Left ventricular mass regression following aortic valve replacement with mechanical valves

Objective The degree of Left Ventricular Mass Index (LVMI) regression following aortic valve replacement correlates with long-term survival. This study aims to assess the extent of LVMI regression at 3 months following aortic valve replacement (AVR) with different types and sizes of mechanical valves in rheumatic aortic valve disease. Methods The LVMI regression was studied in 34 consecutive patients, undergoing elective AVR for rheumatic aortic stenosis and/or regurgitation. They were grouped in A and B, matched in age, body surface area and pre-operative LVMI, receiving respectively a tilting disc and a bileaflet mechanical valve. The LVMI was calculated by M-mode echocardiography using the Devereux' formula pre-operatively and three months post-operatively. The trend of LVMI reduction was compared between the two groups and amongst the patients with stenotic, regurgitant and mixed aortic valve, pathologies; and receiving different sizes of valves. Results The mean preoperative LVMI was 199g±79.5 g/m². At three months post aortic valve replacement, the mean LVMI was 130g±49.0 g/m². There was a significant reduction of LVMI post-operatively (p=0.001) at three months follow-up. The extent of LVMI regression following surgery amongst the groups A and B did not vary significantly (p=0.92). The extent of LVMI regression did not vary significantly in patients with different aortic valve pathology nor with different sizes of the valves implanted. Conclusions There is a significant early LVMI regression following aortic valve replacement in rheumatic aortic valve disease. The type and the size of the mechanical prosthesis or the rheumatic pathology do not appear to influence this regression.     

Valvular heart disease

Summary Although valvular stenosis may be evaluated adequately by measuring transvalvular pressure gradients with Doppler echocardiography and cardiac catheterization, these methods have failed to provide reliable and accurate quantification of valvular regurgitation. In recent years the development of magnetic resonance imaging has broadened the diagnostic spectrum in cardiology, since it allows assessment of ventricular volumes without geometrical assumptions and the non-invasive quantification of blood flow within the heart and great vessels. The purpose of this overview is to evaluate “established” diagnostic tools and to show the capabilities of magnetic resonance imaging in the assessment of valvular heart disease. Eingegangen am 18. Dezember 1996 Angenommen am 19. Dezember 1996     

Flow characteristics past jellyfish and St. Vincent valves in the aortic position under physiological pulsatile flow conditions

Thrombus formation and hemolysis have been linked to the dynamic flow characteristics of heart valve prostheses. To enhance our understanding of the flow characteristics past the aortic position of a Jellyfish (JF) valve in the left ventricle, in vitro laser Doppler anemometry (LDA) measurements were carried out under physiological pulsatile flow conditions. The hemodynamic performance of the JF valve was then compared with that of the St. Vincent (SV) valve. The comparison was given in terms of mean systolic pressure drop, back flow energy losses, flow velocity, and shear stresses at various locations downstream of both valves and at cardiac outputs of 3.5 L/min, 4.5 L/min, and 6.5 L/min respectively. The results indicated that both valves created disturbed flow fields with elevated levels of turbulent shear stress as well as higher levels of turbulence in the immediate vicinity of the valve and up to 1 diameter of the pipe (D) downstream of the valve. At a location further downstream, the JF valve showed better flow characteristics than the SV in terms of velocity profiles and turbulent shear stresses. The closure volume of the SV valve was found to be 2.5 times higher than that of the JF valve. Moreover, the total back flow losses and mean systolic pressure drop also were found to be higher in the SV than the JF valve.     

Regurgitations in a Lamb with Acute Coenurosis-A case Report

Coenurosis is a disease of the central nervous system in sheep, caused by Coenurus cerebralis, the larval stage of Multiceps multiceps, which inhabits the small intestine of Canidae. A case of regurgitations in a 2.5 month old lamb with acute coenurosis is being reported. The lamb was presented with a sudden onset of ataxia and regurgitations for 10 days. The post-mortem examination revealed 4 immature C. cerebralis cysts between 0.5 and 1.5 cm in diameter located in the brainstem and cerebellum, and histopathological examination revealed multifocal pyogranulomatous meningoencephalitis, so a diagnosis of acute coenurosis was established. Thus, acute coenurosis should be included in the differential diagnosis of regurgitations in lambs.     

Application of Percutaneous Balloon Mitral Valvuloplasty in Patients of Rheumatic Heart Disease Mitral Stenosis Combined with Tricuspid Regurgitation

Background:

Tricuspid regurgitation (TR) is frequently associated with severe mitral stenosis (MS), the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty (PBMV) procedure in rheumatic heart disease patients with mitral valve (MV) stenosis and tricuspid valve regurgitation.

Methods:

Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV: MV area (MVA), TR area (TRA), atrial pressure and diameter, and pulmonary artery pressure (PAP). The patients were followed for 6 months to 9 years.

Results:

After PBMV, the MVAs increased significantly (1.7 ± 0.3 cm² vs. 0.9 ± 0.3 cm², P < 0.01); TRA significantly decreased (6.3 ± 1.7 cm² vs. 14.2 ± 6.5 cm², P < 0.01), right atrial area (RAA) decreased significantly (21.5 ± 4.5 cm² vs. 25.4 ± 4.3 cm², P < 0.05), TRA/RAA (%) decreased significantly (29.3 ± 3.2% vs. 44.2 ± 3.6%, P < 0.01). TR velocity (TRV) and TR continue time (TRT) as well as TRV × TRT decreased significantly (183.4 ± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P < 0.01; 185.7 ± 13.6 ms vs. 238.6 ± 11.3 ms, P < 0.01; 34.2 ± 5.6 cm vs. 60.7 ± 8.5 cm, P < 0.01, respectively). The postoperative left atrial diameter (LAD) significantly reduced (41.3 ± 6.2 mm vs. 49.8 ± 6.8 mm, P < 0.01) and the postoperative right atrial diameter (RAD) significantly reduced (28.7 ± 5.6 mm vs. 46.5 ± 6.3 mm, P < 0.01); the postoperative left atrium pressure significantly reduced (15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P < 0.01), the postoperative right atrial pressure decreased significantly (13.2 ± 2.4 mmHg vs. 18.5 ± 4.3 mmHg, P < 0.01). The pulmonary arterial pressure decreased significantly after PBMV (48.2 ± 10.3 mmHg vs. 60.6 ± 15.5 mmHg, P < 0.01). The symptom of chest tightness and short of breath obviously alleviated. All cases followed-up for 6 months to 9 years (average 75 ± 32 months), 2 patients with severe regurgitation died (1 case of massive cerebral infarction, and 1 case of heart failure after 6 years and 8 years, respectively), 2 cases lost access. At the end of follow-up, MVA has been reduced compared with the postoperative (1.4 ± 0.4 cm² vs. 1.7 ± 0.3 cm², P < 0.05); LAD slightly increased compared with the postoperative (45.2 ± 5.7 mm vs. 41.4 ± 6.3 mm, P < 0.05), RAD slightly also increased compared with the postoperative (36.1 ± 6.3 mm vs. 28.6 ± 5.5 mm, P < 0.05), but did not recover to the preoperative level. TRA slightly increased compared with the postoperative, but the difference was not statistically significant (P > 0.05). The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative (P > 0.05), the remaining patients without serious complications.

Conclusions:

PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.     

Non-alcoholic fatty liver disease is associated with high prevalence of gastro-oesophageal reflux symptoms

Background

Gastro-oesophageal reflux symptoms are usually reported by patients with obesity and metabolic syndrome. Aim of this study was to assess the prevalence and clinical characteristics of gastro-oesophageal reflux symptoms in subjects with non-alcoholic fatty liver disease.

Methods

Cross-sectional, case–control study of 185 consecutive patients with non-alcoholic fatty liver disease and an age- and sex-matched control group of 112 healthy volunteers. Participants were interviewed with the aid of a previously validated questionnaire to assess lifestyle and reflux symptoms in the 3 months preceding enrolment. Odds ratios were determined before and after adjustment for body mass index, increased waist circumference, physical activity, metabolic syndrome and proton pump inhibitors and/or antiacid medication.

Results

The prevalence of heartburn and/or regurgitation and of at least one of gastro-oesophageal reflux symptoms was significantly higher in the non-alcoholic fatty liver disease group. Non-alcoholic fatty liver disease subjects were associated to higher prevalence of heartburn (adjusted odds ratios: 2.17, 95% confidence intervals: 1.16–4.04), regurgitation (adjusted odds ratios: 2.61, 95% confidence intervals: 1.24–5.48) and belching (adjusted odds ratios: 2.01, 95% confidence intervals: 1.12–3.59) and had higher prevalence of at least one GER symptom (adjusted odds ratios: 3.34, 95% confidence intervals: 1.76–6.36).

Conclusion

Non-alcoholic fatty liver disease is associated with a higher prevalence of gastro-oesophageal reflux symptoms.     

左室训练术对矫正性大动脉转位合并三尖瓣关闭不全的影响

目的左室退化先天性矫正性大动脉转位患者常常合并不同程度的三尖瓣关闭不全,左室训练术可有效的提高形态学左心室的后负荷,改善形态学左心室的功能,本文进一步评价左室训练术对三尖瓣功能的可能影响。方法2005年5月至2011年5月,24例左室退化先天性矫正性大动脉转位患儿行左室训练术,男性13例,女性11例,年龄3．73±4．35岁（0．17-22岁）,体重15．71±10．95kg（5．1—61kg）,其中合并三尖瓣关闭不全23例（轻度11例,中度7例,重度5例）。术前经超声心动网,心血管造影或心导管检查确诊,形态学左室舒张末径21．56±6．60mm（8-32mm）,形态学左室后壁厚度4．29±1．52mm（2-7mm）,形态学左室与形态学右室压力比0．41±0．12（0．12-0．65）。手术均采用胸骨上端小切口或胸骨正中切口,在全麻下完成左室训练术。结果全组患者无住院死亡．出院时超声心动图检查：5例患者三尖瓣关闭不全消失,三尖瓣仍存在不同程度关闭不全18例（轻度12例,中度4例,重度2例）,其中：9例患者TR程度均较术前减轻,双心室结构和功能良好,室间隔位置较术前略向形态学右心室侧移位,形态学左室舒张末径较术前略增大。术后随访1月-35月,无远期死亡。所有患儿一般情况好,生命体征平稳,心功能I—II级,8例患者三尖瓣关闭不全消失,三尖瓣存在不同程度关闭不全14例（轻度8例,中度4例,重度2例）,其中：8例患者TR程度均较术前显著减轻,形态学左室舒张末径26．17±7．11mm（14—40mm）,形态学左心室后壁厚度4．95±1．44mm（4—9mm）。结论左室训练术可改善左室退化先天性矫正性大动脉转位患者三尖瓣关闭不全的程度,其原因可能与左室训练术增加形态学左心室压力负荷及增加形态学左心室后壁厚度,形态学左心室腔扩大,室间隔向形态学右心室侧移位,形态学右心室腔相对缩小,三尖瓣叶对合改善,三尖瓣反流减轻。