835 results on '"Leaflet (botany)"'
Search Results
2. Aortic Valve Leaflet Rupture Causing Delayed Left Main Coronary Ostial Obstruction During Valvuloplasty Preceding TAVR
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Mark Zainea, Akarsh Parekh, DO Melissa Ianitelli, DO Victor Hunyadi, and DO Vivek Sengupta
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Aortic valve ,medicine.medical_specialty ,LMCA, left main coronary artery ,Transcatheter aortic ,medicine.medical_treatment ,AS, aortic stenosis ,Structural Interventions ,Valve replacement ,Internal medicine ,medicine ,cardiovascular diseases ,AV, aortic valve ,Leaflet (botany) ,aortic valve cusp rupture ,TAVR, transcatheter aortic valve replacement ,business.industry ,Balloon valvuloplasty ,coronary occlusion ,leaflet rupture ,BAV, balloon aortic valvuloplasty ,medicine.anatomical_structure ,balloon aortic valvuloplasty ,Coronary occlusion ,Cardiology ,cardiovascular system ,transcatheter aortic valve replacement ,Case Report: Clinical Case ,Cardiology and Cardiovascular Medicine ,business ,radiation-induced valvular heart disease - Abstract
A 69-year-old man with mediastinal radiation history underwent balloon valvuloplasty before transcatheter aortic valve replacement, which caused aortic leaflet rupture leading to unstable severe aortic regurgitation and subsequent left main ostial obstruction. A balloon-expanding valve was implanted to capture the ruptured leaflet and a left main stent was placed. (Level of Difficulty: Advanced.), Central Illustration
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- 2021
3. Tricuspid Valve Tethering Is Associated with Residual Regurgitation after Valve Repair in Hypoplastic Left Heart Syndrome: A Three-Dimensional Echocardiographic Study
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Justin Grenier, Kandice Mah, Nee Scze Khoo, Richard B. Thompson, Mirza Vamiq Rasool Beigh, Amal Silmi, Lily Lin, Timothy Colen, and Sachie Shigemitsu
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medicine.medical_specialty ,Echocardiography, Three-Dimensional ,Regurgitation (circulation) ,Hypoplastic left heart syndrome ,Internal medicine ,Hypoplastic Left Heart Syndrome ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Child ,Papillary muscle ,Surgical repair ,Leaflet (botany) ,Tricuspid valve ,business.industry ,medicine.disease ,Tricuspid Valve Insufficiency ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,cardiovascular system ,Cardiology ,lipids (amino acids, peptides, and proteins) ,Tricuspid Valve ,Tricuspid Valve Regurgitation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Tricuspid valve regurgitation (TR) is a risk factor for morbidity and mortality in children with hypoplastic left heart syndrome (HLHS). Surgical tricuspid valve (TV) repair is common, but durable repair remains challenging. The aim of this study was to examine mechanisms of TR requiring surgery, features associated with unsuccessful repair, and TV changes after surgical repair. Methods Thirty-six patients with HLHS requiring TV repair (TVR) and 36 matched control subjects with HLHS were assessed using two-dimensional and three-dimensional echocardiography. Using three-dimensional echocardiography, TV coordinates from the annulus, leaflet, and ventricle were used to measure annular, leaflet, prolapse, and tethering values and anterior papillary muscle angle. TR grade and ventricular size, function, and shape were assessed using two-dimensional echocardiography. Results Patients requiring TVR had greater total leaflet prolapse, larger TV annular and leaflet areas, and flatter annuli, with no difference in tethering, coaptation index, or anterior papillary muscle angle. In patients with HLHS, successful TVR at follow-up (58%) was associated with preoperative total leaflet prolapse (especially posterior). Unsuccessful repair was associated with preoperative tethering of the septal leaflet. TVR in patients with HLHS caused a reduction of total annular and leaflet size and reduced prolapse and tethering of the posterior leaflet but did not affect anterior leaflet prolapse or septal leaflet tethering. Conclusions Features associated with TVR include a flattened and dilated TV annulus with leaflet prolapse. The additional presence of a tethered septal leaflet before TVR is associated with significant postoperative TR. Current surgical techniques, predominantly posterior annuloplasty and commissuroplasty, adequately address annular size and posterior leaflet pathology, but not septal leaflet tethering. Individualized and innovative surgical techniques are vital to improve surgical repair success.
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- 2021
4. The feasibility of mitral valve device foldoplasty: an in vivo study to evaluate durable retention
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Kimberlee Gauvreau, Peter E. Hammer, Isaac Wamala, Mossab Y Saeed, Pedro J. del Nido, Nikolay V. Vasilyev, Daniel Bautista-Salinas, and Sunil J. Ghelani
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Swine ,medicine.medical_treatment ,Experimental ,In vivo ,Mitral valve ,medicine ,Animals ,Embolization ,Cardiac Surgical Procedures ,Reduction (orthopedic surgery) ,Mitral valve repair ,Mitral regurgitation ,Mitral Valve Prolapse ,Leaflet (botany) ,business.industry ,Mitral Valve Insufficiency ,Surgery ,medicine.anatomical_structure ,Feasibility Studies ,Mitral Valve ,Implant ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES We have previously shown in experimental settings that a leaflet foldoplasty device reduces redundant leaflet area to re-establish mitral valve (MV) coaptation. The current study investigates the in vivo device retention and functional durability following foldoplasty. METHODS The prototype is of superelastic nitinol formed into a 3-dimensional shape. It is unfolded to engage a specified area of leaflet tissue and then folded to exclude this tissue from the coaptation surface. Design modifications were made and tested in benchtop studies to determine the optimal design for durable retention within the leaflet. To evaluate in vivo performance, posterior leaflet chordae were severed in Yorkshire pigs to produce complete posterior leaflet prolapse and severe mitral regurgitation. Design modifications were then used for MV repair. Five animals that underwent repair using the optimal design were observed for 2 weeks postoperative to evaluate the functional result and implant retention. RESULTS Device position and orientation were maintained at 2 weeks while preserving the functional MV repair in all 5 animals. Coaptation height was 5.5 ± 1.5 mm, which was not significantly different from a baseline of 4.9 ± 0.8 mm. The degree of leaflet excursion was 41.0 ± 16.0 compared to a baseline of 58.7 ± 27.5. CONCLUSIONS Device foldoplasty is a new concept for MV repair based on the reduction of redundant leaflet tissue area. This study demonstrates the feasibility of safe maintenance of this repair without early dislodgement or embolization.
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- 2021
5. Double-leaflet Technique for Mitral Regurgitation With Small or Tethered Posterior Leaflet
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Hayato Morimura, Hiroshi Nakanaga, and Minoru Tabata
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,Posterior leaflet ,medicine ,Humans ,cardiovascular diseases ,Functional mitral regurgitation ,Papillary muscle ,Mitral valve repair ,Mitral regurgitation ,Leaflet (botany) ,Autologous pericardium ,business.industry ,technology, industry, and agriculture ,Mitral Valve Insufficiency ,Anatomy ,Middle Aged ,medicine.anatomical_structure ,cardiovascular system ,Mitral Valve ,Female ,lipids (amino acids, peptides, and proteins) ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Small leaflets make mitral valve repair procedures challenging. Our double-leaflet technique creates a new autologous pericardial leaflet attached to the papillary muscle, annuloplasty ring, and neighboring scallops above the small or tethered posterior leaflet. This simple additional technique provides deep coaptation after mitral valve repair for both degenerative and functional mitral regurgitation with the small or tethered posterior leaflet.
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- 2022
6. The Effect of Nutritional Education with Leaflet and Diet Application on Nutritional Status Changes in Obese College Students
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Diah Puspa, Inggita Kusumastuty, and Dian Handayani
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Gerontology ,Leaflet (botany) ,business.industry ,Medicine ,Nutritional status ,business - Abstract
Obesity is excessive body fat condition due to differences in energy consumption and expenditure. In Indonesia, the prevalence of obese women >18 years old is 32.9%. Interventions are performed with control eating and increased physical activity through an educational approach. A Leaflet is a print media containing some information, while my weight loss diet application is used by people that want to lose weight. Therefore, this study aims to determine the effect of nutritional education with leaflet and my weight loss diet application on nutritional status changes in obesity. True experimental design was used with pre-post test on female students divided into two groups in Universitas Brawijaya (n= 44) and selected by purposive sampling. Also, Independent-Samples T-Test and Mann Whitney analysis were conducted. The results showed a body mass index decrease in both media and no significant change related to BMI (p = 0.733). However, the decrease was more shown on the leaflet, where the body fat percentage had a significant change (p = 0.000). Hence, intervention using the leaflet is more effective on nutritional status changes related with BMI and body fat percentage in obese students.
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- 2021
7. Does the Leaflet Fusion Subtype Affect Pattern and Rate of Growth in BAV Aortopathy?: A Study of 102 BAV Aortopathy Cases With A Literature Review
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Ashutosh Hardikar and Robin Harle
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Male ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Heart Valve Diseases ,Hemodynamics ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,Internal medicine ,medicine.artery ,Humans ,Medicine ,030212 general & internal medicine ,Aorta ,Retrospective Studies ,Fusion ,Leaflet (botany) ,business.industry ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,Aortic Valve ,Descending aorta ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Bicuspid aortic valves (BAV) and related aortopathy remain an intriguing topic. Not all BAVs get diseased and around 40% would develop aortic dilatation in their lifetime. If haemodynamic theory is to be believed, then leaflet fusion pattern should have an impact. This study sought to compare the association of aortic morphologies and rate of growth in a set of 102 BAV acropathies operated at a single centre, based on the fusion patterns. Methods Data on aortic valve replacements over a 10-year period was analysed from a prospectively maintained database. Of the 198 BAV undergoing surgery, 102 had aortic dilatation above 40 mm on echocardiogram. These underwent computed tomography (CT) aortograms and were followed up as a part of a database. The impact of leaflet fusion patterns on aortic dilatation pattern and rate was analysed. Results Of the 102, two patients had type 0 pathology and one had left-noncoronary (LN) leaflet fusion. Seventy-four (74) had type 1A or left-right (RL) fusion and 25 had type 1B right-noncoronary (RN) fusion. RL fusion had more males, were taller, bigger and had more proportion of aortic stenosis (AS). Aortic diameters, angles and growth rates at root, ascending/descending aorta and arch were not different. Regression analyses for size or growth did not show any significant impact of fusion pattern. Conclusions Left-right fusion pattern comprised three-quarters of BAV in this cohort and these patients were bigger, taller and had a greater proportion of males with increased rate of aortic stenosis. Despite these differences, there was no significant impact of fusion pattern on aortic size or rate of growth.
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- 2021
8. EVALUATION OF YIELD AND RESISTANCE TO COTTON LEAF WORM FOR SOME NEW GENOTYPES OF SOYBEAN UNDER OLD LANDS AND NEWLY RECLAIMED LANDS CONDITIONS IN EL-BEHEIRA GOVERNORATE
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F.A. Waly
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Larva ,Leaflet (botany) ,Resistance (ecology) ,business.industry ,fungi ,food and beverages ,Sowing ,General Medicine ,Biology ,Horticulture ,Agriculture ,Yield (wine) ,Genotype ,Instar ,business - Abstract
A field traial allowed in completely randomized design with three replications were conducted in the research farm of the agricultural research station of Etay Al-Baroud (old land) and the research farm of the Faculty of Agriculture, Damanhur University, in El-Bostan region, El-Beheira Governorate (newly reclaimed lands) during 2018 and 2019 seasons to evaluate the performance of twelve new genotypes of soybean compared with the three commercial varieties Giza 111, Giza 22 and Crawford. The resistance of genotypes to cotton leaf worm was estimated in the laboratory by raising a fourth instar larvae of cotton leaf worm and leaving them for feeding on the middle leaflet of the third upper trifoliate leaf of the plant for 24 hours, after that the areas that the insect fed on were measured as a percentage of the total area of the leaf (leaf area consumed). The resistance to cotton leaf worm in the field was estimated by vision according to the Smith and Brim 1979 method (defoliation %). The results confirmed that mean square due to genotypes, locations and genotypes x location were highly significant for all studied traits except the locations mean square for number of hairs under binocular field area and branches number /plant in the first season and genotypes x location mean square of number of hairs under binocular field area, branches number /plant, maturity date and 100-seed weight in both seasons as well as number of pods/plant in the second season. All tested genotypes significantly differ in their performances in all studied traits across the two locations and the four genotypes Line 3, Line 105, Line 127 and Line 129 seemed to excellent genotypes for yield and resistance to cotton leaf worm across the two locations. The consumed leaf area caused by cotton leaf worm and oil percentage negatively associated with pubescence density while seed yield positively associated with pubescence density. Seed yield and oil percentage negatively associated with the defoliation value. In general, it can be said that the four soybean genotypes, Line 3, Line 105, Line 127 and Line 129 are promising genotypes that could be sowing in newly reclaimed lands to expand soybean cultivation in Egypt.
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- 2021
9. Leaflet Dimensions as a Guide to Remodeling Annuloplasty During Aortic Valve Repair
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Domenico Mazzitelli, J. Scott Rankin, Marek A. Deja, Vinay Badhwar, Lawrence M. Wei, Yeong-Hoon Choi, Marek Jasinski, and Theodor Fischlein
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Leaflet (botany) ,business.industry ,Aortic Valve Insufficiency ,General Medicine ,Middle Aged ,Cardiac Valve Annuloplasty ,Aortic valve repair ,Aortic Valve ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Aorta ,Aged ,Dilatation, Pathologic - Abstract
Objective In chronic aortic insufficiency (AI), the method and degree of annular downsizing required to achieve durable coaptation in aortic valve repair (AVr) remains poorly defined. This study evaluated the relationship between leaflet size and annular diameter to predict adequate annular sizing in remodeling AVr. Methods Under regulatory supervision, 74 patients with chronic tri-leaflet AI underwent AVr using ring annuloplasty and leaflet reconstruction. Fifty-four (73%) had ascending aortic ( n = 25) and/or root ( n = 29) aneurysms, and aortic grafts were sized 5 to 7 mm larger than the rings. Intraoperatively, leaflet free-edge length (FEL) was measured with special ball sizers positioned in the coronary sinus, and “normal” annular diameter was predicted from the validated formula: Required “normal” diameter = FEL/1.5. “Normal” annular diameters predicted from FEL were compared with pathologic diameters measured intraoperatively with Hegar dilators, and both were correlated with gender, age, and BSA. Results Average age was 62.1 ± 13.3 years (mean ± SD), 73% (54/74) were male, and 96% (71/74) had moderate-to-severe AI. All patients had annular dilatation, with a pathologic diameter 26.6 ± 2.3 mm before repair, and a predicted “normal” diameter of 21.7 ± 1.7 mm ( P < 0.001). Both predicted and pathologic annular diameters were larger in men ( P < 0.001), but no relationship existed with age. BSA correlated with both predicted and pathologic diameters, although variability was large. Conclusions Based on a simple validated method to predict “normal” annular diameter, all patients with chronic AI have some degree of annular dilatation. This finding implies that most AVr should include annuloplasty, with adequate and precise annular reduction based on leaflet size.
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- 2021
10. Leaflet and Neoskirt Height in Transcatheter Heart Valves
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Jaffar M. Khan, Jian Ye, Janarthanan Sathananthan, Georgios Tzimas, David Meier, David A. Wood, Andrew G Chatfield, Anthony Chuang, Mariama Akodad, Uri Landes, Stephanie L. Sellers, Gaurav S. Gulsin, Jonathon Leipsic, Philippe Blanke, Anson Cheung, and John G. Webb
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medicine.medical_specialty ,Leaflet (botany) ,business.industry ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
11. Relationship Between Mitral Leaflet Size and Coaptation and Their Associated Factors in Patients with Normal Left Ventricular Size and Systolic Function
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Yuko Yamanaka, Naoko Sawada, Issei Komuro, Takayuki Kawata, Yutaka Yatomi, Hiroyuki Morita, Megumi Hirokawa, Masao Daimon, Tomoko Nakao, Koichi Kimura, and Boqing Xu
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Body surface area ,medicine.medical_specialty ,Leaflet (botany) ,Ejection fraction ,business.industry ,General Medicine ,Systolic function ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Mitral valve ,cardiovascular system ,medicine ,Cardiology ,In patient ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Enlargement of the mitral valve (MV) has gained attention as a compensatory mechanism for functional mitral regurgitation (FMR). We aimed to determine if MV leaflet area is associated with MV coaptation-zone area and identify the clinical factors associated with MV leaflet size and coaptation-zone area in patients with normal left ventricle (LV) systolic function and size using real-time 3D echocardiography (RT3DE).We performed RT3DE in 135 patients with normal LV size and ejection fraction. MV leaflet and coaptation-zone areas were measured using custom 3D software. The clinical factors associated with MV leaflet and coaptation-zone areas were evaluated using univariate and multivariate linear regression analyses.There was a significant relationship between MV leaflet and coaptation-zone areas (r = 0.499, P < 0.001). MV leaflet area was strongly associated with body surface area (BSA) (r = 0.905, P < 0.001) rather than LV size and age. MV leaflet area/BSA was independently associated with male gender (P = 0.002), lower diastolic blood pressure (P = 0.042), and LV end-diastolic volume (LVEDV) index (P = 0.048); MV coaptation-zone area/BSA was independently associated with lower LVEDV index (P = 0.01).In patients with normal LV systolic function and size, MV leaflet size has a significant impact on competent MV coaptation. MV leaflet area might be intrinsically determined by body size rather than age and LV size, and the MV leaflet area/BSA is relatively constant. On the other hand, some clinical factors might also influence MV leaflet and coaptation-zone area.
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- 2021
12. Transcatheter Mitral Valve Repair With Leaflet-to-Ring Technique in the Presence of a Radiolucent Prosthetic Ring
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Matthew A. Romano, Steven F. Bolling, Daniel S. Menees, Neal M. Duggal, Stanley Chetcuti, and Gorav Ailawadi
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Heart Valve Prosthesis Implantation ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,Leaflet (botany) ,business.industry ,MitraClip ,Radiodensity ,Mitral Valve Insufficiency ,Ring (chemistry) ,Surgery ,Treatment Outcome ,Heart Valve Prosthesis ,Humans ,Mitral Valve ,Medicine ,Transcatheter mitral valve repair ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Published
- 2021
13. Embolized mechanical aortic valve leaflet causing infrarenal aortic stenosis and claudication
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Pantelis Hadjizacharia, Bryan Eldreth, and David Feuer
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,lcsh:Surgery ,030204 cardiovascular system & hematology ,Aortic disease ,Intravascular foreign body ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Case report ,medicine ,Leaflet escape ,Leaflet (botany) ,business.industry ,technology, industry, and agriculture ,Mechanical Aortic Valve ,lcsh:RD1-811 ,medicine.disease ,Thrombosis ,Surgery ,Stenosis ,Prosthetic heart valve ,lcsh:RC666-701 ,cardiovascular system ,lipids (amino acids, peptides, and proteins) ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Claudication ,Complication ,business - Abstract
Leaflet escape from mechanical heart valves is a rare but potentially fatal complication of prosthetic valve replacement. Historically, the incompetent valve is replaced emergently and the escaped leaflet is subsequently retrieved from its settlement in a distal vessel. If it is not retrieved, the fragment can increase the risk of infection, thrombosis, and migration. We report a case of a mechanical aortic valve leaflet that embolized during valve reoperation and caused occlusive aortic disease found 2 years later. This case emphasizes the importance of locating leaflet fragments after they are noticed missing.
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- 2020
14. The Effectiveness of The Use of Leaflet Media on The Prevention Behavior of Pathological Women of Childbearing Age in Polindes, Kedaton Village, Kapas District, Bojonegoro District
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Eri Puji Kumalasari
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medicine.medical_specialty ,Leaflet (botany) ,business.industry ,Family medicine ,Childbearing age ,Medicine ,business ,Pathological - Abstract
Background: Flour albus causes discomfort so that it requires increased behavior in preventing fluorine albus. The behavior of preventing vaginal discharge in fertile age women is still a health problem that needs attention. The Health Promotion Model theory emphasizes the active role of fertile age women in regulating healthy living behavior which aims as the prevention of a disease including fluorine albus or vaginal discharge, one of which is health education through leaflet media (Rachmadianti, 2019). Purpose: to determine the effectiveness of the use of leaflet media on the prevention behavior of pathological leucorrhoea in fertile aged women at the Polindes, Kedaton Village, Kapas District, Bojonegoro Regency. Methods: The research design used in this study was a pre-experimental design with one group pretest-posttest design. The sample in this study were some of the women of fertile age at the Polindes Village of Kedaton, Kapas District, Bojonegoro Regency as many as 39. The data analysis technique used in this study was the Mc Nemar test statistic. Results: more than some respondents had positive behavior, namely as many as 20 (51.3%) before being given leaflet media, and more than some respondents had positive behavior, namely as many as 31 (79.5%) after being given leaflet media. The results of calculations by SPSS with the Mc Nemar test showed that the significance value obtained to analyze the effectiveness of leaflet media on pathological vaginal discharge prevention behavior in women of childbearing age was 0.003. With a significance level of 5%, 0.003
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- 2020
15. Leaflet kinematics after the Yacoub and Florida-sleeve operations: results of an in vitro study
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Michal Jaworek, Francesco Trinca, Carlo Antona, Paola Redaelli, Giordano Tasca, Riccardo Vismara, and Federico Lucherini
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Adult ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Swine ,Leaflet kinematics ,Aortic Valve Insufficiency ,0206 medical engineering ,Pulsatile flow ,Valve opening ,02 engineering and technology ,Kinematics ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Internal medicine ,medicine ,Animals ,In vitro study ,Closing (morphology) ,Aorta ,Leaflet (botany) ,business.industry ,Aortic valve sparing ,General Medicine ,020601 biomedical engineering ,Biomechanical Phenomena ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Florida ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES The Florida-sleeve is a valve-sparing technique that causes minimal interference to leaflet kinematics and aortic root dynamism. The aim of this in vitro study was to evaluate the effects of the Florida-sleeve and Yacoub techniques on aortic leaflet kinematics. METHODS Two groups of 6 whole porcine hearts were treated with either the Florida-sleeve technique or the Yacoub technique and tested in a pulsatile loop. Valve fluid dynamics, coronary flow analysis and valve echocardiograms were performed both before and after the procedures. RESULTS Both procedures showed no difference in rapid valve opening time as compared with their respective baseline values. The Florida-sleeve procedure showed a shorter slow closing time (192 ± 19 ms vs baseline 244 ± 14 ms, P = 0.016) and increased slow closing velocity (−1.5 ± 0.4 cm/s vs baseline −0.8 ± 0.4 cm/s, P = 0.038). In the rapid valve closing phase, the Yacoub procedure showed a trend towards slower closing valve velocity (−16 ± 9 cm/s vs baseline −25 ± 9 cm/s, P = 0.07). The Yacoub procedure showed larger leaflet displacement at the end of the slow valve closing time that was 2.0 ± 0.5 cm vs baseline 1.5 ± 0.3 cm, P = 0.044. When comparing the Florida-sleeve and Yacoub procedures, the former showed statistically significant shorter slow valve closing time (P = 0.017). CONCLUSIONS This study showed that the Florida-sleeve technique alters the slow closing phase of the aortic valve leaflet kinematics when compared with both the normal baseline and Yacoub procedure, while the latter showed a larger leaflet displacement before the rapid closing valve phase.
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- 2020
16. Unusual Cause of Severe Tricuspid Regurgitation
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Puneet Bhatla, Aeshita Dwivedi, Eugene Kim, Dan G. Halpern, Elias Zias, Muhamed Saric, Alan F. Vainrib, and Daniel Bamira
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0301 basic medicine ,medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,TR, tricuspid regurgitation ,cardiac magnetic resonance imaging ,RA, right atrium ,Case Report ,Regurgitation (circulation) ,030105 genetics & heredity ,motor vehicle accident ,tricuspid valve ,Vehicle accident ,Avulsion ,03 medical and health sciences ,0302 clinical medicine ,Blunt ,stomatognathic system ,Clinical Case ,Cardiac magnetic resonance imaging ,Internal medicine ,3D, 3-dimensional ,medicine ,Diseases of the circulatory (Cardiovascular) system ,cardiovascular diseases ,Leaflet (botany) ,Tricuspid valve ,medicine.diagnostic_test ,business.industry ,transesophageal echocardiography ,CT, computed tomography ,RV, right ventricle ,medicine.anatomical_structure ,RC666-701 ,Cardiology ,cardiovascular system ,TV, tricuspid valve ,leaflet tear ,avulsion ,Cardiology and Cardiovascular Medicine ,Complication ,business ,030217 neurology & neurosurgery - Abstract
Tricuspid regurgitation (TR) is an uncommon and underdiagnosed complication of blunt chest trauma. Typical mechanisms include torn chordae, papillary muscle rupture, and radial leaflet tear. We describe an unusual case of traumatic TR due to circumferential avulsion of the anterior tricuspid leaflet from the tricuspid annulus and the crucial role of multimodality imaging in its diagnosis and treatment. (Level of Difficulty: Intermediate.), Graphical abstract
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- 2020
17. Effect of Leaflet Type and Leaflet-Stent Attachment Height on Transcatheter Aortic Valve Leaflet Thrombosis Potential
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Ajit P. Yoganathan, Beatrice Ncho, Vahid Sadri, Andrew W. Siefert, and Jillian Ortner
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medicine.medical_specialty ,Leaflet (botany) ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,technology, industry, and agriculture ,Biomedical Engineering ,Medicine (miscellaneous) ,Stent ,medicine.disease ,Thrombosis ,Valve leaflet ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,lipids (amino acids, peptides, and proteins) ,cardiovascular diseases ,business - Abstract
Transcatheter aortic valve replacement devices vary in leaflet material and in the height for which leaflets attach to the stented valve frame. Combinations of these features can influence leaflet dynamics, neo-sinus geometries, and fluid dynamics, thereby reducing or exacerbating the potential for blood flow stasis and leaflet thrombosis. To investigate these interconnected relationships, this study evaluated the effects of transcatheter valve leaflet type [porcine versus bovine pericardium] and the leaflet-stent attachment height (low, mid, and high) on flow stasis and potential for leaflet thrombosis. Transcatheter valve models were manufactured and tested within an aortic simulator under pulsatile left heart hemodynamic conditions. Transvalvular hemodynamics, leaflet kinematics, and flow structures were evaluated by direct measurement, high-speed imaging, and two differing techniques of particle image velocimetry. Transcatheter valves with porcine pericardial leaflets were observed to be less stiff, exhibit a lesser resistance to flow, were associated with reduced regions of neo-sinus flow stasis, and superior sinus washout times. More elevated attachments of the leaflets were associated with less neo-sinus flow stasis. These initial results and observations suggest combinations of leaflet type and stent attachment height may reduce transcatheter aortic valve flow stasis and the potential for leaflet thrombosis.
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- 2022
18. Early and mid-term outcomes of mitral repair due to leaflet prolapse in a national referral center
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Barbara Vidal, Daniel Pereda, María Ascaso, Manuel Castellá, Eduard Quintana, and Elena Sandoval
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medicine.medical_specialty ,Leaflet (botany) ,business.industry ,General surgery ,Medicine ,Referral center ,General Medicine ,business ,Term (time) - Published
- 2021
19. In-Vitro Assessment of the Effects of Transcatheter Aortic Valve Leaflet Design on Neo-Sinus Geometry and Flow
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Ajit P. Yoganathan, Beatrice Ncho, Jillian Ortner, Vahid Sadri, and Sai S Kollapaneni
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medicine.medical_specialty ,Transcatheter aortic ,Biomedical Engineering ,Prosthesis Design ,Transcatheter Aortic Valve Replacement ,Valve leaflet ,Aortic sinus ,Internal medicine ,medicine ,Animals ,cardiovascular diseases ,Sinus (anatomy) ,Leaflet (botany) ,business.industry ,Models, Cardiovascular ,technology, industry, and agriculture ,medicine.disease ,Thrombosis ,Biomechanical Phenomena ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Hydrodynamics ,cardiovascular system ,Cardiology ,Cattle ,lipids (amino acids, peptides, and proteins) ,business ,Pericardium ,Clinical risk factor ,Thrombotic complication - Abstract
Transcatheter aortic valve (TAV) leaflet thrombosis is a clinical risk with potentially fatal consequences. Studies have identified neo-sinus flow stasis as a cause of leaflet thrombosis. Flow stasis is influenced by the TAV leaflets, which affect the local fluid dynamics in the aortic sinus and neo-sinus. This study evaluated the effects of TAV leaflet features on the neo-sinus flow as a measure of leaflet thrombosis risk. Five TAVs of varied leaflet length and insertion height were tested in a simulator. Hydrodynamics and leaflet kinematics through en-phase imaging were quantified. Velocity fields were assessed using high-speed particle image velocimetry. Regions of flow stasis and particle residence times (PRTs) were quantified. TAVs with shorter leaflet length exhibited larger orifice areas and lower transvalvular pressure gradients. Shorter leaflet length and increased leaflet insertion TAVs additionally exhibited lower neo-sinus PRTs (0.44 ± 0.21 vs 2.83 ± 0.48 cycles, p
- Published
- 2020
20. The role of four-dimensional computed tomography in transcatheter aortic valve replacement prosthesis endocarditis with concurrent leaflet thrombosis: a case report
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Adam J. Brown, Nancy Khav, and Hashrul Rashid
- Subjects
medicine.medical_specialty ,Transcatheter aortic valve replacement/implantation ,medicine.medical_treatment ,Case Reports ,Prosthesis ,Valve replacement ,Case report ,medicine ,Endocarditis ,AcademicSubjects/MED00200 ,Computed tomography ,Leaflet thrombosis ,Cardiac Imaging (Echocardiography / Cardiac MRI / Nuclear Cardiology) ,Four-Dimensional Computed Tomography ,Leaflet (botany) ,business.industry ,Aortic stenosis ,valvular heart disease ,medicine.disease ,Thrombosis ,Infective endocarditis ,cardiovascular system ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Transcatheter aortic valve replacement (TAVR) is becoming increasingly utilized for the treatment of severe aortic valvular heart disease. Infective endocarditis of TAVR is rare but associated with higher mortality and morbidity. The potential for leaflet thrombosis following TAVR is also becoming increasingly recognized. Diagnosis of these conditions on echocardiography can be challenging due to prosthesis artefact. Case summary An 84-year-old man with a previous transcatheter aortic valve replacement presented with a febrile illness and bacteraemia. Transthoracic and transoesophageal echocardiography demonstrated high transvalvular gradients with features of prosthesis endocarditis, though leaflet morphology could not be fully assessed due to prosthesis artefact. Four-dimensional computed tomography revealed hypo-attenuated leaflet thickening with reduced leaflet motion, consistent with prosthesis leaflet thrombosis. The patient was successfully treated with antibiotics and anticoagulation, with resolution of the infection and normalization of the transvalvular gradient after 6 weeks. Discussion Echocardiography should be the first-line investigation for assessing leaflet morphology in suspected prosthetic valve endocarditis or leaflet thrombosis but its accuracy may be limited by artefact. Our case highlights that four-dimensional computed tomography provides further evaluation of prosthesis leaflet morphology/motion, providing valuable diagnostic information.
- Published
- 2020
21. Leaflet fracture and embolization from an On-X mechanical mitral valve
- Author
-
Johannes L. Bjørnstad, Erik Helgeland, Karl Andreas Dumont, and Kristoffer Andresen
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Leaflet (botany) ,Mechanical Mitral Valve ,business.industry ,medicine.medical_treatment ,Fracture (geology) ,Medicine ,Surgery ,Embolization ,Adult: Mitral Valve: Case Reports ,business - Published
- 2020
22. 'Not another leaflet please': Improving the delivery of physical activity information and interventions for people with breast cancer
- Author
-
Lee Corsini, Helen Mcleod, Natalie Harris, Mary Woods, Theresa Wiseman, Hazel Hunter, Sarah Adomah, Carolyn Moore, Ruth Tigue, Natalie Doyle, Catherine Sandsund, and Siobhan Cowan-Dickie
- Subjects
lcsh:R5-920 ,medicine.medical_specialty ,Breast cancer ,Leaflet (botany) ,business.industry ,Psychological intervention ,Physical activity ,Physical therapy ,medicine ,lcsh:Medicine (General) ,medicine.disease ,business - Abstract
An experience-based co-design (EBCD) project at a UK cancer centre identified unmet staff and patient needs and prioritized four areas for physical activity (PA) service improvement: messaging about PA from healthcare professionals; timing of messaging; individualising information; and peer discussion.
- Published
- 2020
23. The utility of aortic valve leaflet reconstruction techniques in children and young adults
- Author
-
Beatrice Bonello, Branko Mimic, Richard Issitt, Slobodan Ilic, Luke M. Wiggins, Jan Marek, and Martin Kostolny
- Subjects
Male ,Reoperation ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Time Factors ,Adolescent ,Bovine pericardium ,Aortic Valve Insufficiency ,Transplantation, Heterologous ,Heart Valve Diseases ,Hemodynamics ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Transplantation, Autologous ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Bicuspid Aortic Valve Disease ,Risk Factors ,Interquartile range ,medicine ,Animals ,Humans ,cardiovascular diseases ,Cardiac Surgical Procedures ,Young adult ,Child ,Retrospective Studies ,Tissue engineered ,Leaflet (botany) ,business.industry ,Age Factors ,Aortic Valve Stenosis ,Recovery of Function ,Plastic Surgery Procedures ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Aortic Valve ,cardiovascular system ,Cattle ,Female ,Cardiology and Cardiovascular Medicine ,business ,Pericardium - Abstract
The treatment of aortic valve disease in children and adolescents requires an individualized approach to provide a long-term solution with optimal hemodynamic profile. The role of aortic leaflet reconstruction techniques is evolving.We retrospectively reviewed the charts of 58 patients who underwent aortic valve tricuspidalization either by an Ozaki procedure (neo-tricuspidalization) or single leaflet reconstruction between 2015 and 2019. Immediate operative results as well as hospital and short-term outpatient follow-up data were evaluated.Fifty-eight patients underwent leaflet reconstruction with 40 (69%) receiving a neo-tricuspidalization and 18 patients (31%) undergoing single leaflet reconstruction, using either a glutaraldehyde fixed autologous pericardium or tissue engineered bovine pericardium (CardioCel; Admedus, Queensland, Australia). The median age at the time of surgery was 14.8 years (interquartile range, 10.6-16.8 years). Twenty-three patients (40%) had isolated aortic regurgitation. The peak velocity across the aortic valve decreased from 3.4 ± 1.2 meters per second (m/s) preoperatively to 2.0 ± 0.4 m/s (P .001) after surgery and remained stable (2.2 ± 0.7 m/s) during a median echocardiographic follow-up of 14.1 months (7.2-20.1 months) for the whole cohort. Freedom from reoperation or moderate and greater aortic regurgitation at 1, 2, and 3 years was 94.2% ± 3.3%, 85.0% ± 5.8%, and 79.0% ± 8.0%, respectively, with no difference between the neo-tricuspidalization and single leaflet reconstruction groups (P = .635). There were 6 late reoperations (10%) of which 3 were due to endocarditis.Aortic leaflet reconstruction provides acceptable short-term hemodynamic outcomes and proves the utility of this technique as an adjunctive strategy for surgical treatment of aortic valve disease in children and young adults.
- Published
- 2020
24. Impact of Over-Expansion on SAPIEN 3 Transcatheter Heart Valve Pericardial Leaflets
- Author
-
Rihab Bouchareb, Karen Pl. Lau, Geoffrey W. Payne, Djamel Lebeche, Leila B. Mostaço-Guidolin, Tillie-Louise Hackett, Stephanie L. Sellers, Janarthanan Sathananthan, Jonathon Leipsic, Mark Hensey, Joshua Bugis, John G. Webb, Philipp Blanke, and P. Pibarot
- Subjects
medicine.medical_specialty ,Leaflet (botany) ,medicine.anatomical_structure ,business.industry ,Internal medicine ,Cardiology ,medicine ,Heart valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
This study sought to investigate the impact of extensive over-expansion of transcatheter heart valves (THVs) on leaflet structure. THVs may be over-expanded beyond recommended labeling in certain c...
- Published
- 2020
25. Reduced Leaflet Motion after Transcatheter Aortic-Valve Replacement
- Author
-
Ole, De Backer, George D, Dangas, Hasan, Jilaihawi, Jonathon A, Leipsic, Christian J, Terkelsen, Raj, Makkar, Annapoorna S, Kini, Karsten T, Veien, Mohamed, Abdel-Wahab, Won-Keun, Kim, Prakash, Balan, Nicolas, Van Mieghem, Ole N, Mathiassen, Raban V, Jeger, Martin, Arnold, Roxana, Mehran, Ana H C, Guimarães, Bjarne L, Nørgaard, Klaus F, Kofoed, Philipp, Blanke, Stephan, Windecker, Lars, Søndergaard, and Cardiology
- Subjects
Male ,medicine.medical_treatment ,Computed tomography ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Rivaroxaban ,Valve replacement ,Atrial Fibrillation ,Medicine ,030212 general & internal medicine ,610 Medicine & health ,Aged, 80 and over ,Prosthetic valve ,Leaflet (botany) ,medicine.diagnostic_test ,General Medicine ,Clopidogrel ,Intention to Treat Analysis ,CARDIOLOGY ESC ,Cardiovascular Diseases ,Aortic Valve ,Heart Valve Prosthesis ,cardiovascular system ,Cardiology ,Drug Therapy, Combination ,Female ,lipids (amino acids, peptides, and proteins) ,Thickening ,medicine.medical_specialty ,Transcatheter aortic ,SOCIETY ,Hemorrhage ,TAVR ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Thromboembolism ,Internal medicine ,MANAGEMENT ,Humans ,cardiovascular diseases ,Four-Dimensional Computed Tomography ,Aged ,EUROPEAN ASSOCIATION ,Aspirin ,business.industry ,technology, industry, and agriculture ,THROMBOSIS ,Multicenter study ,IMPLANTATION ,business ,Platelet Aggregation Inhibitors ,Factor Xa Inhibitors - Abstract
BACKGROUND: Subclinical leaflet thickening and reduced leaflet motion of bioprosthetic aortic valves have been documented by four-dimensional computed tomography (CT). Whether anticoagulation can reduce these phenomena after transcatheter aortic-valve replacement (TAVR) is not known.METHODS: In a substudy of a large randomized trial, we randomly assigned patients who had undergone successful TAVR and who did not have an indication for long-term anticoagulation to a rivaroxaban-based antithrombotic strategy (rivaroxaban [10 mg] plus aspirin [75 to 100 mg] once daily) or an antiplatelet-based strategy (clopidogrel [75 mg] plus aspirin [75 to 100 mg] once daily). Patients underwent evaluation by four-dimensional CT at a mean (±SD) of 90±15 days after randomization. The primary end point was the percentage of patients with at least one prosthetic valve leaflet with grade 3 or higher motion reduction (i.e., involving >50% of the leaflet). Leaflet thickening was also assessed.RESULTS: A total of 231 patients were enrolled. At least one prosthetic valve leaflet with grade 3 or higher motion reduction was found in 2 of 97 patients (2.1%) who had scans that could be evaluated in the rivaroxaban group, as compared with 11 of 101 (10.9%) in the antiplatelet group (difference, -8.8 percentage points; 95% confidence interval [CI], -16.5 to -1.9; P = 0.01). Thickening of at least one leaflet was observed in 12 of 97 patients (12.4%) in the rivaroxaban group and in 33 of 102 (32.4%) in the antiplatelet group (difference, -20.0 percentage points; 95% CI, -30.9 to -8.5). In the main trial, the risk of death or thromboembolic events and the risk of life-threatening, disabling, or major bleeding were higher with rivaroxaban (hazard ratios of 1.35 and 1.50, respectively).CONCLUSIONS: In a substudy of a trial involving patients without an indication for long-term anticoagulation who had undergone successful TAVR, a rivaroxaban-based antithrombotic strategy was more effective than an antiplatelet-based strategy in preventing subclinical leaflet-motion abnormalities. However, in the main trial, the rivaroxaban-based strategy was associated with a higher risk of death or thromboembolic complications and a higher risk of bleeding than the antiplatelet-based strategy. (Funded by Bayer; GALILEO-4D ClinicalTrials.gov number, NCT02833948.).
- Published
- 2020
26. Leaflet stress quantification of porcine vs bovine surgical bioprostheses: an in vitro study
- Author
-
Viktória Stanová, Philippe Pibarot, Régis Rieu, Lionel Thollon, Paul Barragan, Yves Godio Raboutet, Laboratoire de Biomécanique Appliquée (LBA UMR T24), and Aix Marseille Université (AMU)-Université Gustave Eiffel
- Subjects
medicine.medical_specialty ,Leaflet (botany) ,business.industry ,Biomedical Engineering ,Bioengineering ,General Medicine ,medicine.disease ,Computer Science Applications ,Human-Computer Interaction ,[SPI]Engineering Sciences [physics] ,Internal medicine ,Cardiology ,Medicine ,In vitro study ,business ,Medical therapy ,Progressive disease ,ComputingMilieux_MISCELLANEOUS - Abstract
Calcified aortic stenoses are among the most prevalent form of cardiovascular diseases in the industrialized countries. This progressive disease, with no effective medical therapy, ultimately requi...
- Published
- 2022
27. Valve-in-Valve Transcatheter Aortic Valve Replacement in a High-Risk Patient with a Biocor Bioprosthesis and a Flail Prosthetic Valve Leaflet
- Author
-
Oliver Abela, Michael Schoeller, Parker Williams, Charles Lambert, and Marc Bloom
- Subjects
Prosthetic valve ,medicine.medical_specialty ,Leaflet (botany) ,Valve replacement ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,cardiovascular system ,medicine ,General Medicine ,business ,Valve in valve ,Surgery - Abstract
An 80-year-old woman with a history of surgical aortic valve replacement with a 21 mm St. Jude Medical Biocor porcine aortic valve 14 years prior presented with New York Heart Association (NYHA) class III symptoms, severe aortic insufficiency from a degenerated prosthesis, and a large echocardiographic mobile mass representing a highly mobile prosthetic leaflet. The patient worsened to NYHA class IV symptoms despite medical management. The Society of Thoracic Surgery mortality risk score was extremely high. However, a valve-in-valve transcatheter aortic valve replacement (TAVR) was found to be a reasonable option. We used a 20 mm SAPIEN 3 Ultra valve (Edwards Lifesciences Inc., Irvine, CA, USA) with a SENTINEL embolic protection device (Boston Scientific, Marlborough, MA, USA). During valve deployment, the echocardiographic mobile mass was visually pinned between the new TAVR valve and the surgical bioprosthetic valve. No large embolic debris was noted within the embolic protection device, and the patient remained without any new focal neurologic deficits in the perioperative period and at the 30-day follow-up. The severe aortic insufficiency resolved, and the patient clinically improved to NYHA class II symptoms.
- Published
- 2022
28. Balloon-Augmented Leaflet Modification With Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction and Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction: Benchtop Validation and First In-Man Experience
- Author
-
Christopher G Bruce, Jeremiah P. Depta, Dursun Korel Yildirim, Vasilis Babaliaros, Gaetano Paone, Norihiko Kamioka, James M. McCabe, Keshav Kohli, Patrick T. Gleason, Toby Rogers, Adam B. Greenbaum, Robert J. Lederman, Jaffar M. Khan, Joe Xie, Kendra J. Grubb, and Emily Perdoncin
- Subjects
medicine.medical_specialty ,Electrosurgery ,medicine.medical_treatment ,Iatrogenic Disease ,Balloon ,Lacerations ,Article ,Transcatheter Aortic Valve Replacement ,Mitral valve ,medicine ,Animals ,Humans ,cardiovascular diseases ,Heart Valve Prosthesis Implantation ,Leaflet (botany) ,business.industry ,Coronary Vessels ,Surgery ,Pectinidae ,Treatment Outcome ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Anterior mitral leaflet ,cardiovascular system ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background: Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) and laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) reduce the risk of coronary and left ventricular outflow obstruction obstruction during transcatheter aortic valve replacement and transcatheter mitral valve replacement. Despite successful laceration, BASILICA or LAMPOON may fail to prevent obstruction caused by inadequate leaflet splay in patients having challenging anatomy such as very small valve-to-coronary distance, diffusely calcified, rigid leaflets, or undergoing transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement. We describe a novel technique of balloon-augmented (BA) leaflet laceration to enhance leaflet splay. Methods: We measured the incremental leaflet splay from BA-BASILICA in vitro. From November 2019 to March 2021, 16 patients underwent BA-BASILICA and 4 BA-LAMPOON at 3 centers. Results: BA-BASILICA increased benchtop leaflet tip splay 17%, maximum splay angle 30%, and splay area 23%, resulting in a more rounded apex and larger effective area. Sixteen patients at risk for inadequate BASILICA leaflet splay, including 4 transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement, underwent BA-BASILICA. All had successful leaflet laceration. One had coronary obstruction requiring immediate orthotopic stenting. Two underwent elective orthotopic coronary stenting through the transcatheter valve cells for leaflet prolapse without coronary ischemia. There were no deaths during the procedure or at 30 days. Four patients at risk for inadequate anterior mitral leaflet splay underwent BA-LAMPOON. All had successful target leaflet laceration without left ventricular outflow obstruction obstruction or procedural death. One died within 30 days. Conclusions: BA leaflet laceration enhances leaflet splay in vitro and may allow transcatheter aortic valve replacement and transcatheter mitral valve replacement in patients otherwise ineligible for traditional BASILICA or LAMPOON due to challenging anatomy. Graphic Abstract: A graphic abstract is available for this article.
- Published
- 2021
29. Papillary Muscle Reorientation for Systolic Anterior Motion After Mitral Valve Repair
- Author
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Taichi Sakaguchi, Naosumi Sekiya, Mitsuhiro Yamamura, Arudo Hiraoka, Masaaki Ryomoto, and Hiroe Tanaka
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Systole ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Mitral valve ,Internal medicine ,medicine ,Humans ,In patient ,cardiovascular diseases ,Cardiac Surgical Procedures ,Papillary muscle ,Mitral valve repair ,Leaflet (botany) ,business.industry ,Ventricular wall ,technology, industry, and agriculture ,Mitral Valve Insufficiency ,Middle Aged ,Papillary Muscles ,Plastic Surgery Procedures ,Surgical correction ,medicine.anatomical_structure ,030228 respiratory system ,cardiovascular system ,Cardiology ,Mitral Valve ,lipids (amino acids, peptides, and proteins) ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Systolic anterior motion (SAM) of the mitral valve is a well-known complication in mitral valve repair. Because excessive leaflet tissue is an important mechanism, surgical correction is sometimes required to reduce leaflet height or mobility. However, a different approach may be necessary in cases of normal leaflet height. Herein, we describe papillary muscle reorientation for treating SAM after isolated anterior leaflet repair. The papillary muscle heads were approximated and fixed to the posterior ventricular wall, relocating them away from the ventricular septum. This technique is useful for treating postrepair SAM, without addressing the leaflet, in patients with degenerative mitral disease.
- Published
- 2021
30. Early Effects of Transcatheter Edge-to-Edge Leaflet Repair for Tricuspid Regurgitation: First-in-Human Experience with Computed Tomography
- Author
-
Yu Du, John R. Lesser, Go Hashimoto, Miho Fukui, Bernardo B.C. Lopes, Paul Sorajja, João L. Cavalcante, and Aisha Ahmed
- Subjects
medicine.medical_specialty ,Leaflet (botany) ,medicine.diagnostic_test ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Computed tomography ,First in human ,Radiology ,Regurgitation (circulation) ,Edge (geometry) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
31. Blood-filled, pouch-forming tricuspid septal leaflet in a patient with tricuspid valve dysplasia
- Author
-
Hidetsugu Asai, Takuya Okamoto, Tsuyoshi Tachibana, Yuchen Cao, and Jin Ikarashi
- Subjects
Pulmonary and Respiratory Medicine ,Heart Defects, Congenital ,Heart Septal Defects, Ventricular ,Leaflet (botany) ,business.industry ,Heart Valve Diseases ,BLOOD FILLED ,General Medicine ,Anatomy ,Tricuspid Valve Insufficiency ,Tricuspid valve dysplasia ,Treatment Outcome ,Medicine ,Humans ,Surgery ,Tricuspid Valve ,Pouch ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
32. Asymmetric leaflet tethering is associated with worse outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation
- Author
-
L Stolz, M Orban, D Braun, P Doldi, T Stocker, M Mehr, J Steffen, K Loew, C Hagl, S Massberg, M Naebauer, and J Hausleiter
- Subjects
medicine.medical_specialty ,Mitral valve repair ,Mitral regurgitation ,Leaflet (botany) ,Tethering ,business.industry ,Internal medicine ,medicine.medical_treatment ,Cardiology ,Medicine ,Edge (geometry) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The impact of mitral valve (MV) tethering patterns on outcomes of patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) for severe secondary mitral regurgitation (SMR) is unknown. Purpose The purpose of this study was to evaluate the impact of asymmetric postero-anterior and medio-lateral MV leaflet tethering on procedural and survival outcomes after TEER for SMR. Methods Symmetry of postero-anterior leaflet tethering was defined as the ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in the central MV segment 2. The ratio of the tenting area between MV segments 3 and 1 (S3/S1 ratio) was defined as medio-lateral tethering symmetry. We used receiver operating characteristics and a proportional Cox model to identify cut-off values of asymmetric postero-anterior and medio-lateral tethering for prediction of two-year survival after TEER. Results 178 patients receiving TEER for SMR were included. Asymmetric postero-anterior tethering was observed in 67 patients (37.6%, PLA/ALA ratio cut-off >1.54). Medio-lateral tethering was asymmetric in 49 patients (27.5%, S3/S1 ratio cut-off >1.49). MR was reduced to MR ≤2+ in 91.6% of patients, while postprocedural MR remained higher in the presence of asymmetric postero-anterior tethering (p=0.01). After adjustment for potential clinical and echocardiographic confounders, multivariable Cox regression analysis confirmed asymmetric postero-anterior tethering (HR=2.77, CI=1.43–5.38, p Conclusions Asymmetric postero-anterior and medio-lateral MV leaflet tethering patterns independently increase two-year all-cause mortality in patients undergoing TEER for SMR. Detailed echocardiographic patient selection might improve outcomes after TEER. Funding Acknowledgement Type of funding sources: None. Postero-anterior tetheringMedio-lateral tethering
- Published
- 2021
33. Subclinical leaflet thrombosis after transcatheter aortic valve replacement and anticoagulant treatment: lights and shadows
- Author
-
Matteo Sturla, Riccardo Terzi, and Francesco Condello
- Subjects
medicine.medical_specialty ,Hematology ,Leaflet (botany) ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Anticoagulants ,Thrombosis ,Aortic Valve Stenosis ,medicine.disease ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Anticoagulant therapy ,Valve replacement ,Internal medicine ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Medicine ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Subclinical infection - Published
- 2021
34. Mitral repair with leaflet preservation versus leaflet resection and ventricular reverse remodeling from a randomized trial
- Author
-
Howard Leong-Poi, Faeez Mohamad Ali, Richard P. Whitlock, Geraldine Ong, Benoit de Varennes, Makoto Hibino, Wendy Tsang, David Messika-Zeitoun, Nitish K. Dhingra, Denis Bouchard, Adrian Quan, Vincent Chan, Alexander J. Gregory, David A. Latter, C. David Mazer, Hwee Teoh, Subodh Verma, Kim A. Connelly, and Michael W.A. Chu
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Mitral regurgitation ,Ejection fraction ,Leaflet (botany) ,business.industry ,Diastole ,Regurgitation (circulation) ,medicine.disease ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Mitral valve prolapse ,End-diastolic volume ,Surgery ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
In the Canadian Mitral Research Alliance (CAMRA) Trial CardioLink-2 leaflet resection versus preservation techniques for posterior leaflet prolapse was investigated and no difference was shown in their effect on mean mitral gradient at peak exercise at 12 months postoperatively. The purpose of this subanalysis was to evaluate the effect of the 2 strategies on left ventricular (LV) reverse remodeling after repair.A total of 104 patients were randomized to either a leaflet resection or leaflet preservation strategy. Echocardiograms, performed at baseline (preoperative), predischarge, and 12 months postoperatively, were analyzed in a blinded fashion at a core laboratory.All patients underwent successful mitral repair. At discharge, 3 patients showed moderate mitral regurgitation, whereas the remainder showed mild or less regurgitation. Compared with the baseline echocardiogram, the indexed end diastolic volume was reduced at the discharge echocardiogram (P .0001) and was further reduced at the 12-month echocardiogram (P = .01). In contrast, the indexed end systolic volume did not significantly change from baseline assessed at the predischarge echocardiogram (P = .32) but improved at 12 months postoperatively (P .0001), resulting in a corresponding improvement in ejection fraction at 12 months (P .0001). The type of mitral repair strategy had no significant effect on LV reverse remodeling trends.The mitral repair strategies used did not influence postoperative LV reverse remodeling, which occurred in stages. Although LV end diastolic dimensions recovered before discharge, improvements in LV end systolic dimension were evident 12 months after repair.
- Published
- 2021
35. Late-Phase Delayed Coronary Obstruction Caused by Protruding Calcified Aortic Valve Leaflet After Balloon-Expandable Transcatheter Aortic Valve Replacement
- Author
-
Gilbert H.L. Tang, Samin K. Sharma, Sunny Goel, Samantha Lee, Annapoorna Kini, Parasuram Krishnamoorthy, and Keisuke Yasumura
- Subjects
medicine.medical_specialty ,Calcified aortic valve ,Transcatheter aortic ,medicine.medical_treatment ,Coronary Angiography ,Prosthesis Design ,Transcatheter Aortic Valve Replacement ,Valve replacement ,Late phase ,Internal medicine ,Multidetector Computed Tomography ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ultrasonography, Interventional ,Aged, 80 and over ,Leaflet (botany) ,business.industry ,Percutaneous coronary intervention ,Aortic Valve Stenosis ,Coronary Vessels ,Balloon expandable stent ,Coronary Occlusion ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
36. Clinical valve thrombosis post-transcatheter aortic valve implantation with hypoattenuating leaflet thickening in computed tomography: anticoagulation is the answer
- Author
-
Ricardo Ladeiras-Lopes, Ricardo Fontes-Carvalho, Diogo Santos-Ferreira, and Eulália Pereira
- Subjects
medicine.medical_specialty ,Leaflet (botany) ,medicine.diagnostic_test ,Transcatheter aortic ,Valve thrombosis ,business.industry ,Computed tomography ,medicine.disease ,Thrombosis ,medicine ,AcademicSubjects/MED00200 ,Radiology ,Thickening ,Cardiovascular Flashlight ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
37. Leaflet Injuries After Percutaneous Edge-to-Edge Repair
- Author
-
Francesco Maisano
- Subjects
mitral valve ,medicine.medical_specialty ,Percutaneous ,leaflet repair ,Hemodynamics ,complication ,Edge (geometry) ,hemodynamics ,Mitral valve ,pulmonary hypertension ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Leaflet (botany) ,business.industry ,valve repair ,medicine.disease ,Pulmonary hypertension ,Surgery ,medicine.anatomical_structure ,RC666-701 ,Mini-Focus Issue: Procedural Complications: Part 2 ,cardiac assist devices ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Editorial Comment - Abstract
Corresponding Author
- Published
- 2021
38. Commentary: Prosthetic valve leaflet: Still too many questions are unanswered
- Author
-
Stefano D'Alessandro and Francesco Formica
- Subjects
Pulmonary and Respiratory Medicine ,Prosthetic valve ,medicine.medical_specialty ,Leaflet (botany) ,business.industry ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2022
39. Commentary: The importance of achieving leaflet coaptation in mitral repair for functional mitral regurgitation: It's just math!
- Author
-
Steven F. Bolling and Alexander A. Brescia
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Leaflet (botany) ,business.industry ,Internal medicine ,medicine ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Functional mitral regurgitation - Published
- 2021
40. Two cases of catastrophic deterioration and multiple leaflet detachment in Trifecta valves
- Author
-
Tsukada T, Osaka M, Suzuki Y, Hiramatsu Y, Mathis B, Imai N, Kaminishi Y, and Sakamoto H
- Subjects
medicine.medical_specialty ,Leaflet (botany) ,business.industry ,cardiovascular system ,Medicine ,business ,Surgery - Abstract
Reports of early and catastrophic acute structural valve deterioration (SVD) in Trifecta valves (Abbott, St Paul, MN, USA) with multiple leaflet detachment are rare. We encountered two cases of early SVD in Trifecta valves with tears on two leaflets. Both cases presented with acute heart failure because of aortic insufficiency and underwent redo aortic valve replacement; one patient died due to multiple organ failure caused by cardiogenic shock. Durability issues with valves necessitate long-term vigilance in aortic valve replacement patients.
- Published
- 2021
41. Aortic Valve Repair in Young Patients: A Single Patch Design for Leaflet Extension
- Author
-
Jooncheol Min, Jae Hong Lee, Sungkyu Cho, Hye Won Kwon, Yu Jin Kwak, Woong Han Kim, Jae Gun Kwak, and Hong Ju Shin
- Subjects
Reoperation ,medicine.medical_specialty ,Leaflet (botany) ,business.industry ,Aortic Valve Insufficiency ,Regurgitation (circulation) ,Aortic Valve Stenosis ,Vascular surgery ,medicine.disease ,Surgery ,Cardiac surgery ,Stenosis ,Aortic valve repair ,Treatment Outcome ,Concomitant ,Aortic Valve ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,medicine ,Humans ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,business ,New York Heart Association Class I - Abstract
The surgical treatment for young patients with aortic valve diseases has not been standardized because of differences in the patients’ growth. We aimed to investigate short-term results of aortic valve repair with leaflet extension techniques. From October 2017 to June 2020, we performed aortic valve repair with leaflet extension technique in 15 consecutive patients with a median age of 13 years (range, 33 months–27 years). Among them, all had moderate or severe aortic regurgitation (AR), eight had concomitant aortic stenosis, and 12 underwent prior cardiac operations. The leaflet patch design has been modified from separate patch design to single patch design. No early and late deaths were reported, no re-operations were performed, and temporary ectopic atrial arrhythmia was the only early complication noted. The patients were discharged with less than moderate AR after a median postoperative period of 5 (range, 3–7) days. All the patients were New York Heart Association class I after a median follow-up period of 17.3 (range, 4.4–34.6) months. However, two patients progressed to moderate AR postoperatively at 6 and 30 months, respectively, after which one was treated with single patch technique. Among the remaining patients, six had trace, six had mild, and one had mild-to-moderate AR. Aortic valve repair with leaflet extension is acceptable in young patients. Our single patch design was easy to manipulate and showed good short-term results. Long-term follow-up is required to further confirm the efficacy of this technique.
- Published
- 2021
42. Case Report: - Aortic Valve Replacement due to Aortic Valve Leaflet Perforation after PCI
- Author
-
Yasser Shaban Mubarak and Muhammad Hussian Abdel Wahaab
- Subjects
Aortic valve ,medicine.medical_specialty ,Leaflet (botany) ,business.industry ,Perforation (oil well) ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Aortic valve replacement ,Conventional PCI ,cardiovascular system ,medicine ,cardiovascular diseases ,business - Abstract
Percutaneous Coronary Intervention (PCI) is widely recognized as an effective treatment for Acute Coronary Syndrome (ACS). Inspite of advances in equipment and experience of interventional cardiologist, still there are rare complications occurred [1]. Iatrogenic injury of the aortic valve leaflet is a rare. Aortic insufficiency (AI) after a PCI suggests an iatrogenic valve injury. Aortic leaflet injury is not common but possible complication of PCI. Because of the serious consequences, it should be mentioned in the informed consent. Aortic repair of iatrogenic injury is possible, and it can be performed with excellent clinical and functional midterm results. So, Aortic valve replacement (AVR) is the last option [2].
- Published
- 2020
43. Leaflet perforation or tear late after transcatheter aortic valve implantation
- Author
-
Shinichi Fukuhara and Daniel R. Liesman
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Leaflet (botany) ,Transcatheter aortic ,business.industry ,Perforation (oil well) ,medicine ,Surgery ,business ,Adult: Aortic Valve: Case Reports - Published
- 2020
44. Transapical and Transfemoral Combined Mitral Valve Repair With Annular and Leaflet Therapies
- Author
-
Javier Cobiella, David Meerkin, Kristof Wrobel, Luis Nombela-Franco, Luis Maroto, Ehud Raanani, Andrea Colli, and Alexander Lipey
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Beating heart ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Prosthesis Design ,transcatheter mitral valve repair ,mitraclip ,mitral leaflet therapy ,mitral regurgitation ,neochord ,transcatheter mitral anuloplasty ,% diameter reduction ,03 medical and health sciences ,0302 clinical medicine ,Mitral valve ,medicine ,Humans ,Prosthesis design ,Aged ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Prosthetic valve ,Mitral valve repair ,Leaflet (botany) ,business.industry ,Endovascular Procedures ,Mitral Valve Insufficiency ,Echocardiography, Doppler, Color ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,Heart Valve Prosthesis ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Two high-risk patients were successfully treated with concomitant implantation of a transapical off-pump beating heart semirigid D-shape annuloplasty device combined in 1 case with a transfemoral edge-to-edge device and in another with transapical chordal implantation. The significant anteroposterior diameter reduction offered by the annuloplasty implantation maximized the leaflet coaptation obtained by the prolapse correction performed with the leaflet devices. Combining the transcatheter annuloplasty device and leaflet/chordal repair technologies represents progress toward definitive transcatheter treatment of degenerative mitral valve disease.
- Published
- 2020
45. A Descriptive Study to assess Positive and Negative Symptoms among Diagnosed Schizophrenic Clients with a view to Develop Leaflet on Home Management of Schizophrenic Clients for their Family Members in a Selected Hospital at Raipur (C.G.)
- Author
-
Reena Barai
- Subjects
medicine.medical_specialty ,Leaflet (botany) ,business.industry ,Home management ,Family medicine ,Medicine ,Descriptive research ,business - Published
- 2020
46. Leaflet Prolapse After BASILICA and Transcatheter Aortic Valve Replacement
- Author
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Michele Pighi, Mitsunobu Kitamura, Mohamed Abdel-Wahab, and Flavio Ribichini
- Subjects
medicine.medical_specialty ,Leaflet (botany) ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,Valve replacement ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 64-year-old man on long-term hemodialysis with severe native aortic stenosis was referred for transcatheter aortic valve replacement (TAVR) but had high-risk features for left-sided coronary obstruction (low coronary height [8 mm], borderline virtual transcatheter valve-to-coronary distance [4.5
- Published
- 2020
47. Left Ventricular Outflow Tract Obstruction From Preserved Leaflet After Mitral Valve Replacement
- Author
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Mohammed Imam, Ashwad Afzal, Mukund Das, Krystyna Bronchard, Iosif Gulkarov, Frank M. Rosell, Adam Lackey, and Kumudha Ramasubbu
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Chronic congestive heart failure ,Leaflet (botany) ,business.industry ,Aortic root ,medicine.medical_treatment ,Mitral valve replacement ,Ventricular outflow tract obstruction ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Multiple factors ,030228 respiratory system ,Internal medicine ,Anterior mitral leaflet ,cardiovascular system ,medicine ,Cardiology ,Surgery ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve leaflet - Abstract
Left ventricular outflow tract obstruction (LVOTO) can be caused by multiple factors. One of the rare causes of LVOTO is preserved anterior mitral valve leaflet and chordal apparatus after mitral valve replacement. We describe a case of a patient with worsening chronic congestive heart failure secondary to LVOTO from systolic anterior motion of residual native anterior mitral leaflet. In this patient, LVOTO was surgically corrected by excision of anterior leaflet and chordal apparatus through the aortic root.
- Published
- 2020
48. Hypoattenuated Leaflet Thickening in Transcatheter and Surgical Aortic Valves
- Author
-
Joelle Kefer, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, and UCL - (SLuc) Service de pathologie cardiovasculaire
- Subjects
Aortic valve ,medicine.medical_specialty ,Leaflet (botany) ,business.industry ,hypoattenuated leaflet thickening ,Surgery ,Transcatheter Aortic Valve Replacement ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,medicine ,Thickening ,leaflet thrombosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
In 2015, Makkar et al. (1) detected a reduced leaflet motion (RLM) by 4-dimensional computed tomography (CT) in a patient included in the PORTICO IDE (The Portico Re-sheathable Transcatheter Aortic Valve System U.S. Investigational Device Exemption [PORTICO IDE] study: a prospective clinical trial to evaluate TAVR with either a Portico valve [St. Jude Medical] or a commercially available valve) study who had had a stroke after transcatheter aortic valve replacement (TAVR). It was the beginning of the story of possible subclinical leaflet thrombosis in bioprosthetic valves, a phenomena referred to as hypoattenuating leaflet thickening (HALT), with reference to their CT appearance. [...]
- Published
- 2020
49. Non-physiologic closing of bi-leaflet mechanical heart prostheses requires a new tri-leaflet valve design
- Author
-
Gilles D. Dreyfus, Didier Lapeyre, Bart Meuris, Thierry Carrel, Bernhard Vennemann, Bas A.J.M. de Mol, Walter P. Dembitsky, Dominik Obrist, and Hartzell V. Schaff
- Subjects
medicine.medical_specialty ,Cardiac & Cardiovascular Systems ,Design ,FLOW ,610 Medicine & health ,030204 cardiovascular system & hematology ,Prosthesis Design ,Cardiac valve ,Thrombosis ,Anticoagulation ,Mechanical heart-valve ,Unmet needs ,Mechanical heart ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Platelet activation ,Science & Technology ,Leaflet (botany) ,business.industry ,Hemodynamics ,Models, Cardiovascular ,Forward flow ,Flow (mathematics) ,Heart Valve Prosthesis ,Cardiovascular System & Cardiology ,Cardiology ,TRILEAFLET ,SHEAR ,Stress, Mechanical ,Rheology ,Cardiology and Cardiovascular Medicine ,business ,Life Sciences & Biomedicine - Abstract
Mechanical heart valve prostheses are based on older designs without changes during the last 40 years. Today, there is an unmet need for less thrombogenic mechanical prostheses. Analysis of the relationship between flow characteristics and thromboembolic complications is possible using numerical and biomolecular flow studies that have shown that the reverse rather than the forward flow is responsible for local platelet activation and thrombosis. After peak flow, leaflets experience flow deceleration and the leaflets are still widely open when the flow becomes zero. The closure of the valve starts with the onset of reverse flow. Therefore, the valve closes extremely fast with most of the leaflet traveling angle occurring in, International Journal of Cardiology, 304, ISSN:0167-5273
- Published
- 2020
50. Bioprosthetic Valve Leaflet Thrombosis
- Author
-
Blase A. Carabello
- Subjects
Bioprosthetic valve ,medicine.medical_specialty ,Leaflet (botany) ,business.industry ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Thrombosis - Published
- 2020
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