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Mechanical valve dysfunction

Wadi Mawad, Mark K Friedberg
PURPOSE OF REVIEW: Assessment of diastolic function by echocardiography is challenging but important. Left ventricular filling has been more extensively studied than the right ventricle, and predominantly in adult populations. Although multiple parameters exist to assess diastolic function, they all have limitations, including load and heart rate dependency, which make assessment of diastolic function particularly challenging. The purpose of this article is to review evolving concepts and modalities for echo assessment of diastolic function in children...
January 2017: Current Opinion in Cardiology
Varun K Krishnamurthy, Andrew J Stout, Matthew C Sapp, Brittany Matuska, Mark E Lauer, K Jane Grande-Allen
Aortic valve disease (AVD) is one of the leading causes of cardiovascular mortality. Abnormal expression of hyaluronan (HA) and its synthesizing/degrading enzymes have been observed during latent AVD however, the mechanism of impaired hyaluronan homeostasis prior to and after the onset of AVD remains unexplored. Transforming growth factor beta (TGFβ) pathway defects and biomechanical dysfunction are hallmarks of AVD, however their association with altered hyaluronan regulation is understudied. Expression of HA homeostatic markers was evaluated in diseased human aortic valves and TGFβ1-cultured porcine aortic valve tissues using histology, immunohistochemistry and Western blotting...
November 14, 2016: Matrix Biology: Journal of the International Society for Matrix Biology
Elena Galli, Alain Leguerrier, Erwan Flecher, Christophe Leclercq, Erwan Donal
BACKGROUND: In aortic stenosis (AS), the left ventricle (LV) should face an increased afterload that is due to both the stenotic aortic valve and the peripheral vascular resistance (PVR). Valvulo-arterial impedance (ZVa ) is a recently introduced parameter, which permits the evaluation of global LV afterload in AS. Aim of this study was to assess the influence of increasing ZVa on the longitudinal, circumferential, and radial components of LV mechanics. METHODS: A total of 126 patients (mean age: 80...
November 2, 2016: Echocardiography
W David Merryman, Cynthia R Clark
Calcific aortic valve disease (CAVD) is an age-related disorder that causes significant cardiovascular morbidity and mortality, and is directly responsible for ~15,000 patient deaths per year in the USA. Currently, the molecular mechanism by which CAVD initiates is unknown, making discovery of a non-surgical strategy challenging (reviewed in (1)). Garg et al. made a seminal discovery in 2005 when they showed NOTCH1 mutations led to heritable CAVD.(2) Since then, the heart valve research community has sought a causal mechanism that could connect NOTCH1 dysfunction to idiopathic CAVD...
October 27, 2016: Circulation
Per Martin Arvidsson, Johannes Töger, Marcus Carlsson, Katarina Steding-Ehrenborg, Gianni Pedrizzetti, Einar Heiberg, Hakan Arheden
Intracardiac blood flow is driven by hemodynamic forces that are exchanged between the blood and myocardium. Previous studies have been limited to 2D measurements or investigated only LV forces. Right ventricular forces and their mechanistic contribution to asymmetric redirection of flow in the RV have not been measured. We therefore aimed to quantify three-dimensional hemodynamic forces in both ventricles in a cohort of healthy subjects, using magnetic resonance imaging 4D flow measurements. 25 controls,14 elite endurance athletes, and two patients with left ventricular dyssynchrony were included...
October 21, 2016: American Journal of Physiology. Heart and Circulatory Physiology
Lindsey J Anstine, Chris Bobba, Samir Ghadiali, Joy Lincoln
Risk factors of heart valve disease are well defined and prolonged exposure throughout life leads to degeneration and dysfunction in up to 33% of the population. While aortic valve replacement remains the most common need for cardiovascular surgery particularly in those aged over 65, the underlying mechanisms of progressive deterioration are unknown. In other cardiovascular systems, a decline in endothelial cell integrity and function play a major role in promoting pathological changes, and while similar mechanisms have been speculated in the valves, studies to support this are lacking...
October 15, 2016: Journal of Molecular and Cellular Cardiology
Laura Mourino-Alvarez, Montserrat Baldan-Martin, Laura Gonzalez-Calero, Carlos Martinez-Laborde, Tamara Sastre-Oliva, Rafael Moreno-Luna, Luis F Lopez-Almodovar, Pedro L Sanchez, Francisco Fernandez-Aviles, Fernando Vivanco, Luis R Padial, Finn Akerstrom, Gloria Alvarez-Llamas, Fernando de la Cuesta, María G Barderas
BACKGROUND: The most common valve diseases are calcific aortic stenosis (AS) and aortic regurgitation (AR). The former is characterized by thickening of valve leaflets followed by progressive calcification, which produces progressive aortic valve (AV) narrowing, increased pressure afterload on the left ventricle (LV) and subsequent LV hypertrophy. On the other hand, AR is due to malcoaptation of the valve leaflets with resultant diastolic reflux of blood from aorta back to the LV producing volume and pressure overload and progressive LV dilatation...
September 26, 2016: International Journal of Cardiology
Armin Zittermann, Andreas Koster, David Faraoni, Jochen Börgermann, Uwe Schirmer, Jan F Gummert
OBJECTIVES: The relationship between the transfusion of red blood cell (RBC) units and outcomes in patients undergoing cardiac surgery is the subject of intense debates. In this study, we investigated the relationship between the transfusion of 1-2 leucocyte-depleted (LD) RBC units and outcomes in patients undergoing open-heart valve surgery. METHODS: The investigation encompassed consecutive patients undergoing open-heart valve surgery at our institution between July 2009 and March 2015 who received no (RBC- group) or 1-2 units of LD RBC (RBC+ group)...
September 27, 2016: Interactive Cardiovascular and Thoracic Surgery
Jose María González-Santos, María Elena Arnáiz-García, María José Dalmau-Sorlí, Jose Alfonso Sastre-Rincón, Jesús Hernández-Hernández, María Elena Pérez-Losada, Víctor Sagredo-Meneses, Javier López-Rodríguez
A patient who underwent previous implantation of a mitral valve replacement with a Björk-Shiley Delrin (BSD) mitral valve prosthesis during infancy was admitted to our institution 43 years later after an episode of syncope and cardiac arrest. Under extreme hemodynamic instability, a mitral valve prosthetic dysfunction causing massive mitral regurgitation was identified. The patient underwent an emergent cardiac operation, and a complete disc fracture with partial disc migration was found. Exceptional cases of mechanical prosthetic heart valve fracture exist...
October 2016: Annals of Thoracic Surgery
Ana Redondo Palacios, José López Menéndez, Javier Miguelena Hycka, Miren Martín García, Laura Varela Barca, Andrea Ferreiro Marzal, Rafael Muñoz Pérez, Enrique Oliva De Anquín, Ignacio García Andrade, Tomasa Centella Hernández, Daniel Celemín Canorea, Jorge Rodríguez-Roda Stuart
BACKGROUND: Nowadays, Tricuspid valve replacement (TVR) is much less common than aortic or mitral valve replacement, since repair is almost always preferable. Prosthetic tricuspid valves are associated with high mortality and morbidity, mostly due to thrombotic or hemorrhagic events. Nevertheless, there is lack of evidence of which is the optimal type of valve (biological versus mechanical) in tricuspid position. METHODS: We analysed all the patients who underwent TVR in our Institution, from 2005 to 2015...
September 16, 2016: Journal of Cardiovascular Surgery
Michael T Tanoue, Sverre E Kjeldsen, Richard B Devereux, Peter M Okin
BACKGROUND: Abnormal P-wave terminal force in lead V1 (PTF-V1) is an ECG marker of increased left atrial (LA) volume, elevated LA filling pressures and/or LA systolic dysfunction. Because left ventricular (LV) diastolic dysfunction is one of the potential mechanisms driving LA remodelling, we hypothesized that PTF-V1 might be an additional ECG marker of diastolic dysfunction. METHODS: LV diastolic function after 3 years' systematic antihypertensive treatment was examined in relation to baseline PTF-V1 in 431 hypertensive patients undergoing protocol-driven blood pressure reduction who had baseline and year-3 ECG and echocardiographic data and a preserved LV ejection fraction (EF >45%) at year-3...
August 9, 2016: Blood Pressure
Tomoko Machino-Ohtsuka, Yoshihiro Seo, Tomoko Ishizu, Kimi Sato, Akinori Sugano, Masayoshi Yamamoto, Yoshie Hamada-Harimura, Kazutaka Aonuma
BACKGROUND: Left atrial remodeling caused by persistent atrial fibrillation (AF) causes atrial functional mitral regurgitation (MR), even though left ventricular (LV) remodeling and organic changes of the mitral leaflets are lacking. The detailed mechanism of atrial functional MR has not been fully investigated. METHODS AND RESULTS: Of 1,167 patients with AF who underwent 3D transesophageal echocardiography, 75 patients were retrospectively selected who developed no, mild, or moderate-to-severe atrial functional MR (n=25 in each group) despite an LV ejection fraction ≥50% and LV volumes within the normal range...
September 23, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Christian Jung, Michael Lichtenauer, Hans-Reiner Figulla, Bernhard Wernly, Bjoern Goebel, Martin Foerster, Christoph Edlinger, Alexander Lauten
Degenerative aortic stenosis (AS) is the most frequent form of acquired valvular heart disease. AS is known to entail endothelial dysfunction caused by increased mechanical shear stress leading to elevated circulatory levels of microparticles. Endothelial and platelet microparticles (EMP and PMP) are small vesicles that originate from activated cells and thrombocytes. We sought to evaluate whether transcatheter aortic valve implantation (TAVI) procedure would elicit effects on circulating EMP and PMP. 92 patients undergoing TAVI procedure for severe AS were included in this study...
August 3, 2016: Heart and Vessels
Huang Ying, Chen Jianping, Yuan Jianqing, Zhong Shanquan
INTRODUCTION: Vascular dementia (VaD) is a heterogeneous disease that can vary in clinical presentation and cognitive profile. The cognitive profiles of different VaD subtypes depend on the anatomical distribution of the vascular insults that have been documented. MATERIAL AND METHODS: We reviewed demographic, cognitive, and imaging data in 402 patients who were clinically diagnosed with VaD between January 2002 and June 2012 at the First Affiliated Hospital of Gan Nan Medical College in Ganzhou, China...
August 1, 2016: Archives of Medical Science: AMS
I Konomi, A Tasoulis, I Kaltsi, E Karatzanos, I Vasileiadis, P Temperikidis, S Nanas, C I Routsi
The objective of this study was to investigate the contribution of left ventricular (LV) diastolic dysfunction to weaning failure, along with the levels of the currently used cardiac biomarkers. Forty-two mechanically ventilated patients, who fulfilled criteria for weaning from mechanical ventilation (MV), underwent a two-hour spontaneous breathing trial (SBT). Transthoracic echocardiography (TTE) was performed before the start of the SBT. The grade of LV diastolic dysfunction was assessed by pulsed-wave Doppler and tissue Doppler imaging at the level of the mitral valve...
July 2016: Anaesthesia and Intensive Care
Constanze Bening, Rainer Leyh
Left ventricular (LV) dysfunction in conjunction with postcapillary pulmonary hypertension (PH) is frequently associated with right ventricular (RV) dysfunction, determining the patient prognosis. Compensatory mechanisms for RV dysfunction have not been previously evaluated in detail. Since calcium dependent right atrial (RA) dynamics are a surrogate for RA contractile properties, the present study examined the calcium dependency of RA tissue obtained from patients with or without postcapillary PH. In total, 15 patients with PH (PH group; mean age, 70...
August 2016: Experimental and Therapeutic Medicine
Justin T Tretter, Mark K Friedberg, Rachel M Wald, Doff B McElhinney
Transcatheter pulmonary valve replacement (TPVR) is an important treatment option in repaired tetralogy of Fallot (TOF) and right ventricular outflow tract (RVOT) dysfunction. Indications for timing of TPVR are extrapolated from surgical pulmonary valve replacement guidelines, which are themselves controversial as published evidence is scarce and expert opinion therefore prevails. We review current indications for PVR following TOF repair, focusing on those for TPVR specifically, and discuss anatomical and functional considerations as these pertain to determination of candidacy for TPVR...
October 15, 2016: International Journal of Cardiology
Haki Jashari, Katarina Lannering, Pranvera Ibrahimi, Demir Djekic, Mats Mellander, Annika Rydberg, Michael Y Henein
INTRODUCTION: Surgical repair of coarctation of the aorta (CoA) is a safe procedure in children, however the condition is known for its potential recurrence and other related complications. The available evidence shows abnormal intrinsic properties of the aorta in CoA, thus suggesting additional effect, even after CoA repair, on left ventricular (LV) function. Accordingly, we sought to obtain a better understanding of LV myocardial mechanics in very early-corrected CoA using two-dimensional STE...
October 15, 2016: International Journal of Cardiology
Ali Naderi Mahabadi, Bassam Alhaddad, Stanley Ballou
Cardiac involvement is fairly common in patients with systemic lupus erythematosus (SLE). It may involve all layers of the heart and coronary arteries as well as the heart valves. We report an extremely rare presentation of valvulitis and valvular dysfunction associated with systemic lupus erythematosus. This is the first case of lupus valvulitis which required three mechanical prosthetic valve replacements with disease recurrence leading to a fatal outcome. This is, in our point of view, the consequence of aggressive natural history of the disease and perhaps late diagnosis and treatment of underlying SLE which was unsuccessful...
2016: Case Reports in Rheumatology
Ivancarmine Gambardella, Mario Gaudino, Claudio Ronco, Christopher Lau, Natalia Ivascu, Leonard N Girardi
Acute kidney injury (AKI) in cardiac surgery has traditionally been linked to reduced arterial perfusion. There is ongoing evidence that central venous pressure (CVP) has a pivotal role in precipitating acute renal dysfunction in cardiac medical and surgical settings. We can regard this AKI driven by systemic venous hypertension as 'kidney congestive failure'. In the cardiac surgery population as a whole, when the CVP value reaches the threshold of 14 mmHg in postoperative period, the risk of AKI increases 2-fold with an odds ratio (OR) of 1...
November 2016: Interactive Cardiovascular and Thoracic Surgery
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