Emergency Valve Research Articles

Potassium extrusion by plant cells: evolution from an emergency valve to a driver of long-distance transport.

The ability to accumulate nutrients is a hallmark for living creatures and plants evolved highly effective nutrient transport systems, especially for the uptake of potassium (K+). However, plants also developed mechanisms that enable the rapid extrusion of K+ in combination with anions. The combined release of K+ and anions is probably an ancient extrusion system, as it is found in the Characeae that are closely related to land plants. We postulate that the ion extrusion mechanisms have developed as an emergency valve, which enabled plant cells to rapidly reduce their turgor, and prevent them from bursting. Later in evolution, seed plants adapted this system for various responses, such as the closure of stomata, long-distance stress waves, dropping of leaves by pulvini, and loading of xylem vessels. We discuss the molecular nature of the transport proteins that are involved in ion extrusion-based functions of plants and describe the functions that they obtained during evolution.

Thrombotic Thrombocytopenia Purpura (TTP) following emergent aortic valve replacement after a complicated TAVR procedure: a case report and review of the literature

BackgroundThrombotic thrombocytopenic purpura (TTP) is a rare hematological disorder. The occurrence of TTP subsequent to an emergent aortic valve replacement after a TAVR procedure is exceedingly uncommon with only a few reported cases worldwide.Case PresentationWe report the case of a 70-year-old female patient diagnosed with aortic insufficiency. Following a transcatheter aortic valve replacement, she underwent emergency aortic valve replacement under cardiopulmonary bypass on the subsequent day due to heart valve displacement. The postoperative diagnosis revealed TTP and symptomatic treatment involving plasma exchange was administered. After demonstrating steady improvement, the patient was eventually discharged.ConclusionAortic valve replacement after TAVR is a high-risk procedure and increases susceptibility for developing secondary TTP. The diagnosis and treatment of secondary TPP is considerably challenging, and early diagnosis with symptomatic treatment including plasma exchange can increase patient survival.

Early vs. late transcatheter aortic valve replacement in acute heart failure hospitalizations: A comparative nationwide analysis

BackgroundSevere aortic stenosis (AS) is the most common valvular disease in the USA. Patients undergoing urgent or emergent transcatheter aortic valve replacement (TAVR) have worse clinical outcomes than those undergoing non-urgent procedures. No studies have examined the impact of procedural TAVR timing on outcomes in AS complicated by acute heart failure (AHF). AimsWe aimed to evaluate differences in in-hospital mortality and clinical outcomes between early (<48 h) vs. late (≥48 h) TAVR in patients hospitalized with AHF using a real-world US database. MethodsWe queried the National Inpatient Sample database to identify hospitalizations with a diagnosis of AHF, aortic valve disease, and a TAVR procedure (2015–2020). The associations between TAVR timing and clinical outcomes were examined using logistic regression model. ResultsA total of 25,290 weighted AHF hospitalizations were identified, of which 6855 patients (27.1 %) underwent early TAVR, and 18,435 (72.9 %) late TAVR. Late TAVR patients had higher in-hospital mortality rate (2.2 % vs. 2.8 %, p < 0.01) on unadjusted analysis but no significant difference following adjustment for demographic, clinical, and hospital characteristics [aOR 1.00 (0.82–1.23)]. Late TAVR was associated with higher odds of cardiac arrest (aOR 1.50, 95 % CI: 1.18–1.90) and use of mechanical circulatory support (aOR 2.05, 95 % CI: 1.68–2.51). Late TAVR was associated with longer hospital stay (11 days vs. 4 days, p < 0.01) and higher costs ($72,851 vs. $53,209, p < 0.01). ConclusionEarly TAVR was conducted in approximately 25 % of the AS patients admitted with AHF, showing improved in-hospital outcomes before adjustment, with no significant differences observed after adjustment.

A case of truncus arteriosus with severe heart failure and pulmonary stenosis: bridge to transplant candidacy with surgical correction and a ventricular-assist device.

Ventricular-assist device therapy for small patients with congenital heart disease is challenging due to its complex anatomy and hemodynamics. We describe a 3-year-old patient with heart failure with truncus arteriosus in the palliative stage. The patient underwent palliative right ventricular outflow tract reconstruction following bilateral pulmonary artery banding. At 6months of age, the patient developed severe truncal valve regurgitation and left ventricular dysfunction. Emergent truncal valve replacement with a mechanical valve was performed, but left ventricular dysfunction persisted. At 3years of age, the patient developed acute progression of heart failure triggered by influenza infection. The patient was intubated and transferred to our center to determine the indication for heart transplantation. On the second day after admission, signs of multiorgan failure appeared. Emergent ventricular-assist device implantation for both ventricles was performed with truncal valve closure, ventricular septal defect closure, atrial septal defect closure, and re-right ventricular outflow tract reconstruction. The right ventricular-assist device was successfully removed on the seventh postoperative day. Due to the small pulmonary arteries, severe pulmonary stenosis persisted after ventricular-assist device implantation, but it gradually improved with multiple pulmonary angioplasties. The patient was registered in the Japanese organ transplant network and is awaiting a donor organ in a stable condition.

Early Structural Valve Deterioration of Balloon Expandable Transcatheter Aortic Valve Leaflets Due to Intrinsic and Extrinsic Nodular Calcification in a Hemodialysis Patient: A Case Report

Abstract Background Several reports have shown that transcatheter aortic valves are comparable in durability to surgical aortic valves. However, early structural valve deterioration (SVD) is rarely reported to occur, especially in hemodialysis patients. Case Summary We present a case of rapidly progressive bioprosthetic aortic valve stenosis in a patient with end-stage renal disease (ESRD) secondary to diabetic nephropathy in an 83-year-old female admitted due to progressive dyspnea and orthopnea. A 23-mm sized SAPIEN3 bioprosthetic aortic valve showed normal function for the first year after transcatheter aortic valve implantation (TAVI), but then rapidly developed stenosis and required acute hospitalization for heart failure a year and a half after surgery. Emergent surgical aortic valve replacement (SAVR) with a 19-mm On-X valve (CryoLife, Kennesaw, GA, USA) was performed. Pathological examination of the explanted SAPIEN 3 valve demonstrated severely degenerated bioprosthetic pericardial leaflets with severe intrinsic and extrinsic nodular calcification, which could limit the leaflet motion. Discussion There is a lack of reports on the long-term procedural outcomes of TAVI in hemodialysis patients. The development of SVD in patients undergoing dialysis is multifactorial and has yet to be fully elucidated. In the presented case, the removed TAVI valve had severe extrinsic calcified nodules alongside a fibrin thrombus. Considering these pathological findings, antithrombotic therapy to prevent fibrin thrombus from adhering to the TAVI valve may be important to avoid early SVD.

The Results of Urgent and Emergent Transcatheter Mitral Valve Repair (MitraClip®): A Comparison with Standard Elective Repair.

Mitral regurgitation (MR) is the most common valvular disease worldwide. MR has been managed surgically, with either a mitral valve replacement or repair. Percutaneous transcatheter mitral valve repair (TMVr) with MitraClip® insertion has gained wide popularity and success over medical and surgical therapy for MR. Some patients with acute MR or decompensated heart failure could benefit from urgent TMVr. This meta-analysis aims to compare clinical outcomes of urgent versus elective TMVr. We performed a study-level meta-analysis to compare the clinical outcomes of urgent versus elective TMVr using the MitraClip system. The primary endpoint outcome was all-cause mortality. Additional outcomes included procedural success, postoperative acute kidney injury (AKI), stroke, and length of in-hospital stay. Overall, 30-day mortality was significantly higher in the urgent group (odds ratio [OR]: 2.74; 95% confidence interval [CI] [2.17, 3.48]; P < 0.00001; I² =0%). However, subgroup analysis of matched cohorts showed no significant difference between both groups (OR: 1.80; 95% CI [0.94, 3.46]; P = 0.08; I² =0%). One-year mortality was similar between both groups (and: 1.67; 95% CI [0.96, 2.90]; P = 0.07; I² =0%). Procedural success was similar between both groups (89.4% vs. 89.8%; P = 0.43). Postoperative AKI was significantly higher in the urgent group (OR: 4.12; 95% CI [2.87, 5.91]; P < 0.00001; I² =0%). Urgent TMVr should be indicated in select populations as it is considered therapeutic with acceptable outcomes therein.

Cardiovascular outcomes of emergent vs elective transcatheter aortic valve replacement in severe aortic stenosis: regression matched meta-analysis.

Transcatheter aortic valve replacement (TAVR) has been highly increased as the recommended option for patients with a high surgical risk. This study aims to commit a systematic review and meta-analysis to assess the outcomes in severe aortic stenosis patients following emergency transcatheter aortic valve replacement (emergent TAVR) compared to elective TAVR or eBAV followed by elective TAVR. We conducted a systematic literature search of PubMed, Embase, Cochrane CENTRAL, CINAHL, Science Direct, and Google Scholar. We included nine studies in the latest analysis that reported the desired outcomes. Outcomes were classified into primary outcomes: 30-day all-cause mortality and 30-day readmission rate, and secondary outcomes, which were further divided into (a) peri-procedural outcomes, (b) vascular outcomes, and (c) renal outcomes. Statistical analysis was performed using Stata v.17 (College State, TX) software. A total of 44,731 patients with severe aortic stenosis were included (emergent TAVR n = 4502; control n = 40045). 30-day mortality was significantly higher in the emergent TAVR group (OR: 2.62; 95% CI = 1.76-3.92; P < 0.01). Regarding post-procedural outcomes, the length of stay was significantly higher in the emergent TAVR group (Hedges's g: +4.73 days; 95% CI = +3.35 to +6.11; P < 0.01). With respect to vascular outcomes, they were similar in both groups. Regarding renal outcomes, both acute kidney injury (OR: 2.52; 95% CI = 1.59-4.00; P < 0.01) and use of renal replacement therapy (OR: 2.33; 95% CI = 1.87-2.91; P < 0.01) were significantly higher in emergent TAVR group as compared to the control group. Our study demonstrated that despite increased 30-day mortality and worse renal outcomes, the post-procedural outcomes were similar in emergent and elective TAVR groups. The increased mortality and worse renal outcomes are likely due to hemodynamic instability in the emergent group. The similarity of post-procedural outcomes is evidence of the safety of TAVR even in emergent settings.

Emergent transcatheter mitral valve implantation: Early and mid-term outcomes

Emergent transcatheter mitral valve implantation: Early and mid-term outcomes

Low-temperature characteristics of rubbers and performance tests of type 120 emergency valve diaphragms

PurposeThe type 120 emergency valve is an essential braking component of railway freight trains, but corresponding diaphragms consisting of natural rubber (NR) and chloroprene rubber (CR) exhibit insufficient aging resistance and low-temperature resistance, respectively. In order to develop type 120 emergency valve rubber diaphragms with long-life and high-performance, low-temperatureresistant CR and NR were processed.Design/methodology/approachThe physical properties of the low-temperature-resistant CR and NR were tested by low-temperature stretching, dynamic mechanical analysis, differential scanning calorimetry and thermogravimetric analysis. Single-valve and single-vehicle tests of type 120 emergency valves were carried out for emergency diaphragms consisting of NR and CR.FindingsThe low-temperature-resistant CR and NR exhibited excellent physical properties. The elasticity and low-temperature resistance of NR were superior to those of CR, whereas the mechanical properties of the two rubbers were similar in the temperature range of 0 °C–150 °C. The NR and CR emergency diaphragms met the requirements of the single-valve test. In the low-temperature single-vehicle test, only the low-temperature sensitivity test of the NR emergency diaphragm met the requirements.Originality/valueThe innovation of this study is that it provides valuable data and experience for future development of type 120 valve rubber diaphragms.

Abstract 12522: Non-Ischemic Papillary Muscle Rupture Due to MRSA Myocarditis

Case Presentation: A 46-year-old male with diabetes, ESRD, and recurrent MRSA bacteremia, presented with septic shock and suffered cardiac arrest. Following resuscitation EKG showed inferolateral ischemia. TTE revealed acute mitral valve regurgitation resulting from posteromedial papillary muscle rupture (PMR). An intra-aortic balloon pump was implanted for cardiogenic shock. Coronary angiography revealed right dominant circulation and thrombotic occlusion of a small caliber distal left circumflex artery (LCX). Emergent mitral valve replacement surgery was performed. Pathologic analysis of the excised muscle and leaflet showed marked acute inflammation, bacterial invasion, and myocyte necrosis, confirming non-ischemic rupture due to MRSA myocarditis. Discussion: PMR predominantly occurs after MI, complicating 0.03% of STEMI cases in the reperfusion era. Non-ischemic causes are rare. Coexistence of myocarditis, infective endocarditis (IE), and MI poses a challenge in determining etiology. Establishing causation guides whether to expedite emergent valve surgery or focus on cardiomyocyte salvage by revascularization. The posteromedial papillary muscle is most commonly involved in PMR due to single blood supply from the PDA (most commonly a branch of the RCA, and less commonly the LCX). Coronary angiography, postoperative histopathology, and culture results determined the etiology of PMR was fulminant MRSA bacteremia culminating in myocarditis. Bacterial colonization and resultant inflammation induced physical and mechanical strain leading to complete rupture. The occluded LCX was incidental, and may have been the result of septic embolization, which occurs in up to 65% of left-sided IE. Albeit rare, non-ischemic etiologies must be considered when the anatomic presentation of acute PMR on TTE is incongruent with angiography. Definitive treatment relies on surgical intervention and mechanical circulatory support is often necessary.

Abstract 12289: A Postpartum Diastolic Murmur

A 44-year-old G3P1011 underwent uncomplicated Caesarian section for obstetric indications with delivery of a healthy girl. Several hours postpartum, she developed hypoxemia requiring transient supplemental oxygen. Cardiology was consulted for further evaluation. Upon initial assessment, she appeared comfortable with an oxygen saturation of 93% on room air. She reports an otherwise uneventful pregnancy. Her past medical history is significant for chronic hypertension on propranolol. She was afebrile with a HR of 91, BP 147/66 (left arm) and 155/68 (right arm). Her JVP was 10-11 cm H20. There was a III/IV low-pitched decrescendo early-mid diastolic murmur, loudest at the left lower sternal border, radiating to the apex, and a systolic ejection murmur. EKG (panel A) showed normal sinus rhythm, with no ischemic abnormalities. Due to the discovery of a new murmur, there was concern for valvular pathology as a cause for her suspected heart failure, particularly aortic regurgitation (AR). An urgent TTE (panel C-E) was requested and showed a dissection flap in the ascending aorta, effacement of the sinotubular junction, and severe AR. CT angiogram confirmed the diagnosis of type A aortic dissection (AD; panel B). Twelve hours after the delivery of her baby, she underwent emergent aortic valve repair and aortic arch replacement. She recovered well and was discharged home post-op day 6. Though no human data exists, animal data suggests increased AD risk in breastfeeding animals with Marfan Syndrome. Due to her near catastrophic presentation, she elected to not breastfeed. Her genetic testing results are pending. AD in pregnancy is rare. There is an increased risk of AD in pregnant compared to non-pregnant women. AD often occurs in the third trimester or postpartum, and most women are unaware of a preexisting arteriopathy. In this case, the detection of a diastolic murmur resulted in rapid diagnosis and treatment, essential in the management of this life-threatening condition.

Splenic Artery Infectious Aneurysms in Infective Endocarditis – An Observational Study and Comprehensive Literature Review

PurposeTo determine the prevalence, the clinical and radiological features, associated factors, treatment and outcome of splenic artery aneurysms (SAAs) in infective endocarditis (IE). MethodsWe retrospectively reviewed 474 consecutive patients admitted to our institution with definite IE (2005-2020) ResultsSix patients had SAAs (1.3%; 3 women; mean age: 50). In all cases the diagnosis was obtained by abdominal CT-angiography (CTA). SAAs-IE were solitary, saccular with a mean diameter of 30mm (range: 10-90mm). SAAs-IE were intrasplenic (n=4) or hilar (n=2). Streptococcus spp were the predominant organisms (n=4).In all cases a left-sided native valve was involved (aortic, n=3; mitral, n=2, mitral-aortic, n=1). SAAs were silent in half-patients, and were revealed by abdominal pain (n=2) and by the resurgence of fever after cardiac surgery (n=1).All patients underwent emergent valve replacement. One patient died within 24h from multiorgan failure. For the others, uneventful coil embolization was performed in 4 patients after valve replacement (3 diagnosed early, one at 8 weeks). In the remaining patients, SAA-IE diagnosed at abdominal-CTA at day 16, with complete resolution under appropriate antibiotherapy alone. ConclusionSAAs-IE are a rare occurrence that may be clinically silent. SAAs-IE can be intrasplenic or hilar in location. Endovascular treatment in this context was safe. According to current guidelines, radiologic screening by abdominal-CTA allowed the detection of silent SAAs which could be managed by endovascular treatment to prevent rupture. The delayed formation of these SAAs could justify a CTA control at the end of antibiotherapy.

Feasibility of emergent transcatheter aortic valve replacement sequentially followed by cardiac computed tomography angiography: experience from the procedure.

Feasibility of emergent transcatheter aortic valve replacement sequentially followed by cardiac computed tomography angiography: experience from the procedure.

Anévrysme rénal infectieux retardé, 3 mois après chirurgie cardiaque pour une endocardite infectieuse à Streptococcus pyogenes ; cas et revue de la littérature

Infective endocarditis (IE) due to Streptococcus pyogenes (SP) (Group A Streptococcus) is uncommon and infectious renal artery aneurysm (IRAA) is an exceptional complication of IE, with few cases reported in the literature.We describe a case of SP native mitral valve IE in a 58-year-old man, presenting with large valve vegetations, abscess and severe regurgitation. Initial CT-angiography showed bilateral kidney and splenic infarcts.He underwent successful emergent bioprosthetic valve replacement. Antibiotic regimen consisted in linezolid and rifampicin for 8 weeks. Three months later, CT-angiography for feet gangrene revealed a 16mm aneurysm of the left intraparenchymal renal artery, which was occluded by coil-embolization.This case shows that an infectious aneurysm may develop several months after antibiotic treatment and emergent valve replacement for IE.

Emergent transcatheter mitral valve implantation: Early and mid-term outcomes

BackgroundTranscatheter mitral valve implantation (TMVI) may be attractive to treat high-risk patients with mitral bioprosthesis or annuloplasty ring failure or severe mitral annular calcification. AimTo report the outcomes of patients after valve-in-valve/ring/mitral annular calcification TMVI using balloon expandable transcatheter aortic valves, according to the degree of urgency of the procedure. MethodsAll patients who underwent TMVI in our centre from 2010 to 2021 were classified into three groups: elective, urgent or emergent/salvage TMVI. ResultsA total of 157 patients were included: 129 (82.2%) had elective, 21 (13.4%) urgent and 7 (4.4%) had emergent/salvage TMVI. Patients with emergent/salvage TMVI had a higher EuroSCORE II: elective, 7.3%; urgent, 9.7%; emergent/salvage, 54.5% (P<0.0001). The indication for TMVI was bioprosthesis failure in all of the emergent/salvage group, in 13 of the urgent group (61.9%) and in 62 of the elective group (48.1%). Overall, the technical success rate of TMVI was 86%, and was similar in the three groups (elective, 86.1%; urgent, 95.2%; emergent/salvage, 71.4%). The cumulative survival rate at 2-year follow-up was lower in the emergent/salvage group than in the elective or urgent group (42.9% vs 71.2% for the elective group; 76.2% for the urgent group; log-rank test, P=0.012). The excess mortality in the emergent/salvage group occurred during the first month postprocedure. Thereafter, the 30-day landmark analysis did not show any more statistical difference between the three groups (log-rank test, P=0.94). ConclusionsEmergent/salvage TMVI was associated with high early mortality, but 1-month survivors had similar outcomes to patients with elective/urgent TMVI. The degree of urgency of the procedure should not prevent TMVI in high-risk patients.

Advanced Manufacturing Design of an Emergency Mechanical Ventilator via 3D Printing—Effective Crisis Response

Nowadays, there is a market need that is pushing manufacturers to support more sustainable product designs regardless of any crisis. Two important lessons that society inferred from the COVID-19 pandemic are that the industry needs an improved collaboration efficiency that can handle such emergencies and improve its resource conservation to avoid having shortages. Additive manufacturing technologies use 3D object scanners to direct hardware to deposit material, layer upon layer, in precise geometric shapes, and are positioned to provide a disruptive transformation in how products are designed and manufactured. They can provide for the planet in fighting against crisis from a materials and applications perspective. In this context, the optimization and production of emergency ventilators in health systems were investigated with plans for 3D printing received from the University of Illinois Urbana–Champaign. An evaluation of the printability of CAD files and a partial redesign to limit dimensional variability, acceptable surface finish, and a more efficient printing process were performed. Six parts of the design were redesigned to make printing easier, faster, and less expensive. In the case of the O2 inlet attachment, the necessary supports were difficult to remove due to the part’s geometry, leading to redesign. The modulator top and bottom part, the patient tee, the manometer body, and the pop-off valve cap were also redesigned in order to avoid dimensional variability and possible rough surfaces. Metallic and thermoplastic composite ventilators were produced and then tested in real operating conditions, such as in a hospital setting with a realistic oxygen supply. The preliminary findings are promising compared to the initial design, both in terms of construction quality and performance such as exhalation rate adjustment and emergency valve operation. Also, a combination of manufacturing technologies was evaluated. The modifications allowed optimal casting (injection molding) of the parts and therefore faster production, instead of printing each part, when high output is required.

Emergent transcatheter aortic valve implantation combined with enterectomy for acute decompensated heart failure caused by severe aortic stenosis and strangulated femoral hernia.

A 74-year-old female was admitted to our department with orthopnea, oliguria, and vomiting. She had a pacemaker implanted two years ago. Physical examination revealed an 8 cm × 6 cm bulge in the right groin. The transthoracic echocardiography showed that the area of aortic orifice was 0.4 cm2 and the left ventricle ejection fraction (LVEF) was 25%. The Society of Thoracic Surgeons score was 25.6%. Abdominal ultrasound demonstrated right femoral hernia with intestinal obstruction. Because of hemodynamic instability and the risk of intestinal necrosis, emergent transcatheter aortic valve implantation (TAVI) combined with hernia repair was scheduled to perform. The procedure was performed under general anesthesia with intubation. The transesophageal echocardiography (TEE) showed that the maximal and mean pressure gradient was 64 and 35 mmHg, respectively (Panels A–C); coronary angiography indicated no coronary artery stenosis. We chose left femoral artery access for TAVI through a totally percutaneous approach. According to TEE, aortic root angiography and based on the balloon pre-dilation (Panel D), 26 Venus-A self-expandable valve was successfully implanted (Panel F). And then, the right oblique cutdown was performed, and a tense hernial sac was revealed, in which we observed an 8-cm-long necrotic bowel (Panel E). The gastrointestinal surgeon had to resect the strangulated and anastomose the normal bowel. TEE showed that the maximal and mean aortic pressure gradient was 13 and 7 mmHg, respectively (Panels G and H). Thirteen days later after the operation, the patient was discharged from the hospital with no complications. Follow-up echocardiography demonstrated that the device position was appropriate, no perivalvular leakage, and the LVEF increased to 50%.

Cardiac valve surgery in Far North Queensland, Australia. A retrospective audit of rheumatic heart disease prevalence, patient demographics and surgical management

Abstract Funding Acknowledgements Type of funding sources: None. Background Rheumatic heart disease (RHD) is a preventable valve disease following acute rheumatic fever. It results in &amp;gt;300,000 deaths annually worldwide (1). While commonly encountered in the developing world, the prevalence in Australia remains high with over 6000 patients currently living with RHD (2). This disease is over-represented in Northern Australia among the indigenous community with Aboriginal and Torres-strait Islander people accounting for over 80% of cases (2). Purpose This audit will evaluate the contribution of RHD to valve surgeries in Far North Queensland (FNQ) and the effect this has on procedure type and patient demographics. Methods We analysed a cohort of 200 consecutive patients from a regional centre in FNQ referred for valve surgery. We recorded age, gender, indigenous status, valve aetiology, ejection fraction (EF), surgery type, and procedure urgency. This data was then compared to the latest European Association for Cardio-Thoracic Surgery (EACTS) registry report (3). Results 136 male and 64 female patients underwent 162 elective and 38 emergent valve procedures. The surgeries performed were bioprosthetic AVR (119), mechanical AVR (12), bioprosthetic MVR (14), mechanical MVR (11), TAVR (17), mitral valve repair (25), tricuspid valve repair (6) and balloon valvuloplasty (5) with combined CABG (33) and aortic root surgery (20). Average age at surgery was 64.2 years (range 21 – 89) which is significantly younger than the EACTS age at aortic, mitral and combined valve/CABG procedures. Notably, the average age at surgery reaches 75 years in European countries with a gross national income of $70,000 per capita. However, this is not evident in FNQ. 27 of the 200 procedures were for RHD and the average age of these patients was 45.4 years which explains this discrepancy. Indigenous patients accounted for 16.5% of total, and 77.8% of rheumatic valve surgeries. Mechanical prostheses comprised 15% and 48% of total and rheumatic valve replacements respectively which contrasts with 30-40% in the EACTS registry. RHD also accounted for almost the entirety of tricuspid valve surgeries and balloon valvuloplasties. The EACTS report suggested higher EF’s in Asian countries due to higher prevalence of RHD. This was not observed in our data with no statistically significant difference in EF between RHD patients and the overall cohort. Unfortunately, there is a lack of valve pathology data in the EACTS registry which limits further comparisons. Conclusion RHD is responsible for a significant proportion of valve surgery in FNQ. The indigenous population accounts for a vast majority of these patients. This has caused a shift towards lower age at surgery, higher proportions of mechanical valve replacements, valvuloplasties and tricuspid valve replacements. EF did not significantly differ in patients with rheumatic valve pathology. More data surrounding valve pathology is needed to draw similar conclusions in the EACTS cohorts.

A Rare Case Report of Ruptured Sinus of Valsalva Aneurysm

&lt;p&gt;主動脈竇動脈瘤是一種罕見的心臟結構病變，因具非特異性表徵及困難診斷，容易導致高死亡風險。本案例是一位53歲男性患者，因急性胸痛入院治療，藉由實驗室檢查發現心肌酵素升高、D-二聚體升高，心電圖檢查為aVR導程ST段上升、於第I、II、V4~6導程出現ST-T波段變化，初步診斷為左冠狀動脈主幹心肌梗塞，立即行冠狀動脈攝影檢查發現無異常。個案出現胸痛合併心因性休克之症狀，從中排除主動脈剝離、肺栓塞、心包填塞等診斷，深入檢視病史紀錄及影像報告，發現心臟超音波、胸部電腦斷層及冠狀動脈血管攝影檢查有由左流向右心室的瘻管分流，最終確診為主動脈竇動脈瘤破裂。患者緊急接受右冠狀竇動脈瘤修補及主動脈瓣置換手術治療後，胸痛、休克狀況改善且左心室功能恢復，術後預後良好。在面對急性胸痛合併血液動力學不穩定的患者時，除了須考慮症狀相關的疾病診斷外，當聽診發現S1及S2連續性心雜音時，建議將主動脈竇動脈瘤破裂列入考慮，以掌握治療處置之重要時機。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Aneurysm of the sinus of Valsalva is a rare cardiac anomaly due to the nonspecific symptoms and dif-ficult confirmation of diagnosis leading to high mortality. This report describes the case of a 53-year-old man who had suffered from acute chest pain. The electrocardiogram showed the ST segment ele-vation in lead aVR and ST-T wave changes in leads I, II and V4-6. Elevated D-dimer levels and cardi-ac enzymes were also observed. Acute myocardial infarction caused by the left main coronary artery obstruction was initial diagnosed. Coronary angiogram was performed immediately and the result indicated non-obstructive coronary artery. However, cardiogenic shock with persistent chest pain was discovered. Aortic dissection, pulmonary thromboembolism and cardiac tamponade were gradually excluded. Through detailed review and analysis of medical history, physical assessment and image ex-aminations with echocardiography, chest computed tomography and coronary angiogram, a ruptured sinus of Valsalva aneurysm was eventually diagnosed based on image examinations which revealed left-to-right shunt communicating with the right-sided heart chambers. The patient received emergen-cy right coronary sinus aneurysm repairment and aortic valve replacement surgery. Symptoms with chest pain and shock gradually disappeared and left ventricular function was restored postoperatively. The patient demonstrated excellent recovery. In facing relevance diagnostics for patients with acute chest pain and hemodynamic instability, a ruptured sinus of Valsalva aneurysm must be considered to endure best treatment timing if heart auscultation reveals S1 and S2 continuous murmurs.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Two cases of sudden leaflet dehiscence after transcatheter aortic valve replacement

BackgroundTranscatheter aortic valve replacement (TAVR) has caused a paradigm shift in the treatment of severe aortic stenosis. Although less invasive and good early results of TAVR have been reported, the long-term durability of the transcatheter aortic valve is still unclear.Case presentationWe performed an emergent surgical aortic valve replacement (SAVR) for two cases of acute heart failure due to sudden transcatheter aortic valve dehiscence after 7 or 6 years of primary TAVR. In both cases, transthoracic echocardiography revealed severe transvalvular regurgitation of the transcatheter aortic valve. Intraoperative findings revealed dehiscence on both sides of the anatomical non-coronary cusp without evident signs of degeneration, such as thickening, calcification, or infection. The postoperative course of the cases was uneventful, and the patients were discharged home on days 20 and 48 after the reoperation.ConclusionsAlthough the cause of the valvular disease is unknown, we are seriously concerned that the number of similar cases will increase in the future. We should be cautious in expanding the application of TAVR without evidence of long-term safety.