Should mitral valve prolapse be considered as one of the risk factors for open angle glaucoma? A preliminary observation

AIM:To assess the incidence of mitral valve prolapse in patients with newly diagnosed primary open angle glaucoma.METHODS:The study included 12 patients without any other comorbidities or taking any general or local medications.Each patient underwent a full ophthalmological examination with visual field assessment and optical computed tomography of the macula and optic nerve head.Carotid Doppler ultrasound was performed to exclude impaired blood flow in this region and transthoracic echocardiography with assessment of the function and morphology of the heart valves.RESULTS:In the study group,mitral valve prolapse was found in seven patients(58.3%),while mitral valve regurgitation in 11 patients(91.7%).One case of normal pressure glaucoma and four cases of juvenile glaucoma were diagnosed.There were also other risk factors for glaucoma:myopia(58.3%),migraine headaches(41.7%),a positive family history of glaucoma(16.7%).CONCLUSION:Mitral valve prolapse could be indicated as a new risk factor for glaucoma.It seems reasonable to conduct screening tests for glaucoma in patients with mitral valve prolapse in the course of echocardiography.

First-in-human Results of the Novel Transcatheter Mitral Valve Repair System for Severe Mitral Regurgitation

Objective:To evaluate the feasibility,safety,and effectiveness of a novel edge-to-edge mitral valve repair system(the NovoClasp system)in patients with severe mitral regurgitation.Methods:In this prospective,single-arm,first-in-human study conducted at Beijing Anzhen Hospital,data were collected from patients undergoing transcatheter edge-to-edge repair using the NovoClasp system.The study candidates were patients exhibiting a mitral regurgitation severity of 3+or more and were at high-risk or contraindicated for surgical intervention.Technical success and device success according to the Mitral Valve Academic Research Consortium definitions were used as primary outcomes.Other safety and efficacy outcomes were prospectively assessed at device implantation,discharge,and 30 d,6 months,and 12 months post-procedure.Results:Between October 1,2021,and January 31,2022,11 patients were treated for moderate-to-severe(grade 3+)or severe(grade 4+)mitral regurgitation using the NovoClasp system.All patients had a baseline New York Heart Association functional class oflll-lIV,with 7/11 exhibiting complex mitral valve disease.All patients achieved the primary endpoints of technical and device success,with a post-operative 30-d mitral regurgitation grade reduction to 2+or lower,which was maintained at 12 months.One patient had minor bleeding and hematoma at the access site before discharge,and 2 patients were readmitted due to fast atrial fibrillation within 12 months post-discharge.No additional cases of death,adverse cerebral or cardiovascular events,or device-related complications was observed during the follow-up.Conclusion:This study suggested the potential feasibility and safety of the NovoClasp system,showing a promising technical and device success rate,along with a decrease in mitral regurgitation severity.A further pivotal study is needed to assess the procedural and long-term outcomes.

Left atrial appendage aneurysm: A case report

BACKGROUND An aneurysm of the left atrial appendage is one of the rare but potentially hazardous heart defects.The risk of lethal complications grows with its size.To date,about 150 cases of this defect have been described in the literature.We present a case of left atrial appendage aneurysm with the deformation of the mitral valve and the left main coronary and circumflex artery,which required mitral valve annuloplasty and bifurcation stenting.CASE SUMMARY A 58-year-old man presented to our hospital complaining of shortness of breath,general weakness,dizziness during physical exertion,and fatigue.Based on the results of echocardiography,an aneurysm of the left atrium was suspected.A free-breathing real-time cine magnetic resonance imaging with electrocardiograph synchronization confirmed the diagnosis of left atrial appendage aneurysm.The patient underwent an aneurysmectomy via a median sternotomy with cardiopulmonary bypass.Intraoperative transesophageal echocardiography revealed relative mitral insufficiency that was corrected with an annuloplasty ring.Intraoperative coronary angiogram showed impaired blood flow in the left main coronary and circumflex artery and 60%stenosis.For this reason,bifurcation stenting was performed.The patient had an uneventful postoperative clinical course and was discharged from the hospital on the 10th day in a satisfactory condition.CONCLUSION Left atrial appendage aneurysm is a rare and dangerous heart pathology that requires surgery to prevent related complications.

Cardiac Complications in Maroteaux-Lamy Syndrome： Case Report

MLS （Maroteaux-Lamy syndrome） or MPS VI （mucopolysaccharidosis VI） is an autosomal recessive pathology in which there is absence or low activity of the enzyme N-Acetylgalactosamine-4-Sulfatase, which hydrolyzes GAGs （glycosaminoglycans） in the body （mainly dermatan sulfate）. Consequently, there occurs lysosomal deposition of GAGs in connective tissue multisystemic. Myocardium and heart valves are frequently affected structures, presenting a direct correlation with the reports of complications and deaths. Case report： RGS, male, 3 years and 2 months, diagnosed with MPS VI from the first month of life, in weekly ERT （enzyme replacement therapy） since 4 months of age （inconstant）. At physical examination： normotensive, with holosystolic heart murmur 3＋/6＋ in mitral focus. Complementary tests： normal electrocardiogram, echocardiogram with pronounced mitral regurgitation, concentric left ventricular hypertrophy of moderate degree and mild aortic insufficiency. Discussion： Mitral valve disease is common in patients with MLS. Conditions such as cardiomyopathy, fibroelastosis, aneurysm and pulmonary hypertension may occur in these patients, indicative of morbidity and mortality. Early and constant ERT may be useful in slowing a progression of heart disease. Conclusions： follow-up with a cardiologist is important to evaluate the progression of cardiac complications in MPS VI. Constant and early ERT provides better prognosis for these patients.

Percutaneous Implantation of Mitraclip Device： First Case Report in the West of Parana

MI （mitral insufficiency） is the most common valvulopathy currently, with surgery being the gold standard treatment. However, about half of patients with severe MI have a high surgical risk because of their age or comorbidities, therefore surgery is contraindicated, In this context, Mitraclip appears, a device that allows the percutaneous treatment of MI and which is presented as a safe alternative and able to improve the quality of life for these patients. This work describes the first procedure performed at a referral hospital in western Parana-Brazil. It is a male patient with mitral valve insufficiency due to mitral prolapse, submitted to endovascular therapy due to the high surgical risk because of his advanced age, presence of comorbidities and left ventricular dysfunction. From this modality, partial regurgitation improvement and intense symptomatic relief were obtained, demonstrating the great potential of the MitraClip device to improve the quality of life of its patients.

Development in mechanisms of ischemic mitral regurgitation

Objective The clinical diagnosis and treatment of ischemia mitral regurgitation （IMR） remained difficult because of its unclear mechanisms. This paper reviews studies on the mechanisms of IMR during the last 20 years, and discusses the relevance of the various mechanisms. Data sources Data used in this review were mainly from CNKI and Pubmed in English. The search terms were ＂ischemia mitral regurgitation mechanism＂, ＂myocardial infarction＂ AND ＂mitral regurgitation＂. Study selection Articles were selected if they involved mechanisms of IMR. Results IMR is one of the common complications of coronary artery disease. But currently, the clinical diagnosis and treatment of IMR remained difficult because of its unclear mechanisms. Conclusions For now, dominating theory of ischemic mitral regurgitation mechanisms are left ventricular remodeling, imbalance of leaflet tethering and the closing force, left ventricular dysfunction, changes in spatial structure of the annulus and the dyssynchrony of the left ventricular electromechanical activity.