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Summary Current data evaluating outcomes of valve replacement surgery in patients with overweight/obesity is contradictory. There is a scarce study comparing outcomes of valve surgery considering the type of valve involved in the procedure. We followed outcomes in patients with overweight and obesity after valve replacement surgery with or without coronary artery bypass graft (CABG) and also patients with aortic valve replacement (AVR) and mitral valve replacement (MVR), separately to compare their mid‐term prognosis in each group. Consecutive patients who had undergone cardiac valve surgery with or without CABG in Tehran Heart Center were enrolled. We enrolled 3158 patients. Median survival was 125.71 ± 82.20 weeks in patients with overweight/obesity. We found a significantly higher LVDd, LVDs and RVDd in patients with CABG (51.85 ± 7.31, 36.80 ± 8.81 and 30.04 ± 3.58, respectively) compared to the valve group (50.10 ± 6.35 mm, 35.08 ± 7.29 mm and 29.76 ± 4.07 mm, respectively). All‐cause mortality is significantly higher in patients with AVR (5.7%) than those with MVR (3.3%). Patients with CABG are at higher risk of myocardial infarction (MI) compared to the ones without CABG (0.8% vs. 0.1%). No significant interaction was observed between the type of valve surgery (AVR/MVR) or valve surgery combinations (valve/valve + CABG) (p‐values = .81 vs. .97, respectively). Post‐operative outcomes in patients with overweight/obesity depend on several factors such as type of valve involved and presence of CABG. Risk management can lower the rate of mortality and morbidity in these patients. [ABSTRACT FROM AUTHOR]

Septic pulmonary embolism (SPE) is a rare clinical entity that is distinct from the classic and more common non-septic thrombotic pulmonary embolism. SPE should be suspected in patients with a systemic acute inflammatory reaction or sepsis who develop signs and symptoms of pulmonary involvement. The diagnosis of SPE depends on the specific radiologic finding of multiple, peripheral, nodular, possibly cavitated lesions. SPE should prompt an immediate search for the primary source of infection; typically, right-sided infective endocarditis, cardiac implantable electronic devices, and septic thrombophlebitis as a complication of bone, skin, and soft tissue infection including Lemierre's syndrome, indwelling catheters, or direct inoculation via injection drug use. Invasive treatment of the infection source may be necessary; in thrombophlebitis, the efficacy and safety of anticoagulation remain undefined. Blood cultures may be negative, particularly among patients with recent antibiotic exposure, and broad-spectrum antimicrobial therapy should be considered. The in-hospital mortality of SPE ranges up to 20% in published case series. While trends in the incidence of SPE are unknown, the opioid epidemic, the growing use of cardiac implantable electronic devices worldwide, and the reported increase in cases of septic thrombophlebitis may be leading to an escalation in SPE cases. We provide a contemporary profile of SPE and propose a clinical management algorithm in patients with suspected or confirmed SPE. [ABSTRACT FROM AUTHOR]

Background and Objectives: The main cause of morbidity and mortality in hemodialysis patients is cardiovascular disease, which is quite common. The main objective of our study was to investigate the relationship between oxidative stress, inflammation, and vascular and valvular calcifications in hemodialysis patients. Materials and Methods: This observational study had 54 hemodialysis patients, with an average age of 60.46 ± 13.18 years. Cardiovascular ultrasound was used to detect and/or measure aortic and mitral valve calcifications, carotid and femoral atheroma plaques, and common carotid intima-media thickness. The aortic calcification score was determined using a lateral abdomen plain radiograph. The inflammatory, oxidative, metabolic, and dietary statuses, as well as demographic characteristics, were identified. Results: There were significant correlations between the levels of IL-6 and carotid plaque number (p = 0.003), fibrinogen level and aortic valve calcifications (p = 0.05), intima-media thickness (p = 0.0007), carotid plaque number (p = 0.035), femoral plaque number (p = 0.00014), and aortic calcifications score (p = 0.0079). Aortic annulus calcifications (p = 0.03) and intima-media thickness (p = 0.038) were adversely linked with TNF-α. Nutrition parameters were negatively correlated with atherosclerosis markers: number of carotid plaques with albumin (p = 0.013), body mass index (p = 0.039), and triglycerides (p = 0.021); number of femoral plaques with phosphorus (0.013), aortic calcifications score with albumin (p = 0.051), intima-media thickness with LDL-cholesterol (p = 0.042). Age and the quantity of carotid plaques, femoral plaques, and aortic calcifications were linked with each other (p = 0.0022, 0.00011, and 0.036, respectively). Aortic annulus calcifications (p = 0.011), aortic valve calcifications (p = 0.023), and mitral valve calcifications (p = 0.018) were all associated with an increased risk of death. Conclusions: Imaging measures of atherosclerosis are adversely connected with dietary status and positively correlated with markers of inflammation and risk of mortality. [ABSTRACT FROM AUTHOR]

Background and Objectives: The main cause of morbidity and mortality in hemodialysis patients is cardiovascular disease, which is quite common. The main objective of our study was to investigate the relationship between oxidative stress, inflammation, and vascular and valvular calcifications in hemodialysis patients. Materials and Methods: This observational study had 54 hemodialysis patients, with an average age of 60.46 ± 13.18 years. Cardiovascular ultrasound was used to detect and/or measure aortic and mitral valve calcifications, carotid and femoral atheroma plaques, and common carotid intima-media thickness. The aortic calcification score was determined using a lateral abdomen plain radiograph. The inflammatory, oxidative, metabolic, and dietary statuses, as well as demographic characteristics, were identified. Results: There were significant correlations between the levels of IL-6 and carotid plaque number (p = 0.003), fibrinogen level and aortic valve calcifications (p = 0.05), intima-media thickness (p = 0.0007), carotid plaque number (p = 0.035), femoral plaque number (p = 0.00014), and aortic calcifications score (p = 0.0079). Aortic annulus calcifications (p = 0.03) and intima-media thickness (p = 0.038) were adversely linked with TNF-α. Nutrition parameters were negatively correlated with atherosclerosis markers: number of carotid plaques with albumin (p = 0.013), body mass index (p = 0.039), and triglycerides (p = 0.021); number of femoral plaques with phosphorus (0.013), aortic calcifications score with albumin (p = 0.051), intima-media thickness with LDL-cholesterol (p = 0.042). Age and the quantity of carotid plaques, femoral plaques, and aortic calcifications were linked with each other (p = 0.0022, 0.00011, and 0.036, respectively). Aortic annulus calcifications (p = 0.011), aortic valve calcifications (p = 0.023), and mitral valve calcifications (p = 0.018) were all associated with an increased risk of death. Conclusions: Imaging measures of atherosclerosis are adversely connected with dietary status and positively correlated with markers of inflammation and risk of mortality.

BackgroundThis study aimed to define changes in the metabolic and protein profiles of patients with calcific aortic valve disease (CAVD).Methods and resultsWe analyzed cardiac valve samples of patients with and without (control) CAVD (n = 24 per group) using untargeted metabolomics and tandem mass tag-based quantitative proteomics. Significantly different metabolites and proteins between the CAVD and control groups were screened; then, functional enrichment was analyzed. We analyzed co-expressed differential metabolites and proteins, and constructed a metabolite-protein-pathway network. The expression of key proteins was validated using western blotting. Differential analysis identified 229 metabolites in CAVD among which, 2-aminophenol, hydroxykynurenine, erythritol, carnosine, and choline were the top five. Proteomic analysis identified 549 differentially expressed proteins in CAVD, most of which were localized in the nuclear, cytoplasmic, extracellular, and plasma membranes. Levels of selenium binding protein 1 (SELENBP1) positively correlated with multiple metabolites. Adenosine triphosphate-binding cassette transporters, starch and sucrose metabolism, hypoxia-inducible factor 1 (HIF-1) signaling, and purine metabolism were key pathways in the network. Ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), calcium2+/calmodulin-dependent protein kinase II delta (CAMK2D), and ATP binding cassette subfamily a member 8 (ABCA8) were identified as hub proteins in the metabolite-protein-pathway network as they interacted with ADP, glucose 6-phosphate, choline, and other proteins. Western blotting confirmed that ENPP1 was upregulated, whereas ABCA8 and CAMK2D were downregulated in CAVD samples.ConclusionThe metabolic and protein profiles of cardiac valves from patients with CAVD significantly changed. The present findings provide a holistic view of the molecular mechanisms underlying CAVD that may lead to the development of novel diagnostic biomarkers and therapeutic targets to treat CAVD.

Background: The aim of the study was to investigate the correlation between serum magnesium (Mg) level and cardiac valve calcification (CVC) in patients with chronic kidney disease (CKD). Methods: A total of 232 CKD patients hospitalized from August 2016 to December 2020 were divided into CVC and non-CVC groups. Their clinical data and laboratory examination results were compared, the risk factors for CVC in CKD patients were explored using logistic regression analysis, and Spearman's method was used to analyze the correlation between serum Mg level and CVC degree. According to the tertiles of mean serum Mg level, they were assigned into low serum Mg group (≤ 0.96 mmol/L), middle serum Mg group (0.97 - 1.07 mmol/L), and high serum Mg group (≥ 1.08 mmol/L). The relationship of serum Mg level with CVC risk in CKD patients was analyzed through the Cox regression model, and a prediction model was established using independent risk factors. Results: Long CKD duration, low serum Mg level, high serum phosphorus (P) level, and high CKD stage were independent risk factors for CVC. Serum Mg level was significantly negatively correlated with the severity of CVC (r = -0.743, p < 0.05). The risk of CVC was significantly higher in low serum Mg group than that in high serum Mg group [hazard ratio (HR) = 2.852, 95% confidence interval (CI): 1.325 - 6.432, p = 0.005]. A CVC prediction model was established based on independent risk factors as follows: CVC predictive value = EXP [0.491 - 0.546 (CKD duration) - 0.454 (serum P level) + 2.145 (serum Mg level) - 0.812 (CKD stage)]/1 + EXP [0.491 - 0.546 (CKD duration) - 0.454 (serum P level) + 2.145 (serum Mg level) - 0.812 (CKD stage)]. The area under curve of the model was 0.750 (95% CI: 0.822 - 0.965), and that of the CVC prediction model for CKD patients in test set was 0.774 (95% CI: 0.761 - 0.975), showing no significant difference from that in training set (p > 0.05). Conclusions: Low serum Mg level serves as an independent risk factor for CVC in CKD patients, and may increase the risk of CVC. Therefore, the serum Mg level in CKD patients should be corrected timely in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: A motion compensation method that is aimed at correcting motion artifacts of cardiac valves is proposed. The primary focus is the aortic valve. Methods: The method is based around partial angle reconstructions and a cost function including the image entropy. A motion model is applied to approximate the cardiac motion in the temporal and spatial domain. Based on characteristic values for velocities and strain during cardiac motion, penalties for the velocity and spatial derivatives are introduced to maintain anatomically realistic motion vector fields and avoid distortions. The model addresses global elastic deformation, but not the finer and more complicated motion of the valve leaflets. Results: The method is verified based on clinical data. Image quality was improved for most artifact‐impaired reconstructions. An image quality study with Likert scoring of the motion artifact severity on a scale from 1 (highest image quality) to 5 (lowest image quality/extreme artifact presence) was performed. The biggest improvements after applying motion compensation were achieved for strongly artifact‐impaired initial images scoring 4 and 5, resulting in an average change of the scores by −0.59±0.06$-0.59\pm 0.06$ and −1.33±0.03$-1.33\pm 0.03$, respectively. In the case of artifact‐free images, a chance to introduce blurring was observed and their average score was raised by 0.42 ± 0.03. Conclusion: Motion artifacts were consistently removed and image quality improved. [ABSTRACT FROM AUTHOR]

Background: Studies have reported that dental procedures may serve as a portal of entry for bacteria into the blood circulation, commonly termed as bacteremia which may inhabitate the heart and joints subjected to repair and replacement by prosthesis and may lead to complications in immunocompromised patients. Dental procedure may play a pivotal role in the development of infective endocarditis and infection around the prosthetic joint. Antibiotic use is suggested for all dental procedures requiring gingival manipulation or of the periapical region of teeth or mucosal incision in these patients. Objective: The present study has been conducted to inspect the antibiotic prescribing practices of general dentists among 250 dental practitioners. Methods: The study was conducted on 250 dental surgeons practicing in the urban Indian population of various parts of the country. A validated questionnaire was developed by a multidisciplinary dental and medical team and was circulated on the subject of the basic knowledge and awareness about antibiotic prophylaxis in susceptible patients. The data from the participants were collected, collated, and statistically analyzed. Results: The present study comprised 250 dental surgeons; 178 out of 250 were male, whereas 72 were female. Antibiotic prophylaxis guidelines were followed by 169 practitioners (67.60%), whereas 81 (32.40%) dentists did not follow any guidelines. Out of 169, 67 followed the American Academy of Orthopaedic Surgeons (AAOS) guidelines (39.64%), 58 followed American Heart Association (AHA) guidelines (34.30%), whereas 44 followed general physician's guidelines (26.03%). On screening the underlying conditions for which antibiotic cover was prescribed, it was shown that majority of the dental surgeons did the same for patients with cardiac valve repair or replacement (230; 92%), followed by infective endocarditis (212; 84.80%); organ transplant (212; 84.405); diabetes (189; 75.60%); prosthetic joint replacement (150; 60%); and congenital heart defect (110; 44%). Conclusion: Patients should then be trained to perform meticulous oral hygiene and advised to schedule regular dental checkups to maintain optimal dental health. Dentists should use antibiotic prophylaxis in only conditions associated with a valid scientific basis and should follow the standard protocols recommended by the American Dental Association, AHA, or AAOS.

Increased mechanical forces on developing cardiac valves drive formation of the highly organized extracellular matrix (ECM) providing tissue integrity and promoting cell behavior and signaling. However, the ability to investigate the response of cardiac valve cells to increased mechanical forces is challenging and remains poorly understood. The developmental window from birth (P0) to postnatal day 7 (P7) when biomechanical forces on the pulmonary valve (PV) are altered due to the initiation of blood flow to the lungs was evaluated in this study. Grossly enlarged PV, in mice deficient in the proteoglycan protease ADAMTS5, exhibited a transient phenotypic rescue from postnatal day 0 (P0) to P7; the Adamts5−/− aortic valves (AV) did not exhibit a phenotypic correction. We hypothesized that blood flow, initiated to the lungs at birth, alters mechanical load on the PV and promotes ECM maturation. In the Adamts5−/− PV, there was an increase in localization of the proteoglycan proteases ADAMTS1, MMP2, and MMP9 that correlated with reduced Versican (VCAN). At birth, Decorin (DCN), a Collagen I binding, small leucine-rich proteoglycan, exhibited complementary stratified localization to VCAN in the wild type at P0 but colocalized with VCAN in Adamts5−/− PV; concomitant with the phenotypic rescue at P7, the PVs in Adamts5−/− mice exhibited stratification of VCAN and DCN similar to wild type. This study indicates that increased mechanical forces on the PV at birth may activate ECM proteases to organize specialized ECM layers during cardiac valve maturation.

Background: Studies have reported that dental procedures may serve as a portal of entry for bacteria into the blood circulation, commonly termed as bacteremia which may inhabitate the heart and joints subjected to repair and replacement by prosthesis and may lead to complications in immunocompromised patients. Dental procedure may play a pivotal role in the development of infective endocarditis and infection around the prosthetic joint. Antibiotic use is suggested for all dental procedures requiring gingival manipulation or of the periapical region of teeth or mucosal incision in these patients. Objective: The present study has been conducted to inspect the antibiotic prescribing practices of general dentists among 250 dental practitioners. Methods: The study was conducted on 250 dental surgeons practicing in the urban Indian population of various parts of the country. A validated questionnaire was developed by a multidisciplinary dental and medical team and was circulated on the subject of the basic knowledge and awareness about antibiotic prophylaxis in susceptible patients. The data from the participants were collected, collated, and statistically analyzed. Results: The present study comprised 250 dental surgeons; 178 out of 250 were male, whereas 72 were female. Antibiotic prophylaxis guidelines were followed by 169 practitioners (67.60%), whereas 81 (32.40%) dentists did not follow any guidelines. Out of 169, 67 followed the American Academy of Orthopaedic Surgeons (AAOS) guidelines (39.64%), 58 followed American Heart Association (AHA) guidelines (34.30%), whereas 44 followed general physician's guidelines (26.03%). On screening the underlying conditions for which antibiotic cover was prescribed, it was shown that majority of the dental surgeons did the same for patients with cardiac valve repair or replacement (230; 92%), followed by infective endocarditis (212; 84.80%); organ transplant (212; 84.405); diabetes (189; 75.60%); prosthetic joint replacement (150; 60%); and congenital heart defect (110; 44%). Conclusion: Patients should then be trained to perform meticulous oral hygiene and advised to schedule regular dental checkups to maintain optimal dental health. Dentists should use antibiotic prophylaxis in only conditions associated with a valid scientific basis and should follow the standard protocols recommended by the American Dental Association, AHA, or AAOS. [ABSTRACT FROM AUTHOR]

The atrioventricular canal (AVC) is the site where key structures responsible for functional division between heart regions are established, most importantly, the atrioventricular (AV) conduction system and cardiac valves. To elucidate the mechanism underlying AVC development and function, we utilized transgenic zebrafish line sqet31Et expressing EGFP in the AVC to isolate this cell population and profile its transcriptome at 48 and 72 hpf. The zebrafish AVC transcriptome exhibits hallmarks of mammalian AV node, including the expression of genes implicated in its development and those encoding connexins forming low conductance gap junctions. Transcriptome analysis uncovered protein-coding and noncoding transcripts enriched in AVC, which have not been previously associated with this structure, as well as dynamic expression of epithelial-to-mesenchymal transition markers and components of TGF-β, Notch, and Wnt signaling pathways likely reflecting ongoing AVC and valve development. Using transgenic line Tg(myl7:mermaid) encoding voltage-sensitive fluorescent protein, we show that abolishing the pacemaker-containing sinoatrial ring (SAR) through Isl1 loss of function resulted in spontaneous activation in the AVC region, suggesting that it possesses inherent automaticity although insufficient to replace the SAR. The SAR and AVC transcriptomes express partially overlapping species of ion channels and gap junction proteins, reflecting their distinct roles. Besides identifying conserved aspects between zebrafish and mammalian conduction systems, our results established molecular hallmarks of the developing AVC which underlies its role in structural and electrophysiological separation between heart chambers. This data constitutes a valuable resource for studying AVC development and function, and identification of novel candidate genes implicated in these processes. [ABSTRACT FROM AUTHOR]

Metastatic involvement of cardiac valve and pericardium mimicking a cardiac valve pathology accompanied with cardiac tamponade is a rare phenomenon. These metastases commonly arise from the lymphoreticular system, the pulmonary system, and breast. Metastatic spread of breast carcinoma to the cardiac valve is exceedingly rare, and only two case reports have been detected in English literature so far. We report a rare case of a patient with adenocarcinoma of the breast, which presented with severe mitral valve regurgitation and pericardial effusion which was managed urgently with mitral valve replacement. Our case shows the probability of combined metastatic pericardial and valve involvement in patients with breast adenocarcinoma. The patient was treated with mitral valve replacement and intrapericardial infusion of cisplatinum drug to control possible recurrent effusion.

Objective: To compare the efficacy and safety of nonvitamin K oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) following bioprosthetic cardiac valve replacement.Methods: This was a retrospective analysis conducted at a community teaching hospital in the southeastern United States between August 2015 and August 2018. Patients 18 years of age and older who underwent cardiac valve replacement and were prescribed oral anticoagulation were screened for inclusion. Patients were excluded if they had a mechanical valve replacement, experienced a venous thromboembolism, cerebrovascular accident, or acute coronary syndrome within 1 month before valve replacement, changed oral anticoagulation during the study period, were lost to follow-up, or declined to participate in the follow-up survey. The primary outcome was a composite of thromboembolic events within 90 days following bioprosthetic cardiac valve replacement. The safety outcome was major bleeding within 180 days of bioprosthetic cardiac valve replacement.Results: The primary outcome of a composite of thromboembolic events within 90 days following bioprosthetic cardiac valve replacement occurred in 1 patient (4.3%) in the VKA group and 4 patients (7.4%) in the NOAC group. Major bleeding occurred in 2 patients (8.7%) in the VKA group and 0 patients in the NOAC group.Conclusion: Our study is the first to report the efficacy and safety of NOACs compared with VKA therapy following bioprosthetic cardiac valve replacement irrespective of an atrial fibrillation diagnosis. Notably, two of the thromboembolic events in the NOAC group occurred while therapy was held or inappropriately dosed; when these events are removed, the rate of thromboembolism is 3.8%. This rate is consistent with the VKA group. Our study adds to a small pool of literature regarding the use of NOACs following bioprosthetic cardiac valve replacement and suggests that NOACs may have similar efficacy and improved safety as compared with VKA therapy. Large randomized controlled trials are warranted to confirm our observations. [ABSTRACT FROM AUTHOR]

Aim:Mucopolysaccharidosis Type IVA (MPS IVA), Morquio A, is caused by the deficiency in lysosomal enzyme N-acetylgalactosamine-6-sulfate sulfatase. Multisystemic involvements include skeletal systems, pulmonary disease, valvular heart disease, hearing loss, mild hepatomegaly, corneal clouding, coarse facial features.Materials and Methods:We retrospectively analyzed clinical and laboratory and follow up findings of our 25 patients with ministry for primary industries independent verification agency.Results:Mean age of the patients was 14.9±7.05 (5.5-36 years). Mean age at diagnosis was 7.3±6.2 years (6 months-31 years). Female: male ratio was 13/12. All patients had skeletal manifestation and X-ray analysis demonstrated “dysostosis multiplex”. Twelve patients (48%) had cardiac valve disease. Twenty three (92%) patients had corneal clouding, 15 (60%) patients had hearing loss and 9 (36%) had hepatomegaly. Six (24%) patients were unable to walk. Mean follow up period is 7.4 years ±3.5 years (3 months-17 years). Four patients have not visit our clinical for last ≥3 years. Three patients died during follow up.Conclusion:MPS IVA is a severe disorder and is usually fatal in the second or third decade of life due to the complications of the disease. Early diagnosis of the patient became more important, because specific therapy with elasulphase alpha was approved recent years ago.

The most common causes of infective endocarditis (IE) are Staphylococcus, Streptococcus, Enterococcus, and HACEK-related organisms. In 15–30% of the IE cases, standard blood cultures remain sterile. We aimed at identifying the causative agent of a blood-culture-negative IE by whole metagenome shotgun sequencing (WMGS). A 54-year old woman diagnosed with community-onset pneumonia by a general practitioner, was admitted with dyspnea, cough and fever. The patient's blood cultures were repeatedly negative. The transesophageal echocardiography and transthoracic echocardiography showed an echo density on the left coronary leaflet of the aortic valve and signs suggestive of a ruptured abscess of the mitro-aortic junction. The patient underwent a semi-urgent aortic valve replacement by a mechanical prosthetic valve. We extracted DNA from the surgically-removed fresh valve tissue. The extraction procedure included bacterial/fungal DNA enrichment procedure. Nextera XT library prepared from the valve DNA extract was sequenced (2 × 250) on an Illumina MiSeq instrument. Sequence reads were mapped against bacterial genomic sequences, 16S rRNA genes and clade-specific taxonomic markers. Most of the 103,136 sequencing reads classified as bacterial were assigned to Neisseria meningitidis. In line with these data, mapping of reads against clade-specific and 16S rRNA gene markers revealed N. meningitidis as the most represented species. Assembled metagenomic fragments had the best average nucleotide identity (ANI) with N. meningitidis. Comparison of assembled contigs to reference alleles showed that this strain belongs to the ST-41/44 complex. N. meningitidis is commonly associated with meningitis and/or septicemia but should not be neglected as a causative agent of IE, which became exceedingly rare with the introduction of antibiotics. Our data show that WMGS may be used as a diagnostic procedure to strengthen the diagnosis of IE and to obtain draft genomic sequence of the pathogen and typing information.

Purpose: Pseudoexfoliation syndrome (PEX) is an age-related systemic elastic fibrillopathy disorder featuring an excessive production and accumulation of elastic fibre components in the extracellular matrix and is associated with impaired protective mechanisms against oxidative and cellular stress. PEX is diagnosed solely by ophthalmologists; however, PEX deposits have been detected in the connective tissues of many extraocular organ systems. This large, retrospective case-control study investigates whether patients with PEX have an increased risk of extraocular comorbidities. Methods: Cases and controls were drawn from consecutive patients over 50 years of age undergoing in-house ophthalmological operations under general anaesthesia or in standby preparedness for general anaesthesia. The participants were grouped based solely on PEX-positive (n = 325) or PEX-negative (n = 911) status. The same teams of ophthalmologists and anaesthesiologists uniformly documented every known systemic comorbidity of each patient through two independent rounds of standard anamnestic procedure and protocols in preparation for general anaesthesia. For the purpose of this study, every systemic comorbidity was registered from these forms and subsequently categorized into 17 disease groups based on the International Classification of Diseases (ICD-10) of the World Health Organization (WHO). Odds ratios (ORs) comparing comorbidities in cases and controls were adjusted for age and gender using logistic regression. Results: After adjustment for multiple testing, patients with PEX had an increased odds ratio for respiratory OR 2.1 [1.4; 3.0], cardiac OR 2.5 [1.6; 4.2], vascular OR 2.0 [1.4; 2.8], and urogenital conditions OR 2.3 [1.4; 3.7]. Renal and psychiatric comorbidities were nominally significant. While no substantially higher frequency was found for hernias, aneurysms, aortic dissection, or varicose veins among PEX-positive patients, higher rates of cardiac valve disorders and benign prostate hyperplasia were found among the PEX-positive individuals. Conclusion: In addition to confirming an increased risk of respiratory, cardiovascular, and urogenital comorbidities, our data found an increased risk of cardiac valve disorders and benign prostate hyperplasia among PEX-positive patients, which may be manifestations of the underlying systemic elastotic fibrillopathy and warrants further exploration, including future histological study. [ABSTRACT FROM AUTHOR]

Objective To summarize the clinical characteristics of patients with non-infectious aortitis. Methods A retrospective analysis was made among 124 patients with non-infectious aortitis who were hospitalized in the Department of Cardiac Surgery and/or Rheumatology in Zhongshan Hospital Affiliated to Fudan University, from Jan., 2010 to Dec., 2017. Data were collected and analyzed, including preoperative general information, laboratory and radiologic examinations, and the clinical and surgical outcomes. Results Among the 124 patients, there were 45 patients of Takayasu arteritis (36.3%), 40 patients of isolated aortitis (32.3%), 37 patients of Behcet's disease (29.8%) and 2 patients of giant cell arteritis (1.6%). Moderate to severe aortic valve insufficiency was the most common (82 patients, 66.1%). Takayasu arteritis group was female dominant (3.5:1), while the onset age[(53.5+9.4) years] and diagnosis age[(55.0+9.3) years] in isolated aortitis group were much older (P<0.05). Ninety-seven patients (78.2%) received surgical treatment, of which 69 received primary operations, 28 received secondary operations. Forty-four cases (45.4%) received preoperative treatments of glucocorticoid and/or immunosuppressive agents. Aortic valve replacement (40.2%), Bentall's operation (23.7%) and coronary artery bypass grafting (11.3%) were the most common types of primary operations, resulting in significant decrease in systolic blood pressure[(119.2±38.1) mmHg vs. (108.9±37.9) mmHg, P<0.001]. Perivalvular aortic leakage (19 patients, 67.9%) was the main cause of secondary operations, of which Behcet's disease (13 patients, 68.4%) was common, and only 7 patients (36.8%) received glucocorticoid and/or immunosuppressive therapy prior to operations. Compared with 97 patients with surgery, the proportion of patients treated with glucocorticoids and/or immunosuppressive agents (63.0%) in 27 non-surgery patients was higher, the age of diagnosis (41.6 + 16.4 years) was younger, and women (74.1%) were more common. Of them, 17 patients (63.0%) postponed surgery after treatment with glucocorticoids and/or immunosuppressive agents. Conclusions Non-infectious aortitis was mainly seen in patients with primary systemic vasculitis such as Takayasu arteritis, isolated aortitis and Behcet's disease, with the most common lesion of aortic valve insufficiency. Medical treatment could help control inflammation and delay operation, and surgical treatment could help improve blood pressure. Patients with Behcet's disease without medical treatment would be more likely to suffer from perivalvular leakage after operation. [ABSTRACT FROM AUTHOR]

Metastatic involvement of cardiac valve and pericardium mimicking a cardiac valve pathology accompanied with cardiac tamponade is a rare phenomenon. These metastases commonly arise from the lymphoreticular system, the pulmonary system, and breast. Metastatic spread of breast carcinoma to the cardiac valve is exceedingly rare, and only two case reports have been detected in English literature so far. We report a rare case of a patient with adenocarcinoma of the breast, which presented with severe mitral valve regurgitation and pericardial effusion which was managed urgently with mitral valve replacement. Our case shows the probability of combined metastatic pericardial and valve involvement in patients with breast adenocarcinoma. The patient was treated with mitral valve replacement and intrapericardial infusion of cisplatinum drug to control possible recurrent effusion. [ABSTRACT FROM AUTHOR]

Recently, the number of cardiac surgery in the world and particularly in Russia is raising, especially with utilization of biological prostheses; it is related to average population ageing too. Main disadvantage of such devices is restricted time period of work due to degrading of biomaterials, which demands additional surgery in longterm period (5-10 years). The technology of alternative reimplantation of bioprosthesis by method “prosthesis-into-prosthesis” using transcatheter low invasive devices is the most promising solution for the mortality risk reduction from operations on replacement of failing prosthesis. Current review includes an analysis of clinical results of application of that methodology for correction of acquired defects of aortic, mitral, tricuspid valves, and pulmonary artery valve. The results that are described, witness increasing interest of the world society in methodic as “prosthesis-into-prosthesis”, presenting via attempts for systematization and structuring of the interventions results. However complications that occur, risk and procedure restrictions significantly slow wider spread of the method application.

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 <10 ms with excessively high reverse flow velocities. The pivoting spaces, so-called "Hot Spots" should be eliminated to prevent pathologic shear stress that result in thrombosis. A novel tri-leaflet valve combines favorable hemodynamics with the durability of mechanical heart valve. This valve closes within 60 ms, much slower than bi-leaflet valves and similar to the closing mode of a tissue valve. Micro-particle image velocimetry did not show critical regions of flow stagnation and zones of excessive shear in the pivoting region suggesting low potential for thrombogenic events that should allow to avoid long-term anticoagulation. • This paper summarizes the knowledge about transprosthetic flow in mechanical heart valve and describes the advantages of a new tri-leaflet design that would allow to eliminate long-term anticoagulation [ABSTRACT FROM AUTHOR]

Abstract Despite improved healthcare and changing prevalence of childhood diseases, valvular disease remains a potent cause of morbidity and mortality. Indeed, congenital and acquired native valvular defects remain common pathologies in autopsy and surgical practice. A review of the pathophysiology of these conditions, alongside the macroscopic and microscopic findings is presented. [ABSTRACT FROM AUTHOR]

Copyright of German Journal of Sports Medicine / Deutsche Zeitschrift fur Sportmedizin is the property of Verein zur Forderung der Sportmedizin Hannover e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Octogenarians receiving cardiac valve surgery is increasing and recovery is challenging. Post-acute care (PAC) services assist with recovery, yet services provided in facilities do not provide adequate cardiac-focused care or long-term self-management support. The purpose of the paper was to report post-acute care discharge rates in octogenarians and propose clinical implications to improve PAC services. Using a 2003 Medicare Part A database, we studied post-acute care service use in octogenarians after cardiac valve surgery. We propose expansion of the Geriatric Cardiac Care model to include broader clinical therapy dynamics. The sample (n = 10,062) included patients over 80 years discharged from acute care following valve surgery. Post-acute care services were used by 68% of octagarians following cardiac valve surgery (1% intermediate rehabilitation, 35% skilled nursing facility, 32% home health). The large percentage of octagarians using PAC point to the importance of integrating geriatric cardiac care into post-acute services to optimize recovery outcomes. [ABSTRACT FROM AUTHOR]

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Aim: Mucopolysaccharidosis Type IVA (MPS IVA), Morquio A, is caused by the deficiency in lysosomal enzyme N-acetylgalactosamine-6-sulfate sulfatase. Multisystemic involvements include skeletal systems, pulmonary disease, valvular heart disease, hearing loss, mild hepatomegaly, corneal clouding, coarse facial features. Materials and Methods: We retrospectively analyzed clinical and laboratory and follow up findings of our 25 patients with ministry for primary industries independent verification agency. Results: Mean age of the patients was 14.9±7.05 (5.5-36 years). Mean age at diagnosis was 7.3±6.2 years (6 months-31 years). Female: male ratio was 13/12. All patients had skeletal manifestation and X-ray analysis demonstrated "dysostosis multiplex". Twelve patients (48%) had cardiac valve disease. Twenty three (92%) patients had corneal clouding, 15 (60%) patients had hearing loss and 9 (36%) had hepatomegaly. Six (24%) patients were unable to walk. Mean follow up period is 7.4 years ±3.5 years (3 months-17 years). Four patients have not visit our clinical for last =3 years. Three patients died during follow up. Conclusion: MPS IVA is a severe disorder and is usually fatal in the second or third decade of life due to the complications of the disease. Early diagnosis of the patient became more important, because specific therapy with elasulphase alpha was approved recent years ago. [ABSTRACT FROM AUTHOR]

We report draft genome of a Coxiella burnetii strain sequenced from the native valve of a patient presenting with severe endocarditis in Tunisia. The genome could be sequenced without a cellular or axenic culture step. The MST5 strain was demonstrated to be closely related to the published reference genome of C. burnetii CbuK_Q154. [ABSTRACT FROM AUTHOR]

Background: Heart valve surgery outcomes are unknown in middle-income countries and thus cannot be used in health system decision making processes. This study estimated in-hospital mortality and medium and long-term survival.Methods: This was a retrospective study of 78,806 patients who underwent heart valve surgery between 2001 and 2007 in Brazil. Two national databases were used, the Hospital Information System and the Mortality Information System. Kaplan-Meier survival analysis and log-rank tests were performed. Maximum and median follow-up was 7.7 and 2.8 years, respectively (0.002-7.707).Results: Valve replacement accounted for 69.1% of procedures performed. Mitral stenosis, the most common valve injury, represented 38.9% of the total. In 94.7% of mitral stenosis patients, aetiology was rheumatic heart disease. In-hospital mortality was 7.6% and was higher for women, for patients who had undergone concomitant coronary artery bypass grafting (CABG) and for the elderly. Overall survival was 69.9% at the end of follow-up. Survival was worst among elderly, male and concomitant CABG patients (P<0.001).Conclusions: Rheumatic heart disease is still a major public health problem in Brazil. In-hospital mortality and global survival rates of patients who have undergone heart valve surgery were less satisfactory than those reported in high-income countries. The findings of this study can contribute to guiding decision making processes in middle-income countries similar to Brazil and others concerned with improving the quality of care. [ABSTRACT FROM AUTHOR]