Congenital Valvular Heart Disease Research Articles

Severe acute recoil following transcatheter aortic valve replacement with a self-expanding prosthesis in a heavily calcified bicuspid aortic valve.

Bicuspid aortic valve (BAV) is one of the most common congenital valvular heart diseases occurring in 0.5-2% of the general population, in 2-6% of patients with severe aortic stenosis (AS) and up to 20% of octo/nonagenarians undergoing surgery. In this regard, Transcatheter aortic valve replacement (TAVR) has emerged as a therapeutic alternative. At the present time, there is not enough evidence to determine which is the best therapeutic approach for AS in BAV. We report a severe acute recoil following TAVR with a self-expanding prosthesis in heavily calcified BAV. In addition, we provide an updated review of the clinical significance of prosthesis underexpansion in the medium-term.

Advances in the Diagnosis and Treatment of Congenital Valvular Heart Disease

Advances in the Diagnosis and Treatment of Congenital Valvular Heart Disease

Association of pre-existing maternal cardiovascular diseases with neurodevelopmental disorders in offspring: a cohort study in Sweden and British Columbia, Canada.

We aimed to investigate the associations of pre-existing maternal cardiovascular disease (CVD) with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) in offspring. This population-based cohort study included singletons live-born without major malformations in Sweden (n = 2 699 675) and British Columbia (BC), Canada (n = 887 582) during 1990-2019, with follow-up from age 1 year until the outcome, death, emigration or December 2020, whichever came first. The primary exposure was defined as a composite CVD diagnosed prior to conception: cerebrovascular disease, arrhythmia, heart failure, valvular and congenital heart diseases. The incidences of ADHD, ASD and ID, comparing offspring of mothers with versus without CVD, were calculated as adjusted hazard ratios (aHRs). These results were compared with models using paternal CVD as negative control exposure. Compared with offspring of mothers without CVD, offspring of mothers with CVD had 1.15-fold higher aHRs of ADHD [95% confidence interval (CI): 1.10-1.20] and ASD (95% CI 1.07-1.22). No association was found between maternal CVD and ID. Stratification by maternal CVD subtypes showed increased hazards of ADHD for maternal heart failure (HR 1.31, 95% CI 1.02-1.61), cerebrovascular disease (HR 1.20, 95% CI 1.08-1.32), congenital heart disease (HR 1.18, 95% CI 1.08-1.27), arrhythmia (HR 1.13, 95% CI 1.08-1.19) and valvular heart disease (HR 1.12, 95% CI 1.00-1.24). Increased hazards of ASD were observed for maternal cerebrovascular disease (HR 1.25, 95% CI 1.04-1.46), congenital heart disease (HR 1.17, 95% CI 1.01-1.33) and arrythmia (HR 1.12, 95% CI 1.01-1.21). Paternal CVD did not show associations with ADHD, ASD or ID, except for cerebrovascular disease which showed associations with ADHD and ASD. In this large cohort study, pre-existing maternal CVD was associated with increased risk of ADHD and ASD in offspring.

Hemodynamic changes after repairing the congenital valvular heart disease

Hemodynamic changes after repairing the congenital valvular heart disease

Spectrum of Disorders Leading to Sudden Cardiac Death

Objective: To determine the frequency of disorders leading to sudden cardiac death (SCD).
 Study Design: Cross-sectional study.
 Place and duration of study: Pathology Lab in collaboration with the Cardiology Department, AFIC & NIHD, Rawalpindi Pakistan, from Jan 2017 to Dec 2018.
 Methodology: A total of 305 cases of sudden cardiac death reported within the last 24 hours of a death to AFIC Rawalpindi were included consecutively. Cases with a history of extracardiac diseases leading to sudden death were excluded. Most of the included cases were diagnosed phenotypically based on clinical examination, biochemistry, ECG, echocardiography, angiography, thallium scan, electro-physiological studies, cardiac CT scan, MRI and routine autopsy whenever recommended.
 Results: Out of 305 cases, 197 (65%) were males and 108 (35%) females. Disorders leading to SCD were found in 178 (58.3%) cases due to ischemic heart disease (IHD), aortic dissection (0.7%), hypertrophic cardiomyopathy (HCM) (0.3%), dilated cardiomyopathy (DCM) (10.5%), congenital heart disease (12.1%) and valvular heart disease (7.9%). While in cardiac channelopathies, catecholaminergic polymorphic ventricular tachycardia (CPVT) in 5 (1.6%) and congenital long QT syndrome (LQTS) in 2 (0.7%) cases. However, 24 (7.9%) cases remained as sudden unexplained deaths (SUD).
 Conclusion: In our setup, ischemic heart disease and dilated cardiomyopathy were the commonest causes of sudden cardiac death, followed by congenital heart disease and valvular heart diseases.

Role of cytokine and Toll-like receptor genes in pathogenesis of inborn heart disease

Sporadic congenital heart disease (CHD) may result from immune disorders in the mother – embryo system and/or constitutional disorders in regulatory systems, including those associated with TLR receptors, cytokines and their receptors. The aim of our study was to investigate associations between cytokine and TLR genes and sporadic congenital heart disease in children. In the main group, 188 children with sporadic (without family history) congenital heart defects were examined. Separate groups of CHD were identified: septal CHD – 98 children; valvular heart disease – 17 children; Fallot tetralogy – 15 children; aorta coarctation – 10 children; fetal drains – 32 children; single ventricle affection – 9 children, and anomalous drainage of v. pulmonalis was diagnosed in 7 children. The control group included 103 age- and sex-matched healthy children. We have determined gene polymorphisms of five genes encoding cytokines and their receptors (IL6 rs1800796, IL6 rs2069827, IL6R rs2228145, IL6R rs2229238, IL8 rs4073, IL10 rs1800871, IL10 rs1800896, IL10 rs1800872, TNF rs1800629, TNF rs361525, TNF rs1799964), four genes Toll-like receptors (TLR: TLR1 rs5743611, TLR1 rs5743551, TLR2 rs5743708, TLR2 rs3804099, TLR4 rs4986791, TLR4 rs4986790, TLR6 rs3775073, TLR6 rs5743810). The dbSNP, SNPinfo, SNPnexus databases were used to select and design test systems. Stepwise logistic regression was the main method of statistical analysis. Clinical diagnosis of congenital heart defects is associated with immune regulatory genes. In particular, the missense mutation TLR6 rs5743810, which was a predictor of congenital valvular heart disease, is of particular importance. Development of congenital heart valve defects and aortic coarctation is associated with intergenic interactions of TLR2 rs5743708 with TLR6 rs5743810, and TLR2 rs5743708 with TLR6 rs3775073, respectively. For congenital heart valve defects, such polymorphic regions are as follows: IL6 rs2069827, IL6R rs2229238, and IL8 rs4073, for aortic coarctation – IL6R rs2228145, IL8 rs4073. Development of septal congenital heart defects is associated with general contribution of polymorphic variants of the TLR genes and cytokines to this pathology. A missense mutation of the TLR4 rs4986790 gene and a TNF rs1799964 mutation leading to increased synthesis of the TNFα molecule, may have a combined effect on this process. In general, contribution of TLR and cytokine genes interactions to the CHD development seems to be not significant.

Spiral Computed Tomography in the Quantitative Measurement of the Adjacent Structure of the Left Atrial Appendage in Patients with Atrial Fibrillation.

Cardiac arrhythmias are common clinical cardiovascular diseases. Arrhythmias are abnormalities in the frequency, rhythm, site of origin, conduction velocity, or sequence of excitation of the cardiac impulses. Arrhythmia mechanisms include foldback, altered autonomic rhythm, and triggering mechanisms. It can cause palpitations, dizziness, black dawn, syncope, and angina pectoris and can worsen a preexisting cardiac disease, reduce the quality of life, and increase mortality. Also, by making it one of the constant challenges for the clinical cardiovascular physician, we can get more information. The study included 94 patients with atrial fibers, including 56 men and 38 women aged 57, 46, 11, and 68 years. There are 80 patients with nonatrial fibers, including 44 men and 36 women aged 56, 10, and 83 years. Those who can perform a normal coronary angiography and exclude congenital heart disease, heart valve disease, and other cardiovascular diseases. In both groups, a 256-layer spiral CT examination was performed. A pulmonary vein scanning protocol was applied to the patients with atrial fibrillation, and this can perform normal coronary angiography and exclude those with cardiovascular diseases such as congenital heart disease and valvular heart disease. The purpose of this study is to investigate the anatomical changes of the left atrium and its adjacent structures by applying the 256 nm spiral CT imaging to visualize the left atrium and its adjacent structures and by applying the MPR technology, VR technology, and simulation endoscope techniques.

The resuscitation status of implantable cardioverter-defibrillator patients according to electronic health records: are we ignoring the device?

Abstract Introduction/Background The Care Quality Commission (CQC) has recently raised concerns around resuscitation decisions in the UK. In our hospital an early resuscitation decision is made on admission, often by junior doctors, and documented in electronic notes. Concerns have been raised about the veracity of these discussions in patients with implantable cardioverter-defibrillators (ICD's). We investigated resuscitation status as documented on the electronic record for our ICD population. Methods The ICD database was interrogated in 2020 for patients under current follow-up. Baseline demographics, hospital admissions over the past 5 years and ICD indications were documented from the electronic hospital records. All patients with an electronic do-not-resuscitate (DNR) flag on the electronic system were recorded, as were any documented resuscitation discussions and ICD deactivations between 2015 and 2020. Any patient deaths were recorded and correlated with resuscitation status and ICD status at the time of death. Results Six-hundred and thirty-six patients with ICD's (transvenous, subcutaneous and CRT defibrillators) were identified under follow-up for the study period. The mean age of the population was 68 years old. 251 had an ischaemic cardiomyopathy, 209 had dilated cardiomyopathy, 50 prior ventricular fibrillation or tachycardia, 40 hypertrophic cardiomyopathy, 26 ARVC and the rest a channelopathy, congenital heart disease, sarcoidosis or valvular heart disease. Thirty-seven of the 636 patients were flagged on the electronic record as being not for resuscitation (5.9%). They had a mean age of 79 and 54% had an ischaemic cardiomyopathy. Of these, only 15 (39%) had their ICD deactivated and only 12 of those at the time of the resuscitation decision (32%). 15 of the 37 (39%) patients made DNR have subsequently died. Six of these (40%) had an active ICD at the time of death. In the 257 patients who had had a hospital admission in the study period, 34 were made not for resuscitation during the admission (13%) of whom 11 had their ICD deactivated at the time of discussion (32%). Patients with a DNR flag and an “active” ICD were contacted about deactivation of their ICD and offered discussion with a cardiologist or specialist nurse about ICD deactivation. Of these 9/27 (33%) stated that they wanted resuscitation and the alert was removed and the ICD kept on, although 3 subsequently had the device deactivated. Conclusions In this study the majority of patients with ICD's who were made not for resuscitation on admission to hospital did not have their ICD therapies switched off, therefore putting them at risk of unnecessary ICD shocks. In addition, one third these patients subsequently chose to be for resuscitation after discussion. These complex decisions would be improved with the early involvement of cardiologists and specialist nurses. Funding Acknowledgement Type of funding sources: None.

Straight back syndrome as a clue to diagnosing asymptomatic congenital valvular heart disease and limiting the risk of weightlifting.

Although both are initially asymptomatic, mitral valve prolapse/myxomatous mitral valve disease (MVP/MMVD) and bicuspid aortic valve (BAV), with its associated aortic disease, are currently the two most common congenital valvular heart diseases. Severe mitral regurgitation due to rupture of chordae tendineae (CTR) prompts surgery for MVP/MMVD. Surgery for BAV is performed for severe aortic stenosis and/or regurgitation, often with management of root and/or ascending aortic enlargement. There may be an association between straight back syndrome (SBS) and MVP/MMVD, which may be a key to earlier diagnosis. Other associations link weightlifting with ascending aortic enlargement and with CTR, where the common theme is blood pressure elevation. As the number of people with fitness center memberships continues to increase, this potentially exposes more undiagnosed individuals with MVP/MMVD or BAV to risk from weightlifting. Challenges include making the public aware of this risk and preparing the osteopathic physician to recognize patients at risk through a structured history-taking and targeted cardiovascular examination.

Surgical Treatment of Valvular Heart Disease in Nigeria: A 6-Year Experience.

Surgical treatment of valvular heart disease in Nigeria, the most populous country in sub-Saharan Africa, is adversely affected by socioeconomic factors such as poverty and ignorance. To evaluate our experience in this context, we identified all patients who underwent surgery for acquired or congenital valvular heart disease at our Nigerian center from February 2013 through January 2019. We collected data from their medical records, including patient age and sex, pathophysiologic causes and types of valvular disease, surgical treatment, and outcomes. Ninety-three patients (43 males [46.2%]; mean age, 38.9 ± 10.0 yr [range, 11-80 yr]) underwent surgical treatment of a total of 122 diseased valves, including 72 (59.0%) mitral, 26 (21.3%) aortic, 21 (17.2%) tricuspid, and 3 (2.5%) pulmonary. The most prevalent pathophysiologic cause of disease was rheumatic (87 valves [71.3%]), followed by functional (20 [16.4%]), congenital (8 [6.6%]), degenerative (5 [4.1%]), and endocarditic (2 [1.6%]). All 3 diseased pulmonary valves had annular defects associated with congenital disease. Surgical treatment included mechanical prosthetic replacement of 92 valves (75.4%), surgical repair of 29 (23.8%), and bioprosthetic replacement of 1 (0.8%). We conclude that, in Nigeria, valvular disease is mainly rheumatic, affects mostly younger to middle-aged individuals, and is usually treated with prosthetic replacement.

β-Adrenergic receptor signaling in cardiac function and heart failure

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TPregnancy and Heart Disease: Patient and Healthcare Provider Reported Outcomes [30N

INTRODUCTION: Our objective was to conduct focused interviews with patients, family members and healthcare providers to identify and compare outcomes considered important by each group with what is reported in the literature. METHODS: Pregnant patients with a cardiac condition and their family members were recruited from the Mount Sinai Hospital, Toronto, Canada and an international group of healthcare providers were contacted through email via contact lists assembled by study investigators. Semi-structured interviews with an emphasis on eliciting outcomes were conducted until no new outcomes were identified. RESULTS: Sixteen participants (13 pregnant women and three partners) completed the interviews. Cardiac conditions included arrhythmias (n=5), complex congenital heart disease (n=5) and valvular heart disease (n=3). Ten healthcare providers primarily from Europe and North America, representing cardiology (n-5), obstetrics (n=3), nursing (n=1) and anesthesiology (n=1) were also interviewed. Patients and family members reported 17 unique outcomes, the most frequent of which were: general health and well-being of baby (n=13); congenital defects (n=6); outcomes related to maternal mental health, stress and fatigue (n=5) and appropriate healthcare management (through medications, follow up, continuity of care) (n=4). Healthcare providers reported 65 outcomes, which included maternal mortality (n=7), prematurity (n=7), arrhythmias (n=6), thrombosis, mode of delivery (n=5) and heart failure (n=5). These reflected those encountered in published literature. CONCLUSION: Outcomes considered important by patients and their family members differ from those considered important by clinicians and researchers . Including these outcomes in a core outcome set could improve outcome reporting in studies on cardiac disease in pregnancy.

Ten years risk assessment of atherosclerotic cardiovascular disease using Astro-CHARM and pooled cohort equation in a south Asian sub-population

BackgroundAtherosclerotic cardiovascular diseases (ASCVD) are on the rise in low and middle-income countries attributed to modern sedentary lifestyle and dietary habits. This has led to the need of assessment of the burden of at-risk population so that prevention measures can be developed. The objective of this study was to assess ten years risk assessment of ASCVD using Astro-CHARM and Pooled Cohort Equation (PCE) in a South Asian sub-population.MethodsA total of 386 residents of all six districts of Karachi with no ASCVD were enrolled in the study through an exponential non-discriminative referral snowball sampling technique. The inclusion criteria consisted of age 40 years or above and either gender. Study participants were enrolled after obtaining informed written consent and those study participants who were found to have either congenital heart disease or valvular heart diseases or ischemic heart disease were excluded from the study based on initial screening. For the calculation of 10 years risk of ACVD based on Astro-CHARM and PCE, the variables were obtained including medical history and coronary artery calcium and C-reactive protein measurements.ResultsMean estimated 10-year risk of fatal or non-fatal myocardial infarction or stroke as per the Astro-CHARM was 13.98 ± 8.01%, while mean estimated 10-year risk of fatal or non-fatal myocardial infarction or stroke as per the PCE was 22.26 ± 14.01%. Based on Astro-CHARM, 11.14% of the study participants were labeled as having high risk, while PCE estimated 20.73% of study participants as having high risk of ASCVD.ConclusionDespite the fact that our findings showed substantial differences in ten-year risk of ASCVD between Astro-CHARM and PCE, both calculators can be used to develop a new population and specific risk estimators for this South Asian sub-population. Our study provides the first step towards developing a risk assessment guided decision-making protocol for primary prevention of ASCVD in this population.

Global, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

SummaryBackgroundPrevious congenital heart disease estimates came from few data sources, were geographically narrow, and did not evaluate congenital heart disease throughout the life course. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, this study aimed to provide comprehensive estimates of congenital heart disease mortality, prevalence, and disability by age for 195 countries and territories from 1990 to 2017.MethodsMortality estimates were generated for aggregate congenital heart disease and non-fatal estimates for five subcategories (single ventricle and single ventricle pathway congenital heart anomalies; severe congenital heart anomalies excluding single ventricle heart defects; critical malformations of great vessels, congenital valvular heart disease, and patent ductus arteriosus; ventricular septal defect and atrial septal defect; and other congenital heart anomalies), for 1990 through to 2017. All available global data were systematically analysed to generate congenital heart disease mortality estimates (using Cause of Death Ensemble modelling) and prevalence estimates (DisMod-MR 2·1). Systematic literature reviews of all types of congenital anomalies to capture information on prevalence, associated mortality, and long-term health outcomes on congenital heart disease informed subsequent disability estimates.FindingsCongenital heart disease caused 261 247 deaths (95% uncertainty interval 216 567–308 159) globally in 2017, a 34·5% decline from 1990, with 180 624 deaths (146 825–214 178) being among infants (aged <1 years). Congenital heart disease mortality rates declined with increasing Socio-demographic Index (SDI); most deaths occurred in countries in the low and low-middle SDI quintiles. The prevalence rates of congenital heart disease at birth changed little temporally or by SDI, resulting in 11 998 283 (10 958 658–13 123 888) people living with congenital heart disease globally, an 18·7% increase from 1990 to 2017, and causing a total of 589 479 (287 200–973 359) years lived with disability.InterpretationCongenital heart disease is a large, rapidly emerging global problem in child health. Without the ability to substantially alter the prevalence of congenital heart disease, interventions and resources must be used to improve survival and quality of life. Our findings highlight the large global inequities in congenital heart disease and can serve as a starting point for policy changes to improve screening, treatment, and data collection.FundingBill & Melinda Gates Foundation.

Severe pulmonary hypertension and right ventricular failure.

Perioperative management of severe pulmonary hypertension (PH) is challenging. Anaesthesiologists come across perioperative management of such cases during incidental surgeries, surgery for various congenital heart diseases and valvular heart diseases and for caesarean section or painless labour in pregnant patient with Eisenmenger syndrome. Knowledge of pathophysiology of PH and novel drugs acting through different mechanisms is paramount in managing such patients. This review will help understanding pathophysiology of PH, anaesthetising patients with PH, use of novel drugs for PH and use of new mechanical devices for rescue of failing right ventricle.

Optimization of postoperative medical therapy of infective endocarditis in patients with congenital valvular heart disease

The purpose of this study was to evaluate the effectiveness of combined surgical and medical treatment of infective endocarditis in patients with congenital valvular heart disease when included in a regimen of the drug Reamberin. In this regard, the analysis of the effectiveness of a combination regimen of 74 patients with valvular congenital heart diseases complicated with infective endocarditis. Given the indications for surgical correction operative technique features and possible technical difficulties in carrying out such operations, due to the inflammatory changes and tissue destruction, and ways to overcome them. For the correction of metabolic disorders in the postoperative period, 47 patients (main group) was appointed Reamberin: once, intravenous drip 400 ml/day during the first 5 days after surgery. 27 patients (control group) was conducted infusion therapy depending on the severity of the condition according to the classical scheme. In addition to standard clinical and laboratory examination, to assess the effectiveness of Reamberin was investigated catalase activity of CPK in blood serum in the dynamics of observation (1, 3 and 5 days after surgery). It is revealed that surgical approach, used in complex treatment of patients with valvular congenital heart diseases, including reorganization of the cavities of the heart, increasing the frequency of joints and the use of reinforcing strips of synthetic material that prevents the cutting of sutures through the inflamed tissue has achieved good short-and long-term results. Infective endocarditis and destruction of the valvular annulus fibrosus the use of a frame of strips of polytetrafluoroethylene allows you to restore its integrity and to implant a mechanical prosthesis. The inclusion in the regimen of patients with infective endocarditis complicated by cardiac insufficiency in the early postoperative period the drug Reamberin improves the efficiency of treatment by a more rapid restoration of the normal metabolism of cardiomyocytes and accelerates elimination of signs of heart failure.

A little innocent heart murmur in a child with accessory mitral valve tissue

Accessory mitral valve tissue (AMVT) is a very rare congenital malformation and its incidence is unknown. In adult it was reported that 1 case every 26,000 performed echocardiograms. It may be alone or associated with other abnormalities of the heart [ 1 Rovner A. Thanigaraj S. Perez J.E. Accessory mitral valve in an adult population: the role of echocardiography in diagnosis and management. J. Am. Soc. Echocardiogr. 2005; 18: 494-498https://doi.org/10.1016/j.echo.2005.01.027 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar , 2 Marie-Philippe V. Christophe J. Nicolas V.V. Luc-Philippe C. Left ventricular outflow tract obstruction secondary to accessory mitral valve tissue: a multimodality imaging approach. Eur. Heart J. 2014 Dec 21; 35: 3464 Crossref PubMed Scopus (3) Google Scholar , 3 Chandra D. Gupta A. Gupta V.K. Accessory mitral tissue: a rare cause of left ventricular outflow obstruction. Asian Cardiovasc. Thorac. Ann. 2014 Sep; 22: 878 Crossref PubMed Scopus (2) Google Scholar , 4 Bezgin T. Elveran A. Karagöz A. Çanga Y. Yılmaz F. Mitral valve with a single leaflet. Turk Kardiyol. Dern. Ars. 2014 Jan; 42: 80-82 Crossref PubMed Scopus (7) Google Scholar , 5 Dattilo G. Lamari A. Tulino V. Scarano M. De Luca E. Mutone D. et al. Congenital valvular heart disease with high familial penetrance. Recenti Prog. Med. 2012 Dec; 103: 581-583https://doi.org/10.1701/1206.13361 Crossref PubMed Scopus (25) Google Scholar , 6 Tulino V. Cacace C. Tulino E. Imbalzano E. Dattilo G. Clinical variants in Ebstein's anomaly. Int. J. Cardiol. 2013 Oct 12; 168: 4969-4970https://doi.org/10.1016/j.ijcard.2013.07.138 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 7 Isobe M. Tanaka M. Sekiguchi M. Subaortic stenosis due to accessory tissue of the mitral valve associated with Ebstein's anomaly in an adult. Int. J. Cardiol. 1996 Dec 13; 57: 286-288 Abstract Full Text PDF PubMed Scopus (12) Google Scholar ]. We present a case of a 6 years old patient, sent to cardiac evaluation because of the presence of a heart murmur at the upper left sternal border, previously considered of little importance. He was born from a diabetic smoker mother. An ECG was performed resulting normal. Transthoracic echocardiogram showed a floating ovoid mass below the aortic valve (Fig. 1A ). CW Doppler showed a pressure gradient through the left ventricle outflow tract with a peak velocity of 2.5 m/s. There was a thick tendon between the interventricular septum and the mass (Fig. 1B). The mass was surgically resected and the final diagnosis was accessory mitral valve leaflet (Fig. 1C) [ 8 Imbalzano E. Di Bella G. Lamari A. Scarano M. Casale M. Busacca P. et al. Right ventricular myocardial deformation in young healthy subjects: a comparison study between 2D strain and traditional parameters. J. Exp. Clin. Cardiol. 2014; 20: 2729-2743 Google Scholar , 9 Uysal O.K. Duran M. Ozkan B. Tekin K. Elbasan Z. Asymptomatic accessory mitral valve tissue diagnosed by echocardiography. Korean Circ. J. 2012 Nov; 42: 800https://doi.org/10.4070/kcj.2012.42.11.800 Crossref PubMed Scopus (7) Google Scholar , 10 Mandraffino G. Sardo M.A. Riggio S. D'Ascola A. Loddo S. Alibrandi A. et al. Smoke exposure and circulating progenitor cells: evidence for modulation of antioxidant enzymes and cell count. Clin. Biochem. 2010 Dec; 43: 1436-1442https://doi.org/10.1016/j.clinbiochem.2010.09.023 Crossref PubMed Scopus (40) Google Scholar , 11 Dattilo G. Lamari A. Scarano M. Di Bella G. Imbalzano E. Busacca P. et al. Coronary artery disease and psoriasis. Minerva Cardioangiol. 2014 Feb; 62: 119-121 PubMed Google Scholar , 12 Mathias H. Ismail Y. Hamilton M.C. Manghat N.E. Accessory mitral valve tissue: appearance on cardiac computed tomography. J. Cardiovasc. Comput. Tomogr. 2012 Nov–Dec; 6: 429-430https://doi.org/10.1016/j.jcct.2012.11.001 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 13 Dattilo G. Lamari A. Messina F. Imbalzano E. Salamone I. Carerj S. et al. The chance finding at multislice computed tomography coronary angiography of an ectopic origin of the left circumflex coronary artery from the right sinus of valsalva. Int. J. Cardiol. 2011 Jun 2; 149: e43-e46https://doi.org/10.1016/j.ijcard.2009.03.093 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar , 14 Yamaguchi S. Ishikawa N. Tomita S. Ohtake H. Kiuchi R. Nishida Y. et al. Robotic resection of dual accessory mitral valve tissue in an adult patient. Ann. Thorac. Surg. 2014 Sep; 98: 1096-1098 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 15 Laganà P. Melcarne L. Delia S. Acinetobacter baumannii and endocarditis, rare complication but important clinical relevance. Int. J. Cardiol. 2015 May 6; 187: 678-679https://doi.org/10.1016/j.ijcard.2015.04.019 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar ].

Transcatheter Advances in the Treatment of Adult and Congenital Valvular Heart Disease.

Transcatheter valve therapies represent the newest frontier in interventional cardiology. At present, transcatheter aortic valve replacement and mitral valve edge-to-edge repair are currently approved by the US FDA in appropriately selected patients. These transcatheter therapies are typically employed in patients of advanced age with comorbid conditions. However, many younger adults with congenital heart disease are of comparable surgical risk due to multiple previous open heart surgeries. An array of percutaneous options currently exists for either temporizing or treating such patients (e.g., balloon septostomy, valvuloplasty, coiling of patent ductus arteriosus), but evidence-based treatment options for degenerative valve disease in this population are currently lacking. The most significant advance in this area to date has been the development and validation of transcatheter pulmonic valve implantation. Similarly, catheter-based approaches for the treatment of other valve lesions in patients with congenital valve disease are gaining interest, based in large part on promising evidence from studies of patients with acquired adult valvular heart disease.

Evaluation of Congenital Valvular Heart Diseases by the Pediatrician: When to Follow, When to Refer for Intervention?

Isolated congenital valvular heart disease in children constitutes a small fraction of congenital heart diseases. Valve involvement is seen more along with other congenital diseases. The most commonly involved valve is the pulmonary valve followed by the aortic valve. Stenotic lesions of the pulmonary and aortic valves are more frequently encountered than mitral and tricuspid valvular lesions. The presentation depends on the severity of the lesion and the age of the patient. Symptoms range from asymptomatic status to florid symptoms of valve obstruction and/or leak. Detailed clinical assessment and various imaging techniques confirm the diagnosis and help in management planning. Transcatheter balloon dilatation for obstructive pulmonary valve has very good long-term outcomes. The results of balloon dilation of aortic valve are also good enough for it to be the treatment of choice. Significant lesions of the mitral and tricuspid valve, regurgitant lesions, sub and supra valvular obstructions require surgical correction. Most valvar lesions mandate regular follow up. Communication and coordination between the pediatric cardiologist and the pediatrician helps in the optimal management.

Echocardiographic Findings of Congenital Valvular Heart Disease in Young Athletes

Here the author shows two cardiac ultrasound images of otherwise healthy young athletes recorded during sports preparticipation screening. Figure 1 shows the typical aortic valve deformity called, “hockey stick”, of the bicuspid aortic valve magnified by parasternal long axis view, while Figure 2 shows the typical finding of type I supra-valvular pulmonic stenosis, involving main pulmonary artery, visualized by parasternal short axis view. Despite the congenital heart valvular anomalies, both athletes were considered fit to sports competition. Congenital cardiac anomalies are frequent in young athletes, however in most cases the physical fitness is not compromised. Echocardiography is the mainstay in the diagnosis and follow-up assessment of young athletes with congenital heart disease.