Reducing Morbidity and Mortality in Patients With Coarctation Requires Systematic Differentiation of Impacts of Mixed Valvular Disease on Coarctation Hemodynamics

Background Despite ongoing advances in surgical techniques for coarctation of the aorta (COA) repair, the long‐term results are not always benign. Associated mixed valvular diseases (various combinations of aortic and mitral valvular pathologies) are responsible for considerable postoperative morbidity and mortality. We investigated the impact of COA and mixed valvular diseases on hemodynamics. Methods and Results We developed a patient‐specific computational framework. Our results demonstrate that mixed valvular diseases interact with COA fluid dynamics and contribute to speed up the progression of the disease by amplifying the irregular flow patterns downstream of COA (local) and exacerbating the left ventricular function (global) (N=26). Velocity downstream of COA with aortic regurgitation alone was increased, and the situation got worse when COA and aortic regurgitation coexisted with mitral regurgitation (COA with normal valves: 5.27 m/s, COA with only aortic regurgitation: 8.8 m/s, COA with aortic and mitral regurgitation: 9.36 m/s; patient 2). Workload in these patients was increased because of the presence of aortic stenosis alone, aortic regurgitation alone, mitral regurgitation alone, and when they coexisted (COA with normal valves: 1.0617 J; COA with only aortic stenosis: 1.225 J; COA with only aortic regurgitation: 1.6512 J; COA with only mitral regurgitation: 1.3599 J; patient 1). Conclusions Not only the severity of COA, but also the presence and the severity of mixed valvular disease should be considered in the evaluation of risks in patients. The results suggest that more aggressive surgical approaches may be required, because regularly chosen current surgical techniques may not be optimal for such patients.

Аortic regurgitation – hemodynamic changes and evaluation

Valvular diseases are a leading cause of morbidity, mortality and impaired quality of life in all over the world with different epidemiology. It is extremely important to know the hemodynamic changes for the proper development of a strategy for future interventions. The recent years shows progress in various methodologies of the field of surgery and interventional treatments of valvular diseases. In this section, we focus mainly on aortic regurgitation and its clinical significance.

NcRNAs in Vascular and Valvular Intercellular Communication

Non-coding RNAs have been shown to be important biomarkers and mediators of many different disease entities, including cardiovascular (CV) diseases like atherosclerosis, aneurysms, and valvulopathies. Growing evidence suggests a central role of ncRNAs as regulators of different pathological pathways involved in endothelial dysfunction, cardiovascular inflammation, cell differentiation, and calcification. This review will discuss the role of protein-bound and extracellular vesicular-bound ncRNAs as biomarkers of vascular and valvular diseases, their role as intercellular communicators, and regulators of disease pathways and also highlights possible treatment strategies.

The Role of Multimodality Imaging in Athlete’s Heart Diagnosis: Current Status and Future Directions

“Athlete’s heart” is a spectrum of morphological and functional changes which occur in the heart of people who practice physical activity. When athlete’s heart occurs with its most marked expression, it may overlap with a differential diagnosis with certain structural cardiac diseases, including cardiomyopathies, valvular diseases, aortopathies, myocarditis, and coronary artery anomalies. Identifying the underlying cardiac is essential to reduce the potential for sudden cardiac death. For this purpose, a spectrum of imaging modalities, including rest and exercise stress echocardiography, speckle tracking echocardiography, cardiac magnetic resonance, computed tomography, and nuclear scintigraphy, can be undertaken. The objective of this review article is to provide to the clinician a practical step-by-step approach, aiming at distinguishing between extreme physiology and structural cardiac disease during the athlete’s cardiovascular evaluation.

The Utility of Real-Time Remote Auscultation Using an Internet-Connected Electronic Stethoscope: An Open-Label Randomized Controlled Pilot Trial

Objective: This study aimed to assess the utility of real-time remote auscultation using the cardiopulmonary simulators.Methods: In this open-label, randomized controlled trial, the researchers randomly assigned general internal medicine doctors to the real-time remote auscultation group (intervention group) or the classical auscultation group (control group). In the training session, participants listened to five different lung sounds and five cardiac sounds in a previously determined order with the correct classification. In the test session, participants had to classify the five lung sounds and five cardiac sounds in random order. For both sessions, the intervention group auscultated at a distance of 220 m, with an Internet-connected electronic stethoscope while watching the auscultation places on the computer screen. The control group performed direct auscultation using a classical stethoscope. The primary outcome was the total test score.Results: Twenty participants were included in the study. The total test scores of lung auscultation in the intervention (86%) and control (90%) groups were not significantly different (P = .54). The total test score of cardiac auscultation in the control group (94%) was superior to that in the intervention group (72%, P < .05). Valvular diseases were not misclassified as normal sounds in real-time remote cardiac auscultation. Discussion and Conclusions: The utility of real-time remote lung auscultation using an Internet-connected electronic stethoscope was comparable to that of classical lung auscultation. Classical cardiac auscultation was superior to real-time remote cardiac auscultation. However, real-time remote cardiac auscultation is useful for classifying valvular diseases and normal sounds. Trial Registration: UMIN-CTR UMIN000043153; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049259 The date of first registration:28/01/2021

Left Atrial Appendage Occlusion for Patients with Valvular Diseases: A Prospective Study Design

Background:As increasing evidence showed the efficacy of percutaneous left atrial appendage (LAA) occlusion in reducing the stroke risks in patients with non-valvular atrial fibrillation(AF), we design this study to quantify the effect of surgical LAA occlusion (SLAAO) for patients with valvular diseases and with or without AF.Methods:The current study will be implemented in two parts: Part 1 (AF study) is a prospective longitudinal study with a plan to consecutively register 2032 patients diagnosed with valvular diseases and AF and receiving cardiovascular surgeries. SLAAO will be performed at the individual surgeon’s preference. We centrally conducted a one-year follow-up on stroke, systemic arterial embolism, and all-cause mortality. Part 2 (non AF study) is a single-blinded, multicenter, randomized controlled trial with the purpose to evaluate the efficacy of SLAAO to reduce one-year embolism events in patients with valvular diseases, without AF, and receiving cardiovascular surgeries. 2118 patients will be randomized 1:1 to the intervention or control arm using a central randomization system.Results:The primary outcome is a composition of newly occurred ischemic stroke/transient ischemic attack (TIA) with positive neuroimaging or systemic arterial embolism, and cardiovascular mortality during one-year follow-up.Conclusion:The trial is designed to evaluate the efficacy of SLAAO to reduce embolism events one year after mitral or aortic surgeries, and this paper presents the prospective study protocol. It provides details of patient randomization, follow-up, methods of analysis of the material, and publication plan.

Enlarged Left Atrium And Decreased Left Atrial Strain are Associated with Atrial Fibrillation in Patients with Hyperthyroidism Irrespective of Conventional Risk Factors

Background: The purpose of this study was to investigate factors associated with AF in patients with hyperthyroidism beyond heart failure (HF), coronary heart disease (CHD), or valvular diseases.Methods: A total of 136 patients (mean age, 52 ± 15 years; 86 [63%] female) who were diagnosed with hyperthyroidism for the first time were enrolled. Patients who had HF, CHD, or significant valvular diseases were excluded. Patients were classified into two groups according to the presence (group 1, n=40) and absence of AF (group 2, n=96). Results: AF occurred in 40 (29%) patients and 23 (58%) of these patients showed paroxysmal AF. Among the symptoms of hyperthyroidism, the most common chief complaint was palpitation (30%). Advanced age, presence of prior cerebrovascular events, and presence of palpitations were associated with AF. Larger left atrial volume index (LAVI), increased left ventricular mass index, and decreased left ventricular ejection fraction (LVEF) and S’ velocity were associated with AF. Among them, presence of palpitations and increased LAVI were independently associated with the occurrence of AF. In addition, strain analysis, decreased LA expansion index (EI), ejection fraction (EF), peak atrial longitudinal strain, contraction strain, and late diastolic strain rate (A sr) and systolic strain rate (S sr) were associated with the occurrence of AF and LAVI.Conclusion: Presence of palpitations and enlarged left atrium were associated with the occurrence of AF in patients with hyperthyroidism irrespective of conventional risk factors. Additional LA analysis revealed that decreased LA function was associated with AF and enlarged left atrium.

Computational Analysis of Wall Shear Stress Patterns on Calcified and Bicuspid Aortic Valves: Focus on Radial and Coaptation Patterns

Calcification and bicuspid valve formation are important aortic valve disorders that disturb the hemodynamics and the valve function. The detailed analysis of aortic valve hemodynamics would lead to a better understanding of the disease’s etiology. We computationally modeled the aortic valve using simplified three-dimensional geometry and inlet velocity conditions obtained via echocardiography. We examined various calcification severities and bicuspid valve formation. Fluid-structure interaction (FSI) analyses were adapted using ANSYS Workbench to incorporate both flow dynamics and leaflet deformation accurately. Simulation results were validated by comparing leaflet movements in B-mode echo recordings. Results indicate that the biomechanical environment is significantly changed for calcified and bicuspid valves. High flow jet velocities are observed in the calcified valves which results in high transvalvular pressure difference (TPG). Wall shear stresses (WSS) increased with the calcification on both fibrosa (aorta side) and ventricularis (left ventricle side) surfaces of the leaflet. The WSS distribution is regular on the ventricularis, as the WSS values proportionally increase from the base to the tip of the leaflet. However, WSS patterns are spatially complex on the fibrosa side. Low WSS levels and spatially complex WSS patterns on the fibrosa side are considered as promoting factors for further calcification and valvular diseases.

Radiographic Assessment of Dogs with Congestive Heart Failure

Background: Radiography is widely used for diagnosis of congestive heart failure as it enables non-invasive assessment of cardiac size, shape and pulmonary vasculature. So, the present study was conducted to record the radiographic changes in dogs with congestive heart failure.Methods: Fifty-one dogs with cardiac insufficiency brought to Teaching Veterinary Hospital of GADVASU, showing one of the clinical signs of chronic cough, dyspnea, exercise intolerance, abdominal distension, syncope and cyanosis were selected and were subjected to Lateral and Ventro-dorsal chest radiography. Result: Dilated cardiomyopathy was present in 24 dogs. Radiographically, pulmonary edema, cardiomegaly, vessel congestion were more common in dilated cardiomyopathy (DCM). Valvular diseases were present in 16 dogs and radiographically left atrial (LA) dilatation was present in dogs with valvular diseases. Pericardial effusions were present in 11 dogs showing enlarged globoid heart radiographically.