Heart Valve Research Articles

Non-bacterial thrombotic endocarditis: a clinical and pathophysiological reappraisal.

Non-bacterial thrombotic endocarditis (NBTE), formerly recognized as marantic endocarditis, represents a rare cardiovascular pathology intricately linked with hypercoagulable states, notably malignancy and autoimmune disorders. Characterized by the development of sterile vegetations comprised of fibrin and platelets on cardiac valves, NBTE poses a diagnostic challenge due to its resemblance to infective endocarditis. Therapeutic endeavours primarily revolve around addressing the underlying aetiology and instituting anticoagulant regimens to forestall embolic events, with surgical intervention seldom warranted. Non-bacterial thrombotic endocarditis frequently coexists with malignancies and autoimmune conditions, such as lupus and antiphospholipid antibody syndrome, and, more recently, has been associated with COVID-19. Its pathogenesis is underpinned by a complex interplay of endothelial dysfunction, hypercoagulability, hypoxia, and immune complex deposition. Clinical manifestations typically manifest as embolic phenomena, particularly cerebrovascular accidents, bearing substantial mortality rates. Diagnosis necessitates a high index of suspicion and meticulous exclusion of infective endocarditis, often facilitated by advanced cardiac imaging modalities. Anticoagulation, typically employing low molecular weight heparin or warfarin, constitutes the cornerstone of pharmacological intervention. Surgical recourse may be warranted in instances of refractory heart failure or recurrent embolic events. Given its multifaceted nature, the management of NBTE mandates a multidisciplinary approach, with prognosis contingent upon individual clinical intricacies. Future endeavours should prioritize further research to refine therapeutic strategies and enhance patient outcomes.

Prognostic impact of mild renal dysfunction in patients undergoing valve surgery.

To analyze the impact of mild renal dysfunction on the prognosis of patients undergoing valve surgery. A total of 6,210 consecutive patients(3,238 women; mean age, 59.2 ± 12.7 years) who underwent left-sided heart valve surgery between 2000 and 2022 were included in the study cohort. The primary outcome was all-cause death, and the secondary outcome was a composite of death, reoperation, stroke, and heart failure. The restricted cubic spline function was utilized to investigate the association between eGFR and clinical outcomes, which was validated using inverse probability treatment weighting(IPTW)-adjusted analysis. Severities of baseline renal dysfunction were none in 1520(24.5%), mild in 3557(57.3%), moderate in 977(15.7%), severe in 59(1.0%), and end-stage in 97(1.6%). Clinical outcomes varied significantly according to the degree of baseline renal dysfunction. The restricted cubic spline function curve showed a non-linear association, indicating that the significantly adverse effects of low eGFR on clinical outcomes were diminished in cases of mild renal dysfunction. This finding was corroborated by IPTW-adjusted analysis and subgroup analyses did not show significant differences in clinical outcomes according to the presence of mild renal dysfunction(all-cause mortality, HR: 1.08; 95% CI: 0.90-1.28; P = 0.413; composite outcome, HR: 1.06; 95% CI: 0.92-1.21; P = 0.421). In patients undergoing valve surgery, long-term clinical outcomes were significantly associated with the degree of baseline renal function impairment, but not with the presence of mild renal dysfunction, demonstrating a non-linear association between baseline renal function and postoperative outcomes.

Direct Oral Anticoagulants: Quick Primer on When to Use and When to Avoid.

Direct oral anticoagulants (DOACs) have transformed the landscape of antithrombotic therapy in the past two decades. However, there is uncertainty about when they should or should not be used for treatment or prevention of thromboembolic events. DOACs have largely replaced warfarin for many patients with atrial fibrillation or venous thromboembolism who require anticoagulant therapy. In addition to noninferior efficacy, fewer drug-drug and food-drug interactions and improved convenience; DOACs have been shown to reduce the risk of intracranial hemorrhage. They have also received new indications compared with warfarin, such as cardiovascular risk reduction in patients with stable atherosclerotic diseases. However, there are some scenarios in which DOACs are associated with inferior efficacy or worse safety compared with standard treatment, such as warfarin. These include patients with mechanical heart valves, thrombotic antiphospholipid syndrome, and others. Although DOACs offer a streamlined and convenient option for the management of many patients with or at risk of thromboembolic events, their use should be avoided in certain high-risk scenarios. This minireview summarizes such conditions and those in which there is uncertainty for use of DOACs for particular diseases or particular patient subgroups.

Cyclin‐dependent kinase 13 is indispensable for normal mouse heart development

AbstractCongenital heart disease (CHD) has an incidence of approximately 1%. Over the last decade, sequencing studies including large cohorts of individuals with CHD have begun to unravel the genetic mechanisms underpinning CHD. This includes the identification of variants in cyclin‐dependent kinase 13 (CDK13), in individuals with syndromic CHD. CDK13 encodes a serine/threonine protein kinase. The cyclin partner of CDK13 is cyclin K; this complex is thought to be important in transcription and RNA processing. Pathogenic variants in CDK13 cause CDK13‐related disorder in humans, characterised by intellectual disability and developmental delay, recognisable facial features, feeding difficulties and structural brain defects, with 35% of individuals having CHD. To obtain a greater understanding for the role that this essential protein kinase plays in embryonic heart development, we have analysed a presumed loss of function Cdk13 transgenic mouse model (Cdk13tm1b). The homozygous mutants were embryonically lethal in most cases by E15.5. X‐gal staining showed Cdk13 expression localised to developing facial regions, heart and surrounding areas at E10.5, whereas at E12.5, it was more widely present. In the E15.5 heart, staining was seen throughout. RT‐qPCR showed significant reduction in Cdk13 transcript expression in homozygous compared with WT and heterozygous hearts at E10.5 and E12.5. Detailed morphological 3D analysis of embryonic and postnatal hearts was performed using high‐resolution episcopic microscopy, which affords a more detailed analysis of structures such as cardiac valve leaflets and endocardial cushions, compared with more traditional histological techniques. We show that both the homozygous and heterozygous Cdk13tm1b mutants exhibit a range of CHD, including ventricular septal defects, bicuspid aortic valve, double outlet right ventricle and atrioventricular septal defects. 100% (n = 4) of homozygous hearts displayed CHD. Differential expression was seen in Cdk13tm1b homozygous mutants for two genes known to be necessary for normal heart development. The types of defects, and the presence of CHD in heterozygous mice (17.02%, n = 8/47), are consistent with the CDK13‐related disorder phenotype in humans. This study provides important insights into the effects of reduced function of CDK13 in the mouse heart and contributes to our understanding of the mechanism behind this disorder as a cause of CHD.

Predictive Role of Preoperative Controlled Nutritional Status Score on Prolonged Mechanical Ventilation after Heart Valve Surgery

Background: Postoperative prolonged mechanical ventilation (MV) in patients with heart valve disease (HVD) is usually concomitant with poor prognosis. Its relationship with preoperative nutritional status still remains unclear. The present study intends to explore the influence of preoperative controlled nutritional status (CONUT) score on early postoperative outcomes and its predictive role in prolonged MV. Methods: HVD patients receiving cardiac surgeries in our department from January 2022 to December 2023 were retrospectively selected. CONUT score was calculated according to the level of serum albumin, total cholesterol and lymphocyte counts. When the CONUT score was greater than or equal to 3, patients were included in high CONUT group, and the other patients were included in low CONUT score group. Propensity score matching (PSM) was used to adjust baseline characteristics. Results: A total of 411 patients were included, of which 129 patients had the preoperative CONUT score greater than or equal to 3 points, accounting for 31.4%. After adjustment at a ratio of 1:2, 103 patients were included in high CONUT group while 206 patients were included in low CONUT group. The incidence of postoperative ventilator associated pneumonia (VAP) in high CONUT group was significantly higher than that in low CONUT group (p = 0.039). Length of ICU stay showed up a significant extension in high CONUT group compared with low CONUT group (p = 0.041). Significantly prolonged MV time could be observed in high CONUT group compared with low CONUT group (p = 0.022). The proportion of patients receiving MV over 48 h and 72 h in high CONUT group significantly increased (p = 0.020 and 0.009 respectively) except for MV over 24 h. MV time of all patients was found to be significantly correlated with CONUT score (r = 0.186, p = 0.001). The area under the curve (AUC) for CONUT predicting MV >48 h was 0.625 (p = 0.008), with sensitivity of 0.419 and specificity of 0.808. The AUC for CONUT predicting MV >72 h was 0.691 (p = 0.003), with sensitivity of 0.545 and specificity of 0.801. Conclusions: Preoperative CONUT score had an accurate predictive role of postoperative prolonged MV and early poor prognosis in HVD patients, which deserves much attention to improve clinical outcomes.

Percutaneous Pulmonary Valve Implantation With Self‐Expanding Valves for Carcinoid Heart Diseases

ABSTRACTCarcinoid heart disease is an important complication of neuroendocrine tumors that may lead to significant morbidity and mortality. Right‐sided heart valve involvement with consequent valve dysfunction is one of the common manifestations. Patients often have multiple, significant comorbidities with advanced metastatic disease and, as such, may not be suitable for surgical valve replacement due to excessive risk. Transcatheter valve replacement using balloon‐expandable valves has been the mainstay of management for these patients, particularly with stenotic lesions but there is limited experience in patients with pulmonary regurgitation and dilated pulmonary arteries outside the dimensions that would be suitable for these valves. We report three successful cases of percutaneous pulmonary valve implantation with the VenusP‐valve, a large self‐expanding valve platform, and highlight the technical aspects and challenges specific to treatment of pulmonary regurgitation in patients with carcinoid heart disease. Percutaneous pulmonary valve implantation, using the VenusP‐valve, may be considered an effective treatment in this patient group.

Multivalvular prolapse: A case report of concurrent mitral, aortic, and tricuspid valve involvement in the same patient with severe regurgitation and heart failure features

Myxomatous valvular disease of cardiac valves has been reported in various studies and case reports which involves mainly mitral valve. This valvular involvement produces several degrees of regurgitant lesions, causing symptoms. Concomitant involvement of mitral, aortic, and tricuspid valves has been rarely reported. Here, we report a case of a 49-year-old male with triple valve prolapse, presenting with dyspnea and palpitations. The patient was managed conservatively as he was not fit for surgical intervention. This report adds to the limited data available in the literature and current guidelines to support clinical decision-making.

Management of multiple valve replacement operations for a young patient with hypereosinophilic syndrome and valvular heart disease: a case report

BackgroundHypereosinophilic syndrome (HES) is characterized by the overproduction of eosinophils and manifests as valvular disease and thrombogenesis. Herein, we report our experience with a patient with HES requiring multiple reoperations for prosthetic heart valve replacement via median sternotomy.Case presentationThe patient was a 54-year-old man who had undergone four valve replacement operations via median sternotomy (three mitral valve replacements and one double valve replacement) because of valvular diseases complicated by HES since he was 26 years old. All the artificial valves were bioprosthetic to prevent thrombotic events. At presentation, he had developed structural deterioration of the artificial aortic valve with severe stenosis. His prosthetic mitral valve did not fulfil the criteria for intervention, as it exhibited only mild regurgitation and no stenosis. The explanted mitral prosthetic valve at the previous (fourth) surgery had exhibited eosinophilic infiltration, resulting in the introduction of cyclosporin for poorly controlled HES. We conducted re-aortic valve replacement via a fifth median sternotomy using a bioprosthetic valve, and no eosinophilic infiltration was observed in the explanted valve. The patient was discharged on postoperative day 15 without complications.ConclusionsControlling eosinophil count during the pre- and postoperative course is vital in treating patients with HES after valve replacement surgery. A holistic management and therapeutic strategy, including prosthetic valve selection and medication for HES is required to improve outcomes of patients with HES and heart valve disease.

Direct Oral Anticoagulants Versus Warfarin in Patients With Isolated Heparin-Induced Thrombocytopenia or Heparin-Induced Thrombocytopenia With Thrombosis.

No existing studies compare oral anticoagulants to treat heparin-induced thrombocytopenia with or without thrombosis (HIT/HITT). This retrospective study evaluated thrombotic and bleeding outcomes in adults treated for HIT/HITT with a direct oral anticoagulant (DOAC) or warfarin between 2012 and 2023 within the Ochsner Health System. Patients with mechanical heart valves, valvular atrial fibrillation, antiphospholipid syndrome, active malignancy, or venous thromboembolism (VTE) within the previous 6 months were excluded. The primary outcome was a composite of new or progressive VTE or arterial thromboembolism. Secondary outcomes included major and clinically relevant non-major bleeding, duration of hospitalization, time to platelet recovery, and incidence of skin necrosis, gangrene, and amputation. Forty-nine patients receiving a DOAC and 30 patients receiving warfarin were included. Baseline characteristics were similar between cohorts. There were non-statistically significant increased rates of both the primary outcome (8.9% vs. 4.3%, p = 0.65) and the composite bleeding outcome (32.7% vs. 23.3%, p = 0.37) in the DOAC cohort. Larger, prospective studies are needed to confirm these findings.

Myval Transcatheter Heart Valve: The Future of Transcatheter Valve Replacement and Significance in Current Timeline.

The Myval is a balloon-expandable transcatheter heart valve (THV) developed by Meril Life Sciences Pvt. Ltd. (Vapi, Gujarat, India) that has an innovative operator-friendly design that aids in improving deliverability and features precise deployment. Various clinical studies demonstrate its effectiveness and safety, making it a promising choice in valvular interventions. Myval has been successfully utilized as a transcatheter aortic valve implantation (TAVI) device in cases with conduction disturbances, bicuspid aortic valve anatomy, non-calcified aortic regurgitation, dysfunctional stenosed right ventricular outflow tract (RVOT) conduits, pulmonary valve replacement, mitral valve replacement, and valve-in-valve and valve-in-ring implantation procedures. Myval's diverse sizes are also of key importance in complex cases of large annuli and complex anatomy. Further long-term studies are needed to consolidate these results. Its introduction signifies a significant advancement in cardiology, aiming to enhance patient outcomes and quality of life. In the present review, we provide an update on new-generation Myval THV series and review the available clinical data published to date with an emphasis on diverse use in specific clinical scenarios.

Matrix Metalloproteinase-Responsive Controlled Release of Self-Assembly Nanoparticles Accelerates Heart Valve Regeneration In Situ by Orchestrating Immunomodulation.

In situ tissue engineering heart valves (TEHVs) are the most promising way to overcome the defects of existing valve prostheses. Despite their promising prospects, the clinical translation of TEHVs remains a formidable challenge, mainly due to unpredictable host interactions post-implantation. An immunomodulatory idea based on hydrogel encapsulation of nanoparticle-coated heart valve scaffolds is introduced. Specifically, galactose-modified human serum albumin nanoparticles (miR-93@HSA NPs) to deliver microRNA-93 mimics are utilized, which target macrophages and induce their differentiation into the anti-inflammatory M2 subtype, fostering a conducive immune microenvironment. Matrix metalloproteinase (MMP)-responsive hydrogel is used to encapsulate the nanoparticles, enabling targeted and sustained release. Results show that the miR-93@HSA NPs exhibit excellent ability to induce macrophage polarization toward the M2 phenotype. A decellularized valve modified with hydrogel reveals MMP-response release of the miR-93@HSA NPs. In vitro, the immunomodulatory heart valve possesses good endocytocompatibility and effectively reprograms macrophages when cocultured with HUVECs or RAW264.7 macrophages. In vivo, this valve scaffold promises to mitigate early inflammatory damage and provide a pro-endothelialization niche for scaffolds' constructive remodeling. With the use of cell coculture systems and transcriptome sequencing, the mechanism of immune-modulating scaffold accelerating endothelialization is being elucidated. The immunomodulatory heart valve scaffold holds promising potential for clinical translation.

Butterfly-Inspired Multiple Cross-Linked Dopamine-Metal-Phenol Bioprosthetic Valves with Enhanced Endothelialization and Anticalcification.

Valve replacement is the most effective means of treating heart valve diseases, and transcatheter heart valve replacement (THVR) is the hottest field at present. However, the durability of the commercial bioprosthetic valves has always been the limiting factor restricting the development of interventional valve technology. The chronic inflammatory reaction, calcification, and difficulty in endothelialization after the implantation of a glutaraldehyde cross-linked porcine aortic valve or bovine pericardium often led to valve degeneration. Improving the biocompatibility of valve materials and inducing endothelialization to promote in situ regeneration can extend the service life of valve materials. Herein, inspired by the hardening process of butterfly wings, this study proposed a dopamine-metal-phenol strategy to modify decellularized porcine pericardium (DPP). This is a strategy to make dopamine (DA) coordinate trivalent metal chromium ions (Cr(III)) with antiplatelets (PLTs) and anti-inflammatory properties, and then cross-link it with tea polyphenols (TP) to generate a valve scaffold that is mechanically comparable to glutaraldehyde-cross-linked scaffolds but avoids the cytotoxicity of aldehyde and presents better biocompatibility, hemocompatibility, anticalcification, and anti-inflammatory response properties.

Management of giant left atrial thrombus late after transcatheter mitral valve-in-ring replacement using a transcatheter aortic valve: a case report

BackgroundIn symptomatic high-risk patients with severe mitral valve regurgitation (MR), who are not eligible for surgery, Transcatheter edge-to-edge repair (TEER) or transcatheter mitral valve replacement (TMVR) may be an option, especially when surgical mitral valve repair by annuloplasty has been performed earlier. After TMVR, the appropriate anticoagulation regimen is still matter of debate.Case presentationWe here report on a 78-year-old frail lady with heart failure and atrial fibrillation who underwent surgical reconstruction of the mitral valve nine years ago. Due to high surgical risk and after heart team discussion, TMVR using a transcatheter aortic valve prosthesis (valve-in-ring concept) was performed successfully via the transapical access route. Several months later, an excellent result could be confirmed. Since surgical excision of the left atrial appendage was carried out during first surgery, oral anticoagulation was withdrawn. Two months later, the patient presented with a massive LA thrombus mass and severe stenosis of the mitral valve prosthesis requiring re-do surgery.ConclusionsManagement of anticoagulation in patients with atrial fibrillation and successfully performed LAA excision is still a matter of debate, in particular after transcatheter heart valve implantation in mitral position. TMVR devices may be very thrombogenic. Thus, caution should be used whenever discontinuing oral anticoagulation in these patients. Despite the lack of evidence, withdrawal of anticoagulation should be avoided here, especially in the absence of bleeding complications. Left atrial appendage closure or excision should not influence this decision.

Quantitative Structure-Activity Relationship Models to Predict Cardiac Adverse Effects.

Drug-induced cardiotoxicity represents one of the most common causes of attrition of drug candidates in preclinical and clinical development. For this reason, the evaluation of cardiac toxicity is essential during drug development and regulatory review. In the present study, drug-induced postmarket adverse event combinations from the FDA Adverse Event Reporting System were extracted for 2002 drugs using 243 cardiac toxicity-related preferred terms (PTs). These PTs were combined into 12 groups based on their clinical relevance to serve as training sets. The optimal classification scheme was determined using a combination of data sources that included drug labeling information, published literature, clinical study data, and postmarket surveillance data. Two commercial QSAR platforms were used to construct 12 models, including general cardiac toxicity, cardiac ischemia, heart failure, cardiac valve disease, myocardial disease, pericardial disease, structural heart disease, cardiac arrhythmia, Torsades de Pointes, long QT syndrome, atrial fibrillation and ventricular arrhythmia, and cardiac arrest. The cross-validated performance for the new models reached a sensitivity of up to 80% and negative predictivity of up to 80%. These new models covering a wide range of cardiac endpoints will provide fast, reliable, and comprehensive predictions of potential cardiotoxic compounds in drug discovery and regulatory safety assessment.

Abstract 4137441: Online Cognitive Behavioral Therapy Targeting Psychological Distress Following Open Heart Surgery: An Uncontrolled Pilot Study

Background: Cardiac surgery is a significant procedure that reduces mortality and alleviates symptom burden in individuals with cardiovascular diseases. However, many patients develop depression and cardiac-related anxiety postoperatively, which negatively affects long-term prognosis and rehabilitation. There is a clinical need to develop scalable psychological treatments to mitigate these negative health effects. Objective: To investigate the feasibility and potential efficacy of a brief internet-delivered cognitive behavioral therapy (internet-CBT) intervention to reduce psychological distress in patients following cardiac surgery. Methods: The pilot study included 32 cardiac surgery patients (i.e., CABG, heart valve repair/replacement, aortic repair, or combined CABG and valve repair/replacement) with endorsed postoperative psychological distress and/or interference with daily life who underwent surgery from eight weeks to nine months prior to enrollment. Exclusion criteria included prior cardiac surgery with a ventricular assist device or heart transplant and severe medical or psychiatric illness. The internet-CBT targeted cardiac anxiety and depressive inactivity, lasted for five weeks, and was guided by clinical psychologists via text-based interactive online treatment modules. It included interoceptive exposure, in-vivo exposure, and behavioral activation. Self-assessments were completed at pre-treatment, post-treatment, and at 6-month follow-up. Results: Preliminary analyses post-treatment showed substantial pre-post improvements across multiple domains. Notable findings included significant reductions in depressive symptoms (Cohen’s d = 0.70; p = 0.04), cardiac anxiety (Cohen’s d = 1.53; p < 0.001), and perceived severity of post-operative symptoms (Cohen’s d = 1.06; p = 0.006). Participants demonstrated high adherence to the treatment, with the large majority of participants completing all five treatment modules (83.3%). Satisfaction with the treatment was also high (25.5 points out of 32), as measured by the Client Satisfaction Questionnaire, and no adverse events were reported. Conclusion: This novel internet-CBT intervention post-cardiac surgery appears to be feasible, acceptable, and clinically promising in reducing postoperative psychological distress. It could be used as a viable adjunct treatment to enhance recovery post-cardiac surgery. These preliminary findings warrant further testing in a randomized controlled trial.

Abstract 4116300: Valvular Abnormalities and Risk of Abdominal Aortic Aneurysm Associated with Fluoroquinolone Use; A Retrospective Cohort Study

Introduction: Fluoroquinolones (FQ) are efficacious antibiotics whose antimicrobial effect is achieved through bacterial DNA gyrase inhibition. However, there is evidence suggesting that FQ may cause impaired collagen synthesis and an increase in tissue collagen degradation. Collagen serves as a predominant structural constituent of the aortic wall and heart valves. These structures undergo tissue maintenance, which necessitates the regulated expression of MMPs and TGF-β. In this study, we hypothesized that prolonged usage of FQs may increase risk of valvular abnormalities and abdominal aortic aneurysm. Methods: We conducted a retrospective cohort study utilizing de-identified patient data from the TriNetX platform, an extensive electronic health records (EHR) system. The cohorts consisted of smoker patients who used FQs for more than two consecutive weeks, Cohort A, N= 352,215 and smoker patients without a history of FQ use, Cohort B, N=350,912. Propensity score matching balanced baseline characteristics between cohorts: age, sex, ethnicity, and comorbidities. Results: The risk of developing AAA among smokers with a history of FQ use was 1.222% while the risk was 0.806% among smokers without history of FQ use (P< 0.0001, 95% CI (0.63,0.691), Risk Ratio (RR)= 0.66). The risk of developing nonrheumatic (NR) aortic insufficiency among smokers with history of FQ use was 1.479% while smokers with no history of fluoroquinolone use had a 0.95% risk (P<<0.0001, 95% CI (0.616,0.67), RR= 0.643). The risk of developing NR mitral insufficiency in smokers with history of FQ use was 3.873% versus their smoker FQ naive counterparts risk of 2.317% (P< 0.0001, 95% CI (0.582,0.615), RR= 0.598). NR tricuspid insufficiency in smokers with FQ usage was also increased versus their smoker FQ naive counterparts at 3.089% and 1.758%, respectively (P< 0.0001, 95% CI (0.552,0.587), RR =0.569). Conclusions: This study uncovered a significant association between FQ use, risk of AAA, and NR-valvular insufficiencies among smokers. In particular, male smokers are at highest risk of developing AAA. This same population is at risk for prostatitis that would likely need treatment with FQs, further increasing their risk. Despite the efficacy of this class of antibiotics, caution is paramount when prescribing FQs in individuals who are actively smoking or have any connective tissue pathologies.

Abstract 4136984: Low Occurence of Fetal Extranodal Findings and AV Interval Prolongation in Prospectively Followed High Titer Anti-Ro Pregnancies

. Background: Third-degree atrioventricular block (AVB) is the most common manifestation of Anti-Ro antibody associated fetal cardiac disease. Extranodal findings of isolated cardiac echogenicity, valvulitis with insufficiency and AV interval prolongation have been reported but not described in large prospective series. Aims: To report the occurrence and outcomes of extranodal findings in subjects followed prospectively since 2020 in STOP BLOQ (Surveillance and Treatment to Prevent Fetal AV block Likely to Occur Quickly) and the Registry for Neonatal Lupus (RNL). Methods: We reviewed fetal echo reports from pregnant STOP BLOQ and RNL Anti-Ro antibody subjects. Pregnancies with high (>1000 EU for anti-Ro52 or 60) antibody titers measured in a core research lab underwent surveillance with home fetal heart rate monitoring (FHRM) 3x/day and weekly or bi-weekly fetal echos from 17- 26 gestational weeks. Low titer subjects underwent echo or no surveillance based on local site protocol. We evaluated cardiac function, effusions, cardiac echogenicity and its location, any tricuspid (TV) or mitral (MV) insufficiency trivial or >trivial) and AV conduction times (<150, 150-170 or >170 ms) Results: Echo reports were available in 622 prospectively followed pregnancies (376 high (40/376 with a previously affected child) and 246 low-titer pregnancies. All had subjectively normal ventricular function and none had effusions. Seven fetuses, 2 low and 5 high titer at 19 (range 16.7-21.7) weeks demonstrated cardiac echogenicity (n=6), AV or semilunar valve insufficiency (n=2) or AV interval 150-170 ms (n=2) (Table). Subjects 1 and 2, both high titer and treated with prophylactic Plaquenil (400 mg/d before 10 gestational weeks), had prior fetal AVB. Subject #1 had normal AV conduction but MV and TV echogenicity and moderate insufficiency of both valves which resolved in days after IVIG and dexamethasone (dex) treatment, but 3° AVB developed at 19 weeks after dex wean. Subjects 2-7 received no treatment and extranodal findings did not progress to cardiac dysfunction or AVB. During the same time period, 10 high titer subjects developed 2° or 3° AVB. Conclusion: Anti-Ro associated extranodal findings are rare, occurring in 1% of pregnancies overall and in 5% of pregnancies with a previously affected child. Unlike AVB, extranodal findings can occur in low titer pregnancies. The role of treatment for isolated extranodal findings in the absence of cardiac dysfunction is unclear.

ENDOCARDITE BACTERIANA E PROFILAXIA ANTIBIÓTICA NA ODONTOLOGIA: MANEJO E PREVENÇÃO EM PACIENTES DE RISCO

This study addresses bacterial endocarditis, a severe inflammatory condition of the endocardium caused by the colonization of pathogenic bacteria or fungi. The objective was to analyze and synthesize evidence regarding risk factors, pathogenic mechanisms, diagnostic methods, prevention strategies, and therapeutic approaches for this disease, with an emphasis on the relationship between oral infections and bacterial endocarditis. A literature review was conducted, selecting articles from the PubMed, Medline, and Google Scholar databases published between 2011 and 2024, using specific keywords: "Bacterial Endocarditis," "Oral Infections," "Antibiotic Prophylaxis," "Dental Biofilm," and applying rigorous inclusion and exclusion criteria to ensure the relevance and quality of the studies. The literature unanimously indicates that antibiotic prophylaxis is the best way to prevent the development of bacterial endocarditis (BE), particularly in patients with risk factors, such as those with congenital heart diseases or valve prostheses. Administering antibiotics before procedures that may cause bacteremia is essential to reduce the risk of infection. Effective prevention involves not only antibiotic prophylaxis but also continuous education for patients and healthcare professionals about the importance of maintaining oral health to prevent systemic complications. The adoption of preventive measures can significantly reduce the incidence of BE, especially in individuals with preexisting heart conditions. In this sense, dentistry plays a vital role, as dental procedures can cause temporary bacteremia, and collaboration between healthcare professionals and dentists is crucial to ensure the protection of these patients.

Abstract 4132498: Hemodynamic and Clinical Outcomes with Balloon-Expandable Valves Versus Self-Expanding Valves in Patients with Small Aortic Annulus Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis of Randomized Controlled Trials and Propensity Score Matched Studies

Background: Transcatheter aortic valve implantation (TAVI) is thought to be more effective than surgery for patients with small aortic annulus (SAA), however, the comparative efficacy of different transcatheter heart valves (THVs) remains uncertain. The objective of this meta-analysis was to compare the effects of balloon-expandable valves (BEVs) and self-expanding valves (SEVs) on hemodynamic parameters and clinical outcomes in patients with SAA who underwent TAVI. Methods: A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception until May 2024 to identify eligible randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. Clinical outcomes were evaluated using a random-effects model to pool risk ratios (RRs) with 95% confidence intervals (CIs). Results: The analysis included 8 studies; 2 RCTs and 6 PSM studies, with a total of 2,180 patients with SAA. BEVs were associated with a smaller indexed effective orifice area (MD: -0.18, 95% CI: -0.31 to -0.05) and a higher transvalvular mean pressure gradient (MD: 5.23, 95% CI 3.44 to 7.02) than SEVs. The risk for prosthesis-patient mismatch (PPM) (RR= 1.82, 95% CI: 1.27 to 2.60) and severe PPM (RR= 2.77, 95% CI: 1.93 to 3.98) was significantly higher for patients receiving BEVs than those receiving SEVs. However, no significant difference was observed between BEVs and SEVs regarding the risk of paravalvular leak (RR= 0.98, 95% CI: 0.57 to 1.69) and the permanent pacemaker implantation (RR= 0.78, 95% CI: 0.50 to 1.23). Although patients receiving BEVs showed a slightly lower risk of major bleeding events (RR= 0.69, 95% CI: 0.49 to 0.99), BEVs were associated with a significantly increased risk of 1-year cardiovascular mortality (RR= 1.61, 95% CI: 1.05 to 2.47) compared to those receiving SEVs. However, no significant differences were observed between BEVs and SEVs regarding 30-day all-cause mortality (RR= 1.19, 95% CI: 0.57 to 2.49), 1-year all-cause mortality (RR= 1.17, 95% CI: 0.89 to 1.53), stroke rates (RR= 0.83, 95% CI: 0.52 to 1.31) and any vascular complication (RR= 1.13, 95% CI: 0.72 to 1.75). Conclusion: In patients with SAA, SEVs showed reduced risks of PPM and severe PPM compared to BEVs, along with a larger indexed effective orifice area. Moreover, SEVs were associated with a lower risk of 1-year cardiovascular mortality.

Hypolipidemic and Cardioprotective Efficacy of Peltophorum pterocarpum Linn in Doxorubicin Induced Cardiotoxicity in Rats

Background: Cardiovascular disease (CVD) refers to a common group of illnesses affecting the heart and blood arteries. It encompasses heart valve problems, atherosclerosis, angina, cardiomyopathy, coronary artery disease (CAD), and infections of the heart which are considered the main causes of death. Modern medications have some success but they typically come with unfavorable side effects. Researchers are paying attention to herbal remedies because of their limited or no negative effects. This study was conducted to find out the hypolipidemic and cardioprotective potential of the ethanolic extract of Peltophorum pterocarpum (P. pterocarpum) Linn leaves in doxorubicin-induced cardiac damage in rats. Methods: The ethanolic extract of P. pterocarpum leaves was subjected to compound identification by GC-MS analysis. For in vivo analyses, the rats were divided into six groups. Cardiac damage was induced by doxorubicin at a dosage of 1.5 ml/kg b.wt. various dosages of extract (200 and 300 mg/kg b.wt.) were injected and propranolol (25 mg/kg b.wt.) is used as a standard drug. After the treatment of the extract, biochemical parameters were evaluated followed by in silico analysis. Result: The levels of cardiac marker and lysosomal enzymes significantly increased in toxin-treated rats, and the mitochondrial enzyme levels were significantly reduced. After treatment with P. pterocarpum leaf extract, the levels significantly (P less than 0.05) returned to normal. These results may prove the cardiac protective effect of the ethanolic extract of P. pterocarpum leaves in DOX-induced cardiotoxicity rats.