BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous gra...BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous grafts,the safety of transfemoral access via direct graft puncture,especially when performed twice within a short period,remains unclear compared to alternative access methods.We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty(BAV)and TAVR.CASE SUMMARY An 82-year-old man presented with dyspnea on exertion.Echocardiogram was significant for severe aortic stenosis.Following a heart team discussion,the patient was scheduled for a balloon valvuloplasty followed by staged TAVR.Based on pre-TAVR computed tomography angiogram,the aortobifemoral graft was deemed as an appropriate access site.Micropuncture needle was used to access the right femoral artery graft,and the sheath was upscaled to 10 Fr.He underwent successful intervention to ostial left anterior descending and left circumflex arteries,and BAV with 22 mm Vida BAV balloon.Hemostasis was achieved using Perclose.For TAVR,an 8 Fr sheath was inserted via the right femoral bypass graft.The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal.A 5Fr sheath was used for left femoral bypass graft access.Patient underwent successful TAVR with 29 mm CoreValve.Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.展开更多
Interrupted Aortic Arch(IAA)combined with aortic stenosis(AS)is a rare and complex congenital cardiac anomaly that presents significant challenges in clinical management.In this letter,we aim to share our experience i...Interrupted Aortic Arch(IAA)combined with aortic stenosis(AS)is a rare and complex congenital cardiac anomaly that presents significant challenges in clinical management.In this letter,we aim to share our experience in performing hybrid procedures on an infant diagnosed with IAA combined with bicuspid AS.This child exhibited significant recovery during follow-up.展开更多
Bicuspid aortic valve (BAV) is a common congenital heart valve disease, often accompanied by aortic valve stenosis or regurgitation, infective endocarditis, and aortic diseases such as aortic dilation and dissection. ...Bicuspid aortic valve (BAV) is a common congenital heart valve disease, often accompanied by aortic valve stenosis or regurgitation, infective endocarditis, and aortic diseases such as aortic dilation and dissection. This article aims to review the definition, pathogenesis and genetic basis, classification methods, clinical features and current status of research and treatment and prognosis of BAV, and provide reference for the diagnosis and treatment of BAV. The content and structure of this article are as follows: The first part introduces the definition of BAV;The second part introduces the etiology and classification methods of BAV;The third part briefly describes the clinical manifestations and diagnosis of BAV;The fourth part discusses the treatment strategies and prognosis prediction of BAV;Finally, the article summarizes and looks forward to the future research directions.展开更多
Background:Calcific aortic valve stenosis(CAVS)is one of the most challenging heart diseases in clinical with rapidly increasing prevalence.However,study of the mecha-nism and treatment of CAVS is hampered by the lack...Background:Calcific aortic valve stenosis(CAVS)is one of the most challenging heart diseases in clinical with rapidly increasing prevalence.However,study of the mecha-nism and treatment of CAVS is hampered by the lack of suitable,robust and efficient models that develop hemodynamically significant stenosis and typical calcium deposi-tion.Here,we aim to establish a mouse model to mimic the development and features of CAVS.Methods:The model was established via aortic valve wire injury(AVWI)combined with vitamin D subcutaneous injected in wild type C57/BL6 mice.Serial transthoracic echocardiography was applied to evaluate aortic jet peak velocity and mean gradi-ent.Histopathological specimens were collected and examined in respect of valve thickening,calcium deposition,collagen accumulation,osteogenic differentiation and inflammation.Results:Serial transthoracic echocardiography revealed that aortic jet peak velocity and mean gradient increased from 7 days post model establishment in a time depend-ent manner and tended to be stable at 28 days.Compared with the sham group,sim-ple AVWI or the vitamin D group,the hybrid model group showed typical pathological features of CAVS,including hemodynamic alterations,increased aortic valve thicken-ing,calcium deposition,collagen accumulation at 28 days.In addition,osteogenic dif-ferentiation,fibrosis and inflammation,which play critical roles in the development of CAVS,were observed in the hybrid model.Conclusions:We established a novel mouse model of CAVS that could be induced efficiently,robustly and economically,and without genetic intervention.It provides a fast track to explore the underlying mechanisms of CAVS and to identify more effec-tive pharmacological targets.展开更多
BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach conce...BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain,which our meta-analysis aims to address.AIM To explore safety and efficacy outcomes for patients undergoing TAVR,comparing periprocedural continuation vs interruption of OAC therapy.METHODS A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC.Data were pooled using a random-effects model with risk ratio(RR)and their 95%confidence interval(CI)as effect measures.All statistical analyses were conducted using Review Manager with statistical significance set at P<0.05.RESULTS Four studies were included,encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8%males.A total of 733 patients underwent OAC interruption and 1080 continued.Stroke incidence was significantly lower in the OAC continuation group(RR=0.62,95%CI:0.40-0.94;P=0.03).No significant differences in major vascular complications were found between the two groups(RR=0.95,95%CI:0.77-1.16;P=0.60)and major bleeding(RR=0.90,95%CI:0.72-1.12;P=0.33).All-cause mortality was non-significant between the two groups(RR=0.83,95%CI:0.57-1.20;P=0.32).CONCLUSION Continuation of OAC significantly reduced stroke risk,whereas it showed trends toward lower bleeding and mortality that were not statistically significant.Further large-scale studies are crucial to determine clinical significance.展开更多
Objective To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older.Methods We conducted a cohort study using the UK Biobank data to assess the relationship be...Objective To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older.Methods We conducted a cohort study using the UK Biobank data to assess the relationship between handgrip strength and incident aortic stenosis in individuals aged 60 years and older.Handgrip strength was measured using a Jamar J00105 hydraulic hand dynamometer.Adjusted Cox proportional hazards regression models were conducted to assess the association between handgrip strength and incident aortic stenosis.Results We included 157,097 UK Biobank participants(78,151 women and 78,946 men)in our study,with mean age of 64±2.9 years.During a median follow-up of 8.1(7.4–8.8)years,1543(1.0%)participants developed incident aortic stenosis.Compared with those with the lowest handgrip strength(tertile 1),the adjusted hazard ratios(95%confidence interval)of incident aortic stenosis in the middle(tertile 2)and the highest(tertile 3)were 0.86(0.77–0.97)and 0.76(0.67–0.87),respectively.Conclusions Higher handgrip strength was associated with lower risk of developing aortic stenosis in older adults.Future studies warrant preventive strategies for older adults with lower handgrip strength.展开更多
This study explores the implementation of computed tomography(CT)reconstruction and simulation techniques for patient-specific valves,aiming to dissect the mechanical attributes of calcified valves within transcathete...This study explores the implementation of computed tomography(CT)reconstruction and simulation techniques for patient-specific valves,aiming to dissect the mechanical attributes of calcified valves within transcatheter heart valve replacement(TAVR)procedures.In order to facilitate this exploration,it derives pertinent formulas for 3D multi-material isogeometric hyperelastic analysis based on Hounsfield unit(HU)values,thereby unlocking foundational capabilities for isogeometric analysis in calcified aortic valves.A series of uniaxial and biaxial tensile tests is executed to obtain an accurate constitutive model for calcified active valves.To mitigate discretization errors,methodologies for reconstructing volumetric parametric models,integrating both geometric and material attributes,are introduced.Applying these analytical formulas,constitutive models,and precise analytical models to isogeometric analyses of calcified valves,the research ascertains their close alignment with experimental results through the close fit in displacement-stress curves,compellingly validating the accuracy and reliability of the method.This study presents a step-by-step approach to analyzing themechanical characteristics of patient-specific valves obtained fromCT images,holding significant clinical implications and assisting in the selection of treatment strategies and surgical intervention approaches in TAVR procedures.展开更多
BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts p...BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.展开更多
HACEK organisms represent a rare but important group of causative pathogens in endocarditis. These bacteria have historically been associated with culture-negative endocarditis;however, modern laboratory techniques ha...HACEK organisms represent a rare but important group of causative pathogens in endocarditis. These bacteria have historically been associated with culture-negative endocarditis;however, modern laboratory techniques have made this less common. In this case, we present a 74-year-old man who presented with acute onset altered mentation, fever, and sepsis. He was ultimately found to have Haemophilus influenzae meningitis, cerebral empyema, aortic valve endocarditis, psoas myositis, and L2 - L3 diskitis with osteomyelitis. Although HACEK organisms are commonly found in the oropharynx and upper respiratory tract in humans, our patient did not report recent preceding dental or ENT procedures. H. influenzae is responsible for approximately 0.16% of all cases of bacterial endocarditis, representing a very limited subset. Although generally considered low virulent pathogens, this case demonstrates the unusual extent of infection from a HACEK organism, H. influenzae, causing aortic valve endocarditis as well as atypical non-cardiac sequelae, including acute meningitis.展开更多
BACKGROUND: Current data is lacking about the progression of ascending aortic dilatation after transcatheter aortic valve replacement(TAVR) in aortic stenosis(AS) patients with bicuspid aortic valve(BAV) and tricuspid...BACKGROUND: Current data is lacking about the progression of ascending aortic dilatation after transcatheter aortic valve replacement(TAVR) in aortic stenosis(AS) patients with bicuspid aortic valve(BAV) and tricuspid aortic valve(TAV). This study aims to assess the ascending aortic dilatation rate(mm/year) after TAVR in patients with BAV versus TAV using a multidetector computed tomography(MDCT) fol ow-up and to determine the predictors of ascending aortic dilatation rate.METHODS: Severe AS patients undergoing TAVR from March 2013 to March 2018 at our center with MDCT follow-ups were included. BAV and TAV were identified using baseline MDCT. Baseline and follow-up MDCT images were analyzed,and the diameters of ascending aorta were measured. Study end point is ascending aortic dilatation rate(mm/year). Furthermore,factors predicting ascending aortic dilatation rate were also investigated.RESULTS: Two hundred and eight patients were included,comprised of 86 BAV and 122 TAV patients. Five,4,3,2,and 1-year MDCT follow-ups were achieved in 7,9,30,46,and 116 patients. The ascending aortic diameter was significantly increased after TAVR in both BAV group(43.7±4.4 mm vs. 44.0±4.5 mm;P<0.001) and TAV group(39.1±4.8 mm vs. 39.7±5.1 mm;P<0.001). However,no difference of ascending aortic dilatation rate was found between BAV and TAV group(0.2±0.8 mm/year vs. 0.3±0.8 mm/year,P=0.592). Multivariate linear regression revealed paravalvular leakage(PVL) grade was independently associated with ascending aortic dilatation rate in the whole population and BAV group,but not TAV group. No aortic events occurred during follow-ups.CONCLUSION: Ascending aortic size continues to grow after TAVR in BAV patients,but the dilatation rate is mild and comparable to that of TAV patients. PVL grade is associated with ascending aortic dilatation rate in BAV patients post-TAVR.展开更多
Background There was a causal relationship between elevated lipoprotein(a)[Lp(a)]levels and increased risk of calcific aortic valve stenosis(CAVS)in whites and blacks.The present study aimed to investigate whether Lp(...Background There was a causal relationship between elevated lipoprotein(a)[Lp(a)]levels and increased risk of calcific aortic valve stenosis(CAVS)in whites and blacks.The present study aimed to investigate whether Lp(a)levels were associated with aortic stenosis(AS)severity and clinical events in Chinese patients.Methods Levels of serum Lp(a)were measured in 652 patients with CAVS,whom all underwent baseline echocardiographic examination.The clinical endpoint was defined as a composite of aortic valve replacement(AVR)and cardiac death.Results Patients in the tertile 3 of Lp(a)had a higher percentage of severe AS compared with those in the tertile 1 and 2 of Lp(a)(46.2%vs.33.9%,P=0.005).Moreover,the top tertile of Lp(a)was an independent predictor of severe AS(OR=1.78,95%CI:1.18-2.66,P=0.006).However,there was no significant association between tertile 3 of Lp(a)and clinical events(hazard ratio:0.73;95%CI:0.43-1.24;P=0.239)in the multivariate Cox regression analysis during a mean follow-up time of 3.16±2.74 years.Conclusions Elevated Lp(a)level was an independent predictor of severe AS by echocardiography in the Chinese population,but was not associated with the increased risk of AVR and cardiac death,suggesting that Lp(a)levels might be helpful in the risk stratification of patients with CAVS.展开更多
Frailty is generally defined as a clinical syndrome of decreased physiologic reserve which drives to increased vulnerability and susceptibility to different stressors together with poor recovery to homeostasis.[1]The ...Frailty is generally defined as a clinical syndrome of decreased physiologic reserve which drives to increased vulnerability and susceptibility to different stressors together with poor recovery to homeostasis.[1]The relevance of frailty status in a wide range of prospective cohorts is mostly related to an increasing burden in both mortality,hospital readmissions,disability,and falls.展开更多
BACKGROUND Aortic stenosis is one of the rare valvular complications in a transplanted heart.Over the past 8 years,transcatheter approach for aortic valve replacement(TAVR)has been slowly evolving to be the preferred ...BACKGROUND Aortic stenosis is one of the rare valvular complications in a transplanted heart.Over the past 8 years,transcatheter approach for aortic valve replacement(TAVR)has been slowly evolving to be the preferred approach in these patient population when compared to the surgical approach.We report a second case in the United States with successful transfemoral minimal approach with minimal sedation for TAVR in a heart transplant recipient 19 years post transplantation for severe symptomatic calcified aortic stenosis.CASE SUMMARY We present a case of 73-year-old male who has undergone successful minimal approach transcatheter aortic valve replacement in an allograft heart.Patient had received orthotopic heart transplantation 19 years ago for non-ischemic cardiomyopathy.Follow up transthoracic echocardiograms as per routine protocol did not show any aortic valve disease until 15 years post transplantation.Aortic valve was noted to be mildly sclerotic at that time and gradually progressed to severe symptomatic aortic stenosis over the next 4 years.Patient had complaints of worsening shortness of breath that limited his functional capacity.Overall his post heart transplantation period has been mostly uneventful except for allograft non occlusive vasculopathy and aortic stenosis.His Society of Thoracic Surgery risk score was 12.205%and he was considered to be a high-risk surgical candidate by surgeon.Decision was made to undergo transcatheter aortic valve replacement.CONCLUSION With the improved survival of these patients,we think it is time to look intopathophysiology of valvular disease in transplant heart recipients.Some other unanswered questions include,underlying donor and recipient risk factors for valvular diseases in heart transplant recipients.展开更多
A single coronary artery is a very rare condition,commonly associated with other congenital anomalies.It could be generally considered as neither benign nor malignant form of congenital coronary artery anomalies since...A single coronary artery is a very rare condition,commonly associated with other congenital anomalies.It could be generally considered as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches.By presenting the patient who underwent successful coronary artery bypass grafting and aortic valve replacement surgery in a presence of isolated single coronary artery,we intend to emphasize natural and procedural risks and distinguish casual from causal in this extremely rare clinical and surgical scenario.展开更多
Background: Long standing aortic stenosis leads to elevated left ventricular (LV) pressure and as a result LV hypertrophy and myocardial fibrosis shall increase. The left ventricular ejection fraction (EF) usually rem...Background: Long standing aortic stenosis leads to elevated left ventricular (LV) pressure and as a result LV hypertrophy and myocardial fibrosis shall increase. The left ventricular ejection fraction (EF) usually remains adequately-preserved until advanced and late stages of aortic stenosis. But the preserved muscle of the LV is only limited to a portion of the entire myocardium. Speckle tracking echocardiography has proved its superiority to the standard two-dimensional echocardiography method in the detection of Left Ventricular (LV) function. Global Longitudinal strain (GLS) is considered as the most robust myocardial strain component.?Objective: The aim of the study is to assess the early course of left ventricular reverse remodelling after Transcutaneous Aortic Valve Implantation (TAVI) in patients with symptomatic severe aortic valve stenosis.?Methods: 50 patients with severe symptomatic valvular aortic stenosis undergoing TAVI as decided by the heart team after comprehensive discussion.?Standard transthoracic echocardiography including Doppler analysis was performed. 2D speckle-tracking strain assessment of Global radial, circumferential and longitudinal strain at parasternal mid-ventricular short-axis view (at the level of papillary muscle) and from the apical long-axis, two-chamber and four-chamber views with a frame rate between 40 and 80 frames per second. Tracing of endocardial borders was done. Patients with significant coronary artery disease were fully revascularized by percutaneous coronary intervention prior to the study and the procedure. Results: 23 (46%) patients were males, while 27 (54%) were females. The patients’ stratification according to comorbidities/associated risk factors revealed that 54% of the patients had DM, 86% were hypertensive, 38% had chronic kidney disease (CKD), and 32% had a previous percutaneous coronary intervention (PCI).?The mean age for our study participants ranged?from 60 to 92 years (Mean ± SD = 76.60 ± 5.96). Left ventricular diastolic diameter (LVDd) was 44.24?±?2.8?mm before TAVI that became 45.5?±?2.6?mm after TAVI, and ejection fraction (EF) increased from 52.82?±?6.3?before TAVI to 56.70?±?5.4?after TAVI, both with highly significant difference (P P value less than 0.001. Global circumferential strain (GCS) also improved significantly from -20.14?±?1.8 before TAVI to -21.72?±?1.7 after TAVI with a P value less than 0.001. Global radial strain (GRS) also increased significantly from 37.38?±?8 before TAVI to 41.68?± 6.3 after TAVI with a P value less than 0.001. Conclusion: TAVI is effective in improving left ventricular function presented not only by ejection fraction (EF%), but also in global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS).展开更多
Background: The Gorlin equation is the reference method for the assessment of aortic valve area in aortic stenosis and is calculated using a constant, called the coefficient of contraction, which is empirically assume...Background: The Gorlin equation is the reference method for the assessment of aortic valve area in aortic stenosis and is calculated using a constant, called the coefficient of contraction, which is empirically assumed to be 1. This coefficient is the ratio of effective aortic area to anatomic aortic area, and a value of 1 indicates that both are the same. The purpose of this study was to estimate the actual coefficient of contraction in patients with aortic stenosis and to evaluate its impact on aortic area as calculated by the Gorlin equation. Methods: We studied 17 patients with moderate to severe aortic stenosis. Effective aortic area was calculated using the continuity equation. Anatomic aortic area was obtained by planimetry with transesophageal echocardiography. Aortic valve area by the Gorlin equation was calculated from echocardiography data. The coefficient of contraction was derived as above. Results: The coefficient of contraction was inversely related to the pressure recovery. Effective area was correlated with anatomic area (r = 0.86, P 2). Aortic area by the Gorlin equation was not correlated with anatomic area, but the correlation became significant when the Gorlin equation was corrected for coefficient of contraction and pressure recovery. Conclusions: Using a coefficient of contraction of 1 in the Gorlin equation gives a poor correlation with anatomic area. Using the calculated coefficient of contraction for each patient and the mean gradient for pressure recovery improves the correlation with anatomic area. These facts could be taken in account when Gorlin equation is considered as the reference method.展开更多
Hoarseness of voice is a common symptom of many laryngeal and extralaryngeal conditions. It is very crucial to identify the culprit behind it, keeping in mind all the various differentials. We re-port a case of a 35-y...Hoarseness of voice is a common symptom of many laryngeal and extralaryngeal conditions. It is very crucial to identify the culprit behind it, keeping in mind all the various differentials. We re-port a case of a 35-year-old woman presenting with complaint of hoarseness of voice. Upon car-diac evaluation, the patient was diagnosed with bicuspid aortic valve, with severe aortic stenosis and dilation of ascending aorta. We suspected that the plausible reason for hoarseness of voice was compression of recurrent laryngeal nerve due to dilation of aorta, i.e., Ortner’s syndrome. But to our surprise, CT of aorta and neck revealed extensive elongated cervical vagus nerve schwannoma. Such type of association is unique and new to voluminous medical literature.展开更多
Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvemen...Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.展开更多
Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical tre...Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical treatment is always challenging. Here we report a minimally invasive and endovascular management of these two pathologies in a 89-year-old man with LAD-stented ischemic cardiomyopathy. We describe our initial therapeutic strategy, per procedure difficulties and final management of this challenging case. Finally, we discuss the different therapeutic options for the endovascular treatment of aortic arch aneurysm associated with aortic valve stenosis.展开更多
In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from...In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from several renowned clinical studies and focused on the primary prevention of managing the modifiable factors,e.g.,paroxysmal atrial fibrillation before the TAVR.展开更多
文摘BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous grafts,the safety of transfemoral access via direct graft puncture,especially when performed twice within a short period,remains unclear compared to alternative access methods.We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty(BAV)and TAVR.CASE SUMMARY An 82-year-old man presented with dyspnea on exertion.Echocardiogram was significant for severe aortic stenosis.Following a heart team discussion,the patient was scheduled for a balloon valvuloplasty followed by staged TAVR.Based on pre-TAVR computed tomography angiogram,the aortobifemoral graft was deemed as an appropriate access site.Micropuncture needle was used to access the right femoral artery graft,and the sheath was upscaled to 10 Fr.He underwent successful intervention to ostial left anterior descending and left circumflex arteries,and BAV with 22 mm Vida BAV balloon.Hemostasis was achieved using Perclose.For TAVR,an 8 Fr sheath was inserted via the right femoral bypass graft.The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal.A 5Fr sheath was used for left femoral bypass graft access.Patient underwent successful TAVR with 29 mm CoreValve.Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.
基金Supported by Zhejiang University Scientific Research Development Project(2021FZZX005-06).
文摘Interrupted Aortic Arch(IAA)combined with aortic stenosis(AS)is a rare and complex congenital cardiac anomaly that presents significant challenges in clinical management.In this letter,we aim to share our experience in performing hybrid procedures on an infant diagnosed with IAA combined with bicuspid AS.This child exhibited significant recovery during follow-up.
文摘Bicuspid aortic valve (BAV) is a common congenital heart valve disease, often accompanied by aortic valve stenosis or regurgitation, infective endocarditis, and aortic diseases such as aortic dilation and dissection. This article aims to review the definition, pathogenesis and genetic basis, classification methods, clinical features and current status of research and treatment and prognosis of BAV, and provide reference for the diagnosis and treatment of BAV. The content and structure of this article are as follows: The first part introduces the definition of BAV;The second part introduces the etiology and classification methods of BAV;The third part briefly describes the clinical manifestations and diagnosis of BAV;The fourth part discusses the treatment strategies and prognosis prediction of BAV;Finally, the article summarizes and looks forward to the future research directions.
基金National Natural Science Foundation of China,Grant/Award Number:81770252,82030014,82271606 and U22A20267Binjiang Institute of Zhejiang University,Grant/Award Number:ZY202205SMKY001Key Program of Major Science and Technology Projects in Zhejiang Province,Grant/Award Number:2021C03097 and 2022C03063。
文摘Background:Calcific aortic valve stenosis(CAVS)is one of the most challenging heart diseases in clinical with rapidly increasing prevalence.However,study of the mecha-nism and treatment of CAVS is hampered by the lack of suitable,robust and efficient models that develop hemodynamically significant stenosis and typical calcium deposi-tion.Here,we aim to establish a mouse model to mimic the development and features of CAVS.Methods:The model was established via aortic valve wire injury(AVWI)combined with vitamin D subcutaneous injected in wild type C57/BL6 mice.Serial transthoracic echocardiography was applied to evaluate aortic jet peak velocity and mean gradi-ent.Histopathological specimens were collected and examined in respect of valve thickening,calcium deposition,collagen accumulation,osteogenic differentiation and inflammation.Results:Serial transthoracic echocardiography revealed that aortic jet peak velocity and mean gradient increased from 7 days post model establishment in a time depend-ent manner and tended to be stable at 28 days.Compared with the sham group,sim-ple AVWI or the vitamin D group,the hybrid model group showed typical pathological features of CAVS,including hemodynamic alterations,increased aortic valve thicken-ing,calcium deposition,collagen accumulation at 28 days.In addition,osteogenic dif-ferentiation,fibrosis and inflammation,which play critical roles in the development of CAVS,were observed in the hybrid model.Conclusions:We established a novel mouse model of CAVS that could be induced efficiently,robustly and economically,and without genetic intervention.It provides a fast track to explore the underlying mechanisms of CAVS and to identify more effec-tive pharmacological targets.
文摘BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain,which our meta-analysis aims to address.AIM To explore safety and efficacy outcomes for patients undergoing TAVR,comparing periprocedural continuation vs interruption of OAC therapy.METHODS A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC.Data were pooled using a random-effects model with risk ratio(RR)and their 95%confidence interval(CI)as effect measures.All statistical analyses were conducted using Review Manager with statistical significance set at P<0.05.RESULTS Four studies were included,encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8%males.A total of 733 patients underwent OAC interruption and 1080 continued.Stroke incidence was significantly lower in the OAC continuation group(RR=0.62,95%CI:0.40-0.94;P=0.03).No significant differences in major vascular complications were found between the two groups(RR=0.95,95%CI:0.77-1.16;P=0.60)and major bleeding(RR=0.90,95%CI:0.72-1.12;P=0.33).All-cause mortality was non-significant between the two groups(RR=0.83,95%CI:0.57-1.20;P=0.32).CONCLUSION Continuation of OAC significantly reduced stroke risk,whereas it showed trends toward lower bleeding and mortality that were not statistically significant.Further large-scale studies are crucial to determine clinical significance.
基金supported by the National Natural Science Foundation of China (81970325, and 82170375)Key Research and Development Project of Science&Technology Department of Sichuan Province (2022ZDZX0020)+2 种基金Key Research and Development Support Project of Science&Technology Department of Chengdu (2021-YF08-00121-GX)Chinese Medical Association Cardiovascular Branch (CSC) Clinical Research Special Fund Project(CSCF2020B04)West China Hospital 1·3·5 Discipline of Excellence Project-Percutaneous transcatheter aortic valve implantation and Mechanisms of aortic stenosis and the clinical applications
文摘Objective To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older.Methods We conducted a cohort study using the UK Biobank data to assess the relationship between handgrip strength and incident aortic stenosis in individuals aged 60 years and older.Handgrip strength was measured using a Jamar J00105 hydraulic hand dynamometer.Adjusted Cox proportional hazards regression models were conducted to assess the association between handgrip strength and incident aortic stenosis.Results We included 157,097 UK Biobank participants(78,151 women and 78,946 men)in our study,with mean age of 64±2.9 years.During a median follow-up of 8.1(7.4–8.8)years,1543(1.0%)participants developed incident aortic stenosis.Compared with those with the lowest handgrip strength(tertile 1),the adjusted hazard ratios(95%confidence interval)of incident aortic stenosis in the middle(tertile 2)and the highest(tertile 3)were 0.86(0.77–0.97)and 0.76(0.67–0.87),respectively.Conclusions Higher handgrip strength was associated with lower risk of developing aortic stenosis in older adults.Future studies warrant preventive strategies for older adults with lower handgrip strength.
基金supported by the Natural Science Foundation of China(Project Nos.52075340 and 61972011)the Shanghai Special Research Project on Aging Population and Maternal and Child Health(Project No.2020YJZX0106).
文摘This study explores the implementation of computed tomography(CT)reconstruction and simulation techniques for patient-specific valves,aiming to dissect the mechanical attributes of calcified valves within transcatheter heart valve replacement(TAVR)procedures.In order to facilitate this exploration,it derives pertinent formulas for 3D multi-material isogeometric hyperelastic analysis based on Hounsfield unit(HU)values,thereby unlocking foundational capabilities for isogeometric analysis in calcified aortic valves.A series of uniaxial and biaxial tensile tests is executed to obtain an accurate constitutive model for calcified active valves.To mitigate discretization errors,methodologies for reconstructing volumetric parametric models,integrating both geometric and material attributes,are introduced.Applying these analytical formulas,constitutive models,and precise analytical models to isogeometric analyses of calcified valves,the research ascertains their close alignment with experimental results through the close fit in displacement-stress curves,compellingly validating the accuracy and reliability of the method.This study presents a step-by-step approach to analyzing themechanical characteristics of patient-specific valves obtained fromCT images,holding significant clinical implications and assisting in the selection of treatment strategies and surgical intervention approaches in TAVR procedures.
文摘BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.
文摘HACEK organisms represent a rare but important group of causative pathogens in endocarditis. These bacteria have historically been associated with culture-negative endocarditis;however, modern laboratory techniques have made this less common. In this case, we present a 74-year-old man who presented with acute onset altered mentation, fever, and sepsis. He was ultimately found to have Haemophilus influenzae meningitis, cerebral empyema, aortic valve endocarditis, psoas myositis, and L2 - L3 diskitis with osteomyelitis. Although HACEK organisms are commonly found in the oropharynx and upper respiratory tract in humans, our patient did not report recent preceding dental or ENT procedures. H. influenzae is responsible for approximately 0.16% of all cases of bacterial endocarditis, representing a very limited subset. Although generally considered low virulent pathogens, this case demonstrates the unusual extent of infection from a HACEK organism, H. influenzae, causing aortic valve endocarditis as well as atypical non-cardiac sequelae, including acute meningitis.
基金supported by the Advanced Technique Research of Valvular Heart Disease Treatment Project(2015C03028)Role of TPP1 in anti-senescence and functional optimization of aged mesenchymal stem cells(81570233)+2 种基金Zhejiang Clinical Research Center for Cardiovascular and Cerebrovascular Disease(2018E50002)Role of FAIM in survival and functional improvement for aged mesenchymal stem cells(81770253)Zhejiang Clinical Research Center for Cardiovascularand Cerebrovascular Disease(2018E50002)
文摘BACKGROUND: Current data is lacking about the progression of ascending aortic dilatation after transcatheter aortic valve replacement(TAVR) in aortic stenosis(AS) patients with bicuspid aortic valve(BAV) and tricuspid aortic valve(TAV). This study aims to assess the ascending aortic dilatation rate(mm/year) after TAVR in patients with BAV versus TAV using a multidetector computed tomography(MDCT) fol ow-up and to determine the predictors of ascending aortic dilatation rate.METHODS: Severe AS patients undergoing TAVR from March 2013 to March 2018 at our center with MDCT follow-ups were included. BAV and TAV were identified using baseline MDCT. Baseline and follow-up MDCT images were analyzed,and the diameters of ascending aorta were measured. Study end point is ascending aortic dilatation rate(mm/year). Furthermore,factors predicting ascending aortic dilatation rate were also investigated.RESULTS: Two hundred and eight patients were included,comprised of 86 BAV and 122 TAV patients. Five,4,3,2,and 1-year MDCT follow-ups were achieved in 7,9,30,46,and 116 patients. The ascending aortic diameter was significantly increased after TAVR in both BAV group(43.7±4.4 mm vs. 44.0±4.5 mm;P<0.001) and TAV group(39.1±4.8 mm vs. 39.7±5.1 mm;P<0.001). However,no difference of ascending aortic dilatation rate was found between BAV and TAV group(0.2±0.8 mm/year vs. 0.3±0.8 mm/year,P=0.592). Multivariate linear regression revealed paravalvular leakage(PVL) grade was independently associated with ascending aortic dilatation rate in the whole population and BAV group,but not TAV group. No aortic events occurred during follow-ups.CONCLUSION: Ascending aortic size continues to grow after TAVR in BAV patients,but the dilatation rate is mild and comparable to that of TAV patients. PVL grade is associated with ascending aortic dilatation rate in BAV patients post-TAVR.
文摘Background There was a causal relationship between elevated lipoprotein(a)[Lp(a)]levels and increased risk of calcific aortic valve stenosis(CAVS)in whites and blacks.The present study aimed to investigate whether Lp(a)levels were associated with aortic stenosis(AS)severity and clinical events in Chinese patients.Methods Levels of serum Lp(a)were measured in 652 patients with CAVS,whom all underwent baseline echocardiographic examination.The clinical endpoint was defined as a composite of aortic valve replacement(AVR)and cardiac death.Results Patients in the tertile 3 of Lp(a)had a higher percentage of severe AS compared with those in the tertile 1 and 2 of Lp(a)(46.2%vs.33.9%,P=0.005).Moreover,the top tertile of Lp(a)was an independent predictor of severe AS(OR=1.78,95%CI:1.18-2.66,P=0.006).However,there was no significant association between tertile 3 of Lp(a)and clinical events(hazard ratio:0.73;95%CI:0.43-1.24;P=0.239)in the multivariate Cox regression analysis during a mean follow-up time of 3.16±2.74 years.Conclusions Elevated Lp(a)level was an independent predictor of severe AS by echocardiography in the Chinese population,but was not associated with the increased risk of AVR and cardiac death,suggesting that Lp(a)levels might be helpful in the risk stratification of patients with CAVS.
文摘Frailty is generally defined as a clinical syndrome of decreased physiologic reserve which drives to increased vulnerability and susceptibility to different stressors together with poor recovery to homeostasis.[1]The relevance of frailty status in a wide range of prospective cohorts is mostly related to an increasing burden in both mortality,hospital readmissions,disability,and falls.
文摘BACKGROUND Aortic stenosis is one of the rare valvular complications in a transplanted heart.Over the past 8 years,transcatheter approach for aortic valve replacement(TAVR)has been slowly evolving to be the preferred approach in these patient population when compared to the surgical approach.We report a second case in the United States with successful transfemoral minimal approach with minimal sedation for TAVR in a heart transplant recipient 19 years post transplantation for severe symptomatic calcified aortic stenosis.CASE SUMMARY We present a case of 73-year-old male who has undergone successful minimal approach transcatheter aortic valve replacement in an allograft heart.Patient had received orthotopic heart transplantation 19 years ago for non-ischemic cardiomyopathy.Follow up transthoracic echocardiograms as per routine protocol did not show any aortic valve disease until 15 years post transplantation.Aortic valve was noted to be mildly sclerotic at that time and gradually progressed to severe symptomatic aortic stenosis over the next 4 years.Patient had complaints of worsening shortness of breath that limited his functional capacity.Overall his post heart transplantation period has been mostly uneventful except for allograft non occlusive vasculopathy and aortic stenosis.His Society of Thoracic Surgery risk score was 12.205%and he was considered to be a high-risk surgical candidate by surgeon.Decision was made to undergo transcatheter aortic valve replacement.CONCLUSION With the improved survival of these patients,we think it is time to look intopathophysiology of valvular disease in transplant heart recipients.Some other unanswered questions include,underlying donor and recipient risk factors for valvular diseases in heart transplant recipients.
文摘A single coronary artery is a very rare condition,commonly associated with other congenital anomalies.It could be generally considered as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches.By presenting the patient who underwent successful coronary artery bypass grafting and aortic valve replacement surgery in a presence of isolated single coronary artery,we intend to emphasize natural and procedural risks and distinguish casual from causal in this extremely rare clinical and surgical scenario.
文摘Background: Long standing aortic stenosis leads to elevated left ventricular (LV) pressure and as a result LV hypertrophy and myocardial fibrosis shall increase. The left ventricular ejection fraction (EF) usually remains adequately-preserved until advanced and late stages of aortic stenosis. But the preserved muscle of the LV is only limited to a portion of the entire myocardium. Speckle tracking echocardiography has proved its superiority to the standard two-dimensional echocardiography method in the detection of Left Ventricular (LV) function. Global Longitudinal strain (GLS) is considered as the most robust myocardial strain component.?Objective: The aim of the study is to assess the early course of left ventricular reverse remodelling after Transcutaneous Aortic Valve Implantation (TAVI) in patients with symptomatic severe aortic valve stenosis.?Methods: 50 patients with severe symptomatic valvular aortic stenosis undergoing TAVI as decided by the heart team after comprehensive discussion.?Standard transthoracic echocardiography including Doppler analysis was performed. 2D speckle-tracking strain assessment of Global radial, circumferential and longitudinal strain at parasternal mid-ventricular short-axis view (at the level of papillary muscle) and from the apical long-axis, two-chamber and four-chamber views with a frame rate between 40 and 80 frames per second. Tracing of endocardial borders was done. Patients with significant coronary artery disease were fully revascularized by percutaneous coronary intervention prior to the study and the procedure. Results: 23 (46%) patients were males, while 27 (54%) were females. The patients’ stratification according to comorbidities/associated risk factors revealed that 54% of the patients had DM, 86% were hypertensive, 38% had chronic kidney disease (CKD), and 32% had a previous percutaneous coronary intervention (PCI).?The mean age for our study participants ranged?from 60 to 92 years (Mean ± SD = 76.60 ± 5.96). Left ventricular diastolic diameter (LVDd) was 44.24?±?2.8?mm before TAVI that became 45.5?±?2.6?mm after TAVI, and ejection fraction (EF) increased from 52.82?±?6.3?before TAVI to 56.70?±?5.4?after TAVI, both with highly significant difference (P P value less than 0.001. Global circumferential strain (GCS) also improved significantly from -20.14?±?1.8 before TAVI to -21.72?±?1.7 after TAVI with a P value less than 0.001. Global radial strain (GRS) also increased significantly from 37.38?±?8 before TAVI to 41.68?± 6.3 after TAVI with a P value less than 0.001. Conclusion: TAVI is effective in improving left ventricular function presented not only by ejection fraction (EF%), but also in global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS).
文摘Background: The Gorlin equation is the reference method for the assessment of aortic valve area in aortic stenosis and is calculated using a constant, called the coefficient of contraction, which is empirically assumed to be 1. This coefficient is the ratio of effective aortic area to anatomic aortic area, and a value of 1 indicates that both are the same. The purpose of this study was to estimate the actual coefficient of contraction in patients with aortic stenosis and to evaluate its impact on aortic area as calculated by the Gorlin equation. Methods: We studied 17 patients with moderate to severe aortic stenosis. Effective aortic area was calculated using the continuity equation. Anatomic aortic area was obtained by planimetry with transesophageal echocardiography. Aortic valve area by the Gorlin equation was calculated from echocardiography data. The coefficient of contraction was derived as above. Results: The coefficient of contraction was inversely related to the pressure recovery. Effective area was correlated with anatomic area (r = 0.86, P 2). Aortic area by the Gorlin equation was not correlated with anatomic area, but the correlation became significant when the Gorlin equation was corrected for coefficient of contraction and pressure recovery. Conclusions: Using a coefficient of contraction of 1 in the Gorlin equation gives a poor correlation with anatomic area. Using the calculated coefficient of contraction for each patient and the mean gradient for pressure recovery improves the correlation with anatomic area. These facts could be taken in account when Gorlin equation is considered as the reference method.
文摘Hoarseness of voice is a common symptom of many laryngeal and extralaryngeal conditions. It is very crucial to identify the culprit behind it, keeping in mind all the various differentials. We re-port a case of a 35-year-old woman presenting with complaint of hoarseness of voice. Upon car-diac evaluation, the patient was diagnosed with bicuspid aortic valve, with severe aortic stenosis and dilation of ascending aorta. We suspected that the plausible reason for hoarseness of voice was compression of recurrent laryngeal nerve due to dilation of aorta, i.e., Ortner’s syndrome. But to our surprise, CT of aorta and neck revealed extensive elongated cervical vagus nerve schwannoma. Such type of association is unique and new to voluminous medical literature.
文摘Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.
文摘Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical treatment is always challenging. Here we report a minimally invasive and endovascular management of these two pathologies in a 89-year-old man with LAD-stented ischemic cardiomyopathy. We describe our initial therapeutic strategy, per procedure difficulties and final management of this challenging case. Finally, we discuss the different therapeutic options for the endovascular treatment of aortic arch aneurysm associated with aortic valve stenosis.
文摘In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from several renowned clinical studies and focused on the primary prevention of managing the modifiable factors,e.g.,paroxysmal atrial fibrillation before the TAVR.
