Valve Regurgitation Research Articles

Diagnostic value of aortic valve displacement by tissue tracking for identification of aortic valve stenosis severity

Abstract Background The assessment of aortic stenosis (AS) severity on transthoracic echocardiography (TTE) may be challenging, especially in normal flow, low gradient (NF LG) group with preserved ejection fraction (EF), where reclassification of AS severity after initial TTE was observed in 52% pts (1). Calcifications and fibrosis of valve leaflets result in increased stiffness and impaired mobility, which can be quantified by tissue tracking (TT). TT is an echocardiographic modality that displays longitudinal displacement of selected area by integrating tissue velocity over time. Purpose Assessment of the diagnostic value of aortic valve displacement (AVD) by TT as a test that may increase accuracy of AS severity diagnosis in TTE. Methods 205 pts (aged 71±10 yrs, men 43%) without more than mild aortic regurgitation, mitral or tricuspid valve disease, EF ≤55%, indexed stroke volume (SVI) ≤35 ml/m2, cardiac rhythm disturbances and poor acoustic window were selected out of 842 pts screened for AS in our institution between 2020 and 2023. Based on aortic valve area (AVA) value, moderate (n=51, AVA >1.0 cm2) or severe (n=154, AVA ≤1.0 cm2) AS was diagnosed. In severe AS group, 45 pts were classified as NF LG AS (mean gradient <40 mmHg). Additionally 30 pts (aged 68±10 yrs, men 46%) without abnormalities on TTE entered control group. During TTE in five- and three-chamber views, TT was applied and region of interest was adjusted to cover whole aortic valve (AV) during cardiac cycle. Single loop was analysed with Q-analysis software. The measurement in millimetres (mm) of positive wave representing displacement of AV was performed in both views by two independent echocardiographers (Figure 1). AVD was calculated by summing up results from both views. Receiver-operating characteristic curves for AVD in the whole study group and NF LG AS to diagnose severe AS were plotted. Results AVD was already significantly decreased in moderate AS compared with age- and sex-matched healthy controls, being 22.8±2.8 mm and 24.3±2.1 mm respectively (P=0.01). In pts with severe AS, AVD was further significantly reduced compared to moderate AS pts, being 19.3±3.2 mm (P<0.0001). In the whole study group, AVD with a cut-off point <19.6 mm provided 55.8% sensitivity but 96.1 % specificity to diagnose severe AS (Figure 2B). In pts with NF LG AS, AVD with a cut-off point <20.6 mm provided 71.4% sensitivity and a specificity of 79.6% (Figure 2A). Intraclass correlation coefficient of 0.87; 95% CI (0.84–0.89) indicated good interobserver reproducibility of AVD measurement. Conclusions Aortic valve displacement by tissue tracking in TTE is a valuable, new echocardiographic tool for identification of AS severity and may improve diagnostic accuracy of AS severity in NF LG AS.Figure 1Figure 2

Implementing a novel selection criteria and pathway for same-day discharge after TAVI

Abstract Background The expansion in indications for transcatheter aortic valve implantation (TAVI) has fuelled an increase in demand worldwide. Prolonged waiting lists and waiting list mortalities are not infrequent and often arise from limited hospital capacity and infrastructure. Approaches to address this have included procedural modifications – ‘minimalist TAVI’ and more recently the development of pathways to facilitate early discharge post-TAVI, such as same-day discharge (SDD) post-procedure. Purpose This study aims to evaluate the safety and effectiveness of a novel SDD pathway a large volume tertiary referral cardiac centre. Methods A new SDD pathway was established between March 2023 and February 2024 at a large-volume tertiary cardiac centre in UK. All patients accepted for TAVI were screened for SDD suitability based on three factors: 1) availability of adequate social support, (defined as presence of able-bodies adult individual to assist in home recovery), 2) technically suitable for transfemoral approach and 3) presence of previous pacemaker or low risk for conduction abnormalities (defined as no baseline conduction disturbances). Following TAVI, patients were deemed suitable for SDD if they were clinically stable, the procedure was technically successful and there were no procedural complications. Demographic, clinical, procedural and outcome data were collected for all patients enrolled onto the SDD pathway and reasons for non-SDD were identified. Ethical approval was obtained in accordance with local institutional policies. Results From March 2023 to February 2024, 81 out of 305 patients (26.6%) were enrolled onto the SDD pathway (median age 82 years old, 66.7% male, median STS risk score 2.34%). Indications for TAVI were severe native aortic stenosis (74/81, 91.4%), severe native aortic regurgitation (2/81, 2.5%) and severe surgical valve degeneration (5/81, 6.2%). SDD was feasible for 58/81 (71.6%) of patients, with 10/81 (12.3%) discharged the following day and 13/81 (16.0%%) requiring >24 hours hospital admission (Figure 1). Reasons for non-SDD included new conduction abnormality (10/81, 12.3%), vascular complication (6/81, 7.4%), acute stroke (3/81, 3.7%), patient preference (2/81, 2.5%) and haemodynamic instability (2/81, 2.5%). Out of the 58 SDD patients, 25/58 (43.1%) had no previous permanent pacemaker system and in these patients a balloon-expandable valve was selected for 24/25 (96.0%) of patients (Figure 2). Conclusions Patient selection based on the presence of social support at home, low risk of conduction abnormalities or previous pacemaker combined with appropriate valve selection can facilitate a safe and effective SDD post-TAVI programme.

Clinical characteristics of patients with moderate or severe valvular heart disease

Objective: To describe the characteristics, etiology and patterns of outpatients and inpatients patients with moderate or severe valvular heart disease (VHD). Methods: This is a cross-sectional study. Outpatients and inpatients with moderate or severe VHD who underwent transthoracic echocardiography for first examination from 1st January 2001 to 1st January 2020 in Southwest Hospital, Army Medical University were enrolled. Data were collected from medical records and big data platform of Southwest Hospital. Characteristics of age and gender, etiology and types of VHD were descriptively analysed. Results: A total of 68 354 patients with moderate or severe VHD were enrolled. The age was 63 (50, 72) years. And 35 706 (52.24%) patients were female. (1) Age characteristics: There was similar age trend between male and female patients with moderate or severe VHD. The number of patients increased firstly and then decreased and reached its peak in the age group of 65-69 years old. The peak age of mitral stenosis patients was 45-49 years, which was earlier than that of whole patients with moderate or severe VHD. The median age of patients with bicuspid aortic valve was 42 years. (2) Gender characteristics: The proportion of tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, mitral stenosis and valve surgery in female patients with moderate or severe VHD were higher than those in male patients. The proportion of aortic regurgitation, aortic stenosis and bicuspid aortic valve in male patients with moderate or severe VHD were significantly higher than those in female patients (all P<0.05). (3) Etiology: The proportion of rheumatic VHD was 13.07% (8 934/68 354), which was higher than that of degenerative VHD (0.67% (458/68 354)). (4) Types of VHD: Tricuspid regurgitation made contribution to the largest proportion with 60.72% (41 503/68 354), followed by mitral regurgitation, aortic regurgitation, mitral stenosis, pulmonary regurgitation and aortic stenosis. Conclusions: There are certain regional characteristics in the prevalence of moderate or severe VHD in southwest China, suggesting different attention should be paid on the whole process of refined management of moderate or severe VHD.

Therapeutic results of three-dimensional aortic valve anatomic repair for regurgitant bicuspid aortic valve

Objective: To explore the surgical technique and results of three-dimensional aortic valve anatomic repair for bicuspid aortic valve (BAV) with aortic regurgitation (AR). Methods: This is a retrospective case series study. From August 2021 to December 2023, 130 consecutive patients with BAV-AR underwent aortic valve anatomic repair at the Department of Cardiothoracic Surgery, Zhongshan Hospital, Fudan University,and the data were retrospectively analyzed. There were 115 males and 15 females, aged (38.6±11.7) years (range: 15 to 67 years). All patients received modified aortic root reconstruction, to do three-dimensional root remodeling, including the basal ring, sinus of Valsalva and sino-tubular junction simultaneously. Perioperative and follow-up data were collected and analyzed. Comparisons between groups were performed using independent samples t-test, Wilcoxon paired signed-rank test, or χ² test. Results: No patient transferred to valve replacement during the operation. The cardiopulmonary bypass time (M(IQR)) was 109 (34) minutes (range:67 to 247 minutes), and the aortic cross-clamp time was 76 (26) minutes (range: 32 to 158 minutes). Preoperative transesophageal echocardiography showed 123 patients (94.6%) presented with moderate or severe regurgitation. Immediately postoperative transesophageal echocardiography showed no regurgitation in 22 patients (16.9%), trace regurgitation in 81 patients (62.3%) and mild regurgitation in 27 patients (20.8%). Follow up was complete in all patients, with a follow-up of 5.5 (9.4) months (range: 0.1 to 27.6 months). No mortality was observed during follow-up. Echocardiography was obtained in 112 patients at the latest follow-up, including no regurgitation in 4 patients (3.6%), trace regurgitation in 58 patients (51.8%), mild regurgitation in 45 patients (40.2%), moderate regurgitation in 4 patients (3.6%), and severe regurgitation in 1 patient (0.9%). Conclusion: For patients with BAV-AR who have good valve quality and no severe aortic sinus dilation, the recent outcomes of three-dimensional anatomical repair technique, focusing on overall remodeling of the aortic root, are satisfactory.

Commentator Discussion: Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trial

Commentator Discussion: Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trial

Clinical analysis of maternal autoantibody-mediated complete left bundle branch block in 9 children

Objective: To analyze the clinical characteristics, treatment, and outcomes of children with complete left bundle branch block (CLBBB) mediated by maternal autoantibodies. Methods: A retrospective analysis was conducted on nine children diagnosed with maternal autoantibody-mediated CLBBB, treated at Beijing Anzhen Hospital and Fujian Provincial Hospital from March 2015 to August 2023. Their clinical characteristics, electrocardiographic and echocardiographic findings before and after treatment were reviewed. Paired sample t-test was used for inter-group comparison. Results: Among the mothers, 6 had positive antinuclear antibodies (ANA), 5 had anti-Sjogren syndrome antigen A antibodies, and 3 had anti-Ro-52 antibodies. The cohort included one female and eight male children, diagnosed with CLBBB at the age of 1 (2, 13) months. The positive autoantibodies in the infants, consisted with maternal antibodies, were detected within the first 3 months of life among 3 cases. Treatments included anti-heart failure therapy, myocardial nutritional support, intravenous immunoglobulin (IVIG) and glucocorticoids. Before treatment, the levels of troponin I (0.175 (0.060, 10.270) μg/L) and N-terminal pro-B-type natriuretic peptide (420 (327, 12 865) ng/L) were elevated, which normalized in most cases after treatment. Post-treatment, the QRS duration significantly shortened compared to pre-treatment ((137±15) vs.(169±25) ms, t=3.76, P<0.001), and the QTc interval significantly decreased ((433±41) vs. (514±27) ms, t=4.95, P=0.001). Before treatment, varying degrees of mitral and tricuspid regurgitation and marked interventricular septal dyskinesia were observed in echocardiography. After treatment, valve regurgitation and ventricular septum motion significantly improved, with a marked increase in left ventricular ejection fraction ((51±13)% vs. (27±6)%, t=-6.66, P<0.001). Conclusions: Maternal autoantibody-mediated CLBBB in children presents with chronic heart failure in infancy. Early treatment with anti-heart failure medications, IVIG and glucocorticoids can improve clinical symptoms.

A Study on Ejection Fraction in Patients with Mitral and Aortic Regurgitation Based on Cardiovascular Models

Background: Whether it is healthy or patients with mitral and aortic regurgitation, clinicians cannot measure the regurgitation of the valve when using two-dimensional echocardiography to measure ejection fraction. Whether the mitral valve and aortic valve are in a healthy state or in a reflux state, there is a reflux volume. The actual stroke output will be less than the stroke output measured by echocardiography, making the calculated ejection fraction higher. Methods: This article proposes for the first time the concept of net ejection fraction (NEF) as the percentage of net stroke output to left ventricular end diastolic volume. The net stroke output is the integral of aortic valve flow during one cardiac cycle at the same time. Using a systemic arterial circulation model, investigate the relationship between ejection fraction and net ejection fraction through numerical simulation methods. Results: The final results showed a strong linear correlation between mitral regurgitation volume (VRmi), aortic regurgitation volume (VRao), and the difference between ejection fraction and net ejection fraction (DEF). The net ejection fraction of the moderate mitral regurgitation group decreased by an average of 26.3% ± 9.95% compared to the ejection fraction measured by echocardiography. The severe mitral regurgitation group showed a decrease of 31.9% ± 9.3%. Moderate descent of aortic valve by 25.8% ± 11.1%. Severe aortic valve descent of 30.9% ± 10.3%. Conclusions: Clinical doctors can evaluate the left ventricular systolic function of patients based on the ejection fraction measured by echocardiography combined with valve regurgitation. The net ejection fraction avoids overestimation of left ventricular systolic function and has high reliability. It can accurately reflect the left ventricular systolic function of patients with mitral and aortic regurgitation, and has certain guiding significance for clinical doctors to grasp the patient's condition.

Validation of Yeo’s index in assessing severity of rheumatic mitral stenosis in mixed valve lesions

IntroductionYeo’s Index, product of the mitral leaflet separation index and dimensionless index, is a novel measure of the severity of rheumatic mitral stenosis (MS). We assess Yeo’s index in patients with rheumatic MS with or without mixed valve disease. MethodsIn a retrospective cohort study, Yeo’s index was measured in 237 cases of rheumatic MS − 124 in a transthoracic echocardiography validation cohort using mitral valve area (MVA) by pressure half-time and planimetry as comparator and 113 in a transesophageal echocardiography (TEE) validation cohort using TEE three-dimensional MVA as comparator. Patients were considered to have mixed valve disease if they had MS and concomitant mitral regurgitation or aortic valve disease. ResultsThere were 113 patients with isolated MS and 124 patients with mixed valve disease. Overall, Yeo’s index ≤ 0.26 cm showed 93.0 % sensitivity and 87.5 % specificity for identifying severe MS (MVA ≤ 1.5 cm2). In isolated MS, Yeo’s index ≤ 0.26 cm showed sensitivity of 94.6 % and specificity of 90.0 % for identifying severe MS, while in mixed valve disease sensitivity was 90.6 % and specificity 86.7 %. Overall, Yeo’s index ≤ 0.15 cm showed 83.6 % sensitivity and 94.3 % specificity for very severe MS (MVA ≤ 1.0 cm2). In isolated MS, the threshold of ≤0.15 cm showed sensitivity of 84.4 % and specificity of 92.6 % for very severe MS, while in mixed valve disease sensitivity was 81.3 % and specificity 95.3 %. The presence of atrial fibrillation did not influence the performance of Yeo’s index. ConclusionYeo’s Index accurately differentiates severity of rheumatic MS with or without mixed valve disease.

One-Year Outcome of an Ongoing Pre-Clinical Growing Animal Model for a Tissue-Engineered Valved Pulmonary Conduit.

Objectives: A self-constructed valved pulmonary conduit made out of a de-cellularized porcine small intestinal submucosal extracellular matrix biological scaffold was tested in a chronic growing lamb model. Methods: The conduit was implanted in pulmonary valve position in 19 lambs. We monitored clinical, laboratory, and echocardiographic findings until 12 months after surgery. In two animals, euthanasia was planned at nine and twelve months. Pre-mortem chest computed tomography and post-mortem pathologic work up were performed. Data are presented as frequency and percentage, median and range, or mean and standard deviation. Results: Twelve (63.2%) animals survived the perioperative period. Three unexpected deaths occurred during the follow-up period: one due to aspiration pneumonia at 23 days after surgery, and two due to early and late infective endocarditis of the conduit at 18 and 256 days. In the two animals with planned scarification, the pre-mortem CT scan revealed mild or no calcification within the conduit or valve leaflets. In the echocardiographic examination at 12 months, peak and mean systolic pressure gradients across the conduit valve were 6.5 (3-21) mmHg and 3 (2-12) mmHg, while valve regurgitation was none (n = 2), trivial (n = 5), moderate (n = 1), or severe (n = 1). No clinical or laboratory signs of hemolysis were seen. After 12 months of follow-up, the animals' body weights had increased from 33 (27-38) kg to 53 (38-66) kg (p = 0.010). Conclusions: Implantation of a valved pulmonary conduit in our growing lamb model was feasible. Infective endocarditis of the implanted valved conduit remained a significant complication.

Development and validation of an ex vivo porcine model of functional tricuspid regurgitation

Background and Aim: Ex vivo models of functional tricuspid regurgitation (FTR) are needed for pre-clinical testing of novel surgical and interventional repair strategies, but current options are costly or have not been formally validated. The objective of this research was to create and validate an ex vivo model to test novel repair methods for FTR. Methods: In explanted porcine hearts, the right atrium was excised to visualize the tricuspid valve. The pulmonary artery and aorta were clamped and cannulated, the coronary arteries ligated, and the right and left ventricles statically pressurized with air to 30 mmHg and 120 mmHg, respectively. FTR was induced by increasing right ventricular pressure to 80 mmHg for 3 h, which resulted in progressive tricuspid annular enlargement, right ventricular dilation, papillary muscle displacement, and central tricuspid malcoaptation. A structured light scanner was used to image the 3D topography of the tricuspid valve in both the native and FTR state, and images were exported into scan-to-computer-aided design software, which allowed for high-resolution 3D computational reconstruction. Relevant geometric measurements were sampled including annular circumference and area, major and minor axis diameter, and tenting height, angle, and area. Geometric measurements from the ex vivo model were compared to clinical transthoracic echocardiographic (TTE) measurements using two-sample t-tests. Results: A total of 12 porcine hearts were included in the study. Annular measurements of the native valve were comparable to published TTE data, except for the minor axis diameter, which was shorter in the ex vivo model (2.5 vs. 3.1 cm, P = 0.007). Induction of FTR in the ex vivo model resulted in annular enlargement (FTR vs. native: circumference 13.7 vs.11.8 cm, P = 0.012; area 14 vs. 11 cm2, P = 0.011). Ex vivo leaflet measurements in both the native and FTR model differed from published TTE data, but demonstrated comparable directional changes between the native and regurgitant states, including increased tenting height, area, and volume. Conclusion: The ex vivo pneumatically-pressurized porcine model closely recapitulates the geometry of both the native and regurgitant tricuspid valve complex in humans and holds promise for testing novel FTR repair strategies. Relevance for Patients: Currently available interventions for the tricuspid valve have a risk of permanent conduction abnormalities and are insufficient in addressing tricuspid disease for a subset of patients. This ex vivo model provides a platform for testing of novel interventions that address the deficiencies of current tricuspid therapies.

A fluid-structure interaction simulation on the impact of transcatheter micro ventricular assist devices on aortic valves

Background and ObjectiveThe implantation of ventricular assist devices (VADs) has become an important treatment option for patients with heart failure. Aortic valve insufficiency is a common complication caused by VADs implantation. Currently, there is very little quantitative research on the effects of transcatheter micro VADs or the intervention pumps on the aortic valves. MethodsIn this study, the multi-component arbitrary Lagrange-Eulerian method is used to perform fluid-structure interaction simulations of the aortic valve model with and without intervention pumps. The effects of intervention pumps implantation on the opening area of the aortic valves, the stress distribution, and the flow characteristics are quantitatively analyzed. Statistical results are consistent with clinical guidelines and experiments. ResultsThe implantation of intervention pumps leads to the valve insufficiency and causes weak valve regurgitation. In the short-term treatment, the valve regurgitation is within a controllable range. The distribution and variation of stress on the leaflets are also affected by intervention pumps. The whirling flow in the flow direction affects the closing speed of the aortic valves and optimizes the stress distribution of the valves. In the models with whirling flow, the effects of intervention pumps implantation on valve motion and stress distribution differ from those without whirling flow. However, the valve insufficiency and valve regurgitation caused by intervention pumps still exist in the models with whirling flow. Conventional artificial bioprosthetic valves have limited effectiveness in treating the valve diseases caused by intervention pumps implantation. ConclusionsThis study quantitatively investigates the impact of intervention pumps on the aortic valves, and investigates the effect of blood rotation on the valve behavior, which is a gap in previous research. We suggest that in the short-term treatment, the implantation of intervention pumps has limited impact on aortic valves, caution should be exercised against valve regurgitation issues caused by intervention pumps.

Investigation of Valvular Heart Defects Through Phonocardiogram Signals

Cardiovascular disease (CVD) is a serious illness that affects the world. Early detection and prevention of CVD is thought to help reduce CVD mortality rates. Valvular heart defects will be challenging to diagnose without echocardiogram. Despite the fact that this method is relatively reliable, both the device and the process are time-consuming where this can be dangerous for those who require rapid medical attention. Therefore, this study would concentrate on the use of phonocardiogram (PCG) signals to provide early screening assessment for valvular heart defects such as aortic stenosis (AS), mitral stenosis (MS), mitral regurgitation (MR) and mitral valve prolapse (MVP). Signal processing techniques which involves pre-processing, segmentation, feature extraction and classification are applied to analyze PCG signal. Daubechies wavelet with 5th order (Db5) with 7th level of decomposition is used to remove undesirable signal in PCG signal and reconstructed back from 1 to level 6 Daubechies wavelet with 5th order. The signal was then segmented using average Shannon energy. The segmented signal is then entered into feature extraction process. Then, feature extraction was done in time-frequency analysis by using Stockwell transform which is also known as S-transform. Finally, the classification process was done using K Nearest Neighbor (KNN), Support Vector Machine (SVM), and Ensemble classifier on all dataset with an overall best accuracy of 96.32%, 94.88% and 98.02%, respectively. This study’s outcome would be an advancement diagnostic tool that capable of analyzing PCG signal data and helps physicians by providing early detection for any valvular heart defects

A multiple variable index and extracardiac-Fontan associated hepatic fibrosis

BackgroundThe serial follow-up of Fontan-associated liver disease is challenging, as laboratory values are frequently normal, especially with mild to moderate liver disease. ObjectiveWe investigated a composite index's correlation with hepatic biopsy total fibrosis scores in extracardiac Fontan patients. MethodsWe identified extracardiac Fontan patients undergoing cardiac catheterization and transvenous hepatic biopsies between June 2013 and September 2023 and liver shear wave elastography between January 2017 and July 2023. We developed a composite index from the following: 1) elastography values, 2) sex, 3) history of a neonatal aortopulmonary shunt for pulmonary flow obstruction, 4) pacemaker, 5) Fontan duration, 6) bilirubin values, 7) univentricular dysfunction, 8) atrioventricular valvar regurgitation, 9) mean Fontan pressures, and 10) venovenous collaterals presence. We correlated the index with hepatic total fibrosis scores (0–8), the sum of pathology grading (0 to 4) performed for sinusoidal and portal fibrosis. We defined a hepatic total fibrosis score of 0–3 as none to mild and 4–8 as moderate to severe fibrosis. ResultsWe identified 62 patients who underwent 92 transvenous liver biopsies, with 30 patients undergoing 2 biopsies. The average age at biopsy was 15 ± 2 years. We found a strong correlation (rho = 0.8, p = .00001) between liver total fibrosis scores and composite index values. A receiver operating characteristic analysis demonstrated that an index cut-off value of ≥26 predicted a total fibrosis score of ≥4 with a sensitivity of 71 % and a specificity of 75 % (AUC = 0.73, 95 % CI 0.63, 0.83, p = .0001). ConclusionsWe developed a composite index with a moderate predictive ability to discriminate none to mild from moderate to severe hepatic fibrosis. Nevertheless, additional data is needed to assist further validation and determine its clinical utility in the serial follow-up of Fontan associated liver disease.

Semilunar valve growth and function 10 years after infant heart transplantation: Predicting long-term outcomes of partial heart transplants.

Partial heart transplants are a new type of pediatric transplant that replace defective heart valves with the parts of matched donor hearts containing the necessary valves. Short-term outcomes of partial heart transplants are excellent, but long-term outcomes are unknown. In order to predict the long-term outcomes of partial heart transplants, we evaluated long-term growth and function of semilunar heart valves transplanted in infancy as part of a heart transplant. All children who underwent infant heart transplantation at a single center from 1997 to 2014 were included in this study. Children in whom echocardiograms after heart transplantation and after 10 years were not available for review were excluded. The echocardiograms were reviewed by two authors to analyze semilunar valve annulus diameters, Z-scores, peak valve gradients, and valve regurgitation. Statistical difference was determined using two-tailed, paired sample t-tests with Bonferroni correction for multiple comparisons. Data from 15 patients were analyzed. The aortic valve annulus averaged 1.3 cm (range 0.7-1.8 cm) immediately after transplantation and grew to an average of 1.7 cm (range 1.4-2.3 cm) after 10 years (p < .001). After 10 years, the aortic valve peak gradient avereraged 5.1 mmHg (range 2.1-15.5 mmHg) and none of the valves had more than trivial regurgitation. The pulmonary valve annulus averaged 1.5 cm (range 1.1-2.5 cm) immediately after transplantation and grew to an average of 2.1 cm (range 1.0-2.9 cm) after 10 years (p < .001). After 10 years, the pulmonary valve peak gradient averaged 4.3 mmHg (range 1.1-13.8 mmHg), and 7% of valves had moderate regurgitation. Semilunar heart valves transplanted in infancy as part of a heart transplant demonstrate statistically significant growth and excellent function after 10 years. This predicts excellent long-term outcomes of partial heart transplants.

Carcinoid Heart Disease Associated with Primary Ovarian Carcinoid Tumor: A Rare Presentation

Primary ovarian carcinoid tumors, an extremely rare subset of ovarian malignancies (&lt;0.1% of cases), typically manifest with abdominal pain and bloating. The occurrence of carcinoid heart disease (CHD) without classic carcinoid syndrome features is exceptionally uncommon. We report a 54-year-old female presenting with dyspnea and edema over months, lacking typical carcinoid syndrome signs. Initial assessments diagnosed heart failure, supported by elevated NT-Pro BNP, echocardiographic right ventricular dilation, and pulmonary/tricuspid valve regurgitation (normal left ventricular function). Right heart catheterization showed normal pulmonary/right ventricular pressures. Subsequent investigations (computed tomography thorax abdomen pelvis, 5-hydroxyindole acetic acid levels) strongly suggested carcinoid disease, confirmed by an octreotide scan revealing an octreotide-secreting ovarian carcinoid tumor. Surgical intervention included tricuspid and pulmonary valve repair, total abdominal hysterectomy, and bilateral salpingo-oophorectomy. Primary ovarian carcinoid tumors, though rare, may lead to unexpected complications like CHD. Timely diagnosis and intervention are pivotal for optimizing patient outcomes in such cases.

Left Ventricle Myocardial Work Correlated with Functional Capacity in Severe Rheumatic Mitral Stenosis with Preserved Left Ventricular Ejection Fraction.

Functional capacity is reduced in mitral stenosis (MS) patients. Previous studies showed a correlation between left atrial strain and functional capacity in this population. However, currently, no left ventricle (LV) echocardiographic parameters were associated with functional capacity in patients with MS. Noninvasive LV pressure-strain loop analysis is a new echocardiographic method for evaluating LV function, integrating longitudinal strain from speckle-tracking analysis and noninvasively measured blood pressure to estimate myocardial work (MW) that overcomes the preload-dependent characteristics conventional parameters by integrating afterload. This study aimed to evaluate the association between MW and functional capacity measured using exercise tests in patients with severe MS and preserved LV ejection fraction (LVEF). Adult patients with symptomatic severe rheumatic MS (mitral valve area <1.5 cm2), and preserved LVEF (>50%) and sinus rhythm who underwent echocardiography and exercise stress test in our hospital from 2019 to 2021 were included. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, significant mitral regurgitation or aortic valve lesions, coronary artery disease, intracardiac shunt, and atrial fibrillation. Standard echocardiographic parameters were measured, and all MW parameters were included. Exercise treadmill testing was performed using the modified Bruce protocol. A total of 33 individuals with isolated severe rheumatic MS in sinus rhythm (age 39.8 ± 9.8 years) were included in the study. Patients with severe isolated MS showed significantly impaired LV-global longitudinal strain values compared to normal reference values. Furthermore, patients with severe MS showed significantly lower values of global work index, global constructive work, and efficiency compared to normal values and higher wasted work. Global work efficiency was significantly correlated to the duration of exercise (P = 0.025, Pearson's r = 0.389). In stable patients with isolated severe mitral stenosis, MW efficiency significantly correlated with functional capacity measured objectively through exercise testing.

Post-CPB echocardiography showing two well-seated prosthetic valves and trace PR from a trace-to-mild paravalvular leak. There was no evidence of tricuspid valve regurgitation or tricuspid valve stenosis.

Post-CPB echocardiography showing two well-seated prosthetic valves and trace PR from a trace-to-mild paravalvular leak. There was no evidence of tricuspid valve regurgitation or tricuspid valve stenosis.

CFD Based on The Visualisation of Aortic Valve Mechanism in Aortic Valve Stenosis for Risk Prediction at The Peak Velocity

Aortic valve disease plays a crucial role in the development of cardiovascular disease (CVD), leading to increased rates of mortality and morbidity. Two diseases, aortic valve regurgitation and aortic valve stenosis are known to occur in the aortic valve. However, aortic valve stenosis is gaining attention due to its severe impact on the patient. The malfunction of the aortic valve might be affected by blood flow, which leads to stenosis. This study aims to investigate the blood flow re-circulation on the aortic valve in different stenotic regions when the blood’s velocity reaches the pick flow of the time in the systole phases. Four different models of aortic valve stenotic are designed using computer-aided design (CAD) software. The computational fluid dynamics (CFD) approach governed by the Navier-Stokes equation is imposed to identify the characteristics of the blood backflow at the left ventricle. Several hemodynamic factors are considered, such as time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI) and relative residence time (RRT). The blood flow characteristic is expected to be chaotic, especially at the highest percentages of aortic valve stenosis, presenting the worst condition to the heart. This finding supports healthcare providers in foreseeing the deterioration of the patient’s condition and opting for aorta valve surgery replacement.

Low Free Thyroxine (FT4) in critically ill juvenile systemic lupus erythematosus: a diagnostic approach

Introduction: Thyroid dysfunction was frequent in systemic lupus erythematosus (SLE) patients, which may present as euthyroid, hypothyroid, or hyperthyroid states. Critical conditions have a higher chance of euthyroid sick syndrome due to alterations in the hypothalamic-pituitary-thyroid (HPA) axis. Renal impairment was associated with an increased risk of low FT4 due to proteinuria followed by thyroid loss. Case Description: We reported one patient, a 15-year-old girl, who complained of shortness of breath and revealed acute respiratory distress syndrome, valve regurgitation, and pericardial effusion. She also felt joint pain over the leg and odor urination. Further evaluation showed non-scaring alopecia, pyuria, proteinuria &gt;0.5 gram/24 hours, urinary cast, and acute kidney injury stage failure. ANA (IF) pattern: scattered with titer 1:100, ANA profile indicated Smith (Sm) antigen (+) and C3 108.3 mg/d, which fulfilled Systemic Lupus International Collaborating Clinics (SLICC) 2015 and European League Against Rheumatism (EULAR) 2019 criteria for SLE. On the fourth day of treatment, the patient had acute confusion, hypothermia, and sinus bradycardia, while the investigation of FT4 hormone was 0.45 ng/dL, TSH 2.39 uIu/ml, which revealed euthyroid sick syndrome. After treatment with a high dose of methylprednisolone, cyclophosphamide, rituximab, levothyroxine, a phosphodiesterase inhibitor, and a diuretic, she deteriorated and passed away. Conclusion: The higher prevalence of thyroid dysfunction in juvenile SLE patients necessitates further attention. Lupus nephritis, increased creatinine level, detection of Smith (Sm) antigen, and critical condition were also at higher risk of low FT4 in juvenile SLE patients. This condition may have a worsened prognosis with prompt diagnosis and treatment.

Risk of infective endocarditis after hybrid melody mitral valve replacement in infants: the French experience.

Surgical management of mitral valve disease is challenging in infants <1 year old. We aimed at reviewing the French experience with Melody mitral valve replacement in critically ill infants. A retrospective cohort study reporting the French experience with Melody mitral valve replacement. Seven symptomatic infants [complete atrioventricular septal defect (n = 4, Down syndrome: n = 3), hammock valve (n = 3)] underwent Melody mitral valve replacement [age: 3 months (28 days to 8 months), weight: 4.3 kg (3.2-6.4 kg)] because of severe mitral valve regurgitation (6) or mixed valve disease (1) and 14 mm (11-16 mm) mitral valve annulus. In 2 patients whose valve was felt irreparable, Melody mitral valve replacement was performed straightaway. The others underwent 2 (1-3) previous attempts of valve repair; 3 were on extracorporeal membrane oxygenation. Melody mitral valve replacement led to competent valve and low gradient [3 mmHg, (1-4 mmHg)]. One patient died 3 days post-implant from extracorporeal membrane oxygenation-related stroke. Of the 6 discharged home patients, 3 (50%) were readmitted for a definite diagnosis (1) or high suspicion (2) of infective endocarditis, of which 2 died. Over the follow-up, 1 underwent balloon expansions of the valve at 9- and 16-months post-implant, and mechanical mitral valve replacement at 2 years; another is currently planned for transcatheter Melody valve dilation. Melody mitral valve replacement may be considered in selected infants with small mitral valve annulus as an alternative to mechanical mitral valve replacement. Our experience highlights a high-risk of late infective endocarditis that deserves further consideration.