scholarly journals 746 Assessment of intracardiac fluid-dynamics of patients with aortic stenosis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Jolanda Sabatino ◽  
Isabella Leo ◽  
Antonio Strangio ◽  
Sabrina La Bella ◽  
Marco Maglione ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Aortic Stenosis ◽  
Clinical Setting ◽  
Flow Dynamics ◽  
Paravalvular Leak ◽  
Quantitative Indices ◽  
Significant Difference ◽  
Technological Developments ◽  
Intracardiac Flow ◽  
Echocardiographic Assessment

Abstract Aims Recent technological developments enabled visualization of intracardiac flow patterns. This study aims to evaluate intracardiac flow dynamics of patients with aortic stenosis (AS). Methods and results Sixty-one patients with severe AS and 38 healthy sex- and BSA-matched controls (CTRL) were prospectively included. Standard echocardiographic assessment was performed in all patients. Fluid dynamics were evaluated using the HyperDoppler software to measure vortex area (VA), vortex length (VL), and vortex depth (VD). The assessment of VA, VL, and VD was feasible and reliable, as the inter-rater variability (ICCs) were very good for VA (0.878, P = 0.033), VL (0.960, P = 0.004), and VD (0.905, P = 0.021). Mean VA, VL, and VD (P = 0.033, P = 0.026, and P > 0.001, respectively) were significantly larger in AS patients compared with CTRL. A significant difference in the delta values of VA and VL, reflecting their change from before to after TAVI, was observed in patients with and without significant paravalvular leak. Conclusions The newly developed quantitative indices of flow dynamics, namely VA, VL, and VD, were significantly increased in the LV of patients with severe AS compared to controls and their measurement was feasible and reliable in a clinical setting.

scholarly journals Assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Strangio ◽  
J Sabatino ◽  
I Leo ◽  
M Maglione ◽  
F Troilo ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Left Ventricular ◽  
Flow Dynamics ◽  
Vortical Flow ◽  
Paravalvular Leak ◽  
Vortex Center ◽  
Aortic Valve Area ◽  
Longitudinal Length ◽  
Significant Difference ◽  
Intracardiac Flow

Abstract Background Assessment of intracardiac flows and turbulence has acquired rising significance in the past few years, due to the development and introduction of technologies for non-invasive cardiovascular imaging. Recent studies have shown that alterations in intracardiac fluid dynamics can be helpful to identify abnormalities in cardiac function. Purpose This study investigates the additional information provided by the quantitative assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis (AS), by using an advanced echocardiography vortex-based approach. Methods Sixty-one patients with severe AS (33 females) and 38 healthy sex- and BSA-matched controls (CTRL) (15 females) were prospectively included and underwent echocardiographic assessment of intracardiac flow dynamics. Echocardiographic measurements were performed on apical three chamber views. The HyperDoppler software adapted to the echo-scanner without contrast injection was used to assess intracardiac vortex properties. The following parameters were obtained: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex center from the LV base relative to the total LV long axis). Inter-rater variability was measured using intraclass correlation coefficients (ICCs) between two independent operators. Results Patients with severe AS (mean gradient: 47,5±13,9 mmHg; aortic valve area: 0.7±0.2 cm2; ejection fraction: 53±7%) had increased LV wall thickness (p<0.001) and mass index (p<0.001) compared with controls. Greater indexed left atrial volume (p<0.001), E/e' (p<0.001) and trans-tricuspid gradient (p<0.001) were also observed in the AS group. The assessment of VA, VL and VD was feasible in the whole population. Their calculation was reliable, as ICCs were very good for VA (0.878, p=0.033), VL (0.960, p=0.004) and VD (0,905, p=0.021). Mean VA was significantly larger in patients with severe aortic stenosis compared with CTRL (p=0.033). VL and VD (p=0.026 and p>0.001, respectively) were significantly higher in AS patients compared with CTRL. Among those who underwent TAVR, we observed a significant difference in the delta values of VA and VL pre-postTAVR in patients with and without significant paravalvular leak (p<0.05). Conclusions The newly defined VA, VL and VD, quantitative indices of vortical flow, were significantly increased in the LV cavity of patients with severe AS compared to normal subjects. These indices, whose measurement was feasible and reliable, might provide complementary information to standard echocardiography, useful for the further diagnostic and prognostic characterization of the heterogeneous population of patients with severe AS. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals The Effect of Smart Boards on the Cognition and Motivation of Students

2017 ◽  
Vol 7 (1) ◽  
pp. 60 ◽  
Author(s):  
Nitza Davidovitch ◽  
Roman Yavich
Keyword(s):  
Sixth Grade ◽  
Research Literature ◽  
General Level ◽  
Significant Finding ◽  
Level Of Satisfaction ◽  
Significant Difference ◽  
Technological Developments ◽  
Research Findings ◽  
Measure Change ◽  
Smart Boards

In recent years the research literature has explored technological developments in varied areas that measure change. The current study focuses on the smart board, and its purpose is to examine its effect on the school system. The study was conducted via a questionnaire completed by 130 respondents (boys and girls) in the fifth and sixth grades of two elementary schools in Jerusalem—Efrata and Tali Gilo. Smart boards were introduced in these two schools in recent years.We hypothesized that smart boards improve teaching, based on the teaching measures developed by Nira Hativa of Tel Aviv University: order and organization, level of clarity, interest, and general level of satisfaction. The study’s significant finding is that the greatest improvement since the introduction of smart boards is in the variable of clarity, and a significant difference was found in the favor of sixth grade students. Additionally, a significant difference was found in the variable of interest, in favor of the girls. All four variables appear to be interrelated, and each contributes to the student’s success and to improving the student’s learning process.The research findings illuminate the contribution of technology to teaching, through a case study of smart boards, in the dimension of clarity, found by the study to be a significant criterion of good teaching. Examination of the various technological tools in light of their contribution to the research-proven dimensions of outstanding teaching might enhance the pedagogical contribution of technological developments to teaching.

scholarly journals Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Charbel Abi Khalil ◽  
Barbara Ignatiuk ◽  
Guliz Erdem ◽  
Hiam Chemaitelly ◽  
Fabio Barilli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Randomized Clinical Trials ◽  
Severe Aortic Stenosis ◽  
Paravalvular Leak ◽  
Effective Orifice Area ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Heart Valve

AbstractTranscatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51–0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73–0.38]) in gradient and an increase of 0.47 (95% CI [0.38–0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12–0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53–16.46]). All results were sustainable at 2 years.

scholarly journals Echocardiographic Assessment of Cardiac Structural and Functional Indices in Broiler Chickens Treated with Silver Nanoparticles

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Hamid Raieszadeh ◽  
Vahid Noaman ◽  
Mehrdad Yadegari
Keyword(s):  
Broiler Chickens ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Internal Diameter ◽  
Treatment Groups ◽  
Randomized Design ◽  
Linear Probe ◽  
Significant Difference ◽  
Echocardiographic Assessment ◽  
Fractional Shortening

270 Ross broiler chickens of twenty days old were housed in 18-floor pens in a completely randomized design with six treatment groups and three replicate groups and fifteen chicks per each pen. The treatment groups (1–6) consisted of 0, 10, 20, 30, 50, and 70 ppm of nanocide in drinking water, respectively. At 26 days of age, 3 chickens were selected randomly for echocardiography using a 7.5 MHz linear probe, and the left ventricular internal diameter at the end of diastole (LVIDd), left ventricular internal diameter at the end of systole (LVIDs), left ventricular fractional shortening (LVFS), ejection fraction (EF), stroke volume (SV), interventricular septum thickness at the end of systole (IVSTs), and interventricular septum thickness at the end of diastole (IVSTd) were evaluated. LVIDd and LVIDs in group six were of higher rate than other groups and showed statistically significant differences with groups two, three, and four (P<0.05). LVFS, percentage of EF, and IVSTd were minimum in group six and had significant difference with other groups (P<0.05). The results of this study showed that prescription of high dosage of nanocide leads to cardiovascular problems with decrease in myocardial contractility and increase in the internal diameter of left ventricle.

scholarly journals Sequential Coordination between Lingual and Pharyngeal Pressures Produced during Dry Swallowing

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Jitsuro Yano ◽  
Yoichiro Aoyagi ◽  
Takahiro Ono ◽  
Kazuhiro Hori ◽  
Wakami Yamaguchi ◽  
...  
Keyword(s):  
Strong Correlation ◽  
Healthy Subjects ◽  
Hard Palate ◽  
Flow Dynamics ◽  
Tongue Pressure ◽  
Pressure Flow ◽  
Measuring Point ◽  
Pharyngeal Pressure ◽  
Median Part ◽  
Significant Difference

The aim of this study was to investigate oropharyngeal pressure flow dynamics during dry swallowing in ten healthy subjects. Tongue pressure (TP) was measured using a sensor sheet system with five measuring points on the hard palate, and pharyngeal pressure (PP) was measured using a manometric catheter with four measuring points. The order and correlations of sequential events, such as onset, peak, and offset times of pressure production, at each pressure measuring point were analyzed on the synchronized waveforms. Onset of TP was earlier than that of PP. The peak of TP did not show significant differences with the onset of PP, and it was earlier than that of PP. There was no significant difference between the offset of TP and PP. The onset of PP was temporally time-locked to the peak of TP, and there was an especially strong correlation between the onset of PP and TP at the posterior-median part on the hard palate. The offset of PP was temporally time-locked to that of TP. These results could be interpreted as providing an explanation for the generation of oropharyngeal pressure flow to ensure efficient bolus transport and safe swallowing.

scholarly journals Technology Integrated in Interactive Entrepreneurship Activity to Enhance Students Mastery in Mathematics Concept for Active Mathematics Teaching

2020 ◽  
Vol 8 (6) ◽  
pp. 250-255
Keyword(s):  
Learning Strategies ◽  
Learning Strategy ◽  
Positive Impact ◽  
Mathematics Learning ◽  
Treatment Session ◽  
Learning Activity ◽  
Control Group ◽  
Significant Difference ◽  
Technological Developments ◽  
The Impact

This study aims to examine the effectiveness of interactive entrepreneurship activity in mathematics learning towards students’ mastery in mathematics concepts. The objective is to look at the impact of implementing an active learning strategy combined with technology on mastery of mathematics concepts after engaging in a learning activity. The combination of technology in interactive learning and games kits in the form of interactive entrepreneurship activity has resulted in the innovation of learning strategies to enhance the learning interest, enjoyment and to influence the mastery of students' mathematics concepts. The effectiveness study of the strategy was conducted using an experimental study design that involved 109 students from 2 secondary schools who had participated in a 4-week mathematics learning treatment session. The experiment group was exposed to interactive entrepreneurship activity through the use of a learning kit while the control group followed conventional learning for a selected mathematics topic. Post-test were conducted to see differences in understanding and achievement of mathematics concepts for both groups of students. The results show that there is a significant difference between the mastery of mathematics concept of the experiment group students and the control group students. This shows that the integration of technology in learning activities has a positive impact on student learning. The implications of the study indicate that teachers need to constantly improve pedagogical knowledge based on current technological developments and improve teaching strategies in order to improve student competencies. The parties also need to provide the latest technology to improve the quality of education in line with global developments.

Abstract TP146: Impaired Acute Collateral Flow Dynamics Experimental Stroke In Type 2 Diabetic Mice

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yosuke Akamatsu ◽  
Chih C Lee ◽  
Ruikang K Wang ◽  
Jialing Liu
Keyword(s):  
Blood Flow ◽  
Neurologic Deficit ◽  
Flow Dynamics ◽  
Collateral Flow ◽  
Doppler Flowmetry ◽  
Collateral Arteries ◽  
Significant Difference ◽  
Blood Flow Dynamics ◽  
Collateral Vessels

Introduction: Type 2 diabetes mellitus (T2DM) is a major risk factor for stroke, yet it is unclear whether T2DM associated-poor outcome after stroke is related to unfavorable cerebral blood flow dynamics. The current study aimed to investigate the effect of T2DM on acute blood flow dynamics and stroke outcome. Methood: Adult male db/db and db/+ mice (8-9 weeks of age) were subjected to permanent distal middle cerebral artery occlusion (pMCAo). Neurologic deficit was assessed with a 5-point scoring system (0 to 4) and infarction volume was determined at 48 hours after pMCAo by TTC staining. Hemodynamics was evaluated by laser doppler flowmetry. The number of connecting collateral vessels, functional microvascular network morphology, and vessel area density of the ischemic hemisphere were determined by DiI-labeling, and optical coherence tomography (OCT), respectively. Results: db/db mice had a higher baseline blood glucose level (341±39.7 vs. 172±26.5 mg/dl, p <0.01) and a larger infarct volume after pMCAO compared to db/+ mice (69.5±5.4 vs. 51.0±3.1 mm 3 , p <0.01). Neurologic deficit did not differ between groups at 2 hours after pMCAO, but was significantly worse in the db/db at 24 hours after pMCAo compared to db/+ mice (1.9±0.1 vs. 1.4±0.2, p <0.05), correlated with lower rCBF in the core of the MCA territory at 24 and 48 hours (10.9%±1.1 vs. 14.4%±0.8, p <0.05 and 9.5%±1.0 vs. 14.1%±1.2, p =0.01). Ipsilateral functional microvascular density as detected by OCT did not differ between groups at one hour after occlusion but was significantly lower in the db/db mice at 24 hr after pMCAo ( p <0.05). However, we did not observe a significant difference in the number of connecting collateral arteries between groups at 48 hours after pMCAo in this age group. Conclusion: Our results demonstrate that T2DM is associated with lower rCBF and lower density of functional blood vessels during the acute phase of pMCAo, which might in part, contribute to the observed worse outcome in the db/db mice. Ongoing experiments will investigate whether T2DM affects the flow dynamics in individual collateral following MCA occlusion and outward remodeling of the collateral vessels.

P6508Percutaneous versus surgical paravalvular leak: a ten-year tertiary centre experience

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Sa Mendes ◽  
R Teles ◽  
J Neves ◽  
M Trabulo ◽  
M Almeida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Open Heart Surgery ◽  
Percutaneous Closure ◽  
Paravalvular Leak ◽  
P Value ◽  
Percutaneous Technique ◽  
High Risk Population ◽  
Heart Team ◽  
Technical Success ◽  
Significant Difference

Abstract Aims Paravalvular leak (PVL) presents an incidence ranging from 2–17%. Open heart surgery is considered the standard treatment and there is no consensus regarding the role of percutaneous closure of non-endocarditis PVL. Methods Single-centre retrospective study including consecutive patients that had their PVL closed percutaneously or by surgery, after heart team agreement, between 2007 and 2018. The primary goal was to assess mortality and rehospitalizations. The secondary goals were: a) the technical success, defined as reduction in regurgitation [≥1 degree] and b) clinic and laboratorial improvement. Results Forty-eight patients were included (mean age of 66±13 years, 56% male), 12 submitted to percutaneous closure and 36 to surgery (74 vs 65 years, p=0,026, respectively), with similar gender distribution. 56% had an aortic PVL, with the remainder having a mitral leak, with no difference between groups. The indications were heart failure in 91% and haemolytic anaemia in 42%. A combination of both indications and NYHA heart failure functional class ≥ III were higher in percutaneous group. The severity of leak was comparable in both groups. Patients treated percutaneously had a significant higher rate of atrial fibrillation (92% vs 42%), COPD (33% vs 3%), peripheral artery disease (58% vs 22%) and higher EuroScore II (13,1% [7,1 - 19,0 CI 95%] vs 4,1 [2,9 - 6,5 CI 95%], p=0,003). There was no significant difference between groups with respect to all- cause mortality at 6 months, and to cardiovascular (CV) mortality and CV rehospitalization at 1-year follow-up. The technical success was lower in percutaneous group, but clinic and laboratorial results did not differ (table). Primary and secondary [(a) tecnical success (b) clinical and laboratorial improvements] endpoints of percutaneous vs surgery paravalvular leak closure Percutaneous PVL closure Surgical PVL Closure p-value Mortality @ 6 M 17% 25% p=1.000 CV Mortality @ 12 M 25% 31% p=1.000 Rehospitalization @ 12 M 18% 21% p=0.694 Technical success (a) 75% 97% p=0.043 NYHA improvement (b) 70% 71% p=0.171 Hb improvement (b) mean Δ: 1.2±1.1 g/dl mean Δ: 1.3±2.5 g/dl p=0.737 LDH reduction (b) mean Δ: −682±828 U/L mean Δ: −473±1215 U/L p=0.577 Conclusions In this high-risk population, clinical and laboratorial improvement was achieved by both methods. The percutaneous technique seems more appropriate for patients with higher risk, despite a lower technical success in the reduction of the severity of the leak.

scholarly journals Percutaneous Valvular Closure Followed by TAV-in-TAV Intervention during a Single Procedure in order to Treat a Severe Paravalvular Leak after Performing TAVI in a Bicuspid Aortic Stenosis

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Georgios Tzimas ◽  
Eric Eeckhout ◽  
Panagiotis Antiochos ◽  
Christan Roguelov ◽  
Stephane Fournier ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Paravalvular Leak ◽  
Haemodynamic Instability ◽  
Single Procedure ◽  
Transcatheter Aortic Valve ◽  
First Case ◽  
Effective Reduction ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

In an era where transcatheter aortic valve implantation (TAVI) indications and utilization are expanding beyond high-risk patients, paravalvular leak remains the intervention’s Achilles heel. Effective reduction of paravalvular leak is important in order to ensure an optimal clinical outcome. We present here the first case report in which percutaneous valvular closure using Amplatzer plugs followed by a TAV-in-TAV intervention during the same procedure managed to resolve a severe paravalvular leak with haemodynamic instability, after TAVI for a bicuspid aortic stenosis.

scholarly journals Infective Endocarditis After Surgical and Transcatheter Aortic Valve Replacement: A State of the Art Review

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
Sophia L. Alexis ◽  
Aaqib H. Malik ◽  
Isaac George ◽  
Rebecca T. Hahn ◽  
Omar K. Khalique ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Prosthetic Valve Endocarditis ◽  
Paravalvular Leak ◽  
Surgical Aortic Valve Replacement ◽  
Entry Site ◽  
Transcatheter Aortic Valve ◽  
Significant Difference

Abstract Prosthetic valve endocarditis (PVE) after surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) carries significant morbidity/mortality. Our review aims to compare incidence, predisposing factors, microbiology, diagnosis, management, and outcomes of PVE in surgical aortic valve replacement/TAVR patients. We searched PubMed and Embase to identify published studies from January 1, 2015 to March 13, 2020. Key words were indexed for original reports, clinical studies, and reviews. Reports were evaluated by 2 authors against a priori inclusion/exclusion criteria. Studies were included if they reported incidence and outcomes related to surgical aortic valve replacement/TAVR PVE and excluded if they were published pre‐2015 or included a small population. We followed the Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines for all stages of the design and implementation. Study quality was based on the Newcastle‐Ottawa Scale. Thirty‐three studies with 311 to 41 025 patients contained relevant information. The majority found no significant difference in incidence of surgical aortic valve replacement/TAVR PVE (reported as 0.3%–1.2% per patient‐year versus 0.6%–3.4%), but there were key differences in pathogenesis. TAVR has a specific set of infection risks related to entry site, procedure, and device, including nonstandardized protocols for infection control, valve crimping injury, paravalvular leak, neo‐leaflet stress, intact/calcified native leaflets, and intracardiac hardware. With the expansion of TAVR to lower risk and younger patients, a better understanding of pathogenesis, patient presentation, and guideline‐directed treatment is paramount. When operative intervention is necessary, mortality remains high at 20% to 30%. Unique TAVR infection risks present opportunities for PVE prevention, therefore, further investigation is imperative.

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