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Key Clinical Message: Acute aortic dissection in unusual/rare circumstances may become chronic and multi lumen. A high clinical acumen, examination and investigations in the acute setting, may help reduce late/misdiagnosis and complications in low resource settings. [ABSTRACT FROM AUTHOR]

Guillain‐Barré syndrome incidence within 8 weeks of a surgical procedure appears to be more common than previously thought. GBS following open‐heart surgery is exceedingly rare, perhaps underdiagnosed or underreported given surveillance data incidence. Clinicians should be keenly aware of this association and quickly consider a GBS diagnosis. [ABSTRACT FROM AUTHOR]

Abdominal aortic aneurysm (AAA) rupture is a common cause of death in adults. Current AAA treatment is by open surgical or endovascular aneurysm repair. Rodent model and human epidemiology, and genetic and observational studies over the last few decades have highlighted the potential of a number of drug therapies, including medications that lower blood pressure, correct dyslipidaemia, or inhibit thrombosis, inflammation or matrix remodelling, as approaches to managing small AAA. This review summarizes prior AAA pathogenesis data from animal and human studies aimed at identifying targets for the development of drug therapies. The review also systematically assesses past randomized placebo-controlled drug trials in patients with small AAAs. Eleven previously published randomized-controlled clinical trials testing different drug therapies aimed at slowing AAA progression were identified. Five of the trials tested antibiotics and three trials assessed medications that lower blood pressure. Meta-analyses of these trials suggested that neither of these approaches limit AAA growth. Allocation to blood pressure-lowering medication was associated with a small reduction in AAA rupture or repair, compared to placebo (relative risk 0.94, 95% confidence intervals 0.89, 1.00, P = 0.047). Three further trials assessed the effect of a mast cell inhibitor, fibrate or platelet aggregation inhibition and reported no effect on AAA growth or clinical events. Past trials were noted to have a number of design issues, particularly small sample sizes and limited follow-up. Much larger trials are needed to properly test potential therapeutic approaches if a convincingly effective medical therapy for AAA is to be identified. [ABSTRACT FROM AUTHOR]

The right management of both mitral and aortic disease can be challenging, especially in asymptomatic patients. The current guidelines recommend valve repair or replacement when symptoms arise or when there is an evident left ventricular dysfunction. However, deciding the optimal surgical timing can be very difficult, since the line between the absence of symptoms and being minimally symptomatic, especially in the elderly, is blurred. Another relevant issue regards the second surgical criterion: operating on a patient with a reduced left ventricular ejection fraction or with a dilated left ventricle might jeopardize the possibility of a fully reverse remodeling of the heart after surgery. In this scenario, the left atrium might play an important role. In particular, left atrial deformation might be a very useful tool to detect early ultrastructural alterations, and help or support guiding a patient‐tailored treatment at an early stage, optimizing the outcome in the long term. [ABSTRACT FROM AUTHOR]

Objective: Cardiac amyloidosis (CA) is as an infiltrative disorder primarily caused by extracellular tissue deposition of amyloid fibrils in the myocardial interstitium. The current study was designed to test whether alterations in ascending aortic elastic properties could be detected by echocardiography in CA patients, and to compare their results to controls.Patients and Methods: We included 19 CA patients from which CA proved to be AL amyloidosis in 17 cases and transthyretin (TTR) amyloidosis in 2 cases. Their results were compared to 20 age-, gender-, and risk factor-matched controls.Results: There was significantly greater interventricular septum and left ventricular (LV) posterior wall thickness, lower LV ejection fraction and greater E/A in CA patients than in controls, suggesting systolic, and diastolic dysfunction. CA patients also showed significantly reduced aortic strain and pulsatile change in aortic diameter, and increased aortic stiffness index.Conclusion: These results suggest increased aortic stiffness in CA patients. [ABSTRACT FROM AUTHOR]

Sarcopenia is the degenerative loss of core muscle mass. It is an aspect of frailty, which is associated with increased rates of peri-operative harm. We assessed the association of the cross-sectional areas of abdominal muscles, including psoas, with survival during a median (IQR [range]) follow-up of 3.8 (3.2-4.4 [0.0-5.1]) years after scheduled endovascular (132) or open (5) abdominal aortic aneurysm repair in 137 patients. In multivariate analysis, mortality hazard (95%CI) was independently associated with: age, 1.06 (1.01-1.13) per year, p = 0.03; and the adjusted area of the left psoas muscle, 0.94 (0.81-1.01) per mm2 .kg-0.83 , p = 0.08. Shortened hospital stay was independently associated with haemoglobin concentration and adjusted left psoas muscle area, hazard ratio (95%) 1.01 (1.00-1.02) per g.l-1 and 1.05 (1.02-1.07) per mm2 .kg-0.83 , p = 0.04 and 0.001, respectively. [ABSTRACT FROM AUTHOR]

We report a rare case of progressive left ventricular outflow tract ( LVOT) obstruction after percutaneous device closure of a mechanical prosthetic mitral valve ( MV) paravalvular leak ( PVL) in the region of aortomitral curtain in a patient who also had small mechanical aortic valve prosthesis with patient-prosthesis mismatch. [ABSTRACT FROM AUTHOR]

Companion animals are routinely anesthetized or heavily sedated for cardiac MRI studies, however effects of varying anesthetic protocols on cardiac function measurements are incompletely understood. The purpose of this prospective study was to compare effects of two anesthetic protocols (Protocol A: Midazolam, fentanyl; Protocol B: Dexmedetomidine) on quantitative and qualitative blood flow values measured through the aortic, pulmonic, mitral, and tricuspid valves using two-dimensional phase contrast magnetic resonance imaging (2D PC MRI) in healthy dogs. Mean flow per heartbeat values through the pulmonary artery (Qp) and aorta (Qs) were compared to right and left ventricular stroke volumes (RVSV, LVSV) measured using a reference standard of 2D Cine balanced steady-state free precession MRI. Pulmonary to systemic flow ratio (Qp/Qs) was also calculated. Differences in flow and Qp/Qs values generated using 2D PC MRI did not differ between the two anesthetic protocols ( P = 1). Mean differences between Qp and RVSV were 3.82 ml/beat (95% limits of agreement: 3.62, −11.26) and 1.9 ml/beat (−7.86, 11.66) for anesthesia protocols A and B, respectively. Mean differences between Qs and LVSV were 1.65 ml/beat (−5.04, 8.34) and 0.03 ml/beat (−4.65, 4.72) for anesthesia protocols A and B, respectively. Mild tricuspid or mitral reflux was seen in 2/10 dogs using 2D PC MRI. No aortic or pulmonic insufficiency was observed. Findings from the current study indicated that these two anesthetic protocols yield similar functional measures of cardiac blood flow using 2D PC MRI in healthy dogs. Future studies in clinically affected patients are needed. [ABSTRACT FROM AUTHOR]

Purpose To characterize the postsurgical hemodynamics in aortic valve bypass (AVB) patients, and to determine the relationship between presurgical native aortic valve pressure gradient and postsurgical hemodynamics. Materials and Methods Twenty patients scheduled for AVB surgery underwent presurgical transthoracic Doppler echocardiography to assess the degree of aortic stenosis and postsurgical cardiac magnetic resonance imaging (MRI) to acquire phase contrast magnetic resonance (PCMR) flow values along the ascending and descending aorta, and in the conduit. Net flow values were calculated from the PCMR images and compared to presurgical aortic valve pressure gradient measurements. Results PCMR showed that: 1) The blood flow split between the aorta and the conduit was 35%:65% of cardiac output and 2) 60% of patients had net retrograde blood flow in the superior thoracic aorta over the cardiac cycle. Patients with presurgical pressure gradient (ΔP) > 45 mmHg had significantly less blood flow out of the native aorta than patients with ΔP < 45 mmHg, and had significantly more retrograde flow in the superior thoracic aorta postsurgery. Conclusion In patients undergoing AVB, presurgical aortic valve pressure gradient is associated with the volume of blood flow out the aorta and the direction of blood flow in the superior thoracic aorta after conduit addition as measured by PCMR. J. Magn. Reson. Imaging 2014;40:899-905. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background Predicting subaortic stenosis ( SAS) in adult Golden Retriever dogs ( GRs) by evaluating them as puppies is hampered by the progressive expression of the SAS phenotype in youth. In some children who develop SAS as adults, an abnormal aortoseptal angle (Ao SA) precedes development of stenosis. Objectives To determine the normal Ao SA in young adult GRs using echocardiography; to assess the value of Ao SA in GR puppies for predicting development of the SAS phenotype. Animals Forty-eight 2- to 6-month-old GR puppies. Methods Prospective study. Puppies were recruited from clients and breeders. Puppies were evaluated with a physical examination and an echocardiogram, and this evaluation was repeated when they were 12-18-month-old adults. Puppies were classified as unaffected ( WNL) or affected ( SAS) retroactively, based on their results as adults. Results In WNL young adult GRs, mean ± SD Ao SA was 152.3 ± 6.5°. Mean ± SD Ao SA in SAS puppies (144.9 ± 8.6°) was significantly different from mean Ao SA in WNL puppies (155.7 ± 8.8°, P < .01). No puppy with Ao SA >160° had the SAS phenotype as a young adult; 93% (75.7-99.1%) of puppies with Ao SA <145° had the SAS phenotype as young adults. Peak LVOT velocity increased significantly between evaluations ( P < .0001) whereas Ao SA did not ( P = .45). Conclusion and Clinical Significance A steep Ao SA in GR puppies is associated with the SAS phenotype in young adulthood. Some GR puppies have an abnormal Ao SA that persists in young adulthood and is detectable before peak LVOT velocity reaches levels consistent with SAS. [ABSTRACT FROM AUTHOR]

Objective: Deteriorations in coronary flow velocity reserve (CFR) and aortic distensibility have been demonstrated in coronary artery disease. The objective of the present study was a simultaneous echocardiographic evaluation of the CFR and aortic distensibility indices before and after successful percutaneous coronary interventions (PCI) in patients with left anterior descending coronary artery (LAD) disease. Methods: The study population, comprising 12 patients (4 women and 8 men) with significant proximal LAD stenosis, were compared with matched controls. Transesophageal echocardiography (TEE) was carried out to evaluate the CFR and aortic distensibility indices (the aortic elastic modulus E(p) and Young's circumferential static elastic modulus E(s)) before and after PCI to the LAD. The subjects underwent TEE on average 8 ± 11 days before PCI and 25 ± 6 weeks after PCI. Results: An improvement in CFR was demonstrated in patients with LAD stenosis after successful PCI (1.71 ± 0.36 vs. 2.08 ± 0.28, P < 0.05), which paralleled the decreases in E(p) (936 ± 544 mmHg vs. 567 ± 184 mmHg, P < 0.05) and E(s) (10,207 ± 6,295 mmHg vs. 5,831 ± 2,010 mmHg, P < 0.05) during the follow-up. Conclusion: The aortic distensibility improves in parallel with the increase in CFR in patients with LAD stenosis after successful PCI. [ABSTRACT FROM AUTHOR]

Background: Aortic valve replacement with a cryopreserved aortic homograft (CH) is an attractive alternative to bioprosthesis implantation. The aim of the study was to compare the hemodynamic performance of CH implanted with aortic root inclusion compared to prototype stentless (SS) bioprosthesis, standard stented (SD) bioprosthesis, and a native aortic valve. Methods: Hemodynamics and Doppler echocardiographic measurements such as left ventricular ejection fraction, aortic valve orifice area index (AVOAI), mean and maximal transvalvular gradients, were obtained at rest and immediately after exercise in 28 patients after aortic valve replacement with CH (n = 10), SS (n = 9), or SD (n = 9), and in a control group (CG) of 15 normal volunteers. Results: Rest and peak exercise heart rate and workload achieved were not different among the groups. Baseline AVOAI was larger for CH and CG compared to SS and SD groups (P < 0.05). Maximal and mean transvalvular pressure gradients at rest were lower for CH compared to SS and SD groups (P < 0.05), but higher than CG (P < 0,05). Conclusion: Implanted aortic CH had better hemodynamic performance than SS and SD bioprosthesis and similar to native normal aortic valves, both at rest and immediately after exercise. [ABSTRACT FROM AUTHOR]

Valvular heart disease occurs in 2–3% of the general population with an increase in prevalence with advancing age. The aetiology of valvular heart disease has evolved in recent decades with degenerative aortic and mitral valve disease supplanting rheumatic heart disease as a primary cause. The common valve lesions to be discussed in this article are aortic stenosis and mitral regurgitation. The traditional approach to calcific aortic stenosis when either symptoms or left ventricular impairment develops is surgical aortic valve replacement and it remains a treatment with excellent outcomes. In recent years there has been interest in less invasive approaches, including percutaneous and transapical aortic valve implantation. With refinements in technology these approaches are becoming a potential treatment option, primarily for high-risk patients who may otherwise be unsuitable for traditional open surgical treatment. Catheter-based approaches for mitral valve disease are also evolving. Mitral regurgitation may often be the result of mitral annular dilatation seen in patients with an enlarged left ventricle or left atrium. Percutaneous implantation of a constricting device in the coronary sinus, which lies in close proximity to the mitral annulus, results in a change to the geometry of the mitral valve and reduced regurgitation. Another technique in patients with degenerative mitral regurgitation is the endovascular edge-to-edge repair in which coaptation of the mitral valve leaflets can be improved with a percutaneously deployed clip. Small patient series indicate that these new techniques are promising. As such, advances in percutaneous interventional and surgical approaches have the potential to further improve outcomes for selected patients with valvular heart disease. [ABSTRACT FROM AUTHOR]

Background: Boxers are predisposed to subaortic and pulmonic stenosis (SAS, PS). Screening of puppies may be useful in estimating the risk of their developing a defect that potentially compromises life expectancy or exercise tolerance. Hypothesis: Presence of SAS or PS in adult Boxers can be predicted by auscultation and Doppler echocardiography at 9–10 weeks of age. Animals: Eighty-five Boxer puppies examined at 9–10 weeks of age and at 12 months of age. Methods: Prospective, longitudinal observational study. Auscultation by stethoscope and continuous wave-Doppler echocardiography for peak velocities ( Vmax) in the aorta (Ao) and pulmonary artery (PA). Results: Intensity of heart murmurs in puppies correlated with VmaxAo and VmaxPA in adults. VmaxAo and VmaxPA in puppies correlated with VmaxAo and VmaxPA in adults, respectively. From puppy to adult, VmaxAo increased and VmaxPA remained unchanged. The negative predictive value for absent or only a soft (≤II/VI) murmur in puppies being associated with VmaxAo and PA ≤ 2.4 m/s as an adult was 90% and ≤3.5 m/s 100%. The negative predictive value of a Vmax≤ 2.4 m/s as a puppy still being ≤2.4 m/s as an adult was 94% for Ao and 96% for PA, and of a Vmax≤ 3.5 m/s, 99% for Ao and 100% for PA. Conclusions and Clinical Importance: Even though VmaxAo increases during growth in Boxer puppies, indicating relative narrowing of the aorta, puppies with VmaxAo ≤ 2.4 m/s do not usually progress to clinically have relevant SAS at 12 months of age. [ABSTRACT FROM AUTHOR]

Background: Cardiac murmurs associated with valvular regurgitation occur commonly in conditioned performance horses, but their association with athletic performance is unknown. Hypothesis: Cardiac valvular regurgitation has a negative association with race performance. Animals: Five hundred and twenty-six “race fit” Thoroughbred racehorses engaged in either flat (race distance 1,000–2,500 m) or jump racing (race distance 3,200–6,400 m). Methods: Cardiac auscultation and color flow Doppler (CFD) echocardiography were performed on 777 occasions. The associations between the presence and severity of either an audible cardiac murmur or valvular regurgitation assessed by CFD, and published, objective measures of race performance were determined using a standard regression approach. Results: The prevalence of murmurs and of regurgitation varied significantly between racetypes ( P<.02), generally increasing from 2-year olds to chasers. There were no consistent associations between racing performance and either grade of murmur or regurgitation, whether the presence or absence of regurgitation or murmur, or only murmurs ≥3/6 or regurgitation ≥6/9, were considered. Conclusions and Clinical Importance: There were differences in prevalence and severity of murmurs of atrioventricular and aortic valve regurgitation between racehorses in different disciplines. Data also showed that neither regurgitation nor murmurs were negatively associated with Timeform rating, an index of UK racehorse quality, in any of the groups of racehorses studied. [ABSTRACT FROM AUTHOR]

This report highlights the need for close surveillance of bioprosthetic valves. Unaccountable degeneration of bioprosthetic valves can develop early after implantation and usually requires replacing the failed valve with a mechanical prosthesis. [ABSTRACT FROM AUTHOR]

Presents several studies about arterial structure and compliance. "The Effect of Chronic Coffee Consumption on Aortic Stiffness and Wave Reflections in Hypertensive Patients," by Nikolaos Alexopoulos et al; "Hypertensive Men With Erectile Dysfunction Have Increased Aortic Stiffness Compared to Hypertensives With Normal Erectile Function," by Gregory Vyssoulis et al; "The Regulatory Role of Matrix Metalloproteinases-2 and -9 on Arterial Stiffness in Healthy Adults," by Konstantinos Aznaouridis et al.

This study evaluated cryopreserved homografts (Group 1) and porcine heterografts decellularized with deoxicholic acid (Group 2), implanted in the right ventricular outflow tract of juvenile sheep. Two groups with four animals in each were used and all animals survived with good outcome. Animals were sacrificed 90 or more days after surgery (90–150 days). On the third and fifth postoperative months they were submitted to echocardiographic examination with normal function and appearance observed for both groups. Explants were evaluated through histological analysis, atomic spectrophotometry and radiological examination. Calcium content was higher in the cusps of cryopreserved homografts, despite an otherwise similar macroscopic appearance between grafts of both groups. Decellularized heterografts were progressively repopulated by autologous cells suggesting some regenerative ability and longer durability than conventional homografts. [ABSTRACT FROM AUTHOR]

Unlabelled: The aims of this study were to evaluate cardiac involvement, assess risk factors and mortality, and define the outcome of cardiac abnormalities with age in the different types of mucopolysaccharidoses (MPS). The echocardiograms of 99 patients with MPS, aged 1-24 y (median age 10.3 y) were reviewed between 1978 and 2000. Mitral regurgitation (MR) was detected in 29 patients (29%). MR was more frequent in types IH [n = 11 (38%)], II [n = 10 (24%)] and III [n = 4 (20%)]. Sixteen patients (16%) developed aortic regurgitation (AR), seen mostly in types II [n = 9 (56%)] and IV [n = 4 (24%)]. AR and/or MR was detected in 37 patients and 8 had both abnormalities of borderline significance (odds ratio 2.95, 95% confidence interval 1.0-8.85, p = 0.05). Of 99 patients, 47 had a normal study on their first echocardiogram, whereas only 7 had a normal study on subsequent echocardiograms. Fifty-four (54%) had a single echocardiogram. Of these, 27 (50%) were abnormal and 27 normal. Forty-five patients had more than one echocardiogram, of which 25 (56%) were abnormal and 20 normal. In 13/20 (65%) a cardiac abnormality developed on a subsequent echocardiogram which was statistically significant (p = 0.002). Overall mitral and aortic valve abnormalities showed a positive association with age. Univariate analysis of risk factors showed that increasing age, MPS I and ejection fraction were significant risk factors for death. However, left ventricular hypertrophy, mitral valve abnormalities and type II MPS were not significant risk factors for death, with borderline significance for aortic valve abnormalities.Conclusion: This study demonstrates the evaluation of ventricular function, which is a significant risk factor for death, along with increasing age and MPS I, and outlines the borderline significance of aortic valve abnormalities, which has not been mentioned in previous studies. It also shows that mitral valve lesions, commonly seen in MPS, were not a significant risk factor for death. The results emphasize the importance of performing serial echocardiograms in patients with MPS to assess ventricular function and the progression of cardiac abnormalities with age. [ABSTRACT FROM AUTHOR]

Background: Patients with aortic dissection during pregnancy and postpartum period exhibit a high mortality. At present, a complete overview of aortic dissection during pregnancy and postpartum period is lacking. ​Methods: This systematic review included 80 reports published from 2000 to 2020, comprising a total study population of 103 patients with aortic dissection. ​Results: We found that Stanford Type A aortic dissection was more common in prepartum cases, especially in the third trimester, while postpartum cases of aortic dissection were more common in Stanford Type B. The most common risk factor was connective tissue disease, with no other known risk factors. The mode of delivery had no significant effect on the type of postpartum aortic dissection. Reduced maternal and fetal mortality was observed when patients with Stanford Type A aortic dissection occurring after 28 gestational weeks underwent cesarean section followed by aortic replacement. Patients with Stanford Type B aortic dissection were treated mainly with medication and/or endovascular repair. ​Conclusion: Contemporary management of patients during pregnancy and within 12 weeks postpartum requires multidisciplinary cooperation and includes serial, noninvasive imaging, biomarker testing, and genetic risk profiling for aortopathy. Early diagnosis and accurate treatment are essential to reduce maternal and fetal mortality., (© 2021 Wiley Periodicals LLC.)

Background Arterial thromboses following cisplatin-based chemotherapy in head and neck cancers are extremely rare and devastating complication. Methods and Results A 54-year-old male smoker had an acute history of left lower limb pain and calf claudication 3 days following the first cycle of cisplatin-based chemotherapy given concurrently with radiotherapy for squamous cell carcinoma of the base of tongue. CT angiography showed extensive abdominal aortic thrombus along with involvement of left common iliac, saphenopopliteal, and tibeal arteries as well as moderate stenosis in the proximal segments of left anterior descending and right coronary artery. We suggest that endothelial damage and hypercoaguable state secondary to cisplatin may have induced severe arterial and coronary thrombosis. Conclusions This is the first reported case of acute multiple arterial thrombosis following cisplatin in head and neck cancer. It is a dreaded complication and has a dismal prognosis if not promptly recognized and treated. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]

Spontaneous calcific cerebral embolus is a rare complication of calcific vascular disease such as calcified aortic plaques, and calcific aortic and mitral stenosis. Fewer than 10 case reports are described in the literature. Cerebral ischaemic symptoms may provide the indication for surgical replacement, even in the absence of valvular insufficiency or stenotic symptoms. We report a case of stroke in a young man with a known bicuspid calcific aortic valve. [ABSTRACT FROM AUTHOR]

Introduction: Cor-Knot automated fastener has been used as an adjunct in heart valve surgery to eliminate the need for manual tying during valve implantation. Although reduced operative time and facilitation for minimally invasive surgery are clear benefits, whether their use translates to improved patient outcome remains debatable. This study aims to review the safety and efficacy of automated fasteners in heart valve surgeries., Method: Specific searches were conducted via online medical databases (Pubmed, Embase, Ovid) between 1950 and June 2019. Longitudinal studies were included that provided operative parameters., Results: The initial literature search identified 3773 articles, but only eight met the inclusion criteria and were used for analysis: four studies related to aortic valve replacement (AVR), four related to mitral valve (MV) intervention (total n = 810). The meta-analysis revealed the significantly shorter aortic cross-clamp time in the Cor-knot group compared to manual tying, both in AVR and MV surgeries (P < .05). Cardiopulmonary bypass time was significantly shorter in the Cor-knot group when analyzing studies in MV surgery (weighted mean difference [WMD]: 110.0; 95% confidence interval: 12.3-207.7; P = .027) The use of Cor-Knot did not increase the risk of permanent pacemaker implantation, paravalvular leak, and 30-day mortality. The majority of studies reported no change in the length of intensive unit care and total hospital stay., Conclusion: We confirmed that the majority of existing literatures indicated the safety and intraoperative efficacy with automated fastener application. Nevertheless, there is currently no evidence to support automated fastened sutures can translate its intraoperative advantages to improved patient outcome., (© 2019 Wiley Periodicals, Inc.)