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1.
J Card Surg ; 34(11): 1408-1410, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31478247

RESUMO

Concern for early degeneration limits the use of bioprosthetic heart valves. A 77-year-old man who underwent surgical aortic valve replacement at age 70 for severe aortic stenosis (AoS) presented with premature bioprosthesis degeneration and AoS recurrence. Transthoracic echocardiography demonstrated severe AoS and aortic regurgitation, a 30% ejection fraction, and pulmonary hypertension. Transesophageal echocardiography revealed that the aortic regurgitation was due to a 5-mm paravalvular leak (PVL). A high EuroScoreII excluded surgical treatment. Simultaneous transcatheter aortic valve replacement and PVL closure with an Occlutech PLD Square 5 Twist PVL closure device were performed with good results and improved clinical status.


Assuntos
Estenose da Valva Aórtica/cirurgia , Falha de Prótese , Idoso , Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/diagnóstico , Bioprótese , Ecocardiografia , Humanos , Masculino , Recidiva , Substituição da Valva Aórtica Transcateter
2.
Elife ; 102021 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-33507147

RESUMO

Human diseases arise in a complex ecosystem composed of disease mechanisms and the whole-body state. However, the precise nature of the whole-body state and its relations with disease remain obscure. Here we map similarities among clinical parameters in normal physiological settings, including a large collection of metabolic, hemodynamic, and immune parameters, and then use the mapping to dissect phenotypic states. We find that the whole-body state is faithfully represented by a quantitative two-dimensional model. One component of the whole-body state represents 'metabolic syndrome' (MetS) - a conventional way to determine the cardiometabolic state. The second component is decoupled from the classical MetS, suggesting a novel 'non-classical MetS' that is characterized by dozens of parameters, including dysregulated lipoprotein parameters (e.g. low free cholesterol in small high-density lipoproteins) and attenuated cytokine responses of immune cells to ex vivo stimulations. Both components are associated with disease, but differ in their particular associations, thus opening new avenues for improved personalized diagnosis and treatment. These results provide a practical paradigm to describe whole-body states and to dissect complex disease within the ecosystem of the human body.


Assuntos
Doenças Cardiovasculares/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/metabolismo , Feminino , Humanos , Masculino , Síndrome Metabólica/classificação , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
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