.001), and the mean MVMG significantly decreased (from 19.62±5.91 mmHg to 8.90±4.73 mmHg; P<0.001) after the procedure. A significant decrease in the systolic pulmonary artery pressure was also detected. Mitral regurgitation did not increase in severity in 16 (51.6%) patients. There was no significant relationship between the Apgar score, weight, height, and the head circumference at birth and at the radiation time. Conclusion: In our series, PTMC during pregnancy was a safe and effective procedure. Lowering the radiation time with low frame-count techniques confers a significant decrease in radiation-related complications.
Collapse
Affiliation(s)
- Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valve Diseases Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Niloufar Samiei, Associate Professor of Cardiology, Heart Valve Diseases Research Center, Rajaie Cardiovascular, Medical, and Research Center, Vali-Asr Ave., Tehran, Iran. 1996911101. Tel: +98 21 23922161. Fax: +98 21 23922340.E-mail: .
| | - Somayyeh Ahmadi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasim Naderi
- Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Sanati
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Kashfi
- Heart Valve Diseases Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Sattarzadeh
- Echocardiography Laboratory, Department of Cardiovascular Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Maternal, Fetal and Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Bayat
- Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
| | - Sanaz Pourtaghi
- Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
| | - Mohsen Nasiri
- Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
| |
Collapse
|
38
|
Abstract
The vast majority of tricuspid valve regurgitations are of low degree without prognostic relevance in healthy individuals; however, morbidity and mortality increase with the degree of regurgitation, which can be secondary to either primary (structural) or secondary (functional) alterations of the valve. Due to the frequent lack of symptoms, echocardiographic examinations should be annually performed in patients with higher degree (at least moderate) tricuspid valve regurgitation, in particular in the presence of risk factors. Individual therapeutic management strategies should consider the etiology of the tricuspid valve regurgitation, the degree of regurgitation, the valve pathology and the risk-to-benefit ratio of the envisaged therapeutic procedure. Medicinal treatment options for tricuspid valve regurgitation are limited and generalized recommendations cannot be provided due to the lack of conclusive clinical trials. Symptomatic therapeutic measures encompass especially (loop) diuretics for the reduction of preload and afterload of the right ventricle. Pharmaceutical reduction of the heart rate should be avoided in patients with right heart insufficiency. While symptomatic therapeutic measures are often associated with only moderate effects, the most effective therapy of tricuspid valve regurgitation consists in the treatment of underlying illnesses, in most cases pulmonary hypertension due to pulmonary arterial hypertension (PAH), left heart disease or acute pulmonary embolism. Based on a number of published clinical studies and licensing of new drugs, treatment options for patients with PAH and heart failure with reduced ejection fraction (HFrEF) have substantially improved during the past years allowing for a differentiated, individualized management.
Collapse
Affiliation(s)
- M Lankeit
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland. .,Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland. .,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.
| | - K Keller
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland
| | - C Tschöpe
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.,Berlin-Brandenburger Centrum für Regenerative Therapien (BCRT), Berlin, Deutschland
| | - B Pieske
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.,Deutsches Herzzentrum Berlin (DHZB), Berlin, Deutschland
| |
Collapse
|
39
|
Chow SC, Lee AP, Ho AM, Chan HH, Underwood MJ, Wan S. Redo tricuspid valve operation in patients with 1 st-generation mitral prostheses. Asian Cardiovasc Thorac Ann 2018; 26:524-528. [PMID: 30099881 DOI: 10.1177/0218492318795545] [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] [Indexed: 11/17/2022]
Abstract
Background In patients with remarkably enlarged cardiac chambers and history of implantation of older types of mitral valve prosthesis, the considerations for reoperative tricuspid valve surgery are not limited to the risks of sternal reentry but also include the dilemma of whether to carry out prophylactic replacement of the normal functioning but outdated prosthesis or leave it in situ. Methods We reviewed our surgical strategy and postoperative 5-year follow-up findings in two patients who underwent redo tricuspid surgery 3 to 4 decades after mechanical mitral valve replacement. Both patients presented with significant symptoms of progressive right heart failure due to severe tricuspid regurgitation, despite optimal medical therapy. Results We found the beating-heart approach to be an effective and safe method for redo tricuspid surgery. Both first-generation mitral mechanical prostheses were not replaced and have remained well functional upon the patients' postoperative 5-year follow-up, respectively. Conclusion For patients with normal functioning first-generation mechanical mitral prostheses, whether to prophylactically replace the prosthesis should be based on an individualized risk-benefit analysis.
Collapse
Affiliation(s)
- Simon Cy Chow
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alex Pw Lee
- 2 Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Anthony Mh Ho
- 3 Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Herman Hm Chan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Malcolm J Underwood
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Song Wan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| |
Collapse
|
40
|
Kozlowski P, Rodriguez-Molares A, Tangen TA, Kristoffersen K, Torp H, Gerard O, Samset E. Adaptive Color Gain for Vena Contracta Quantification in Valvular Regurgitation. Ultrasound Med Biol 2018; 44:1770-1777. [PMID: 29779888 DOI: 10.1016/j.ultrasmedbio.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 02/18/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
Severe valvular regurgitation can lead to pulmonary hypertension, atrial fibrillation and heart failure. Vena contracta width is used to estimate the severity of the regurgitation. Parameters affecting visualization of color Doppler have a significant impact on the measurement. We propose a data-driven method for automated adjustment of color gain based on the peak power of the color Doppler signal in the vicinity of the vena contracta. A linear regression model trained on the peak power was used to predict the orifice diameter. According to our study, the color gain should be set to about 6 dB above where color Doppler data completely disappears from the image. Based on our method, orifices with reference diameters of 4, 6.5 and 8.5 mm were estimated with relative diameter errors within 18%, 12% and 14%, respectively.
Collapse
Affiliation(s)
- Pawel Kozlowski
- GE Vingmed Ultrasound, Oslo, Norway; Department of Informatics, University of Oslo, Oslo, Norway.
| | | | | | | | - Hans Torp
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Eigil Samset
- GE Vingmed Ultrasound, Oslo, Norway; Department of Informatics, University of Oslo, Oslo, Norway; Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Norway
| |
Collapse
|
41
|
Wang K, Jia B. [Progress of surgical treatment for aortic valve diseases in children]. Zhonghua Wai Ke Za Zhi 2018; 56:414-7. [PMID: 29886662 DOI: 10.3760/cma.j.issn.0529-5815.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As the primary treatment of aortic valve stenosis in children, surgical aortic valvotomy (SAV) and balloon aortic valvuloplasty (BAV) are widely used. With the similar early curative effect to BAV, SAV performs better in long-term follow-up. But the first choice for aortic valve stenosis is still controversial. These years, aortic valve repair is valued and different repair techniques have been reported and achieved good results. The complex repair techniques, as leaflet extension, leaflet replacement or valve reconstruction, are effective in treating diseased valves that cannot be repaired before. Ozaki technology, using glutaraldehyde-treated autologous pericardium to replace the aortic valve, makes the surgery more standardized and reproducible by developing special instruments. Pulmonary autograft (Ross procedure) is considered to be superior to other valve replacement technologies due to the good hemodynamic performance and lower reoperation rate. Mechanical valve is still used in some cases, but the quality of life is low due to the lifelong anticoagulation, and it has a high reintervention rate. The biological valve has been rarely used in children because of its high rate of early calcification and structural failure.
Collapse
|
42
|
Jonckers M, Van Grootven B, Willemyns E, Hornikx M, Jeuris A, Dubois C, Herregods MC, Deschodt M. Hospitalization-associated disability in older adults with valvular heart disease: incidence, risk factors and its association with care processes. Acta Cardiol 2018; 73:1-7. [PMID: 29301463 DOI: 10.1080/00015385.2017.1421300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to determine the incidence and recovery of hospitalisation-associated disability (HAD), the associated risk factors, and the link with care processes in patients aged 70 years or older hospitalised with valvular heart disease (VHD). METHODS Prospective cohort study performed on the cardiology and cardiac surgery units of University Hospitals Leuven, Belgium. HAD was defined as the loss of independence to complete one of the Activities of Daily Living (ADLs) between hospital admission and discharge. Recovery of HAD at 30 days post hospital discharge was achieved when patients recovered their baseline ADL status (2 weeks before hospital admission) (ClinicalTrials.gov: NCT02572999). RESULTS Eighty patients were enrolled in the study, 77 completed the assessment at discharge and 62 responded at 30 days follow-up. Forty patients (51.9%) developed HAD; 18 of them (45.0%) recovered their baseline ADL status. The risk of HAD increased when patients were physically restrained (relative risk (RR) 1.73, 95% confidence interval (CI) 1.20-2.49), had indwelling catheters (RR 1.80, 95% CI 0.85-3.80) and received preventive pressure ulcer measures (RR 1.71, 95% CI 1.07-2.74). Patients with HAD had longer hospital stays (+3 days, p = .011) and longer use of indwelling catheters (+2 days, p = .024). CONCLUSION Half of the older adults with VHD developed HAD. The results indicate a potential association between HAD and care processes, which could be used as quality measures and intervention targets. Validation in larger cohort studies is recommended.
Collapse
Affiliation(s)
- Maren Jonckers
- a Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium
| | - Bastiaan Van Grootven
- a Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium
- b Research Foundation Flanders , Flanders , Belgium
| | - Ester Willemyns
- a Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium
| | - Miek Hornikx
- c Department of Cardiovascular Diseases , University Hospitals Leuven , Leuven , Belgium
| | - Anthony Jeuris
- a Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium
| | - Christophe Dubois
- c Department of Cardiovascular Diseases , University Hospitals Leuven , Leuven , Belgium
- d Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium
| | - Marie-Christine Herregods
- c Department of Cardiovascular Diseases , University Hospitals Leuven , Leuven , Belgium
- d Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium
| | - Mieke Deschodt
- e Department of Chronic Diseases, Metabolism and Ageing , University Hospitals Leuven , Leuven , Belgium
- f Pflegewissenschaft - Nursing Science, Department of Public Health , University of Basel , Basel , Switzerland
| |
Collapse
|
43
|
de Aquino Xavier RM, Azevedo VMP, Godoy PH, Migowski A, Ribeiro ALP, Chaves RBM, Correia MG, de Aquino Xavier C, de Aquino Hashimoto L, Weksler C, Silva NASE. Medium-term outcomes of 78,808 patients after heart valve surgery in a middle-income country: a nationwide population-based study. BMC Cardiovasc Disord 2017; 17:302. [PMID: 29284400 PMCID: PMC5745641 DOI: 10.1186/s12872-017-0725-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/28/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Heart valve surgery outcomes are unknown in middle-income countries and thus cannot be used in health system decision making processes. This study estimated in-hospital mortality and medium and long-term survival. METHODS This was a retrospective study of 78,806 patients who underwent heart valve surgery between 2001 and 2007 in Brazil. Two national databases were used, the Hospital Information System and the Mortality Information System. Kaplan-Meier survival analysis and log-rank tests were performed. Maximum and median follow-up was 7.7 and 2.8 years, respectively (0.002-7.707). RESULTS Valve replacement accounted for 69.1% of procedures performed. Mitral stenosis, the most common valve injury, represented 38.9% of the total. In 94.7% of mitral stenosis patients, aetiology was rheumatic heart disease. In-hospital mortality was 7.6% and was higher for women, for patients who had undergone concomitant coronary artery bypass grafting (CABG) and for the elderly. Overall survival was 69.9% at the end of follow-up. Survival was worst among elderly, male and concomitant CABG patients (P<0.001). CONCLUSIONS Rheumatic heart disease is still a major public health problem in Brazil. In-hospital mortality and global survival rates of patients who have undergone heart valve surgery were less satisfactory than those reported in high-income countries. The findings of this study can contribute to guiding decision making processes in middle-income countries similar to Brazil and others concerned with improving the quality of care.
Collapse
Affiliation(s)
- Regina Maria de Aquino Xavier
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | - Vitor Manuel Pereira Azevedo
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | | | - Arn Migowski
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | - Antonio Luiz Pinho Ribeiro
- University Hospital and School of Medicine - Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil
| | - Rogério Brant Martins Chaves
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | - Marcelo Goulart Correia
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | - Carolina de Aquino Xavier
- University Hospital and School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Clara Weksler
- Hospital School, National Institute of Cardiology (INC), Ministry of Health, Rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
44
|
Jobs A, Stiermaier T, Klotz S, Eitel I. [Antiplatelet or anticoagulative strategies after surgical/interventional valve treatment]. Herz 2017; 43:26-33. [PMID: 29147971 DOI: 10.1007/s00059-017-4646-2] [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] [Indexed: 11/28/2022]
Abstract
At the end of August 2017 the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) published new joint guidelines for the treatment of valvular heart disease. These guidelines incorporate the scientific progress since the last version of the guidelines published in 2012. This article reviews current guideline recommendations for antiplatelet and anticoagulative therapy after surgical/interventional treatment of the aortic and mitral valves and discusses the underlying scientific evidence.
Collapse
Affiliation(s)
- A Jobs
- Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - T Stiermaier
- Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - S Klotz
- Klinik für Herz- und thorakale Gefäßchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - I Eitel
- Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| |
Collapse
|
45
|
Sun BJ, Jin X, Song JK, Lee S, Lee JH, Park JB, Lee SP, Kim DH, Park SJ, Kim YJ, Cho GY, Song JM, Kang DH, Sohn DW. Clinical Characteristics of Korean Patients with Bicuspid Aortic Valve Who Underwent Aortic Valve Surgery. Korean Circ J 2017; 48:48-58. [PMID: 29171200 PMCID: PMC5764870 DOI: 10.4070/kcj.2017.0124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 01/09/2023] Open
Abstract
Background and Objectives Clinical data for Korean patients with bicuspid aortic valve (BAV) that underwent aortic valve (AV) surgery are currently limited. Methods Data for 1,160 consecutive adult BAV patients who underwent AV surgery from 2000 to 2014 in 4 tertiary referral centers were retrospectively analyzed. A standard case report form was used for clinical and echocardiographic parameters. Results Mean age at the time of AV surgery was 59±13 years. The most common cause of AV surgery was aortic stenosis (AS, 892 [77%]), followed by aortic regurgitation (AR, 199 [17%]), and infective endocarditis (69 [6%]). AS showed a skewed peak in the aged population and was the predominant cause of AV surgery (87%) in patients ≥50 years of age, whereas AR (46%) and active infective endocarditis (19%) were more common in younger patients (p<0.001). Echocardiographic determination of the BAV phenotype revealed that fusion of the right coronary cusp (RCC) and left coronary cusp (LCC) was most common (622 [53%]), followed by fusion of RCC and non-coronary cusp (NCC) (313 [27%]), and fusion of LCC and NCC (42 [4%]); the BAV phenotype could not be determined in the remaining 183 patients (16%). Fusion of RCC and LCC was more commonly observed in patients with AR than in those with AS (74% vs. 49%; p<0.001). Conclusion BAV patients were characterized by distinct surgical indications according to their age. Possible associations between BAV phenotypes and surgical indications with potential impacts of ethnicity need to be tested in further studies.
Collapse
Affiliation(s)
- Byung Joo Sun
- Department of Cardiology, Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Xin Jin
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, Seoul, Korea.,Research Institute for Valvular Heart Disease, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwan Song
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, Seoul, Korea.,Research Institute for Valvular Heart Disease, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sahmin Lee
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, Seoul, Korea.,Research Institute for Valvular Heart Disease, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hye Lee
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, Seoul, Korea.,Research Institute for Valvular Heart Disease, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Bean Park
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Pyo Lee
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae Hee Kim
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, Seoul, Korea.,Research Institute for Valvular Heart Disease, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Ji Park
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Jin Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Goo Yeong Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Min Song
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, Seoul, Korea.,Research Institute for Valvular Heart Disease, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk Hyun Kang
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, Seoul, Korea.,Research Institute for Valvular Heart Disease, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Won Sohn
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
46
|
Xu ZJ, Pan J, Zhou Q, Wang DJ. [Analysis of the prevalence and risk factors of preoperative angiography confirmed coronary artery stenosis in patients with degenerative valvular heart disease]. Zhonghua Xin Xue Guan Bing Za Zhi 2017; 45:837-42. [PMID: 29081171 DOI: 10.3760/cma.j.issn.0253-3758.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To estimate the prevalence and the risk factors of preoperative coronary angiography (CAG) confirmed coronary stenosis in patients with degenerative valvular heart disease. Methods: A total of 491 patients who underwent screening CAG before valvular surgery due to degenerative valvular heart disease were enrolled from January 2011 to September 2014 in our hospital, and clinical data were analyzed. According to CAG results, patients were divided into positive CAG result (PCAG) group or negative CAG (NCAG) group. Positive CAG result was defined as stenosis ≥50% of the diameter of the left main coronary artery or stenosis ≥70% of the diameter of left anterior descending, left circumflex artery, and right coronary artery.Risk factors of positive CAG result were analyzed by multivariable logistic regression analysis, and Bootstrap method was used to verify the results. Results: There were 47(9.57%)degenerative valvular heart disease patients with PCAG. Patients were older ((68.0±7.6)years vs.(62.6±7.1)years, P<0.001) and the prevalence of typical angina was significantly higher (14.89%(7/47)vs. 2.03%(9/444), P<0.001)in PCAG group than in NCAG group. Multivariable logistic regression analysis showed that age (OR=1.118, 95%CI 1.067-1.172, P<0.001), typical angina (OR=8.970, 95%CI 2.963-27.154, P<0.001), and serum concentration of apolipoprotein B (OR=20.311, 95%CI 4.774-86.416, P<0.001) were the independent risk factors of PCAG in degenerative valvular heart disease patients. Bootstrap method revealed satisfactory repeatability of multivariable logistic regression analysis results (age: OR=1.118, 95%CI 1.068-1.178, P=0.001; typical angina: OR=8.970, 95%CI 2.338-35.891, P=0.001; serum concentration of apolipoprotein B: OR=20.311, 95%CI 4.639-91.977, P=0.001). Conclusions: A low prevalence of PCAG before valvular surgery is observed in degenerative valvular heart disease patients in this patient cohort. Age, typical angina, and serum concentration of apolipoprotein B are independent risk factors of PCAG in this patient cohort.
Collapse
|
47
|
Reiter C, Grund M, Nahler A, Steinwender C, Lambert T. Rupture of the aortic root : A rare but life-threatening complication of transcatheter aortic valve replacement. Wien Klin Wochenschr 2017; 129:906-909. [PMID: 28980129 DOI: 10.1007/s00508-017-1272-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/04/2017] [Indexed: 11/30/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has been shown to be a valid treatment option for patients with significant symptomatic aortic valve stenosis and high surgical risk. Rupture of the aortic root is a rare but life-threatening complication that occurs in approximately 1% of procedures and usually manifests as an acute complication at the time of valve implantation; however, physicians should be aware of a potentially subacute onset, since early recognition and immediate management are crucial. While many potential causes have been described, it is currently unknown which combinations will lead to its occurrence. Accurate preprocedural assessment of the aortic annulus and its adjacent structures as well as adequate sizing of the prosthetic valve are important steps to prevent rupture of the device landing zone.
Collapse
Affiliation(s)
- Christian Reiter
- Department of Cardiology, Kepler University Hospital, Linz, Austria.
| | - Michael Grund
- Department of Cardiology, Kepler University Hospital, Linz, Austria
| | - Alexander Nahler
- Department of Cardiology, Kepler University Hospital, Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Linz, Austria.,Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Lambert
- Department of Cardiology, Kepler University Hospital, Linz, Austria
| |
Collapse
|
48
|
Ruiz D, Oates JC, Kamen DL. Antiphospholipid Antibodies and Heart Valve Disease in Systemic Lupus Erythematosus. Am J Med Sci 2017; 355:293-298. [PMID: 29549933 DOI: 10.1016/j.amjms.2017.07.007] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/05/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Abstract
Evaluation of antiphospholipid antibodies (aPL) and correlation with heart valve abnormalities among patients with systemic lupus erythematosus (SLE). Nested case-control study was conducted with 70 patients with SLE selected from a longitudinal database based on levels of aPL and presence or absence of valve disease by echocardiogram. Valvular abnormalities observed were regurgitation (52), other (14), artificial valves (4), stenosis (2), thickening (2) and no Libman-Sacks endocarditis (0). The mitral valve was the most commonly affected (30 abnormalities), followed by the tricuspid (20 abnormalities). Multivariate logistic regression for those with and without an aPL value ≥20 units/mL, adjusted for disease duration and age, showed significant differences for any valve abnormality (odds ratio [OR] = 3.1; 95% CI: 1.0-8.9; P = 0.041) and individually for the tricuspid valve (OR = 3.3; 95% CI: 1.0-11.1; P = 0.052) but not for the mitral valve (OR = 2.1; 95% CI: 0.68-6.45; P = 0.195). Levels of aPL ≥20 units/mL showed no association with aortic (P = 0.253), pulmonic (P = 1.000), tricuspid (P = 0.127), or mitral (P = 0.249) valve abnormalities. Levels of aPL correlate with certain valvular abnormalities among patients with SLE.
Collapse
Affiliation(s)
- Daniel Ruiz
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jim C Oates
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Diane L Kamen
- Department of Medicine, Medical University of South Carolina, Charleston, SC.
| |
Collapse
|
49
|
Abstract
Many patients with severe aortic stenosis have a "low-flow, low-gradient" aortic stenosis. The management of these patients can be quite difficult, as these patients often show impairment of the left ventricle, which can lead to false measurements of the severity of stenosis and also leads to a higher risk during aortic valve replacement. More diagnostic tools than only standard echocardiography are needed to correctly differentiate true severe aortic stenosis from pseudo severe aortic stenosis.
Collapse
|
50
|
Mestres CA, Quintana E, Miro JM. Infective endocarditis and multidisciplinary work: a call for action in Asia. Asian Cardiovasc Thorac Ann 2017; 25:261-263. [PMID: 28480736 DOI: 10.1177/0218492317708095] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carlos A Mestres
- 1 Department of Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,2 Hospital Clinic Infective Endocarditis Working Group, Barcelona, Spain
| | - Eduard Quintana
- 2 Hospital Clinic Infective Endocarditis Working Group, Barcelona, Spain.,3 Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- 2 Hospital Clinic Infective Endocarditis Working Group, Barcelona, Spain.,4 Department of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| |
Collapse
|