Epidermal secretion-purified biosensing patch with hydrogel sebum filtering membrane and unidirectional flow microfluidic channels.

The development of biosensing electronics for real-time sweat analysis has attracted increasing research interest due to their promising applications for non-invasive health monitoring. However, one of the critical challenges lies in the sebum interference that largely limits the sensing reliability in practical scenarios. Herein, we report a flexible epidermal secretion-purified biosensing patch with a hydrogel filtering membrane that can effectively eliminate the impact of sebum and sebum-soluble substances. The as-prepared sebum filtering membranes feature a dual-layer sebum-resistant structure based on the poly(hydroxyethyl methacrylate) hydrogel functionalized with nano-brush structured poly(sulfobetaine) to eliminate interferences and provide self-cleaning capability. Furthermore, the unidirectional flow microfluidic channels design based on the Tesla valve was incorporated into the biosensing patch to prevent external sebum contamination and allow effective sweat refreshing for reliable sensing. By seamlessly combining these components, the epidermal secretion-purified biosensing patch enables continuous monitoring of sweat uric acid, pH, and sodium ions with significantly improved accuracy of up to 12 %. The proposed strategy for enhanced sweat sensing reliability without sebum interference shows desirable compatibility for different types of biosensors and would inspire the advances of flexible and wearable devices for non-invasive healthcare.

Fluid-structure interaction simulation of the three-leaflet aortic valve using COMSOL.

The simulation of the aortic valve (AV) remains challenging due to its geometric complexity and the multi-physics nature of the problem. In this study, we utilized COMSOL to establish a three-dimensional, three-leaflet AV fluid-structure interaction model and investigated the influence of material properties on the valve's mechanical behavior in a healthy state. The results indicated that variations in the aortic wall material model had a minor impact on AV hemodynamics. Additionally, while the linear elastic properties of the leaflets limit valve opening and closing, this material model allows for rapid assessment of AV performance within the range of material deformation.

Unmet needs and knowledge gaps in aortic stenosis: A position paper from the Heart Valve Council of the French Society of Cardiology.

Nowadays, valvular heart disease remains a significant challenge among cardiovascular diseases, affecting millions of people worldwide and exerting substantial pressure on healthcare systems. Within the spectrum of valvular heart disease, aortic stenosis is the most common valvular lesion in developed countries. Despite notable advances in understanding its pathophysiological processes, improved cardiovascular imaging techniques and expanding therapeutic options in recent years, there are still unmet needs and knowledge gaps regarding aortic stenosis pathophysiology, severity assessment, management and decision-making strategy. This review, prepared on behalf of the Heart Valve Council of the French Society of Cardiology, describes these gaps and future research perspectives to improve the outcome of patients with aortic stenosis.

A Case of Granulicatella adiacens Osteomyelitis and Mitral Valve Endocarditis.

Granulicatella adiacens is a nutritionally variant streptococci (NVS) that can cause various infections, including but not limited to endocarditis, osteomyelitis, pneumonia, and abscess. We report a case of an 80-year-old male who was found to have Granulicatella adiacens osteomyelitis and mitral valve endocarditis. Also included is a systematic review of osteomyelitis caused by Granulicatella adiacens.

Advances in melt electrowriting for cardiovascular applications.

Melt electrowriting (MEW) is an electric-field-assisted additive biofabrication technique that has brought significant advancements to bioinspired scaffold design for soft tissue engineering and beyond. Owing to its targeted microfiber placement, MEW has become a powerful platform technology for the fabrication of in vitro disease models up to functional biohybrid constructs that are investigated in vivo to reach clinical translation soon. This work provides a concise overview of this rapidly evolving field by highlighting the key contributions of MEW to cardiovascular tissue engineering. Specifically, we i) pinpoint the methods to introduce microvascular networks in thick 3D constructs benefitting from (sacrificial) MEW microfibers, ii) report MEW-based concepts for small-diameter vascular grafts and stents, iii) showcase how contracting cardiac tissues can profit from the tunable structure-property relationship of MEW scaffolds, and iv) address how complete regenerative heart valves can be built on complex fiber scaffold architectures that recapitulate J-shaped tensile properties and tissue heterogeneity. Lastly, we touch on novel biomaterial advancements and discuss the technological challenges of MEW to unlock the full potential of this transformative technology.

Cellular and extracellular proteomic profiling of paradoxical low-flow low-gradient aortic stenosis myocardium.

Aims: Patients with severe aortic stenosis (AS), low transvalvular flow (LF) and low gradient (LG) with normal ejection fraction (EF)-are referred to as paradoxical LF-LG AS (PLF-LG). PLF-LG patients develop more advanced heart failure symptoms and have a worse prognosis than patients with normal EF and high-gradient AS (NEF-HG). Despite its clinical relevance, the mechanisms underlying PLF-LG are still poorly understood. Methods: Left ventricular (LV) myocardial biopsies of PLF-LG (n = 5) and NEF-HG patients (n = 6), obtained during transcatheter aortic valve implantation, were analyzed by LC-MS/MS after sequential extraction of cellular and extracellular matrix (ECM) proteins using a three-step extraction method. Proteomic data are available via ProteomeXchange with identifier PXD055391. Results: 73 cellular proteins were differentially abundant between the 2 groups. Among these, a network of proteins related to muscle contraction and arrhythmogenic cardiomyopathy (e.g., cTnI, FKBP1A and CACNA2D1) was found in PLF-LG. Extracellularly, upregulated proteins in PLF-LG were related to ATP synthesis and oxidative phosphorylation (e.g., ATP5PF, COX5B and UQCRB). Interestingly, we observed a 1.3-fold increase in cyclophilin A (CyPA), proinflammatory cytokine, in the extracellular extracts of PLF-LG AS patients (p < 0.05). Consistently, immunohistochemical analysis confirmed its extracellular localization in PLF-LG AS LV sections along with an increase in its receptor, CD147, compared to the NEF-HG AS patients. Levels of core ECM proteins, namely collagens and proteoglycans, were comparable between groups. Conclusion: Our study pinpointed novel candidates and processes with potential relevance in the pathophysiology of PLF-LG. The role of CyPA in particular warrants further investigation.

Immediate results of transcatheter aortic valve implantation.

OBJECTIVE: Aim: To assess, analyze and present early postoperative results of transcatheter aortic valve implantation in patients with aortic stenosis. PATIENTS AND METHODS: Materials and Methods: During the period from 2017 to 2023, we examined in total 77 patients with severe aortic stenosis and high risk of surgery who were eligible for the TAVI procedure at the "Heart Institute Ministry of Health of Ukraine". RESULTS: Results: Before implantation, the mean and maximum aortic valve gradients were 53.7±19.1 mm Hg and 90.1±28.8 mm Hg, respectively. The mean and maximum aortic valve gradients after implantation were 9.67±3.18 and 18.7±6.41, respectively (p<0.001). The calculated left ventricular ejection fraction was 57.5±8.22% before surgery and 58.8±7.91% after surgery (p=0.412). After the procedure, moderate (2) degree of paravalvular aortic regurgitation was observed in 2 patients and light degree - in 21 patients. Before surgery, mitral regurgitation of 2-3 degrees was observed in 15 patients, and only in two patients after TAVI The survival rate of our patients was 96.4% after 180 days of supervision. In-hospital and 30-day mortality was 1.8%, while 180-day mortality was 3.6%. No deterioration was observed in patients with moderate aortic regurgitation during echocardiographic studies performed at 1, 3 and 6 months after TAVI. CONCLUSION: Conclusions: TAVI is rapidly emerging as a life-saving alternative for patients who are inoperable or at high risk of surgery due to comorbidities. The selection of patients for TAVI is important to optimize procedural and long-term outcomes. It is important for cardiologists in our country to refer patients with severe aortic stenosis after diagnosis to centers that perform TAVI.

Incidence of aortic valve reintervention in patients with aortic stenosis undergoing transcatheter aortic valve implantation versus surgical aortic valve replacement: a systematic review and updated meta-analysis of randomized studies.

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) are established interventions for alleviating symptoms and enhancing survival in individuals with severe aortic stenosis (AS). However, the long-term outcomes and incidence of reintervention associated with TAVI and SAVR remain uncertain. METHODS: We conducted a systematic review and meta-analysis to compare the incidence of reintervention in TAVI versus SAVR. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs). Risk ratios (RR) and 95% confidence intervals (CI) were pooled with a random-effects model. A p-value < 0.05 was considered statistically significant. RESULTS: Nine RCTs were included, with 5144 (50.9%) patients randomized to TAVI. Compared with SAVR, TAVI increased reinterventions (RR 1.89; 95% CI 1.29-2.76; p < 0.01) and the need for pacemakers (RR 1.91; 95% CI 1.49-2.45; p < 0.01). In addition, TAVI significantly reduced the incidence of new-onset atrial fibrillation (RR 0.43; 95% CI 0.32- 0.59; p < 0.01). There were no significant differences in all-cause mortality (RR 1.04; 95% CI 0.92-1.16; p = 0.55), cardiovascular mortality (RR 1.04; 95% CI 0.94-1.17; p = 0.44), stroke (RR 0.97; 95% CI 0.80-1.17; p = 0.76), endocarditis (RR 0.96; 95% CI 0.70-1.33; p = 0.82), and myocardial infarction (RR 1.06; 95% CI 0.79-1.41; p = 0.72) between groups. CONCLUSIONS: In patients with severe AS, TAVI significantly increased the incidence of reinterventions and the need for pacemakers as compared with SAVR.

Left atrioventricular valve regurgitation repair with concomitant outflow obstruction release on repaired atrioventricular septal defect case.

BACKGROUND: Left ventricular outflow tract stenosis and atrioventricular valve regurgitation are often problems encountered in adulthood after complete atrioventricular septal defect repair. The surgical approach and indications for managing long-term outcomes such as left atrioventricular valve regurgitation and left ventricular outflow tract stenosis after complete atrioventricular septal defect repair have been discussed. CASE PRESENTATION: A 23-year-old woman with intellectual disability was diagnosed with complete atrioventricular septal defect and underwent two-patch repair without cleft closure in childhood. Follow-up examination in adulthood demonstrated moderate left-sided atrioventricular valve regurgitation and left ventricular outflow tract stenosis with a circumferential ridge (peak velocity, 3.7 m/s; pressure gradient, 54 mmHg). Intraoperative findings showed a circumferential ridge under the aortic valve, and we removed the ridge. In addition, a cleft was present at the anterior leaflet, and we completely closed the cleft. Anticoagulation therapy was not initiated, and no embolic complications occurred. Follow-up echocardiography demonstrated no ridge under the aortic valve and only mild-range left AVVR. CONCLUSIONS: We successfully performed surgical treatment without valve replacement or anticoagulation therapy in a patient with poor medical compliance. Delayed reoperation leads to degeneration of the valve structure and makes more difficult to repair. Atrioventricular valve regurgitation should be evaluated in combination with based on the etiology of the regurgitation especially cleft related or not, in addition to the dilatation annulus, cleft size, and depth of the leaflet coaptation depth, and associated other valve diseases.

Aortic root replacement for bicuspid aortic valve dysfunction does not impair survival rates.

BACKGROUND: Patients with a bicuspid aortic valve carry an increased risk for developing an ascending aortic aneurysm due to intrinsic aortic wall alterations. A lower threshold for aortic surgery may therefore be considered in these patients, especially in those who require aortic valve surgery. This study aimed to compare the outcomes of an isolated aortic valve replacement with that of an aortic root replacement in bicuspid aortic valve patients with an indication for aortic valve surgery. METHODS: Patients were included in retrospect from a tertiary academic hospital. Included patients received an elective aortic valve (AVR) or a composite valve-graft conduit (both mechanical and biological) between 2006 and 2021 without any concomitant procedure. Mortality data were retrieved from a national database and comparisons, including survival analyses, were performed between both groups. RESULTS: A total of 132 isolated AVR and 149 aortic root replacements were included. Patients who received an isolated AVR were significantly older than the aortic root replacement group (62.9 vs. 57.7 year respectively, p < 0.001). Survival analyses showed a comparable long-term mortality between both groups (8.1% vs. 9.1%, p = 0.321). CONCLUSION: This study shows that performing an aortic root replacement with a composite valve-graft conduit in bicuspid aortic valve patients does not impair the survival outcomes. In the light of preventing potential future aortic complications within this patient group with a congenitally and structurally weakened aortic wall, a more aggressive approach towards the treatment of BAV aortopathy might be considered.

Outcome of patient undergoing redo mitral valve surgery with incidence rate of mitral valve infective endocarditis.

BACKGROUND: The incidence of infective endocarditis (IE) in patients undergoing redo mitral valve (MV) surgery was evaluated. The outcomes of all the patients and the patients' specific characteristics were recorded. The patients were analyzed to further the research of IE in this population. METHOD: This was a retrospective review of patients admitted for redo MV surgery with a prospective follow-up of electronic medical records at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, from 2009 to 2019. Pre/intra/post-operative factors contributing to mortality, morbidity, and freedom of adverse events were analyzed. RESULT: A total of 211 patients underwent redo MV surgery, and 41 patients (19.4%) had IE; and 51% of this subset of patients, 21 individuals, developed IE after the initial MV surgery. MV stenosis was moderate/severe in 50 patients. Furthermore, MV regurgitation was present in 89 patients. Multivariate analysis of the data revealed multiple factors influencing mortality: age, peripheral vascular disease, concomitant procedures, peripheral vascular disease, red blood cell transfusions, preoperative mechanical valves, and active IE. In-hospital Mortality was 10.9%. The one-, five-, and ten-year survival was 88%, 79%, and 69% across all patients. CONCLUSION: Although redo MV surgery has acceptable outcomes; the presence of IE or concomitant procedures is a significant health detriment in these patients. Our study highlights the need for careful patient management and more in-depth research in this area to improve patient outcomes.

Silent severe aortic regurgitation due to blunt chest trauma: ignore it at your peril-a case report.

Background: Blunt chest trauma (BCT) presenting to the emergency department is common and may cause life-threatening cardiac complications. Whilst complications causing haemodynamic instability are generally detected promptly, others may present late with long-term consequences. We describe a rare, serious complication of BCT presenting five years after a road traffic accident (RTA). Case summary: A 23-year-old man was incidentally found to have a murmur. Past history was notable only for BCT with rib fracture sustained in a RTA 5 years prior. Examination revealed a hyperdynamic pulse, loud decrescendo diastolic murmur, and Duroziez's sign over the femoral arteries. Echocardiography showed severe valvular aortic regurgitation (AR) from a hole in the left coronary cusp and holodiastolic flow reversal in the descending aorta. The left ventricle (LV) showed marked dilatation in diastole, mild dilatation in systole, and preserved systolic function. The aorta was normal. Severe AR was attributed to his previous BCT, with AR causing subsequent LV dilatation. He underwent aortic valve replacement (AVR) with rapid recovery. He remains well, and his echo shows a well-functioning AVR with normalization of LV dimensions. Discussion: Aortic regurgitation following BCT is rare but well-recognized, most often resulting from RTAs. Only a third of cases are diagnosed acutely. In others, lack of haemodynamic instability means that emergency echocardiography is not routinely performed, such that this may go unrecognized with long-term consequences. Clinicians should be aware of possible valve damage following BCT. Prompt echocardiography should be routinely performed for all BCT at initial presentation, even without haemodynamic instability.

A Vascular Plug for Persistent Shock Following Transcatheter Mitral Valve Replacement.

A 78-year-old woman with severe bioprosthetic mitral valve degeneration underwent successful transcatheter mitral valve replacement with a valve-in-valve procedure. This case postprocedure was complicated by cardiogenic shock from left ventricular perforation and underscores the importance of the accurate assessment and treatment of patients following transcatheter valvular procedures.

Diagnosing Prosthetic Valve Endocarditis Despite a Negative Work-Up.

A 38-year-old patient with a prosthetic aortic valve had weeks of fever and respiratory symptoms. Although endocarditis was suspected early, numerous blood cultures and echocardiograms failed to confirm the diagnosis. Key questions were: What is a broad differential diagnosis for the above symptoms? What is unique about diagnosing prosthetic valve endocarditis compared with native valve endocarditis? What other imaging modalities are useful for diagnosing prosthetic valve endocarditis when initial echocardiographic evaluation is negative? What organisms are classically implicated in "culture negative" infective endocarditis? Serial blood cultures and multimodal imaging, including cardiac positron emission computed tomography with 18F-fluorodeoxyglucose, lead to a diagnosis of prosthetic valve endocarditis with a HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) pathogen. Repeat blood cultures and serial multimodal imaging are paramount to diagnosing prosthetic valve endocarditis, particularly when caused by a fastidious organism.

Prenatally Diagnosed Case of Successful Survival of an Unguarded Mitral Valve Orifice.

An unguarded mitral valve orifice is a rare condition characterized by a thinned, hypocontractile left ventricle on fetal echocardiogram. This is the first report of an unguarded mitral valve orifice with a double-outlet right ventricle and intact ventricular septum diagnosed prenatally from these typical ultrasound features.

Transcatheter Aortic Valve Implantation Using the Evolut FX+ Platform With Optimal Diamond-Coronary Alignment.

We present one of the inaugural transcatheter aortic valve implantation procedures using the latest Medtronic platform, Evolut FX+. Successful coronary angiography was achieved within 28 seconds and 1 minute 49 seconds for the left and right coronary arteries, respectively. Postoperative cardiac computed tomography scan demonstrated optimal commissural and diamond-coronary alignment.

Left Coronary Artery Compression and Stent Fracture Following Self-Expanding Transcatheter Pulmonary Valve Implantation.

Coronary compression and vascular perforation have not been reported for self-expanding transcatheter pulmonary valves. We describe a patient with tetralogy of Fallot after self-expanding valve implantation who developed left coronary artery compression from the valve. In addition, a wire frame fracture resulted in perforation of the aorta.

Florida Sleeve Technique for an Aortic Root Aneurysm in a Marfan Syndrome Patient.

Valve-sparing aortic root replacement is not widely performed due to technical requirements. The Florida sleeve technique (FST) is a new technique for aortic root remodeling with the preservation of the aortic valve without aortic root wall resection and coronary artery reconstruction. We successfully treated with the FST for a Marfan syndrome patient with an aortic root aneurysm and aortic valve insufficiency. We believe that this technique is very suitable for cases with moderately enlarged aortic roots. It could reduce surgical risks and prevent dilatation of the aortic root through coverage with a graft for a long time.

Ulnariashun-biseriata sp. nov. (Bacillariophyta) from the Shun River in Hunan Province, China.

A new species, Ulnariashun-biseriata sp. nov., was found in the Shun River of Hunan Province, southern China, and its morphology was described based on light and scannning electron microscope obervations. Ulnariashun-biseriata is characterized by its lanceolate valve outline, apiculate valve apices, slightly undulate valve margins, mostly biseriate striae, variable central area, and closed valvocopula. Many abnormal valves of U.shun-biseriata were observed in the samples investigated and the most frequent morphological abnormalities consisted of a lack of symmetry relative to the apical axis caused by a unilateral expansion in the middle part of the valve.