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Aims: Mitral stenosis (MS) occasionally coexists with aortic stenosis (AS). Limited data are available regarding the functional class and clinical outcomes of patients who undergo transcatheter aortic valve implantation (TAVI) for combined AS and MS. This study compared the clinical outcomes in patients with and without MS who underwent TAVI for severe AS and assessed the impact of mitral annulus calcification (MAC) severity, transmitral gradient (TMG) and mitral valve area (MVA) on outcomes in patients with combined AS and MS. Methods: We investigated patients in the OCEAN‐TAVI registry who underwent TAVI. MS was defined as an MVA ≤ 1.5 cm2 or TMG ≥ 5 mmHg. The composite of all‐cause death and admission for heart failure was compared between patients with and without MS. The impact of MAC, TMG and MVA on outcomes was assessed in patients with combined AS and MS. Results: We identified 106 patients with MS (MAC 84%; TMG 6.4 ± 2.6 mmHg; MVA 1.10 ± 0.31 cm2) and 6570 without MS as controls. The MS group was older (85 ± 5 vs. 84 ± 5 years, P = 0.033), more of women (85 vs. 67%, P < 0.01), and had a higher risk of surgery (the Society of Thoracic Surgeons Mortality Score 8.7 ± 5.1 vs. 7.6 ± 5.9, P = 0.047) than the controls. In the MS group, the New York Heart Association Functional Class was 3 or 4 in 56% of the patients at baseline and 6% at 1 year after TAVI. Thirty‐day mortality (2.8% vs. 1.3%, P = 0.18) and early composite outcomes (17% vs. 15%, P = 0.56) were comparable between patients with and without MS. During a median follow‐up of 2.1 years, the presence of MS was associated with a higher incidence of adverse events compared with controls (adjusted hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.34–2.51, P < 0.01), even on propensity score matched analysis (adjusted HR 1.91; 95% CI 1.14–3.22, P < 0.01). Moderate or severe MAC contributed to increased risk of adverse events in patients with MS (adjusted HR 2.89; 95% CI 1.20–6.99, P = 0.018), but TMG and MVA did not. Conclusions: In patients undergoing TAVI for severe AS, those with moderate or severe MS experienced worse outcomes after TAVI compared with those without MS. Patients with combined AS and MS sustained symptom improvement at 1‐year post‐TAVI. MAC severity was a useful predictor of adverse events compared with MS haemodynamics such as TMG and MVA in patients with combined AS and MS. [ABSTRACT FROM AUTHOR]

The importance of the right ventricle (RV) was neglected or forgotten for decades. The RV has an essential function in cardiovascular physiology and pathology. The RV dysfunction is one of the causes of morbidity and mortality in valvular heart disease (VHD), especially in mitral stenosis (MS). Right ventricular systolic and diastolic function are important for the determination of clinical symptoms, exercise functional capacity, pre-procedure survival, and post-procedure outcome in patients with MS. Right ventricular dysfunction in MS with a sign of systemic venous congestion is easy to recognize, but MS without clinical evidence of RV dysfunction has not been studied. Detecting RV dysfunction earlier in MS is important in clinical practice. [ABSTRACT FROM AUTHOR]

Yeo's index, the product of the mitral leaflet separation index and dimensionless index of mitral valve (MV), was recently described to accurately identify severe rheumatic mitral stenosis (MS). We assess the association between Yeo's index and clinical outcomes in patients with rheumatic MS. We studied 297 patients with rheumatic MS. Clinical and echocardiographic data were obtained from the electronic medical record and Yeo's index was measured in all cases. The outcome studied was a composite of all cause death, heart failure (HF) hospitalisation, MV intervention and stroke or transient ischaemic attack. We also performed subgroup analysis of patients without pre-existing atrial fibrillation (AF) to assess for association with new onset AF. The median follow up was 6.3 years; 145 patients (48.8%) developed the composite outcome. Yeo's index (p < 0.001), mitral valve area (MVA) by pressure half-time (PHT) (p = 0.028) and planimetry (p < 0.001), age (p = 0.016), history of diabetes mellitus (p = 0.029), previous HF (p = 0.021), left ventricular ejection fraction (p = 0.022), and pulmonary artery systolic pressure (p = 0.007) were univariately associated with the composite outcome. Yeo's index remained independently associated with the composite outcome in multivariate analysis (p < 0.001, HR 0.094, 95% CI 0.260–0.340). This was primarily driven by MV intervention. In a subgroup analysis of patients without pre-existing AF, Yeo's index was independently associated with new onset AF (p = 0.024, HR 0.354, 95% CI 0.143–0.874). This demonstrated that Yeo's index was independently associated with clinical outcomes in patients with rheumatic MS which was mainly driven by MV intervention. [ABSTRACT FROM AUTHOR]

Background: In symptomatic high-risk patients with severe mitral valve regurgitation (MR), who are not eligible for surgery, Transcatheter edge-to-edge repair (TEER) or transcatheter mitral valve replacement (TMVR) may be an option, especially when surgical mitral valve repair by annuloplasty has been performed earlier. After TMVR, the appropriate anticoagulation regimen is still matter of debate. Case presentation: We here report on a 78-year-old frail lady with heart failure and atrial fibrillation who underwent surgical reconstruction of the mitral valve nine years ago. Due to high surgical risk and after heart team discussion, TMVR using a transcatheter aortic valve prosthesis (valve-in-ring concept) was performed successfully via the transapical access route. Several months later, an excellent result could be confirmed. Since surgical excision of the left atrial appendage was carried out during first surgery, oral anticoagulation was withdrawn. Two months later, the patient presented with a massive LA thrombus mass and severe stenosis of the mitral valve prosthesis requiring re-do surgery. Conclusions: Management of anticoagulation in patients with atrial fibrillation and successfully performed LAA excision is still a matter of debate, in particular after transcatheter heart valve implantation in mitral position. TMVR devices may be very thrombogenic. Thus, caution should be used whenever discontinuing oral anticoagulation in these patients. Despite the lack of evidence, withdrawal of anticoagulation should be avoided here, especially in the absence of bleeding complications. Left atrial appendage closure or excision should not influence this decision. [ABSTRACT FROM AUTHOR]

Introduction-Mitral stenosis (MS) is the most common valve disease seen as a sequel of rheumatic fever and usually presents with exertional dyspnoea and right-side heart failure and pulmonary arterial hypertension. Normal Left Atrial function consists of reservoir, conduit and pump function. To assess the outcomes of successful BMV on LA functions in patients with isolated severe rheumatic MS in sinus rhythm over a period of one year follow up. Material & Methods: Prospective observation study done on patients with severe mitral stenosis with suitable valve morphology who are undergoing PTMC. Thorough history taking, full clinical examination, 12 lead ECG, full 2D, M mode & Doppler transthoracic echocardiographic and transesohageal echocardiography study in standard views. Observation & Results: Peak atrial longitudinal stain improved significantly over a period of 12 months. LA dimension also reduced immediately 24 hr after BMV from 42.4 ± 7.6mm to 41.1±5.4. LA volume also reduced significantly 24 hr post bmv (P value-< 0.033) and during 1 month (P value-< 0.021) and 12 months follow up (P value-< 0.011). MVA by planimetry increased significantly from pre BMV value of 0.89±0.11 cm2 to 1.83±0.3 cm2 at 24 hr post BMV. Conclusion: All Left atrial parameters in terms of mitral valve area, left atrial volume index, mean gradient across mitral valve, pulmonary artery systolic pressure has shown significant improvement. However larger study is needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Introduction: Rheumatic Fever and Rheumatic Heart Disease is a significant cause of cardiovascular diseases in the world today. Impaired function of the Left Atrial Appendages (LAA), such as reduced flow velocity and reduced atrial strain, typically results in thrombus formation. Recovery of LAA velocity after PTMC depends directly upon improving the mitral valve hemodynamics and reducing the trans-mitral gradient. Material & Methods: Prospective observation study on 50 patients with severe mitral stenosis with suitable valve morphology undergoing PTMC. Transesophageal echocardiography (TEE) was performed for assessment of left atrial appendage functions as well as to rule out any clot. After PTMC, TEE was performed at least after1 month and then at 12 months follow up. Observation & Results: Youngest patient was 13-year female and eldest one was 51 years male. LAA end systolic volume was decreased significantly after PTMC. The LAA ejection fraction (LAAEF) increased significantly from pre BMV value of 42.82±1.572 % to 54.24±1.341%. LAA emptying velocity (LAAEV) increment upto 20% seen post BMV at 1 month follow up which remained consistent at 12 months follow up. Conclusion: LAA ejection fraction and LAA emptying velocity by transesophageal echocardiography at least one month post PTMC have also shown significant improvement. However large and detailed studies needed to establish our findings. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a common arrhythmia in clinical practice, and oral anticoagulation is the cornerstone of stroke prevention in AF. Direct oral anticoagulants (DOAC) significantly reduce the incidence of intracerebral hemorrhage with preserved efficacy for preventing stroke compared to vitamin K antagonists (VKA). However, the pivotal randomized controlled trials (RCTs) of DOAC excluded patients with valvular heart disease, especially mitral stenosis, which remains an exclusion criterion for DOAC use. The INVICTUS study was a large multicenter global RCT aimed at evaluating the role of DOAC compared to VKA in stroke prevention among patients with rheumatic valvular AF. In this study, rivaroxaban failed to prove superiority over VKA in preventing the composite primary efficacy endpoints of stroke, systemic embolism, myocardial infarction, and death. Unfortunately, the bleeding rates were not lower with rivaroxaban either. The death and drug discontinuation rates were higher in the DOAC arm. Close to the heels of the dismal results of INVICTUS, an apixaban trial in prosthetic heart valves, PROACT-Xa, was also prematurely terminated due to futility. Hence, for AF complicating moderate-to-severe mitral stenosis or prosthetic valve VKA remains the standard of care. However, DOAC can be used in patients with surgical bioprosthetic valve implantation, TAVR, and other native valve diseases with AF, except for moderate-to-severe mitral stenosis. Factor XI inhibitors represent a breakthrough in anticoagulation as they aim to dissociate thrombosis from hemostasis, thereby indicating a potential to cut down bleeding further. Multiple agents (monoclonal antibodies—e.g., osocimab, anti-sense oligonucleotides—e.g., fesomersen, and small molecule inhibitors—e.g., milvexian) have garnered positive data from phase II studies, and many have entered the phase III studies in AF/Venous thromboembolism. Future studies on conventional DOAC and new-generation DOAC will shed further light on whether DOAC can dethrone VKA in valvular heart disease. [ABSTRACT FROM AUTHOR]

Introduction: High pulmonary artery pressure (PAP) is a critical survival parameter in patients with severe mitral stenosis. We investigated changes in PAP and their impact on survival in patients undergoing mitral valve replacement for severe mitral stenosis. Methods: We retrospectively analyzed 42 patients who underwent mitral valve replacement for severe mitral stenosis between January 2020 and January 2022. Changes in systolic pulmonary artery pressure (sPAP) assessed by echocardiography and survival outcomes were analyzed. Results: The mean age of the patients was 56.05±14.21 years. Among the patients, 71.4% were female and 28.6% were male. The median postoperative sPAP was 29 mmHg, which was significantly lower than the preoperative value (p<0.001). In the subgroup analysis according to preoperative sPAP value, the postoperative sPAP change was 17.87% in <50 mmHg group and 41.61% in >50 mmHg group, which indicated a statistically significant difference (p=0.003). In the patient group with preoperative sPAP <50 mmHg, the expected 3-year survival rate was 85.2% compared with 75.8% in the patient group with sPAP >50 mmHg, and the differences were insignificant (p=0.510). Conclusion: Patients with severe mitral stenosis and high sPAP can undergo surgery with acceptable survival expectancy. However, the decrease in pulmonary pressure in the early postoperative period alone cannot adequately predict survival. [ABSTRACT FROM AUTHOR]

This article reviews and discusses non-myocardial disorders that represent diagnostic challenges when evaluating patients for suspected heart failure with preserved left ventricular ejection fraction. This includes pre-capillary pulmonary hypertension, which is important to differentiate from post-capillary hypertension caused by left-sided heart disease. The impact of electrical disorders on LV diastolic function is also reviewed, and includes a discussion of left bundle branch, which has both a direct effect on LV diastolic function, as well as a long-term effect due to remodelling. Furthermore, evaluation of diastolic function in patients with atrial fibrillation is discussed. Pericardial diseases are reviewed as well as effects of a normal pericardium on diastolic function in failing hearts. Finally, the article reviews how valvular diseases impact LV diastolic function. [ABSTRACT FROM AUTHOR]

Multi-modality imaging is the recommended approach to assess the severity of valvular heart diseases. Rheumatic mitral stenosis (MS), however, has yet to benefit from this approach. The aim of this study is to assess the added value of cardiac MRI (CMR) and computed tomography (CT) calcium score in assessing severity of MS when compared to 3D echocardiography. Patients with MS in sinus rhythm were included. Both CMR and 3D echo assessments of the mitral valve were performed. Subsequently, three radiologists and three cardiologists independently measured mitral valve area (MVA). In addition, CT of the mitral valve was conducted. Mitral calcium score was calculated according the Agatston method. A total of 41 patients were included. CMR significantly overestimated MVA when compared to 3D echo MVA regardless of the investigator [F (1, 40) = 23.3, p < 0.001, η2 = 0.36]. The more severe the MS, the greater the overestimation by CMR compared to 3D echo. Regarding CT of the mitral valve, 25 (61%) patients had an undetectable calcium. There was no significant difference in CT calcium scores between severe and non-severe MS (74 ± 282 HU vs. 65 ± 210 HU, p = 0.9). MVA measurement by CMR is overestimated when compared to 3D echo. Additionally, mitral valve calcium score is not correlated to MS severity. [ABSTRACT FROM AUTHOR]

Background: Scheie syndrome, an attenuated subtype of mucopolysaccharidosis type I, is a rare storage disease that causes progressive glycosaminoglycans (GAGs) accumulation. Cardiovascular disorders determine the prognosis, and cardiac valve abnormalities are the most common cause. The patients are usually young so mechanical valve replacement is often performed, but because of the features of this disease, the surgical treatment is very risky. Recently, transcatheter aortic valve implantation (TAVI) has been reported as an alternative choice for aortic stenosis, but optimal choice is still unclear. Here, we introduce a patient that underwent TAVI and refer to the histological finding of a biological valve extracted in relation to GAGs accumulation. Case presentation: A 54-year-old woman with Scheie syndrome underwent valve surgeries three times throughout her whole life. At age 41, she received a mitral valve replacement with a mechanical valve for mitral stenosis. She promptly developed severe diastolic dysfunction and low output syndrome after the release of aortic clamping, thus requiring temporary mechanical circulatory support4. At age 51, she suffered from heart failure due to severe aortic stenosis and underwent TAVI because conventional aortic valve replacement (AVR) was deemed too risky. Three years later, her heart failure relapsed, and an echocardiogram unexpectedly revealed thickened bioprosthetic valve leaflets and a significant pressure gradient across the valve, consistent with early structural valve deterioration. AVR was performed via median sternotomy with a mechanical valve. As with the first operation, she presented refractory heart failure requiring mechanical circulatory support and was meticulously managed. However, she steadily showed worsening of multiple organ systems and died 9 days after the operation. Pathological autopsy and histological examination revealed accumulation of tissue with GAGs on the leaflets of the bioprosthetic valve of TAVI, which may have been the cause of early structural valve deterioration. Conclusion: For patients with Scheie syndrome, a biological valve can be compromised by the accumulation of GAGs, thereby causing early SVD. These findings may support valve selection for these high-risk patients. [ABSTRACT FROM AUTHOR]

To examine temporal changes in patient characteristics, the incidence rate of surgical intervention, and the three-year mortality rate for patients undergoing surgical intervention for mitral valve stenosis (MS) from 2001 to 2021 in Denmark. Utilizing Danish nationwide registries, we identified all adult patients undergoing first-time surgical intervention for MS (2001–2021). Temporal changes in the incidence rate of surgical intervention across calendar periods were investigated (2001–2005, 2006–2010, 2011–2015, and 2016–2021). Using Kaplan-Meier estimates, we computed temporal changes in three-year all-cause mortality across calendar periods. With multivariable Cox regression analysis, we assessed the adjusted rates of mortality. We included 256 patients (median age 60.3 years, 31.3% males). A stepwise decrease in the burden of chronic heart failure was identified (2001–2005: 54%, and 2016–2021: 20%, p-value < 0.001 for trend), while the burden of atrial fibrillation seemed stable (2001–2005: 51%, and 2016–2021: 46%, p-value = 0.27 for trend). The proportion of patients with rheumatic MS was 64% in 2001–2005 and 33% in 2016–2021, p-value < 0.001 for trend. 28 patients (10.9%) had mitral valve surgery prior to the first-time surgical intervention for MS. A stepwise decrease in the incidence rate of surgical intervention was observed: 3.3 cases per million person-years in 2001–2005 and 2.2 in 2016–2021. The incidence of patients diagnosed with first-time MS remained stable over calendar periods (2001–2005: 54.5 incidences per million person-years, and 2016–2021: 41.9, p-value = 0.46 for trend). The in-hospital mortality was 8.6% and the three-year mortality after surgical discharge was 9.0%, and we found no difference over calendar periods in either crude estimates or adjusted analysis. From nationwide data across three decades, we identified that the incidence of surgical interventiondecreased significantly within the past 20 years, while all-cause mortality remained stable. The burden of heart failure decreased, while the burden of atrial fibrillation remained stable over the study period. [ABSTRACT FROM AUTHOR]

Background/Objectives: We assessed the effectiveness and safety of vitamin K antagonists (VKAs) versus direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) using artificial intelligence techniques. Methods: This is a retrospective study in 15 Spanish hospitals (2014–2020), including adult AF patients with no history of anticoagulation, thrombosis events, rheumatic mitral valvular heart disease, mitral valve stenosis, or pregnancy. We employed EHRead® technology based on natural language processing (NLP) and machine learning (ML), along with SNOMED-CT terminology, to extract clinical data from electronic health records (EHRs). Using propensity score matching (PSM), the effectiveness, safety, and hospital mortality of VKAs versus DOACs were analyzed through Kaplan–Meier curves and Cox regression. Results: Out of 138,773,332 EHRs from 4.6 million individuals evaluated, 44,292 patients were included, 79.6% on VKAs and 20.4% on DOACs. Most patients were elderly [VKA 78 (70, 84) and DOAC 75 (66, 83) years], with numerous comorbidities (75.5% and 70.2% hypertension, 47.2% and 39.9% diabetes, and 40.3% and 34.8% heart failure, respectively). Additionally, 60.4% of VKA and 48.7% of DOAC users had a CHA2DS2-VASc Score ≥4. After PSM, 8929 patients per subgroup were selected. DOAC users showed a lower risk of thrombotic events [HR 0.81 (95% CI 0.70–0.94)], minor bleeding [HR 0.89 (95% CI 0.83–0.96)], and mortality [HR 0.80 (95% CI 0.69–0.92)]. Conclusions: Applying NLP and ML, we generated valuable real-world evidence on anticoagulated AF patients in Spain. Even in complex populations, DOACs have demonstrated a better safety and effectiveness profile than VKAs. [ABSTRACT FROM AUTHOR]

Acute articular rheumatism (AAR) primarily affects children aged 5 to 15, causing fever and non-suppurative arthritis, and can lead to severe heart problems such as mitral stenosis and aortic insufficiency. Descriptions of early years by Hippocrates and Galen were expanded in a in the 19th century by Jean-Baptiste Bouillaud, who linked AAR to heart complications. An exploration of the historical development of AAR can be beneficial to further medical understanding. Time period between Renaissance and mid-20th century unveiled a series of hallmarks in diagnosis, symptomatology, feverous attacks and treatment. As research method, a documentary research related to the subject. Of great importance concerning AAR’s understanding are Hippocrates’ early descriptions, Jerome Cardan’s Renaissance distinction between “morbus articularis” and podagral (gout), and Jean-Baptiste Bouillaud’s 19th-century linkage of AAR to heart disease. Furthermore, contributions from Théodore-Hermann Meynet, Louis Bard, and Edmond Weill were pivotal in clarifying the clinical and cardiac aspects of the disease. During 19th century new diagnostic factors like visceral lesions and clearer understanding of chemical and mineral drugs supplied novel approaches. In the 20th century, research in the United States confirmed the streptococcal cause of AAR, marking an advancement of great significance in the understanding the cause of AAR, as well as its progression. Even since the ancient times AAR has been recognized. Various nominations described the disease, while gradually physicians understood the causes and the nature of the disease, as philosophical physiology gave space to clinical anatomy and medical science of the mechanized era. Advancements made during the last centuries aided in AAR further understanding. The comprehension of the evolution of AAR is crucial in order to appreciate its current medical perspective and treatment. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Rheumatic mitral stenosis is a common rheumatic heart diseases in sub‐Saharan Afrleading to increased morbidity and mortality. Percutaneous mitral balloon valvuloplasty is the mainstay of less invasive therapy in those with moderate to severe valve stenosis, being symptomatic despite optimal medical therapy. Though generally save with experienced hand and setup, post procedural complications include development of mitral regurgitation, tear and thrombosis. Mitral leaflet tear and development of infective endocarditis are an uncommon but might lead to increased morbidity, rehospitalization and mortality. [ABSTRACT FROM AUTHOR]

Percutaneous mitral balloon commissurotomy (PMBC) is the standard treatment option for patients with rheumatic mitral stenosis (MS), according to current guidelines. This study aimed to compare the outcomes of rheumatic mitral valve repair (rMVR) and PMBC in this patient population. Baseline, clinical, and follow-up data from 703 patients with rheumatic heart disease who underwent PMBC or rMVR at the current centre were collected and analysed. A 1:1 propensity score (PS) matching method was used to balance the differences in baseline characteristics between the two groups. The primary outcome was mitral valve reoperation, and the secondary outcome was all-cause mortality. Propensity score matching generated 101 patient pairs for comparison. In the matched population, there were no significant differences in the early clinical outcomes between the groups. The median follow-up time was 40.9 months. Overall, patients in the rMVR group had a statistically significantly lower risk of mitral valve reoperation than those in the PMBC group (HR 0.186; 95% CI 0.041–0.835; p=0.028). Regarding all-cause mortality, no statistically significant differences were observed between the rMVR and PMBC groups (HR 4.065; 95% CI 0.454–36.374; p=0.210). Compared with PMBC, rMVR has more advantages for the correction of valve lesions; therefore, it may offer a better prognosis than PMBC in select patients with rheumatic MS. However, this finding needs to be verified in future studies with larger sample sizes and longer follow-up periods. [ABSTRACT FROM AUTHOR]

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Background Rheumatic heart disease (RHD) is a major global health issue because of its potential to cause heart failure. While RHD has been reported more frequently in women, this case report highlights the clinical manifestations, diagnosis, and management of rheumatic multivalvular disease in a young Asian male. Case summary A 46-year-old Asian man with a history of percutaneous mitral valvuloplasty (PMV) was admitted with dyspnoea and generalized oedema that severely hindered his quality of life. Transthoracic and transoesophageal echocardiography revealed severe mitral stenosis, left atrial appendage (LAA) thrombus, and severe tricuspid regurgitation due to RHD. Following a comprehensive evaluation by a multidisciplinary team, we advised mitral valve replacement, LAA thrombectomy, and tricuspid valve annuloplasty based on the detailed imaging of the valve anatomy and the patient's low surgical risk. Surgical intervention led to considerable improvement in the patient's symptoms, enabling a return to routine activities. Discussion This case highlights the chronic nature of RHD and its potential to cause heart failure. This report emphasizes the need for regular follow-up in patients with a history of RHD to detect potential complications and ensure timely management. The successful outcome in this case underscores the importance of a team-based approach for managing complex valvular heart disease. [ABSTRACT FROM AUTHOR]

Background and Aims To assess sex differences in disease characteristics and treatment of patients with severe native valvular heart disease (VHD) included in the VHD II EURObservational Research Programme. Methods A total of 5219 patients were enrolled in 208 European and North African centres and followed for 6 months [41.2% aortic stenosis (AS), 5.3% aortic regurgitation (AR), 4.5% mitral stenosis (MS), 21.3% mitral regurgitation (MR), 2.7% isolated right-sided VHD, 24.9% multiple left-sided VHD]. Indications for intervention were considered concordant if corresponding to class I recommendations specified in the 2012 ESC or 2014 AHA/ACC VHD guidelines. Results Overall, women were older, more symptomatic, and presented with a higher EuroSCORE II. Bicuspid aortic valve and AR were more prevalent among men while mitral disease, concomitant tricuspid regurgitation (TR), and AS above age 65 were more prevalent among women. On multivariable regression analysis, concordance with recommended treatment was significantly poorer in women with MS and primary MR (both P <.001). Age, patient refusal, and decline of symptoms after conservative treatment were reported significantly more often as reasons to withhold the intervention in females. Concomitant tricuspid intervention was performed at a similar rate in both sexes although prevalence of significant TR was significantly higher in women. In-hospital and 6-month survival did not differ between sexes. Conclusions (i) Valvular heart disease subtype varied between sexes; (ii) concordance with recommended intervention for MS and primary MR was significantly lower for women; and (iii) survival of men and women was similar at 6 months. [ABSTRACT FROM AUTHOR]

Abstract Aims Mitral stenosis (MS) occasionally coexists with aortic stenosis (AS). Limited data are available regarding the functional class and clinical outcomes of patients who undergo transcatheter aortic valve implantation (TAVI) for combined AS and MS. This study compared the clinical outcomes in patients with and without MS who underwent TAVI for severe AS and assessed the impact of mitral annulus calcification (MAC) severity, transmitral gradient (TMG) and mitral valve area (MVA) on outcomes in patients with combined AS and MS. Methods We investigated patients in the OCEAN‐TAVI registry who underwent TAVI. MS was defined as an MVA ≤ 1.5 cm2 or TMG ≥ 5 mmHg. The composite of all‐cause death and admission for heart failure was compared between patients with and without MS. The impact of MAC, TMG and MVA on outcomes was assessed in patients with combined AS and MS. Results We identified 106 patients with MS (MAC 84%; TMG 6.4 ± 2.6 mmHg; MVA 1.10 ± 0.31 cm2) and 6570 without MS as controls. The MS group was older (85 ± 5 vs. 84 ± 5 years, P = 0.033), more of women (85 vs. 67%, P

Abstract Yeo’s index, the product of the mitral leaflet separation index and dimensionless index of mitral valve (MV), was recently described to accurately identify severe rheumatic mitral stenosis (MS). We assess the association between Yeo’s index and clinical outcomes in patients with rheumatic MS. We studied 297 patients with rheumatic MS. Clinical and echocardiographic data were obtained from the electronic medical record and Yeo’s index was measured in all cases. The outcome studied was a composite of all cause death, heart failure (HF) hospitalisation, MV intervention and stroke or transient ischaemic attack. We also performed subgroup analysis of patients without pre-existing atrial fibrillation (AF) to assess for association with new onset AF. The median follow up was 6.3 years; 145 patients (48.8%) developed the composite outcome. Yeo’s index (p

Introduction: High pulmonary artery pressure (PAP) is a critical survival parameter in patients with severe mitral stenosis. We investigated changes in PAP and their impact on survival in patients undergoing mitral valve replacement for severe mitral stenosis. Methods: We retrospectively analyzed 42 patients who underwent mitral valve replacement for severe mitral stenosis between January 2020 and January 2022. Changes in systolic pulmonary artery pressure (sPAP) assessed by echocardiography and survival outcomes were analyzed. Results: The mean age of the patients was 56.05±14.21 years. Among the patients, 71.4% were female and 28.6% were male. The median postoperative sPAP was 29 mmHg, which was significantly lower than the preoperative value (p

Abstract Background Ball thrombus is rare and life-threatening. The correct diagnosis and timely management are key to improving patient prognosis. Here, we present a case report and literature review of ball thrombus. Case presentation A 75-year-old woman presented to our outpatient clinic because of palpitations and chest distress for 8 months. She was diagnosed mitral stenosis, and transthoracic echocardiography (TTE) showed a round mass attached to the left atrial (LA) wall. Before anesthesia induction, TTE found that the mass has dropped from the LA wall, and was spinning in the LA causing intermittent obstruction of the valve. Anesthesia induction was then carried out under TTE monitoring, and transesophageal echocardiograph found another mass in the LA appendage after intubation. She underwent LA mass removal and mitral valve replacement, and was discharged uneventfully. Histopathology confirmed the diagnosis of thrombus. Our literature review identified 19 cases of ball thrombus between 2015 and 2024. The average age was 54.8 (range 3–88) years. Heart failure was present as the initial symptom in 11 cases, and most patients had mitral valve disease or concomitant with atrial fibrillation. 12 cases received surgery, and 7 received medical treatment only. 2 deaths occurred, one due to the obstruction of left ventricular inflow tract and the other due to the worsening of heart failure. Conclusion Ball thrombus is rare in clinical settings. Urgent thrombectomy should be performed as soon as possible, and echocardiography can be used for real-time monitoring during surgery.

Abstract Background Rheumatic mitral stenosis (MS) remains a common and concerning health problem in Asia. Percutaneous balloon mitral valvuloplasty (PBMV) is the standard treatment for patients with symptomatic severe MS and favorable valve morphology. However, studies on the incidence and predictors of adverse cardiac outcomes following PBMV in Asia have been limited. This study aims to evaluate the incidence and predictors of adverse outcomes in patients with rheumatic MS following PBMV. Methods A retrospective cohort study was conducted on patients with symptomatic severe MS who underwent successful PBMV between 2002 and 2020 at a tertiary academic institute in Thailand. Patients were followed up to assess adverse outcomes, defined as a composite of cardiac death, heart failure hospitalization, repeat PBMV, or mitral valve surgery. Univariable and multivariable analyses were performed to identify predictors of adverse outcomes. A p-value of

Abstract Mitral stenosis (MS) is a complex valvular pathology with significant clinical burden even today. Its effect on the right heart is often overlooked, despite it playing a considerable part in the symptomatic status. We enrolled 39 mitral valve stenosis patients and 39 age- and gender-matched healthy controls. They underwent conventional, speckle-tracking and 3D echocardiographic examinations. The 3D data was analyzed using the ReVISION software to calculate RV functional parameters. In the MS group, 3D RV ejection fraction (EF) (49 ± 7% vs. 61 ± 4%; p

Kefelegn Dejene Tadesse,1 Yidnekachew Asrat Birhan2 1Cardiology Department, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia; 2Internal Medicine Department, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Kefelegn Dejene Tadesse, Email kefruit@gmail.comAbstract: Percutaneous transvenous mitral commissurotomy is an established treatment for rheumatic mitral stenosis. Dextrocardic heart can be affected by rheumatic pathology just like the normal heart. However, it is technically demanding to percutaneous interventions especially the septal puncture which should be done in a mirror image of the normal. Here we are reporting a 45 year old woman with severe rheumatic mitral stenosis with dextrocardia with situs inversus totalis. She has undergone a successful percutaneous transvenous mitral commissurotomy.Keywords: dextrocardia, mitral stenosis

Background: Pulmonary hypertension (PH) often complicates mitral stenosis (MS). The prognostic impact of pulmonary vascular resistance (PVR) in MS patients remains unclear. Previous study has demonstrated the prognostic impact of right atrial pressure (RAP) in patients with primary PH. We aim to determine the prognostic impact of PVR and RAP in patients with rheumatic MS undergoing percutaneous mitral balloon valvuloplasty (PMBV). Methods: A total of 58 patients with symptomatic severe rheumatic MS who underwent PMBV between 2016 and 2020 were included. Patients were divided into two groups: PVR ≤ 2WU (N = 26) and PVR > 2WU (N = 32). The composite endpoint included death, reintervention or persistent NYHA functional class III-IV during follow-up. Results: The median age was 50 (42–60) years, with 82.8% being female. Median pulmonary artery systolic pressure (PASP) was 42 (35–50.5) mmHg. Patients with PVR ≤ 2WU had lower PASP on both echocardiogram and catheterization. The PMBV success rate was 75.9%. Multivariate analysis, adjusted for PVR, showed RAP as the only independent predictor of the composite endpoint (HR:1.507, 95% CI:1.015–2.237, p = 0.042). The optimal RAP cutoff was 9.5 mmHg (HR:3.481, 95% CI:1.041–11.641; p = 0.043). Conclusions: RAP was an independent predictor of adverse outcomes in patients with rheumatic MS undergoing PMBV, while PVR did not show prognostic significance. These findings suggest that the prognostic value of PVR may be lower than expected. [ABSTRACT FROM AUTHOR]

Background: Ball thrombus is rare and life-threatening. The correct diagnosis and timely management are key to improving patient prognosis. Here, we present a case report and literature review of ball thrombus. Case presentation: A 75-year-old woman presented to our outpatient clinic because of palpitations and chest distress for 8 months. She was diagnosed mitral stenosis, and transthoracic echocardiography (TTE) showed a round mass attached to the left atrial (LA) wall. Before anesthesia induction, TTE found that the mass has dropped from the LA wall, and was spinning in the LA causing intermittent obstruction of the valve. Anesthesia induction was then carried out under TTE monitoring, and transesophageal echocardiograph found another mass in the LA appendage after intubation. She underwent LA mass removal and mitral valve replacement, and was discharged uneventfully. Histopathology confirmed the diagnosis of thrombus. Our literature review identified 19 cases of ball thrombus between 2015 and 2024. The average age was 54.8 (range 3–88) years. Heart failure was present as the initial symptom in 11 cases, and most patients had mitral valve disease or concomitant with atrial fibrillation. 12 cases received surgery, and 7 received medical treatment only. 2 deaths occurred, one due to the obstruction of left ventricular inflow tract and the other due to the worsening of heart failure. Conclusion: Ball thrombus is rare in clinical settings. Urgent thrombectomy should be performed as soon as possible, and echocardiography can be used for real-time monitoring during surgery. [ABSTRACT FROM AUTHOR]

Background/Objectives: Non-vitamin K antagonist oral anticoagulants (NOACs) have demonstrated similar effectiveness and safety profiles to vitamin K antagonists (VKAs) in treating nonvalvular atrial fibrillation (AF). Given their favorable pharmacological profile, including the rapid onset and offset of action, fixed dosing, and predictable pharmacokinetics with a consistent dose-response relationship, reducing the need for frequent blood tests, researchers have investigated the potential of NOACs in patients with AF and valvular heart disease (VHD). Methods: Clinical trials, excluding patients with mechanical prosthetic valves or moderate/severe mitral stenosis, have shown the benefits of NOACs over VKAs in this population. However, there is a need for further research to determine if these findings apply to mechanical valve prostheses and NOACs. Results: Several ongoing randomized controlled trials are underway to provide more definitive evidence regarding NOAC treatment in moderate to severe rheumatic mitral stenosis. Importantly, recent trials that included patients with atrial fibrillation and bioprosthetic valves (also transcatheter heart valves) have provided evidence supporting the safety of NOACs in this specific patient population. Ongoing research aims to clearly define the specific scenarios where NOACs can be safely and effectively prescribed for various types of VHD, including moderate/severe mitral stenosis and mechanical valves. Conclusions: The aim of this review is to accurately identify the specific situations in which NOACs can be prescribed in patients with VHD, with a focus centered on each type of valvulopathy. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most common and persistent cardiac arrhythmia in clinical practice, with an overall prevalence in the world is estimated to be 0.47%, but there is significant regional variation and has various predisposing factors and causes. Methodology: A descriptive study was undertaken in Tertiary teaching hospital Bengaluru. Study population was considered from in-patients of all the departments of the hospital. A pretested Semi structured questionnaire was administered on study subjects. Results: Most of the study participants were aged above 60 years, with slight male 33(55%) preponderance compared to female 27(45%). The most common underlying comorbidity was Rheumatic heart disease 26(43.3%) and among rheumatic heart disease, mitral stenosis was the most common valvular lesion observed i.e. 15 cases out of 26 cases. 29% of study participants with atrial fibrillation belonged to normal category in BMI range according to South East Asian region but 25% of them where in Obese 1 category. Underlying heart condition i.e. 60 (100%) and obesity 38 (61.3%) were most commonly seen Risk factors among study participants. Conclusion: Atrial fibrillation is seen to increase in prevalence with advancing age. No significant difference was found with respect to gender, the ratio of male: female is 55:45. Rheumatic valvular heart disease was the most common etiology of atrial fibrillation observed in the present study. The number of patients with AF is predicted to rise steeply in the coming years hence early identification and management has to be done. Health education has to be given to population. [ABSTRACT FROM AUTHOR]

The aim was to investigate LA strain by feature tracking cardiac MRI in mitral stenosis (MS) patients before and after percutaneous balloon mitral valvuloplasty (PBMV). Patients underwent cardiac MRI before and after successful PBMV (n = 18). Mitral valve area, transmitral velocity and gradients, LA volumes and ejection fraction (LAEF) were measured. LA strain feature tracking analysis was used to calculate LA reservoir, conduit, and booster strain. LA strain, LA volumes, LAEF and mitral valve severity indices were compared before and after PBMV. Correlations between LA strain and other cardiac MRI parameters were assessed. After PBMV, mitral valve area increased from 1.18 ± 0.25 cm2 to 2.26 ± 0.27 cm2, p < 0.001. Transmitral peak velocity decreased from 1.7 ± 0.37 m/s to 1.3 ± 0.27 m/s, p < 0.001. Transmitral peak gradient decreased from 12.4 ± 4.8 mmHg to 6.8 ± 2.9 mmHg, p < 0.001, and mean gradient decreased from 6.9 ± 3.8 mmHg to 2.9 ± 1.4 mmHg, p < 0.001. Maximal LA volume decreased from 73.1 ± 14.2 ml/m2 to 62.7 ± 16.3 ml/m2, p = 0.018; corrected p value = 0.054. LAEF increased from 36.3 ± 8.7% to 44.4 ± 9.5%, p = 0.010. Reservoir strain increased from 11.7 ± 3.1% to 14.9 ± 3.6% after PBMV, p = 0.009, and conduit strain from 3.8 ± 2% to 6 ± 2.3%, p = 0.005. Booster strain insignificantly increased after PBMV. Cardiac MRI feature tracking provides information on the 3 LA functional phases. Significant improvement was observed in reservoir and conduit functions after successful PBMV. Key points: Cardiac MRI feature tracking of the left atrium does not require additional imaging sequences and could be obtained from routine cine imaging. Cardiac MRI feature tracking provides information on the 3 functional phases of left atrium. [ABSTRACT FROM AUTHOR]

Background and Objectives: The relationship between physical frailty, age-related conditions, and the incidence of degenerative valvular heart disease (VHD) remains unclear. This study aimed to investigate the potential association between physical frailty and the development of degenerative VHD. Research Design and Methods: Participants from the UK Biobank who were initially free of VHD and heart failure were categorized into 3 groups based on the frailty phenotype: non-frailty, pre-frailty, and frailty. The frailty phenotype was determined by evaluating the following 5 components: weight loss, exhaustion, reduced physical activity, slow gait speed, and low grip strength. The incidence of degenerative VHD, including mitral valve regurgitation (MR), aortic valve regurgitation (AR), and aortic valve stenosis (AS), was assessed using hospital admission or death registries. Results: Among the 331 642 participants, 11 885 (3.6%) exhibited frailty and 143 379 (43.2%) were categorized as pre-frailty. During a median follow-up of 13.8 years, there were 3 684 MR, 1 205 AR, and 3 166 AS events. Compared to non-frailty participants, those with pre-frailty and frailty showed significantly increased risks for MR (hazard ratio [HR], HRpre-frailty:1.19, 95% confidence interval [CI]: 1.11–1.28; HRfrailty: 1.50, 95% CI: 1.30–1.74), AR (HRpre-frailty:1.19, 95% CI: 1.05–1.34; HRfrailty: 1.58, 95% CI: 1.22–2.04), and AS (HRpre-frailty:1.19, 95% CI: 1.11–1.29; HRfrailty: 1.74, 95% CI: 1.51–2.00). Among the 5 components, slow gait speed showed the strongest association with the risk of various types of VHD (HRMR: 1.50, 95% CI: 1.34–1.65; HRAR: 1.50, 95% CI: 1.24–1.80; HRAS: 1.46, 95% CI: 1.32–1.62), followed by exhaustion, low grip strength, and weight loss. Discussion and Implications: Pre-frailty and frailty were associated with a higher risk of all 3 types of degenerative VHD. Early detection and intervention for pre-frailty and frailty in middle-aged and older individuals may assist in preventing or delaying the onset of degenerative VHD. [ABSTRACT FROM AUTHOR]

Background Left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke prevention in select patients with atrial fibrillation (AF). In this study, we describe the case of a patient with delayed device-related thrombus (DRT) at 13 months post-LAAO in a setting of atrial stasis due to a worsening mitral bioprosthetic stenosis. Case summary A 69-year-old woman with a history of rheumatic mitral stenosis and regurgitation post-bioprosthetic mitral valve replacement (6 years prior) and paroxysmal AF was referred for percutaneous LAAO due to recurrent severe gastrointestinal bleeding while on anticoagulation. She underwent an uncomplicated LAAO, for which a 35 mm Watchman Flx device was used. Peri-procedural transoesophageal echocardiogram (TEE) at the time of implant showed thickened and calcified mitral bioprosthetic leaflets and a mild mitral stenosis. Her 45-day post-LAAO TEE showed a mild mitral stenosis and no peri-device leak or DRT. At 12 months, the patient had worsening exertional dyspnoea and pedal oedema. Her 12-month transthoracic echocardiogram (TTE) showed a moderate mitral stenosis and LAAO remained free of DRT. Her symptoms were deemed secondary from a worsening mitral valve stenosis. Mitral valve-in-valve (MViV) replacement was planned because the patient was deemed a prohibitive risk for a redo surgical replacement. Transthoracic echocardiogram on the day of MViV showed a large thrombus on the LAAO device. MViV was postponed. After the patient completed 45 days of anticoagulation with warfarin, a repeat TTE was performed, which showed a resolution of DRT. Transcatheter MViV was performed successfully. Discussion This case demonstrates that increased stasis and left atrial dysfunction from prosthetic mitral stenosis can be a risk factor for late DRT after successful LAAO. The use of a LAAO occlusion device in the presence of a mitral bioprosthesis requires more frequent echocardiographic monitoring to assess both the function of the prosthesis and a delayed formation of thrombus. More studies need to be conducted to assess the safety of percutaneous LAAO devices in those with mitral bioprosthesis. [ABSTRACT FROM AUTHOR]

Background Infective endocarditis (IE) is a serious and fatal condition, with prosthetic valve endocarditis representing the worst prognosis. The recommended nuclear imaging modality 2-deoxy-2-[18F]fluoro- D- glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) has limitations. In this case series, we present two patients with IE scanned with a novel PET tracer [64Cu]Cu-DOTATATE ([64Cu]Cu-[1,4,7,10-tetraazacyclododecane- N , N ′, N ″, N ‴-tetra acetic acid]-d-Phe1, Tyr3-octreotate). Case summary An 84-year-old female patient (Patient 1) with a biological mitral valve prosthesis (MVP) was admitted acutely from the outpatient clinic. Transoesophageal echocardiography showed vegetations on the MVP. The patient underwent [64Cu]Cu-DOTATATE PET/CT, which showed uptake at the site of infection. The patient underwent surgical valve replacement. The post-operative period was without significant complications, and the patient was discharged home. In another case, a 72-year-old male patient (Patient 2) with a medical history of mild mitral valve stenosis, aortic valve stenosis, and gastrointestinal stromal tumour was admitted to the hospital for back and abdominal pain and subfebrile episodes. Transoesophageal echocardiography showed large vegetations in the native aortic valve. The patient underwent [64Cu]Cu-DOTATATE PET/CT, which showed no uptake at the site of the suspected infection. The patient underwent surgical valve replacement. The post-operative period was characterized by Candida albicans sternitis, and after prolonged hospitalization, the patient died of respiratory failure as a complication of sepsis. Discussion In conclusion, this is the first case series presenting two patients with definite IE (modified Duke criteria), who were scanned with the novel [64Cu]Cu-DOTATATE PET/CT. Patient 1, with endocarditis in the MVP, showed an uptake of the tracer, while Patient 2, with native aortic valve endocarditis, did not show any uptake. [ABSTRACT FROM AUTHOR]

Background: Calcified amorphous tumor (CAT) of the heart is a rare, non-neoplastic cardiac mass with mitral valves and annuli being the most common sites. The presence of mitral annular calcification (MAC) is associated with an increased risk of stroke or other systemic embolisms. Here, we report a case of CAT showing rapid growth with MAC and investigate the link between the two. Case presentation: A 71-year-old man presented at our hospital with dyspnea and had been undergoing hemodialysis for 26 years for chronic glomerulonephritis. Transthoracic echocardiography (TTE) revealed moderate mitral stenosis with bulky MAC. Two months later, the patient developed progressive dyspnea, and follow-up TTE revealed a highly mobile mass (8 × 5 mm) attached to the left ventricular (LV) side of the posterior MAC. He underwent surgery because of congestive heart failure and a high risk of embolization. Surgical inspection revealed that the tumor was attached beneath the P3 segment of the mitral valve on the LV side and was removed. When removing the MAC, toothpaste-like contents drained from the encapsulated mass inside the MAC at the P3 segment, where the tumor was located. After reconstructing the posterior mitral annulus defect with a bovine pericardial patch, mitral valve replacement with a mechanical prosthesis, a maze procedure, and left appendage closure were performed. Histopathological examination revealed that the excised tumor contained fibrin and calcium deposits. The mass was diagnosed as a CAT. Conclusions: CAT may be one of the causes of stroke induced by MAC. Routine follow-up echocardiography should be recommended for patients with MAC, especially those undergoing hemodialysis. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is a supraventricular arrhythmia associated with uncoordinated atrial activation. Atrial fibrillation is complication of rheumatic heart disease and is associated with substantial morbidity and mortality. It is a growing public health problem and economic and social burden. Studies investigating the prevalence and factors associated with atrial fibrillation among chronic rheumatic heart disease patients in Ethiopia are scarce. Therefore, this study aimed to determine the prevalence and factors associated with atrial fibrillation in patients with chronic rheumatic heart disease. Methods and materials: A hospital-based cross-sectional study was conducted. A total of 410 patients were selected using a systematic random sampling method. The data were entered into Epi-Data version 4.6 and subsequently exported to SPSS version 26 software for analysis. A binary logistic regression model was applied to identify significant variables related to AF. Results: In this study, 410 patient charts were reviewed. The prevalence of atrial fibrillation was 43% (95% CI of 38% up to 48%). Male (AOR = 3.81, 95% CI 2.00-7.26), age greater than 30 years (AOR = 7.26, 95% CI 3.93–13.41), heart failure (AOR = 4.65, 95% CI 2.39–9.04), mitral valve stenosis (AOR = 6.36, 95% CI 2.92–13.87), and left atrial diameter enlargement (AOR = 3.41, 95% CI 1.64–7.09) were associated with atrial fibrillation. Conclusions and recommendations: Atrial fibrillation leads patients to frequent hospital admission and increases hospital mortality. As a result, health care professionals need to pay more attention to and apply more clinical treatment for older patients, those with heart failure, those with mitral valve stenosis, and those with left atrial diameter enlargement-associated causes of atrial fibrillation. [ABSTRACT FROM AUTHOR]

Background & objective: Postpartum hemorrhage (PPH) is quite common an obstetric emergency, and is a nightmare for the anesthesiologist as well as the obstetrician. We compared the hemodynamic profiles of oxytocin and carbetocin for prevention of postpartum hemorrhage during elective cesarean delivery in patients with mild to moderate mitral or aortic stenosis. Methodology: This randomized controlled trial included full term pregnant women with known mild to moderate mitral or aortic valve stenosis and undergoing elective cesarean delivery. After delivery of the shoulder of the baby, the participant received either oxytocin or carbetocin. Patients' hemodynamic parameters, including blood pressure, heart rate, cardiac output, and systemic vascular resistance, were recorded. The primary outcome was the 5-min average cardiac output after the drug administration. Secondary outcomes were cardiac output, systolic blood pressure, heart rate and systemic vascular resistance, blood loss, and the need for rescue uterotonics. Results: Forty-five patients (23 patients in the carbetocin group and 22 in the oxytocin group) were analyzed. The 5- min average cardiac output after drug injection was comparable between the two groups. The number of participants needing rescue uterotonic boluses were significantly more in the oxytocin group than in the carbetocin group (P = 0.022). Conclusion: In full-term pregnant women with stenotic valvular pathologies, carbetocin showed superior uterotonic effect compared to oxytocin; however, both drugs resulted in the equivalent hemodynamic effects. [ABSTRACT FROM AUTHOR]

Background: Net atrioventricular compliance (Cn) can affect the accuracy of mitral valve area (MVA) assessment. We assessed how different methods of MVA assessment are affected by Cn, and if patients with abnormal Cn may be identified by clinical and/or echocardiographic parameters. Methods: We studied 244 patients with rheumatic MS. The concordance between mitral valve area (MVA) by 2D planimetry, pressure half-time (PHT), continuity equation (CE), Yeo's index, and 3-dimensional mitral valve area assessed by transesophageal echocardiography (TEE 3DMVA) in patients with normal and abnormal Cn (Cn ≤ 4 mL/mmHg) were evaluated in the 110 patients with both transesophageal echocardiogram (TEE) and transthoracic echocardiogram (TTE). Variables that were associated with abnormal Cn were validated in the remaining 134 patients with only TTE. Results: Except for MVA by CE, concordance with TEE 3DMVA was poorer for all other methods of MVA assessment in patients with abnormal Cn. But, the difference in concordance was only statistically significant for MVA by PHT. Patients with MVA ≤ 1.5 cm2 by 2D planimetry and PHT ≤ 130 ms were likely to have an abnormal Cn. (specificity 98.5%). This finding was validated in the remaining 134 patients (specificity 93%). Conclusions: MVA assessment by PHT is significantly affected by Cn. Abnormal Cn should be suspected when 2D planimetry MVA is ≤1.5 cm2 together with an inappropriately short PHT that is ≤130 ms. In this scenario, MVA by PHT is inaccurate. [ABSTRACT FROM AUTHOR]

Mitral valve stenosis (MS) can be concomitantly present in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Some studies have reported up to one-fifth of patients who underwent TAVI also have MS. The relationship between mitral stenosis and TAVI has led to concerns regarding increased adverse cardiac outcomes during and after the procedure. The Nationwide Readmission Database (NRD 2016–2019) was utilized to identify TAVI patients with MS with ICD-10-CM codes. The primary outcome was a 30-day readmission rate. Secondary outcomes included predictors of all-cause readmissions, length of stay, and total hospitalization cost. We assessed readmission frequency with a national sample weighed at 30 days following the index TAVI procedure. Unadjusted and adjusted odds ratios were analyzed for in-hospital outcomes using univariate and multivariate logistic regression for study cohorts. A total of 217,147 patients underwent TAVI procedures during the queried time period of the study. Of these patients, 2140 (0.98 %) had MS. The overall 30-day all-cause readmission rate for the study cohort was 12.4 %. TAVI patients with MS had higher rates of 30-day readmissions (15.8 % vs 12.3 %, aOR 1.22, CI: 1.03–1.45, P < 0.01). Additionally, TAVI patients with MS had longer lengths of hospital stay during index admissions (5.7 vs. 4.3 days), along with higher total hospitalization costs ($55,157 vs. $50,239). In contrast, in-hospital mortality during index TAVI admission did not differ significantly between the two groups, although there was a trend toward higher mortality in the MS group (2.1 % vs. 1.5 %). Among the TAVI MS cohort, patients admitted on weekends (aOR: 1.11, 95 % CI: 1.02–1.22, P = 0.01), admitted to non-metropolitan hospitals (aOR: 1.29, 95 % CI: 1.11–1.66, P = 0.04) and presence of co-morbidities such as atrial fibrillation (AF)/flutter (aOR: 1.24, 95 % CI: 1.16–1.32, P < 0.01), chronic obstructive pulmonary disease (COPD) (aOR: 1.16, 95 % CI: 1.11–1.22, P < 0.01), prior stroke (aOR: 1.09, 95 % CI: 1.03–1.14, P < 0.01), chronic kidney disease (CKD) ≥3 (aOR: 1.16, 95 % CI: 1.11–1.22, P < 0.01), end-stage renal disease (ESRD) (aOR: 1.75, 95 % CI: 1.61–1.90, P < 0.01), and anemia (aOR: 1.23, 95 % CI: 1.18–1.28, P < 0.01) were associated with increased odds of readmission. Concomitant MS in patients undergoing TAVI is associated with higher readmission rates and total hospital costs. This can contribute significantly to healthcare-related burdens. Further studies are required to evaluate in-hospital outcomes and predictors of readmission in patients undergoing TAVI with the presence of concomitant MS. [Display omitted] • TAVI patients with concurrent MS were more likely to be readmitted within 30 days following the procedure. • Hospitalization in a non-metropolitan hospital, weekend admissions, and multiple co-morbidities were significantly associated with higher odds of 30-day readmission in this cohort. • There was no significant difference in the short-term in-patient mortality rate for patients with concomitant mitral stenosis following TAVI. • The total hospitalization cost and length of stay were significantly higher for the TAVI with MS cohort. [ABSTRACT FROM AUTHOR]

Background: Rheumatic mitral stenosis (MS) remains a common and concerning health problem in Asia. Percutaneous balloon mitral valvuloplasty (PBMV) is the standard treatment for patients with symptomatic severe MS and favorable valve morphology. However, studies on the incidence and predictors of adverse cardiac outcomes following PBMV in Asia have been limited. This study aims to evaluate the incidence and predictors of adverse outcomes in patients with rheumatic MS following PBMV. Methods: A retrospective cohort study was conducted on patients with symptomatic severe MS who underwent successful PBMV between 2002 and 2020 at a tertiary academic institute in Thailand. Patients were followed up to assess adverse outcomes, defined as a composite of cardiac death, heart failure hospitalization, repeat PBMV, or mitral valve surgery. Univariable and multivariable analyses were performed to identify predictors of adverse outcomes. A p-value of < 0.05 was considered statistically significant. Results: A total of 379 patients were included in the study (mean age 43 ± 11 years, 80% female). During a median follow-up of 5.9 years (IQR 1.7–11.7), 74 patients (19.5%) experienced adverse outcomes, with an annualized event rate of 2.7%. Multivariable analysis showed that age (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.008–1.05, p = 0.006), significant tricuspid regurgitation (HR 2.17, 95% CI 1.33–3.56, p = 0.002), immediate post-PBMV mitral valve area (HR 0.39, 95% CI 0.25–0.64, p = 0.01), and immediate post-PBMV mitral regurgitation (HR 1.91, 95% CI 1.18–3.07, p = 0.008) were independent predictors of adverse outcomes. Conclusions: In patients with symptomatic severe rheumatic MS, the incidence of adverse outcomes following PBMV was 2.7% per year. Age, significant tricuspid regurgitation, immediate post-PBMV mitral valve area, and immediate post-PBMV mitral regurgitation were identified as independent predictors of these adverse outcomes. [ABSTRACT FROM AUTHOR]

Mitral stenosis (MS) is a complex valvular pathology with significant clinical burden even today. Its effect on the right heart is often overlooked, despite it playing a considerable part in the symptomatic status. We enrolled 39 mitral valve stenosis patients and 39 age- and gender-matched healthy controls. They underwent conventional, speckle-tracking and 3D echocardiographic examinations. The 3D data was analyzed using the ReVISION software to calculate RV functional parameters. In the MS group, 3D RV ejection fraction (EF) (49 ± 7% vs. 61 ± 4%; p < 0.001), global circumferential (GCS) (− 21.08 ± 5.64% vs. − 25.07 ± 4.72%; p = 0.001) and longitudinal strain (GLS) (− 16.60% ± 4.07% vs. − 23.32 ± 2.82%; p < 0.001) were reduced. When comparing RV contraction patterns between controls, MS patients in sinus rhythm and those with atrial fibrillation, radial (REF) (32.06 ± 5.33% vs. 23.62 ± 7.95% vs. 20.89 ± 6.92%; p < 0.001) and longitudinal ejection fraction (LEF) (24.85 ± 4.06%; 17.82 ± 6.16% vs. 15.91 ± 4.09%; p < 0.001) were decreased in both MS groups compared to controls; however, they were comparable between the two MS subgroups. Anteroposterior ejection fraction (AEF) (29.16 ± 4.60% vs. 30.87 ± 7.71% vs. 21.48 ± 6.15%; p < 0.001) showed no difference between controls and MS patients in sinus rhythm, while it was lower in the MS group with atrial fibrillation. Therefore, utilizing 3D echocardiography, we found distinct morphological and functional alterations of the RV in MS patients. [ABSTRACT FROM AUTHOR]

[Display omitted] [ABSTRACT FROM AUTHOR]

Background: Cardiac disease in pregnancy is considered to be an important cause of maternal morbidity and mortality. Cardiac disease complicates 1-3% of all pregnancies and considered as leading cause of indirect maternal deaths. Cardiac disease in pregnancy is considered to be high risk and management of it in pregnancy is challenging. Aim: To evaluate fetomaternal outcome in cardiac disease complicating pregnancy. Objectives: To evaluate fetal and maternal outcome in pregnancy with cardiac disease. To measure the prevalence of cardiac disease in pregnancy. Materials & Methods: A retrospective observational study of all women who delivered at a tertiary care centre from 2011 to 2018 with heart disease complicating pregnancy were included in the study. Their details were collected from the case record and registers, using data collection proforma. The outcomes were studied. Results: The prevalence of cardiac disease was found to be 0.66%. Most common heart disease in pregnancy was found to Rhematic heart disease (72%). Among them the most common heart disease was found to be mitral stenosis (35%). Conclusion: Cardiac disease is a high risk pregnancy and has major effect on fetal and maternal outcome morbidity and mortality in pregnancy. Hence proper antenatal monitoring, involvement of multidisciplinary team and delivery in a tertiary care setup with ICU and Cardiac care facilities will definitely improve the fetal and maternal outcomes in cardiac disease complicating pregnancy. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to investigate the impact of the systemic immune-inflammation index (SII) and plasma atherogenic index (PAI) on adverse outcomes in patients undergoing percutaneous mitral balloon valvuloplasty (PMBV). A 5-year follow-up was conducted in patients with mitral stenosis who underwent PMBV, assessing all-cause mortality, major adverse cardiovascular events (MACE), surgical need for the mitral valve, and requirement for repeat PMBV. Methods: This single-center retrospective study included 103 patients who underwent PMBV due to rheumatic mitral valve disease between January 2014 and January 2019. Demographic characteristics and pre- and postprocedural echocardiographic data of the patients were analyzed. The 5-year follow-up included assessments of all-cause mortality, MACE, surgical requirement for the mitral valve, and rates of repeat PMBV. Laboratory parameters at admission and at the third-month follow-up were recorded through a review of patient records. Results: A total of 103 patients (75 females) with a mean age of 41.81±14.83 years were enrolled in the study. At admission, the SII was calculated as 8.49±6.27, PAI as 0.45±0.25, and the mitral valve area (MVA) as 1.16±0.19 cm2. Post-procedurally, MVA increased to 1.72±0.23 (p=0.001). At the third-month follow-up, SII was 7.77±7.16, and PAI was 0.47±0.25. While a statistically significant decrease was observed in SII post-procedure (p<0.001), no significant change was noted in PAI (p=0.843). When examining 5-year MACE rates in the deceased group, the SII at admission was 765.5±577.3, and at the third month, it was 794.2±907.6 (p>0.05). Regarding 5-year MACE rates in the deceased group, the PAI value at admission was 0.4±0.41, and at the third month, it was 0.4±0.42 (p>0.05). Conclusion: In patients undergoing PMBV, SII is a significant parameter indicating a reduction in inflammation. However, both SII and PAI are insufficient for predicting the 5-year MACE frequency after PMBV. Additional parameters are required to indicate poor prognosis. [ABSTRACT FROM AUTHOR]

Background: Yeo's index is a novel measure of the severity of rheumatic mitral valve stenosis (MS). It is derived from the product of the mitral leaflet separation index and dimensionless index. This study aims to validate Yeo's index using a transesophageal echocardiogram (TEE) three-dimensional (3D) mitral valve area (MVA) as a comparator and to compare the concordance of existing echocardiographic measures of the MVA with TEE 3DMVA. Methods and Results: We studied 111 patients with rheumatic MS who underwent both transthoracic echocardiography (TTE) and a TEE assessment of MS severity. Yeo's index, the MVA determined by 2D planimetry, pressure half-time (PHT) and continuity equation (CE) measured on TTE were compared with the TEE 3DMVA. With a linear correlation, Yeo's index showed the best correlation with TEE 3DMVA (r2 = 0.775), followed by 2D planimetry (r2 = 0.687), CE (r2 = 0.598) and PHT (r2 = 0.363). Using TEE 3DMVA as comparator, Yeo's index (ρc = 0.739) demonstrated the best concordance, followed by 2D planimetry (ρc = 0.632), CE (ρc = 0.464) and PHT (ρc = 0.366). When both Yeo's index and 2D planimetry suggested significant MS, the positive predictive value was high (an AUC of 0.966 and a PPV of 100.00% for severe MS, and an AUC of 0.864 and a PPV of 85.71% for very severe MS). When both measures suggested the absence of significant MS, the negative predictive value was also high (an AUC of 0.940 and an NPV of 88.90% for severe MS, and an AUC of 0.831 and an NPV of 88.71% for very severe MS). Conclusions: Yeo's index performed well in identifying severe MS when compared with TEE 3DMVA and may be a useful adjunct to existing methods of measuring MS severity. Combining it with 2D planimetry could further enhance its accuracy. [ABSTRACT FROM AUTHOR]

Objectives: Due to rheumatic heart disease, young people are more likely to develop valvular heart disease in developing countries. In countries like Pakistan, surgeons implant more bioprosthetic mitral valves (MVs) in younger patients. However, bioprosthetic valves degenerate rapidly in younger people, leading to bioprosthetic MV dysfunction (BMVD). This study aims to evaluate the clinical characteristics and long-term outcomes of patients with bioprosthetic MV replacement (MVR) at a tertiary care hospital in a South Asian country. Material and Methods: This is a retrospective observational study, conducted at a tertiary care hospital. We included a total of 502 patients who underwent bioprosthetic MVR from the year 2006 to 2020. Clinical and surgical characteristics along with transthoracic echocardiographic findings (pre-surgery and recent most follow-up studies) were noted. Follow-up data were also collected. Results: Out of 502 patients, 322 (64%) were female, mean age at the time of surgery was 49.42 ± 14.56 years. Mitral regurgitation was more common, found in 279 (55.6%) patients followed by mitral stenosis in 188 (37.5%) patients. MVR was done as an elective procedure due to the New York Heart Association (NYHA) II to IV symptoms at the time of surgery in 446 (88.8%) patients. In the mean follow-up of 6.59 ± 2.99 years, BMVD was observed in 183 (36.5%) patients. However, re-do MV surgery was done in only 49 (9.8%) patients. Patients were divided into two groups based on normal functioning bioprosthetic MV and BMVD. Comparing the two groups, individuals with normal functioning bioprosthetic MV had a mean age of 51.6 ± 14.27 years, while those with BMVD had a mean age of 45.639 ± 14.33 years at the time of index surgery (P = 0.000). There were more long-term complications including heart failure (n = 16, 8.74%), atrial fibrillation (n = 11, 6.01%), and death (n = 6, 3.28%) in the BMVD group which were statistically significant. Conclusion: This study is distinct because it demonstrates the outcomes of bioprosthetic valve replacement in a relatively younger South Asian population. Due to rapid degeneration of bioprosthetic valve in younger patients, significant number of patients developed BMVD along with poor long-term clinical outcomes, even at a short follow-up period of <10 years. These findings are similar to international data and signify that mechanical MVR may be a more reasonable alternative in younger patients. [ABSTRACT FROM AUTHOR]

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Objectives: The severity of pulmonary artery hypertension affects the outcomes of patients undergoing mitral valve replacement (MVR). Speckle-tracking derived strain is a new modality for the assessment of the right ventricular (RV) function as well as the longitudinal contractile pattern. Our main objective of this study was to evaluate the right ventricular (RV) function in patients undergoing MVR with pulmonary artery systolic pressure (PASP) of more than 50 mmHg at 1 and 4 weeks postoperatively. Material and Methods: This prospective cohort study included 40 patients with rheumatic heart disease (RHD) (mitral stenosis [MS] and mitral regurgitation [MR]) scheduled to undergo MVR between January 2022 and December 2023 in AIIMS, New Delhi. Serial 2D echocardiography, tissue Doppler imaging, as well as RV speckle-tracking echocardiography were performed, and serum brain natriuretic peptide (BNP) levels were measured during the pre-operative period, 1st week and 4th weeks postoperatively to evaluate RV function. Results: Tricuspid annular plane systolic excursion (TAPSE) and left ventricular ejection fractions (LVEFs) were significantly lower at 1 week after surgery, compared to pre-operative levels, and reached the pre-operative values at 4 weeks after surgery. The RV fractional area change (RVFAC) at 4 weeks postoperatively significantly increased compared to 1st week and baseline values. The tricuspid valve (TV) tissue velocity in systole (S′), TV velocity in diastole (E′), RV global strain (RVGLS), and RV free wall strain (RVFWLS) at post-operative 4 weeks were lower than pre-operative values, and this difference was statistically significant. Conclusion: Four weeks after MVR, in adult patients with RHD (MS and MR) having PASP >50 mmHg, it was observed that deformational indices or speckle-tracking echocardiography such as RVGLS and RVFWLS predict better RV dysfunction than linear indices like TAPSE. The BNP, PASP (delta TR), right atrial volume, left atrial volume, LV internal diameter in systole, and LV internal diameter in diastole decreased significantly in these patients. RVFAC increased significantly to compensate for the loss of longitudinal function. [ABSTRACT FROM AUTHOR]

Background Lutembacher's syndrome refers to the rare combination of atrial septal defect and mitral stenosis. This condition is still underdiagnosed despite its distinct clinical, paraclinical, and therapeutic implications. Case summary We report the case of a 60-year-old woman presenting with acute congestive heart failure. Investigations revealed the combination of low-gradient severe rheumatic mitral stenosis and ostium secundum atrial septal defect. Despite the medical team's conservative management of her condition and recommendation for surgical intervention, the patient chose to discharge herself against medical advice. She died 6 months later. Conclusion Lutembacher's syndrome continues to be a rare condition in our practice. Once low-gradient severe mitral stenosis is diagnosed, it is essential to search for an associated atrial septal defect, especially when there is an early onset of significant right ventricular enlargement or dysfunction or when an intriguing inconsistency exists between the mitral area and the transmitral gradient. [ABSTRACT FROM AUTHOR]

Objectives Rheumatic mitral stenosis (RMS) remains a significant health challenge, particularly in low- and middle-income countries, due to limited access to preventive measures and timely treatment. Percutaneous mitral balloon valvuloplasty (PMBV) has become the preferred treatment for RMS, offering a less invasive alternative to surgical mitral valve replacement. This study aimed to evaluate the demographic, clinical, and echocardiographic characteristics of patients with RMS undergoing PMBV and to assess the procedural outcomes. Materials and Methods This study included 52 patients who underwent PMBV RMS. Patients with non-RMS, incomplete patient files, or previous valve surgeries were excluded. Results The procedural success rate was 87%, with better outcomes observed in patients with a Wilkins score ≤8 than in those with a score >8. PMBV resulted in a significant increase in mitral valve area (MVA) (from 1.18±0.19 cm² to 2.27±0.48 cm², p=0.001) and a decrease in both mean mitral valve gradient (from 12.82±3.5 mmHg to 5.97±2.04 mmHg, p=0.001) and maximum mitral valve gradient (from 27.12±14.0 mmHg to 12.70±3.1 mmHg, p=0.001). Although the procedure was generally safe, manageable complications, such as chordal rupture (1 case, 1.9%) and mitral regurgitation (MR) progression, were observed, particularly in patients with higher Wilkins scores. Conclusion The significant improvements in MVA and reduced gradient observed in our study underscore the effectiveness of PMBV, even in patients with higher Wilkins scores. Although we observed manageable complications, such as chordal rupture and MR progression, the overall safety and efficacy of PMBV in our patient population highlight its value as a practical and effective treatment option for RMS in our clinical setting. These findings support the continued use of PMBV as a standard treatment approach in our region, potentially enhancing the quality of care for patients with this condition. Keywords:Balloon valvuloplasty, gradient mitral, stenosis, percutaneous, rheumatic, Wilkins scores: [ABSTRACT FROM AUTHOR]