Month: January 2025

JTCVS Open. 2024 Sep 17;22:395-404. doi: 10.1016/j.xjon.2024.09.008. eCollection 2024 Dec.

ABSTRACT

OBJECTIVE: The study objective was to investigate the effect of free-edge length on valve performance in bicuspidization repair of congenitally diseased aortic valves.

METHODS: In addition to a constructed unicuspid aortic valve disease model, 3 representative groups-free-edge length to aortic diameter ratio 1.2, 1.57, and 1.8-were replicated in explanted porcine aortic roots (n = 3) by adjusting native free-edge length with bovine pericardium. Each group was run on a validated ex vivo univentricular system under physiological parameters for 20 cycles. All groups were tested within the same aortic root to minimize inter-root differences. Outcomes included transvalvular gradient, regurgitation fraction, and orifice area. Linear mixed effects model and pairwise comparisons were used to compare outcomes across groups.

RESULTS: The diseased control group had a mean transvalvular gradient of 28.3 ± 5.5 mm Hg, regurgitation fraction of 29.6% ± 8.0%, and orifice area of 1.03 ± 0.15 cm². In ex vivo analysis, all repair groups had improved regurgitation and transvalvular gradient compared with the diseased control group (P < .001). Free-edge length to aortic diameter of 1.8 had the highest amount of regurgitation among the repair groups (P < .001) and 1.57 the least (P < .001). Free-edge length to aortic diameter of 1.57 also exhibited the lowest mean gradient (P < .001) and the largest orifice area (P < .001).

CONCLUSIONS: Free-edge length to aortic diameter ratio significantly impacts valve function in bicuspidization repair of congenitally diseased aortic valves. As the ratio departs from 1.57 in either direction, effective orifice area decreases and both transvalvular gradient and regurgitation fraction increase.

PMID:39780804 | PMC:PMC11704580 | DOI:10.1016/j.xjon.2024.09.008

Gen Thorac Cardiovasc Surg Cases. 2024 Aug 31;3(1):39. doi: 10.1186/s44215-024-00164-4.

ABSTRACT

BACKGROUND: Calcified amorphous tumor (CAT) of the heart is a rare, non-neoplastic cardiac mass with mitral valves and annuli being the most common sites. The presence of mitral annular calcification (MAC) is associated with an increased risk of stroke or other systemic embolisms. Here, we report a case of CAT showing rapid growth with MAC and investigate the link between the two.

CASE PRESENTATION: A 71-year-old man presented at our hospital with dyspnea and had been undergoing hemodialysis for 26 years for chronic glomerulonephritis. Transthoracic echocardiography (TTE) revealed moderate mitral stenosis with bulky MAC. Two months later, the patient developed progressive dyspnea, and follow-up TTE revealed a highly mobile mass (8 × 5 mm) attached to the left ventricular (LV) side of the posterior MAC. He underwent surgery because of congestive heart failure and a high risk of embolization. Surgical inspection revealed that the tumor was attached beneath the P3 segment of the mitral valve on the LV side and was removed. When removing the MAC, toothpaste-like contents drained from the encapsulated mass inside the MAC at the P3 segment, where the tumor was located. After reconstructing the posterior mitral annulus defect with a bovine pericardial patch, mitral valve replacement with a mechanical prosthesis, a maze procedure, and left appendage closure were performed. Histopathological examination revealed that the excised tumor contained fibrin and calcium deposits. The mass was diagnosed as a CAT.

CONCLUSIONS: CAT may be one of the causes of stroke induced by MAC. Routine follow-up echocardiography should be recommended for patients with MAC, especially those undergoing hemodialysis.

PMID:39517092 | PMC:PMC11533609 | DOI:10.1186/s44215-024-00164-4