Search

Risk for transmission of SARS-CoV-2 through allogeneic human tissue transplantation is unknown. To further evaluate the risk of virus transmission, tissues were obtained from deceased donors who had tested positive for SARS-CoV-2 RNA via nasopharyngeal swab. This study evaluated an array of human tissues recovered for transplantation, including bone, tendon, skin, fascia lata, vascular tissues, and heart valves. Tissue samples and plasma or serum samples, if available, were tested for viral RNA (vRNA) using a real time PCR system for the presence of virus RNA. All samples were tested in quadruplicate for both subgenomic (sgRNA) and genomic (gRNA) RNA encoding the SARS-CoV-2 nucleocapsid gene. Amplification of a cellular housekeeping gene served as the positive control for every sample. A total of 47 tissue samples from 17 donors were tested for SARS-CoV-2 RNA. Four donors had plasma or serum available for paired testing. SARS-CoV-2 RNA was not detected from any tissue or plasma/serum sample tested. Based on these findings, risk of transmission through the transplantation of tissue types studied from SARS-CoV-2 infected donors is likely to be low.

While quadricuspid morphology is commonly observed in truncal valves, quadricuspid aortic valves (QAV) are rare and their natural history is not well described. This retrospective study of 37 patients describes the diagnostic associations and morphologic variability of QAVs in children (median age at diagnosis 4.3 y IQR 0–12 y). Associated congenital heart diseases were present in 54% (most commonly tetralogy of Fallot (TOF) and valvar pulmonary stenosis). Among patients with isolated QAV, 11 had genetic syndrome and 5 had skeletal anomalies. Valve morphology was most commonly type B (41%) and A (35%; Hurvitz and Roberts). Dilated aortic root (Z ≥ 2) was present in 5 and dilated ascending aorta in 9 patients at diagnosis. All patients with type C (n = 3) and G (n = 1) had aortic dilation. At diagnosis, >mild AR was rare (n = 1), mild regurgitation was common (n = 12, 32%), >mild AS was rare (n = 2), and mild AS was uncommon (n = 4). Over a median follow-up of 3.3y (IQR 0.9-11y), progression of AR was seen in 2 patients and progression of aortic root or ascending aorta dilation (increase in Z score by ≥ 2) was seen in 5 patients. In conclusion, QAV is a rare congenital anomaly and about half of the cases are found in hearts that are otherwise structurally normal. A relatively high prevalence is seen in patients with TOF, pulmonary stenosis, skeletal deformities, and genetic syndromes. Meticulous evaluation of aortic valve morphology should be conducted on echocardiograms performed for these indications. [ABSTRACT FROM AUTHOR]

Progressive differentiation controlled by intercellular signaling between pharyngeal mesoderm, foregut endoderm, and neural crest-derived mesenchyme is required for normal embryonic and fetal development. Gasotransmitters (criteria: 1) a small gas molecule; 2) freely permeable across membranes; 3) endogenously and enzymatically produced and its production regulated; 4) well-defined and specific functions at physiologically relevant concentrations; 5) functions can be mimicked by exogenously applied counterpart; and 6) cellular effects may or may not be second messenger-mediated, but should have specific cellular and molecular targets) are integral to gametogenesis and subsequent embryogenesis, fetal development, and normal heart maturation. Important for in utero development, the heme oxygenase/carbon monoxide system is expressed during gametogenesis, by the placenta, during embryonic development, and by the fetus. Complex sequences of biochemical pathways result in the progressive maturation of the human heart in utero. The resulting myocardial architecture, consisting of working myocardium, coronary arteries and veins, epicardium, valves and cardiac skeleton, endocardial lining, and cardiac conduction system, determines function. Oxygen metabolism in normal and maldeveloping hearts, which develop under reduced and fluctuating oxygen concentrations, is poorly understood. "Normal" hypoxia is critical for heart formation, but "abnormal" hypoxia in utero affects cardiogenesis. The heme oxygenase/carbon monoxide system is important for in utero cardiac development, and other factors also result in alterations of the heme oxygenase/carbon monoxide system during in utero cardiac development. This review will address the role of the heme oxygenase/carbon monoxide system during cardiac development in embryo and fetal development. [ABSTRACT FROM AUTHOR]

Rebecca T. Hahn, a Professor of Medicine at Columbia University Irving Medical Center, is a visionary in structural heart disease and interventional echocardiography. Born in St. Louis, Missouri, to Chinese immigrant parents, she has made significant contributions to the field, training numerous fellows and colleagues in valve imaging. Dr. Hahn's work focuses on percutaneous approaches to aortic, mitral, and tricuspid valve diseases, and she has led key consensus statements on valve imaging and recognition of imaging in structural heart disease competencies. Her research and leadership have been instrumental in advancing the field of interventional echocardiography. [Extracted from the article]

Introduction: Infections with coagulase negative staphylococcal species (CoNS) are a major cause of mortality and morbidity in joint and heart valve replacement procedures, largely due to biofilm formation. Cells within biofilms have higher rates of antibiotic resistance than their planktonic counterparts; consequently, novel mechanisms are needed to combat these infections. Methods: To enhance antibiotic delivery and penetration, this innovative study involved treating CoNS biofilms with murine blood clots impregnated with antibiotics. We then investigated the impact of this treatment on biofilm density, metabolism, and architecture. Results: Our pilot study demonstrates that this method of antibiotic delivery results in improved biofilm clearance, relative to conventional exposure methods. Discussion: Our results demonstrate that blood clot exposure has an intrinsic impact on biofilm density and potentially reduces colonization, warrenting further investigation into the mechanism. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cardiac surgery is associated with perioperative complications, some of which might be attributable to hypotension. The Hypotension Prediction Index (HPI), a machine-learning-derived early warning tool for hypotension, has only been evaluated in noncardiac surgery. We investigated whether using HPI with diagnostic guidance reduced hypotension during cardiac surgery and in the ICU. DESIGN: Randomized clinical trial conducted between May 2021 and February 2023. SETTING: Single-center study conducted in an academic hospital in the Netherlands. PATIENTS: Adults undergoing elective on-pump coronary artery bypass grafting, with or without single heart valve surgery, were enrolled if a mean arterial pressure (MAP) greater than or equal to 65 mm Hg was targeted during the surgical off-pump phases and ICU stay. After eligibility assessment, 142 of 162 patients approached gave informed consent for participation. INTERVENTIONS: Patients randomized 1:1 received either diagnostic guidance in addition to standard care if HPI reached greater than or equal to 75 (n = 72) or standard care alone (n = 70). MEASUREMENTS AND MAIN RESULTS: The primary outcome was the severity of hypotension, measured as time-weighted average (TWA) of MAP less than 65 mm Hg. Secondary outcomes encompassed hypertension severity and intervention disparities. Of 142 patients randomized, 130 were included in the primary analysis. The HPI group showed 63% reduction in median TWA of hypotension compared with the standard care group, with a median of differences of –0.40 mm Hg (95% CI, –0.65 to –0.27; p < 0.001). In the HPI group, patients spent a median 28 minutes (95% CI, 17–44 min) less in hypotension, with a measurement duration of 322 minutes in the HPI group and 333 minutes in the standard care group. No significant differences were observed in hypertension severity, treatment choice, or fluid, vasopressors, and inotrope amounts. CONCLUSIONS: Using HPI combined with diagnostic guidance on top of standard care significantly decreased hypotension severity in elective cardiac surgery patients compared with standard care. [ABSTRACT FROM AUTHOR]

The study was conducted during July to October, 2020 at the Department of Veterinary Anatomy, College of Veterinary Science and Animal Husbandry, Nanaji Deshmukh Veterinary Science University, Jabalpur, Madhya Pradesh, India to investigate the histological and histochemical features of the hearts of 18 prenatal healthy goats (Capra hircus). The heart shape varied among the groups; groups I and II exhibited an ovoid shape, while group III had a flattened cone shape. Histological examinations revealed both superficial and deep cardiac muscle fibers in the atrial walls, forming muscular arches in the atrium. The ventricular myocardium was composed of three distinct layers of muscle fibers, with the middle layer being the thickest. The left ventricular wall was significantly thicker than the right. The cardiac valves were identified as endocardial flaps. Histochemical analysis showed that collagen and elastic fibers were more abundant in the atria than in the ventricles, with collagen primarily surrounding blood vessels. Reticular fibers formed networks in both the atria and ventricles. A weak to moderate periodic acid- Schiff (PAS) reaction was observed in the atria, ventricles, blood vessels, and atrioventricular cusps. Metachromasia was noted in both the atria and ventricles. Additionally, DNA content in atrial nuclei exhibited moderate staining across all age groups. These findings provide a detailed histological and histochemical description of prenatal goat heart development, contributing to the understanding of fetal cardiovascular maturation. [ABSTRACT FROM AUTHOR]

This study presents a novel method to enhance the biocompatibility of decellularized porcine aortic segments while preserving their mechanical properties and histological structure. Detergent-decellularized aortic segments were treated with modified globular chitosan (Novochizol™) at varying concentrations (0.5%, 1%, 2%, and 3%) by sonication and subsequently subjected to mechanical testing. To further improve cell infiltration, blind-ended laser channels were created within the decellularized segments. The modified grafts were then seeded with porcine vascular interstitial cells in vitro for 7 days or implanted into the thoracic aorta of minipigs for 30 days. Histological analysis was performed at each stage of the study. Impregnation with Novochizol™ significantly increased the specific strength (from 0.97 ± 0.19 MPa to 4.99 ± 2.43 MPa) and Young's modulus (from 0.73 ± 0.06 MPa to 14.66 ± 7.14 MPa) of the decellularized aortic segments. Histological examination confirmed the preservation of the connective tissue matrix's morphological structure. Optimal modification conditions were identified as a 30 min sonication in a 1% Novochizol™ solution at 25 °C. A 35 ms continuous laser treatment was sufficient to create a 1 mm deep blind-ended channel, thereby promoting the seeding of vascular interstitial cells within the acellular graft, as confirmed by implantation in minipigs. [ABSTRACT FROM AUTHOR]

Background/Objectives: For transcatheter aortic valve implantation (TAVI) therapy, a catheter-guided crimped valve is deployed into the aortic root. Valve types such as Edwards balloon-expandable valves and Medtronic self-expandable valves come in different sizes and are chosen based on patient-specific aortic anatomy, including aortic root diameter measurement. Complications may arise due to variations in anatomical characteristics and the implantation procedure, making pre-implantation assessment important for predicting complications. Methods: Computational modeling, particularly finite element analysis (FEA), has become popular for assessing wall stresses and deformations in TAVI. In this study, a finite element model including the aorta, native leaflets, and TAVI device was used to simulate procedures and assess patient-specific wall stresses and deformations. Results: Using the Medtronic Evolut R valve, we simulated TAVI for 14 patients to analyze the effects of geometrical variations on structural stresses. Virtual TAVIs with different valve sizes were also simulated to study the influence of TAV size on stresses. Our results show that variations in aortic wall geometries and TAV sizes significantly influence wall stresses and deformations. Conclusions: Our study is one of the first comprehensive FEA investigations of aortic geometrical variations and valve sizes on post-TAVI stresses, demonstrating the non-linear relationship between aortic dimensions, TAV sizes, and wall stresses. [ABSTRACT FROM AUTHOR]

Systemic inflammation after heart valve replacement surgery commonly results in complications including cognitive impairment. This study was designed to investigate whether valvular heart disease itself and inflammation after valve replacement surgery affects cognition and the related functional connectivity (FC) of the hippocampal memory network. Forty-three patients with valvular heart disease were screened for recruitment and assessed with cognition function tests, blood inflammatory cytokine measurements, and functional magnetic resonance imaging scans before surgery and on postoperative day 7 and 30. Age- and sex-matched healthy controls (n =30) were recruited for comparison. The brain FC networks using the hippocampus as a seed were analysed. Bivariate correlation and structural equation model analyses were carried out to investigate the association between altered FC, memory, and inflammation. Thirty-five patients and 29 healthy controls completed the study, and their data were finally analysed and reported. Compared with healthy controls, the surgery group had increased FC in the bilateral precuneus and middle cingulate and paracingulate gyri before surgery. They exhibited impaired memory, increased plasma concentrations of proinflammatory cytokines, and decreased hippocampal FC at postoperative day 7. At 30 days after surgery, the FC abnormalities seen before surgery and at postoperative day 7 were restored to the level comparable with the healthy controls. High systemic inflammation was significantly associated with worse memory and lower FC in the hippocampal memory network. Valve replacement surgery temporarily disrupts the hippocampal memory network with transient associated memory decline. ChiCTR2300069614. [ABSTRACT FROM AUTHOR]

Mechanosensitive processes in cardiac development rely on various tissue mechanics, all of which are crucial for proper morphogenesis. Recent progress in in vivo models such as zebrafish and chicken has significantly enhanced our understanding of the biomechanics of cardiac morphogenesis owing to their experimental manipulability. Biophysical modeling of mechanical stress is providing new perspectives on cardiac biomechanics and offers important insights into heart development. Advances in a wide range of methodologies are capturing the biomechanics involved in cardiac development, thereby contributing to a comprehensive understanding of these processes. The structural development of the heart depends heavily on mechanical forces, and rhythmic contractions generate essential physical stimuli during morphogenesis. Cardiac cells play a critical role in coordinating this process by sensing and responding to these mechanical forces. In vivo , cells experience rhythmic spatial and temporal variations in deformation-related stresses throughout heart development. What impact do these mechanical forces have on heart morphogenesis? Recent work in zebrafish (Danio rerio) offers important insights into this question. This review focuses on endocardial (EdCs) and myocardial cells (cardiomyocytes, CMs), key cell types in the heart, and provides a comprehensive overview of forces and tissue mechanics in zebrafish and their direct influence on cardiac cell identity. [ABSTRACT FROM AUTHOR]

Tricuspid valve transcatheter edge-to-edge repair has emerged as a valuable treatment option for patients with severe tricuspid regurgitation (TR). This study aims to investigate the safety and effectiveness of the PASCAL transcatheter valve repair system in treating severe TR in a real-world patient population. The PASTE (PASCAL for Tricuspid Regurgitation—a European registry) study is an investigator-initiated, multicenter, retrospective, and prospective observational cohort analysis conducted across 16 European heart valve centers including consecutive patients treated with the PASCAL transcatheter valve repair system from February 2019 to November 2023. Echocardiographic assessments were performed at baseline, discharge, and follow-up, and were subjected to centralized analysis. The study included 1,059 high-risk patients (mean age 79 ± 9 years; 53% female; TRI-SCORE risk 23% ± 18%; 87% NYHA functional class III/IV) with multiple comorbidities. Severe or higher graded TR was observed in 96% of patients. Intraprocedural success according to Tricuspid Valve Academic Research Consortium criteria was achieved in 85%, and TR reduced to ≤moderate in 87%. Independent predictors for a postprocedure residual TR of >moderate were coaptation gaps ≥8 mm (OR: 1.67; 95% CI: 1.03-2.72; P = 0.038), tenting height ≥10 mm (OR: 2.18; CI: 1.30-3.65; P = 0.003), the presence of a transvalvular lead (OR: 1.91; 95% CI: 1.19-3.05; P = 0.007), right ventricular dilatation >42 mm (OR: 3.35; 95% CI: 1.37-9.1; P = 0.009) and massive/torrential TR at baseline (OR: 4.59; 95% CI: 2.35-8.96; P < 0.001). At 1 year, 83% of patients showed ≤moderate TR. Significant clinical improvements included enhanced NYHA functional class (66% class I/II vs 17% at baseline; P < 0.001). Patients treated with the first-generation PASCAL system (n = 570) and with the new PASCAL Precision system (n = 489) had similar clinical profiles and TR severity at baseline. However, the Precision cohort showed greater TR reduction to trace/mild (63% vs 49%; P < 0.001), shorter procedure times (median 93 minutes [Q1-Q3: 69-130 minutes] vs 120 minutes [Q1-Q3: 82-165 minutes]; P < 0.001), and higher clinical success rates according to the Tricuspid Valve Academic Research Consortium at 30 days and 1 year (87% vs 81% [ P = 0.021] and 56% vs 50% [ P = 0.044], respectively). Higher center experience (≥21 patients/year) resulted in higher intraprocedural and clinical success. The PASCAL system effectively treats severe TR in high-risk patients, offering sustained TR reduction and significant clinical improvements at 1-year follow-up. (PASCAL for Tricuspid Regurgitation—a European registry [PASTE]; NCT05328284) [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The selection of an appropriate gastrointestinal (GI) reconstruction procedure after proximal gastrectomy (PG) has long been a challenge. Surgeons have had a long history of exploring anti-reflux gastroesophageal anastomosis. The aim of this article is to systematically summarize the anti-reflux principles of GI reconstructive procedures through a review of the previous literature and to provide a theoretical basis for clinicians to select or innovate procedures. Methods: The PubMed, Google Scholar, China National Knowledge Infrastructure, Cochrane Databases and Medline were searched using Medical Subject Headings terms and keywords from inception until May 1, 2023. We traced the early research on the anti-reflux mechanisms of the esophagogastric junction and analyzed each piece of literature. Results: Three principles according to the current mainstream anti-reflux esophagogastrostomy: (1) reduction of the acid secreting glands; (2) reconstruction of the His angle or fundus; (3) reconstruction of the anti-reflux valve resembles the cardiac (including barrier method, rotation method, and compression method). This article provides a literature review of anti-reflux esophagogastrostomy after PG. Conclusions: Anti-reflux esophagogastrostomy, represented by seromuscular flap valvuloplasty, which restored the natural physiological structure, had better feasibility and safety theoretically. However, this still needs to be supported by evidence from large multi-center prospective randomized controlled studies. [ABSTRACT FROM AUTHOR]

Background: The volume of cardiac valve and coronary artery revascularization procedures is rising in the United States. This cross-sectional study explores ethnic disparities in mortality in cardiac surgery attributed to mechanical failures of implantable heart valves and coronary artery grafts. Methods: We used the CDC Wide-Ranging Online Data for Epidemiologic Research Multiple Causes of Death database to identify patients whose single cause of death was categorized by complications of cardiovascular prosthetic devices, implants, and grafts (ICD-10 code T82) between 1999 and 2020. The Joinpoint software (version 5.2.0, National Cancer Institute) was used to construct log-linear regression models to estimate the average annual percent changes in age-adjusted mortality (per 100,000). These patterns were compared and stratified by sex, age (0–44, 44–64, and 65 years or older), and US census regions between White, Black, Hispanic, non-Hispanic, American Indian, Alaskan Native, Asian American, and Pacific Islanders. Results: Age-adjusted mortality due to mechanical failures of cardiac implants and grafts declined across ethnicities from 2.21 (95% CI 2.16–2.27) in 1999 to 0.88 (95% CI 0.85–0.91) in 2020. Black populations (1.31 [95% CI 1.20–1.42]), both men (1.56 [95% CI 1.37–1.74]) and women (1.02 [95% CI 0.90–1.15]) experienced higher mortality in 2020 compared to all other ethnicities. This disparity was pronounced in younger groups (age 0–64), wherein age-adjusted mortality among Black populations (0.18 [95% CI 0.13–0.25]) more than doubled that of White populations (0.08 [95% CI 0.06–0.10]). Conclusions: Over the last two decades, age-adjusted mortality due to mechanical complications of cardiovascular implants has declined significantly. However, Black men and women, particularly younger patients, continue to experience higher death rates compared to other ethnicities. [ABSTRACT FROM AUTHOR]

Non-bacterial thrombotic endocarditis (NBTE), formerly recognized as marantic endocarditis, represents a rare cardiovascular pathology intricately linked with hypercoagulable states, notably malignancy and autoimmune disorders. Characterized by the development of sterile vegetations comprised of fibrin and platelets on cardiac valves, NBTE poses a diagnostic challenge due to its resemblance to infective endocarditis. Therapeutic endeavours primarily revolve around addressing the underlying aetiology and instituting anticoagulant regimens to forestall embolic events, with surgical intervention seldom warranted. Non-bacterial thrombotic endocarditis frequently coexists with malignancies and autoimmune conditions, such as lupus and antiphospholipid antibody syndrome, and, more recently, has been associated with COVID-19. Its pathogenesis is underpinned by a complex interplay of endothelial dysfunction, hypercoagulability, hypoxia, and immune complex deposition. Clinical manifestations typically manifest as embolic phenomena, particularly cerebrovascular accidents, bearing substantial mortality rates. Diagnosis necessitates a high index of suspicion and meticulous exclusion of infective endocarditis, often facilitated by advanced cardiac imaging modalities. Anticoagulation, typically employing low molecular weight heparin or warfarin, constitutes the cornerstone of pharmacological intervention. Surgical recourse may be warranted in instances of refractory heart failure or recurrent embolic events. Given its multifaceted nature, the management of NBTE mandates a multidisciplinary approach, with prognosis contingent upon individual clinical intricacies. Future endeavours should prioritize further research to refine therapeutic strategies and enhance patient outcomes. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsInfective endocarditis (IE) is diagnosed using the Duke criteria, which were updated in 2023. In the Duke-ISCVID 2023 criteria, Gemella was recognised as a typical IE pathogen. This study investigates the impact of this change and compares the clinical characteristics of Gemella IE to IE caused by other pathogens.Data on IE caused by Gemella species and other pathogens was retrieved from the Swedish Registry of Infective Endocarditis (SRIE). Clinical characteristics of Gemella IE were compared to episodes of IE caused by non-beta haemolytic streptococci, by Staphylococcus aureus and by enterococci.In the SRIE, 29 episodes of Gemella IE were identified among a total of 7677 registered episodes, corresponding to 0.4% of all cases. The most common species were Gemella morbillorum (47%) and Gemella bergerii (27%). The proportion of episodes meeting the criteria for definite IE increased from 13 (45%) with the modified Duke criteria to 21 (72%) with the Duke-ISCVID criteria. Median age of patients with Gemella IE was 70 years, 40% were females and 90% hade native valve IE. One third of the patients underwent heart valve surgery and only one patient (3%) died. Many clinical aspects of IE caused by Gemella resembled those of IE caused by non-beta haemolytic streptococci.Gemella IE is a rare condition and shares several characteristics with IE caused by non-beta haemolytic streptococci. The prognosis of IE caused by Gemella appears to be relatively favourable. [ABSTRACT FROM AUTHOR]

Objective: To explore the safety and efficacy of low-intensity anticoagulation in patients after On-X mechanical aortic valve replacement. Methods: A total of 104 patients undergoing aortic valve replacement in Cardiac Surgery Department of Sichuan Provincial People's Hospital from December 2018 to December 2021 were randomly divided into low-intensity anticoagulant (INR:1.5-2.0) and high-intensity anticoagulant (INR:2.0-2.5) to compare the incidence of adverse events related to postoperative anticoagulation between the two groups. Results: Fifty-three patients were included in the low-intensity anticoagulation group (INR 1.5-2.0), and 51 patients were included in the high-intensity group (2.0-2.5). There was no significant difference in baseline data and surgical index between the two groups (P > 0.05); there were statistically significant differences in PT, INR and bleeding events (P < 0.05), but no significant difference in embolic events (P > 0.05). Conclusion: For patients requiring On-X mechanical aortic valve replacement who have no risk factors for thromboembolism, it is appropriate to control the INR in the target range 1.5-2.0, which can reduce the incidence of bleeding adverse events and significantly improve the quality of life, without increasing the risk of thromboembolic adverse events. [ABSTRACT FROM AUTHOR]

Decellularized grafts have shown promising results in tissue engineering. The aim of decellularization is to create a scaffold that is devoid of immunogenic components, has natural tissue architecture, and can provide cellularity again. The aim of our study is to obtain a living/regenerative valve by coculture of HUVEC and human dermal fibroblast cells on the pulmonary heart valves of decellularized young sheep and subsequently perform their in vitro characterization to determine its suitability for clinical studies. Various characterization tests were applied to sheep pulmonary heart valves decellularized by the detergent-based method. HUVEC and dermal fibroblast cells were seeded on the scaffold, and their viability was determined by MTT analysis, adhesion by SEM, and cell infiltration by histological staining. Finally, to determine the regenerative ability of the resulting live cap, collagen type I (Col1), collagen type III (Col3), and elastin (Eln) gene expressions were analyzed by PCR. The results showed that cell proliferation increased day by day on the scaffold. In histological findings, it was observed that cellular regeneration was almost completely achieved, especially in arterial wall samples. According to PCR findings, a significant increase in Col1, Col3, and Eln gene expressions was observed in arterial wall samples. In this study, for the first time in the literature, the regeneration potential of differentiated human cells on decellularized sheep heart valves was observed, and markers related to new ECM production were analyzed. In conclusion, we suggest that the decellularized heart valves of young sheep can be used as a starting matrix in tissue engineering studies, and clinical studies are needed. [ABSTRACT FROM AUTHOR]

Simulating the cardiac valves is one of the most complex tasks in cardiovascular modeling. As fluid–structure interaction simulations are highly computationally demanding, machine-learning techniques can be considered a good alternative. Nevertheless, it is necessary to design many aortic valve geometries to generate a training set. A method for the design of a synthetic database of geometric models is presented in this study. We suggest using synthetic geometries that enable the development of several aortic valve and left ventricular models in a range of sizes and shapes. In particular, we developed 22 variations of left ventricular geometries, including one original model, seven models with varying wall thicknesses, seven models with varying heights, and seven models with varying shapes. To guarantee anatomical accuracy and physiologically acceptable fluid volumes, these models were verified using actual patient data. Numerical simulations of left ventricle contraction and aortic valve leaflet opening/closing were performed to evaluate the electro-physiological potential distribution in the left ventricle and wall shear stress distribution in aortic valve leaflets. The proposed synthetic database aims to increase the predictive power of machine-learning models in cardiovascular research and, eventually, improve patient outcomes after aortic valve surgery. [ABSTRACT FROM AUTHOR]

The article discusses the use of percutaneous peripheral cannulation for minimally invasive heart valve surgery, focusing on the results from the Multicenter Promise Registry in Germany. The study compared patients who underwent plug-based versus suture-based vascular closure devices (VCDs) during the surgery. The findings showed that patients in the plug-based group had higher rates of immediate hemostasis and lower need for additional VCDs or surgical cut-down, indicating that the use of dedicated VCDs for vascular access site closure is feasible and safe. Overall, the study concluded that perioperative vascular access site complications were low in both groups, suggesting that this approach may become standard practice in minimally invasive heart valve surgery. [Extracted from the article]

The article discusses the challenges of using natural hydrogels in tissue engineering due to their poor mechanical properties, particularly in load-bearing soft tissues like the heart. The study introduces a natural bioink, GelGOMA, covalently linked to graphene oxide, which exhibits enhanced biocompatibility, mechanical strength, and electrical conductivity suitable for 3D bioprinting of mini heart structures. The GelGOMA hydrogel shows promising results in terms of conductivity, compressive strength, and printability, making it a potential candidate for tissue engineering applications in functional hearts and wearable electronic devices. [Extracted from the article]

This article compares the outcomes of using supraannular self-expanding transcatheter heart valves (THV) versus intraannular THV in patients with small aortic annuli for transcatheter aortic valve implantation (TAVI). The study found that both types of THV showed similar early clinical and hemodynamic outcomes, with no significant differences in mortality, pacemaker implantation, stroke, myocardial infarction, renal failure, or device success rates. While the study suggests that the Nitinol stent design in small aortic annuli may offer hemodynamic benefits, further research is needed to assess the long-term durability of these results. [Extracted from the article]

This article discusses the use of transcatheter aortic valve implantation (TAVI) in patients with left ventricular assist devices (LVAD) and aortic regurgitation (AR). The study found that using dedicated devices and pre-stenting in device landing zones improved procedural success in these high-risk patients. The research highlights the need for further studies to enhance outcomes and improve long-term survival in this challenging patient population. [Extracted from the article]

The article discusses the optimization of the decellularization process of native porcine heart valves to obtain cell-free xenograft scaffolds with the best mechanical properties. Through various decellularization protocols, researchers were able to extract nearly all DNA content using a new experimental protocol (NEP) involving eco-friendly detergents and enzymes. The resulting substitutes showed lower systolic gradients and higher valve opening areas compared to untreated leaflets, indicating potential for reduced immunogenicity and support for tissue-engineered heart valves. [Extracted from the article]

The article discusses the development of biodegradable poly-ε-caprolactone (PCL) scaffolds for tissue-engineered 3D tri-leaflet valved stents as an alternative treatment for right ventricular outflow tract dysfunction. Human endothelial colony-forming cells (ECFCs), human induced pluripotent stem cell-derived MSCs (hMSCs), and porcine MSCs (pMSCs) were successfully seeded on the scaffolds for 3 weeks to create the valved stent grafts. The study found that all cell lineages were able to increase the leaflet area within the 3-week timeframe, showing promise for future therapeutic options. [Extracted from the article]

This article discusses the use of balloon over- and underfilling strategies in transcatheter aortic valve implantation (TAVI) for patients with borderline aortic annuli dimensions. The study analyzed outcomes of 126 patients who received TAVI using balloon-expandable transcatheter heart valves with modified balloon filling volumina. The results showed that individualized balloon filling strategies were safe and effective in addressing borderline aortic annulus dimensions, with overfilling more common in patients with mild calcification and underfilling less frequent. Propensity score matching revealed no significant differences in clinical endpoints between patients with individualized versus nominal balloon filling. [Extracted from the article]

This article examines changes in patient characteristics and procedural measures over a 10-year period in aortic valve-in-valve procedures for degenerated surgical bioprostheses. The study found a shift towards lower-risk profiles in patients over time, changes in access routes and types of transcatheter heart valves used, shorter procedure times, and increased rates of certain procedures like BASILICA and valve fracturing. Despite these changes, outcomes such as device success, stroke, and 30-day mortality remained consistently positive, indicating the procedure's clinical efficacy and safety. [Extracted from the article]

The article "Impact of Calcification on Hemodynamic Performance of Tubular Heart Valves" explores the influence of calcifications on the hemodynamic properties of different heart valve geometries. The study compares a newly developed tubular aortic valve prosthesis with a conventional tricuspid AVP, finding that the tubular valve design shows a more favorable response to calcification in terms of pressure gradients and effective orifice area. The research suggests that alternative valve geometries, such as the tubular design, could offer significant benefits over current biological aortic valve prostheses, but further studies are needed to confirm long-term viability. [Extracted from the article]

The article "Development and Hemodynamic Analysis of Low-pressure Tubular Heart Valves" explores the creation and testing of a tubular heart valve designed for interventional mitral valve replacement. The study compares this tubular valve with a traditional three-leaflet bioprosthesis, showing that the tubular valve design resulted in lower pressure gradients and increased effective orifice area (EOA). These findings suggest potential advantages for the tubular valve in low-pressure systems like the pulmonary veins. [Extracted from the article]

This article discusses the outcomes of transcatheter aortic valve implantation (TAVI) in patients who had previous aortic root surgery with failing native or prosthetic aortic valves. The study included 21 patients who underwent TAVI after various types of aortic root surgeries. The results showed that TAVI for failing aortic root surgery is safe and feasible, with low rates of mortality and rehospitalization at the 1-year mark. The study emphasizes the importance of meticulous planning and analysis to minimize risks in this specific subgroup of patients. [Extracted from the article]

The article discusses the challenges of replacing failing heart valves with transcatheter valves, which have a limited durability of approximately 10 years. To address the need for replacement, TAVI valve in valve procedures are often used, but the inner diameter of the degenerated valve sets limits on the size of the new valve. The study examines the expansion process of various prostheses using different balloons and devices, highlighting the importance of selecting suitable tools for effective valve expansion. The results show that while expansion is possible, it varies depending on the valve type and design, emphasizing the need for further development of appropriate techniques and embolic protection devices. [Extracted from the article]

This article discusses an in-vitro study on the hydrodynamic performance of different transcatheter heart valves (THV) in small surgical heart valves (SHV) during valve-in-valve (ViV) procedures. The study found that self-expandable supra-annular THV had lower transvalvular pressure gradients and leakage volumes compared to balloon-expandable THV, especially at high cardiac output. The results suggest that supra-annular THV may be a better option for ViV implantation in SHV with small annuli, but the high gradients under stress indicate the need for surgical reintervention in such cases. [Extracted from the article]

The article compares Aortic Valve-in-Valve (ViV) procedures for degenerated bioprosthetic surgical aortic valve replacement (SAVR) with transcatheter heart valves (THV). The study found that ViV procedures for both SAVR and THV showed similar clinical safety and efficacy, but there were differences in procedural measures, such as the types and sizes of valves used. The time to ViV was notably shorter after transcatheter aortic valve implantation (TAVI), indicating a potential increase in ViV procedures for THV in the future. [Extracted from the article]

Background: According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC's program, but few data have been reported so far. Methods: We retrospectively collected patients with isolated, native aortic valve stenosis who had been visited in our HVC at least once between 2021 and 2024. For each outpatient visit, symptoms, physical examination, echocardiographic data, complementary tests, and indications were acquired. Also, adverse events (hospitalization, unplanned procedures, and death) were retrieved. Results: A total of 320 patients were included. Mean visits/patient ratio was 1.2. At the first visit, 69.7% already had severe aortic stenosis, and severe symptoms (NYHA ≥ III) were evident in 24.4%. In addition, 26.5%, 59.1%, 12.8%, and 1.6% were in Généreux stage I, II, III, and IV, respectively. Overall, 197 (78.5%) and 54 (21.5%) patients received an indication for transcatheter AVR and surgical AVR, respectively. AVR-free survival was 46%, 23%, and 6% at 6, 12, and 24 months, respectively (mean 8.8 months CI95% 7.7–9.9). Adverse event-free survival was 97.2%, 95.5%, and 85% at 3, 6, and 12 months, respectively. Conclusions: Patients referred to our HVC already had an advanced disease with cardiac damage. Transcatheter AVR was mostly indicated, and it showed excellent short-term results. A low rate of adverse events was seen among patients in follow-up, but the odds of receiving AVR were high and driven by Généreux's stage. Despite these favorable results, further efforts to sensitize earlier patient referral should be made. [ABSTRACT FROM AUTHOR]

A fundamental event in the formation of heart valves involves the transformation of endocardial cells within the outflow tract (OFT) and atrioventricular canal (AVC) cushions through a process known as endothelial-to-mesenchymal transition (EndMT). Aberrant EndMT is a primary cause of congenital valvular malformations. Manic Fringe (MFNG) has been previously associated with cardiovascular development, although its role in heart valve development remains underexplored. In this study, we seek to enhance our understanding of MFNG's involvement in valve formation and its association with EndMT. Staining results of histological section revealed the expression of MFNG in the AVC and OFT from embryonic day 9.5 to 10.5 (E9.5–E10.5), when EndMT takes place. Cellular data demonstrated that MFNG exerts a positive regulatory influence on the EndMT process, promoting endothelial cell (EC) migration by enhancing the activity of the Notch signalling pathway. MFNG knockdown mediated by antisense morpholino oligonucleotides (MO) injection caused abnormal development of the heart and valves in zebrafish. Furthermore, through whole-exome sequencing (WES), we identified a heterozygous MFNG mutation in patients diagnosed with tetralogy of Fallot-pulmonary valve stenosis (TOF-PS). Cellular and molecular assays confirmed that this deleterious mutation reduced MFNG expression and hindered the EndMT process. In summary, our study verifies that MFNG plays a role in promoting EndMT mediated by the Notch signalling pathway during the heart and valve development. The MFNG deleterious variant induces MFNG loss of function, potentially elucidating the underlying molecular mechanisms of MFNG's involvement in the pathogenesis of congenital heart valve defects. These observations contribute to our current genetic understanding of congenital heart valve disease and may provide a potential target for prenatal diagnosis and treatment. Key messages: Our examination revealed, for the first time, that MFNG exhibited high expression levels during EndMT of heart valve development in mice. Our findings provide compelling evidence that MFNG plays a role in promoting EndMT mediated by the Notch signalling pathway. Our results identified, for the first time, a deleterious MFNG p. T77M variant that inhibited the EndMT process by downregulating the activity of the Notch signalling pathway, thereby preventing the normal valve formation. MFNG may serve as an early diagnostic marker and an effective therapeutic target for the clinical treatment of congenital heart valve defects. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, several trials and observational studies have validated the use of minimally invasive cardiac interventions as viable treatment options for various cardiac diseases. Transcatheter techniques for severe aortic valve stenosis have rapidly emerged as alternatives to surgical aortic valve replacement in certain patient populations. Additionally, non-surgical treatment options have expanded for conditions affecting other cardiac valves, such as the mitral valve. These emerging minimally invasive interventions complement already well-established endovascular techniques for, among others, atrial septal defect closure, left atrial appendage occlusion and pulmonary vein isolation in patients with atrial fibrillation. Given their non-surgical nature and lack of direct visualisation of the targeted anatomy, these procedures heavily rely on precise pre-procedural radiological imaging for optimal patient selection and procedural success. Method: This paper is based on the expert opinion of the authors and an exhaustive literature research. Results: This manuscript reviews the most commonly employed minimally invasive cardiac interventions, highlighting the essential pre-procedural imaging information and key aspects that must be included in radiological reports to mitigate potential complications. Conclusion: Accurate pre-procedural imaging is crucial for ensuring safe and effective minimally invasive cardiac interventions, underscoring the importance of the radiologist in the pre-procedural work-up of these patients. [ABSTRACT FROM AUTHOR]

The valve-in-valve transcatheter-aortic-valve-implantation (VIV-TAVI) represents an emerging procedure for the treatment of degenerated aortic bio-prostheses, and the occurrence of patient-prosthesis mismatch (PPM) after VIV-TAVI might affect its clinical efficacy. This study aimed to test a multimodal imaging approach to predict PPM risk during the TAVI planning phase and assess its clinical predictivity in VIV-TAVI procedures. Consecutive patients undergoing VIV-TAVI procedures at our Institution over 6 years were screened and those treated by self-expandable supra-annular valves were selected. The effective orifice area (EOA) was calculated with a hybrid Gorlin equation combining echocardiographic data with invasive hemodynamic assessment. Severe PPM was defined according to such original multimodality assessment as EOAi≤0.65 cm2/m2 (if BMI < 30 kg/m2) or < 0.55 cm2/m2 (if BMI ≥ 30 kg/m2). The primary endpoint was a composite of all-cause mortality and valve-related re-hospitalization during the clinical follow-up. A total of 40 VIV-TAVI was included in the analysis. According to the pre-specified multimodal imaging modality assessment, 18 patients (45.0 %) had severe PPM. Among all baseline clinical and anatomical characteristics, estimated glomerular filtration rate before VIV-TAVI (OR 0.872, 95%CI[0.765–0.994], p = 0.040), the echocardiographic pre-procedural ≥moderate AR (OR 0.023, 95%CI[0.001–0.964], p = 0.048), the MSCT-derived effective internal area (OR 0.958, 95%CI[0.919–0.999], p = 0.046) and the implantation depth (OR 2.050, 95%CI[1.028–4.086], p = 0.041) resulted as independent predictors of severe PPM at multivariable logistic analysis. At a mean follow-up of 630 days, patients with severe PPM showed a higher incidence of the primary endpoint (9.1%vs.44.4 %; p = 0.023). In VIV-TAVI using self-expandable supra-annular valves, a multimodal imaging approach might improve clinical outcome predicting severe PPM occurrence. Hybrid assessment of effective orifice area with multimodal imaging Abbreviations: VIV = valve-in-valve; TAVI = transcatheter aortic valve implantation; THV = transcatheter heart valve; PPM = patient-prosthesis mismatch; eGFR = estimated glomerular filtration rate; AR = aortic regurgitation; EOA = effective orifice area; HR = heart rate; SV = stroke volume; SEP = systolic ejection period; MG = mean gradient; EIA: effective internal area Created with BioRender.com [Display omitted] • The valve-in-valve transcatheter-aortic-valve-implantation (VIV-TAVI) represents an emerging procedure for the treatment of degenerated aortic bio-prostheses, and the occurrence of patient-prosthesis mismatch (PPM) might affect its clinical efficacy. • This study aimed to test a multimodal imaging approach to predict PPM risk during the TAVI planning phase and assess its clinical predictivity in VIV-TAVI procedures. • In VIV-TAVI using self-expandable supra-annular valves, a multimodal imaging approach might improve clinical outcome predicting severe PPM occurrence. [ABSTRACT FROM AUTHOR]

Background The initial outcomes of transcatheter aortic valve replacement in patients with left ventricular outflow tract calcification are poor. Furthermore, balloon-expandable transcatheter aortic valve replacement is associated with an increased risk of annular rupture, and self-expandable transcatheter aortic valve replacement is associated with worse post-operative residual paravalvular leakage grades. Therefore, developing an optimal method for transcatheter aortic valve replacement for patients with left ventricular outflow tract calcification is desirable. Case summary We present two cases of successful balloon-expandable transcatheter aortic valve replacement, wherein the transcatheter heart valve was implanted above the left ventricular outflow tract calcification to avoid annular rupture and paravalvular leakage, and one case each of balloon-expandable and self-expandable transcatheter aortic valve replacements, wherein the transcatheter heart valve was implanted at a normal height. Although annular rupture did not occur in any of the cases, more-than-mild paravalvular leakage persisted post-operatively in cases where the transcatheter heart valve was placed at a normal height. Discussion Annular rupture is more likely to occur in areas with high calcification at the joint than in noncalcified areas. Furthermore, the greater the calcification in the landing zone of the transcatheter heart valve, the more the paravalvular leakage persists. Therefore, high implantation of transcatheter heart valves above the left ventricular outflow tract calcification can be an effective method to avoid annular rupture and paravalvular leakage. [ABSTRACT FROM AUTHOR]

Background: Mastocytosis is a systemic disease involving the clonal expansion of mast cells in multiple organs. Given that immune system overreaction and excessive histamine release are among the most prominent events in mastocytosis, the incidence of complications caused by immune reactions is expected to increase across various organs. While systemic manifestations of mastocytosis have been reported frequently, cardiac complications are less often discussed. These Cardiac complications can be early indicators of the disease but such uncommon features may lead to delays in diagnosis. The significance of mast cells and histamine release in the cardiovascular system is acknowledged in prior studies. Case Presentation: This study presents a case of recurrent prosthetic mitral valve malfunction in a 52-year-old patient with a history of cutaneous mastocytosis, who underwent mitral valve replacement three times over ten years. Despite being on appropriate anticoagulation therapy (INR: 2.5-3.5), the patient experienced recurrent prosthetic valve thrombosis. This is, to our knowledge, the first report of prosthetic mitral valve thrombosis in a patient with mastocytosis. Conclusion: Interestingly, cardiac complications may be the first presentation of systemic mastocytosis, diagnosed long after the initial symptoms. The majority of such cases had no visible cutaneous manifestations (table 1). Regarding our case report, we recommend our colleagues to closely monitor and remain vigilant for possible cardiac symptoms of mastocytosis patients with prosthetic cardiac valves. [ABSTRACT FROM AUTHOR]

Background: Automated 4D flow MRI valvular flow quantification without time‐consuming manual segmentation might improve workflow. Purpose: Compare automated valve segmentation (AS) to manual (MS), and manually corrected automated segmentation (AMS), in corrected atrioventricular septum defect (c‐AVSD) patients and healthy volunteers, for assessing net forward volume (NFV) and regurgitation fraction (RF). Study Type: Retrospective. Population: 27 c‐AVSD patients (median, 23 years; interquartile range, 16–31 years) and 24 healthy volunteers (25 years; 12.5–36.5 years). Field strength/Sequence: Whole‐heart 4D flow MRI and cine steady‐state free precession at 3T. Assessment: After automatic valve tracking, valve annuli were segmented on time‐resolved reformatted trans‐valvular velocity images by AS, MS, and AMS. NFV was calculated for all valves, and RF for right and left atrioventricular valves (RAVV and LAVV). NFV variation (standard deviation divided by mean NFV) and NFV differences (NFV difference of a valve vs. mean NFV of other valves) expressed internal NFV consistency. Statistical Tests: Comparisons between methods were assessed by Wilcoxon signed‐rank tests, and intra/interobserver variability by intraclass correlation coefficients (ICCs). P < 0.05 was considered statistically significant, with multiple testing correction. Results: AMS mean analysis time was significantly shorter compared with MS (5.3 ± 1.6 minutes vs. 9.1 ± 2.5 minutes). MS NFV variation (6.0%) was significantly smaller compared with AMS (6.3%), and AS (8.2%). Median NFV difference of RAVV, LAVV, PV, and AoV between segmentation methods ranged from −0.7–1.0 mL, −0.5–2.8 mL, −1.1–3.6 mL, and − 3.1–‐2.1 mL, respectively. Median RAVV and LAVV RF, between 7.1%–7.5% and 3.8%–4.3%, respectively, were not significantly different between methods. Intraobserver/interobserver agreement for AMS and MS was strong‐to‐excellent for NFV and RF (ICC ≥0.88). Data Conclusion: MS demonstrates strongest internal consistency, followed closely by AMS, and AS. Automated segmentation, with or without manual correction, can be considered for 4D flow MRI valvular flow quantification. Level of Evidence: 3 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Background: Infective endocarditis (IE) is an infectious disease caused by the hematogenous dissemination of bacteria into heart valves. Improving the identification of pathogens that cause IE is important to increase the effectiveness of its therapy and reduce the mortality caused by this pathology. Methods: Ten native heart valves obtained from IE patients undergoing heart valve replacements were analyzed. Bacterial invasion in the heart valves was studied by Gram staining of histological sections. Histopathological changes accompanied with bacterial invasion were studied by immunohistochemical analysis of pan-leukocyte marker CD45, platelet marker CD41, and neutrophil myeloperoxidase. The taxonomic diversity of the bacteria was analyzed using 16S rRNA metabarcoding. Results: Gram staining of the histological sections revealed bacterial cells localized on the atrial surface at the leaflet's free edge or on the ventricular surface at the leaflet's base within fibrin deposits in only three of the studied heart valves. Bacterial colonies were co-localized with microthrombi (CD41+ cells) containing single leucocytes (CD45+ cells), represented by segmented neutrophils. As a result of 16S rRNA metabarcoding, we detected the following bacterial genera: Pseudomonas (70% of the studied heart valves), Roseateles (60%), Acinetobacter (40%), Sphingomonas (40%), Enterococcus (30%), Reyranella (20%), Sphingobium (20%), Streptococcus (20%), Agrobacterium (20%), Ralstonia (10%), and Bacillus (10%). Conclusions: A number of opportunistic microorganisms that could not be detected by routine laboratory tests and were not eliminated during antibiotic therapy were identified in the IE-affected heart valves. The obtained results show the importance of 16S rRNA metabarcoding of heart valves removed due to IE not only as an independent diagnostic method but also as a highly accurate approach that complements routine tests for pathogen identification. [ABSTRACT FROM AUTHOR]

Hydrogel-based soft machines are promising in diverse applications, such as biomedical electronics and soft robotics. However, current fabrication techniques generally struggle to construct multimaterial three-dimensional hydrogel architectures for soft machines and robots, owing to the inherent hydrogel softness from the low-density polymer network nature. Herein, we present a multimaterial cryogenic printing (MCP) technique that can fabricate sophisticated soft hydrogel machines with accurate yet complex architectures and robust multimaterial interfaces. Our MCP technique harnesses a universal all-in-cryogenic solvent phase transition strategy, involving instant ink solidification followed by in-situ synchronous solvent melting and cross-linking. We, therefore, can facilely fabricate various multimaterial 3D hydrogel structures with high aspect ratio complex geometries (overhanging, thin-walled, and hollow) in high fidelity. Using this approach, we design and manufacture all-printed all-hydrogel soft machines with versatile functions, such as self-sensing biomimetic heart valves with leaflet-status perception and untethered multimode turbine robots capable of in-tube blockage removal and transportation. Hydrogel-based machines have potential in a range of applications, but it can be challenging to prepare multimaterial devices with complex structures. Here, the authors report the development of a multimaterial cryogenic printing technique that can be used to prepare three-dimensional structures with geometries such as overhanging, thin-walled and hollow. [ABSTRACT FROM AUTHOR]

Heart disease remains a leading cause of mortality worldwide, making early detection and diagnosis crucial for preventing severe outcomes. Echocardiogram based classification of heart valve conditions is vital for effectively diagnosing and managing heart disease. In this paper, we present a novel hybrid deep learning framework that integrates convolutional neural networks (CNNs) with recurrent neural networks (RNNs) alongside a 3D-Echo Fusion approach and a Dual Attention Model for heart valve disease classification using echocardiogram videos. Our method employs a CNN-based encoder to extract spatial features from individual video frames, which are then enhanced through a 3D-Echo Fusion technique to capture comprehensive volumetric information. An RNN models the temporal dynamics of heart valve motion, while the Dual Attention Model refines the classification process by enabling the model to focus on the most relevant features. This integration results in a classification accuracy of 98.7% and an AUC score of 0.85, demonstrating the model’s effectiveness in heart valve disease classification. The high accuracy and interpretability of the model provide potential clinical benefits by supporting decision-making and improving patient care. Furthermore, our proposed method addresses challenges related to the variability and complexity of cardiac data, aligning with current research that advocates for automated learning models in interpreting echocardiographic imagery. By leveraging advanced deep learning techniques, including 3D-Echo Fusion, our approach promises high classification accuracy while reducing reliance on manual annotations, thus enhancing scalability in cardiac diagnostics.

The reconstruction of a heart valve through in situ tissue engineering remains a formidable challenge, particularly for patients with diabetes mellitus, because the pathophysiological alterations associated with diabetes substantially impair the cardiovascular system's intrinsic repair capacity. In this study, reactive oxygen species (ROS) regulation are integrated into the fabrication of pro‐endothelialization interfaces to counteract the adverse repair environment. Specifically, a heparin‐mimicking alginate‐derived glycopeptide and the natural ROS scavenger melanin are modified onto the surface of a decellularized extracellular matrix (dECM). This tailored interface significantly enhances endothelial cell (EC) adhesion while reducing platelet adhesion. The incorporation of melanin effectively suppresses ROS elevation in ECs and macrophages under hyperglycemic conditions. Consequently, this intervention promotes EC rejuvenation by enhancing proliferation, migration, and anti‐apoptotic capabilities, while concurrently attenuating the release of inflammatory and pro‐fibrotic factors by macrophages. The dECM is intravascularly implanted in a diabetic rabbit model after being fabricated into a covered stent, demonstrating favorable remodeling characteristics such as enhanced endothelialization and reduced fibrotic deposition. This scaffold design, specifically tailored to the pathological conditions of diabetes, offers a precise biomaterial strategy for in situ heart valve tissue engineering. [ABSTRACT FROM AUTHOR]