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
Vocal cord paralysis that presents as hoarseness due to an underlying cardiovascular pathology is a rare clinical entity known as Ortner’s syndrome(OS).The syndrome was first described in 1897 by Norbert Ortner in a ...Vocal cord paralysis that presents as hoarseness due to an underlying cardiovascular pathology is a rare clinical entity known as Ortner’s syndrome(OS).The syndrome was first described in 1897 by Norbert Ortner in a report of three patients with severe mitral stenosis.[1]Notably,a review of published cases showed that between 1955 and 1990,mitral stenosis was the primary cause of OS.However,since the 1990s,vascular lesions(especially thoracic aortic aneurysms)have become the most common cause of OS.[2]This epidemiologic shift may be due to improved early detection and treatment of mitral stenosis.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
Cardiac papillary fibroelastoma is a benign heart tumor that,despite its histologically benign nature,can have devastating clinical consequences.Advances in cardiac imaging have made papillary fibroelastoma the most c...Cardiac papillary fibroelastoma is a benign heart tumor that,despite its histologically benign nature,can have devastating clinical consequences.Advances in cardiac imaging have made papillary fibroelastoma the most common primary benign tumor,surpassing cardiac myxoma.These tumors predominantly occur on the surface of heart valves,with the aortic valve being the most frequently affected(44%),followed by the mitral valve(35%)and other locations.Aortic fibroelastomas are the second most common primary cardiac tumor,known for their risk of embolic complications.Surgical excision is recommended for symptomatic lesions,but the management of small and asymptomatic fibroelastomas remains uncertain,particularly in elderly patients with comorbidities.[1-3].展开更多
Background:Enhancing the quality of images from retinal,MRI and echocardiography imaging shows promise with SR-GANs for medical imaging use.Using these networks,it is possible to produce high-quality images even from ...Background:Enhancing the quality of images from retinal,MRI and echocardiography imaging shows promise with SR-GANs for medical imaging use.Using these networks,it is possible to produce high-quality images even from low-quality medical scans.Methods:To do this,SR-GANs make use of growth from low to high resolutions in two 2×stages,multiple sizes of filters and powerful loss functions.The medical super-resolution network and denoising SR-GAN focus on problems such as image noise and artifacts to improve a photo’s stability,ability to extract features and how it looks.Results:Assessment by numbers has found that using SR-GAN-based approaches leads to marked improvements such as increases in the PSNR by up to 4.85 dB and improvements in the SSIM by between 0.04 and 0.05.Such improvements are better than traditional super-resolution methods which help doctors achieve clear images of the mitral valve in cardiac ultrasonography.Conclusion:It is anticipated that applying SR-GANs in clinical tasks will increase the accuracy of diagnoses,ease the workload for patients and widen the application of super-resolution methods in various medical procedures.The results prove that SR-GANs improve the picture quality of echocardiograms used for diagnosing mitral valve problems.Having proven the model in research settings,future studies should try to apply it to real-world clinical cases,test for its use across a range of imaging devices and perfect the system to ensure it is efficient for use in medical settings.展开更多
BACKGROUND Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality.The prevalence of at least moderate valvular heart disease is 2.5%across all ...BACKGROUND Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality.The prevalence of at least moderate valvular heart disease is 2.5%across all age groups,but its prevalence increases with age.Mitral regurgitation and aortic stenosis are the most frequent types of valvular heart disease in the community and hospital context,res-pectively.Surgical valve replacement(or mitral valve repair)is the standard of care for treating heart valve disease.However,the replacement of a prosthetic heart valve can lead to complications,either in the peri-procedural phase or in the long-term follow-up period.CASE SUMMARY We present a case of a 71-year-old female patient with a history of mitral valve replacement and warfarin anti-coagulation therapy.She was admitted to the intensive care unit due to spontaneously reperfused ischemic stroke of probable cardioembolic etiology.A dysfunctional mitral prosthesis was identified due to malfunction of one of the fixed discs.Furthermore,a possible microthrombotic lesion was suspected.Therefore,systemic thrombolysis was performed with subsequent normalization of mitral disc opening and closing.CONCLUSION This case underscores the critical importance of a multidisciplinary approach for timely decision-making in critically ill patients with prosthetic valve complications.展开更多
Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wid...Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wide strip of a third patch that is incorporated to the upper margin of the left side of the ventricular septal defect(VSD)patch.This third patch counteracts not only the valvular tissue loss caused by the suture bites but also the rightward displacement of the VSD patch in a bulged fashion that occurs with increased left ventricular pressure after weaning from cardiopulmonary bypass.This unfavorable outcome was addressed with the current technique through augmentation of the left-sided bridging leaflets serving to prevent the separation of them from their corresponding mural leaflets.The concept was applied in two cases with Down syndrome aged 5 months and 6 months,respectively,as a rescue procedure in the same session just after a failed cAVSD repair.Since the immediate-and short-term outcomes of the atrioventricular valves in regard to regurgitation are satisfying,we believe that the technique proposed herein holds promise for the future in terms of tackling residual atrioventricular valve regurgitation.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
Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due t...Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due to mitral chordae rupture.Trauma patients may also have other potential pre-diagnoses that could explain symptoms related to heart failure,such as tachycardia,circulatory shock,and acute hypoxemia.The possibility of traumatic chordae tendinea rupture being a preventable cause of mortality should be carefully evaluated.展开更多
The olfactory bulb(OB)is the first relay station in the olfactory system and functions as a crucial hub.It can represent odor information precisely and accurately in an ever-changing environment.As the only output neu...The olfactory bulb(OB)is the first relay station in the olfactory system and functions as a crucial hub.It can represent odor information precisely and accurately in an ever-changing environment.As the only output neurons in the OB,mitral/tufted cells encode information such as odor identity and concentration.Recently,the neural strategies and mechanisms underlying odor representation and encoding in the OB have been investigated extensively.Here we review the main progress on this topic.We first review the neurons and circuits involved in odor representation,including the different cell types in the OB and the neural circuits within and beyond the OB.We will then discuss how two different coding strategies—spatial coding and temporal coding—work in the rodent OB.Finally,we discuss potential future directions for this research topic.Overall,this review provides a comprehensive description of our current understanding of how odor information is represented and encoded by mitral/tufted cells in the OB.展开更多
BACKGROUND Mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral regurgitation.Achieving precise measurements of artificial chordae tendineae length(CL)i...BACKGROUND Mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral regurgitation.Achieving precise measurements of artificial chordae tendineae length(CL)is an important factor in the procedure;however,no objective index currently exists to facilitate this measurement.Therefore,preoperative assessment of CL is critical for surgical planning and support.Four-dimensional x-ray micro-computed tomography(4D-CT)may be useful for accurate CL measurement considering that it allows for dynamic three-dimensional(3D)evaluation compared to that with transthoracic echocardiography,a conventional inspection method.AIM To investigate the behavior and length of mitral chordae tendineae during systole using 4D-CT.METHODS Eleven adults aged>70 years without mitral valve disease were evaluated.A 64-slice CT scanner was used to capture 20 phases in the cardiac cycle in electrocardiographic synchronization.The length of the primary chordae tendineae was measured from early systole to early diastole using the 3D image.The primary chordae tendineae originating from the anterior papillary muscle and attached to the A1-2 region and those from the posterior papillary muscle and attached to the A2-3 region were designated as cA and cP,respectively.The behavior and maximum lengths[cA(ma),cP(max)]were compared,and the correlation with body surface area(BSA)was evaluated.RESULTS In all cases,the mitral anterior leaflet chordae tendineae could be measured.In most cases,the cA and cP chordae tendineae could be measured visually.The mean cA(max)and cP(max)were 20.2 mm±1.95 mm and 23.5 mm±4.06 mm,respectively.cP(max)was significantly longer.The correlation coefficients(r)with BSA were 0.60 and 0.78 for cA(max)and cP(max),respectively.Both cA and cP exhibited constant variation in CL during systole,with a maximum 1.16-fold increase in cA and a 1.23-fold increase in cP from early to mid-systole.For cP,CL reached a plateau at 15%and remained elongated until end-systole,whereas for cA,after peaking at 15%,CL shortened slightly and then moved toward its peak again as end-systole approached.CONCLUSION The study suggests that 4D-CT is a valuable tool for accurate measurement of both the length and behavior of chordae tendineae within the anterior leaflet of the mitral valve.展开更多
BACKGROUND Unroofed coronary sinus(UCS)is a rare subtype of atrial septal defect.It is frequently associated with a persistent left superior vena cava and is often part of a more intricate cardiac malformation.CASE SU...BACKGROUND Unroofed coronary sinus(UCS)is a rare subtype of atrial septal defect.It is frequently associated with a persistent left superior vena cava and is often part of a more intricate cardiac malformation.CASE SUMMARY This report describes a rare case of an adolescent patient with UCS featuring atrial situs solitus,absence of the right superior vena cava and a persistent left superior vena cava draining into the left atrium consistent with total unroofing of the coronary sinus.This was associated with concurrent severe mitral insufficiency secondary to redundant and prolapsing leaflets,and a substantial left-to-right shunt across the coronary sinus orifice.A comprehensive examination of the existing literature is included,shedding light on the diagnostic challenges of UCS and describing the available surgical options within the context of mitral valve surgery.CONCLUSION UCS is a complex condition requiring careful consideration of associated anomalies and a tailored surgical approach.展开更多
Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAP...Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.展开更多
Granulicatella adiacens (G. adiacens), formerly classified as a nutritionally variant streptococci (NVS), is a commensal organism in the mouth. It is known to be a rare cause of infective endocarditis (IE). This case ...Granulicatella adiacens (G. adiacens), formerly classified as a nutritionally variant streptococci (NVS), is a commensal organism in the mouth. It is known to be a rare cause of infective endocarditis (IE). This case report presents a case of IE caused by G. adiacens in a 63-year-old man with mitral valve prolapse (MVP), severe mitral regurgitation (MR), and dual vessel disease (DVD). G. adiacens was isolated from two of three blood cultures, and the organism was sensitive to penicillin, vancomycin, cefotaxime, and gentamicin. He was successfully treated with a combination of ceftriaxone and gentamicin. Prompt identification of the organism and determination of antibiotic sensitivity pattern led to successful treatment. This case report showcases the challenges in diagnosis, and treatment, giving insight to healthcare providers on a rare entity.展开更多
Transcatheter aortic valve implantation(TAVI)has emerged as the primary treatment strategy for severe symptomatic aortic stenosis(AS)in the older population(>75 years of age)with high-risk surgical profiles[1].
Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we ...Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.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]
文摘Vocal cord paralysis that presents as hoarseness due to an underlying cardiovascular pathology is a rare clinical entity known as Ortner’s syndrome(OS).The syndrome was first described in 1897 by Norbert Ortner in a report of three patients with severe mitral stenosis.[1]Notably,a review of published cases showed that between 1955 and 1990,mitral stenosis was the primary cause of OS.However,since the 1990s,vascular lesions(especially thoracic aortic aneurysms)have become the most common cause of OS.[2]This epidemiologic shift may be due to improved early detection and treatment of mitral stenosis.
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.
文摘Cardiac papillary fibroelastoma is a benign heart tumor that,despite its histologically benign nature,can have devastating clinical consequences.Advances in cardiac imaging have made papillary fibroelastoma the most common primary benign tumor,surpassing cardiac myxoma.These tumors predominantly occur on the surface of heart valves,with the aortic valve being the most frequently affected(44%),followed by the mitral valve(35%)and other locations.Aortic fibroelastomas are the second most common primary cardiac tumor,known for their risk of embolic complications.Surgical excision is recommended for symptomatic lesions,but the management of small and asymptomatic fibroelastomas remains uncertain,particularly in elderly patients with comorbidities.[1-3].
文摘Background:Enhancing the quality of images from retinal,MRI and echocardiography imaging shows promise with SR-GANs for medical imaging use.Using these networks,it is possible to produce high-quality images even from low-quality medical scans.Methods:To do this,SR-GANs make use of growth from low to high resolutions in two 2×stages,multiple sizes of filters and powerful loss functions.The medical super-resolution network and denoising SR-GAN focus on problems such as image noise and artifacts to improve a photo’s stability,ability to extract features and how it looks.Results:Assessment by numbers has found that using SR-GAN-based approaches leads to marked improvements such as increases in the PSNR by up to 4.85 dB and improvements in the SSIM by between 0.04 and 0.05.Such improvements are better than traditional super-resolution methods which help doctors achieve clear images of the mitral valve in cardiac ultrasonography.Conclusion:It is anticipated that applying SR-GANs in clinical tasks will increase the accuracy of diagnoses,ease the workload for patients and widen the application of super-resolution methods in various medical procedures.The results prove that SR-GANs improve the picture quality of echocardiograms used for diagnosing mitral valve problems.Having proven the model in research settings,future studies should try to apply it to real-world clinical cases,test for its use across a range of imaging devices and perfect the system to ensure it is efficient for use in medical settings.
文摘BACKGROUND Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality.The prevalence of at least moderate valvular heart disease is 2.5%across all age groups,but its prevalence increases with age.Mitral regurgitation and aortic stenosis are the most frequent types of valvular heart disease in the community and hospital context,res-pectively.Surgical valve replacement(or mitral valve repair)is the standard of care for treating heart valve disease.However,the replacement of a prosthetic heart valve can lead to complications,either in the peri-procedural phase or in the long-term follow-up period.CASE SUMMARY We present a case of a 71-year-old female patient with a history of mitral valve replacement and warfarin anti-coagulation therapy.She was admitted to the intensive care unit due to spontaneously reperfused ischemic stroke of probable cardioembolic etiology.A dysfunctional mitral prosthesis was identified due to malfunction of one of the fixed discs.Furthermore,a possible microthrombotic lesion was suspected.Therefore,systemic thrombolysis was performed with subsequent normalization of mitral disc opening and closing.CONCLUSION This case underscores the critical importance of a multidisciplinary approach for timely decision-making in critically ill patients with prosthetic valve complications.
文摘Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wide strip of a third patch that is incorporated to the upper margin of the left side of the ventricular septal defect(VSD)patch.This third patch counteracts not only the valvular tissue loss caused by the suture bites but also the rightward displacement of the VSD patch in a bulged fashion that occurs with increased left ventricular pressure after weaning from cardiopulmonary bypass.This unfavorable outcome was addressed with the current technique through augmentation of the left-sided bridging leaflets serving to prevent the separation of them from their corresponding mural leaflets.The concept was applied in two cases with Down syndrome aged 5 months and 6 months,respectively,as a rescue procedure in the same session just after a failed cAVSD repair.Since the immediate-and short-term outcomes of the atrioventricular valves in regard to regurgitation are satisfying,we believe that the technique proposed herein holds promise for the future in terms of tackling residual atrioventricular valve regurgitation.
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Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due to mitral chordae rupture.Trauma patients may also have other potential pre-diagnoses that could explain symptoms related to heart failure,such as tachycardia,circulatory shock,and acute hypoxemia.The possibility of traumatic chordae tendinea rupture being a preventable cause of mortality should be carefully evaluated.
基金supported by the National Natural Science Foundation of China(Nos.32271055 and 32070995)the Jiangsu Province Innovative and Entrepreneurial Team Program,and the Guangdong Medical University(No.GDMUB2022048),China.
文摘The olfactory bulb(OB)is the first relay station in the olfactory system and functions as a crucial hub.It can represent odor information precisely and accurately in an ever-changing environment.As the only output neurons in the OB,mitral/tufted cells encode information such as odor identity and concentration.Recently,the neural strategies and mechanisms underlying odor representation and encoding in the OB have been investigated extensively.Here we review the main progress on this topic.We first review the neurons and circuits involved in odor representation,including the different cell types in the OB and the neural circuits within and beyond the OB.We will then discuss how two different coding strategies—spatial coding and temporal coding—work in the rodent OB.Finally,we discuss potential future directions for this research topic.Overall,this review provides a comprehensive description of our current understanding of how odor information is represented and encoded by mitral/tufted cells in the OB.
文摘BACKGROUND Mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral regurgitation.Achieving precise measurements of artificial chordae tendineae length(CL)is an important factor in the procedure;however,no objective index currently exists to facilitate this measurement.Therefore,preoperative assessment of CL is critical for surgical planning and support.Four-dimensional x-ray micro-computed tomography(4D-CT)may be useful for accurate CL measurement considering that it allows for dynamic three-dimensional(3D)evaluation compared to that with transthoracic echocardiography,a conventional inspection method.AIM To investigate the behavior and length of mitral chordae tendineae during systole using 4D-CT.METHODS Eleven adults aged>70 years without mitral valve disease were evaluated.A 64-slice CT scanner was used to capture 20 phases in the cardiac cycle in electrocardiographic synchronization.The length of the primary chordae tendineae was measured from early systole to early diastole using the 3D image.The primary chordae tendineae originating from the anterior papillary muscle and attached to the A1-2 region and those from the posterior papillary muscle and attached to the A2-3 region were designated as cA and cP,respectively.The behavior and maximum lengths[cA(ma),cP(max)]were compared,and the correlation with body surface area(BSA)was evaluated.RESULTS In all cases,the mitral anterior leaflet chordae tendineae could be measured.In most cases,the cA and cP chordae tendineae could be measured visually.The mean cA(max)and cP(max)were 20.2 mm±1.95 mm and 23.5 mm±4.06 mm,respectively.cP(max)was significantly longer.The correlation coefficients(r)with BSA were 0.60 and 0.78 for cA(max)and cP(max),respectively.Both cA and cP exhibited constant variation in CL during systole,with a maximum 1.16-fold increase in cA and a 1.23-fold increase in cP from early to mid-systole.For cP,CL reached a plateau at 15%and remained elongated until end-systole,whereas for cA,after peaking at 15%,CL shortened slightly and then moved toward its peak again as end-systole approached.CONCLUSION The study suggests that 4D-CT is a valuable tool for accurate measurement of both the length and behavior of chordae tendineae within the anterior leaflet of the mitral valve.
文摘BACKGROUND Unroofed coronary sinus(UCS)is a rare subtype of atrial septal defect.It is frequently associated with a persistent left superior vena cava and is often part of a more intricate cardiac malformation.CASE SUMMARY This report describes a rare case of an adolescent patient with UCS featuring atrial situs solitus,absence of the right superior vena cava and a persistent left superior vena cava draining into the left atrium consistent with total unroofing of the coronary sinus.This was associated with concurrent severe mitral insufficiency secondary to redundant and prolapsing leaflets,and a substantial left-to-right shunt across the coronary sinus orifice.A comprehensive examination of the existing literature is included,shedding light on the diagnostic challenges of UCS and describing the available surgical options within the context of mitral valve surgery.CONCLUSION UCS is a complex condition requiring careful consideration of associated anomalies and a tailored surgical approach.
文摘Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.
文摘Granulicatella adiacens (G. adiacens), formerly classified as a nutritionally variant streptococci (NVS), is a commensal organism in the mouth. It is known to be a rare cause of infective endocarditis (IE). This case report presents a case of IE caused by G. adiacens in a 63-year-old man with mitral valve prolapse (MVP), severe mitral regurgitation (MR), and dual vessel disease (DVD). G. adiacens was isolated from two of three blood cultures, and the organism was sensitive to penicillin, vancomycin, cefotaxime, and gentamicin. He was successfully treated with a combination of ceftriaxone and gentamicin. Prompt identification of the organism and determination of antibiotic sensitivity pattern led to successful treatment. This case report showcases the challenges in diagnosis, and treatment, giving insight to healthcare providers on a rare entity.
文摘Transcatheter aortic valve implantation(TAVI)has emerged as the primary treatment strategy for severe symptomatic aortic stenosis(AS)in the older population(>75 years of age)with high-risk surgical profiles[1].
文摘Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.
