Mitral regurgitation (MR) is a highly prevalent valvular heart disease globally,with untreated severe cases demonstrating associations with elevated morbidity,mortality,and adverse cardiovascular outcomes.[1,2]While t...Mitral regurgitation (MR) is a highly prevalent valvular heart disease globally,with untreated severe cases demonstrating associations with elevated morbidity,mortality,and adverse cardiovascular outcomes.[1,2]While transcatheter edge-toedge repair (TEER) has emerged as an alternative option for high surgical risk patients with severe MR,[3,4]severe MR of Carpentier class IIIa (characterized by restricted leaflet motion during both systole and diastole) has been considered a relative contraindication for TEER interventions due to stenosis risk and procedural complexity.[5,6]展开更多
Background:Endoplasmic reticulum(ER)stress is an important factor in the development of numerous cardiovascular disorders;nevertheless,the association between ER stress and mitral regurgitation(MR)remains inadequately...Background:Endoplasmic reticulum(ER)stress is an important factor in the development of numerous cardiovascular disorders;nevertheless,the association between ER stress and mitral regurgitation(MR)remains inadequately characterized.The molecular mechanism of pimobendan(PIMO)that contributes to the delay in congestive heart failure(CHF)in MR associated with apoptosis and fibrosis is still unclear.Our aim was to examine the impact of PIMO on ER stress,apoptosis,and fibrosis in a chronic MR rat model.Methods:MR was surgically induced in 10 Sprague–Dawley rats,with 5 serving as sham operation controls.At 8 weeks postsurgery,the MR animals were randomly allocated into two groups:MR and MR+PIMO groups.PIMO was administered twice daily through oral gavage for 4 weeks,whereas the sham and MR groups were administered similar quantities of drinking water.Echocardiography was conducted before the delivery of PIMO as a baseline measure and at the end of the study.At the end of the investigation,hearts were procured for histopathological and ER stress evaluations.Results:PIMO significantly maintained heart function and structural remodeling in the MR animals.PIMO significantly reduced MR-induced myocyte apoptosis(p=0.044)and fibrosis(p=0.002)by reducing the messenger RNA expression of genes associated with ER stress(GRP78[glucose-regulated protein 78],ATF4[activating transcription factor 4],and CHOP[C/ERP homologous protein])compared to the MR group(p<0.05,p<0.01,and p<0.001,respectively).Conclusion:PIMO demonstrated cardioprotective benefits on heart function,myocyte apoptosis,and fibrosis by regulating ER stress in an MR-induced CHF rat model.展开更多
BACKGROUND Observational studies reported characteristics and outcomes of patients with secondary mitral valve regurgitation(MR)who underwent transcatheter edge-toedge repair of the mitral valve.No study investigated ...BACKGROUND Observational studies reported characteristics and outcomes of patients with secondary mitral valve regurgitation(MR)who underwent transcatheter edge-toedge repair of the mitral valve.No study investigated the temporal trend of patient characteristics and outcomes in comparison with the published randomized trials.AIM To investigate the temporal trend in baseline characteristics and outcomes of patients with secondary MR who underwent transcatheter edge-to-edge repair of the mitral valve in the real world compared with those from the published landmark trials.METHODS A comprehensive systematic literature search was conducted using MEDLINE,EMBASE,and CENTRAL databases,and the identified observational studies were divided into two five-year recruitment periods.The first period included 36 studies that enrolled patients between 2008 and 2012,and the second period included 25 studies that recruited patients between 2013 and 2017-2018.Pooled variables of each five-year recruitment period were compared with those of the landmark trials.A random-effects model was used for statistical comparisons.RStudio and RevMan software were used for the analysis.RESULTS Overall,there were no major variations in the findings between the first and the second five-year recruitment periods.EVEREST program vs observational studies:Patients in the EVEREST program were more likely to have non-ischemic MR etiology[odds ratio(OR)=3.59,95%confidence interval(CI):2.92-4.42]and atrial fibrillation(OR=1.71,95%CI:1.42-2.06).They were less likely to receive angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers(OR=0.72,95%CI:0.58-0.90)and implantable cardiac device(OR=0.41,95%CI:0.33-0.49)as well as less likely to be symptomatic at hospital presentation without a difference in MR grade≤2+or mortality at 12-month follow-up.COAPT trial vs observational studies:COAPT patients were more likely to have prior myocardial infarction(OR=1.62,95%CI:1.27-2.06)and renal insufficiency(OR=2.66,95%CI:2.05-3.45).They were more likely to receive beta-blockers(OR=2.54,95%CI:1.68-3.85)and an implanted cardiac device(OR=2.20,95%CI:1.71-2.84).There was no difference in procedure success or mortality.MITRA-FR trial vs observational studies:MITRA-FR patients were less likely to have atrial fibrillation(OR=0.49,95%CI:0.34-0.69)and renal insufficiency(OR=0.18,95%CI:0.11-0.28)but more likely to have a history of myocardial infarction(OR=1.48,95%CI:1.06-2.05)and to receive diuretics(OR=19.81,95%CI:2.75-142.48)and implantable cardiac devices(OR=1.69,95%CI:1.21-2.37).At hospital presentation,they were less likely to be symptomatic(OR=0.25,95%CI:0.18-0.35)without a difference in MR grades 3+and 4+.There was no difference in terms of MR grade or mortality at 12-month follow-up.CONCLUSION Patients in the landmark studies may have favourable or unfavourable characteristics when compared to those in the observational studies,but this did not translate into different outcomes over time.展开更多
The prevalence of mitral regurgitation(MR)is increasingly worldwide as a consequence of improved survival and ischemic heart disease.Severe MR is associated with worse prognosis,independent of left ventricular functio...The prevalence of mitral regurgitation(MR)is increasingly worldwide as a consequence of improved survival and ischemic heart disease.Severe MR is associated with worse prognosis,independent of left ventricular function and associated comorbidities.[1-3]Although surgical valve repair or replacement remains the standard treatment for patients with chronic MR,up to 50%of MR patients with symptomatic MR are not referred for surgery,mainly because of multiple comorbid conditions resulting in high surgical risk.[4]There is,therefore,a clear need for less invasive approaches for this patient group.展开更多
Background Predicting in-hospital mortality in elderly patients with dilated cardiomyopathy(DCM)is critical for improving clinical management.This study investigated the prognostic significance of mitral valve regurgi...Background Predicting in-hospital mortality in elderly patients with dilated cardiomyopathy(DCM)is critical for improving clinical management.This study investigated the prognostic significance of mitral valve regurgitant area(MVRA)as a predictor of in-hospital mortality.Methods A total of 813 elderly patients(age≥60 years)diag-nosed with DCM were included in this retrospective study,with admissions spanning from January 2010 to Decem-ber 2019.Univariate and multivariate Cox regression analyses were conducted to assess the association between MVRA and in-hospital mortality.Receiver operating characteristic(ROC)curve and Kaplan-Meier survival analy-ses were employed to assess the predictive performance of MVRA and to compare cumulative survival rates be-tween groups,respectively.Results MVRA was significantly associated with in-hospital mortality in both univar-iate and multivariate analyses(HR:1.119,95%CI:1.028-1.218,P=0.009).ROC curve analysis demonstrated good prognostic performance for MVRA[area under curve(AUC):0.714].Kaplan-Meier analysis revealed that patients with high MVRA(HMVRA)had significantly worse in-hospital survival outcomes(log-rank χ2=12.628,P<0.001).Conclusions An increase in MVRA is significantly associated with higher in-hospital mortality in elderly DCM patients,with an MVRA exceeding 7 cm2 indicating a notably increased mortality rate.MVRA serves as a simple and effective parameter for risk assessment and treatment monitoring in DCM patients.展开更多
BACKGROUND:Research has revealed a relationship between atrial fi brillation(AF)and valvular heart disease;however,the causality remains largely unknown.This study explored whether a causal association between AF and ...BACKGROUND:Research has revealed a relationship between atrial fi brillation(AF)and valvular heart disease;however,the causality remains largely unknown.This study explored whether a causal association between AF and non-rheumatic aortic valve disease(AVD)and mitral valve disease(MVD)could be found.METHODS:A two-sample Mendelian randomization(TSMR)method was applied to determine the causal eff ect of AF on AVD,mitral regurgitation,and MVD.The inverse variance weighted(IVW)method was used as the primary analytical approach,and several complementary analyses were conducted.Outliers were detected using the Mendelian Randomization Pleiotropy RESidual Sum and Outlier(MR-PRESSO)and radial Mendelian randomization(MR)methods.RESULTS:Genetically predicted AF was found to be causally associated with the risk of MVD(odds ratio[OR]=1.001;95%confi dence interval[CI]:1.000-1.001;P=1.33×10-6)and mitral regurgitation(OR=1.001;95%CI:1.000-1.002;P=0.009).However,no signifi cant causal associations between AF and AVD were detected(OR=1.000;95%CI:0.999-1.000;P=0.804).Causal eff ects were still detected,even after adjusting for potential risk factors or removing the identifi ed outliers.Reverse MR analyses revealed no signifi cant causal eff ect of valvular heart disease on AF.CONCLUSION:Our findings demonstrate a positive causal association between AF,MVD,and mitral regurgitation,but not AVD.Further research and an aggressive AF management strategy should be explored as potential measures for preventing MVD.展开更多
Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought...Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought that GBS only results in invasive disease in pregnant females and neonates,recent literature has suggested an increasing incidence of invasive GBS among non-pregnant individuals within the United States.展开更多
Objectives To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC). Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdo...Objectives To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC). Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdong cardiovascular institute between February 2001 and August 2002. Serial echocardiograms were performed in all patients at baseline, discharge and annually thereafter. Results Five-year follow-up rate was 97.1%. Five-year survival rate was 100%. Before and after PMMC and at follow-up, mean mitral valve area by two-dimensional echocardiography was (0.87±0.15) cm2, (2.11±0.38) cm2 and (1.81±0.36) cm2, respectively (P<0.01). Five-year mitral restenosis rate was 6.1%. Conclusion PMMC can achieve excellent and sustained long-term results in selected patients with mitral echocardiographic score exceeding or being equal to 9.展开更多
The patient was admitted to OndokuzMay<span style="color:#4F4F4F;font-family:-apple-system, "font-size:16px;white-space:normal;background-color:#F7F7F7;">ı</span>s University Animal ...The patient was admitted to OndokuzMay<span style="color:#4F4F4F;font-family:-apple-system, "font-size:16px;white-space:normal;background-color:#F7F7F7;">ı</span>s University Animal Hospital Internal Medicine outpatient clinic with complaints of epileptic seizures and hypothyroidism. A description of the patient’s owner is available in the history information. There was no physician information. Bradycardia was found in the electrocardiography of the patient.<span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "="">2-D, M-Mode, PW, CW and Color doppler examinations were performed. Left-ventricular hypokinetic and mitral and tricuspidal valve movements were observed with limited M-Mode imaging. Anterior mitral orifice of 2 mm width was detected on septal mitral valve by PW doppler and color doppler. With this orifice, the presence of regurgitant jet, which covers LA at a rate of 1/3 and was 3.2 m/sec, together with mitral regurgitation (0.5 m/sec.), was demonstrated. PISA calculations;VFR (mL/s), ERO (mm<sup>2</sup>) and RVol (mL/pulse) values </span></span></span><span><span><span style="font-family:;" "="">were calculated as if there were mitral regurgitation and data were obtained for mild-m</span></span></span><span><span><span style="font-family:;" "="">oderate mitral regurgitation. Therefore, no operative treatment of the orifice was recommended.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "="">Mitral valve orifice is a rare pathology and this is the first report in canine veterinary practice with degenerative mitral valve disorder. We aimed to underline the possibility of mitral orifice development in degenerative mitral valve disorders, known to present with vegetations and varying degrees of prolapsus, conventionally.</span></span></span>展开更多
<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Percutaneous mitral balloon valvuloplasty is the main</spa...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Percutaneous mitral balloon valvuloplasty is the main</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">procedure in mitral stenosis (MS). It can replace surgical commissurotomy in many cases;however, mitral regurgitation (MR) remains the major procedure complication.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">This study was conducted to investigate</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">predictors of MR as a complication following</span><b></b><span style="font-family:Verdana;">percutaneous mitral valvuloplasty (PMV) using multitrack balloon technique.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">This cohort study was conducted at both Menoufia University Hospital and Mabaret Misr Elkadima Hospital. We enrolled 121 patients with moderate to severe MS who were subjected to</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">PMV using multitrack balloon technique during the period from October 2017 to October 2019. Transthoracic echocardiographic evaluation was performed for all patients before and after the procedure. Patients who developed severe MR post procedure were compared with other patients to identify important distinction points.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Most patients (N = 109, </span><span style="font-family:;" "=""><span style="font-family:Verdana;">90.1%) developed no/mild MR (group A), whereas 12 (9.9%) patients developed severe MR (group B) after PMV. Those who developed severe MR had significantly higher weight, height, body mass index, and body surface area (P value < 0.001 for each). Also, there was a significant difference between both groups regarding pre-operative Wilkins score (8.7 ± 1.3 for severe MR versus 7.9 ± 1.2 for No/Mild MR, P = 0.046). Patients who developed severe MR had higher incidence of other valvular lesions such as mild aortic regurgitation (91.7% versus 36.7%, P < 0.001), higher mitral valve (MV) commissural calcification (50.0% versus 14.7%, P = 0.008), pre-operative MR (100.0% versus</span><a name="page2"></a><span style="font-family:Verdana;"> 35.8%, P < 0.001), higher prevalence of atrial fibrillation (100.0% versus 38.5%, P < 0.001). Regarding balloon sizing, it was significantly higher among patients who developed severe MR compared with those having mild or no MR (P = 0.001). Multivariate regression analysis identified MV balloon sizing (OR 3.877, CI 95% 1.131</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">13.289, P = 0.031) and MV commissural asymmetry of calcification (OR 67.48, CI 95% 5.759</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">790.72, P = 0.001) as significant predictors of outcomes of MV commissurotomy.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Mitral valve calcification, balloon sizing, and MV asymmetry are significant factors that can predict the development of MR after balloon valvuloplasty.</span>展开更多
Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitr...Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.展开更多
Infective endocarditis (IE) is the infection of inner endothelial layer of the heart including the heart valves and it may present as rapidly progressive or manifest itself as subacute or chronic disease. The epidemio...Infective endocarditis (IE) is the infection of inner endothelial layer of the heart including the heart valves and it may present as rapidly progressive or manifest itself as subacute or chronic disease. The epidemiology of infective endocarditis has been changed over the past few decades and the incidence of IE in children in United States and Canada is 1 in 1250 pediatric hospital admissions in the early 1980s. At least 70% of infective endocarditis in children occurs with congenital heart disease whereas rheumatic heart disease in southern states of India and the degenerative mitral valve disease (myxomatous, mitral valve prolapse) in the western countries are the most underlying predisposing conditions to infective endocarditis in adolescents. The characteristic lesion of infective endocarditis is “vegetation” and a “large” vegetation >10 mm in size has been reported with an incidence of 15.9% - 62.5% in patients. The significance of vegetation size has been a subject of discussion for many years to predict the embolic episodes. Background of this case study illustrated the varying size and shape of giant vegetation attached to the anterior leaflet of mitral valve in an underlying rheumatic mitral valvulitis and its consequence of valve damage such as chordal rupture, flail leaflet and mitral regurgitation with a description of anatomic features and echocardiographic manifestations in a 10-year-old female child.展开更多
As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to ...As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population.Recent years have brought a progression of surgical treatments toward less invasive strategies.This has given rise to percutaneous approaches for the correction of valvular heart disease.Percutaneous mitral valve repair using the MitraClip system (Abbott Vascular,Santa Clara,CA,USA) creates a double orifice and has been successfully used in selected patients with mitral regurgitation.We review the rationale,procedural aspects,and clinical data thus far available for the MitraClip approach to mitral regurgitation.展开更多
Plasma concentrations of endothelin in bloor from the femoral vein and the antecubital vein were measured in 35 patients with mitral stenosis and heart failure before and after percutaneous balloon mitralvalvuloplasty...Plasma concentrations of endothelin in bloor from the femoral vein and the antecubital vein were measured in 35 patients with mitral stenosis and heart failure before and after percutaneous balloon mitralvalvuloplasty(PBMV). The basal plasma concentrations of endothelin in blood from the antecubirtal vein in the patients were significantly higher than those in 32 control subjects (15. 40± 3. 32 vs. 9. 59± 2. 66 pg/ml, P<0. 001). Plasma endothelin concentrations in patients in New York Heart Association functional classes Ⅱ and Ⅲ were significantly higher than those in control subjects, respectively. The concentrations of endothelin in patients with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm. Ten to fifteen minutes after PBMV, plasma endothelin concentrations in blood from the femoral vein significantly decreased from 16. 14 ± 3. 34 to 13. 74 ± 3. 78 pg/ml (P<0. 01 ). Seventy-two hours after the procedure, the concentrations of endothelin in blood from the antecubital vein had fallen to 12. 31 ± 2. 55 pg/ml (P<0. 001 vs. before PBMV and control subjects). Plasma endothelin concentrations still tended to be higher in patients with atrial fibrillation than those in normal sinus rhythm, but the difference did not reach statistical significance. There were weak but significantly correlations of plasma endothe lin concentrations with the mean left atrial pressure (r= 0. 424 , P < 0.001 ), mean right atrial pressure (r=0. 323, P<0. 01), mean transmitral pressure gradient (r= 0. 397, P<0. 001), heart rate (r= 0. 350,P<0. 005)and mitral valve area (r=-0. 454, P<0. 001) in the patients before and after PBMV.展开更多
Functional mitral regurgitation is a common finding among heart failure patients with ischemic and non-ischemic dilated cardiomyopathies.The presence of moderate or severe mitral regurgitation is associated with highe...Functional mitral regurgitation is a common finding among heart failure patients with ischemic and non-ischemic dilated cardiomyopathies.The presence of moderate or severe mitral regurgitation is associated with higher morbidity and mortality.Heart failure patients meeting electrocardiogram and left ventricle function criteria are good candidates for cardiac resynchronization therapy,which may reduce the degree of functional mitral regurgitation in the short and long term,specifically targeting myocardial dyssynchrony and inducing left ventricle reverse remodeling.In this article,we analyze data from the literature about predictors of mitral regurgitation improvement after cardiac resynchronization therapy implantation.展开更多
Background This preclinical study in sheep sought to demonstrate the initial safety and feasibility of a novel transcatheter mitral valve system(Mi-thos valve)composed of a self-expanding frame and a bovine pericardia...Background This preclinical study in sheep sought to demonstrate the initial safety and feasibility of a novel transcatheter mitral valve system(Mi-thos valve)composed of a self-expanding frame and a bovine pericardial tissue bioprosthesis.Methods The valve was implanted in 26 sheep using a transapical approach for short-and long-term evaluation.The technical feasibility,safety,durability,and valve function were evaluated during and 6 months after the procedure using intracardiac and transthoracic echocardiography,multisliced computed tomography,histological analysis,and electron microscopy.Results The success rate of valve implantation was 100%,and the immediate survival rate after surgery was 84%.Five animals died within 90 min after the development of the prosthetic valve due to an acute left ventricular outflow tract obstruction(n=2)and sudden intraoperative ventricular fibrillation(n=3).Twelve animals died within 1 month due to acute left heart dysfunction.Mild(n=5)and moderate(n=2)paravalvular leakage occurred in seven animals,and two moderate PVL animals died of chronic heart failure within three months.Multimodality imaging studies of the remaining seven animals showed excellent function and alignment of the valves,with no coronary artery obstruction,no left ventricular outflow tract obstruction,no severe transvalvular gradients and no paravalvular leakage.Macroscopic evaluation demonstrated stable,secure positioning of the valve,with full endothelialization of the valve leaflets without injury to the ventricular or atrial walls.Histological and electron microscopic examinations at six months showed no obvious macro-or microcalcification in the leaflets.Conclusions Preclinical studies indicate that transcatheter implantation of the Mi-thos valve is technically safe and feasible.The durability,functionality,and lack of leaflet calcification were all verified in animal experiments.The information from these preclinical studies will be applied to patient selection criteria and the first-in-human studies.展开更多
Many patients with left ventricular systolic dysfunction have concomitant mitral regurgitation(MR). Their symptoms and prognosis worsen with increasing severity of MR. Percutaneous Mitra Clip® can be used saf...Many patients with left ventricular systolic dysfunction have concomitant mitral regurgitation(MR). Their symptoms and prognosis worsen with increasing severity of MR. Percutaneous Mitra Clip® can be used safely to reduce the severity of MR even in patients with advanced heart failure and is associated with improved symptoms, quality of life and exercise tolerance. However, a few patients with very poor left ventricular systolic function may experience significant haemodynamic disturbance in the peri-procedural period. We present three such patients, highlighting some of the potential problems encountered and discuss their possible pathophysiological mechanisms and safety measures.展开更多
AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic seve...AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic severe MR who underwent Mitra Clip~?implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair.RESULTS The study population consisted of 46 consecutive patients(mean logistic Euro SCORE 32% ± 21%). The degree of MR decreased significantly(severe MR before Mitra Clip~? 100% vs after Mitra Clip~? 13%; P < 0.001),and the NYHA functional classes improved(NYHA III/IV before Mitra Clip~? 98% vs after Mitra Clip~? 35%; P < 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%,respectively. During the follow-up of 473 ± 274 d,11 patients died(90% due to cardiovascular death). A preprocedural plasma B-type natriuretic peptide level > 817 pg/m L was associated with all-cause mortality(hazard ratio,6.074; 95%CI: 1.257-29.239; P = 0.012).CONCLUSION Percutaneous mitral valve repair with Mitra Clip~? has positive effects on hemodynamics and symptoms. Despite the study patients' multiple comorbidities and extremely high operative risk,one-year outcomes after Mitra Clip~? are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival.展开更多
Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction.Percutaneous mitral valve repair has become an appealing alternative approach for patients...Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction.Percutaneous mitral valve repair has become an appealing alternative approach for patients who are not suitable for surgery.However,clinical trial data are not available on the institutional impact of a percutaneous mitral valve repair program on mitral valve surgery.The current study retrospectively evaluated the impact of the MitraClip program on the mitral valve surgery volume and outcomes.Patient data were retrieved from the 2 years before and the 2 years after initiation of the MitraClip program.The volume of MitraClip procedures increased from eight cases in 2015 to 91 cases in 2017.Since the initiation of the MitraClip program in 2015,the volume of both mitral valve replacement and mitral valve repair also increased(43 vs.60 and 110 vs.154,respectively).Importantly,we observed improved surgical outcomes,including fewer perioperative complications and lower operative mortality and in-hospital mortality.Data from our single-institution experience indicate that the introduction of the MitraClip program is associated with increased mitral valve surgery volume and improved outcomes.The establishment of the MitraClip program enables the hospital to provide higher quality of care and potentially become a referring center for structural heart patients.展开更多
Plasma dynorphin A1-13 levels were measured in 33 patients with mitral stenosis before and after percutaneous balloon mitral commissurotomy (PBMC). The results show that the basal levels of plasma dynorphin in blood f...Plasma dynorphin A1-13 levels were measured in 33 patients with mitral stenosis before and after percutaneous balloon mitral commissurotomy (PBMC). The results show that the basal levels of plasma dynorphin in blood from the antecubital vein in the patients were significantly higher than those in 31 healthy control subjects. The increase in circulating dynorphin closely correlated with the functional cardiac status and the presence of atrial fibrillation. Ten to fifteen minutes after PBMC, plasma dynorphin levels in blood from the femoral vein increased significantly. Seventy-two hours after the procedure, the levels of plasma dynorphin in blood from the antecubital vein had decreased significantly , but they did not decrease to the normal range. Plasma dynorphin levels in blood from the femoral vein were positively correlated with the mean left atrial pressure and the mean right atrial pressure before the first balloon inflation. Plasma dynorphin levels in blood from the antecubital vein were positively correlated with the heart rate and the mean transmitral pressure gradient, and negatively with the mitral valve area before and 72 hours after PBMC.展开更多
基金supported by the 1·3·5 Project for Disciplines of Excellence from West China Hospital of Sichuan University(ZYGD23021&23HXFH009)Sichuan Science and Technology Program(No.2025ZNSFSC1698)the Sichuan Provincial Cadre Health Research Program(ZH2024-103).
文摘Mitral regurgitation (MR) is a highly prevalent valvular heart disease globally,with untreated severe cases demonstrating associations with elevated morbidity,mortality,and adverse cardiovascular outcomes.[1,2]While transcatheter edge-toedge repair (TEER) has emerged as an alternative option for high surgical risk patients with severe MR,[3,4]severe MR of Carpentier class IIIa (characterized by restricted leaflet motion during both systole and diastole) has been considered a relative contraindication for TEER interventions due to stenosis risk and procedural complexity.[5,6]
基金The 100th Anniversary Chulalongkorn University Fund for Doctoral Scholarshipthe National Budget to CULAC,Grant/Award Number:390252002+1 种基金the 90th Anniversary of Chulalongkorn University Fund,Grant/Award Number:GCUGR1125641042Dthe Thailand Science Research and Innovation Fund at Chulalongkorn University,Grant/Award Number:HEAF673100100。
文摘Background:Endoplasmic reticulum(ER)stress is an important factor in the development of numerous cardiovascular disorders;nevertheless,the association between ER stress and mitral regurgitation(MR)remains inadequately characterized.The molecular mechanism of pimobendan(PIMO)that contributes to the delay in congestive heart failure(CHF)in MR associated with apoptosis and fibrosis is still unclear.Our aim was to examine the impact of PIMO on ER stress,apoptosis,and fibrosis in a chronic MR rat model.Methods:MR was surgically induced in 10 Sprague–Dawley rats,with 5 serving as sham operation controls.At 8 weeks postsurgery,the MR animals were randomly allocated into two groups:MR and MR+PIMO groups.PIMO was administered twice daily through oral gavage for 4 weeks,whereas the sham and MR groups were administered similar quantities of drinking water.Echocardiography was conducted before the delivery of PIMO as a baseline measure and at the end of the study.At the end of the investigation,hearts were procured for histopathological and ER stress evaluations.Results:PIMO significantly maintained heart function and structural remodeling in the MR animals.PIMO significantly reduced MR-induced myocyte apoptosis(p=0.044)and fibrosis(p=0.002)by reducing the messenger RNA expression of genes associated with ER stress(GRP78[glucose-regulated protein 78],ATF4[activating transcription factor 4],and CHOP[C/ERP homologous protein])compared to the MR group(p<0.05,p<0.01,and p<0.001,respectively).Conclusion:PIMO demonstrated cardioprotective benefits on heart function,myocyte apoptosis,and fibrosis by regulating ER stress in an MR-induced CHF rat model.
文摘BACKGROUND Observational studies reported characteristics and outcomes of patients with secondary mitral valve regurgitation(MR)who underwent transcatheter edge-toedge repair of the mitral valve.No study investigated the temporal trend of patient characteristics and outcomes in comparison with the published randomized trials.AIM To investigate the temporal trend in baseline characteristics and outcomes of patients with secondary MR who underwent transcatheter edge-to-edge repair of the mitral valve in the real world compared with those from the published landmark trials.METHODS A comprehensive systematic literature search was conducted using MEDLINE,EMBASE,and CENTRAL databases,and the identified observational studies were divided into two five-year recruitment periods.The first period included 36 studies that enrolled patients between 2008 and 2012,and the second period included 25 studies that recruited patients between 2013 and 2017-2018.Pooled variables of each five-year recruitment period were compared with those of the landmark trials.A random-effects model was used for statistical comparisons.RStudio and RevMan software were used for the analysis.RESULTS Overall,there were no major variations in the findings between the first and the second five-year recruitment periods.EVEREST program vs observational studies:Patients in the EVEREST program were more likely to have non-ischemic MR etiology[odds ratio(OR)=3.59,95%confidence interval(CI):2.92-4.42]and atrial fibrillation(OR=1.71,95%CI:1.42-2.06).They were less likely to receive angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers(OR=0.72,95%CI:0.58-0.90)and implantable cardiac device(OR=0.41,95%CI:0.33-0.49)as well as less likely to be symptomatic at hospital presentation without a difference in MR grade≤2+or mortality at 12-month follow-up.COAPT trial vs observational studies:COAPT patients were more likely to have prior myocardial infarction(OR=1.62,95%CI:1.27-2.06)and renal insufficiency(OR=2.66,95%CI:2.05-3.45).They were more likely to receive beta-blockers(OR=2.54,95%CI:1.68-3.85)and an implanted cardiac device(OR=2.20,95%CI:1.71-2.84).There was no difference in procedure success or mortality.MITRA-FR trial vs observational studies:MITRA-FR patients were less likely to have atrial fibrillation(OR=0.49,95%CI:0.34-0.69)and renal insufficiency(OR=0.18,95%CI:0.11-0.28)but more likely to have a history of myocardial infarction(OR=1.48,95%CI:1.06-2.05)and to receive diuretics(OR=19.81,95%CI:2.75-142.48)and implantable cardiac devices(OR=1.69,95%CI:1.21-2.37).At hospital presentation,they were less likely to be symptomatic(OR=0.25,95%CI:0.18-0.35)without a difference in MR grades 3+and 4+.There was no difference in terms of MR grade or mortality at 12-month follow-up.CONCLUSION Patients in the landmark studies may have favourable or unfavourable characteristics when compared to those in the observational studies,but this did not translate into different outcomes over time.
基金supported by the Cultivation of Scientific Research Project of Changhai Hospital,Shanghai,China(No.2021JCMS20)Major Topics of the Health Commission of Jiangsu Province(ZD2021020).
文摘The prevalence of mitral regurgitation(MR)is increasingly worldwide as a consequence of improved survival and ischemic heart disease.Severe MR is associated with worse prognosis,independent of left ventricular function and associated comorbidities.[1-3]Although surgical valve repair or replacement remains the standard treatment for patients with chronic MR,up to 50%of MR patients with symptomatic MR are not referred for surgery,mainly because of multiple comorbid conditions resulting in high surgical risk.[4]There is,therefore,a clear need for less invasive approaches for this patient group.
基金supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project(No.2023ZD0504600)the National Science Foundation of Guangdong Province(No.2023B1515020082)。
文摘Background Predicting in-hospital mortality in elderly patients with dilated cardiomyopathy(DCM)is critical for improving clinical management.This study investigated the prognostic significance of mitral valve regurgitant area(MVRA)as a predictor of in-hospital mortality.Methods A total of 813 elderly patients(age≥60 years)diag-nosed with DCM were included in this retrospective study,with admissions spanning from January 2010 to Decem-ber 2019.Univariate and multivariate Cox regression analyses were conducted to assess the association between MVRA and in-hospital mortality.Receiver operating characteristic(ROC)curve and Kaplan-Meier survival analy-ses were employed to assess the predictive performance of MVRA and to compare cumulative survival rates be-tween groups,respectively.Results MVRA was significantly associated with in-hospital mortality in both univar-iate and multivariate analyses(HR:1.119,95%CI:1.028-1.218,P=0.009).ROC curve analysis demonstrated good prognostic performance for MVRA[area under curve(AUC):0.714].Kaplan-Meier analysis revealed that patients with high MVRA(HMVRA)had significantly worse in-hospital survival outcomes(log-rank χ2=12.628,P<0.001).Conclusions An increase in MVRA is significantly associated with higher in-hospital mortality in elderly DCM patients,with an MVRA exceeding 7 cm2 indicating a notably increased mortality rate.MVRA serves as a simple and effective parameter for risk assessment and treatment monitoring in DCM patients.
基金supported by grants from the National Key Research and Development Program of China(2023YFC3606500)the Natural Science Foundation of Zhejiang Province(LR22H020001)the National Natural Science Foundation of China(82470428).
文摘BACKGROUND:Research has revealed a relationship between atrial fi brillation(AF)and valvular heart disease;however,the causality remains largely unknown.This study explored whether a causal association between AF and non-rheumatic aortic valve disease(AVD)and mitral valve disease(MVD)could be found.METHODS:A two-sample Mendelian randomization(TSMR)method was applied to determine the causal eff ect of AF on AVD,mitral regurgitation,and MVD.The inverse variance weighted(IVW)method was used as the primary analytical approach,and several complementary analyses were conducted.Outliers were detected using the Mendelian Randomization Pleiotropy RESidual Sum and Outlier(MR-PRESSO)and radial Mendelian randomization(MR)methods.RESULTS:Genetically predicted AF was found to be causally associated with the risk of MVD(odds ratio[OR]=1.001;95%confi dence interval[CI]:1.000-1.001;P=1.33×10-6)and mitral regurgitation(OR=1.001;95%CI:1.000-1.002;P=0.009).However,no signifi cant causal associations between AF and AVD were detected(OR=1.000;95%CI:0.999-1.000;P=0.804).Causal eff ects were still detected,even after adjusting for potential risk factors or removing the identifi ed outliers.Reverse MR analyses revealed no signifi cant causal eff ect of valvular heart disease on AF.CONCLUSION:Our findings demonstrate a positive causal association between AF,MVD,and mitral regurgitation,but not AVD.Further research and an aggressive AF management strategy should be explored as potential measures for preventing MVD.
文摘Group B Streptococcus(GBS;Streptococcus agalactiae)is a gram-positive coccus that colonizes the gastrointestinal and genital tracts in adults,as well as the upper respiratory tract in infants.While it has been thought that GBS only results in invasive disease in pregnant females and neonates,recent literature has suggested an increasing incidence of invasive GBS among non-pregnant individuals within the United States.
文摘Objectives To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC). Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdong cardiovascular institute between February 2001 and August 2002. Serial echocardiograms were performed in all patients at baseline, discharge and annually thereafter. Results Five-year follow-up rate was 97.1%. Five-year survival rate was 100%. Before and after PMMC and at follow-up, mean mitral valve area by two-dimensional echocardiography was (0.87±0.15) cm2, (2.11±0.38) cm2 and (1.81±0.36) cm2, respectively (P<0.01). Five-year mitral restenosis rate was 6.1%. Conclusion PMMC can achieve excellent and sustained long-term results in selected patients with mitral echocardiographic score exceeding or being equal to 9.
文摘The patient was admitted to OndokuzMay<span style="color:#4F4F4F;font-family:-apple-system, "font-size:16px;white-space:normal;background-color:#F7F7F7;">ı</span>s University Animal Hospital Internal Medicine outpatient clinic with complaints of epileptic seizures and hypothyroidism. A description of the patient’s owner is available in the history information. There was no physician information. Bradycardia was found in the electrocardiography of the patient.<span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "="">2-D, M-Mode, PW, CW and Color doppler examinations were performed. Left-ventricular hypokinetic and mitral and tricuspidal valve movements were observed with limited M-Mode imaging. Anterior mitral orifice of 2 mm width was detected on septal mitral valve by PW doppler and color doppler. With this orifice, the presence of regurgitant jet, which covers LA at a rate of 1/3 and was 3.2 m/sec, together with mitral regurgitation (0.5 m/sec.), was demonstrated. PISA calculations;VFR (mL/s), ERO (mm<sup>2</sup>) and RVol (mL/pulse) values </span></span></span><span><span><span style="font-family:;" "="">were calculated as if there were mitral regurgitation and data were obtained for mild-m</span></span></span><span><span><span style="font-family:;" "="">oderate mitral regurgitation. Therefore, no operative treatment of the orifice was recommended.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "="">Mitral valve orifice is a rare pathology and this is the first report in canine veterinary practice with degenerative mitral valve disorder. We aimed to underline the possibility of mitral orifice development in degenerative mitral valve disorders, known to present with vegetations and varying degrees of prolapsus, conventionally.</span></span></span>
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Percutaneous mitral balloon valvuloplasty is the main</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">procedure in mitral stenosis (MS). It can replace surgical commissurotomy in many cases;however, mitral regurgitation (MR) remains the major procedure complication.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">This study was conducted to investigate</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">predictors of MR as a complication following</span><b></b><span style="font-family:Verdana;">percutaneous mitral valvuloplasty (PMV) using multitrack balloon technique.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">This cohort study was conducted at both Menoufia University Hospital and Mabaret Misr Elkadima Hospital. We enrolled 121 patients with moderate to severe MS who were subjected to</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">PMV using multitrack balloon technique during the period from October 2017 to October 2019. Transthoracic echocardiographic evaluation was performed for all patients before and after the procedure. Patients who developed severe MR post procedure were compared with other patients to identify important distinction points.</span></span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Most patients (N = 109, </span><span style="font-family:;" "=""><span style="font-family:Verdana;">90.1%) developed no/mild MR (group A), whereas 12 (9.9%) patients developed severe MR (group B) after PMV. Those who developed severe MR had significantly higher weight, height, body mass index, and body surface area (P value < 0.001 for each). Also, there was a significant difference between both groups regarding pre-operative Wilkins score (8.7 ± 1.3 for severe MR versus 7.9 ± 1.2 for No/Mild MR, P = 0.046). Patients who developed severe MR had higher incidence of other valvular lesions such as mild aortic regurgitation (91.7% versus 36.7%, P < 0.001), higher mitral valve (MV) commissural calcification (50.0% versus 14.7%, P = 0.008), pre-operative MR (100.0% versus</span><a name="page2"></a><span style="font-family:Verdana;"> 35.8%, P < 0.001), higher prevalence of atrial fibrillation (100.0% versus 38.5%, P < 0.001). Regarding balloon sizing, it was significantly higher among patients who developed severe MR compared with those having mild or no MR (P = 0.001). Multivariate regression analysis identified MV balloon sizing (OR 3.877, CI 95% 1.131</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">13.289, P = 0.031) and MV commissural asymmetry of calcification (OR 67.48, CI 95% 5.759</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">790.72, P = 0.001) as significant predictors of outcomes of MV commissurotomy.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Mitral valve calcification, balloon sizing, and MV asymmetry are significant factors that can predict the development of MR after balloon valvuloplasty.</span>
文摘Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.
文摘Infective endocarditis (IE) is the infection of inner endothelial layer of the heart including the heart valves and it may present as rapidly progressive or manifest itself as subacute or chronic disease. The epidemiology of infective endocarditis has been changed over the past few decades and the incidence of IE in children in United States and Canada is 1 in 1250 pediatric hospital admissions in the early 1980s. At least 70% of infective endocarditis in children occurs with congenital heart disease whereas rheumatic heart disease in southern states of India and the degenerative mitral valve disease (myxomatous, mitral valve prolapse) in the western countries are the most underlying predisposing conditions to infective endocarditis in adolescents. The characteristic lesion of infective endocarditis is “vegetation” and a “large” vegetation >10 mm in size has been reported with an incidence of 15.9% - 62.5% in patients. The significance of vegetation size has been a subject of discussion for many years to predict the embolic episodes. Background of this case study illustrated the varying size and shape of giant vegetation attached to the anterior leaflet of mitral valve in an underlying rheumatic mitral valvulitis and its consequence of valve damage such as chordal rupture, flail leaflet and mitral regurgitation with a description of anatomic features and echocardiographic manifestations in a 10-year-old female child.
文摘As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population.Recent years have brought a progression of surgical treatments toward less invasive strategies.This has given rise to percutaneous approaches for the correction of valvular heart disease.Percutaneous mitral valve repair using the MitraClip system (Abbott Vascular,Santa Clara,CA,USA) creates a double orifice and has been successfully used in selected patients with mitral regurgitation.We review the rationale,procedural aspects,and clinical data thus far available for the MitraClip approach to mitral regurgitation.
文摘Plasma concentrations of endothelin in bloor from the femoral vein and the antecubital vein were measured in 35 patients with mitral stenosis and heart failure before and after percutaneous balloon mitralvalvuloplasty(PBMV). The basal plasma concentrations of endothelin in blood from the antecubirtal vein in the patients were significantly higher than those in 32 control subjects (15. 40± 3. 32 vs. 9. 59± 2. 66 pg/ml, P<0. 001). Plasma endothelin concentrations in patients in New York Heart Association functional classes Ⅱ and Ⅲ were significantly higher than those in control subjects, respectively. The concentrations of endothelin in patients with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm. Ten to fifteen minutes after PBMV, plasma endothelin concentrations in blood from the femoral vein significantly decreased from 16. 14 ± 3. 34 to 13. 74 ± 3. 78 pg/ml (P<0. 01 ). Seventy-two hours after the procedure, the concentrations of endothelin in blood from the antecubital vein had fallen to 12. 31 ± 2. 55 pg/ml (P<0. 001 vs. before PBMV and control subjects). Plasma endothelin concentrations still tended to be higher in patients with atrial fibrillation than those in normal sinus rhythm, but the difference did not reach statistical significance. There were weak but significantly correlations of plasma endothe lin concentrations with the mean left atrial pressure (r= 0. 424 , P < 0.001 ), mean right atrial pressure (r=0. 323, P<0. 01), mean transmitral pressure gradient (r= 0. 397, P<0. 001), heart rate (r= 0. 350,P<0. 005)and mitral valve area (r=-0. 454, P<0. 001) in the patients before and after PBMV.
文摘Functional mitral regurgitation is a common finding among heart failure patients with ischemic and non-ischemic dilated cardiomyopathies.The presence of moderate or severe mitral regurgitation is associated with higher morbidity and mortality.Heart failure patients meeting electrocardiogram and left ventricle function criteria are good candidates for cardiac resynchronization therapy,which may reduce the degree of functional mitral regurgitation in the short and long term,specifically targeting myocardial dyssynchrony and inducing left ventricle reverse remodeling.In this article,we analyze data from the literature about predictors of mitral regurgitation improvement after cardiac resynchronization therapy implantation.
基金This paper was supported by the National Key Research and Development Plan(2016YFC1101000)National Natural Science Foundation of China(81600240 and 81470500)The Distinguished Young Scholar Cultivation Project of Xijing Hospital(XJZT14J03,XJZT15ZL01,and 13QNP129)。
文摘Background This preclinical study in sheep sought to demonstrate the initial safety and feasibility of a novel transcatheter mitral valve system(Mi-thos valve)composed of a self-expanding frame and a bovine pericardial tissue bioprosthesis.Methods The valve was implanted in 26 sheep using a transapical approach for short-and long-term evaluation.The technical feasibility,safety,durability,and valve function were evaluated during and 6 months after the procedure using intracardiac and transthoracic echocardiography,multisliced computed tomography,histological analysis,and electron microscopy.Results The success rate of valve implantation was 100%,and the immediate survival rate after surgery was 84%.Five animals died within 90 min after the development of the prosthetic valve due to an acute left ventricular outflow tract obstruction(n=2)and sudden intraoperative ventricular fibrillation(n=3).Twelve animals died within 1 month due to acute left heart dysfunction.Mild(n=5)and moderate(n=2)paravalvular leakage occurred in seven animals,and two moderate PVL animals died of chronic heart failure within three months.Multimodality imaging studies of the remaining seven animals showed excellent function and alignment of the valves,with no coronary artery obstruction,no left ventricular outflow tract obstruction,no severe transvalvular gradients and no paravalvular leakage.Macroscopic evaluation demonstrated stable,secure positioning of the valve,with full endothelialization of the valve leaflets without injury to the ventricular or atrial walls.Histological and electron microscopic examinations at six months showed no obvious macro-or microcalcification in the leaflets.Conclusions Preclinical studies indicate that transcatheter implantation of the Mi-thos valve is technically safe and feasible.The durability,functionality,and lack of leaflet calcification were all verified in animal experiments.The information from these preclinical studies will be applied to patient selection criteria and the first-in-human studies.
文摘Many patients with left ventricular systolic dysfunction have concomitant mitral regurgitation(MR). Their symptoms and prognosis worsen with increasing severity of MR. Percutaneous Mitra Clip® can be used safely to reduce the severity of MR even in patients with advanced heart failure and is associated with improved symptoms, quality of life and exercise tolerance. However, a few patients with very poor left ventricular systolic function may experience significant haemodynamic disturbance in the peri-procedural period. We present three such patients, highlighting some of the potential problems encountered and discuss their possible pathophysiological mechanisms and safety measures.
文摘AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic severe MR who underwent Mitra Clip~?implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair.RESULTS The study population consisted of 46 consecutive patients(mean logistic Euro SCORE 32% ± 21%). The degree of MR decreased significantly(severe MR before Mitra Clip~? 100% vs after Mitra Clip~? 13%; P < 0.001),and the NYHA functional classes improved(NYHA III/IV before Mitra Clip~? 98% vs after Mitra Clip~? 35%; P < 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%,respectively. During the follow-up of 473 ± 274 d,11 patients died(90% due to cardiovascular death). A preprocedural plasma B-type natriuretic peptide level > 817 pg/m L was associated with all-cause mortality(hazard ratio,6.074; 95%CI: 1.257-29.239; P = 0.012).CONCLUSION Percutaneous mitral valve repair with Mitra Clip~? has positive effects on hemodynamics and symptoms. Despite the study patients' multiple comorbidities and extremely high operative risk,one-year outcomes after Mitra Clip~? are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival.
文摘Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction.Percutaneous mitral valve repair has become an appealing alternative approach for patients who are not suitable for surgery.However,clinical trial data are not available on the institutional impact of a percutaneous mitral valve repair program on mitral valve surgery.The current study retrospectively evaluated the impact of the MitraClip program on the mitral valve surgery volume and outcomes.Patient data were retrieved from the 2 years before and the 2 years after initiation of the MitraClip program.The volume of MitraClip procedures increased from eight cases in 2015 to 91 cases in 2017.Since the initiation of the MitraClip program in 2015,the volume of both mitral valve replacement and mitral valve repair also increased(43 vs.60 and 110 vs.154,respectively).Importantly,we observed improved surgical outcomes,including fewer perioperative complications and lower operative mortality and in-hospital mortality.Data from our single-institution experience indicate that the introduction of the MitraClip program is associated with increased mitral valve surgery volume and improved outcomes.The establishment of the MitraClip program enables the hospital to provide higher quality of care and potentially become a referring center for structural heart patients.
文摘Plasma dynorphin A1-13 levels were measured in 33 patients with mitral stenosis before and after percutaneous balloon mitral commissurotomy (PBMC). The results show that the basal levels of plasma dynorphin in blood from the antecubital vein in the patients were significantly higher than those in 31 healthy control subjects. The increase in circulating dynorphin closely correlated with the functional cardiac status and the presence of atrial fibrillation. Ten to fifteen minutes after PBMC, plasma dynorphin levels in blood from the femoral vein increased significantly. Seventy-two hours after the procedure, the levels of plasma dynorphin in blood from the antecubital vein had decreased significantly , but they did not decrease to the normal range. Plasma dynorphin levels in blood from the femoral vein were positively correlated with the mean left atrial pressure and the mean right atrial pressure before the first balloon inflation. Plasma dynorphin levels in blood from the antecubital vein were positively correlated with the heart rate and the mean transmitral pressure gradient, and negatively with the mitral valve area before and 72 hours after PBMC.
