百花齐放,促进中国二尖瓣介入治疗事业蓬勃发展

二尖瓣反流(mitral regurgitation,MR)是最常见的瓣膜疾病之一,其发病率随着年龄增长而增高,75岁以上人群发病率高达10%以上[1-2]。高龄重症二尖瓣反流是临床治疗的难点,患者往往因心功能低下、合并症多、高龄等因素无法耐受外科手术,经导管二尖瓣介入治疗凭借其创伤小的优势为这些患者提供了新的治疗选择。

A case of post traumatic mitral chordae rupture mimicking acute respiratory distress syndrome

Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due to mitral chordae rupture.Trauma patients may also have other potential pre-diagnoses that could explain symptoms related to heart failure,such as tachycardia,circulatory shock,and acute hypoxemia.The possibility of traumatic chordae tendinea rupture being a preventable cause of mortality should be carefully evaluated.

Evaluation of mitral chordae tendineae length using four-dimensional computed

BACKGROUND Mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral regurgitation.Achieving precise measurements of artificial chordae tendineae length(CL)is an important factor in the procedure;however,no objective index currently exists to facilitate this measurement.Therefore,preoperative assessment of CL is critical for surgical planning and support.Four-dimensional x-ray micro-computed tomography(4D-CT)may be useful for accurate CL measurement considering that it allows for dynamic three-dimensional(3D)evaluation compared to that with transthoracic echocardiography,a conventional inspection method.AIM To investigate the behavior and length of mitral chordae tendineae during systole using 4D-CT.METHODS Eleven adults aged>70 years without mitral valve disease were evaluated.A 64-slice CT scanner was used to capture 20 phases in the cardiac cycle in electrocardiographic synchronization.The length of the primary chordae tendineae was measured from early systole to early diastole using the 3D image.The primary chordae tendineae originating from the anterior papillary muscle and attached to the A1-2 region and those from the posterior papillary muscle and attached to the A2-3 region were designated as cA and cP,respectively.The behavior and maximum lengths[cA(ma),cP(max)]were compared,and the correlation with body surface area(BSA)was evaluated.RESULTS In all cases,the mitral anterior leaflet chordae tendineae could be measured.In most cases,the cA and cP chordae tendineae could be measured visually.The mean cA(max)and cP(max)were 20.2 mm±1.95 mm and 23.5 mm±4.06 mm,respectively.cP(max)was significantly longer.The correlation coefficients(r)with BSA were 0.60 and 0.78 for cA(max)and cP(max),respectively.Both cA and cP exhibited constant variation in CL during systole,with a maximum 1.16-fold increase in cA and a 1.23-fold increase in cP from early to mid-systole.For cP,CL reached a plateau at 15%and remained elongated until end-systole,whereas for cA,after peaking at 15%,CL shortened slightly and then moved toward its peak again as end-systole approached.CONCLUSION The study suggests that 4D-CT is a valuable tool for accurate measurement of both the length and behavior of chordae tendineae within the anterior leaflet of the mitral valve.

Unroofed coronary sinus,left-sided superior vena cava and mitral insufficiency:A case report and review of the literature

BACKGROUND Unroofed coronary sinus(UCS)is a rare subtype of atrial septal defect.It is frequently associated with a persistent left superior vena cava and is often part of a more intricate cardiac malformation.CASE SUMMARY This report describes a rare case of an adolescent patient with UCS featuring atrial situs solitus,absence of the right superior vena cava and a persistent left superior vena cava draining into the left atrium consistent with total unroofing of the coronary sinus.This was associated with concurrent severe mitral insufficiency secondary to redundant and prolapsing leaflets,and a substantial left-to-right shunt across the coronary sinus orifice.A comprehensive examination of the existing literature is included,shedding light on the diagnostic challenges of UCS and describing the available surgical options within the context of mitral valve surgery.CONCLUSION UCS is a complex condition requiring careful consideration of associated anomalies and a tailored surgical approach.

Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

Granulicatella adiacens: A Rare Cause of Infective Endocarditis: A Case Report

Granulicatella adiacens (G. adiacens), formerly classified as a nutritionally variant streptococci (NVS), is a commensal organism in the mouth. It is known to be a rare cause of infective endocarditis (IE). This case report presents a case of IE caused by G. adiacens in a 63-year-old man with mitral valve prolapse (MVP), severe mitral regurgitation (MR), and dual vessel disease (DVD). G. adiacens was isolated from two of three blood cultures, and the organism was sensitive to penicillin, vancomycin, cefotaxime, and gentamicin. He was successfully treated with a combination of ceftriaxone and gentamicin. Prompt identification of the organism and determination of antibiotic sensitivity pattern led to successful treatment. This case report showcases the challenges in diagnosis, and treatment, giving insight to healthcare providers on a rare entity.

In-Hospital Outcomes in Minimally Invasive Mitral Valve Surgery: First Results in a Brazilian Single Center

Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel® program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m2, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.

Related mechanisms and research progress in straight back syndrome

Despite the high prevalence of straight back syndrome(SBS),there is still limited research on this condition,posing challenges for effective diagnosis and treatment.The disease has been known for a long time,but there have been few related studies,which mostly consist of case reports.These studies have not been systematically summarized,making it difficult to meet the current needs of diagnosis and treatment.This article summarized the existing literature and comprehensively reviewed the diagnosis,pathogenesis,treatment,and research status of mitral valve prolapse related to SBS.We specifically emphasized the mechanisms and prognosis of SBS combined with mitral valve prolapse and discussed the latest research progress in this disease.

Development and validation of a score predicting mortality for older patients with mitral regurgitation

OBJECTIVE To develop and validate a user-friendly risk score for older mitral regurgitation(MR)patients,referred to as the Elder-MR score.METHODS The China Senile Valvular Heart Disease(China-DVD)Cohort Study functioned as the development cohort,while the China Valvular Heart Disease(China-VHD)Study was employed for external validation.We included patients aged 60 years and above receiving medical treatment for moderate or severe MR(2274 patients in the development cohort and 1929 patients in the validation cohort).Candidate predictors were chosen using Cox’s proportional hazards model and stepwise selection with Akaike’s information criterion.RESULTS Eight predictors were identified:age≥75 years,body mass index<20 kg/m^(2),NYHA class Ⅲ/Ⅳ,secondary MR,anemia,estimated glomerular filtration rate<60 mL/min per 1.73 m^(2),albumin<35 g/L,and left ventricular ejection fraction<60%.The model displayed satisfactory performance in predicting one-year mortality in both the development cohort(C-statistic=0.73,95%CI:0.69-0.77,Brier score=0.06)and the validation cohort(C-statistic=0.73,95%CI:0.68-0.78,Brier score=0.06).The Elder-MR score ranges from 0 to 15 points.At a one-year follow-up,each point increase in the Elder-MR score represents a 1.27-fold risk of death(HR=1.27,95%CI:1.21-1.34,P<0.001)in the development cohort and a 1.24-fold risk of death(HR=1.24,95%CI:1.17-1.30,P<0.001)in the validation cohort.Compared to EuroSCORE II,the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort(C-statistic=0.71 vs.0.70,net reclassification improvement=0.320,P<0.01;integrated discrimination improvement=0.029,P<0.01).CONCLUSIONS The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.

The impact of aging on cardiac remodeling in chronic mitral regurgitation

BACKGROUND Chronic mitral regurgitation(MR)is a volume overload state that causes dilatation of the left sided cardiac chambers.The presence of significant dilatation is considered an indication for mitral valve intervention,however,aging may affect left ventricular(LV)remodeling independently of valvular disease.The objective of this study was to examine age-related changes in cardiac remodeling in a broad population of patients with chronic MR.METHODS Consecutive subjects that underwent echocardiography examinations recorded in the echocardiography database of a university-affiliated laboratory were retrieved.Subjects were categorized into none/mild,moderate or severe MR.For purposes of analysis of differences with aging,the population was divided into groups above and below 70 years of age and standard echocardiographic measurements were compared between the groups.RESULTS A total of 3492 subjects with at least moderate MR(mean age:76 years,52%female)were included in the study and compared to 18,250 subjects with none or mild MR.Older patients had significantly smaller LV end-diastolic diameters and volumes and significantly larger left atrial(LA)volumes when compared to the younger group.LA volume index increased in both age groups as MR severity increased,while LV end-diastolic volume increased with increasing MR only in the younger population.CONCLUSIONS Cardiac remodeling in chronic MR is significantly influenced by age.Guideline based recommendations of timing of mitral valve interventions in asymptomatic MR patients,based on assessment of LA and LV remodeling,may need to take age into account.

Rheumatic valvular heart disease treated with traditional Chinese medicine:A case report

BACKGROUND Rheumatic heart disease(RHD)is an autoimmune disease that leads to irreversible valve damage and heart failure.Surgery is an effective treatment;however,it is invasive and carries risks,restricting its broad application.Therefore,it is essential to find alternative nonsurgical treatments for RHD.CASE SUMMARY A 57-year-old woman was assessed with cardiac color Doppler ultrasound,left heart function tests,and tissue Doppler imaging evaluation at Zhongshan Hospital of Fudan University.The results showed mild mitral valve stenosis with mild to moderate mitral and aortic regurgitation,confirming a diagnosis of rheumatic valve disease.After her symptoms became severe,with frequent ventricular tachycardia and supraventricular tachycardia>200 beats per minute,her physicians recommended surgery.During a 10-day preoperative waiting period,the patient asked to be treated with traditional Chinese medicine.After 1 week of this treatment,her symptoms improved significantly,including resolution of the ventricular tachycardia,and the surgery was postponed pending further follow-up.At 3-month follow-up,color Doppler ultrasound showed mild mitral valve stenosis with mild mitral and aortic regurgitation.Therefore,it was determined that no surgical treatment was required.CONCLUSION Traditional Chinese medicine treatment effectively relieves symptoms of RHD,particularly mitral valve stenosis and mitral and aortic regurgitation.

Importance of concomitant functional mitral regurgitation on survival in severe aortic stenosis patients undergoing aortic valve replacement

BACKGROUND Mitral regurgitation(MR)is commonly seen in patients with severe aortic stenosis(AS)undergoing aortic valve replacement(AVR).But the long-term implications of MR in AS are unknown.AIM To investigate MR’s impact on survival of patients undergoing surgical AVR for severe AS.METHODS Of the 740 consecutive patients with severe AS evaluated between 1993 and 2003,287 underwent AVR forming the study cohort.They were followed up to death or till the end of 2019.Chart reviews were performed for clinical,echocardiographic,and therapeutic data.MR was graded on a 1-4 scale.Mortality data was obtained from chart review and the Social Security Death Index.Survival was analyzed as a function of degree of MR.RESULTS The mean age of the severe AS patients who had AVR(n=287)was 72±13 years,46%women.Over up to 26 years of follow up,there were 201(70%)deaths,giving deep insights into the determinants of survival of severe AS who had AVR.The 5,10 and 20 years survival rates were 75%,45%and 25%respectively.Presence of MR was associated with higher mortality in a graded fashion(P=0.0003).MR was significantly associated with lower left ventricular(LV)ejection fraction and larger LV size.Impact of MR on mortality was partially mediated through lower LV ejection fraction and larger LV size.By Cox regression,MR,lower ejection fraction(EF)and larger LV end-systolic dimension were independent predictors of higher mortality(χ^(2)=33.2).CONCLUSION Presence of greater than 2+MR in patients with severe AS is independently associated with reduced survival in surgically managed patients,an effect incremental to reduced EF and larger LV size.We suggest that aortic valve intervention should be considered in severe AS patients when>2+MR occurs irrespective of EF or symptoms.

Anatomic Correlates of Mitral Systolic Anterior Motion in Transposition of the Great Arteries Following Atrial Switch Operation

Introduction:We sought to investigate whether the development of sub-pulmonic systolic anterior motion(SAM)may be inherent to the anatomy of the the mitral valve(MV)or affected by external factors,such as a dilated right ventricle or chest abnormalities in d-looped transposition of the great arteries post atrial switch operation(d-TGA/AtS).Methods:Analysis was performed of clinical and cardiac imaging studies acquired on 19 adult patients with d-TGA/AtS(age 42±6 years old,56%male)between 2015–2019.Echocardiography data included mitral apparatus anatomy,and CT/MRI data included biventricular dimensions,function,and Haller index(HI)for pectus deformity.Results:Patients with leaflet SAM(n=6)compared to patients without SAM(n=13)had higher MV protrusion height(2.3±0.5 vs.1.5±0.4 cm,p≤0.01)and longer anterior MV leaflet length(3.1±0.4 cm vs.2.6±0.3 cm p≤0.05),when compared to those without.CT/MRI showed higher sub-pulmonic left ventricular ejection fraction(LVEF)in the SAM group(71%±8%vs.54%±7%,respectively).RV size and function,significant chest deformity(HI>3.5),presence of a ventricular lead pacemaker,and septal thickness did not play a role in development of SAM.Conclusions:An elongated mitral apparatus is associated with the development of SAM,and the development of left ventricular outflow tract obstruction(LVOTO),in d-TGA/AtS.LV hyperkinesia is associated with SAM.Systemic RV dimensions,septal thickness,and degree of chest deformity did not differ significantly between subjects with SAM and those without.

Mitral Valve Abnormalities during Hypertrophic Cardiomyopathy: Study on a Cohort in Dakar

INTRODUCTION: Mitral valve abnormalities in hypertrophic cardiomyopathy (HCM) are becoming increasingly well defined, and their role in intra-ventricular obstruction is well defined. The aim of this study was to evaluate mitral valve abnormalities in patients with HCM. PATIENTS AND METHODS: We conducted a descriptive cross-sectional study from May 1 to July 1, 2022 in the Cardiology Department of Aristide Le Dantec Hospital. All patients with HCM aged at least 18 years old were included. The parameters studied concerned mainly the mitral valvular apparatus (papillary muscles abnormalities, leaflet length, mitral insufficiency). RESULTS: A total of 10 patients were included. Mean age was 58.3. On Doppler echocardiography, mean interventricular septal thickness was 20.6 mm. The mean maximum intra-ventricular gradient was 21.06 mmHg. Two patients had significant intraventricular obstruction. The mean length of the anterior mitral valve leaflet was 28.7 ± 3.55 mm, with extremes of 22 and 33 mm. The posterior mitral leaflet averaged 14.8 ± 3.16 mm. Nine (9) out of 10 patients had an elongated anterior valve leaflet. Elongation of the posterior leaflet was noted in 6 patients. With regard to papillary muscle position, 6 patients had an anterolateral ascending pillary muscle. These patients had a mean intra-ventricular gradient of 25 mmHg, compared with 16.5 mmHg in the others cases. We found no direct insertion on the mitral valve. Mitral insufficiency was noted in 9 patients, including 5 with mild insufficiency and 4 with moderate one. CONCLUSION: Mitral valve abnormalities in HCM appear to be frequent. They should be analyzed for a better diagnostic and therapeutic approach.

Primary Left Atrial Intimal Sarcoma Disguised as Functional Mitral Stenosis: A Case Study

A 66-year-old female with a 1-month history of increasing fatigue, dyspnea on exertion, and palpitations presented with clinical signs of heart failure. Chest computed tomography (CT) revealed a large, mobile left atrial (LA) mass attached to the mitral valve causing severe mitral stenosis and mitral regurgitation. The mass was surgically debulked and the mitral valve was replaced. Pathology revealed a poorly differentiated malignant spindle cell neoplasm with diffuse nuclear positivity of MDM2 and multifocal positivity of CDK4, consistent with intimal sarcoma. This case seeks to describe an uncommon presentation of a rare malignancy, and the surgical and medical management of the disease.

经皮二尖瓣球囊扩张术后肾素-血管紧张素-醛固酮系统的变化研究

研究表明，肾素-血管紧张素-醛固酮系统参与了风湿性二尖瓣狭窄患者心房重构的发生和发展Ⅲ。经皮二尖瓣球囊成形术（percutaneous ballon mitral valvuloplasty，PBMV）已成为治疗二尖瓣狭窄的安全、可靠、有效的方法，但有关改善心房重构方面的研究报道不多。

CHANGES OF PLASMA ENDOTHELIN CONCENTRATIONS BEFORE AND AFTER PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY IN PATIENTS WITH MITRAL STENOSIS

Plasma concentrations of endothelin in bloor from the femoral vein and the antecubital vein were measured in 35 patients with mitral stenosis and heart failure before and after percutaneous balloon mitralvalvuloplasty(PBMV). The basal plasma concentrations of endothelin in blood from the antecubirtal vein in the patients were significantly higher than those in 32 control subjects (15. 40± 3. 32 vs. 9. 59± 2. 66 pg/ml, P<0. 001). Plasma endothelin concentrations in patients in New York Heart Association functional classes Ⅱ and Ⅲ were significantly higher than those in control subjects, respectively. The concentrations of endothelin in patients with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm. Ten to fifteen minutes after PBMV, plasma endothelin concentrations in blood from the femoral vein significantly decreased from 16. 14 ± 3. 34 to 13. 74 ± 3. 78 pg/ml (P<0. 01 ). Seventy-two hours after the procedure, the concentrations of endothelin in blood from the antecubital vein had fallen to 12. 31 ± 2. 55 pg/ml (P<0. 001 vs. before PBMV and control subjects). Plasma endothelin concentrations still tended to be higher in patients with atrial fibrillation than those in normal sinus rhythm, but the difference did not reach statistical significance. There were weak but significantly correlations of plasma endothe lin concentrations with the mean left atrial pressure (r= 0. 424 , P < 0.001 ), mean right atrial pressure (r=0. 323, P<0. 01), mean transmitral pressure gradient (r= 0. 397, P<0. 001), heart rate (r= 0. 350,P<0. 005)and mitral valve area (r=-0. 454, P<0. 001) in the patients before and after PBMV.

Histological Structure Difference of Dog's Olfactory Bulb Between Different Age and Sex

The purpose of this article is to detect sex and age difference in the structure of the olfactory bulb in dogs by histological methods. The thickness of the olfactory bulbs layers and its main cells were analyzed comparatively with the methods of HE-staining and statistics, through which we studied the development course of dogs＇ olfactory bulb and the structural differences which affect the olfaction in both males and females. The results showed that between both male and female juveniles and adult males and females, the difference in thickness of each layer is not significant. But the difference in quantity of mitral cells between adult males and females was significant. Meanwhile, the structure of every layer in juvenile dogs was apparent while the volume and the weight of adult dogs＇ olfactory bulb and each layer＇s width increased significantly. On the other hand, the density of each layer＇s cells decreased apparently. Our results demonstrated that the olfactory bulb developed with age, and the apparent differences in morphology and quantity of mitral cells between males and females may be one of the reasons leading to the sexual variations of olfactory sensitivity.