Complications of transcatheter paravalvular leak device closure of mitral valve: An updated review of the literature and a rare case presentation.

Paravalvular leak (PVL) is an uncommon complication of prosthetic valve implantation, which can lead to infective endocarditis, heart failure, and hemolytic anemia. Surgical reintervention of PVLs is associated with high mortality rates. Transcatheter PVL closure (TPVLc) has emerged as an alternative to surgical reoperation. This method provides a high success rate with a low rate of complications. This article reviews the pathogenesis, clinical manifestation, diagnosis, and management of PVL and complications following TPVLc. Besides, we presented a case of a patient with severe PVL following mitral valve replacement, who experienced complete heart block (CHB) during TPVLc. The first TPVLc procedure failed in our patient due to possible AV-node insult during catheterization. After 1 week of persistent CHB, a permanent pacemaker was implanted. The defect was successfully passed using the previous attempt. Considering the advantages of TPVLc, procedure failure should be regarded as a concern. TPVLc should be performed by experienced medical teams in carefully selected patients.

Short and mid-term outcomes of valve-sparing, aortic root reimplantation (David's procedure).

BACKGROUND: In the current study, we aimed to report the short- and mid-term outcomes of patients undergoing valve-sparing aortic root reimplantation (VSARR) and our center's experience with the procedure. METHODS: Forty patients with aortic root aneurysms underwent VSARR at our center from 2010 until 2022. We retrospectively reviewed the medical records of these patients and extracted the relevant data. After carefully examining the aortic valve, the surgeon decided to perform Bentall or David's procedure during the operation. RESULTS: The study population comprised 31 (77.5%) men and nine (22.5%) women, with a mean age of 55.35 ± 15.40. One patient developed hemodynamic instability post-surgery in the hospital and died from multi-organ failure. Another patient had severe AI in the intraoperative echocardiography, and aortic valve replacement with a prosthetic graft was performed during the same operation. In pre-operation echocardiography, 25 (62.5%) patients had severe, nine (22.5%) had moderate, and six (15%) had mild AI. In the in-hospital post-operation follow-up echo, AI was improved, and no patients had severe AI (P < 0.001). Only eight patients had moderate AI in post-one-year follow-up echo exams, while the rest had mild AI. CONCLUSION: David's procedure showed excellent mid-term results in our center, with only one in-hospital mortality.

Latent Avulsion of the Posterior Mitral Leaflet Base from the Mitral Annulus Following a Motor Vehicle Accident: A Case Report.

Injuries to the heart and great vessels should always be considered after blunt chest trauma. Valvular damage rarely occurs after blunt trauma, but symptoms may be delayed. A 58-year-old woman was referred to our hospital with exertional dyspnea (functional class III) and palpitations for elective transesophageal echocardiography. Her symptoms had exacerbated in the preceding 2 or 3 months. Physical examination showed holosystolic murmurs (IV/VI) at the lower sternal border with extension to the apex. Transesophageal echocardiography revealed avulsion of the base of the posterior mitral valve leaflet (P3) from the annulus. In the past medical history, there was a history of a motor vehicle accident 9 months earlier. The patient was recommended for mitral valve surgery. Mitral valve replacement was performed, and the diagnosis was confirmed by surgery. The patient was discharged without any complications.

Determinants of the Volumetric Markers of Left Atrial Contraction Function in Coronary Artery Disease: A Cross-sectional Study.

BACKGROUND: A body of research advocates the prognostic role and usefulness of the volumetric markers of left atrial (LA) phasic functions in the diagnosis of LA dysfunction. We aimed to determine the independent determinants of the volumetric markers of LA contraction function in candidates for coronary artery bypass graft (CABG) surgery. METHODS: This cross-sectional study enrolled 516 candidates for CABG. The biplane maximal, minimal, and pre-P volumes of the LA were measured with two-dimensional echocardiography, and LA active emptying fraction was calculated. The standardized correlation coefficient for the correlation between each factor and LA active emptying fraction was calculated by using univariate and backward multivariable regression analyses. RESULTS: The multivariable regression analysis demonstrated that the heart rate (ß = 0.15; p = 0.001), S (ß = 0.09; p = 0.036), E/e' ratio (ß = -0.11; p = 0.014), left ventricle (LV) ejection fraction (ß = 0.15; p = 0.001), and LA enlargement (ß = -0.19; p < 0.001) were the independent determinants of LA active emptying fraction. CONCLUSIONS: The independent determinants of LA contraction function were the heart rate, S, LV ejection fraction, LA enlargement, and E/e' ratio in candidates for CABG surgery.

Effects of obesity on left atrial phasic functions in patients with chronic ischemic heart disease and preserved left ventricular ejection fraction without recent myocardial infarction: a two-dimensional speckle-tracking echocardiography study.

PURPOSE: Left atrial (LA) phasic functions in various subgroups of subjects with obesity are differently impaired, suggesting that obesity may have diverse effects in dissimilar subgroups of subjects with obesity. We aimed to compare the effects of obesity on LA phasic functions in patients suffering from chronic ischemic heart disease with a preserved left ventricular ejection fraction and without a recent myocardial infarction. METHODS: In our cross-sectional study, 145 consecutive candidates for isolated coronary artery bypass graft (CABG) surgery were divided according to the presence of obesity into 2 groups: obese (36 patients) and nonobese (103 patients), and LA phasic functions were evaluated by two-dimensional speckle-tracking echocardiography (2D STE). RESULTS: The longitudinal strain rate during the reservoir phase (3.0 ± 0.7 s-1 vs 2.7 ± 0.6 s-1; P = 0.032), longitudinal strain during the contraction phase (19.2 ± 4.7% vs 17.2 ± 4.1%; P = 0.022), and the longitudinal strain rate during the contraction phase (4.4 ± 1.2 s-1 vs 3.9 ± 1.2 s-1; P = 0.036) decreased in the obese group compared with the nonobese group. The other longitudinal 2D STE-derived markers of the LA phasic functions were not different between the 2 groups. CONCLUSIONS: Among patients suffering from chronic ischemic heart disease with a preserved left ventricular ejection fraction and without a recent myocardial infarction, LA reservoir and contraction functions as measured by 2D STE were impaired in patients with obesity compared with those without it.

The evaluation of right ventricular function in patients with diabetes mellitus and significant stenosis at the proximal portion of the right coronary artery.

PURPOSE: Previous studies have indicated that right ventricular (RV) function is damaged in diabetes mellitus (DM); however, it is not clear whether in the presence of chronic ischemia, RV function is different between patients with and without DM (DM + and DM - , respectively). METHODS: This cross-sectional study enrolled 90 consecutive candidates for coronary artery bypass graft surgery and allocated them to 3 groups: 24 DM - patients with the absence of stenosis of more than 50% in the proximal and mid parts of the right coronary artery (the DM - RCA - group [control]), 33 DM - patients with the presence of significant stenosis (> 70%) in the proximal part of RCA (the DM - RCA + group), and 33 DM + patients with RCA + (the DM + RCA + group). RV function was evaluated based on longitudinal deformation markers, measured via the 2D speckle-tracking echocardiographic examination of right ventricular free wall (RVFW). RESULTS: The systolic strain value, systolic strain rate, and late diastolic strain rate of RVFW were not statistically significantly different between the three groups. Our adjusted post hoc analysis showed that the early diastolic strain rate of RVFW in the DM + RCA + group was lower than that in the DM - RCA + and DM - RCA - groups (1.5 s-1 ± 0.4 vs 1.7 s-1 ± 0.5 vs 1.7 s-1 ± 0.4). CONCLUSIONS: Diastolic function in the presence of DM was impaired irrespective of RCA - or RCA + . Additionally, RCA + had no effect on systolic and diastolic RV functions at rest in our DM - patients.

A potential misdiagnosis in the COVID-19 pandemic era: a case report of superimposed thrombosis or tumor recurrence.

BACKGROUND: The clinical manifestations of coronavirus disease 2019 (COVID-19) overlap with those of other disorders, especially cardiovascular disease. CASE PRESENTATION: We herein describe a 58-year-old woman who presented with syncopal episodes and dyspnea on exertion with a left atrial (LA) mass, scheduled for surgical removal and mitral valve replacement. Nearly 3 months later, the patient developed dyspnea, fever, and a sore throat, resulting in hospital admission with suspected COVID-19. During the diagnostic evaluation, a larger LA mass was detected. The mass seemed to be a COVID-19-induced organized thrombus with prosthetic mitral valve malfunction. Resection was, therefore, planned. An immunohistochemistry study revealed a liposarcoma. CONCLUSIONS: The unusual early recurrence of liposarcomas and the misdiagnosis with COVID-19-induced thrombosis are the hallmark of the present case.

Intrapericardial solitary fibrous tumor: A case report and review of literature.

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm mostly originates from pleura, but rarely from other parts of the body including pericardium. We report a case of a 44-year-old woman with dyspnea and intermittent edema in whom a large intrapericardial mass was discovered by echocardiography. Computed tomography (CT) revealed a focal pericardial calcification in right AV grove with pressure on right ventricle and right atrial, with no connection to cardiac chambers. Histopathological findings after complete resection of the mass revealed fibroconnective tissue with heavy calcification and no evidence of inflammation or malignancy. We reviewed the literature on pericardial solitary fibrous tumors up to 2020.

Iatrogenic left circumflex coronary occlusion following mitral valve replacement surgery: A case report.

Injury to epicardial coronary arteries following mitral valve replacement surgery, albeit rare, could have fatal complications. In this case, we suggest conservative medical treatment as a safe approach in patients who are not suitable to undergo revascularization.

Assessment of the ability of the CHA2DS2-VASc scoring system to grade left atrial function by 2D speckle-tracking echocardiography.

BACKGROUND: The CHA2DS2-VASc scoring system is correlated with left atrial (LA) reservoir function in patients with atrial fibrillation (AF) rhythm or paroxysmal AF. We assessed the ability of CHA2DS2-VASc to grade LA function in patients with sinus rhythm who were candidates for coronary artery bypass grafting (CABG). METHODS: This cross-sectional study recruited 340 consecutive candidates for CABG and categorized them according to their CHA2DS2-VASc scores as mild-, moderate-, and high-risk score groups with 34 (10%), 83 (24%), and 223 (66%) patients, respectively. LA function was evaluated via 2D speckle-tracking echocardiography in terms of global longitudinal strain and strain rate during the reservoir, conduit, and contraction phases. In-hospital mortality, postoperative AF, prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation were assessed. RESULTS: LA strain and strain rate during the reservoir phase was statistically significantly lower in the high-risk score group than the low- and moderate-risk score groups (27.8 ± 6.9% vs 31.0 ± 5.0% vs 29.8 ± 6.1%, respectively; P = 0.004 and 2.6 ± 0.7 s-1 vs 2.9 ± 0.6 s-1 vs 2.9 ± 0.6 s-1, correspondingly; P = 0.009) and regarding LA strain and strain rate during the conduit phase (9.7 [7.1-12.5]% vs 12.9 [9.4-15.1]% vs 11.5 [9.1-13.8]%, correspondingly; P < 0.001 and 2.1 [1.6-2.7] s-1 vs 2.8 [2.4-3.6] s-1 vs 2.6 [2.2-3.0] s-1, respectively; P < 0.001). In addition, LA strain rate during the conduit phase was lower in the moderate-risk score group than the low-risk score group. After adjustments for possible confounders, these differences remained statistically significant. The risk of postoperative AF and prolonged ICU stay was highest in the high-risk score group (relative risk = 9.67 (1.31-71.43) and 8.05 (1.08-60.16), respectively; P = 0.026 and P = 0.042, respectively). CONCLUSIONS: LA reservoir and conduit functions decreased in the high-risk score group, which was accompanied by an increased risk of postoperative AF and prolonged ICU stay.