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1.
Artigo em Inglês | MEDLINE | ID: mdl-33619556

RESUMO

OBJECTIVES: Heart failure induced by valvular cardiomyopathy occurs in a substantial proportion of patients undergoing heart valve surgery. We aimed (i) to quantify beta-adrenoceptor (beta-AR) function by measuring the inotropic effect of isoprenaline in left ventricular (LV) tissue and (ii) to correlate beta-AR-mediated inotropy with clinical markers of heart failure. METHODS: A total of 179 LV myocardial samples were obtained from 104 consecutive patients who underwent aortic valve (AV) surgery between 2017 and 2019. Beta-ARs were stimulated by increasing the concentrations of isoprenaline, followed by a single high concentration of forskolin and calcium. Beta-AR sensitivity was estimated as the concentration to achieve half maximum effects (EC50). Maximum effect size was calculated as the relative beta-AR-mediated inotropic response compared to the force in the presence of high calcium [FISO/Ca (%)]. In vitro data were correlated with the clinical indicators of LV disease. RESULTS: FISO/Ca was independent of age and sex and amounted to 79.6 ± 20.5%. In a multivariate regression model, we found a significant inverse association between FISO/Ca and preoperative left ventricular end-diastolic diameter increase per 10 mm (OR -9.24, 95% CI -16.66 to -1.82; P = 0.015). Furthermore, patients with end-stage heart failure showed a strong tendency towards more severe reduction of max beta-AR response, as indicated by reduced FISO/Ca in a multivariate model (OR -29.60, 95% CI -61.92 to 2.72; P = 0.055). CONCLUSIONS: Our study indicates that in vitro myocardial contractility testing can quantify beta-AR dysfunction in patients with AV disease. We found a significant association between reduced beta-AR sensitivity and increased LV diameter, which may indicate a role of beta-AR dysfunction in the development of heart failure in patients with AV disease.

2.
J Mol Cell Cardiol ; 2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33631188

RESUMO

AIM: To obtain a quantitative expression profile of the main genes involved in the cAMP-signaling cascade in human control atria and in different cardiac pathologies. METHODS AND RESULTS: Expression of 48 target genes playing a relevant role in the cAMP-signaling cascade was assessed by RT-qPCR. 113 samples were obtained from right atrial appendages (RAA) of patients in sinus rhythm (SR) with or without atrium dilation, paroxysmal atrial fibrillation (AF), persistent AF or heart failure (HF); and left atrial appendages (LAA) from patients in SR or with AF. Our results show that right and left atrial appendages in donor hearts or from SR patients have similar expression values except for AC7 and PDE2A. Despite the enormous chamber-dependent variability in the gene-expression changes between pathologies, several distinguishable patterns could be identified. PDE8A, PKI3G and EPAC2 were upregulated in AF. Different phosphodiesterase (PDE) families showed specific pathology-dependent changes. CONCLUSION: By comparing mRNA-expression patterns of the cAMP-signaling cascade related genes in right and left atrial appendages of human hearts and across different pathologies, we show that 1) gene expression is not significantly affected by cardioplegic solution content, 2) it is appropriate to use SR atrial samples as controls, and 3) many genes in the cAMP-signaling cascade are affected in AF and HF but only few of them appear to be chamber (right or left) specific. TOPIC: AC, AKAP, PDE, Epac, PKA, CaMKII TRANSLATIONAL PERSPECTIVE: The cyclic AMP signaling pathway is important for atrial function. However, expression patterns of the genes involved in the atria of healthy and diseased hearts are still unclear. We give here a general overview of how different pathologies affect the expression of key genes in the cAMP signaling pathway in human right and left atria appendages. Our study may help identifying new genes of interest as potential therapeutic targets or clinical biomarkers for these pathologies and could serve as a guide in future gene therapy studies.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33284970

RESUMO

OBJECTIVES: The aim of this study was to compare the effect of asymmetric versus symmetric bicuspid aortic valve (BAV) repair on transvalvular flow patterns and aortic wall shear stress (WSS). METHODS: Four-dimensional flow magnetic resonance imaging was prospectively and consecutively performed in patients with congenital aortic valve (AV) disease before and after AV repair. The following MRI-based parameters were assessed: (i) flow eccentricity index, (ii) backward flow across the AV, (iii) grading of vortical and helical flow, and (iv) WSS (N/m2) in the proximal aorta. MRI-derived flow parameters were compared between patients who underwent 'asymmetric BAV repair' (n = 13) and 'symmetric BAV repair' (n = 7). RESULTS: A total of 20 patients (39 ± 12 years, 80% male), who underwent BAV repair, were included. In the asymmetric BAV repair group, circumferential WSS reduction was found at the level of the aortic arch (P = 0.015). In the symmetric BAV repair group, postoperative circumferential WSS was significantly reduced compared to baseline at all levels of the proximal aorta (all P < 0.05). Postoperative circumferential WSS was significantly higher in the asymmetric versus symmetric BAV repair group at the level of the sinotubular junction (0.45 ± 0.15 vs 0.30 ± 0.09 N/m2; P = 0.028), ascending aorta (0.59 ± 0.19 vs 0.44 ± 0.08 N/m2; P = 0.021) and aortic arch (0.59 ± 0.25 vs 0.40 ± 0.08 N/m2; P = 0.017). Segmental WSS analysis showed significantly higher postoperative WSS after asymmetric versus symmetric BAV repair, especially in the anterior aortic segment (P = 0.004). CONCLUSIONS: Symmetric BAV repair results in more physiological flow patterns and significantly reduces WSS, as compared to asymmetric BAV repair. From a haemodynamic point of view, symmetric AV geometry should be attempted in every congenital AV repair.

4.
Biomarkers ; 25(8): 711-718, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33090032

RESUMO

OBJECTIVES: We aimed to elucidate the correlation between expression patterns of aortic tissue microRNAs and the aortopathy formation in bicuspid aortic valve (BAV) disease. METHODS: All 65 patients who underwent elective aortic valve repair/replacement +/- proximal aortic replacement due to BAV disease with or without concomitant aortic aneurysm were identified from our BAV registry. Aortic tissue was collected intraoperatively from the ascending aorta at the greater and lesser curvature. Aortic tissue microRNAs analysis included 11 microRNAs (miR-1, miR-17, miR-18a, miR-19a, miR-20a, miR-21, miR-29b, miR-106a, miR-133a, miR-143 and miR-145). Furthermore, analysis of MMP2, TIMP1/2 mRNA and the protein expression was subsequently performed. The primary study endpoint was the correlation between microRNAs and MMP2, TIMP1/2 mRNA/protein expression. RESULTS: We found a significant association between miR-133a and TIMP1 mRNA (r = 0.870, p < 0.001), an inverse correlation between miR-143a and MMP2 protein expression (r= -0.614, p = 0.044) and a positive correlation between miR-133a and TIMP-2 protein expression (r = 0.583, p = 0.036) at the greater curvature. CONCLUSION: Our findings indicate that aortic tissue microRNAs may reflect remodelling processes of the proximal aorta in BAV aortopathy. Specific aortic tissue microRNAs may exert their regulatory effects on the aortopathy through their impact on MMPs/TIMPs homeostasis at the level of the greater curvature.

5.
Acta Physiol (Oxf) ; : e13564, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33002334

RESUMO

AIM: There is an increasing awareness of the impact of age and sex on cardiovascular diseases (CVDs). Differences in physiology are suspected. Beta-adrenoceptors (beta-ARs) are an important drug target in CVD and potential differences might have significant impact on the treatment of many patients. To investigate whether age and sex affects beta-AR function, we analysed a large data set on beta-AR-induced inotropy in human atrial trabeculae. METHODS: We performed multivariable analysis of individual atrial contractility data from trabeculae obtained during heart surgery of patients in sinus rhythm (535 trabeculae from 165 patients). Noradrenaline or adrenaline were used in the presence of the beta2 -selective antagonist (ICI 118 551, 50 nmol/L) or the beta1 -selective antagonist (CGP 20712A, 300 nmol/L) to stimulate beta1 -AR or beta2 -AR respectively. Agonist concentration required to achieve half-maximum inotropic effects (EC50 ) was taken as a measure of beta-AR sensitivity. RESULTS: Impact of clinical variables was modelled using multivariable mixed model regression. As previously reported, chronic treatment with beta-blockers sensitized beta-AR. However, there was no significant interaction between basal force, maximum force and beta-AR sensitivity when age and sex were modelled continuously. In addition, there was no statistically significant effect of body mass index or diabetes on atrial contractility. CONCLUSION: Our large, multivariable analysis shows that neither age nor sex affects beta-AR-mediated inotropy or catecholamine sensitivity in human atrial trabeculae. These findings may have important clinical implications because beta-ARs, as a common drug target in CVD and heart failure, do not behave differently in women and men across age decades.

6.
Expert Rev Cardiovasc Ther ; 18(9): 625-633, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32811206

RESUMO

INTRODUCTION: While the understanding of the pathophysiology and clinical implication of bicuspid aortic valves evolves rapidly, the natural history of unicuspid aortic valves is still poorly understood. Hence, a universally accepted diagnostic work-up process and therapy recommendations for UAV still have to be established. AREAS COVERED: This article aims to give an overview on the most recent literature addressing the pathophysiology, the diagnostic tools and appropriate surgical therapy options of unicuspid aortic valve. Due to the rare prevalence, the understanding of pathophysiology is still missing. Further, symptomatic aortic valve disease are seen much earlier life stage in this cohorts. Thus, it highlights the several surgical treatment options with pro and contra especially for the young adult cohorts. EXPERT OPINION: Large scale prospective observational studies using standardized diagnostic criteria are needed to reveal the clinical course. Further appropriate treatment strategies of unicuspid aortic valve patients is demanded.

7.
Prog Cardiovasc Dis ; 63(4): 475-481, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32640281

RESUMO

Patients with a bicuspid aortic valve (BAV) frequently develop aneurysms of the aortic root and tubular ascending aorta. Aneurysms of the aortic arch, in the absence of concomitant aortopathies, are much less common. According to the 2018 American Association of Thoracic Surgery consensus guidelines on BAV-related aortopathy, prophylactic surgical aortic repair / replacement is recommended starting at a maximum aortic diameter of 50 mm in patients with risk factors. Concomitant aortic surgery is also recommended at an aortic diameter of 45 mm in those patients with other indications for cardiac surgery (most commonly aortic valve procedures). The ultimate goal of prophylactic aortic surgery is the prevention of aortic catastrophes, e.g. aortic rupture or acute aortic dissection, which are associated with high morbidity and mortality. The surgical technique used - in elective and emergency cases - depends on the involvement and nature of the aortic valve disease, as well as the extent of aortic aneurysm formation. The current review focusses on the surgical management of the aortic root, tubular ascending aorta, and proximal aortic arch in BAV patients. Despite the abovementioned recommendations, many BAV patients develop acute aortic syndromes below the recommended aortic diameter thresholds. Further research is therefore required in order to identify high-risk BAV subgroups that would benefit from earlier surgical repair.


Assuntos
Aneurisma Aórtico/cirurgia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/etiologia , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Implante de Prótese Vascular , Anuloplastia da Valva Cardíaca , Doenças das Valvas Cardíacas/patologia , Humanos , Técnicas de Sutura
8.
Eur Heart J Case Rep ; 4(3): 1-5, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32617510

RESUMO

Background: Due to ongoing left ventricular (LV) remodeling and consecutive geometric displacement of both papillary muscles, end-stage heart failure is frequently associated with relevant functional mitral regurgitation (FMR) Type IIIb. Treatment strategies of FMR and their prognostic impact are still controversial. Case summary: We present a case of an 80-year-old patient who suffered from recurrent symptoms of congestive heart failure due to dilated cardiomyopathy and concomitant severe FMR. To specifically address severe tethering of both mitral leaflets heart team decision was to perform minimally invasive mitral valve repair (MVR) including a subannular LV remodeling procedure, instead of an interventional edge-to-edge repair (MitraClip® procedure). In addition to mitral valve ring annuloplasty, standardized relocation of both papillary muscles was performed successfully, leading to a complete resolution of mitral leaflet tethering. There were no procedural complications and the patient was discharged with an excellent functional result without residual mitral regurgitation. Furthermore, after 12 and 24 months, he reported an increase of his functional exercise capacity and a remarkable reverse LV remodeling could be demonstrated. Discussion: Novel subannular repair techniques, especially the relocation of both papillary muscles, specifically address severe leaflet tethering in FMR and have an obvious potential to improve long-term competence of MVR. Therefore, they could be considered as a viable therapeutic option even in elderly patients presenting with end-stage cardiomyopathy and severe leaflet tenting.

9.
Ann Thorac Surg ; 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-32526161

RESUMO

BACKGROUND: Aortic valve replacement (AVR) is a standard of care in the treatment of aortic stenosis. The aim of the study was to evaluate the long-term outcome and quality of life (QoL) after biological AVR in patients younger than 60 years of age. METHODS: A total of 354 consecutive patients less than or equal to 60 years who underwent biological AVR at our institution (2005-2015) were included. The primary endpoint was actual freedom from AV reintervention, and secondary endpoints were actual freedom from major adverse cardiac and cerebrovascular events (MACCE) as well as mental and physical QoL. RESULTS: Mean age was 52.3 ± 7.1 years and mean follow-up duration was 78.7 ± 38.1 months. Overall survival at 5, 10, and 12 years was 87.6%, 76.3%, and 63.5%, and actual freedom from AV reintervention was 85.5%, 67.8%, and 52.9%, respectively. Actual freedom from MACCE was 82.8%, 63.2%, and 50.4%, respectively. Cox regression revealed concomitant coronary artery disease (P < .001) and creatinine at baseline (P < .001) as independent predictors of survival, AV reintervention, and MACCE. Physical QoL was similar (P = .427) and mental QoL (P = .005) was significantly better compared with the published age-matched control subjects. CONCLUSIONS: Biological AVR in patients less than or equal to 60 years of age is associated with a significant occurrence of actual AV reintervention and MACCE at 10 to 12 years. Mental QoL after biological AVR was superior compared with healthy control subjects. The effect of the most recently developed bioprosthesis, specifically for younger patients, needs to be evaluated. Therefore, a shared decision-making process in prosthetic AV selection is mandatory in AVR patients less than or equal to 60 years of age.

10.
Asian Cardiovasc Thorac Ann ; : 218492320927233, 2020 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-32498553

RESUMO

There is growing clinical need and interest to implement novel risk prediction tools in bicuspid aortic valve-associated proximal aortic disease, so-called bicuspid aortic valve aortopathy. Inherent limitations of the diameter-based risk stratification for adverse aortic events in bicuspid aortic valve aortopathy patients have recently been recognized. Therefore, alternative diagnostic tools and subsequent adjustments in the treatment guidelines are urgently needed. Herein, we summarize the current evidence on recent diagnostic developments to improve risk stratification in bicuspid aortic valve aortopathy, including circulating microRNAs as biomarkers to predict the progression of aortic disease.

11.
Ann Thorac Surg ; 2020 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-32544455

RESUMO

We report on a young patient with bicuspid aortic valve operated on for type A acute aortic dissection due to a blunt thoracic trauma. Aortic root replacement, ascending aortic and total arch repair together with the postoperative course were uneventful. Multigenerational genetic analyses revealed mutations in the NOTCH1 and ACTA2 genes in the patient and his father. The screening of his parents and children revealed no bicuspid aortic valve or aortic root dilation. This exceptionally rare case of double-hit mutations and the presence of blunt trauma reveals the complex etiology of aortic dissection in patients with bicuspid aortic valve.

12.
Prog Cardiovasc Dis ; 63(4): 434-441, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32485187

RESUMO

The congenital bicuspid aortic valve (BAV) is a heterogeneous condition that is better understood considering 3 types of valvulo-aortopathy presentations: A typical-presentation valvulo-aortopathy, a complex-presentation valvulo-aortopathy and an uncomplicated/undiagnosed-presentation. The burden of BAV-related complications has been elucidated in patients with the typical-presentation valvulo-aortopathy and is discussed in this review. These patients enjoy an overall normal expected long-term survival as long as complications are identified and treated in a timely manner. This notion and the fact that the most dreaded complications (infective endocarditis and aortic dissection) are infrequent, represent important reassuring points for the BAV patient. Common complications such as valve dysfunction and aorta dilatation must be the subject of focused research in prevention and treatment. Conversely, BAV patients with complex-presentation valvulo-artopathy, as well as typical valvulo-aortopathy BAV patients who are older, with advanced valvular dysfunction, and possible late-referral to specialized care, may incur a survival penalty as compared to the general population. An evidence-based discussion of these concepts is provided in this review.


Assuntos
Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/diagnóstico , Adulto , Fatores Etários , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/mortalidade , Humanos , Pessoa de Meia-Idade , Taxa de Sobrevida , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-32386768

RESUMO

OBJECTIVE: We aimed to analyze the association among flow patterns, gene expression, and histologic alterations of the proximal aorta in patients with aortic valve disease. METHODS: A total of 131 patients referred for aortic valve replacement were grouped by valve dysfunction (aortic stenosis vs aortic regurgitation) and valve morphology (bicuspid vs tricuspid). On the basis of magnetic resonance imaging, aortic tissue from outer and inner curvature was collected for gene expression and histologic analysis. To identify differences in aortic remodeling, age- and sex-adjusted data for inflammation (CCL2, VCAM1, inflammation and atherosclerosis) and medial degeneration (COL1A1, ELN, fibrosis, elastin fragmentation, and cystic medial necrosis) were compared. RESULTS: First, we compared all patients with aortic regurgitation (n = 64) and patients with aortic stenosis (n = 67). In patients with aortic regurgitation, COL1A1 expression and all histologic markers were significantly increased. With respect to aortic diameter, all subsequent analyses were refined by considering only individuals with aortic diameter 40 mm or greater. Second, patients with bicuspid aortic valve were compared, resulting in a similar aortic diameter. Although patients with aortic regurgitation were younger, no differences were found in gene expression or histologic level. Third, valve morphology was compared in patients with aortic regurgitation. Although aortic diameter was similar, patients with regurgitant bicuspid aortic valve were younger than patients with regurgitant tricuspid aortic valve. Inflammatory markers were similar, whereas markers for medial degeneration were increased in patients with regurgitant tricuspid aortic valve. CONCLUSIONS: Our results indicate that the proximal aorta in patients with aortic regurgitation showed an increased inflammation and medial degeneration compared with patients with aortic stenosis. Refining both groups by valve morphology, in patients with bicuspid aortic valve, no difference except age was detected between aortic regurgitation and aortic stenosis. In patients with aortic regurgitation, tricuspid aortic valve revealed increased markers for medial degeneration but no differences regarding inflammatory markers.

14.
J Cardiovasc Magn Reson ; 22(1): 29, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-32354361

RESUMO

BACKGROUND: Aortic valve repair has become a treatment option for adults with symptomatic bicuspid (BAV) or unicuspid (UAV) aortic valve insufficiency. Our aim was to demonstrate the feasibility of 4D flow cardiovascular magnetic resonance (CMR) to assess the impact of aortic valve repair on changes in blood flow dynamics in patients with symptomatic BAV or UAV. METHODS: Twenty patients with adult congenital heart disease (median 35 years, range 18-64; 16 male) and symptomatic aortic valve regurgitation (15 BAV, 5 UAV) were prospectively studied. All patients underwent 4D flow CMR before and after aortic valve repair. Aortic valve regurgitant fraction and systolic peak velocity were estimated. The degree of helical and vortical flow was evaluated according to a 3-point scale. Relative flow displacement and wall shear stress (WSS) were quantified at predefined levels in the thoracic aorta. RESULTS: All patients underwent successful aortic valve repair with a significant reduction of aortic valve regurgitation (16.7 ± 9.8% to 6.4 ± 4.4%, p < 0.001) and systolic peak velocity (2.3 ± 0.9 to 1.9 ± 0.4 m/s, p = 0.014). Both helical flow (1.6 ± 0.6 vs. 0.9 ± 0.5, p < 0.001) and vortical flow (1.2 ± 0.8 vs. 0.5 ± 0.6, p = 0.002) as well as both flow displacement (0.3 ± 0.1 vs. 0.25 ± 0.1, p = 0.031) and WSS (0.8 ± 0.2 N/m2 vs. 0.5 ± 0.2 N/m2, p < 0.001) in the ascending aorta were significantly reduced after aortic valve repair. CONCLUSIONS: 4D flow CMR allows assessment of the impact of aortic valve repair on changes in blood flow dynamics in patients with bicuspid aortic valve disease.


Assuntos
Aorta Torácica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Aortografia , Anuloplastia da Valva Cardíaca , Doenças das Valvas Cardíacas/cirurgia , Hemodinâmica , Interpretação de Imagem Assistida por Computador , Imagem Cinética por Ressonância Magnética , Adulto , Aorta Torácica/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estudos de Viabilidade , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
Quant Imaging Med Surg ; 10(4): 853-861, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32355649

RESUMO

Background: Aortic valve (AV) repair has evolved towards a treatment alternative in young patients with AV regurgitation and was accompanied by the development of surgical repair strategies. An efficient and reproducible AV annulus stabilization (i.e., annuloplasty) has been proposed as a crucial component to obtain the long-term stability of AV repair. However, there is still major controversy regarding the most appropriate annuloplasty approach. We aimed to address AV annulus structures which are relevant for AV annuloplasty, based on MS-CT data. Methods: We retrospectively analysed 326 consecutive patients with AV disease who all underwent preprocedural MS-CT examination. Study cohort was subdivided according to the underlying AV pathology: 25 patients with aortic regurgitation (AR subgroup) (mean age 73±11 years, 68% male), 243 patients with aortic stenosis (AS subgroup) (73±11 years, 68% male) and 58 patients with normally functioning AV (normal AV subgroup) (mean age 76±7 years, 36% male). We systematically measured maximum and minimum AV annulus diameter, AV annular area, projected AV annular perimeter and anatomic AV annular perimeter during mid-systole using MS-CT data. Based on these measurements, AV annular eccentricity index was calculated [(max AV annulus × 100/min AV annulus) - 100]. Furthermore, we assessed the tissue components of AV annular plane, distinguishing between muscular and fibrous portions of the basal ring. Results: AV annular eccentricity index was significantly larger in the normal AV-subgroup as compared to the AR-subgroup (33.2%±10.7% vs. 27.8%±9.2%; P=0.048) as well as to the AS-subgroup (33.2%±10.7% vs. 20.4%±8.8%; P<0.001). AV annular area was significantly larger in the AR subgroup as compared to the AS subgroup (5.7±1.0 vs. 5.1±0.8 cm2; P=0.003) and normal AV subgroup (5.7±1.0 vs. 4.8±0.8 cm2; P<0.001). Intramuscular plane in the right coronary sinus was significantly increased in the AR subgroup vs. AS subgroup (12.8±2.7 vs. 7.5±3.6 mm; P<0.001) and normal AV subgroup (12.8±2.7 vs. 8.7±3.0 mm; P<0.001). Muscular component of the basal ring was significantly reduced in the AR subgroup vs. AS subgroup (37.5%±5.1% vs. 40.5%±5.5%; P=0.039) and normal AV subgroup (37.5%±5.1% vs. 44.3%±10.2%; P=0.001). Conclusions: MS-CT enables a quantitative analysis of aortic root anatomy which may have an impact on AV annuloplasty. AR patients differ significantly regarding their AV annular dimensions and basal ring morphology as compared to the AS patients and those with a normal AV function. These findings may have major implications in tricuspid AV repair when designing the most appropriate AV annulus stabilisation technique.

16.
J Invasive Cardiol ; 32(9): 330-334, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32428868

RESUMO

BACKGROUND: New transcatheter equipment and accumulated experience have stimulated further refinements in implantation techniques. We aimed to compare the outcomes of transfemoral transcatheter aortic valve replacement (TF-TAVR) with and without the use of contrast medium (CM) in patients with glomerular filtration rate (GFR) <30 mL/min/1.73 m². METHODS: This single-center, retrospective study included all patients who underwent TF-TAVR procedure with Edwards Sapien balloon-expandable bioprostheses between September 2017 and September 2018 at the Zentralklinik Bad Berka Germany, and compared outcomes of TF-TAVR with and without the use of CM. RESULTS: A total of 98 consecutive patients were included in this study; 25 patients underwent TF-TAVR without the use of CM and 73 patients underwent TF-TAVR with the use of CM. Acute kidney injury was significantly higher in patients who received CM (15 patients [20.5%] in the control group vs 1 patient [4%] in the study group; P=.04). Other procedure-related complications were equally distributed between both groups. CONCLUSION: TF-TAVR without the use of CM can be considered a safe and reproducible alternative technique. Furthermore, it reduced the incidence of postoperative acute kidney injury in patients with GFR <30 mL/min/1.73 m².

17.
J Clin Med ; 9(4)2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32326432

RESUMO

Pregnancy poses a threat to women with aortopathy. Conclusive data on the obstetric and aortic outcome in this risk collective, especially when it comes to aortic complications in the long term, are still missing. This study offers a comparative analysis of pregnancy-associated outcome in 113 consecutive women with Marfan syndrome or bicuspid aortic valve disease, including 46 ever-pregnant and 37 never-pregnant women with Marfan syndrome, and 23 ever-pregnant and 7 never-pregnant females with bicuspid aortic valve disease. The overall obstetric outcome was comparable between ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease (p = 0.112). Pregnancy-associated aortic dissection occurred in two women with Marfan syndrome (3%) during a total of 62 completed pregnancies, whereas no single case of aortic event occurred in women with bicuspid aortic valve disease during a total of 36 completed pregnancies (p = 0.530). In the long-term follow-up, aortic dissection occurred in 21% of ever-pregnant women with Marfan syndrome, but in none of the women with bicuspid aortic valve disease (p = 0.022). Proximal aortic surgery was performed with similar frequency in ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease in the long term (p = 0.252). However, ever-pregnant women with Marfan syndrome were younger when surgery was performed (44 ± 9 vs. 59 ± 7 years; p = 0.041). In Marfan syndrome, long-term growth of the aorta was comparable between ever-pregnant and never-pregnant women. Pregnancy thus exhibited an increased immediate aortic risk only in women with Marfan syndrome, but not in women with bicuspid aortic valve disease. Previous pregnancy did not relate to an increased long-term risk of adverse aortic events in women with Marfan syndrome or with bicuspid aortic valve disease.

18.
PLoS One ; 15(4): e0231378, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271849

RESUMO

Protocols for "Enhanced recovery after surgery (ERAS)" are on the rise in different surgical disciplines and represent one of the most important recent advancements in perioperative medical care. In cardiac surgery, only few ERAS protocols have been described in the past. At University Heart Center Hamburg, Germany, we invented an ERAS protocol for patients undergoing minimally invasive cardiac valve surgery. In this retrospective single center study, we aimed to describe the implementation of our ERAS program and to evaluate the results of the first 50 consecutive patients. Our ERAS protocol was developed according to a modified Kern cycle by an expert group, literature search, protocol creation and pilot implementation in the clinical practice. Data of the first 50 consecutive patients undergoing minimally invasive cardiac valve surgery were analysed retrospectively. The key features of our multidisciplinary ERAS protocol are physiotherapeutic prehabilitation, minimally invasive valve surgery techniques, modified cardiopulmonary bypass management, fast-track anaesthesia with on- table extubation and early mobilisation. A total of 50 consecutive patients (mean age of 51.9±11.9 years, mean STS score of 0.6±0.3) underwent minimally-invasive mitral or aortic valve surgery. The adherence to the ERAS protocol was high and neither protocol related complications nor in-hospital mortality occurred. 12% of the patients developed postoperative atrial fibrillation, postoperative delirium emerged in two patients and reintubation was required in one patient. Intensive care unit stay was 14.0±7.4 hours and total hospital stay 6.2±2.9 days. Our ERAS protocol is feasible and safe in minimally-invasive cardiac surgery setting and has a clear potential to improve patients outcome.


Assuntos
Valva Aórtica/cirurgia , Recuperação Pós-Cirúrgica Melhorada , Valva Mitral/cirurgia , Adulto , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Dor/etiologia , Complicações Pós-Operatórias , Estudos Retrospectivos , Cooperação e Adesão ao Tratamento , Resultado do Tratamento
19.
J Clin Med ; 9(1)2020 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-31940858

RESUMO

Congenital heart disease (CHD)-associated aortopathy is a very heterogeneous entity with a wide spectrum of clinical presentations. The pathogenesis of aortopathy is still incompletely understood, and, therefore, the best prevention and management strategy is currently unknown. The most common entity of CHD-associated aortopathies is bicuspid aortic valve (BAV)-associated aortic disease (so called bicuspid aortopathy) that is found in 50%-60% of BAV individuals. BAV aortopathy has been reported in association with an increased risk of aortic events, especially aortic dissection and sudden cardiac death. Risk stratification of adverse aortic events is still very rudimentary and considers only the maximal aortic diameter, which makes it unsuitable for an individual risk prediction. This introductory Editorial highlights the unmet clinical need for more integrative and translational research to unravel pathogenetic pathways in the development of CHD-associated aortopathies, integrating recently identified genetic lesions and knowledge on circulating biomarkers and microstructural changes in the diseased aorta.

20.
J Clin Med ; 9(1)2020 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-31963884

RESUMO

OBJECTIVE: Aortic size-based criteria are of limited value in the prediction of aortic events, while most aortic events occur in patients with proximal aortic diameters < 50 mm. Serological biomarkers and especially circulating microRNAs (miRNAs) have been proposed as an elegant tool to improve risk stratification in patients with different aortopathies. Therefore, we aimed to evaluate the levels of circulating miRNAs in a surgical cohort of patients presenting with bicuspid aortic valve disease and distinct valvulo-aortic phenotypes. METHODS: We prospectively examined a consecutive cohort of 145 patients referred for aortic valve surgery: (1) Sixty three patients (mean age 47 ± 11 years, 92% male) with bicuspid aortic valve regurgitation and root dilatation (BAV-AR), (2) thirty two patients (mean age 59 ± 11 years, 73% male) with bicuspid aortic valve stenosis (BAV-AS), and (3) fifty patients (mean age 56 ± 14 years, 55% male) with tricuspid aortic valve stenosis and normal aortic root diameters (TAV-AS) who underwent aortic valve+/-proximal aortic surgery at a single institution. MicroRNAs analysis included 11 miRNAs, all published previously in association with aortopathies. Endpoints of our study were (1) correlation between circulating miRNAs and aortic diameter and (2) comparison of circulating miRNAs in distinct valvulo-aortic phenotypes. RESULTS: We found a significant inverse linear correlation between circulating miRNAs levels and proximal aortic diameter in the whole study cohort. The strongest correlation was found for miR-17 (r = -0.42, p < 0.001), miR-20a (r = -0.37, p < 0.001), and miR-106a (r = -0.32, p < 0.001). All miRNAs were significantly downregulated in BAV vs. TAV with normal aortic root dimensions Conclusions: Our data demonstrate a significant inverse correlation between circulating miRNAs levels and the maximal aortic diameter in BAV aortopathy. When comparing miRNAs expression patterns in BAV vs. TAV patients with normal aortic root dimensions, BAV patients showed significant downregulation of analyzed miRNAs as compared to their TAV counterparts. Further multicenter studies in larger cohorts are needed to further validate these results.

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