scholarly journals Post Radiotherapy Lesions of the Heart Valves. Principles of Diagnosis and Results of Treatment

Kardiologiia ◽  
2019 ◽  
Vol 59 (3) ◽  
pp. 36-42
Author(s):  
R. M. Muratov ◽  
S. I. Babenko ◽  
A. S. Sachkov ◽  
N. N. Soboleva ◽  
E. A. Andrianova
Keyword(s):  
Radiation Therapy ◽  
Heart Disease ◽  
Aortic Valve ◽  
Coronary Arteries ◽  
Heart Valves ◽  
Severe Heart Failure ◽  
Clinical Manifestations ◽  
Cardiac Complications ◽  
Valve Prosthesis ◽  
Thoracic Irradiation

Background. The use of radiation therapy for the treatment of tumors of the chest сan lead to the development of cardiac pathology, including that of the valves and coronary arteries. Study aim: to analyze the specifics of post-radiation lesions of the valvular apparatus and coronary arteries, and to assess the immediate results and risks of surgical correction of detected defects. Materials and  methods. In the Emergency department of surgery of acquired heart disease of A. N. Bakulev National Medical Research Center of Cardiovascular Surgery in the period from 2004 to 2017 were examined and operated 46 patients aged 35–81 years (mean age 56±12.4 years, 80 % women). The period from primary irradiation of the chest to surgical treatment of valvular pathology ranged from 4 to 40 years. Indications for thoracic radiotherapy were Hodgkin’s lymphoma in 23 patients (50 %), breast cancer – in 20 (43 %). Results. Stenosis of the aortic valve was the leading defect in 42 patients (91 %). According to coronary angiography, coronary artery disease was diagnosed in 31 patients (67 %). Isolated aortic valve prosthesis was performed in 14 (30 %) patients, other operations were combined. Hospital mortality was 11 % (5 patients). There were no deaths among patients who underwent radiation therapy after mastectomy. Main nonlethal complications were: pericardial effusion in 6 patients (13 %), hydrothorax requiring repeated pleural punctures in 5 patients (11 %). Conclusion. The variety of clinical manifestations of radiation heart disease and its progressive nature emphasize the need for long-term dynamic observation of patients after thoracic irradiation in order to timely identify the pathology and eliminate the risk of sudden cardiac complications and the development of severe heart failure decompensation.

A New Generation of Aortic Valve Prosthesis: Design, Manufacture and Hydrodynamic Assessment

2012 ◽  
Author(s):  
Benyamin Rahmani ◽  
Hossein Ghanbari ◽  
Spyridon Tzamtzis ◽  
Gaetano Burriesci ◽  
Alexander M. Seifalian
Keyword(s):  
Aortic Valve ◽  
Heart Valves ◽  
Artery Bypass ◽  
Polymeric Materials ◽  
Valve Prosthesis ◽  
Nanocomposite Polymer ◽  
Cardiac Procedure ◽  
Aortic Valve Prosthesis ◽  
Suboptimal Design ◽  
New Generation

Aortic valve replacement (AVR) is the second most common cardiac procedure after coronary artery bypass grafting, accounting for more than 200,000 transplantations annually worldwide [1]. Currently available mechanical and bioprosthetic heart valve replacements are not ideal as they are associated with relevant complications. The tri-leaflet polymeric heart valves (PHVs) have been widely investigated as possible alternative to these substitutes. However, the clinical application of PHVs has been limited by their suboptimal design and poor durability of available polymeric materials. This study presents a new concept of surgical aortic valve using a novel nanocomposite polymer.

Proposed percutaneous aortic valve prosthesis made of cryogel

2019 ◽  
Vol 233 (5) ◽  
pp. 515-524 ◽  
Author(s):  
Hadi Mohammadi ◽  
Dylan Goode ◽  
Guy Fradet ◽  
Kibret Mequanint
Keyword(s):  
Aortic Valve ◽  
Heart Valves ◽  
Kidney Injury ◽  
Blood Stream ◽  
Valve Prosthesis ◽  
Element Analysis ◽  
Novel Approach ◽  
Natural Geometry ◽  
Myocardial Infraction ◽  
Aortic Valve Prosthesis

Transcatheter heart valves are promising for high-risk patients. Generally, their leaflets are made of pericardium stented in a Nitinol basket. Despite their relative success, they are associated with significant complications such as valve migration, implantation risks, stroke, coronary obstruction, myocardial infraction, acute kidney injury (which all are due to the release of detached solid calcific pieces in to the blood stream) and expected issues existing with tissue valves such as leaflet calcification. This study is an attempt to fabricate the first ever polymeric percutaneous valves made of cryogel following the geometry and mechanical properties of porcine aortic valve to address some of the above-mentioned shortcomings. A novel, one-piece, tricuspid percutaneous valve, consisting of leaflets made entirely from the hydrogel, polyvinyl alcohol cryogel reinforced by bacterial cellulose natural nanocomposite, attached to a Nitinol basket was developed and demonstrated. Following the natural geometry of the valve, a novel approach was applied based on the revolution about an axis of a hyperboloid shape. The geometry was modified based on avoiding sharp warpage of leaflets and removal of the central opening orifice area of the valve when valve is fully closed using the finite element analysis. The modified geometry was replaced by a cloud of (control) points and was essentially converted to Bezier surfaces for further adjustment. A cavity mold was then designed and fabricated to form the valve. The fabricated valve was sewn into the Nitinol basket which is covered by Dacron cloth. The models presented in this study merit further development and revisions for both aortic and mitral positions.

scholarly journals 49 years of normal functioning Starr–Edwards aortic valve prosthesis

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Mouhamed Amr Sabouni ◽  
Robin H Baumeister ◽  
Paul Traverse
Keyword(s):  
Aortic Valve ◽  
Heart Valves ◽  
Valve Prosthesis ◽  
Normal Functioning ◽  
The Past ◽  
Aortic Valve Prosthesis

Abstract Although it is no longer in production, the Starr–Edwards valve has successfully replaced hundreds of thousands of heart valves in the past 50 years of its use. We report on the case of a valve in the aortic position still functioning 49 years after implantation without replacement, showcasing the valve’s durability.

scholarly journals Peripartum Cardiomyopathy: a Life Threatening Obstetric Emergency

2019 ◽  
Vol 13 (2) ◽  
pp. 93-96
Author(s):  
Dilruba Zeba ◽  
Mrinmoy Biswas ◽  
Rajib Biswas
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Angiotensin Receptor Blockers ◽  
Multiple Pregnancy ◽  
Systolic Heart Failure ◽  
Severe Heart Failure ◽  
Clinical Manifestations ◽  
Peripartum Cardiomyopathy ◽  
Presenting Symptoms ◽  
Life Threatening

Peripartum cardiomyopathy (PPCM) is a rare, life-threatening heart disease of unclear origin and is characterized by heart failure of sudden onset between the final weeks of pregnancy and 5 months after delivery. Incidence varies over geography and ethnicity. Risk factors include advanced maternal age, multiparity, preeclampsia, multiple pregnancy, anaemia, and so many other causes. PPCM is often not diagnosed until late in its course, because of its clinical manifestations are highly variable and a heart disease may not be suspected at first. Frequent presenting symptoms of PPCM, such as lassitude, shortness of breath on mild exertion and coughing are often initially misinterpreted as evidence of pneumonia or as physiological accompaniments of pregnancy and delivery. The clinical picture of PPCM corresponds to a dilated cardiomyopathy (DCM) with signs of severe heart failure. Medical management is similar to other causes of systolic heart failure, except for the ACE inhibitors and angiotensin receptor blockers are avoided in pregnancy. As there are lots of physiological changes during pregnancy and immediately after delivery, it is usually difficult to measure PPCM effectively. Complications include cardiac arrhythmia, thromboembolism, and refractory heart failure. Maternal deaths are not uncommon. Recently the role of abnormal prolactin metabolism and resulting myocardial toxicity have been explored and bromocriptine has shown promise as a potential treatment option. Faridpur Med. Coll. J. Jul 2018;13(2): 93-96

scholarly journals Carcinoid Heart Disease: Pathophysiology, Pathology, Clinical Manifestations, and Management

Cardiology ◽  
2020 ◽  
pp. 1-9
Author(s):  
Chengyue Jin ◽  
Ajay Nair Sharma ◽  
Balasingam Thevakumar ◽  
Muhammad Majid ◽  
Shahad Al Chalaby ◽  
...  
Keyword(s):  
Heart Disease ◽  
Heart Valves ◽  
Fibrous Tissue ◽  
Clinical Manifestations ◽  
Carcinoid Heart Disease ◽  
Right Heart ◽  
Limited Mobility ◽  
Vasoactive Substances ◽  
Pulmonic Regurgitation ◽  
Surgical Valve Replacement

Carcinoid heart disease (CHD) is a rare and potentially lethal manifestation of an advanced carcinoid (neuroendocrine) tumor. The pathophysiology of CHD is related to vasoactive substances secreted by the tumor, of which serotonin is most prominent in the pathophysiology of CHD. Serotonin stimulates fibroblast growth and fibrogenesis, which can lead to cardiac valvular fibrosis. CHD primarily affects right heart valves, causing tricuspid and pulmonic regurgitation and less frequently stenosis of these valves. Left heart valves are usually spared because vasoactive substances such as serotonin are enzymatically inactivated in the lung vasculature. The pathology of CHD is characterized by plaque-like deposition of fibrous tissue on valvular cusps, leaflets, papillary muscles, chordae, and ventricular walls. Symptomatic CHD usually presents between 50 and 70 years of age, initially as dyspnea and fatigue. Echocardiography is the mainstay of imaging and demonstrates thickened right heart valves with limited mobility and regurgitation. Treatment focuses on control of the underlying carcinoid syndrome, targeting subsequent valvular heart disease and managing consequent heart failure. Surgical valve replacement and catheter-directed valve procedures may be effective for selected patients with CHD.

Aortic valve prosthesis–patient mismatch and exercise capacity in adult patients with congenital heart disease

Heart ◽  
2015 ◽  
Vol 102 (2) ◽  
pp. 107-113 ◽  
Author(s):  
Ymkje J van Slooten ◽  
Joost P van Melle ◽  
Hendrik G Freling ◽  
Berto J Bouma ◽  
Arie PJ van Dijk ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Aortic Valve ◽  
Exercise Capacity ◽  
Congenital Heart ◽  
Adult Patients ◽  
Valve Prosthesis ◽  
Aortic Valve Prosthesis

Endovascular treatment in patients with combined pathology

2015 ◽  
Vol 6 (3) ◽  
pp. 123-128 ◽  
Author(s):  
Evgeny Antonovich Shloydo ◽  
Igor Alexandrovich Pyaterichenko ◽  
Victoria Valentinovna Zvereva ◽  
Yuriy Romanovich Kovalev ◽  
Alexey Viktorovich Sizov
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Age Groups ◽  
Balloon Catheter ◽  
Severe Heart Failure ◽  
Uterine Fibroids ◽  
Surgical Interventions

Aortic valve stenosis is one of the most common diseases from the group of acquired heart disease, especially in elderly patients. Aortic valve replacement has become the “gold standard” and gives excellent results in all age groups of patients. For aortic valve replacement is sent to only one third of patients due to high risk due to age, severity of the defect, reduced contractility of the left ventricle, pulmonary hypertension and other comorbidities. One of the attempts to reduce the frequency of complications and mortality in this group of patients, and subsequently to make it possible to perform other surgical interventions, including aortic valve replacement, which is considered inoperable patients is holding a less traumatic surgery - aortic balloon catheter valvuloplasty. In the clinical observation deals with the case of heart disease - critical aortic stenosis, ischemic heart disease complicated by pulmonary hypertension and severe heart failure, in combination with gynecological diseases (uterine fibroids, endometrial hyperplasia in postmenopausal women), complicated by uterine bleeding and hemorrhagic anemia. Consider the risks of different surgical interventions. The possibility of modern endovascular care of patients in this situation simultaneously perform operations on uterine artery embolization, coronary angioplasty with stenting and aortic catheter balloon valvuloplasty. Also shown is the nearest and remote results of operative intervention.

scholarly journals Thrombotic and hemorrhagic complications during pregnancy, delivery and the postpartum period in females with prosthetic heart valves

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G G Sefieva ◽  
U M Shadrina ◽  
E V Karelkina ◽  
O A Li ◽  
A E Bautin ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Postpartum Period ◽  
Heart Valves ◽  
Nyha Class ◽  
Clinical Manifestations ◽  
Mechanical Valve ◽  
Prosthetic Heart Valves ◽  
Valve Prosthesis ◽  
Mechanical Prostheses ◽  
Hemorrhagic Complications

Abstract Background/Introduction Women with mechanical prosthetic heart valves are at greatest risk of developing complications.The main reason is that mechanical prosthetic heart valves require lifelong anticoagulation to reduce the high risk of associated thrombotic and hemorrhagic complications. Purpose The main goal of this study was to estimated risk factors and frequency of thrombotic and hemorrhagic complications during pregnancy, delivery and the postpartum period in women with prosthetic heart valves Methods According to retrospective cohort analyses in this study were included 70 patients with prosthetic heart valves who delivered in a specialized perinatal center from October 2010 to February 2020. All the patients were divided into two groups depending on prosthesis type: mechanical prostheses (44 deliveries in 44 patients), biological prostheses (22 deliveries in 19 patients). All patients were performed ECHO (Vivid 7, GE, USA). The average age were 30.7±5.2 years. The N-terminal brain natriuretic propeptide (NT-proBNP) concentration was determined by the quantitative electrochemiluminescence method using a Cobas E 411 analyzer (Roche, Switzerland). The activity of the anti –Xa factor was measured by chromogenic assays. Results In 9 (21.4%) pregnants with a mechanical valve prosthesis (MVP), prosthetic thrombosis was recorded until 2016. In 1 patient with mechanical valve prosthesis (2%) during pregnancy was complicated by an acute cerebral circulation disorder. Since 2016 there were monitored the activity of the anti –Xa factor. In 7 patients on the background of a change in anticoagulant therapy, pregnancy stopped in the early stages. Before pregnancy, 31.4% of the patients didn't have heart failure clinical manifestations, but in 12 (17.1%) patients during pregnancy had increase in NYHA Class maximum to NYHA Class III. The average NT-proBNP concentration was 912.3±1586.6 pg / ml. The frequency of the cesarean section in both groups was high: in patients with mechanical valve prosthesis in 78.5% and in the group of patients with biological valve prostheses in 68.1% of cases. There were not registered any new cases of prosthetic thrombosis after delivery, however, 9 patients had hemorrhagic complications in the early postpartum period, which required relaparotomy and blood transfusions. Regardless of frequent complications during pregnancy and in the postpartum period, no fatal outcomes have been reported. Conclusion The absence of mortality over the 9-years old observation and delivery in patients with valvular prostheses demonstrates the feasibility of monitoring and delivery of this category of patients in a specialized multidisciplinary medical center with experience in managing patients during pregnancy with valvular prostheses on anticoagulant therapy. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Thromboembolic complications in antiphospholipid syndrome and ankylosing spondylitis (two clinical cases)

2021 ◽  
Vol 15 (1) ◽  
pp. 98-104
Author(s):  
K. S. Nurbaeva ◽  
F. A. Cheldieva ◽  
A. A. Shumilova ◽  
A. M. Lila ◽  
T. M. Reshetnyak
Keyword(s):  
Ankylosing Spondylitis ◽  
Aortic Valve ◽  
Antiphospholipid Syndrome ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Valve Prosthesis ◽  
First Case ◽  
Tnfα Inhibitors ◽  
Clinical Cases

We presented two clinical cases with clinical manifestations of antiphospholipid syndrome (APS) and ankylosing spondylitis (AS). The peculiarity of these cases is the onset of diseases in childhood, as well as the presence of not only extra-skeletal manifestations, but also complications or manifestations of other pathology. In the first case, it was thrombosis of the superficial veins of the lower limbs with the development of postthrombotic syndrome. In the second case, aortic valve defect, as a result of aortitis with a dilatation of the ascending aorta, which led to aortic valve replacement and its subsequent dysfunction because of thrombosis of the valve prosthesis. The frequency of detection of antiphospholipid antibodies (aPL), APS and thrombosis in AS is discussed. The role of tumor necrosis factor α (TNFα) inhibitors in the induction of aPL synthesis and the development of APS in patients with AS is considered either. Separately, we discussed the role of TNFα inhibitors, which are the main drugs in the treatment of ankylosing spondylitis, in the induction of aPL synthesis and the development of APS. Data on the occurrence of aPL, the reasons for the development of thrombosis in APS and the role of TNFα inhibitors remains incomplete. Perhaps the combination of APS and AS is an underestimated problem, and the information available in the literature does not reflect the real numbers. It is obvious that further research is needed to improve the treatment of patients with AS with thrombosis.

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