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How to cite: Geske, J. B., Evans, T. C., Jr, & Nishimura, R. A. (2015). Quantitative Cardiology: Back to Square One. The Journal of heart valve disease, 24(3), 404.

Background and aim of the study: The trileaflet heart valve is a more desirable mechanical heart valve due to its similarity to native heart valves, which produce a central blood flow with decreased blood flow disturbance. There are, however, many challenges and difficulties in designing a trileaflet valve, mainly due to a greater number of moving mechanical parts.

Methods: The flow profiles through a bileaflet mechanical heart valve (BMHV) and a trileaflet mechanical heart valve (TMHV) were compared at downstream regions. Geometric models of a 29 mm St. Jude Medical BMHV and a TMHV were used and positioned at the anatomic position in a curved aortic downstream geometry. Three-dimensional numerical simulations for both types of mechanical heart valve were performed under normal physiological pulsatile flow conditions. Flow profiles were studied under three different implantation locations at Z = 1D (D = 29 mm inlet diameter), 2D and 4D along the aorta centerline during peak systole.

Results: The simulation results showed different flow fields at the downstream positions at Z = 1D and 2D. The leaflets of the BMHV obstructed the flow, while the TMHV allowed a central orifice flow which resulted in a more physiological flow profile. Further downstream, at Z = 4D, the flow fields shared similarities in terms of the flow profile and velocity magnitude.

Conclusion: The findings of this study may help to further improve the development of the TMHV.

How to cite: Kuan, Y. H., Nguyen, V. T., Kabinejadian, F., & Leo, H. L. (2015). Computational Hemodynamic Investigation of Bileaflet and Trileaflet Mechanical Heart Valves. The Journal of heart valve disease, 24(3), 393–403.

Background and aim of study: A kinetic profile revealing calcification progression is a powerful method for assessing the anti-calcification efficacy of various tissue treatments compared to the traditional analysis of a single time point in studies with rabbits.

Methods: Tissue calcification was compared between test and control discs in rabbits. Test groups received either ThermaFix-processed bovine pericardium, or porcine leaflets processed with Linx, or alpha-amino oleic acid (AOA). Control groups received glutaraldehyde-treated porcine valve leaflets, and bovine pericardium. Tissue discs were implanted intramuscularly in rabbits and explanted every five days until day 75. Levels of calcium and phosphorus were then monitored in the rabbit tissues.

Results: Calcium concentrations were plotted over time, with a sigmoidal curve being used for each kinetic profile. The ThermaFix group exhibited a lower calcium plateau level compared to the bovine control (107 ± 24 versus 258 ± 120 μg Ca2+ per mg dry tissue, respectively), while the Linx group exhibited a lower calcium plateau compared to porcine controls (130 ± 34 μg versus 280 ± 80 μg Ca2+ per mg dry tissue, respectively). The AOA group showed a low level of calcification through 40 days, but this was subsequently increased to a plateau of 258 ± 135 μg Ca2+ per mg dry tissue.

Conclusion: The study results showed that effects on the rate and level of calcification of anti-calcification technologies can be modulated. In particular, time is important when assessing tissue technology effectiveness.

How to cite: Wright, G., & de la Fuente, A. (2015). Effectiveness of Anti-Calcification Technologies in a Rabbit Model. The Journal of heart valve disease, 24(3), 386–392.

Osler's disease is a rare condition of autosomal dominant inheritance characterized by bleeding and telangiectasia of the skin and mucosal membranes. A few reports exist of open-heart surgery in patients with Osler's disease. Here, the case is presented of a successful pulmonary valvuloplasty using autologous pericardium to treat active infectious endocarditis of the pulmonary valve in a patient with Osler's disease. Such patients are at higher risk of bacteremia because of their chronic nasal bleeding or pulmonary arteriovenous fistula. In patients with Osler's disease, valuvloplasty using autologous pericardium is considered effective for preventing the later recurrence of IE.

How to cite: Konishi, Y., Sakon, Y., Nakamura, K., Fukunaga, N., Kanemitsu, H., & Koyama, T. (2015). Pulmonary Valvuloplasty by Autologous Pericardium in a Patient with Active Infectious Endocarditis and Osler's Disease. The Journal of heart valve disease, 24(3), 383–385.

Cardiac sarcomas are rare and have a poor prognosis. The details are presented of a patient with a right atrial angiosarcoma who underwent radical resection with reconstruction of the right atrium with a bovine pericardial patch, tricuspid valve replacement, and bypass of the right coronary artery. Survival is improved in patients who successfully undergo total (R0) resection. For this reason, an aggressive approach to resection is recommended, with extensive reconstruction for all patients with cardiac sarcoma.

How to cite: Chiu, P., Black, A., & Woo, Y. J. (2015). Radical Resection of Cardiac Angiosarcoma with Atrioventricular Reconstruction. The Journal of heart valve disease, 24(3), 379–382.

A 40-year-old female of African origin presented in the 32nd week of her second pregnancy with thrombosis of a bileaflet mechanical prosthesis implanted in the mitral position. After an emergency cesarean section, she was successfully treated by means of a multidisciplinary approach.

How to cite: Celiento, M., Levantino, M., Cela, V., Cioni, R., Guarracino, F., & Bortolotti, U. (2015). Management of Prosthetic Thrombosis During Pregnancy: Importance of a Multidisciplinary Approach. The Journal of heart valve disease, 24(3), 376–378.

Background and aim of the study: The population of pregnant women with valvular heart disease (VHD), and in particular with valvular heart prostheses (VHPs), represents a unique patient group where data are scarce, and where there is an increased risk for adverse maternal and obstetric events. The study aim was to assess the experience of a tertiary center with regards to cardiac and pregnancy outcomes in women with VHD, comparing VHPs with other VHD pathologies.

Methods: A retrospective analysis of 84 pregnancies in women with VHD (mean age 27.5 ± 5.5 years) was carried out over a 10-year period. Twenty-three pregnancies with VHPs (group A) and 61 with other VHD pathologies (group B) were identified and their cardiac, obstetric, and neonatal outcomes evaluated.

Results: At the start of pregnancy, group A included more patients with an impaired left ventricular ejection fraction (LVEF) (15.8% versus 3.9%, p = 0.014), with a previous history of cardiac medication (82.6% versus 29.5%, p = 0.000), and with arrhythmic or ischemic events (18.2% versus 4.9%, p = 0.076). A deterioration in NYHA functional class was the most common cardiac complication (8.3%), and in 7.1% of patients it was necessary to initiate some form of cardiac medication. No maternal deaths were recorded. Group A presented significantly more hemorrhagic and thrombotic complications; all of these events were in women receiving low-molecular-weight heparin. There were 95.5% live births, with a medium birth weight of 3068 ± 498 g. In the VHP group there was also a higher incidence of spontaneous abortion (26.1 versus 3.3, p = 0.005), newborns small for gestational age (30.0 versus 0.4, p = 0.07) and mean Apgar score < 7 (16.7 versus 0.0, p = 0.031). Warfarin embryopathy was observed in one case.

Conclusion: With the multidisciplinary care provided, pregnancy was relatively well tolerated and successful. However, the presence of a VHP remains a challenging condition that is associated with elevated maternal and fetal morbidity. A worse baseline cardiac status of the mother, as well as anticoagulation issues, were determinants for these findings.

How to cite: Monteiro, A. V., Rebelo, J., Patricio, L., Campos, A., Borges, A., & Ferreira, R. C. (2015). Ten Years' Experience of Pregnancy Outcomes in Women with Cardiac Valvulopathies: Are Valve Prostheses Worst?. The Journal of heart valve disease, 24(3), 368–375.

Background and aim of the study: Aortic valve replacement in patients with a small aortic root may be associated to high residual gradients. In such patients, both stentless valves and aortic annulus enlargement can reduce these residual gradients. Several studies have reported that Trifecta valves yield very good hemodynamic results. The aim of the present study was to compare the hemodynamic performance of Trifecta vs. Freestyle valves at one year in patients with an aortic annulus ≤ 2.3 cm.

Methods: Between September 2011 and September 2013, 40 patients with a native aortic annulus diameter ≤ 2.3 cm and average age of 81 ± 4 years, were randomized to receive either a St-Jude Trifecta stented prosthesis (20 patients) or a Medtronic Freestyle stentless prosthesis (20 patients).

Results: No differences between Trifecta and Freestyle were found at one year in mean gradient s: 6.1 ± 3 mmHg and 6.6 ± 3 mmHg (p = 0.796); effective ori fice area: 1.82 ± 0.3 mmHg and 1.76 ± 0.4 mmHg (p = 0.676) or regression of left ventricular mass: - 25% ± 14 vs. -19% ± 16 (p = 0.204), respectively. Only moderate patient -pro sthesis mismatch was found, which affected 3 patient s in each group.

Conclusion: At one year both stentless and stented prostheses yielded comparable hemodynamic results. These data suggest that Trifecta implantation is a valid means of avoiding patient -prosthesis mismatch in aortic valve replacement in elderly patients with a small native aortic annulus.

How to cite: Tasca, G., Martino, A. S., Giannico, F., Riva, B., Redaelli, P., Lobiati, E., Triggiani, M., Galanti, A., & Gamba, A. (2015). Hemodynamic comparison between Trifecta and Freestyle valves implanted in small aortic roots. One-year echocardiographic results from a prospective randomized study. The Journal of heart valve disease, 24(3), 360–367.

Background and aim of the study: Prosthetic valve thrombosis (PVT) is a rare but serious complication of the prosthetic heart valve. Although recent guidelines generally recommend surgical treatment as the main option for patients with obstructive left-sided PVT, thrombolytic therapy (TT) may offer another attractive approach. There is also no consensus on the type, dose and route of administration of thrombolytic agents. The present study included a small series of patients with low-dose, slow infusion tissue-type plasminogen activator (tPA) to treat PVT in the mitral position.

Methods: Eight consecutive episodes of mitral PVT (one woman was pregnant) in seven patients were treated with low-dose (25 mg), slow infusion (within 6 h) tPA, if needed, with repeat sessions of TT (with the same protocol up to a total dose of 150 mg) until a satisfactory result was achieved.

Results: The cause of PVT was inadequate anticoagulation with warfarin or low-molecular-weight heparin in all patients on admission. A complete resolution of hemodynamic instability and echocardiographic abnormalities was observed in all cases, without mortality. In addition, there were no thromboembolic and major hemorrhagic complications in the case series.

Conclusion: These findings suggest that low-dose, slow infusion tPA may be applicable to bileaflet mitral PVT in relatively stable patients, and may represent a therapeutic option to surgery.

How to cite: Ari, H., Dogan, A., Ceviker, K., Aksoy, F., Arslan, A., & Varol, E. (2015). A Case Series of Obstructive Prosthetic Mitral Valve Thrombosis, Successfully Treated with Low-Dose, Slow Infusion Tissue-Type Plasminogen Activator. The Journal of heart valve disease, 24(3), 353–359.

Background and aim of the study: The percutaneous approach for a failed bioprosthetic valve is an emerging alternative to redo-valve surgery in patients at high surgical risk. The study aim was to describe the treatment of patients with structural bioprosthetic valve deterioration, using the valve-in-valve technique.

Methods: A total of 33 consecutive patients with symptomatic structural bioprosthetic valve deterioration was treated at the authors' institution, using the valve-in-valve technique.

Results: The valve-in-valve procedure in the aortic position was performed in 23 patients (mean age 81.4 ± 5.9 years; mean STS score 9.6 ± 5.4). The self-expandable and balloon-expandable devices were used in 21 cases (91.3%) and two cases (8.7%), respectively. Procedures were performed via the trans-femoral, trans-axillary and trans-apical routes in 18 (78.2%), three (13%) and two (8.7%) cases, respectively. After the procedure, all patients were in NYHA class I/II. Survival rates were 95.6% at the one-year follow up. The valve-in-valve procedure in the mitral position was performed in 10 patients (mean age 73.6 ± 15 years; mean STS score 7.7 ± 4.1). All procedures were performed using the balloon-expandable device via the trans-apical route. The composite end point of device success was achieved in all patients. Survival rates were 100% and 75% at one month and two years' follow up, respectively. A single valve-in-valve implantation within a failed tricuspid bioprosthetic valve was also successfully performed.

Conclusion: In the authors' experience, the valve-in-valve technique for the treatment of a wide range of bioprosthetic valve deterioration modes of failure in different valve positions is safe and very effective.

How to cite: Codner, P., Assali, A., Vaknin-Assa, H., Shapira, Y., Orvin, K., Sharony, R., Sagie, A., & Kornowski, R. (2015). Treatment of Aortic, Mitral and Tricuspid Structural Bioprosthetic Valve Deterioration Using the Valve-in-Valve Technique. The Journal of heart valve disease, 24(3), 345–352.

Next-generation transcatheter heart valves are designed to overcome procedure-related adverse events such as vascular complications and annulus rupture, and to minimize paravalvular regurgitation. The Direct Flow Medical valve is fully repositionable and shows promising results. The case is presented of Direct Flow Medical valve implantation in a patient with a functional bicuspid aortic valve. Multiple repositioning maneuvers failed to overcome the anatomic difficulties, and this resulted in a moderately high persisting gradient and moderate paravalvular leakage. Surgical valve explantation was necessary which, to the present authors' knowledge, is the first such case of Direct Flow Medical valve explantation to be performed.

How to cite: Scholtz, S., Horstkotte, D., Gummert, J., Börgermann, J., & Scholtz, W. (2015). First Explantation of Direct Flow Medical Transcatheter Valve. The Journal of heart valve disease, 24(3), 342–344.

The optimal surgical intervention for tricuspid valve endocarditis remains challenging in the setting of intravenous drug abuse. The situation is often complicated by aggressive bacterial pathogens, an increased risk of reinfection and reoperation, and poor long-term survival, despite a typically younger age at presentation. Herein, the case is presented of a 30-year-old female with infective endocarditis of the tricuspid valve secondary to intravenous drug abuse. The patient underwent minimally invasive tricuspid valve reconstruction utilizing a bovine pericardial tricuspid tube. This is a viable alternative to conventional techniques, and may reduce the risk of reinfection and reoperation, maintain ventriculo-tricuspid integrity, provide structural support, and also be performed via a minimally invasive approach.

How to cite: Mihos, C. G., Pineda, A. M., Santana, O., Krishna, R. K., & Lamelas, J. (2015). Tricuspid Valve Repair with Pericardial Tube Placement via a Right Minithoracotomy. The Journal of heart valve disease, 24(3), 338–341.

The number of transvenous extraction procedures for leads of intracardiac rhythm devices increased recently and the most common reason for lead extraction is device infection. In some cases, combined use of two different techniques is necessary. Long-term results of this approach are not clear. In this case report, we present a patient with biventricular implantable cardioverter defibrillator who underwent percutaneous hardware removal due to recurrent pacemaker pocket infections. Mechanical dilator sheath removal and Needle's Eye Snare were used in the same patient. Although asymptomatic, tricuspid stenosis was detected three years after the operation.

How to cite: Guray, U., Ipek, E. G., Ucar, O., & Guray, Y. (2015). Asymptomatic Tricuspid Stenosis Following a Complex Lead Extraction Procedure. The Journal of heart valve disease, 24(3), 335–337.

Tricuspid regurgitation (TR) remains a challenging condition, the indication, timing and type of surgery for which are not yet well established. A 42-year-old woman was referred to the authors' institution with recurrent, symptomatic TR at one year after she had undergone tricuspid valve repair for an Ebstein's anomaly. At 14 months after the first surgery a bioprosthesis was implanted for a detached annuloplasty ring, and she made a complete recovery. However, at 15 months after valve replacement she presented again with right heart failure and massive TR due to rare early pannus formation. A re-redo tricuspid valve replacement was performed. Tricuspid valve replacement with a bioprosthesis is a valid option if repair is unsuccessful. However, there is a need to be aware of concomitant problems such as a requirement for pacemaker implantation, the risk for prosthesis thrombosis or pannus formation, and the importance of anticoagulation therapy. Annual transthoracic echocardiographic follow up is advisable to exclude subclinical TR.

How to cite: De Brabandere, K., Amsel, B. J., & Rodrigus, I. (2015). The FORGOTTEN (TRICUSPID) VALVE; THIRD TIME, RIGHT TIME. The Journal of heart valve disease, 24(3), 331–334.

Background and aim of the study: It was hypothesized that sleep disorders might be present due to functional heart failure in patients with mitral stenosis (MS), and might be accompanied by obstructive-type sleep disorders. To examine this hypothesis, non-smoker and non-obese patients with rheumatic MS and without concomitant diseases were investigated for sleep disorders.

Methods: Patients admitted to the cardiology outpatient clinic at the authors' institution for rheumatic MS during a one-year period were included in the study. Patients were evaluated using the Epworth sleepiness scale, apnea-hypopnea index (AHI), and echocardiographic examination. The relationship between echocardiographic findings and AHI was assessed.

Results: Eighteen patients were included in the study. All patients had sinus rhythm and normal electrocardiography recordings, with no coronary artery disease or concomitant cardiac disease. Obstructive sleep apnea (OSA) was determined in 16 patients. AHI was positively correlated with the mean apnea duration, mean gradient, rapid eye movement (REM)-AHI and non-REM-AHI. AHI, pulmonary artery pressure, mitral valve area, mean gradient, left ventricular end-systolic diameter, left ventricular end-diastolic diameter and mean REM-AHI differed significantly according to the degree of MS. AHI was shown to be increased as the degree of MS increased.

Conclusion: The frequency of OSA was found to be significantly higher in patients with MS. In addition to cardiac problems, these patients need to be evaluated also for sleep problems and treated appropriately.

How to Cite: Asker, M., & Asker, S. (2015). Sleep Apnea in Patients with Rheumatic Mitral Stenosis. The Journal of heart valve disease, 24(3), 325–330.

Transcatheter mitral valve repair is an effective treatment option for patients with symptomatic mitral regurgitation and high surgical risk. Typically, transcatheter mitral valve repair is less effective in reducing mitral regurgitation severity compared to surgical mitral valve repair. Herein is presented a case of complete resolution of mitral regurgitation, as assessed by Doppler echocardiography and left atrial V-wave.

How to cite: Eleid, M. F., Pollak, P. M., Pislaru, S. V., Reeder, G. S., & Rihal, C. S. (2015). Vanishing V-Wave: Percutaneous Edge-to-Edge Repair for Severe Mitral Regurgitation. The Journal of heart valve disease, 24(3), 323–324.

Reoperation for paravalvular leakage can cause recurrent paravalvular leakage through severe damage to the mitral annulus. Previously, mitral valve replacement using a half-and-half technique for extensive mitral annular calcification was reported; here, application of the technique to treat recurrent paravalvular leakage is described. A 78-year-old male with three prior mitral valve replacements developed recurrent paravalvular leakage, for which he had undergone his third mitral valve replacement at the age of 69 years. On this occasion, a mechanical valve with circumferential equine pericardial patch reinforcement of the annulus had been used. Five years later, the patient developed hemolytic anemia and congestive heart failure due to recurrent paravalvular leakage. Intraoperatively, broad dehiscence was seen between the prosthetic valve and mitral annulus at two sites, the anterior and posterior commissures, without infection. A fourth mitral valve replacement was performed with a St. Jude Medical valve, using a half-and-half technique. This entailed the use of non-everting mattress sutures on the anterior half of the annulus, and everting mattress sutures on the left atrial wall around the posterior half of the annulus. Extensive annular defects required reinforcement of the posterior mitral annulus with a bovine pericardial patch. Postoperative echocardiography showed no paravalvular leakage. The half-and-half technique may be useful in treating recurrent paravalvular leakage of the mitral valve.

How to cite: Morisaki, A., Kato, Y., Takahashi, Y., & Shibata, T. (2015). Mitral Valve Replacement with Half-and-Half Technique for Recurrent Mitral Paravalvular Leakage. The Journal of heart valve disease, 24(3), 320–322.

Percutaneous valve repair with the MitraClip represents a new and promising therapeutic option for patients with severe mitral regurgitation (MR). Mitral valve prolapse and flail leaflet are two major causes of degenerative MR in patients who underwent the MitraClip procedure. Mitral annular calcification (MAC) is also a less-frequent cause of degenerative MR. Among patients with MAC, open surgical treatment or valvular replacement is the treatment of choice for severe MR. Herein we present a case with severe MR secondary to MAC in whom successful percutaneous valve repair was accomplished with the MitraClip system due to the high risk of open-heart surgery.

How to cite: Bilge, M., Ali, S., Alsancak, Y., & Yasar, A. S. (2015). Percutaneous Mitral Valve Repair with the MitraClip System in Mitral Regurgitation Due to Mitral Annular Calcification. The Journal of heart valve disease, 24(3), 316–319.

Coronary obstruction following transcatheter aortic valve replacement (TAVR) is a dreaded complication which occurs in less than 1% of the procedures. Temporary hemodynamic support may be required in cases of hemodynamic collapse while performing a high-risk percutaneous coronary intervention in these patients. A challenging case is described where emergent percutaneous biventricular support (Tandem Heart for right ventricular support and Impella CPTM for left ventricular support) was used as a bridge to recovery in a patient with coronary obstruction during TAVR with the Edwards SAPIEN prosthesis.

How to cite: Singh, V., & Heldman, A. (2015). Emergent Percutaneous Biventricular Support during Transcatheter Aortic Valve Replacement. The Journal of heart valve disease, 24(3), 313–315.

A 78-year-old man was referred for surgical treatment of a 55 x 59 mm abdominal aortic aneurysm (AAA). However, clinical and instrumental data revealed a more complex case than was initially thought, the patient having a large AAA in the setting of severe symptomatic aortic stenosis with multiple comorbidities. Following multidisciplinary discussion, a combined transcatheter aortic valve implantation and endovascular aneurysm repair was performed. The present case represents a good example of the importance of the heart team in the project of tailored operative strategies, and in the optimization of the interventional therapy for the individual patient.

How to cite: Marchi, F., Cerillo, A. G., Rizza, A., Mariani, M., De Caterina, A. R., Palmieri, C., Maffei, S., & Berti, S. (2015). Large Abdominal Aortic Aneurysm in a High-Risk Surgical Patient: Combined Percutaneous Transfemoral TAVI and EVAR Procedure. The Journal of heart valve disease, 24(3), 310–312.

Background and aim of the study: Cardiac surgery with the use of cardiopulmonary bypass in patients with end-stage liver disease is associated with a high risk of postoperative morbidity and mortality due to bleeding, and a high incidence of bacterial infection with associated secondary complications. Minimized extracorporeal perfusion circuits (MECCs) with a lower priming volume, reduced foreign surface area, and interdisciplinary preoperative and postoperative treatment may address these negative effects and improve patient outcomes. The study aim was to evaluate the feasibility of the MECC and optimized supportive therapy in patients with advanced-stage liver cirrhosis.

Methods: Seven consecutive male patients (median age 56 years; range 54-67 years) with hepatic cirrhosis (Child-Pugh score B, median Model of End-stage Liver Disease (MELD) score 14; range 8-26) underwent aortic valve replacement (AVR) using MECC. Supportive preoperative and postoperative management included digestive decontamination, antioxidant supplements, and adjusted anti-infective therapy.

Results: All patients survived the hospital course, with 30-, 60-, and 90-day mortality of 0%. The median intensive care unit and in-hospital lengths of stay were 3 days (range: 1-5 days) and 13 days (range: 5-18 days), respectively. One patient required reexploration due to bleeding, and another suffered from a seizure without permanent neurologic deficits. No patient required new-onset hemodialysis. At a median follow up of 22 months (range: 2-46 months) all patients were alive but displayed only minor improvements in cardiac symptoms (median NYHA class III (range: II-III) at baseline versus II (range: II-III) postoperatively) and hepatic symptoms.

Conclusion: Conventional AVR in patients with advanced-stage liver cirrhosis using MECC and optimal medical treatment is feasible. Further studies are required to evaluate the impact of alternative interventional techniques in this high-risk cohort.

How to cite: Peterss, S., Beckmann, E., Bhandari, R., Hadem, J., Hagl, C., Khaladj, N., Haverich, A., & Kutschka, I. (2015). Aortic Valve Replacement in Patients with End-Stage Liver Disease: A Modified Perfusion Concept in High-Risk Patients. The Journal of heart valve disease, 24(3), 302–309.

Background and aim of the study: Based on superior long-term results, an increasing interest in the Ross procedure for young adult patients can be observed. After the first publication of this challenging procedure through a minimally invasive access, this operation has become an alternative to conventional sternotomy at the authors' department. This analysis compares the results and quality of life of the conventional and the minimally invasive Ross procedures.

Methods: By April 2013, a total of 136 patients had undergone the Ross procedure at the authors' institution. Preoperative parameters did not differ between the conventional group (C-group; n = 58; mean age 49 years) and the minimally invasive group (M-group; n = 78; mean age 50 years). Only the aortic cross-clamp time was longer for the M-group (151 versus 140 min).

Results: One C-group patient died on the day of operation. Consecutively, survival was 99% for the follow up period of 1,093 ± 601 days. Valve-related reoperations were necessary for four patients. One C-group patient developed a distal pulmonary stenosis due to fibrotic scar tissue. Two M-group patients showed fistulas after early endocarditis, but the native valves could be preserved in these cases. One C-group patient with recurrent severe aortic regurgitation showed holes in two of three cusps. The SF-36 questionnaire detected better physical parameters (physical function, physical role function) for patients after minimally invasive access.

Conclusion: The minimally invasive Ross procedure allows the same excellent clinical outcome as the conventional technique. However, the physical quality of life is better with the minimally invasive procedure, in addition to an improved cosmetic result.

How to cite: Franke, U. F., Ursulescu, A., Göbel, N., Nagib, R., Hansen, M., Yadav, R., Baumbach, H., & Albert, M. (2015). Results and Quality of Life after Minimally Invasive Ross Procedure. The Journal of heart valve disease, 24(3), 295–301.

A 63-year-old male patient with HIV disease presented with dyspnea and complete heart block, and was found to have aortic valve (AV) endocarditis secondary to Candida parapsilosis infection. Echocardiography demonstrated AV endocarditis and possible aortic root versus subannular abscess with moderate AV regurgitation (AR), a ventricular septal defect (VSD) and possible left ventricular to right atrial shunt (Gerbode defect). Large AV vegetations, subannular abscess with an acquired membranous VSD, Gerbode defect, and tricuspid annular abscess at the insertion of septal leaflet were noted intraoperatively. The patient underwent AV replacement with a stented bioprosthesis, two-sided VSD patch closure, and tricuspid valve (TV) repair with an annuloplasty ring. The left-sided patch closed the VSD and facilitated AV replacement, while the right-sided patch facilitated the TV repair.

How to cite: Pasrija, C., Mohammed, I., Shats, I., Hong-Zohlman, S., Reoma, J., Mazzeffi, M. A., & Rajagopal, K. (2015). Gerbode Defect as a Result of Fungal Aortic Valve Endocarditis. The Journal of heart valve disease, 24(3), 292–294.

The reimplantation technique is one of the most popular valve-sparing procedures. Previously published in-vitro studies have demonstrated the success of the aortic interleaflets triangle reshaping approach in increasing the coaptation surface. An alternative positioning of the pledgeted stitches used in the proximal suture line of the David operation is proposed to simultaneously stabilize the annulus and improve the valve functional reserve in case of annulo-aortic ectasia due to dilation of the interleaflet triangles.

How to cite: Antona, C., Romagnoni, C., Contino, M., & Mangini, A. (2015). Reimplantation Technique: A New Approach to Increase Aortic Valve Coaptation. The Journal of heart valve disease, 24(3), 290–291.

Transcatheter aortic valve implantation (TAVI) is a new promising therapeutic option for patients with symptomatic severe calcific aortic valve stenosis (AS) who are inoperable or at high risk for conventional cardiac surgery. Percutaneous transvenous mitral commissurotomy (PTMC) is performed routinely in patients with severe mitral stenosis (MS) having a favorable anatomy. Although concurrent TAVI and PTMC is a theoretically possible approach in the treatment of patients with severe AS and MS who are unsuitable for conventional surgery, no cases have yet been reported in which this combined technique is used. For patients with severe AS and MS, the standard therapy is replacement of both the mitral and aortic valves. Herein are presented the details of a 52-year-old woman with urethral carcinoma, in whom simultaneous TAVI and PTMC was the chosen technique to treat combined severe rheumatic AS and MS in a single procedure.

How to cite: Bilge, M., Alsancak, Y., Ali, S., & Yasar, A. S. (2015). Concurrent Transcatheter Aortic Valve Implantation and Percutaneous Transvenous Mitral Commissurotomy for Totally Percutaneous Treatment of Combined Severe Rheumatic Aortic and Mitral Stenosis. The Journal of heart valve disease, 24(3), 286–289.

Background and aim of the study: To date, no study has determined the specified Bernoulli constant (K) and validated the simplified Bernoulli equation for semilunar valve stenosis by simultaneous measurement of peak jet flow velocity and maximum pressure gradient in humans.

Methods: Using multisensor catheters, the relationship between the peak jet flow velocity (V) and maximum-pressure gradient (max-PG) across the stenosis were analyzed, and K-values calculated for patients with pulmonary (n = 37) and aortic (n = 6) valve stenosis, who were stratified by max-PG into two groups: max-PG 50 mmHg (n = 28; group A) and those with max-PG > 50 mmHg (n = 15; group B).

Results: The specified constant K obtained for max-PG with peak jet flow velocity squared (V2) was 3.9, which was very close to the simplified Bernoulli constant (= 4.0), with a wide distribution in K-value for max-PG (median [interquartile range]: 3.9 [3.0-4.5]). Although there were no significant differences in specified K-values between two groups (p = 0.216), the values of K were significantly more widely scattered in group A than in group B (3.4 [2.5-4.8] versus 4.1 [3.8-4.4]; p < 0.001).

Conclusion: The study results confirmed that, the more severe the stenosis the better suited the simplified Bernoulli constant (K = 4.0) could be for assessing semilunar valve stenosis. This result is consistent with the fluid-mechanical theorem that the kinetic energy of the jet (1/2) ρV92) (= 4.0V(2)) produced by the stenosis disappears completely only downstream of the severe semilunar valve stenosis.

How to cite: Hanya S. (2015). Analysis of Specified Bernoulli Constant for Semilunar Valve Stenosis in Humans. The Journal of heart valve disease, 24(3), 280–285.

Background and aim of the study: The dynamics of left ventricular mass (LVM) regression following the relief of chronic left ventricular pressure overload are prone to variation. The study aim was to identify determinants of LVM regression following transcatheter aortic valve implantation (TAVI).

Methods: A total of 134 patients undergoing TAVI was identified. A retrospective analysis was performed of LVM indexed to body surface area (LVMi), calculated using transthoracic echocardiography at baseline and at six to 12 months post-TAVI.

Results: At six to 12 months after TAVI, there was a significant reduction in mean LVMi (from 118.2 ± 26.67 g/m2 to 103.4 ± 27.07 g/m2; p < 0.001) driven by a decrease in left ventricular wall thickness. The relative wall thickness (RWT) was decreased (0.54 ± 0.10 cm versus 0.51 ± 0.09 cm; p = 0.006), whereas the prevalence of concentric remodeling (RWT ≥ 0.42) remained unchanged (85.1% versus 80.6%; p = 0.3). However, 47 patients (35.1%) demonstrated significant LVMi regression, but had a lower baseline LVMi than patients who demonstrated significant regression (109.8 ± 25.8 g/m2 versus 122 ± 26.1 g/m2; p = 0.008) but had otherwise similar characteristics. A greater magnitude of LVMi reduction was associated with a greater baseline LVMi (r = 0.39; p < 0.001), where patients with LVMi in the highest quartile had the most substantial reduction in LVMi (p < 0.001). Multivariable analysis identified pre-TAVI LVMi as the sole independent predictor of LVMi regression at six to 12 months post-TAVI (P = 0.45; 95% confidence interval 0.255-0.534; p < 0.001).

Conclusion: LVM regression at six to months post-TAVI was variable, with about one-third of patients not showing a significant regression. Only baseline LVM predicted LVM regression; patients with a higher baseline LVM demonstrated a greater regression.

How to cite: Weissler-Snir, A., Shapira, Y., Sagie, A., Kazum, S., Assali, A., Vaknin-Assa, H., Bental, T., Codner, P., Orvin, K., Kornowski, R., & Vaturi, M. (2015). Determinants of Left Ventricular Mass Regression in Patients with Severe Symptomatic Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation. The Journal of heart valve disease, 24(3), 272–279.