scholarly journals Preliminary Short-term Results of a Population of Patients Treated with MitraClip Therapy: One Center Experience

2017 ◽  
Vol 11 ◽  
Author(s):  
Rossana Taravella ◽  
Melchiorre Gilberto Cellura ◽  
Giuseppe Cirrincione ◽  
Salvatore Asciutto ◽  
Marco Caruso ◽  
...  
Keyword(s):  
New York ◽  
Nyha Class ◽  
Great Majority ◽  
Heart Association ◽  
Functional Class ◽  
Class Iii ◽  
Nyha Functional Class ◽  
Mitral Repair ◽  
Mitraclip Therapy

<p><span>Objectives: This retrospective analysis sought to evaluate 1-month outcomes and therapy effectiveness of a population of patients treated with MitraClip therapy. We describe in this article the preliminary results of primary effictiveness endpoint.</span></p><p><span>Background: Percutaneous Mitral Repair is being developed to treat severe mitral regurgitation (MR),with increasing real-world cases of functional MR(FMR). In the EVEREST(Endovascular Valve Edge-to-Edge Repair Study)II trial,percutaneous device showed superior safety but less reduction in MR at 1year. 4-year outcomes from EVEREST II trial showed no difference in the prevalence of moderate-severe and severe MR or mortality at 4years between surgical mitral repair and percutaneous approach.</span></p><p><span>Methods: We analysed retrospectively collected data from one center experience in Italy enrolled from January2011 to December2016. The study included 62patients[mean age74±11years, 43 men(69%)] with MR of at least grade3+. Most of patients had functional MR, were in New York Heart Association(NYHA) functional class III or IV,with a large portion(78%) of mild-to-moderate Tricuspid Regurgitation(TR). One or more clips were implanted in 67procedures(62 patients).<span>  </span></span></p><span>Results and Conclusions: Severity of MR was reduced in all successfully treated patients,54(90%) were discharged with MR≤2+(primary effictiveness endpoint). Clinical 1-month follow-up data showed an improvement in NYHA functional class (42patients (70%) in NYHA class I-II). 60 of 62 (97 %) successfully treated patients were free from death and mitral valve surgery at 1-month follow-up. MitraClip therapy reduces functional MR with acute MR reduction to &lt;2+ in the great majority of patients,with a large freedom from death, surgery or recurrent MR in a great portion of patients.</span>

Outcomes of Patients Undergoing Primary Fontan Operation Beyond First Decade of Life

2017 ◽  
Vol 8 (4) ◽  
pp. 487-494 ◽  
Author(s):  
Sachin Talwar ◽  
Sukhjeet Singh ◽  
Vishnubhatla Sreenivas ◽  
Kulwant Singh Kapoor ◽  
Saurabh Kumar Gupta ◽  
...  
Keyword(s):  
Ventricular Dysfunction ◽  
Nyha Class ◽  
Fontan Operation ◽  
Functional Class ◽  
Early Mortality ◽  
Thromboembolic Events ◽  
Class Iii ◽  
Pleural Effusions ◽  
Nyha Functional Class

Objectives: Studies on older patients undergoing primary Fontan operation (FO) are limited, with conflicting results. We review our experience with these patients beyond the first decade of life. Patients and Methods: Between January 2000 and December 2014, a total of 105 patients ≥10 years of age (mean 15.6 ± 4.9, range 10-31, median 15 years) underwent primary FO without a prior bidirectional superior cavopulmonary anastomosis (Bidirectional Glenn [BDG]). Mean preoperative New York Heart Association (NYHA) class was 2.2 ± 0.57. Results: Operative procedure was extra-cardiac FO in 62 patients (8 were fenestrated). Forty-three had a lateral tunnel FO (26 were fenestrated). There were 11 (10.5%) early deaths. Fourteen of the 94 early survivors experienced prolonged pleural effusions, 7 had arrhythmias, and 2 had thromboembolic events. Two patients underwent Fontan takedown. On univariate analysis, NYHA functional class III, mean pulmonary artery (PA) pressure ≥15 mm Hg, hematocrit ≥60%, preoperative ventricular dysfunction, and atrioventricular valve regurgitation (AVVR) were associated with early mortality. Median follow-up was 78 (mean 88.9 ± 6.3) months. In 94 survivors, 6 (6.4%) late deaths were encountered. At last follow-up, 81 (86.2%) survivors were in NYHA class I. Actuarial survival was 84.7% ± 3.7% at 5, 10, and 15 years. Conclusion: Carefully selected adolescents and young adults can safely undergo the primary FO. However, persistent pleural effusions, arrhythmias, thromboembolic events, and the need for reoperation mandate regular follow-up in such patients. Preoperative NYHA functional class III, mean PA pressure ≧ 15 mm Hg, hematocrit ≥ 60%, ventricular dysfunction, and AVVR were associated with early mortality, suggesting that primary FO should be avoided in such patients.

Arterial embolisation and coiling for high-output heart failure and pulmonary hypertension ınduced by hepatic arteriovenous fistula in a patient with hereditary hemorrhagic telengiectasia

Open Medicine ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 369-373
Author(s):  
Sadık Açikgöz ◽  
Gülten Taçoy ◽  
Baran Önal ◽  
Beytullah Yıldırım ◽  
Atiye Çengel
Keyword(s):  
Heart Failure ◽  
New York ◽  
Pulmonary Hypertension ◽  
Arteriovenous Fistula ◽  
Arteriovenous Malformations ◽  
Nyha Class ◽  
Severe Heart Failure ◽  
Heart Association ◽  
Functional Class ◽  
Class Iii

AbstractHereditary hemorrhagic telangiectasia (HHT) is a genetic vascular disorder characterised by epistaxis, telangiectases, and visceral arteriovenous malformations. Hyperdynamic blood flow associated with arteriovenous malformations may lead to pulmonary hypertension, global heart failure, and valvular insufficiencies. We report a patient who had HHT with severe heart failure (New York Heart Association [NYHA] class III-IV) and pulmonary hypertension caused by an hepatic arteriovenous fistula. After successful transarterial embolisation of the right branch of the hepatic artery with polyvinyl alcohol (PVA) particles and coils, 4 to 7 mm in size, the patient was discharged with functional class II (NYHA) heart failure.

scholarly journals Effectiveness of Artificial Neochordae Implantation in Tricuspid Valve Repair

2019 ◽  
Vol 46 (2) ◽  
pp. 100-106
Author(s):  
Salih Salihi ◽  
H. Tarik Kiziltan ◽  
Ahmad Huraibat ◽  
Askin Ali Korkmaz ◽  
Ibrahim Kara ◽  
...  
Keyword(s):  
New York ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Heart Association ◽  
Functional Class ◽  
Tricuspid Valve Repair ◽  
Class Iii ◽  
Valve Repair ◽  
New York Heart Association

Various techniques for treating tricuspid regurgitation have been described; however, because of scarce data about the long-term outcomes of different repairs, the optimal technique has not been established. We evaluated the effectiveness and durability of artificial neochordae implantation in the treatment of tricuspid regurgitation. From 2009 through 2014, 507 patients underwent tricuspid valve repair at our institution. Of those, 48 patients implanted with artificial neochordae were included in our study. The median age of the participants was 62 years (range, 4–77 yr) and 50% were women. Thirty patients (63%) were in New York Heart Association functional class III, and 11 (23%) were in class II. The cause of tricuspid regurgitation was functional in 33 patients (69%) and rheumatic in 15 (31%). In 46 patients, neochordae implantation was performed in addition to Kay annuloplasty (n=13) or ring annuloplasty (n=33). Forty-two patients were discharged from the hospital with absent or mild tricuspid regurgitation. The mean follow-up period was 44.3 ± 20.2 months. Follow-up echocardiograms revealed that tricuspid regurgitation was absent, minimal, or mild in 38 patients (80.8%), moderate in 7, and severe in 2. Our results indicate that the use of artificial neochordae implantation as an adjunct procedure to annuloplasty leads to effective and durable repair in comparison with conventional techniques for treating tricuspid regurgitation.

Illness Perception and Its Changes During Six Months After Cardiac Rehabilitation

2019 ◽  
Vol 26 (3) ◽  
pp. 90-100
Author(s):  
Justė Lukoševičiūtė ◽  
Kastytis Šmigelskas
Keyword(s):  
New York ◽  
Social Factors ◽  
Nyha Class ◽  
Illness Perception ◽  
Heart Association ◽  
Class Iii ◽  
Cognitive Representations ◽  
Coronary Syndrome ◽  
Type D ◽  
New York Heart Association

Abstract. Illness perception is a concept that reflects patients' emotional and cognitive representations of disease. This study assessed the illness perception change during 6 months in 195 patients (33% women and 67% men) with acute coronary syndrome, taking into account the biological, psychological, and social factors. At baseline, more threatening illness perception was observed in women, persons aged 65 years or more, with poorer functional capacity (New York Heart Association [NYHA] class III or IV) and comorbidities ( p < .05). Type D personality was the only independent factor related to more threatening illness perception (βs = 0.207, p = .006). At follow-up it was found that only self-reported cardiovascular impairment plays the role in illness perception change (βs = 0.544, p < .001): patients without impairment reported decreasing threats of illness, while the ones with it had a similar perception of threat like at baseline. Other biological, psychological, and social factors were partly associated with illness perception after an acute cardiac event but not with perception change after 6 months.

4307Lung ultrasound in stable ambulatory chronic heart failure patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Domingo ◽  
L Conangla ◽  
J Lupon ◽  
M De Antonio ◽  
P Moliner ◽  
...  
Keyword(s):  
Cox Regression ◽  
Functional Class ◽  
Class Iii ◽  
Nyha Functional Class ◽  
End Point ◽  
Ambulatory Patients ◽  
Beta Coefficient ◽  
One Year ◽  
B Lines

Abstract Background The role of lung ultrasound (LUS) in diagnosis and response to diuretic treatment of patients with acute HF has been widely studied, but less is known about its value in chronic HF. Purpose To assess the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients and to explore the relationship of LUS findings with clinical data, such as NYHA functional class, left ventricular ejection fraction (LVEF) and NTproBNP. Methods Consecutive stable ambulatory patients who attended a scheduled follow-up visit in a HF clinic were included. LUS were performed with a pocket device and examined 4 chest areas per side (two anterior and two lateral). Scans were analysed offline by two investigators blinded to clinical data, who evaluated the number of B-lines of each area. The addition number of B-lines of each area and the quartiles of such addition were used for the analyses. The primary outcome end-point was the composite of all-cause death or hospitalization due to HF at one year. Linear regression and Cox regression analyses were performed. Results Five-hundred seventy-seven patients were included between July 2016 and July 2017 (age 69±12 years, 72% men). The main HF aetiology was ischemic heart disease (43%) followed by dilated cardiomyopathy (20%). Median HF duration was 79 months (Q1-Q3 38–144). Mean LVEF was 45%±13 (mean LVEF when admitted at the Unit 34%±13). Most patients were in NYHA functional class II (70%), 13% were in class I and 17% in class III. Median NTproBNP was 722 ng/L (Q1-Q3 262–1760). Mean number of B-lines was 5±6 (Q1, 0; Q2, 1–3; Q3, 4–7; Q4, ≥8). The number of B-lines was associated with age (beta-coefficient 0.11, p<0.001), NYHA functional class (beta-coefficient 1.75, p<0.001), and logNTproBNP (beta-coefficient 1.40, p<0.001). Mean number of B-lines according to NYHA functional class was: class I, 3.5±6; class II, 4.9±6; and class III, 7.1±7. During the one year follow-up 47 patients suffered the primary end-point. In total there were 24 HF related hospitalizations and 26 deaths. In Cox regression analysis, Q4 of B-lines showed a double risk of suffering the primary end-point (HR 2.13 [95% CI 1.18–3.84], p=0.01). However, statistically significance was not maintained for LUS results in the multivariable analysis when age, NYHA functional class and logNTproBNP were included in the model, although a 38% increase in the risk of suffering the primary end-point for Q4 was observed (HR 1.38 [95% CI 0.75–2.54], p=0.31). Conclusion In outpatients with stable chronic HF, the number of B-lines detected in LUS was associated with age, NYHA functional class and NTproBNP. Patients having ≥8 B-lines had a significant double risk of HF related hospitalization or all-cause death at one year. However, when strongly powerful prognostic variables such as NYHA class and NTproBNP were included in the model LUS did not retain an independent prognostic role.

scholarly journals Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

2019 ◽  
Vol 28 (1) ◽  
pp. 3-13 ◽  
Author(s):  
J. F. Veenis ◽  
J. J. Brugts
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Remote Monitoring ◽  
Heart Association ◽  
The United States ◽  
Pharmacological Therapy ◽  
Functional Class ◽  
Class Iii ◽  
Additional Tool

AbstractExacerbations of chronic heart failure (HF) with the necessity for hospitalisation impact hospital resources significantly. Despite all of the achievements in medical management and non-pharmacological therapy that improve the outcome in HF, new strategies are needed to prevent HF-related hospitalisations by keeping stable HF patients out of the hospital and focusing resources on unstable HF patients. Remote monitoring of these patients could provide the physicians with an additional tool to intervene adequately and promptly. Results of telemonitoring to date are inconsistent, especially those of telemonitoring with traditional non-haemodynamic parameters. Recently, the CardioMEMS device (Abbott Inc., Atlanta, GA, USA), an implantable haemodynamic remote monitoring sensor, has shown promising results in preventing HF-related hospitalisations in chronic HF patients hospitalised in the previous year and in New York Heart Association functional class III in the United States. This review provides an overview of the available evidence on remote monitoring in chronic HF patients and future perspectives for the efficacy and cost-effectiveness of these strategies.

scholarly journals Outcome after percutaneous edge-to-edge mitral repair for functional and degenerative mitral regurgitation: a systematic review and meta-analysis

Heart ◽  
2017 ◽  
Vol 104 (4) ◽  
pp. 306-312 ◽  
Author(s):  
Mauro Chiarito ◽  
Matteo Pagnesi ◽  
Enrico Antonio Martino ◽  
Michele Pighi ◽  
Andrea Scotti ◽  
...  
Keyword(s):  
Systematic Review ◽  
New York ◽  
Mitral Regurgitation ◽  
Meta Analysis ◽  
Heart Association ◽  
Class Iii ◽  
Term Outcome ◽  
Mitral Repair ◽  
New York Heart Association ◽  
One Year

ObjectivesDifferences in terms of safety and efficacy of percutaneous edge-to-edge mitral repair between patients with functional and degenerative mitral regurgitation (MR) are not well established. We performed a systematic review and meta-analysis to clarify these differences.MethodsPubMed, EMBASE, Google scholar database and international meeting abstracts were searched for all studies about MitraClip. Studies with <25 patients or where 1-year results were not delineated between MR aetiology were excluded. This study is registered with PROSPERO.ResultsA total of nine studies investigating the mid-term outcome of percutaneous edge-to-edge repair in patients with functional versus degenerative MR were included in the meta-analysis (n=2615). At 1 year, there were not significant differences among groups in terms of patients with MR grade≤2 (719/1304 vs 295/504; 58% vs 54%; risk ratio (RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly lower rate of mitral valve re-intervention in patients with functional MR compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR 0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16% (408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77; p=0.18). Functional MR group showed significantly higher percentage of patients in New York Heart Association class III/IV (234/1480 vs 49/583; 16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs 31/220; 23% vs 14%; p=0.03). No differences were found in terms of single leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device embolisation (no events reported in both groups) at 1 year.ConclusionsThis meta-analysis suggests that percutaneous edge-to-edge repair is likely to be an efficacious and safe option in patients with both functional and degenerative MR. Large, randomised studies are ongoing and awaited to fully assess the clinical impact of the procedure in these two different MR aetiologies.

scholarly journals Clinical course and prognosis of dilated cardiomyopathy in children

2019 ◽  
Vol 7 (11) ◽  
pp. 4218
Author(s):  
Iranna S. Hirapur ◽  
Ravindran Rajendran ◽  
Jayaranganath . ◽  
Manjunath Nanjappa
Keyword(s):  
New York ◽  
Dilated Cardiomyopathy ◽  
Clinical Course ◽  
Care Center ◽  
Nyha Class ◽  
Tertiary Care ◽  
Heart Association ◽  
Paediatric Population ◽  
Class Iii ◽  
Serious Disease

Background: Epidemiology and clinical course of dilated cardiomyopathy (DCM) in children and infants are not well established. Thus, this study aims to investigate the clinical course and prognosis of DCM in childrenMethods: This was a single-center, prospective, observational study conducted at a tertiary-care center in India between February 2011 and September 2012. A total of 31 patients admitted to the paediatric department diagnosed with DCM were included in the study. Patients were divided into three groups based on the age at the time of diagnosis: 0-3 years, >3-12 years and >12-16 years. Among the study population, 28 patients were followed up for a mean period of 1.44 years and three patients were lost to follow-up.Results: Of the 31 patients, 11 patients were male with a mean age of 8.9±6 years and 20 patients were female with a mean age of 8.3±6 years. All patients were presented with same characteristics of New York heart association (NYHA) class III-IV dyspnoea and fatigue. Among 28 patients who were followed-up for a mean period of 1.44 years, 20(71.4%) patients died and eight patients were on follow up. Of the eight patients, five patients were with NYHA class III symptoms and three patients were with NYHA class I-II symptoms.Conclusions: Dilated cardiomyopathy in children is a very serious disease with a grave prognosis. Patients with NYHA III-IV symptoms have a very high mortality rate and potential use of other therapies remains to be fully evaluated in paediatric population.

Real-Time Three-Dimensional Echocardiographic Study of Left Ventricular Function After Infarct Exclusion Surgery for Ischemic Cardiomyopathy

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Jian Xin Qin ◽  
Takahiro Shiota ◽  
Patrick M. McCarthy ◽  
Michael S. Firstenberg ◽  
Neil L. Greenberg ◽  
...  
Keyword(s):  
New York ◽  
Ischemic Cardiomyopathy ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Before And After ◽  
Infarct Exclusion ◽  
New York Heart Association ◽  
Lv Volume

Background —Infarct exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determine the impact of surgery due to complicated geometric changes. Methods and Results —Thirty patients who underwent IE (mean age 61±8 years, 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed transthoracically 42±67 days after surgery in 22 patients. Repeated measures ANOVA was used to compare the values before and after IE surgery and at follow-up. Significant decreases in LV end-diastolic (EDVI) and end-systolic (ESVI) volume indices were apparent immediately after IE and in follow-up (EDVI 99±40, 67±26, and 71±31 mL/m 2 , respectively; ESVI 72±37, 40±21, and 42±22 mL/m 2 , respectively; P <0.05). LV ejection fraction increased significantly and remained higher (0.29±0.11, 0.43±0.13, and 0.42±0.09, respectively, P <0.05). Forward stroke volume in 16 patients with preoperative mitral regurgitation significantly improved after IE and in follow-up (22±12, 53±24, and 58±21 mL, respectively, P <0.005). New York Heart Association functional class at an average 285±144 days of clinical follow-up significantly improved from 3.0±0.8 to 1.8±0.8 ( P <0.0001). Smaller end-diastolic and end-systolic volumes measured with RT3DE immediately after IE were closely related to improvement in New York Heart Association functional class at clinical follow-up (Spearman’s ρ=0.58 and 0.60, respectively). Conclusions —RT3DE can be used to quantitatively assess changes in LV volume and function after complicated LV reconstruction. Decreased LV volume and increased ejection fraction imply a reduction in LV wall stress after IE surgery and are predictive of symptomatic improvement.

scholarly journals Peripartum Cardiomyopathy in South Indian Women—Challenges and Outcomes

2019 ◽  
Vol 04 (03) ◽  
pp. 129-132
Author(s):  
Jayaraj Cecily Mary Majella ◽  
Ganesan Gnanavelu
Keyword(s):  
New York ◽  
Pregnant Women ◽  
Nyha Class ◽  
Tertiary Care ◽  
Heart Association ◽  
Peripartum Cardiomyopathy ◽  
Care Hospital ◽  
Class Iii ◽  
Indian Women ◽  
South Indian

Abstract Introduction Peripartum cardiomyopathy (PPCM) continues to be a therapeutic challenge. Actual incidence is not exactly known as routine screening by echocardiogram is not recommended for all pregnant women across various parts of the world. Aim We, in our study, report the incidence, clinical profile, and prognosis of peripartum cardiomyopathy among South Indian women in a tertiary care hospital. Materials and Methods All pregnant ladies, referred for cardiac evaluation in the last month of pregnancy and 5 months postpartum, were included in this study. Transthoracic ehocardiography was used for the diagnosis of PPCM. The patients who were diagnosed with PPCM were followed-up clinically and echocardiographically for 1, 3, 6 months and 1 year. Results Among 5,475 of pregnant women who were screened with transthoracic echocardiogram, 14 patients were diagnosed with PPCM (0.26%). All 14 PPCM patients presented with New York Heart Association (NYHA) class III or IV. The incidence of PPCM was high in primigravida in our subgroup. The thrombus burden was high, constituting 42.86% in our subgroup and mortality occurred in three patients. Conclusion The incidence of PPCM was 0.25% in our subgroup, with high–thrombus burden. Hence, early diagnosis and proper anticoagulation is the need of the hour among appropriate patients along the heart failure management.

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