The clinical effect of a combined technical system for bicuspid aortic valves repair / 中国胸心血管外科临床杂志

@#Objective    To summarize the clinical result of a combined technical system for bicuspid aortic valve (BAV) repair. Methods    Patients who diagnosed as BAV and sever aortic regurgitation (AR) underwent a strategy of combined repair technics including annuloplasty, sinus plasty, leaflet plasty, sinus-tubular junction (STJ) plasty depending on anatomy pathological characteristics between October 2019 and January 2021 were enrolled. The clinical data of the patients were analyzed. Results    A total of 17 patients were enrolled. There were 11 males and 6 females with an average age of 18-49 (32.4±13.6) years. Fifteen patients had typeⅠand 2 patients had typeⅡBAV according to Sievers classification. Annuloplasty was applicated in 13 patients, sinus plasty in 8 patients, leaflet plasty in 17 patients, and STJ plasty in 11 patients, respectively. The cardiopulmonary bypass (CPB) time was 95 (84, 135) min, aortic cross-clamping time was 68 (57, 112) min, and the ICU stay time was 17 (12, 25) h. After the operation, mild AR was presented in 14 patients, moderate AR in 1 patient and severe AR in 2 patients. The latter 3 patients underwent second operation under CPB, after then, 1 patient had mild AR and 2 patients had moderate AR. The follow-up time was 13.1±4.6 months. At the latest follow-up, 12 patients had mild AR and 5 patients had moderate AR, and no patient had reoperation. Conclusion    A combined technical system for BAV repair can be used effectively and safely with an acceptable short and middle-term result.

Progress in the pathogenesis of congenital bicuspid aortic valves and the associated complications / 国际儿科学杂志

Congenital bicuspid aortic valves(BAV)is one of the most common congenital heart diseases.It is generally diagnosed by echocardiography when deterioration of the abnormal leaflets becomes clinically evident.Patients with BAV are at increased risks of developing serious complications, including aortic stenosis, aortic regurgitation, aortic dilation, aortic dissection and/or aneurysm, which seriously threatens the health of patients.Although its diagnosis and surgical treatment have been clear, the specific pathogenesis has not been completely revealed.Recently, studies have found that gene mutations and related signaling pathway abnormalities are associated with BAV and its complications.And epigenetics and environmental factors are involved in the development and progress of BAV.Understanding the underlying cellular and molecular basis of normal and pathological aortic valve development may improve the preventative and therapeutic approaches to valve degeneration.

Implante Valve-in-Valve: uma opção / Valve-in-valve implant: an option

Os relatos de implante de valve-in-valve no Brasil são escassos, mas têm aumentado de frequência nos países desenvolvidos. Relata-se o caso de paciente feminina, 73 anos, que se submeteu a implante transcutâneo de prótese aórtica valve-in-valve há quatro anos. A paciente havia implantado bioprótese aórtica por cirurgia há 24 anos, evoluindo com degeneração da prótese, tendo recusado a troca valvar por nova cirurgia aberta. Após avaliação de equipe multidisciplinar foi indicado o implante transcutâneo de prótese aórtica valve-in-valve. Após quatro anos, a paciente apresentou melhora da classe funcional de insuficiência cardíaca e a durabilidade da prótese tem sido satisfatória.

Although valve-in-valve implantation reports are still sparse in Brazil, they are becoming more frequent in the developed countries. This case report addresses a 73-year-old female patient who underwent a transcutaneous aortic valve-in-valve prosthesis implant four years ago, subsequent to an aortic bioprosthesis implant operation 24 years earlier that degenerated, with the patient refusing to replace the valve through a further open surgery. After evaluation, a multidisciplinary team recommended a transcutaneous aortic valve-in-valve prosthesis implant. Four years later, the functional class of her heart failure has improved and the durability of the prosthesis has been satisfactory.

Preparation of valved aortic stent and in vitro implantation to aortic valve position through catheter / 第二军医大学学报

Objective: To evaluate the feasibility of implanting a new self-expanding valved stent for aortic valve implantation and its influence on coronary blood flow. Methods: We designed a self-expanding valved stent made from super-elastic memory nitinol alloy, with a tubular shape and a wide mesh in the cavate middle part. A valvular ring made of nitinol wire was sutured on the lower part. Fresh porcine pericardium was decellularized, treated with 0.6% glutaraldehyde solution for 36 h, trimmed into leaflets, and sutured by hand into the valvular ring. The valved stent was pulled into a 14-French sheath by a silk and positioned in the left ventricle of isolated pig heart via the ascending aorta, and then deployed over the native aortic valves by pulling back the outer sheath. Water was injected into the ascending aorta by a silicon tube to evaluate the competence of the prosthetic heart valves and its effect on coronary flow. Results: The prepared valved aortic stent could be stably positioned over the native valves and could be removed after deployment. The prosthetic heart valves showed a satisfactory function and had no influence on coronary flow and mitral valve motion. Conclusion: This self-expanding valved stent is well-designed and allows for aortic valve implantation over the native valves without interfering the coronary flow; it can be evaluated further in vivo.

Transapical aortic valve implantation with a new self-expanding valved stent in canines: An observation of short-term outcomes / 第二军医大学学报

Objective: To discuss the feasibility of using the off-pump antegrade transventricular route for aortic valved stent implantation in canines, and to observe the short-term outcomes. Methods: Fresh porcine pericardium was treated with 0.6% glutaraldehyde solution for 36 h; then it was trimmed and sutured into a valvular ring and fixed on a new self-expanding dumbbell-shaped nickel-titanium shape-memory alloy stent. The valved stents were then implanted off-pump in 8 canines. A limited or full sternotomy approach was used to access the apex of the heart. The crimped valve was introduced through a sheath in the left ventricular apex under ultrasound guidance. The function of valved stents was evaluated with electrocardiogram, echocardiography, computed tomography and DSA angiography early and 3 months after the procedure. Results: We successfully prepared the valved aortic stent. Five canines survived after implantation of the aortic valved stents. Angiographic and echocardiographic observation confirmed that the location and function of the stent were satisfactory, without influencing coronary blood flow and mitral valve function. CT examination showed no migration of the stent 3 months after the procedure, and there were no other prominent complications. Conclusion: Our new self-expanding valved stent can be deployed over the native aortic valves via transapical route, and the short-term outcome is satisfactory.

Preparation of valved aortic stent and in vitro implantation to aortic valve position through catheter / 第二军医大学学报

Objective:To evaluate the feasibility of implanting a new self-expanding valved stent for aortic valve implantation and its influence on coronary blood flow. Methods:We designed a self-expanding valved stent made from super-elastic memory nitinol alloy,with a tubular shape and a wide mesh in the cavate middle part. A valvular ring made of nitinol wire was sutured on the lower part. Fresh porcine pericardium was decellularized,treated with 0. 6% glutaraldehyde solution for 36 h,trimmed into leaflets,and sutured by hand into the valvular ring. The valved stent was pulled into a 14-French sheath by a silk and positioned in the left ventricle of isolated pig heart via the ascending aorta,and then deployed over the native aortic valves by pulling back the outer sheath. Water was injected into the ascending aorta by a silicon tube to evaluate the competence of the prosthetic heart valves and its effect on coronary flow. Results:The prepared valved aortic stent could be stably positioned over the native valves and could be removed after deployment. The prosthetic heart valves showed a satisfactory function and had no influence on coronary flow and mitral valve motion. Conclusion:This self-expanding valved stent is well-designed and allows for aortic valve implantation over the native valves without interfering the coronary flow; it can be evaluated further in vivo.