Introduction:  Controversies have been found regarding the association of body mass index with high blood pressure.  Some studies found no strong, statistically significant association between Body Mass Index (BMI) and blood pressure in the adult population. While some studies show a positive correlation between BMI and blood pressure, this is not consistently observed across all populations and studies, especially in South Asian populations like those in India.  Increase in body mass index increases risk of developing high blood pressure. This study was conducted to find association between body mass index and blood pressure in north Indian adult population. Methods: A cross-sectional study was conducted among 245 adults of District Hapur, Uttar Pradesh using convenient sampling method. The questionnaire was adopted from the step 2 (physical measurements) section of the WHO STEPS instrument.  Results: Among 245 subjects, almost half (48.5%) of the subjects had normal body mass index. One-fourth (25%) of the subjects were overweight. About 60 percent of the respondents had normal systolic blood pressure. There were no significant positive correlations of body mass index with both systolic BP, diastolic BP and age. However, significant positive correlation was found between age and systolic BP. Conclusions: The study finding concluded that there are no significant positive correlations of body mass index with both systolic BP, diastolic BP and age. However, age and systolic BP has significant positive correlation. Therefore, with increase in age, regular monitoring of BP is required.

Background: Mental disorders like depression, anxiety in childhood can negatively affect healthy development by interfering with children’s ability to achieve social, emotional, cognitive, and academic milestones and to function in daily settings. The present study was conducted to assess prevalence of depression and anxiety disorders among school going children.  Materials and Methods: The present cross-sectional study was conducted among adolescent students. The sample size for the study was 800. Demographic data was collected. Depression anxiety stress scale (DASS)–21 was used to detect depression, anxiety, and stress. Data was entered on microsoft excel software and statistical analysis was done using SPSS.  Results: In the present study total 800 students were studied out of which 63.75% were males and 36.25% were females. Overall prevalence of depression, anxiety and stress was 24.37%, 45.62%, 30% respectively. Most of students suffered from moderate type of depression and anxiety (45.12%, 33.97%) and normal stress (55.83%) respectively.  Conclusion: The present study concluded that anxiety was more prevalent in adolescent school children followed by stress and depression. Most of students suffered from moderate type of depression and anxiety and normal stress. 

Introduction: Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension plus significant end-organ dysfunction with or without proteinuria, typically presenting after 20 weeks of gestation or postpartum. The pathogenesis involves both abnormal placentation and maternal systemic vascular dysfunction.

Objectives. An Evaluation of   Perinatal Outcome in Women with Preeclampsia and its Association with Serum Uric Acid Levels: Case Control Study.

Materials and Methods: A case control study   was carried out from January 2020- July 2020, in the Department of Obstetrics & Gynecology in a medical college and hospital. The study protocol was approved by the institutional ethics committee and institutional study adopting random sampling system sampling procedure. Total 120 participant were approached to project among them 22 were excluded due to technically criteria and 98 were included on the  basis of fulling of  the eligibility criteria It was performed on 49 patients of preeclampsia (case group) and 49 normal pregnant women (control group) in between gestational age of 25-41weeks of pregnancy, who were admitted in the department of Obstetrics and Gynecology of IIMSAR Haldia, both groups were compared for Prenatal outcome and impact of serum uric acid on preeclampsia.

Results: It was performed on 49 patients of preeclampsia (case group) and 49 normal pregnant women (control group) in between gestational age of 25-41weeks of pregnancy, who were admitted in the department of Obstetrics and Gynecology of IIMSAR Haldia, both groups were compared for Prenatal outcome and impact of serum uric acid on preeclampsia. One hundred and Twenty participants were initially approached in the project and screened for inclusion in the study, following which 18.33 % of the participants were excluded while 98 were finally recruited. They were categorized into two groups: group A which comprised 49 pregnant women diagnosed with preeclampsia and group B which comprised 49 normotensive, nonproteinuric controls.

Conclusions: In this study it was found that study observed that SUA levels vary significantly in HDP, being higher in severe preeclampsia. Preeclampsia present at earlier weeks of gestation. In contrast, gestational hypertension presents mostly at term. There is an increased risk of ICU admission and preterm delivery in patients with high uric acid levels. There is also an increased risk of delivering low-birth-weight babies with high uric acid levels.

Background: Diabetes is a significant contributor to both morbidity (illness) and mortality (death). Individuals with diabetes experience a higher risk of various health problems, including cardiovascular disease, kidney disease, nerve damage, and vision loss, leading to increased morbidity. Diabetes is also a direct cause of death, contributing to a substantial number of fatalities globally. The prevalence of diabetes mellitus is increasing globally and a range of ocular conditions with sight threatening complications due to diabetes are known to occur.

Aim of this study to Study the diabetes related ocular changes in patients with type 2 diabetes mellitus in a tertiary care hospital.

Design: Observational study.

Materials and Methods: The study was conducted in a tertiary hospital. After obtaining institutional ethical committee approval It was a Observational prospective study conducted on 150 patients with Diabetes Mellitus type 2 in the department of Ophthalmology, at a tertiary care centre, from April 2020 to October 2020. Patients aged 35to 75 years with duration of diabetes mellitus of more than 5 years were included. They underwent a detailed fundus examination and ocular evaluation which included refraction, Schirmer’s test, corneal sensitivity, Applanation tonometry, gonioscopy along with systemic investigations and the observed findings were recorded. The data collected was entered in excel spread sheet. The data was analysed by using SPSS statistical software version 20. Statistical analysis in the form of percentages was done. Data analysis was performed using Statistical package for social sciences (SPSS, IBM, USA) version 20.0Results: It was noted that among the study population, majority of them (42.2%) were in the age group between 51-60 years and men (54.4%) were more in number than females (45.5%). Diabetic retinopathy was the most common ocular manifestation (47.7%) followed by cataract (44.4%), cranial nerve palsy (16.6%) and glaucoma (16.6%).

Conclusion: These ocular findings suggest that regular screening and eye examinations of diabetic patients is mandatory to reduce the burden of visual impairment.

Background: Cardiovascular diseases (CVDs) are among the leading causes of mortality globally, and oral health has been implicated as a potential modifiable risk factor. Patients with partial or complete edentulism often seek prosthodontic rehabilitation and may represent a group at elevated risk for CVD due to poor oral health. Aim: To assess the prevalence of cardiovascular disease among patients seeking prosthodontic rehabilitation and evaluate associated risk factors. Materials and Methods: A cross-sectional observational study was conducted on 250 patients reporting for prosthodontic rehabilitation. Data on demographic details, medical history including cardiovascular conditions, oral examination findings, and prosthodontic needs were recorded and statistically analyzed. Results: Among 250 patients, 28.4% had a medically diagnosed cardiovascular condition. A significant association was observed between edentulism status and presence of CVD (p<0.05). Older age, male gender, and smoking were significantly associated with higher prevalence. Conclusion: A considerable proportion of patients seeking prosthodontic treatment had cardiovascular disease, emphasizing the need for thorough systemic health evaluation and interdisciplinary coordination.

Background: Cognitive and manual dexterity decline in elderly patients can compromise the success of prosthodontic treatment. Pre-treatment assessment may help clinicians tailor therapy more effectively. Aim: To evaluate the current practices and awareness of cognitive and manual dexterity assessment among prosthodontists before initiating treatment in elderly patients. Materials and Methods: A cross-sectional survey was conducted among 150 prosthodontists using a validated questionnaire. Data were analyzed for trends in assessment techniques, frequency of evaluation, and its impact on treatment planning. Results: Only 38% of practitioners routinely assessed cognitive function, while 26% assessed manual dexterity. The majority (68%) agreed that such assessments significantly influence treatment outcomes. Lack of training and time constraints were reported as barriers. Conclusion: There is a critical gap in routine cognitive and manual dexterity assessment in geriatric prosthodontics. Increased awareness and incorporation of standardized protocols are essential for improved patient outcomes

Background: There is growing evidence linking oral health and systemic conditions, particularly cardiovascular diseases. Edentulism and prior periodontal disease are considered significant indicators of systemic inflammation. Aim: To evaluate the correlation between periodontal status before edentulism, current cardiovascular risk profiles, and edentulous conditions among complete denture wearers. Materials and Methods: A cross-sectional study was conducted with 200 complete denture wearers aged 45 and above. Data were collected using a questionnaire, clinical history, and cardiovascular assessments. Historical periodontal status was evaluated through patient dental records. Results: Participants with a history of severe periodontal disease before becoming edentulous showed a significantly higher prevalence of hypertension, elevated LDL levels, and past cardiovascular events. Duration of edentulism correlated with increasing cardiovascular risk. Conclusion: A strong correlation exists between historical periodontal disease, edentulism, and cardiovascular risk. This highlights the need for integrated dental and medical health strategies, especially in elderly populations.

Background: Tuberculosis (TB) of the chest primarily affects the lungs but has significant extrapulmonary complications, including orthopaedic manifestations such as spinal deformities and joint involvement.Objective: To investigate the frequency and management of orthopaedic complications in patients with pulmonary TB. Methods: A retrospective analysis of 200 pulmonary TB cases treated at a tertiary care hospital. Data on the prevalence and management of skeletal complications were statistically analyzed using chi-square, t-tests, and ANOVA. Results: Spinal deformities were observed in 25% of cases, joint involvement in 15%, and other skeletal complications in 10%. Medical management with anti-tubercular therapy (ATT) showed improvement in 60% of cases, while surgical interventions demonstrated favorable outcomes in 75%. Physiotherapy improved functionality in 75% of patients. Conclusion: Early detection, adherence to ATT, and a multidisciplinary approach, including surgical and rehabilitative care, are essential to improve outcomes in patients with TB chest and associated orthopaedic complications.

A 33-year-old immunocompetent man was admitted to the authors' hospital with a one-month duration of fevers, chills, and non-productive coughs, and suddenonset weakness and ischemic pain of both lower extremities. Physical examination revealed crepitating rales heard over bilateral lung fields. On auscultation, a grade 2~3/6 systolic murmur was heard over the leftlower sternal border and apical area. Transthoracic echocardiography revealed a mobile mass on the tricuspid valve compatible with vegetation, in addition to concomitant mitral valve vegetation (Video 1). Thoracic computed tomography (CT) with contrast revealed cavitary lesions of the left and right lung fields (Fig. 1A and B). Abdominal CT showed a splenic infarction (Fig. 2A), a renal infarction (Fig. 2B), and thromboembolic occlusion of the distal aorta and right common iliac artery (Fig. 3). The patient denied any history of intravenous drug abuse. Blood cultures grew Streptococcus agalactiae (penicillin G-sensitive with a minimal inhibitory concentration ≤0.06 μg/ml). Video 1: Transthoracic echocardiography showing mobile masses on tricuspid and mitral valves compatible with vegetation on the apical four-chamber view.

How to cite: Jeong, S. J., Seol, S. H., & Sang Song, P. (2017). Image of the Month: Concomitant Tricuspid and Mitral Native Valve Infective Endocarditis. The Journal of heart valve disease, 26(1), 122–123.

A 72-year-old female with a previous history of aortic valve replacement by biological prosthesis was admitted with progressive heart failure. The clinical course was unfavorable, requiring inotropic support and invasive mechanical ventilation. Auto-triggering of the ventilator from cardiac origin has been previously described, and explained as a consequence of hyperdynamic circulation. In our case, the oscillatory movements due to the aortic regurgitation are transmitted to the airway. Early recognition of this condition can facilitate not only the correction this asynchrony in mechanical ventilation but also should raise the suspicion of aortic regurgitation.

How to cite: C Garcia-Rubira, J., J Cristo-Ropero, M., Almendro-Delia, M., & Hidalgo-Urbano, R. (2017). A New Sign of Severe Aortic Regurgitation Detected Through Airflow Analysis in Mechanical Ventilation. The Journal of heart valve disease, 26(1), 121.

A small-sized bioprosthesis can limit transcatheter valve-in-valve (V-in-V) implantations. The case is reported of a 91-year-old woman who had successfully undergone a V-in-V procedure with a 26 mm CoreValve in a previously implanted Mitroflow 19 mm valve. At the five-year follow up the prosthesis showed good echocardiographic function and the patient was alive and free from major symptoms. The patient died three months after the follow up examination at the age of 96 years. This case demonstrates the feasibility, with acceptable longterm functioning, of a V-in-V procedure involving a small bioprosthesis. To the authors' knowledge, the present report is the longest follow up of a patient who underwent V-in-V transcatheter aortic valve implantation in a 19 mm bioprosthesis (15.4 mm internal diameter). Video 1: Preoperative aortography showing moderate-to-severe aortic regurgitation. Video 2: Pre-implantation aortic balloon valvuloplasty. Video 3: Post-deployment aortography showing moderate-to-severe aortic regurgitation. Video 4: The final result. After post-dilation of the under-expanded 26 mm CoreValve, the aortic regurgitation is slightly reduced.

How to cite: Salizzoni, S., Conrotto, F., Rinaldi, M., Paolo Ussia, G., Ferraro, G., Giorgi, M., & D'Amico, M. (2017). Transfemoral Valve-In-Valve in a Degenerated Small Aortic Bioprosthesis: Five-Year Follow Up. The Journal of heart valve disease, 26(1), 118–120.

Transcatheter valve-in-valve (VIV) implantation has been recently proposed as an alternative to surgical reoperative aortic valve replacement in patients with a failing aortic bioprosthesis. Experience with transcatheter VIV implantation at other valve positions is very limited. Herein is reported the case of an 18-year-old man with Ebstein's anomaly and severe tricuspid valve (TV) regurgitation status after bioprosthetic valve replacement, who developed new dyspnea on exertion three years after the initial valve replacement. Transesophageal echocardiography showed a severely dilated right atrium and new TV stenosis with an immobile leaflet. The patient underwent successful VIV implantation of a 29-mm SAPIEN XT bioprosthetic valve, with resolution of symptoms and no residual TV regurgitation or stenosis at the two-year follow up. Video 1: Degenerative bioprosthetic tricuspid valve. TEE showing the degenerative bioprosthetic tricuspid valve, and color Doppler during systole showing severe tricuspid regurgitation. Video 2: Degenerative bioprosthetic tricuspid valve. Three-dimensional TEE showing stenosis with an immobile leaflet creating a coaptation defect, viewed from the right atrium. Video 3: Transcatheter VIV replacement with a 29-mm Edwards SAPIEN XT deployed within the tricuspid valve prosthesis. Final result after valve implantation, demonstrating a patent valve orifice, and appropriate apposition of transcatheter valve within a pre-existing surgical Carpentier-Edwards bioprosthetic valve, viewed from the right ventricle. Video 4: Transcatheter VIV replacement with a 29-mm Edwards SAPIEN XT deployed within the tricuspid valve prosthesis. Final result after valve implantation, demonstrating a patent valve orifice, and appropriate apposition of transcatheter valve within a pre-existing surgical Carpentier-Edwards bioprosthetic valve, viewed from the right atrium.

Hoiw to cite: Villablanca, P. A., Shah, A. M., Briceno, D. F., Zaidi, A. N., Chau, M., Garcia, M. J., Slovut, D., & Taub, C. (2017). Transcatheter Valve-in-Valve Implantation: Failing Tricuspid Bioprosthesis in a Patient with Ebstein’s Anomaly. The Journal of heart valve disease, 26(1), 114–117.

The case is reported of a 79-year-old female who received a patch augmentation of the tricuspid anterior and septal leaflets with a resected left atrial wall to address recurrent tricuspid regurgitation, including tricuspid valve tethering. The patient was admitted to the authors' hospital for chronic heart failure with paravalvular leakage after aortic valve replacement and recurrent severe tricuspid regurgitation. She had undergone two previous cardiac surgeries. Re-tricuspid repair required an augmentation of the tricuspid valve leaflets in addition to tricuspid annuloplasty. As the autologous pericardium was unsuitable for a patch due to thickened and stiffened changes, the decision was taken to use a left atrial wall resected to reduce the size of giant left atrium, which was thin and easy to handle. This is the first report of tricuspid leaflet augmentation using a patch derived from the left atrial wall, which is a useful method in patients where pericardium is not available.

How to cite: Endo, D., Kuwaki, K., Yamamoto, T., & Amano, A. (2017). Redo Tricuspid Valve Repair with Leaflet Augmentation Using the Left Atrial Wall. The Journal of heart valve disease, 26(1), 111–113.

Right ventricular (RV) hypoplasia with isolated myocardial disease and complete absence of RV trabeculae is a rare congenital heart disease, the current treatment of which is ineffective. Here, a rare case is presented of a middle-aged female patient with RV hypoplasia complicated by tricuspid regurgitation, right atrial thrombus, and atrial fibrillation. The patient was treated with a one-and-a-half ventricular repair, and showed significant improvements in cardiac function and physical activity tolerance. The study results suggest that this surgical approach can significantly improve the prognosis of an adult patient with isolated RV hypoplasia.

How to cite: Tan, Q., Zi, J., Zhu, M., & Wang, A. (2017). Isolated Right Ventricular Apical Trabecular Hypoplasia: A Case Report. The Journal of heart valve disease, 26(1), 107–110.

Granulomatosis with polyangiitis (GPA) is a rare vasculitis that can have multisystem involvement, though cardiac involvement is very rare. The case is described of a 53-year-old woman who presented with acute aortic and mitral valve regurgitation requiring surgical intervention. Pathology from the excised aortic valve showed geographic necrosis concerning for GPA. Subsequent rheumatologic testing was positive for anti-serine proteinase 3 (PR3) antibody, consistent with GPA. A year after the valve surgery the patient was found to have a vegetation of the mitral valve and elevated PR3 antibody levels, and was successfully treated with an intensification of immunosuppression. The cardiac involvement of GPA is discussed and big data analyzed to identify the epidemiology of valvular involvement. In conclusion, GPA can have multiple different valvular manifestations with a high recurrence rate. GPA should be considered in patients who present with acute valvular disease without any clear precipitant.

How to cite: Al-Kindi, S. G., Amer Al-Aiti, M., Yang, M., & Josephson, R. A. (2017). Granulomatosis with Polyangiitis Presenting with Acute Aortic and Mitral Regurgitation: Case Report and Big-Data Analysis. The Journal of heart valve disease, 26(1), 103–106.

Background: Candida spp. are a rare but important cause of infective endocarditis. The study aim was to describe pertinent clinical data on consecutive patients with Candida endocarditis treated at a tertiary referral center between 1984 and 2013.

Methods: A retrospective search of the authors' endocarditis database was performed and the medical records of patients with confirmed Candida endocarditis were reviewed. Important data relating to demographics, medical history and clinical data, as well as information on outcome and treatment, were extracted.

Results: Between 1984 and 2013, a total of 12 episodes of Candida endocarditis in 11 patients (age range: 18 to 85 years) were treated at the authors' department (1.6% of all endocarditis episodes). Prosthetic valve endocarditis (PVE) was present in six patients. In 72% of cases the infection was healthcare-acquired. Endocarditis was shown to occur from 30 days to more than 600 days after cardiovascular surgery. Six patients were surgically treated. All removed valves were microbiologically positive, despite previous antifungal treatment. One patient with two episodes of Candida parapsilosis PVE was successfully treated conservatively, as was one patient with polymicrobial liver abscess, fungal spondylodiscitis and vegetation on the aortic valve. The total mortality rate was 45%.

Conclusions: Candida endocarditis has a high mortality, and because of its rare occurrence it is difficult to define the most appropriate treatment. There may be a considerable time lag between cardiovascular surgery and the advent of endocarditis.

How to cite: Lejko Zupanc, T., & Logar, M. (2017). Candida Endocarditis: A Review of Twelve Episodes in Eleven Patients. The Journal of heart valve disease, 26(1), 98–102.

Background: The Labcor TBLP Supra™ prosthesis is a second-generation tissue valve that has evolved from the Labcor TBLP™ prosthesis, first introduced in 1984. The Supra prosthesis is a triple-composite porcine valve, with no specific anticalcification treatment being used in its production other than standard tissue fixation with 0.4% glutaraldehyde. To date, more than 100,000 Supra valves have been implanted, mainly in South America. Despite this remarkably high number of implants, only marginal data exist concerning durability and safety issues. Hence, the study aim was to analyze short-term and intermediate outcomes relating to the clinical and hemodynamic performance of the Supra valve, as well as complication rates METHODS: A follow up study was initiated to evaluate outcomes and durability of the Labcor Supra prosthesis. Between September 2004 and October 2010, a total of 331 patients (mean age 75.8 ± 7.2 years; mean logistic EuroSCORE 8.5 ± 2.3%) underwent aortic valve replacement using the Supra porcine bioprosthesis.

Results: The 30-day mortality rate was 4.8% (n = 16). The overall actuarial five-year survival was 72.3 ± 4.9%, and eight-year survival was 60.4 ± 5.6%. Actuarial freedom from reoperation was 96.3 ± 2.4% after five years, and 92.5 ± 3.5% after eight years. Actuarial freedom from structural valve deterioration (SVD) was 99.7 ± 0.3% at five years, and 97.2 ± 0.8% at eight years; actuarial freedom from thromboembolism was 97.5 ± 1.0% and 95.7 ± 1.6% at these times. Actuarial freedom from event rates for endocarditis were 99.5 ± 0.3% and 96.8 ± 0.6%, and 96.1 ± 0.9% and 93.0 ± 1.4% for reoperation CONCLUSIONS: No evidence was found of increased rates of SVD. All parameters studied were comparable to those examined for other second-generation porcine prostheses. Further long-term follow up investigations are required however, for the final judgment of this prosthesis.

How to cite: 

Background: Transcatheter aortic valve replacement (TAVR) has recently been shown to be equivalent to surgical aortic valve replacement (SAVR) in intermediate-risk patients. As TAVR expands towards the traditionally SAVR population, TAVR versus SAVR durability becomes increasingly important. While the durability of TAVR is unknown, valve design - particularly with regards to leaflet stress - impacts on valve durability. Although leaflet stress cannot be measured directly, it can be determined using finite element modeling, with such models requiring the mechanical properties of the leaflets. Balloon-expandable TAVR involves the use of bovine pericardial leaflets treated in the same manner as surgical bioprosthetic leaflets. The study aim was to determine the leaflet mechanical properties of Carpentier-Edwards bioprostheses for future TAVR and SAVR computational models.

Methods: A total of 35 leaflets were excised from 12 Carpentier-Edwards Model 3000TFX Perimount Magna aortic bioprostheses (21 mm, 23 mm, and 25 mm) and subjected to displacement-controlled equibiaxial stretch testing. The stress-strain data acquired were fitted to a Fung constitutive model to describe the material properties in circumferential and radial directions. Leaflet stiffness was calculated at specified physiological stress, corresponding to zero pressure, systemic pressure, and between zero and systemic pressure.

Results: The 21-mm bioprostheses had significantly thinner leaflets than the larger bioprostheses. A non-linear stress-strain relationship was observed in all leaflets along the circumferential and radial directions. No significant difference in leaflet stiffness at systemic pressure, or between zero and systemic pressure, was found among the three bioprosthesis sizes. However, the leaflets from the 23 mm bioprosthesis were significantly more compliant than those of the 21 mm and 25 mm bioprostheses at zero pressure in the circumferential direction. No differences were observed in leaflet stiffness in circumferential versus radial directions.

Conclusions: The bovine pericardial leaflets from Carpentier-Edwards Perimount Magna bioprostheses showed no differences in material properties among different valve sizes at systemic pressure. The thinner 21 mm leaflets did not show any corresponding differences in leaflet stiffness, which suggests that the thinner TAV leaflets may have a similar stiffness to their thicker SAV counterparts.

How to cite: Kuang, H., Xuan, Y., Lu, M., Mookhoek, A., Wisneski, A. D., Guccione, J. M., Ge, L., & Tseng, E. E. (2017). Leaflet Mechanical Properties of Carpentier-Edwards Perimount Magna Pericardial Aortic Bioprostheses. The Journal of heart valve disease, 26(1), 81–89.

Background and aim of study: One of the first steps in qualifying a new prosthetic valve for eventual clinical use is preclinical flow performance testing in vitro. Such testing is typically performed in an in-vitro test system that simulates the pumping mechanics of the left ventricle of the heart, generally referred to as a pulse duplicator or duplicator. Historically, test results in these systems have varied from duplicator to duplicator. This collaborative effort between heart valve manufacturers and the Food and Drug Administration (FDA) was designed to evaluate the variability of the pulse duplicator test technology for pulsatile flow performance measurement in an interlaboratory round robin.

Methods: The participants jointly developed and followed a limited test protocol based on accepted methods outlined in the International Standards Organization 5840: Cardiovascular Implants - Cardiac Valve Prostheses, and in the FDA Replacement Heart Valve Guidance. One 25 mm valve, each of four basic designs, was circulated to test centers which included four manufacturers and two FDA duplicators. The pressure drop and regurgitation data were then collected and summarized by the FDA.

Results: Considerable variation was observed in hydrodynamic performance measures of pressure drop across the valve and back flow leakage through the valve among the different duplicators. Despite the variations seen in these measures, the results from all centers showed that the valves conformed to certain minimum performance criteria.

Conclusions: Despite the fact that the valves would have been judged to have met Minimum Performance Requirements of effective orifice area and regurgitant fraction, as specified in the international standard, variations in measurements existed among duplicators. Valve manufacturers should use a reference valve of similar design in hydrodynamic performance testing to assess the individual measurement conditions in the duplicator.

How to cite: Retta, S. M., Kepner, J., Marquez, S., Herman, B. A., S Shu, M. C., & Grossman, L. W. (2017). In-Vitro Pulsatile Flow Measurement in Prosthetic Heart Valves: An Inter-Laboratory Comparison. The Journal of heart valve disease, 26(1), 72–80.

Background: Heart valves which exist naturally in an extreme-pressure system must have evolved in a way to resist the stresses of high pressure. Giraffes are interesting as they naturally have a blood pressure twice that of humans. Thus, knowledge regarding giraffe heart valves may aid in developing techniques to design improved pressure-resistant biological heart valves.

Methods: Heart valves from 12 giraffes and 10 calves were explanted and subjected to either biomechanical or morphological examinations. Strips from the heart valves were subjected to cyclic loading tests, followed by failure tests. Thickness measurements and analyses of elastin and collagen content were also made. Valve specimens were stained with hematoxylin and eosin, elastic van Gieson stain, Masson's trichrome and Fraser-Lendrum stain, as well as immunohistochemical reactions for morphological examinations.

Results: The aortic valve was shown to be 70% (95% CI 42-103%) stronger in the giraffe than in its bovine counterpart (p <0.001). No significant difference was found between mitral or pulmonary valves. After normalization for collagen, no significant differences were found in strength between species. The giraffe aortic valve was found to be significantly stiffer than the bovine aortic valve (p <0.001), with no significant difference between mitral and pulmonary valves. On a dry weight basis, the aortic (10.9%), pulmonary (4.3%), and mitral valves (9.6%) of giraffes contained significantly more collagen than those of calves. The elastin contents of the pulmonary valves (2.5%) and aortic valves (1.5%) were also higher in giraffes.

Conclusions: The greater strength of the giraffe aortic valve is most likely due to a compact collagen construction. Both, collagen and elastin contents were higher in giraffes than in calves, which would make giraffe valves more resistant to the high-pressure forces. However, collagen also stiffens and thickens the valves. The mitral leaflets showed similar (but mostly insignificant) trends in strength, stiffness, and collagen content.

How to cite: Amstrup Funder, J., Christian Danielsen, C., Baandrup, U., Martin Bibby, B., Carl Andelius, T., Toft Brøndum, E., Wang, T., & Michael Hasenkam, J. (2017). How Heart Valves Evolve to Adapt to an Extreme-Pressure System: Morphologic and Biomechanical Properties of Giraffe Heart Valves. The Journal of heart valve disease, 26(1), 63–71.

Background: Various approaches such as antegrade trans-septal, retrograde transfemoral and transapical techniques have been used to close mitral paravalvular leak (PVL) in patients with an aortic prosthesis. During the implementation of these techniques, an arteriovenous guidewire loop is often created for device delivery. However, passing through a mechanical aortic valve may cause hemodynamic compromise and prolong the procedure. To date, no studies have evaluated antegrade mitral PVL closure without the use of an arteriovenous wire loop in patients with a mechanical aortic prosthesis. Herein is described a different mitral PVL closure technique by means of a trans-septal approach without construction of an arteriovenous guidewire loop in this type of patient.

Methods: Four patients (two males, two females; mean age 57 ± 10 years; range: 46-67 years) with severe mitral PVL and a mechanical aortic prosthesis were referred for percutaneous closure of a mitral PVL. All patients underwent antegrade trans-septal mitral PVL closure without the creation of an arteriovenous wire loop. Data prospectively collected included assessments from preoperative and postoperative two- and three-dimensional transesophageal echocardiography (TEE).

Results: Preoperative TEE demonstrated severe mitral PVL in all four patients. All patients experienced a substantial reduction in symptoms associated with the marked reduction in PVL following repair. There were no procedural complications. The median procedural time was 113 min (range: 50-145 min) and median fluoroscopy time was 23 min (range: 17-25 min).

Conclusions: An alternative, safe, effective and efficient mitral PVL closure approach in patients with a mechanical aortic prosthesis has been devised. This technique can prevent aortic valve dysfunction, reduce costs, and also decrease complication rates.

How to cite: Kilic, T., Coskun, S., Karauzum, K., Yavuz, S., & Sahin, T. (2017). Percutaneous Antegrade Trans-Septal Closure of Mitral Paravalvular Leak without Creation of an Arteriovenous Wire Loop in Patients with Coexistent Mechanical Aortic Valve. The Journal of heart valve disease, 26(1), 54–62.

Background: The study aim was to analyze the authors' experience with aortic root surgery in Marfan syndrome (MFS), and to expand the surgical outcome data of patients meeting the Ghent criteria (Marfan registry).

Methods: Analyses were performed of data acquired from MFS patients (who met the Ghent criteria), including an aortic root surgery and Kaplan-Meier survival.

Results: Between April 2004 and February 2012, a total of 59 MFS patients (mean age at surgery 36 ± 13 years) underwent 67 operations for aortic root aneurysm (n = 52), aortic valve (AV) regurgitation (n = 15), acute aortic dissection (n = 2), and/or mitral valve (MV) regurgitation resulting from MV prolapse (n = 7). Of 59 initial operations, 21 (36%) involved AV-replacing root surgery, 38 (64%) AV-sparing root surgery, seven (12%) aortic arch or hemi-arch repair, and five (8%) simultaneous MV surgery. There were no early mortalities. The mean follow up was 6.8 ± 1.2 years, with five deaths (8%) and a relatively low reoperation rate (10 reoperations in nine patients; 14%). Seven reoperations involved AV or aortic root surgery (including four for AV regurgitation following failed AV-sparing surgery), two MV repair/replacements, and one coronary artery bypass graft. Eight patients (21%) with AV-sparing surgery had moderate/severe AV regurgitation at the last follow up before re-intervention. The mean five-year freedom from postoperative death was 91.2 ± 8.8%, from cardiac reoperation 86.3 ± 4.5%, and more-than-moderate AV regurgitation 90.3 ± 4.8%.

Conclusions: Prophylactic aortic surgery in MFS patients with AV-replacing root or AV-sparing root surgery carries a low risk of operative morbidity and death when performed at an experienced center. AV-sparing root surgery increases the risk of AV regurgitation and, possibly, of re-intervention. Regular clinical follow up is important after any aortic root surgery in MFS patients, with a delineation of risk factors for AV regurgitation after AV rootsparing surgery.

How to cite: Attenhofer Jost, C. H., Connolly, H. M., Scott, C. G., Ammash, N. M., Bowen, J. M., & Schaff, H. V. (2017). Aortic Root Surgery in Marfan Syndrome: Medium-Term Outcome in a Single-Center Experience. The Journal of heart valve disease, 26(1), 45–53.

Background: Left ventricular (LV) function and the dimensions of aortic valves from normally functioning bicuspid aortic valve (BAV) patients were compared with those of healthy control patients. A comparison between patients with antero-posterior BAV (BAV-AP) or right-left BAV (BAV-RL) was also performed, and the determinants of aortopathy and LV function were investigated.

Methods: Sixty-eight patients with aortic velocities <2 m/s and trivial or mild aortic regurgitation were included in the study. All patients underwent transesophageal echocardiography to diagnose BAV and identify associated phenotypes. Twodimensional (2D), Doppler echocardiographic evaluation, and strain imaging were also performed, and the results compared with those obtained from 55 age- and gender-matched healthy controls.

Results: The LV ejection fractions were similar between BAV patients and healthy controls, while LV global longitudinal strain (LVGLS) (p = 0.03) and LV global circumferential strain (LVGCS) (p = 0.02) were significantly lower among BAV patients. Aortic velocities and aortic dimensions at theannulus, sinus of Valsalva and sinotubular junction were significantly greater in BAV patients (all p <0.001). The diameter of the tubular ascending aorta (AA) was correlated with age (r = 0.55, p <0.001), septal E/e' (r = 0.4, p = 0.003), and LV mass index (r = 0.29, p = 0.024). Multivariate analyses revealed that the primary determinant of the AA diameter in BAV patients was age (β = 0.38, p = 0.04), and enlargement of the AA was independent of the diastolic properties of the left ventricle and LVGLS. No significant differences were observed among the 2D or Doppler echocardiography parameters, nor among strain measurements, between BAV-AP (n = 47) and BAV-RL (n = 21) phenotypes.

Conclusions: Subclinical myocardial dysfunction was observed in BAV patients with normal aortic valve function. LV dysfunction was independent of age, aortic velocity and AA diameter, which suggested the presence of intrinsic myocardial disease. Aging contributes to aortic dilatation in normally functioning BAV.

How to cite: Tuluce, K., Yakar Tuluce, S., Cagri Simsek, E., Bayata, S., & Nazli, C. (2017). Assessment of Contributors of Aortopathy and Subclinical Left Ventricular Dysfunction in Normally Functioning Bicuspid Aortic Valves. The Journal of heart valve disease, 26(1), 37–44.

During the past decade there has been a major shift in the use of surgical bioprostheses. Consequently, due to the increasing age of the population there will be a major increase in the incidence of failure of these prostheses. While mortality associated with the re-replacement of surgical valve failures remains high, advances in transcatheter interventions have permitted the use of transcatheter valves in degenerative surgical bioprostheses. Herein is described the first use of the Symetis transfemoral ACURATEneo™ valve-in-valve procedure, together with details of the associated technical challenges. Video 1: Positioning of the TAVI prosthesis. Video 2: Valve deployment.

How to cite: Pllaha, E., Pagnotta, P., Rossi, M., & Reimers, B. (2017). Symetis TF ACURATEneo™ Valve-in-Valve: A New Indication for Another Self-Expanding TAVI Prosthesis?. The Journal of heart valve disease, 26(1), 32–36.

Aortic regurgitation (AR) is characterized by the backflow of blood from the aorta to the left ventricle. Acute AR typically causes severe pulmonary edema and hypotension, and is a surgical emergency. In chronic AR, however, compensatory mechanisms can clinically compensate for years, with normal left ventricular function and no symptoms. While the hemodynamic mechanisms of chronic AR on the left ventricle are well described, the hemodynamic mechanisms of acute AR are not clear. Most of the literature on acute AR includes either small series or case reports. During the past decade the number of transcatheter aortic valve replacements (TAVRs) performed has increased dramatically, and TAVR is now an accepted treatment option for patients with severe aortic stenosis who are not surgical candidates or are at high risk for surgery. However, potential acute mild to severe AR occurring after TAVR seems a new and common cause of AR. Since more than mild AR increases the risk of mortality, the quantification of AR severity is a major challenge after TAVR. More accurate, reproducible and quantitative criteria need to be developed to assess and highlight the unknowns of acute AR. Information relating to the pathophysiology and hemodynamics of acute AR and TAVR-related acute AR, respectively, are collated in this review.

How to cite: Bugan, B., Yildirim, E., Celik, M., & Cagdas Yuksel, U. (2017). Acute Aortic Regurgitation in the Current Era of Percutaneous Treatment: Pathophysiology and Hemodynamics. The Journal of heart valve disease, 26(1), 22–31.

Aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) is associated with an increased risk of mortality. In severe cases, abrupt hemodynamic changes may occur with a sudden increase in left ventricular end-diastolic pressure that results in frank pulmonary edema, hypoxia, and cardiogenic shock. Here, the case is reported of a patient who developed severe AR immediately after valve deployment that led to severe hemodynamic compromise. The procedural techniques necessary for the immediate management of severe transvalvular and paravalvular AR are described.

How to cite: Damluji, A. A., Alfonso, C. E., & Cohen, M. G. (2017). Procedural Techniques for the Management of Severe Transvalvular and Paravalvular Aortic Regurgitation During TAVR. The Journal of heart valve disease, 26(1), 18–21.

Background: Stabilization of the ventriculo-aortic junction (VAJ) is gaining increasing interest in the context of aortic valve repair, since its dilation is a well-recognized risk factor for long-term repair failure. Interleaflets triangles are key elements of the VAJ, but cannot be completely visualized using echocardiography. A three-dimensional (3D) reconstruction of electrocardiogram-triggered computed tomography (CT) scan images allows an analysis of the real dimensions and anatomic characteristics of the subcommissural triangles.

Methods: A method was developed to visualize the interleaflets triangle at the CT-scan based on multiplanar post-processing reconstructions. Attention was focused on the triangles' apical angle evaluation. The data obtained with CT-scan reconstructions were compared with those collected in a previous post-mortem study to validate this measurement method.

Results: In the CT-scan group the angles between the left and right coronary sinuses, and the right non-coronary and left non-coronary sinuses were 46.23 ± 7.79°, 47.38 ± 6.97°, 45° [range: 42.75- 50.75°], respectively, and in the post-mortem group were 45.44 ± 12.39°, 48.31 ± 1218°, 50.25 ± 7.29°. No statistically significant differences between the two groups were identified (p = 0.84, 0.81, and 0.23).

Conclusions: Based on experience acquired in the operating room, the acute-angle subcommissural triangles were considered normal, the equilateral triangles mildly dilated, and the obtuse triangles severely dilated. According to this classification, different reparative approaches were selected. A CTscan 3D reconstruction method, as validated by the present data, allows a preoperative evaluation of the triangles and VAJ in order to best plan a surgical reparative approach tailored to a single patient.

How to cite: Romagnoni, C., Mangini, A., Contino, M., Rosa, R., Ippolito, S., Gelpi, G., & Antona, C. (2017). Preoperative Computed Tomography Scan Analysis of Interleaflets Triangles to Guide Aortic Root Repair Procedures. The Journal of heart valve disease, 26(1), 12–17.

Transcatheter heart valve replacement is an emerging technology in the treatment of valvular disease. During recent years, the opportunity to replace a heart valve via percutaneous access or via a miniinvasive access without the use of cardiopulmonary bypass has revolutionized the approach to this pathology. The different designs of transcatheter valves have also altered the spectrum of possible complications, with the unexpected occurrence of leaflet hypomobility after valve deployment. Here, the pathophysiological pattern of this complication is categorized, and an analysis provided of recently reported clinical evidences.

How to cite: Gallo, M., Demertzis, S., Gerosa, G., & Ferrari, E. (2017). Leaflet Hypomobility After Transcatheter Aortic Valve Replacement: Thrombosis or Mechanical Factors? A Possible Pathophysiological Pattern. The Journal of heart valve disease, 26(1), 9–11.

Heart valve disease (VHD) presents with different prevalence rates and clinical outcomes based on gender, impacting diagnosis, treatment decisions, and prognosis. This article examines the gender-specific differences in the prevalence, clinical manifestations, and outcomes of various types of heart valve disease, including aortic stenosis, mitral regurgitation, and other valvular conditions. It also explores the implications for management strategies and future research directions to address these disparities.

Infective endocarditis (IE) is a serious and potentially life-threatening condition characterized by infection of the endocardial surface of the heart, primarily affecting heart valves. This article reviews the impact of IE on heart valve integrity, discussing the pathophysiology, clinical manifestations, diagnostic challenges, and management strategies associated with this condition. By analyzing recent advancements and outcomes, we aim to highlight the importance of early diagnosis and effective treatment to preserve heart valve function and improve patient prognosis.

Pregnancy presents unique challenges for individuals with heart valve disease (VHD), influencing both maternal and fetal outcomes. This article reviews the implications of heart valve disease during pregnancy, focusing on the risks associated with various types of valve disorders, strategies for management, and long-term outcomes. By synthesizing recent research and clinical guidelines, we aim to provide a comprehensive overview of how VHD affects pregnancy and how best to approach management to optimize both maternal and fetal health.

Valvular heart disease (VHD) is a leading cause of morbidity and mortality globally, particularly in older populations. It plays a critical role in the development of heart failure (HF), as the two conditions share several pathophysiological mechanisms. This article reviews the connection between valve disease and heart failure, focusing on how impaired valve function contributes to cardiac remodeling, increased hemodynamic load, and reduced ventricular function. Advances in diagnosis and treatment, including surgical and transcatheter interventions, are also discussed, with a focus on improving patient outcomes.

Biological heart valves (BHVs) are an important alternative to mechanical valves for patients requiring heart valve replacement. Despite their advantages in terms of biocompatibility and reduced need for anticoagulation, challenges remain in ensuring the long-term durability and optimal function of these valves. Animal models have played a pivotal role in understanding BHV performance and providing insights into their structural integrity, durability, and interaction with host tissues. This article provides a comprehensive review of biological heart valve performance, focusing on the contribution of animal studies to the understanding of valve degeneration, calcification, and hemodynamic function.

Three-dimensional (3D) printing technology is rapidly transforming various aspects of medical practice, particularly in the field of cardiovascular surgery. In heart valve disease, 3D printing offers groundbreaking potential for personalized diagnosis, surgical planning, and the creation of patient-specific prosthetic valves. This article reviews the recent advances in 3D printing for heart valve disease management and discusses its future perspectives, including the production of biocompatible materials for valve replacement and the development of tissue-engineered heart valves. The challenges and future directions of integrating 3D printing into clinical practice are also discussed.

Prosthetic valve endocarditis (PVE) is a severe infection associated with high morbidity and mortality in patients who have undergone valve replacement surgery. Its diagnosis and management are complex due to the involvement of both prosthetic material and native tissue. This article reviews the current approaches to the diagnosis, treatment, and prognosis of PVE, including advancements in diagnostic imaging, antimicrobial therapy, and surgical interventions. It also discusses the prognostic factors that influence clinical outcomes.

Heart valve calcification (HVC) is a common degenerative process leading to valvular heart disease (VHD), particularly aortic stenosis. The pathological process involves the active deposition of calcium in the valve tissues, leading to stiffening and functional impairment. This article reviews the current understanding of the mechanisms behind heart valve calcification and explores emerging pharmacological approaches aimed at preventing or slowing its progression.

Heart valve disease (HVD) is a significant concern in athletes due to its potential impact on cardiovascular performance and the increased risk of sudden cardiac events during intense physical activity. This article provides a comprehensive review of the risk assessment and management of HVD in athletes, highlighting the clinical considerations unique to this population. A systematic approach to diagnosis, risk stratification, and decision-making for return to play is essential for optimizing the outcomes of athletes with HVD.

Heart valve disease can be managed through either valve repair or valve replacement, depending on various clinical factors. This article examines the indications for choosing between valve repair and replacement, and compares the outcomes associated with each approach. We review current guidelines, surgical techniques, and long-term outcomes to provide a comprehensive understanding of when each option is preferred and the impact on patient health and quality of life.

Background: The study aim was to assess differences in clinical outcome, safety, and associated costs between sutureless and aortic isolated aortic valve replacement (AVR) with a standard bioprosthesis.

Methods: A retrospective comparative study was conducted to investigate 65 patients, each of whom had undergone isolated AVR with a traditional aortic valve (T) or a Perceval S sutureless aortic prosthesis (P) between January 2010 and December 2012. Cost data were drawn from the proprietary cost accounting system of the hospital, excluding acquisition costs of the devices. A linear regression model was used to estimate the mean total costs difference between groups.

Results: The mean cardiopulmonary bypass time and aortic cross-clamp times in the T and P groups were 80 ± 41 min and 58 ± 26 min versus 38 ± 16 min and 26 ± 10 min, respectively (p <0.0001). The mean intensive care unit and ward stays in both groups were 4.2 ± 5.9 and 11.9 ± 6.5 days versus 3.8 ± 4.7 and 10 ± 4.5 days, respectively (p = 0.68 and p = 0.05). The mean costs savings for group P compared to group T were €3,801 (p = 0.13), mainly driven by hospital stay costs. Savings between the P and T groups increased with age: €4,992 in patients aged 70-79 years and €9,326 in those aged 80+ years, and with risk (€4,296 for high-risk patients).

Conclusions: Sutureless aortic valves present shorter procedural times and lower hospital costs compared to traditional valves, with higher cost savings at increased patient age and risk. Sutureless aortic valves seem to be cost-effective in patients undergoing AVR.

How to cite: Laborde, F., Folliguet, T., Ghorayeb, G., & Zannis, K. (2017). Sutureless Valves Reduce Hospital Costs Compared to Traditional Valves. The Journal of heart valve disease, 26(1), 1–8.