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Mechanical valve obstruction

Enrico Ferrari, Luigi Biasco, Francesco Faletra, Anson Cheung, Marco Moccetti, Giovanni Pedrazzini, Stefanos Demertzis, Tiziano Moccetti
Transcatheter mitral valve replacement with the TiaraTM valve can be performed in inoperable patients with severe functional regurgitation. Risk of left ventricular outflow tract obstruction can be prevented using preoperative 3D-imaging and 3D-printed models. However, in case of mono-disk mechanical prosthesis previously implanted in aortic position (Bjork-Shiley) there is an additional risk of mechanical interference leading to reduced leaflet motion and aortic valve dysfunction. Hereafter, we describe the case of a patient with a 27mm mono-disk mechanical aortic valve implanted in 1978, Euroscore-II of 18% and STS-score (mortality) of 16% who successfully underwent a transapical TiaraTM valve implantation...
March 5, 2018: Seminars in Thoracic and Cardiovascular Surgery
Rominder Grover, Mickael Ohana, Chesnal Dey Arepalli, Stephanie L Sellers, John Mooney, Shaw-Hua Kueh, Ung Kim, Philipp Blanke, Jonathon A Leipsic
PURPOSE OF REVIEW: Recent advancements in transcatheter valvular interventions have resulted in a growing demand for advanced cardiac imaging to help guide these procedures. RECENT FINDINGS: Both echocardiography and multi-detector computed tomography have played essential roles in the maturation of transcatheter aortic valve replacement and are now building on these experiences and helping inform the nascent field of transcatheter mitral interventions. Advanced imaging is essential to aid in the diagnosis and determination of the mechanism of mitral regurgitation...
March 6, 2018: Current Cardiology Reports
Long Deng, Xueying Huang, Chun Yang, Yunhu Song, Dalin Tang
Left ventricular outflow tract obstruction is observed in 70% of patients with hypertrophic cardiomyopathy, which occurs in about 1 of every 500 adults in the general population. It has been widely believed that the motion of the mitral valve, in particular, its systolic anterior motion (SAM), attributes significantly to such obstruction. For a better understanding of the mitral valve motion, a 3D patient-specific fluid-structure interaction model of the left ventricle from a patient with hypertrophic obstructive cardiomyopathy based on computed tomography (CT) scan images was proposed in this study...
February 21, 2018: Computer Methods in Biomechanics and Biomedical Engineering
Mitsunobu Kitamura, Tobias Schmidt, Karl-Heinz Kuck, Christian Frerker
PURPOSE OF REVIEW: Interventional techniques have been developed for a wide spectrum of mechanisms of heart failure (HF), especially in valvular heart disease and cardiomyopathies (ischaemic cardiomyopathy and hypertrophic cardiomyopathy). In this article, we review recent reports on catheter interventions to treat patients with HF. RECENT FINDINGS: Direct modification using the Parachute device and the REVIVENT-TC device for patients with impaired left ventricle with large infarct scars improves geometry and haemodynamic efficiency, resulting in a reduction of HF symptoms...
February 12, 2018: Current Cardiology Reports
Joseph L Blackshear
Gastrointestinal bleeding with severe aortic stenosis was originally described in the 1950s by Heyde, although for years, the association was debated. Further discovery of mechanisms and the ubiquity and severity of acquired von Willebrand syndrome in the left ventricular assist device therapy have removed any doubts. At this time, gastrointestinal bleeding from intestinal angiodysplasia in patients with turbulence-related proteolysis of the highest molecular weight multimers of von Willebrand factor is now known to occur in patients with aortic stenosis, and also subaortic obstruction and associated mitral insufficiency in hypertrophic cardiomyopathy, isolated mitral and aortic insufficiency, endocarditis, and in patients with prosthetic valve dysfunction, either from stenosis or insufficiency...
February 3, 2018: Current Treatment Options in Cardiovascular Medicine
M Okuyama, S Kato, S Sato, J Okazaki, Y Kitamura, T Ishikawa, Y Sato, S Isono
BACKGROUND: Difficult mask ventilation is common and is known to be associated with sleep-disordered breathing (SDB). It is our hypothesis that the incidence of expiratory retropalatal (RP) airway closure (primary outcome) during nasal positive pressure ventilation (PPV) is more frequent in patients with SDB (apnea hypopnea index ≥5 h-1) than non-SDB subjects. METHODS: The severity of SDB was assessed before surgery using a portable sleep monitor. In anaesthetized and paralysed patients with (n=11) and without SDB (n=9), we observed the behaviour of the RP airway endoscopically during nasal PPV with the mouth closed and determined the dynamic RP closing pressure, which was defined as the highest airway pressure above which the RP airway closure was reversed...
January 2018: British Journal of Anaesthesia
Tarun Kumar, Satyam Rajvanshi, Ajay Kumar Sharma, Neeraj Pandit
Large intracavitary masses such as those occupying most of a cardiac chamber and obstructing blood flow are not routinely encountered in clinical practice. The differential diagnosis includes neoplastic as well as nonneoplastic causes. Primary cardiac tumors by themselves are uncommon. We hereby report a rare case of a middle-aged female presenting with New York Heart Association Class III symptoms, whose transthoracic echocardiogram revealed a huge mass in right-sided chambers with a novel double ball valve type movement...
October 2017: Heart Views: the Official Journal of the Gulf Heart Association
Dimitrios Toumpanakis, Vyronia Vassilakopoulou, Ioanna Sigala, Panagiotis Zacharatos, Ioanna Vraila, Vassiliki Karavana, Stamatios Theocharis, Theodoros Vassilakopoulos
BACKGROUND: Inspiratory resistive breathing (IRB), a hallmark of obstructive airway diseases, is associated with large negative intrathoracic pressures, due to strenuous contractions of the inspiratory muscles. IRB is shown to induce lung injury in previously healthy animals. Src is a multifunctional kinase that is activated in the lung by mechanical stress. ERK1/2 kinase is a downstream target of Src. We hypothesized that Src is activated in the lung during IRB, mediates ERK1/2 activation and IRB-induced lung injury...
December 13, 2017: Respiratory Research
Miriam Silaschi, Lenard Conradi, Olaf Wendler, Friederike Schlingloff, Utz Kappert, Ardawan J Rastan, Hardy Baumbach, David Holzhey, Walter Eichinger, Ralf Bader, Hendrik Treede
OBJECTIVES: We present 1-year outcomes of the post-market registry of a next-generation transcatheter heart valve used for aortic regurgitation (AR). BACKGROUND: Transcatheter aortic valve replacement (TAVR) is routine in high-risk patients with aortic stenosis but is not recommended for AR. The JenaValve™ (JenaValve Technology GmbH, Munich, Germany) overcomes technical challenges in AR patients through a leaflet clipping mechanism. METHODS: The JenaValve EvalUation of Long Term Performance and Safety In PaTients with SEvere Aortic Stenosis oR Aortic Insufficiency (JUPITER) Registry is a European study to evaluate safety and effectiveness of this THV...
November 24, 2017: Catheterization and Cardiovascular Interventions
Arumugam Chandrakasu, Avinash Jayachandran, Pradeep Gopinath Nayar, Chokkalingam Meyyappan, Ganesh Narayan, Ahamed Basha Abdul Bari, Prince Johnson Samuel
BACKGROUND: Thrombosis of a mechanical prosthetic heart valve is a potentially life-threatening complication associated with a high mortality. Although thrombolytic therapy has been considered highly beneficial in this situation, very few studies have been conducted to monitor the effectiveness of such thrombolytic therapy among Asian populations. Hence, the study aim was to evaluate the clinical profile, efficacy and safety of the thrombolytic agent streptokinase (SK) in patients with obstructive thrombosis of a left-sided mechanical heart valve...
May 2017: Journal of Heart Valve Disease
Masami Takagaki, Hiroki Yamaguchi, Shinichi Mitsuyama, Tasuku Kadowaki, Takeshi Ando
Venovenous extracorporeal membrane oxygenation is now an established treatment for acute respiratory distress syndrome. However, this treatment remains rare in octogenarians and is associated with poor outcomes. An 81-year-old man with a history of chronic obstructive pulmonary disease and heavy smoking underwent mitral and tricuspid valve repair and the Maze procedure for mitral and tricuspid regurgitation and paroxysmal atrial fibrillation. Although he was extubated the following day, his postoperative course was complicated with pneumonia followed by acute respiratory distress syndrome...
December 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Ignacio J Amat-Santos, Carlos Cortés, Luis Nombela Franco, Antonio J Muñoz-García, Jose Suárez De Lezo, Enrique Gutiérrez-Ibañes, Vicenç Serra, Mariano Larman, Raúl Moreno, Jose M De La Torre Hernandez, Rishi Puri, Pilar Jimenez-Quevedo, José M Hernández García, Juan H Alonso-Briales, Bruno García, Dae-Hyun Lee, Paol Rojas, Teresa Sevilla, Renier Goncalves, Silvio Vera, Itziar Gómez, Josep Rodés-Cabau, José A San Román
OBJECTIVES: The aim of this study was to determine the prognosis and specific complications of patients with prosthetic mitral valves (PMVs) undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: TAVR is performed relatively often in patients with PMVs, but specific risks are not well described. METHODS: A multicenter analysis was conducted, including patients with severe symptomatic aortic stenosis who underwent TAVR at 10 centers...
October 9, 2017: JACC. Cardiovascular Interventions
Cristian Mirabile, Alessandra Mazzola, Liana Valeanu, Vanessa Lopez-Lopez, Claudio Barbanti, Camilla Biselli, Carole Hennequin, Sophie Malekzadeh-Milani, Mirela Bojan
BACKGROUND: The Modified Blalock-Taussig shunt (MBTS) is the most common palliative operation performed in patients with complex cardiac defects. Postoperative morbidity and mortality rates are high, mainly due to shunt thrombosis and over-shunting. Over-shunting may be difficult to identify postoperatively based on conventional criteria. Since plasma B-type natriuretic peptide (BNP) concentrations correlate with the magnitude of shunting in various left-to-right shunt cardiac defects, we investigated its ability to identify postoperative MBTS over-shunting...
December 15, 2017: International Journal of Cardiology
Sebastián Fernández-Bussy, Gonzalo Labarca, Iván Caviedes, Hiren J Mehta, Michael Jantz, Adnan Majid
Chronic obstructive pulmonary disease (COPD) has no curative treatment, and in moderate to advanced stages, functional parameters and quality of life are affected. Lung volume reduction improves respiratory parameters and quality of life of these patients. Endoscopic lung volume reduction is a minimally invasive procedure that uses endobronchial valves or coils. Valves are unidirectional, blocking the air from entering the target lobe during inspiration, allowing the exit of air and secretions during expiration...
May 2017: Revista Médica de Chile
Ozan M Demir, Neil Ruparelia, Angela Frame, Sayan Sen, Ghada W Mikhail, Michael Fertleman, Iqbal S Malik
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of symptomatic aortic stenosis. The number of TAVR procedures is expected to increase exponentially in the next decade. Therefore, patients will inevitably present with signs and symptoms attributable to TAVR bioprosthesis failure many years after an acutely successful procedure. Their management will become increasing important moving forward. Areas covered: The aim of this article is to review the causes of bioprosthesis failure and outline optimal management strategies in elderly patients...
September 15, 2017: Expert Review of Medical Devices
Ioannis Ntalas, Júlia Karády, Stam Kapetanakis, Ronak Rajani
Obstructive prosthetic valve thrombosis (PVT) is a rare but severe complication that usually occurs in the presence of suboptimal anticoagulation. Although fluoroscopy is commonly used to detect abnormal leaflet motion as a surrogate marker for PVT, its inability to directly visualize adjacent tissue and valve physiology leaves it susceptible to miss clinically important PVT. In this manuscript, we report the case of a 54-year-old woman with a mechanical mitral valve who was admitted to our institute with exertional dyspnea...
August 30, 2017: Echocardiography
Sushil Allen Luis, Lori A Blauwet, Himabindu Samardhi, Cathy West, Ramila A Mehta, Chris R Luis, Gregory M Scalia, Fletcher A Miller, Darryl J Burstow
This study aimed to investigate the utility of transthoracic echocardiographic (TTE) Doppler-derived parameters in detection of mitral prosthetic dysfunction and to define optimal cut-off values for identification of such dysfunction by valve type. In total, 971 TTE studies (647 mechanical prostheses; 324 bioprostheses) were compared with transesophageal echocardiography for evaluation of mitral prosthesis function. Among all prostheses, mitral valve prosthesis (MVP) ratio (ratio of time velocity integral of MVP to that of left ventricular outflow tract; odds ratio [OR] 10...
October 15, 2017: American Journal of Cardiology
Cristina Pislaru, Mahmoud M Alashry, Jeremy J Thaden, Patricia A Pellikka, Maurice Enriquez-Sarano, Sorin V Pislaru
BACKGROUND: Left ventricular (LV) filling following atrial contraction generates LV myocardial stretch that propagates from base to apex with a speed proportional to myocardial elasticity. The aim of this study was to test the hypothesis that intrinsic velocity propagation of myocardial stretch (iVP) would be altered in patients with valvular disease and chronic LV pressure overload or volume overload, which may adversely affect mechanical properties of the LV tissue. A second aim was to compare iVP with flow propagation velocity in the chamber...
November 2017: Journal of the American Society of Echocardiography
Dimitrios Toumpanakis, Konstantinos Loverdos, Vassiliki Tzouda, Vyronia Vassilakopoulou, Eleni Litsiou, Christina Magkou, Vassiliki Karavana, Michael Pieper, Theodoros Vassilakopoulos
INTRODUCTION: Resistive breathing (RB), a hallmark of obstructive airway diseases, is characterized by strenuous contractions of the inspiratory muscles that impose increased mechanical stress on the lung. RB is shown to induce pulmonary inflammation in previous healthy animals. Tiotropium bromide, an anticholinergic bronchodilator, is also shown to exert anti-inflammatory effects. The effect of tiotropium on RB-induced pulmonary inflammation is unknown. METHODS: Adult rats were anesthetized, tracheostomized and breathed spontaneously through a two-way non-rebreathing valve...
2017: International Journal of Chronic Obstructive Pulmonary Disease
Lucy M Safi, Sarah V Tsiaras
Valvular heart disease in women of childbearing age poses an increased risk of adverse maternal and fetal outcomes, and management in pregnancy can be challenging. Ideally, patients with suspected valvular disease should have preconception counseling by a multidisciplinary team including cardiologists with expertise in pregnancy and a maternal-fetal medicine specialist. Preconception planning should include a cardiac assessment of maternal risk, determination of frequency of surveillance, and a cardiovascular management plan during delivery...
September 2017: Current Treatment Options in Cardiovascular Medicine
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