Long-Term Durability of Transcatheter Aortic Valve Prostheses

Background

Very little is known about long-term valve durability after transcatheter aortic valve replacement (TAVR).

Valvular heart disease in Antiphospholipid antibody syndrome: Isolated Tricuspid stenosis

Antiphospholipid antibody syndrome (APLS) is a rare disorder characterized by a hypercoagulable state. Manifestations include arterial or venous thrombosis, recurrent fetal wastage, coronary artery disease, valvular heart disease, dilated cardiomyopathy, pulmonary artery hypertension, and intracardiac thrombus. Most commonly mitral valve is affected followed by aortic and then tricuspid valve. In this report, a rare case of spontaneous aortic thrombosis with tricuspid stenosis uncomplicated by other valve lesions is presented with clinical and echocardiographic studies and computed tomographic images.     

Pediatric cardiac computed tomography angiography: Expert consensus from the Filiale de Cardiologie Pédiatrique et Congénitale (FCPC) and the Société Française d’Imagerie Cardiaque et Vasculaire diagnostique et interventionnelle (SFICV)

This article was designed to provide a pediatric cardiac computed tomography angiography (CCTA) expert panel consensus based on opinions of experts of the Société Française d’Imagerie Cardiaque et Vasculaire diagnostique et interventionnelle (SFICV) and of the Filiale de Cardiologie Pédiatrique Congénitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, CTA radiation dose reduction techniques, and post-processing techniques. The consensus was based on data from available literature (original papers, reviews and guidelines) and on opinions of a group of specialists with extensive experience in the use of CT imaging in congenital heart disease. In order to reach high potential and avoid pitfalls, CCTA in children with congenital heart disease requires training and experience. Moreover, pediatric cardiac CCTA protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible to prevent unnecessary radiation exposure. We also provided a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.     

Anuric Acute Renal Failure Associated with Pericardial Effusion without Signs of Cardiac Tamponade

This article describes the anuric acute renal failure (ARF) secondary to massive pericardial effusion without tamponade in an 84 year-old man. He was referred to our emergency room with progressive dyspnea and azotemia. An electrocardiogram showed sinus tachycardia. A two-dimensional echocardiogram confirmed the presence of severe pericardial effusion without prominent ventricular diastolic collapse and there were no changes in his vital signs. Laboratory findings showed that his blood urea nitrogen and serum creatinine levels were 91.8 and 3.77 mg/dL, respectively. Renal ultrasonography showed no signs of hydronephrosis. Urine output did not increase in spite of giving a saline and furosemide infusion but increased immediately after pericardiocentesis with drainage. His renal function was completely restored 3 days after the procedure. A pericardial biopsy demonstrated invasion of malignant cells. We should keep in mind that pericardial effusion is one of the causes of anuric ARF, although it is not accompanied by tamponade.     

经胸超声心动图评估人工机械主动脉瓣血管翳清除术及再次置换术的安全性及有效性

目的：本研究对比人工机械主动脉瓣血管翳患者采用血管翳清除术与再次置换术两种手术方式的围手术期临床结果及术前、术后经胸超声心动图（transthoracic echocardiogram, TTE）参数，探讨人工机械主动脉瓣血管翳清除术及再次置换术的安全性及有效性。方法：复旦大学附属中山医院自2019年9月至2022年3月外科手术中证实41例人工机械主动脉瓣梗阻原因为血管翳。其中17例采取血管翳清除术，而保留原有的人工机械瓣，24例采取人工机械主动脉瓣再次置换术。结果：两种手术方式在术前及术后1周TTE检测指标跨瓣峰值流速（transvalvular peak velocity, Vmax），跨瓣峰值压差（transvalvular peak pressure gradient, PGmax），跨瓣平均压差（transvalvular mean pressure gradient, TMPG），左心室舒张末期内径（left ventricular end-diastolic diameter, LVEDD），左心室收缩末期内径（left ventricular end-systolic diameter, LVSDD）及左心室射血分数（left ventricular ejection fraction，LVEF）两组间均无统计学差异，术前TTE两组均符合手术指征，术后两组TMPG均低于20mmHg。术中再次置换组较血管翳清除组体外循环时间及主动脉夹闭时间明显延长，两者差异具有统计学意义（P<0.001），体外循环时间与术后第１天复查血清肌钙蛋白T（cardiac troponin T, cTnT）增高呈中等正相关关系（rs=0.543,P<0.001）。术后第1天再次置换组白细胞（white blood cell, WBC）高于血管翳清除组（P<0.05）。术后住院期间再次置换组的患者并发症发生共10例（41.6%），其中包括2例为严重的多器官功能障碍，住院期间死亡人数为4例（16.7%）；而血管翳清除组出现并发症仅有４例（23.5%），无围手术期死亡。结论：围手术期临床结果及TTE指标显示血管翳清除术是一种安全有效的手术方式。TTE是人工机械主动脉瓣置换术后长期随访有效影像学手段。