Prosthesis Implantation

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Editorial

Computational Fluid Dynamics (CFD) For Predicting Pathological Changes In The Aorta: Is It Ready For Clinical Use?

Dominik Obrist et al. Hendrik von Tengg-Kobligk

Patient-specific modelling

Patient-specific models have been successfully deployed by many researchers. Nevertheless, the translation of high-resolution radiological data into geometrical vascular models for CFD remains a time-intensive task which is often cumbersome and requires trained specialists. There is a lack of automated segmentation and meshing tools for biomedical tasks. Recent developments based on deep neural networks may provide acceptable solutions for clinical use.

The setting of boundary conditions (e.g., velocity profiles at inflow/outflow) requires great care, because boundary conditions have a strong effect on the quality of the results. Therefore, it is useful to include flow measurements at well-defined locations (e.g., 2D+time or 3D+time blood flow MRI) into radiologic protocols. Next to the adequate choice of the modality and body location, this requires appropriate temporal and spatial resolution of the scans.

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Viewpoint

Early Diagnosis and Treatment in Infective Endocarditis: Challenges for a Better Prognosis

Daniely Iadocico Sobreiro et al. Roney Orismar Sampaio Rinaldo Focaccia Siciliano Calila Vieira Andrade Brazil … Carlos Eduardo de Barros Branco Antônio Sergio de Santis Andrade Lopes Flávio Tarasoutchi Tânia Mara Varejão Strabelli

Infective endocarditis (IE), a microbial infection of the cardiac or adjacent vascular endothelium, remains a feared disease, although the modern diagnosis systematizations date back to 1885 by Osler. Although relatively uncommon, with approximately 3-10 cases per 100,000 individuals/year, the mortality remains high: more than one-third of patients die in the first year after the diagnosis.^, Only early diagnosis and treatment, whether exclusively clinical or associated with cardiac surgery, may interfere to reduce this high mortality rate.

IE used to be more frequent in young and middle-aged adults with rheumatic or congenital heart disease. However, recent studies have shown a significant reduction in the incidence of IE in these groups, especially in more developed countries.

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Original Article

Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

André Luiz Silveira Souza et al. Constantino González Salgado Ricardo Mourilhe-Rocha Evandro Tinoco Mesquita … Luciana Cristina Lima Correia Lima Nelson Durval Ferreira Gomes de Mattos Arnaldo Rabischoffsky Francisco Eduardo Sampaio Fagundes Alexandre Siciliano Colafranceschi Luiz Antonio Ferreira Carvalho

Abstract

Background:

Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease.

Objective:

To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation.

Methods:

Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality.

Results:

A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm² and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%.

Conclusion:

Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.

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Case Report

Endovascular stent-graft treatment of penetrating aortic ulcer

Rogério Tadeu Tumelero et al. Norberto Toazza Duda Alexandre Pereira Tognon Luciano Panata … Júlio Cesar Canfield Teixeira João Batista Machado Giongo

Penet rat ing aor t ic atherosclerot ic ulcer i s an underdiagnosed condition that presents high rates of morbidity and mortality. We report two cases of patients with severe chest pain, with no ischemic features, who underwent chest angiotomography and showed an ulceration of the aortic wall, with contrast penetration into the middle layer. Due to the failure of the medical treatment, the patients underwent percutaneous aortic stent implantation with complete resolution of symptoms.

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Computational Fluid Dynamics (CFD) For Predicting Pathological Changes In The Aorta: Is It Ready For Clinical Use?

Patient-specific modelling

Early Diagnosis and Treatment in Infective Endocarditis: Challenges for a Better Prognosis

Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Endovascular stent-graft treatment of penetrating aortic ulcer

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