Form Of Valvular Heart Disease Research Articles

FOXC1 and FOXC2 Ablation Causes Abnormal Valvular Endothelial Cell Junctions and Lymphatic Vessel Formation in Myxomatous Mitral Valve Degeneration.

Mitral valve (MV) disease including myxomatous degeneration is the most common form of valvular heart disease with an age-dependent frequency. Genetic evidence indicates that mutations of the transcription factor FOXC1 are associated with MV defects, including MV regurgitation. In this study, we sought to determine whether murine Foxc1 and its closely related factor, Foxc2, are required in valvular endothelial cells (VECs) for the maintenance of MV leaflets, including VEC junctions and the stratified trilaminar ECM (extracellular matrix). Adult mice carrying tamoxifen-inducible, vascular endothelial cell (EC), and lymphatic EC-specific, compound Foxc1;Foxc2 mutations (ie, EC-Foxc-DKO and lymphatic EC-Foxc-DKO mice, respectively) were used to study the function of Foxc1 and Foxc2 in the maintenance of MVs. The EC and lymphatic EC mutations of Foxc1/c2 were induced at 7 to 8 weeks of age by tamoxifen treatment, and abnormalities in the MVs of these mutant mice were assessed via whole-mount immunostaining, immunohistochemistry/RNAscope, Movat pentachrome/Masson Trichrome staining, and Evans blue injection. EC deletions of Foxc1 and Foxc2 in mice resulted in abnormally extended and thicker MVs by causing defects in the regulation of ECM organization with increased proteoglycan and decreased collagen. Notably, reticular adherens junctions were found in VECs of control MV leaflets, and these reticular structures were severely disrupted in EC-Foxc-DKO mice. PROX1 (prospero homeobox protein 1), a key regulator in a subset of VECs on the fibrosa side of MVs, was downregulated in EC-Foxc1/c2 mutant VECs. Furthermore, we determined the precise location of lymphatic vessels in murine MVs, and these lymphatic vessels were aberrantly expanded and dysfunctional in EC-Foxc1/c2 mutant MVs. Lymphatic EC deletion of Foxc1/c2 also resulted in similar structural/ECM abnormalities as seen in EC-Foxc1/c2 mutant MVs. Our results indicate that Foxc1 and Foxc2 are required for maintaining the integrity of the MV, including VEC junctions, ECM organization, and lymphatic vessel formation/function to prevent myxomatous MV degeneration.

Sex Differences in Epidemiological Distribution and Outcomes of Surgical Mitral Valve Disease.

Mitral valve (MV) disease is the most common form of valvular heart disease. Findings that indicate women have a higher risk for unfavorable outcomes than men remain controversial. This study aimed to determine the sex-based differences in epidemiological distributions and outcomes of surgery for MV disease.Methods and Results: Overall, 18,572 patients (45.3% women) who underwent MV surgery between 2001 and 2018 were included. Outcomes included in-hospital death and all-cause mortality during follow up. Subgroup analysis was conducted across different etiologies, including infective endocarditis (IE), degenerative, ischemic, and rheumatic mitral pathology. The overall MV repair rate was lower in women than in men (20.5% vs. 30.6%). After matching, 6,362 pairs (woman : man=1 : 1) of patients were analyzed. Women had a slightly higher risk for in-hospital death than men (10.8% vs. 9.8%; odds ratio [OR]: 1.11, 95% confidence interval [CI]: 0.99-1.24; P=0.075). Women tended to have a higher incidence of de novo dialysis (9.8% vs. 8.6%; P=0.022) and longer intensive care unit stay (8 days vs. 7.1 days; P<0.001). Women with IE had poorer in-hospital outcomes than men; however, there were no sex differences in terms of all-cause mortality. Sex-based differences of MV intervention still persist. Although long-term outcomes were comparable between sexes, women, especially those with IE, had worse perioperative outcomes than men.

Impact of biological sex on valvular heart disease, interventions, and outcomes.

Valvular heart disease (VHD) is common, affecting>14% of individuals aged >75, and is associated with morbidity, including heart failure and arrhythmia, and risk of early mortality. Increasingly, important sex differences are being found between males and females with VHD. These sex differences can involve the epidemiology, pathophysiology, presentation, diagnosis, and outcomes of the disease. Females are often disadvantaged, and female sex has been shown to be associated with delayed diagnosis and inferior outcomes in various forms of VHD. In addition, the unique pathophysiologic state of pregnancy is associated with increased risk for maternal and fetal morbidity and mortality in many forms of VHD. Therefore, understanding and recognizing these sex differences, and familiarity with the attendant risks of pregnancy and management of pregnant females with VHD, is of great importance for any primary care or cardiovascular medicine practitioner caring for the female patient. This review will outline sex differences in aortic, mitral, pulmonic, and tricuspid VHD, with particular focus on differences in pathophysiology, clinical presentation, and outcomes. In addition, the pathophysiology and management implications of pregnancy will be discussed.

Ten-year outcomes of surgical treatment of ischemic mitral regurgitation-a retrospective study

Background: Mitral regurgitation (MR) is a prevalent form of valvular heart disease, affecting millions of people worldwide. Primary MR occurs due to mitral valve dysfunction, while secondary MR is caused by left ventricle remodelling. The study aimed to investigate the long-term outcomes of patients with IMR after undergoing coronary surgeries, including coronary artery bypass graft (CABG) with or without mitral valve repair or replacement. Methods: Retrospective, observational study design was planned. Pre-operative and postoperative data were collected from 68 patients with ischemic MR who underwent coronary artery bypass surgery, with or without Mitral valve replacement or mitral valve repair. (That is CABG only/CABG+MVR/CABG+MVr) in the year between 2001 and 2010. Patients followed up at 3 months, 1 year, and 10 years after the procedure. Results: Significant improvements in New York heart association (NYHA) functional class and MR status were observed for all three surgical groups, namely, a) CABG surgery, b) coronary artery bypass graft surgery with mitral valve replacement (CABG+MVR), and c) coronary artery bypass graft surgery with mitral valve repair (CABG+MVr). After 10 years, redo surgery rates were minimal for CABG only and CABG+MVR groups of patients, while CABG+MVr required 20% redo surgery. Postoperative complications, such as left ventricle failure, were seen in the immediate postoperative period, leading to the death of those patients 3 months following the surgery. After 3 months, complications decreased over time for all groups. Conclusions: Surgical interventions effectively improved functional outcomes and reduced MR severity in patients with ischemic MR. Redo surgery rates were low for most patients, indicating the success of the initial procedures.

Engineered Extracellular Vesicle-Based Therapies for Valvular Heart Disease.

Valvular heart disease represents a significant burden to the healthcare system, with approximately 5 million cases diagnosed annually in the US. Among these cases,calcific aortic stenosis (CAS) stands out as the most prevalent form of valvular heart disease in the aging population. CAS is characterized by theprogressive calcification of the aortic valve leaflets,leading to valve stiffening. While aortic valve replacement is the standard of care for CAS patients, the long-term durability of prosthetic devices is poor, calling for innovative strategies to halt or reverse disease progression. Here, we explor the potentialuse of novel extracellular vesicle (EV)-based nanocarriers for delivering molecular payloads to the affected valvetissue. This approach aims to reduce inflammation and potentially promote resorption of the calcified tissue. Engineered EVs loaded with the reprogramming myeloid transcriptionfactors, CEBPA and Spi1, known tomediatethe transdifferentiation of committed endothelialcells into macrophages. We evaluated the ability of these engineered EVs to deliver DNA and transcripts encoding CEBPA and Spilinto calcified aortic valve tissue obtainedfrom patients undergoing valve replacement due to aortic stenosis.We also investigated whether these EVs could induce the transdifferentiation of endothelial cells into macrophage-like cells. Engineered EVs loaded with CEBPA + Spi1 were successfully derived from human dermal fibroblasts. Peak EV loading was found to be at 4h after nanotransfection of donor cells. TheseCEBPA + Spi1 loaded EVs effectively transfected aortic valve cells, resulting in thesuccessful induction oftransdifferentiation, both in vitro with endothelial cells and ex vivo withvalvular endothelial cells, leading to the development ofanti-inflammatory macrophage-like cells. Our findings highlight the potential of engineered EVs as a next generation nanocarrier to target aberrant calcifications on diseased heart valves. This development holds promise asa novel therapy for high-risk patientswho may not be suitable candidates for valve replacement surgery. The online version contains supplementary material available at 10.1007/s12195-023-00783-x.

Transcatheter Mitral Valve Replacement with Dedicated Devices.

Mitral regurgitation is the most common form of valvular heart disease. The anatomy and pathophysiology of mitral valve regurgitation are very complex, and dedicated devices are required for transcatheter mitral valve replacement in patients with a high or prohibitive surgical risk. In the United States, all transcatheter mitral valve replacement devices are still being studied and are not yet approved for commercial use. Early feasibility studies have demonstrated good technical success and short-term outcomes, but larger samples and longer-term outcomes still need to be assessed. Furthermore, significant advances in device technology, delivery systems, and implantation techniques are essential to avoid left ventricular outflow tract obstruction, and valvular and paravalvular regurgitation as well as ensuring good anchoring of the prosthesis.

Fully Automated Artificial Intelligence Assessment of Aortic Stenosis by Echocardiography

Aortic stenosis (AS) is a common form of valvular heart disease, present in over 12% of the population age 75years and above. Transthoracic echocardiography (TTE) is the first line of imaging in the adjudication of AS severity but is time-consuming and requires expert sonographic and interpretation capabilities to yield accurate results. Artificial intelligence (AI) technology has emerged as a useful tool to address these limitations but has not yet been applied in a fully hands-off manner to evaluate AS. Here, we correlate artificial neural network measurements of key hemodynamic AS parameters to experienced human reader assessment. Two-dimensional and Doppler echocardiographic images from patients with normal aortic valves and all degrees of AS were analyzed by an artificial neural network (Us2.ai) with no human input to measure key variables in AS assessment. Trained echocardiographers blinded to AI data performed manual measurements of these variables, and correlation analyses were performed. Our cohort included 256 patients with an average age of 67.6±9.5years. Across all AS severities, AI closely matched human measurement of aortic valve peak velocity (r=0.97, P<.001), mean pressure gradient (r=0.94, P<.001), aortic valve area by continuity equation (r=0.88, P<.001), stroke volume index (r=0.79, P<.001), left ventricular outflow tract velocity-time integral (r=0.89, P<.001), aortic valve velocity-time integral (r=0.96, P<.001), and left ventricular outflow tract diameter (r=0.76, P<.001). Artificial neural networks have the capacity to closely mimic human measurement of all relevant parameters in the adjudication of AS severity. Application of this AI technology may minimize interscan variability, improve interpretation and diagnosis of AS, and allow for precise and reproducible identification and management of patients with AS.

Transcatheter Mitral Valve Repair Versus Transcatheter Mitral Valve Replacement in Patients with Mitral insufficiency

Mitral regurgitation (MR) is the most prevalent form of valvular heart disease. Transcatheter mitral valve repair (TMVr) and transcatheter mitral valve replacement (TMVR) have recently emerged as alternatives to open heart surgical repair or replacement. However, studies on the comparative outcomes of TMVr and TMVR are limited. This study aims to compare the demographics, complications and outcomes of TMVr and TMVR based on a real-world investigation of the National Inpatient Sample (NIS) database. From 2016-2018 in the NIS database, a total of 210 and 3370 patients who underwent TMVR and TMVr, respectively, were selected. The mean age of the patients was 75.99 years (TMVr) and 69.6 years (TMVR) (p <0.01). The mortality of patients who received TMVR was higher compared to that of patients who were treated with TMVr (8.1 vs. 1.9%, p <0.01). The patients who underwent TMVR were more likely to suffer perioperative complications including blood transfusions (16.2 vs. 5.0%, p <0.01) and acute kidney injury (22.9 vs. 13.3%, p <0.01). The average cost of treatment was higher (USD $278864 vs. USD $216845, p <0.01), and the average duration of hospitalization was longer (8.73 vs. 4.17 d, p <0.01) for TMVR compared to TMVr. When taking into account perioperative comorbidities and other factors, TMVR was associated with a worse adjusted in-hospital mortality (odds ratio [OR], 3.307 [95% CI, 1.533-7.136]; p <0.01). TMVr is associated with lower mortality, peri-procedural morbidity, and resource use compared to TMVR. A patient-centered approach can help guide decision-making about the choice of intervention for the individual patient and more studies evaluating the long-term outcomes and durability of TMVR are needed at present.

SENILE CALCIFIC AORTIC VALVE STENOSIS: MODERN INTERVENTIONS IN UKRAINE

Background. Aortic valve stenosis remains the most dominant form of valvular heart disease. The aortic valve area below 1.0 cm2 is an assignment to the interventions. The modern senile aortic valve stenosis treatment options are mini-surgical valve replacement (mini-SVR), balloon aortic valvuloplasty (BAV), and transcatheter aortic valve implantation (TAVI). This study aims to inform readers about up-to-date interventions for patients with senile calcific aortic valve stenosis in Ukraine, based on the experience of the Cardiac surgery department in Lviv, Ukraine.&#x0D; Methods. From a single-centre retrospective registry (10/2015-02/2022), 204 patients were included. One hundred seven patients underwent mini-SVR, tree BAV, and four – TAVI. Diagnostic modalities used to assess the anatomy of the aortic valve were: ECHO, ECG-gated computer tomography with aortic valve calcic scoring, and Angiography. Interventional procedure techniques were BAV, TAVI; surgical: mini-SVR via upper ministernotomy or right-sided minithoracotomy.&#x0D; Results. Anatomical assessment of the aortic valve in senile aortic valve stenosis was based on the morphology of the aortic valve (bicuspid or tricuspid aortic valve), asymmetrical hypertrophy of the left ventricular outflow tract, and coronary ostia height. The age-related anatomical features were calcium deposits in the leaflet, coronary ostium and mitral annular calcification. Ministernotomy (in 67 cases) and a right-sided minithoracotomy (in 40 cases) were performed to secure the “heart step” without instability of the chest cage with the smaller valve size implantation than was expected before. Preserving the chest cage and avoiding aortic cross-clamp/cardio-pulmonary bypass were advantages of TAVI. Fragile patients expected TAVI risks: aortic root damage, paravalvular leak, moderate aortic insufficient, the risk of atrioventricular block and embolic stroke, and kidney dysfunction.&#x0D; Conclusions. Mini-surgical valve replacement and transcatheter aortic valve implantation are accessible procedures in Ukraine for senile calcific aortic valve stenosis treatment.

Classification of Valvular Regurgitation Using Echocardiography

Echocardiography (echo) is a commonly utilized tool in the diagnosis of various forms of valvular heart disease for its ability to detect types of cardiac regurgitation. Regurgitation represents irregularities in cardiac function and the early detection of regurgitation is necessary to avoid invasive cardiovascular surgery. In this paper, we focussed on the classification of regurgitations from videographic echo images. Three different types of regurgitation are considered in this work, namely, aortic regurgitation (AR), mitral regurgitation (MR), and tricuspid regurgitation (TR). From the echo images, texture features are extracted, and classification is performed using Random Forest (RF) classifier. Extraction of keyframe is performed from the video file using two approaches: a reference frame keyframe extraction technique and a redundant frame removal technique. To check the robustness of the model, we have considered both segmented and nonsegmented frames. Segmentation is carried out after keyframe extraction using the Level Set (LS) with Fuzzy C-means (FCM) approach. Performances are evaluated in terms of accuracy, precision, recall, and F1-score and compared for both reference frame and redundant frame extraction techniques. K-fold cross-validation is used to examine the performance of the model. The performance result shows that our proposed approach outperforms other state-of-art machine learning approaches in terms of accuracy, precision, recall, and F1-score.

Trends in Medicare Payments for Beneficiaries With Aortic Stenosis.

Background Aortic stenosis (AS) is the most common form of valvular heart disease with an increasing prevalence. Management of AS has changed dramatically with the introduction of transcatheter aortic valve replacement (AVR). The shift in management of AS, combined with an aging population, may increase the cost of patients with AS in the US health care system. Methods and Results We performed a retrospective cohort study, using inpatient, carrier, and outpatient data from a 20% Medicare fee-for-service beneficiaries' sample from 2008 to 2019 and included beneficiaries, aged ≥65 years. We identified beneficiaries with a diagnosis of AS and stratified the sample into 3 age groups: 66 to 74, 75 to 84, and ≥85 years. We evaluated the crude and adjusted changes in annual Medicare payments (total and component) per beneficiary. We identified 1 887 340 (1.6%) Medicare beneficiaries diagnosed with AS. The average annual spending for Medicare beneficiaries with AS was $19 241 in 2010 and increased annually by $301 to $23 174 in 2019 (P<0.0001). Annual Medicare payments on patients with AS increased from $2 894 995 131 in 2010 to $4 619 077 182 in 2019, a difference of >1.7billion dollars. Inpatient spending increased 1.1% per year, with the highest increase in patients aged ≥85 years (1.9%). The percentage of beneficiaries undergoing surgical AVR decreased from 3.7% to 1.6%, and annual spending on surgical AVR decreased an average of 7.2% per year. The percentage of beneficiaries undergoing transcatheter AVR increased from 0% in 2010 to 3.8% in 2019, and annual spending for transcatheter AVR increased by 458.7% per year. Conclusions Although average annual Medicare spending per beneficiary modestly increased over the study period, the increase in the prevalence of AS and the proportion of beneficiaries undergoing (transcatheter) interventions for AS led to a substantial increase in overall Medicare spending among patients with AS.

Artificial intelligence to assist physicians in identifying patients with severe aortic stenosis

Severe aortic stenosis (AS) remains a life-threatening form of valvular heart disease. Missed diagnosis of severe AS can lead to a delay in treatment and poor outcomes, but there are limited tools available to help physicians minimize the risk of missed diagnoses. Here, a Diagnostic Precision Algorithm was developed from a de-identified dataset of 1,147,157 echocardiographic reports from 35 institutions to help physicians identify patients who may have incorrectly not received a severe AS diagnosis and prioritize these findings for secondary clinical review. Inclusion criteria required the presence of three standard Doppler indices (aortic valve area [AVA], jet velocity [JV], and mean pressure gradient [MPG]), with at least one in the severe AS range (per AHA/ACC criteria), and documented assessment of AS severity. Included reports were divided into training/validation (N = 18,040) and test (N = 4,533) datasets. Using a decision tree algorithm, a Severe AS Index that estimates the likelihood that a patient with similar values would have severe AS diagnosed was developed from the training/validation dataset using AVA, JV, and MPG measurements, as well as left ventricular ejection fraction (LVEF) when available. This was compared to the reported interpretation of the echocardiogram, which was extracted using a validated natural language processing algorithm that demonstrated 100% accuracy across a sample of 600 echocardiographic reports. When the prediction of the Severe AS Index and the report interpretation disagreed, the patient was flagged for secondary review. Across the test dataset, the Diagnostic Precision Algorithm successfully predicted the actual severe AS population proportion with an average error of 2.1% points when LVEF was available and 2.2% points when LVEF was not available. The Diagnostic Precision algorithm was highly accurate at identifying the likelihood of severe AS diagnosis and applying this information to prioritize physician follow-up for patients who may have undiagnosed severe disease.

A Case of Transient Mitral Regurgitation: Not Everything Is Always What It Seems

Mitral regurgitation (MR) is a common form of valvular heart disease that is associated with significant morbidity and mortality. MR can be broadly classified into 2 different categories: primary and secondary MR. Primary MR usually is caused by leaflet abnormalities, whereas secondary MR is a chronic disease secondary to geometric distortion of both the annulus and subvalvular apparatus because of left ventricular remodeling. Without acute changes in loading conditions, myocardial blood flow, or rhythm disturbances, functional MR typically is not transient. In this E-Challenge, the authors show a transient and completely reversible acute and severe form of functional MR with the use of multimodal echocardiography.

The current landscape of lipoprotein(a) in calcific aortic valvular disease.

Calcific aortic stenosis (CAVS) is the most common form of valvular heart disease in developed countries, increasing in prevalence with the aging population. Surgical or transcatheter aortic valve replacement is the only treatment available for CAVS. However, these interventions are typically reserved for severe symptomatic aortic stenosis (AS). The purpose of this review is to summarize the recent literature in uncovering the underlying pathophysiology of CAVS in the setting of lipoprotein (a) [Lp(a)] and emerging therapies targeting Lp(a) which may help halt disease progression in CAVS. Pathophysiologic, epidemiological, and genetic studies over the past two decades have provided strong evidence that Lp(a) is an important mediator of calcific aortic valvular disease (CAVD). Studies suggest that Lp(a) is a key carrier of pro-calcifying oxidized phospholipids (OxPL). The metabolism of OxPL results in a pro-inflammatory state and subsequent valvular thickening and mineralization through pro-osteogenic signaling. The identification of Lp(a) as a causal mediator of CAVD has allowed for opportunities for emerging therapeutic agents which may slow the progression of CAVD (Fig. 1JOURNAL/cocar/04.03/00001573-202109000-00007/figure1/v/2021-08-04T080204Z/r/image-jpeg). This review summarizes the current knowledge on the association of Lp(a) with CAVD and ongoing studies of potential Lp(a)-lowering therapies. Based on the rate-limiting and causal role of Lp(a) in progression of CAVS, these therapies may represent novel pharmacotherapies in AS and inform the developing role of Lp(a) in the clinical management of CAVD.

Epidemiological Features of Aortic Stenosis in a French Nationwide Study: 10-Year Trends and New Challenges.

BackgroundAortic stenosis (AS) is one of the most common forms of valvular heart disease. Our aim was to estimate the burden of AS in the hospital in France, describe patient characteristics, and evaluate the mortality rate and temporal trends.Methods and ResultsAll patients hospitalized for AS in France between 2006 and 2016 were identified from the national hospital discharge database. Patients’ sociodemographic, medical, and surgical characteristics and temporal trends were described. All AS‐related deaths between 2000 and 2014 were identified using death certificates. In 2016, 26 071 patients were hospitalized for AS: 56.5% were men with an average age of 77 years. The all‐cause mortality rate at 1 year postindex stay was 11%. The rate of patients hospitalized for AS increased by 59% between 2006 and 2016, reaching 38.7/100 000 person‐years in 2016. This increase was most pronounced in patients aged >75 years. The number of transcatheter aortic valve implantations increased following their introduction in 2010. In 2016, 44% of patients were treated with aortic valve surgery during the index hospital stay or following year (mean age, 71.5 years), and 34% were treated with transcatheter aortic valve implantation (mean age, 83.0 years). In 2014, 6186 deaths caused by AS were identified in death certificates: 41.6% were men with an average age of 87 years. The age‐standardized mortality rate increased by 5% between 2000 and 2014, reaching 8.5/100 000 person‐years in 2014.ConclusionsThe rate of patients hospitalized for AS increased in recent years in line with the higher life expectancy and introduction of transcatheter aortic valve implantation. Mortality increased more moderately.

Features of carcinoid heart disease identified by cardiac computed tomography

BackgroundCarcinoid heart disease (HD) is a rare form of valvular heart disease, the features of which have not been fully described by cardiac computed tomography (CT). MethodsAll patients with carcinoid HD that underwent cardiac CT, either preoperatively or for assessment of coronary arteries, between Apr-2006 and Dec-2019 at the Royal Free Hospital, UK, were reviewed. ResultsOf 32 patients with carcinoid HD, 29 (91%) had heart valve involvement. Abnormalities of the tricuspid and pulmonary valves were present in all patients, affecting all three leaflets in 23/26 (89%) unoperated patients for both valves. The aortic valve was affected in 4/29 (14%) patients and the mitral valve in 5/29 (17%). Left heart valves were affected in 6/29 (21%) patients. One patient (1/29; 3%) had all four valves affected. Severe changes with significant valvular regurgitation were seen in ≥75% of patients with tricuspid, pulmonary, and aortic valve abnormalities. Three patients had carcinoid myocardial metastases (3/32; 9%) and one patient had constrictive pericarditis (1/32; 3%). Ten patients had surgery of whom four (40%) had invasive coronary angiography preoperatively. Ten patients had a patent foramen ovale. Cardiac CT allowed an accurate assessment of damage to different leaflets/cusps, particularly of the pulmonary valve, where visualization with echocardiography was often (3/8; 38%) incomplete. ConclusionCardiac CT is a powerful tool for assessment of cardiac valve abnormalities, coronary arteries and the spatial relationship of coronary arteries with myocardial metastasis in patients with carcinoid HD, and should form part of multimodal imaging of this complex pathology.

Epidemiology of left sided valvular heart disease in patients undergoing echocardiography in a Sub-Saharan African population, South West region of Cameroon

Background: Historically, rheumatic heart disease (RHD) has been the dominant form of valvular heart disease (VHD) in developing countries including Sub-Saharan Africa. But other forms of VHD are emerging due to increasing life expectancy and improvement in the socio-economic status. We aimed to describe the demographic characteristics, etiology and pattern of left sided VHD in Buea, South West region of Cameroon.

MR Product as a Novel Diagnostic Indicator for Chronic Secondary Mitral Regurgitation.

BackgroundChronic secondary mitral regurgitation (SMR) is a common form of valvular heart disease. Its diagnosis through echocardiography is challenging and dependent on subjective interpretations. The subjective error to diagnose SMR can be reduced by developing accurate predictive quantitative parameters that support echocardiographic interpretations and clinical manifestations. The present study aims to develop a new diagnostic indicator for chronic SMR. The new indicator called MR product is the product of left atrial diameter (LAD) and left ventricular internal dimension at end-systole (LVIDs).Materials and MethodsAn analytical, case-control study was conducted from transthoracic echocardiography (TTE) reports of 720 patients performed according to the guidelines of the American Society of Echocardiography. The LAD and LVIDs were measured using the standard M Mode TTE. Out of the 720 patients who underwent TTE, 300 patients were diagnosed with chronic SMR by experienced clinicians. Only 115 of those 300 patients met the inclusion criteria for chronic SMR. ResultsThe MR product was significantly associated with chronic SMR (rho = 0.83) and predicted it with an odds ratio of 1.014 (p < 0.001). The MR product was able to diagnose SMR with a sensitivity of 94.8% and a specificity of 92.2%, respectively, for a cut off value of 1,045 mm2.ConclusionA new parameter called MR product (LAD multiplied with LVIDs) has very high sensitivity and specificity for SMR. Therefore, it can aid in establishing its diagnosis, along with other diagnostic modalities. The new parameter may also potentially increase the diagnostic accuracy of the disease.

Indications and Results of Repair of the Rhumatismal Valve in Children in Senegal concerning 63 Cases

In Africa, acute rheumatic fever is endemic. Cardiac involvement is one of the most common complications in the form of valvular heart disease representing all damages to the heart valves. It is in this perspective that we realized this study whose general objective was to evaluate the results of mitral repair surgery in children in Senegal and the specific objective was to state the indications for mitral repair surgery and assess the results in terms of morbidity and mortality. This is a retrospective and analytical monocentric study, in the thoracic and cardiovascular surgery department of FANN National University Hospital Center in Dakar. It took place over a period of 30 months. All the patients who underwent mitral surgery, aged less than 18 years were included. The total number of patients was 63, including 39 girls and 24 boys, a sex ratio of 0.62. The average age at the time of the surgery was 12 years old [5 - 17]. The functional symptomatology was dominated by the dyspnea found in all the patients. Cardiac ultrasound was diagnosed with mitral regurgitation in all patients. For all surgical procedures, the approach was a vertical midline sternotomy. The mitral valve was approached by left atriotomy in 40 patients (63.5%) and by transseptal way in 23 patients. All patients had undergone mitral valve repair associated or not with either aortic valve repair in 9 patients (14.2%), aortic valve replacement in 3 patients (4.8%), or one tricuspid valve repair in 31 patients (49%). The average duration of intubation was 6 hours [2 - 52]. The average length of stay in intensive care was 2 days. Postoperative complications have been observed. Surgery was performed in 10 patients with 3 mitral valve replacements, 2 aortic valve replacements, a double mitral and an aortic valve replacement associated with a tricuspid repair and in 4 cases a perfection of their mitral repair. Early and late surgical mortality was zero. The average follow-up time for our patients was 9 months [1 - 26]. During their follow-up, the evolution was favorable in 89% of patients who no longer had any functional symptoms.

Lp(A)-Induced Metabolic Activity In Valve Interstitial Cells Drives Inflammation And Ultimately Calcification

Background and Aims: Calcific Aortic Valve Stenosis (CAVS) is the most common form of valvular heart disease and to date, no effective treatments slowing down disease progression are available. Lipoprotein(a) [Lp(a)], a major carrier of oxidized phospholipids (oxPLs), is a causal, genetic risk factor for CAVS. Valve Interstitial Cells (VICs) are crucial in driving calcification and progressive valvular narrowing. To date, the exact molecular mechanism remains unknown. However, previous studies suggest that Lp(a) induces metabolic reprogramming of the vessel wall, thereby driving sustained inflammation and atherogenesis. We hypothesized that the inflammatory and calcific response of Lp(a) is mediated by Lp(a)-induced metabolic alterations of VICs. Targeting these metabolic changes could potentially be used to reverse inflammation and prevent CAVS progression.