Identification of Human Pathological Mitral Chordae Tendineae Using Polarization-sensitive Optical Coherence Tomography.

Defects of the mitral valve complex imply heart malfunction. The chordae tendineae (CTs) are tendinous strands connecting the mitral and tricuspid valve leaflets to the papillary muscles. These CTs are composed of organized, wavy collagen bundles, making them a strongly birefringent material. Disorder of the collagen structure due to different diseases (rheumatic, degenerative) implies the loss or reduction of tissue birefringence able to be characterized with Polarization Sensitive Optical Coherence Tomography (PS-OCT). PS-OCT is used to discriminate healthy from diseased chords, as the latter must be excised and replaced in clinical conventional interventions. PS-OCT allows to quantify birefringence reduction in human CTs affected by degenerative and rheumatic pathologies. This tissue optical property is proposed as a diagnostic marker for the identification of degradation of tendinous chords to guide intraoperative mitral valve surgery.

Aspergillus endocarditis in lung transplant recipient: successful surgical treatment.

Solid organ transplantation can be followed by Aspergillus infection, implying high mortality rates. The highest infection rates are registered among lung transplant recipients. We present a recent case of an Aspergillus endocarditis in a young lung transplant recipient.

Clinical course and predictors of death in prosthetic valve endocarditis over a 20-year period.

OBJECTIVE: To compare early and late outcome of patients with prosthetic valve endocarditis treated medically versus surgically and to determine predictors of in-hospital death. We retrospectively reviewed patient's clinical records, including laboratory findings, surgery, and pathologic files, in an acute-care, 1200-bed teaching hospital. METHODS: One hundred thirty-three episodes of definite prosthetic valve endocarditis as defined by the Duke University diagnostic criteria occurred in 122 patients from January 1986 to December 2005. Logistic regression model was used to identify prognostic factors of in-hospital mortality. Long-term follow-up was made to assess late prognosis. RESULTS: Bioprostheses were involved in 52% of cases and mechanical valves in 48%. The aortic valve was affected in 45% of patients. Staphylococcus epidermidis was isolated in 23% of cases, Streptococcus spp in 21%, S aureus in 13%, and Enterococcus in 8%. Cultures were negative in 18% of cases. Twenty-six patients were treated medically and 107 with combined antibiotics and valve replacement. The operative mortality was 6.5% and the in-hospital mortality, 29%. Presence of an abscess at echocardiography, urgent surgical treatment, heart failure, thrombocytopenia, and renal failure were significant predictors of in-hospital death. Kaplan-Meier survival at 12 months was 42% in patients treated medically and 71% in those treated surgically (P = .0007). Freedom from endocarditis was 91% at the end of follow-up. CONCLUSIONS: Prosthetic valve endocarditis is a serious condition with high mortality. Patients with perivalvular abscess had a worse prognosis, and combined surgical and medical treatment could be the preferred approach to improve outcome.

[Functional ischemic mitral regurgitation: an open debate]. / Insuficiencia mitral isquémica funcional: un debate abierto.

Functional ischemic mitral regurgitation is a complex disorder with a poor prognosis. Although the underlying anatomical and pathophysiological mechanisms are not entirely clear, it is known that postinfarction left ventricular remodeling is the most significant factor in the development of this mitral valve lesion. Echocardiography and magnetic resonance imaging have made significant contributions to clarifying the many mechanisms that progressively worsen mitral regurgitation. There is still controversy about the best surgical approach, particularly with regard to whether to replace or repair the valve, the type and size of prosthesis to be used in mitral annuloplasty, the durability of repair, valve-related complications, and medium-term survival. The early recurrence (< or =6 months) of mitral regurgitation after surgery has been reported in 17%-29% of patients. Better understanding of the origin and evolution of functional ischemic mitral regurgitation is necessary to enable the adoption of a more effective surgical approach to this enigmatic valvular disease.

Insuficiencia mitral isquémica funcional: un debate abierto / Functional Ischemic Mitral Regurgitation: an Open Debate

La insuficiencia mitral isquémica funcional es una enfermedad compleja de mal pronóstico. Los mecanismos anatómicos y fisiopatológicos causales no han sido totalmente aclarados. El remodelado ventricular izquierdo postinfarto es el principal factor inductor de la lesión mitral. La ecocardiografía y la resonancia magnética han contribuido de manera importante al esclarecimiento delos diferentes mecanismos que progresivamente agravan la regurgitación mitral. El tratamiento quirúrgico óptimo es controvertido, sobre todo en lo relativo a la decisión de sustituir o reparar la válvula, el tipo y el tamaño de la anuloplastiamitral, la durabilidad de la reparación, las complicaciones relacionadas con la válvula mitral y la supervivencia a medio plazo. Recientemente se ha descrito la reaparición precoz (≤ 6 meses) de la regurgitación mitral tras la cirugía en el 17-29% de los pacientes. Es preciso aumentar los conocimientos sobre el origen y la evolución de la insuficiencia mitral isquémica funcional con el fin de que sea posible realizar una cirugía más eficiente para esta enigmática enfermedad valvular

Functional ischemic mitral regurgitation is a complex disorder with a poor prognosis. Although the underlying anatomical and pathophysiological mechanisms are not entirely clear, it is known that post-infarction left ventricular remodeling is the most significant factor in the development of this mitral valve lesion. Echocardiography and magnetic resonance imaging have made significant contributions to clarifying the many mechanisms that progressively worsen mitral regurgitation. There is still controversy about the best surgical approach, particularly with regard to whether to replace or repair the valve, the type and size of prosthesis to be used in mitral annuloplasty, the durability of repair, valve-related complications, and medium-term survival. The early recurrence(≤6 months) of mitral regurgitation after surgery has been reported in 17%-29% of patients. Better understanding of the origin and evolution of functional ischemic mitral regurgitation is necessary to enable the adoption of a more effective surgical approach to this enigmatic valvular disease

Guías de práctica clínica de la Sociedad Española de Cardiología en Cardiología Intervencionista: angioplastia coronaria y otras técnicas / Interventional Cardiology: Coronary Angioplasty and other Techniques

La cardiología intervencionista ha experimentado en los últimos años un gran crecimiento. En esta guía de actuación clínica se revisa la evidencia científica existente y su implicación en la utilidad de las diferentes técnicas en distintos contextos clínicos y anatómicos. La revisión incluye los apartados: 1. Coronariografía.2. Angioplastia con balón.3. Stent coronario.4. Otras técnicas intervencionistas: aterectomía direccional, aterectomía rotacional, catéter de extracción transluminal, balón de corte, láser intracoronario y transmiocárdico e irradiación intracoronaria.5. Inhibidores de los receptores de la GP IIb/IIIa.6. Nuevas técnicas diagnósticas: ecografía intracoronaria, angioscopia, Doppler coronario y guía de presión. El grado de consenso de las fuentes consultadas y de los expertos son expresados utilizando la clasificación en clases I, IIa, IIb y III, utilizada en las guías del American College of Cardiology/American Heart Association (AU)