Transapical transcatheter aortic valve replacement in bicuspid aortic valve patients: In-hospital outcomes / 中国胸心血管外科临床杂志

@#Objective    To compare the in-hospital outcomes of transapical transcatheter aortic valve replacement (TA-TAVR) for bicuspid aortic valve (BAV) patients and tricuspid aortic valve (TAV) patients. Methods    Patients (including BAV and TAV patients) who underwent TA-TAVR with the J-ValveTM in West China Hospital from July 2014 to July 2020 were included consecutively. The clinical outcomes of the patients were analyzed. Results    A total of 354 patients were included in the study, 75 in the BAV group and 279 in the TAV group. There were 229 males and 125 females with a mean age of 72.2±6.0 years. No death occurred during the procedure, and the overall technical success rate was 97.7%. The all-cause in-hospital mortality rate was 1.4%. Twenty (26.7%) patients with BAV and 46 (16.5%) patients with TAV had mild or higher perivalvular leaks immediately after the procedure. No patients with BAV required permanent pacemaker implantation postoperatively, while 13 (4.7%) TAV patients required permanent pacemaker implantation, with an overall pacemaker implantation rate of 3.7%. One (1.3%) BAV patient and 7 (2.5%) TAV patients developed acute kidney injury postoperatively. One (1.3%) BAV patient and 1 (0.4%) TAV patient developed peri-operative myocardial infarction. The average postoperative hospital stay was 7.6±3.6 d for BAV patients and 8.6±6.1 d for TAV patients. There was no statistical difference in primary or secondary in-hospital outcomes between BAV and TAV patients (P>0.05). Conclusion    Compared to TAV patients, BAV patients have similar in-hospital outcomes, with a low incidence of adverse clinical outcomes, which provides preliminary evidence for its implementation in Chinese patients with a high proportion of BAV.

Resultados a siete años de la cirugía de reemplazo valvular aórtico en mayores de 80 años / Seven-year results of aortic valve replacement surgery in patients over 80 years of age

Resumen Objetivo: Describir las características clínicas y los resultados operatorios y a siete años del reemplazo valvular aórtico en una cohorte de pacientes mayores de 80 años. Materiales y métodos: Estudio descriptivo retrospectivo de 75 pacientes consecutivos mayores de 80 años, intervenidos de reemplazo valvular aórtico exclusivo entre 2007 y 2019 en el Hospital Guillermo Grant Benavente. Se estudian sus características demográficas, clínicas, ecocardiográficas, riesgo operatorio, cirugías, complicaciones y mortalidad operatoria y supervivencia alejada hasta el 15 de marzo 2021. Resultados: La edad media de la cohorte fue 83,05 ± 2,9 años (rango 80-95) y 43 pacientes eran mujeres (57,3%). La lesión valvular predominante fue la estenosis aórtica (89,3%). 10 pacientes tenían enfermedad coronaria asociada (13,3%) y 2 endocarditis activa. El riesgo de mortalidad operatoria calculado por EuroSCORE aditivo, logístico, II y STS score fue 7,58 ± 1,8; 9,88 ± 6,5%; 3,72 ± 3,5% y 4,27 ± 3,2%, respectivamente. Se utilizó prótesis biológica en 70 (92%) pacientes. Hubo 29 complicaciones operatorias y fallecieron 11 (14,7%) pacientes. El seguimiento promedio fue 7,1 años (rango 2-14), durante el cual fallecen 28 pacientes. La supervivencia a uno, tres y cinco años fue 82, 76, 66 y 48% respectivamente. Conclusiones: La cirugía de reemplazo valvular aórtico en octogenarios en nuestro medio es un procedimiento poco frecuente. La mortalidad observada fue mayor que la estimada por las escalas de riesgo. El reemplazo valvular quirúrgico es una alternativa de tratamiento de la enfermedad de la válvula aórtica en pacientes seleccionados. Se deben evaluar estrategias para mejorar los resultados.

Abstract Objective: To describe the clinical characteristics and operative and 7-year results of aortic valve replacement in a cohort of patients older than 80 years. Materials and methods: Retrospective descriptive study of 75 consecutive patients older than 80 years of age who underwent exclusive aortic valve replacement between 2007 and 2019 at the Guillermo Grant Benavente Hospital. Demographic, clinical, echocardiographic characteristics, operative risk, surgeries, complications and operative mortality and long-term survival until March 15, 2021 are studied. Results: The mean age of the cohort was 83.05 ± 2.9 years (range 80-95) and 43 patients were women (57.3%). The predominant valve lesion was aortic stenosis (89.3%). Ten patients had an associated coronary artery disease (13.3%) and 2 had active endocarditis. The risk of operative mortality calculated by EuroSCORE additive, logistic, II and STS score was 7.58 ± 1.8; 9.88 ± 6.5%; 3.72 ± 3.5% and 4.27 ± 3.2%, respectively. A biological prosthesis was used in 70 (92%) patients. There were 31 operative complications and 11 (14.7%) patients died. The mean follow-up was 7.1 years (range 2-14), during which 28 patients died. Survival at 1, 3, and 5 years was 82, 76, 66 and 48%, respectively. Conclusions: Aortic valve replacement surgery in octogenarians in our setting is a rare procedure. The observed mortality was higher than that estimated by the risk scales. Surgical valve replacement is an alternative treatment for aortic valve disease in selected patients. Strategies to improve results should be evaluated.

Tratamiento en un tiempo quirúrgico de una coartación aortica asociada a valvulopatía aórtica bicúspide severa. Reporte de un caso

Percutaneous surgery is the treatment of choice of isolated aortic coarctation in adults However, when there are other heart problems related to aortic coarctation, its surgical management may vary. We report a 41-year-old male presenting with aortic coarctation associated with severe, symptomatic, bicuspid aortic valve lesions and significant left ventricular dysfunction. He underwent open heart surgery for the surgical resolution of these problems. One year after surgery the results are satisfactory with no evidence of postoperative complications and a significant improvement of patient symptoms and left ventricular function.

Abordaje del implante valvular aórtico transcateter durante la pandemia por COVID-19 con alta prevoz: reporte de una serie de casos / Transcatheter aortic valve implantation (TAVI) with conscious sedation and early discharge: report of seven cases

COVID-19 pandemic generated multiple challenges for the health system. Cardiovascular disease is associated with a worse prognosis of infections. Moreover, most hospital resources and operative rooms were destined to patients with COVID-19 infection, deferring the treatment of most valvular patients requiring surgery. We report seven patients with symptomatic severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) with conscious sedation and early discharge. No patient required intensive care unit admission or mechanical ventilation. After a 90-day follow-up, there were no complications or unplanned readmissions.

La edad avanzada en forma aislada no constituye una limitación para el reemplazo valvular aórtico quirúrgico / Old Age Alone is not a Limitation for Surgical Aortic Valve Replacement

RESUMEN Introducción: El reemplazo quirúrgico de la válvula aórtica (REEAO) en pacientes con valvulopatía aórtica grave sintomática, es el tratamiento definido como el de referencia. Sin embargo, el implante valvular aórtico transcatéter (TAVI) se posiciona actualmente como una alternativa en pacientes de diferentes riesgos según los scores internacionales. Algunas guías consideran al TAVI como el procedimiento preferible en los pacientes añosos. Objetivos: Conocer el riesgo y resultados de morbimortalidad del REEAO en pacientes adultos clasificados según la edad en mayores de 75 años, o de 75 años o menos. Material y métodos: Estudio retrospectivo sobre 228 pacientes consecutivos intervenidos mediante REEAO entre el 1 de enero de 2011 y el 31 de diciembre de 2020 por valvulopatía aórtica grave sintomática. Del total de pacientes operados, 46 (16%) eran mayores de 75 años (Grupo 1, G1) y 182 pacientes (84%) tenían 75 años o menos (Grupo 2, G2). Se excluyeron pacientes con enfermedad coronaria concomitante, endocarditis bacteriana u otras valvulopatías asociadas. Resultados: Los pacientes del G1 tenían mayor riesgo de morbimortalidad quirúrgica analizado por scores de riesgo validados: ArgenSCORE de 1,55 (RIC 0,99-3,33) vs 1,08 (RIC 0,68-2,23), p = 0,02 y STS score de 2,33 (RIC 1,57-3,23) vs. 0,94 (RIC 0,721,44), p = 0,0001, con respecto al G2; no se encontraron en cambio diferencias significativas en el EuroSCORE II : 2,37 (RIC 1,19-3,61) vs. 1,83 (RIC 1,16-3,04), p = 0,2. La mortalidad registrada global fue del 1,7% (G1: 2,1% vs. G2: 1,6% , p NS); no se observaron accidente cerebrovascular (ACV) ni infarto agudo de miocardio (IAM) perioperatorios. Conclusiones: La escasa presentación de muerte, ACV e IAM sugiere que el tratamiento seleccionado para estos pacientes fue adecuado, con excelentes resultados sin diferencias entre los dos grupos etarios.

ABSTRACT Background: Surgical aortic valve replacement (SAVR) is the reference treatment in patients with symptomatic severe aortic valve disease. However, according to international scores, transcatheter aortic valve implantation (TAVI) is currently an alternative in different risk patients, and some guidelines consider TAVI as a preferable procedure in elderly patients. Objectives: The aim of this study was to assess SAVR morbidity and mortality risk and results in adult patients, classified according to age as >75 years or ≤75 years. Methods: A retrospective study was performed on 228 consecutive patients undergoing SAVR between January 1, 2011 and December 31, 2020 for symptomatic severe aortic valve disease. Among the total number of patients operated on, 46 (16%) were >75 years (Group 1, G1) and 182 (84%) were ≤75 years (Group 2, G2). Patients with concomitant coronary heart disease, bacterial endocarditis or other associated valve diseases were excluded from the analysis. Results: Group 1 patients had greater risk of surgical morbidity and mortality analyzed by validated risk scores: ArgenSCORE 1.55 (IQR 0.99-3.33) vs 1.08 (IQR 0.68-2.23), p = 0.02 and STS score 2.33 (IQR 1.57-3.23) vs. 0.94 (IQR 0.72-1.44), p = 0.0001, with respect to G2, while no significant differences were found for EuroSCORE II: 2.37 (IQR 1.19-3.61) vs. 1.83 (IQR 1.163.04), p = 0.2. Overall mortality was 1.7% (G1: 2.1% vs. G2: 1.6%, p=NS), with no perioperative stroke or acute myocardial infarction (AMI). Conclusions: The low number of deaths, stroke and AMI observed suggests that the selected treatment for these patients was adequate, with excellent results and without significant differences between these two age groups.

Redefiniendo el estándar de oro para el reemplazo valvular aórtico: mínimamente invasivo y recuperación acelerada / Redefining the gold standard for aortic valve replacement: minimally invasive with accelerated recovery

Background: Despite being introduced 20 years ago minimally invasive aortic valve replacement is only performed routinely in a minority of patients world-wide. Aim: To report the operative outcome of minimally invasive aortic valve replacement done through a partial upper sternotomy. Patients and Methods: Retrospective analysis of data recorded prospectively of 450 consecutive patients with a median age of 66 years (59% males) who had a minimally invasive aortic replacement. Results: 79% of patients had aortic stenosis. Cross clamp/cardiopulmonary bypass times (median) were 56 and 68 minutes respectively. Conversion to full sternotomy was required in 2.6% of patients, reoperation for bleeding in 2.9%. 1.6% suffered a stroke and 19% postoperative atrial fibrillation. 0.9% required a permanent pacemaker. Postoperative mortality was 0.9%. Median postoperative hospital stay was six days. Conclusions: Minimally invasive aortic valve replacement can be performed with satisfactory results.

Ross procedure to cure aortic valve disease in children with expended polytetrafluoraethylene(ePTFE) artificial valve for right ventricular outflow tract reconstruction / 中华胸心血管外科杂志

Objective:To review and analyze the clinical experience of children with aortic valve stenosis and/or insufficiency treated with autologous pulmonary valve for aortic valve replacement procedure(Ross operation) with ePTFE artificial valve for right ventricular outflow tract reconstruction.Methods:From 2015 to 2020, 8 cases of aortic stenosis and/or aortic insufficiency treated by Ross operation in our center were collected, with an age of 0.5-13.2 years old. 4 cases of aortic stenosis were diagnosed preoperatively, 3 cases of aortic stenosis with aortic insufficiency, and 1 case of infective endocarditis involving the aortic valve. The operation was carried out in three steps: Harvest autologous pulmonary valve; the diseased aortic valve was resected and autologous pulmonary valve was transplanted to the aorta by aortic root transplantation; the right ventricular outflow tract was reconstructed by a handmade ePTFE artificial flap blood vessel.Results:In 6 cases, the right ventricular outflow tract was reconstructed by hand-sewn ePTFE trileaflets, and artificial univalve in 2 cases, no death occurred during operation; all patients were cured and discharged. The patients were followed up for 1 to 36 months, with mean of(12.63±12.19) months. There was no long-term death or valvular complications. During follow-up echocardiography indicated 1 case of moderate aortic regurgitation, 1 case of mild-moderate regurgitation, and moderate regurgitation was found in 2 patients with artificial single pulmonary valve. For the remaining patients, they were mild aortic regurgitation, and a trivial or mild pulmonary artery regurgitation with hand-sewn three-leaflets ePTFE artificial vessel; All patients were followed up at the last time with a peak pressure of(6.63±3.46) mmHg(1 mmHg=0.133 kPa) across the aortic valve. The left ventricular outflow tract and aortic annulus shrank slightly after surgery(the diameter of one patient with Ross-Konno operation increased), but the annulus diameter increased with age. There was no need for further intervention.Conclusion:The Ross operation is safe for the treatment of aortic valve disease, it has good hemodynamic effect, and the autologous pulmonary artery has growth potential, especially suitable for children and young patients. Hand-sewn ePTFE with trileaflet vessels for reconstruction of right ventricular outflow tract performs well in anti-regurgitation function in the short term or may be used as a replacement material for the homograft/heterograft vessel, but longer follow-up and more cases are needed.

Conservative treatment of unicuspid aortic valve with newly diagnosed type a aortic dissection

Abstract We present a case of a 36-year-old male patient with known arthrogryposis multiplex congenita and an associated unicuspid aortic valve. The patient later developed a significant aneurysm of the ascending aorta, however refused surgical intervention and missed follow-up appointments for 5 years. During an urgent, general practitioner-initiated transthoracic echocardiography follow-up, a chronic type A aortic dissection was diagnosed as a result of progressive aortic dilatation. Due to the stationary pressure gradients and non-progressive leaflet fibrosis, a conservative approach for to the unicuspid aortic valve was chosen, combined with replacement of the ascending aorta and partial replacement of the aortic arch.

Efficacy of different treatment strategies for congenital aortic valve disease in 85 children from a single center: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To analyze the early- and middle-term prognosis of various surgical methods in children with congenital aortic valve diseases, to provide reference for surgical methods in children with aortic valve stenosis or regurgitation. Methods    The clinical data of 85 children with various aortic valve diseases treated in the Children’s Hospital of Fudan University from January 2005 to December 2018 were retrospectively analyzed. There were 64 males and 21 females, with an average age of 45 months ranging from 5 days to 15 years. Among them 18 patients underwent balloon aortic valvuloplasty (BAV), 8 surgical aortic valvotomy (SAV), 27 aortic valve autogenous pericardium repair, 16 mechanical arterial valve replacement and 16 Ross operation. They were followed up for 6.25±2.76 years. The re-intervention and survival status after different operations were analyzed. Results    There were 3 deaths and 17 reoperations in 85 children. The 5-year survival rate of the patients with SAV, BAV, aortic valve autogenous pericardium repair, mechanical arterial valve replacement and Ross operation was 87.4%, 88.9%, 100.0%, 100.0% and 100.0%, respectively; there was no statistical difference in the early and middle-term survival rates among various operations (P>0.05). The 5-year free from re-intervention rate of the patients with SAV, BAV, aortic valve autogenous pericardium repair, mechanical arterial valve replacement and Ross operation was 44.4%, 18.4%, 100.0%, 66.9% and 80.5%, respectively; there was a statistical difference in the early and middle-term re-intervention rate among various operations (P<0.05). Conclusion    The operation of congenital aortic stenosis or regurgitation needs to be performed according to the pathological changes of the valvular tissues. For children with severe lesions, SAV is recommended for the first intervention. For congenital aortic stenosis, SAV and BAV are both palliative operations which need further evaluation and re-intervention. Ross operation and mechanical arterial valve replacement have low re-intervention rate, and the middle- and long-term follow-up shows that the effect is accurate. Aortic valve autogenous pericardium repair is expected to become a method to delay or replace Ross operation and valve replacement.

Coronary artery disease is associated with valvular heart disease, but could it Be a predictive factor?

Objective This study was conducted to evaluate the prevalence of significant coronary artery disease (CAD) in patients with severe valvular heart disease (VHD) and the association between these two cardiac entities. Our research aims to introduce the theory of a possible causal relationship. Methods A retrospective study was conducted on 1308 consecutive patients who underwent surgery for severe VHD in the cardiovascular department of Notre-Dame de Secours University Hospital (NDSUH) between December 2000 and December 2016. According to transthoracic echocardiography, patients were divided into 4 groups: patients with severe aortic stenosis (AS), patients with severe aortic regurgitation (AR), patients with severe mitral stenosis (MS), and patients with severe mitral regurgitation (MR). Preoperative coronary angiographies were reviewed for the presence or the absence of significant CAD (≥50% luminal stenosis). Chi-square test and 2 × 2 tables were used. Results Of the 1308 patients with severe VHD, 1002 patients had isolated aortic valve disease, 240 patients had isolated mitral valve disease, and 66 patients had combined aortomitral valve disease. CAD was detected in 27.75% of all patients with severe VHD, in 32% of patients with isolated aortic valve disease, and in 15% of patients with isolated mitral valve disease. Statistical analysis showed a higher prevalence in patients with severe aortic valve stenosis and a significant relationship between CAD and aortic valve disease, mainly severe AS (p < 0.0001). Conclusion The prevalence of CAD in patients with VHD is 27.75%, and it correlates significantly with aortic valve disease, in particular with severe AS. Future large studies are needed to evaluate the possible causal relationship.

Early clinical experience of transcatheter aortic valve implantation via apical approach for high-risk aortic valve disease in single-center / 中国胸心血管外科临床杂志

@#Objective    To summarize the clinical experience in the treatment of high-risk patients with severe aortic valve disease by transcatheter aortic valve implantation (TAVI) via heart apex approach and to evaluate the early efficacy. Method    Five patients who underwent TAVI via heart apex approach from September 2017 to February 2019 in Henan Thoracic Hospital were retrospectively analyzed, including 3 males and 2 females, aged 65-84 (74.6±4.5) years. Result    All operations were performed through a small left incision into the thoracic cavity (3-5 cm), and then through the J-Valve transport system, the aortic valve was successfully released via heart apex after precise positioning under digital subtraction angiography. One patient developed ventricular fibrillation during the operation, and the operation was completed with the assistance of emergency femoral arteriovenous catheterization cardiopulmonary bypass; one patient underwent percutaneous coronary intervention first because of severe coronary stenosis; one patient had paroxysmal atrial fibrillation during the perioperative period, and had hepatorenal insufficiency and thrombocytopenia after the operation, and was improved after medical treatment; one patient had perivalvular leak during the operation, and was improved after re-implantation of the valve; one patient was in stable condition during operation and recovered smoothly after operation. Surgery was successful in all 5 patients. The follow-up time was 2-19 months, and the early clinical effect was good. Conclusion    The short-term clinical efficacy of TAVI via heart apex approach in the treatment of high-risk severe aortic valve disease is definite and safe, but the long-term and medium-term effects need to be further evaluated.

Research progress on non-coding RNA in calcific aortic valve disease / 第二军医大学学报

[Abstract] Calcific aortic valve disease is a process involving complex pathological changes such as endothelial injury, chronic inflammation, extracellular matrix remodeling, cell phenotype differentiation and apoptosis. The aortic valve is mainly composed of internal valve interstitial cells and external valve endothelial cells, and they are all involved in the pathological process of calcific aortic valve disease. Non-coding RNA participates in the pathophysiological process of cardiovascular disease mainly through post-transcriptional regulation mechanism, and may play an important role in the development and progression of calcific aortic valve disease.

Gene Silencing of PTX3 by siRNA Inhibits Expression of Inflammatory Factors in Aortic Valve Interstitial Cells / 华中科技大学学报(医学版)

Objective@# To explore the role of lipopolysaccharide（LPS）in the pathogenesis of calcific aortic valve disease（CAVD）by detecting the expression of inflammatory factors in aortic valve interstitial cells（AVICs），and the expression of interleukin-6（IL-6），interleukin-8（IL-8），monocyte chemoattractant protein-1（MCP-1）after silencing pentraxin 3（PTX3）gene，to test the effect of PTX3 on the pathophysiological process of CAVD. @*Methods@#We obtained aortic valves for immunohistochemistry staining from 12 patients with CAVD，and from 12 patients without aortic valve disease receiving heart transplant operation as controlAVICs were cultured in vitro，different concentrations of LPS（0，50，100，200 ng/mL）treated cells for 24 h，and then the expression levels of IL-6，IL-8 and MCP-1 were analyzed by real-time polymerase chain reaction（real-time PCR）. After AVICs were transfected with PTX3 siRNA for 48 h to knockdown the expression of PTX3 protein，PTX3 was tested by Western blotting. The levels of IL-6，IL-8 and MCP-1 were detected by real-time PCR 24 h after treatment with LPS（100 ng/mL）in AVICs with PTX3 siRNA transfection. @*Results@#The calcific aortic valves significantly expressed PTX3 as compared with control.LPS dose-dependently increased IL-6，IL-8 and MCP-1 in AVICs. Compared with control groups，100 ng/mL LPS significantly increased IL-6，IL-8 and MCP-1 mRNA（P<0.05，P<0.01）. PTX3 siRNA markedly decreased the levels of PTX3 protein compared with control groups（P<0.01）. Levels of IL-6，IL-8 and MCP-1 were significantly reduced in LPS plus PTX3 siRNA group compared with controls（all P<0.05）.@*Conclusion@#The calcific aortic valves have a higher level of PTX3 than control valves.LPS stimulates the expression of IL-6，IL-8 and MCP-1 in AVICs，but silencing PTX3 gene significantly inhibits LPS-stimulated expression of IL-6，IL-8 and MCP-1. PTX3 may play a role in CAVD pathogenesis by regulating expression of inflammatory factors

Surgical Outcomes and Autograft Function after the Ross Procedure in Neonates and Infants / 日本心臓血管外科学会雑誌

Objective: In Japan, only a few reports of the Ross procedure in neonates and infants have been published. The objective of this study was to evaluate the outcome of patients undergoing a Ross procedure before the age of one year, and to review the validity of opting for this procedure at this age. Methods: The records of 13 infants (including three neonates) undergoing a Ross procedure between December 1996 and June 2017 were reviewed. Major outcomes studied included graft-associated morbidity, autograft function, and the need for reoperation. Results: The median age at the time of Ross procedure was 166 days, and median weight was 5.7 kg. Primary diagnoses were aortic stenosis in 10 cases and aortic insufficiency in three. Nine cases required emergent Ross procedure due to left ventricular dysfunction refractory to medication, requirement of mechanical ventilation or intravenous inotropic drugs. Concomitant procedures included three aortic coarctation repairs, two annular enlargement procedures with a Konno incision and one each of aortic and mitral annuloplasty. The mean cross-clamp time was 131 min and the mean extracorporeal circulation time was 178 min. Two cases required extracorporeal membrane oxygenation. Seven underwent delayed sternal closure and four required postoperative peritoneal dialysis. The median duration of mechanical ventilation was five days and the median length of intensive care unit stay was seven days. Survival was 100% at a median follow-up of 9.9 years. The diameter of the aortic annulus mostly stayed within normal limits, although sinus of Valsalva's enlargement beyond normal value was noted in some cases. Trans-aortic valve pressure gradient was less than 20 mmHg and aortic insufficiency was less than mild in all cases, thus requiring no reintervention for the valve. Two cases required coronary arterial bypass and release of the subaortic stenosis. Freedom from reoperation for the left heart was 100% at one year, and 81.5% at five years and 10 years. Ten cases required reoperation for the right heart, and freedom from reoperation was 84.6% at one year, 29.7% at five years and 9.9% at 10 years. Conclusion: Durability of the pulmonary autograft was excellent. The Ross procedure can be an effective treatment strategy for severe aortic valve diseases in neonates and infants.

Association mechanism of plasma protein convertase subtilisin/Kexin type 9 and calcific aortic valve disease / 中国免疫学杂志

Objective:To evaluate the association between the level of plasma proprotein convertase subtilisin/Kexin 9 (PCSK9) with incidence and severity of calcified aortic valve disease(CAVD).Methods:We prospectively recruited 120 CAVD patients with at least increased echo density and 40 control patients by transthoracic echocardiography.All patients were grouped by CT quantitative scoring system:aortic valve calcification (AVC)1,2,3 and 4.Calcium score of aortic valve were calculated.Total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C),triglyceride (TG), carrying lipoprotein A1 (apo A1) and apolipoprotein B (apo B),lipoprotein (a) {LP (a)} and hypersensitive C-reactive protein (hsCRP) were detected by biochemical analyzer.Plasma PCSK9 levels were measured by enzyme-linked immunosorbent assay.The re-lationship between AVC and plasma PCSK9 level,blood lipid,Apo A1,Apo B and hsCRP was analyzed.Results:The data indicated that Apo,B Lp(a) and LDL-C levels in AVC2-4 level was significantly higher than that of AVC1(P<0.05),while TG,APO,A1 HDL-C and hsCRP were not different significantly in the four groups.The levels of TC in group AVC3 and AVC4 were significantly higher than those in group AVC1(P<0.05).At the same time,the patients of grade AVC2-4 have higher level of plasma PCSK9 than patients of group AVC1(P<0.05).Correlation analysis was performed and aortic valve calcium score were significantly correlated with TC (r=0.248,P=0.026),LDL-C (r=0.222,P=0.048),Lp(a) (r=0.276,P=0.013),Apo A1(r=0.245,P=0.012),Apo B(r=0.212, P=0.019) and PCSK9(r=0.309,P=0.005) in all study subjects.PCSK9 was positively correlated with TC,LDL,LP (a),Apo A1, Apo,and no correlation with hsCRP (B).Conclusion:The level of PCSK9 in CAVD patients was significantly higher than that in control group.And there is an association of PCSK9 levels with the presence of CAVD,however.

Calcific aortic valve disease: A review of the pathogenesis and therapeutical trends / 第二军医大学学报

The incidence of calcific aortic valve disease (CAVD) has increased dramatically as a result of the decline in rheumatic fever and the increase of the aging population, and by now CAVD has become the most common cardiac valve disease in the elderly in China. CAVD used to be thought as an irreversible passive process relating to valve degeneration and calcium accumulation. However, latest research has shown that CAVD is a complex active process, which involving vascular endothelial injury, lipid infiltration, chronic inflammation, matrix remodeling, cell differentiation, progressive bone formation, and neovascularization. Besides, genetic mutation also play a significant role in the process. Novel therapeutic target and technology such as transcatheter aortic valve implantation have been developed, which casts new lights on CAVD prevention and treatment. This review focused on the current understanding of the pathogenesis and future diagnosis/ therapies of CAVD.

Biological characteristics of valvular interstitial cells in calcific aortic valve disease / 第二军医大学学报

To observe the biological characteristics of valvular interstitial cells in calcific aortic valve disease (CAVD), so as to lay a foundation for future study. Methods Tissue culture inoculation and immunomagnetic bead separation method were used to isolate the valvular interstitial cells from the normal aortic valves and CAVD valves. The morphological and behavioral characteristics of the isolated valvular interstitial cells were observed. Immunocytochemistry and flow cytometry an alysis were employed to determine cellular immunophenotype. Results Compared to normal valvular interstitial cells, CAVD valvular interstitial cells displayed a myofibroblast- and osteoblast- like morphology. When the cell density reached acertain level, they spontaneously retracted from the neighboring areas and grouped into aggregates, forming calcific nodules. Furthermore, CAVD valvular interstitial cells cultured in vitro were positive for myofibroblast markera α-SMA and osteoblast marker alkaline phosphatase. Conclusion Biological characteristic change of CAVD valvular interstitial cells might be the major reason for the thickening, calcification, and commissural fusion in CAVD valvular samples.

A Clinicopathological Study on Aortic Valves in Children / 华中科技大学学报（医学）（英德文版）

In order to investigate the clinicopathological characteristics of aortic valve disease in children, all the native surgically excised aortic valves obtained between January 2003 and December 2005 were studied macroscopically and microscopically. The patients' medical records were reviewed and the clinical information was extracted. According to preoperative echocardiography, intraoperative assessment, and postoperative pathology, combined with clinical symptoms and signs, aortic valve diseases were divided into three categories: aortic stenosis (AS), aortic insufficiency (AI), and aortic stenosis with insufficiency (AS-AI). The etiology was determined according to the macroscopic, microscopic and clinical findings. The results showed that among 70 aortic valves, patient age ranged from 6 to 18 years, with a mean of 15.4 years, and there were 56 boys and 14 girts (male: female=4:1). Forty-four children only had pure aortic valve disease, and the other 26 children had aortic valve disease associated with other heart valve diseases. There were 5 cases of AS (7.14%), 60 cases of AI (85.71%) and 5 cases of AS-AI (7.14%). The causes were congenital aortic valve malformation (32 cases, 45.71%), rheumatic disease (28 cases, 40%), infective endocarditis (7 cases,10%), Marfan syndrome (2 cases, 2.86%), and undetermined (1 case, 1.43%). It was concluded that the common causes of aortic valve disease in order of frequency in children were congenital aortic valve malformation, rheumatic disease, infective endocarditis, and Marfan syndrome. AI was more common in children with aortic valve disease. Compared with adult patients, congenital bicuspid aortic valve in children was often AI. Histologically, the leaflets of congenital bicuspid aortic valve were mainly myxomatous, fibrosis and calcification less seen. AI was frequently found in rheumatic disease, mostly associated with other heart valve diseases. Macroscopic and microscopic examinations together with clinical information, echocardiographic findings and operative details were important in evaluating the etiology of aortic valve disease.