Real-time Three-Dimensional Color Doppler Flow Imaging： An Improved Technique for Quantitative Analysis of Aortic Regurgitation

The recently introduced real-time three-dimensional color Doppler flow imaging （RT-3D CDFI） technique provides a quick and accurate calculation of regurgitant jet volume （RJV） and fraction. In order to evaluate RT-3D CDFI in the noninvasive assessment of aortic RJV and regurgitant jet fraction （RJF） in patients with isolated aortic regurgitation, real-time three-dimensional echocardiographic studies were performed on 23 patients with isolated aortic regurgitation to obtain LV end-diastolic volumes （LVEDV）, end-systolic volumes （LVESV） and RJV, and then RJF could be calculated. The regurgitant volume （RV） and regurgitant fraction （RF） calculated by two-dimensional pulsed Doppler （2D-PD） method served as reference values. The results showed that aortic RJV measured by the RT-3D CDFI method showed a good correlation with the 2D-PD measurements （r= 0.93, Y=0.89X＋ 3.9, SEE= 8.6 mL, P〈0.001 ）; the mean （SD） difference between the two methods was - 1.5 （9.8） mL. % RJF estimated by the RT-3D CDFI method was also correlated well with the values obtained by the 2D-PD method （r=0.88, Y=0.71X＋ 14.8, SEE= 6.4 %, P〈0. 001）; the mean （SD） difference between the two methods was -1.2 （7.9） %. It was suggested that the newly developed RT-3D CDFI technique was feasible in the majority of patients. In patients with eccentric aortic regurgitation, this new modality provides additional information to that obtained from the two-dimensional examination, which overcomes the inherent limitations of two-dimensional echocardiography by depicting the full extent of the jet trajectory. In addition, the RT-3D CDFI method is quick and accurate in calculating RJV and RJF.

Transcatheter Valve-in-Valve implantation after late migration of balloon expandable Sapien- XT prosthesis in a severe pure aortic regurgitation case

A 76-year old female, was admitted in our cardiac surgery clinic to perform surgical aortic valve replacement due to a severe aortic regurgitation with symptoms of congestive heart failure. Her past medical history included moderately impaired renal function （GFR 48 mL/min） and arterial hy- pertension.

In-hospital outcomes of transapical versus surgical aortic valve replacement: from the U.S. national inpatient sample

OBJECTIVE To compare the outcomes of transapical transcatheter aortic valve replacement(TA-TAVR)and surgical aortic valve replacement(SAVR)using a large US population sample.METHODS The U.S.National Inpatient Sample was queried for all patients who underwent TA-TAVR or SAVR during the years2016-2017.The primary outcome was all-cause in-hospital mortality.Secondary outcomes were in-hospital stroke,pericardiocentesis,pacemaker insertion,mechanical ventilation,vascular complications,major bleeding,acute kidney injury,length of stay,and cost of hospitalization.Outcomes were modeled using multi-variable logistic regression for binary outcomes and generalized linear models for continuous outcomes.RESULTS A total of 1560 TA-TAVR and 44,280 SAVR patients were included.Patients who underwent TA-TAVR were older and frailer.Compared to SAVR,TA-TAVR correlated with a higher mortality(4.5%vs.2.7%,effect size(SMD)=0.1)and higher periprocedural complications.Following multivariable analysis,both TA-TAVR and SAVR had a similar adjusted risk for in-hospital mortality.TA-TAVR correlated with lower odds of bleeding with(adjusted OR(aOR)=0.26;95%CI:0.18-0.38;P<0.001),and a shorter length of stay(adjusted mean ratio(aMR)=0.77;95%CI:0.69-0.84;P<0.001),but higher cost(aMR=1.18;95%CI:1.10-1.28;P<0.001).No significant differences in other study outcomes.In subgroup analysis,TA-TAVR in patients with chronic lung disease had higher odds for mortality(aOR=3.11;95%CI:1.37-7.08;P=0.007).CONCLUSION The risk-adjusted analysis showed that TA-TAVR has no advantage over SAVR except for patients with chronic lung disease where TA-TAVR has higher mortality.

Calculation of left ventricular diastolic time constant(Tau) in dogs with aortic regurgitation using continuous-wave Doppler spectra

OBJECTIVE To investigate a new noninvasive method for calculating left ventricular diastolic time constant(Tau) through a continuous-wave aortic regurgitation Doppler spectrum.METHODS According to ultrasound guidance, twenty-four animal models(beagles) of aortic regurgitation and acute ischemic left ventricular diastolic dysfunction were created. The left ventricular diastolic function was manipulated with dobutamine or esmolol and fifty-nine hemodynamic stages were achieved. Raw audio signals of the continuous-wave Doppler spectra were collected, and new aortic regurgitation Doppler spectra were built after reprocessing by a personal computer. The updating time of the spectral line was 0.3 ms. The new Doppler spectra contour line was automated using MATLAB(MATrix LABoratory, MathWorks, Natick, MA, USA), and two time intervals,(t2–t1) and(t3–t1) were measured on the ascending branch of the aortic regurgitation Doppler spectrum. Then, the two time intervals were substituted into Bai's equations, and Doppler-derived Tau(Tau-D)was resolved and compared with catheter-derived Tau(Tau-c).RESULTS There is no significant difference between Tau-D and Tau-c(45.95 ± 16.90 ms and 46.81 ± 17.31 ms, respectively;P >0.05). Correlation analysis between Tau-c and Tau-D suggested a strong positive relationship(r = 0.97, P = 0.000). A Bland-Altman plot of Tau-c and Tau-D revealed fair agreement.CONCLUSIONS This new calculation method is simple, convenient, and shows a strong positive relationship and fair agreement with the catheter method.

Transcatheter closure of ventricular septal defect in patients with aortic valve prolapse and mild aortic regurgitation:feasibility and preliminary outcome

Objective:To evaluate the feasibility,safety and efficacy of transcathcter closure of ventricular septal defect(VSD)in patients with aortic valve prolapse(AVP)and mild aortic regurgitation(AR).Methods:Between January 2008 and July 2014,transcatheter closure of VSD was attempted in 65 patients.Results:The total intermediate closure successful rate in all subjects was 96.9%.During the perioperative period,no death,major bleeding,pericardial tamponade,occluder dislodgement,residual shunt or hemolysis occurred.Two procedures had been forced to suspend due to significant aggregation of device related aortic regurgitation,three cases of transient complete left bundle branch block occurred but did not sustain.At 1-year followup,no patients had residual shunts and complications.Furthermore,grade of residual AR were relieved in 61.9%(39/63)cases and degree of AVP were ameliorated in 36.5%(23/63)patients;Conclusions:Transcatheter closure VSD in selected patients with AVP and mild AR is technically feasible and highly effective.Long term safety and efficacy needs to be assessed.

Transfemoral aortic valve implantation in the case of pre-existing mitral prosthesis and pure aortic regurgitation: A case report

BACKGROUND Transcatheter aortic valve replacement(TAVR)is recommended in patients with severe aortic stenosis who have high surgical risk.However,in the pre-existing mechanical mitral valve prosthesis and natural pure aortic regurgitation,TAVR is relatively contraindicated.In this report,we described one case of TAVR with native aortic regurgitation in the presence of mechanical mitral valve prosthesis.CASE SUMMARY A 64-year-old man with a medical history of mitral valve replacement had severe dyspnea and was symptomatic even at rest for 3 mo.His echocardiography showed severe native pure aortic regurgitation.His euroscore was 15.A TAVR procedure with an evolut R was planned.A 34 mm evolut R was placed by transesophageal echocardiography.The mitral prosthesis was functioning normally,and mild-moderate paravalvular leakage was evident by transesophageal echocardiography.The patient recovered without any complication.At 1 mo follow up,the patient was well,and no paravalvular leakage was noted.CONCLUSION TAVR for pure aortic regurgitation in the presence of prosthetic mitral valve can be a safe procedure.

A Pregnant Patient with Aortic Regurgitation and Symptoms of Acute Heart Failure Caused by Peripartum Cardiomyopathy: A Case Report

Introduction: Knowledge of the risks of pregnancy with heart disease is important because the maternal mortality is much higher than the average. Peripartum cardiomyopathy (PPCM) is rare but it is one of major causes of maternal death. We experienced a pregnant patient with severe aortic regurgitation (AR) presented symptoms of acute heart failure. Her heart failure was not better after an emergency cesarean section and aortic valve replacement (AVR) therefore we think that PPCM caused her heart failure. Case presentation: A 35-year-old woman diagnosed as having severe AR became pregnant. No changes in the AR were apparent during pregnancy. However, the patient developed symptoms of acute heart failure at 37 weeks of gestation, and an emergency cesarean section was performed under general anesthesia. Her hemodynamic status worsened after the cesarean section, and AVR was performed. She was supported with percutaneous cardiopulmonary support (PCPS) after the operation. As recovery seemed to take longer than usual, we decided to implant a ventricular assist device (VAD). Her condition improved after VAD placement, but then she died from a cerebral infarction. In this case, the heart failure was an acute-onset even though AR was stable before and after the pregnancy, and the heart failure did not improve after AVR. Therefore, we concluded that PPCM, rather than AR caused her heart failure. Conclusions: We encountered a case of a pregnant patient with severe AR who presented with symptoms of acute heart failure caused by PPCM. The effect of AR to her heart failure could not be easily denied. This delayed the diagnosis of PPCM, which in turn delayed our decision to use a VAD. Therefore, PPCM should be considered when pregnant patients with heart disease present symptoms of heart failure.

Transcatheter Aortic Valve Replacement in Patients With Pure Native Aortic Regurgitation:Results From a Multicenter Registry Study

Objective:Patients with untreated severe aortic regurgitation(AR)have a high risk of mortality.Transfemoral transcatheter aortic valve replacement(TF-TAVR)is a treatment option for AR;however,the safety and efficacy of this technique have not been sufficiently established.This study aimed to evaluate the clinical and anatomical variables correlating with device success of TF-TAVR using a self-expanding valve system for pure AR.Methods:Patients with pure native severe AR who underwent TF-TAVR using a self-expanding valve system were registered at 5 Chinese centers.The primary endpoint was device success at 1 month after TAVR.The secondary endpoint was the composite of major adverse cardiovascular events(MACE)at 6 months,including all-cause death,ischemic stroke,emergency conversion to cardiac surgery,and permanent pacemaker implantation.Echocardiography was used to analyze the left ventricular function before the TAVR procedure and during follow-up.Multivariable logistic regression and Cox regression analyses were performed to find relevant independent risk factors.Results:Between September 2019 and February 2022,79 patients with AR were enrolled in the study.At 1 month,device success was achieved in 60(75.9%)patients.By 6 months,29(36.7%)patients had MACE.Echocardiography revealed improved left ventricular function after TAVR.Multivariate regression analysis demonstrated that the Society of Thoracic Surgeons risk score(odds ratio 0.760,95%confidence interval(Cl):0.584-0.989;P=0.041)and annulus perimeter(odds ratio 0.888,95%Cl:0.796-0.992;P=0.035)were 2 predictors of device success.Moreover,annulus perimeter(<80.2mm),but not Society of Thoracic Surgeons risk score,was associated with a significant reduction in MACE at 6 months(hazard ratio 2.223,95%Cl:1.060-4.659;P=0.028).Conclusions:TF-TAVR using a self-expanding valve system appears to be a safe and feasible treatment for patients with pure native severe AR,particularly those with a less enlarged annulus.

Infective bicuspid aortic valve endocarditis causing acute severe regurgitation and heart failure:A case report

BACKGROUND Infective endocarditis(IE)is an uncommon but potentially life-threatening infection,which occasionally develops into acute severe valve insufficiency leading to the onset of heart failure,and necessitates timely intervention.However,the variable and atypical clinical manifestations always make the early detection of IE difficult and challenging.CASE SUMMARY A 45-year-old female who was previously healthy presented with exertional shortness of breath and paroxysmal nocturnal dyspnea.She also suffered from a significant decrease in exercise capacity,whereas her body temperature was normal.She had severe hypoxemia and hypotension along with a marked aortic valve murmur.Diffuse pulmonary edema and bilateral pleural effusion were observed on both chest X-ray and computed tomography scan.Transthoracic echocardiography was performed immediately and revealed severe regurgitation of the bicuspid aortic valve.Transesophageal echocardiography was further performed and vegetations were detected.In addition to adequate medical therapy and ventilation support,the patient underwent urgent and successful aortic valve replacement.Her symptoms were significantly relieved and the postoperative chest X-ray showed that pulmonary edema was significantly reduced.Histopathology of the resected valve and positive microorganism culture of the surgical specimen provided evidence of definite IE.CONCLUSION IE should be considered in critical patients with refractory heart failure caused by severe bicuspid aortic valve regurgitation.

The outcome of ventricular septal defect combined with aortic regurgitation after surgical repair

Objective:Ventricle septal defect(VSD)is commonly associated with aortic regurgitation and aortic leaflet prolapse due to anatomic and hemodynamic factors.The concomitant intervention of the aortic valve during VSD repair remains one of the major concerns.Moreover,little is known about the structure and hemodynamic change in the presence of postoperative progressive AR after VSD repair.Methods:From August 2012 to February 2019,VSD patients with aortic regurgitation who underwent VSD surgical repair with or without aortic valve intervention in our institution were retrospectively reviewed.Preoperative echo and postoperative echo in the followup were collected and compared.Results:The mean age of the patients on VSD repair was 3.2.Those with postoperative progressive aortic regurgitation showed significantly increased right atrium,mean pulmonary artery,valve flow velocity,and A-wave velocity,and significantly reduced right ventricle outflow tract and descending aorta flow velocity(P<0.05).Additionally,compared with no AR intervention,aortic valvuloplasty during VSD repair predispose patients to have progressive AR(P<0.05).Conclusion:There was augmented capacity in the right-heart system and increased valvular flow velocity in the left-heart system in VSD patients combined with postoperative AR.Additional aortic valvuloplasty or aortic valve replacement during surgical VSD repair might not be necessary,especially for those with no or mild AR preoperatively.Aortic valve replacement,if required,is a more appropriate alternative in halting postoperative AR progression than aortic valvuloplasty.

Study on regurgitation of a bearing-less mini axial aortic valvo-pump with closed impeller

The back-flow of an aortic valvo-pump will re-duce the pumping flow rate but can wash out the gap between the rotor and the stator, and thus can improve the antithrombogenicity of the de-vice. To investigate the regurgitation of a 23mm OD aortic valvo-pump, its closed impeller was replaced by a cylinder and hereby the valvo- pump had lost its pumping function. The pres-sure head crossing the aortic valvo-pump was maintained by a locally made pulsatile centrifugal pump, beating rhythmically from 30 to 120mmHg. The back flow from outlet to inlet of valvo-pump via the above-mentioned gap was measured. Results demonstrated that this gap and the pressure head had remarkable effect on back- flow;a larger gap and/or a larger pressure head would lead to a larger back-flow. By 0,20mm gap and 100mmHg pressure head, the valvo-pump had ca. 0,8 l/min back-flow. Instantaneous meas-urement indicated that the back-flow had a pul-satile form with high rate during diastole while low rate during systole of the natural heart imi-tated by pulsatile centrifugal pump. The pump rotated at 12500rpm, 15000rpm and 17500rpm respectively, but it was found the rotating speed had no affection on back-flow. This investigation provides a basis for pump design seeking for both increase of the flow rate and improvement of the compatibility;the former is particularly important for a mini axial pump and the latter is extremely difficult for closed impeller.

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.

Coronary Artery Perforation Complicated With Acute Aortic Valve Regurgitation During Percutaneous Coronary Intervention:Report of Two Cases

CORONARY artery perforation catastrophic complication （CAP） is a rare, of percutaneous coronary intervention （PCI）. CAP during PCI procedure is invariably associated with high riskpatients with complex coronary artery disease such as coronary calcified lesions, multi-vessel lesions, coronary chronic total occlusion and so on,

The Structural Impact of Aortic Valve Replacement on Mitral Regurgitation

Background: Structural changes to the mitral annulus occur following aortic valve replacement (AVR) for severe aortic stenosis which may influence functional mitral regurgitation (MR). Methods: A retrospective review of 44 patients who underwent open AVR for aortic stenosis at a single center from 2010-2013 was performed. Patients undergoing concomitant aortic root surgery or with severe MR were excluded. MR was evaluated with preoperative and postoperative transthoracic echocardiograms. Univariate and multivariable analyses were performed to assess for factors associated with postoperative MR improvement and worsening. Results: Prior to AVR, none had severe MR, 5% (2 patients) had moderate, 9% (4 patients) mild-to-moderate, 46% (20 patients) mild, and 23% (9 patients) trace MR. Of patients with pre-operative MR, 44% (16 patients) experienced improvement of MR. Six patients had worsening of MR and the remaining 22 patients had no change. Cases of more severe MR were more likely to improve compared with mild or trace MR (P = 0.04). MR worsening was significantly more likely in patients with bicuspid aortic valves (83% vs. 24%;P = 0.004), and with larger aortic annulus diameters (P = 0.03). MR worsening was less frequent in cases of mitral annular calcification (0% vs 42%;P = 0.04) and left atrial enlargement (17% vs 65%;P = 0.03). Logistic regression analysis revealed negative predictors for MR improvement were mitral annular calcification (P = 0.04) and larger aortic annulus diastolic diameter (P = 0.05). Conclusion: Structural factors such as aortic annular size, mitral annular calcification and valve morphology may impact MR following AVR and should be investigated further as potential targets of surgical therapy.

Prognostic value of the ratio between prosthesis area and indexed annulus area measured by MultiSlice-CT for transcatheter aortic valve implantation procedures

Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation （TAVI） procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn＇t well established. We compared different level of oversizing in our cohort of con- secutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes. Methods From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT （MSCT） and the procedures were achieved using Edwards Sapien~ or Corevalve devices~. Retrospectively, according to pre-procedural MSCT and the valve size, pa- tients were classified into three groups： normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium （VARC-2） endpoints. Results Two hundred and sixty eight patients had a MSCT and underwent TAVI procedure, with mainly Corevalve~. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pacemaker （PM） implantation rate was significantly higher in the severe oversizing group （P = 0.03）, while we observed more in-hospital congestive heart-failure （P = 0.02） in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation （AR） in the normal sizing group （P = 0.07）. Conclusions Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival.

Assessment of aortic valve disease--a clinician oriented review

Aortic valve disease [aortic stenosis(AS) and aortic regurgitation(AR)] represents an important global healthproblem; when severe, aortic valve disease carries poor prognosis. For AS, aortic valve replacement, either surgical or interventional, may provide definite treatment in carefully selected patients. For AR, valve surgery(either replacement or-in selected cases-aortic valve repair) remains the gold standard of care. To properly identify those patients who are candidates for surgery, the clinician has to carefully assess the severity of valve disease with an understanding of the potential pitfalls involved in these assessments. This review focuses on the practical issues concerning the evaluation of patients with AS and AR from a general cardiologist's perspective. The most important issues regarding the documentation of the severity of AS and AR are summarized. More specific issues, such as the role of stress echocardiography, other imaging techniques and details regarding the treatment options(medical, surgical, or interventional), are mentioned briefly.

Morphology and Function of the Aortic Valve after Transcatheter Closure of Ventricular Septal Defect with Aortic Valve Prolapse

Objective:This study aims to evaluate the morphology and function of the aortic valve after transcatheter closure of ventricular septal defect(VSD)with aortic valve prolapse(AVP)abased on clinical and radiological outcomes.Methods:From January 2013 to November 2014,164 consecutive patients(97 males,59.1%)with VSD and AVP were treated by transcatheter closure.The patients were divided into the mild AVP group(n=63),moderate AVP group(n=89)and severe AVP group(n=12).The clinical and radiological outcomes of these patients were analyzed retrospectively.Results:In total,146(89.0%)patients were successfully treated with VSD occluders,including 59/63(93.7%)with mild AVP,80/89(89.9%)with moderate AVP and 7/12(58.3%)with severe AVP.The degree of AVP was ameliorated or disappeared in 39(26.7%)patients,and remained unchanged in 103(70.5%)patients after the intervention.In the 35 patients who initially had trivial-to-moderate aortic regurgitation(AR),the degree of AR was ameliorated or disappeared in 25(71.4%)patients,aggravated from trivial to mild AR in 1(2.9%)patient,and remained unchanged in 9(25.7%)patients.In 111 patients without AR,1(0.9%)patient had mild AR and 24(21.6%)patients had trivial AR after intervention.The depth and width of the prolapsed aortic valve decreased after transcatheter closure of VSD in all three groups.During the 70-month(range,54–77)follow-up period,no patients with AVP and AR needed an aortic valve intervention.Conclusions:Transcatheter closure of VSD with AVP is feasible.The morphology and function of the prolapsed aortic valve improved and remained stable for a long period after intervention.

Early surgical intervention in culture-negative endocarditis of the aortic valve complicated by abscess in an infant:A case report

BACKGROUND Surgical therapy of infective endocarditis(IE)involving aortic valves and mitral valves is widespread.However,there are few reports concerning patients with culture-negative endocarditis complicated by the appearance of comorbid valvular perforation and abscess.Therefore,real-time surveillance of changes in cardiac structure and function is critical for timely surgical management,especially in patients who do not respond to medical therapy.CASE SUMMARY Here,we report an atypical case in a 9-mo-old infant without congenital heart disease but with symptoms of intermittent fever and macular rashes.Physical examination,laboratory tests,and electrocardiograms suggested a diagnosis of IE,although the result of blood cultures was exactly negative.After treatment with antibiotic drugs,the patient got a transient recovery.On the 9th day,we proceeded with continuous echocardiogram due to fever again and the results revealed aortic valve abscess with perforation,regurgitation,vegetation,and pericardial effusion.Intraoperative monitoring revealed aortic valve perforation,presence of apothegmatic cystic spaces below the left coronary cusp of the aortic valve,and severe aortic valve regurgitation.Aortic valve repair was performed by autologous pericardial patch plasty.The patient was discharged after 4 wk of treatment and no complications occurred after surgery.CONCLUSION Our case demonstrated the necessity of serial echocardiography monitoring for possible adverse symptoms of IE in pediatric patients.

Rapid right ventricular pacing for balloon valvuloplasty in congenital aortic stenosis:A systematic review

BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during BAV on aortic regurgitation(AR)in pediatric patients.METHODS A systematic review of the MEDLINE,Cochrane Library,and Scopus databases was conducted according to the PRISMA guidelines(end-of-search date:July 8,2020).The National Heart,Lung,and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.RESULTS Five studies reporting on 72 patients were included.The studies investigated the use of RRVP-assisted BAV in infants(>1 mo)and older children,but not in neonates.Ten(13.9%)patients had a history of some type of aortic valve surgical or catheterization procedure.Before BAV,58(84.0%),7(10.1%),4(5.9%)patients had AR grade 0(none),1(trivial),2(mild),respectively.After BAV,34(49.3%),6(8.7%),26(37.7%),3(4.3%),patients had AR grade 0,1,2,and 3(moderate),respectively.No patient developed severe AR after RRVP.One(1.4%)developed ventricular fibrillation and was defibrillated successfully.No additional arrhythmias or complications occurred during RRVP.CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV,which could potentially decrease AR rates.

Rheumatic Aortic Valve Disease with Mitral Stenosis—A Case Report

Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.