- Valve Sparing Root Replacement Provides Similar Mid-term Outcomes in Bicuspid and Trileaflet Valves. [Journal Article]
- ATAnn Thorac Surg 2018 Sep 18
- CONCLUSIONS: VSRR can be safely and effectively performed in patients with trileaflet and bicuspid valves. Operative outcomes and valve function were equivalent in bicuspid and trileaflet patients in mid-term follow-up. Performance of VSRR is a viable term option in the setting bicuspid aortic valve aortopathy.
- Principal component analysis-based features generation combined with ellipse models-based classification criterion for a ventricular septal defect diagnosis system. [Journal Article]
- APAustralas Phys Eng Sci Med 2018 Sep 20
- In this study, a simple and efficient diagnostic system, which adopts a novel methodology consisting of principal component analysis (PCA)-based feature generation and ellipse models-based classifica...
In this study, a simple and efficient diagnostic system, which adopts a novel methodology consisting of principal component analysis (PCA)-based feature generation and ellipse models-based classification criterion, is proposed for the diagnosis of a ventricular septal defect (VSD). The three stages corresponding to the diagnostic system implementation are summarized as follows. In stage 1, the heart sound is collected by 3M-3200 electronic stethoscope and is preprocessed using the wavelet decomposition. In stage 2, the PCA-based diagnostic features, [[Formula: see text]], are generated from time-frequency feature matrix ([Formula: see text]). In the matrix TFFM, the time domain features [Formula: see text] are firstly extracted from the time domain envelope [Formula: see text] for the filtered heart sound signal [Formula: see text], and frequency domain features, [Formula: see text], are subsequently extracted from a frequency domain envelope ([Formula: see text]) for each heart sound cycle automatically segmented via the short time modified Hilbert transform (STMHT). In stage 3, support vector machines-based classification boundary curves for the dataset [Formula: see text] are first generated, and least-squares-based ellipse models are subsequently built for the classification boundary curve. Finally, based on the ellipse models, the classification criterion is defined for the diagnosis of VSD sounds. The proposed diagnostic system is validated by sounds from the internet and by sounds from clinical heart diseases. Moreover, comparative analysis to validate the usefulness of the proposed diagnostic system, mitral regurgitation and aortic stenosis sounds are used as examples for detection. As a result, the higher classification accuracy, which is achieved by this study compared to the other methods, is [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] for diagnosing small VSD, moderate VSD, large VSD and normal sounds, respectively.
- The usefulness of selected biomarkers in aortic regurgitation. [Journal Article]
- CJCardiol J 2018 Sep 20
- CONCLUSIONS: Elevated preoperative RDW and hs-TnT were associated with a poorer outcome following aortic valve surgery.
- Aortic valve repair for aortic regurgitation and preoperative echocardiographic assessment. [Review]
- JMJ Med Ultrason (2001) 2018 Sep 19
- Aortic valvuloplasty (AVP) has been performed less frequently than mitral valvuloplasty. The survival benefit of AVP over replacement has been demonstrated. Therefore, standardization of AVP is cruci...
Aortic valvuloplasty (AVP) has been performed less frequently than mitral valvuloplasty. The survival benefit of AVP over replacement has been demonstrated. Therefore, standardization of AVP is crucial for its widespread adoption. The hemodynamic advantage of AVP of preserving the native aortic valve may be one reason for the survival benefit. Recent guidelines still recommend AVP in selected cases compared with the less restricted recommendation for mitral valvuloplasty, although recent studies have proposed earlier indication for surgical intervention. Indication for aortic root replacement is also still conservative, especially in Japan. However, more liberal root replacement should be recommended for better repair when AVP is indicated. Theoretically, all aortic regurgitation lesions can be repaired with acceptable durability. However, restricted cusp should be extended by a pericardial patch, which itself has emerged as a risk of recurrence. Therefore, indications for aortic regurgitation for type III lesions should be determined carefully. Special consideration is crucial for bicuspid aortic valve repair; prevention of postoperative stenosis is especially important. Arrangement of the commissure position is the most important consideration for this purpose, although it remains controversial. Therefore, detailed diagnosis is important in planning AVP, and echocardiography plays a key role in this process.
- Variants in cardiac GATA genes associated with bicuspid aortic valve. [Journal Article]
- EJEur J Clin Invest 2018 Sep 19; :e13027
- CONCLUSIONS: This study associates additional genetic variants in GATA4 and GATA5 with BAV, supporting the implication of these genes in the development of this valvulopathy. The discovery of all the genetic factors involved will contribute to a better understanding of the process and, therefore, to detect a genetic predisposition and even to the identification of therapeutic targets. This article is protected by copyright. All rights reserved.
- Comparison of Early and Long-Term Outcomes After Transcatheter Aortic Valve Implantation in Patients with New York Heart Association Functional Class IV to those in Class III and Less. [Journal Article]
- AJAm J Cardiol 2018 Aug 21
- Our aim was to investigate the impact of a baseline New York Heart Association (NYHA) class IV on clinical outcomes of a large real-world population who underwent transcatheter aortic valve implantat...
Our aim was to investigate the impact of a baseline New York Heart Association (NYHA) class IV on clinical outcomes of a large real-world population who underwent transcatheter aortic valve implantation (TAVI). The primary end points were all-cause mortality, cardiovascular mortality, and re-hospitalization, evaluated at the longest available follow-up and by means of a 3-month landmark analysis. The secondary end points were: change in NYHA class, left ventricular ejection fraction, pulmonary pressure and mitral regurgitation. Out of 2,467 patients, 271 (11%) had a NYHA functional class IV at the admission. The latter had higher Society of Thoracic Surgeons (STS) score (9.2% vs 5.5%; p < 0.001) compared to NYHA ≤ III patients, owing to more comorbidities (prior myocardial infarction, severe long-term kidney disease, atrial fibrillation, left ventricular dysfunction, significant mitral regurgitation, pulmonary hypertension). Device success was similar between the two groups (93.7% vs 94.5%; p = 0.583). At a median follow-up of 15 months (interquartile range 4 to 36 months) a lower freedom from primary end points was observed among NYHA IV versus NYHA ≤ III group (survival from all-cause death: 52% vs 58.4%; p = 0.002; survival from cardiovascular death: 72.5% vs 76.5%; p = 0.091; freedom from re-hospitalization: 81.5% vs 85.4%; p = 0.038). However, after adjustment for baseline imbalance, NYHA IV did not influence the relative risk of long-term primary end points. A 3-month landmark analysis showed that NYHA IV independently predicted 3-month all-cause and cardiovascular mortality (hazard ratio: 1.77; 95% CI [1.10 to 2.83]; p = 0.018 and hazard ratio: 1.64; 95% CI [1.03 to 2.59]; p = 0.036, respectively). Instead, after 3-month follow-up NYHA IV did not affect the risk of primary end points. A significant improvement of the secondary end points was noted in both NYHA IV and NYHA ≤≤ III groups. In conclusion, the presence of NYHA class IV in TAVI candidates was associated to a significant increased risk of mortality within 3 months. Patients with baseline NYHA IV who survived at 3 months had a long-term outcome comparable to that of other subjects. Left ventricular systolic function, pulmonary pressure, and mitral insufficiency significantly improved after TAVI regardless of baseline NYHA class IV.
- Toward standardization of valve-sparing root replacement and annuloplasty. [Review]
- GTGen Thorac Cardiovasc Surg 2018 Sep 17
- CONCLUSIONS: Standardization of VSRR may be feasible, and VSRR is expected to be more widely adopted, which will improve the guidelines.
- Impact of Direct TAVR Without Balloon Aortic Valvuloplasty on Procedural and Clinical Outcomes: Insights From the FRANCE TAVI Registry. [Journal Article]
- JCJACC Cardiovasc Interv 2018 Sep 06
- CONCLUSIONS: We confirmed that TAVR without BAV is frequently performed in France with good procedural results. This procedure is associated with procedural simplification and lower rates of residual aortic regurgitation.
- Optimal positioning of self-expanding valves before deployment decreases paravalvular regurgitation following transcatheter aortic valve replacement. [Journal Article]
- CCCatheter Cardiovasc Interv 2018 Sep 14
- CONCLUSIONS: Positioning the MCV such that the LCC/NCC is ≥1.48 may result in less PVL.
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- Percutaneous transhepatic biliary drainage catheter fracture: A case report. [Journal Article]
- AHAnn Hepatobiliary Pancreat Surg 2018; 22(3):282-286
- Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report...
Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report on a 76-year-old lady with recurrent pyogenic cholangitis and PTBD catheter fracture. She had hepatitis B virus-related Child-Pugh class A liver cirrhosis, hypothyroidism, hyperlipidaemia, and previous atrial fibrillation with a background of mild mitral, tricuspid and aortic valvular regurgitation. She had history of laparoscopic cholecystectomy in the past. She was deemed to be a high operative risk and declined hepatic resection. She had undergone multiple endoscopic and percutaneous biliary interventions to control sepsis and stone burden. A bilateral PTBD catheter was left in situ with plans for 3-monthly change. However, she defaulted follow-up and presented 11 months later with complaints of pain over the drain site and inability to flush the right catheter. Abdominal X-ray and computed tomography scans detected right catheter fracture at two places, making three fragments. She underwent percutaneous removal of the proximal fragment by an interventional radiology team. A temporary 4 Fr catheter was inserted to maintain biliary access. Endoscopic removal of the intra-biliary fragments was done the next day. Complete removal was confirmed on fluoroscopy. Finally, the 4 Fr catheter was replaced by a new 12 Fr catheter. The patient was discharged well.