Mitral Valve Involvement Research Articles

Multivalvular prolapse: A case report of concurrent mitral, aortic, and tricuspid valve involvement in the same patient with severe regurgitation and heart failure features

Myxomatous valvular disease of cardiac valves has been reported in various studies and case reports which involves mainly mitral valve. This valvular involvement produces several degrees of regurgitant lesions, causing symptoms. Concomitant involvement of mitral, aortic, and tricuspid valves has been rarely reported. Here, we report a case of a 49-year-old male with triple valve prolapse, presenting with dyspnea and palpitations. The patient was managed conservatively as he was not fit for surgical intervention. This report adds to the limited data available in the literature and current guidelines to support clinical decision-making.

CHARACTERISTICS OF CLINICAL MANIFESTATIONS IN INFECTIVE ENDOCARDITIS WITH MITRAL VALVE INVOLVEMENT

The purpose of the work is to analyze the clinical manifestations of infective endocarditis with mitral valve involvement. Materials and methods. The study included 287 patients who underwent mitral valve surgery, comprising 205 males and 82 females, with an average age of 50.1 ± 2.9 years, all of whom had a history of infectious endocarditis affecting the mitral valve. Results. The study analyzed the age groups of participants, considering their sex. It was found that in the age groups of ≥ 19, 20-29, 60-69, and 70-79 years, the sex differences in the incidence of infective endocarditis were not statistically significant (p ≥ 0.05). However, in the age groups of 30-39 years (p = 0.05, χ² = 3.87), 40-49 years (p = 0.02, χ² = 5.26), and 50-59 years (p = 0.006, χ² = 7.55), male patients were found to be affected more frequently. The most common etiopathogenetic causes of infectious endocarditis were identified as bronchopulmonary, urological, and general surgical factors. Key factors influencing susceptibility to infectious endocarditis included degenerative factors, congenital heart defects, and acquired heart defects resulting from rheumatic disease. The most frequent complications of infectious endocarditis presenting as organ failure included pneumonia, acute cerebrovascular accident, and acute heart failure. The frequency of emergency operations was significantly higher in patients who underwent mitral valve plastic surgery compared to those who had mitral valve replacement (p = 0.02, χ² = 5.16). Conclusions. The study results indicated that male patients are affected more frequently by infective endocarditis (p = 0.001, χ² = 10.73). It was observed that among the age groups of 30 to 59 years, male patients experience infective endocarditis significantly more often. Additionally, it was established that clinical features significantly influence the urgency of surgical interventions. The frequency of emergency operations was notably higher in patients who underwent mitral valve plastic surgery (p = 0.02, χ² = 5.16).

From flank pain to splenic abscess: a complex case of infective endocarditis with literature review

BackgroundInfective endocarditis (IE) is a severe condition characterized by inflammation of the heart endocardium and valves, commonly caused by Gram-positive bacteria. Complications such as embolic phenomena and organ abscesses can arise, necessitating timely diagnosis and intervention.Case presentationWe report the case of a 20-year-old female with a history of cerebral and splenic infarctions due to IE. The patient presented with left-sided flank pain, urinary burning, and fever. Examination revealed mitral and aortic valve involvement, splenomegaly, and neurological deficits. Despite initial antibiotic therapy, the patient developed a splenic abscess and drug-induced neutropenia. She required aortic valve replacement and was successfully managed with a multidisciplinary approach.ConclusionMultidisciplinary management, including timely surgical intervention and advanced imaging, is essential for favorable outcomes in IE patients. This case underscores the importance of early detection and tailored treatment strategies in managing severe complications associated with IE.

Clinical profile, microbiology and outcomes in infective endocarditis treated with aortic valve replacement: a multicenter case-control study

BackgroundAortic valve infective endocarditis (IE) is associated with significant morbidity and mortality. We aimed to describe the clinical profile, risk factors and predictors of short- and long-term mortality in patients with aortic valve IE treated with aortic valve replacement (AVR) compared with a control group undergoing AVR for non-infectious valvular heart disease.MethodsBetween January 2008 and December 2013, a total of 170 cases with IE treated with AVR (exposed cohort) and 677 randomly selected non-infectious AVR-treated patients with degenerative aortic valve disease (controls) were recruited from three tertiary hospitals with cardiothoracic facilities across Scandinavia. Crude and adjusted hazard ratios (HR) were estimated using Cox regression models.ResultsThe mean age of the IE cohort was 58.5 ± 15.1 years (80.0% men). During a mean follow-up of 7.8 years (IQR 5.1-10.8 years), 373 (44.0%) deaths occurred: 81 (47.6%) in the IE group and 292 (43.1%) among controls. Independent risk factors associated with IE were male gender, previous heart surgery, underweight, positive hepatitis C serology, renal failure, previous wound infection and dental treatment (all p < 0.05). IE was associated with an increased risk of both short-term (≤ 30 days) (HR 2.86, [1.36–5.98], p = 0.005) and long-term mortality (HR 2.03, [1.43–2.88], p < 0.001). In patients with IE, chronic obstructive pulmonary disease (HR 2.13), underweight (HR 4.47), renal failure (HR 2.05), concomitant mitral valve involvement (HR 2.37) and mediastinitis (HR 3.98) were independent predictors of long-term mortality. Staphylococcus aureus was the most prevalent microbe (21.8%) and associated with a 5.2-fold increased risk of early mortality, while enterococci were associated with the risk of long-term mortality (HR 1.78).ConclusionsIn this multicenter case-control study, IE was associated with an increased risk of both short- and long-term mortality compared to controls. Efforts should be made to identify, and timely treat modifiable risk factors associated with contracting IE, and mitigate the predictors of poor survival in IE.

Cardiovascular crossroads - exploring the impact of atrial fibrillation on mitral valve regurgitation and MitraClip treatment

Abstract Introduction The use of the MitraClip technique is becoming increasingly popular as a treatment option for patients suffering from mitral valve regurgitation who are not suitable for surgery. It is unclear how pre-existing atrial fibrillation impacts patients during the procedure. Purpose The question arises: What is the underlying cause of atrial fibrillation in patients with significant mitral valve involvement and why do some patients remain unaffected? This study aims to compare and identify differences in cohorts of patients with and without atrial fibrillation before the MitraClip procedure. Methods We analyzed a register of 279 patients who underwent MitraClip treatment. The study classified the patients according to the presence (n=140, 50%) or absence (n=139, 50%) of atrial fibrillation prior to the procedure. We utilized univariate analysis to compare demographic, clinical, and echocardiographic parameters. Multivariate logistic regression was also performed to determine significant predictors. Results Both cohorts were of similar size, but there were significant differences in certain parameters. Women were more frequent in the group without atrial fibrillation (45% compared to 34%, p=0.045). The group with atrial fibrillation was slightly older (73 years compared to 70 years, p&amp;lt;0.001) and had a lager body surface area (1.95 compared to 1.87, p=0.005). Parameters such as Euroscore II, NT-proBNP and creatinine levels were not significantly different. Nevertheless, it is important to note that the group with atrial fibrillation had a greater transverse dimension of the left atrium (55 compared to 50, p&amp;lt;0.001). Additionally, the atrial fibrillation group exhibited a higher degree of tricuspid regurgitation (2.9 vs 2.0, p=0.007) and a slightly lower baseline VO2 max (11.63 vs 12.59, p&amp;lt;0.001). Multivariate logistic regression revealed that baseline tricuspid regurgitation is a significant predictor of atrial fibrillation, with and odds ratio of 2.066 (95% CI: 1.041-4.097, p=0.038). Conclusion During the MitraClip procedure, patients with atrial fibrillation demonstrate certain specific characteristics, including older age, increased body surface area, larger left atrial size, and higher grade of tricuspid regurgitation. The significant association of tricuspid regurgitation with atrial fibrillation emphasizes its potential role in clinical evaluation and subsequent treatment.

SEVERE MITRAL INSUFFICIENCY FROM RHEUMATIC DISEASE: A CASE REPORT

Abstract Acute rheumatic fever continues to be a major health problem in many parts of thw world. It’s more common in low–income or developing parts of the world. Antibiotics for bacterial infections may not be available in these areas. In developed countries, cardiac involvement is quite rare. Although traditionally considered to be a disease associated with poverty, rheumatic fever continues to persist even among the middle–class population in developed countries. Children and teenagers with intreated strep infections are the most likely to get rheumatic fever. Signs of heart damage can develop years after the infection. Rheumatic heart disease is the result of valvular damage caused by an abnormal immune response to Streptococcus pyogenes infection. After multiple episodes of rheumatic fever, progressive fibrosis of the heart valves can occur: mitral regurgitation is the most common valvular lesion. We report the case of a 13–year–old, Italian, middle–class girl with rheumatic mitral valve involvement. A 13–years–old comes to the clinic for onset of worsening dyspnea ad easy fatigability. History turns out to be negative for cardiovascular disease and history of recent infections. Echocardiographic examination showed a dilated left ventricle (VTD 148ml, 98 m/mq) with preserved chinese. Severe dilatation of the left atrium with atrio–aortic ratio 2.3 and atrial volume 91 ml/mq. The mitral valve presented a myxomatous, thickened leaflets, predominantly the posterior which appeared retracted and hypomobile with thickening of the subvalvular apparatus with coaptation deficit along the entire coaptation rhyme realizing severe degree insufficiency (CV 7mm, ERO 0.8 cm2, CO 39 l/min). A small cleft at the level of A1, main lesion jet (A1–P3–P2) was also visible. The Echocardiographic appearance suggested outcomes from rheumatic disease so antistreptolysin titer and anti–DNase B antibodies were assayed with high levels found. Penicillin prophylaxis was therefore initiated. For the continuation of the therapeutic course, the case was discussed collegially and a valve replacement rather tan repair was advocated because the valvular and subvalvular apparatus were far too damaged.

Serum 25(OH)D Levels and Mitral Valve Calcification in Patients with Severe Rheumatic Mitral Stenosis

Background: Rheumatic heart disease (RHD) imposes a significant burden on patients and the health system, especially in the developing countries. Recently, the role of vitamin D deficiency in increasing the severity of valve involvement and calcification in patients with RHD has been suggested. However, its role in the severe stenosis of the mitral valve is unknown. The aim of this study was to determine the relationship between serum levels of 25(OH)D and mitral involvement severity scores in patients with severe mitral stenosis (MS). Materials and Methods: In this cross-sectional study conducted in Shahid Madani Heart Center, Tabriz, Iran, 104 patients with severe rheumatic MS were reviewed, in the absence of other underlying diseases. Trans-esophageal Echocardiography was performed for all patients, and mitral valve Wilkins score and mitral valve area were calculated. Blood samples were taken from patients and levels of 25(OH)D, total calcium, phosphorus, and i-PTH were measured. Results: Eighty eight cases were female and 16 were male. Eighty-one patients had mild to moderate mitral calcification and in 23 patients with mitral valve was severely calcified. Furthermore, 54 were vitamin D deficient, while 35 had insufficient vitamin D levels, and only 15 had normal blood levels of vitamin D. In addition high serum iPTH levels were present in 83 patients (80%). The levels of 25(OH)D, calcium, phosphorous, and iPTH with total Wilkins score, calcification score and mitral valve area were not significantly correlated (p&gt;0.05 for all above). Conclusions: Although no correlation was found between the severity of mitral valve involvement, and vitamin D and iPTH levels, vitamin D deficiency and secondary hyperparathyroidism tend to be common among patients with severe rheumatic MS, which may play a role in the progression of the disease.

Surgical Treatment of Active Endocarditis Pre- and Post-COVID-19 Pandemic Onset.

Despite advanced diagnosis and treatment, infective endocarditis (IE) is a potentially life-threatening condition. The impact of COVID-19 on the diagnosis and outcome of the surgical treatment of IE is uncertain. The aim of this study was to analyze the incidence, characteristics, and outcomes of surgically treated IE before and after the COVID-19 pandemic. This study retrospectively analyzed the data of 535 patients who underwent valve surgical procedures for IE between January 2010 and December 2022 in a single cardiac surgery center. Patients were divided into two groups depending on the date of their operation: before (n = 393) and after (n = 142) COVID-19 onset. In order to balance the groups, inverse probability of treatment weighting (IPTW) calculated from the propensity score (PS) was applied. Weighted univariate logistic regressions were reported for outcomes; weights were derived from IPTW. Interrupted time series analysis (ITSA) according to Linden's method was used to evaluate the changes in the manifestation of IE after 11 March 2020. Patients from the post-COVID-19 cohort (after 11 March 2020) had a greater number of comorbidities such as diabetes (29.6% vs. 16.3% p = 0.001), hypertension (71.1% vs. 59.5% p = 0.015), and preoperative kidney injury requiring dialysis (9.2% vs. 2.5% p = 0.002), but the median additive and logistic EuroSCORE were not statistically different. In the post-COVID-19 group, we observed a greater prevalence of Staphylococcus aureus-related endocarditis (24.5% vs. 15.4% p = 0.026), a consequent reduction in Staphylococcus non aureus-related endocarditis (12.2% vs. 20.1% p = 0.048), and a decrease in aortic valve replacements (43.0% vs. 53.9%), while the number of mitral valve replacements and repair was greater (21.1% vs. 15.0% and 6.3% vs. 4.3%, respectively). No differences were found in the two groups concerning early death, death, or relapse at 1 year after surgery. Data obtained by multivariable analysis identified preoperative renal dysfunction requiring dialysis as the only common risk factor for early mortality via stratifying by time periods in analysis. The incidence of surgically treated IE significantly increases after the COVID-19 pandemic with a higher incidence of mitral valve involvement with respect to the aortic valve. Although a delay in surgical timing occurred during the COVID-19 pandemic, data in terms of mortality and outcomes were largely unaffected.

Clinical Characteristics and Valve Lesions in Rheumatic Heart Disease Among Children at Hiwot Fana Comprehensive Specialized Hospital: A Comparative Study of Newly Diagnosed and Known Cases

Background. Rheumatic heart disease remains a significant health burden in resource-limited settings. This study investigated the clinical characteristics and valve lesion patterns of RHD in children from Eastern Ethiopia, comparing newly diagnosed and known RHD patients. Objective. This study aimed to characterize the clinical features and valve lesion patterns in children with Rheumatic heart disease and provide a comparative analysis between newly diagnosed and known cases. Methods. A hospital-based cross-sectional study was conducted at Hiwot Fana Comprehensive Specialized Hospital from January 1 to December 31, 2021. A total of 39 children with RHD were included, with data collected from medical records, clinical assessments, and echocardiographic evaluations. Descriptive statistics and chi-square tests were used for analysis. Results. Among the 39 children studied, 25 were newly diagnosed and 14 were known RHD cases. The majority were female (71.8%). The median age was 10 years. Shortness of breath (53.9%) and cough (38.5%) were the most common presenting complaints. Only 14.3% of known RHD patients were adherent to secondary prophylaxis. Severe acute malnutrition and severe anemia were the most common comorbidities. Class IV heart failure was present in 89.7% of the patients. Echocardiographic findings revealed that all patients had mitral valve involvement, with mitral regurgitation (94.9%) being the most frequent. Conclusion. This study revealed that rheumatic diseases in children in Eastern Ethiopia present at advanced stages. Low adherence to secondary prophylaxis and high rates of severe heart failure highlights the consequences of delayed diagnosis and management. These findings underscore the urgent need for better healthcare infrastructure, enhanced prevention programs, and improved strategies to increase prophylaxis adherence to prevent disease progression and improve outcomes for affected children.

Abstract 14871: Mitral Valve Involvement in Systemic Sclerosis, Post COVID-19 Infection

Introduction: We report a case of mitral valve regurgitation as cardiac involvement of systemic sclerosis (SSc) in a 52-year-old woman post COVID-19 infection. Case Description: 52-year-old female presented with new-onset, progressive dyspnea, dryness and thickness of the skin, intermittent palpitations, and weight loss 3 months after recovered from COVID-19. Initial laboratory studies showed low hemoglobin levels and elevated pro-BNP, troponin-T, hs-CRP and ESR. An autoimmune panel was ordered and revealed positive antinuclear antibodies (ANA) and positive scleroderma related antibodies (anti-RNA polymerase III). Chest radiography and Chest CT without contrast both showed septal and bronchial wall thickening. A transthoracic echocardiogram was performed and showed a severely dilated left atrium and mildly thickened mitral valve leaflets with severe mitral regurgitation. A transesophageal echocardiogram revealed a thickened anterior mitral leaflet and restricted mobility of the posterior leaflet with mitral regurgitation being moderate in severity. These findings were consistent with the reported changes seen on echocardiogram and in autopsies in patients with SSc. The diagnosis of SSc in this patient was made and the patient was started on mycophenolate. Conclusions: This case highlights the possible mechanisms through which COVID-19 may trigger the development of autoimmune and inflammatory reactions which, in our case, lead to the development of mitral regurgitation as a sequela of SSc. Imagine 1. Imagine 2.

Abstract 17883: Subacute Native Aortic and Mitral Valve Endocarditis Manifesting as Embolic ST-Elevation Myocardial Infarction

Case description: A 54-year-old male presented with one day of substernal chest pain. He also reported two months of malaise, myalgias, chills, and intermittent fevers. Medical history was notable for well-controlled hypertension and negative for dyslipidemia, diabetes, or drug and tobacco use. Family history was negative for premature coronary artery disease. Vitals were notable for fever of 103F, blood pressure of 108/56 mmHg, and heart rate of 88 beats per minute. Physical exam showed bounding pulses and a soft diastolic murmur at the left lower sternal border. Electrocardiogram showed inferior lead ST-elevations. He was taken for cardiac catheterization and found to have a totally occlusive thrombus in the distal right coronary artery with minimal disease in the remaining vessels. He underwent aspiration thrombectomy and placement of drug eluting stent with normal flow. He was transferred to the coronary intensive care unit. Labs showed mild leukocytosis, normal serum creatinine, and unremarkable urinalysis. Echocardiogram showed a 1.7 x 0.5 cm mobile echodensity on the aortic valve with severe aortic regurgitation and a small echodensity on the anterior mitral leaflet. Blood cultures grew Enterococcus faecalis. A CT scan of the head, chest, abdomen, and pelvis revealed no embolic disease. He underwent urgent surgery due to concern for infective endocarditis with coronary embolism. Purulence was found at the stent site and the posterior descending artery was obliterated by necrotic tissue. A bypass graft was placed distal to the stent site and infected territory was unroofed and irrigated. Mitral and aortic valve replacement was performed. He tolerated surgery and was discharged with 6 weeks of intravenous antibiotics. Discussion: This case was unique in the subacute chronicity of endocarditis and lack of other systemic emboli. Clinically relevant coronary embolism was reported in only 1.5% of cases of infective endocarditis but microemboli were found in 60% postmortem. Embolization is more common with mitral valve involvement, &gt;10 mm vegetation, and fungal or staphylococcal disease. Angiographic evidence of heavy thrombus burden or lack of significant atherosclerosis after myocardial infarction may prompt evaluation for coronary embolism.

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.

Surgical treatment of aortic root abscess: 10-year single center experience

The issue of optimal surgical scope in patients with aortic root abscess due to infective endocarditis remains open, since there are different strategies and interventional methods. In addition, the guidelines do not give preference to any particular type of surgical intervention and recommend an individual approach to each situation. The study included 25 patients with aortic root abscess due to aortic valve infective endocarditis. The most frequently performed surgical intervention in patients was the Ross procedure (n=12, 48%). Eight (32%) patients of the center underwent aortic homograft root replacement. Combined surgery was performed in 7 (28%) patients as follows: 3 (12%) patients — interventions on the mitral valve (all patients underwent mitral valve repair due to mitral valve involvement in abscess), 3 (12%) — coronary artery bypass grafting, 1 (4%) — ascending aortic replacement due to dilatation. Five- and ten-year survival after surgical treatment of patients with aortic root abscess was 86,9% and 78,6%, respectively. There was no reintervention and recurrence of infective endocarditis in the long-term period.

Surgical treatment of aortic root abscess: 10-year single center experience

The issue of optimal surgical scope in patients with aortic root abscess due to infective endocarditis remains open, since there are different strategies and interventional methods. In addition, the guidelines do not give preference to any particular type of surgical intervention and recommend an individual approach to each situation. The study included 25 patients with aortic root abscess due to aortic valve infective endocarditis. The most frequently performed surgical intervention in patients was the Ross procedure (n=12, 48%). Eight (32%) patients of the center underwent aortic homograft root replacement. Combined surgery was performed in 7 (28%) patients as follows: 3 (12%) patients — interventions on the mitral valve (all patients underwent mitral valve repair due to mitral valve involvement in abscess), 3 (12%) — coronary artery bypass grafting, 1 (4%) — ascending aortic replacement due to dilatation. Five- and ten-year survival after surgical treatment of patients with aortic root abscess was 86,9% and 78,6%, respectively. There was no reintervention and recurrence of infective endocarditis in the long-term period.

Evolution of Infective Endocarditis Profiles in South-Central Chile: A Four-Decade Analysis of Surgical Patients

To describe the changes observed in operated patients with infective endocarditis (IE) in the south-central region of Chile during the last four decades. Case series study. The target population was patients diagnosed with IE and indication for valve surgery between 1983 and 2020 from a Chilean public hospital. The universe (n = 306) was divided into four groups according to the period of valve surgery. Sociodemographic and clinical variables between these groups were compared using the Kruskal-Wallis and Chi-square tests for independence. Cumulative survivals were calculated and compared using the Gehan-Breslow-Wilcoxon test. Age at diagnosis (p < 0.001), frequency of comorbidities (p < 0.001), clinical presentation compatible with acute kidney injury (p < 0.001), independent mitral valve involvement (p < 0.001), positivity of microbiological cultures (p < 0.012) and cumulative survival (p = 0,015) increased. The delay from symptom onset to diagnosis (p = 0.003), clinical presentation compatible with heart failure (p < 0.001), independent involvement of the aortic valve (p < 0.001), and surgical indication for large vegetation (p < 0.001) decreased. The IE profile of patients seen in a public hospital in the south-central region of Chile has undergone significant changes during the last four decades.

Cardiac surgery of aortic valve and ascending aorta (Bentall procedure) in a patient with Fabry disease without enzyme replacement therapy: an overview of aortic and aortic valve surgical tips

Introduction: Fabry disease (FD) is a rare disease in which cardiovascular events are one of its manifestations. Aortic and mitral valve involvement are among its manifestations, but due to the concern of suture failure without enzyme replacement therapy (ERT), the desire for its surgery has been very low, and its reported cases have been few. After the introduction of ERT, cardiovascular surgery for such patients has been gradually reported from different places, but due to the high cost of ERT, it is not practically available to patients in the third world and the backward countries. Reports of the experiences of patients with FD who underwent cardiac surgery without ERT can help improve cardiac surgery in these patients. Case Report: A 34-year-old man diagnosed with FD due to chronic renal failure and underwent dialysis 3 times a week for 1.5 years became a candidate for kidney transplant. In pre-transplant examinations, dilatation of aortic root and aortic valve insufficiency were diagnosed, and the patient’s kidney transplant surgery was postponed until after cardiac surgery. The patient underwent cardiac surgery, aortic valve replacement, and ascending aortic replacement, as well as re-implantation of both right and left coronary buttons on the ascending aorta (Bentall procedure). The post-surgery period passed without any special event. The patient’s dialysis continued; after 4 months, he underwent kidney transplant surgery, and the one-year follow-up period also was good. Conclusion: Although there is very little evidence of cardiovascular surgery in patients with FD without ERT, and surgeons have always been worried about suture failure and complications of cardiac surgery, due to the high cost of ERT, this treatment is not available to everyone. The introduced patient underwent cardiac surgery by Bentall procedure without receiving ERT and was discharged without any special complications. By reporting and collecting similar cases, guidance may be provided for patients with FD for whom ERT is not available.

Clinical Presentation and Pattern of Cardiac Involvement in Patients with Rheumatic Heart Disease: A Prospective Observational Study

Context: Rheumatic heart disease (RHD). Aim: The aim of the study was to study the clinical presentation and pattern of cardiac involvement in adult patients with RHD. Settings and Design: This was a prospective observational study from a tertiary care hospital in South India. Subjects and Methods: Consecutive adult patients diagnosed with and treated for RHD in our tertiary care teaching hospital in Tirupati were screened for inclusion. In all patients, details of appropriate laboratory and imaging investigations that have been carried out were noted. Statistical Analysis Used: Descriptive statistics (frequencies, mean standard deviation, and median [interquartile range (IQR)]) were reported. Results: A total of 120 patients were enrolled. Their mean age was 45.7–12.2 years; there were 79 females. The median (IQR) follow-up was 364 (156–702) weeks. Single-valve disease was seen in 51.7% (n = 62); others (n = 58) had multivalvular disease (mitral stenosis [MS] + aortic regurgitation [AR] [n = 47, 81%] and mitral regurgitation + AR [n = 11, 19%]). Among patients with single-valve involvement, 58 (93.5%) had mitral valve disease. Overall, 116 of 120 (96.6%) patients had mitral valve involvement. Among patients with mitral valve disease (n = 116), MS was severe in 62 (51.6%). Atrial fibrillation was evident in 59 (49.2%) patients; of these, 8 had cardioembolic strokes. Forty-four (36.7%) had undergone percutaneous transvenous mitral commissurotomy. Prosthetic mitral valve obstruction was observed in 2/20 patients who had undergone mitral valve replacement or double-valve replacement. Conclusions: In patients with RHD, mitral valve involvement (either alone or in combination with the aortic valve) was most common; MS was most common.

1990. Prognostic factors for long-term mortality in left-sided infective endocarditis after surgical treatment

Abstract Background Infective endocarditis is not a prevalent disease but has a high mortality rate. Especially left-sided infective endocarditis (LSIE) shows a higher mortality rate than right-sided infective endocarditis. Surgical treatment is occasionally considered for LSIE, but not much data is available on the long-term prognostic factors for LSIE after surgical treatment. This study investigated the risk factors for long-term mortality in LSIE patients who underwent surgical treatment. Methods This retrospective study enrolled adult patients with LSIE admitted to Severance Hospital in South Korea and underwent surgical treatment from November 2005 to August 2017. The primary outcome was overall all-cause mortality. Multivariate Cox regression analyses were performed to assess the risk factors for long-term mortality of LSIE with surgical treatment. Results 239 cases with LSIE who underwent surgery were enrolled in this study. The median follow-up period was 6.2 years, and there were 34 deaths (14.2%) during the period. The mortality group showed older age (61.0 [53.0-72.0] vs 51.0 [39.0-61.0] years, P = 0.001), more chronic kidney disease (17.6% vs 3.9%, P = 0.007), more chronic liver disease (CLD) (14.7% vs 3.4%, P = 0.017), more cerebral embolisms (58.8% vs 26.8%, P &amp;lt; 0.001), less isolated mitral valve involvement (29.4% vs 52.7%, P = 0.020), and higher Sequential Organ Failure Assessment score (2.0 [1.0-4.0] vs 1.0 [1.0-2.0], P = 0.014). The survivor and mortality groups showed no statistical difference in the time to surgery. Multivariate Cox analyses demonstrated cerebral embolism (Hazard ratio (HR): 3.62, 95% Confidence Interval (CI): 1.79-7.31, P &amp;lt; 0.001), CLD (HR: 4.24, CI: 1.53-11.76, P = 0.005), and age (HR: 1.03, CI: 1.00-1.06, per 1 year, P = 0.021) as risk factors for overall mortality. Kaplan-Meier survival curve showed significant difference between the patients with and without cerebral embolism (P &amp;lt; 0.001, log-rank). Figure 1.Kaplan-Meier survival curve for overall mortality Conclusion Cerebral embolism, CLD, and older age were associated with the long-term mortality in LSIE patients who underwent surgery. Preventive strategies for cerebral embolism are essential for the improvement in LSIE treatment. Disclosures All Authors: No reported disclosures.

Does Perivalvular Involvement Affect the Long-Term Surgical Outcomes of Primary Left-Sided Endocarditis?

Surgical treatment of infective endocarditis (IE) remains challenging, especially in cases of perivalvular destruction and poor clinical presentation. We evaluated the outcomes of surgery for simple (isolated leaflet involvement) versus complex (perivalvular involvement) primary left-sided native valve endocarditis. From 2005 to 2019, a total of 128 consecutive patients (age 57.7 ± 14.2 years) with IE were surgically managed. Study end points were operative and late mortality and freedom from recurrent infection and reoperation for recurrent endocarditis. Patients were categorized as having simple IE (n = 91) versus complex IE (n = 37) based on the preoperative imaging and/or intraoperative findings. Valves involved were aortic in 39% (n = 50), mitral in 46% (n = 59), or both (11%, n = 14). The operative mortality was 11.7% (n = 15), and 9 of them (60%) presented with shock or multiorgan failure. A critical preoperative state was the only independent risk factor for early mortality (odds ratio 7.43, p <0.01). The overall survival was 81.9%, 74.8%, 58%, and 52% at 1, 5, 10, and 15 years, respectively. Long-term survival was similar between simple and complex groups (p = 0.29). Chronic renal failure was the only independent risk factor for late mortality (hazard ratio 2.44, p = 0.02). Freedom from re-endocarditis was 95.2%. None of the patients underwent reoperation because of recurrent endocarditis. Mitral valve repair was performed in 30.7% of all cases with mitral valve involvement. None of them had significant mitral regurgitation or recurrent endocarditis on follow-up. In conclusion, surgery for IE in the setting of complex perivalvular involvement is associated with a low rate of recurrent endocarditis or reoperation and comparable long-term survival to patients with isolated leaflet involvement. Mitral valve repair was feasible and durable in a significant proportion of patients even in the presence of endocarditis.

Obstetric outcome in patients with rheumatic heart disease: experience in a tertiary hospital

Aims: To determine the clinical outcome of rheumatic heart disease in pregnancy.&#x0D; Methods: Retrospective cross-sectional descriptive study from April 2019 to April 2021 in Nobel Medical College, Biratnagar, Nepal. Feto-maternal variables were taken for their health status. Data presented in table with frequency.&#x0D; Results: Out of 13013 deliveries in a year, 49 had cardiac disease (0.37%) and 38 had rheumatic heart disease (0.29%) over 28 weeks of gestation; 95% (n=36) had mitral valve involvement; 12 were primigravida and 7 preterm at the time of delivery. Half of them underwent caesarean section for various indications. Most common maternal complications were cardiac failure, cardiac arrythmia, admission to ICU, obstetric complications, including maternal mortality in 5.2% (n=2) cases. Low birth was in 29% (n=11) of cases, and 34% (n=13) of them needed NICU care at the time of delivery. There was history of rheumatic fever in 9 cases (24%).&#x0D; Conclusions: Rheumatic heart disease is the commonest diagnosis among heart disease in pregnancy and adverse event can be minimized by multidisciplinary intervention