Valve Incompetence Research Articles

Thermal imaging as a diagnostic tool for superficial venous insufficiency - a systematic review.

Evaluation of the literature assessing the use of thermography, a non-invasive imaging modality that detects pathological temperature variation, in recognising superficial venous insufficiency (SVI). A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were screened by two individuals and data was subsequently extracted. Methodological quality was assessed with Cochrane's risk of bias tool. Four studies comprising 363 patients were included. Three studies identified increased temperature uptake in veins with incompetent valves on venous duplex (p < .05). One study reported sensitivity and specificity of thermal imaging in SVI as 98.30% (95% CI, 95.2%-99.4%) and 100% (95% CI 85.7%-100%) respectively. Thermal imaging could act as a screening tool in SVI. This review highlights a lack of high-quality prospective studies evaluating the role of thermal imaging as a diagnostic tool that could expedite the assessment of patients.

Varicosities in Pregnancy

Varicose vein is a dilated swelled leg veins with back flow of blood caused by incompetent valve closure which result in venous congestion and vein enlargement. It usually affects the saphenous vein and its branches. The condition may be worsening with menstrual cycle, with pregnancy and response to exogenous hormonal therapy( oral contraceptives).It deals about the causes of varicosities and how it occurs in pregnancy. Varicosities had different signs and symptoms which occurs during the time of delivery and also had preventive treatment alternative remedies and safe treatment option after pregnancy in varicose vein.

Aortic valve replacement in younger patients with aortic valve insuffienciency

Aortic valve replacement is the common treatment of choice for severe aortic valve insufficiency (AI). AI is often caused by aortic root dilatation which leads to valve incompetence despite structurally normal valve leaflets. For this condition, aortic repair surgery with ring annuloplasty is considered a potentially superior option. Despite the availability of different annuloplasty rings, no guidelines for the surgical procedure nor the choice of annuloplasty ring exist. In this review, we outline the surgical treatment using valve-preserving procedures as an alternative to conventional aortic valve replacement.

Aortic regurgitation in left ventricular assist device patients - Does aortic root dilatation contribute to valve incompetence?

Aortic regurgitation (AR) is a known complication after left ventricular assist device (LVAD) implantation potentially leading to recurrent heart failure. Possible pathomechanisms include valvular pathologies and aortic root dilatation. We assessed aortic root dimensions in a group of consecutive LVAD patients who received HeartMate 3. Since 11/2015, we identified 68 patients with no or mild AR at the time of HeartMate 3 implantation who underwent serial echocardiography to assess AR and aortic root dimensions (annulus, sinus, and sinotubular junction). Median follow-up was 40 months (2-94 months). Results were correlated with clinical outcomes. Patients were 60 ± 10 years old, predominantly male (88%) and 35% presented in preoperative critical condition as defined by INTERMACS levels 1 and 2. During follow-up, 23 patients developed AR ≥ II (34%). Actuarial incidence was 8% at 1 year, 29% at 3 years and 41% at 5 years. Echocardiography revealed practically stable root dimensions at the latest follow-up compared to the preoperative state (annulus: 23 ± 3 mm vs. 23 ± 2 mm, sinus: 32 ± 4 mm vs. 33 ± 3 mm, sinotubular junction: 27 ± 3 mm vs. 28 ± 3 mm), irrespective of the development of AR. Serial CT angiograms were performed in 13 patients to confirm echocardiographic findings. Twenty-one patients died during LVAD support leading to a 5-year survival of 71%, showing no difference between patients with and without AR ≥ II (p = 0.573). At least moderate AR develops over time in a substantial fraction of patients (one-third over 3 years). The mechanism does not seem to be related to dilatation of the aortic annulus or root.

Association Between Physical Examination, Doppler Ultrasound, and Histological Findings and Varicocele Diagnosis in Kidney Donors: A Cross-Sectional Study

Background: Varicocele is a leading cause of male infertility. Left-sided nephrectomy has been associated with an increased risk of varicocele. Objectives: This study aimed to report the frequency and investigate the association between physical examination, Doppler ultrasonography, histological findings, and varicocele diagnosis in kidney donors who underwent left-sided nephrectomy. Methods: This cross-sectional study included adult males who underwent nephrectomy. The study compared the results of physical examination, ultrasound, and histological findings of the diameter of the left spermatic vein and pampiniform venous plexus. The chi-square test was used to assess differences in the diagnosis and grading of varicocele between the different methods. Results: Fifty males with a mean age of 36.6 years were included. Through physical examination, 42% were diagnosed with varicocele, with most cases classified as grade II. Ultrasound examination revealed that 46% had varicocele, with the majority also being grade II. Histological findings showed that most cases had intact valves (54%), followed by lax and incompetent valves (32%), and no valves (4%). There was a significant difference between the physical examination diagnosis of varicocele and the histological findings (P = 0.04), whereas the difference was not significant for Doppler ultrasound (P = 0.07). Conclusions: In kidney donors, there was a notable discrepancy in varicocele diagnosis between physical examination and histological findings, unlike ultrasound. Larger observational studies are recommended to further assess this association and explore alternative methods for varicocele diagnosis.

Incompetent neck valves threaten the aging brain.

Incompetent neck valves threaten the aging brain.

Influence of Timing of Stenting on Condition of Venous Valves of Lower Extremities, Frequency and Severity of Development of Post-Thrombotic Disease

INTRODUCTION: Acute deep vein thrombosis (DVT) of the lower extremities (LE) is a life-threatening condition, accompanied by high rates of disability among people of working age. Despite early detection of DVT and the use of recommended antithrombotic therapy, damage to the venous wall, development of valvular reflux and post-thrombotic disease (PTD) inevitably occur. The clinical picture of PTD becomes evident after the development of valve incompetence, which leads to vertical venous reflux and chronic venous hypertension. Timely elimination of venous obstruction can preserve the functionality of valve structures, which will subsequently help reduce the frequency and severity of PTD. AIM: To evaluate the impact of the timing of stenting on the condition of the venous valves, the frequency and severity of the development of PTD in patients with acute DVT of LE. MATERIALS AND METHODS: A prospective interventional study included 49 patients with acute iliofemoral thrombosis. After selective thrombolysis, 25 patients underwent early (within 7 days) and 24 patients underwent delayed (7–30 days) stenting. The incidence and severity of PTD was assessed on the Villalta scale at 3, 6 and 12 months. The effect of treatment on the condition of the venous valves of the LE was assessed at 12 months. On ultrasound examination, reflux was assessed using a scoring system. RESULTS: At 12 months, 2 (8%), 13 (52%), and 10 (40%) patients who underwent delayed stenting, developed severe, moderate, or mild PTD, respectively. In the early stenting group, 6 (25%) patients had no symptoms of PTD, 15 (62.5%) and 3 (12.5%) developed mild and moderate PTD, respectively (p = 0.0005). At 12 months, in the early stenting group, the absence of reflux was recorded in 6 (25%) patients, 4 (17%) patients had valve reflux in the femoral segment, and 14 (58%) in the popliteal segment. In the delayed stenting group, valvular incompetence of both segments was detected in 12 (48%) patients; in 4 (16%) and 9 (36%) patients, the valves of the femoral and popliteal veins were preserved; there were no patients without reflux in both segments. Treatment results for this indicator were better if early stenting was performed (p = 0.0005). CONCLUSION: Early stenting after selective thrombolysis in patients with proximal DVT of LE leads to a decrease in the incidence and severity of symptoms of PTD, and can reduce the incidence of reflux in the deep veins.

Safety of tildrakizumab: a disproportionality analysis based on the FDA adverse event reporting system (FAERS) database from 2018-2023.

Background: Tildrakizumab, the IL-23 inhibitor, is used to treat plaque psoriasis and psoriatic arthritis. Many studies have reported adverse drug reactions (ADRs) associated with Tildrakizumab. Objective: The aim of this study was to describe ADRs associated with Tildrakizumab monotherapy by mining data from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: The signals of Tildrakizumab-associated ADRs were quantified using disproportionality analyses such as the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multiitem gamma Poisson shrinker (MGPS) algorithms. Results: A total of 10,530,937 reports of ADRs were collected from the FAERS database, of which 1,177 reports were identified with tildrakizumab as the "primary suspect (PS)". Tildrakizumab-induced ADRs occurred against 27 system organ classes (SOCs). A total of 32 significant disproportionality Preferred Terms (PTs) conformed to the algorithms. Unexpected significant ADRs such as coronavirus infection, herpes simplex, diverticulitis, atrial fibrillation and aortic valve incompetence were also possible. The median time to onset of Tildrakizumab-associated ADRs was 194 days (interquartile range [IQR] 84-329 days), with the majority occurring, within the first 1 and 3 months after initiation of Tildrakizumab. Conclusion: This study identified a potential signal for new ADRs with Tildrakizumab, which might provide important support for clinical monitoring and risk prediction.

The sex prevalence of lower limb varicose vein networks

ObjectiveTo determine the sex prevalence of lower limb varicose networks fed by reflux of the great saphenous vein (GSV), anterior accessory saphenous vein (AASV), and small saphenous vein singularly or in combination. MethodsWe scanned by the means of the same color Doppler ultrasound protocol 3000 lower limbs in 1500 consecutive patients, affected by symptomatic chronic venous insufficiency from 2013 to 2023. Limbs with normal venous function, incomplete scans, or that were affected by post-thrombotic syndrome, pelvic reflux, isolated perforator reflux, venous malformation, phlebolymphedema and Clinical, Etiological, Anatomical, Pathophysiological clinical class C5 and C6 were excluded from the final analysis. ResultsOverall, 1072 patients—252 (23.5%) males and 820 (76.5%) females (P < .0001) matched for age (P = .692)—were included in the study for a total of 1956 limbs affected by primary chronic venous insufficiency, clinical class C2 to C4. The main finding was the significant prevalence of varicose networks fed by reflux of the AASV alone (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.26-3.06; P = .001) or combined with GSV (OR, 1.84; 95% CI, 1.34-2.52; P = .0002) in females. In contrast, GSV insufficiency alone was significantly prevalent in males (OR, 0.54; 95% CI, 0.43-0.68; P < .0001). No significant sex differences regarding SSV reflux were detected. Moreover, we considered the presence of competent terminal valve (TV+) at the level of the saphenofemoral junction, which resulted more significantly present in female (OR, 1.57; 95% CI, 1.12-2.19; P = .0083); to the contrary incompetent terminal valve (TV−) was more common in males (OR, 0.64; 95% CI, 0.46-0.89; P = .0083). Finally, considering reflux in the AASV territory in the presence of a TV+, a strong prevalence in females was detected (OR, 2.28; 95% CI, 1.48-3.52; P = .0002), whereas males developed reflux along the GSV when a concomitant TV− was present (OR, 0.62; 95% CI, 0.41-0.94; P = .0244). ConclusionsThe analysis of the lower limb varicose networks highlights that reflux along the AASV alone, in presence of a TV+ at the junction or coupled with GSV insufficiency, is more prevalent in females. In contrast, GSV resulted the main trunk feeding varicose veins in males, in particular when a TV− was detected. Our findings suggest that females could be more prone to developing varicose veins with an ascending mechanism, whereas in males the descending one seems to be more common.

Key Regulators of Angiogenesis and Inflammation Are Dysregulated in Patients with Varicose Veins.

Varicose veins (VVs) are the most common manifestation of chronic venous disease (CVD) and appear as abnormally enlarged and tortuous superficial veins. VVs result from functional abnormalities in the venous circulation of the lower extremities, such as venous hypertension, venous valve incompetence, and venous reflux. Previous studies indicate that enhanced angiogenesis and inflammation contribute to the progression and onset of VVs; however, dysregulations in signaling pathways associated with these processes in VVs patients are poorly understood. Therefore, in our study, we aimed to identify key regulators of angiogenesis and inflammation that are dysregulated in patients with VVs. Expression levels of 18 genes were analyzed in peripheral blood mononuclear cells (PBMC) using real-time PCR, as well as plasma levels of 6 proteins were investigated using ELISA. Higher levels of CCL5, PDGFA, VEGFC, TGF-alpha, TGF-beta 1, and VEGF-A, as well as lower levels of VEGFB and VEGF-C, were found to be statistically significant in the VV group compared to the control subjects without VVs. None of the analyzed factors was associated with the venous localization of the varicosities. The presented study identified dysregulations in key angiogenesis- and inflammation-related factors in PBMC and plasma from VVs patients, providing new insight into molecular mechanisms that could contribute to the development of VVs and point out promising candidates for circulatory biomarkers of this disease.

Cardiac function, haemodynamics, and valve competence with exercise in patients with heart failure with preserved ejection fraction and mild to moderate secondary mitral regurgitation.

This study aimed to evaluate the clinical significance of secondary mitral regurgitation (MR) in patients with heart failure with preserved ejection fraction (HFpEF). We conducted a prospective study enrolling consecutively evaluated patients with HFpEF undergoing invasive haemodynamic exercise testing with simultaneous echocardiography. Compared to HFpEF without MR (n = 145, 79.7%), those with mild or moderate MR (n = 37, 20.3%) were older, more likely to be women, had more left ventricular (LV) systolic dysfunction, and more likely to have left atrial (LA) myopathy reflected by greater burden of atrial fibrillation, more LA dilatation, and poorer LA function. Pulmonary artery (PA) wedge pressure was higher at rest in HFpEF with MR (17 ± 5 mmHg vs. 20 ± 5 mmHg, p = 0.005), but there was no difference with exercise. At rest, only 2 (1.1%) patients had moderate MR, and none developed severe MR. Pulmonary vascular resistance was higher, and right ventricular (RV)-PA coupling was more impaired in patients with HFpEF and MR at rest and exercise. LV and LA myocardial dysfunction remained more severe in patients with MR during stress compared to those without MR, characterized by greater LA dilatation during all stages of exertion, lower LA emptying fraction and compliance, steeper and rightward-shifted LA pressure-volume relationships, and reduced LV longitudinal contractile function. Patients with HFpEF and mild or moderate MR have more severe LV systolic dysfunction, LA myopathy, RV-PA uncoupling, and more severe pulmonary vascular disease. Mitral valve incompetence in this setting is a phenotypic marker of more advanced disease but is not a causal factor in development of HFpEF.

Fluid mechanics of aortic valve incompetence in the dilated left ventricle

Introduction: Aortic insufficiency (AI) occurs when the aortic valve fails to close completely, allowing backward blood flow into the left ventricle (LV). The progression of AI can lead to ventricular dysfunction and congestive heart failure, setting off a self-perpetuating cycle that worsens these conditions. This study employed models of repeatable and reversible AI within a simulated circulatory loop to analyze vortex dynamics, AI parameters, and gain insights into the efficiency of ventricular washout.Method: A transparent silicone model of an LV with an ejection fraction of 17% served as the baseline, simulating a condition without AI. Mild, moderate, and severe AI were induced using 3D-printed stents, obstructing the complete closure of the aortic valve while allowing unimpeded forward blood flow. Midplane velocity fields were analyzed to compute AI and vortex properties, energy dissipation rate, blood residence time, and shear activation potential.Results and discussion: With increasing AI severity, the regurgitant jet expanded, impeding the development and trajectory of mitral inflow. The inefficiency in fluid transport became apparent through a declining ratio of total kinetic energy rate to energy dissipation rate and an increasing residence time. Impaired ventricular washout resulted in the accumulation of fluid with elevated shear activation potential in the LV. These findings suggested that AI progressively induces abnormal intraventricular flow, heightening the thromboembolic risk in heart failure patients. The study also advocates for the potential application of mock circulatory system to explore the effects of various AI configurations, especially when combined with other cardiac implants like artificial heart valve or left ventricular assist device.

A Study of Valvular Incompetencies in the Lower Limb Veins Using Doppler Ultrasound Findings.

Varicose veins (VV) are one of the most common pathologies associated with the venous system of the lower limb. In the Indian population, its incidence is higher, and it is one of the most commonly encountered cases in the hospital. The study aimed to note the widely affected anatomical structure in male and female varicose patients using Doppler ultrasound (DU) examination findings. A total of 200 Doppler ultrasound reports of varicose patients were retrospectively analyzed and categorized based on the affected structure. The demographic data of all cases, such as age, sex, brief history, signs, symptoms, and affected side of the lower limb, was noted. Anatomical structures causing venous refluxes in the saphenous systems, junctions, and perforating venous systems were noted. Pearson's correlation coefficient was applied to find out its association. Out of 200 Doppler reports studied, 133 (67%) were male and 67 (33%) were female patients. The majority, 180 (90%) cases, belonged to C1-C3 stages according to the Clinical, Etiology, Anatomy, and Pathological (CEAP) classification, while 20 (10%) were in C4-C5 stages. Male patients aged between 31 and 40 years were predominantly affected, with their left side being affected most commonly. In female patients, the older age group of 50-60 years was predominantly affected.Great saphenous reflux in the groin due to incompetent terminal valve was noted in 126 (63%) cases. In the perforator venous (PV)system,defects in the medial leg perforator (189 (95%)), posterior leg (92(46%)), and thigh perforator (20 (10%)) were noted. In the present study, the occurrence of varicose veins is due to the involvement of superficial, deep, and perforator veins with varying percentages. Among the structures, the medial leg perforator was predominantly involved, followed by other perforators. Since most patients were in C1-C3 stages, the involvement of deep veins was noted minimally.

Erratum

Gastrointestinal symptoms related to antireflux surgery are result of either an incompetent gastroesophageal valve, a supra-therapeutic valve or other complications of anti-reflux surgery such as decreased gastric accommodation, rapid gastric emptying, gastroparesis, paraesophageal hernia, or exacerbation of another undiagnosed motility disorder. Here, we reviewed a diagnostic approach for these symptoms which starts with detailed history and a tailored approach in use of diagnostic tests and empirical treatment to aid in diagnosis. In treatment for these symptoms, a conservative approach with lifestyle modifications should be employed first and repeat surgical procedure should be reserved as the last option. Of the emerging endoscopic therapies for symptoms refractory to medical therapy, gastric per-oral endoscopic myotomy is effective in improving gastric emptying and related symptoms.

Atypical Forms of Lower Limb Varicose Vein Disease: Features of Diagnosis and Surgical Treatment

INTRODUCTION: Lower limb varicose vein disease (LLVVD) is the most common vascular disease with a predominant lesion of the main trunks of saphenous veins. At the same time, there exist atypical variants of lesion of the venous system in LLVVD, which cause difficulties in diagnosis and treatment.&#x0D; AIM: To study the incidence rate, anatomical bases of the varicose transformation, the features of reflux formation and the results of surgical treatment in atypical forms of LLVVD.&#x0D; MATERIALS AND METHODS: The study involved 600 patients with LLVVD, C2-C3 class of clinical manifestations in CEAP classification; 82 of them had atypical forms. The mean age of patients was 40.2 ± 9.2 years, duration of disease 15.0 ± 5.6 years. Duplex scanning of the lower limb venous system was conducted according to Russian recommendations for the diagnosis and treatment of chronic venous disorders of lower limbs of 2018. Patients with atypical forms of LLVVD additionally underwent computed tomography of the venous system with contrast. Surgical treatment of 50 patients with atypical forms of LLVVD included separation of the site of opening of a tributary in the area of saphenofemoral junction after preliminary marking and isolated elimination of varicose tributaries using Muller hooks; incompetent perforating veins were ligated at the epi- or subfascial levels depending on the location. The results were considered in the periods for up to two years.&#x0D; RESULTS: According to our data, the incidence of atypical forms of LLVVD was 13.7%. Lesion of the large tributaries of the main saphenous veins accounted for the highest proportion of atypical forms of LLVVD — 68.3%. Of these, varicose transformation of the anterolateral tributary made 98.2%, and of the superficial iliac circumflex vein — 1.8%. Isolated varicose transformation of perforating veins occurred in 31.7% of cases, where transformation of perforating veins of the gluteal area made 7.7%, of perforating veins of the posterolateral surface of the thigh — 46.2%, and of perforating veins of the patella region — 46.2%. The technical success in the postoperative period in the form of elimination of varicose saphenous veins and of the source of their incompetence was achieved in 100% of cases.&#x0D; CONCLUSIONS: The incidence of atypical forms of LLVVD is 13.7%, with the main trunks of saphenous veins remaining competent. The anatomical and hemodynamic basis for such forms of LLVVD is incompetence of the deep vein valves, from where the reflux is transmitted to tributaries of the saphenofemoral junction and/or perforating veins of the gluteal region, femoral region or popliteal fossa. Precise separation of varicose tributaries and perforating veins with preservation of the main trunks of subcutaneous veins is an organ-saving method of LLVVD treatment with a good effect in the follow-up period of up to two years.

A disproportionality analysis of adverse events associated to pertuzumab in the FDA Adverse Event Reporting System (FAERS)

BackgroundPertuzumab is widely used for the treatment of HER2 + breast cancer. But its safety in the real world should be continuously monitored. So, we evaluated the safety of pertuzumab by pharmacovigilance analyze based on related adverse events (AEs) from the FDA Adverse Event Reporting System (FAERS) and find whether potential or uncertain adverse events were present.MethodsIn disproportionality analysis, four algorithms were employed to detect the signals of pertuzumab from the FAERS between 2012 and 2022. In addition, we also used MYSQL 8.0, Navicat Premium 15, and Microsoft EXCEL 2019 to analyze the potential and high-ROR (reporting odds ratio) signals of pertuzumab. We also collected the onset times of pertuzumab-associated AEs.ResultsFrom January 2012 to December 2022, there are 39,190,598 AEs reported from the FAERS database, of which 14,707 AEs listed pertuzumab as the ‘primary suspected (PS)’ drug. A total of 115 (46 potential) significant disproportionality preferred terms (PTs) conforming to the four algorithms were retained. Finally, we detected that the pertuzumab-induced AEs occurred in 12 organ systems. For pertuzumab, unexpected and significant PTs of AEs were found, including but not limited to below PTs: haematotoxicity, cardiotoxicity, cardiomyopathy, mitral valve incompetence, tachycardia, intestinal perforation, hemorrhoids, erysipelas, dehydration, pneumonitis, skin toxicity, onychomadesis, cyanosis, and circulatory collapse. We found there were 9 strong signals (5 potential safety signals) and 68 medium intensity signals (21 potential safety signals) according to IC025 (information component). The potential strong signals (IC025 > 3.0) were myelosuppression, cardiotoxicity, cardiac dysfunction, ejection fraction decreased, interstitial lung disease, and onychomadesis. Excluding unreported or unreasonable onset time reports, a total of 2016 AEs reported onset time and the median onset time was 117 days (4, 96), as median (Q1, Q3). Notably, most of the all AEs (n = 1133, 56%) and cardiac-related events (n = 405, 53%) all occurred within one month after pertuzumab therapy.ConclusionAnalysis of FAERS data identified pertuzumab-associated AEs, and our findings supported continuous clinical monitoring, pharmacovigilance, and further studies of pertuzumab. A significant association was detected between pertuzumab and some potential adverse events which should be regarded with some care. We have to pay attention to the first month after pertuzumab therapy and prepare emergency measures, especially for the elderly and patients with cardiovascular diseases.

Post-transplant left atrial function depends on the technique used for orthotopic heart transplantation

Abstract Background Even short episodes of post-transplant atrial fibrillation (AF) have been shown to increase the risk of adverse outcomes, including thromboembolic events, graft failure, and increased mortality. Of the two most commonly used heart transplantation techniques - bicaval and total orthotopic heart transplantation (OHTx), the former approach combines the donor and recipient atria, and may predispose to supraventricular arrhythmias, especially atrial fibrillation, as well as lead to a higher incidence of atrioventricular valve incompetence. Existing data relate mainly to the more non-physiological left atrial (LA) size and geometry after bicaval OHTx, while little is known about differences in LA function between patients treated with both techniques. Aim To compare LA functional and morphological characteristics between patients after bicaval and total OHTx. Methods The study group consisted of 28 patients who underwent OHTx between May 2021 and December 2022: 14 consecutive patients after total OHTx and 14 subjects after bicaval OHTx matched by age and time from heart transplant. Echocardiographic examination included standard measurements and left ventricle (LV) and LA longitudinal deformation assessment by speckle tracking technique. Results All enrollees were male. There were no differences between the groups after total and bicaval OHTx in anthropometric and laboratory parameters. Routine endomyocardial biopsies performed during follow-up after OHTx in all patients did not show severe graft rejection. No significant differences were found in LV dimensions, ejection fraction and stroke volume, Doppler velocities of mitral inflow and mitral annulus, as well as LV global longitudinal strain. In contrast to LV measures, significant between-group differences were demonstrated for LA parameters: LA volume index was significantly higher, and peak atrial longitudinal strain (PALS) corresponding to LA early diastole in the reservoir phase and peak atrial contraction strain (PACS) corresponding to LA systole were significantly higher in the total OHTx group than in the bicaval OHTx group (Table). Conclusions Total OHTx technique is associated with a more favorable LA morphology and function, which may explain the lower prevalence of atrial fibrillation reported in the literature in patients treated with this method. The clinical significance of reduced LA contribution to LV filling in patients subjected to bicaval OHTx needs further exploration.

Chronic venous insufficiency and venous leg ulcers: Aetiology, on the pathophysiology-based treatment.

The chronic venous disease covers a wide spectrum of venous disorders that are characterized by severely impaired blood return that primarily affects veins in the lower extremities. Morphological and functional abnormalities of the venous system led to chronic venous insufficiency (CVI), and present as leg heaviness/achiness, edema, telangiectasia, and varices. The term 'chronic venous insufficiency' (CVI) refers to a disease of greater severity. Venous dysfunction is associated with venous hypertension and is associated with venous reflux due to poorly functioning or incompetent venous valves, which ultimately reduces venous return, leading to a cascade of morphological, physiological, and histologic abnormalities such as blood pooling, hypoxia, inflammation, swelling, skin changes (lipodermatosclerosis), and in severe cases, venous leg ulcers (VLU). This review summarizes recent knowledge about the aetiology, risk factors, and pathophysiology of VLU and compared the possibilities of their treatment.

Machine Learning-Based Segmentation of the Thoracic Aorta with Congenital Valve Disease Using MRI.

Subjects with bicuspid aortic valves (BAV) are at risk of developing valve dysfunction and need regular clinical imaging surveillance. Management of BAV involves manual and time-consuming segmentation of the aorta for assessing left ventricular function, jet velocity, gradient, shear stress, and valve area with aortic valve stenosis. This paper aims to employ machine learning-based (ML) segmentation as a potential for improved BAV assessment and reducing manual bias. The focus is on quantifying the relationship between valve morphology and vortical structures, and analyzing how valve morphology influences the aorta's susceptibility to shear stress that may lead to valve incompetence. The ML-based segmentation that is employed is trained on whole-body Computed Tomography (CT). Magnetic Resonance Imaging (MRI) is acquired from six subjects, three with tricuspid aortic valves (TAV) and three functionally BAV, with right-left leaflet fusion. These are used for segmentation of the cardiovascular system and delineation of four-dimensional phase-contrast magnetic resonance imaging (4D-PCMRI) for quantification of vortical structures and wall shear stress. The ML-based segmentation model exhibits a high Dice score (0.86) for the heart organ, indicating a robust segmentation. However, the Dice score for the thoracic aorta is comparatively poor (0.72). It is found that wall shear stress is predominantly symmetric in TAVs. BAVs exhibit highly asymmetric wall shear stress, with the region opposite the fused coronary leaflets experiencing elevated tangential wall shear stress. This is due to the higher tangential velocity explained by helical flow, proximally of the sinutubal junction of the ascending aorta. ML-based segmentation not only reduces the runtime of assessing the hemodynamic effectiveness, but also identifies the significance of the tangential wall shear stress in addition to the axial wall shear stress that may lead to the progression of valve incompetence in BAVs, which could guide potential adjustments in surgical interventions.

The role of venous intervention for the treatment of patients with venous leg ulceration.

More than 1 million people are estimated to have lower limb venous ulceration in the UK. Such wounds are predominantly caused by sustained venous hypertension, as a result of chronic venous insufficiency, often due to venous valve incompetence or an impaired calf muscle pump. Compression therapy is key to venous leg ulcer management and the majority of nurses are aware of the importance of starting patients on compression therapy as early as possible. However, there appears to be a lack of awareness of the importance of venous assessment and that more patients could benefit from endovenous correction of superficial venous incompetence.