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PubMed2003

Regional differences in surgical heart valve disease in Europe: comparison between northern and southern subsets of the EuroSCORE database.

BACKGROUND AND AIMS OF THE STUDY: Although rates for coronary and valve surgery vary between northern and southern Europe, differences in the features of valve disease leading to surgery in Europe are poorly documented. The study aim was to compare demographics, risk factors, procedures and outcome in valve surgery between European regions, using the EuroSCORE database. METHODS: Between September and December 1995, information on 98 variables (risk factors, procedures and outcome) were collected on valve surgery patients in 128 European centers. Patients were allocated to two geographic subgroups (north, n = 1,990; south, n = 3,682). The distribution of variables was assessed. Subsequently, the impact of preoperative and operative risk factors on mortality was analyzed in both groups using a bivariate analysis. Risk-adjusted outcomes were then compared according to the EuroSCORE. RESULTS: Significant differences were identified for clinical features, risk factors and procedures. In northern Europe, surgery was performed on older patients with more severe coronary or associated disease, whilst in the south the cardiac status seemed more severely compromised. Degenerative aortic disease prevailed in the north (aortic valve replacement in 72.7% of cases), whilst in the south mitral surgery accounted for 46.1% of procedures. Despite differences in crude mortality (6.9% north versus 5.7% south), outcomes (when adjusted to risks) seemed comparable (observed-to-expected mortality ratio 0.90 for north versus 0.84 for south). The impact of individual risk factors on mortality was similar, except for atrial fibrillation. CONCLUSION: Despite large epidemiological differences between northern and southern Europe in terms of valve surgery, performances and outcomes were similar when individual risk factors and overall risk profiles were taken into account.

Aged↗
PubMed2003

Evidence of woven bone formation in heart valve disease.

The pathogenesis of acquired cardiac valve disease still remains a matter of controversy. In this work, scanning electron and polarised light microscopic investigations in addition to energy dispersive X-ray microanalyses (EDAX) were carried out on explanted human aortic and mitral valves to determine the morphology and element composition of calcified areas in valvular lesions. Biopsies were taken from aortic valves removed from 28 male patients (average age, 75+/-1 years) and 46 females (68+/-3 years) and from mitral valves obtained from 18 male patients (72+/-3 years) and 8 females (71+/-6 years). By means of scanning electron microscopy, multiple foci of calcified areas were identified. Endothelial cells in these areas appeared swollen and displayed reduced cell-cell contacts. The calcium deposits were separated from the adjacent tissue by layers of collagen fibers. Often a layer of woven bone tissue separated intravalvular inclusions from hyperplastic collagen fibers. Using EDAX analysis, calcium and phosphorus were detected in these valvular lesions. The major finding of our study is the presence of woven bone tissue in explanted cardiac valves, which may result from pathological strains or mechanical overloading of the collagen fibers.

Aged↗
PubMed2005

Numerical simulation of cardiovascular dynamics with healthy and diseased heart valves.

This paper presents a new concentrated parameter model for cardiovascular dynamics that includes an innovative model of heart valve dynamics, which is embedded in the overall model of the four chambers of the heart and the systemic and pulmonary circulation loops. The heart chambers are described with a variable elastance model, and the systemic and pulmonary loops are described with modified Windkessel models. In modelling the heart valve dynamics, the various factors that influence the valve motion are examined, and the governing differential equation for valve motion is derived. The heart valve model includes the influence of the blood pressure effect, the friction effect from the tissue, and from blood motion. As improvement from previous works, the contribution of the blood vortex effect in the vicinity of the valve leaflets to valve motion is specially considered. The proposed model is then used in simulation of healthy and certain pathological conditions such as mitral valve stenosis and aortic regurgitation. The predicted results agree well with results illustrated in cardiology textbooks.

Adult↗
PubMed1995

[Recommendations for prevention of thromboembolism in heart valve diseases. Working Group on Valvular Heart Disease, European Society of Cardiology].

Thromboembolic events are still a major cause of morbidity and mortality in patients with native valvular heart disease and in patients with prosthetic heart valves. Although the introduction of oral anticoagulation reduced this risk, thromboembolism and anticoagulation-related hemorrhages still represent significant problems in the management of these patients. In this article the guidelines developed by the Working Group on Valvular Heart Disease of the European Society of Cardiology for the management of antithrombotic therapy in heart valve disease are thoroughly discussed. The indication for and intensity of anticoagulation in various clinical situations, the concept of risk factor-adjusted intensity of anticoagulation, and the concept of control of oral anticoagulation with the International Normalized Ratio are presented.

Administration, Oral↗
PubMed1990

Valvular heart disease, infected valves and prosthetic heart valves.

The major causes of systemic embolism from valvular heart disease (mitral, aortic and mitral valve prolapse), prosthetic valves (both mechanical and tissue valves) and infected valves (endocarditis) are reviewed from the standpoint of their incidence and complications. Recommendations for therapy with anticoagulants or other antithrombotic therapy are set forth following the guidelines recently provided by the Second American College of Chest Physicians Conference on Antithrombotic Therapy. Adherence to these recommendations can significantly decrease the risk of systemic embolism in patients with these valvular heart problems.

Embolism↗
PubMed1985

[Surgical treatment of heart valve diseases and coronary diseases in the elderly].

The results of the operative treatment of valvular and coronary heart disease in large groups of elderly patients demonstrate that age per se is no contraindication for cardiac surgery. Age holds only the sixth place in the ranking list of risk factors, at least for coronary revascularization. One has to be aware that the operative risk in patients well over 60 years of age is somewhat higher than in younger individuals. However, there is no clearly identifiable age-related measure for indication or contraindication in the particular case. Surgery should be considered in an elderly patient if he or she had been leading a normal active life before the onset of limiting symptoms caused by the underlying valvular or coronary heart disease. These patients should have a strong motivation to improve their lifestyle postoperatively. Severe additional disease should be considered as a potential reason for renunciation.

Age Factors↗
PubMedDate not supplied

New frontiers in the pathology and therapy of heart valve disease: 2006 Society for Cardiovascular Pathology, Distinguished Achievement Award Lecture, United States-Canadian Academy of Pathology, Atlanta, GA, February 12, 2006.

This review summarizes several areas relative to the pathology of heart valve disease in which there has been rapid and ongoing evolution, namely, our understanding of: (a) the dynamic functional biology of cardiac valves; and (b) the pathology/pathobiology of valvular heart diseases; (c) new developments in valve repair and substitution using percutaneous approaches; and (d) progress toward the exciting potential of therapeutic valvular tissue engineering and regeneration, including the challenges that will need to be overcome before such therapeutic advances can become clinically useful.

Heart Valve Diseases↗
PubMed1998

Spectral analysis of heart valve sound for detection of prosthetic heart valve diseases.

The spectral analysis of heart valve sound is a noninvasive diagnostic method known to be useful in evaluating the state of the heart valve function. This may provide early detection of valve calcification, thrombus or destruction, since previous studies have shown that the dominant frequency peak moved to a high frequency area when natural heart valve leaflets were calcified, stiffened or destroyed. However, it is important for a heart valve sound diagnostic system to find a proper spectral analysis method on phonocardiography. Until now, conventional frequency analyses such as the Fourier transform or autoregressive spectral estimation technique have been used to estimate spectral components of a phonocardiogram, but they are inappropriate because the signal frequency is assumed to remain constant during the transform interval. To overcome this problem, in this study, FOS (Fast Orthogonal Search) & MUSIC (MUltiple SIgnal Classification), which both appeared suitable for the analysis of biological data, were applied to prosthetic heart valve sound as the new heart valve sound spectral analysis methods. Five subjects with normally functioning mechanical heart valves and a patient with a malfunctioning one were selected to collect the heart valve sound signals. As a result, the second dominant peak frequency proved to be important along with the first dominant peak frequency in identifying the valve function. This study showed that the new heart valve sound spectral analysis method presented in this paper may be an effective method in heart valve sound analysis. Further study using this system in a large population of patients will aid in providing a diagnostic method in the early detection of valve failure.

Female↗
PubMed1977

[Perfusion scintigraphy of the myocardium in cardiological diagnosis. Coronary diseases, primary myocardial diseases and rheumatic heart valve diseases].

In 123 patients perfusion scintigrams were compared with the data of clinical investigation, right and left heart catheterisation and coronary arteriography. The intracoronary application of radioactive labelled human-albumin-microspheres and human-microaggregates were without any complications. The patients suffered from coronary heart diseases, primary myocardial diseases and rheumatic valvula heart diseases. There was a good correlation between the myocardial perfusion defect and the degree of coronary artery stenoses. Furthermore an excellent correlation was found between perfusion defects and levocardiographic findings: left ventricular aneurysms, akinetic or hypokinetic areas and the ejection fraction of the left ventricle. All myocardial infarctions were detected by a perfusion defect in the scintigrams. In 16 cardiacsurgery-patients large myocardial perfusion defects were found to be myocardial scars. In primary myocardial diseases perfusion scintigraphy is an effective method of detecting pathological myocardial patterns. The degree of perfusion defects correlates excellently with the levocardiographic findings. It seems that in rheumatic valvular diseases perfusion-scintigraphy is a method to discover rheumatic myocardial abnormalities--probably scar tissue. In comparison with thallium scintigrams it was shown that extensive myocardial failures (aneurysms) can be represented by both nuclear medical procedures but that perfusion scintigraphy is more sensitive and correlates more closely to the levocardiogram findings.

Angiography↗
PubMed1998

[Heart valve disease in women in the reproductive age].

About 1% of pregnant women have concomitant cardiac disease. An understanding of the impact of the physiologic changes associated with pregnancy upon structural cardiac disease is essential for proper counseling and management of these complex patients, which should be treated in a specialized team with experience in congenital as well adult disease. The availability of echocardiography provides information about disease aetiology, accurate and non invasive assessment of severity and means of monitoring progression. Contraindication for pregnancies still remain severe pulmonary artery hypertension and Eisenmenger-syndrome and severe surgical non corrected cyanotic disease as well. Postrheumatic stenosis, even when previously asymptomatic, can lead to pulmonary edema. Although pregnancies with asymptomatic regurgitant lesions are better tolerated. The best procedure in severe aortic insufficiency still remains controversial. Patients with Marfan syndrome and aortic root dilatation are at risk for aortic dissection and are difficult to manage. In patients with artificial valves continuing anticoagulation with warfarin is proposed in Europe. Due to accelerated valve deterioration during pregnancy the use of bioprotheses in women who need valvular heart surgery before pregnancy necessitate later valve replacement again and perhaps an autograft or homograft could be an alternate approach. Bacterial endocarditis in pregnancy shows a low incidence and is often associated with prior history of rheumatic or congenital heart disease. Therefore prophylaxis is recommended. There is an increase in the incidence of congenital heart disease among the offsprings of affected parents. Fetal echocardiography, in combination with a multidisciplinary postnatal approach, can be used in the successful treatment of severe form of congenital heart disease.

Adult↗
PubMed2004

Blood serum apolipoproteins B and A-I in females suffering from rheumatic heart valve disease.

OBJECTIVE: With the aim to check whether the atherogenic factors are involved in the mechanisms of valve fibrosis, we have studied the blood serum concentrations of apolipoproteins (apo) A-I and B concentration in patients suffering from rheumatic heart valve fibrosis. METHOD: The quantities of apoA-I and apoB in the blood serum were tested by the ELISA method. Concentration of apoA-I and B in the blood serum was determined in rheumatic females with replacement of the damaged valves: after aortic valve operation (n=11; mean age 43.3+/-3.6 years) and after mitral valve operation (n=29; 41.3+/-4.1). The results obtained for rheumatic patients were compared with the data on age-matched healthy females (n=43; 39.5+/-5.2 years). RESULTS: Significantly lower apoA-I level in the blood serum of all patients suffering from rheumatic heart valve disease was determined as compared with controls: in the pooled group of patients (1.02+/-0.22 vs 1.23+/-0.23 g/l, P<0.001), in women after aortic valve replacement (0.98+/-0.21 vs. 1.23+/-0.23 g/l, P<0.005), and in women after mitral valve surgery (1.03+/-0.23 g/l vs 1.23+/-0.23 g/l, P<0.005). The apoB level in patients suffering from rheumatic heart valve disease did not differ from that of controls. The apoB/apoA-I ratio for patients with valve fibrotic damage was significantly higher as compared to controls in all groups (P<0.02). The increase of apoB/apoA-I ratio in patients with rheumatic valve fibrosis was caused by lower apoA-I levels in blood serum. CONCLUSION: The obtained results indicate that decreased apoA-I levels in blood serum can be indicative of valve fibrosis in rheumatic heart valve disease patients.

Adult↗