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1.
Artigo em Inglês | MEDLINE | ID: mdl-32356619

RESUMO

The implantation of a decellularized aortic homograft in children and young adults has been shown to be a good alternative to existing surgical approaches. Lower risk of calcification and the potential of growth render a homograft a promising valve substitute. The child presented in this video tutorial is a 10-year-old boy diagnosed with congenital aortic stenosis which was treated by balloon valvuloplasty early in life. Current echocardiographic findings show severe aortic regurgitation and stenosis. The tutorial provides detailed insight into how to implant a decellularized aortic homograft as a total root replacement.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/transplante , Valvuloplastia com Balão , Aloenxertos , Insuficiência da Valva Aórtica/etiologia , Criança , Ecocardiografia , Humanos , Masculino , Transplante Homólogo
2.
Cardiovasc Eng Technol ; 11(1): 84-95, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31667784

RESUMO

PURPOSE: Accurately reproducing physiological and time-varying variables in cardiac bioreactors is a difficult task for conventional control methods. This paper presents a new controller based on a genetic algorithm for the control of a cardiac bioreactor dedicated to the study and conditioning of heart valve substitutes. METHODS: A multi-objective genetic algorithm was designed to obtain an accurate simultaneous reproduction of physiological periodic time functions of the three most relevant variables characterizing the blood flow in the aortic valve. These three controlled variables are the flow rate and the pressures upstream and downstream of the aortic valve. RESULTS: Experimental results obtained with this new algorithm showed an accurate dynamic reproduction of these three controlled variables. Moreover, the controller can react and adapt continuously to changes happening over time in the cardiac bioreactor, which is a major advantage when working with living biological valve substitutes. CONCLUSION: The strong non-linear interaction that exists between the three controlled variables makes it difficult to obtain a precise control of any of these, let alone all three simultaneously. However, the results showed that this new control algorithm can efficiently overcome such difficulties. In the particular field of bioreactors reproducing the cardiovascular environment, such a flexible, versatile and accurate reproduction of these three interdependent controlled variables is unprecedented.


Assuntos
Algoritmos , Valva Aórtica/fisiologia , Bioprótese , Reatores Biológicos , Pressão Sanguínea , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Engenharia Tecidual/instrumentação , Valva Aórtica/transplante , Velocidade do Fluxo Sanguíneo , Células Cultivadas , Humanos , Mecanotransdução Celular , Estresse Mecânico , Fatores de Tempo , Técnicas de Cultura de Tecidos
3.
A A Pract ; 13(12): 457-460, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31651414

RESUMO

The angle correction feature in ultrasound systems is used when there is difficulty accurately aligning the Doppler beam with the flow to be interrogated. The operator can manually "correct" the angle to the actual direction of flow. Subsequently, the machine corrects the peak velocity for the angle. We present a case of aortic valve replacement (AVR) in which falsely high transaortic gradients were obtained immediately after separation from cardiopulmonary bypass (CPB). We recommend that there be a more prominent notification when the angle correction feature is used with machine prompts confirming when a peak velocity is obtained using angle correction.


Assuntos
Implante de Prótese de Valva Cardíaca , Ultrassonografia Doppler , Idoso , Aorta/transplante , Valva Aórtica/transplante , Humanos , Masculino , Valva Mitral/transplante
5.
Rev. chil. cardiol ; 38(1): 64-67, abr. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1003639

RESUMO

Abstracts: Successful treatment following percutaneous angioplasty (PTCA) and percutaneous trans aortic valve aortic valve stenosis and critical obstruction of the main left coronary artery is presented. Due to a very high estimated surgical risk the patient underwent PTCA of the main left trunk followed, a week later, by trans catheter implantation of an aortic valve (TAVI). The procedure was uneventful, and the clinical condition of the patient was excellent at one year (Functional class I).


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/terapia , Intervenção Coronária Percutânea/métodos , Substituição da Valva Aórtica Transcateter , Valva Aórtica/transplante , Próteses Valvulares Cardíacas , Stents , Implante de Prótese de Valva Cardíaca
6.
Cell Tissue Bank ; 20(2): 221-241, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30903411

RESUMO

The aortic and pulmonary allograft heart valves (AHV) are used in the cardiac surgery for replacing the impaired semilunar valves. They are harvested from donor hearts and cryostored in tissue banks. The expiration period was set to 5 years arbitrarily. We hypothesized that their mechanical and structural properties do not deteriorate after this period. A total of 64 human AHV (31 aortic and 33 pulmonary) of different length of cryopreservation (fresh, 0-5, 5-10, over 10 years) were sampled to different tissue strips (artery, leaflet, ventriculo-arterial junction) and tested by tensile test with loading velocity 10 mm/min until tissue rupture. Neighbouring regions of tissue were processed histologically and evaluated for elastin and collagen area fraction. The results were evaluated statistically. In aortic AHV, the physical deformation response of wall samples to stress did not changed significantly neither during the process of cryopreservation nor during the first 10 years of storage. In pulmonary AHV, the ultimate strain dropped after 5 years of cryopreservation indicating that pulmonary artery was significantly less deformable at the time of rupture. On the other hand, the ultimate stress was equal during the first 10 years of cryostorage. The changes in collagen and elastin amount in the tissue samples were not associated with mechanical impairment. Neither elasticity, stiffness and solidity nor morphology of aortic and pulmonary AHV did not change reasonably with cryopreservation and in the first 10 years of cryostorage. This evidence suggests that the expiration period might be extended in the future.


Assuntos
Valva Aórtica/transplante , Criopreservação/métodos , Valva Pulmonar/transplante , Bancos de Tecidos , Adulto , Colágeno/análise , Elastina/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante Homólogo
7.
Mater Sci Eng C Mater Biol Appl ; 97: 632-643, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30678950

RESUMO

The original intention for building a tissue-engineered heart valve (TEHV) was to simulate a normal heart valve and overcome the insufficiency of the commonly used heart valve replacement in the clinic. The endothelialization of the TEHV is very important as the endothelialized TEHV can decrease platelet adhesion and delay the valvular calcification decline process. In this work, we encapsulated vascular endothelial growth factor (VEGF) into polycaprolactone (PCL) nanoparticles. Then, through the Michael addition reaction, PCL nanoparticles were introduced onto the decellularized aortic valve to prepare a hybrid valve. The encapsulation efficiency of the PCL nanoparticles for VEGF was up to 82%, and the in vitro accumulated release rate was slow without an evident initial burst release. In addition, the hybrid valve had a decreased hemolysis ratio and possessed antiplatelet adhesion capacity, and it was able to promote the adhesion and proliferation of endothelial cells, covering the surface with a dense cell layer to accelerate endothelialization. An experiment involving the subcutaneous implant in SD rats showed that at week 8, lots of blood capillaries were formed in the hybrid valve. Mechanics performance testing indicated that the mechanical property of the hybrid valve was partly improved. Taken together, we applied a nano-drug controlled release system to fabricate TEHV, and provide an approach for the biofunctionalization of the TEHV scaffold for accelerating endothelialization.


Assuntos
Valva Aórtica/química , Portadores de Fármacos/química , Nanopartículas/química , Engenharia Tecidual , Fator A de Crescimento do Endotélio Vascular/química , Animais , Valva Aórtica/fisiologia , Valva Aórtica/transplante , Plaquetas/citologia , Plaquetas/fisiologia , Próteses Valvulares Cardíacas , Células Endoteliais da Veia Umbilical Humana , Humanos , Adesividade Plaquetária , Poliésteres/química , Coelhos , Ratos , Ratos Sprague-Dawley , Regeneração , Propriedades de Superfície , Suínos , Fator A de Crescimento do Endotélio Vascular/metabolismo
8.
J Thorac Cardiovasc Surg ; 157(1): 134-141.e3, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30005885

RESUMO

OBJECTIVE: Although the Ross procedure provides excellent long-term survival and a high quality of life, its use has been limited to relatively few centers. In this study, we evaluated long-term Ross procedure results in adults to assess the predictors of pulmonary autograft durability. METHODS: Between 1998 and 2015, 793 consecutive adult patients underwent the Ross procedure. The total root replacement technique was used in all patients. RESULTS: The early mortality rate was 2.9%. The mean follow-up duration was 6.5 ± 3.2 years, and the 10-year survival rate was 90.4%. Longitudinal mixed-effects ordinal regression identified a combination of bicuspid aortic valve and aortic insufficiency (odds ratio, 2.19; P < .001) as predictors for progression of autograft valve insufficiency at follow-up. The cumulative incidence of autograft reoperations at 10 years was 8.6%. Competing risk regression identified bicuspid aortic valve insufficiency as the independent predictor of autograft reoperation (subdistribution hazard ratio, 2.16; P = .030). Moreover, patients with bicuspid aortic valve and aortic insufficiency had greater increases in annulus (P < .001), sinus (P < .001), and ascending aorta (P < .001) diameters over time. CONCLUSIONS: For patients undergoing the Ross procedure, a combination of bicuspid aortic valves and aortic insufficiency is the main risk factor for late autograft dilatation and dysfunction.


Assuntos
Valva Aórtica/transplante , Sobrevivência de Enxerto , Valva Pulmonar/cirurgia , Adolescente , Adulto , Idoso , Autoenxertos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
9.
PLoS One ; 13(11): e0207943, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30481212

RESUMO

BACKGROUND AND AIMS: With the intention to gain support for the hypothesis that incident ischemic complications of atherosclerotic disease involve a stochastic aspect, we performed a histological, qualitative evaluation of the epidemiology of coronary atherosclerotic disease in a cohort of aortic valve donors. PATIENTS AND METHODS: Donors (n = 695, median age 54, range 11-65 years) were dichotomized into a non-cardiovascular (non-CVD) and a cardiovascular disease death (CVD) group. Consecutive 5 mm proximal left coronary artery segments were Movat stained, and the atherosclerotic burden for each segment was graded (revised AHA-classification). RESULTS: Non-CVD and CVD groups showed steep increase of atherosclerosis severity beyond the age of 40, resulting in an endemic presence of advanced atherosclerosis in men over 40 and women over 50 years. In fact, only 19% of the non-CVD and 6% of the CVD donors over 40 years were classified with a normal LCA or a so called non-progressive lesion type. Fibrous calcified plaques (FCP), the consolidated remnants of earlier ruptured lesions, dominated in both non-CVD and CVD donors. Estimates of the atherosclerosis burden (i.e. average lesion grade, proportion of FCPs, and average number of FCPs per cross-section) were all higher in the CVD group (p<1.10-16, p<0.0001, and p<0.05, respectively). CONCLUSIONS: Dominance of consolidated FCP lesions in males over 40 and females over 50 years, show that plaque ruptures in the left coronary artery are common. However, the majority of these ruptures remain asymptomatic. This implies that the atherosclerotic process is repetitive. A relative difference in disease burden between CVD and non-CVD donors supports the concept that complications of atherosclerotic disease involve a stochastic element.


Assuntos
Doença da Artéria Coronariana/patologia , Placa Aterosclerótica/parasitologia , Tromboembolia/patologia , Adolescente , Adulto , Idoso , Valva Aórtica/transplante , Criança , Estudos de Coortes , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Placa Aterosclerótica/mortalidade , Placa Aterosclerótica/patologia , Processos Estocásticos , Tromboembolia/mortalidade , Doadores de Tecidos , Adulto Jovem
10.
Curr Med Sci ; 38(5): 765-775, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30341511

RESUMO

A tissue engineering model of heart valve calcification induced in a bioreactor was established to evaluate the calcification induced by abnormal mechanical stimulation and explore the underlying molecular mechanisms. Polyethylene glycol (PEG)-modified decellularized porcine aortic leaflets seeded with human valve interstitial cells (huVICs) were mounted on a Ti-Ni alloy frame to fabricate two-leaflet and threeleaflet tissue engineered valves. The two-leaflet model valves were exposed to abnormal pulsatile flow stimulation with null (group A), low (1000 mL/min, group B), medium (2000 mL/min, group C), and high velocity (3000 mL/min, group D) for 14 days. Morphology and calcification were assessed by von Kossa staining, alkaline phosphatase (ALP) content, and Runx2 immunostaining. Leaflet calcification and mRNA and protein expression of transforming growth factor (TGF)-ß1, bone morphogenetic protein 2 (BMP2), Smad1, and MSX2 were measured at different time points. ALP content was examined in two-leaflet valves seeded with BMP2 shRNA plasmid-infected huVICs and exposed to the same stimulation conditions. The results showed that during 14 days of flow stimulation, huVICs on the leaflet surface proliferated to generate normal monolayer coverage in groups A, B, and C. Under mechanical stimulation, huVICs showed a parallel growth pattern in the direction of the fluid flow, but huVICs exhibited disordered growth in the high-velocity flow environment. von Kossa staining, ALP measurement, and immunohistochemical staining for Runx2 confirmed the lack of obvious calcification in group A and significant calcification in group D. Expression levels of TGF-ß1, BMP2, and MSX2 mRNA and protein were increased under fluid stimulation. ALP production by BMP2 shRNA plasmid-infected huVICs on model leaflets was significantly reduced. In conclusion, abnormal mechanical stimulation in a bioreactor induced calcification in the tissue engineering valve model. The extent of calcification correlated positively with the flow velocity, as did the mRNA and protein levels of TGF-ß1, BMP2, and MSX2. These findings indicate that TGF-ß1/BMP2 signaling is involved in valve calcification induced by abnormal mechanical stimulation.


Assuntos
Proteína Morfogenética Óssea 2/genética , Calcinose/genética , Doenças das Valvas Cardíacas/genética , Proteínas de Homeodomínio/genética , Fator de Crescimento Transformador beta1/genética , Idoso , Animais , Aorta/citologia , Aorta/transplante , Valva Aórtica/citologia , Valva Aórtica/transplante , Reatores Biológicos , Calcinose/fisiopatologia , Calcinose/terapia , Subunidade alfa 1 de Fator de Ligação ao Core/genética , Feminino , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/química , Transdução de Sinais/genética , Proteína Smad1/genética , Suínos , Engenharia Tecidual
11.
J Cardiovasc Transl Res ; 11(6): 470-482, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30105605

RESUMO

Transcatheter aortic valve replacement (TAVR) is being extended to younger patients. However, TAVR-compatible bioprostheses are based on xenogeneic materials with limited durability. Off-the-shelf tissue-engineered heart valves (TEHVs) with remodeling capacity may overcome the shortcomings of current TAVR devices. Here, we develop for the first time a TEHV for TAVR, based on human cell-derived extracellular matrix and integrated into a state-of-the-art stent for TAVR. The TEHVs, characterized by a dense acellular collagenous matrix, demonstrated in vitro functionality under aortic pressure conditions (n = 4). Next, transapical TAVR feasibility and in vivo TEHV functionality were assessed in acute studies (n = 5) in sheep. The valves successfully coped with the aortic environment, showing normal leaflet motion, free coronary flow, and absence of stenosis or paravalvular leak. At explantation, TEHVs presented full structural integrity and initial cell infiltration. Its long-term performance proven, such TEHV could fulfill the need for next-generation lifelong TAVR prostheses.


Assuntos
Valva Aórtica/transplante , Bioprótese , Próteses Valvulares Cardíacas , Engenharia Tecidual/métodos , Substituição da Valva Aórtica Transcateter/instrumentação , Animais , Valva Aórtica/citologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/metabolismo , Células Cultivadas , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Matriz Extracelular/metabolismo , Estudos de Viabilidade , Hemodinâmica , Humanos , Modelos Animais , Desenho de Prótese , Carneiro Doméstico , Fatores de Tempo , Tecidos Suporte , Tomografia Computadorizada por Raios X
12.
Adv Clin Exp Med ; 27(8): 1033-1036, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29975466

RESUMO

BACKGROUND: The aim of our experimental work was to assess the impact and morphological changes that arise during different thawing protocols on human aortic valve (AV) leaflets resected from cryopreserved aortic root allografts (CARAs). OBJECTIVES: Two thawing protocols were tested: 1. CARAs were thawed at a room temperature (23°C); 2. CARAs were placed directly into a water bath at a temperature of 37°C. After all the samples were thawed, non-coronary AV leaflets were sampled from each specimen and fixed in a 4% formaldehyde solution before they were sent for morphological analysis. MATERIAL AND METHODS: All the samples were washed in distilled water for 5 min and dehydrated in a graded ethanol series (70%, 85%, 95%, and 100%) for 5 min at each level. The tissue samples were then immersed in 100% hexamethyldisilazane (HMDS) for 10 min, and then air-dried in an exhaust hood at room temperature. Processed samples were mounted on stainless steel stubs and coated with gold. Histological analysis was performed with the use of an electron microscope on a scanning mode operating at 25 kV - BS 301. RESULTS: Thawing protocol 1 (room temperature at 23°C): 6 (100%) samples showed loss of the endothelial covering of the basal membrane with no damage to the basal lamina. Thawing protocol 2 (water bath at 37°C): 5 (83%) samples showed loss of the endothelial covering of the basal membrane with no damage to the basal lamina. One (17%) sample showed loss of the endothelial covering the basal membrane with significant damage to the basal membrane. CONCLUSIONS: Based on our experimental work, we can clearly conclude that cryopreserved AV leaflet allografts show identical structural changes at different rates of thawing.


Assuntos
Valva Aórtica/transplante , Criopreservação/métodos , Transplante Homólogo/métodos , Aloenxertos , Humanos
13.
Transpl Infect Dis ; 20(5): e12962, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29975810

RESUMO

To the best of our knowledge, we report the first case of pre-transplant unrecognized disseminated Coxiella burnetii infection, unmasked in the post-transplant period leading to both heart and kidney allograft dysfunction. A 59 year old man with a history of simultaneous heart-kidney transplantation due to end stage heart failure from severe aortic regurgitation (AR) and cryoglobulinemic immune complex mediated concentric necrotizing glomerulonephritis (GN), presents with a history of intermittent fevers and fatigue. Prior to transplantation he was treated for multiple episodes of culture negative endocarditis requiring bio-prosthetic valve replacement. Evaluation of fever included a transesophageal echocardiogram (TEE) that revealed a large hyperechoic mass on the anterior mitral leaflet with perforation, severe mitral regurgitation and moderate AR. Blood cultures were negative at that time. Owing to development of allograft mitral and aortic valve insufficiency, he underwent allograft bio-prosthetic mitral valve (MV) replacement and aortic valvuloplasty 2 years following his transplantation. Pathologic examination of the allograft mitral valve demonstrated fibrinopurulent exudate with degenerating bacterial organisms, consistent with vegetation and myxoid degenerative changes. Due to a high suspicion for native heart C. burnetii prosthetic valve endocarditis prior to transplantation, we re-evaluated the native explanted heart histopathology, as well as the explanted allograft MV. Cardiac allograft and native MV were positive for C. burnetii by real-time PCR. C. burnetii serology was consistent with persistent infection as well.


Assuntos
Coxiella burnetii/isolamento & purificação , Endocardite Bacteriana/diagnóstico , Transplante de Coração/efeitos adversos , Transplante de Rim/efeitos adversos , Febre Q/diagnóstico , Aloenxertos , Valva Aórtica/transplante , Bioprótese/efeitos adversos , Bioprótese/microbiologia , Hemocultura , Endocardite Bacteriana/microbiologia , Coração/microbiologia , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/microbiologia , Humanos , Rim/microbiologia , Rim/patologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Período Pré-Operatório , Transplantes
14.
Cardiovasc Pathol ; 35: 52-56, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29800929

RESUMO

Mucopolysaccharidosis type IVB (MPS IVB) is a very rare lysosomal storage disorder characterized by skeletal dysplasia, hearing disorder, and cardiac valvular disease. Herein, we report an extremely rare manifestation of MPS IVB in a 60-year-old female patient who underwent a successful aortic valve replacement. The patient presented with mild coarse facial features, short stature, mild dyspnea, sternal protrusion, mild lumbar hyperlordosis, and waddling gait owing to bilateral femoral head necroses and bilateral arthrosis of the knees. The patient also suffered from dyspnea, NYHA II-III. Echocardiography revealed severe stenosis of a calcified aortic valve (AVA 0.67 cm2, AVAi 0.45 cm2/m2, PG max/mean 130/80 mmHg), left ventricular hypertrophy with predominant septal thickening (18 mm) and mild left ventricle outflow tract obstruction at rest, mild mitral valve regurgitation, and dilated ascending aorta (36 mm, 26.5 mm/m2). Dyspnea resolved after septal myectomy and replacement of the aortic valve with bioprosthesis. Excretion levels and spectrum of glycosaminoglycans (GAGs) in urine were normal in the patient. We confirmed the diagnosis of MPS IVB by identifying decreased beta-galactosidase activity in isolated leukocytes (6 nmol/h/mg; controls 95-272) and by molecular genetic analyses (c.438_440delTCT and c.817_818TG>CT mutations in the GLB1 gene). Primary lysosomal storage of glycosaminoglycans was detected in fibroblasts of the aortic valve. Additional pathologies included valvular fibrosis, calcification, neovascularization, and mild chronic inflammation. In conclusion, the diagnosis of MPS IVB should be considered in older patients with cardiac valvular disease and progressive skeletal abnormality even if urinary excretion levels of GAGs are normal.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Valva Aórtica/transplante , Calcinose/cirurgia , Implante de Prótese de Valva Cardíaca , Mucopolissacaridose IV/diagnóstico , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/fisiopatologia , Bioprótese , Biópsia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/fisiopatologia , Análise Mutacional de DNA , Diagnóstico Tardio , Ecocardiografia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Mucopolissacaridose IV/complicações , Mucopolissacaridose IV/genética , Mutação , Fatores de Tempo , Resultado do Tratamento , beta-Galactosidase/genética
15.
Cardiovasc Pathol ; 35: 8-11, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29729634

RESUMO

We report a 52-year-old male patient who had a quadricuspid aortic valve (QAV) associated with aortic regurgitation (AR) and left ventricular hypertrophy (LVH). A new accessory cusp (ACC) with maximum thickness than other cusps was located between right coronary cusp (RCC) and left coronary cusp (LCC). The histopathological features revealed markedly thickened and distorted cusp architecture with fibrosis and/or myxomatous degeneration in both non-coronary cusp (NCC) and ACC. Two equal sizes for larger cusps (RCC and NCC) and two equal sizes for smaller cusps (LCC and ACC) were obtained. This QAV belonged to type C QAV of Hurwitz's classification, but also suggested as a modified type III of Jagannath's classification or a new type V of Nakamura's classification by locating ACC between RCC and LCC.


Assuntos
Insuficiência da Valva Aórtica/patologia , Valva Aórtica/anormalidades , Cardiopatias Congênitas/patologia , Hipertrofia Ventricular Esquerda/patologia , Valva Aórtica/fisiopatologia , Valva Aórtica/transplante , Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Biópsia , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Fibrose , Cardiopatias Congênitas/classificação , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Esquerda/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
J Cardiovasc Comput Tomogr ; 12(4): 338-343, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29735255

RESUMO

BACKGROUND: Aortic valve calcification patterns were associated with short- and long-term outcomes in previous small observational datasets of patients undergoing transcatheter aortic valve implantation (TAVI). The specific impact of multi detector-row computed tomography (MDCT) findings on outcomes in women has not been reported. We sought to describe the associations between MDCT characteristics and clinical outcomes in a registry of 547 women undergoing TAVI. METHODS: WIN-TAVI is the first all-female registry to study the safety and effectiveness of TAVI in women (n = 1019). Thirteen sites participated in the MDCT sub-study and contributed pre-TAVI MDCT studies in 547 consecutive subjects. All MDCT data were analyzed in an independent core lab blinded to clinical outcomes. Key measurements included number of valve leaflets, aortic annulus area and perimeter, left and right coronary artery height, aortic cusp calcium volume, commissural calcification and left ventricular outflow tract (LVOT) calcification. Calcium volume of the aortic valvular complex was quantified using a threshold relative to patient-specific contrast attenuation in the arterial blood pool. We examined univariate and multivariate associations between ECG-gated contrast MDCT characteristics and 1-year mortality or stroke, new pacemaker implantation and new onset atrial fibrillation (AF). RESULTS: The CT sub-study sample had a mean age of 82.8 ±â€¯6.3 years, mean logistic EuroSCORE of 17.8 ±â€¯11.3%, and mean STS score of 8.2 ±â€¯7.4%. Transfemoral access was used in 89.6% of patients. After multivariate adjustment, moderate or severe LVOT calcification was an independent predictor of 1-year mortality or stroke (HR = 1.91; 95% CI: 1.11-3.30; p = 0.02). Calcium volume in the right coronary cusp was an independent predictor of new pacemaker (HR = 1.18 per 100 m3 increment; p = 0.04), whereas calcium volume of the non-coronary cusp had a protective effect (HR = 0.78 per 100 mm3 increment; p = 0.004). Severe calcification of the non-coronary/right-coronary commissure was an independent predictor of new AF (HR = 5.1; p = 0.008). CONCLUSION: Computed tomography provides important prognostic information in women undergoing TAVI. Moderate or severe LVOT calcification is associated to an almost two-fold increased risk of mortality or stroke at one year. Different calcification patterns of the aortic valve may predict diverse rhythm abnormalities.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/transplante , Arritmias Cardíacas/epidemiologia , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Tomografia Computadorizada Multidetectores , Acidente Vascular Cerebral/epidemiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Saúde da Mulher , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/terapia , Calcinose/mortalidade , Calcinose/fisiopatologia , Estimulação Cardíaca Artificial , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Modelos Logísticos , Análise Multivariada , América do Norte/epidemiologia , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/mortalidade , Obstrução do Fluxo Ventricular Externo/fisiopatologia
17.
Semin Thorac Cardiovasc Surg ; 30(2): 144-149, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29522810

RESUMO

With the introduction of the latest generation Sapien 3 (S3) transcatheter aortic valve, there has been a reduction in the usage of transapical (TA) approach for transcatheter aortic valve replacements in many centers. However, despite the smaller sheath size and the more streamlined delivery system, vascular complications continue to occur, especially in patients with peripheral vascular disease. Thus, our institution has maintained a stringent TA protocol aiming to prevent these complications. We hypothesize that this protocol has helped to reduce vascular complications and improve outcomes at our institution even in the S3 era. All transcatheter aortic valve replacement procedures done at our institution were considered for analysis. Patients were grouped according to whether their procedure was done before (Pre-S3 era) or after (S3 era) the introduction of the S3 valve, as well as whether they underwent a TA or a transfemoral (TF) approach. A femoral artery intraluminal diameter of <7.5 mm in the Pre-S3 era and <5.5 mm in the S3 era with circumferential calcifications triggered TA approach consideration. Vascular complications included vascular perforation, dissection, flow-limiting stenosis, unplanned vascular surgery, significant postprocedural bleeding, hematoma at the access site, and retroperitoneal bleed. The Welch t test of unequal variance and chi-squared test were used as appropriate. An alpha of <0.05 was considered significant. A total of 275 patients were included in the analysis (121 Pre-S3 era and 154 S3 era). The TA approach was utilized in 45% in the Pre-S3 era vs 15% in the S3 era (P < 0.001). Within the S3 era, 131 underwent the TF approach compared with 23 who underwent the TA approach. TA and TF patients were similar in all preoperative characteristics except hypertension. Mortality was significantly lower in the S3 era (0% vs 4% in the pre-S3 era, P = 0.02). Overall rates of vascular complications were similar between the Pre-S3 and the S3 eras (16% vs 14%, P = 0.63). Overall adverse outcomes were similar between the TA and the TF groups. TA patients saw significantly longer intensive care unit stay and total hospital stay. Our results show that despite a smaller sheath size, vascular complications continue at a similar rate into the S3 era. This occurred in the setting of an ongoing aggressive TA utilization in select patients, specifically those with peripheral vascular disease. Maintaining this approach is likely a large contributor to both our current success and reduced mortality.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/transplante , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Doenças Vasculares/etiologia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/mortalidade , Doenças Vasculares/terapia
18.
J Cardiovasc Comput Tomogr ; 12(4): 290-297, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29519754

RESUMO

OBJECTIVES: We sought to determine the impact of aortic root calcium on the risk of significant paravalvular regurgitation (sPAR) in transcatheter aortic valve replacement (TAVR). METHODS: In 302 consecutive patients from 3 centers, aortic root calcium was quantified volumetrically on pre-TAVR multidetector computed tomography (MDCT) in three regions: 1) the aortic valve region, 2) the overall left ventricular outflow tract (LVOT) and 3) the upper LVOT. Transcathether heart valve (THV) oversizing was calculated as (THV nominal area/MDCT annular area-1) × 100. The study endpoint sPAR was a composite of post-dilatation (PD) and PAR > mild. RESULTS: sPAR occurred in 15% (46/302) of patients. Upper LVOT calcium volume was more predictive of sPAR than overall LVOT calcium volume, with an area under the receiver operating curve (AUC) (95% confidence interval [CI]) of 0.80 (0.67-0.89) vs. 0.60 (0.51-0.70); p = 0.0001. The optimal cut-off calcium volume thresholds determined from receiver operating curves were 21 mm3 and 30 mm3 for upper LVOT and overall LVOT calcium, respectively. Upper LVOT calcium ≥ 21 mm3, but not overall LVOT calcium ≥ 30 mm3, independently predicted sPAR, odds ratio (95%CI): 9.5 (4.1-22.3) vs 1.6 (0.6-2.7). Upper LVOT calcium was more predictive of sPAR in patients with THV oversizing ≥ 13% compared to patients with THV oversizing <13%, AUC (95% CI): 0.83 (0.72-0.93) vs. 0.67 (0.51-0.74); p < 0.0001. CONCLUSIONS: Upper LVOT calcium predicts more-than-mild paravalvular regurgitation following TAVR or the need for postdilatation. Upper LVOT calcium is most predictive of paravalvular regurgitation in the event of THV oversizing ≥ 13%.


Assuntos
Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Valva Aórtica/transplante , Calcinose/cirurgia , Cálcio/metabolismo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/metabolismo , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/metabolismo , Estenose da Valva Aórtica/fisiopatologia , Área Sob a Curva , Colúmbia Britânica , Calcinose/diagnóstico por imagem , Calcinose/metabolismo , Calcinose/fisiopatologia , Distribuição de Qui-Quadrado , Dinamarca , Ecocardiografia Transesofagiana , Feminino , Próteses Valvulares Cardíacas , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/metabolismo , Ventrículos do Coração/fisiopatologia , Humanos , Modelos Logísticos , Londres , Masculino , Tomografia Computadorizada Multidetectores , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Desenho de Prótese , Curva ROC , Reprodutibilidade dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/instrumentação , Resultado do Tratamento
19.
Semin Thorac Cardiovasc Surg ; 30(2): 160-163, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29518534

RESUMO

Transcatheter mitral valve replacement with the Tiara valve can be performed in inoperable patients with severe functional regurgitation. Risk of left ventricular outflow tract obstruction can be prevented using preoperative 3D imaging and 3D-printed models. However, in the case of mono-disk mechanical prostheses previously implanted in aortic position (Bjork-Shiley), there is an additional risk of mechanical interference leading to reduced leaflet motion and aortic valve dysfunction. Hereafter, we describe the case of a patient with a 27-mm mono-disk mechanical aortic valve implanted in 1978, a EuroSCORE II of 18%, and a Society of Thoracic Surgeon score (mortality) of 16% who successfully underwent a transapical Tiara valve implantation.


Assuntos
Valva Aórtica/transplante , Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/transplante , Idoso , Valva Aórtica/fisiopatologia , Cateterismo Cardíaco/métodos , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Modelos Anatômicos , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Impressão Tridimensional , Desenho de Prótese , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Kyobu Geka ; 71(1): 43-47, 2018 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-29483480

RESUMO

Aortic root replacement with a cryopreserved allograft aortic valve is effective for active infectious endocarditis and prosthetic valve endocarditis, especially with a perivalvular abscess, since an allograft seems to be resistant to infection by maintaining viable cells under the process of programmed freezing. From December 1998 to March 2017, aortic root replacement with allograft aortic valves were performed in 38 patients in the University of Tokyo. The in-hospital mortality was 18%, the 5-year survival rate was 68%, and the 5-year freedom rate of reoperation was 75%. Although the clinical outcome was improved as institutional experiences increased recently, pseudoaneurysm during the long-term follow-up period needs special attention. The health-insurance system was applied to this allograft treatment in April 2016 by the Ministry of Health, Labour and Welfare. There are still some hurdles for obtaining institutional certification and financial resources, and enough number of donor allografts, so as to use them more commonly.


Assuntos
Valva Aórtica/transplante , Doenças das Valvas Cardíacas/cirurgia , Aloenxertos , Criopreservação , Humanos
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