Valvular Replacement Research Articles

TRANSIENT LOAD DEPENDENT SEVERE AORTIC REGURGITATION IN A PATIENT WITH STENTLESS AORTIC VALVE REPLACEMENT

Exercise induced dyspnea in patients with valvular surgical replacement has a broad differential, requiring extensive history combined with cardiac imaging. A 64-year-old male with medical history of rheumatic aortic valve stenosis with surgical stentless bioprosthetic aortic (Sorin SOLO) valve

Lest we Forget: Rheumatic Fever is Still Damaging Hearts

Rheumatic Heart Disease (RHD) is still a burden in many developing countries and indigenous communities within developed countries. A simple sore throat caused by the Group A β-hemolytic Streptococcus bacterium in children, teenagers and young adults, unrecognized and/or under-treated, is all it takes to begin a whole cascade of damage to the heart valves and other cardiac structures resulting in valvular stenosis and incompetence. Its complications are enormous ranging from life-long morbidity and reduced productivity, need for open heart surgery for valvular repair or replacement (often requiring long term anticoagulation), risk of strokes, increased financial burden to individuals and health systems, and many more. Many heart valve replacement surgeries even in developed countries are, still, a result of rheumatic valvular heart disease. Yet many clinicians remain very much confused as to how to recognize and prevent this condition.

Echocardiographic features in antiphospholipid-negative Sneddon's syndrome and potential association with severity of neurological symptoms or recurrence of strokes: a longitudinal cohort study.

Sneddon's syndrome (SS) may be classified as antiphospholipid positive (aPL+) or negative (aPL- SS). An association between Libman-Sacks (LS) endocarditis and strokes has been described in aPL+ patients. To describe cardiac involvement in aPL- SS and assess the potential association between LS endocarditis and severity or recurrence of neurological symptoms. This longitudinal cohort study included aPL- SS patients followed in our departments between 1991 and June 2018. All patients underwent transthoracic 2D and Doppler echocardiography at diagnosis. Follow-up echocardiography was performed annually and the potential relationship between LS endocarditis development and neurovascular relapse as well as long-term cardiac worsening was prospectively assessed. We included 61 patients [52 women; median age 45 (range 24-60)]. For valvular involvement, 36 (59%) patients showed leaflet thickening; 18 (29.5%) had LS endocarditis at baseline. During a median follow-up of 72 months, LS endocarditis developed in eight (17.4%) patients, and 13 (28.3%) showed significant worsening of their cardiac status, including two who needed valvular replacement. After adjusting for baseline antithrombotic treatment regimen, neither the presence of LS endocarditis at baseline nor development during follow-up was associated with neurological relapse [hazard ratio (HR): 1.06, 95% confidence interval (CI): 0.33-4.74, P = 0.92] and [HR: 0.38, 95% CI: 0.02-1.89, P = 0.31], respectively. A long-term follow-up is needed to detect cardiac complications in aPL- SS. No change in neurological relapse was observed in patients presenting LS endocarditis occurrence during follow-up without any modification in antithrombotic treatment. Further research is necessary to assess the usefulness of treatment escalation in these patients.

P296 The effect of ideal BSA in patients with moderate aortic stenosis?

Abstract INTRODUCTION The current obesity epidemic has an impact on calculated BSA. Obesity significantly increases the calculated BSA from what the ideal BSA would be if based on a patient’s ideal body weight. PURPOSE To determine the effect of ideal BSA on AV area index in patients with moderate aortic stenosis and normal left ventricular function. METHODS Our ECHO database was searched for all patients with an LVEF >50% and moderate aortic stenosis based on a mean aortic gradient of 20-39 mmHg and an AV area >1.00 cm2. Patients with more than mild aortic regurgitation, previous valvular repair or replacement, significant mitral valve disease or any LV wall motion abnormalities were excluded. Ideal weight was calculated using the Devine formula = Constant + 2.3 x [height in inches-60], where constant= 50Kg in males and 45.5Kg in females). Body surface area in m2 was calculated using the formula = [√ (height in cm x weight in Kg)/3600]. The paired t-test was used to determine differences between means and the Fisher’s exact test was used to determine differences between proportions. A p value of <0.05 was considered significant. RESULTS There were 210 females (mean age 75.4 ± 11.9 years, mean AV gradient 25.3 ± 4.8 mmHg, mean AVA 1.28 ± 0.27 cm2) and 385 males (mean age 72.7 ± 11.3 years, mean AV gradient 25.9 ± 5.2 mmHg, mean AVA 1.32 ± 0.28 cm2). Other important variables are seen in table 1. There were highly significant differences between actual and ideal measurements of weight, BSA and AV area index. Based on the actual BSA there were 151 of 385 male patients (39.2%) with severe aortic stenosis (<0.60 cm2/m2), which dropped to 66 of 385 patients (17.1%) when the ideal BSA was used in the calculation (P < 0.0001, Fisher’s exact test). For females there were 44 of 210 patients with severe aortic stenosis (21.0%) which dropped to 3 (1.4%) when the ideal BSA was used in the calculation (P < 0.0001, Fisher’s exact test). CONCLUSIONS Use of the ideal BSA, based on ideal weight, significantly reclassifies women in terms of AS severity and will be consistent throughout time. All mean aortic gradients and AV areas, by definition, and 98.6% of the ideal AV area indices being in the moderate AS range. The data is less compelling in males but is still significantly improved with 82.9% of AV area indices being correctly assigned. Table 1. Weight/kg (Females) Weight/kg (Males) BSA/m2 (Females) BSA/m2 (Males) AVAI (Females) AVAI (Males) Actual. 77.5 ± 21.4 90.1 ± 16.9 1.79 ± 0.23 2.04 ± 0.20 0.72 ± 0.16 0.65 ± 0.14 Ideal. 51.6 ± 6.2 69.3 ± 7.1 1.51 ± 0.12 1.83 ± 0.14 0.85 ± 0.17 0.73 ± 0.16 P value. <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 AVAI = Aortic valve area index (cm2/m2). BSA = Body surface area (m2).

P92 A novel method of correcting the left ventricular stroke volume by Doppler echocardiography: comparison with multidetector computed tomography

Abstract Background Although transthoracic Doppler echocardiography is widely used for estimating left ventricular stroke volume (SV), accelerated blood flow in the left ventricular (LV) outflow tract may lead to overestimation. SV can be calculated accurately from left ventricular end-systolic and end-diastolic volume determined by multi-detector computed tomography (MDCT). However, radiation exposure as well as the use of contrast medium hampers its routine use. Purpose The purpose of this study was to examine whether the correction of SV measured by pulsed wave Doppler echocardiography (SVdop) can accurately predicts SV obtained by MDCT (SVct). Methods： We enrolled consecutive 61 patients who underwent both MDCT and transthoracic echocardiography. Patients with moderate or severe valvular diseases and valve replacement surgery were excluded. Correction of SV was explored with SVct as a reference. Results： Univariate analysis showed that SVdop (r = 0.42, P = 0.0007) and patient age (r=-0.50, P < 0.0001) were significantly correlated with SVct. On the other hand, left ventricular ejection fraction calculated by Teicholz method (EFteich) (r = 0.19, P = 0.14), systolic blood pressure (r = 0.07, P = NS), and LV mass index (r=-0.02, P = NS) were not correlated with SVct. Multivariate analysis showed that SVdop, patient age and EFteich were the independent predictive factors for SVct (R2 = 0.49, P < 0.0001). Based on these correlations, we postulated SV as: corrected SV = SVdop × 0.40 + EFteich × 0.46 – age × 0.67 + 44.77. As expected, the correlation between corrected SV and SVct significantly improved (r = 0.70, P < 0.0001). Bland-Altman plot analysis showed that corrected SV significantly reduced the variation between SVdop and SVct, and diminished the overestimation of SVdop (Figure). Conclusion： The new correction formula of SVdop may correct the overestimation of SV obtained by pulsed wave Doppler echocardiography, although the formula remains to be validated in a separate cohort of patients. Abstract P92 Figure

Infective endocarditis in children

Infective endocarditis (IE) in children is unfrequent but potentially serious. The aim of the present study was to describe our pediatric population and to highlight the differences with the adult population. In this retrospective monocentric cohort, 52 consecutive children with IE were included between January, 2000 and May, 2018. The median age was 9 [4-14] years. Thirty-two (61.5%) children had congenital cardiac disease among which 65% with ventricular septal defect (isolated or combined to another malformation). In the non-congenital group, 12 patients (23.1% of the entire cohort) had immune deficiency. Fever was the most frequent symptom (83%). A new or changed heart murmur was present in 16 children (31%), heart failure in 8 patients (15%). The aortic valve was affected in 14 children (27%), such was the mitral valve. Right-sided IE was frequent (18 children, 34%). There were 3 IE after MELODY valve implantation. Streptococci and Staphylococci were the most frequent bacteria (34%). The causal infective agent was not found in 8 patients (15%). One child died (septic shock), 21 patients (40%) had embolisms (6 cerebral, 8 pulmonary) with no difference between congenital heart disease and normal heart. Surgery was necessary for 24 children (46%) and more frequently required during the active phase for non-congenital children ( P < 0.05). There were 10 valvular replacements. Compared to adults studies, this monocentric cohort of IE in children revealed a high level of bacterial identification, a great proportion of immune deficiency and a high incidence of right-sided endocarditis.

Assessment of Nurses knowledge toward prevention of Complications related Valvular Replacement Surgery at Surgical Department in AL-Nasiriyah Heart Center

Objectives: The study aims to assess the nurses knowledge toward prevention of complications related to valvular replacement surgery and to find out the relationship between nurses knowledge and their demographic and occupational characteristic's Which as (Age, gender, level of education ,years of experience in Surgical Department , and training sessions)&#x0D; &#x0D; Methodology: A descriptive design (a cross-sectional study ) was carried out from December 2017 to May 2018 in order to assess nurses' knowledge of preventing complications Valvular Replacement Surgery at Surgical Department in Nasiriyah Heart Center on a purposive (non-probability) sample was used in this study that composed of (70) nurses of the morning and night shifts. Data were collected by using the technique of self-report questionnaire which designed and constructed by the researchers from previous related studies and consisted of two Part one included ' socio-demographic characteristics for the nurses, Part two : knowledge items related to anatomy , physiology heart valve , heart valve replacement and complication heart valve replacement. and nursing care . The validity of the questionnaire was determined by presenting the questionnaire to (13) specialized experts. The reliability of the internal consistency was achieved by applying the alpha correlation Coefficient (r=0.85) which was statistically acceptable. The data were analyzed by applying descriptive and inferential statistics .&#x0D; Results: The results showed that most of the participants in the research of nurses at age group (20-29) years, and the study revealed that the nurses have a moderate knowledge towards the prevention of complications of valve replacement surgery by significant level among all items of the scale. The study concluded that most nurses did not have sufficient experience in work in the surgical department and most of them did not train well . &#x0D; Recommendations: The study recommended spreading awareness among nurses regarding the prevention of complications of valves replacement surgery through instructional sessions and continuing education lectures to increase awareness of nurse's in ways of preventing complications of heart valve replacement.

Management of Rheumatic Heart Diseases in Burundi

Background: The surgical management of rheumatic heart disease (RHD) in Burundi is almost impossible because of the absence of the technical plateau. Aim: To describe the therapeutic and evolutionary aspects of RHD in Burundi. Patients and methods: This is a retrospective and analytical study of patients' records in surgical indication and/or operated for RHD by facilitation of “Maison du Bon Samaritain du Burundi (MBSB)” from February 2015 to February 2017. Results: Among 89 patients consulting for RHD, 45 (50.56%) were operated. The average age of the patients was 25 years. Females predominated with 64.04% of cases. The age of most of patients was between 4 and 40 years with 74 cases (83.14%). All patients had been received at the heart failure stage including 83 (93.25%) at stage III or IV according to the New York Heart Association (NYHA) classification. The ejection fraction was ≤ 50% in 61 patients (68.53%). Pulmonary arterial hypertension was recorded in 79 patients (88.76%). On chest X-ray, cardiomegaly was found in 85 patients (95.50%). Electrical abnormalities were dominated by dilatation of the left atrium in 48 cases (53.93%). Isolated valvular lesions were the most numerous with 67 cases (75.28%). The operative management was mainly valvular replacement (93.47%) with an operative success of 100% six months after the intervention. Conclusion: The diagnosis of RHD was late. Young people were more vulnerable. The postoperative prognosis at six months was good.

Heat shock protein 90 is downregulated in calcific aortic valve disease

BackgroundCalcific aortic valve disease (CAVD) is an atheroinflammatory process; finally it leads to progressive calcification of the valve. There is no effective pharmacological treatment for CAVD and many of the underlying molecular mechanisms remain unknown. We conducted a proteomic study to reveal novel factors associated with CAVD.MethodsWe compared aortic valves from patients undergoing valvular replacement surgery due to non-calcified aortic insufficiency (control group, n = 5) to a stenotic group (n = 7) using two-dimensional difference gel electrophoresis (2D-DIGE). Protein spots were identified with mass spectrometry. Western blot and immunohistochemistry were used to validate the results in a separate patient cohort and Ingenuity Pathway Analysis (IPA) was exploited to predict the regulatory network of CAVD.ResultsWe detected an upregulation of complement 9 (C9), serum amyloid P-component (APCS) and transgelin as well as downregulation of heat shock protein (HSP90), protein disulfide isomerase A3 (PDIA3), annexin A2 (ANXA2) and galectin-1 in patients with aortic valve stenosis. The decreased protein expression of HSP90 was confirmed with Western blot.ConclusionsWe describe here a novel data set of proteomic changes associated with CAVD, including downregulation of the pro-inflammatory cytosolic protein, HSP90.

Sarcoidosis cardíaca, un desafío diagnóstico. Reporte de dos casos

Cardiac sarcoidosis is underdiagnosed; it may occur in asymptomatic patients or be fatal as a consequence of severe arrhythmias, sudden death and refractory heart failure. Immunosuppressive treatment can improve the course of the disease. Two clinical cases with previously known sarcoidosis are presented and in the evolution cardiac sarcoidosis is diagnosed. In the first case, the diagnosis was made by means of myocardial biopsy during valvular replacement surgery, and in the second case by positron emission tomography requested for suspicion of cardiac sarcoidosis, when presenting palpitations and sinus arrhythmia. Clinical, diagnostic and therapeutic aspects are discussed.

Potential utility of metagenomic sequencing for improving etiologic diagnosis of infective endocarditis.

Aim: To explore potential utility of metagenomic sequencing for improving etiologic diagnosis of infective endocarditis (IE) caused by fastidious bacteria. Materials & methods: Plasma and heart valves of two patients, who were diagnosed with IE caused by Bartonella quintana and Propionibacterium species, were sequenced by using Illumina MiSeq and Nanopore MinION. Results: For patient 1, B. quintana was detected in the plasma pool collected 4 days before valvular replacement surgery. For patient 2, Propionibacterium sp. oral taxon 193 was detected in the plasma sample collected on hospital day 1. Nearly complete bacterial genomes (>98%) were retrieved from resected heart valves of both patients, enabling detection of antibiotic resistance-associated features. Real-time sequencing of heart valves identified both pathogens within the first 16 min of sequencing runs. Conclusion: Metagenomic sequencing may be a helpful supplement to IE diagnostic workflow, especially when conventional tests fail to yield a diagnosis.

La réadaptation du patient valvulaire

Valvular disease is the second indication of cardiac rehabilitation (CR) after coronary artery disease. Patients suffering valvular disease are addressed to CR after valvular repair, and are usually old. Valvular replacement are the most frequent, and more and more patients being treated by TAVI are addressed to CR. CR takes place on two phases: From the seventh (day 7) to the fifteenth (day 15) day: management of complications, respiratory physio, and help to autonomy if necessary. From the fifteenth day (day 15): rehabilitation to exercise after an exercise stress test with or without MVO2 measurement. Because the patients are taking anticoagulants and are at risk of endocarditis, therapeutic education takes an important place during the stage. CR of patients suffering valvular disease has demonstrated its usefulness with: An increase of exercise capacity in all kind of valvular disease; A reduction of left ventricular hypertrophy in patients with aortic valve stenosis. No serious complication was observed in all studies regarding CR in patients with valvular disease.

Mitochondrial DNA Mutations and Rheumatic Heart Diseases.

Acute rheumatic fever (ARF) is an autoimmune disease affecting the heart-valve endocardium in its final stage. Although rare in developing countries, ARF persists in third-world countries, particularly Senegal, where rheumatic heart diseases (RHDs) are the most common pediatric cardiovascular pathology. This study aimed to investigate mutations in MT-CYB in ARF and RHD in Senegalese patients. MT-CYB was amplified from blood samples from ARF patients at the Clinical of Thoracic and Cardiovascular Surgery of Fann National University Hospital Centre, Dakar, Senegal (control group, healthy individuals) and sequenced. More than half of the MT-CYB mutations (58.23%) were heteroplasmic. Transitions (61.67%) were more frequent than transversions (38.33%), and non-synonymous substitutions represented 38.33% of mutations. Unoperated RHD patients harbored frequent MT-CYB polymorphisms (7.14 ± 14.70 mutations per sample) and accounted for 72.73% of mutations. Paradoxically, subjects undergoing valvular replacement harbored infrequent polymorphisms (1.39 ± 2.97 mutations per patient) and lacked 36 mutations present in unoperated subjects. A genetic differentiation was observed between these two populations, and the mutations in operated subjects were neutral, while those in unoperated subjects were under positive selection. These results indicate a narrow link (perhaps even causal) between MT-CYB mutations and ARF and its complications (i.e., RHDs) and that these mutations are largely deleterious.

Obesity as a Risk Factor Among Hospitalized Patients with Infective Endocarditis.

ObjectiveObesity contributes to diagnostic and management challenges for many hospitalized patients. The impact of obesity on in-hospital outcomes in patients with infective endocarditis has not been studied and was the focus of this investigation.MethodWe used the 2013 and 2014 Nationwide Inpatient Sample to identify adults ≥18 years of age with a principle diagnosis of endocarditis. We divided the sample into 2 groups based on presence of absence of obesity. Multivariate linear and logistic regression analysis was used to compare in-hospital mortality, valvular replacement, length of stay (LOS), and hospitalization charges.ResultsA total of 24 494 adults 18 years and older were hospitalized with infective endocarditis, of which 2625 were classified as obese. Patients with obesity were older (mean age, 57.8 ± 0.3 vs 54.3 ± 0.6 years; P < .01), more likely to be female (50.1% vs 36.1%; P < .01), and had more comorbidities (Charlson comorbidity score ≥ 3, 50.6% vs 28.8%; P < .01). Multivariate regression analysis found no differences between the 2 groups for mortality or repairs or replacements for any valve. On evaluation of resource utilization, patients with obesity had longer average LOS (13.9 days; confidence interval [CI], 12.7–15.1 vs 12.4 days; CI, 12.0–12.8; P = .016) and higher total hospital charges (US $160 789.90; CI, $140.922.40–$180 657.50 vs US $130 627.20; CI, $123 916.70–$137 337.70; P <.01). After adjustment for LOS for total hospital charges, there was no observed difference $11436.26 (CI, -$6649.07–$29521.6; P = .22).Conclusions. Obesity does not significantly impact in-hospital mortality or surgical valvular interventions among patients hospitalized with infective endocarditis, but obesity is associated with increased utilization of hospital resources.

Clinical use and laboratory testing of oral anticoagulation therapy: experience from Finland

Anticoagulation therapy has been undergoing a transition during the last decade with the progressive availability of direct oral anticoagulants (DOACs). While DOACs are increasingly used in common indications for anticoagulation, including non-valvular atrial fibrillation (AF), deep vein thrombosis (DVT) and pulmonary embolism (PE), traditional anticoagulants, either warfarin or heparins, remain the primary choice for patients with cardiac valvular replacement, severe thrombophilia, pediatric, pregnant and many cancer patients. Laboratory monitoring of warfarin and heparins are well established, while under specific emergency conditions DOACs require specific assays, the availability of which may be limited. Finland benefits from centralized laboratory networks, offering harmonized services throughout our rather sparsely populated country. Specific assays for all DOACs are available 24/7 in the core laboratory (Southern Finland). Interaction, collaboration and continuous education between clinic and laboratory is increasingly needed, under the era of rapid change of traditions in anticoagulation management.

Clinical assessment of aortic valve stenosis: Comparison between 4D flow MRI and transthoracic echocardiography.

BackgroundThe prevalence of valvular aortic stenosis (AS) increases as the population ages. Echocardiographic measurements of peak jet velocity (Vpeak), mean pressure gradient (Pmean), and aortic valve area (AVA) determine AS severity and play a pivotal role in the stratification towards valvular replacement. A multimodality imaging approach might be needed in cases of uncertainty about the actual severity of the stenosis.PurposeTo compare four‐dimensional phase‐contrast magnetic resonance (4D PC‐MR), two‐dimensional (2D) PC‐MR, and transthoracic echocardiography (TTE) for quantification of AS.Study TypeProspective.PopulationTwenty patients with various degrees of AS (69.3 ± 5.0 years).Field Strength/Sequences4D PC‐MR and 2D PC‐MR at 3T.AssessmentWe compared Vpeak, Pmean, and AVA between TTE, 4D PC‐MR, and 2D PC‐MR. Flow eccentricity was quantified by means of normalized flow displacement, and its influence on the accuracy of TTE measurements was investigated.Statistical TestsPearson's correlation, Bland–Altman analysis, paired t‐test, and intraclass correlation coefficient.Results4D PC‐MR measured higher Vpeak (r = 0.95, mean difference + 16.4 ± 10.7%, P <0.001), and Pmean (r = 0.92, mean difference + 14.9 ± 16.0%, P = 0.013), but a less critical AVA (r = 0.80, mean difference + 19.9 ± 20.6%, P = 0.002) than TTE. In contrast, unidirectional 2D PC‐MR substantially underestimated AS severity when compared with TTE. Differences in Vpeak between 4D PC‐MR and TTE showed to be strongly correlated with the eccentricity of the flow jet (r = 0.89, P <0.001). Use of 4D PC‐MR improved the concordance between Vpeak and AVA (from 0.68 to 0.87), and between PGmean and AVA (from 0.68 to 0.86).Data Conclusion4D PC‐MR improves the concordance between the different AS parameters and could serve as an additional imaging technique next to TTE. Future studies should address the potential value of 4D PC‐MR in patients with discordant echocardiographic parameters. Level of Evidence: 2 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2020;51:472–480.

Transaortic valvular replacement prognosis according to aortic stenosis category

Transcatheter aortic valve replacement (TAVR) has revolutionized the prognosis of patients with severe aortic stenosis. Four categories of aortic stenosis can be defined depending on left ventricular ejection fraction (EF), mean transvalvular gradient and stoke volume index. Whether aortic stenosis category influence prognosis after TAVR regarding functional improvement and mortality. In total, 263 TAVR patients with a complete baseline echocardiography and one year follow-up, were retrospectively classified into four categories: high gradient ( n = 211); low-flow, low-gradient aortic stenosis with reduced EF ( n = 21); low-flow, low-gradient aortic stenosis with preserved EF ( n = 8) and normal-flow, low-gradient aortic stenosis with preserved EF ( n = 23). At 12 months follow-up, 39 deaths occurred (14.8%): 25 in the high gradient group (11.8%), 9 in the low-gradient, low-flow, reduced EF group (43%), 1 in the low-gradient, low-flow, preserved EF group (12.5%), 4 in the low-gradient, normal flow group (17.4%). In a multivariate model, one-year all-cause mortality was higher in low-gradient, low-flow, reduced EF group ( P < 0.0001) than in others (HR = 3.86; 95% CI 1.83–8.14; P = 0.0004). Patients with low-gradient, low-flow, reduced EF had less improvement in terms of dyspnea one month after the procedure with more patients in the NYHA 4 stage in this group ( P = 0.003). A complete echocardiography is necessary to evaluate aortic stenosis, its severity and its type before TAVR. Patients with low-gradient, low-flow reduced EF had a higher mortality rate one year after TAVR and remained more symptomatic one month after the procedure.

Characterization of patients admitted to cardiac rehabilitation program

Introduction: Cardiovascular disease (CVD) is the leading cause of death in Europe, including Portugal. Referral to a cardiovascular rehabilitation program (CRP) is a class I recommendation for all patients with coronary artery disease based on findings that participation can reduce cardiovascular (CV) and all-cause-mortality, as well as improve functional capacity and quality of life [1]. Fewer than half of all eligible cardiovascular patients benefit from CRP in most European countries. In Portugal, only 10% of patients with post-acute coronary syndrome (ACS) are admitted to CRP [2]. The purpose of this study is to characterize the patients who participated in the first three years of Hospital Garcia de Orta’s cardiac reconditioning program in terms of key demographic variables and the prevalence of common risk factors. Material and methods: A transversal, descriptive study of patients admitted to CRP during the first three years of existence in Hospital Garcia de Orta. The following parameters were analyzed: age, gender, admission diagnosis and risk factors for CVD - hypertension, diabetes mellitus, dyslipidemia, increased body mass index, smoking and family history of CVD. This study follows all the principles of the Declaration of Helsinki. Results: 57 patients were admitted with a mean age of 53 [32–79] years old, predominantly male (74%). 55 were admitted after ACS (53 status after PCI and 2 status after CABG), 1 after valvular replacement surgery and 1 with heart failure class III (NYHA). The prevalence of hypertension was 56%; LDL ≥100 mg/dL 54%; HDL ≤45 mg/dL 52%; cholesterol ≥175 mg/dL 52%; triglycerides ≥150 mg/dL 39%; overweight 44%; obesity 19%; 53% were smokers; 16% with diabetes mellitus and family history of CVD in 63%. Discussion and conclusion: During this period only 57 patients were admitted, mainly due to a lack of staff, resources and infrastructures. Our CRP is expanding, foreseeing a greater admission of eligible patients in the future. In spite of the small sample size we observe a high prevalence of CV risk factors among our patient which is consistent with the data from literature. Thus referral to CRP is crucial as they include several strategies which aim to reduce CV risk factors and therefore reduce of cardiovascular disease morbi-mortality.

Not Your Typical Dyspnea of Pregnancy: A Case Report of Transcatheter Valve-in-Valve Replacement During Pregnancy

Because technology for valvular replacement continues to evolve, we expect it to be further reaching in the applications for intermediate- to high-risk surgical candidates. Although the patient population for transcatheter aortic valve replacement has widened, it is still extremely rare in the pregnant patient. We report a case of a transcatheter valve-in-valve implantation in the second trimester of pregnancy. The patient experienced an excellent outcome after comprehensive coordination across multiple services. We discuss anesthetic considerations in the care of the pregnant patient for transcatheter aortic valve implantation.

GDF-15 IS ASSOCIATED WITH FUNCTIONAL CAPACITY & VENTRICULAR DYSFUNCTION IN PATIENTS WITH MODERATE TO SEVERE AORTIC STENOSIS & PRESERVED EJECTION FRACTION

Aortic stenosis (AS) is the most common valvular disease and aortic valve replacement (AVR) is indicated in symptomatic patients or with decline in left ventricular ejection fraction (LVEF). LV remodelling and diastolic dysfunction often occur prior to symptom onset and earlier AVR may be beneficial