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.

Curva de Aprendizagem da Mortalidade Hospitalar da Substituição da Válvula Aórtica Transcateter: Insights do Registro Nacional Brasileiro / Learning Curve for In-Hospital Mortality of Transcatheter Aortic Valve Replacement: Insights from the Brazilian National Registry

Resumo Fundamento Dados robustos sobre a curva de aprendizagem (LC) da substituição da válvula aórtica transcateter (TAVR) são escassos nos países em desenvolvimento. Objetivo Avaliar a LC da TAVR no Brasil ao longo do tempo. Métodos Analisamos dados do registro brasileiro de TAVR de 2008 a 2023. Pacientes de cada centro foram numerados cronologicamente em número sequencial de caso (NSC). A LC foi realizada usando um spline cúbico restrito ajustado para o EuroSCORE-II e o uso de próteses de nova geração. Ainda, os desfechos hospitalares foram comparados entre grupos definidos de acordo com o nível de experiência, com base no NSC: 1º ao 40º caso (experiência inicial), 41º ao 80º caso (experiência básica), 81º ao 120º caso (experiência intermediária) e 121º caso em diante (experiência alta). Análises adicionais foram conduzidas de acordo com o número de casos tratados antes de 2014 (>40 e ≤40 procedimentos). O nível de significância adotado foi p <0,05. Resultados Foram incluídos 3194 pacientes de 25 centros. A idade média foi 80,7±8,1 anos e o EuroSCORE II médio foi 7±7,1. A análise da LC demonstrou uma queda na mortalidade hospitalar ajustada após o tratamento de 40 pacientes. Um patamar de nivelamento na curva foi observado após o caso 118. A mortalidade hospitalar entre os grupos foi 8,6%, 7,7%, 5,9%, e 3,7% para experiência inicial, básica, intermediária e alta, respectivamente (p<0,001). A experiência alta foi preditora independente de mortalidade mais baixa (OR 0,57, p=0,013 vs. experiência inicial). Centros com baixo volume de casos antes de 2014 não mostraram uma redução significativa na probabilidade de morte com o ganho de experiência, enquanto centros com alto volume de casos antes de 2014 apresentaram uma melhora contínua após o caso de número 10. Conclusão Observou-se um fenômeno de LC para a mortalidade hospitalar do TAVR no Brasil. Esse efeito foi mais pronunciado em centros que trataram seus 40 primeiros casos antes de 2014 que naqueles que o fizeram após 2014.

Abstract Background Robust data on the learning curve (LC) of transcatheter aortic valve replacement (TAVR) are lacking in developing countries. Objective To assess TAVR's LC in Brazil over time. Methods We analyzed data from the Brazilian TAVR registry from 2008 to 2023. Patients from each center were numbered chronologically in case sequence numbers (CSNs). LC was performed using restricted cubic splines adjusted for EuroSCORE-II and the use of new-generation prostheses. Also, in-hospital outcomes were compared between groups defined according to the level of experience based on the CSN: 1st to 40th (initial-experience), 41st to 80th (early-experience), 81st to 120th (intermediate-experience), and over 121st (high-experience). Additional analysis was performed grouping hospitals according to the number of cases treated before 2014 (>40 and ≤40 procedures). The level of significance adopted was <0.05. Results A total of 3,194 patients from 25 centers were included. Mean age and EuroSCORE II were 80.7±8.1 years and 7±7.1, respectively. LC analysis demonstrated a drop in adjusted in-hospital mortality after treating 40 patients. A leveling off of the curve was observed after case #118. In-hospital mortality across the groups was 8.6%, 7.7%, 5.9%, and 3.7% for initial-, early-, intermediate-, and high-experience, respectively (p<0.001). High experience independently predicted lower mortality (OR 0.57, p=0.013 vs. initial experience). Low-volume centers before 2014 showed no significant decrease in the likelihood of death with gained experience, whereas high-volume centers had a continuous improvement after case #10. Conclusion A TAVR LC phenomenon was observed for in-hospital mortality in Brazil. This effect was more pronounced in centers that treated their first 40 cases before 2014 than those that reached this milestone after 2014.

Resumen: Consenso internacional para la nomenclatura y clasificación de la válvula aórtica bicúspide congénita y su aortopatía, con fines clínicos, quirúrgicos, intervencionistas y de investigación / Summary: International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes

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Abstract This consensus of nomenclature and classification for congenital bicuspid aortic valve and its aortopathy is evidence-based and intended for universal use by physicians (both pediatricians and adults), echocardiographers, advanced cardiovascular imaging specialists, interventional cardiologists, cardiovascular surgeons, pathologists, geneticists, and researchers spanning these areas of clinical and basic research. In addition, as long as new key and reference research is available, this international consensus may be subject to change based on evidence-based data1.

Endocarditis por Haemophilus aphrophilus

La endocarditis infecciosa (EI) es una enfermedad causada por microorganismos que se asientan principalmente en las válvulas cardiacas. Frecuentemente ocurren por laceraciones orales, gastrointestinales y urogenitales, además de procedimientos médicos que pueden causar bacteriemia la cual conlleva a adherencia bacteriana e inflamación local y éstas a destrucción valvular(1,2). Las bacterias grampositivas son mayoritariamente asociadas a EI, y en menor proporción, las del grupo HACEK, saprofitos de la orofaringe, que son responsables de menos del 5% de casos(2-4). Se presenta el caso de un varón de 23 años con cuadro de 1 mes de evolución de sensación febril, sudoración y astenia; al que posteriormente se agrega tos productiva. Se plantea foco probable cardiológico por antecedentes y hallazgos físicos, retornando aislamiento del germen Haemophilus aphrophilus, microorganismo poco habitual.

Infective endocarditis (IE) is a disease caused by microorganisms that settle mainly in the heart valves. They frequently occur due to oral, gastrointestinal and urogenital lacerations, in addition to medical procedures that can cause bacteremia which leads to bacterial adhesion and local inflammation and these to valve destruction(1,2).. Gram-positive bacteria are mostly associated with IE, and to a lesser extent, those of the HACEK group, saprophytes of the oropharynx, which are responsible for less than 5% of cases(2-4). We present the case of a 23-year-old man with a 1-month history of fever, sweating, and asthenia; to which a productive cough is later added. A probable cardiological focus is proposed due to history and physical findings, returning isolation of the Haemophilus aphrophilus germ, an unusual microorganism.

Endocarditis Infecciosa: una mirada desde la semiología, a propósito de un caso / Infectious Endocarditis: a View from Semiology, case report

Infective endocarditis (IE) is an infection of the inner lining of the heart, especially the heart valves, and carries high morbidity and mortality. It can manifest itself acutely or subacutely, the latter being more insidious. Diagnosis is challenging, especially in early stages, requiring high clinical suspicion using modified Duke criteria. Treatment involves antimicrobials and in certain cases cardiac surgery is essential. The clinical case presents a patient with a history of aortic valve replacement, who develops acute symptoms. Although the diagnosis of endocarditis is achieved, a por physical examination delays starting optimal treatment. Early diagnosis is crucial to avoid adverse outcomes. Post-hospital discharge follow-up is essential to identify possible long-term complications.

La endocarditis infecciosa es una infección del revestimiento interno del corazón, especialmente de las válvulas cardíacas, con alta morbimortalidad. Se manifiesta como aguda o subaguda, siendo esta última más insidiosa. El diagnóstico es desafiante, especialmente en etapas tempranas, requiriendo sospecha clínica en pacientes con fiebre, factores de riesgo cardiacos o no cardiacos y el uso de los criterios de Duke- International Society of Cardiovascular Infectious Diseases. El tratamiento implica antimicrobianos y en ciertos casos es imprescindible la cirugía cardiaca. Se presenta un caso clínico de un paciente con antecedentes de reemplazo valvular aórtico, que desarrolla síntomas agudos. Aunque se logra el diagnóstico de endocarditis, un examen físico poco exhaustivo causa retraso en el inicio del tratamiento óptimo. Un diagnóstico temprano es crucial para evitar resultados adversos. Es esencial la vigilancia estrecha post alta hospitalaria debido a complicaciones a largo plazo.

Manejo del tracto de salida del ventrículo derecho con implante percutáneo de válvula Melody en pacientes pediátricos: experiencia en un centro de alta complejidad en Colombia / Management of right ventricular outflow tract with percutaneous Melody valve implantation in pediatric patients: experience in a high complexity center in Colombia

Resumen Antecedentes: Las cardiopatías congénitas plantean un desafío terapéutico, específicamente la estenosis de la válvula pulmonar. Esta ha sido tratada durante muchos años con procedimientos invasivos e inserción de bioprótesis, que con el tiempo se vuelven disfuncionales y pueden reestenosarse por acumulación de tejido fibroso y calcificación. Debido a las complicaciones generadas por la injuria quirúrgica, se han descrito medidas menos invasivas para el manejo de la estenosis residual e inicial por medios endovasculares en adultos y más recientemente en población pediátrica. Objetivo: El objetivo de este reporte es describir la misma en el manejo endovascular del tracto de salida del ventrículo derecho, como el inicio de un trabajo continuo para la mejoría de los resultados pediátricos en países en vía de desarrollo. Métodos: Se presentan siete casos pediátricos de manejo endovascular del tracto de salida derecho; tres de ellos sometidos a valvuloplastia quirúrgica con persistencia de la estenosis pulmonar, por lo cual se decidió inserción percutánea de una válvula pulmonar (IVPP) transcatéter con válvula Melody utilizando la técnica valve-in-valve, con lo que se consiguió una resolución del 100% de la estenosis y no se presentó ningún tipo de complicación asociada al procedimiento. Resultados: En cuatro pacientes se logró una implantación exitosa de la válvula por vía percutánea en diferentes cardiopatías congénitas, siendo uno de ellos en tracto nativo; además, destaca el caso de un paciente en quien se realizó fractura intencional de la válvula pulmonar, procedimiento innovador en el manejo endovascular pediátrico en Colombia. Conclusiones: En estos pacientes el procedimiento resultó ser poco invasivo, seguro y efectivo. La técnica IVPP podría ser considerada una opción viable en Colombia (y en otros países en desarrollo) para el manejo de implantes valvulares primarios fallidos o incluso en tractos nativos.

Abstract Background: Congenital heart disease poses a therapeutic challenge, specifically pulmonary valve stenosis. This has been treated for many years with invasive procedures and bioprostheses, which over time, become dysfunctional due to the accumulation of fibrous tissue and calcification. Objective: The aim of this study is to describe the use of endovascular management in the right ventricular outflow tract, as the beginning of an ongoing effot to improve pediatric outcomes in developing countries. Methods: Seven pediatric patients with endovascular management of the right outflow tract are presented. Three of them underwent surgical valvuloplasty with persistent pulmonary stenosis. They decided to insert a percutaneous transcatheter pulmonary valve (PPVI) with a Melody valve using the valve-in-valve technique, with 100% stenosis and no complications associated with the procedure. Results: Four patients with successful percutaneous valve implantation had different congenital heart diseases. In addition, the case of a patient in whom an intentional pulmonary valve fracture was performed, an innovative procedure in pediatric endovascular management in the country, is highlighted. Conclusions: The procedure was minimally invasive, safe, and effective. The IVPP technique could be a viable option in our country for managing failed primary valve implantations or even in native tracts.

Análisis de la la muerte súbita cardíaca por prolapso de la válvula mitral en una autopsia de una mujer sin antecedente de cardiopatía. Reporte de caso / Analysis of sudden cardiac death due to mitral valve prolapse in an autopsy of a woman with no history of heart disease. Case report

Resumen En Costa Rica, el Reglamento de la Autopsia Hospitalaria y Médico Legal establece que la autopsia médico legal es obligatoria para toda muerte súbita. La patología cardíaca es responsable aproximadamente del 80 % de las muertes súbitas que requieren una autopsia forense; el prolapso de la válvula mitral (degeneración mixomatosa de la válvula mitral) es una de las formas más comunes de valvulopatía cardíaca, es relativamente común (2%-3% de la población general), y a menudo se considera benigno, la tasa anual de muerte cardíaca súbita (MSC) en individuos con MVP (0,2%-0,4% /año) es aproximadamente el doble que el observado en la población general (0,1%-0,2% año).

Abstract In Costa Rica, the Hospital and Legal Autopsy Regulations establish that a legal medical autopsy is mandatory for all sudden deaths. Cardiac pathology is responsible for approximately 80% of sudden deaths requiring a forensic autopsy; Mitral valve prolapse (myxomatous mitral valve degeneration) is one of the most common forms of heart valve disease, is relatively common (2%-3% of the general population), and is often considered benign, the annual rate of Sudden cardiac death (SCD) in individuals with MVP (0.2%-0.4%/year) is approximately twice that observed in the general population (0.1%-0.2%/year).

Anomalía de Ebstein: a propósito de un caso / Ebstein anomaly: about a case

La anomalía de Ebstein es una cardiopatía congénita rara y poco frecuente caracterizada por el adosamiento de los velos valvulares tricuspídeos; en la etapa prenatal se estima que su incidencia corresponde a un 3% de todas las cardiopatías diagnosticadas. Se presenta el caso de un feto con diagnóstico de anomalía de Ebstein a quien se le realizó un diagnóstico prenatal adecuado, lo que permitió planificar el nacimiento neonatal con un equipo multidisciplinario integral. Debido a la rareza del diagnóstico prenatal de esta entidad, se describe el caso clínico y los hallazgos imagenológicos representativos.

Ebsteins anomaly is a rare and infrequent congenital heart disease characterized by the attachment of the tricuspid valve leaflets; in the prenatal stage it is estimated that its incidence corresponds to 3% of all diagnosed heart diseases. We present the case of a fetus diagnosed with Ebsteins anomaly who underwent an adequate prenatal diagnosis, which made it possible to plan the neonatal birth with a comprehensive multidisciplinary team. Due to the rarity of the prenatal diagnosis of this entity, the clinical case and the representative imaging findings are described.

Clinical effectiveness of valve-sparing aortic root replacement in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot / 中国胸心血管外科临床杂志

@#Objective     To evaluate the clinical effectiveness of valve-sparing aortic root replacement (VSARR) in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot (TOF). Methods     A retrospective analysis was conducted on clinical data of TOF patients with aortic root dilation who underwent VSARR in our hospital from 2016 to 2022. Results     Finally 14 patients were collected, including 8 males and 6 females, with a median age of 22 years ranging from 12-48 years. Among them, 5 patients had severe aortic valve regurgitation, 4 moderate regurgitation, and 5 mild or no regurgitation. Six patients had sinus of valsalva dilation, and 8 significant dilation of the ascending aorta. One patient had residual shunt due to ventricular septal defect, and 9 severe pulmonary valve regurgitation. The David procedure was performed in 10 patients, Yacoub procedure in 2 patients, and Florida sleeve in 2 patients. There was no perioperative mortality in the group. The median follow-up time was 2.9 years (ranging from 0.4 to 6.0 years). One patient had mild aortic valve regurgitation, and the rest had minimal or no regurgitation. One patient had mild stenosis of the left ventricular outflow tract, and the rest patients had no obvious stenosis. Conclusion     VSARR is a satisfactory treatment for aortic root dilation in patients with TOF, with no significant increase in the incidence of left ventricular outflow tract stenosis or aortic regurgitation during mid-term follow-up.

Observation of the prophylactic use of prokinetic agents in patients after tricuspid valve replacement under cardiopulmonary bypass / 药学实践与服务

Objective To analyze the postoperative therapeutic effect of prokinetic agents in patients after tricuspid valve replacement （TVR） under cardiopulmonary bypass. Methods Patients received TVR under cardiopulmonary bypass （during June 2010 to December 2021） in the department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University were selected as the subjects of our study. The data of basic characteristics, first postoperative defecation time and postoperative recovery condition were collected and retrospectively analyzed in the patients taking prokinetic agents within three days after surgery （prevention group） and patients not taking prokinetic agents within three days after surgery （control group）. Results A total of 184 patients were selected, including 101 in the prevention group and 83 in the control group. The first defecation time of patients in the prevention group was significantly earlier than that in the control group （P<0.05）. The incidences of abdominal distension and pulmonary infection in the prevention group were significantly lower than that in the control group. The length of time in ICU, postoperative mechanical ventilation and nasogastric tube decompression in the prevention group were significantly shorter than that in the control group （P<0.05）. Conclusion Taking prokinetic agents within three days after TVR under cardiopulmonary bypass could effectively improve the prognosis of patients.

Advances in risk factors for restenosis after percutaneous balloon pulmonary valvuloplasty for congenital pulmonary valve stenosis / 国际儿科学杂志

Congenital pulmonary valve stenosis（PS）is a common congenital heart disease. Simple PS makes up approximately 8%~10% of congenital heart disease，and 20% of complex congenital heart disease complicated with PS. Percutaneous balloon pulmonary valvuloplasty（PBPV），which has undergone nearly 40 years of continuous improvement，has emerged as the preferred treatment for PS due to its superior safety and less trauma. However，residual stenosis was found in some patients during long-term follow-up，and repeat PBPV or even surgical repair was required. Identifying the risk factors for postoperative restenosis will further improve postoperative outcomes and reduce the probability of reintervention in the future. This article reviews the risk factors for restenosis of PS after PBPV including age，severity，morphologic characteristics of the valve leaflets and the choice of the balloon.

Advances in cardiovascular diseases in children with Turner syndrome / 国际儿科学杂志

Turner syndrome（TS），a condition among females with a karyotype containing one X chromosome and complete or partial absence of the second sex chromosome，affects 20～50 in 100 000 newborn girls. Congenital or acquired cardiovascular diseases are present in about half of patients with TS. The congenital defects occur in about 25%～50% of TS patients；aortic dilatation as an important risk factor for aortic dissection is common in adult patients with TS. Furthermore，arrhythmias are found more frequently in patients with TS. A higher prevalence of hypertension in children and adolescents with TS has also been reported，and the application of 24h ambulatory blood pressure monitoring may facilitates the diagnosis of hypertension among these children and adolescent.Thus，active health education，correct follow-up and timely intervention are crucially needed.

Outcome analysis of functional mitral regurgitation after transcatheter aortic valve replacement in patients with severe bicuspid aortic stenosis / 复旦学报（医学版）

Objective To explore the relationship between the types of bicuspid aortic valves(BAV)and the outcome of functional mitral regurgitation(FMR)and the affecting factors of FMR.Methods From Jun 2018 to Sep 2022,patients with severe BAV aortic valve stenosis(AS)complicated with FMR underwent post transcatheter aortic valve replacement(TAVR)in Zhongshan Hospital,Fudan University were retrospectively analyzed.The baseline information and imaging data of different BAV patients were collected.Logistic regression was used to analyze the factors affecting the outcome of FMR(improvement and non-improvement).Result A total of 100 patients with TAVR were included,including 49 patients with type 0 of BAV and 51 patients with type 1 of BAV.Compared with patients of type 1,patients of type 0 had younger age[(72.78±6.09)y vs.(77.00±8.35)y,P=0.050],lower male ratio(47%vs.73%,P= 0.009)higher BMI[(23.19±2.62)kg/m2 vs.(21.99±3.13)kg/m2,P=0.041],and lower incidence of aortic regurgitation(69%vs.92%,P=0.040).Compared with the non-improvement group,the improvement group had a lower incidence of coronary heart disease(5%vs.18%,P=0.042),higher incidence of pulmonary hypertension(20%vs.2%,P=0.007),larger left ventricular diastolic diameter[(51.98±6.74)mm vs.(48.04±7.72)mm,P=0.009]and higher maximum flow velocity[(4.86±0.95)cm/s vs.(4.47±0.75)cm/s,P= 0.023]of the aortic valve.The results of Logistic regression analysis showed that preoperative pulmonary hypertension,left ventricular end-diastolic diameter and maximum valvular flow velocity of BAV patients were the potential affecting factors of FMR improvement after TAVR.Conclusion No significant difference was found in FMR improvement between BAV patients of type 0 and type 1 after TAVR.For BAV patients with AS,preoperative pulmonary hypertension,larger left ventricular end-diastolic diameter,and faster aortic valve flow velocity were associated with higher FMR improvement rate.

Research advances in animal models of tricuspid regurgitation / 复旦学报（医学版）

Tricuspid regurgitation(TR)cases are widely distributed in China.Poor clinical drug efficacy,high surgical risk,and poor prognosis for right heart failure are found in patients with moderate or severe TR.In recent years,with the innovation of valve instruments and the development of technology,transcatheter tricuspid valve treatment could be a new choice for high-risk TR patients in surgery.Many TR animal models have emerged these years for the research of the mechanism of TR and for the clinical verification of instruments.Therefore,this review focuses on how to develop an animal model of TR and discusses the advantages and disadvantages of these techniques.

Postoperative care of one case with multiple aortic valve surgery after implantation of a new no-suture of biological valve / 中国实用护理杂志

To summarize the perioperative nursing experience of a patient with the first multiple aortic valve operation in China implanted a new non-sutured biological heart valve. The main contents of nursing included through capacity management, prevention and control of bleeding and thrombocytopenia, arrhythmia monitoring and correction, infection prevention and control, analgesic sedation, prevention of related complications, whole-course psychological counseling and nutritional support. After careful treatment and nursing, the patient recovered well and was transferred out of ICU in 4 days and discharged in 10 days.

A one-stop comparative study of CTA scan delay protocol for TAVI/TAVR patients / 西安交通大学学报(医学版)

Objective To compare the effect of preoperative CTA examination using group injection test and group injection tracking delay protocol on image quality in patients with transcatheter aortic valve implantation(TAVI)/transcatheter aortic valve replacement(TAVR).Methods A total of 43 patients who underwent TAVI/TAVR preoperative one-stop CTA examination in our hospital were randomly divided into two groups,and preoperative CTA examination was performed using group injection tracking and group injection test.After the scanning was completed,the aortic root sinus(C1),the proximal left and right coronary arteries(C2,C3),the ascending aorta(A1),the abdominal aorta(A2),the left and right femoral arteries(A3,A4),and the CT value and SD value of the paraspinal muscles of the same layer were measured;the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the corresponding parts were calculated.The obtained data results were compared and analyzed from both subjective and objective aspects.Results There was no significant difference in image quality between the two groups in the aortic root sinus(C1),the proximal left and right coronary arteries(C2,C3),or the ascending aorta(A1)(P＞0.05).At the renal artery level,there was a significant difference in image quality between the abdominal aorta(A2)and the left and right femoral artery levels(A3,A4)(P＜0.05).Conclusion In the preoperative one-stop CTA examination of TAVI/TAVR patients,the CTA images below the renal artery level can obtain better image quality than the group injection tracking method.

Comparison and analysis of modeling heart valve bracket based on magnetic resonance imaging / 中国组织工程研究

BACKGROUND:Currently,artificial valves used in heart valve operations include biological valves and mechanical valves.The design and processing of the biological valve bracket determine the shape of the biological valves,which in turn determines their service life. OBJECTIVE:Various lobe and bracket models were created based on the spatial geometric equation.Through a comparison of the deformation and stress distribution of various lobe and bracket models,a more rational bracket model was derived.Subsequently,3D printing technology was utilized to produce a solid model. METHODS:According to the geometric and mathematical models of the heart valve leaf and valve bracket,parabolic and ellipsoidal heart valve bracket models were created.Three-dimensional modeling was used to design the heart valve bracket.Two-way fluid-structure coupling analysis was conducted to analyze the force and deformation of the valve bracket in the blood flow field.An appropriate printing method and materials were selected to achieve 3D printing of the heart valve bracket. RESULTS AND CONCLUSION:The distribution rules of deformation,maximum principal stress,and maximum shear stress of the parabolic bracket and ellipsoidal bracket are the same.The deformation and stress of the ellipsoidal bracket were greater than those of the parabolic bracket.The distribution law of maximum principal stress and maximum shear stress was mainly concentrated in the joint part of the lobe and bracket.The total deformation,maximum principal stress,and maximum shear stress of the bracket decrease with the increase of the bracket diameter.

Rehabilitation effect of Cox health behavior interaction mode in elderly patients with valvular heart dis-ease and its impact on quality of life / 心血管康复医学杂志

Objective:To explore the rehabilitation effect of Cox health behavior interaction mode in elderly patients with valvular heart disease(VHD)and its impact on their quality of life(QOL).Methods:A total of 120 elderly VHD patients enrolled from Jun 2020 to Jun 2022 were divided into routine nursing group(n=60)and Cox group(n=60,received Cox health behavior interaction mode intervention)according to random number table method.Both groups were intervened for six months.General data,cardiac function,6min walking distance(6MWD),QOL,sleep quality and disease percep-tion before and after intervention were compared between two groups.Results:Compared with routine nursing group after six months,there were significant rise in left ventricular ejection fraction(LVEF)[(48.87±4.41)％vs.(51.94± 4.04)％],6MWD[(353.20±4.83)m vs.(424.93±4.40)m],scores of China questionnaire of quality of life in pa-tients with cardiovascular diseases(CQQC)[(84.67±4.05)scores vs.(134.46±4.58)scores]and control attitude scale-revised(CAS-R)[(22.13±3.21)scores vs.(34.98±3.39)scores],and significant reductions in left ventricular end-systolic diameter(LVESd)[(54.99±6.07)mm vs.(49.01±5.48)mm],left ventricular end-diastolic diameter(LVEDd)[(59.20±7.16)mm vs.(54.05±6.14)mm]and Pittsburgh sleep quality index(PSQI)[(14.53±2.42)scores vs.(9.31±1.10)scores]in Cox group,P=0.001 all.Conclusion:The Cox health behavior interaction mode plays a role in the treatment and rehabilitation of elderly patients with valvular heart disease,which can observably improve their cardiac function,physical endurance and quality of life.

Influencing factors of delirium after cardiac valve replacement under cardiopulmonary bypass with propofol sedation / 新乡医学院学报

Objective To investigate the influencing factors of delirium after cardiac valve replacement went under car-diopulmonary bypass(CPB)with propofol sedation.Methods A total of 152 patients underwent cardiac valve replacement under CPB in Nanyang Central Hospital from January 2020 to December 2022 were selected as research objects,and they were randomly divided into observation group A[50 ≤bispectral index(BIS)＜60]and observation group B(35≤BIS＜45)according to the depth of propofol sedation,with 76 cases in each group.The clinical data such as age,gender,body mass index(BMI),diabetes,hypertension,coronary heart disease,chronic obstructive pulmonary disease,sleep disorder,nutritional disorder,anxiety,depression,smoking history,drinking history,preoperative cardiac insufficiency,intraoperative hypoxemia,intraoperative hypoproteinemia,postoperative acute renal injury,secondary intubation,massive blood transfusion,excessive pain,postoperative left ventricular ejection fraction(LVEF),surgical method and CPB time were collected,and the incidence of postoperative delirium of patients was evaluated by the confusion assessment method of intensive care unit(CAM-ICU)method.The incidence of postoperative delirium of patients between observation group A and observation group B was compared.The influencing factors of postoperative delirium occurrence was analyzed by using univariate and multivariate logis-tic regression analysis.Results Among the 152 patients underwent heart valve replacement,36 patients experienced postoperative delirium,with an incidence of 23.68％.The incidence of postoperative delirium of patients in the observation group A and the observation group B was 38.16％(29/76),9.21％(7/76),respectively;the incidence of postoperative delirium of patients in the observation group A was significantly higher than that in the observation group B(x2=17.617,P＜0.05).The gender,BMI,diabetes,hypertension,coronary heart disease,cognitive disorder,sleep disorder,nutritional disorder,anxiety,depression,smoking history,drinking history,intraoperative hypoxemia,intraoperative hypoproteinemia,postoperative acute renal injury,secondary intubation,massive blood transfusion,and surgical method were not related to postoperative delirium(P＞0.05);the age,chronic obstructive pulmonary disease,preoperative heart failure,excessive pain,postoperative LVEF,and CPB time were associated with postoperative delirium(P＜0.05).Multivariate logistic regression analysis showed that age 60 years,preoperative cardiac dysfunction,excessive pain,and CPB time≥100 minutes were risk factors for postoperative delirium(P＜0.05),while postoperative LVEF≤50％and propofol sedation depth of 35≤BIS＜45 were protective factors for postoperative delirium(P＜0.05).Conclusion Propofol sedation depth of 35≤BIS＜45,postoperative LVEF ≥50％can effectively reduce the risk of postoperative delirium after cardiac valve replacement under CPB.Age≥60 years old,preoperative cardiac insufficiency,excessive pain,and CPB time≥100 min can increase the risk of postoperative delirium.