Valve Function Research Articles

On Cytheridella whitmani sp. nov. (Crustacea, Ostracoda) from Cape Cod (Massachusetts, USA), with a reappraisal of the taxonomy of the genus

Cytheridella whitmani Martens, sp. nov. is described from lakes on Cape Cod (MA, USA). The species differs from its congeners mainly by the shape of the female carapace and by the morphology of the hemipenis, especially of the distal lobe and the copulatory process. The literature on the genus is reviewed and the synonymy of the fossil Cytheridella boldii Purper, 1974 with the type species C. ilosvayi Daday, 1905, both described from South America, is confirmed. The status of Cytheridella americana (Furtos, 1936) is reverted to that of “uncertain species”. Beside the type species and the new species, the genus currently includes only three further species from Africa: C. monodi Klie, 1936, C. damasi Klie, 1944 (with synonym C. chariessa Rome, 1977), and C. tepida Victor, 1987. The morphology of the new species is discussed in comparison with the congeneric species, especially regarding the valve ornamentation, the structure and function of the third thoracopod, the hemipenis and the caudal ramus. It is suggested that C. whitmani is a recent invasive species in the lakes of the Cape Cod peninsula. Its occurrence at northern latitudes is unexpected, as its congeneric species are consistently (sub-) tropical.

Fate of Semilunar Valves From Discarded Hearts at the Time of Pediatric Heart Retransplantation.

Partial heart transplantation (PHT) is a novel procedure for children in need of a growing valve replacement option. One challenge is identifying suitable donor valves. Semilunar heart valves from patients receiving a retransplant may be a source, however their functionality and growth potential especially at the time of retransplant are unknown. We aimed to assess growth and function of these valves. Data from patients undergoing a retransplant at a single institution were analyzed. Echocardiograms were compared following the primary transplant and immediately before retransplant to assess growth and valve function. Thirteen patients were included. Recipient and donor ages at the primary transplant were median (range): 2 years (0-13) and 3 years (0-40), respectively. The median time to retransplant was 11 years (2-21). There was an overall growth across all semilunar valve measurements; aortic valve annulus diameter (mean increase ± standard deviation): 0.2 ± 0.12 cm, aortic root: 0.29 ± 0.16 cm, and pulmonary valve annulus: 0.5 ± 0.34 cm; all p < 0.05. The growth rate of valves was higher in younger patients and showed a better correlation with graft age relative to recipient age: aortic valve annulus growth R2: 0.61 (graft age) versus 0.54 (recipient age); aortic root R2: 0.73 versus 0.57; pulmonary valve annulus R2: 0.94 versus 0.86. No patients had clinically significant regurgitation or stenosis on the latest echocardiogram. All except one patient's measurement had valve Z-scores within ±2 at retransplant. Explanted hearts from patients undergoing retransplantation could be considered an additional source of semilunar valves for PHT. Valves from these hearts were found to function normally and grew in proportion with the recipient's body. Valves from younger donors/recipients demonstrated a more rapid growth rate.

Right ventricular function outcomes of percutaneous balloon mitral valvuloplasty: a 3-dimensional echocardiography and 2-dimensional speckle tracking analysis

Abstract Background Rheumatic heart disease (RHD) is a significant cause of mitral stenosis (MS), particularly affecting young adults in developing regions. Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a recognized intervention for severe symptomatic mitral stenosis with favorable morphology. However, its impact on various cardiac parameters needs thorough evaluation by new imaging techniques to increase measurement accuracy and decrease inter-observer variability. Purpose This study aims to evaluate the impact of PBMV on cardiac function and structure among patients with severe rheumatic mitral stenosis, focusing on mitral valve function, Pulmonary artery systolic pressure (PASP) and right ventricular (RV) parameters. Methods A prospective study was conducted involving 30 patients (80% female, mean age 33.1 years) diagnosed with severe rheumatic mitral stenosis. All participants underwent PBMV. Pre- and 30 days post-procedure assessments included conventional echocardiographic parameters, three-dimensional (3D) RV assessment and two-dimensional (2D) strain RV analysis. Statistical analyses were performed to determine significant changes post-PBMV. Results Echocardiographic evaluation showed a decrease in trans-mitral mean pressure gradient and Pressure Half Time (both P&amp;lt;0.001). Improvements were also noted in 2D and 3D mitral valve planimetry values (P&amp;lt;0.001). However, mitral regurgitation (MR) severity increased in some cases (P=0.022). Regarding right ventricular analysis, significant reductions were observed in RV basal, mid and longitudinal diameters (P&amp;lt;0.001 for all). RV Fractional Area Change (FAC%) increased significantly (P&amp;lt;0.001). TAPSE also showed a significant increase (P&amp;lt;0.001), reflecting improved RV functional performance. PASP and TR severity both showed marked reductions (P&amp;lt;0.001), whereas a subgroup analysis indicated that patients with atrial fibrillation (AF) had a less pronounced decrease in PASP compared to those with sinus rhythm. Strain analysis revealed substantial improvements in RV strain parameters, with significant increases in basal, mid, apical, and mean (RVFW) free wall strain (P&amp;lt;0.001) and RV global longitudinal strain (RV GLS) (P&amp;lt;0.001). 3D echocardiography demonstrated significant decreases in RV end-systolic volume (P=0.004) and marked increases in RV EF ejection fraction (P&amp;lt;0.001) and stroke volume (P&amp;lt;0.001), while end-diastolic volume showed no significant change (P=0.061). the study demonstrates that the decline in PASP can significantly predict improvements in both 2D and 3D RV function parameters following PBMV. Conclusion RV performance showed substantial improvement early post-PBMV, as evidenced by marked increases in 3D right ventricular ejection fraction (3DRVEF), right ventricular free wall (RVFW) strain, and RV global longitudinal strain. These enhancements were significantly predicted by the reduction in pulmonary artery systolic pressure (PASP). RV conventional Echocardiographic Parame RV 3D echocardiography and 2D speckle tr

Effects of prosthetic heart valve-associated subclinical intravascular hemolysis on endothelium and cardiovascular system: a retrospective cohort study

Abstract Background Mechanical prosthetic heart valve implantation is a surgical treatment method used in the treatment of severe and symptomatic valvular disease. Regular follow-up of prosthetic valve functions, clinical and laboratory parameters is of great importance in patients who have undergone valve implantation. Chronic subclinical intravascular hemolysis is frequently seen in this patient group, but its management and long-term adverse effects are uncertain. In this study, it was aimed to determine the effects of subclinical hemolysis on the endothelium by comparing the frequency of clinical events such as pulmonary hypertension and atherosclerotic vascular events in patients with mechanical valves. Methods In this single-center, retrospective cohort, patients with functional mechanical prosthetic valves were evaluated. A total of 346 patients who underwent aortic and/or mitral valve replacement were included in the study according to the inclusion and exclusion criteria. The severity of mechanical intravascular hemolysis (MIH) in patients was evaluated based on serum lactate dehydrogenase (LDH) levels measured during follow-up after valve implantation. The study population was divided into two groups according to the median follow-up LDH value (fLDH) of 264.5 U/L: non-hemolysis/mild hemolysis (Group 1) and moderate hemolysis (Group 2). Study patients were evaluated for pulmonary hypertension (PHT) and major adverse cardiovascular events (MACE) during the retrospective follow-up period. Results The mean age of the study patients was 57.5±12.5 years, and the study population consisted of 65% male patients. The mean follow-up period of the patients was 9.4 years (±3.3). MACE (composite of non-fatal cerebrovascular event, myocardial infarction, new-onset arrhythmia, cardiovascular death, and elective coronary revascularization) were observed in 5.2% (n=18) of the study population. New-onset PHT was detected in 122 patients (35.3%) during follow-up period. When compared in terms of MACE, 1 event (0,6%) occurred in group 1, while 17 events (9,8%) occurred in group 2 (p&amp;lt;0.001). In the multivariate analysis performed with logistic regression method to determine statistical significance of the parameters that stand out in terms of MACE prediction, fLDH value ≥ 265 and having DM were found to be statistically significant variables (fLDH; OR = 37.18, 95% CI: 3.24-426.35, p=0.004, DM; OR = 27.14, 95% CI: 1.22-601.72, p=0.037). Conclusion The results of the study show that subclinical intravascular hemolysis in prosthetic heart valve patients may be associated with the development of MACE and PHT. Evaluation of the severity of hemolysis, which can be evaluated by LDH level in routine clinical practice, can be a prognostic factor in this patient group and may contribute to the appropriate management and treatment of patients. Baseline characteristics Critical outcomes of study

Bioprosthetic valve function in carcinoid heart disease

Abstract Background Carcinoid heart disease (CHD) is a complication of neuroendocrine tumours (NETs) with significant cardiovascular morbidity and mortality. It causes fibrotic damage to predominantly the right-sided valves with subsequent tricuspid valve (TV) and/or pulmonary valve (PV) regurgitation leading to right ventricular (RV) dilatation and dysfunction. The definitive treatment is valve replacement commonly using bioprosthetic valves. Case studies have suggested that bioprosthetic valve degeneration may occur due to ongoing carcinoid plaque deposition, but serial data is lacking. Purpose To assess the trajectory of prosthetic valve function on serial transthoracic echocardiography (TTE) in patients with CHD and determine the effect on long-term outcomes. Methods A retrospective multicentre observational cohort study including 81 patients who had valve replacement for CHD between 2005-2022. TTE data assessing prosthetic valve function (peak velocity, mean gradient, para/transvalvular regurgitation) and any associations with outcome were identified. Results Eighty-one patients (64±8 years, 56% male) were followed up for a median of 24 months (IQR: 8-48), during which there were 52 deaths, an estimated median survival of 32 months and 1-, 3- and 5-year survival rates of 69%, 48% and 38%, respectively. The post-operative TTE was carried out at a median of 10 days (IQR: 7-47) after surgery. Of the 71 patients with available post-operative TTEs, 48 had &amp;gt;1 TTE. No significant trends were seen in TV parameters over time. PV peak velocity and mean gradient increased significantly over time (p=&amp;lt;0.001). Increasing TV peak velocities were significantly associated with shorter survival (p=0.008) and those with increases of &amp;gt;5% per year had 5-year survival of 0% compared to 70% in those with decreasing by &amp;lt;5% per year. Increasing PV mean gradients were associated with longer survival (p=0.014), with 5-year survival 35%, 55%, and 91% for patients with increases of &amp;lt;0, 0-2 and ≥2 mmHg per year, respectively. This may reflect RV remodelling and improved RV function. There were 5 cases of prosthetic valve dysfunction, with only 1 needing re-intervention with transcatheter valve-in-valve procedure. A cause of death was available for 39 patients, 46% were due to NET causes and 31% due to cardiac causes. Conclusions Our data suggests that bioprosthetic valve degeneration in CHD is uncommon. TV function did not change over time and PV velocities although increased with time did not lead to significant valve dysfunction. The main cause of death was due to advancing NET disease. This raises the question as to whether transcatheter replacement may be a viable alternative in patients with CHD, who are facing a median survival of less than 3 years.

Image-Based Analysis of Correlation Between Valve Stent Deformation and Valve Function in Transcatheter Aortic Valve Replacement.

Currently, there remains a paucity of research on the deformation and valve function of transcatheter heart valves (THV) in patients with aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR). This study aimed to thoroughly explore the correlation between THV deformation and postoperative hemodynamics in these patients. In this study, we assessed 39 AR patients treated with the J-Valve THV system during TAVR. We utilized postoperative cardiac-enhanced computed tomography angiography (CTA) to examine the extent of stent deformation, correlating these measurements with concurrent echocardiographic data. Among patients with AR, the J-Valve exhibited three distinct configurations: rectangular, trapezoidal, and inverted trapezoidal shapes. The rectangular configuration showed a trend toward a larger effective orifice area (EOA) compared to the trapezoidal and inverted trapezoidal configurations (rectangular: 2.20 ± 0.11 cm², trapezoidal: 1.88 ± 0.08 cm², inverted trapezoidal: 2.04 ± 0.08 cm²; p = 0.068). Stratified analysis of the degree of inclined commissural posts indicated that THVs with all three commissural angles < 5° exhibited the highest standard EOA (sEOA). An increase in the number and degree of inclined commissural posts correlated with a decrease in sEOA. Furthermore, a higher EOA was observed when the expansion in the mid and transition level exceeded 80%. During the TAVR procedure, ensuring sufficient expansion in the mid and transition level of the stent, maintaining the stent in a rectangular configuration, and avoiding tilting of the commissural posts contribute to achieving favorable postoperative hemodynamics.

Kissing balloon technique as rescue strategy to treat left ventricular outflow tract obstruction after transcatheter mitral valve replacement: a case report

Abstract Background Transcatheter mitral valve replacement (TMVR) has become a viable, minimally invasive treatment for inoperable patients with severe mitral valve disease, particularly among elderly individuals with significant comorbidities. A key complication of TMVR is left ventricular outflow tract (LVOT) obstruction, necessitating various preventive and therapeutic strategies. This report presents a case of severe LVOT obstruction following TMVR and highlights the effective application of the kissing balloon technique as a therapeutic intervention. Case Presentation A 79-year-old female with New York Heart Association class IV dyspnea due to severe mitral stenosis and a high operative risk (STS-PROM score 6.2%) underwent TMVR. Pre-procedural evaluations indicated significant mitral valve calcification and a mitral valve area of 0.9 cm². After successful TMVR deployment, post-implantation echocardiography revealed an LVOT pressure gradient of 53/85 mmHg, prompting the use of the kissing balloon technique, which reduced the gradient to 28 mmHg. Follow-up assessments showed normal mitral valve function and stable LVOT gradients during short-term follow-up throughout the patient’s hospital stay. Discussion LVOT obstruction is a potentially life-threatening complication of TMVR, often associated with high mortality rates due to hemodynamic impairment. This complication can arise from various anatomical factors and valve positioning issues. Several strategies have been developed to address LVOT obstruction, including the laceration of the anterior mitral leaflet and alcohol septal ablation. The successful implementation of the kissing balloon technique in this case underscores its potential to improve outcomes in LVOT obstruction.

The Evolution of Ventriculoperitoneal Shunt Valves and Why They Fail.

This article reviews the historical progression of ventriculoperitoneal shunt valve designs with the goal of providing an understanding of their functionality and failure mechanisms. While shunting is the predominant treatment for hydrocephalus, the statistics of overall shunt failure remain high, and valve failure is responsible for a significant percentage of revision surgeries. Therefore, this review spans valve evolution from an engineering perspective with an emphasis on discussing potential failure mechanisms and patient-specific valve selection. Information is provided on the importance of valves in hydrocephalus treatment with discussion on each class of valves and their advantages and shortcomings. Substantial development over decades has significantly improved valve functionality, and ongoing research continues to provide more robust valves and shunt systems for hydrocephalus management.

The effect of power-based control on the haemodynamics and valve function of the biventricular assist circulation system.

Biventricular assist devices (BiVAD) are capable of providing mechanical support to the left and right ventricles to improve blood supply in heart failure, thereby maintaining patients' lives and improving their quality of life. But there is evidence that the incidence of aortic valve incompetence and other valvular pathologies is related to BiVAD support. Such as constant speed (CS) control may cause the valve to close completely and lose its normal valve function. The valve function is related to the percentage of valve opening which is approximately 30% of the cardiac cycle. This study developed a power-based control model for BiVAD that could regulate motors' speed by altering the power to satisfy objectives of keeping valve function and restoring physiologic perfusion. The effects of the power-based controller on the hemodynamics and valve function were investigated by simulating BiVAD under constant power and variable power controls. Different heart failure and activity levels were also mimicked under variable power control to obtain the BiVAD's critical parameters and the assist ratios. The results show that the power-based control can help the BiVAD to assist a patient with heart failure, and the power settings should comprehensively consider objectives of valve function and physiologic perfusion.

Serial changes of systemic ventricular function and atrioventricular valve function in patients with failing Fontan.

This study investigated the longitudinal changes in ventricular function and atrioventricular valve function to clarify the timing and the mechanisms of failing Fontan. Patients who underwent total cavopulmonary connection between 1994 and 2023 were reviewed, and longitudinal echocardiographic examinations of ventricular function and atrioventricular valve regurgitation were analyzed. A total of 650 patients were included. The most frequent primary diagnosis was hypoplastic left heart syndrome in 175. Dominant right ventricle was observed in 337 (51.8%). The median age at total cavopulmonary connection was 2.3 (1.8-3.3) years. Failing Fontan was observed in 78 patients (12%) during the median follow-up of 6.2 years. Among them, dominant right ventricle was observed in 51 patients (65.4%). Patients with protein-losing enteropathy or plastic bronchitis (n = 37) developed Fontan failure early (median 2.6 years post-total cavopulmonary connection). Still, patients maintained ventricular function (93.1% normal at 5 years) and atrioventricular valve competence (no case of moderate/severe regurgitation at 5 years) over time. Patients who developed failing Fontan associated with progression of heart failure (n = 41) had later onset (median 8.3 years post-total cavopulmonary connection) but indicated progressive ventricular dysfunction (68.3% normal at 5 years, 53.8% normal at 10 years) and atrioventricular valve regurgitation (12.3% moderate/severe at 5 years, 15.3% moderate/severe at 10 years). Patients with failing Fontan indicated different serial ventricular and atrioventricular valve function profiles. Ventricular function was preserved in failing Fontan patients with protein-losing enteropathy or plastic bronchitis, whereas progressive ventricular dysfunction was observed in failing Fontan patients with heart failure.

Stuck Prosthetic Valves: Clinical Implications of Pannus Formation and Gradient Measurement in Surgical Outcomes.

Objective: Stuck prosthetic valves, often resulting from pannus formation or thrombus accumulation, represent a critical complication in prosthetic valve management, carrying significant risks for morbidity and mortality. This study aims to identify factors associated with stuck valve development and assess the effectiveness of interventions in restoring normal valve function. Methods: A total of 27 patients with stuck valves were analyzed, including mitral, aortic, and tricuspid valve cases. Metallic valves were initially implanted in all patients. Interventions included pannus cleaning in suitable cases and valve replacement when necessary, with the replacement being either metallic and biological based on clinical indications. Preoperative and postoperative ECG rhythms, left ventricular ejection fraction (LVEF) values, and gradient measurements were evaluated across patient groups. Results: No significant difference was found in time since initial surgery across valve types (p = 0.67), except in mitral valves, where time was longer in the replacement group (p = 0.02). Maximum gradients were higher in the pannus cleaning group for mitral valves (p = 0.03), while overall gradient values showed no significant differences. Postoperative left ventricular ejection fraction improved significantly in all groups (p < 0.001). Conclusions: The findings highlight the importance of timely intervention in managing stuck prosthetic valves, which are associated with severe hemodynamic compromise and embolic risk. Pannus cleaning emerged as a viable alternative in selected cases where the obstruction was localized, with the valve structure otherwise intact. Biological valve replacements demonstrated superior rhythm stabilization in this study, although definitive conclusions are constrained by the minimal sample size (n = 2). Future research should focus on expanding sample sizes and incorporating comprehensive preoperative analyses to better inform surgical and clinical management strategies.

An Aortic Root Abscess Mimic Identified by Multi-disciplinary Imaging Review: a Case Report

Abstract Background While echocardiography and cardiac Positron Emission Tomography (PET) can aid in the diagnosis of prosthetic valve endocarditis (PVE), post-operative changes can lead to false-positive imaging findings. We report a case of a patient with an aortic valve prosthesis with remnant BioGlue deposits mimicking a paravalvular abscess on imaging in the setting of suspected PVE. Case Summary A 67-year-old man presented with two days of fever, chills, and altered mentation. He had a history of two prior aortic root replacements—nineteen and four years prior to his presentation. He had blood cultures that were persistently positive for Pseudomonas aeruginosa. Initial transesophageal echocardiogram (TEE) was notable for a thickening of the posterior aortic root thought to be consistent with post-surgical changes. Cardiac PET showed significant uptake around the prosthetic aortic valve, concerning for a paravalvular abscess. However, given the patient’s high risk for re-do surgery, clearance of blood cultures and preserved valve function, our multidisciplinary endocarditis team (MET) recommended non-surgical management, and close follow-up. After six weeks of appropriate antibiotics, a TEE demonstrated concern for an evolving paravalvular abscess. The MET performed extensive review of his prior surgical interventions and cardiac imaging, revealing the previous use of surgical BioGlue and stability in the aortic root on imaging, consistent with non-infectious post-surgical changes and conservative management was recommended. Discussion Thorough review of prior interventions and serial imaging in patients with suspected PVE through a multidisciplinary team approach is essential in elucidating the complete, often complex, clinical picture and recommending the most appropriate management.

The Genetic and Imaging Key to Understanding Bicuspid Aortic Valve Disease

Bicuspid Aortic Valve (BAV) is a prevalent congenital heart defect, characterized by the presence of two cusps instead of three, leading to significant clinical implications such as aortic stenosis, regurgitation, and aneurysms. Understanding the genetic underpinnings of BAV is essential for early diagnosis and management, which can prevent severe complications like aortic dissection and heart failure. Recent studies have identified critical genes associated with BAV, including NOTCH1, GATA4, GATA5, SMAD6, NKX2.5, BMP2, and ROBO4, all of which play vital roles in aortic valve development and function. Imaging advancements, particularly in cardiac MRI and echocardiography, have enhanced the assessment of valve morphology and hemodynamics, with Wall Shear Stress emerging as a promising biomarker. This review consolidates current genetic and imaging research, elucidating the contributions of genetic variants to the etiology and progression of BAV, while emphasizing the importance of imaging biomarkers in clinical management. The findings aim to improve genetic screening strategies, facilitate early diagnosis, and guide the development of targeted therapies for individuals with BAV.

LONG-TERM OUTCOMES OF YOUNG PATIENTS AFTER SURGICAL CLOSURE OF VENTRICULAR SEPTAL DEFECT WITH EPOXY-TREATED XENO-PERICARDIAL “KEMPERIPLAS-NEO” PATCH

HighlightsVentricular septal defect is the most common congenital heart defect requiring open-heart surgery. The epoxy-treated patch made from xeno-pericardium used to correct this defect was assessed from the standpoint of efficacy, safety, thrombogenicity and degree of calcification AnnotationAim. To assess long-term outcomes of ventricular septal defect closure using epoxy-treated xeno-pericardial “KemPeriplas-Neo” patch in children.Methods. This retrospective study included 42 patients aged 16 months to 18 years, diagnosed with ventricular septal defect (VSD, membranous and muscular) and undergoing VSD closure. The study did not include patients with congenital heart defects (CHD) and congenital and acquired valvular heart diseases. In the long-term follow-up, VSD patch closure (including pseudoaneurysms, fibrosis, recanalization of VSD and recurrence, macrocalcification) was assessed using postoperative transthoracic echocardiography (TTE).Results. Mean age of patients at the time of surgery was 67.4 ± 53.4 months (range 16–216 months), and at the time of the study 178.2 ± 35.9 months (range 101–243 months). The mean follow-up period was 111.5 ± 18.5 months (range 70.0–147 months). According to TTE results, there were no complications after procedure. Valve function after surgical closure of VSD was satisfactory. Reoperations were not required, and there were no cases of acute stoke and myocardial infarction in the follow-up period. Moreover, there were no in-hospital deaths and no long-term fatal outcomes.Conclusion. The data obtained indicate the safety and effectiveness of conducting ventricular septal defect closure using epoxy-treated xeno-pericardial “KemPeriplas-Neo” patch. The VSD patch did not disturb the movement of the interventricular septum, and it did not negatively affect the adjacent areas, including the aorta. However, it is necessary to increase the number of patients and conduct a comparative analysis with other types of patches (synthetic, glutaraldehyde–treated) for a more detailed study of the VSD patch efficacy.

Optimization of Inkjet Printers and Exploration of Human Development and Electromagnetic Valve Technology

With the rapid development of digital technology, inkjet printing technology is being increasingly applied in various fields. The electromagnetic valve, as the core component controlling ink droplet ejection, determines the precision and stability of the printing process. This paper delves into the optimization of inkjet printers, underscoring their pivotal role in sustainable development and the critical function of solenoid valves in controlling ink ejection for achieving high-quality printing. It discusses thermal and piezoelectric inkjet technologies, addressing the challenges faced by solenoid valves, such as environmental adaptability and durability. The paper further explores optimization solutions and future trends, including miniaturization and enhanced environmental adaptability. Conclusively, advancements in inkjet printers and solenoid valves are essential for improving efficiency, reducing costs, and promoting environmental sustainability. The optimization of inkjet printers not only enhances printing efficiency and quality but also positively impacts energy conservation, emission reduction, and resource utilization, making them increasingly significant in the digital transformation across various industries.

3D Printers Future Directions of 3D Printing Cardiac Care

Abstract: Three-dimensional (3D) printing is at the crossroads of printer and materials engineering, non-invasive diagnostic imaging, computer-aided design, and structural heart intervention. Cardiovascular applications of this technology development include the use of patient-specific 3D models for medical teaching, exploration of valve and vessel function, surgical and catheter-based procedural planning, and early work in designing and refining the latest innovations in percutaneous structural devices. In this review, we discuss the methods and materials being used for 3D printing today. We discuss the basic principles of clinical image segmentation, including coregistration of multiple imaging datasets to create an anatomic model of interest. With applications in congenital heart disease, coronary artery disease, and surgical and catheter-based structural disease, 3D printing is a new tool that is challenging how we image, plan, and carry out cardiovascular interventions.

Expanding the phenotypic and genetic spectrum of GTPBP3 deficiency: findings from nine Chinese pedigrees.

GTPBP3 catalyzes τm5(s2) U biosynthesis at the 34th wobble position of mitochondrial tRNAs, the hypomodification of τm5U leads to mitochondrial disease. While twenty-three variants of GTPBP3 have been reported worldwide, the genetic landscape in China remains uncertain. By using whole-exome sequencing, the candidate individuals carrying GTPBP3 variants were screened and identified. Pathogenicity analysis of variants was biochemically verified by patients-derived immortalized lymphocytes and cell models. Through whole-exome sequencing, thirteen variants associated with GTPBP3 were identified in nine Chinese pedigrees, with eight of these variants being newly reported. Affected individuals displayed classic neurologic phenotypes and heart complications including developmental delay, seizures, hypotonia, exercise intolerance, and hypertrophic cardiomyopathy. Additionally, they displayed new symptoms such as eye problems like strabismus and heart issues related to valve function. Studies conducted on patient-derived cells provided evidence of reduced levels of GTPBP3 and impairment in mitochondrial energetic biogenesis. Re-expressing GTPBP3 variants in knockout cell lines further defined the pathogenicity of the novel variants. Analysis of the genetic spectrum in the Chinese population highlighted a concentration in exons 4 and 6, with c.689A > C being the prominent hotspot. Our findings emphasize the extensive clinical and genetic implications of GTPBP3-related mitochondrial disorders, particularly within the Chinese population, but further investigations are needed to explore the phenotype-genotype correlation.

Artificial Heart Valve Scaffold Based on Electrospun PCL/PU Three-Layer Composite Fibers

Abnormal heart valve function is a major cause of heart disease and is often associated with high rates of morbidity and mortality from heart disease. Focusing on the field of valve replacement, tissue-engineered heart valves are becoming popular and attracting more attention. In this work, an artificial heart valve scaffold based on polycaprolactone/polyurethane (PCL/PU) three-layer composite fibers was prepared by 3D printing and electrospinning, including an inner PCL layer, a middle PCL/PU layer, and an outer PCL layer. The obtained valve scaffold had strong circumferential mechanical properties when PCL/PU = 1:2, and its elastic modulus was 14.7 MPa, similar to that of natural valve. The heart valve scaffold had good cytocompatibility, and the final cell survival rate was 99.8% after 14 days of cell culture. The layered structure makes the artificial heart valve more similar to the natural structure of the mammalian heart, which is conducive to cell proliferation and differentiation, and provides a reference solution for interventional treatment of heart valves.

Fabrication and in vivo testing of a sub-mm duckbill valve for hydrocephalus treatment

Hydrocephalus is characterized by the accumulation of excess cerebrospinal fluid (CSF) in the cranium due to an imbalance between production and absorption of CSF. The standard treatment involves the implantation of a shunt to divert excess CSF into the peritoneal cavity, but these shunts exhibit high failure rates over time. In pursuit of improved reliability and performance, this study proposes a miniaturized valve designed to mimic the natural one-way valve function of the arachnoid granulations and thereby replace the shunts. A benchtop testing setup was employed to characterize the behavior of the fabricated valve. Additionally, an animal study was conducted to assess the valve’s in vivo performance. This involved the injection of saline into the lateral ventricle to elevate intracranial pressure (ICP), followed by the drainage of the saline through the valve inserted into the cisterna magna (CM) to reduce pressure. Our prototype features a silicone duckbill valve design combined with a silicone tube as an inlet. Through benchtop testing, the valve exhibited unidirectional flow with negligible reverse leakage, revealing that critical parameters such as the width of the fluid channel (W) and bill length (L) could be controlled to optimize valve performance. Notably, the valve configuration with W= 0.8mm and L < 0.5mm achieved the lowest cracking pressure (2.22 ± 0.07 mmHg) and outflow resistance (22.00 ± 0.70 mmHg/mL/min) within the low cracking pressure range of conventional shunts. Our observations of the in vivo test demonstrated that when untreated states, pressure differences from baseline to peak exceeded 20 mmHg due to the absence of drainage, resulting in sustained pressure elevation. Conversely, upon treating states by removing the clamp, pressure differences from baseline to peak remained below 5 mmHg, indicating effective drainage of injected saline through the valve. These promising results highlight the potential of the miniaturized duckbill valve as an alternative for ICP management in hydrocephalus, offering improved control and reliability compared to conventional shunting systems. Further research is required to evaluate the valve’s performance as a chronic implant.

Haemodynamic Assessment and Outcomes of Aortic Valvuloplasty for Aortic Regurgitation in Patients with Bicuspid Aortic Valve

Background: Aortic valvuloplasty for bicuspid aortic valve carries a risk of postoperative stenosis. We evaluated the haemodynamic differences between aortic valvuloplasty for bicuspid aortic valve, tricuspid aortic valve, and aortic valve replacement by echocardiography. We also assessed whether a higher postoperative pressure gradient affects the outcomes of aortic valvuloplasty for bicuspid aortic valve. Methods: From 2014 to 2021, patients undergoing aortic valvuloplasty were classified into aortic valvuloplasty for bicuspid aortic valve (Group-PB) and aortic valvuloplasty for tricuspid aortic valve (Group-PT). We also enrolled patients undergoing aortic valve replacement (Group-R) between 2002 and 2021. Mid-term outcomes were compared within Group-PB based on peak pressure gradients of ≥20 mmHg (subgroup-H) and &lt;20 mmHg (subgroup-L). Results: Group-PB included 42 patients and Group-PT included 70 patients. Both 7-day and 1-year echocardiography showed the highest peak/mean pressure gradients in Group-PB (n = 41) and the lowest values in Group-PT (n = 67). Propensity scoring analysis yielded similar results to an unadjusted analysis. The mid-term outcomes were not significantly different between subgroup-H (n = 20) and subgroup-L (n = 22), with rates of freedom from aortic regurgitation &gt;II at 5 years of 94.4% vs. 94.4% (p = 0.749) and freedom from reoperation of 94.4% vs. 100.0% (p = 0.317), respectively. Conclusions: Aortic valvuloplasty for tricuspid aortic valve shows favourable valve function in the early postoperative period, whereas aortic valvuloplasty for bicuspid aortic valve has a risk of postoperative stenosis. However, a high pressure gradient (peak pressure gradient of ≥20 mmHg) after aortic valvuloplasty for bicuspid aortic valve does not impact mid-term outcomes.