Trans-catheter Bioprosthetic Heart Valve Implantation in Iran (Tehran Heart Centre Experiance)

Introduction: With the development of interventional cardiology in the world, in addition to coronary and aortic diseases, the treatment of heart valve diseases through catheters has recently begun. The treatment of aortic stenosis (which was only possible with open surgery and valve replacement) was first performed in the world in 2002 by Alain Cribier in France with catheter insertion of the valve and was called Trans catheter Aortic valve implantation TAVI. Trans catheter Aortic valve implantation (TAVI) was performed in Iran in 2009 in the Heart Centre of Tehran and now is routinely performed by both Balloon Expanding and self-expanding valves. In addition, we do valve in valve implantation for degenarative biopresthetic valve, in all Heart valve positions too. The short and medium term results of this treatment were reviewed in the form of research projects and published in several articles. In this review, we have explained the initiating of this new procedure in our country with the following results.

Intestinal Complication With Myxomatous Mitral Valve Diseases in Chihuahuas

The effects of cardiac disease on the intestine have been reported in humans but not in dogs. We investigated the effects of myxomatous mitral valve disease (MMVD), which is capable of causing congestion and tissue hypoperfusion, on the intestine in Chihuahuas, a breed frequently encountered in clinical practice as the preferred breed for MMVD. In this study, 69 Chihuahuas were divided into four groups based on echocardiography and chest radiography: 19 healthy Chihuahuas (H) and 50 Chihuahuas with MMVD classified according to the ACVIM consensus (stage B1, B2, C/D). In all the cases, serum intestinal fatty acid-binding protein (I-FABP) and D/L-lactate concentrations, markers of intestinal mucosal injury, were measured. I-FABP was significantly higher in stage C/D Chihuahuas than in other groups (p < 0.05), and stage B2 was significantly higher than H (p < 0.05). D-lactate was significantly increased in stages B2 and C/D compared to H and stage B1 (p < 0.05). L-lactate was significantly higher in stage C/D Chihuahuas than in any other group (p < 0.05), and stage B2 was significantly higher than that in H and stage B1 (p < 0.05). Intestinal mucosal injury risk was significantly higher in Chihuahuas with heart failure due to MMVD, suggesting that the risk could increase with worsening heart disease. This is the first study to investigate the intestinal complications of MMVD, and further investigations a needed in the future.

When Aortic Stenosis Is Not Alone: Epidemiology, Pathophysiology, Diagnosis and Management in Mixed and Combined Valvular Disease

Aortic stenosis (AS) may present frequently combined with other valvular diseases or mixed with aortic regurgitation, with peculiar physio-pathological and clinical implications. The hemodynamic interactions between AS in mixed or combined valve disease depend on the specific combination of valve lesions and may result in diagnostic pitfalls at echocardiography; other imaging modalities may be helpful. Indeed, diagnosis is challenging because several echocardiographic methods commonly used to assess stenosis or regurgitation have been validated only in patients with the single-valve disease. Moreover, in the developed world, patients with multiple valve diseases tend to be older and more fragile over time; also, when more than one valvular lesion needs to address the surgical risk rises together with the long-term risk of morbidity and mortality associated with multiple valve prostheses, and the likelihood and risk of reoperation. Therefore, when AS presents mixed or combined valve disease, the heart valve team must integrate various parameters into the diagnosis and management strategy, including suitability for single or multiple transcatheter valve procedures. This review aims to summarize the most critical pathophysiological mechanisms underlying AS when associated with mitral regurgitation, mitral stenosis, aortic regurgitation, and tricuspid regurgitation. We will focus on echocardiography, clinical implications, and the most important treatment strategies.

Morphometric study on papillary muscles of human tricuspid valve-dissection method

Aim of the present study was to observe the measurements of anterior papillary muscles present in tricuspid valve of human heart. Measurements of anterior papillary muscles in tricuspid valve gains utmost importance in cardiac surgeries because they are the causes of myocardial infarction in recent times because of its variations and detection of these causes by advent in modern technologies which will help in treatment of tricuspid valve diseases. This study was carried out on 96 normal formalin fixed human heart specimens. Dissection was performed according to standard techniques. Anterior papillary muscles were observed and length, width and thickness of each muscle were measured and documented. In the present study, numbers of anterior papillary muscles were present with a frequency of 1-3, with most common appearance of 1 muscle in 66 hearts (68.8%) and least common incidence of 3 muscles in 6 hearts (6.3%). Anterior papillary muscles were present in all 96 hearts. In measurements, anterior papillary muscles mean height was 1.49±0.44 cm; mean width was 0.82±0.21 cm and mean thickness was 0.64±0.15 cm respectively. We hope this study will serve to understand the morphometry of anterior papillary muscles better and will help in various surgical procedures and cardiac treatment done on tricuspid valve.

A cadaveric study on chordae tendinae of human tricuspid valve

Aim of the present study was to observe the types of chordae tendinae present in tricuspid valve of human heart. Morphology of chordae tendinae in tricuspid valve gains utmost importance in cardiac surgeries in recent times because advent in modern technologies in treatment of tricuspid valve diseases.This study was carried out on 96 normal formalin fixed human post-mortem heart specimens. Types of chordae tendinae observed on the basis of their attachments.Chordae tendinae were observed in all specimens. Five types of chordae tendinae were identified namely rough zone, free edge, fan shaped, deep and basal chordae. Anterior papillary muscle was seen providing attachment to 2 to 9; Posterior papillary muscles were seen with 1 to 6 and Septal papillary muscles provided attachment to 1 to 4 chordae tendinae.We hope this study will serve to understand the tricuspid valve complex and types of different chordae tendinae better and it will help in various surgical procedures done on tricuspid valve.

The Common Combination of Aortic Stenosis with Mitral Regurgitation: Diagnostic Insight and Therapeutic Implications in the Modern Era of Advanced Echocardiography and Percutaneous Intervention

The combination of aortic stenosis (AS) and mitral regurgitation (MR) is common in patients with degenerative valvular disease. It is characterized by having complex pathophysiology, leading to potential diagnostic pitfalls. Evidence is scarce in the literature to direct the diagnostic framework and treatment of patients with this particular combination of multiple valvular diseases. In this complex scenario, the appropriate use of advanced echocardiography and multimodality imaging methods plays a central role. Transcatheter mitral valve replacement or repair and transcatheter aortic valve replacement widen the surgical options for valve diseases. Therefore, there is an increasing need to reconsider the function, timing, and mode intervention for patients with a combination of AS with MR towards more personalized treatment.