Journal of Heart Valve Disease最新文献

{"title":"Septic Shock, Meningoencephalitis and Multiple Pulmonary Emboli: Case Report of an Uncommon Clinical Presentation of Ventricular Septal Defect Acute Infective Endocarditis.","authors":"Laura Varela Barca,&nbsp;Jose López-Menéndez,&nbsp;Ana Redondo Palacios,&nbsp;Jorge Rodríguez-Roda Stuart","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The case is reported of a 55 year-old woman, with a previously known congenital septal defect, who was admitted to the emergency department with a diagnosis of meningoencephalitis, septic shock, and rapid clinical deterioration. Echocardiography revealed a vegetation occupying the right-side heart. Endocarditis affectation of the septal defect, aortic and tricuspid valves was noted and blood cultures were positive for Staphylococcus aureus. Urgent surgical treatment was performed whereby the ventricular septal defect was closed, a meticulous debridement of the affected area was conducted, and the aortic and tricuspid valves were replaced.</p>","PeriodicalId":50184,"journal":{"name":"Journal of Heart Valve Disease","volume":"26 5","pages":"606-609"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40526511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Change in Patient-Reported Health Status after Transcatheter Aortic Valve Replacement, and Postoperative Outcomes.","authors":"Alexis Kofi Okoh,&nbsp;Nathan Kang,&nbsp;Dhaval Chauhan,&nbsp;Nicky Haik,&nbsp;Dustin Hanos,&nbsp;Marc Cohen,&nbsp;Chungeng Chen,&nbsp;Bruce Haik,&nbsp;Mark J Russo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The study aim was to investigate the relationship between postoperative morbidity after transcatheter aortic valve replacement (TAVR) and short-term patient-reported health status, using the Kansas City Cardiomyopathy Questionnaire (KCCQ).</p><p><strong>Methods: </strong>The association between 30-day post-procedure changes in patient-reported heath status and post-TAVR outcomes was examined. Patients were stratified into three groups based on observed changes in KCCQ-Overall scores (OS): Group A, increase in KCCQ-OS ≥10 points; Group B, KCCQ-OS scores <10 points; and Group C, decline in KCCQ-OS ≥10 points. Variation components of KCCQ scores were determined using paired t-tests. Postoperative morbidity was investigated. Multivariable logistic regression was used to identify pre-procedural factors associated with an increase or decline in KCCQ-OS at 30 days.</p><p><strong>Results: </strong>A total of 223 patients with complete baseline and postoperative 30-day KCCQ responses was studied. At the 30-day follow up there was a significant change in baseline mean KCCQ-OS for all patients (mean difference 14.1; p <0.0001). Improvement in KCCQ-OS ≥10 was observed in 130 patients (58%), 64 patients (29%) had no change, and 29 patients (13%) had a decline in KCCQ-OS ≥10. The incidence of acute kidney injury (AKI), permanent pacemaker (PPM) placement and new-onset arrhythmia (NOA) was higher in group C than in groups A and B: AKI, 11%, 0%, 0%; p <0.001; PPM, 21%, 4%, 6%; p = 0.004; and NOA, 21%, 5%, 8%, p = 0.026. Independent predictors of decline in KCCQ scores after TAVR were PPM requirement (estimate: 0.76 CI 0.22, 1.29; p = 0.005) and NYHA functional class (III/IV) (estimate: -0.41 CI -0.71, 0.10; p = 0.009).</p><p><strong>Conclusions: </strong>TAVR patients experienced an improvement in health status after the procedure, but for a smaller proportion their health status worsened. Patients who experience perioperative complications may have a decline in their health status after the procedure in the short term.</p>","PeriodicalId":50184,"journal":{"name":"Journal of Heart Valve Disease","volume":"26 5","pages":"493-501"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40526524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Improvement in Mitral Regurgitation after Cardiac Resynchronization Therapy in Cardiomyopathy Patients.","authors":"Hakimeh Sadeghian,&nbsp;Masoumeh Lotfi-Tokaldany,&nbsp;Mahdi Montazeri,&nbsp;Ali Kazemi Saeed,&nbsp;Mohammad Sahebjam,&nbsp;Akram Sardari,&nbsp;Gita Ejmalian","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The study aim was to investigate factors affecting the improvement of mitral regurgitation (MR) severity within 48 hours after cardiac resynchronization therapy (CRT) in patients with cardiomyopathy.</p><p><strong>Methods: </strong>Sixty-nine cardiomyopathy patients (48 males, 21 females; mean age 59.12 ± 9.66 years) in NYHA functional class ≥III, with left ventricular ejection fraction (LVEF) ≤35%, and QRS duration >120 ms, with MR ≥moderate, were included in the study. Conventional echocardiography was performed before and within 48 h after CRT, and all patients underwent tissue Doppler imaging prior to CRT. Improved MR was defined as a reduction of at least one grade in MR severity.</p><p><strong>Results: </strong>After CRT, 49 patients (71%) showed MR improvement but 20 (29%) had no MR improvement. The mean MR severity grade was reduced significantly, from 2.70 ± 0.77 before CRT to 1.90 ± 0.94 after CRT (p<0.001). The group with improved MR had a significantly higher rate of left bundle branch block (75.5% versus 45%; p = 0.015), a higher QRS duration (172.00 ± 31.98 versus 147.25 ± 28.75 ms; p = 0.001), a higher median septal lateral delay (70 versus 35 ms, p = 0.035), and a higher median anteroseptal to posterior-wall delay by M mode (200 versus 130 ms, p = 0.041). Older age, longer QRS duration, and septallateral delay remained significant independent predictors of MR improvement. A greater proportion of patients with improved MR showed ≥5% increase in LVEF (55.1% versus 30.0%, p = 0.058).</p><p><strong>Conclusions: </strong>CRT acutely reduced the severity of functional MR in the majority of cardiomyopathy patients. Those patients with improved MR showed a higher frequency of ≥5% increase in LVEF after CRT. Older age, longer QRS duration, and septallateral delay were independent predictors of MR improvement after CRT.</p>","PeriodicalId":50184,"journal":{"name":"Journal of Heart Valve Disease","volume":"26 5","pages":"557-563"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40437334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term (up to 21 Years) Follow Up after Biological and Mechanical Aortic Valve Replacement in Younger Patients.","authors":"Stanislav Tsvelodub,&nbsp;Barbara Pieper,&nbsp;Sina Stock,&nbsp;Hans-Hinrich Sievers,&nbsp;Doreen Richardt","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Despite the limited durability of biological aortic valves, increasing numbers of younger patients are choosing to receive them, due mainly to the lack of a need for permanent anticoagulation. Few data exist, however, regarding the outcomes of valve replacement in patients aged <55 years, and additional data are required in this patient population.</p><p><strong>Methods: </strong>Between 1993 and 2014, at the authors' institution, a total of 448 patients (237 males, 101 females; mean age 45.8 ± 8.0 years) underwent aortic valve replacement (AVR) with either a mechanical prosthesis (M1 group, n = 318) or a biological prosthesis (B1 group, n = 130). The mean follow up was 8.5 ± 5.8 years (range: 4 days to 20.8 years) in the M1 group, and 4.9 ± 4.6 years (range: 2 days to 21 years) in the B1 group. The entire collective (EC) (n = 448 patients) was compared and analyzed with a selective collective (SC) (n = 109 patients) after exclusion of patients with concomitant procedures or comorbidities (M2 group, n = 74; B2 group, n = 35).</p><p><strong>Results: </strong>Early mortality was greater after biological AVR in the EC (6.1% versus 1.9%), but in the SC no early deaths were observed after both primary and redo procedures. The reoperation rate was greater after biological AVR in both collectives. The late mortality, survival and endocarditis rates were comparable in both collectives. Bleeding occurred more often in the EC after mechanical AVR.</p><p><strong>Conclusions: </strong>Biological AVR in patients aged <55 years provides satisfactory outcomes, whereas reoperations were performed less commonly in patients with mechanical valve substitutes. In selective patients, AVR can be performed with zero mortality.</p>","PeriodicalId":50184,"journal":{"name":"Journal of Heart Valve Disease","volume":"26 5","pages":"528-536"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40437864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of a New-Generation Stentless Aortic Valve: A Single-Center Experience with 251 Consecutive Implants.","authors":"Guglielmo Stefanelli,&nbsp;Fabrizio Pirro,&nbsp;Giuseppe Danniballe,&nbsp;Alina Olaru,&nbsp;Marco Meli,&nbsp;Luca Weltert","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The study aim was to investigate the hemodynamic behavior over time and ease of implant and durability of the Sorin Pericarbon Freedom (SPF)® stentless pericardial aortic xenograft.</p><p><strong>Methods: </strong>Between March 2003 and April 2010, a total of 251 consecutive, non-selected patients (mean age 70.1 years; range: 17-89 years; 17.1% aged >80 years) received a SPF bioprosthesis as an aortic valve substitute at the authors' institution. All implantations were performed by a single surgeon using a classical, double-line, subcoronary implant technique. Of these patients. 108 (43%) underwent a concomitant procedure. The mean logistic EuroSCORE was 8.3. Patients were followed for complications and hemodynamic evaluation. Echocardiographic controls and clinical data were obtained at discharge, and at six months' and eight years' follow up.</p><p><strong>Results: </strong>The in-hospital/30-day mortality was 1.2% for the entire group, but 0% for patients with isolated valve replacement. A total of 27 deaths had occurred at the time of the last follow up (22 were due to non-cardiac causes). At follow up (mean 3.7 years; range: 0-7.8 years), 91.1% of survivors were in NYHA classes I or II. Freedom from reoperation and from structural valve deterioration was 96.0% and 96.8%, respectively, at 7.8 years. The mean pressure gradient of the series (measured using echocardiography) was 10.3 ± 4.5 mmHg at discharge, and 8.3 ± 4.5mmHg at the time of the last follow up. The mean effective orifice area was 1.85 ± 0.70 cm2 for the entire series, and there was an absence of prosthesis-patient mismatch in 90% of patients.</p><p><strong>Conclusions: </strong>The study results confirmed the favourable hemodynamic behavior, low risk of implantation and acceptable durability of the pericardial stentless SPF aortic prosthesis. The data also endorsed use of the SPF as an aortic valve substitute, even in a young and active population, and particularly in the presence of a small aortic annulus. The accuracy of implantation remains a crucial factor for durability and subsequent satisfactory hemodynamic performance. A longer follow up would provide further information with regards to complications and durability of the SPF prosthesis.</p>","PeriodicalId":50184,"journal":{"name":"Journal of Heart Valve Disease","volume":"26 5","pages":"518-527"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40549581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Therapy of a Stenotic Parachute Mitral Valve Previously Treated by Surgery.","authors":"Roberta De Rosa,&nbsp;Dietmar Schranz,&nbsp;Mariuca Vasa-Nicotera,&nbsp;Birgit Assmus,&nbsp;Petar Risteski,&nbsp;Anton Moritz,&nbsp;Andreas M Zeiher,&nbsp;Stephan Fichtlscherer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Parachute mitral valve (PMV) is a congenital heart anomaly which consists of a unifocal attachment of the mitral valve chordae into a single or dominant papillary muscle. This morphological anomaly determines the impairment of mitral leaflet motion, resulting in different grades of mitral stenosis. Due to its frequent association with other congenital cardiac defects requiring surgical correction, the therapy of a relevant stenotic PMV is usually represented by surgical commissurotomy. Herein is reported the case of a PMV treated by surgery in infancy, which showed a severe restenosis after 34 years and was successfully treated by percutaneous valvuloplasty with the additional creation of a restrictive atrial communication.</p>","PeriodicalId":50184,"journal":{"name":"Journal of Heart Valve Disease","volume":"26 4","pages":"488-491"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35709993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Impella 5.0 Prior to Transcatheter Aortic Valve Replacement in a Patient with Severe Aortic Stenosis and Cardiogenic Shock.","authors":"Dustin W Johnson,&nbsp;John P ErwinIII","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The use of transcatheter aortic valve replacement (TAVR) has risen dramatically during the past decade. Notably, the procedure can reduce symptoms and improve prognosis in patients who would otherwise be excluded from intervention due to prohibitive surgical risk. During the same time period, the use of percutaneous mechanical circulatory support devices for patients with severe left ventricular dysfunction, including the Impella System (Abiomed, Inc., Danvers, MA, USA), has also increased. These devices provide superior hemodynamic effects compared to intra-aortic balloon pumping. However, data relating to use of the Impella in patients with both severe left ventricular dysfunction and significant aortic valve disease are limited. Herein is presented the case of a 59-year-old man with severe aortic stenosis and cardiogenic shock who was treated successfully with an Impella 5.0 as a temporizing measure prior to TAVR. A brief review is also provided of the use of mechanical circulatory support devices in this subset of patients. Video 1: Transesophageal echocardiography video demonstrating stenotic aortic valve pre-intervention in side-by-side long and short axes. Video 2: Transthoracic echocardiography video, parasternal short axis, demonstrating Impella 5 in the left ventricle. Video 3: Fluoroscopy video demonstrating deployment of the Edwards SAPIEN transcatheter aortic valve. Video 4: Transesophageal echocardiography video showing the Edwards SAPIEN transcatheter aortic valve in long axis. Video 5: Transesophageal echocardiography video showing the Edwards SAPIEN transcatheter aortic valve in short axis.</p>","PeriodicalId":50184,"journal":{"name":"Journal of Heart Valve Disease","volume":"26 4","pages":"485-487"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35709992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fenfluramine-Phentermine is Associated with an Increase in Cellular Proliferation Ex Vivo and In Vitro.","authors":"Nalini M Rajamannan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background and aim of the study: </strong>Fenfluraminephentermine (FenPhen) has been implicated in accelerated valvular heart disease, characterized by valvular regurgitation and thickening, and resembling the histopathologic lesions found in carcinoid. The study aim was to determine whether cellular proliferation is present in FenPhen-exposed valves, by utilizing an in-vitro model to test whether FenPhen has a direct mitogenic effect on cardiac valvular cells, as compared to serotonin.</p><p><strong>Methods: </strong>Ex-vivo valves were tested for proliferation in surgically removed FenPhen-exposed valves (n = 10) and compared to proliferation levels in normal human cardiac valves removed at autopsy (n = 10). Immunostaining for a DNA polymerase, proliferating cell nuclear antigen (PCNA), was performed and quantified using digital imaging analysis. In-vitro assays were performed for direct proliferative effects of serotonin and FenPhen (10-6, 10-7 and 10-8 M) on porcine aortic valve subendothelial cells, using a [3H]-thymidine incorporation assay.</p><p><strong>Results: </strong>Ex-vivo PCNA levels in human FenPhenexposed valves were elevated compared to controls (22.8 ± 4.54 versus 1.26 ± 0.47; p <0.001). In vivo, serotonin and FenPhen markedly increased (10-fold) cell proliferation (as measured by [3H]-thymidine incorporation) in subendothelial cells in vitro (p <0.001). This proliferative response was demonstrated by PCNA staining in carcinoid heart valves and FenPhen-exposed valves. Mechanistically, plateletderived growth factor increased cell proliferation in a dose-related manner (p <0.001), the response being inhibited by a MAP kinase inhibitor (determined by monitoring p42/44 levels).</p><p><strong>Conclusions: </strong>In vitro, FenPhen acts as a powerful mitogen on subendothelial myofibroblast valve cells. Ex vivo, cellular proliferation was significantly elevated in human FenPhen-exposed cells.</p>","PeriodicalId":50184,"journal":{"name":"Journal of Heart Valve Disease","volume":"26 4","pages":"467-471"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35709989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Surgery for Severe Aortic Regurgitation with Systolic Left Ventricular Dysfunction.","authors":"Piergiorgio Bruno,&nbsp;Federico Cammertoni,&nbsp;Raphael Rosenhek,&nbsp;Andrea Mazza,&nbsp;Marialisa Nesta,&nbsp;Francesco Burzotta,&nbsp;Domenico D'Amario,&nbsp;Massimo Massetti","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background and aim of the study: </strong>Management of patients with aortic regurgitation (AR) and severe impairment of left ventricular (LV) function characterized by an ejection fraction (EF) ≤35% is challenging. Conflicting results regarding perioperative and long-term survival of these patients have been reported. The study aim was to compare in-hospital outcomes and long-term survival of patients with AR and severe LV dysfunction versus moderate dysfunction (35% <EF <50%) versus preserved LV function (EF ≥50%).</p><p><strong>Methods: </strong>Between January 2006 and December 2013, a retrospective review was conducted of 119 consecutive patients with severe isolated AR who underwent aortic valve replacement at our institution. Overall, 17 patients (14%) had severe LV dysfunction, 26 (22%) had moderate LV dysfunction, and 76 (64%) had a preserved LV function.</p><p><strong>Results: </strong>Patients with severely depressed EF were older and more severely symptomatic according to NYHA classification. Operative mortality was 0% in all groups. At a median echocardiographic follow up of 21 months, a statistically significant reverse remodelling of the left ventricle and an improvement in EF of the low-EF group were found. Survival for the overall population was 98.3%, 80.7% and 48.1% at one, five, and nine years, respectively. Long-term postoperative survival was not affected by baseline EF (p = 0.635), but age >70 years and NYHA class III/IV symptoms were predictive of survival.</p><p><strong>Conclusions: </strong>In-hospital and long-term survival was similar in patients with severe LV dysfunction and with preserved or moderately reduced LV function. Positive reverse LV remodelling and improved LV function was evident at the two-year echocardiographic follow up in these patients, who should not be denied aortic valve surgery.</p>","PeriodicalId":50184,"journal":{"name":"Journal of Heart Valve Disease","volume":"26 4","pages":"372-379"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35710594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiological Factors Associated with Left Ventricular Perforation in Transcatheter Aortic Valve Implantation by Transfemoral Approach.","authors":"Tamer Owais,&nbsp;Mohammad El Garhy,&nbsp;Jürgen Fuchs,&nbsp;Kushtrim Disha,&nbsp;Sameh Elkaffas,&nbsp;Martin Breuer,&nbsp;Bernward Lauer,&nbsp;Thomas Kuntze","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background and aim of the study: </strong>Left ventricular (LV) perforation is one of the rare and most serious complications of transcatheter aortic valve implantation (TAVI). The study aim was to determine the pathophysiological factors associated with this serious complication.</p><p><strong>Methods: </strong>A retrospective study was conducted of pathophysiological factors shown in echocardiograms and computed tomography angiograms performed preoperatively in patients who developed LV perforation during transfemoral TAVI (study group) with regards to anatomic and functional variables. Results were then compared with data acquired from a randomly selected sample of patients without perforation (control group). Among 963 TAVI cases, LV perforation occurred in 11 patients (three males, eight females; mean age 79 years). These patients showed complications of LV perforation that required emergency sternotomy and repair of injury to the left ventricle. Ten patients were rescued by the procedure, but one patient died during surgery.</p><p><strong>Results: </strong>Focus on preoperative factors and intraoperative steps was established in favor to identify possible predictors of LV perforation. A LV cavity size <4.2 cm and a hypercontractile ventricle were identified in 10 patients (90%). Only one patient had a dilated cardiomyopathic left ventricle, with a cavity size of 6.1 cm and an ejection fraction of 10%. The present study results revealed other specific patient-related factors, namely a narrow aorto-mitral angle and a thin ventricular muscular wall despite long-standing aortic stenosis. All 11 patients had an average mid-LV muscular wall thickness of 5 mm. An inverse proportional relationship between the aorto-mitral angle and the incidence of perforation was noted, where in all 11 patients the wire had directed itself towards the anterior free wall of the left ventricle, where it induced injury.</p><p><strong>Conclusions: </strong>A small LV cavity, a hypercontractile state, a thin muscular wall, and a narrow aorto-mitral angle may be considered potential predictors of the occurrence of LV perforation during TAVI.</p>","PeriodicalId":50184,"journal":{"name":"Journal of Heart Valve Disease","volume":"26 4","pages":"430-436"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35710539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}