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Patients with rheumatic heart disease (RHD) undergoing non-cardiac surgeries present a challenge for anesthesiologists. This case report discusses the anesthetic management of a 56-year-old female with severe mitral stenosis, posted for acetabulum fracture ?xation. The patient's history revealed RHD with severe mitral stenosis, mild mitral regurgitation, and severe pulmonary hypertension. Considering the risks associated with neuraxial anesthesia in mitral stenosis, general anesthesia (GA) with a Pericapsular Nerve Group (PENG) block was chosen. The patient was carefully premedicated, induced with appropriate drugs, and monitored intraoperatively. The PENG block, performed under ultrasound guidance, aimed to reduce hip pain without causing motor blockade. The patient remained hemodynamically stable throughout the surgery, and postoperatively, the combination of GA with PENG block provided effective pain control, reducing the need for opioids. This approach contributed to an early recovery, emphasizing the importance of tailored anesthesia strategies for valvular heart disease patients undergoing non-cardiac surgeries.

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Objective:To explore the effectiveness and feasibility of strengthening inspiratory muscle training program matching the preoperative waiting time for patients with valvular heart disease in China with limited resources in preventing postoperative pulmonary complications(PPCs). Method:Patients undergoing elective heart valve surgery were randomly divided into control group and inter-vention group,with 65 patients in each group.All the enrolled patients received a routine physical therapy pro-gram before surgery,and the intervention group received an additional 3 days of enhanced inspiratory muscle training program before surgery.The incidence of postoperative complications was recorded for all patients with-in 14 days after surgery,respiratory function and motor capacity(6-minute walking test)were tested for all patients on the day of admission and discharge,and the length of postoperative hospital stay was counted. Result:Compared with the control group,the incidence of PPCs was lower in the intervention group(OR 2.18,95％CI 1.07-4.47,P-0.03),and the walking distance was longer(P=0.01).There was no statistical difference in lung function and length of hospital stay(P＞0.05),and no adverse events occurred during train-ing.There was no significant difference in general demographic characteristics between the two groups before treatment.The incidence of PPCs in the intervention group was lower than that in the control group(P＜0.05),and the 6-minute walking distance at discharge was higher than that in the control group(P＜0.05).There were no statistically significant differences in lung function and postoperative hospital stay between the intervention group and the control group(P＞0.05),and no adverse events occurred during training. Conclusion:Enhanced inspiratory muscle training 3 days before surgery is safe and feasible in patients with elective heart valves and can reduce postoperative pulmonary complications and improve the level of motor function at discharge.

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Objective To investigate the expressions of 12 cytokines(IL-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17,IFN-α,IFN-γ,TNF-α)and procalcitonin in patients with infective endocarditis(IE).Methods Ten IE patients admitted to our hospital from December 2021 to December 2022 were included into the IE group,10 patients with non-infectious and non-rheumatic valvular diseases who were admitted to our hospital at the same period were randomly selected as the control group,and blood sampling of all patients were conducted at admission.The expressions of 12 cytokines and blood routine indexes were detected by flow cytometry,and the level of procalcitonin was detected by ELISA.The correlations among the expression levels of cytokines in IE patients were analyzed by Pearson method and the correlations of IL-8 level and white blood cell count with procalcitonin in IE patients were analyzed by Spearman method.Results Compared with the control group,the levels of cytokines of IL-1β,IL-2,IL-6,IL-10,TNF-α,IFN-α,IFN-γ and IL-12p70 in the IE group were significantly increased(P<0.05),the white blood cell count,neutrophil percentage and procalcitonin were significantly increased(P<0.05).There was no significant difference in the percentage of monocytes between the two groups(P>0.05).IFN-α of IE patients was positively correlated with IL-2,TNF-α,IL-1β and IL-12p70,IL-2 was positively correlated with TNF-α and IL-1β,IL-12p70 was positively correlated with IFN-γ,and procalcitonin was significantly positively correlated with IL-8 and white blood cell count,with statistically significant differences(P<0.05).Conclusion The levels of IL-1β,IL-2,IL-6,IL-10,TNF-α,IFN-α,IFN-γ,IL-12p70 and procalcitonin in IE patients are significantly higher than those in the normal population,and the detections of these indicators are of guiding significance for the early diagnosis of IE and the evaluation of the severity of the disease.

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Objective To explore the nursing effect of PDCA circulation nursing model based on health concept on patients with valvular heart disease.Methods A total of 116 patients with valvular heart disease hospitalized in Jinhua People's Hospital from December 2018 to December 2021 were selected as study objects.According to random number table method,the included patients were divided into control group and observation group,with 58 cases in each group.The patients in control group received routine nursing intervention,while the patients in observation group received PDCA circulation nursing intervention.The quality of life,self-rating anxiety scale(SAS)score,self-rating depression scale(SDS)score,complications and nursing satisfaction of two groups were compared.Results After nursing,the scores of physical function,psychological function,social function and overall quality of life in two groups were significantly higher than those before nursing(P<0.05),and the scores of above indexes of patients in observation group were significantly higher than those in control group(P<0.05).After nursing,SAS and SDS scores of two groups were significantly lower than those before nursing(P<0.05),and SAS and SDS scores of observation group were significantly lower than those of control group(P<0.05).The complication rate of observation group was significantly lower than that of control group(χ2=4.668,P=0.003).There was no significant difference in nursing satisfaction between two groups(χ2=2.511,P=0.113).Conclusion Patients with valvular heart disease can improve their quality of life,relieve anxiety and depression,and reduce complications by using PDCA circulation nursing model based on health concept.

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@#Objective     To evaluate the risk factors for postoperative in-hospital mortality in elderly patients receiving cardiac valvular surgery, and develop a new prediction models using the least absolute shrinkage and selection operator (LASSO)-logistic regression. Methods     The patients≥65 years who underwent cardiac valvular surgery from 2016 to 2018 were collected from the Chinese Cardiac Surgery Registry (CCSR). The patients who received the surgery from January 2016 to June 2018 were allocated to a training set, and the patients who received the surgery from July to December 2018 were allocated to a testing set. The risk factors for postoperative mortality were analyzed and a LASSO-logistic regression prediction model was developed and compared with the EuroSCOREⅡ. Results     A total of 7 163 patients were collected in this study, including 3 939 males and 3 224 females, with a mean age of 69.8±4.5 years. There were 5 774 patients in the training set and 1 389 patients in the testing set. Overall, the in-hospital mortality was 4.0% (290/7 163). The final LASSO-logistic regression model included 7 risk factors: age, preoperative left ventricular ejection fraction, combined coronary artery bypass grafting, creatinine clearance rate, cardiopulmonary bypass time, New York Heart Association cardiac classification. LASSO-logistic regression had a satisfying discrimination and calibration in both training [area under the curve (AUC)=0.785, 0.627] and testing cohorts (AUC=0.739, 0.642), which was superior to EuroSCOREⅡ. Conclusion     The mortality rate for elderly patients undergoing cardiac valvular surgery is relatively high. LASSO-logistic regression model can predict the risk of in-hospital mortality in elderly patients receiving cardiac valvular surgery.

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Objectives:To evaluate and predict the risk for in-hospital mortality in elderly patients receiving cardiac valvular surgery preferably,we developed a new prediction model using machine learning. Methods:Clinical data including baseline characteristics,peri-operative data and primary endpoint of 7 163 elderly patients aged 65 years or older undergoing cardiac valvular surgery from January 2016 to December 2018 from 87 hospitals were collected from the Chinese Cardiac Surgery Registry(CCSR).Patients from January 2016 to June 2018 were assigened to the training cohort(n=5 774)and patients from July to December 2018 were assigened to the validation cohort(n=1 389).The primary endpoint was in-hospital mortality.Machine learning algorithms were used to analyze risk factors and develop prediction model. Results:Overall in-hospital mortality was 4.1%.Linear discriminant analysis(LDA),support vector classification(SVC)and logistic regression(LR)models in the training cohort all have high AUCs and low Brier scores,with good discrimination and calibration.In validation cohort,the AUC of LDA,SVC and LR were 0.744,0.744 and 0.746 respectively,which were significantly better than that of 0.642 using the European System for Cardiac Operative Risk Evaluation II(EuroSCORE II)model(P<0.05). Conclusions:The mortality rate for elderly patients undergoing cardiac valvular surgery is relatively high.LDA,SVC and LR can predict the risk for in-hospital mortality in elderly patients receiving cardiac valvular surgery with high accuracy.

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Resumo Fundamento: O pós-operatório de cirurgia cardíaca valvar é desafiador devido ao risco de sangramento, levando a complicações e aumento da morbimortalidade. Objetivo: Desenvolver um escore de risco para prever hemorragia em pacientes no pós-operatório de cirurgia valvar. Métodos: Estudo retrospectivo de pacientes submetidos a cirurgia valvar entre 2021 e 2022 no IDPC. Pacientes com sangramento maior foram selecionados com base nos critérios de BARC e Bojar. Foi realizada uma análise de regressão logística para fatores relacionados ao sangramento e foi criado um nomograma. Para significância estatística, foram considerados p<0,05 e um intervalo de confiança de 95%. O estudo foi aprovado pelo CEP. Resultados: Foram analisados 525 pacientes com idade média de 56 anos e predomínio do sexo feminino. A valvopatia mais comum foi a insuficiência mitral, 8,8% apresentaram sangramento aumentado e houve 4,3% de reabordagens cirúrgicas. As variáveis com significância estatística foram: insuficiência tricúspide (OR 3,31, p < 0,001), doença renal crônica/lesão renal aguda (OR 2,97, p = 0,006), hemoglobina pré-operatória (OR 0,73, p < 0,001), reoperações (OR 2,5, p = 0,003), tempo de circulação extracorpórea (CEC) (OR 1,12, p < 0,001), abordagem de 2 valvas OR de 2,23 (p = 0,013), uso de concentrado de hemácias OR de 2,8 (p = 0,001). No modelo múltiplo a insuficiência tricúspide, tempo de CEC e hemoglobina pré-operatória alcançaram significância estatística. Conclusão: O tempo de CEC, hemoglobina pré-operatória e insuficiência tricúspide associaram-se independentemente com hemorragia pós-operatória. A escala proposta é plausível, e pode auxiliar na predição de risco de sangramento.

Abstract Background: The postoperative period of heart valve surgery is challenging due to the risk of bleeding, leading to complications and increased morbidity and mortality. Objective: To develop a risk score to predict bleeding in patients after valve surgery. Methods: Retrospective study of patients operated on between 2021 and 2022. Patients with major bleeding were selected based on the BARC and Bojar criteria. A logistic regression analysis was performed for factors related to bleeding and a nomogram of scores was created. For statistical significance, p<0.05 and a 95% confidence interval were considered. The study was approved by the CEP. Results: 525 patients were analyzed, with a mean age of 56 years and a predominance of females. The most common valve disease was mitral insufficiency, 8.8% had increased bleeding and 4.3% had surgical reoperations. The variables with statistical significance were tricuspid insufficiency (OR 3.31, p < 0.001), chronic kidney disease/acute kidney injury (OR 2.97, p = 0.006), preoperative hemoglobin (OR 0.73, p < 0.001), reoperations (OR 2, 5, p = 0.003), cardiopulmonary bypass (CPB) time (OR 1.12, p < 0.001), 2-valve approach OR of 2.23 (p = 0.013), use of packed red blood cells OR of 2.8 (p = 0.001). In the multiple model, tricuspid insufficiency, CPB time and preoperative hemoglobin reached statistical significance. Conclusion: CPB time, preoperative hemoglobin and tricuspid insufficiency were independently associated with postoperative bleeding. The proposed scale is plausible and can help predict the risk of bleeding.

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Valvular heart disease can be acquired or congenital. Although the incidence of rheumatic heart disease is on the decline, the number of patients with congenital heart disease who survive into adulthood has grown substantially over the past 30 years. Therefore, a large number of patients with valvular heart disease will be of childbearing age. Here we presented a case of second gravida who was diagnosed with rheumatic heart disease and had undergone mitral valve prosthesis and tricuspid valve repair delivered a healthy live male baby weighing 2.250 kg.

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Percutaneous transvenous mitral commissurotomy (PTMC) is the procedure of choice for select patients with mitral valve disease who have favorable valve architecture and meet the requirements for balloon valve dilatation. Complications following PTMC are rare (<3%). A 56-year-old woman with rheumatic valvular heart disease, severe mitral stenosis and moderate mitral regurgitation in atrial fibrillation underwent elective PTMC. She developed an extra-cardiac perforation during PTMC because of abnormal catheter course, and underwent emergency mitral valve replacement with extra-cardiac perforation repair. Catheter-related complications following PTMC are rare but not unheard of. Prompt management of immediate complications result in favorable outcomes.

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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.

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Objective:To analyze the clinical characteristics of infantile Takayasu Arteritis (TAK) complicated with cardiac involvements.Methods:The clinical data and cardiac lesions of infantile TAK were collected retrospectively, and the clinical characteristics of the disease were analyzed and summarized. Mainly using decriptive statistical methods.Results:In these 20 cases, 16 cases (80%) had cardiac involvements, only 2 cases had related symptoms. The common lesions were coronary artery lesion (CAL), valvular disease, and elevated myocardial enzymes, while the rare lesions were arrhythmia, pericardial effusion, hypertensive heart disease, and heart failure. One case had acute heart failure, which was systolic heart failure and was accompanied by hypertensive heart disease. All 14 patients with CAL were found by conventional coronary ultrasound screening. A total of 39 CAL were found, all of which were coronary artery dilation, and the left main coronary artery was involved. Five patients had heart valve disease, all of them were valve insufficiency. The involved valves were mitral and tricuspid valves, and one of them was severe insufficiency. Arrhythmias were found in 2 cases, of which P1 was found to have paroxysmal atrial tachycardia with high atrioventricular block at 3 months. All 20 children survived and were in stable condition after being treat with biological agents and/or glucocorticoids. A case of hypertensive heart disease complicated with heart failure was followed up for 4 years, and the cardiac function and blood pressure returned to normal. Fourteen children with CAL lesions were given oral aspirin disease, the CALs disappeared in 10 cases and retracted in 4 cases. During the follow-up of 5 children with heart valves, insufficiency disappeared in 4 cases and improved in 1. No child underwent valve replacement during the follow-up. One of the children with arrhythmia was treated with antiarrhythmic drugs. After treatment, the arrhythmia disappeared. Now they have been followed up for 5 years without recurrence.Conclusion:Infantile TAK has a high incidence of heart involvement, with extensive lesions but insidious clinical symptoms. CALs are common, and heart failure is rare. It should be evaluated and treated as early as possible.

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In the theoretical teaching of valvular heart disease, the traditional teaching method makes the learners feel very abstract and the learning effect is poor. In bedside teaching, the heart characteristics of specific patients cannot be directly displayed to learners, and learners are difficult to construct theoretical knowledge and clinical performance. Based on the clinical bedside internship based on experiential learning theory, this study uses cardiac virtual image technology to reconstruct the cardiac images of clinical patients, restoring the internal structure of their hearts, supplemented by dynamic blood flow images, to make learners can clarify the relationship between cardiac morphology and hemodynamics, so that learners can intuitively learn these knowledge. Through the teaching practice of this study, it is found that high-quality curriculum design and guided teaching combined with the application of new VR technology can significantly improve the learning experience and effect of learners.

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Objective:To evaluate the clinical and echocardiographic characteristics of valvular involvement in SLE patients and its predictive value for valvular outcome.Methods:A retrospective study included 58 adult SLE patients with valvular involvement diagnosed for the first time by echocardiography in the First Affiliated Hospital of Wenzhou Medical University. According to gender and age, 1∶2 SLE patients without valvular involvement were selected as the control group. Clinical and echocardiographic data within 24 hours after initial admission were collected. The predictive factors were analyzed using cox parametric regression analysis.Results:①Among 58 patients,significant valve lesions were detected by echocardiography in 50 and presented as valve thickening with regurgitation. The mitral valve was the most commonly affected, followed by the aortic valves. ②Compared with the non-valvular involvement group, the percent of CRP, SLC-R, IgA、aCL-IgG were higher in the valvular involvement group [CRP:60.3% vs 30.4%, χ2=10.54, P=0.001; SLC-R: 63.8% vs 19.8%, χ2=33.08, P<0.001; IgA:27.6% vs 22.4%, χ2=16.04, P<0.001; aCL-IgG: 27.6% vs 2.6%, χ2=24.84, P<0.001]. ③Cox parametric regression analysis showed that CRP [ HR (95% CI)=2.641(1.499, 4.654), P=0.001,SLC-R HR(95% CI)=3.234(11.776, 5.888), P<0.001], and aCL-IgG[ HR(95% CI)=2.166 (1.148, 4.087) , P=0.017] were independent predictors of valvular involvement. Conclusion:SLE patients with increased levels of CRP、SLC-R、IgA and aCL-IgG have a high risk of valvular involvement. CRP、SLC-R and aCL-IgG are independent predictors of valvular involvement.

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Resumo A doença valvar cardíaca é um problema de saúde crescente no mundo. Os pacientes com valvopatia podem apresentar diversas emergências cardiovasculares. O manejo desses pacientes é um desafio no departamento de emergência, principalmente quando a condição cardíaca prévia é desconhecida. Atualmente, recomendações específicas para o manejo inicial são limitadas. A presente revisão integrativa propõe uma abordagem baseada em evidência, de três etapas, desde a suspeita de valvopatia à beira do leito até o tratamento inicial das emergências. A primeira etapa é a suspeita de uma condição valvar subjacente com base nos sinais e sintomas. A segunda etapa consiste na tentativa de confirmação diagnóstica e avaliação da gravidade da valvopatia com exames complementares. Finalmente, a terceira etapa aborda as opções diagnósticas e terapêuticas para insuficiência cardíaca, fibrilação atrial, trombose valvar, febre reumática aguda, e endocardite infecciosa. Além disso, apresentamos imagens de exames complementares e tabelas para apoio aos médicos.

Abstract Valvular heart disease (VHD) is an increasing health problem worldwide. Patients with VHD may experience several cardiovascular-related emergencies. The management of these patients is a challenge in the emergency department, especially when the previous heart condition is unknown. Specific recommendations for the initial management are currently poor. This integrative review proposes an evidence-based three-step approach from bedside VHD suspicion to the initial treatment of the emergencies. The first step is the suspicion of underlying valvular condition based on signs and symptoms. The second step comprises the attempt to confirm the diagnosis and assessment of VHD severity with complementary tests. Finally, the third step addresses the diagnosis and treatment options for heart failure, atrial fibrillation, valvular thrombosis, acute rheumatic fever, and infective endocarditis. In addition, several images of complementary tests and summary tables are provided for physician support.

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Aims: To study the clinical and pathological manifestations of missed cases of rheumatic heart disease (RHD) and postulate possible reasons behind a missed diagnosis. Materials and Methods: Retrospective 20-year (2000–2019) autopsy data of chronic RHD were reviewed and patients, in whom the valvular deformities had been incidental autopsy findings, were selected. The clinical details of these patients were correlated with the morphology of the affected valves. On this pathological analysis, the patients were assigned to a category of subtle or significant valvular deformity. By clinically correlating, the latter group was subdivided into clinically misdiagnosed, clinically undiagnosed, and sudden cardiac death. Statistical Analysis: Nil. Results: Among the 475 cases of chronic RHD identified at autopsy in the study period, the disease was diagnosed incidentally in 69 patients (14.5%). Significant valvular deformity was noted in 61 cases while the other 8 cases had subtle valvular deformity. The most common cause of death was cardiac failure in 39 out of 69 patients (56%). Eleven (16%) patients had experienced sudden cardiac death. Among the undiagnosed cases, 5 (7%) of them had a diagnosis of non-rheumatic cardiac disease, while the other 14 (20.5%) patients had overwhelming non-cardiac diseases. Conclusions: Our study indicates that mortality and morbidity due to RHD are underdetermined. The patients remain undiagnosed due to either insignificant valvular involvement, clinically silent in the presence of significant valvular deformity, presence of other overwhelming diseases or misdiagnosis partly due to the resemblance with the other pathologies.

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A rare case of hereditary spherocytosis (HS) and rheumatic mitral stenosis coexisting in a patient having severe stenosis, atrial fibrillation, and symptoms of the left ventricular dysfunction, along with hemolytic anemia attributed to HS. We present the case of a 58-year-old lady who presented to the emergency department with complaints of increasing shortness of breath for the past week. She was examined to have atrial fibrillation with a fast ventricular rate. On investigations, she was found to have severe rheumatic mitral stenosis with evidence of hemolytic anemia. Further, evaluation of the cause of her anemia revealed HS.This case highlights the importance of the evaluation of anemia in patients with valvular heart diseases. If a treatable cause is found, anemia can be treated to reduce the cardiac burden

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Resumen Introducción: La endocarditis infecciosa continúa siendo una condición amenazante para la vida, que puede afectar cualquier órgano y sistema, con alta mortalidad, atribuible principalmente a Staphylococcus aureus. Implica un reto diagnóstico y terapéutico, que requiere un cuidado multidisciplinario. Objetivo: Describir las características clínicas y microbiológicas en pacientes con endocarditis infecciosa. Materiales y método: Estudio observacional descriptivo basado en la revisión de historias clínicas en un centro médico de referencia en Medellín, Colombia, incluyendo pacientes mayores de 18 años hospitalizados durante el periodo de enero de 2011 a febrero de 2017. Resultados: 130 pacientes, con edad promedio de 53 años (± 16). La hipertensión arterial y la enfermedad renal crónica fueron la comorbilidad más frecuente (55% y 38%, respectivamente). La fiebre fue el síntoma cardinal (90%). Predominó la endocarditis infecciosa de válvula nativa (85.7%), afectando principalmente la mitral (40%). El agente etiológico más frecuente fue S. aureus (sensible a oxacilina 44%), y se complicaron con embolia el 52.5% y con falla cardiaca el 30.8%. La mortalidad intrahospitalaria fue del 39.2%. Conclusiones: La endocarditis infecciosa tiene variadas manifestaciones clínicas, entre las que destacan la embolia sistémica y la falla cardiaca aguda, que condicionan una mortalidad elevada (mayor que la reportada en otros estudios). El aislamiento microbiológico más frecuente es el bacteriano, principalmente S. aureus, como lo muestra la tendencia global.

Abstract Background: Infective endocarditis continues to be a life-threatening condition, can involve every organ system, with high mortality, attributable mainly to Staphylococcus aureus. It implies a diagnostic and therapeutic challenge, which requires multidisciplinary care. Objective: To describe the clinical and microbiological characteristics in patients with infectious endocarditis. Materials and method: Descriptive observational study, based on the review of medical records in a reference medical center in Medellín, Colombia. Including patients over 18 years hospitalized during the period from January 2011 to February 2017. Results: 130 patients, with an average age of 53 years (± 16). Hypertension and chronic kidney disease was the most common comorbidity (55% and 38%, respectively). Fever was the cardinal symptom (90%). Native valve infective endocarditis predominated (85.7%), mainly affecting the mitral valve (40%). The most frequent etiologic agent was Staphylococcus aureus (oxacillin sensitive 44%), embolism was the main complication by 52.5% followed by heart failure (30.8%). In-hospital mortality was 39.2%. Conclusions: Infective endocarditis has varied clinical manifestations, including systemic embolism and acute heart failure, which lead to high mortality (higher than that reported in other studies). The most frequent microbiological isolation is bacterial, mainly Staphylococcus aureus, as shown by the global trend.

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Mitral regurgitation in conduction disorders is a rare feature of functional valve regurgitation. In patients with high-grade atrioventricular block, the onset of ventricular ejection may shift with atrial telesystole; in this case, the rise in left ventricular filling pressure after atrial systole, especially in the case of complete atrioventricular block leading to an inversion of the LA-LV gradient during the supraventricular relaxation phase and diastolic mitral insufficiency can gradually set in , as well as secondary tricuspid regurgitation Here we report the observation of a patient admitted for a complete atrioventricular block, with reversible mitral and tricuspid regurgitation after implantation of a pace maker

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Abstract Objectives: Bicuspid aortic valve (BAV) is an important aetiology of aortic stenosis and the use of transcatheter aortic valve implantation (TAVI) has not been fully explored in this cohort. This systematic review and meta-analysis compared the outcomes of TAVI in stenotic BAV against tricuspid aortic valve (TAV). Methods: An electronic literature search was performed in PubMed, MEDLINE, EMBASE, and Scopus to identify all studies comparing TAVI in stenotic BAV versus TAV. Only studies comparing TAVI in BAV versus TAV were included, without any limit on the study date. Primary endpoints were 30-day and 1-year mortality, while secondary endpoints were postoperative rates of stroke, acute kidney injury (AKI), and permanent pacemaker (PPM) requirement. A trial sequential analysis (TSA) was performed for all endpoints to understand their significance. Results: Thirteen studies met the inclusion criteria (917 BAV and 3079 TAV patients). The BAV cohort was younger (76.8±7.43 years vs. 78.5±7.12 years, P=0.02), had a higher trans-aortic valve gradient (P=0.02), and larger ascending aortic diameters (P<0.0001). No significant difference was shown for primary (30-day mortality [P=0.45] and 1-year mortality [P=0.41]) and secondary endpoints (postoperative stroke [P=0.49], AKI [P=0.14], and PPM requirement [P=0.86]). The BAV group had a higher rate of significant postoperative aortic regurgitation (P=0.002). TSA showed that there was sufficient evidence to conclude the lack of difference in PPM requirements, and 30-day and 1-year mortality between the two cohorts. Conclusion: TAVI gives satisfactory outcomes for treating stenotic BAV and should be considered clinically.

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Objective:To explore the effect of self-made dynamic cardiovascular three-dimensional model combined with CBL (case-based learning) teaching method in the clerkship of valvular heart disease for medical students.Methods:Sixty five-year clinical medical undergraduates from Nanjing Medical University (Batch 2016) were randomly divided into experimental group and control group. The experimental group received dynamic cardiovascular 3D model combined with CBL teaching method, while the control group received traditional model combined with CBL teaching method. After the course, the teaching effect was evaluated by examination and questionnaire. SPSS 19.0 was used for independent sample t test and chi-square test. Results:Compared with the control group, the students in experimental group had higher scores of basic theoretical knowledge [(43.10±3.51) vs. (40.87±3.19)] and clinical thinking ability [(42.20±3.15) vs. (40.20±3.81)], with significant differences ( P<0.05). Furthermore, they showed higher evaluation and satisfaction to learning initiative and enthusiasm, mastery of theoretical knowledge, clinical thinking ability, classroom learning interest, classroom activity and clarity of knowledge teaching, with significant differences ( P<0.05). Conclusion:In the teaching of valvular heart disease clerkship, the application of self-made dynamic cardiovascular three-dimensional model combined with CBL teaching method, can cultivate students' clinical diagnostic thinking ability and improve teaching quality.