Degree Of Regurgitation Research Articles

Surgical treatment of hypertrophic cardiomyopathy: what’s new?

The aim — to investigate the effectiveness of surgical septal myectomy in patients with obstructive form of hypertrophic cardiomyopathy (HCM) and to determine its effect on survival and quality of life.Materials and methods. The research included 118 consequential symptomatic patients with obstructive form of HCM who underwent surgical extensive myectomy with secondary chordae resection and mobilization of the anterior and posterior groups of papillary muscles (PM). An evaluation of the following parameters in group of patients before and after surgical intervention was performed: systolic pressure gradient (SPG) on the left ventricle outflow tract (LVOT), mitral regurgitation (MR) degree, NYHA functional class, survival rate and main post­operative complications.Results and discussion. According to the obtained data, SPG decreased from 93.6 ± 23.2 mmHg prior the surgery to 19.7 ± 11.4 mmHg after the treatment (p < 0.001). 21 (17.8 %) patients had moderate degree of MR after the surgery, while before the intervention the number of patients who had moderate or severe MR degree made up 101 (85.5 %) out of 118 (p < 0.001). Out of 118 patients, 36 (30.5 %) of whom had III — IV NYHA functional class of heart failure before the procedure, 115 (97.4 %) switched to functional class I — II in the latest follow­up (p < 0.001). The mortality accounted for 1.7 %. Out of 118 patients under study, one (0.8 %) underwent cardioverter­defibrillator implantation in the post­operative period for the prophilaxis of sudden death, and 5 (4.2 %) patients underwent pacemaker implantation due to complete post­operative AV­block.Conclusions. Surgical septal myectomy by professor P. Ferrazzi procedure is a gold standard of treatment of patients with obstructive form of HCM. Successful correction of HCM can be conducted only by a high­qualified surgeon with experience of reconstruction of valvular pathologies and in an expert center, where it is possible to perform routine pre­operative MRI or CT‑planning and mandatory intraoperative echocardiographic control.

Tetralogy of Fallot with absent pulmonary valve syndrome: A 34-year African single centre experience

Background: Absent pulmonary valve syndrome (APVS) is most commonly associated with Tetralogy of Fallot (TOF). TOF with APVS is characterised by features of TOF with either rudimentary ridges or complete absence of pulmonary valve tissue. This is often associated with varying degrees of pulmonary stenosis and severe pulmonary regurgitation with massive dilatation of the proximal branch pulmonary arteries, causing compression of the tracheobronchial tree. Hence, respiratory symptoms are a common presenting feature. Methods: Cases of TOF with APVS were extracted from the paediatric cardiology database at Chris Hani Baragwanath Academic Hospital (CHBAH) for January 1981 - April 2016. Results: A total of 15 patients with TOF and APVS were seen at CHBAH over the 34-year study period. TOF with APVS comprised 3% of all TOF patients. Ten (67%) patients presented before 1 year of age. The majority of patients (67%) had respiratory symptoms as their cause of presentation, of which 6 (40%) were infants. Fourteen (93%) patients were described to have the characteristic to-and-fro murmur at presentation. Five patients (33%) were suspected of having 22q11.2 deletion syndrome, but only 4 were tested and 2 were found to be positive. A third of patients underwent surgical intervention and 4 of the 15 patients (27%) were known to be alive at 10 years of age. Conclusions: TOF with APVS compromised 3% of all TOF patients, correlating with the literature. It is associated with the 22q11.2 deletion syndrome and was suspected in 33% of patients. TOF with APVS should be strongly considered in a child less than 1 year presenting with respiratory symptoms and a characteristic to-andfro murmur.

Impact of a Composite Valved RV-PA Graft After Stage 1 Palliation

The use of a valved right ventricular to pulmonary artery shunt (RVPAS) has been reported by some to improve pulmonary artery growth after stage 1 palliation (S1P). We retrospectively reviewed all patients undergoing an S1P with an RVPAS between January 2013 and May 2017, stratified by RVPAS type: a ring-reinforced polytetrafluoroethylene (PTFE) graft or a composite graft that included a distal valved femoral or saphenous vein homograft. We examined the association of RVPAS type on postoperative hemodynamics, time to reintervention, pulmonary artery growth, and survival. Among 94 infants, 56 (60%) underwent PTFE-only shunt, 24 (25%) underwent femoral vein homograft, and 14 (15%) underwent saphenous vein homograft, and no relevant risk factor differences were found between the groups. Arterial saturation was 2.3% higher (p=0.014) and serum lactic acid was 1.24 mg/dL lower (p= 0.03) in the femoral vein homograft group than in the PTFE-only group, although venous saturation was similar. By 60 days, 50% of patients with saphenous vein homograft had a reintervention compared with 5% with PTFE graft (p < 0.0001) and 12% with femoral vein homograft (p= 0.2 versus PTFE). At the time of stage 2 palliation, no differences were found in pulmonary artery size or growth over time by either echocardiogram or angiography or in the density of aortopulmonary collaterals or degree of tricuspid regurgitation. The 12-month survival was similar between the groups. The use of an interposition femoral vein homograft into the RVPAS may enhance perioperative stability, but it does not substantially improve interstage growth of the pulmonary arteries. Use of saphenous vein homograft is associated with earlier time to reintervention after S1P.

Associated Valvular Heart Diseases among ASD Patients Undergoing Surgical Repair

Background: Congenital heart diseases (CHD) are one of the most common developmental errors in humans.Objectives: The purpose of the present study was to see the frequencies of various types of atrial septal defect (ASD) and associated cardiovascular disorders in patients undergoing surgical repair.Methodology: This cross-sectional study was conducted on patients undergoing surgical repair at the National Institute of Cardiovascular Diseases (NICVD) or the National Heart Foundation and Research Institute (NHF &amp; RI) in Dhaka, during the period of July, 2010 to June, 2011. Patients presented with ASD at any age of both sexes were selected as study population. Diagnoses were revealed with echocardiography and confirmed preoperatively by registered cardiac surgeons.Results: The morphological types of ASD were ostium secundum type in 96% cases and sinus venosus type in 4% cases. Atrial septal defects were either small or larger defects associated with pulmonary hypertension in 38 (76%) cases, varying degree of tricuspid regurgitation was seen in 33 (66%) patients and dilated pulmonary artery was noted in 24 (48%) cases. Ventricular septal defect in 4 (8%) cases, tricuspid atresia in 2 (4%) cases and mitral valve prolapse in 6 (12%) cases were also observed.Conclusions: Ostium secundum type of ASD is found to be the commonest type of ASDJournal of Current and Advance Medical Research 2018;5(2):60-63

Relation of mitral valve morphology to surgical repair results in patients with mitral valve prolapse: A three‐dimensional transesophageal echocardiography study

The identification of predictors of mitral valve (MV) repair results is important for quality improvement in cardiac surgery. The aim of this study was to evaluate the relationship between MV morphological quantification by three-dimensional (3D) transesophageal echocardiography and mitral repair results. Fifty-four patients with MV prolapse who were submitted to surgical repair were divided into 2 groups according to their postoperative mitral regurgitation (MR) degree (group 1, grade 0-I MR; group 2, ≥grade II MR). Morphological parameters related to the mitral ring, dimension of leaflets and prolapse, coaptation line, distance from papillary muscles to the leaflet border and valve angles were analyzed by 3D MV quantification. Cardiac remodeling and MR quantitative parameters were also evaluated. There was no correlation between 3D MV quantification and surgical results; a multivariate analysis did not show an association between morphological parameters and surgical outcome. The distance from the posteromedial papillary muscle to the leaflet border was higher (P=.038) in patients with ≥grade II postoperative MR. The left atrial diameter, left ventricular end-systolic diameter, left ventricular end-diastolic and end-systolic volumes were larger in patients with a significant residual MR (P<.05). Three-dimensional MV quantification did not predict the postoperative MR grade; however, the distance from the posteromedial papillary muscles to the leaflet border may be related to suboptimal repair results. Furthermore, excessive cardiac remodeling was related to postoperative MR≥grade II, what could suggest a potential benefit of early surgical treatment.

Dobutamine stress echocardiography in pulmonary arterial hypertension

BackgroundThere is a growing interest in exploring the concept of right ventricular functional reserve in patients with pulmonary arterial hypertension. However, it is still unclear how it should be assessed. Aim of the study was to investigate the determinants of the changes in cardiac output and in pulmonary pressure during dobutamine stress echocardiography in pulmonary arterial hypertension. MethodsLow-dose dobutamine stress echocardiography was performed in 55 patients and 28 controls. Tricuspid annular plane systolic excursion, its ratio to systolic pulmonary artery pressure, right ventricular area change, degree of tricuspid regurgitation, right ventricular end-systolic pressure-area ratio, cardiac output were assessed at rest and at peak stress. ResultsAccording to the stress induced increase in cardiac output, patients were classified into 2 groups: above/equal to the median of 2.8 L/min (high cardiac output) or below the median (low cardiac output). High cardiac output patients were characterized by a greater increase in heart rate (+45.1 ± 17.5 vs +21.3 ± 17.7 bpm), a greater improvement in tricuspid annular plane systolic excursion (+4.2 ± 3.3 vs +1.9 ± 2.6 mm, P = 0.005) and a decrease in tricuspid regurgitation (P = 0.010) as compared to low cardiac output patients. Changes in pulmonary pressure were not associated with changes in indicators of right ventricular function but only with changes in heart rate. ConclusionsThe increase in cardiac output during dobutamine is associated with an improvement in longitudinal right ventricular function, a decrease in tricuspid regurgitation and an increase in heart rate. Changes in pulmonary pressure only reflect the changes in heart rate.

Prenatal interventional therapy in two cases with critical pulmonary stenosis or pulmonary atresia with intact ventricular septum

Objectives: Two cases who underwent fetal pulmonary valvuloplasty (FPV) for pulmonary atresia with intact ventricular septum (PA-IVS) or critical pulmonary stenosis with intact ventricular septum (CPS-IVS) successfully were reported. The aim of the report was to explore the criteria for case selection, the technical essentials of FPV, and the postpartum outcome of the fetus. Methods: One case with PA-IVS and the other with CPS-IVS were enrolled in September 2016 and February 2017 in Guangdong General Hospital, and both cases were diagnosed with severe right ventricular dysplasia and tricuspid regurgitation by fetal echocardiogram. Parameters of right ventricle development and hemodynamics from echocardiography included tricuspid/mitral annulus (TV/MV), right ventricle/left ventricle long-axis (RV/LV), pulmonary/aortic annulus (PV/AV), tricuspid inflow duration/cardiac cycle, degree of tricuspid regurgitation (TR), blood flow direction of arterial duct and ductus venosus. Multidisciplinary team including the maternal-fetal cardiology, pediatric cardiology, cardiac surgery, obstetrics, neonatology and anesthesiology was summoned to discuss the indications and timing of PFV. Two cases underwent ultrasound-guiding trans-abdominal PFV at the 28 weeks of gestational age. Echocardiography was performed to observe the opening and closing of the pulmonary valve, and to evaluate the development of right ventricle and improvement in hemodynamics every 2-4 weeks until delivery. Results: From the technical perspective, pulmonary balloon valvuloplasty was successfully performed in these two cases. The opening of pulmonary valve improved in these two cases at 2-4 weeks after FPV. However, an obvious restenosis was detected in the first case at 5-8 weeks after FPV. In the first case, the echocardiography parameters including TV/MV, RV/LV, PV/AV and tricuspid inflow duration/cardiac cycle increased from 0.56, 0.42, 0.85,0.26 to 0.59, 0.51, 0.87, 0.32 at 5-8 weeks after FPV, respectively. However, the direction of blood flow through the arterial duct was still reverse. In the second case, TV/MV, RV/LV, PV/AV and tricuspid inflow duration/cardiac cycle ratio increased from 0.70, 0.63, 0.91,0.35 to 0.80, 0.80, 0.97, 0.42 at 5-8 weeks after FPV, respectively. The direction of blood flow through the arterial duct changed to bidirectional. Both fetuses were born alive. The first case underwent pulmonary valve commissurotomy and modified Blalock-Taussig shunt on the 8(th) day after delivery and received follow-up for 6 months. The strategy for the next-step therapy was still pending. The second case underwent transcutaneous pulmonary balloon valvuloplasty on the 19(th) day after delivery and received follow-up for 3 months. The opening of pulmonary valve improved obviously and the cardiac function was normal in the second case. Conclusions: FPV is safe and effective for fetus during the second and third trimester of pregnancy, and FPV is beneficial for the development of fetal ventricle, valve and large artery. In addition, FPV may help to avoid the postnatal surgery for isolated single ventricle, improve fetal heart failure and prevent fetal death.

Management of Incomplete Initial Repair in the Treatment of Degenerative Mitral Insufficiency.

We sought to present our institutional protocol to manage incomplete initial repair of degenerative mitral regurgitation and to evaluate its mid-term outcomes. Eight hundred and fifteen patients with degenerative mitral insufficiency undergoing mitral valve repair were investigated in this study. The initial repair attempt was incomplete in 48 patients, leaving a degree of residual regurgitation > mild, and an elevated transmitral gradient or systolic anterior motion (SAM). These patients were further treated with medication or mitral valve re-repair or replacement under reinstituted cardiopulmonary bypass. Transesophageal echocardiographic reports and operational records were reviewed to identify morphological causes and establish management of incomplete initial repair. Mid-term outcomes of patients with re-repair and complete initial repair were evaluated and compared. Residual mitral regurgitation > mild was detected in 25 patients, an elevated transmitral gradient was detected in seven patients, and SAM was detected in 16 patients. The condition of eight patients with SAM was resolved with medication only. Mitral valve re-repair was performed in 23 patients and replacement was performed in 17, with comparable early mortality and morbidity. At 60.3 ± 25.5 months after surgery, late mitral stenosis and reoperation rate were significantly higher in re-repair patients than in patients with complete initial repair, despite comparable survival, left chamber reverse remodeling, and degree of residual regurgitation. Based on our institutional protocol, acceptable outcomes can be achieved for patients with incomplete initial mitral valve repair. Management should be tailored based on the characteristics of the mitral valve complex, expected repair durability, and operative risk.

The Fate of the Tricuspid Valve After the Transatrial Closure of the Ventricular Septal Defect

The transatrial repair of the ventricular septal defect (VSD) requires an adequate exposure of its rim. We retrospectively evaluated the effect of using the tricuspid valve incision (TVI) technique, with detachment or radial incision, on the postoperative outcome of children undergoing surgical VSD repair. From January 2008 to September 2017, we retrospectively enrolled 141 patients, divided into two groups: 97 patients (68.8%) underwent TVI and 44 patients (31.2%) did not undergo TVI. All patients received an echocardiogram upon discharge from the hospital and after 1 month, 3 months, 6 months, and 1 year from the treatment. No perioperative or late deaths occurred. TVI was associated with a slightly longer cardiopulmonary bypass and cross-clamp time, but there were no differences in the surgical outcome between the two groups. Moreover, no differences occurred concerning residual VSD, atrioventricular block, or tricuspid regurgitation at discharge. Echocardiograms at follow-up were available for 134 patients (95%) with a median of 5.3 years (range, 0.5 to 9.3 years), and the degree of tricuspid regurgitation did not differ between groups. No patient required reoperation for tricuspid regurgitation or residual interventricular shunt. Finally, no difference was found when the two TVI subgroups were compared. TVI should be used whenever intraoperative exposure of VSD is compromised to avoid a residual shunt and atrioventricular block. Here we show that this procedure does not significantly compromise tricuspid function, although a large, multicenter, randomized controlled trial is advised to validate this hypothesis.

Septal Leaflet Versus Chordal Detachment in Closure of Hard-to-Expose Ventricular Septal Defects

Different techniques have been used for exposure of ventricular septal defect (VSD) margins when there is crowding of the VSD anatomy by tricuspid valve subvalvar apparatus. This study compared surgical outcomes for the two techniques of tricuspid valve leaflet detachment and the rarely described tricuspid valve chordal detachment for hard-to-expose VSDs. Patients undergoing transatrial VSD repair were identified from our institutional database. Follow-up echocardiography and patient data were obtained from medical records. Between January 2005 and August 2016, 130 isolated conoventricular VSDs were repaired. Among these, 26 patients underwent leaflet detachment, 15 underwent chordal detachment, and 89 underwent regular VSD repair (reference group). The groups did not differ significantly in age, weight, postoperative length of stay, genetic/syndromic abnormalities, time to extubation, and left and right ventricular systolic function. The cardiopulmonary bypass and cross-clamp time were significantly longer in the leaflet detachment group than in the reference group (118 ± 28 vs 102 ± 32 minutes [p= 0.02] and 73 ± 20 vs 61 ± 23 minutes [p= 0.01], respectively). Echocardiographic follow-up was available for 87 patients at a mean of 2.6 years (range, 1 month to 11 years). Tricuspid regurgitation was rated as none or trivial in 66 (76%), mild in 20 (23%), and moderate in 1 reference group patient. There was no difference in presence of residual VSD or degree of tricuspid regurgitation among the three groups. There was no reoperation for tricuspid regurgitation. Tricuspid valve leaflet and chordal detachment techniques provide an equally viable and safe alternative to closure of hard-to-expose VSDs while maintaining appropriate tricuspid valve function. Their use in our series did not lead to increased tricuspid valve dysfunction at early-to-midterm echocardiographic assessment.

Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis: A 14-Year Single Centre Review

The approach to intervention for congenital aortic valve stenosis (AS) differs depending upon centre bias toward a primary catheter or surgical approach. We therefore investigated associations with freedom from re-intervention (FFI) in the cohort of children who underwent primary balloon aortic valvuloplasty (BAV) for congenital AS in our centre. All patients who underwent BAV as a primary procedure in the period between 2001 and 2015 in a single service were included. Echocardiographic parameters before and after catheterisation and procedural data was collected on all patients. Sixty-four (64) patients underwent BAV as the primary intervention during the study period. Follow-up data was available for 60 of these. Balloon aortic valvuloplasty was performed at a median age of 143 days (range 2 days-18.8 years). Freedom from re-intervention was observed in 75% of patients with a median follow-up of 6.8 years and a mean follow-up of 3 years. Catheter-based peak-to-peak aortic valve gradients decreased from 58±15.9mmHg to 22.9±13.1mmHg. There was no short- or long-term mortality. FFI was predicted by aortic valve morphology (p<0.01), post-BAV mean echo gradient (p=0.03) and post-BAV regurgitation (p<0.01). No patient had re-intervention for restenosis with post-BAV mean echo gradient <30mmHg. Catheter gradients before and after BAV approached significance for predicting FFI (p=0.06 and p=0.09 respectively). Fifteen (15) patients were neonates with significantly lower aortic valve (AoV) Z-scores (mean 0.63 vs 1.76, p=0.002) and no difference in FFI (p=0.19). Annulus size, balloon/annulus ratio (within the range utilised) and pre-BAV echo findings were not predictive for re-intervention. Balloon aortic valvuloplasty is an effective primary approach to congenital valvular AS with the potential of avoiding surgical intervention in the majority of patients at all ages. Freedom from re-intervention in our cohort was associated with valve morphology and the degree of stenosis and regurgitation immediately post BAV.

Analyzing the association between aortic regurgitation and atherosclerosis: is pulse pressure a cause of atherosclerosis?

ABSTRACTIf pulse pressure, one of the mechanical stresses, is a risk factor for atherosclerotic cardiovascular disease, then atherosclerosis should be progressive in aortic regurgitation which is a representative disease with increased pulse pressure. This cross-sectional study included 1,149 patients. We examined the influence of aortic regurgitation on maximum intima-media thickness or brachial-ankle pulse wave velocity. The degree of aortic regurgitation was classified into 4 grades by color Doppler examination. There were 177 patients with aortic regurgitation. Pulse pressure was significantly higher in patients with aortic regurgitation than in those without it. On multiple regression analysis, aortic regurgitation was not found to be a significant independent variable for maximum intima-media thickness [standard partial regression coefficient: aortic regurgitation = grade 1, 0.011, P = 0.7635; aortic regurgitation ≥ grade 2, −0.034, P = 0.3289] and brachial-ankle pulse wave velocity [standard partial regression coefficient: aortic regurgitation = grade1, −0.043, P = 0.1197; aortic regurgitation ≥ grade2, 0.002, P = 0.9358] after adjusting for age, sex, body mass index, presence or absence of cardiovascular disease, antihypertensive treatment, diabetes, dyslipidemia, and smoking. These results found no causal association between aortic regurgitation and atherosclerosis, and were a contradiction to the opinion that pulse pressure was a risk factor of atherosclerosis.

Long-term follow-up of percutaneous balloon pulmonary valvuloplasty in pulmonary valve stenosis in 230 children

Objective To evaluate the safety and efficacy of percutaneous balloon pulmonary valvuloplasty (PBPV) in the treatment of the children with pulmonary stenosis (PS), and to observe the long-term prognosis and analyze the influencing factors. Methods The total of 230 children were collected, who had been diagnosed with pulmonary valve stenosis and had undergone percutaneous balloon pulmonary valvuloplasty between November 1987 and November 2015 in Shandong Provincial Hospital Affiliated to Shandong University.Their ages ranged from 4 months to 17 years, and the follow-up duration lasted from 1 month to 29 years.The data included clinical data and long-term follow-up data of hospitalized children, and the echocardiography data from the healthy peers in the same period.Then the data were analyzed statistically. Results In this study, 228 cases of children were successfully performed PBPV, and the success rate was 99%(228/230 cases). The pulmonary transvalvular gradient (△P) of preoperation, 24 hours postoperatively, half a year postoperatively, 2 years postoperatively, 5 years postoperatively, and 10 years postope-ratively was (63.5±23.8) mmHg(1 mmHg=0.133 kPa), (26.2±11.1) mmHg, (24.8±9.8) mmHg, (20.9±8.9) mmHg, (18.1±8.7) mmHg, (15.3±7.3) mmHg and (15.3±7.3) mmHg, respectively.The immediate postoperative △P was significantly lower than that of preoperation (P<0.01), and the △P of the most children decreased in the long-term follow-up.The results of Logistic regression analysis showed that valve dysplasia with right ventricular outflow tract stenosis and the immediate postoperative residual transvalvular gradient degree were the risk factors for long term curative effect of PBPV in children who could not reach the best standard.The restenosis rate was 4.6%(3/65 cases) with children followed up for more than 10 years.The incidence of long-term follow-up pulmonary valve regurgitation (83%) was significantly higher than that before operation (58%) and short term (68%) after operation, and the degree of regurgitation also increased (P<0.05), while the degree of regurgitation of the tricuspid regurgitation decreased gradually during the follow-up (P<0.05); the right ventricular diastolic diameter of the patients at 10 years or more after the operation was measured as (19.27±3.03) mm, which was significantly higher than that (15.24±2.89) mm of the healthy children of at the same term healthy age (P<0.05). Conclusions The PBPV has a high success rate in the treatment of children with PS, and it has good medium-long-term curative effect, less complications and lower restenosis rate.Therefore, PBPV can be used as the first choice for PS.However, the incidence and degree of pulmonary regurgitation has an increasing trend after PBPV and the right ventricular diastolic diameter is still larger than that of the healthy children.Therefore, the long-term follow-up is necessary out of the hospital. Key words: Percutaneous balloon pulmonary valvuloplasty; Pulmonary valve stenosis; Child; Follow-up

Echocardiographic evaluation of right and left heart findings according to the severity of the disease in stable chronic obstructive pulmonary disease

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is seen alongside some systemic diseases that result in impaired functional capacity, worsening dyspnea, decreased health-related quality of life and increased mortality. Cardiovascular diseases, considering their effect on mortality, play an important role in such diseases. Objective: The aim of this study to evaluate the cardiac changes that develop secondary to COPD and attempt to identify any correlation between the severities of the disease determined using GOLD guidelines and ECHO findings. Method: This prospective study involved 32 male patients who presented to the pulmonary disease outpatient clinic with stable COPD. We compared the severity of COPD with the ECO findings of the patients. Findings: Correlations were found between the severity of COPD and heart rate, the number of cigarettes smoked and the respiratory function test results. Measurable tricuspid regurgitation was detected in 26 patients (26/32=81.2%), and the degree of tricuspid regurgitation according to the severity of COPD. Conclusion: We suggest that cardiac influences should be diagnosed early in the course of the disease, and that treatment be started to decrease the rates of mortality and morbidity in patients with COPD.

Handmade Trileaflet Valve Design and Validation for Pulmonary Valved Conduit Reconstruction Using Taguchi Method and Cascade Correlation Machine Learning Model

Pulmonary valve diseases in children and adults include different degrees of stenosis, regurgitation, or congenital defects. Valve repair or replacement surgery is used to treat valvular dysfunction and to improve regurgitations flow for pulmonary valve pathologies. Handmade trileaflet valve designs with different ranges of diameters have been used for pulmonary valved conduit reconstruction among children or adult patients with available conditions. In this paper, we propose a multiple regression model as a cascade-correlation-network-based estimator to determine optimal trileaflet parameters, including width, length, and upper/lower curved structures, for trileaflet valve reconstruction. The diameter of the main pulmonary artery is determined via computed tomography pulmonary angiography, and a trileaflet valve template is rapidly sketched. The actual valve is constructed using an expanded polytetrafluoroethylene material. Using an experimental pulmonary circulation loop system, design parameters and valve efficacy can be validated by the Taguchi method through calculation of signal-to-noise ratios. Experimental results indicate that in contrast to commercial valve stents, the handmade trileaflet valve exhibits good performance and is a valuable option in treatment of severe pulmonary regurgitation.

Ebstein&amp;#39;s Anomaly—An Overview

Aim: To present the various echocardiographic spectrum of Ebstein’s mal-formation in adolescence and adults. Introduction: Ebstein’s anomaly has different anatomic and hemodynamic variables with clinical manifestations of cyanosis, right-sided heart failure and arrhythmias. The leaflet tethering and dysplasia, together with dilatation of the tricuspid valve ring, constitute the anatomic cause of tricuspid regurgitation observed in this condition. Case Reports: The spectrum of leaflet tethering from mild to extreme with varying degrees of tricuspid regurgitation were documented by echocardiography in a 16-year-old cyanotic male with Ebstein’s anomaly associated with an atrial septal defect and mild low tricuspid regurgitation (TR), 22-year-old acyanotic male with right-sided heart failure due to severe tricuspid regurgitation and an intact atrial septum, 55-year-old asymptomatic female with moderate high tricuspid regurgitation. The extreme form was described as an “atretic” mem-brane in a 28-year-old cyanotic male and as a “blanket” of leaflet tissue in a 30-year-old cyanotic male. Conclusion: Ebstein’s anomaly has to be sus-pected clinically in presence of cyanosis with a WPW (Wolf-Parkinson-White) or atrioventricular (AV) block pattern of ECG and its management is complex and must be individualized. RV (right ventricular) exclusion procedures are preferred in advanced cases.

The Value of Echocardiography in the Diagnosis of Non-compaction of the Ventricular Myocardium

To analyze the echocardiographic features of non-compaction of the ventricular myocardium (NVM) and evaluate the diagnostic value of echocardiography in NVM. 34 patients with clinically diagnosed cardiac insufficiency and cardiac arrhythmia were examined by multi-slice scan with GE vivid 7 and Philips IE33 color Doppler sonography. The echocardiographic findings were NVM. Echocardiographic features of NVM were summarized and the distribution characteristics of the lesion area were analyzed. It was found that echocardiography in all 34 patients had obvious characteristics. The myocardium at the lesion site was divided into 2 distinct layers. The outer layer was thin and dense, and the inner layer was thicker, consisting of rich trabeculae and deep recesses with different sizes, which tended to occur in the apical and lateral walls. Color Doppler ultrasound can detect blood flow in the recess and interconnect with the heart cavity. 34 patients were involved in varying degrees of valvular regurgitation of mitral, tricuspid and aortic valves. 29 patients had left ventricular dysfunction, 17 patients with complete left bundle branch block, 12 patients with premature ventricular contractions, and 7 patients with atrial fibrillation. To be concluded, NVM has typical echocardiographic features. Echocardiography can be diagnosed without noticeable symptoms, and it is the most convenient method for diagnosis of NVM.

Is tricuspid annuloplasty increasing surgical mortality and morbidity during mitral valve replacement? A single-centre experience

Performance of tricuspid annuloplasty (TA) in patients undergoing mitral valve surgery is recommended based on the degree of tricuspid regurgitation and tricuspid annulus size, but is often underused. To evaluate the impact of combined TA on in-hospital outcome in patients undergoing mitral valve replacement (MVR). We selected all consecutive patients who underwent MVR for native valve disease. Clinical, echocardiographic and in-hospital complications were obtained from chart review. We identified 287 patients (mean age 62±17 years; 44% men). Combined TA was performed in 165 patients (57%), who had more rheumatic disease (71% vs. 24%; P<0.0001) and mitral stenosis (55% vs. 22%; P<0.0001), but less endocarditis (4% vs. 31%; P<0.0001), were more often in atrial fibrillation (54% vs. 22%; P<0.0001), were more severely symptomatic (80% vs. 57%; P<0.0001), presented with a higher systolic pulmonary artery pressure (SPAP) (53±16 vs. 45±15mmHg; P=0.0002) and were less likely to have required emergency surgery (17% vs. 38%; P<0.0001). Despite this higher risk profile, in-hospital mortality was slightly lower (5% vs. 13%; P=0.02) and complication rates were similar (redo surgery 22% vs. 16% [P=0.18] and tamponade 20% vs. 15% [P=0.15]). After adjustment for age, sex, functional class, SPAP, emergency surgery and concomitant coronary artery bypass graft or aortic valve replacement surgery, combined TA was not associated with an increased rate of in-hospital death (P=0.08) or major complications (P=0.89). In a consecutive series of patients who underwent MVR, TA did not seem to have a negative impact on immediate outcome. Hence, additional performance of TA at the time of MVR should not be declined on the basis of an increased surgical risk.

Effect of aorto-ventricular angulation on procedural success in transcatheter aortic valve replacements with the Lotus Valve system.

To determine the effect of aorto-ventricular angulation (AA) on procedural success with the Lotus Valve system. AA, the angulation of the aortic valve basal plane, may affect the deployment of transcatheter aortic valve replacements (TAVRs). The Lotus Valve system is fully repositionable and delivered on a pre-shaped catheter which may alter the impact of AA on its deployment. The effect of AA on procedural and clinical outcomes with the Lotus valve is unreported. Consecutive patients who underwent transfemoral TAVR with the Lotus Valve system were analyzed. AA was determined on pre-procedural multi-detector computed tomography imaging. Device success, procedural characteristics, and clinical events were assessed according to Valve Academic Research Consortium-2 (VARC2) definitions. One hundred sixty-five patients were analyzed (48% male, mean age 84 years). The mean AA was 47.8 degrees. Patients were, therefore, divided into low AA (AA < 48°) or high AA (AA ≥ 48°). Baseline characteristics were similar in both cohorts. Device success and procedural outcomes were also similar including procedure time, contrast dose, and need to reposition. There was no difference in degree of moderate or greater para-valvular regurgitation (PVR) (0% vs. 3%, P = 0.09). Clinical outcomes of death, stroke, myocardial infarction, and other major VARC2 endpoints were similar. AA did not affect device success or clinical outcome with the Lotus Valve system. The Lotus' unique design features may have mitigated the impact of AA by improving the accuracy, ease of valve positioning, and reducing PVR.

Surgical treatment and early-mid follow-up results of complete atrioventricular septal

Objective: To discuss the surgical treatment and early-mid follow-up results of complete atrioventricular septal defect (CAVSD). Methods: The clinic data of 235 cases of CAVSD underwent surgical treatment at Department of Cardiac Surgery, Guangdong General Hospital from June 2009 to June 2016 was analyzed retrospectively (104 male and 131 female patients). The patients were aged 18 days to 58 years (mid age 8.9 months) at surgery, and 2 cases of newborns (0.9%), 24 cases of 1 to 3 months (10.2%), 56 cases of 4 to 6 months (23.8%), 66 cases of 7 to 12 months (28.1%), 36 cases of 1 to 3 years (15.3%), 37 cases of 4 to 18 years (15.7%), and 14 cases above 18 years (6.0%). There were 129 cases of Rastelli type A (54.89%), 16 cases of type B (6.8%), 25 cases of type C (10.6%) and 65 cases of transitional type (27.7%). The patients were combined with 7 cases of unroofed coronary sinus syndrome, 5 cases of coarctation of aorta, 4 cases of tetralogy of Fallot, 3 cases of double outlet right ventricle, 1 case of transposition of the great arteries, 1 case of multiple ventricular septal defect, 1 case of pulmonary artery sling. The CAVSD correction operations were performed in 199 cases with modified single patch technique (84.7%), 26 cases with two patch technique (11.1%), 10 cases with conventional single patch technique (4.3%), and the corrective surgeries of other anomalies were performed in the meantime. Generalized Estimated Equation was used to statistical analysis of postoperative regurgitation level of mitral valve and tricuspid valve. Results: Followed-up for 1 to 7 years, 18 cases (7.7%) died overall and 15 cases (6.4%) died within 30 days post-operation.The mortality of little infant (operation age ≤3 months) was much highest(26.9%). The mortality of different operation age had significant difference(P=0.007). There was no difference among the mortality with three techniques. Seven cases (3.0%) suffered from the re-operation for severe mitral regurgitation. A total of 217 patients survived more than 1 year after initial surgery, and there were 11 cases (5.1%) with severe mitral regurgitation and 7 cases (3.2%) with severe tricuspid valve regurgitation at 1 year post-operation.The degree of mitral regurgitation after operation decreased at 1 week to 6 months, and slightly higher after 1 year postoperatively.The ratios of severe mitral regurgitation in different operative age group was statistically significant difference(P=0.017), mainly from 3 months group and 1 to 3 years group.The degree of tricuspid regurgitation decreased significantly after operation, and decreased gradually in the follow-up period. The ratio of postoperative residual severe tricuspid regurgitation was the highest in surgical aged >18 years old, less in 3 years group, the lowest in 3 to 18 years group. Conclusions: The mortality and the ratio of patients with serious mitral regurgitation were higher in infants less 3 months than elder patients. The infants need more frequently follow-up and medicine treatment after operation. The modified one patch technique is effective for all age groups.