Valves in the Heart of the Big Apple VI: Evaluation and Management of Valvular Heart Diseases 2010

s Cardiology 2010;115:251–293 252 Severity of Valvular Involvement in Rheumatic Heart Disease on Echocardiography H.A. Aurakzai, A. Shahbaz, S. Hameed, S. Gohar, M. Qureshi, H. Khan, W. Sami, M. Azhar, J.S. Khan Punjab Institute of Cardiology, Lahore, Pakistan Objective: RHD continues to be a major public health problem in developing countries like Pakistan. We conducted this study to analyze the severity of valvular lesions on echocardiography in patients pre-diagnosed with Rheumatic Heart Disease (RHD). Methods: The transthoracic echocardiographic records of RHD patients from 2004–2008 were retrospectively reviewed for type and degree of valvular involvement according to AHA/ACC guidelines. Results: A total of 13,414 patients [7,219 males (53.8%), 6.195 females (46.2%)] ranging from 11 to 90 years with a mean age of 42.33 ( 8 18.976) were studied. On echocardiography, 7,500 (56%) had mitral regurgitation (8.8% severe MR), 6,449 (48.2%) had tricuspid regurgitation (7.1% severe TR) and 5,550 (41.4%) had aortic regurgitation (4.8% severe AR). MS was detected in 2,729 (20.3%) patients (15.3% severe MS), AS in 102 (0.8%) and TS in 31 (0.2%) patients. Mixed mitral valve disease was seen in 3,185 (23.7%), mixed aortic valve disease in (222) 1.7% and mixed tricuspid valve disease in 47 (0.4%)patients.All three valves were involved in 2,826 (21.06%) patients, combination of mitral and aortic valves in 3,103 (23.13%), mitral and tricuspid in 3,784 (28.2%), and mitral only in 3,701 (27.59%) patients. There was some mitral valve abnormality in all patients. Conclusion: Mitral valve was most commonly affected, while regurgitant lesions were more common than stenotic lesions, and most severe in younger patients. All valvular lesions had almost an equal distribution among the sexes, except aortic regurgitation, which was more common in females. Therefore, echocardiography should be done routinely for patients with RHD, focusing on younger population, to facilitate diagnosis and definitive treatment before complications set in. Long-Term Outcome of Multiple Valve Surgery in Octogenarians – A Single Centre Experience S.K. Balasubramanian, S. Messer, V. Rajamiyer, C. Sudarshan Department of Cardiothoracic Surgery, Papworth Hospital NHS Trust, Papworth Everard, Cambridge, UK Objectives: Cardiac surgery in octogenarians has seen a dramatic increase in the last decade. Aim of this study was to assess in hospital mortality and long-term outcome of octogenarians undergoing more than one valve operation in our institution. Methods: Retrospective analysis of prospectively collected data for all the patients underwent multiple valve surgery over a period of 12 years was done. Demographic and perioperative variables were analyzed to identify the risk factors for hospital mortality. Discharged patients were assessed in the follow up clinic and telephonic survey was conducted to assess functional status. Results: Between 1997 and 2009, 69 patients underwent multiple valve surgery. Median age was 82 years [range: 80 to 89]. 54% were male. Mitral and aortic valve surgery, mitral and tricuspid valve surgery, aortic valve and tricuspid surgery and triple valve surgery were performed in 58, 28, 4 and 10%, respectively. Preoperative pulmonary hypertension, renal dysfunction and atrial fibrillation were present in 26, 39 and 67%, respectively. 32% had coronary artery disease. Urgent operations were done in 20%. In hospital mortality was 16%. One year and five year survival rate was 75 and 50%, respectively. Univariate and multivariate analyses predicted urgent surgical procedures as a significant risk factor for in hospital mortality [(p = 0.038) OR: 0.22 (95%CI: 0.055–0.88)]. Telephonic survey revealed that 70% of long-term survivors showed improved NYHA status at least by one grade. Conclusions: Multiple valve procedures can be safely performed in octogenarians with acceptable in hospital mortality and long-term survival. Majority of long-term survivors have an improved functional status. A Common Reference System for Fluoroscopic and Two-Dimensional Transoesophageal Echocardiographic Localization and Guidance of Mitral Periprosthetic Transcatheter Leak Reduction A.J. Basmadjian a , H. Mahjoub a , S. Noble a , R. Ibrahim a , J. Potvin a , E. O’Meara a , A. Dore a , F. Marcotte a , R. Bonan a , J. Crépeau a , A. Mansour b , A. Ducharme a Department of Medicine, a Montreal Heart Institute, Université de Montréal, and the b Montreal Heart Institute Coordinating Center, Montreal, Que., Canada Background : Transcatheter reduction (TCR) represents a modern and attractive alternative to surgery for the treatment of mitral periprosthetic leak (PPL) in patients with high operative risk. Accurate localization of PPL and precise communication between echocardiographer and interventional cardiologist are essential for success. The objective was to describe and compare a novel fluoroscopic and a transoesophageal echocardiographic (2D-TEE) method to localize mitral PPL for TCR. Methods: We analysed TEE and fluoroscopic images of patients with mitral PPL who underwent multiplane 2D-TEE guided TCR procedures in our institution. The 12-hour surgeon’s view system was used prospectively to localize PPL by TEE. An echocardiographer blinded to procedural TEE findings later retrospectively reviewed TEE examinations. A corresponding 12-hour time-clock system was plotted for fluoroscopic PPL localization. PPLs were localized offline using fluoroscopic images by an independent interventional cardiologist blinded to TEE results using the crossing guidewire position in the left anterior oblique view as reference for PPL localization. Agreement between methods was evaluated. Results: Complete imaging data were available for analysis in 20 patients who, between 2002 and 2009, underwent TCR where the defect was successfully crossed. There was excellent agreement between procedural TEE and retrospective TEE review for PPL localization (100%; p ! 0.0001), and between fluoroscopic and procedural TEE localization (90%; CI = [77%; 100%]; p = 0.0003). In only two cases where there was disagreement, fluoroscopic PPL localization was adjacent to TEE localization. Conclusion: Localization of PPL with this novel fluoroscopic system shows very good agreement with the highly reproducible TEE method.