Trans-Catheter Valve-in-Valve Implantation for the Treatment of Aortic Bioprosthetic Valve Failure

Aortic valve-in-valve (ViV) procedure is a valid treatment option for patients affected by bioprosthetic heart valve (BHV) degeneration. However, ViV implantation is technically more challenging compared to native trans-catheter aortic valve replacement (TAVR). A deep knowledge of the mechanism and features of the failed BHV is pivotal to plan an adequate procedure. Multimodal imaging is fundamental in the diagnostic and pre-procedural phases. The main challenges associated with ViV TAVR consist of a higher risk of coronary obstruction, severe post-procedural patient-prosthesis mismatch, and a difficult coronary re-access. In this review, we describe the principles of ViV TAVR.

Shone’s Complex and Aortic Dissection: Case Report and Review of a Rare, Underdiagnosed Congenital Heart Disease

BackGround Shone’s complex is a rare congenital heart disease consisting of a variety of left ventricular inflow and outflow tract lesions. Patients typically present in childhood and require early surgical intervention. However, with improved surgical techniques these patients are surviving later into adulthood which comes with a new set of medical complications providers need to be aware of. Case Presentation We present a case of a patient with a complex cardiac history including an incomplete Shone’s complex diagnosed in childhood with multiple surgical interventions who presents with persistent symptomatic atrial flutter and a type A aortic dissection in the setting of severe patient prosthesis mismatch. The patient was being followed outpatient for an enlarging chronic aortic aneurysm and was non-compliant with his medications when he presented with sharp chest pain radiating to his back. He was found to have an acute type A aortic dissection and was taken emergently to the operating room for a skirted Bentall procedure, aortic valve replacement, and right sided MAZE. Conclusions Shone’s complex is a rare congenital heart disease associated with significant morbidities in adulthood, such as atrial flutter, patient prosthesis mismatch, and aortic dissection. As patients continue to live longer into adulthood with this disease, it is important to raise awareness of this rare syndrome for providers and highlight its potential complications. Further research is needed to determine appropriate guidelines for when to intervene on aortopathy-associated CHD.

Technique for Adaptation of Konno Aortoventriculoplasty in Patient-Prosthesis Mismatch

The patient-prosthesis mismatch has been reported as an important cause of adverse outcome following aortic valve replacement. The relief of patient-prosthesis mismatch generally requires a reoperation of comprehensive nature, which necessitates an extensive aortic root enlargement. The Konno aortoventriculoplasty represents an efficient treatment option, as this technique provides both extreme root enlargement and relief of the frequently associated subvalvular obstruction. However, the application and conduct of the procedure may somewhat differ from the pediatric Konno procedures.This article describes our surgical technique adaptation in Konno-aortoventriculoplasty for adult patient-prosthesis mismatch cases, highlighting the differing points from the pediatric-Konno.

Nghiên cứu đặc điểm bất tương hợp van - bệnh nhân sau thay van nhân tạo điều trị hẹp van động mạch chủ tại Bệnh viện Trung ương Quân đội 108

Mục tiêu: Nhận xét đặc điểm bất tương hợp van - bệnh nhân (Patient - prosthesis mismatch: PPM) ở bệnh nhân thay van nhân tạo điều trị hẹp van động mạch chủ (HC) và một số yếu tố liên quan. Đối tượng và phương pháp: 67 bệnh nhân được thay van động mạch chủ điều trị hẹp chủ tại Bệnh viện Trung ương Quân đội 108 trong thời gian 2010 - 2020. Nghiên cứu mô tả tiến cứu với các biến số: Tình trạng PPM và các yếu tố liên quan như bệnh kết hợp, chênh áp, NYHA và chỉ số khối cơ thất trái (LVMI). Kết quả: PPM nhẹ chiếm 1,5 – 20% trong 48 tháng theo dõi, không có PPM vừa và nặng. Các yếu tố liên quan PPM gồm nữ giới và đái tháo đường (p<0,05), tăng huyết áp, cỡ van (21 - 23), loại van sinh học không có mối liên quan (p>0,05). Chênh áp qua van tương quan chặt chẽ với PPM theo phương trình hồi qui tuyến tính bậc 2. PPM làm tăng độ suy tim theo NYHA (p<0,05) và giảm LVMI trở về bình thường sau mổ (p<0,05). Kết luận: Lựa chọn van nhân tạo phù hợp với người bệnh là rất quan trọng ảnh hưởng đến đến sự cải thiện triệu chứng và hình thái thất trái sau mổ.

Patient Prosthesis Mismatch in Double Valve Replacement - A Retrospective Study at a Tertiary Care Center in Bangalore

BACKGROUND Valve replacement has become the mainstay of management for rheumatic heart diseases. However, an important and frequent complication of valve replacement is patient prosthesis mismatch (PPM). The present study was undertaken to evaluate a single institution experience on the clinical pattern and presentation of PPM, and the outcomes of double valve replacement surgery. METHODS This retrospective, regional study was carried out among 316 consecutive patients who underwent concomitant aortic and mitral valve surgery (with or without tricuspid annuloplasty) in this tertiary care hospital. Particulars regarding the clinical profile and procedure details (valve types and sizes and priority of surgery) of these patients were documented from the medical records. RESULTS In this institute, the valves used were predominantly mechanical (92.6 %) when compared to bioprosthesis in 7.4 % (47/632 valves - 23 mitral position and 24 in aortic position). The most common sizes used in the aortic and mitral position were 21 mm & 27 mm respectively. In spite of the seemingly lower sizes used in the patients undergoing double valve replacement (DVR) the incidence of PPM is less owing to the fact that the population under study had a lower body surface area (BSA) and body mass index (BMI) - 1.17 ± 0.3 & 19.86 ± 3.9 respectively. CONCLUSIONS It may be emphasized that if the valve size required to be implanted is derived based on the patient’s BSA and indexed effective orifice area, the incidence of patient prosthesis mismatch can be minimized drastically and with it the in-hospital mortality and morbidity. KEYWORDS Aortic Stenosis, Double Valve Replacement, Mitral Valve, Prosthesis, Rheumatic Heart Disease