Echocardiography-guided Cardiac Implantable Electronic Device Implantation to Reduce Device Related Tricuspid Regurgitation: A Prospective Controlled Study.

BACKGROUND: Endocardial leads of permanent pacemakers (PPM) and implantable defibrillators (ICD) across the tricuspid valve (TV) can lead to tricuspid regurgitation (TR) or can worsen existing TR with subsequent severe morbidity and mortality. OBJECTIVES: To evaluate prospectively the efficacy of intraprocedural 2-dimentional-transthoracic echocardiography (2DTTE) in reducing/preventing lead-associated TR. METHODS: We conducted a prospective randomized controlled study comparing echocardiographic results in patients undergoing de-novo PPM/ICD implantation with intraprocedural echo-guided right ventricular (RV) lead placement (Group 1, n=56) versus non-echo guided implantation (Group 2, n=55). Lead position was changed if TR grade was more than baseline in Group 1. Cohort patients underwent 2DTTE at baseline and 3 and/or 6 months after implantation. Excluded were patients with baseline TR > moderate or baseline ≥ moderate RV dysfunction. RESULTS: The study comprised 111 patients (74.14 ± 11 years of age, 58.6% male, 19% ICD, 42% active leads). In 98 patients there was at least one follow-up echo. Two patients from Group 1 (3.6%) needed intraprocedural RV electrode repositioning. Four patients (3.5%, 2 from each group, all dual chamber PPM, 3 atrial fibrillation, 2 RV pacing > 40%, none with intraprocedural reposition) had TR deterioration during 6 months follow-up. One patient from Group 2 with baseline mild-moderate aortic regurgitation (AR) had worsening TR and AR within 3 months and underwent aortic valve replacement and TV repair. CONCLUSIONS: The rate of mechanically induced lead-associated TR is low; thus, a routine intraprocedural 2DTTE does not have a significant role in reducing/preventing it.

Western-designed total knee implants mismatch Saudi patient knees. Anatomical bony measurements documented by computed tomography.

OBJECTIVES: To determine the anthropometric features of Saudi knees compared with knees of other ethnicities and reveal mismatches among different knee implant systems. METHODS: All knee computed tomography images obtained between January 2016 and September 2016 for varying medical reasons in a tertiary care hospital in Southwestern Saudi Arabia were retrospectively evaluated. Patients aged less than 18 years, with trauma or soft tissue or bone tumors were excluded.  Eleven parameters were measured for each knee joint. RESULTS: We evaluated 100 knees of 50 Saudi patients (25 men, 25 women) aged 28-85 (mean, 57.3) years. No statistically significant differences were found in age and Sasaki angle measurements between male and female patients. All other parameters were significantly larger in male than female knees. Our measurements were close to those published for Chinese, Thai, and Korean patients; however, published measurements were larger for Caucasian and Indian knees than our measurements. CONCLUSION: The Saudi population has morphological features of knee bone anatomy that do not match with the widely available prostheses designed for Caucasian knees. As several studies of different ethnicities have documented considerable prosthesis mismatch; our study further indicates the need for new implant designs that take these variations into account.

Role of positioning of femoral component in the anterior-posterior direction on postoperative anterior pain in TKA.

INTRODUCTION AND PURPOSE: The patellofemoral joint has proved to be the most problematic element of modern TKA for postoperative anterior knee pain; the positioning of the femoral component constitutes a critical phase in this issue. The objective of our study was to evaluate the possible role of either anterior positioning or posterior positioning of the femoral shield compared to the reference plane represented by the anterior cortex, on the anterior knee pain after knee arthroplasty. METHODS: Forty-eight patients treated with TKA were followed up approximately 12 months. None of them have been submitted to any patellar treatment. We observed the position of femoral shield with respect to the anterior cortical line of femur dividing patients into three groups: patients with significant notching, patients with no notching (shield corresponding to anterior cortical line) and patients with anterior positioning of shield. We evaluated clinical and functional outcomes with KSS, anterior knee pain with Kujala's score and adverse events such as periprosthetic fractures. RESULTS: We found a better clinical and functional result for patients with femoral shield positioned in line with anterior cortical cortex with respect to both TKAs with femoral notching and to protruding anterior femoral components; there were no main differences in anterior postoperative score by Kujala's system. We observed a periprosthetic fracture in a patient with an important femoral notching. CONCLUSIONS: We cannot consider our study as an objective conclusion to the argument. We need more RCTs in order to study the proper influence of either notching or protrusion of femoral shield component onto anterior postoperative pain. Anyway positioning of femoral shield in anterior-posterior direction could be an interesting new critical object of study about anterior knee pain after TKA.

Fassier-Duval Rod Failure: Is It Related to Positioning in the Distal Epiphysis?

BACKGROUND: The relationship between Fassier-Duval (FD) rod placement and rod failure rates has not previously been quantified. METHODS: Retrospective review was conducted on patients with osteogenesis imperfecta treated with FD rods between 2005 and 2017. Age at first surgery, sex, Sillence type of osteogenesis imperfecta, bisphosphonate treatment, location of rod (side of body and specific bone), and dates of surgeries, radiographs, and rod failures were collected. C-arm images determined rod fixation within the distal epiphysis at the time of surgery. C-arm variables included rod deviation (percent deviation from the midline of the distal epiphysis) and anatomical direction of deviation (anterior/posterior and medial/lateral). X-ray images were examined for rod failure, which was defined as bending, pulling out of the physis, protrusion out of the bone, and/or failure to telescope. Cox proportional hazards regression models were used to compare failure rates with location of placement within the distal epiphysis allowing for clustering of the data by side (left or right) and bone (femur or tibia). RESULTS: The cohort was 13 patients (11 female individuals and 2 male individuals) with a total of 66 rods and 75 surgeries. Mean time from the first surgery to the last follow-up visit was 8.9 years (SD=5 y). There was a 7% increase in hazard of failure per 1-mm increase in antero-posterior (AP) deviation [hazard ratio (HR), 1.07; 95% confidence interval (CI), 1.01-1.14; P=0.029)]. Similarly, there was a 9% increase in hazard of failure for every 1-mm increase in lateral deviation (HR, 1.09; 95% CI, 1.01-1.18; P=0.019). A 12% increase in hazard of failure per 10% increase in deviation from the midline for both AP and lateral radiograph views was also found, although this was only statistically significant for lateral deviation on the AP radiograph view (HR, 1.12; 95% CI, 1.01-1.25; P=0.030). CONCLUSIONS: FD rod placement within the distal epiphysis has significant impact on increasing rod survival. LEVEL OF EVIDENCE: Level III-therapeutic study.

Radiological evaluation of inner ear trauma after cochlear implant surgery by cone beam CT(CBCT).

PURPOSE: Cochlear implantation (CI) has been extended to involve younger age group with higher incidence of residual hearing which increases the need of minimizing surgical inner ear trauma. Radiological evaluation for electrode position has been studied yet without assessment of inner ear trauma, our objective is radiological evaluation of post cochlear implantation inner ear trauma MATERIAL AND METHODS: 20 patients with CI for pre lingual SNHL were included in this study. Cone beam CT (CBCT) was used for evaluation of electrode position and assessment of inner ear trauma. A Neuroradiologist and an implant surgeon analyzed the relation of inserted electrode to the intra-cochlear structures, with introduction of novel radiological grading for inner ear trauma. RESULTS: The mean major cochlear diameter was 8.9 mm, the mean angular depth of insertion was 406.9944 (SD = 165.0559). Ten patients were with no cochlear trauma (grade 0), three patients were grade 1, two patients were grade 2 and five patients were grade 3 inner ear trauma. CONCLUSION: Radiological evaluation for electrode position should extend to involve assessment of inner ear trauma using relation of the implant to cochlear internal structures which could be performed by CBCT with high resolution and least metallic artifacts.

Evaluation of salivary cortisol levels in relation to dento-maxillary prosthesis adjustment.

PURPOSE: The purpose of this study was to investigate the influence of dento-maxillary prosthesis adjustment procedure on levels of salivary cortisol. METHODS: Nine participants (six men, three women, mean age 65.9 years) took part in this study. Saliva samples were collected before and after dento-maxillary prosthesis adjustment during the four different visits. Free cortisol levels were determined using a salivary cortisol immunoassay kit (expanded-range high-sensitivity salivary cortisol enzyme immunoassay kit, Salimetrics). Besides, original self-report sheets, a 35-item food intake questionnaire, the University of Washington Quality of Life (UW-QOL) questionnaire version 4, and the Geriatric Oral Health Assessment Index (GOHAI) questionnaire were also administered. The changes of salivary cortisol levels were analyzed using 2-level multilevel linear regression, with adjustment for age, sex, and time. Wilcoxon signed-rank test was used to compare scores of the food intake questionnaire, UW-QOL questionnaire, and GOHAI questionnaire. RESULTS: Salivary cortisol levels decreased significantly after carrying out the dento-maxillary prosthesis adjustment procedure. During the third adjustment, the salivary cortisol levels were significantly low. In addition, salivary cortisol levels of participants aged 70 years and over were significantly higher than other aged groups. The total scores for grade III-V of the food intake questionnaire increased significantly. Other questionnaires had a trend toward increasing scores, yet the differences were not significant. CONCLUSIONS: Within the limitations of this study, the results suggest that a reduction in symptoms of discomfort may have an influence on the decrease of salivary cortisol levels in dento-maxillary prosthesis wearers.

Scleral Lens Issues and Complications Related to a Non-optimal Fitting Relationship Between the Lens and Ocular Surface.

INTRODUCTION: The advent of high oxygen permeability (Dk) of rigid contact lens materials has reduced complications related to hypoxia when using scleral contact lenses (ScCLs). However, new issues and complications have emerged. Some of these issues and complications are caused by the nonoptimal fitting relationship with the underlying ocular surface, which may pose a challenge in their management. METHOD: PubMed searches using different keywords and an investigation into the issues and complications etiology were conducted. Detailed guidelines for their management are provided. RESULTS: The literature provides a few reports of severe adverse reactions to ScCLs. The most common issues, unique to ScCL wear, have been described. Likewise, other anomalies in ScCL fitting may affect patient satisfaction and lead to drop out, promoting eye surgery or dramatic psychological effects. The management of these issues and complications may be also frustrating for clinicians who will, in turn, rarely, or not at all, prescribe them. CONCLUSION: Scleral contact lenses intimidate practitioners because of their large diameter and the lack of knowledge in regard to the fitting process but especially because of the challenging management of issues and complications that may occur relating to the lens fitting relationship with the underlying ocular surface. A detailed description of the etiology and management of these anomalies will allow practitioners to gain more confidence in fitting ScCLs and prescribe them more often. Patients are the primary beneficiaries from wearing these large rigid lenses; ScCLs represent a life-changing event for many patients.

Mitral annuloplasty ring suture forces: Impact of surgeon, ring, and use conditions.

OBJECTIVE: The study objective was to quantify the effect of ring type, ring-annulus sizing, suture position, and surgeon on the forces required to tie down and constrain a mitral annuloplasty ring to a beating heart. METHODS: Physio (Edwards Lifesciences, Irvine, Calif) or Profile 3D (Medtronic, Dublin, Ireland) annuloplasty rings were instrumented with suture force transducers and implanted in ovine subjects (N = 23). Tie-down forces and cyclic contractile forces were recorded and analyzed at 10 suture positions and at 3 levels of increasing peak left ventricular pressure. RESULTS: Across all conditions, tie-down force was 2.7 ± 1.4 N and cyclic contractile force was 2.0 ± 1.2 N. Tie-down force was not meaningfully affected by any factor except surgeon. Significant differences in overall and individual tie-down forces were observed between the 2 primary implanting surgeons. No other factors were observed to significantly affect tie-down force. Contractile suture forces were significantly reduced by ring-annulus true sizing. This was driven almost exclusively by Physio cases and by reduction along the anterior aspect, where dehiscence is less common clinically. Contractile suture forces did not differ significantly between ring types. However, when undersizing, Profile 3D forces were significantly more uniform around the annular circumference. A suture's tie-down force did not correlate to its eventual contractile force. CONCLUSIONS: Mitral annuloplasty suture loading is influenced by ring type, ring-annulus sizing, suture position, and surgeon, suggesting that reports of dehiscence may not be merely a series of isolated errors. When compared with forces known to cause suture dehiscence, these in vivo suture loading data aid in establishing potential targets for reducing the occurrence of ring dehiscence.

Effectiveness of controlled telescoping system for lateral hip pain caused by sliding of blade following intramedullary nailing of trochanteric fracture.

INTRODUCTION: The purpose of this study was to demonstrate the effectiveness of controlled telescoping system for lateral hip pain caused by sliding of the blade following intramedullary nailing of trochanteric fractures. MATERIALS AND METHODS: A retrospective cohort study was performed to compare the controlled telescoping system (Compression Hip Nail; CHN) with the conventional sliding system (Proximal Femoral Nail Antirotation; PFNA) for trochanteric fractures. 74 cases in the PFNA group and 77 cases in the CHN group were included from two university hospitals in this study. All patients had a minimum of 12-month follow up period. Lateral hip pain was evaluated and operation time and blood loss during the surgery were measured. The fracture classification was evaluated. The quality of postoperative reduction and other complications after surgery were also evaluated and tip-apex distance (TAD), telescoping and lateral protrusion of the blade and lag screw were measured. RESULTS: The mean age was 78.5 years in the PFNA group and 74.7 years in the CHN group (p=0.25). The mean telescoping was 19.2mm in the PFNA group and 10.7mm in the CHN group (p<0.001). The mean length of lateral protrusion was 10.5mm in the PFNA group and 2.5mm in the CHN group (p<0.001). Twenty-eight patients in the PFNA group complained of lateral hip pain, whereas 12 patients in the CHN group did (p=0.002). These four variables showed statistically significant differences between the PFNA and CHN groups (p<0.05). The length of lateral protrusion was the only variable significantly related to lateral hip pain through multivariate logistic regression analysis (p=0.045). CONCLUSIONS: The degree of lateral protrusion was mainly related to lateral hip pain. Therefore, controlled telescoping would help to decrease lateral hip pain by decreasing the lateral protrusion beyond the lateral femoral cortex.

Association of endotracheal tube repositioning and acute laryngeal lesions during mechanical ventilation in children.

The objective of this study is to determine the incidence of post-extubation acute laryngeal lesions in a pediatric intensive care unit (PICU) and potential risk factors. Children, aged 28 days to 5 years, admitted to the PICU who required endotracheal intubation for at least 24 h were enrolled. Exclusion criteria were a previous intubation, history of laryngeal disease, current or past tracheostomy, the presence of craniofacial malformations and patients considered on palliative care. All patients underwent flexible fiber-optic laryngoscopy (FFL) not later than 8 h after extubation. A blinded researcher identified and classified laryngeal lesions based on recorded media. 231 children were enrolled between November 2005 and December 2015. At FFL examination, 102 children (44.15%) presented moderate to severe laryngeal lesions. On a multivariable analysis, we found that for each additional day with repositioning of the endotracheal tube, there was an increase of 7.3% (RR 95% CI 1.012-1.137; P = 0.018) on the baseline risk of developing moderate to severe acute laryngeal lesions. Furthermore, for each additional dose of sedation per day of intubation, there was also an increase of 3.5% on the same baseline risk (RR 95% CI 1.001-1.070; P = 0.041). The amount of tube repositioning episodes and the need for extra doses of sedation (as a proxy for possible agitation) were found to be associated with acute laryngeal lesions. Adequate sedation and minimized tube repositioning should be pursued to possibly prevent the development of post-extubation airway compromise.

Can Perceval sutureless valve reduce the rate of patient-prosthesis mismatch?†.

OBJECTIVES: The aim of this study is to compare the theoretical incidence of patient-prosthesis mismatch (PPM) in patients undergoing a sutureless or a sutured aortic valve replacement using an exact statistical matching. METHODS: Between May 2012 and March 2016, 65 patients with severe symptomatic aortic stenosis underwent a sutureless aortic valve replacement with the Perceval bioprosthesis in 2 centres. Moreover, 177 aortic valve replacements with conventional sutured bioprosthesis were performed between August 2003 and September 2015. Perceval and sutured patients were 1:1 exactly matched for sex and body surface area (BSA), resulting in 62 couples (sutureless: BSA 1.77 ± 0.16 m 2 , female 62.9% vs sutured: BSA 1.77 ± 0.15 m 2 , female 62.9%). RESULTS: After matching, the indexed effective orifice area was 1.50 ± 0.18 cm 2 /m 2 and 0.81 ± 0.19 cm 2 /m 2 in the sutureless and the sutured group, respectively ( P < 0.001). No PPM occurred in patients who received a Perceval bioprosthesis ( n = 62). In the sutured group ( n = 62), 38 patients (61.3%) developed a PPM, which was moderate in 41.9% ( n = 26) and severe in 19.4% ( n = 12) ( P < 0.001). CONCLUSIONS: The indexed effective orifice area of the sutureless group was significantly larger than in the sutured one. The incidence of PPM with the conventional sutured biprosthesis was 61.3%, while it decreases to 0% in the sutureless group. No PPM was reported in the sutureless valve group. Therefore, the Perceval sutureless valve provides larger effective orifice areas compared to the sutured conventional bioprosthesis and could be considered as a good option to reduce the risk of a PPM.

Fracture and Lung Penetration of a Left Ventricular Lead Stabilized by Retained Stylet.

During cardiac resynchronization therapy (CRT) pacemaker implantation in a 54-year-old female patient, removing the stylet resulted in repeated left ventricular (LV) lead dislodgment. Lead stability was achieved by retaining the stylet within the lead lumen. Two years after cardiac resynchronization therapy, a LV lead fracture near the connector pin occurred. The proximal lead segment was removed, and a new connector pin was attached. Two years after that, the same lead fractured in the right atrium with the stylet penetrating the lung. The LV lead and retained stylet were successfully extracted. LV lead dislodgment is a limitation of CRT, but using the retained stylet technique to achieve lead stability is potentially dangerous and is not recommended.

Checagem dos modelos precisos na Implantodontia através do “Index de resina” / Using the “resin Index” to check the accuracy of the plaster model in implantology

A perfeita adaptação passiva das próteses sobre implantes é um fator importante para a obtenção do sucesso na Implantodontia. Para tanto, a eliminação de variáveis que possam afetar o processo de confecção de uma estrutura protética é fundamental, essas vão desde o procedimento de moldagem até a execução da peça protética, sendo que essa fase representa a transição da situação clínica para a fase laboratorial; desta maneira, o modelo de trabalho deve ser o mais preciso possível para evitar qualquer tipo de diferença significativa na adaptação final do trabalho. A confecção, em boca, do “Index de resina” é para auxiliar a conferencia dessa precisão de adaptação no modelo de gesso, eliminando futuros problemas no assentamento das estruturas, na dissipação das cargas mastigatórias e comprometimento da qualidade final do trabalho. Isto se torna imprescindível quando utilizamos a tecnologia CAD/CAM, pois as estruturassão fresadas em monobloco, onde se obtém uma estrutura única em que o assentamento passivo depende diretamente das informações de posicionamento dos análogos, passadas ao software através do modelo de gesso que foi previamente escaneado.

The perfect passive adaptation of the implant prosthesis is an important factor to achievesuccess in implantology. Therefore, the elimination of variables that can affect the process ofprosthetic construction is critical. These variables range from dental impression technique until the final execution of the implant supported prosthesis. The Prosthetic phase is the transition ofthe clinical situation to the laboratory phase; this way, the working model must be as accurateas possible to avoid any significant difference in the final adaptation of the restoration. Theproduction, in mouth, of the “resin Index” is to assist the conference of the precision fit on thestone model, eliminating future problems in the settlement of structures, dissipation of masticatory loads and commitment of the final quality of work. This becomes more imperative whenwe use the CAD / CAM technology, because the structures are milled in a single block where youget a unique structure in which the liability settlement depends directly on the analog position information, passed to the software through the plaster model that was previously scanned.

Hemodynamic Conditions may Influence the Oversizing of Stent Grafts and the Postoperative Surveillance of Patients with Ruptured Abdominal Aortic Aneurysm Treated by EVAR.

BACKGROUND: To report the causes of second rupture in patients treated with a stent graft for ruptured abdominal aortic aneurysm (rAAA). CASE REPORT: A 69-year-old man was admitted for abdominal pain and hypovolemic shock 22 months after endovascular exclusion of an rAAA with an aortomonoiliac stent graft and a crossover bypass despite normal duplex ultrasound and sac shrinkage at 1 year. During emergent laparotomy, a type IA endoleak was discovered and the aortomonoiliac stent graft was explanted. A Dacron bypass was interposed between the infrarenal aorta and the iliac extension stent graft. CONCLUSIONS: Considering the literature, this report has 3 implications for the endovascular treatment of rAAA. First, 30% oversizing is preferable to 15% when treating an rAAA assessed by computed tomography angiography (CTA) performed during permissive hypotension. Second, the surveillance program should rely on CTA and not on a duplex examination to detect any endoleaks or migration. Finally, partial stent graft explantation is a valid option for decreasing aortic clamping time.

Is patient-prosthesis mismatch a predictor of survival or a surrogate marker of co-morbidities in cardiac surgery?

BACKGROUND: Patient-prosthesis mismatch (PPM) has ignited much debate and no definite conclusions have been drawn on the outcome of these patients. Therefore, additional large studies with long-term follow-up are required to help the cardiologist and surgeon outline the best therapeutic strategy for patients with high risk for PPM. METHODS: Patients who underwent aortic valve replacement (AVR) from 2000 to 2013 were identified. Baseline and operative data was extracted and indexed effective orifice area calculated for each patient. The presence of PPM was defined in those patients with an iEOA ≤ 0.85 cm(2)/m(2). Regression analyses were performed to determine the association of PPM with operative mortality, post-operative complications and survival. Predictors for PPM were evaluated based on clinical and operative data. RESULTS: From 2023 patients who underwent AVR, PPM was present in 64.6%. These patients had increased age, more coronary artery bypass procedures, increased risk of diabetes, hypertension, higher creatinine values and higher Euroscore. Age, body surface area, prosthesis type and size were found to be predictors of mismatch. Operative mortality (8.1% vs 5.7%, p = 0.05), stroke (3.9% vs 2.4, p = 0.02) and acute kidney injury (47.6% vs 35.1%, p =< 0 .001) were more frequent in patients with PPM and mean 10-year survival was reduced (6.6 years, 95% CI: 6.3-6.8 vs 7.3, 95% CI: 6.9-7.2, p < 0.001). After adjusting for confounders, PPM was not found to be associated to either adverse outcome or survival. CONCLUSIONS: Patients with PPM have worse operative mortality, post-operative complications and survival mainly due to the fact that they represent a higher risk population based on age and co-morbidities.

Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices: Understanding the differences in the location and type of leaks and their clinical implications.

BACKGROUND: Watchman and Lariat left atrial appendage (LAA) occlusion devices are associated with LAA leaks postdeployment. OBJECTIVE: The purpose of this study was to compare the incidence, characteristics, and clinical significance of these leaks. METHODS: We performed a multicenter prospective observational study of all patients who underwent LAA closure. Baseline, procedural, and imaging variables along with LAA occlusion rates at 30-90 days and 1-year postprocedure were compared. RESULTS: A total of 478 patients (219 with the Watchman device and 259 with the Lariat device) with successful implants were included. Patients in the Lariat group had a higher CHADS2 (congestive heart failure, hypertension, age >74 years, diabetes, stroke) score and a larger left atrium and LAA. A total of 79 patients (17%) had a detectable leak at 1 year. More patients in the Watchman group had a leak compared with those in the Lariat group (46 [21%] vs 33 [14%]; P = .019). All the leaks were eccentric (edge effect) in the Watchman group and concentric (gunny sack effect) in the Lariat group. The size of the leak was larger in the Watchman group than in the Lariat group (3.10 ± 1.5 mm vs 2.15 ± 1.3 mm; P = .001). The Watchman group had 1 device embolization requiring surgery and 2 pericardial effusions requiring pericardiocentesis. In the Lariat group, 4 patients had cardiac tamponade requiring urgent surgical repair. Three patients in each group had a cerebrovascular accident and were not associated with device leaks. CONCLUSION: The Lariat device is associated with a lower rate of leaks at 1 year as compared with the Watchman device, with no difference in rates of cerebrovascular accident. There was no correlation between the presence of residual leak and the occurrence of cerebrovascular accident.

Patient-prosthesis mismatch increases the mean platelet volume in patients with aortic valve replacement.

PURPOSE: Patient-prosthesis mismatch (PPM) is defined when the ratio of the effective orifice area of the normally functioning prosthetic valve to the body surface area of the patient is <0.85 cm(2)/m(2). The aim of this study was to assess the measurements of the mean platelet volume (MPV) as an indicator of platelet activation in patients with PPM. METHODS: A total of 109 patients with isolated aortic valve replacement (AVR) procedures with a mechanical prosthesis and a control group from a normal population of 102 people compatible in terms of age and sex were chosen for the study. The AVR group was subdivided into a PPM group (n = 41) and non-PPM group (n = 68). All patients and control participants underwent echocardiographic examinations, with simultaneous measurements of the serum MPV values. RESULTS: The MPV measurements were significantly higher in the patients with AVR compared to the control group (8.97 ± 0.93 vs. 8.26 ± 0.14, p < 0.001). Higher results were also obtained in the patients with PPM compared to the non-PPM group (9.36 ± 0.61 vs. 8.73 ± 1.01, p < 0.001). The platelet counts were found to be similar in both groups (p > 0.05). CONCLUSIONS: We have herein shown that the PPM patients had a significantly higher MPV compared to the patients with AVR without PPM and healthy subjects.