Effect of Combined Etomidate-Ketamine Anesthesia on Perioperative Electrocardiogram and Postoperative Cognitive Dysfunction of Elderly Patients with Rheumatic Heart Valve Disease Undergoing Heart Valve Replacement

Objective. To explore the effect of combined etomidate-ketamine anesthesia on perioperative electrocardiogram (ECG) and postoperative cognitive dysfunction (POCD) of elderly patients with rheumatic heart valve disease (RHVD) undergoing heart valve replacement. Methods. The data of 100 elderly RHVD patients treated in our hospital from May 2019 to May 2020 were selected for the retrospective analysis, and by adopting the double-blind method, the patients were divided into the ketamine group (n = 50) and the combined group (n = 50) according to the anesthesia methods. During the induction of anesthesia, the patients of the two groups were given a small dose of ketamine (0.5 mg/kg) at 5 μg/kg/min continuously via pump injection until the end of surgery, and on this basis, with the same anesthesia measures, those in the combined group were given etomidate (0.3 mg/kg) additionally. The patients’ perioperative ECG indicators, POCD scores, and Numeric Rating Scale (NRS) scores were compared between the two groups. Results. Compared with the ketamine group, the combined group presented significantly lower incidence of ST-T wave changes after anesthesia induction and at the time of intubation and skin incision ( P < 0.05 ), significantly lower average magnitude of ST-segment depression after anesthesia induction ( P < 0.001 ), significantly lower average magnitude of ST-segment elevation after anesthesia induction and extubation ( P < 0.001 ), significantly lower POCD incidence (6.%, P < 0.05 ), and significantly better NRS score after surgery ( P < 0.001 ). Conclusion. Combined etomidate-ketamine anesthesia can stabilize the perioperative ECG indicators of elderly RHVD patients undergoing heart valve replacement, improve their postoperative cognitive function, and reduce their pain sensation, which should be promoted and applied in practice.

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Multisite Infective Endocarditis/Endarteritis in a Young Peripartum Patient with Patent Ductus Arteriosus and Rheumatic Heart Valve Disease: A Case Report

Echocardiography ◽

10.1111/j.1540-8175.2009.01111.x ◽

2010 ◽

Vol 27 (4) ◽

pp. 466-469 ◽

Cited By ~ 7

Author(s):

Kumral Cagli ◽

Fatma Nurcan Basar ◽

Kerim Cagli ◽

Adnan Yalcinkaya ◽

Ozcan Ozeke ◽

...

Keyword(s):

Case Report ◽

Infective Endocarditis ◽

Patent Ductus Arteriosus ◽

Heart Valve ◽

Ductus Arteriosus ◽

Valve Disease ◽

Heart Valve Disease ◽

Rheumatic Heart Valve Disease ◽

Rheumatic Heart ◽

Patent Ductus

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Right ventricular dysfunction in rheumatic heart valve disease: A clinicopathological evaluation

The National Medical Journal of India ◽

10.4103/0970-258x.321133 ◽

2020 ◽

Vol 33 (6) ◽

pp. 329

Author(s):

Shantanu Pande ◽

SurendraK Agarwal ◽

Prabhat Tewari ◽

Vinita Agrawal ◽

Nilesh Srivastav ◽

...

Keyword(s):

Right Ventricular ◽

Heart Valve ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Valve Disease ◽

Heart Valve Disease ◽

Rheumatic Heart Valve Disease ◽

Rheumatic Heart

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Epidemiological Approach to Understand Rheumatic Heart Valve Disease: Case of Thoracic Cardiovascular Clinic of Fann Hospital (Dakar)

World Journal of Cardiovascular Diseases ◽

10.4236/wjcd.2020.1010071 ◽

2020 ◽

Vol 10 (10) ◽

pp. 750-760

Author(s):

Marie Parsine Sall ◽

Fatimata Mbaye ◽

Mbacké Sembéne ◽

Amadou Gabriel Ciss

Keyword(s):

Heart Valve ◽

Valve Disease ◽

Heart Valve Disease ◽

Disease Case ◽

Rheumatic Heart Valve Disease ◽

Rheumatic Heart ◽

Epidemiological Approach

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Protective effects of dexmedetomidine on the ischemic myocardium in patients undergoing rheumatic heart valve replacement surgery

Experimental and Therapeutic Medicine ◽

10.3892/etm.2021.9844 ◽

2021 ◽

Vol 21 (5) ◽

Author(s):

Wei Chen ◽

Yan Wang ◽

Zhiguo Pan ◽

Xiyuan Chen ◽

Dihuan Luo ◽

...

Keyword(s):

Valve Replacement ◽

Heart Valve ◽

Ischemic Myocardium ◽

Heart Valve Replacement ◽

Protective Effects ◽

Replacement Surgery ◽

Valve Replacement Surgery ◽

Rheumatic Heart

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Abstract 13401: Prothymosin Alpha (Protα) Associates With Pathogenesis and Sex Predisposition in Rheumatic Heart Valve Disease

Circulation ◽

10.1161/circ.142.suppl_3.13401 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Livia Passos ◽

Mark C Blaser ◽

Dayanna Romero ◽

Dakota Becker Greene ◽

Adrien Lupieri ◽

...

Keyword(s):

Heart Valve ◽

Mononuclear Cells ◽

Valve Disease ◽

Heart Valve Disease ◽

Aortic Valves ◽

Cd8 Cells ◽

Public Health Burden ◽

Network Analyses ◽

Rheumatic Heart Valve Disease ◽

Rheumatic Heart

Introduction: Acute rheumatic fever (ARF) results from autoimmune responses to group A streptococcus. ARF can cause chronic rheumatic heart valve disease (RHVD), a major public health burden in low- and middle-income countries. Although ARF affects both sexes equally, females have a higher prevalence of RHVD. We identified a target protein, ProTα, that may contribute to pathophysiology of and gender predisposition in RHVD. Estradiol regulates ProTα, which influences transcriptional activity of the estrogen receptor (ER). Methods: Human heart valves (n=120) obtained from heart transplantation and valve replacement surgeries, including non-diseased mitral and aortic valves (NDMV and NDAV, n=17/group), rheumatic mitral and aortic valves (RMVD, n=45; RAVD, n=8) and calcifying valves from patients with calcific aortic valve disease (CAVD, n=33) underwent proteomic and network analyses, and immunohistochemical assessment of CD68, CD4, CD8 and ProTα. ProTα levels were measured in plasma and peripheral mononuclear cells (PBMCs) from RHVD patients and healthy donors (n=14/group) by ELISA and flow cytometry. Results: A comparison of proteomes from NDMV and NDAV established the baseline differences between valve types. 12 proteins were enriched (q<0.05) in NDMV that may indicate the mitral valve predisposition to RVHD. Proteome analysis of non-diseased and diseased valves (NDMV vs RMVD, NDAV vs RAVD) identified a total of 213 proteins enriched in RHVD (q<0.05). The expression of the 12 NDMV-enriched proteins were evaluated across the 213 proteins enriched in diseased valves, resulting in the identification of ProTα common to both the RMVD and RAVD proteomes, but absent in CAVD. Additional KEGG pathway enrichment analyses linked 6 among 213 proteins with the estrogen signaling pathway (p<0.05). Immunoreactive ProTα colocalized with T CD8 cells in RHVD. ProTα and ERα also correlated strongly in circulating T CD8 cells in RHVD (p<0.05). ProTα plasma levels were higher in RHVD patients than healthy individuals (2 fold, p<0.05). Conclusion: We propose that ProTα is a novel contributor to the immunopathogenesis of RHVD and may regulate sex predisposition in this disease.

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OS 01-07 CLINICAL IMPORTANCE OF COLLAGEN METABOLISM MARKERS IN RHEUMATIC HEART VALVE DISEASE IN INDIAN SUBPOPULATION

Journal of Hypertension ◽

10.1097/01.hjh.0000499973.02423.08 ◽

2016 ◽

Vol 34 (Supplement 1) ◽

pp. e46 ◽

Cited By ~ 1

Author(s):

Tanima Banerjee ◽

Somaditya Mukherjee ◽

Sudip Ghosh ◽

Monodeep Biswas ◽

Santanu Datta ◽

...

Keyword(s):

Heart Valve ◽

Clinical Importance ◽

Collagen Metabolism ◽

Valve Disease ◽

Heart Valve Disease ◽

Rheumatic Heart Valve Disease ◽

Rheumatic Heart

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Calcification of Trileaflet Polyurethane Heart Valve

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19486 ◽

2010 ◽

Cited By ~ 1

Author(s):

Parnian Boloori Zadeh ◽

Hamid N.-Hashemi ◽

Scott C. Corbett ◽

Ahmet U. Coskun

Keyword(s):

Valve Replacement ◽

Heart Valve ◽

Heart Valves ◽

Heart Valve Replacement ◽

Heart Valve Disease ◽

Blood Proteins ◽

Replacement Surgery ◽

Limited Life ◽

Alternative Material

Heart valve disease is a common type of cardiac disease that causes a large number of mortalities worldwide. Patients with severe heart valve problems are required to undergo heart valve replacement surgeries. Mechanical and bioprosthetic heart valves are the current available prostheses for patients in need of a heart valve replacement surgery. Mechanical heart valves are susceptible to thromboembolism and thrombosis and bioprosthetic valves have a limited life-span because of leaflet wear and calcification. Different polyurethane valves were suggested as an alternative material. However, prior results indicated that tested polyurethanes failed due to calcification. The mechanism for polyurethane calcification is not yet completely understood. Kou Imachi et al. [2], suggested that the calcification is due to entrapment of blood proteins and/or phospholipids in microgaps in the polymer and subsequent attraction of Ca ion, leading to formation of calcium phosphate (Ca3(PO4)2). Bisphosphonates (BP), which are considered to enhance the calcification resistance of polymers once covalently bonded to the material, indicated promising results in some studies. Focus of the present study is the trileaflet polyurethane valve, originally developed in the design of the AbioCor® replacement heart, and has demonstrated excellent durability and hemocompatibility in clinical evaluation. Over the past three years, this valve has been modified and its potential as a replacement valve have been studied [1]. Valve hemodynamic analysis showed that it is comparable to bioprosthetic valve in terms of fluid flow, pressure drop and regurgitation [1]. In order to ensure the suitability of the trileaflet polyurethane valve as a replacement valve its fatigue and calcification resistance are studied. The purpose of this paper is to simulate calcification of trileaflet polyurethane valves in an in vitro accelerated test and compare that with that of tissue valves. Furthermore the effect of bisphosphonate modified polyurethane on calcification is studied.

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Rheumatic Heart Valve Disease Pathophysiology and Underlying Mechanisms

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.612716 ◽

2021 ◽

Vol 7 ◽

Author(s):

Livia S. A. Passos ◽

Maria Carmo P. Nunes ◽

Elena Aikawa

Keyword(s):

Heart Valve ◽

Inflammatory Responses ◽

Cardiovascular Death ◽

Streptococcal Pharyngitis ◽

Valve Disease ◽

Heart Valve Disease ◽

Middle Income ◽

Underlying Mechanisms ◽

Rheumatic Heart Valve Disease ◽

Rheumatic Heart

Rheumatic heart valve disease (RHVD) is a post-infectious sequel of acute rheumatic fever resulting from an abnormal immune response to a streptococcal pharyngitis that triggers valvular damage. RHVD is the leading cause of cardiovascular death in children and young adults, mainly in women from low and middle-income countries. It is known that long-term inflammation and high degree of fibrosis leads to valve dysfunction due to anatomic disruption of the valve apparatus. However, since public and private investments in RHVD studies are practically inexistent the number of publications is scarce. This disease shows different natural history and clinical presentations as compared to other degenerative heart valve diseases. Although more than five decades passed after the pioneering studies on the pathogenesis of RHVD, it is still unclear how self-tolerance mechanisms fail in this disease, and how humoral and cellular inflammatory responses are interconnected. Despite that pathological mechanisms have been already proposed for RHVD, none of them are able to explain the preferential involvement of the mitral valve. This review focuses on pathophysiology and underlying mechanisms of RHVD.

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