Left Valve Research Articles

Atrioventricular Groove Rupture After Mitral Valve Replacement In A Patient With Atrial Fibrillation Secondary To Rheumatic Cardiopatia: Case Report

Introduction: Atrioventricular sulcus lesion (AVGD) is a catastrophic complication of mitral valve surgeries that occurs in less than 2% of the population, with a mortality of 90%. Left ventricular rupture after mitral valve (MVR) replacement should be diagnosed immediately and repaired without hesitation. There are numerous complications described and known after MVR, such as thromboembolism, structural valve degeneration and endocarditis, paravalvular leakage, conduction irregularities in the pathway and bleeding. Case presentation: We present the case of a female patient with a history of rheumatic heart disease with double mitral injury and atrial fibrillation, in which severe mitral stenosis was documented with ECOTT reflecting thrombi of heterogeneous appearance occupying almost entirely left atrium. Programmed for left auriculotomy, valve replacement and thrombus exceresis, resulting in the procedure lesion of the atrioventricular groove meriting packing of the same and placement of mediastinal probes, with subsequent admission to post-surgical coronary care unit. Conclusions: At present, atrioventricular groove rupture is a rare event with increased mortality, the incidence depends on age and associated risk factors in the patient, In our case, rheumatic heart disease generates arrhythmias as a procoagulant state. Although the rupture can be repaired in a second surgical time, follow-up and post-operative care require comprehensive medical equipment and continuous hemodynamic surveillance.

Borers and epizoans on oyster shells from the upper Tortonian, Lower Chelif Basin, NW Algeria

The three oyster lenses of the upper Tortonian of Djebel Touaka site which are described herein contain three species, Crassostrea gryphoides (Schlotheim), Ostrea lamellosa (Brocchi) and Hyotissa squarrosa (De Serre). The density of shell packing between the lenses is dissimilar. Most of the specimens are disarticulated and poorly fragmented; they exhibit a random distribution and orientation, without any distinct sorting. Bioerosion and encrustation are featured on both surfaces of left and right valves. The identified ichnogenera are Entobia (Bronn), Gastrochaenolites (Leymarie, 1842), Caulostrepsis (Clarke, 1908), Trypanites (Mägdefrau, 1932) and Maeandropolydora (Voigt, 1965). Encrusters are scared, represented by juvenile oysters/other bivalves, bryozoans and barnacles. The coexistence of borings on both sides of valves means that they probably occur not only while alive, but they keep happening after death. The oyster beds were deposited in a foreshore to shoreface environment, from the combined action of wave currents and sedimentation rate.

The prognostic significance of early troponin levels in patients undergoing aortic ridge surgery.

Subaortic stenosis is a CHD that can lead to left ventricular hypertrophy, heart failure, and aortic valve damage if left untreated. The gold standard treatment for subaortic stenosis is septal myectomy. However, there is no clear consensus on the surgical margins required for adequate muscle resection. In this retrospective study, we reviewed the records of 83 patients who underwent subaortic stenosis surgery between 2012 and 2020 to investigate the effect of early troponin levels on prognosis. We excluded patients with additional cardiac pathologies, hypertrophic obstructive cardiomyopathy, and valvular aortic stenosis.Troponin levels were recorded in the early post-operative period, and patients were monitored for complications such as ventricular arrhythmia, left ventricular systolic dysfunction, infective endocarditis, and pacemaker implantation. The troponin levels were significantly higher in the patients who had septal myectomy. The degree of myectomy affected the risk of complications in the early post-operative period and recurrence in the later period. However, when the gradient was substantially or completely removed by myectomy, patients experienced significant symptom improvement in the early post-operative period, and their late survival was equivalent to that of healthy individuals of the same age.Our findings suggest that monitoring troponin levels in patients undergoing septal myectomy may be beneficial in predicting the risk of complications. However, further studies are needed to establish the optimal surgical technique and extent of muscle resection required for subaortic stenosis treatment. Our study adds to the existing knowledge of the benefits and risks associated with septal myectomy as a treatment option for subaortic stenosis.

A Potential Marker for Prognosis in Giant Left Ventricular Patients Undergoing Valve Surgery

Background: Although many clinicians have made efforts to improve the prognosis for giant left ventricular with valve disease patients, potential markers to judge the prognosis of giant left ventricular patients undergoing valve surgery are still unknown. The purpose of this study was to explore the possible impact factors for giant left ventricle prognosis. Methods: From September 2019 to September 2022, 75 patients with preoperative valvular disease with a giant left ventricle (left ventricular end diastolic diameter (LVEDD) >65 mm) underwent cardiac valve surgery. The changes in cardiac function one year after surgery were used to describe prognosis and analyze the potential independent factors affecting surgical prognosis. The left ventricular ejection fraction (LVEF) was considered to be recovered if it was ≥50% on follow-up echocardiography at least 6 months after the diagnosis. Results: The cardiac function of patients with a giant left ventricular and valve disease improved. Compared with preoperation, the left ventricular end diastolic diameter (LVEDD), left ventricular end-systolic dimension (LVESD), pulmonary artery systolic pressure (PASP), NT-proBNP, and cardio thoracic ratio (CTR) were significantly decreased (p < 0.05), and the ratio of severe heart failure was decreased from 60% to 37.33%. In the univariate analyses, the preoperative NT-proBNP levels and PASP were significantly associated with the cardiac function recovery (odds ratio [OR] = 1.001, 95% CI 1.000–1.002, p = 0.027; OR = 1.092, 95% CI 1.015–1.175, p = 0.018). However, during the diagnostic test, PASP did not account for cardiac function recovery (AUROC = 0.505, 95% CI = 0.387–0.713, p = 0.531). Based on the cutoff value in the experiment, we found that a NT-proBNP >753 pg/mL (AUROC = 0.851, 95% CI = 0.757–0.946, p < 0.0001) was a potential prognostic marker for patients with a giant left ventricular valve disease. Conclusions: We have demonstrated that an elevated preoperative NT-proBNP level is an independent predictor of cardiac function recovery in a cohort of giant left ventricular patients undergoing valve surgery, and this is the first study about this specific cohort of patients.

Multimodality imaging assessment of mitral annulus disjunction in consecutive patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Mitral annulus disjunction (MAD) has been investigated through trans-thoracic-echocardiography (TTE) and cardiac magnetic resonance (CMR) in different study cohorts and has been assumed either to represent a structural risk marker of sudden cardiac death or a benign, incidental finding. The imaging modality used to assess MAD might impact its prevalence and clinical significance. Purpose To assess the prevalence of MAD in consecutive patients undergoing TTE and CMR. Methods We retrospectively searched for MAD in consecutive patients undergoing TTE and CMR within six months, one from each other, at our center from March 2021 to April 2022. MAD was assessed in standard echocardiographic and CMR long-axis views and was defined as a ≥ 2 mm displacement between the left atrial wall-mitral valve leaflet junction hinge and the top of the left ventricular wall. Cases of pseudo-MAD and true-MAD were defined by MAD presence, respectively, during only systole and both systole and diastole. Results 124 patients (47 women; mean age: 59 years ± 17) were included. According to CMR, 38 patients (31%) presented with a structurally normal heart, and 37 (30%) presented with MAD. Patients with MAD presented more frequently MVP (27% vs. 1%; P<0.001), whereas patients without MAD were more frequently affected by non-ischemic cardiomyopathy (30% vs. 11%; p = 0.02). The two groups did not differ in age, sex, cardiac risk factors, symptoms, left ventricular volumes, ejection-fraction, pre-contrast T1- and T2-mapping, mitral annulus dimension and mitral regurgitation. MAD prevalence was higher by CMR than by TTE (30% vs. 8%; P=0.028). There was a low inter-modality agreement for the detection of MAD presence (Cohen's kappa=0.34) and a moderate agreement for MAD extent (ICC=0.71; 95% LOA 0.59, 0.8, p<0.05). Median MAD extent reported CMR and TTE were 2.6 mm (IQR 2.05–3.75 mm) and 4 mm (IQR 2.65–4.65 mm) respectively. All patients showing MAD at TTE demonstrated it at CMR too. Cases of true-MAD were observed at CMR (14% of the total cohort) but not at TTE. Conclusion In this cohort of consecutive patients, MAD was missed by TTE in more than 2 out of 3 patients exhibiting it at CMR. The high prevalence of MAD at CMR and the absence of significant association between this phenomenon and morpho-functional or structural alterations argue in favor of a benign finding at CMR. TTE detected MADs with higher extents compared to CMR. Further longitudinal studies are needed to evaluate the imaging-modality-related clinical relevance of MAD to improve patients’ risk stratification.

On Pseudocypretta franki n. sp. (Ostracoda, Cyprididae) from Lake Sibaya, South Africa

Abstract Pseudocypretta franki n. sp. is described from Lake Sibaya in South Africa. This is the first African species of the genus, which has two further Asian and one South American species. Clearly, the genus has a much wider distribution than originally thought and it is postulated that further species could be found in zoogeographical regions from where it is presently unknown. Pseudocypretta franki n. sp. differs from its congeners in the much larger overlap of the right valve by the left valve along anterior, ventral and posterior sides, and by the shape of the valves both in dorsal and in lateral views. The new species lacks the caudal rami, just as in the South American P. amor, whereas both Asian species do have Cypridopsinae-type reduced caudal rami.

Machine learning prediction of progressive subclinical myocardial dysfunction in moderate aortic stenosis.

Moderate severity aortic stenosis (AS) is poorly understood, is associated with subclinical myocardial dysfunction, and can lead to adverse outcome rates that are comparable to severe AS. Factors associated with progressive myocardial dysfunction in moderate AS are not well described. Artificial neural networks (ANNs) can identify patterns, inform clinical risk, and identify features of importance in clinical datasets. We conducted ANN analyses on longitudinal echocardiographic data collected from 66 individuals with moderate AS who underwent serial echocardiography at our institution. Image phenotyping involved left ventricular global longitudinal strain (GLS) and valve stenosis severity (including energetics) analysis. ANNs were constructed using two multilayer perceptron models. The first model was developed to predict change in GLS from baseline echocardiography alone and the second to predict change in GLS using data from baseline and serial echocardiography. ANNs used a single hidden layer architecture and a 70%:30% training/testing split. Over a median follow-up interval of 1.3 years, change in GLS (≤ or >median change) could be predicted with accuracy rates of 95% in training and 93% in testing using ANN with inputs from baseline echocardiogram data alone (AUC: 0.997). The four most important predictive baseline features (reported as normalized % importance relative to most important feature) were peak gradient (100%), energy loss (93%), GLS (80%), and DI < 0.25 (50%). When a further model was run including inputs from both baseline and serial echocardiography (AUC 0.844), the top four features of importance were change in dimensionless index between index and follow-up studies (100%), baseline peak gradient (79%), baseline energy loss (72%), and baseline GLS (63%). Artificial neural networks can predict progressive subclinical myocardial dysfunction with high accuracy in moderate AS and identify features of importance. Key features associated with classifying progression in subclinical myocardial dysfunction included peak gradient, dimensionless index, GLS, and hydraulic load (energy loss), suggesting that these features should be closely evaluated and monitored in AS.

Evidence of drilling predation in oysters from the Lower Cretaceous of the Neuquén Basin (Argentina) and its implications for Mesozoic predation trends

The study of trace fossils recorded on organic substrata is vital to the understanding of past biotic interactions. Here, oyster valves with circular holes are reported from the Lower Cretaceous (Berriasian to lower Valanginian) strata of the Neuquén Basin. From a total of 1318 oyster specimens, 17 valves presented 19 of these traces, which were studied to determine their origin, frequency and whether taxon, size and/or site selectivity existed. The studied traces, identified as Oichnus isp. (O. paraboloides in three cases), were recorded on four oyster species belonging to three genera: Aetostreon, Ceratostreon, and Nanogyra. Boring frequency was low (maximum = 0.103), and although traces were recorded exclusively on oysters, no taxon selectivity was found. No differences were found between the size of bored versus intact valves. The traces, although mostly recorded on left valves, showed a random distribution within valves, indicating no size or site selectivity. Hole morphology, absence of attachment scars and multiple holes point to a predatory origin. The lack of stereotypy indicates a generalist or facultative producer. Similar traces are usually ascribed to gastropod producers (i.e., naticids or muricids), but the gastropods co-occurring with the studied oysters lack any extant relative with a drilling apparatus. Hence, the producer remains unknown. This record contributes to the filling of the so-called early Mesozoic gap in drilling predation evolutionary history, during which two predation trends seem to have co-occurred: a background type of predation, carried out by generalists or facultative predators, and the rise of highly specialized predators, associated with the emergence of naticids and muricids.

P118 DEGENERATION OF PROSTHETIC HEART VALVES: EXCITING CHALLENGE IN CATH LAB

Abstract Background Prosthetic Heart Valves are always more frequent in the clinical practice. Particularly, sometimes more than one native valve is affected and needs to be surgically treated. On the other side, replaced prosthesis could also degenerate over time, leading to worsening symptomatic heart failure. There are no many cases of combined percutaneous approach to both aortic and mitral prosthetic valve deterioration: our aim is to display a case of this complex clinical setting. Case: A 76–year–old man with previous surgical mitral and aortic valve replacement, respectively through Hancock (27 mm) and Mitroflow (21 mm), was referred to our Centre for dyspnoea on mild efforts. Echocardiography revealed severe degeneration of both prosthetic valves, with moderate mitral stenosis (mean pressure gradient – MG – 6 mmHg) and severe central regurgitation, and high transaortic pressure gradients (MG 58; peak pressure gradient – PG – 103 mmHg). Pulmonary hypertension, mild right ventricle dysfunction and reverse flow in hepatic veins were evident. Results The first intervention was Valve–in–Valve Transcatheter Aortic Valve Implantation (ViV TAVI) with CoreValve Evolut PRO+ (23 mm), followed however by recoil determining moderate aortic stenosis (MG 25, PG 47 mmHg). Hence, as both the left prosthetic valves needed treatment, we decided to plan an elective percutaneous procedure aimed to treat both of them. Aortic ViV cracking was successfully obtained through non–compliant Atlas Gold Balloon (22 mm). Then, transseptal puncture by Brockenbrough needle and SL0 dilator sheath system was used to gain access to the left atrium. Finally, after interatrial shunt pre–dilation, Edwards Sapien 3 Ultra (26 mm) was applied as Mitral ViV during rapid ventricle pacing. Echocardiography showed relevant decrease of aortic pressure gradients (MG 11, PG 19) and downgrading of mitral regurgitation from severe to mild, despite unvaried persistent moderate mitral stenosis and signs of chronic severe pulmonary hypertension. The patient was dismissed in 3 days, after adjusting medical therapy. Conclusions Dysfunction of prosthetic heart valves is challenging to be approached, particularly when involving more than one. The expertise of the Centre assumes great importance in this delicate clinical setting. More explanations are further needed to define type and timing of percutaneous intervention aimed to the treatment of multiple prosthetic valves.

Diagnostic accuracy of two-dimensional and three-dimensional transesophageal echocardiography in detecting pannus and thrombus in left mechanical valve obstruction.

Patients with suspected LMVO on transthoracic echocardiography were enrolled consecutively. All patients underwent two-dimensional and three-dimensional TEE, and open-heart surgery to replace obstructed valves. Macroscopic and microscopic analysis of the excised masses was used as the gold standard for the diagnosis of thrombus and/or pannus. Forty-eight patients [34 women (70.8%), age 49±13 years, New York Heart Association II: 68.8%, New York Heart Association III: 31.2%] were enrolled. In the diagnostic of thrombus, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of three-dimensional TEE were 89.2, 72.7, 85.4, 91.7, and 66.7%, respectively, compared with those of two-dimensional TEE (42.2, 66.7, 43.8, 95, and 7.1%, respectively). In the diagnosis of pannus, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of three-dimensional TEE were 53.3, 100, 85.4, 100, and 82.5%, respectively; compared with those of two-dimensional TEE (7.4, 90.5, 43.8, 50, and 43.2%, respectively). Receiver operating characteristic curves depict that the area under the curves of three-dimensional TEE was higher than the area under the curves of two-dimensional TEE in both diagnoses of thrombus and pannus (0.8560 vs. 0.7330, P=0.0427 and 0.8077 vs. 0.5484, P=0.005, respectively). This study indicated that three-dimensional TEE had a higher diagnostic value than two-dimensional TEE in the detection of thrombus and pannus in patients with LMVO, and can be a reliable imaging modality to identify the causes of LMVO.

A new species of the genus Catillopecten (Bivalvia: Pectinoidea: Propeamussiidae): morphology, mitochondrial genome, and phylogenetic relationship

Catillopecten is a small genus of deep-sea glass scallops, but its diversity is poorly known in many parts of the world ocean. We described C. margaritatus n. sp. (Pectinoidea: Propeamussiidae), and performed morphological analyses and DNA sequencing, and estimated the divergence time of scallops based on samples collected from Haima cold seep in the South China Sea. Morphologically, the new species can be distinguished from congeneric species by its large shell size, relatively small auricle length, absence of monocrystal aerials, presence of longitudinal radial ridges on the left valve, and the alternated rounded striae and distal and proximal growth lines of prisms on the right valve. Anatomically, this new species can be distinguished from C. vulcani by its anteriorly located auriculate gills, compared to the centrally located lamellar gills of the latter, and the different locations of the pericardium. Sequence comparison and phylogenetic analysis based on the 18S rRNA fragments supported the placement of the new species in Catillopecten. We also report the mitogenome of C. margaritatus n. sp. as the only reported mitogenome of the family Propeamussiidae, which differs from those of other scallops substantially in gene order arrangement. Divergence time estimation revealed that Propeamussiidae and Pectinidae diverged in the early Carboniferous, while Catillopecten and Parvamussium diverged during the late Cretaceous to early Eocene. Finally, we presented a key to the species of Catillopecten.

Surgical strategies to address re-operative complex left ventricular outflow tract and thoracic aortic pathology: Cleveland Clinic children's experience.

Complex patients requiring operations on the left ventricular outflow tract, aortic valve, or thoracic aorta after previous repair of aortopathy constitute a challenging group, with limited information guiding decision-making. We aimed to use our institutional experience to highlight management challenges and describe surgical pearls to address them. Forty-one complex patients with surgery on the left ventricular outflow tract, aortic valve, or aorta at Cleveland Clinic Children's between 2016 and 2021 following previous repair of aortic pathology were retrospectively reviewed. Patients with known connective tissue disease or single ventricle circulation were excluded. Median age at index procedure was 23 years (range 0.25-48) with median of 2 prior sternotomies. Previous aortic operations included subvalvular (n = 9), valvular (n = 6), supravalvular (n = 13), and multi-level surgeries (n = 13). Four deaths occurred in median follow-up of 2.5 years. Mean left ventricular outflow tract gradients improved significantly for patients with obstruction (34.9 ± 17.5 mmHg versus 12.6 ± 6.0 mmHg; p < 0.001). Technical pearls include the following: 1) liberal use of anterior aortoventriculoplasty with valve replacement; 2) primarily anterior aortoventriculoplasty following the subpulmonary conus in contrast to more vertical incision for post-arterial switch operation patients; 3) pre-operative imaging of mediastinum and peripheral vasculature for cannulation and sternal re-entry; and 4) proactive use of multi-site peripheral cannulation. Operation to address the left ventricular outflow tract, aortic valve, or aorta following prior congenital aortic repair can be accomplished with excellent outcomes despite high complexity. These procedures commonly include multiple components, including concomitant valve interventions. Cannulation strategies and anterior aortoventriculoplasty in specific patients require modifications.

Of missions and marshes: Stable isotope analysis of Mission-Era Guale oyster harvesting on St. Catherines Island, Georgia

This article presents the results of oxygen stable isotope analysis on eastern oyster (Crassostrea virginica) samples (n = 25) from a Mission-Era (ca. AD 1565–1680) site, Pueblo Santa Catalina de Guale, on St. Catherines Island, GA. Stable isotope analysis was used to assess the seasonality of oyster harvesting on St. Catherines Island during the Mission Era to better understand how Spanish colonization and the Catholic mission system may have impacted Guale foodways. Five eastern oyster left valves were sampled from each known neighborhood of Pueblo Santa Catalina de Guale. Existing data regarding the seasonality of pre-colonial mollusk collection on St. Catherines Island and elsewhere in the coastal Southeast are discussed in conversation with the results of this analysis. This work indicates that Guale residents of St. Catherines Island during the Mission Era were harvesting oysters most intensely during cooler months. This pattern is consistent with estimates of pre-colonial shellfishing seasonality across the region and may even represent a modest increase in the seasonal constriction of shellfishing when compared to data from the preceding period. Salinity estimates based on the isotope data also suggest Guale people during the Mission Era were collecting from a comparatively narrower range of estuarine habitats. We argue that these subtle shifts are a consequence of the reorganization of Guale labor associated with missionization.

Isolated tricuspid regurgitation: a new entity to face. Prevalence, prognosis and treatment of isolated tricuspid regurgitation.

In recent years the tricuspid is no longer considered the "forgotten valve," but nowadays, specialists focused the treatment of tricuspid regurgitation (TR) especially at the time of left heart valve (LHV) surgery, overlooking the emerging entity of isolated TR. Its incidence appears to be rising along with the higher prevalence of atrial fibrillation (AF), intracardiac devices and intravenous drug users. Hence, the aim of the present review is to summarize the available evidences in terms of natural history, clinical presentation and treatment of isolated TR. Tricuspid regurgitation is commonly classified into primary and secondary etiology. Primary or organic TR is relatively uncommon (10%) and may be due to either acquired or congenital diseases. Conversely, secondary or functional TR, caused by dilatation and flattening of the tricuspid annulus along with increase of leaflet tethering due to the remodeling of the right ventricle (RV) has become in last decade an emerging entity. Secondary TR may be due grade progression after left heart valve surgery, to previous TV surgery failure, RV remodeling or permanent AF. Primary TR causes pure volume overload on initially normal right-sided cardiac chambers. Conversely, RV enlargement is the major finding of secondary TR; RV systolic area, RV spherical index and right atrial area were identified as independent factors correlated with TV tethering height. The RV has less muscle mass than the left ventricle, and RV systolic function is therefore more load sensitive. Thus, pulmonary hypertension results in an early fall in RV ejection fraction and associated RV enlargement. An interesting entity is isolated TR related to AF, whose prevalence is estimated to be 14% in recent studies. It is known to cause dilation of the mitral and tricuspid annulus, together with changes in the dynamic mechanisms that govern the variation in area size during the cardiac cycle; as a matter of fact the relative change in TA area was significantly lower in AF (13.5%) than in sinus rhythm (SR) (33.1%). In isolated TR, medical therapy (MT) is indicated only in patients with secondary TR having also severe RV/LV dysfunction or severe pulmonary hypertension. Diuretics are the main MT in case of isolated TR in the presence of right HF in carefully selected candidates, surgery can be performed safely with good long-term survival and it should be considered early at first stages. In the treatment of isolated TR we had two diametrically opposed approaches so far, such as medical therapy, based almost exclusively on diuretics, and surgical therapy. In this scenario, trans-catheter approach is gaining momentum, including repair or replacement treatment. The former sees the use of devices for direct or indirect annuloplasty, or leaflet approximation. The second consists of orthotopic or heterotopic replacement devices (transcatheter tricuspid valve replacement devices). Evidences from randomized studies and longer follow-up will help clarify the best patient selection and treatment strategies.

Tactics of Preoperative Examination of Patients with Infective Endocarditis Complicated by Acute Heart Failure

Background. Management of patients with infective endocarditis (IE) has changed rapidly in recent years with improvements in diagnostic procedures and early aggressive surgical treatment. The annual incidence of IE in high-income countries has reached 9 cases per 100,000 population. Approximately half of patients with IE require surgical treatment due to severe complications, the most common of which is acute heart failure (AHF), which occurs in 40–60% of cases. Clinical scenarios of IE are often complex, requiring rapid diagnostic measures and early appointment of surgical intervention.&#x0D; The aim. To determine the preoperative algorithm of diagnostic and therapeutic measures in the presence of signs of AHF in patients with IE.&#x0D; Materials and methods. The basis of this study is the clinical data of 311 patients with active IE who underwent examination and treatment at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medi- cal Sciences of Ukraine from 01/01/2019 to 10/22/2021. The diagnosis of IE was established in accordance with Duke Endocarditis Service criteria proposed in 1994. The average age of the studied patients was 47.9 ± 3.83 (19 to 77) years.&#x0D; Results. In order to determine the degree of AHF at the preoperative stage, all the patients were divided into 4 groups according to the New York Heart Association functional classification. Preoperative clinical data of IE patients with signs of AHF comprised the basis for functional class IV (59 [18.9%] cases) and formed the studied group. For preoperative diagnosis of AHF, cardiohemodynamic data was obtained based on the results of echocardiographic parameters and level of N-terminal pro-B-type natriuretic peptide (NTproBNP).&#x0D; In order to improve the diagnosis of AHF, tactics of preoperative examination of patients with IE were developed. In our study, the following echocardiographic examination results were indicative in the diagnosis of IE complicated by heart failure: detection of vegetations on the leaflets of the left heart valves, end-diastolic index &gt;94.3 ml/m2, end-systolic index &gt;40.8 ml/m2, pulmonary artery pressure &gt;50 mm Hg. The main biochemical marker of AHF in the group of patients with IE was the threshold level of NTproBNP greater than 7473.7 pg/ml. Identified changes in cardiohemodynamic and biochemical indicators became independent indications for hospitalization in the intensive care unit and emergency preoperative preparation.&#x0D; Conclusions. During hospitalization of patients with IE to the cardiosurgical center, the basis of the effectiveness of the provided care is the timely diagnosis of complications of the underlying disease. Based on the results of the work, the protocol for preoperative AHF diagnosis was developed. Critical levels of biochemical and hemodynamic indicators in patients with IE became an independent indication for hospitalization to the intensive care unit and emergency preoperative management. The early start of intensive care for AHF in IE is a fundamental factor that might influence the choice of treatment strategy.

Songkhramodopsis gen. nov., a new genus of Cypridopsinae (Crustacea: Ostracoda) from Thailand

A new genus and species of subfamily Cypridopsinae Kaufmann, 1900, Songkhramodopsis meischi gen. et sp. nov., is described from the Lower Songkhram River Basin, Thailand. The prominent diagnostic characters of the new genus mainly exist in antennula (A1), antenna (A2) and third thoracopod (T3): the six-segmented A1, the strongly serrated claw G2 on the female A2, the large aesthetasc Y with remarkably large and striated third section and the completely separated terminal segment of T3. The A1 with six segments, together with the distinctive morphology of aesthetasc Y, have been recognized for the first time in the Cypridopsinae. A new tribe, Songkhramodopsini trib. nov., is also erected to accommodate this exceptional new genus and species. The new taxon is also characterized by the left valve overlapping the right valve, the anterior and posterior inner list on both valves, the widely inwardly displaced posterior selvage on right valve, the bifurcate-like tip of an apical ventral seta on A1 first segment, the absence of d1 seta on second thoracopod (T2), the divided penultimate segment of T2, the female caudal ramus with cylindrical base, the very small number of spiny whorls of Zenker organ. A key to tribes of Cypridopsinae is provided.

Pathogenesis of pulmonary hypertension caused by left heart disease.

Pulmonary hypertension has high disability and mortality rates. Among them, pulmonary hypertension caused by left heart disease (PH-LHD) is the most common type. According to the 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension, PH-LHD is classified as group 2 pulmonary hypertension. PH-LHD belongs to postcapillary pulmonary hypertension, which is distinguished from other types of pulmonary hypertension because of its elevated pulmonary artery wedge pressure. PH-LHD includes PH due to systolic or diastolic left ventricular dysfunction, mitral or aortic valve disease and congenital left heart disease. The primary strategy in managing PH-LHD is optimizing treatment of the underlying cardiac disease. Recent clinical studies have found that mechanical unloading of left ventricle by an implantable non-pulsatile left ventricular assist device with continuous flow properties can reverse pulmonary hypertension in patients with heart failure. However, the specific therapies for PH in LHD have not yet been identified. Treatments that specifically target PH in LHD could slow its progression and potentially improve disease severity, leading to far better clinical outcomes. Therefore, exploring the current research on the pathogenesis of PH-LHD is important. This paper summarizes and classifies the research articles on the pathogenesis of PH-LHD to provide references for the mechanism research and clinical treatment of PH-LHD, particularly molecular targeted therapy.

An Early Cretaceous sponge meadow from the Neuquén Basin, west-central Argentina: unsuspected hosts of a dynamic sclerobiont community

ABSTRACTSponges, especially Calcarea, are minor components of benthic associations, especially during the Mesozoic. In the Lower Cretaceous of the Neuquén Basin, small calcareous sponges have been found building a small monospecific meadow. It is restricted to a marlstone lens-shaped bed in a quiet outer-ramp setting in the Cerro Marucho Locality (Picún Leufú depocentre), above a shell bed of small exogyrid oysters; oysters and sponges were the only preserved macrobenthic faunal elements. Individual sponges were small, under 4 cm high, and presented a sub-cylindrical morphology with one or more rounded, apical osculi, many inhalant openings and triactine spicules. Specimens studied here were assigned to Endostoma sp. aff. Endostoma nodosa. These sponges are quite commonly encrusted by exogyrid oysters, serpulids, sabellids, agglutinating foraminifers and cyclostome bryozoans. Overgrowths among sclerobionts were common, though no undoubtedly in vivo interaction has been recorded. Disarticulated left oyster valves were frequently bioclaustrated by the sponges, showing that in vivo settlement upon sponges was common. Many oysters settled in the periphery of the osculum suggesting a commensal relationship. The study of this sponge meadow and its sclerobiont community allowed the identification of different stages of ecological succession. The pioneer stage was characterised by sponge settlement on oyster valves, within an otherwise soft consistency bottom. High sedimentation or high nutrient inputs, either individually or in combination, could explain the great abundance of oysters. During the climax stage, sponges thrived and harboured several sclerobiont taxa, developing a relatively dynamic palaeocommunity. Finally, an intensification in either sedimentation rates or nutrient input (or both) past the tolerable threshold for sponges may have been the cause(s) of the meadow's demise. Endostoma and similar forms were up to now reported mostly from the Jurassic and Cretaceous of Europe as accessory builders, or as accompanying fauna in reefal settings. This new record shows that in rare occasions they could form low-relief meadows on their own.

Imbricated shell sculpture in benthic bivalves.

Molluscan shells display a high diversity of external sculpture. Sculptural elements may be symmetrical, where both edges of an element are morphologically similar, or asymmetrical, where one edge is steeper than the other. Asymmetrical sculpture can be ratcheted, with the leading edges (those in the direction of locomotion or growth) less steep than the trailing edges, or imbricated (leading edges steeper than trailing edges). While the ratcheted sculpture is better known, the diversity of imbricated sculpture has remained largely unexplored. In a survey of extant benthic shell-bearing molluscs, we document imbricated sculpture primarily in epifaunal bivalves or on the exposed sectors of shells of semi-infaunal bivalves. Imbricated sculpture is particularly widespread in pteriomorphian bivalves, but it is absent in the subclade Mytiloidea as well as in highly mobile Pectinidae. It also occurs in many carditid bivalves (Archiheterodonta) and in phylogenetically scattered euheterodonts. In several infaunal bivalves including species of Cardites (Carditidae), Hecuba (Donacidae), and Chione (Veneridae), comarginal elements on the posterior sector are imbricated whereas anterior comarginal ridges are ratcheted. Imbricated sculpture in bivalves tends to be concentrated on the upper (left) valves of pectinids or on the posterior sector of both valves in archiheterodonts and euheterodonts. Imbricated sculpture is uncommon in gastropods, even in epifaunal species, but does occur in the collabral ridges in some Vasidae and a few other groups. Expression of imbricated sculpture does not depend on shell mineral composition or microstructure. The ecological distribution and within-shell pattern of expression of imbricated sculpture point to the likelihood that this type of asymmetrical sculpture is both widespread and potentially functional. Additionally, we present a potential methodology whereby shell sculpture categories (symmetrical, ratcheted, and imbricated) may be quantified by comparing the lengths of corresponding leading and trailing edges across the shell surface.

Anuloplastia de De Vega. Cincuenta años desde el comienzo de la reparación valvular selectiva, regulable y permanente

De Vega annuloplasty consists of a double suture supported by Teflon patches at its ends and tied in such a way as to correct regurgitation in the tricuspid valve. After 50 years since its publication, its historical background, the original technique and the successive modifications that have emerged under the same pathophysiological concept are reviewed. De Vega annuloplasty has been used extensively throughout the world to correct tricuspid insufficiency, especially secondary functional regurgitation concomitantly with mitral valve surgery. It has also been used in traumatic injuries, heart transplantation or the child population. Compared with annuloplasty with a rigid or semirigid ring, it seems to confer less stability over time, without this having translated into an increase in morbidity and mortality or in the rate of reinterventions. It is a fast, simple, reproducible, economical, safe technique that offers excellent clinical results in selected patients, and that after 50 years is still valid, especially as a treatment for non-severe functional tricuspid regurgitation in the context of left valve surgery without significant dilatation of the right ventricle.