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
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
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
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
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
The purpose of this article is to detect sex and age difference in the structure of the olfactory bulb in dogs by histological methods. The thickness of the olfactory bulbs layers and its main cells were analyzed comp...The purpose of this article is to detect sex and age difference in the structure of the olfactory bulb in dogs by histological methods. The thickness of the olfactory bulbs layers and its main cells were analyzed comparatively with the methods of HE-staining and statistics, through which we studied the development course of dogs＇ olfactory bulb and the structural differences which affect the olfaction in both males and females. The results showed that between both male and female juveniles and adult males and females, the difference in thickness of each layer is not significant. But the difference in quantity of mitral cells between adult males and females was significant. Meanwhile, the structure of every layer in juvenile dogs was apparent while the volume and the weight of adult dogs＇ olfactory bulb and each layer＇s width increased significantly. On the other hand, the density of each layer＇s cells decreased apparently. Our results demonstrated that the olfactory bulb developed with age, and the apparent differences in morphology and quantity of mitral cells between males and females may be one of the reasons leading to the sexual variations of olfactory sensitivity.展开更多
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.
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.
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.
基金National Natural Science Foundation of China (30370218)Shan-dong Science Fund for Distinguished Young Scholars(2005BS02005)Science Foundation for Excellent Scholars of Ministry of Education of China (NCET-07-0507)
文摘The purpose of this article is to detect sex and age difference in the structure of the olfactory bulb in dogs by histological methods. The thickness of the olfactory bulbs layers and its main cells were analyzed comparatively with the methods of HE-staining and statistics, through which we studied the development course of dogs＇ olfactory bulb and the structural differences which affect the olfaction in both males and females. The results showed that between both male and female juveniles and adult males and females, the difference in thickness of each layer is not significant. But the difference in quantity of mitral cells between adult males and females was significant. Meanwhile, the structure of every layer in juvenile dogs was apparent while the volume and the weight of adult dogs＇ olfactory bulb and each layer＇s width increased significantly. On the other hand, the density of each layer＇s cells decreased apparently. Our results demonstrated that the olfactory bulb developed with age, and the apparent differences in morphology and quantity of mitral cells between males and females may be one of the reasons leading to the sexual variations of olfactory sensitivity.
