Valve Deformity Research Articles

Deformation of a balloon-expandable transcatheter heart valve during transcatheter aortic valve replacement.

Deformation of a balloon-expandable transcatheter heart valve during transcatheter aortic valve replacement.

An In Silico Model for Predicting the Efficacy of Edge-to-Edge Repair for Mitral Regurgitation.

In recent years, transcatheter edge-to-edge repair (TEER) has been widely adopted as an effective treatment for mitral regurgitation (MR). The aim of this study is to develop a personalized in silico model to predict the effect of edge-to-edge repair in advance to the procedure for each individual patient. For this purpose, we propose a combination of a valve deformation model for computing the mitral valve (MV) orifice area (MVOA) and a lumped parameter model for the hemodynamics, specifically mitral regurgitation volume (RVol). Although we cannot obtain detailed information on the three-dimensional flow field near the mitral valve, we can rapidly simulate the important medical parameters for the clinical decision support. In the present method, we construct the patient-specific pre-operative models by using the parameter optimization and then simulate the postoperative state by applying the additional clipping condition. The computed preclip MVOAs show good agreement with the clinical measurements, and the correlation coefficient takes 0.998. In addition, the MR grade in terms of RVol also has good correlation with the grade by ground truth MVOA. Finally, we try to investigate the applicability for the predicting the postclip state. The simulated valve shapes clearly show the well-known double orifice and the improvement of the MVOA, compared with the preclip state. Similarly, we confirmed the improved reverse flow and MR grade in terms of RVol. A total computational time is approximately 8 h by using general-purpose PC. These results obviously indicate that the present in silico model has good capability for the assessment of edge-to-edge repair.

Deformation of transcatheter heart valves with mitral valve-in-valve.

The use of oversizing in mitral valve-in-valve (MViV) procedures can lead to non-uniform expansion of transcatheter heart valves (THV). This may have implications for THV durability. The objective of this study was to assess the extent and predictors of THV deformation in MViV procedures. We examined 33 patients who underwent MViV with SAPIEN prostheses. The extent of THV deformation (deformation index, eccentricity, neosinus volume, asymmetric leaflet expansion and vertical deformation) and hypoattenuating leaflet thickening (HALT) were assessed using cardiac computed tomography (CT), performed prospectively at 30 days post-procedure. For descriptive purposes, the THV deformation index was calculated, with values >1.00 representing a more hourglass shape. Non-uniform underexpansion of THV was common after MViV implantation, with a median expansion area of 74.0% (interquartile range 68.1-84.1) at the narrowest level and a THV deformation index of 1.21 (1.13-1.29), but circularity was maintained with eccentricity ranging from 0.24 to 0.28. The degree of oversizing was a key factor associated with greater underexpansion and a higher deformation index (β=-0.634; p<0.001; β=0.594; p<0.001, respectively). Overall, the incidence of HALT on the 30-day postprocedural CT was 27.3% (9 of 33). Most patients (32 of 33) were on anticoagulation therapy, but the prothrombin time and international normalised ratio (PT-INR) at the time of the CT scan was <2.5 in 23 of 32 patients. Among patients with a PT-INR of <2.5, HALT was predominantly observed with a high THV deformation index of ≥1.18. THV deformation, i.e., underexpansion and an hourglass shape, commonly occurs after MViV implantation and is negatively affected by excessive oversizing. Optimising THV expansion during MViV could potentially prevent HALT.

Progress of nanomaterials in the treatment of thrombus.

Thrombus has long been the major contributor of death and disability because it can cause adverse effects to varying degrees on the body, resulting in vascular blockage, embolism, heart valve deformation, widespread bleeding, etc. However, clinically, conventional thrombolytic drug treatments have hemorrhagic complication risks and easy to miss the best time of treatment window. Thus, it is an urgent need to investigate newly alternative treatment strategies that can reduce adverse effects and improve treatment effectiveness. Drugs based on nanomaterials act as a new biomedical strategy and promising tools, and have already been investigated for both diagnostic and therapeutic purposes in thrombus therapy. Recent studies have some encouraging progress. In the present review, we primarily concern with the latest developments in the areas of nanomedicines targeting thrombosis therapy. We present the thrombus' formation, characteristics, and biomarkers for diagnosis, overview recent emerging nanomedicine strategies for thrombus therapy, and focus on the future design directions, challenges, and prospects in the nanomedicine application in thrombus therapy.

Research on thermal-structural coupling and structural optimization of switching valve in booster system

Turbocharging technology is the second milestone in the development of internal combustion engine, which has become an inseparable part of engine technology and has a significant impact on the power and economy of internal combustion engine. The switching valve is a key component in the sequential turbocharging system, which plays a key role in realizing the energy distribution of the parallel turbocharger, the pressure ratio with different engine conditions, the flow regulation and the matching of the full working conditions. In order to explore the influence of different driving torque, gas pressure and temperature on the switching valve of the pressurization system, the steady-state statics and thermal-structural coupling simulation of the switching valve at room temperature were carried out by ANSYS Workbench software. Based on the central composite design method and Kriging method, the size combination and multi-objective response surface optimization model of 15 groups of switching valve design variables are obtained. Under the same conditions, the multi-objective genetic algorithm is used for simulation calculation. The results show that the deformation of the switching valve mainly occurs on the valve plate and the valve shaft under different driving torque and temperature, and it is symmetrically distributed. The distribution of deformation, stress, contact pressure and friction stress of the switching valve under different driving torques are the same. With the increase of driving torque and temperature, the deformation, stress, contact pressure and friction stress of the switching valve increase gradually, and the temperature effect is the most obvious. Compared with the original design size, the optimized structure size can effectively reduce the contact pressure of the switching valve and significantly improve the service life of the switching valve.

An improved displacement adjustment method for overlarge deformation of valve at the cryogenic temperatures

Cryogenic valves are mostly designed at the room temperatures and served at the cryogenic temperatures. The wide temperature difference between design and service conditions causes the overlarge deformation of the valve stem structure, resulting in the cryogenic valve prone to leakage, stuck and other unsafety issues. In this study, an improved displacement adjustment (IDA) compensation method is proposed to solve the problem of size over-tolerance and shape deformation of the valve stem at the cryogenic temperatures. The shape of the valve stem is redesigned by combining IDA and the finite element method to meet its ideal service requirements under the cryogenic conditions. One of the features of the IDA method is to optimize the compensation direction by considering the angle change of normal vector on valve stem surface. Another is to improve the iteration efficiency by recognizing the compensation factor through the Lagrange interpolation algorithm. The simulation and experimental results show that the proposed compensation method can effectively reduce the size and shape deviation of the valve stem. Therefore, this study provides a new method to reduce the stem deviation at the cryogenic temperatures by the shape compensation, which has reference significance for the design of other low temperature components.

Finite Element Simulation and Structural Optimization of Structural Flow Sequential Field for Sequential Boost Switching Valve

Turbocharging technology is an important part of engine technology. Under the working condition of 730 °C and 0.5 MPa, the valve plate opening and closing will bear the high pressure of the internal fluid medium, resulting in the deformation of the switching valve. In this paper, ANSYS finite element simulation software is used to establish the valve fluid domain model, and the stress field and deformation law of the valve under the valve plate opening of 0 °~ 90 °are simulated and analyzed. Based on the fluid-solid coupling theory, the deformation and stress distribution of the valve plate structure are obtained by simulation analysis. The simulation results show that the smaller the opening of the valve plate, the more disordered the flow condition. As the opening increases, the flow tends to be stable. When the opening is 30 °, the negative pressure inside the valve is the largest; combined with the fluid-solid coupling analysis, the maximum stress load on the valve plate appears at the connection between the valve plate and the long valve shaft and the short valve shaft, and the maximum pressure appears at the opening of 60 °, which is 37.144 MPa; the maximum deformation occurs at the outer edge of the valve plate. Based on the results of this simulation analysis, the corresponding multi-objective structural optimization of the valve structure is carried out to provide technical reference for the structural design of similar valves.

Revealing the static and dynamic nanomechanical properties of diatom frustules—Nature's glass lace

Diatoms are single cell microalgae enclosed in silica exoskeletons (frustules) that provide inspiration for advanced hybrid nanostructure designs mimicking multi-scale porosity to achieve outstanding mechanical and optical properties. Interrogating the structure and properties of diatoms down to nanometer scale leads to breakthrough advances reported here in the nanomechanical characterization of Coscinodiscus oculus-iridis diatom pure silica frustules, as well as of air-dried and wet cells with organic content. Static and dynamic mode Atomic Force Microscopy (AFM) and in-SEM nanoindentation revealed the peculiarities of diatom response with separate contributions from material nanoscale behavior and membrane deformation of the entire valve. Significant differences in the nanomechanical properties of the different frustule layers were observed. Furthermore, the deformation response depends strongly on silica hydration and on the support from the internal organic content. The cyclic loading revealed that the average compliance of the silica frustule is 0.019 m/N and increases with increasing number of cycles. The structure–mechanical properties relationship has a direct impact on the vibrational properties of the frustule as a complex micrometer-sized mechanical system. Lessons from Nature’s nanostructuring of diatoms open up pathways to new generations of nano- and microdevices for electronic, electromechanical, photonic, liquid, energy storage, and other applications.

Outlet Ventricular Septal Defect: Impact of Surgery on the Late Aortic and Pulmonary Valve Functions

This study retrospectively evaluated long-term post-operative aortic and pulmonary valve functions in outlet ventricular septal defects. We evaluated aortic regurgitation and pulmonary regurgitation using pre- and post-operative echocardiograms. Overall, 158 patients who underwent intracardiac repair due to outlet ventricular septal defects with aortic valve deformity or congestive heart failure were included. The median follow-up period was 7years (interquartile range: 0-17years), without deaths or pacemaker implantations. The age, weight, ventricular septal defect size, and mild aortic regurgitation at surgery were factors associated with post-operative residual aortic regurgitation. Mild pulmonary regurgitation was observed in 12%, 30%, and 40% of patients 5, 10, and 15years after surgery, respectively. There were no significant differences in age and weight at which surgery was performed between patients with mild pulmonary regurgitation and those with less than mild pulmonary regurgitation. However, the number of sutures across the pulmonary valve was associated with post-operative pulmonary regurgitation (P < 0.01). As some patients with mild pre-operative aortic regurgitation may not improve even after surgery, early surgical intervention is necessary when aortic regurgitation appears. Some patients may develop post-operative pulmonary regurgitation in the long term, suggesting the need for careful follow-up.

Association Between Anterior Rhinoscopic/Endoscopic Assessment of Internal Nasal Valve and Various Nasal Deformities in the Rural Population of Vidarbha Region of India: A Cross-Sectional Study.

Background The nasal valves constitute the majority of the nasal cavity's resistance. Any reduction in this already narrow area can cause a significant reduction in the nasal airflow. In this present study, the aim was to do an endoscopic assessment of the internal nasal valve (INV) in patients with various nasal septal deviations, with or without external nasal deformity. We measured endoscopically the INV in various nasal deformities and derived its association with the INV on anterior rhinoscopy and endoscopic assessment. Method We included 75 patients in the study who were analyzed for angle and grade of the INV by anterior rhinoscopic examination and Hopkins rod zero-degree nasal endoscope (Karl Storz SE & Co., Tuttlingen, Germany). Nasal septal deviations were also studied with respect to the Mladina classification. Correlation between various nasal septal deviations with the INV was done. Since studies addressing the classification of INV are not available in the literature, for the purpose of simplification of observation of INV angle, (normal range 9-15 degrees), subjective stratification was made in the study, i.e.below 9, 9-15, and more than 15 degrees for the sake of knowing the underlying cause and its relationship. Result An anterior rhinoscopic examination was performed on 75 patients. INV Grade 1 was the most common, with 18 patients of (69.2%), 15 patients of DNS with caudal dislocation (55.6%), five patients of DNS with spur (38.5%), and four patients of DNS with external nasal deformity (50%). The next frequently observed Grade of INV on anterior rhinoscopy examination was Grade 2, in 11 patients of DNS with caudal dislocation (40.7%), four patients of DNS with spur (30.8%), and three patients of DNS with external deformity (37.5%), which was statistically significant in our study. In the majority of patients with all types of nasal septal deviations with or without external nasal deformity, INV (angle) of less than 9 degrees was noted, which was statistically significant. A linear relationship, ie., Grade 0 INV in Type I, Grade 1INV in types II, III, IV, and V, and Grade 2 in Type VII was observed. Our study is on par with the literature questioning the dogma of the normal angle of INV being 9-15 degrees. Conclusion We were able to establish a positive and complimentary role of anterior rhinoscopic and endoscopic assessment of INV. The proposed novel classification of the angle of INV by endoscopic assessment gives a better insight into the association of INV with various nasal septal deformities with or without external nasal septal deviation.

Deformation of Transcatheter Heart Valve Following Valve-in-Valve Transcatheter Aortic Valve Replacement: Implications for Hemodynamics

BackgroundValve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) may be associated with adverse hemodynamics, which might affect clinical outcomes. ObjectivesThis study sought to evaluate the extent and predictors of transcatheter heart valve (THV) deformity in ViV TAVR and the relation to postprocedural hemodynamics. MethodsWe examined 53 patients who underwent ViV TAVR in surgical heart valves with self-expanding Evolut prostheses. THV deformation was examined using cardiac computed tomography prospectively performed 30 days after ViV TAVR, and correlated with 30-day echocardiographic hemodynamic data. ResultsNear complete expansion of the functional portion of the implanted ViV prostheses (ie, >90%) was observed in 16 (30.2%) patients. Factors related to greater expansion of the functional portion and consequently larger neosinus volume were absence of polymer surgical frame, higher implantation and use of balloon aortic valvuloplasty or bioprosthetic valve fracture during the procedure (all P < 0.05). Underexpansion of the functional portion, but not the valve inflow frame, was closely associated with mean gradient and effective orifice area at 30 days on echocardiography, with and without adjustment for the sizes of the THV and surgical heart valve. ConclusionsUnderexpansion of the functional portion of THV prostheses is common during ViV TAVR, occurs more frequently with deep implantation and the presence of a polymer surgical stent frame, and is associated with worse postprocedural hemodynamics. Procedural techniques, such as higher implantation and balloon postdilatation, may be used to help overcome problems with THV underexpansion and improve clinical outcomes.

Clinical Analysis of Intestinal Tuberculosis: A Retrospective Study.

This study aimed to summarize and analyze the clinical data of intestinal tuberculosis (ITB) in order to provide guidance for accurate diagnosis and treatment of ITB. This study consecutively included patients with ITB who were admitted to our hospital from 2008 to 2021 and retrospectively analyzed their clinical features. Forty-six patients were included. The most common clinical symptom was weight loss (67.4%). Seventy percent of 20 patients were positive for tuberculin skin test; 57.1% of 14 patients were positive for mycobacterium tuberculosis specific cellular immune response test, while 84.6% of 26 patients were positive for tuberculosis infection T cell spot test. By chest computed tomography (CT) examination, 25% and 5.6% of 36 patients were diagnosed with active pulmonary tuberculosis and with inactive pulmonary tuberculosis, respectively. By abdominal CT examination, the most common sign was abdominal lymph node enlargement (43.2%). Forty-two patients underwent colonoscopy, and the most common endoscopic manifestation was ileocecal ulcer (59.5%), followed by colonic ulcer (35.7%) and ileocecal valve deformity (26.2%). ITB most frequently involved the terminal ileum/ileocecal region (76.1%). Granulomatous inflammation with multinucleated giant cells and caseous necrosis was found via endoscopic biopsies, the ultrasound-guided percutaneous biopsy of enlarged mesentery lymph nodes, and surgical interventions. The acid-fast bacilli were discovered in 53.1% of 32 samples. Twenty-one cases highly suspected of ITB were confirmed after responding to empiric anti-tuberculosis therapy. It was necessary to comprehensively analyze clinical features to make an accurate diagnosis of ITB and aid in distinguishing ITB from diseases such as Crohn's disease and malignant tumors.

Single-cell sorting using integrated pneumatic valve droplet microfluidic chip

Single-cell analysis and sorting have been increasingly prevalent in scientific study and industry in recent years. Droplet-based microfluidic systems are significant tools for single cell separation due to the advantages of high-throughput screening flux and relatively simple chip manufacturing. Herein, this work integrated single-cell droplet generation, incubation, and sorting functions into a single microfluidic chip using pneumatic microvalve for single-cell screening of hybridoma cells. The chip realized the generation, storage, incubation, and assay sorting of droplets in order by adjusting the switch of the microvalve. Numerical methods were used to simulate the effects of membrane size and pressure on valve deformation. Incubation results showed that fluorescent signals were generated in the droplets containing both hybridoma cells and microspheres under the control of pneumatic microvalves. In addition, the purity of target droplets was increased from 4.87% before sorting to 89.70% after sorting using fluorescence-activated droplet sorting platform, demonstrating the feasibility of the integrated chip with a pneumatic valve for single-cell screening. The integrated chip is proved to be operated efficiently with minimum cell loss and human labor through reducing the risk of droplet fusion and facilitating the development of automated devices. So, the present study provides an integrated design for microdroplet-based single-cell sorting with various applications, such as single-cell sequencing, antibody screening, and directed evolutionary studies.

A case of Ebstein’s anomaly

Ebstein’s anomaly (EA) is a rare congenital heart disease. It has varied clinical presentation depending upon the spectrum of deformation and function of the tricuspid valve and other structures. A comprehensive evaluation by non- invasive modalities is required for optimal decision making regarding the approach to surgical correction of the disease.

Effects of Hysteresis on the Dynamic Deformation of Artificial Polymeric Heart Valve

The deformation behavior of an artificial heart valve was analyzed using the explicit dynamic finite element method. Time variations of the left ventricle and the aortic pressure were considered as the mechanical boundary conditions in order to reproduce the opening and closing movements of the valve under the full cardiac cycle. The valve was assumed to be made from a medical polymer and hence, a hyperelastic Mooney–Rivlin model was assigned as the material model. A simple formula of the damage mechanics was also introduced into the theoretical material model to express the hysteresis response under the unloading state. Effects of the hysteresis on the valve deformation were characterized by the delay of response and the enlargement of displacement. Most importantly, the elastic vibration observed in the pure elastic response under the full close state was dramatically reduced by the conversion of a part of elastic energy to the dissipated energy due to hysteresis.

Occlusion of the os of the left coronary artery by dysplastic aortic valve tissue presenting as progressive mitral insufficiency and cardiac arrest.

Mitral regurgitation in the neonatal period is relatively rare. It can be secondary to a congenital malformation of the valve apparatus or mitral valve dysfunction and deformation secondary to myocardial dysfunction or volume load of the left ventricle. Less commonly, it can be due to coronary artery abnormalities leading to mitral valve papillary muscle ischaemia and subsequent dysfunction. Such coronary artery abnormalities include anomalous left coronary artery from pulmonary artery, left main coronary artery atresia, or a thromboembolic phenomenon. In this study, we describe a newborn with a dysplastic aortic valve causing obstruction of the os of the left coronary artery leading to progressive mitral insufficiency.

Fluid–structure interaction of human nasal valves under sniff conditions and transport of inhaled aerosols: A numerical study

The nasal valve is the narrowest part of the nasal airway which is responsible for the largest part of the nasal resistance. Even little changes in the aperture can affect the flow downstream through the nose significantly. Its principal function is to limit airflow for example during a rapid and short inhalation, also called a sniff. Coupling Computational Fluid Dynamics (CFD) with Fluid–Structure Interaction (FSI) allows solving and exchanging force and displacement between the solid and fluid domains and offers a more accurate representation of the physical system in confined flow cases. Furthermore, particle transport and deposition are performed in this study to reveal the effect of the complex coupling on the nasal cavity deposition of inhaled aerosols. Two different configurations are used to model the nasal valve and differences in magnitudes in deformations are observed during the sniff. A comparison between FSI results and the in-vivo evaluation of the deformation shows an acceptable agreement as to the first step of validation. In addition, the results demonstrated that FSI increases significantly the particle deposition in the nasal cavity and the micro-particle diameter is the critical range parameter to enhance deposition with nasal valve deformation during a sniff.

Nonalcoholic Fatty Liver Disease: An Emerging Modern-Day Risk Factor for Cardiovascular Disease.

Nonalcoholic fatty liver disease (NAFLD), also named metabolic dysfunction-associated fatty liver disease (MAFLD), is a progressive disease spectrum encompassing simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. It is a clinically silent disease leading to multiple extra-hepatic complications/comorbidities. It is an independent risk factor for cardiovascular disease (CVD), increasing susceptibility to hypertension, atherosclerosis, arrhythmia, myocardial dysfunction, cardiac valve deformation, and venous thrombosis through putative mechanisms including systemic inflammation, endothelial dysfunction, oxidative stress, insulin resistance, and altered lipid metabolism. Eventually, it increases the CVD prevalence, incident, and fatality, contributing to a huge health care burden. In fact, CVD is becoming the leading cause of mortality among patients with NAFLD. Other cardiometabolic risk factors coexisting with NAFLD may also accelerate the synergistic development of CVD, which warrants assessment targeting hypertension, diabetes mellitus (DM), obesity, and dyslipidemia to be an integral part of NAFLD care. Monitoring metabolic biomarkers (glucose, glycosylated hemoglobin [HbA1c], insulin, lipids, and lipoproteins), cardiovascular (CV) risk scores (American College of Cardiology/American Heart Association [ACC/AHA] or Framingham), and subclinical atherosclerosis (coronary artery calcification [CAC], carotid intima-media thickness [CIMT], and carotid plaque) are recommended for risk prediction and reduction. There is no universally accepted treatment for NAFLD, and lifestyle changes with weight loss of at least 10% are the mainstay of management. Combination therapy of ezetimibe and statins have a cardioprotective effect and help reduce liver fat.Despite being an emerging risk factor for CVD and its rapidly increasing pattern affecting a quarter of the global population, NAFLD remains overlooked and undetected, unlike the other traditional risk factors. Hence, we conducted a comprehensive narrative review to shed more light on the importance of screening CVD in NAFLD patients. PubMed indexed relevant articles published from 2002 to 2022 (20 years) were searched in April 2022 using medical subject headings (MeSH) as "nonalcoholic fatty liver disease" [Mesh] AND "cardiovascular diseases" [Mesh]. Evidence from 40 observational studies, three clinical trials, one case series, 45 narrative reviews, four systematic reviews and meta-analyses, three systematic reviews, and one meta-analysis were summarized on the epidemiologic data, pathophysiologic mechanisms, clinical features, diagnostic modalities, overlapping management, perceived challenges and health literacy regarding the CVD risk attributed to NAFLD.

Development of In-Pipe Water Pollution Detection System Focusing on pH Contaminant

Developing an in-pipe water pollution detection system ensures that the contaminated water will not enter the system in the event of water pollution, hence reducing the possibility of a water crisis. In this research, the design of the system was completed using SOLIDWORKS. ANSYS software was used for the deformation simulation analysis of the pH sensor and the ball valve installed in the system due to water pressure. The maximum deformation of the ball valve occurred at the edges of the ball valve for a fully-closed valve and the middle tip of the ball valve when the valve was opened 45°. The deformation is similar in these conditions due to the small area at the edges; thus, the pressure at the location is higher. For the pH sensor, the deformation of the body is approximately 5.7138 × 10-4 mm. The maximum stress is below the limit, proving that the sensor is suitable for operating in that position. Overall, the experimental results proved that the system is able to detect if the water is polluted by sensing the pH level changes in the water and managing the flow of the water pipe. In the future, by complementing this system with the Internet of Things (IoT), it can assist and alert workers in water treatment plants to detect water pollution in their treatment facility at the earliest stage. Thus, reducing operational costs and the closure of water treatment plants can be prevented in the future.

Stress echocardiography in patients with ischemic mitral regurgitation and left ventricular dysfunction qualified to cardiosurgery treatment

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Ischemic mitral regurgitation (IMR) is predominantly related to left ventricle (LV) remodeling and mitral valve deformation. Although coronary artery bypass grafting alone (CABGa) or with mitral annuloplasty (CABGmp) is considered the best therapeutic strategies for patients with IMR, some recurrences are still reported. Purpose The aim of this study was to evaluate use of the mitral deformation indices (MDI) as a predictor of recurrence of IMR in 1-year follow-up after surgery. Methods A total of 145 patients after myocardial infarction with significant IMR, eligible for CABG, were prospectively enrolled in the study. Patients were referred for CABGa (gr.1; n = 90) or CABGmp (gr.2; n = 55), based on clinical assessment and the results of rest and stress echocardiography. One year after surgery each patient underwent the evaluation of cardiovascular events. Univariable logistic regression analysis was used to identify factors of recurrence of IMR in 1 year follow-up. Results Logistic regression analysis revealed that in CABGa group preoperative changes of TA and CH during DBX remained the predictors of the recurrence of IMR in 12 months follow-up. TAdbx &amp;gt; 1 cm2 provided sensitivity of 90% and specificity of 29%, (AUC 0.6436); The best cut-off value for CHdbx was 0.4 cm (sensitivity 90%, specificity 34%; AUC 0.6432). In both groups no significant differences were observed in 12-month mortality (1.2% vs 0%; p = 1.0), hospitalizations due to the heart failure (HF) exacerbation (5.9% vs 8.5%; p = 0.72) and in the incidence of the composite endpoint (deaths/CV hosp/stroke) (7% vs 8.5%; p = 0.742). Conclusion Preoperative assessment of MDI changes during dbx can be used to identify patients with IMR at increased risk of recurrence of significant IMR in 1 year follow-up. Abstract Figure 1 Abstract Figure 2