Aortic valve area index values of Trifecta implants correlate with energy loss and increased valve stress.

Biological valves are becoming more frequently used in aortic valve replacement. While several reports have evaluated the performance of biological valves, echocardiography studies during exercise stress remain scarce. Furthermore, no current reports compare rate changes in the aortic valve area of biological valves under increased exercise load. Here, we performed exercise stress echocardiography in patients after AVR with Trifecta or Inspiris valves and compared the rates of change in aortic valve areas (AVA). In addition, hydrodynamic analysis at rest was conducted with four-dimensional flow magnetic resonance imaging (4D-flow MRI). Exercise stress echocardiography was performed in seven Trifecta and seven Inspiris patients who underwent AVR at our hospital while 4D flow MRI was performed in all but two Trifecta cases. Comparing the percentage change in AVA when loaded to 25 W versus at rest, Trifecta was greater than Inspiris (28.7 ± 36.0 vs - 0.8 ± 12.4%). The smaller AVA at rest was considered causative for this. Meanwhile, Trifecta systolic energy loss in the prosthetic valve segment on 4D-flow MRI (97.5 ± 35.9 vs 52.7 ± 25.3 mW) was higher than Inspiris. The opening of the Trifecta valve was considered to be restricted at rest and this may reflect the current reports of early valve degradation requiring reoperation. Taken together, we observed that the Trifecta design may promote faster wear due to higher valve stress.

Natto consumption suppresses atherosclerotic plaque progression in LDL receptor-deficient mice transplanted with iRFP-expressing hematopoietic cells.

Natto, known for its high vitamin K content, has been demonstrated to suppress atherosclerosis in large-scale clinical trials through a yet-unknown mechanism. In this study, we used a previously reported mouse model, transplanting the bone marrow of mice expressing infra-red fluorescent protein (iRFP) into LDLR-deficient mice, allowing unique and non-invasive observation of foam cells expressing iRFP in atherosclerotic lesions. Using 3 natto strains, we meticulously examined the effects of varying vitamin K levels on atherosclerosis in these mice. Notably, high vitamin K natto significantly reduced aortic staining and iRFP fluorescence, indicative of decreased atherosclerosis. Furthermore, mice administered natto showed changes in gut microbiota, including an increase in natto bacteria within the cecum, and a significant reduction in serum CCL2 expression. In experiments with LPS-stimulated macrophages, adding natto decreased CCL2 expression and increased anti-inflammatory cytokine IL-10 expression. This suggests that natto inhibits atherosclerosis through suppression of intestinal inflammation and reduced CCL2 expression in macrophages.

[Nonbacterial Thrombotic Endocarditis Caused by Antiphospholipid Antibody Syndrome:Report of a Case].

A 73-year-old woman with multiple episodes of cerebral infarction was diagnosed with nonbacterial thrombotic endocarditis( NBTE) and antiphospholipid antibody syndrome. Transesophageal echocardiography revealed highly mobile tumors both in the mitral and the aortic valve, and the patient underwent aortic and mitral valve replacement. Pathologically, tumor of the mitral valve was a thrombus, and that of the aortic valve was a papillary fibroelastoma. Early after surgery, a recurrent thrombus was found in the left atrium, but no organ embolization ensued, and the patient had no adverse event for six months thereafter. Surgery is indicated only in limited cases of NBTE, because postoperative anticoagulation therapy is hard to manage and clinical outcome is poor.

[Turner Syndrome Requiring Two Open Heart Surgeries:Report of a Case].

A 55-year-old woman was diagnosed with Turner syndrome following amenorrhea at age 20. Since then, hormone replacement therapy has been used in the obstetrics and gynecology department, but follow-up for cardiovascular disease has not been performed. At age 44, she was taken to our hospital for the first time because of acute aortic dissection and rupture, and urgently underwent total arch replacement. At age 55, she needed aortic valve and ascending aortic replacements for aortic regurgitation, ascending aortic aneurysm, and heart failure caused by the bicuspid aortic valve. Cardiovascular manifestation in Turner syndrome patients is common, and close follow-up using imaging studies may predict emergency diseases that critically affect patient's life. Medical professionals should inform patients and families of the value of follow-up.

[Aortic Valve Replacement Concomitant with Right and Left Ventricular Outflow Tract Repair Eight Years after Arterial Switch Operation for Double Outlet Right Ventricle;Report of a Case].

We report a case of successful aortic valve replacement and relief of right and left ventricular outflow tract obstruction 8 years after an arterial switch operation for double outlet right ventricle. Since the surgical access to the ascending aorta was limited because of the anatomical feature and the adhesion after the arterial switch operation, arterial infusion site for cardiopulmonary bypass was secured at the right common carotid artery ahead of the sternal re-entry. After cardiopulmonary bypass was established, the right pulmonary artery was divided and then dissection of the ascending aorta was completed to secure the space for aortic valve replacement. A discrete membrane of the left ventricular outflow and muscle bands of the right ventricular outflow were completely resected. The right pulmonary artery was reconstructed by interpose of a prosthetic graft. Our experience would provide a technical option how to handle complex late complications after the arterial switch operation.

Popliteal venous aneurysm with deep venous thrombosis in the contralateral calf: report of a case.

Although a popliteal venous aneurysm is a rare entity, it is an important cause of pulmonary embolism (PE), which is occasionally life-threatening. We herein report a case of a popliteal venous aneurysm with deep venous thrombosis (DVT) in the contralateral calf. A 65-year-old male, who presented with sudden onset palpitation and dyspnea, was transferred to our hospital. Enhanced computed tomography revealed PE and a venous aneurysm of the left popliteal vein. The popliteal venous aneurysm was saccular and had an intramural thrombus. Furthermore, duplex scanning detected DVT in the contralateral calf. The patient underwent a tangential aneurysmectomy with lateral venorraphy. The surgery and postoperative course were uneventful. The PE and calf DVT disappeared with perioperative anticoagulant therapy. It is recommended that, in the treatment of popliteal venous aneurysms, special attention should be given to the condition of the venous vessels of the contralateral leg, because this can influence the therapeutic strategy.