| 1. |
- Bothe, Wolfgang, et al.
(author)
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Regional Mitral Leaflet Opening During Acute Ischemic Mitral Regurgitation
- 2009
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In: Journal of Heart Valve Disease. - : I C R Publishers. - 0966-8519 .- 2053-2644. ; 18:6, s. 586-597
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Journal article (peer-reviewed)abstract
- Background and aim of the studyDiastolic mitral valve (MV) opening characteristics during ischemic mitral regurgitation (IMR) are poorly characterized. The diastolic MV opening dynamics was quantified along the entire valvular coaptation line in an ovine model of acute IMR.MethodsTen radiopaque markers were sutured in pairs on the anterior (A1-E1) and corresponding posterior (A2-E2) leaflet edges from the anterior (A1/A2) to the posterior (E1/E2) commissure in 11 adult sheep. Immediately after surgery, 4-D marker coordinates were obtained before and during occlusion of the proximal left circumflex coronary artery. Distances between marker pairs were calculated throughout the cardiac cycle every 16.7 ms. Leaflet opening was defined as the time after end-systole (ES) when the first derivative of the distance between marker pairs was greater than a threshold value of 3 cm/s. Valve opening velocity was defined as the maximum slope of marker pair tracings.ResultsHemodynamics were consistent with acute ischemia, as reflected by increased MR grade (0.5 ± 0.3 versus 2.3 ± 0.7, p <0.05), decreased contractility (dP/dtmax: 1,948 ± 598 versus 1,119 ± 293 mmHg/s, p <0.05), and slower left ventricular relaxation rate (dP/dtmin: −1,079 ± 188 versus −538 ± 147 mmHg/s, p <0.05). During ischemia, valve opening occurred earlier (A1/A2: 112 ± 28 versus 83 ± 43 ms, B1/B2: 105 ± 32 versus 68 ± 35 ms, C1/C2: 126 ± 25 versus 74 ± 37 ms, D1/D2: 114 ± 28 versus 71 ± 34 ms, E1/E2: 125 ± 29 versus 105 ± 33 ms; all p <0.05) and was slower (A1/A2: 16.8 ± 9.6 versus 14.2 ± 9.4 cm/s, B1/B2: 40.4 ± 9.9 versus 32.2 ± 10.0 cm/s, C1/C2: 59.0 ± 14.9 versus 50.4 ± 18.1 cm/s, D1/D2: 34.4 ± 10.4 versus 25.5 ± 10.9 cm/s; all p <0.05), except at the posterior edge (E1/E2: 13.3 ± 8.7 versus 10.6 ± 7.2 cm/s). The sequence of regional mitral leaflet separation along the line of coaptation did not change with ischemia.ConclusionAcute posterolateral left ventricular ischemia causes earlier leaflet opening, probably due to a MR-related elevation in left-atrial pressure; reduces leaflet opening velocity, potentially reflecting an impaired left ventricular relaxation rate; and does not perturb the homogeneous temporal pattern of regional valve opening along the line of coaptation. Future studies will confirm whether these findings are apparent in patients with chronic IMR, and may help to refine the current strategies used to treat IMR.
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| 2. |
- Fyrenius, Anna, 1969-, et al.
(author)
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Major and minor axes of the normal mitral annulus
- 2001
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In: Journal of Heart Valve Disease. - 0966-8519 .- 2053-2644. ; 10:2, s. 146-152
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Journal article (peer-reviewed)abstract
- Background and aim of the study: A dilated or abnormally shaped mitral annulus is a common cause of mitral valve regurgitation, and may be cured by annuloplastic surgery. Multiplane transesophageal echocardiography (TEE) is the diagnostic technique of choice. Our aim was to evaluate and suggest two-dimensional TEE reference values from a standardized procedure of measuring the mitral annular major and minor axes, and their cyclic changes. Methods: The annulus was approximated elliptic in the horizontal plane. The intercommissural (IC, major axis) and anteroposterior (AP, minor axis) distances were measured at end-systole (ES), at maximal valve opening (MO), and at end-diastole (ED) from a mid-esophageal view, in 13 men and eight women with normal echocardiographic findings. Indexed values and reproducibility were calculated. Results: The success rate was 100% at ES, 90% at MO, and 29% at ED. ES distances were largest (p <0.001) and most reproducible (5-5.9%). Body weight, but not height or age, had a significant impact. ES 95% prediction intervals for IC were 27 to 46 mm (16-23 mm/m2) and 22 to 36 mm (13-18 mm/m2) for AP (p <0.001). Corresponding body weight-corrected intervals were 0.39 to 0.59 (IC) and 0.32 to 0.48 (AP) mm/kg. No subject had IC:AP <1.1 together with an AP >0.45 mm/kg. Conclusion: Among measurements made at ES, MO and ED, those at ES provided the most reproducible results, and high-quality images were obtained in normal, non-obese subjects. The distances should be judged in relation to body weight or surface area and each other. The largest IC distance and the most elliptic shape were at ES, while the annulus was minimal at ED. The procedure and normal ranges presented may contribute to the evaluation of patients with mitral regurgitation.
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| 3. |
- Hultkvist, Henrik, et al.
(author)
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The combined impact of postoperative heart failure and euroScore on long-term outcome after surgery for aortic stenosis
- 2011
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In: Journal of Heart Valve Disease. - 0966-8519 .- 2053-2644. ; 20:6, s. 633-638
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIM OF THE STUDY:Although the EuroSCORE was developed for predicting operative mortality after cardiac surgery, it has also been shown to predict long-term mortality. It has been reported that postoperative heart failure (PHF) in association with surgery, albeit comparatively benign in the short term, has a profound impact on five-year survival after surgery for aortic stenosis (AS). The study aim was to determine the combined impact of EuroSCORE and PHF on long-term survival after isolated aortic valve replacement (AVR) for AS.METHODS:A total of 397 patients (48% females; average age 70 +/- 10 years) who underwent AVR for AS at the authors' institution between 1995 and 2000 was studied. The cohort was subdivided according to the additive EuroSCORE into a high-risk group (EuroSCORE >7) and a low-risk group (EuroSCORE < or = 7), and further analyzed in relation to PHF.RESULTS:The average follow up was 8.1 years (range: 5.2-11.2 years). Forty-five patients (11%) were treated for procedure-associated PHF. Patients with or without PHF and a high-risk EuroSCORE had crude five-year survivals of 57% and 64%, respectively (p = 0.6), whereas those with or without PHF but with a low-risk EuroSCORE had crude five-year survivals of 58% and 89%, respectively (p = 0.0003).CONCLUSION:Both PHF and a high EuroSCORE were associated with poor long-term survival. The role of PHF per se for the long-term prognosis was illustrated by the fact that the negative impact on long-term survival was almost as profound in patients of the low-risk group as of the high-risk group.
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| 4. |
- Lidén, Mats, 1976-, et al.
(author)
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Impact of Heart Rate on Flow Measurements in Aortic Regurgitation
- 2017
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In: Journal of Heart Valve Disease. - : I C R Publishers Ltd.. - 0966-8519 .- 2053-2644. ; 26:5, s. 502-508
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Journal article (peer-reviewed)abstract
- BACKGROUND: Flow measurements using cardiac magnetic resonance imaging (CMRI) enable quantification of the stroke volume, regurgitant volume (RV) and regurgitant fraction (RF) in patients with aortic regurgitation (AR). These variables are used to assess the severity of the valve disease and for the timing of surgery. The aim of the study was to investigate the impact of an increased heart rate on measurement of the RV and RF in patients with AR.METHODS: Among 13 patients with known moderate or severe AR, regurgitant flow measurements, using phase-contrast cine magnetic resonance imaging, were obtained in the ascending aorta. Flow measurements were obtained at rest and at increased heart rates after intravenous administration of atropine.RESULTS: The mean heart rate was 61 beats per min at rest and 91 beats per min after atropine administration. The RV and RF were 52 ml and 35% at rest, respectively, and 34 ml (p <0.001) and 30% (p = 0.065) at increased heart rate, respectively.CONCLUSIONS: An increased heart rate leads to a decreased RV. The RF is more stable and may therefore be preferable for severity grading in AR.
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| 5. |
- Nguyen, Tom, et al.
(author)
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Functional uncoupling of the mitral annulus and left ventricle with mitral regurgitation and dopamine
- 2008
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In: Journal of Heart Valve Disease. - 0966-8519 .- 2053-2644. ; 17, s. 168-178
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Journal article (peer-reviewed)abstract
- BACKGROUND: The mitral annulus and left ventricle are generally thought to be functionally coupled, in the sense that increases in left ventricular (LV) size, as seen in ischemic mitral regurgitation (MR), or decreases in LV size, as seen with inotropic stimulation, are thought to increase or decrease annular dimensions in similar manner. The study aim was to elucidate the functional relationship between the mitral annulus and left ventricle during acute MR and inotrope-induced MR reduction.METHODS: Radiopaque markers were implanted on the left ventricle and mitral annulus of five adult sheep. A suture was placed on the central scallop of the posterior mitral leaflet and exteriorized through the atrial-ventricular groove. Open-chest animals were studied at baseline (CTRL), at seconds after pulling on the suture to create moderate-severe 'pure' MR (PULL), and after titration of dopamine until the MR grade was maximally reduced (PULL+DOPA). This process was repeated two to three times for each animal.RESULTS: The MR grade was increased with PULL (from 0.5 +/- 0.01 to 3.4 +/- 0.4, p < 0.01) and decreased after PULL+DOPA (from 3.4 +/- 0.4 to 1.5 +/- 0.9, p < 0.001). PULL resulted in an increase in mitral annular (MA) area, predominantly by an increase in the muscular mitral annulus. PULL+DOPA caused a decrease in MA area, but the LV volume and dimensions were not altered with either PULL or PULL+DOPA.CONCLUSION: The acute geometric response to 'pure' MR and inotrope-induced MR reduction was limited to the mitral annulus. Surprisingly, the LV volume and dimensions did not change with acute MR or with inotrope-induced MR reduction. This suggests that, under these two conditions in an ovine model, the mitral annulus and left ventricle are functionally uncoupled.
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| 7. |
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| 8. |
- Bjursten, Henrik, et al.
(author)
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Successful Transcatheter Valve-in-Valve Implantation in a Small Deteriorated Aortic Valve Bioprosthesis
- 2013
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In: Journal of Heart Valve Disease. - 0966-8519. ; 22:3, s. 433-435
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Journal article (peer-reviewed)abstract
- Increased life expectancy and improvement in clinical outcome following surgery has led to an increasing number of elderly patients with a history of prior aortic valve replacement (AVR). As a consequence, a considerable number of patients may require reintervention due to a dysfunctional bioprosthesis with structural valve deterioration (SVD). Transcatheter aortic valve implantation (TAVI) has become an established surgical alternative in patients with aortic stenosis and severe comorbidities. For those patients requiring reoperation, the 'valve-in-valve' concept has been described. Here, the case is reported of a patient with a very small Sorin Soprano 18 bioprosthesis with SVD who underwent a reintervention with the transapical valve-in-valve technique. The implantation was uneventful, with no residual paravalvular leakage and a low mean transprosthetic gradient. The valve-in-valve procedure may represent a feasible alternative for redo AVR in patients with a very small, structurally deteriorated bioprosthesis.
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| 9. |
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| 10. |
- Dikhoff, Marie Jose, et al.
(author)
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C4b-Binding Protein Deposition is Induced in Diseased Aortic Heart Valves, Coinciding with C3d
- 2015
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In: Journal of Heart Valve Disease. - 0966-8519. ; 24:4, s. 451-456
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Journal article (peer-reviewed)abstract
- Background and aim of the study: It has been found recently that activated complement is more widespread in diseased aortic valves compared to the endogenous complement inhibitors C1-inhibitor and clusterin. Previously, another endogenous inhibitor of complement, C4b-binding protein (C4BP) has been described in atherosclerotic diseased coronary arteries. The study aim was to analyze C4BP levels in diseased aortic valves. Methods: Aortic valve tissue was derived from surgical procedures and classified as 'degenerative', 'atherosclerotic' or 'atherosclerotic with bacterial infection'. Valves were stained with specific antibodies against C4BP, C3d and caspase-3. Areas of positivity were then quantified using computer assisted morphometry. Results: In atherosclerotic valves, the areas of C4BP and C3d positivity (38.8 +/- 0.4% versus 32.7 +/- 1.0%, respectively) were significantly higher compared to the degenerative and control groups. In atherosclerotic valves with bacterial infection, the area of positivity for C4BP was even further increased compared to atherosclerotic valves (65.1 +/- 1.2%; 70.1 +/- 1.9% for C3d). The areas of C4BP and C3d positivity were not significantly different in all groups. Caspase-3 was only present in <10% of endothelial cells in the atherosclerotic valves without bacterial infection and in neutrophilic granulocytes in atherosclerotic valves, with and without bacterial infection. Conclusion: It has been shown for the first time that C4BP is deposited in the diseased aortic valve, coinciding with C3d. The area of C4BP positivity was more extensive compared to the areas of other endogenous complement inhibitors (C1-inhibitor and clusterin).
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