Shortness of breath (SOB) is common among healthy women with normal pregnancies. However, when no... more Shortness of breath (SOB) is common among healthy women with normal pregnancies. However, when no overt cardiac or extra cardiac etiology is found, a subtle cardiac source must be excluded. Pregnancy may induce or unmask myocardial dysfunction that may cause SOB. Healthy pregnant women with significant SOB were recruited for this study. We performed a comprehensive echocardiographic assessment including tissue Doppler imaging (TDI) and 2- dimensional strain imaging (2DS). The echocardiographic data obtained were compared with that of a control group of pregnant women without SOB. Thirty pregnant women with SOB were enrolled in the study (age, 31.8 ± 4.9 years, and gestation, 38.2 ± 2.8 weeks) for whom no overt etiology for SOB was detected. Patients with SOB compared with controls had thicker hearts (septum: 10.1 ± 1.1 vs 8.9 ± 0.9 mm; P < 0.001; posterior wall: 9.4 ± 1.1 vs 8.9 ± 0.9 mm; P < 0.01), shorter E-wave deceleration time (158.0 ± 50.1 vs 187.1 ± 37.6 msec; P = 0.01)...
The Israel Medical Association journal : IMAJ, 2013
The pathophysiology of aortic stenosis (AS) involves inflammatory features including infiltration... more The pathophysiology of aortic stenosis (AS) involves inflammatory features including infiltration of the aortic valve (AV) by activated macrophages and T cells, deposition of lipids, and heterotopic calcification. To evaluate the correlation between white blood cell (WBC) differential count and the occurrence and progression of AS. We identified in our institutional registry 150 patients with AS who underwent two repeated echo studies at least 6 months apart. We evaluated the association between the average of repeated WBC differential counts sampled during the previous 3 years and subsequent echocardiographic AS indices. There was no significant difference in total WBC, lymphocyte or eosinophil count among mild, moderate or severe AS groups. There was a progressive decrease in monocyte count with increasing AS severity (P = 0.046), more prominent when comparing the mild and severe groups. There was a negative correlation between AV peak velocity or peak or mean gradient and monocyt...
To report a case of serious ventricular arrhythmia during transesophageal echocardiography. A 58-... more To report a case of serious ventricular arrhythmia during transesophageal echocardiography. A 58-year-old woman with previous mitral and tricuspid valve replacement and permanent pacemaker implantation suffered from recurrent fever and Staphylococcus aureus bacteremia. Transesophageal echocardiography was performed as part of the assessment for infective endocarditis. During this procedure the patient developed sustained ventricular tachycardia and subsequently ventricular flutter. She was successfully resuscitated. Subsequently the procedure was undertaken under general anesthesia with no complications. The increasing use of TEE in a wider spectrum of patients, many of whom are seriously ill, may result in serious side-effects.
Objective: Hemodynamic forces are potential determinants of aortic atherosclerosis. Aortic valve ... more Objective: Hemodynamic forces are potential determinants of aortic atherosclerosis. Aortic valve regurgitation (AR) produces increased strokevolume and high pulse-pressure, as well as diastolic retrograde flow that extend to the distal aorta. These hemodynamic changes may contribute to atherogenesis. However, the association between AR and aortic atherosclerosis is not well known. Methods: We assessed the presence, extent and distribution of atherosclerotic lesions in the aorta of 42 patients with chronic AR and compared them to 40 patients with similar risk factor profile for atherosclerosis and no valvular disease. Results: There was no difference in the extent of atheroma in the ascending aorta and aortic arch between patients with and without AR. Mean thickness of the descending aorta was higher in patients with AR compared to controls (2.7±1.46 mm vs. 1.87±1 mm, p = 0.002). Descending aortic atheroma was evident in 25 patients (60%) and 12 patients (30%), respectively (p = 0.01). Complex lesions were seen in 11 patients with AR and in 4 patients in the control group (p = 0.09). Aortic regurgitation was found to be the only predicting factor for the presence of aortic atherosclerosis in the descending aorta (odds ratio 4.1; 95% CI 1.2-14.3, p = 0.03). Patients with AR and descending aortic atherosclerosis had higher descending aorta diameter and lower left ventricular ejection-fraction as compared to patients with AR and no atherosclerosis (p = 0.02 and p = 0.03, respectively). Conclusions: There is an increased prevalence of descending aortic atherosclerosis in patients with significant AR. A larger scale prospective study is needed to assess the clinical implications of these findings.
The mechanism of dipyridamole-induced abnormal increased T1-201 lung uptake in patients without c... more The mechanism of dipyridamole-induced abnormal increased T1-201 lung uptake in patients without coronary artery disease is poorly understood. The purpose of this study was to evaluate the relation between dipyridamole-induced abnormal T1-201 lung uptake and left ventricular (LV) diastolic indexes using Doppler, color M-mode and Tissue Doppler modalities at rest, and at dipyridamole stress echocardiograpy (DSE) in patients with normal myocardial perfusion and LV function. 18 consecutive patients (mean age 64 +/- 7 years) with normal myocardial perfusion and increased lung T1-201 uptake on dipyridamole stress-redistribution single photon emission computed tomography (SPECT) were included in our study. These patients were compared with 18 age-matched control patients with normal perfusion and normal T1-201 lung uptake. All patients underwent DSE. A good correlation was found between the T-201 lung uptake, the peak early velocity of mitral inflow (E, r = 0.57) and estimated pulmonary capillary wedge pressure (PCWP = 1.24[E/Ea] + 1.9, r = 0.68). In patients with increased L/H ratio compared to control group, the E and the PCWP were significantly higher at baseline 81 +/- 18 vs 68 +/- 11 (cm/s) and 13 +/- 3 vs 10.2 +/- 2 (mmHg). An additional significant increase of E to 91 +/- 23 (cm/s (P = 0.001)) and PCWP to 14.8 +/- 3 (P = 0.005) after dipyridamole administration was seen; in contrast to a nonsignificant change observed in control group. For the detection of a dipyridamole induced PCWP &amp;amp;gt;12 mmHg, a L/H ratio of &amp;amp;gt;/=50% had a sensitivity of 72% and a specificity of 83%, resulting in a positive and a negative predictive value of 81% and 75%, respectively. A dipyridamole-induced abnormal T1-201 lung uptake in patients with normal myocardial perfusion and systolic function is predictive of elevated filling pressures at rest and in response to dipyridamole administration, probably reflecting an intrinsic resting diastolic dysfunction and a further abnormal response to vasodilatation.
Peripartum cardiomyopathy (PPCM) is a rare and heterogeneous disease with a higher prevalence in ... more Peripartum cardiomyopathy (PPCM) is a rare and heterogeneous disease with a higher prevalence in African Americans (AAs) in the USA. The clinical features and prognosis of PPCM in AAs have not been sufficiently characterized. We studied 52 AA patients with PPCM and compared clinical characteristics and outcome with those of 104 white patients. AA patients were significantly younger (26 ± 7 vs 30 ± 6 years; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), had a higher prevalence of gestational hypertension (61% vs 41%; P = .03), and were diagnosed more commonly postpartum rather then antepartum (83% vs 64%; P = .03). The rate of left ventricular (LV) recovery (LV ejection fraction [LVEF] ≥50%) was significantly lower in AAs (40% vs 61%; P = .02). AA women also had a larger LV end-diastolic diameter (57 ± 10 vs 51 ± 6 mm; P = .004) as well as lower LVEF (40% ± 16.7% vs 46% ± 14%; P = .002) at the last follow-up. Moreover, AA patients had a significantly higher incidence of the combined end points of mortality and cardiac transplantation (P = .03) and showed a strong trend (P = .09) for increased mortality. AA patients with PPCM in the USA have a different clinical profile and worse prognosis compared with white patients. Further research to evaluate potentially correctable causes for these differences is warranted.
Endothelial progenitor cells (EPCs) have a role in the repair of endothelial surfaces after injur... more Endothelial progenitor cells (EPCs) have a role in the repair of endothelial surfaces after injury. Reduced numbers of EPCs are related to endothelial dysfunction and adverse clinical events, suggesting that endothelial injury in the absence of sufficient repair by circulating EPCs promotes the progression of vascular disease or valvular disorder. The aim of the present study was to assess the number and role of EPCs in patients with aortic valve regurgitation (AR). We assessed the number of EPCs and apoptotic EPCs in 31 patients with significant AR and compared them with 30 patients who had similar risk factors and no valvular disease. The numbers of EPCs and apoptotic EPCs were assessed by flow cytometry. The 2 groups had similar clinical characteristics. Patients with AR had fewer circulating EPCs and late apoptotic EPCs as compared with the control group (0.054 ± 0.03% vs. 0.079 ± 0.06%, P=0.039 and 0% (0-3.4%) vs. 5% (0-14%), P=0.03, respectively). In patients with AR, circulating EPCs correlated negatively with septal thickness (r=-0.47, P=0.01), whereas late apoptotic EPCs had a negative correlation with left ventricular end-systolic diameter (r=-0.57, P=0.01). Patients with AR have fewer EPCs and late apoptotic EPCs. These data suggest an impaired valvular endothelial cell regenerative process in patients with AR.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
We sought to evaluate retrospectively the outcomes of patients at our hospital who had moderate i... more We sought to evaluate retrospectively the outcomes of patients at our hospital who had moderate ischemic mitral regurgitation and who underwent coronary artery bypass grafting (CABG) alone or with concomitant mitral valve repair (CABG+MVr). A total of 83 patients had a reduced left ventricular ejection fraction and moderate mitral regurgitation: 28 patients underwent CABG+MVr, and 55 underwent CABG alone. Changes in mitral regurgitation, functional class, and left ventricular ejection fraction were compared in both groups. The mean follow-up was 5.1 ± 3.6 years (range, 0.1-15.1 yr). Reduction of 2 mitralregurgitation grades was found in 85% of CABG+MVr patients versus 14% of CABG-only patients (P <0.0001) at 1 year, and in 56% versus 14% at 5 years, respectively (P=0.1), as well as improvements in left ventricular ejection fraction and functional class. One-and 5-year survival rates were similar in the CABG+MVr and CABG-only groups: 96% ± 3% versus 96% ± 4%, and 87% ± 5% versus 81% ± 8%, respectively (P=NS). Propensity analysis showed similar results. Recurrent (3+ or 4+) mitral regurgitation was found in 22% and 47% at late follow-up, respectively. In patients with moderate ischemic mitral regurgitation, either surgical approach led to an improvement in functional class. Early and intermediate-term mortality rates were low with either CABG or CABG+MVr. However, an increased rate of late recurrent mitral regurgitation in the CABG+MVr group was observed. (Tex Heart Inst J 2009;36(5):416-24)
Background. The association between the severity of arteriosclerosis in the thoracic aorta in pat... more Background. The association between the severity of arteriosclerosis in the thoracic aorta in patients with isolated aortic stenosis (AS) and with concomitant coronary artery disease (CAD) has been not evaluated. Therefore, the aim of our study was to compare the thoracic aortic atheroma extent and severity in patients with severe AS alone and with concomitant CAD by intraoperative transesophageal echocardiography.
Assessment of aortic stenosis by three-dimensional http://heart.bmj.com/cgi/content/full/93/7/801... more Assessment of aortic stenosis by three-dimensional http://heart.bmj.com/cgi/content/full/93/7/801 Updated information and services can be found at:
zn znan n, Po Po Pola a and nd nd; ; ; 8 He He Hea ar art t t an n nd d d Va Va V scul ul ular r ... more zn znan n, Po Po Pola a and nd nd; ; ; 8 He He Hea ar art t t an n nd d d Va Va V scul ul ular r r Inst titu tu ute, , , Cl Cl Clev ev vel el eland nd nd C C Cli li lini ni nic, c, c, A Abu D D Dha ha habi bi bi, Un Un Unit it ited ed ed A A Ara ra rab b b Em Em Emir i ates; 9 Dept of f f C Card d dio ology y y, G G Gottsegen n n G G György g gy Hun n ng g garian an an I I Ins ns nstit tute o of Card d dio ology gy gy, Bud da dap p pest, H H Hung g gar ry 10 Dept of f f Ca C C rd dio olog g gy, , Facu u ult t ty y y of M M Med d dic c cine, , Cai a ro U U Univ v ver r rsity y y H H Hosp p pit t tal, Eg g gyp pt; 11 D D Divisi i ion on n of f A A Adult t t Cong ng ngen en enit it ital al al a a and V V Val alvu vu vula la lar r He He Heart Di Di Dise se eas as ase, D D Dep ep ept t t of of of C C Ca a ard rd rdio i iova va vasc c cul ul ular ar ar M M Med ed edic ic cin in ine e, e, U U Uni n niv v v a er e e si si ity ty ty H H Hos os osp pita a al l l Mu Mu Muen en enst ster er er Ge Ge Germ rman an a y; y; y; 12 De De ept pt pt o o of f Ob Ob Obst st stet et etri rics cs cs, , , Im Impe pe peri rial al a C C Col ol o le le ege ge ge S S Sch ch c oo oo ool l of of o M Med ed edic ic cin ine, e, e, C C Che he els ls sea ea ea a a and nd d W W Wes es estm tmin inst st ster er e H Hos os ospi pi p ta ta tal l London United Kingdom; Abstract Background-Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event while their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. Methods and Results-Within the prospective, observational, contemporary, worldwide Registry Of Pregnancy And Cardiac disease (ROPAC) we describe the pregnancy outcome of 212 patients with a MHV. We compare them to 134 patients with a tissue heart valve (THV) and 2620 other patients without a prosthetic valve (NoPHV). Maternal mortality occurred in 1.4% of the MHV patients, in 1.5% of THV patients (p=1.000) and in 0.2% of NoPHV patients (p=0.025). Mechanical valve thrombosis complicated pregnancy in 10 (4.7%) MHV patients; in five of them the valve thrombosis occurred in the first trimester, and all five had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of MHV patients, in 5.1% of THV patients (p<0.001) and in 4.9% of NoPHV patients (p<0.001). Only 58% of the MHV patients had a pregnancy free of serious adverse events, versus 79% of THV patients (p<0.001)
Shortness of breath (SOB) is common among healthy women with normal pregnancies. However, when no... more Shortness of breath (SOB) is common among healthy women with normal pregnancies. However, when no overt cardiac or extra cardiac etiology is found, a subtle cardiac source must be excluded. Pregnancy may induce or unmask myocardial dysfunction that may cause SOB. Healthy pregnant women with significant SOB were recruited for this study. We performed a comprehensive echocardiographic assessment including tissue Doppler imaging (TDI) and 2- dimensional strain imaging (2DS). The echocardiographic data obtained were compared with that of a control group of pregnant women without SOB. Thirty pregnant women with SOB were enrolled in the study (age, 31.8 ± 4.9 years, and gestation, 38.2 ± 2.8 weeks) for whom no overt etiology for SOB was detected. Patients with SOB compared with controls had thicker hearts (septum: 10.1 ± 1.1 vs 8.9 ± 0.9 mm; P < 0.001; posterior wall: 9.4 ± 1.1 vs 8.9 ± 0.9 mm; P < 0.01), shorter E-wave deceleration time (158.0 ± 50.1 vs 187.1 ± 37.6 msec; P = 0.01)...
The Israel Medical Association journal : IMAJ, 2013
The pathophysiology of aortic stenosis (AS) involves inflammatory features including infiltration... more The pathophysiology of aortic stenosis (AS) involves inflammatory features including infiltration of the aortic valve (AV) by activated macrophages and T cells, deposition of lipids, and heterotopic calcification. To evaluate the correlation between white blood cell (WBC) differential count and the occurrence and progression of AS. We identified in our institutional registry 150 patients with AS who underwent two repeated echo studies at least 6 months apart. We evaluated the association between the average of repeated WBC differential counts sampled during the previous 3 years and subsequent echocardiographic AS indices. There was no significant difference in total WBC, lymphocyte or eosinophil count among mild, moderate or severe AS groups. There was a progressive decrease in monocyte count with increasing AS severity (P = 0.046), more prominent when comparing the mild and severe groups. There was a negative correlation between AV peak velocity or peak or mean gradient and monocyt...
To report a case of serious ventricular arrhythmia during transesophageal echocardiography. A 58-... more To report a case of serious ventricular arrhythmia during transesophageal echocardiography. A 58-year-old woman with previous mitral and tricuspid valve replacement and permanent pacemaker implantation suffered from recurrent fever and Staphylococcus aureus bacteremia. Transesophageal echocardiography was performed as part of the assessment for infective endocarditis. During this procedure the patient developed sustained ventricular tachycardia and subsequently ventricular flutter. She was successfully resuscitated. Subsequently the procedure was undertaken under general anesthesia with no complications. The increasing use of TEE in a wider spectrum of patients, many of whom are seriously ill, may result in serious side-effects.
Objective: Hemodynamic forces are potential determinants of aortic atherosclerosis. Aortic valve ... more Objective: Hemodynamic forces are potential determinants of aortic atherosclerosis. Aortic valve regurgitation (AR) produces increased strokevolume and high pulse-pressure, as well as diastolic retrograde flow that extend to the distal aorta. These hemodynamic changes may contribute to atherogenesis. However, the association between AR and aortic atherosclerosis is not well known. Methods: We assessed the presence, extent and distribution of atherosclerotic lesions in the aorta of 42 patients with chronic AR and compared them to 40 patients with similar risk factor profile for atherosclerosis and no valvular disease. Results: There was no difference in the extent of atheroma in the ascending aorta and aortic arch between patients with and without AR. Mean thickness of the descending aorta was higher in patients with AR compared to controls (2.7±1.46 mm vs. 1.87±1 mm, p = 0.002). Descending aortic atheroma was evident in 25 patients (60%) and 12 patients (30%), respectively (p = 0.01). Complex lesions were seen in 11 patients with AR and in 4 patients in the control group (p = 0.09). Aortic regurgitation was found to be the only predicting factor for the presence of aortic atherosclerosis in the descending aorta (odds ratio 4.1; 95% CI 1.2-14.3, p = 0.03). Patients with AR and descending aortic atherosclerosis had higher descending aorta diameter and lower left ventricular ejection-fraction as compared to patients with AR and no atherosclerosis (p = 0.02 and p = 0.03, respectively). Conclusions: There is an increased prevalence of descending aortic atherosclerosis in patients with significant AR. A larger scale prospective study is needed to assess the clinical implications of these findings.
The mechanism of dipyridamole-induced abnormal increased T1-201 lung uptake in patients without c... more The mechanism of dipyridamole-induced abnormal increased T1-201 lung uptake in patients without coronary artery disease is poorly understood. The purpose of this study was to evaluate the relation between dipyridamole-induced abnormal T1-201 lung uptake and left ventricular (LV) diastolic indexes using Doppler, color M-mode and Tissue Doppler modalities at rest, and at dipyridamole stress echocardiograpy (DSE) in patients with normal myocardial perfusion and LV function. 18 consecutive patients (mean age 64 +/- 7 years) with normal myocardial perfusion and increased lung T1-201 uptake on dipyridamole stress-redistribution single photon emission computed tomography (SPECT) were included in our study. These patients were compared with 18 age-matched control patients with normal perfusion and normal T1-201 lung uptake. All patients underwent DSE. A good correlation was found between the T-201 lung uptake, the peak early velocity of mitral inflow (E, r = 0.57) and estimated pulmonary capillary wedge pressure (PCWP = 1.24[E/Ea] + 1.9, r = 0.68). In patients with increased L/H ratio compared to control group, the E and the PCWP were significantly higher at baseline 81 +/- 18 vs 68 +/- 11 (cm/s) and 13 +/- 3 vs 10.2 +/- 2 (mmHg). An additional significant increase of E to 91 +/- 23 (cm/s (P = 0.001)) and PCWP to 14.8 +/- 3 (P = 0.005) after dipyridamole administration was seen; in contrast to a nonsignificant change observed in control group. For the detection of a dipyridamole induced PCWP &amp;amp;gt;12 mmHg, a L/H ratio of &amp;amp;gt;/=50% had a sensitivity of 72% and a specificity of 83%, resulting in a positive and a negative predictive value of 81% and 75%, respectively. A dipyridamole-induced abnormal T1-201 lung uptake in patients with normal myocardial perfusion and systolic function is predictive of elevated filling pressures at rest and in response to dipyridamole administration, probably reflecting an intrinsic resting diastolic dysfunction and a further abnormal response to vasodilatation.
Peripartum cardiomyopathy (PPCM) is a rare and heterogeneous disease with a higher prevalence in ... more Peripartum cardiomyopathy (PPCM) is a rare and heterogeneous disease with a higher prevalence in African Americans (AAs) in the USA. The clinical features and prognosis of PPCM in AAs have not been sufficiently characterized. We studied 52 AA patients with PPCM and compared clinical characteristics and outcome with those of 104 white patients. AA patients were significantly younger (26 ± 7 vs 30 ± 6 years; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), had a higher prevalence of gestational hypertension (61% vs 41%; P = .03), and were diagnosed more commonly postpartum rather then antepartum (83% vs 64%; P = .03). The rate of left ventricular (LV) recovery (LV ejection fraction [LVEF] ≥50%) was significantly lower in AAs (40% vs 61%; P = .02). AA women also had a larger LV end-diastolic diameter (57 ± 10 vs 51 ± 6 mm; P = .004) as well as lower LVEF (40% ± 16.7% vs 46% ± 14%; P = .002) at the last follow-up. Moreover, AA patients had a significantly higher incidence of the combined end points of mortality and cardiac transplantation (P = .03) and showed a strong trend (P = .09) for increased mortality. AA patients with PPCM in the USA have a different clinical profile and worse prognosis compared with white patients. Further research to evaluate potentially correctable causes for these differences is warranted.
Endothelial progenitor cells (EPCs) have a role in the repair of endothelial surfaces after injur... more Endothelial progenitor cells (EPCs) have a role in the repair of endothelial surfaces after injury. Reduced numbers of EPCs are related to endothelial dysfunction and adverse clinical events, suggesting that endothelial injury in the absence of sufficient repair by circulating EPCs promotes the progression of vascular disease or valvular disorder. The aim of the present study was to assess the number and role of EPCs in patients with aortic valve regurgitation (AR). We assessed the number of EPCs and apoptotic EPCs in 31 patients with significant AR and compared them with 30 patients who had similar risk factors and no valvular disease. The numbers of EPCs and apoptotic EPCs were assessed by flow cytometry. The 2 groups had similar clinical characteristics. Patients with AR had fewer circulating EPCs and late apoptotic EPCs as compared with the control group (0.054 ± 0.03% vs. 0.079 ± 0.06%, P=0.039 and 0% (0-3.4%) vs. 5% (0-14%), P=0.03, respectively). In patients with AR, circulating EPCs correlated negatively with septal thickness (r=-0.47, P=0.01), whereas late apoptotic EPCs had a negative correlation with left ventricular end-systolic diameter (r=-0.57, P=0.01). Patients with AR have fewer EPCs and late apoptotic EPCs. These data suggest an impaired valvular endothelial cell regenerative process in patients with AR.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
We sought to evaluate retrospectively the outcomes of patients at our hospital who had moderate i... more We sought to evaluate retrospectively the outcomes of patients at our hospital who had moderate ischemic mitral regurgitation and who underwent coronary artery bypass grafting (CABG) alone or with concomitant mitral valve repair (CABG+MVr). A total of 83 patients had a reduced left ventricular ejection fraction and moderate mitral regurgitation: 28 patients underwent CABG+MVr, and 55 underwent CABG alone. Changes in mitral regurgitation, functional class, and left ventricular ejection fraction were compared in both groups. The mean follow-up was 5.1 ± 3.6 years (range, 0.1-15.1 yr). Reduction of 2 mitralregurgitation grades was found in 85% of CABG+MVr patients versus 14% of CABG-only patients (P <0.0001) at 1 year, and in 56% versus 14% at 5 years, respectively (P=0.1), as well as improvements in left ventricular ejection fraction and functional class. One-and 5-year survival rates were similar in the CABG+MVr and CABG-only groups: 96% ± 3% versus 96% ± 4%, and 87% ± 5% versus 81% ± 8%, respectively (P=NS). Propensity analysis showed similar results. Recurrent (3+ or 4+) mitral regurgitation was found in 22% and 47% at late follow-up, respectively. In patients with moderate ischemic mitral regurgitation, either surgical approach led to an improvement in functional class. Early and intermediate-term mortality rates were low with either CABG or CABG+MVr. However, an increased rate of late recurrent mitral regurgitation in the CABG+MVr group was observed. (Tex Heart Inst J 2009;36(5):416-24)
Background. The association between the severity of arteriosclerosis in the thoracic aorta in pat... more Background. The association between the severity of arteriosclerosis in the thoracic aorta in patients with isolated aortic stenosis (AS) and with concomitant coronary artery disease (CAD) has been not evaluated. Therefore, the aim of our study was to compare the thoracic aortic atheroma extent and severity in patients with severe AS alone and with concomitant CAD by intraoperative transesophageal echocardiography.
Assessment of aortic stenosis by three-dimensional http://heart.bmj.com/cgi/content/full/93/7/801... more Assessment of aortic stenosis by three-dimensional http://heart.bmj.com/cgi/content/full/93/7/801 Updated information and services can be found at:
zn znan n, Po Po Pola a and nd nd; ; ; 8 He He Hea ar art t t an n nd d d Va Va V scul ul ular r ... more zn znan n, Po Po Pola a and nd nd; ; ; 8 He He Hea ar art t t an n nd d d Va Va V scul ul ular r r Inst titu tu ute, , , Cl Cl Clev ev vel el eland nd nd C C Cli li lini ni nic, c, c, A Abu D D Dha ha habi bi bi, Un Un Unit it ited ed ed A A Ara ra rab b b Em Em Emir i ates; 9 Dept of f f C Card d dio ology y y, G G Gottsegen n n G G György g gy Hun n ng g garian an an I I Ins ns nstit tute o of Card d dio ology gy gy, Bud da dap p pest, H H Hung g gar ry 10 Dept of f f Ca C C rd dio olog g gy, , Facu u ult t ty y y of M M Med d dic c cine, , Cai a ro U U Univ v ver r rsity y y H H Hosp p pit t tal, Eg g gyp pt; 11 D D Divisi i ion on n of f A A Adult t t Cong ng ngen en enit it ital al al a a and V V Val alvu vu vula la lar r He He Heart Di Di Dise se eas as ase, D D Dep ep ept t t of of of C C Ca a ard rd rdio i iova va vasc c cul ul ular ar ar M M Med ed edic ic cin in ine e, e, U U Uni n niv v v a er e e si si ity ty ty H H Hos os osp pita a al l l Mu Mu Muen en enst ster er er Ge Ge Germ rman an a y; y; y; 12 De De ept pt pt o o of f Ob Ob Obst st stet et etri rics cs cs, , , Im Impe pe peri rial al a C C Col ol o le le ege ge ge S S Sch ch c oo oo ool l of of o M Med ed edic ic cin ine, e, e, C C Che he els ls sea ea ea a a and nd d W W Wes es estm tmin inst st ster er e H Hos os ospi pi p ta ta tal l London United Kingdom; Abstract Background-Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event while their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. Methods and Results-Within the prospective, observational, contemporary, worldwide Registry Of Pregnancy And Cardiac disease (ROPAC) we describe the pregnancy outcome of 212 patients with a MHV. We compare them to 134 patients with a tissue heart valve (THV) and 2620 other patients without a prosthetic valve (NoPHV). Maternal mortality occurred in 1.4% of the MHV patients, in 1.5% of THV patients (p=1.000) and in 0.2% of NoPHV patients (p=0.025). Mechanical valve thrombosis complicated pregnancy in 10 (4.7%) MHV patients; in five of them the valve thrombosis occurred in the first trimester, and all five had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of MHV patients, in 5.1% of THV patients (p<0.001) and in 4.9% of NoPHV patients (p<0.001). Only 58% of the MHV patients had a pregnancy free of serious adverse events, versus 79% of THV patients (p<0.001)
Uploads
Papers by Sorel Goland