Mitral Valve Dysfunction Research Articles

TCT-613 Mitral Valve Dysfunction in Patients With Mitral Annular Calcification

TCT-613 Mitral Valve Dysfunction in Patients With Mitral Annular Calcification

Impact and limitations of 3D computational modelling in transcatheter mitral valve replacement-atwo-centre Dutch experience.

Transcatheter mitral valve replacement (TMVR) has emerged as aminimally invasive alternative to mitral valve surgery for patients at high or prohibitive operative risk. Prospective studies reported favourable outcomes in patients with annulus calcification (valve-in-mitral annulus calcification; ViMAC), failed annuloplasty ring (mitral valve-in-ring; MViR), and bioprosthetic mitral valve dysfunction (mitral valve-in-valve; MViV). Multi-slice computed tomography (MSCT)-derived 3D-modelling and simulations may provide complementary anatomical perspectives for TMVR planning. We aimed to illustrate the implementation of MSCT-derived modelling and simulations in the workup of TMVR for ViMAC, MViR, and MViV. For this retrospective study, we included all consecutive patients screened for TMVR and compared MSCT data, echocardiographic outcomes and clinical outcomes. Sixteen out of 41patients were treated with TMVR (ViMAC n = 9, MViR n = 3, MViV n = 4). Eleven patients were excluded for inappropriate sizing, 4for anchoring issues and 10for an unacceptable risk of left ventricular outflow tract obstruction (LVOTO) based on 3D modelling. There were 3procedure-related deaths and 1non-procedure-related cardiovascular death during 30days of follow-up. LVOTO occurred in 3ViMAC patients and 1MViR patient, due to deeper valve implantation than planned in 3patients, and anterior mitral leaflet displacement with recurrent basal septum thickening in 1patient. TMVR significantly reduced mitral mean gradients as compared with baseline measurements (median mean gradient 9.5(9.0-11.5) mm Hg before TMVR versus 5.0(4.5-6.0) mm Hg after TMVR, p = 0.03). There was no residual mitral regurgitation at 30days. MSCT-derived 3D modelling and simulation provide valuable anatomical insights for TMVR with transcatheter balloon expandable valves in ViMAC, MViR and MViV. Further planning iterations should target the persistent risk for neo-LVOTO.

Clinical presentation and surgical outcomes in patients with Shone's complex: a systematic review.

Shone's complex comprises ofa combination of congenital cardiac anomalies causing obstructions in the left ventricle's inflow and outflow tracts. This systematic review aims to evaluate the clinical features and surgical outcomes of Shone's complex. An electronic literature search of PubMed and Scopus was performed to identify relevant studies related to the presentation, management, and outcomes of Shone's complex. Two reviewers independently performed selection. Data on study characteristics, participant demographics, interventions, outcomes, and follow-up durations were extracted and analyzed. A total of 691 papers were identified, with 18 studies included in the final analysis. The majority of the studies (n = 12) focused on the pediatric age group. The most common clinical presentations were coarctation of the aorta (n = 17) and mitral stenosis (n = 12). Surgical interventions often involved staged approaches, prioritizing outflow before inflow obstructions. Mitral valve repair was preferred over replacement due to better long-term outcomes (n = 8). Biventricular repair was recommended due to improved postoperative outcomes, but often needed reoperations. Reoperations were common, primarily due to recurrent coarctation (n = 10), subaortic stenosis (n = 8), and mitral valve dysfunction (n = 7). Pulmonary hypertension (n = 10) and arrhythmias (n = 11) were significant complications. Most patients were in modified Ross/NYHA functional class 1 on follow-up. Mortality rates ranged from 4 to 28%, with better outcomes associated with early and strategic surgical interventions. Early diagnosis and biventricular repair were associated with better outcomes while transplantation was often an eventuality. Standardized diagnostic criteria, long-term follow-up, and consensus guidelines are needed to improve the management of this congenital heart disease.

Predictors of Mortality Following Mitral Valve Replacement: A SystematicReview

Introduction: Valvular heart diseases are some of the most common causes of cardiovascular morbidity and mortality worldwide. The mitral valve is estimated to be the cause of 15% of deaths in heart valve disease. Mitral valve dysfunction can be treated with a variety of operative options, one of whichis mitral valve replacement. Although it is less desirable than repair, in some situations, it is the only viable option. Thus, we conducted this systematic review to help guide future risk assessment for mitral valve replacement patients and help in the construction of pre-operative risk assessment tools. Methods: This is a systematic review of original articles discussing the topic of predictors of mortality for patients undergoing mitral valve replacement surgery. A systematic search was conducted via independent researchers across a number of databases, starting with PubMed databases utilizing its MeSH database, followed by a complementary search through Google Scholar. Results: In total, 27 original articles were included in a collective cohort of 145005 patients. Older age was the most commonly cited variable as a mortality predictor, followed by decreased left ventricular ejection fraction. EuroSCORE is a well-known scoring system that predicts in-hospital mortality following major cardiac surgeries. It was found that it overestimated mortality greatly, while another study found that the revised EuroSCORE II system was a better predictor of mortality. Overall, we note that both versions usually overestimate mortality. Conclusion: There seems to be an overall agreement over several factors, including older age, decreased ejection fraction, and the expertise of the surgeon and the institution on being clear predictors of postoperative mortality. There is also an obvious need for new tools to better predict mortality rates preoperatively, as the currently used scores often result in greatly inaccurate predictions

Cardiac Sarcoma Mimicking Libman-Sacks Endocarditis in a Patient with Systemic Lupus Erythematosus (SLE): A Case Report and Literature Review.

We present the case of a 39-year-old woman who was diagnosed with SLE and antiphospholipid antibodies 8 years ago. The chief manifestations of her disease included low-grade fever and polyarthritis. Eight months before presentation, she experienced symptoms attributed to a flare of SLE, leading to an increase in immunomodulatory treatment with no improvement. She presented to the emergency room with acute onset of dyspnea. Clubbing of her fingers and toes was noted. When questioned, she reported the onset of clubbing 5 months earlier. A CTA was performed to rule out pulmonary embolism, which was excluded, although it revealed a severely damaged mitral valve with severe insufficiency and a large mass on the valve, protruding into the left atrium. Antibiotics were started, with a working diagnosis of infectious endocarditis; however, the severe mitral valve dysfunction lead to emergency mitral valve replacement, revealing an organized thrombus. She was treated with anticoagulation, with a working diagnosis of Libman-Sacks endocarditis, with no improvement. Additional immunosuppression failed to improve her symptoms. Enlargement of the thrombotic mass and an increased gradient across the prosthetic mitral valve led to repeat surgery, culminating in a diagnosis of high-grade sarcoma within the left atrial mass. We further discuss cardiac sarcoma and describe the occurrence of clubbing in patients with sarcoma. This case highlights the importance of interdisciplinary collaboration and the need for vigilant monitoring in refractory cases, particularly when atypical presentations arise.

Mitral Annulus Disjunction: A Comprehensive Cardiovascular Magnetic Resonance Phenotype and Clinical Outcomes Study.

Clinical importance of mitral annulus disjunction (MAD) is not well established. Characterize a population of MAD all-comers diagnosed by cardiac magnetic resonance imaging (MRI). Retrospective. MAD confirmed in 222 patients, age of 49.2 ± 19.3 years, 126 (56.8%) males. 1.5 T and 3 T/steady-state free precession and inversion recovery. Clinical history, outcomes, imaging, and arrhythmia data. MAD defined as a separation ≥2 mm between left ventricular myocardium and mitral annulus. Presence and pattern of late gadolinium enhancement (LGE) were analyzed. LGE in the papillary muscles and adjacent to MAD were identified as MAD related. Ventricular arrhythmias (VA) were grouped into non-sustained ventricular arrhythmias (NSVA) or sustained. Cardiovascular death assessed. Differences between baseline characteristics were compared. Univariate regression was used to investigate possible associations between ventricular arrhythmia and cardiovascular death with characteristics associated with the severity of MAD. A multivariable logistic regression included significant variables from the univariate analysis and was performed for MAD-related and global LGE. MAD extent 5.0 ± 2.6 mm. MV annulus expanded during systole for MAD ≥6 mm. Systolic expansion associated with prolapse, billowing, and curling. LGE present in 82 patients (36.9%). Twenty-three patients (10.4%) showed MAD-related LGE by three different observers. No association of LGE with MAD extent (P = 0.545) noted. Follow-up 4.1 ± 2.4 years. No sustained VA observed. In univariable analysis, NSVA was more prevalent in patients with MAD ≥6 mm (33.3% vs. 9.9%), but this was attenuated on multivariate analysis (P = 0.054). The presence of NSVA was associated with global LGE but not MAD-related LGE in isolation (P = 0.750). Three patients died of cardiovascular causes (1.4%) and none had MAD-related LGE. None died of sudden cardiac arrest. In patients referred for cardiac MRI, mitral valve dysfunction was associated with MAD severity. Scar was not related to the extent of MAD, but associated with NSVA. The risk of sustained arrhythmias and cardiovascular death was low in this population. 4 TECHNICAL EFFICACY: Stage 2.

A case of mitral regurgitation due to bilateral undifferentiated papillary muscles with detailed preoperative diagnosis of associated morphological abnormalities

Incomplete differentiation of the mitral valve structures during fetal life results in the papillary muscles and tendon cords becoming hypoplastic, a condition termed undifferentiated papillary muscles (UDPM). This fetal abnormality causes a group of diseases that cause mitral valve dysfunction in adult life. Here, we report a case of UDPM centered on the medial posterior apex in which detailed morphological abnormalities were diagnosed preoperatively using echocardiography and three-dimensional computed tomography (3DCT) analysis, contributing to plastic surgery.The patient was a 64-year-old man who was followed up for several years for atrial functional mitral regurgitation (MR), ultimately developing heart failure. His MR was severe, and he was referred for surgery.Echocardiography revealed restrictive tendon cords primarily in the posterior apex, abnormal muscle bundles in the lower part of the valve, and findings indicative of UDPM; this was considered the main cause of MR. The patient had surgery findings similar to the preoperative diagnosis, which greatly aided the surgery. Postoperatively, the MR was well-controlled and mild.UDPM may present as various morphologic and functional abnormalities, including partial club-shaped tendinous MR and rheumatoid mitral stenosis, which are rarely accurately diagnosed preoperatively. Detailed analysis of morphological abnormalities using 3DCT or other methods may be beneficial for a successful plasty.

Cardiovascular screening outcomes in the Dutch survivorship care program for Hodgkin lymphoma survivors.

Hodgkin lymphoma (HL) survivors are at increased risk of cardiovascular disease (CVD) due to former lymphoma treatment. In 2013, cardiovascular screening for 5-year HL survivors according to national guidelines was implemented in Dutch survivorship clinics. We aim to assess the following: (1) adherence to screening guidelines and (2) the yield of (risk factors for) CVD in the screening program. The study population consisted of 5-year HL survivors who received survivorship care at three University Medical Centers from 2013 to 2016 through 2021. Patient characteristics, cardiovascular screening procedures, and outcomes were collected from the medical records. In 186 survivors eligible for cardiovascular screening (mean age 47.8years, 60.8% female), the following diagnostics were performed: complete blood tests (81.0%, median frequency: yearly instead of advised 5-yearly evaluation), electrocardiogram (93.0%), echocardiography (94.6%). Fifty-five percent of survivors had at least one modifiable cardiovascular risk factor (i.e., current smoking, overweight, new/insufficiently controlled hypertension, dyslipidemia, or diabetes). Screening detected ≥ 1 CVD in 31.1% of survivors. Among survivors with available echocardiography report (n = 106), screening detected new aortic and/or mitral valve dysfunction(s) in 51.0% (with grades 3-4 in 4.9%) and impaired left ventricular ejection fraction in 10.3%. Adherence to the screening guidelines in the Dutch HL survivorship care program was reasonable to good and a substantial number of actionable (risk factors for) CVD were diagnosed. Our findings inform HL survivors at high risk of late cardiotoxicity about cardiovascular screening findings and demonstrate appropriate therapeutic actions after diagnosis of (risk factors for) CVD.

Innovations and Developments in Totally Thoracoscopic Cardiac Procedures

New technology is increasing being introduced to minimizing the invasiveness of cardiac surgery. In addition to catheter based interventions and robotic-assisted procedures, totally thoracoscopic cardiac surgery (TTCS) has emerged as a new minimally invasive technique in the cardiac surgeons' armamentarium to treat cardiovascular disease. This review summarizes the existing literature on TTCS and provides updates on the exploration and management of TTCS in various cardiac diseases including mitral and tricuspid valve dysfunction, congenital heart defects, tumors, and hypertrophic obstructive cardiomyopathy. Due to small port incisions and high cost-effectiveness, TTCS has been increasingly embraced by both patients and surgeons. This review summarizes the literature on TTCS and how it may minimize the morbidity associated with open cardiac surgical procedures and result in faster recovery and earlier discharge from the hospital.

Progression of Mild Mitral Annulus Calcification to Mitral Valve Dysfunction and Impact on Mortality

Mitral annulus calcification (MAC) represents a degenerative process resulting in calcium deposition in the mitral valve apparatus. Mitral annulus calcification is associated with adverse clinical outcomes. We sought to examine the long-term significance of mild MAC and its relationship to subsequent mitral valve dysfunction (MVD) and mortality in patients without MVD on the initial echocardiogram. A total of 1,420 patients with mild MAC and no MVD at baseline and 1 or more follow-up echocardiograms at least 1year after the baseline echocardiogram were included in the analysis. For patients with >1 echocardiogram during follow-up, the last echocardiogram was used. The same criteria were used to identify 6,496 patients without MAC. Mitral valve dysfunction was defined as mitral regurgitation (MR) and/or mitral stenosis (MS) of moderate or greater severity. Mixed disease was defined as the concurrent presence of bothmoderate or greater MS and MR. The primary end point was development of MVD, and the secondary end point was all-cause mortality. For patients with mild MAC, age was 74±10years and 528 (37%) were female. Over a median follow-up of 4.7 (interquartile range, 2.7-6.9) years, 215 patients with mild MAC developed MVD, including MR in 170 (79%), MS in 37 (17%), and mixed disease in 8 (4%). In a multivariable regression model compared to patients without MAC, the presence of mild MAC was independently associated with increased mortality (hazard ratio= 1.43; 95% CI 1.24, 1.66; P<.001). Kaplan-Meier 4-year survival rates were 80% and 90% for patients with mild MAC and no MAC, respectively. Mild MAC observed on transthoracic echocardiography is an important clinical finding with prognostic implications for both valvular function and mortality.

Right Ventricular–Pulmonary Arterial Coupling and All-Cause Mortality in Patients with Mitral Annular Calcification–Related Mitral Valve Dysfunction

Right Ventricular–Pulmonary Arterial Coupling and All-Cause Mortality in Patients with Mitral Annular Calcification–Related Mitral Valve Dysfunction

Dynamic changes in mitral valve extracellular matrix, tissue mechanics and function in a mouse model of Marfan syndrome

ObjectiveMouse models of Marfan syndrome (MFS) with Fibrillin 1 (Fbn1) variant C1041G exhibit cardiovascular abnormalities, including myxomatous valve disease (MVD) and aortic aneurism, with structural extracellular matrix (ECM) dysregulation. In this study, we examine the structure-function-mechanics relations of the mitral valve related to specific transitions in ECM composition and organization in progressive MVD in MFS mice from Postnatal day (P)7 to 1 year-of-age. Approach and resultsMechanistic links between mechanical forces and biological changes in MVD progression were examined in Fbn1C1041G/+ MFS mice. By echocardiography, mitral valve dysfunction is prevalent at 2 months with a decrease in cardiac function at 6 months, followed by a preserved cardiac function at 12 months. Mitral valve (MV) regurgitation occurs in a subset of mice at 2–6 months, while progressive dilatation of the aorta occurs from 2 to 12 months. Mitral valve tissue mechanical assessments using a uniaxial Permeabilizable Fiber System demonstrate decreased stiffness of MFS MVs at all stages. Histological and microscopic analysis of ECM content, structure, and fiber orientation demonstrate that alterations in ECM mechanics, composition, and organization precede functional abnormalities in Fbn1C1041G/+MFS MVs. At 2 months, ECM abnormalities are detected with an increase in proteoglycans and decreased stiffness of the mitral valve. By 6–12 months, collagen fiber remodeling is increased with abnormal fiber organization in MFS mitral valve leaflets. At the same time, matrifibrocyte gene expression characteristic of collagen-rich connective tissue is increased, as detected by RNA in situ hybridization and qPCR. Together, these studies demonstrate early prevalence of proteoglycans at 2 months followed by upregulation of collagen structure and organization with age in MVs of MFS mice. ConclusionsAltogether, our data indicate dynamic regulation of mitral valve structure, tissue mechanics, and function that reflect changes in ECM composition, organization, and gene expression in progressive MVD. Notably, increased collagen fiber organization and orientation, potentially dependent on increased matrifibrocyte cell activity, is apparent with altered mitral valve mechanics and function in aging MFS mice.

Echocardiographic assessment of morphofunctional and hemodynamic changes of rheumatic mitral valve dysfunction in the young. Morphological changes in rheumatic valve lesions

Background- Rheumatic fever and its sequel rheumatic heart disease remain a major health problem across the globe. This investigation aims to analyse the mitral valve morphofunctional changes, stratified by severity, and the magnitude of the mitral regurgitation and stenosis through a simplified echocardiographic scoring system in patients with rheumatic heart disease. Methods- As cross-sectional echocardiographic study was carried out in 98 consecutive patients with confirmed rheumatic heart disease. Patients undergoing outpatient clinical care over an 18-month period (mean follow-up period of 9,7±2,9 years) were selected for echocardiographic investigation. After a double-blind echocardiograms review, the inter-rater reliability was calculated (Kappa=0.875 (0.775- 0.974; CI 95%). The morphofunctional data of mitral apparatus were scored on a rating scale from one to fifteen, encompassing three categories (1-5: mild; 6-10: moderate; 10-15: severe) to quantify the degrees of severity. Pearson's Chi-squared test with Yates' continuity correction were performed for comparative analysis and the Wilcoxon test and the Cliff's Delta effect size was calculated to examine differences related to morphological features. Results- The majority of patients had rheumatic heart disease with clinical evidence and twenty patients (20,4%) had subclinical disease.The thickening of both mitral valve leaflets and the restrictive motion of the posterior leaflet were most frequently found in contrast with the low percentage of chordal and/or commissural fusion. The degree of the anterior mitral valve leaflet thickening was proportional to the magnitude of the mitral valve regurgitation (p=0.021). The higher degrees of mitral valve dysfunction were associated with more severe carditis (mitral valve regurgitation, p: 0.000; mitral valve stenosis, p: 0.031). No association was found between the severity of valvular lesions and patient age or length of the disease (p=0.320). The presence of beading was only observed in the acute phase (p=0,000); coaptation defect of the mitral valve was associated with significant left ventricle enlargement (p=0.000). The morphofunctional score of mitral apparatus, stratified by severity, was associated with the magnitude of mitral valve regurgitation (p=0,000) and of mitral valve stenosis (p=0,031) also quantified by severity. The highest scores were observed in patients with the most severe degrees of carditis (p=0,000); however, no association was found with either, the patients’ age (p=0.373) or the duration of the disease (p=0.361). Conclusions- In the analysis of severity of the mitral apparatus deformities and the resulting valve dysfunction, the morphofunctional score stratification was highly associated with the magnitude of mitral regurgitation and stenosis. In this young cohort, the higher scores were associated to severe carditis, but not to the patients’ age or the duration of the disease. Taking into account the low prevalence of severe valve dysfunctions, these results highlight the importance of early intervention and adequate prevention.

Electrocardiogram and echocardiogram patterns among ischemic stroke patients during COVID-19 pandemic

Objectives. Diabetic Ischemic strokes are mostly thromboembolic mainly originating from cardiac diseases. We aimed to assess electrocardiogram and echocardiogram abnormalities in patients with ischemic stroke during the COVID-19 pandemic. Material and methods. This retrospective cross-sectional, hospital-based study was conducted among 299 ischemic stroke patients who were hospitalized in the stroke center, in the north of Iran in 2021. All the data were gathered by checklist from electronic health records. Outcomes. The mean age of participants was 70.37 ± 11.89 (Range: 39, 79) and 134 (44.82%) of them were men. Out of 299 patients, 44 (14.72%) were diagnosed with COVID-19 infection and 75 (25.1%) died in hospital. The most common abnormalities of electrocardiogram and echocardiogram were AF rhythm (22.41%) and mitral valve dysfunction (89.63%), respectively. In univariate analysis, associations were detected between COVID-19 with diastolic and aortic valve dysfunction (P=0.024, P=0.053, respectively) but not with electrocardiogram abnormalities. EF&lt;40 (P=0.005), left ventricular enlargement (P=0.027), right ventricular enlargement (P=0.021), diastolic dysfunction (P=0.003), left atrial enlargement (P&lt;0.001), mitral valve dysfunction (P=0.037) and aortic valve dysfunction (P=0.005) were significantly associated with mortality. In multivariate analysis, no significant association was detected between COVID-19 with echocardiogram and electrocardiogram abnormalities. Conclusions. Aging, comorbidities and atrial fibrillation play an important role in ischemic stroke incidence. COVID-19 may not have any significant associations with echocardiogram and electrocardiogram abnormalities in ischemic stroke patients.

A challenging case of prosthetic mitral valve dysfunction: the value of multimodality imaging.

A challenging case of prosthetic mitral valve dysfunction: the value of multimodality imaging.

Simultaneous bilateral pulmonary and cardiac invasion of metastatic testicular germ cell tumor: A rare case report

AbstractA 23‐year‐old man with a history of a testicular germ cell tumor (GCT) that was incompletely treated, is presented with dyspnea. Significant bilateral pulmonary masses were seen on computed tomography (CT). A large, hypermobile mass in the left atrium (LA) as well as mitral valve dysfunction and moderate pulmonary hypertension was detected by transthoracic echocardiography (TTE). Urgent cardiac surgery was performed to prevent the tumor embolism in addition to restore mitral valve function and reduce pulmonary hypertension. Pathologic reports confirmed testicular GCT. GCT metastasis to the heart and lungs is an incredibly rare phenomenon. To our knowledge, this is the first case of simultaneous GCT metastasis to both lungs and LA. This article highlights the importance of cardiac examinations and imaging in germ cell tumor patients. If there is a functional complication for vital organs such as the heart or lungs, surgical interventions are given priority before starting chemotherapy.

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.

Clinical Characteristics and Long-Term Outcome of Patients with Bio-Prosthetic Mitral Valve – Experience From a South Asian Country

Objectives: The aim of this study is to evaluate clinical characteristics and long-term outcome of the patients with bio-prosthetic mitral valve replacement at a tertiary care hospital of a South Asian country.&#x0D; Methodology: The study is a retrospective observational observational study involving patients who underwent bio-prosthetic mitral valve replacement at a tertiary care hospital in Karachi, Pakistan, between 2006 and 2020, and had at least two complete echocardiograms. Patients with incomplete clinical data, no electronic reports of echocardiograms, and mechanical mitral valve replacement were excluded.&#x0D; Results: This is a retrospective observational study, conducted at a tertiary care hospital. We included a total of 502 patients who underwent bio-prosthetic mitral valve replacement from the year 2006 to 2020. Patients were divided into two groups based on normal functioning bio-prosthetic mitral valve and bio-prosthetic mitral valve dysfunction (BMVD). Out of 502 patients, 322 (64%) were female, mean age at the time of surgery was 49.42 ± 14.56 years. Mitral regurgitation was more common, found in 279 (55.6%) patients followed by mitral stenosis in 188 (37.5%) patients. Mitral valve replacement was done as an elective procedure due to NYHA II to IV symptoms at the time of surgery in 446 (88.8%) patients. In the mean follow-up of 6.59 + 2.99 years, bio-prosthetic mitral valve dysfunction (BMVD) was observed in 183 (36.5%) patients. However, re-do mitral valve surgery was done in only 49 (9.8%) patients. Comparing the two groups, individuals with normal functioning bio-prosthetic mitral valve had a mean age of 51.6 + 14.27 years, while those with BMVD had a mean age of 45.639 + 14.33 years at the time of index surgery (p value=0.000). There were more long-term complications including heart failure (n = 16, 8.74%), atrial fibrillation (n = 11, 6.01%) and death (n = 6, 3.28%) in BMVD group which were statistically significant.&#x0D; Conclusion: This study is distinct because it demonstrates the outcomes of bio-prosthetic valve replacement in a relatively younger South Asian population. Due to rapid degeneration of bio-prosthetic valve in younger patients, a significant number of cases developed BMVD along with poor long-term clinical outcomes even at a short follow up period of less than ten years. These findings are like international data and signify that mechanical mitral valve replacement may be a more reasonable alternative in younger patients.

Decoding calcific mitral valve disease: a novel deep learning model uncovers the role of calcium burden

Abstract Background Mitral annular calcification (MAC) is a common degenerative disease that affects older adults and causes calcium deposition in the mitral annulus, increasing the risk of mitral valve (MV) dysfunction, cardiovascular events, conduction abnormalities, and mortality. While the primary imaging modality recommended for the clinical evaluation of MAC is echocardiography, it has been reported to be found incidentally in approximately 8% of routine thoracic computed tomography (CT) scans. CT scan is a sensitive imaging modality for assessing MAC, providing the resolution necessary to understand the anatomical involvement of calcification. Research has shown that the MAC burden is associated with disease activity and progression. Still, the exact correlation between the quantitative calcium burden and the degree of severity of mitral valve disease is unclear. Purpose Our study aimed to determine the association between MAC, as assessed on CT, and significant mitral stenosis (MS) or mitral regurgitation (MR), as visualised on echocardiography. In addition, we sought to determine the quantitative MAC cutoffs that would optimally predict significant MS or MR on echocardiography. Methods A retrospective cohort study was conducted at our academic centre. Inclusion criteria were: age≥60 years, resting transthoracic echocardiogram performed between 2013-2022, non-gated chest CT performed within one year before echocardiography, and any degree of MAC documented on the echocardiography report. CT scans were requested for clinical indications unrelated to mitral valve disease. Exclusion criteria were: prior mitral valve intervention, endocarditis, and congenital mitral valve disease. Significant calcific mitral valve disease was defined as ≥moderate MR and ≥mild MS on the echocardiography report, ascertained by expert readers based on multiparametric ASE criteria. MAC volume was quantified on the multi-slice CT DICOM images using a 3D U-Net deep neural network previously trained by our group on an independent cohort. Results The cohort consisted of 1,560 unique patients with a mean age of 79 years and 61% females. The echocardiographic prevalence of significant MR and MS was 10% and 4%, respectively, for 211 affected patients. The CT-based mean MAC volume was 949 mm³ in patients with significant MR or MS, as opposed to 334 mm³ in those without (P&amp;lt;0.001). MAC volume &amp;gt;1000 mm³ was the optimal cutoff to predict significant MS (specificity 90%, sensitivity 51%, area under ROC curve 0.79) and significant MR (specificity 89%, sensitivity 21%, area under ROC curve 0.60). Adjusting for age, sex, and comorbid conditions did not affect the observed association between MAC volume and mitral valvulopathy. Conclusion A novel deep learning model for quantifying MAC volume from non-cardiac clinical CT scans was efficient in screening for calcific mitral valve disease, particularly MS, and identifying patients who may benefit from further evaluation.

Abstract 18273: Mitral Annular Calcification is Associated With Higher Operative Risks and Worse Survival in Hypertrophic Cardiomyopathy

Background: Mitral annular calcification (MAC) is common in hypertrophic cardiomyopathy (HCM), usually accompanied by mitral leaflet calcification, subvalvular apparatus calcification, and mitral valve dysfunction. However, the impact of MAC on surgical strategy and clinical outcomes in HCM is not fully understood. Methods: This cohort enrolled 1035 consecutively recruited patients diagnosed with HCM between January 2016 and December 2021. All patients received a computed tomographic scan prior to surgery. Results: Of the 1035 patients, 112 (10.8%) had MAC, including 39 patients with moderate or severe MAC (calcification area greater than one-third of the annulus). Patients with MAC were significantly older (59.6±8.2 years vs. 47.5±12.3 years, p&lt;0.001) and more likely to be female (61.8% vs. 35.4%, p&lt;0.001). Echocardiography showed a higher proportion of mitral leaflet thickening (17.9% vs. 6.0%, p&lt;0.001) in patients with MAC. Moreover, patients with MAC had a higher rate of annular reconstruction (1.79% vs 0.11%, p=0.002), plastic ring implantation (5.36% vs 1.84%, p=0.017), chordae release (12.50% vs 5.09%, p=0.002), artificial neochordoplasty (2.68% vs 0.54%, p=0.015), and fibrous membrane removal (8.93% vs 4.12%, p=0.022), as well as longer ventilation time [19 hours, interquartile range (IQR) 17.0-26.0 vs. 18 hours, IQR 14.0-20.5, p&lt;0.001], intensive care unit stay [61 hours, IQR 36.5-96.0 hours vs. 48 hours IQR 24.0-72.0 hours, p&lt;0.001] and postoperative hospital stay [8days, IQR 7-11 days vs. 7 days, IQR 6-8 days, p&lt;0.001]. During a median follow-up time of 26.2 months (IQR, 17.0 to 39.5 months), 5 death and 158 major adverse cardiovascular events (MACE) were observed. Kaplan-Meier survival curves showed that patients with MAC had a higher cumulative rate of all-cause mortality (p=0.026) and MACE (p=0.003) compared to their counterparts. On multivariable Cox regression analysis, moderate or severe MAC was an independent risk factor for MACE (Hazard ratio =2.38, 95% confidence interval: 1.31-4.32). Conclusions: The prevalence of MAC was 10.8% in this study. The presence of MAC was associated with a higher rate of concomitant operations, longer hospital stays, and worse survival.