Search Results (7)

Background: Among patients with congenital heart disease, particularly those with a history of undergoing the Fontan operation, pregnancy presents a significant maternal–fetal risk, especially when complicated by severe valvular dysfunction. Lung reperfusion syndrome (LRS) is a rare but life-threatening complication occurring following valve intervention. Multidisciplinary management, including by Cardio-Obstetrics teams, is essential for optimizing outcomes in such high-risk cases. Methods: We present the case of a 37-year-old pregnant patient with previously repaired tetralogy of Fallot (via the Fontan procedure) who presented at 24 weeks gestation with worsening severe pulmonary stenosis and right-ventricular dysfunction. The patient had been lost to cardiac follow-up for over a decade. She experienced recurrent arrhythmias, including supraventricular and non-sustained ventricular tachycardia, prompting hospital admission. A multidisciplinary team recommended transcatheter pulmonic valve replacement (TPVR), performed at 28 weeks’ gestation. Results: Post-TPVR, the patient developed acute hypoxia and hypotension, consistent with Lung Reperfusion Syndrome, necessitating intensive cardiopulmonary support. Despite initial stabilization, progressive maternal respiratory failure and fetal compromise led to an emergent cesarean delivery. The neonate’s neonatal intensive care unit (NICU) course was complicated by spontaneous intestinal perforation, while the mother required intensive care unit (ICU)-level care and a bronchoscopy due to new pulmonary findings. She was extubated and discharged in stable condition on postoperative day five. Conclusions: This case underscores the complexity of managing severe congenital heart disease and valve pathology during pregnancy. Lung reperfusion syndrome should be recognized as a potential complication following TPVR, particularly in pregnant patients with Fontan physiology. Early involvement of a multidisciplinary Cardio-Obstetrics team and structured peripartum planning are critical to improving both maternal and neonatal outcomes. Full article

Background: Aortic valve stenosis remains the most prevalent valvular pathology in Western countries. Rapid deployment bioprosthesis (RD) has emerged as a promising alternative to conventional valves for surgical aortic valve replacement (SAVR), particularly in elderly and high-risk patients. This study reports the short- and long-term outcomes of RD in patients with isolated aortic stenosis. Methods: A retrospective single-center analysis was conducted on 382 patients who underwent RD-AVR between 2014 and 2020. Data were collected from clinical files and national electronic databases. Primary outcomes included cardiopulmonary bypass (CPB) and cross-clamping (XC) times, postoperative complications, and long-term survival. Results: The mean age was 75.6 ± 5.9 years, with 29.8% of patients over 80 years old and a mean EuroSCORE II of 2.3 ± 1.5%. CPB and XC times were 36.7 ± 10.8 and 27.4 ± 8.1 min, respectively. Postoperative complications included acute kidney injury (AKI, 53.4%), de novo atrial fibrillation (31.9%), and high-grade/complete atrioventricular block with permanent pacemaker implantation (9.8%). In-hospital and 30-day mortality was 1.02% and 2.3%, respectively. The 5-year survival rate was 77%. At 6 months postoperatively, the mean transvalvular gradient was 11.1 ± 4.7 mmHg. At a median follow-up of 6.7 years, no cases of structural valve deterioration and only one case of endocarditis were reported. Conclusion: In this single-center study, RD in isolated AVR demonstrated favorable short- and long-term outcomes, including no structural valve deterioration at mid-term follow-up. These devices offer a safe and effective alternative to conventional SAVR, particularly in high-risk populations. Full article

Mitral regurgitation (MR) is a common valvular disorder often seen in a severely dilated left ventricle (LV) and reduced LV function. In chronic heart failure (HF), severe functional MR increases preload, wall tension, LV workload, and worsening prognosis. The MitraClip device offers a percutaneous treatment option in HF, although its safety and efficacy in advanced and acute HF remain a gray zone. We present a successful case of the emergent MitraClip intervention in a patient with advanced HF and review the relevant literature. Full article

Background/Objectives: Aortic stenosis (AS) is a critical valvular heart disease associated with significant morbidity and mortality if not managed promptly. Previous studies have highlighted the “weekend effect”, where the day of admission impacts outcomes in various cardiac conditions. This study evaluates the impact of weekend versus weekday admissions on outcomes in patients admitted with acutely decompensated aortic stenosis. Methods: We conducted a retrospective cohort study using the National Inpatient Sample database, focusing on patients emergently admitted with decompensated aortic stenosis. Patient outcomes were compared between those admitted on weekends (midnight Friday to midnight Sunday) and weekdays. Results: Among 94,320 patients included, 4537 (4.81%) were admitted on weekends. Weekend admissions were associated with significantly higher mortality (aOR 1.86; 95% CI 1.27–2.74) and longer hospital stays (mean increase 3.18 days; p < 0.001) compared to weekday admissions. Complication rates were also higher on weekends, including cardiogenic shock (aOR 2.1; 95% CI 1.54–2.87; p < 0.001), acute kidney injury (aOR 2.48; 95% CI 2.09–2.94; p < 0.001), and acute respiratory failure (aOR 2.88; 95% CI 2.38–3.49; p < 0.001). Additionally, weekend admissions had lower rates of transcatheter aortic valve replacement (TAVR) (aOR 0.49; 95% CI 0.40–0.62; p < 0.01) than weekday admissions. Conclusions: Patients with aortic stenosis admitted on weekends face significantly higher mortality, extended hospital stays, and increased complication rates compared to weekday admissions. Transcatheter aortic valve replacement (TAVR) rates were also lower for patients admitted on weekends. The “weekend effect” markedly influences outcomes, underscoring the need for hospital and administrative strategies to mitigate these adverse effects. Implementing standardized protocols and optimizing resource allocation during weekends could potentially reduce mortality and improve patient outcomes, offering a path to more equitable healthcare delivery. Full article

Structural heart disease is increasingly prevalent in the general population, especially in patients of increased age. Recent advances in transcatheter structural heart interventions have gained a significant following and are now considered a mainstay option for managing stable valvular disease. However, the concept of transcatheter interventions has also been tested in acute settings by several investigators, especially in cases where valvular disease comes as a result of acute ischemia or in the context of acute decompensated heart failure. Tested interventions include both the mitral and aortic valve, mostly evaluating mitral transcatheter edge-to-edge repair and transcatheter aortic valve implantation, respectively. This review is going to focus on the use of acute structural heart interventions in the emergent setting, and it will delineate the available data and provide a meaningful discussion on the optimal patient phenotype and future directions of the field. Full article

Aortic regurgitation (AR) is the third most frequent form of valvular disease and has increasing prevalence with age. This will be of increasing clinical importance with the advancing age of populations around the globe. An understanding of the various etiologies and mechanisms leading to AR requires a detailed understanding of the structure of the aortic valve and aortic root. While acute and chronic AR may share a similar etiology, their hemodynamic impact on the left ventricle (LV) and management are very different. Recent studies suggest current guideline recommendations for chronic disease may result in late intervention and suboptimal outcomes. Accurate quantitation of ventricular size and function, as well as grading of the severity of regurgitation, requires a multiparametric and multimodality imaging approach with an understanding of the strengths and weaknesses of each metric. Echocardiography remains the primary imaging modality for diagnosis with supplemental information provided by computed tomography (CT) and cardiac magnetic resonance imaging (CMR). Emerging transcatheter therapies may allow the treatment of patients at high risk for surgery, although novel methods to assess AR severity and its impact on LV size and function may improve the timing and outcomes of surgical intervention. Full article

Acute severe cardiac valve emergencies, such as acute severe mitral regurgitation (AMR) and acute severe aortic regurgitation (AAR), present significant challenges in terms of diagnosis and management. Handheld point-of-care ultrasound devices have emerged as potentially pivotal tools in ensuring the prompt and accurate diagnosis of these left-sided valve emergencies by emergency physicians, particularly in resource-limited settings. Despite the increased utilisation of point-of-care ultrasound by emergency physicians for the management of patients in states of acute cardiorespiratory failure, current diagnostic protocols cannot perform sufficient quantitative assessments of the left-sided cardiac valves. This review elucidates and evaluates the diagnostic utility of handheld point-of-care focused-echocardiography (HoPE) in native AMR and AAR by reviewing the relevant literature and the use of clinical case examples from the Emergency Department at Port Shepstone Regional Hospital (PSRH-ED)—a rural, resource-limited hospital located in KwaZulu-Natal, South Africa. Combining the findings of the review and clinical case illustrations, this review proceeds to synthesise a novel, Bayesian-inspired, iterative diagnostic framework that integrates HoPE into the evaluation of patients with acute cardiorespiratory failure and suspected severe left-sided valve lesions. Full article