Valve Function Research Articles

A novel mouse model for mineral homeostasis disrupting induced calcific aortic valve stenosis

Abstract Background Calcific aortic valve disease (CAVD) is the most common valve disease that has been occurring with rapidly increasing morbidity. Chronic kidney disease (CKD) which disrupts mineral homeostasis due the impaired renal function, is one of the known factors, largely contributing to risk of CAVD, independent of atherosclerosis. To the best of our knowledge, there are few calcific aortic valve stenosis mouse models simulating conditions under CKD that develop hemodynamically significant stenosis as well as calcification, Purpose The purpose was to assess the feasibility to develop a mouse model of CAVD considering risks under CKD. Methods For this model, C57/BL6 mice were firstly underwent aortic valve wire injury by spring guidewires inserting into left ventricle via right common carotid artery. Vitamin D was subcutaneous injected on 3 consecutive days from the second day of aortic valve wire injury. Echocardiography was performed to evaluate aortic valve function at 7, 14 and 28 days. Then the mice were sacrificed and aortic valves were collected to make histological analysis. Results An obvious increase in aortic velocity was already observed at 7 days after injury by continuous echocardiographic assessment and remained stable from 14 days compared with sham mice. Alizarin red staining showed calcium nodules formation in valve leaflets 14 days after injury and became more conspicuous at 28 days. Aortic valve thickening, increased macrophage infiltration, fibrosis and remarkable osteogenic markers were found in aortic valves at 28 days after injury. Conclusions We develop a novel mouse model of CAVD, especially simulating risks under CKD and mineral homeostasis disrupting. This model may be a convenient and valuable tool to investigate the mechanism of CAVD and further explore potential therapeutic strategies.Fig1.Alizarin red staining aortic valvesFig2.Immunostaining of aortic valves

Assessment of aortic valve function in over 47,000 people using deep learning

Abstract Background Aortic valve (AV) stenosis (AS) is associated with a high global burden of mortality and morbidity. Previous studies suggest that even mild AS is associated with worse outcomes, prompting interest in AV function in a healthy population. The UK Biobank is a prospective cohort study with ∼500,000 participants of whom ∼10% have undergone cardiovascular MRI (cMRI). Purpose We aimed to develop a deep learning model to study AV function in cMRI at population level in the UK Biobank. Methods and Results We developed a U-Net based segmentation model with a ResNet34 encoder to study the velocity-encoded image series, computing peak velocity (cm/sec), mean peak gradient ("mean gradient"; mmHg), and aortic valve area (cm2) (AVA) in 47,223 participants. Next, we calculated reference values stratified by age and sex in participants without CVD. In healthy individuals (n=31,909), AVA was lower in older age groups, whereas peak velocity and mean gradient remained similar across age groups. Compared to women, men had greater AVA but similar peak velocity and mean gradient estimates. In the biomarker analysis (taken ∼9.5 years before cMRI), we observed an association of apolipoprotein B (ApoB) (0.033 SD increase per SD, P=3.1×10-12) and lipoprotein a (Lp (a)) (0.027 SD increase, P=4.8×10-07) with higher peak velocity. Using Mendelian Randomization, we found genetic evidence that Lp(a) causally contributes to higher peak velocity (β=0.04, P=6.4 × 10-10) and smaller AVA (β=-0.056, P=1.3 × 10-4). Similarly, ApoB causally contributes to higher peak velocity (β=0.072, P=1.3 × 10-6) and smaller AVA (β=-0.065, P=1.3 × 10-5) in Mendelian Randomization. Peak velocity was strongly associated with incident AV surgery (N=72, Hazard ratio [HR] 2.40 per SD, P=2.6×10-110) and AS (N=123, HR 2.10, P=7.7×10-138). The predictive power for AS was higher when using the top 10% vs the remaining 90% of distribution for mean gradient (N in top 10% with event=87, HR 24.91, P=2.4×10-43) and peak velocity (N=92, HR 33.01, P=3.0×10-43). After excluding individuals with at least mild aortic stenosis (peak velocity > 2m/sec, mean gradient >20mmHg, AVA >1.5 cm2) the top 10% of the remaining population was still highly predictive for AS using mean gradient (N=30, HR 8.90, P=9.4×10-15) and peak velocity (N=35, HR 13.15, P=1.6×10-18). Conclusion We found both epidemiological and causal genetic evidence that elevated ApoB and Lp(a) cause a reduction in AVA. Even aortic velocities below the threshold for mild AS were predictive of future clinical disease, suggesting that there may be a role for monitoring at AVA below the current threshold for mild AS. Future work is needed to understand whether clinical outcomes are better predicted by universal or sex-specific cutoffs.Figure 1:Workflow of deep learning modeHR of incident valvular disease

Long-Term Clinical and Echocardiographic Outcomes Following the Ross Procedure

The Ross procedure as treatment for adults with aortic valve disease (AVD) has been the subject of renewed interest. To evaluate the long-term clinical and echocardiographic outcomes following the Ross procedure for the treatment of adults with AVD. This post hoc analysis of a randomized clinical trial included adult patients (age <69 years) who underwent a Ross procedure for the treatment of AVD, including those with active endocarditis, rheumatic AVD, decreased ejection fraction, and previous cardiac surgery. The trial, conducted from September 1, 1994, to May 31, 2001, compared homograft root replacement with the Ross procedure at a single center. Data after 2010 were collected retrospectively in November and December 2022. Ross procedure. The primary end point was long-term survival among patients who underwent the Ross procedure compared with that in the age-, country of origin- and sex-matched general population. Secondary end points were freedom from any reintervention, autograft reintervention, or homograft reintervention and time-related valve function, autograft diameter, and functional status. This study included 108 adults (92 [85%] male) with a median age of 38 years (range, 19-66 years). Median duration of clinical follow-up was 24.1 years (IQR, 22.6-26.1 years; 2488 patient-years), with 98% follow-up completeness. Of these patients, 9 (8%) had active endocarditis and 45 (42%) underwent reoperations. The main hemodynamic lesion was stenosis in 30 (28%) and regurgitation in 49 (45%). There was 1 perioperative death (0.9%). Twenty-five year survival was 83.0% (95% CI, 75.5%-91.2%), representing a relative survival of 99.1% (95% CI, 91.8%-100%) compared with the general population (83.7%). At 25 years, freedom from any reintervention was 71.1% (95% CI, 61.6%-82.0%); from autograft reintervention, 80.3% (95% CI, 71.9%-89.6%); and from homograft reintervention, 86.3% (95% CI, 79.0%-94.3%). Thirty-day mortality after the first Ross-related reintervention was 0% and after all Ross-related reinterventions was 3.8% (n = 1); 10-year survival after reoperation was 96.2% (95% CI, 89.0%-100%). This study found that the Ross procedure provided excellent survival into the third decade postoperatively that was comparable to that in the general population. Long-term freedom from reintervention demonstrated that the Ross procedure may be a durable substitute into late adulthood, showing a delayed but progressive functional decline. isrctn.org Identifier: ISRCTN03530985.

Abstract 13873: Deep Learning-Based GWAS of Aortic Valve Function Links 81 Loci to Aortic Stenosis Risk

Background &amp; Aims: The genetic influences on normal aortic valve (AV) function and their impact on aortic stenosis (AS) risk are of significant interest. We sought to identify common genetic determinants of normal variation in AV function, and to understand their relationship with clinical disease. Methods: We used deep learning to measure peak velocity, mean gradient, and aortic valve area from MRI in UK Biobank participants. We conducted genome-wide association studies (GWAS) in a subset of 44,780 participants without cardiovascular disease. We performed multi-trait analysis of GWAS (MTAG) to incorporate data from AV measurements and AS diagnoses in UK Biobank and FinnGen, and applied PRScs to construct polygenic scores (PGS). Results: In the unadjusted analysis, 26 loci were associated with at least one AV measurement. Incorporating the AS GWAS using MTAG, we identified 81 distinct loci (62 with AV traits, 54 with AS, 35 overlapping), including PCSK9 (β=0.032, P=5.8E-09) and LDLR (β=0.018, P=2.3E-10). Additional loci were associated with lipid metabolism (LPA, FADS2, SORT1), atherosclerosis (CDKN2B, ARHGEF26, OTUD7B, PRDM16), inflammation (IL6, KLF2, TRAF1), and cardiac development and aortic root function (SMAD3, GATA4, ELN, TBX20, TEX41). The PGS for the unadjusted mean gradient was predictive of AS in FinnGen (HR 1.36 for the top 5% of participants vs all others, P=1.8E-14). All of Us participants in the top 5% of the MTAG-adjusted peak velocity PGS had an HR of 2.5 for incident AS (P=4.4E-08). Mendelian randomization showed association between Lp(a) and LDL—but not ApoA—on greater peak velocity (P=2.7E-13, P=1.6E-16, and P=0.60, respectively). Conclusion: We identified 81 genetic loci linked to AV function or AS. AV measurement PGS were strong predictors of AS risk. ApoB and Lp(a) showed causal association with higher peak velocity. These findings have implications for the early pathogenesis of AS and suggest modifiable pathways as targets for prevention.

Abstract 14595: Leveraging Deep Learning to Elucidate Subclinical Aortic Stenosis Risk

Background and Aims: Aortic stenosis (AS) is associated with a high global burden of morbidity. Current guidelines do not fully define normal aortic valve (AV) function or mild AS. We aimed to study normal variation in AV function and address current gaps in knowledge. Methods: We developed a deep learning model to study velocity-encoded magnetic resonance imaging (MRI) in 47,223 UK Biobank participants. We calculated aortic valve area (AVA), peak velocity (PV), and mean gradient (MG). Results: In healthy individuals, we found an annual decrement of 0.03 cm2 in AVA. Normal variation in AV function was predictive of future AV surgery (HR 2.4 per SD increase in PV, P2.6E-110), heart failure (HR 1.23 per SD, P=2.4E-07), and coronary disease (HR 1.23 per SD, P=2.0E-14). Risk was still elevated when excluding participants with moderate-to-severe AS. We determined thresholds for abnormal AV function as being &gt;95% for all age groups in 31,909 healthy people. This established the boundary between normal variation and mild AS as any of: PV &gt;1.65m/s, MG &gt;4.9mmHg, and AVA &lt;2.1cm2 (men) or &lt;1.7cms2 (women). A total of 3,288 participants (7.0%) met the definition of mild AS which was associated with high risk for AV surgery (HR 57.2, P=4.4E-29). Over a mean 3.1±2.0 years of follow-up, the incidence of AV surgery was 0.02% in those with normal AV function and nearly 20% among participants with MG ≥10mmHg. Greater levels of ApoB, triglycerides, Lp(a), and inflammatory markers were associated with higher AV gradients. Conclusion: In this study, we report the largest analysis of AV function and cardiovascular disease in the general population with MRI using deep learning. We propose thresholds to define the lower bounds of mild AS and demonstrate a step change in cardiovascular risk between normal AV function and mild AS. Atherogenic and inflammatory biomarkers were associated with increased AV gradients. These findings may inform earlier surveillance and efforts to prevent complications of AS.

Abstract 14317: Arterial Thromboembolism in a Patient With Primary Antiphospholipid Antibody Syndrome and a Mitral Valve Mass

Background: Antiphospholipid antibody syndrome (APLAS) is an immune-mediated thrombophilia with multisystem venous and arterial thrombosis. Valvular disease is the most common cardiac presentation of APLAS, usually involving the mitral valve, and rarely affects valve function. Arterial thrombosis leading to myocardial infarction (MI) and left ventricular dysfunction have been described but are rare. We present a challenging case of APLAS with mitral valve involvement complicated by MI and new decompensated heart failure. Case: A 48-year-old male with obesity, hypertension, dyslipidemia, type 2 diabetes mellitus, obstructive sleep apnea, and triple-positive primary antiphospholipid antibody syndrome presented with a 3-day history of angina and dyspnea. He was started on rivaroxaban 9 years prior to presentation for breakthrough venous thrombosis while non-adherent to warfarin. During admission, he was found to have a mitral valve mass complicated by moderate mitral valve regurgitation, decompensated systolic heart failure, ST-segment elevation myocardial infarction, and multifocal strokes. Multimodality imaging (figure 1) in the setting of negative blood cultures suggested a non-infectious mitral valve mass with embolization as the culprit for his presentation. He ultimately underwent successful mechanical mitral valve replacement and bypass grafting with pathology confirming the diagnosis. Discussion: We highlight a case of a non-bacterial thrombotic mitral valve mass leading to moderate valvular regurgitation, acute heart failure, and arterial thromboembolic events in the setting of probable rivaroxaban failure. This case highlights the use of multimodality imaging and a team-based approach to correctly diagnose and treat a high-risk patient with APLAS and surgical valvular disease, as well as the inherent challenges of perioperative thrombotic and hemorrhagic risk assessment and monitoring.

Abstract 14286: Rapid Involution of a Bioprosthetic Transcatheter Aortic Valve Replacement Presenting as Late Bioprosthetic Stenosis

A 65 year old male with a bioprosthetic 29 mm Edwards Sapien Ultra S3 TAVR implant for symptomatic severe aortic stenosis presented for evaluation after a 30-day transthoracic echocardiogram demonstrated bioprosthetic valve stenosis. Following TAVR deployment, TEE showed normal bioprosthetic valve function without evidence of significant paravalvular regurgitation. There were no procedural complications. Echocardiogram performed 1-day post-implantation demonstrated expected transvalvular gradients and valve area. The patient reported immediate symptomatic improvement following TAVR. At 30 days post-implant, TTE demonstrated a peak velocity of 3.37 m/s, mean gradient of 29 mmHg, dimensionless index of 0.29, and effective valve orifice area of 0.9 cm2. This was associated with a progressive decline in exercise capacity. At 57 days post-implant, TEE showed tissue growth of the aortic root anterior to the valve stent, causing deformation and under-expansion of the valve architecture from a circular to an ovoid shape. Notably, the bioprosthetic leaflets did not appear thickened or calcified, but exhibited restricted motion as a result of the abnormal valve architecture. Peak velocity had further increased to 4.6 m/s, with a mean gradient of 57 mmHg, dimensionless index of 0.21, and calculated effective orifice area of 0.52 cm2. Bioprosthetic aortic valve valve stenosis is an expected complication of valve replacement, though typically characterized by progressive leaflet calcification and pannus formation over several years or by valve thrombosis. Here, we present a rare case of rapidly progressive bioprosthetic TAVR stenosis identified at 30 days post-implantation after normal morphology and gradients on immediate and 1-day imaging. Stenosis was characterized by a process of tissue growth anterior to the stent with involution and underexpansion of the stent architecture and morphologically normal leaflet tissue.

Abstract 14148: Left Ventricular Outflow Tract Pseudoaneurysm in a Pediatric Patient: An Unusual Presentation of Endocarditis

Description of Case: A 12-year-old male with known bicuspid aortic valve presented with one month of progressive weight loss and subjective fevers. Transthoracic echocardiogram was concerning for a new left ventricular outflow tract (LVOT) aneurysm (figure 1). His aortic valve stenosis and regurgitation had notably progressed compared to a prior study one year ago. He was urgently referred for cardiac computed tomographic angiography (CCTA), which demonstrated a pseudoaneurysm of the LVOT inferior to the aortic valve and irregularly thickened aortic valve leaflets with a notable perforation (figure 2). Blood cultures were positive for Viridans streptococci, confirming the diagnosis of infective endocarditis. The patient was referred for a Bentall procedure with LVOT pseudoaneurysm repair. Pre-operative transesophageal echocardiogram demonstrated a communication of the non-coronary cusp of the aortic valve and LVOT. Ultimately, aortic root replacement was performed with a 23mm homograft. Our patient recovered well from surgery and now has excellent clinical status with normal aortic valve function. Discussion: Pseudoaneurysm of the LVOT as a result of infective endocarditis is a rare diagnosis, especially in the pediatric population. Of the case reports published, it is most seen in the setting of infection involving the native aortic valve but has also been reported after aortic valve replacement. As in our patient, the most commonly reported location involves the mitral-aortic intervalvular fossa. Symptoms have insidious onset and the diagnosis requires a high level of suspicion. A multimodal imaging approach is warranted for optimal diagnosis and treatment.

Fluid–Structure Interaction Aortic Valve Surgery Simulation: A Review

The complicated interaction between a fluid flow and a deformable structure is referred to as fluid–structure interaction (FSI). FSI plays a crucial role in the functioning of the aortic valve. Blood exerts stresses on the leaflets as it passes through the opening or shutting valve, causing them to distort and vibrate. The pressure, velocity, and turbulence of the fluid flow have an impact on these deformations and vibrations. Designing artificial valves, diagnosing and predicting valve failure, and improving surgical and interventional treatments all require the understanding and modeling of FSI in aortic valve dynamics. The most popular techniques for simulating and analyzing FSI in aortic valves are computational fluid dynamics (CFD) and finite element analysis (FEA). By studying the relationship between fluid flow and valve deformations, researchers and doctors can gain knowledge about the functioning of valves and possible pathological diseases. Overall, FSI is a complicated phenomenon that has a great impact on how well the aortic valve works. Aortic valve diseases and disorders can be better identified, treated, and managed by comprehending and mimicking this relationship. This article provides a literature review that compiles valve reconstruction methods from 1952 to the present, as well as FSI modeling techniques that can help advance valve reconstruction. The Scopus, PubMed, and ScienceDirect databases were used in the literature search and were structured into several categories. By utilizing FSI modeling, surgeons, researchers, and engineers can predict the behavior of the aortic valve before, during, and after surgery. This predictive capability can contribute to improved surgical planning, as it provides valuable insights into hemodynamic parameters such as blood flow patterns, pressure distributions, and stress analysis. Additionally, FSI modeling can aid in the evaluation of different treatment options and surgical techniques, allowing for the assessment of potential complications and the optimization of surgical outcomes. It can also provide valuable information on the long-term durability and functionality of prosthetic valves. In summary, fluid–structure interaction modeling is an effective tool for predicting the outcomes of aortic valve surgery. It can provide valuable insights into hemodynamic parameters and aid in surgical planning, treatment evaluation, and the optimization of surgical outcomes.

Pharyngeal Obturator Prosthesis Ideal for Orthodontic Appliances: A Case Series

(1) Background: Cleft lip and palate is the most common congenital malformation of the head and neck. After surgical closure, velopharyngeal dysfunction can arise, which has implications for phonation, sucking, swallowing, middle ear function, and interpersonal well-being. This case series aimed to present an adaptation of the conventional pharyngeal obturator design in order to allow its use with fixed orthodontic appliances. (2) Methods: A new custom-made pharyngeal obturator device was built in order to enable a correct function of the velopharyngeal valve. The fabrication of the plate was made by altering the conventional Hawley retainer, replacing the Adams hooks with 0.9 mm spherical hooks and removing the buccal arch. (3) Results: The new pharyngeal obturator design was used in six cleft patients with fixed orthodontic appliances. The appliance was well tolerated and there was a slight improvement in auditory-perceptive evaluations. (4) Conclusions: The new pharyngeal bulb design proved to have good retention during fixed orthodontic treatment. Moreover, despite the short-term follow-up, it also showed a reduction in the severity of the hypernasality sentences.

Cardiac output, cerebral blood flow and cognition in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation: design and rationale of the CAPITA study.

Approximately one-third of patients with symptomatic severe aortic valve stenosis who are scheduled for transcatheter aortic valve implantation (TAVI) have some degree of cognitive impairment. TAVI may have negative cognitive effects due to periprocedural micro-emboli inducing cerebral infarction. On the contrary, TAVI may also have positive cognitive effects due to increases in cardiac output and cerebral blood flow (CBF). However, studies that systematically assess these effects are scarce. Therefore, the main aim of this study is to assess cerebral and cognitive outcomes in patients with severe aortic valve stenosis undergoing TAVI. In the prospective CAPITA (CArdiac OutPut, Cerebral Blood Flow and Cognition In Patients With Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation) study, cerebral and cognitive outcomes are assessed in patients undergoing TAVI. One day before and 3months after TAVI, patients will undergo echocardiography (cardiac output, valve function), brain magnetic resonance imaging (CBF, structural lesions) and extensive neuropsychological assessment. To assess longer-term effects of TAVI, patients will again undergo echocardiography and neuropsychological assessment 1year after the procedure. The co-primary outcome measures are change in CBF (in ml/100 g per min) and change in global cognitive functioning (Z-score) between baseline and 3‑month follow-up. Secondary objectives include change in cardiac output, white matter hyperintensities and other structural brain lesions. (ClinicalTrials.gov identifier NCT05481008) CONCLUSION : The CAPITA study is the first study designed to systematically assess positive and negative cerebral and cognitive outcomes after TAVI. We hypothesise that TAVI improves cardiac output, CBF and cognitive functioning.

Use of glutaraldehyde-treated autologous pericardial patch in complete atrioventricular septal defect repair.

Synthetic patch materials, such as polytetrafluoroethylene and knitted polyester, are commonly used for the repair of complete atrioventricular septal defects using the double-patch technique. In our study, we investigated the impact of glutaraldehyde-treated autologous pericardial patch on postoperative atrioventricular valve function. In this retrospective study, patients who underwent repair of complete atrioventricular septal defects using the double-patch technique between January 1, 2018, and May 15, 2023, at our pediatric cardiac center were included in the study. Patients were divided into two groups based on the type of patch used for the repair of the ventricular component of the atrioventricular septal defect: autologous pericardial patch (group 1) and polytetrafluoroethylene patch (group 2). Postoperative data of the patients were retrospectively analyzed. Thirty-four patients (57.6%) were female, and 25 (42.4%) were male, with a median age of 7 (5-18) months. The median body weight at the time of surgery was 5.5 (4.1-10) kilograms. Down syndrome was present in 45 (76.3%) patients. The autologous pericardium was used for ventricular septal defect closure in 44 (74.6%) patients (Group 1), while polytetrafluoroethylene was used in 15 (25.4%) patients (Group 2). Permanent cardiac pacemaker placement was required in 4 (6.8%) patients due to postoperative atrioventricular block. Hospital mortality was 11.9% (n=7). Among these cases, 4 (6.8%) patients died from low cardiac output syndrome, and 3 (5.1%) patients died from sepsis. Postoperative echocardiographic evaluation revealed insignificant residual ventricular septal defects in 17 (28.8%) patients. No significant differences were observed between the groups in terms of mortality and postoperative atrioventricular valve insufficiency. The median follow-up duration for discharged patients was 5 months (7 days to 3.9 years). Throughout the follow-up period, there were no reoperations due to valve insufficiency or left ventricular outflow tract obstruction. Glutaraldehyde-treated autologous pericardium is a safe material that can be confidently used for the repair of the ventricular component of complete atrioventricular septal defects. This patch material does not adversely affect atrioventricular valve function and allows for the successful closure of ventricular septal defects.

Recovery of Tricuspid Valve Function After Resection of a Primary Ovarian Carcinoid Tumor.

Recovery of Tricuspid Valve Function After Resection of a Primary Ovarian Carcinoid Tumor.

Percutaneous Intervention for a Stuck Mechanical Prosthetic Valve at Mitral Position as a Bailout Procedure in a High Surgical Risk Candidate

Mechanical heart valves are the preferred choice for younger individuals when the native valves cannot undergo repair, primarily due to their exceptional durability. It is crucial to meticulously manage the international normalized ratio (INR) within the range of 2.5 to 3.5 to ensure optimal valve function and minimise the risk of thromboembolic complications. Our case report serves to demonstrate the effectiveness of percutaneous balloon dilatation through transcatheter methods as an innovative and promising approach to release a stuck valve, representing a noteworthy addition to the spectrum of treatment options.

1-Year Outcomes Following Transfemoral Transseptal Transcatheter Mitral Valve Replacement: Intrepid TMVR Early Feasibility Study Results

BackgroundHigh surgical risk may preclude mitral valve replacement in many patients. Transcatheter mitral valve replacement (TMVR) using transfemoral transseptal access is a novel technology for the treatment of mitral regurgitation (MR) in high-risk surgical patients. ObjectivesThis analysis evaluates 30-day and 1-year outcomes of the Intrepid TMVR Early Feasibility Study in patients with ≥moderate-severe MR. MethodsThe Intrepid TMVR Early Feasibility Study is a multicenter, prospective, single-arm study. Clinical events were adjudicated by a clinical events committee; endpoints were defined according to Mitral Valve Academic Research Consortium criteria. ResultsA total of 33 patients, enrolled at 9 U.S. sites between February 2020 and August 2022, were included. The median age was 80 years, 63.6% of patients were men, and mean Society of Thoracic Surgeons Predicted Risk of Mortality for mitral valve replacement was 5.3%. Thirty-one (93.9%) patients were successfully implanted. Median postprocedural hospitalization length of stay was 5 days, and 87.9% of patients were discharged to home. At 30 days, there were no deaths or strokes, 8 (24.2%) patients had major vascular complications and none required surgical intervention, there were 4 cases of venous thromboembolism all successfully treated without sequelae, and 1 patient had mitral valve reintervention for severe left ventricular outflow tract obstruction. At 1 year, the Kaplan-Meier all-cause mortality rate was 6.7%, echocardiography showed ≤mild valvular MR, there was no/trace paravalvular leak in all patients, median mitral valve mean gradient was 4.6 mm Hg (Q1-Q3: 3.9-5.3 mm Hg), and 91.7% of survivors were in NYHA functional class I/II with a median 11.4-point improvement in Kansas City Cardiomyopathy Questionnaire overall summary scores. ConclusionsThe early benefits of the Intrepid transfemoral transseptal TMVR system were maintained up to 1 year with low mortality, low reintervention, and near complete elimination of MR, demonstrating a favorable safety profile and durable valve function.

The role of echocardiography in management of patients with hypertrophic cardiomyopathy (review)

The presented contains the discussion about the role of echocardiography in management of patients with hypertrophic cardiomyopathy (HCM). The article provides general information about the role of echocardiography in the diagnosis of the disease, clarification of the specific etiology of hypertrophy and differential diagnosis with secondary hypertrophy and phenocopies of HCMP. The features of right and left ventricular (LV) hypertrophy, determination of its predominant localization, phenotype, and conventionally used parameters for assessing myocardial hypertrophy, including the maximum LV wall thickness, LV myocardial mass and LV myocardial mass index, are discussed in detail. Knowledge of phenotypic variants helps to diagnose HCMP, to differentiated approach the management of patients and to choose the optimal treatment strategy. Special attention is paid to the assessment of the structure and function of the mitral valve (MV), the subvalvular apparatus and the phenomenon of systolic anterior motion of the MV responsible for the development of obstruction of the LV outflow tract. The previously existing opinion that cardiac abnormality in HCMP is limited only by hypertrophy of ventricular myocardium has recently undergone changes. Approximately 60% of patients with HCMP have at least one MV anomaly as a direct consequence of genetic mutations. The most common abnormalities that can be detected with echocardiography include elongation of the valvular leaflets and chords, prolapse of the valvular leaflets, hypertrophy, disposition and change in the number of papillary muscles. The importance and significance of assessing LV systolic and diastolic functions using echocardiography is emphasized. The role of transesophageal echocardiography in visualization of hypertrophy features of the MV structure and in the perioperative period during surgical correction of hypertrophied septum and valvular defects is also discussed.

Partial heart transplantation: Growing heart valve implants for children.

Heart valves serve a vital hemodynamic function to ensure unidirectional blood flow. Additionally, native heart valves serve biological functions such as growth and self-repair. Heart valve implants mimic the hemodynamic function of native heart valves, but are unable to fulfill their biological functions. We developed partial heart transplantation to deliver heart valve implants that fulfill all functions of native heart valves. This is particularly advantageous for children, who require growing heart valve implants. This invited review outlines the past, present and future of partial heart transplantation.

Impact of Variation in Commissural Angle between Fused Leaflets in the Functionally Bicuspid Aortic Valve on Hemodynamics and Tissue Biomechanics.

In subjects with functionally bicuspid aortic valves (BAVs) with fusion between the coronary leaflets, there is a natural variation of the commissural angle. What is not fully understood is how this variation influences the hemodynamics and tissue biomechanics. These variables may influence valvar durability and function, both in the native valve and following repair, and influence ongoing aortic dilation. A 3D aortic valvar model was reconstructed from a patient with a normal trileaflet aortic valve using cardiac magnetic resonance (CMR) imaging. Fluid-structure interaction (FSI) simulations were used to compare the effects of the varying commissural angles between the non-coronary with its adjacent coronary leaflet. The results showed that the BAV with very asymmetric commissures (120∘ degree commissural angle) reduces the aortic opening area during peak systole and with a jet that impacts on the right posterior wall proximally of the ascending aorta, giving rise to elevated wall shear stress. This manifests in a shear layer with a retrograde flow and strong swirling towards the fused leaflet side. In contrast, a more symmetrical commissural angle (180∘ degree commissural angle) reduces the jet impact on the posterior wall and leads to a linear decrease in stress and strain levels in the non-fused non-coronary leaflet. These findings highlight the importance of considering the commissural angle in the progression of aortic valvar stenosis, the regional distribution of stresses and strain levels experienced by the leaflets which may predispose to valvar deterioration, and progression in thoracic aortic dilation in patients with functionally bicuspid aortic valves. Understanding the hemodynamics and biomechanics of the functionally bicuspid aortic valve and its variation in structure may provide insight into predicting the risk of aortic valve dysfunction and thoracic aortic dilation, which could inform clinical decision making and potentially lead to improved aortic valvar surgical outcomes.

Point-of-Care Ultrasound in Detection, Severity and Mechanism of Significant Valvular Heart Disease and Clinical Management.

Early diagnosis of significant valvular heart disease (VHD) enables appropriate implementation of the best therapeutic strategy and follow-up. Cardiac auscultation remains suboptimal in early detection of VHD. The aim of this study was to evaluate the utility of point-of-care ultrasound (POCUS) for early detection of VHD and its severity. All consecutive patients with VHD who did not have a standard echocardiogram prior to first outpatient cardiology consultation underwent history and physical examination followed by POCUS study by an experienced physician in a general cardiology clinic from June 2017 to August 2022 at our institution. Subsequent standard transthoracic echocardiography (sTTE) was performed as the gold standard. Comparison was performed between POCUS and sTTE for the presence and severity of VHD. sTTE was performed by registered cardiac sonographers and interpreted by another cardiologist blinded to the POCUS results. A total of 77 patients were studied (ge 72 ± 11 years, 58.4% males). A total of 89 significant valvular abnormalities were diagnosed. There were 39 (43.8%) cases of regurgitant VHD, 16 (18.0%) of stenotic VHD and 34 (38.2%) had evaluation for prosthetic valve function. The sensitivity (90.9%; 82.4%; 83.3%; 100%) and specificity (100%; 96.7%; 100%; 100%) were high for detecting ≥ moderate aortic regurgitation (AR), mitral regurgitation (MR), aortic stenosis (AS) and prosthetic valvular abnormality, respectively. The weighted κ coefficient between POCUS and sTTE for the assessment of ≥ moderate MR, AR and AS was 0.81 (95% CI, 0.65-0.97), 0.94 (95% CI, 0.84-1.00) and 0.88 (95% CI, 0.76-1.0), respectively, indicating excellent agreement. POCUS can identify patients with significant VHD and may serve as a powerful screening tool for early detection of significant VHD in the outpatient clinical practice with downstream impact on clinical management of significant VHD.

Multi-valve Libman-Sacks's endocarditis-related multiple, massive and fatal systemic embolization. A case report and a review of diagnostic work-up.

We reported a case of non-bacterial thrombotic endocarditis (NBTE) in a 37-year-old woman who presented with signs and symptoms of cardio-embolic cerebral stroke caused by a prothrombotic state due to underlying advanced uterine cancer. Multimodal imaging, including 3D-ecocardiography, as well as laboratory and cultural tests, were critical in making the diagnosis. After starting anticoagulation therapy with low molecular weight heparin (LMWH), the patient underwent surgical aortic valve replacement due to worsening aortic valve function, initial left ventricle enlargement, increasing dimensions, and mobility of vegetations. Unfortunately, vegetations relapsed on the aortic valve bio-prosthesis as well as the mitral leaflets, resulting in a final picture of multi-valve NBTE. The fatal outcome was due to a massive multiple limb embolism, which resulted in leg amputations and septical complications. Starting with the case, we present a brief overview of the pathology's presentation, treatment, management, and prognosis, as well as the diagnostic work-up.