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Aortic regurgitation therapy

Carsten Schwencke, Klaudija Bijuklic, Taoufik Ouarrak, Edith Lubos, Wolfgang Schillinger, Björn Plicht, Holger Eggebrecht, Stephan Baldus, Gerhard Schymik, Peter Boekstegers, Rainer Hoffmann, Jochen Senges, Joachim Schofer
AIMS: The use of the MitraClip system has gained widespread acceptance for the treatment of patients with mitral regurgitation (MR) who are not suitable for the conventional surgery. This study sought to investigate the early and 1-year outcome after MitraClip therapy of patients with MR and cardiac comorbidities. METHODS AND RESULTS: Outcomes through 12-month follow-up of patients (n = 528) who underwent MitraClip implantation were obtained from the German transcatheter mitral valve interventions (TRAMI) registry...
October 17, 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
A W den Hartog, R Franken, M P van den Berg, A H Zwinderman, J Timmermans, A J Scholte, V de Waard, A M Spijkerboer, G Pals, B J M Mulder, M Groenink
BACKGROUND: Mild biventricular dysfunction is often present in patients with Marfan syndrome. Losartan has been shown to reduce aortic dilatation in patients with Marfan syndrome. This study assesses the effect of losartan on ventricular volume and function in genetically classified subgroups of asymptomatic Marfan patients without significant valvular regurgitation. METHODS: In this predefined substudy of the COMPARE study, Marfan patients were classified based on the effect of their FBN1 mutation on fibrillin-1 protein, categorised as haploinsufficient or dominant negative...
November 2016: Netherlands Heart Journal
Merrill H Stewart, J Stephen Jenkins
BACKGROUND: Mitral regurgitation (MR) is the second leading cause of valvular heart disease in the United States behind aortic stenosis. The percutaneous repair of the mitral valve (MitraClip, Abbott, Inc.) has been approved in the United States since 2013 as an alternative to traditional mitral valve surgery. However, many questions are left unanswered about when to perform this procedure and whom to perform it on. METHODS: We reviewed major published literature on the MitraClip from 2003-2016 to help guide clinical decision-making...
2016: Ochsner Journal
A Schmermund, J Eckert, S N Schelle, H Eggebrecht
For the treatment of structural heart disease, current options in the catheterization laboratory include MitraClip® implantation for treating severe mitral regurgitation, transcatheter aortic valve implantation (TAVI), closure of a patent foramen ovale (PFO) and occlusion of the left atrial appendage (LAA). These treatment options are based on a precise diagnosis provided by modern cardiac imaging, which is indispensable for treatment recommendations. Its importance for supporting the invasive procedures in the catheterization laboratory is less well known...
September 19, 2016: Herz
Hardy Baumbach, Samir Ahad, Stephan Hill, Tim Schäufele, Sara Adili, Kristina Wachter, Ulrich F W Franke
An increasing number of patients with severe aortic stenosis and concomitant critical coronary artery disease were referred to our hospital. Some of those patients were classified as high-risk patients qualifying for a transcatheter therapy with the additional need for coronary revascularization. As a consequence of their comorbidities, the established transapical as well as transfemoral approach were either not possible or not favored owing to the indispensable need for coronary revascularization. We present 4 successfully combined off-pump procedures consisting of a transcatheter aortic valve implantation (Edwards SAPIEN XT) via the transaortic approach and an off-pump coronary artery bypass grafting...
September 15, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Samir Kapadia, Shikhar Agarwal, D Craig Miller, John G Webb, Michael Mack, Stephen Ellis, Howard C Herrmann, Augusto D Pichard, E Murat Tuzcu, Lars G Svensson, Craig R Smith, Jeevanantham Rajeswaran, John Ehrlinger, Susheel Kodali, Raj Makkar, Vinod H Thourani, Eugene H Blackstone, Martin B Leon
BACKGROUND: Prior studies of stroke and transient ischemic attack (TIA) after transcatheter aortic valve replacement (TAVR) are limited by reporting and follow-up variability. This is a comprehensive analysis of time-related incidence, risk factors, and outcomes of these events. METHODS AND RESULTS: From April 2007 to February 2012, 2621 patients, aged 84±7.2 years, underwent transfemoral (TF; 1521) or transapical (TA; 1100) TAVR in the PARTNER trial (Placement of Aortic Transcatheter Valves; as-treated), including the continued access registry...
September 2016: Circulation. Cardiovascular Interventions
Claire Bouleti, Marion Chauvet, Guillaume Franchineau, Dominique Himbert, Bernard Iung, Benjamin Alos, Eric Brochet, Marina Urena, Walid Ghodbane, Phalla Ou, Sophie Provenchere, Patrick Nataf, Alec Vahanian
OBJECTIVES: Transcatheter aortic valve implantation (TAVI) has reoriented the treatment of aortic stenosis (AS) for high-risk patients. Little is known about late outcome after TAVI, surgical aortic valve replacement (AVR) or medical treatment in a single centre. We report patients' characteristics, early and 6-year survival rates after the three therapeutic strategies, and the evolution over time. We also analysed predictive factors of mortality after TAVI or surgical AVR. METHODS: Between October 2006 and December 2010, 478 high-risk consecutive patients were referred for severe symptomatic AS...
August 30, 2016: European Journal of Cardio-thoracic Surgery
Anton Tomsic, Wilson W L Li, Marieke van Paridon, Navin R Bindraban, Bas A J M de Mol
Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature...
August 2016: Texas Heart Institute Journal
Hideharu Hagiya, Takeshi Tanaka, Kohei Takimoto, Hisao Yoshida, Norihisa Yamamoto, Yukihiro Akeda, Kazunori Tomono
BACKGROUND: With the development of invasive medical procedures, an increasing number of healthcare-associated infective endocarditis cases have been reported. In particular, non-nosocomial healthcare-associated infective endocarditis in outpatients with recent medical intervention has been increasingly identified. CASE PRESENTATION: A 66-year-old man with diabetes mellitus and a recent history of intermittent urethral self-catheterization was admitted due to a high fever...
2016: BMC Infectious Diseases
Mattia Glauber, Simon C Moten, Eugenio Quaini, Marco Solinas, Thierry A Folliguet, Bart Meuris, Antonio Miceli, Peter J Oberwalder, Manfredo Rambaldini, Kevin H T Teoh, Gopal Bhatnagar, Michael A Borger, Denis Bouchard, Olivier Bouchot, Stephen C Clark, Otto E Dapunt, Matteo Ferrarini, Theodor J M Fischlein, Guenther Laufer, Carmelo Mignosa, Russell Millner, Philippe Noirhomme, Steffen Pfeiffer, Xavier Ruyra-Baliarda, Malakh Lal Shrestha, Rakesh M Suri, Giovanni Troise, Borut Gersak
OBJECTIVE: To define the benefit of sutureless and rapid deployment valves in current minimally invasive approaches in isolated aortic valve replacement. METHODS: A panel of 28 international experts with expertise in both minimally invasive aortic valve replacement and rapid deployment valves was constituted. After thorough literature review, the experts rated evidence-based recommendations in a modified Delphi approach. RESULTS: No guideline could be retrieved...
May 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Muhammad A Soofi, Andrew P Ignaszewski, Anson W Cheung, Jamil G Bashir
Congenitally corrected transposition of the great arteries (ccTGA) is a rare condition with prevalence of <0.5%. Dextrocardia is reported among 20% of them. Among patients with ccTGA, heart failure is a common presentation, especially in the fourth or fifth decade of life and survival is dismal without heart transplantation. A left ventricular assist device (LVAD) is considered for bridge to transplantation if early heart transplantation is not available or as destination therapy for patients ineligible for heart transplant...
August 11, 2016: Interactive Cardiovascular and Thoracic Surgery
M K Konstantinidou, M Nelson, U Rosendahl, G Asimakopoulos
Giant cell arteritis is a common form of vasculitis, although involvement of the aorta is unusual. There is no established association between giant cell aortitis and human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection. We present the case of a 46-year-old female coinfected with HIV and HCV who had never received antiretroviral therapy and developed symptoms of deteriorating shortness of breath on exertion. Investigations demonstrated aortic root and ascending aorta dilatation, along with severe aortic valve regurgitation, for which the patient underwent valve-sparing aortic root replacement (a David procedure)...
August 9, 2016: Annals of the Royal College of Surgeons of England
Michael D Ezekowitz, Rangadham Nagarakanti, Herbert Noack, Martina Brueckmann, Claire Litherland, Mark Jacobs, Andreas Clemens, Paul A Reilly, Stuart J Connolly, Salim Yusuf, Lars Wallentin
BACKGROUND: The RE-LY trial (Randomized Evaluation of Long-Term Anticoagulant Therapy) compared dabigatran 150 and 110 mg twice daily with warfarin in 18 113 patients with atrial fibrillation. Those with prosthetic heart valves, significant mitral stenosis, and valvular heart disease (VHD) requiring intervention were excluded. Others with VHD were included. METHODS: This is a post hoc analysis of the RE-LY trial. RESULTS: There were 3950 patients with any VHD: 3101 had mitral regurgitation, 1179 with tricuspid regurgitation, 817 had aortic regurgitation, 471 with aortic stenosis, and 193 with mild mitral stenosis...
August 23, 2016: Circulation
S Yücel, H Ince, S Kische, M A Sherif, H Bushnaq, A Bärisch, A Öner
The demographic changes in society lead to an increasing number of patients with aortic valve stenosis and mitral regurgitation. Simultaneously the higher age of patients is associated with an increase in multimorbidity with a high surgical risk so that they cannot be referred to surgery. Besides the current gold standard of surgery, minimally invasive therapeutic options are increasingly becoming established for these patients. For the differentiated indications and therapeutic success, a multidisciplinary heart team assumes an important role...
August 2016: Herz
Javier Castrodeza, Ignacio J Amat-Santos, Myriam Blanco, Carlos Cortes, Javier Tobar, Irene Martin-Morquecho, Javier López, Salvatore Di Stefano, Paol Rojas, Luis H Varela-Falcon, Itziar Gomez, Jose A San Roman
BACKGROUND: Recently, the use of transcatheter aortic valve implantation (TAVI) in intermediate-low risk patients has been evaluated in the PARTNER II randomized trial. However, in the last years, this therapy has been employed in this scenario with underreported results, as compared to surgical aortic valve replacement (SAVR). METHODS: We enrolled 362 consecutive patients with severe symptomatic aortic stenosis and intermediate-low surgical risk (logEuroSCORE < 20%), treated in our center with TAVI (103 patients) or single SAVR (259 patients) between 2009 and 2014...
July 21, 2016: Cardiology Journal
Howard C Herrmann, Vinod H Thourani, Susheel K Kodali, Raj R Makkar, Wilson Y Szeto, Saif Anwaruddin, Nimesh Desai, Scott Lim, S Chris Malaisrie, Dean J Kereiakes, Steven Ramee, Kevin L Greason, Samir Kapadia, Vasilis Babaliaros, Rebecca T Hahn, Philippe Pibarot, Neil J Weissman, Jonathon Leipsic, Brian K Whisenant, John G Webb, Michael J Mack, Martin B Leon
BACKGROUND: In the initial PARTNER trial (Placement of Aortic Transcatheter Valves) of transcatheter aortic valve replacement for high-risk (HR) and inoperable patients, mortality at 1 year was 24% in HR and 31% in inoperable patients. A recent report of the 30-day outcomes with the low-profile SAPIEN 3 transcatheter aortic valve replacement system demonstrated very low rates of adverse events, but little is known about the longer-term outcomes with this device. METHODS: Between October 2013 and September 2014, 583 HR (65%) or inoperable (35%) patients were treated via the transfemoral (84%) or transapical/transaortic (16%) access route at 29 US sites...
July 12, 2016: Circulation
Pierre-Vladimir Ennezat, Patrick Bruneval, Daniel Czitrom, Jean-Pierre Gueffet, Nicolas Piriou, Jean Noël Trochu, Odile Patra, Bénédicte Blanchard-Lemoine, Xavier Halna du Fretay, Pierre Nazeyrollas, Bernard Assoun, Yannick Jobic, Eric Brochet, Emmanuel Bogino, Raymond Roudaut, Caroline Augier, Lorraine Greffe, Hélène Petit-Eisenmann, Camille Dambrin, Olivier Chavanon, Louis Guillou, Dominique Grisoli, Pierre Morera, Carlo Banfi, Jean Paul Remadi, Olivier Fabre, André Vincentelli, Sylvie Lantuejoul, Jean-Fortuné Ikoli, Marie-Christine Copin, Marie-Christine Malergue, Sylvestre Maréchaux, Christophe Tribouilloy
BACKGROUND: We have been intrigued by the observation that aortic stenosis (AS) may be associated with characteristic features of mitral drug-induced valvular heart disease (DI-VHD) in patients exposed to valvulopathic drugs, thus suggesting that beyond restrictive heart valve regurgitation, valvulopathic drugs may be involved in the pathogenesis of AS. METHODS: Herein are reported echocardiographic features, and pathological findings encountered in a series of patients suffering from both AS (mean gradient >15mmHg) and mitral DI-VHD after valvulopathic drugs exposure...
October 1, 2016: International Journal of Cardiology
Yoshiki Hiyama, Satoshi Takahashi, Teruhisa Uehara, Koji Ichihara, Jiro Hashimoto, Naoya Masumori
We report a patient with infective endocarditis and pyrogenic spondylitis occurring simultaneously. The patient was a 59-year-old man. He was suspected of having prostate cancer due to a high prostate-specific antigen concentration noted in a checkup. He then underwent a transrectal ultrasound guided prostate biopsy with cefotiam as antimicrobial prophylaxis. He had a fever higher than 38 °C and lumbar pain for a few days after the biopsy. Enterococcus faecalis was isolated from 2 sets of blood culture. Magnetic resonance imaging revealed an abnormal image at C7/Th1 with a signal decrease in T1-weighted sequences and signal increase in T2-weighted sequences that were suspected to be due to bone destruction...
June 28, 2016: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Khadija Aman
BACKGROUND: Mechanical prosthetic heart valves have been used for many decades to replace damaged native valves. Guidelines mandate the use of anticoagulant therapy in patients with mechanical prosthetic valves of any type, irrespective of the position in the heart. The rationale for this is to prevent valve thrombosis and thromboembolic complications without increasing the risk of excess bleeding. We report a case involving a patient with a functioning aortic mechanical valve without any anticoagulation therapy for 33 years...
2016: Journal of Medical Case Reports
Olivier Wigger, Stephan Windecker, Stefan Bloechlinger
Nonbacterial thrombotic endocarditis is a rare cause of valvular heart disease, most commonly associated with advanced malignancy. The morbidity of this kind of endocarditis lies in its tendency to embolize, while the valve function is usually preserved. The central nervous system is the most common site of embolization, leading to ischemic stroke. We report a case of nonbacterial thrombotic endocarditis complicated by intracerebral hemorrhage as the first manifestation of adenocarcinoma of the lung. The endocarditis led to severe aortic regurgitation...
June 20, 2016: Wiener Klinische Wochenschrift
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