Acute Heart Failure in a Patient with Occult Barlow’s Disease Receiving Bevacizumab

Bevacizumab is a recombinant humanized monoclonal antibody and a key drug for treatment of various types of cancer. Bevacizumab is associated with the occurrence of heart failure, but its risk factors remain unknown. A 55-year-old woman was diagnosed with cervical cancer, which was completely treated by bevacizumab-incorporated chemotherapy. During the 9-month bevacizumab therapy, she suffered from hypertension requiring multiple antihypertensive agents. She was admitted to our hospital due to acute heart failure with afterload mismatch and severe mitral regurgitation. A transesophageal echocardiography showed Barlow’s disease with a degenerated and widely prolapsed mitral valve. She received a scheduled surgical mitral valve repair. Post-operative cause was uneventful, but metastatic dissemination developed later. The existence of mitral valve regurgitation, even when sub-clinical, might be a risk of worsening heart failure during bevacizumab therapy. Careful follow-up at an onco-cardiology clinic is highly encouraged particularly for such a cohort during bevacizumab therapy.

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Impact of Mitral Valve Regurgitation Evaluated by Intraoperative Transesophageal Echocardiography on Long-Term Outcomes After Coronary Artery Bypass Grafting

Circulation ◽

10.1161/circulationaha.104.523472 ◽

2005 ◽

Vol 112 (9_supplement) ◽

Author(s):

Jacob N. Schroder ◽

Matthew L. Williams ◽

Jonathan A. Hata ◽

Lawrence H. Muhlbaier ◽

Madhav Swaminathan ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Artery Bypass ◽

Mitral Valve Regurgitation ◽

Valve Regurgitation ◽

Heart Failure Hospitalization ◽

Intraoperative Transesophageal Echocardiography ◽

Cabg Patients

Background— It is unclear if mild or moderate mitral valve regurgitation (MR) should be repaired at the time of coronary artery bypass grafting (CABG). We sought to determine the long-term effect of uncorrected MR, measured by intraoperative transesophageal echocardiography (TEE), in CABG patients. Methods and Results— Between May 1999 and September 2003, data were gathered for 3264 consecutive patients who underwent isolated CABG and had MR graded by intraoperative TEE. MR was graded on the following 5 levels: none, trace, mild, moderate, and severe. Patients who had severe MR or who underwent mitral valve surgery were eliminated from the analysis. The remaining patients were combined into the following 3 groups: none or trace, mild, and moderate MR. Preoperative and follow-up data were 99% complete. The median length of follow-up was 3.0 years. Multivariable analysis controlling for important preoperative risk factors was performed to determine predictors of death and death/hospitalization for heart failure. Increasing MR was a risk factor for death [hazard ratio (HR), 1.44; P <0.001] and death/heart failure hospitalization (HR, 1.34; P <0.01). When patients with moderate MR were eliminated from the analysis, mild MR was a risk factor for death (HR, 1.34; P =0.011) and death/hospitalization for heart failure (HR, 1.34; P <0.001). Conclusions— Even mild MR, identified by intraoperative TEE, predicts worse outcomes after CABG. Revascularization alone did not eliminate the negative long-term effects of mild MR. CABG patients with uncorrected mild or moderate MR are at increased risk for death and heart-failure hospitalization; consideration for surgical repair or more aggressive medical management and follow-up is warranted.

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Remarkable improvement in mitral valve regurgitation in paediatric eosinophilic granuloma with polyangiitis

Cardiology in the Young ◽

10.1017/s1047951117000889 ◽

2017 ◽

Vol 27 (8) ◽

pp. 1644-1646

Author(s):

Niek E. van der Aa ◽

Heynric B. Grotenhuis ◽

Hans (J.) M. Breur

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Acute Heart Failure ◽

Inflammatory Markers ◽

Eosinophilic Granuloma ◽

Mitral Valve Regurgitation ◽

Response To Therapy ◽

Rapid Response ◽

Valve Regurgitation ◽

Remarkable Improvement

AbstractWe report the case of a 12-year-old boy who presented with acute heart failure due to newly developed mitral valve regurgitation. The boy’s history combined with raised levels of inflammatory markers was suggestive of paediatric eosinophilic granuloma with polyangiitis. The echocardiographic course and rapid response to therapy are presented.

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Do Patients With Acute Heart Failure and Preserved Ejection Fraction Have Heart Failure at Follow-Up: Implications of the Framingham Criteria

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2019.04.013 ◽

2020 ◽

Vol 26 (8) ◽

pp. 673-684

Author(s):

CAMILLA HAGE ◽

ULRIKA LÖFSTRÖM ◽

ERWAN DONAL ◽

EMMANUEL OGER ◽

AGNIESZKA KAPŁON-CIEŚLICKA ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Acute Heart Failure ◽

Preserved Ejection Fraction

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Minimally-invasive mitral valve repair of symmetric and asymmetric Barlow´s disease

Clinical Research in Cardiology ◽

10.1007/s00392-021-01844-9 ◽

2021 ◽

Author(s):

Gloria Faerber ◽

Sophie Tkebuchava ◽

Mahmoud Diab ◽

Christian Schulze ◽

Michael Bauer ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Wide Spectrum ◽

Mitral Valve Surgery ◽

Valve Repair ◽

Prolapse Repair ◽

Repair Rate ◽

Barlow’S Disease ◽

Increased Risk

Abstract Objectives Barlow´s disease represents a wide spectrum of mitral valve pathologies associated with regurgitation (MR), excess leaflet tissue, and prolapse. Repair strategies range from complex repairs with annuloplasty plus neochords through resection to annuloplasty-only. The latter requires symmetric prolapse patterns and central regurgitant jets. We aimed to assess repair success and durability, survival, and intraoperative outcomes with symmetric and asymmetric Barlow’s disease. Methods Between 09/10 and 03/20, 103 patients (of 1939 with mitral valve surgery) presented with Barlow´s disease. All received surgery through mini-thoracotomy with annuloplasty plus neochords (n = 71) or annuloplasty-only (n = 31). One valve was replaced for endocarditis (repair rate: 99%). Results Annuloplasty-only patients were older (64 ± 16 vs. 55 ± 11 years, p = 0.008) and presented with higher risk (EuroSCORE II: 4.2 ± 4.9 vs. 1.6 ± 1.7, p = 0.007). Annuloplasty-only patients had shorter cross-clamp times (53 ± 18 min vs. 76 ± 23 min, p < 0.001) and received more tricuspid annuloplasty (15.5% vs. 48.4%, p < 0.001). Operating times were similar (170 ± 41 min vs. 164 ± 35, p = 0.455). In three patients, annuloplasty-only caused intraoperative systolic anterior motion (SAM), which was fully resolved by neochords to the posterior leaflet. There were no conversions to sternotomy or deaths at 30-days. Three patients required reoperation for recurrent MR (at 25 days, 2.8 and 7.8 years). At the latest follow-up, there was no MR in 81.4%, mild in 14.7%, and moderate in 2.9%. Three patients died due to non-cardiac reasons. Surviving patients report the absence of relevant symptoms. Conclusions Minimally-invasive Barlow’s repair is safe with good durability. Annuloplasty-only may be a simple solution for complex but symmetric pathologies. However, it may carry an increased risk of intraoperative SAM.

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Mitral valve repair in heart failure: Five-year follow-up from the mitral valve replacement stratum of the Acorn randomized trial

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2010.10.051 ◽

2011 ◽

Vol 142 (3) ◽

pp. 569-574.e1 ◽

Cited By ~ 63

Author(s):

Michael A. Acker ◽

Mariell Jessup ◽

Steven F. Bolling ◽

Jae Oh ◽

Randall C. Starling ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Randomized Trial ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

Valve Repair

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Early and Mid-term Results of Mitral Valve Repair in Patients with Degenerative Mitral Regurgitation

Kosuyolu Heart Journal ◽

10.51645/khj.2021.m133 ◽

2021 ◽

Author(s):

Hasan Erdem ◽

Emre Selçuk

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Survival Rates ◽

Mitral Valve Regurgitation ◽

Valve Repair ◽

Repair Rate ◽

Mitral Repair ◽

Mid Term Results

Objectives: In this study, we present the mid-term results of patients who underwent valve repair due to degenerative mitral valve regurgitation in the first five years of our mitral valve repair program. Patients and Methods: In this retrospective study, all patients who were operated for degenerative mitral regurgitation by a single surgical team between 2013 and 2017 were investigated. We determined early and mid-term cumulative survival rates, repair failure and freedom from reoperation. In addition, as a specific subgroup, the results of patients under 18 years of age after mitral valve repair were investigated Results: Mitral repair was performed in 121 of 153 degenerative mitral regurgitation patients during the study period. The overall repair rate was 79%. Mitral valve repair rate increased significantly over years. The Median follow-up time was 63 (range 10-92) months. Early mortality was 2.5% (n=3 patients). During the follow-up period, moderate-to-severe mitral regurgitation was observed in 14 (11.8%) patients, mitral valve reoperation was required in 7 (5.9%) patients. Valve repair was performed in 4 of 7 patients under the age of 18. There was no pediatric case requiring reoperation during the follow-up period (median 46 months). Conclusion: Mid-term results of mitral valve repair in degenerative mitral valve patients are satisfactory. The success rate of repair increases in line with surgical experience.

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Abstract 19622: Trans-apical Off-pump Mitral Valve Repair With Neochords Implantation: One Year Clinical and Echocardiographic Follow-up

Circulation ◽

10.1161/circ.132.suppl_3.19622 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Andrea Colli ◽

Laura Besola ◽

Lorenzo Bagozzi ◽

Erica Manzan ◽

Eleonora Bizzotto ◽

...

Keyword(s):

Mitral Valve ◽

Type A ◽

Mitral Valve Regurgitation ◽

Disease Type ◽

Reverse Remodeling ◽

Off Pump ◽

Single Centre Study ◽

Type C ◽

One Year

Introduction: TOP-MINI is a new micro invasive surgical procedure to treat degenerative mitral valve regurgitation due to flail/prolapse. Hypothesis: This prospective single centre study sought to assess the safety and effectiveness of the TOP-MINI procedure up to one year follow-up. Methods: Clinical and Echocardiographic outcomes were evaluated at 1, 3, 6 months and 1 year follow-up for all patients underwent TOP-MINI procedure from November 2013 to March 2015. Procedural success was defined as residual MR≤2+ at any time. Results: Sixty-one patients were treated during study period. One year survival was 96.7±2.3%. Freedom from MR>2+ is shown in figure 1 Panel A, Freedom from MR>2+ according to valve anatomy (Type A isolated P2 disease, Type B posterior multisegment disease, Type C anterior or bileaflet and/or calcified disease) is shown in Figure 1 Panel B. Freedom from MR>2+ according to STS risk profile is shown in Figure 2. The trend of Echocardiographic parameters is shown in Figure 3. Conclusions: TOP-MINI is a safe and effective procedure at 1 year FU. Residual MR is influenced by valve anatomy showing good results in Type A and B patients. Future techniques refinements are needed in order to improve outcomes of Type C patients. The lack of annuloplasty procedure does not influence negatively left ventricle reverse remodeling.

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Abstract 330: Serum Mir-129 and Mir-21 Predict 100-day Mortality in Acute Heart Failure Patients

Circulation Research ◽

10.1161/res.117.suppl_1.330 ◽

2015 ◽

Vol 117 (suppl_1) ◽

Author(s):

Lichan Tao ◽

Yihua Bei ◽

Shutong Shen ◽

Jin Li ◽

Rongrong Gao ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Common Disease ◽

Predictive Values ◽

Circulating Micrornas ◽

Chain Reactions ◽

Polymerase Chain Reactions ◽

Novel Biomarkers ◽

Polymerase Chain

Background: Heart failure is a common disease worldwide and it could be divided as chronic heart failure (CHF) and acute heart failure (AHF). Circulating microRNAs (miRNAs, miRs) have been reported to be novel biomarkers of diagnostic, prognostic and predictive values in cardiovascular diseases. However, little is know about using circulating miRNAs as biomarkers for mortality in AHF patients. Methods and results: A total of 151 AHF patients were enrolled in this study. Ten miRNAs involved in the regulation of AHF including miR-129, miR-675, miR-622, miR-146a, miR-155, miR-21, miR-18b, miR-92b, miR-126 and miR-22 were determined by reverse transcription polymerase chain reactions using total RNA isolated from serum of those 151 patients with AHF enrolled in our center. After a follow-up period of 100 days, 16 patients died and based on that, we found that expression levels of serum miR-129 (p=0.032) and miR-21-5p (p=0.001) were significantly lower in those patients died within 100 days. The kaplan cumulative survival analysis confirmed that patients with higher levels of miR-129 (p=0.036) and miR-21 (p=0.001) had significantly higher survival rate. Conclusion: Serum low levels of miR-129 and miR-21 predict 100-day mortality in AHF patients.

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Mitral valve regurgitation

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198849353.003.0015 ◽

2021 ◽

pp. 199-210

Author(s):

Daniel Rodríguez Muñoz ◽

Kyriakos Yiangou ◽

José Luis Zamorano

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

High Volume ◽

Mitral Valve Regurgitation ◽

Heart Team ◽

Barlow’S Disease ◽

Underlying Mechanisms ◽

Secondary Mr ◽

Annular Calcification

The prevalence of mitral regurgitation (MR) is increasing in Western countries, which results in making it the second most frequent valvular heart disease requiring surgery. MR can be classified as primary (organic) or secondary (functional). Causes of primary MR consist of leaflet lesions, either degenerative changes (Barlow’s disease, fibroelastic degeneration, and annular calcification), rheumatic disease, or infective endocarditis. Causes of secondary MR consist of those that produce geometrical distortion of the subvalvular apparatus due to dilatation and remodelling of the left ventricle such as ischaemic heart disease and cardiomyopathies. The implementation of mitral valve repair as well as the rise of new transcatheter techniques, provided that are performed in experienced, high volume centres with the contribution of a valvular heart team, have impressively changed the prognosis of patients with severe MR. This has set new frontiers in the management of MR and has upgraded the role of imaging, creating new responsibilities, since its presence in every step of the procedure either preoperatively (quantification of MR, determination of the underlying mechanisms, investigation of reparability, determination of prognosis) or intra- and postoperatively, has been declared as fundamental.

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Prognostic Value of Cystatin C-Derived Estimated Glomerular Filtration Rate in Patients with Acute Heart Failure

Cardiorenal Medicine ◽

10.1159/000504084 ◽

2020 ◽

Vol 10 (4) ◽

pp. 232-242 ◽

Cited By ~ 1

Author(s):

Se Yong Jang ◽

Dong Heon Yang ◽

Hyeon Jeong Kim ◽

Bo Eun Park ◽

Yoon Jung Park ◽

...

Keyword(s):

Heart Failure ◽

Glomerular Filtration ◽

Acute Heart Failure ◽

Cystatin C ◽

Prognostic Value ◽

Survival Curve ◽

Characteristic Curve ◽

Curve Analysis ◽

Disease Epidemiology

Background: Renal function is closely related to cardiac function and an important prognostic marker in heart failure. Objective: We aimed to test the prognostic value of cystatin C (cysC)-derived estimated glomerular filtration rates (eGFR) in comparison with eGFRs from creatinine solely based equations in patients with acute heart failure (AHF). Methods: This study included 262 patients (65.8 ± 14.9 years old, 126 male) with AHF. Prognostic value of the eGFRs, from cysC-based equations chronic kidney disease epidemiology collaboration (CKD-EPI-cysC and CKD-EPI-creatinine [cr]-cysC equations) were compared with eGFRs calculated from serum creatinine levels only (Modification of Diet in Renal Disease [MDRD]-4 and CKD-EPI-cr equations). Prognosis was evaluated with the composite of all-cause mortality and hospitalization for heart failure within 1 year. Results: During the follow-up period (mean follow-up period, 264.0 ± 136.1 days), 67 (25.6%) events occurred. Estimated GFR using CKD-EPI-cysC was the best for predicting 1-year outcome using receiver operating characteristic curve analysis (area under curve 0.585, 0.607, 0.669, and 0.652 for eGFRs from MDRD-4, CKD-EPI-cr, CKD-EPI-cysC, and CKD-EPI-cr-cysC respectively). The Kaplan-Meier survival curve analysis showed that only the eGFRs classification from the equations based on cysC significantly predicted 1-year outcome in patients with AHF. Conclusions: Estimated GFRs calculated with cysC predicted the prognosis more accurately in patients with AHF than the eGFRs from creatinine only equations.

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