Progression of valve heart disease in a cohort of patients undergoing renal replacement therapy / Progressão da doença cardíaca valvar em coorte de doentes em terapia renal substitutiva

Abstract Introduction: Cardiovascular disease is an important cause of death among patients with chronic kidney disease (CKD). Valve calcification is a predictor of cardiovascular mortality and coronary artery disease. Objective: To assess heart valve disease frequency, associated factors, and progression in CKD patients. Methods: We conducted a retrospective study on 291 CKD patients at Hospital das Clínicas de Pernambuco. Inclusion criteria were age ≥ 18 with CKD and valve disease, while those on conservative management or with missing data were excluded. Clinical and laboratory variables were compared, and patients were categorized by dialysis duration (<5 years; 5-10 years; >10 years). Statistical tests, including chi-square, Fisher's exact, ANOVA, and Kruskal-Wallis, were employed as needed. Simple and multivariate binary regression models were used to analyze valve disease associations with dialysis duration. Significance was defined as p < 0.05. Results: Mitral valve disease was present in 82.5% (240) of patients, followed by aortic valve disease (65.6%; 86). Over time, 106 (36.4%) patients developed valve disease. No significant association was found between aortic, pulmonary, mitral, or tricuspid valve disease and dialysis duration. Secondary hyperparathyroidism was the sole statistically significant factor for mitral valve disease in the regression model (OR 2.59 [95% CI: 1.09-6.18]; p = 0.031). Conclusion: CKD patients on renal replacement therapy exhibit a high frequency of valve disease, particularly mitral and aortic valve disease. However, no link was established between dialysis duration and valve disease occurrence or progression.

Resumo Introdução: Doenças cardiovasculares são uma causa significativa de morte em pacientes com Doença Renal Crônica (DRC). A calcificação valvar é preditor de mortalidade cardiovascular e doença arterial coronariana. Objetivo: Avaliar a frequência, fatores associados e progressão de valvopatias em pacientes com DRC. Métodos: Coorte retrospectiva com 291 pacientes ambulatoriais no Hospital das Clínicas de Pernambuco. Inclusão: ≥18 anos com DRC e valvopatia; exclusão: tratamento conservador ou dados incompletos. Variáveis clínicas e laboratoriais foram comparadas e categorizadas por tempo de terapia dialítica (TTD): <5 anos, 5-10 anos, >10 anos. Foram aplicados os testes Qui-quadrado, exato de Fisher, ANOVA, Kruskal-Wallis. Associação entre valvopatia e TTD foi avaliada por regressão binária. Significância foi definida como p < 0,05. Resultados: A valvopatia mitral foi encontrada em 82,5% (240) dos casos, seguida da aórtica (65,6%; 86). Houve progressão da doença valvar em 106 (36,4%) pacientes. Não houve associação entre valvopatias aórtica, pulmonar, mitral ou tricúspide e TTD. Hiperparatireoidismo secundário foi a única variável explicativa significativa na regressão para valvopatia mitral (OR 2,59 [IC95%: 1,09-6,18]; p = 0,031). Conclusão: Encontramos alta frequência de valvopatias, especialmente mitral e aórtica, aem pacientes com DRC. Não houve associação entre TTD e valvopatia.

Application of Cut-and-Sew Technique in Thoracoscopic Minimally Invasive Mitral Valve Surgery and Concomitant Maze Procedure

ABSTRACT Introduction: Atrial fibrillation is one of the common complications of mitral valve disease. Currently, in the absence of freezing equipment, it's still impossible to fully conduct a minimally invasive Cox-maze IV procedure to treat atrial fibrillation. Methods: We analyzed the clinical data of 28 patients who underwent thoracoscopic minimally invasive mitral valve full maze surgery in our hospital from October 2021 to September 2022; 13 patients were male and 15 were female, three suffered from paroxysmal atrial fibrillation, and 25 suffered from permanent atrial fibrillation; average age was 61.88±8.30 years, and mean preoperative left atrial diameter was 47.12±8.34 mm. Isolation of left atrial posterior wall (box lesion) was completed in all patients by cut-and-sew technique and bipolar clamp ablation. Results: For these subjects, the median cardiopulmonary bypass time was 169 (109.75-202.75) minutes, aortic cross-clamping time was 106 (77.75-125.50) minutes, and ventilator assistance time was 6.5 (0-10) hours. Among them, eight subjects had the endotracheal tubes removed immediately after surgical operation. Three subjects were in the blanking period; two subjects still had atrial fibrillation at three months after operation, one of whom resumed sinus rhythm after electrical cardioversion therapy; and all the remaining 23 subjects had sinus rhythm. Conclusion: The minimally invasive cut-and-sew technique for electrical isolation of left pulmonary veins can improve sinus conversion rate of patients suffering from both mitral valve disease and atrial fibrillation. In selected subjects, it is safe and has good results in the short-term postoperative period.

Encuesta multinacional y transversal sobre las controversias del reemplazo de la raíz aórtica con conservación valvular / Multinational and Cross-Sectional Survey on Valve-Sparing Aortic Replacement Controversies

RESUMEN Introducción : El reemplazo de la raíz aórtica con conservación valvular (valve-sparing aortic root replacement, VSAR) se ha consolidado como un procedimiento eficaz para el tratamiento del aneurisma de la raíz aórtica, el síndrome de Marfan, la válvula bicúspide y la disección aórtica. Sin embargo, es necesario llegar a una opinión unánime sobre los aspectos clave del VSAR. Material y métodos : Se realizó una revisión bibliográfica de los debates y controversias más frecuentes del VSAR. A partir de esta información se elaboró una encuesta en línea que se envió a cirujanos con experiencia comprobada en VSAR para conocer su opinión sobre los factores relacionados con los pacientes, los aspectos técnicos, la ecocardiografía, la investigación, la formación y el futuro del VSAR. Resultados : Veinte cirujanos completaron la encuesta. Según 14 de cada 20 encuestados, la fracción de eyección grave se consideró una contraindicación para el llevar a cabo este procedimiento. El límite del diámetro del anillo aórtico para la remodelación fue heterogéneo entre los participantes. Todos ellos consideraron que el VSAR es un procedimiento seguro para los pacientes con síndrome de Marfan y válvula bicúspide. En el caso de disección de tipo A, 11 de cada 20 prefirieron este procedimiento solo para los pacientes jóvenes. En lo que respecta al tamaño del injerto, la altura del triángulo intervalvar (8/20) y el diámetro sinotubular (7/20) fueron los más frecuentes. Los cirujanos informaron una tasa de fracaso del 7% en la conversión al procedimiento de Bentall, y un cambio de estrategia intraoperatoria del 26%. No se consideró que un abordaje mínimamente invasivo mejorara los resultados. La mayoría de los cirujanos coincidieron en que el VSAR lo deben realizar cirujanos con mucha experiencia. Conclusiones : El VSAR ha sido aceptado como una opción terapéutica para el aneurisma de la raíz aórtica, y, aunque todavía no es posible llegar a un consenso definitivo, se presenta la valiosa experiencia de los cirujanos más destacados en este campo.

ABSTRACT Background : The valve-sparing aortic root replacement (VSAR) has been established as a successful procedure for aortic root aneurysms, Marfan's syndrome, bicuspid valves, and aortic dissections. However, there is a need for a consensus opinion regarding key aspects of VSAR. Methods : A literature review was performed regarding the most frequent debates and controversies in VSAR. An online survey was developed based on this information, and sent to surgeons with known expertise in VSAR regarding their opinion on patient-related factors, technical aspects, echocardiography, research, training, and the future of VSAR. Results : Twenty surgeons completed the survey. The reduction of left ventricular ejection fraction was considered a contra indication to VSAR when severe by 14/20 surveyed. The aortic annulus diameter cutoff point for the remodeling was heterogenous among participants. All of them felt that VSAR is safe for the Marfan´s syndrome population and bicuspid valves. For type A dissections, 11/20 preferred this procedure only in young patients. Regarding to graft sizing, the height of the interleaflet triangle (8/20) and the sino-tubular diameter (7/20) were the more frequent considered parameters. Surgeons reported a 7% of failure rate, leading to conversion to Bentall surgery, and a 26% change of strategy intraoperatively. A minimally invasive approach was not considered to improve results. Most of the surgeons agreed that VSAR should be performed by high-experienced surgeons. Conclusions : The VSAR has been accepted as a treatment option for the aortic root´s aneurysms, and even though there is still not possible to reach a final consensus, a valuable experience from the most relevant surgeons in the field is presented.

Complicaciones tromboembólicas y hemorrágicas en pacientes portadores de prótesis valvulares del corazón en un centro de tercer nivel. ¿Qué hemos aprendido? / Thromboembolic and hemorrhagic complications in patients with prosthetic heart valves at third level care center. What have we learned?

Resumen Antecedentes: El reemplazo valvular por prótesis mecánicas o biológicas implica riesgo de tromboembolismo y complicaciones hemorrágicas. Objetivo: Determinar las complicaciones relacionadas con la terapia de anticoagulación complementaria y la probabilidad de riesgo en pacientes portadores de prótesis valvulares del corazón. Métodos: Se estudiaron 163 pacientes entre 2002 y 2016, portadores de prótesis mecánicas y biológicas, quienes recibieron antagonistas de la vitamina K posterior al egreso hospitalario. La terapia de anticoagulación se categorizó en óptima y no óptima conforme a los valores de INR previos a las complicaciones. Fueron excluidos los pacientes con comorbilidades y otros factores de riesgo de trombosis y/o sangrado. Resultados: a 68.7 % de los pacientes se les colocó prótesis mecánica y a 31.3 %, biológica (p ≤ 0.001); 25.2 % presentó las complicaciones motivo de estudio (p ≤ 0.001), hemorrágicas en 48.8 %, tromboembólicas en 26.8 % y de ambos tipos en 24.4 % (riesgo relativo = 4.229); a 95.1 % de los pacientes con complicaciones se les colocó prótesis mecánica y a 4.9 %, biológica (p = 0.005); 49.7 % presentó INR no óptimo (p ≤ 0.001). Conclusiones: Ante riesgo alto de complicaciones tromboembólicas y hemorrágicas, la elección de las prótesis valvulares, la prevención y el seguimiento son prioridades, principalmente en quienes requieren terapia de anticoagulación.

Abstract Background: Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications. Objective: To determine the complications related to complementary anticoagulation therapy and the probability of risk. Methods: One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded. Results: In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001). Conclusions: Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy.

Reduced Angiopoietin Factor 2 Levels Are Correlated with Better Cardiac Function and Prognosis in Valvular Heart Disease

ABSTRACT Introduction: There are few circulating biomarkers for valvular heart disease. Angiopoietin (Ang) 1, Ang2, and vascular endothelial growth factor are important inflammation-associated cytokines. The aim of this study was to investigate the clinical significance and association of Ang1, Ang2, and vascular endothelial growth factor in valvular heart disease. Methods: This is a retrospective study; a total of 62 individuals (valvular heart disease patients [n=42] and healthy controls [n=20]) were included. Plasma levels of Ang1, Ang2, and vascular endothelial growth factor were detected by enzyme-linked immunosorbent assays. We retrospectively collected the baseline characteristics and short-term outcomes; logistic regression was performed to identify predictor for short-term mortality. Results: Ang2 was significantly decreased in the valvular heart disease group compared with the healthy control group (P=0.023), while no significant difference was observed in the Ang1 and vascular endothelial growth factor levels. The Ang2 level of New York Heart Association (NYHA) I/II patients — but not NYHA III/IV patients — was significantly decreased compared with that of healthy control individuals (NYHA I/II: P=0.017; NYHA III/IV: P=0.485). Univariable logistic regression analysis indicated that Ang2 was a significant independent predictor for short-term mortality (odds ratio 18.75, P=0.033, 95% confidence interval 8.08-102.33). Ang1 was negatively correlated with Ang2 (P=0.032, Pearson's correlation coefficient =-0.317) and was positively correlated with vascular endothelial growth factor (P=0.019, Pearson's correlation coefficient = 0.359). Conclusion: Ang2 might serve as a therapeutic and prognostic target for valvular heart disease.

Health-related quality of life of patients submitted to correction of heart valve diseases / Qualidade de vida relacionada à saúde de pacientes submetidos à correção de valvopatias

INTRODUCTION: The measurement of the health-related quality of life construct can reveal the positive repercussions on the lives of patients undergoing corrective valve procedures, as well as revealing points that prevent new surgical approaches. OBJECTIVE: To identify the health-related quality of life of valvular heart disease in the perioperative period of conventional valve surgery. METHODS: This is an integrative literature review. Searches were performed independently in four databases using controlled and uncontrolled descriptors. Eligibility criteria were: original articles that addressed the assessment of the health-related quality of life of valvular patients undergoing valve repair and/or valve prosthesis implantation; in Portuguese, English, and Spanish; with a time frame for convenience between 2015 and 2019. RESULTS: 14 studies comprised the final review sample, despite being studies conducted in different countries and with different designs, it was possible to verify the improvement in health-related quality of life when evaluated through generic instruments in valvular patients after valve surgery. However, in studies in which the assessment of the construct occurred through specific instruments, the existence of factors that can interfere with the quality of life of patients undergoing valve implantation was revealed. CONCLUSION: It was noticed that there was generally an improvement in health-related quality of life after the surgical intervention.

INTRODUÇÃO: A mensuração do constructo qualidade de vida relacionada à saúde pode revelar as repercussões positivas na vida dos pacientes submetidos a procedimentos valvares corretivos, bem como revelar pontos que para prevenção de novas abordagens cirúrgica. OBJETIVO: Identificar a qualidade de vida relacionada à saúde de valvopatas no perioperatório de intervenção cirúrgica valvar convencional. MÉTODO: Trata-se de uma revisão integrativa da literatura. As buscas foram realizadas de forma independente, em quatro bases de dados por meio de descritores controlados e não controlados. Os critérios de elegibilidade foram: artigos originais que abordassem a avaliação da qualidade de vida relacionada à saúde de valvopatas submetidos à plastia valvar e/ou implante de prótese valvar; nos idiomas português, inglês e espanhol; com recorte temporal por conveniência entre 2015 e 2019. RESULTADOS: 14 estudos compuseram a amostra final da revisão, apesar de serem estudos realizados em distintos países e com diferentes delineamentos foi possível verificar a melhora da qualidade de vida relacionada à saúde quando avaliada por meio de instrumentos genéricos em valvopatas após a intervenção cirúrgica valvar. Todavia, nos estudos em que a avaliação do constructo ocorreu por meio de instrumentos específicos, foi revelada a existência de fatores que podem interferir na qualidade de vida dos pacientes submetidos aos implantes valvares. CONCLUSÃO: Percebeu-se que geralmente houve melhora da qualidade de vida relacionada à saúde após a intervenção cirúrgica.

Hemocompatibility of bioprosthetic heart valve materials respectively based on glutaraldehyde and non-glutaraldehyde treatment / 中国胸心血管外科临床杂志

@#Objective    To study the hemocompatibility of bioprosthetic heart valve materials respectively based on glutaraldehyde and non-glutaraldehyde treatment. Methods    Fresh bovine pericardium was treated with glutaraldehyde or non-glutaraldehyde after adipose tissue was removed. To evaluate the hemocompatibility of the two bioprosthetic heart valve materials, hemolysis test, in vitro fibrinogen adsorption experiment, platelet adhesion experiment, thrombin-antithrombin complex (TAT) test, complement activation assay and ex vivo circulation experiment were performed. Results    The hemolysis test results demonstrated that both of the materials showed hemolytic rates lower than 5%. The results of TAT test and complement activation assay showed no statistical differences among the two materials and the blank control group. Compared to the bioprosthetic heart valve materials with glutaraldehyde-based treatment, the materials with non-glutaraldehyde-based treatment showed significantly decreased fibrinogen adsorption, platelet adhesion and thrombosis. Conclusion    Compared to the bioprosthetic heart valve materials with glutaraldehyde-based treatment, the materials with non-glutaraldehyde-based treatment show better hemocompatibility.

Discussion on quality control in clinical trials of interventional valvular medical devices / 中国胸心血管外科临床杂志

@#With the rapid development of the field of interventional therapy of cardiac valve, the innovative researches of interventional therapy of cardiac valve products have become the focus of global research. At present, there is a serious shortage of interventional valvular medical devices on the market in China, and large-scale interventional valve products are undergoing early human trials or confirmatory clinical trials. The effective quality control of clinical trials is of great significance to ensure that clinical trial data can be used to support the marketing of device products. By analyzing the problems in clinical trials quality control of interventional valvular medical devices in our hospital, and combining the characteristics of device products and diseases, we explore the key points of quality control and provide reference for the implementation and completion of high-quality clinical trials.

The value of right atrial myocardial fibrosis in evaluating the prognosis of isolated tricuspid valve surgery after left heart valve surgery / 中国胸心血管外科临床杂志

@#Objective    To investigate the predictive value of right atrial myocardial fibrosis in the prognosis of isolated tricuspid regurgitation surgery after left heart valve surgery. Methods    The patients who underwent tricuspid valvuloplasty by the same operator in Guangdong Provincial People's Hospital from April 2016 to August 2021 due to long-term isolated severe tricuspid regurgitation after left heart valve surgery were included in the study. According to the degree of right atrial myocardial fibrosis, the patients were divided into three groups: a mild group, a moderate group, and a severe group. The clinical data of these patients were compared and analyzed. Results    A total of 75 patients were enrolled, including 16 males and 59 females with an average age of 57.0±8.4 years. There were 30 patients in the mild group, 29 patients in the moderate group and 16 patients in the severe group. In terms of the preoperative data, there were statistical differences in cardiac function grade, right atrial diameter, tricuspid incompetence area among the three groups (P<0.05). In terms of the postoperative data, there were statistical differences among the three groups in the cardiopulmonary bypass time, mechanical ventilation time, ICU monitoring time, complication rate and mortality (P<0.05). Further pairwise comparison showed that, compared with the mild group, the severe group had longer mechanical ventilation time (P=0.024), longer ICU monitoring time (P=0.003) and higher incidence of postoperative complications (P=0.024), while the moderate group had no statistical difference in all aspects (P>0.05); compared with the moderate group, the severe group had longer ICU monitoring time (P=0.021) and higher incidence of complications (P=0.006). Conclusion    The early outcome of tricuspid valvuloplasty in patients with isolated tricuspid regurgitation after left heart valve surgery with severe right atrial myocardial fibrosis is worse than that in the patients with mild and moderate fibrosis, suggesting that the degree of myocardial fibrosis in the right atrium can be a predictor of the effect of tricuspid regurgitation surgery and a judgement indicator of the surgery timing.

Analysis of changes in cardiac structure and function in 363 patients with maintenance hemodialysis / 中国医师杂志

Objective:To investigate the characteristics of cardiac structure and function changes in maintenance hemodialysis (MHD) patients.Methods:The information of 363 MHD patients with dialysis age ≥3 months who were registered in Huadu District People′s Hospital of Guangzhou City before January 2020 was collected, and the echocardiographic screening was performed to analyze the changes in cardiac structure and function.Results:The most common abnormal changes of heart structure and function in MHD patients were valve regentation (69.7%), left ventricular hypertrophy (LVH) (51.8%), left ventricular diastolic dysfunction (29.8%), valve calcification (11.6%), and left ventricular systolic dysfunction (10.2%). With the increase of age, the left ventricular ejection fraction of MHD patients decreased, and the proportion of left ventricular diastolic dysfunction, left atrial enlargement and pulmonary hypertension increased (all P<0.05). Among 363 MHD patients, 188(51.8%) had LVH. It was found that LVH patients had higher average single ultrafiltration volume, higher brain natriuretic peptide (BNP) level, more type 2 diabetes, lower left ventricular ejection fraction (all P<0.05), and were more prone to chest tightness, chest pain, post activity shortness of breath, heart failure and other symptoms compared with the non-LVH patients (all P<0.05). Conclusions:Most MHD patients have different degrees of cardiac structural changes. Early intervention, reduction of single ultrafiltration volume and control of blood glucose are beneficial to improve the dialysis quality of MHD patients and reduce the occurrence of cardiovascular events.

The current situation and influencing factors of kinesiophobia in patients after heart valve replacement surgery / 中国实用护理杂志

Objective:To investigate the current situation of kinesiophobia in patients after heart valve replacement surgery and to analyze its influencing factors, and to provide reference for the intervention research of patients with cardiophobia after cardiac valve replacement.Methods:Using cross-sectional survey method and convenient sampling method, 109 patients who underwent cardiac valve replacement surgery in department of cardiothoracic and vascular surgery of Guangxi Zhuang Autonomous Region People′s Hospital from March 2021 to January 2022 were selected as the study subjects. The patients were surveyed with the general questionnaire, Tampa Scale of Kinesiophobia and Visual Analogue Scale.Results:After heart valve replacement, the score of Tampa Scale of Kinesiophobia was (46.90 ± 9.30) points. The score of Visual Analogue Scale was (5.83 ± 1.01) points. The score of Tampa Scale of Kinesiophobia was positively correlated with the score of Visual Analogue Scale ( r=0.46, P<0.01). Multiple linear regression analysis showed that patient′s age, cardiac function level, left ventricular ejection fraction, pain were the main influencing factors of Kinesiophobia ( t values were -2.37-4.34, all P<0.05). Conclusions:Medical staff should understand and accurately assess the status of patient′s kinesiophobia after heart valve replacement surgery, identify high-risk groups of kinesiophobia, and take targeted nursing measures to effectively alleviate postoperative pain, thereby reducing the incidence of kinesiophobia in patients, helping patients to carry out early functional exercise, and prorroting physical recovery.

Practice and experience of clinical pharmacists participating in pharmaceutical care for patients after heart valve replacement / 药学实践杂志

Objective To explore the starting point of pharmaceutical care by clinical pharmacists for patients after heart valve replacement. Methods Combined with typical cases, the content, focus and effects of pharmaceutical care for patients after heart valve replacement were summarized. Results Clinical pharmacists provided pharmaceutical services such as anticoagulant care and warfarin dosage adjustment, infection monitoring and rational use and care of antibacterial, perioperative airway management, stress ulcer (SU) prevention and pharmaceutical care, and warfarin medication education for patients, which had promoted the rational use of drugs and improved the treatment results of patients. Conclusion Pharmaceutical care by clinical pharmacists could be helpful to improve the safety and efficacy of drug treatment for patients after heart valve replacement.

Detection method of early heart valve diseases based on heart sound features / 生物医学工程学杂志

Heart valve disease (HVD) is one of the common cardiovascular diseases. Heart sound is an important physiological signal for diagnosing HVDs. This paper proposed a model based on combination of basic component features and envelope autocorrelation features to detect early HVDs. Initially, heart sound signals lasting 5 minutes were denoised by empirical mode decomposition (EMD) algorithm and segmented. Then the basic component features and envelope autocorrelation features of heart sound segments were extracted to construct heart sound feature set. Then the max-relevance and min-redundancy (MRMR) algorithm was utilized to select the optimal mixed feature subset. Finally, decision tree, support vector machine (SVM) and k-nearest neighbor (KNN) classifiers were trained to detect the early HVDs from the normal heart sounds and obtained the best accuracy of 99.9% in clinical database. Normal valve, abnormal semilunar valve and abnormal atrioventricular valve heart sounds were classified and the best accuracy was 99.8%. Moreover, normal valve, single-valve abnormal and multi-valve abnormal heart sounds were classified and the best accuracy was 98.2%. In public database, this method also obtained the good overall accuracy. The result demonstrated this proposed method had important value for the clinical diagnosis of early HVDs.

The role of echocardiographic screening in reducing the burden of rheumatic heart disease in Latin America / El papel del tamizaje ecocardiográfico en la reducción de la carga de la cardiopatía reumática en América Latina / O papel da triagem ecocardiográfica na redução da carga de doença cardíaca reumática na América Latina

ABSTRACT The objectives of this article are to reflect on the rationale behind the use of echocardiographic screening for rheumatic heart disease and to provide key recommendations about steps needed to implement and improve echocardiographic screening programs in Latin America. Rheumatic heart disease remains a public health problem affecting mainly low-income and lower-middle-income countries and populations. Latin America is an area with economic inequalities, and the epidemiology of rheumatic heart disease remains largely unknown. Echocardiographic screening is useful for updating the epidemiology and providing early diagnosis of the disease. We discuss different approaches used in successful echocardiographic screening programs worldwide and in Latin America. We then identify the key elements needed to establish successful echocardiographic screening programs in Latin America, including increased awareness and involvement from multiple sectors (e.g. the community, health care professionals, scientific organizations and public health entities), identification of areas in need, development of a plan and structure that include different screening approaches, and how to ensure appropriate follow up for those who screen positive.

RESUMEN Los objetivos de este artículo son reflexionar sobre los fundamentos que justifican el uso del tamizaje ecocardiográfico para detectar la cardiopatía reumática y ofrecer algunas recomendaciones importantes sobre los pasos que habría que dar para poner en marcha programas de tamizaje ecocardiográfico y mejorar los existentes en América Latina. La cardiopatía reumática sigue siendo un problema de salud pública que afecta principalmente a países y grupos poblacionales de ingresos bajos y medianos bajos. América Latina es una región de grandes desigualdades económicas y las características epidemiológicas de la cardiopatía reumática siguen siendo desconocidas en gran medida. El tamizaje ecocardiográfico resulta útil para actualizar los datos epidemiológicos y posibilitar un diagnóstico temprano de la enfermedad. En este artículo se analizan los diferentes enfoques empleados en algunos programas de tamizaje ecocardiográfico eficaces de distintas partes del mundo, incluida América Latina. A continuación se determinan los elementos clave necesarios para establecer programas eficaces de tamizaje ecocardiográfico en América Latina, incluida una mayor concientización y participación de diversos sectores (p. ej., la comunidad, los profesionales de salud, las organizaciones científicas y las entidades de salud pública), la identificación de las zonas más necesitadas, la elaboración de un plan y una estructura que incluyan diferentes abordajes del tamizaje, y el modo de garantizar un seguimiento adecuado de aquellas personas con un resultado positivo en el tamizaje.

RESUMO Os objetivos deste artigo são oferecer observações sobre a fundamentação do uso da triagem ecocardiográfica para doença cardíaca reumática e fornecer recomendações importantes sobre as etapas necessárias para implementar e melhorar os programas de triagem ecocardiográfica na América Latina. A doença cardíaca reumática continua sendo um problema de saúde pública que afeta principalmente países e populações de renda baixa e média-baixa. A América Latina é uma área com desigualdades econômicas, e a epidemiologia da doença cardíaca reumática continua amplamente desconhecida. A triagem ecocardiográfica serve para atualizar a epidemiologia e proporcionar o diagnóstico precoce da doença. Examinamos as diferentes abordagens usadas em programas de triagem ecocardiográfica bem-sucedidos em todo o mundo e na América Latina. Em seguida, identificamos os principais elementos necessários para estabelecer programas de triagem ecocardiográfica com sucesso na América Latina. Tais programas incluiriam maior conscientização e envolvimento de vários setores (por exemplo, a comunidade, profissionais de saúde, organizações científicas e entidades de saúde pública), identificação de áreas carentes, desenvolvimento de um plano e estrutura abrangendo diferentes abordagens de triagem e formas de garantir o seguimento adequado de pessoas com resultado positivo na triagem.

Repercusiones cardíacas en pacientes con pectus excavatum: puesta al día. Segunda parte / Cardiac repercussions in patients with pectus excavatum: update. Part two / Repercussões cardíacas em pacientes com pectus excavatum: atualização. Parte dois

El pectus excavatum (PEX) es una deformación de la pared torácica que obedece a una alteración de los cartílagos costales con el consiguiente hundimiento del esternón. Históricamente, se clasificaba como un defecto únicamente estético o cosmético, sin embargo, en los últimos años se han desarrollado nuevos métodos de estudio para la valoración de las repercusiones de esta patología. Existe cada vez más bibliografía que demuestra importantes repercusiones funcionales. Se realizó una puesta al día de las repercusiones cardíacas de la patología y un análisis de los artículos más relevantes de los últimos años. La evidencia actual permite afirmar que existe una afectación cardíaca por compresión esternal en la mayoría de los pacientes con PEX. Las afectaciones incluyen alteraciones anatomofuncionales (trastornos del ritmo, disminución del llenado ventricular), del volumen sistólico, aumento de la presión de la aurícula derecha, valvulopatías, compresión del ventrículo derecho, derrame pericárdico, entre otras. Todo lo cual permite concluir que el PEX puede presentar importantes alteraciones cardíacas que deben ser tenidas en cuenta a la hora de valorar los pacientes con esta patología.

Pectus excavatum (PEX) is a deformation of the chest wall caused by an alteration of the costal cartilages with the consequent collapse of the sternum. Historically, it had been classified as a solely aesthetic or cosmetic defect, however, in recent years new study methods have been developed to assess the repercussions of this pathology, with increasing bibliography showing important functional consequences. We updated the cardiac pathological repercussions and analyzed the most relevant articles of recent years. The current evidence suggests that there is cardiac involvement due to sternal compression in most patients with PEX. These affectations include anatomical functional alterations: rhythm disorders, decreased ventricular filling, decreased stroke volume, increased right atrial pressure, valve disease, right ventricular compression, pericardial effusion, among others. All of which enables us to conclude that PEX can present important cardiac alterations that must be taken into account when assessing patients with this pathology.

Pectus excavatum (PEX) é uma deformação da parede torácica decorrente de uma alteração das cartilagens costais com consequente colapso do esterno. Historicamente, foi classificado como um defeito exclusivamente estético ou cosmético, porém, nos últimos anos, novos métodos de estudo foram desenvolvidos para avaliar as repercussões dessa patologia, com crescente bibliografia mostrando importantes repercussões funcionais. Foi realizada uma atualização das repercussões cardíacas da patologia e análise dos artigos mais relevantes dos últimos anos. As evidências atuais permitem afirmar que há acometimento cardíaco por compressão esternal na maioria dos pacientes com PEX. As afecções incluem alterações anatomofuncionais: distúrbios do ritmo, diminuição do enchimento ventricular, diminuição do volume sistólico, aumento da pressão atrial direita, doença valvular, compressão do ventrículo direito, derrame pericárdico, entre outras. Tudo isso permite concluir que o PEX pode apresentar alterações cardíacas importantes que devem ser levadas em consideração na avaliação de pacientes com essa patologia.

Reparo valvar percutâneo borda a borda da insuficiência mitral após implante transcateter de válvula aórtica / Percutaneous edge-to-edge mitral regurgitation valve repair after transcatheter aortic valve implantation

A insuficiência mitral moderada a grave é observada em 17 a 35% dos pacientes submetidos a implante transcateter de válvula aórtica. Estudo que reporta a insuficiência mitral pós- realização de implante transcateter de válvula aórtica por estenose aórtica demonstra que 50% dos pacientes com refluxo moderado a grave apresentaram melhora da regurgitação, e 8,7% evidenciam piora do quadro. Nesses pacientes com piora, houve aumento da mortalidade. Essa progressão sugere que condutas convencionais, baseadas em otimização medicamentosa, podem não ser capazes de prevenir quadros negativos. Relatamos um caso sobre a evolução da insuficiência mitral após implante transcateter de válvula aórtica e o uso do MitraClip® como alternativa de tratamento e benefícios.

Moderate to severe mitral regurgitation is observed in 17 to 35% of patients undergoing transcatheter aortic valve implantation. A study reporting mitral regurgitation after transcatheter aortic valve implantation due to aortic stenosis demontrated 50% of patients with moderate to severe reflux showed improvement in regurgitation, and 8.7% showed worsening of the condition, which led to increased mortality. This progression suggested conventional management, based on medication optimization, may not be able to prevent poor outcomes. We report a case on the clinical course of a patient with mitral regurgitation after transcatheter aortic valve implantation, and the use of MitraClip® as an alternative treatment and its benefits.

Albumin-Bilirubin Score: A Novel Mortality Predictor in Valvular Surgery

ABSTRACT Introduction: The heart and liver are two organs that are closely related. The Albumin-Bilirubin (ALBI) score is a developed scoring system for assessing liver function. The aims of this study were to examine the correlation between preoperative ALBI score and pulmonary artery pressure and to investigate its ability to predict heart valve surgery mortality outcomes. Methods: The data of 872 patients who underwent isolated and combined heart valve surgery from 2014 to 2021 were retrospectively screened. In the preoperative period, 152 patients with laboratory tests including albumin and total bilirubin were found and analyzed retrospectively. Thirteen of these patients were excluded from the study. The remaining 139 patients were included in the analysis. Baseline demographic data, echocardiography data, performance status, laboratory data, operative data, and postoperative status were collected. The optimal cutoff value of preoperative ALBI score was calculated. Results: The cutoff for ALBI scores was calculated as -2.44 to predict in-hospital mortality (sensitivity = 75.0%, specificity = 70%). Based on the cutoff value, 90 patients had a low ALBI score (≤ -2.44, 64.7%) and 49 patients had a high ALBI score (> -2.44, 35.3%). High ALBI score was associated with an increased incidence of acute kidney injury and in-hospital mortality, and a positive correlation was found between ALBI score and pulmonary artery pressure. Conclusion: In patients with valvular surgery, high ALBI score was an independent prognostic factor of in-hospital mortality and acute kidney injury. It is easily measurable and a cost-effective way to predict mortality.