Aortic valve sclerosis (AVS), an early form of aortic valve disease, develops preferentially on the aortic side of valve leaflets, a predilection that is reflected in an heterogeneous side-specific gene expression profile. It has been ascertained that hypercholesterolemia is sufficient to initiate the endothelial expression of activated leukocyte adhesion molecule (ALCAM; CD166), restricted to the aortic side of the leaflet. Intercellular adhesion molecule-1 (ICAM-1) or vascular cell adhesion molecule-1 (VCAM-1) - both of which are more typically associated with early arterial inflammation - are not differentially expressed. ALCAM up-regulation by hypercholesterolemia suggests a side-specific spatial role in the recruitment of leukocytes to AVS sites.

Background and aim of the study: Bicuspid aortic valve (BAV) disease is associated with an aortopathy resulting in aneurysmal dilatation spanning the root, ascending, and arch segments. To date, no large series of proximal aortic replacement in this population has been reported. The study aim was to report contemporary surgical outcomes for proximal aortic replacement in BAV disease, and to examine the relationships between valve morphology, valve pathophysiology, and pathology of the thoracic aorta.

Methods: Between September 2005 and December 2009, a total of 100 consecutive patients (mean age 54 +/- 13 years; range: 29-80 years) with BAV and proximal aortic enlargement underwent aortic replacement at a single referral institution. Of these patients, 16% had undergone prior aortic valve replacement (AVR). The aortic repair was individually tailored to treat the aortic valve and thoracic aortic pathology, and included supracoronary ascending aortic (AA) replacement (n = 17), AVR with separate supracoronary AA replacement (n = 39), aortic root replacement (n = 42), and valve-sparing root replacement (n = 2). Concomitant arch replacement was performed in 82 patients (80 hemi-arch, two full arch). Other concomitant cardiac procedures were performed in 28 patients.

Results: The 30-day/in-hospital rates of death and stroke were both 1%. The predominant aortic valve pathophysiology was aortic stenosis (AS; 33%), aortic insufficiency (AI; 29%), mixed AS/AI (17%), normally functioning BAV (17%), and unknown (4%). Valve morphology included Sievers Type I, R/L (75%), Type I, R/N (9%), Type I, L/N (2%), Type 0 (7%), and Type II (7%). BAV patients with predominantly AI had more frequent root dilatation (62%) than those with either AS (30%) or normal valve function (35%). Based on BAV morphology, there were no significant differences in maximal thoracic aortic diameters between groups. At a mean follow up of 16 months, there were no late deaths or valve-related complications.

Conclusion: Proximal aortic replacement in patients with BAV can be performed with low rates of mortality and morbidity. The pathologic anatomy of the thoracic aorta was not predicted by the aortic valve morphology, although dilation of the aortic root was most common in BAV patients with a predominant AI pathophysiology. These findings convey the safety and feasibility of treating concomitant aortopathy, including arch replacement as needed, and may help tailor the specific operation needed to the patient's pathology.

Background and aim of the study: Ischemic mitral regurgitation (IMR) often persists, despite annular ring reduction. It has been hypothesized that persistent IMR following ring annuloplasty was related to a continued tethering of the mitral leaflets, as defined by the distance by which the papillary muscles (PMs) were displaced outside the mitral annular ring.

Methods: Seven sheep (four acute, three chronic) with persistent mitral regurgitation (MR) following ring annuloplasty for IMR were studied using three-dimensional (3D) echocardiography to examine the mitral valve geometry. The three stages examined were: Stage 1, baseline; Stage 2, post myocardial infarction (via ligation of the obtuse marginal branches); and Stage 3, post undersized ring annuloplasty. The 3D echocardiography measurements included mitral annular area, tethering distance from the ischemic PM to the anterior annulus, and the outside displacement of the PM relative to ring PM displacement.

Results: Persistent moderate MR remained in these seven sheep following undersized ring annuloplasty (MR vena contracta change (pre versus post ring): 7.0 versus 5.8 +/- 2.4 mm, p = NS), despite a reduction in the mitral annular area of 50 +/- 18% (10.3 +/- 6.3 versus 4.7 +/- 1.3 cm2). Ring annuloplasty shifted the posterior annulus towards the anterior annulus, such that the infarcted PM became displaced outside the mitral annulus. The projected displacement distance of the PM outside versus inside the annular ring was 8.4 +/- 2.4 mm outside mitral annulus post ring versus 3.6 +/- 2.5 mm within mitral annulus pre ring, p < 0001). The displacement distance from the infarcted PM to the mitral annulus restricted the ability of the posterior leaflet to move anteriorly, preventing effective coaptation. By multivariate analysis, this displacement distance was an important determinant of residual MR (p < 0.02).

Conclusion: Persistent MR following ring annuloplasty for IMR relates to persistently abnormal leaflet tethering, with restricted posterior leaflet motion due to PM displacement outside of the mitral annulus.

Background: Voice issues can profoundly impact an individual's quality of life and may be influenced by underlying systemic diseases, including thyroid dysfunction.  Thyroid hormones are essential for the regulation of voice fold function and laryngeal physiology.  This study sought to test thyroid function in patients with voice issues and determine the incidence of thyroid abnormalities within this cohort. Material and Methods: This prospective study involved 60 patients with diverse voice abnormalities. This study was conducted at the Department of Biochemistry, Sardar Rajas Medical College and Hospital, Bhavanipatnam, Odisha, India from November 2010 to October 2011. All patients underwent a comprehensive clinical history assessment, videolaryngoscopic evaluation of the larynx, and voice analysis. Blood samples were obtained to evaluate thyroid function tests, encompassing serum concentrations of TSH, Free T3, and Free T4. Individuals with diagnosed thyroid problems receiving therapy were excluded from the study. Results: The mean age of the 60 patients was 42.5 ± 11.3 years, and out of them, 38 (63.3%) were female and 22 (36.7%) were male.  Of the patients evaluated, 21 (or 35% of the total) had abnormal thyroid function.  Out of the total number of patients, 11 (18.3%) had subclinical hypothyroidism, 10 (10%) had overt hypothyroidism, and 4 (6.7%)...  Hypothyroidism was most often linked to voice problems.  Vocal tiredness, hoarseness, and a decrease in pitch range were the most common complaints.  Vocal fold edema and decreased mobility were common findings on videolarynxgoscopic examinations in patients with hypothyroidism. Conclusion: Hypothyroidism and other forms of thyroid dysfunction were present in a large percentage of patients with vocal abnormalities. To improve voice outcomes, it may be helpful to evaluate thyroid function regularly in patients who have unexplained or persistent voice problems. This will allow for early diagnosis and appropriate treatment.