Risk Stratification and Mortality in Mitral Stenosis Patients

Background: Rheumatic mitral stenosis is the most common valvular abnormalities found in developing countries. Mortality risk in those populations was poorly investigated. In addition, hemodynamic, morphological, and mechanical factors that influence or predict outcome of rheumatic mitral stenosis have not been identified. Aims: To determine predictive factors affecting outcome in rheumatic mitral stenosis patients. Method: This retrospective cohort study was conducted at the National General Hospital Dr. Sardjito, Yogyakarta, Indonesia. The study recruited patients from the Valvular Heart Disease Registry from May 2014 to November 2020. New York Heart Association (NYHA) functional classification, invasive or surgical treatment, and incidence of death were recorded. The baseline rhythm from electrocardiography (ECG) was categorized as sinus rhythm and atrial fibrillation or atrial flutter. Based on the findings of trans thoracal echocardiography (TTE), subjects who had moderate to severe pure rheumatic mitral stenosis (or followed by mitral regurgitation and / or less significant tricuspid regurgitation as a natural history) and subjects with rheumatic mitral stenosis with a combination of other heart valve problems (of which severity more significantly) classified as groups I and II. The mitral valve area (MVA), mitral valve gradient (MVG), left atrial diameter (LA), and mean pulmonary artery pressure (mPAP) were then analyzed. Results: A total of 477 patients (mean age 44.08 ± 10.93 years; 71.5% female) were enrolled in this study. There were 61 deaths during the median follow up of 393 days of which 35 deaths occurred in group I and 26 deaths occurred in group II. Kaplan Meier curve shows the 1 year survival rate is higher in group I than group II which is 92.5% and 92%, respectively. Bivariate followed by multivariate analysis showed MVG and mPAP were predictive risk factors for mortality in group I with p = 0.020 and p = 0.021. MVG parameter values evaluated from echocardiography with a cut-off of more than 10 mmHg and mPAP parameters with a cut-off of more than 50 mmHg were independent predictive risk factors for mortality. Thus, patients were at higher risk of death if MVG > 10 mmHg and mPAP > 50 mmHg Conclusion: One year survival rate in group I was higher than group II. MVG and mPAP were risk factors for predicting mortality in group I.

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Acoustic Reflex Testing in Neonatal Hearing Screening and Subsequent Audiological Evaluation

Journal of Speech Language and Hearing Research ◽

10.1044/2018_jslhr-h-16-0291 ◽

2018 ◽

Vol 61 (7) ◽

pp. 1784-1793

Author(s):

Lilian Cássia Bórnia Jacob-Corteletti ◽

Eliene Silva Araújo ◽

Josilene Luciene Duarte ◽

Fernanda Zucki ◽

Kátia de Freitas Alvarenga

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Gestational Age ◽

Pure Tone ◽

Broadband Noise ◽

Acoustic Reflex ◽

Group I ◽

Group Ii ◽

Gestational Age At Birth ◽

Age At Birth

Purpose The aims of the study were to examine the acoustic reflex screening and threshold in healthy neonates and those at risk of hearing loss and to determine the effect of birth weight and gestational age on acoustic stapedial reflex (ASR). Method We assessed 18 healthy neonates (Group I) and 16 with at least 1 risk factor for hearing loss (Group II); all of them passed the transient evoked otoacoustic emission test that assessed neonatal hearing. The test battery included an acoustic reflex screening with activators of 0.5, 1, 2, and 4 kHz and broadband noise and an acoustic reflex threshold test with all of them, except for the broadband noise activator. Results In the evaluated neonates, the main risk factors were the gestational age at birth and a low birth weight; hence, these were further analyzed. The lower the gestational age at birth and birth weight, the less likely that an acoustic reflex would be elicited by pure-tone activators. This effect was significant at the frequencies of 0.5, 1, and 2 kHz for gestational age at birth and at the frequencies of 1 and 2 kHz for birth weight. When the broadband noise stimulus was used, a response was elicited in all neonates in both groups. When the pure-tone stimulus was used, the Group II showed the highest acoustic reflex thresholds and the highest percentage of cases with an absent ASR. The ASR threshold varied from 50 to 100 dB HL in both groups. Group II presented higher mean ASR thresholds than Group I, this difference being significant at frequencies of 1, 2, and 4 kHz. Conclusions Birth weight and gestational age at birth were related to the elicitation of the acoustic reflex. Neonates with these risk factors for hearing impairment were less likely to exhibit the acoustic reflex and had higher thresholds.

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Clinical Cases: Cases from outside Europe1184Don't overlook Fabry disease as an aetiology of hypertrophic cardiomyopathy1185severe mitral valve damage after MitraClip1186Arrhythmogenic right ventricular dysplasia versus shunt1187A thormbus that stops the giant1188The milk bottle echo1189Myocardial fibrosis in rheumatic mitral stenosis: quantitative evaluation by T1 mapping

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jew264 ◽

2016 ◽

Vol 17 (suppl 2) ◽

pp. ii250-ii252

Author(s):

SH. Park ◽

B. Ren ◽

AM. Jamiel ◽

AM. Ragab ◽

PV. Parekh ◽

...

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Fabry Disease ◽

Quantitative Evaluation ◽

Mitral Stenosis ◽

T1 Mapping ◽

Milk Bottle ◽

Rheumatic Mitral Stenosis ◽

Right Ventricular Dysplasia ◽

Clinical Cases

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Assessment of risk factors for surgical site infection following caesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194886 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4518

Author(s):

Aditi Sangwan ◽

Vani Malhotra

Keyword(s):

Risk Factors ◽

Caesarean Section ◽

Surgical Site Infection ◽

Site Infection ◽

Emergency Caesarean ◽

Group I ◽

Number Of Patients ◽

Duration Of Surgery ◽

Wound Discharge ◽

Group Ii

Background: Assessment of surgical site infection is an important factor to determine the functioning of the health care system. Objectives of this study was to estimate the incidence of surgical site infection among caesarean section cases and to determine the risk factors associated with surgical site infection and comparison with patients having healthy wounds.Methods: One thousand pregnant women who underwent caesarean section were divided into two groups: Group 1 (cases): Those who had SSI within 30 days of caesarean section and Group 2 (controls): Those who didn’t have SSI.Results: Mean age of group I was 25.35±4.40 and 21.12±3.60 years in group II (p >0.05). Mean gestational age of group I cases was 38.07±1.88 weeks and in group II, it was 38.17±2.06 weeks (p >0.05). A total of 37 (82.5%) women in group I and 931 (96.98%) women in group II underwent emergency caesarean section (p <0.05). In group I, mean duration of surgery was 1.0±0.13 hours and 1.02±0.21 hours in group II (p <0.05). Maximum number of patients i.e. 22 (55%) had wound discharge between 4-7 days followed by 11 (27.5%) between 8-10 days. Mean wound discharge was 7.32±3.45 days in group I. Majority of women, i.e. 27 (67%) found to be sterile in the present study followed by 7 (17.5%) women were found to have staphylococcus aureus. Mean duration of resuturing was 17.42±6.98 days. Mean baby weight in group I was 2.72±0.53 kg and in group II it was 2.95±0.53 kg (p <0.001).Conclusions: Risk of developing SSI after caesarean section is multi-factorial and found to be influenced by emergency surgery, PROM, pre-operative anaemia, multiple vaginal examinations, interrupted skin suturing, raised BMI, nulliparity, emergency caesarean, duration of surgery.

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The 5-minute Apgar Score as a Prognostic Factor for Development and Progression of Retinopathy of Prematurity

Folia Medica ◽

10.1515/folmed-2017-0011 ◽

2017 ◽

Vol 59 (1) ◽

pp. 78-83 ◽

Cited By ~ 4

Author(s):

Vasil G. Marinov ◽

Desislava N. Koleva-Georgieva ◽

Nelly P. Sivkova ◽

Maya B. Krasteva

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Retinopathy Of Prematurity ◽

Apgar Score ◽

Prognostic Significance ◽

Significant Risk ◽

Exact Test ◽

Group I ◽

Group Ii ◽

Minute Apgar Score

Abstract Background: A low Apgar score at 5 minutes has been shown to be a risk factor for development of retinopathy of prematurity (ROP). Aim: To examine the prognostic value of Apgar score at 5 minutes for development and progression of ROP. Materials and methods: The study included 132 preterm infants who were screened from 4th week of life onward. Of these, 118 newborns were given Apgar score at 5 minutes. The prognostic significance of this index was studied as an absolute value and as a value ≤ 6. The patients were divided into two groups: group I had no evidence of ROP (n=82) and group II had some signs of ROP (n = 36). Group II was further divided into group IIA - spontaneously regressed cases (n=22), and group IIB with cases which progressed to treatment stages (n=14). We investigated 15 maternal and 20 newborn presumable risk factors for development and progression of ROP. Mann-Whitney U test, χ2 or Fisher’s exact test were used in the statistical analysis. Logistic regression was performed to find significant and independent risk factors for manifestation and progression of ROP. Results: A low 5-minute Apgar score and an Apgar score of 6 or less at 5 minutes were not statistically significant risk factors of ROP (р=0.191, р=0.191, respectively), but were significant risk factors for the manifested ROP to progress to stages requiring treatment (p=0.046, р=0.036, respectively). Conclusion: An Apgar score at 5 minutes of 6 or less was a significant and independent risk factor for progression of ROP to stages requiring treatment.

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426 Involvment of anterior lefleat and persistent MR at discharge are the 2 predictive risk factors for reintervention after mitral valve repair for significant and symptomatic MR

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.240 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

C Fauvel ◽

R Breil ◽

F Doguet ◽

O Raitiere ◽

F Bauer

Keyword(s):

Risk Factors ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Valve Replacement ◽

Mitral Valve Repair ◽

Predictive Factors ◽

Anterior Leaflet ◽

Valve Repair ◽

Grade 3 ◽

Predictive Risk

Abstract Background Mitral regurgitation (MR) is the second most common valve disease in Europe with mitral valve repair being the treatment of choice in symptomatic patients with degenerative MR grade 3+. Purpose the study goal is to evaluate the long-term survival, the rate and the predictive factors of reintervention following mitral valve repair. Method All patients admitted for mitral valve repair in the context of significant MR defined by symptoms and/or critical left ventricular enlargement were included in this retrospective registry from January 2001 to 31 December 2011. The only exclusion criteria was scheduled mitral valve repair converted into mitral valve replacement. Results 426 consecutive patients had mitral valve repair. There were 137 women and 289 men with an average age of 62 ± 13 y. Twenty-two percent, 37%, 36% and 5 % patients were in NYHA functional class 1, 2, 3 and 4, respectively. All patients had MR grade 3+. Indication for mitral valve repair was endocarditis (n = 21), ring dilation (n = 21), ischemic functional MR (n = 26), rheumatic mitral valve (n = 8) and degenerative MR (n = 350). Operating room successful attained 95% % for mitral valve repair with only 5% in-hospital conversion to valve replacement. Of the 426 patients discharged after mitral valve repair, 39 patients died with a survival rate of 10.8 years (95% CI [10.4-11.3], 78.5% > 10 years) and 25 were re-operated. The two predictive factors for reintervention were anterior leaflet degeneration (OR = 3.4 IC95% [1.05-9.8]; p = 0.02) and persistence of mitral leak grade 2+ at discharge (OR = 6.7 IC95% [2-22]; p = 0.001). Conclusion Preoperative degenerative anterior leaflet and post-operative persistent grade 2+ mitral regurgitation are the 2 predictive risk factors for reintervention after mitral valve repair for significant MR.

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Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

International Journal of Angiology ◽

10.1055/s-0039-1693457 ◽

2019 ◽

Vol 28 (04) ◽

pp. 237-244

Author(s):

Teuku Muhammad Haykal Putra ◽

Renan Sukmawan ◽

Elen Elen ◽

Celly A. Atmadikoesoemah ◽

Dwita Rian Desandri ◽

...

Keyword(s):

Cardiac Surgery ◽

Late Gadolinium Enhancement ◽

Mitral Valve ◽

Myocardial Fibrosis ◽

Mitral Stenosis ◽

Postoperative Morbidity ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Gadolinium Enhancement ◽

Rheumatic Mitral Stenosis

Myocardial fibrosis in rheumatic mitral stenosis (MS) is caused by chronic inflammatory process. Its occurrence may lead to hemodynamic problems, especially after cardiac surgery. Myocardial fibrosis predicts worse morbidity after cardiac surgery, notably in coronary heart disease and aortic valve abnormalities. However, this issue has not been explored yet among patients with rheumatic MS.The aim of the study was to investigate prognostic impact of myocardial fibrosis to postoperative morbidity after mitral valve surgery in patients with rheumatic MS.This is a prospectively enrolled observational study of 47 consecutive rheumatic MS patients. All patients had preoperative evaluation with cardiac magnetic resonance imaging (CMR) including late gadolinium enhancement (LGE) protocol for left ventricular myocardial fibrosis assessment prior to mitral valve surgery. All patients were followed during hospitalization period. Postoperative morbidities were defined as stroke, renal failure, and prolonged mechanical ventilation.This study involved 33 women (70.2%) and 14 men (29.8%) with a mean age of 46 ± 10 years. Preoperative myocardial fibrosis was identified in 43 patients (91.5%). Estimated fibrosis volume ranged from 0% to 12.8% (median 2.8%). Postoperative morbidities occurred in 11 patients (23.4%). Significant mean difference of myocardial fibrosis volume was observed between patients with and without morbidity after mitral valve surgery (5.97 ± 4.16% and 3.12 ± 2.62%, p = 0.04). This significant association was allegedly influenced by different postoperative hemodynamic changes between the two groups.More extensive myocardial fibrosis is associated with postoperative morbiditiy after mitral valve surgery in patients with rheumatic MS.

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