Progression of Aortic Regurgitation in Asian Patients with Congenital Sinus of Valsalva Aneurysm

2013 ◽  
Vol 16 (4) ◽  
pp. 219 ◽  
Author(s):  
Zhi-Qiang Li ◽  
Ai-Jun Liu ◽  
Xiao-Feng Li ◽  
Yao-Bin Zhu ◽  
Ying-Long Liu
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Aortic Regurgitation ◽  
Long Term Results ◽  
Sinus Of Valsalva ◽  
Sinus Of Valsalva Aneurysm ◽  
Cox Regression Analysis ◽  
Cardiothoracic Ratio ◽  
The Right

<p><b>Background:</b> We reviewed the experience of An Zhen and Fu Wai Hospital for congenital sinus of Valsalva aneurysm (SVA) to determine risk factors for aortic valve replacement (AVR) and postoperative progression of aortic regurgitation (AR).</p><p><b>Methods:</b> Over a 7-year period, 255 patients underwent surgical repair of an SVA. Aneurysms originated from the right sinus and the noncoronary sinus in 212 patients (83.1%) and 38 patients (14.9%), respectively, and protruded into the right ventricle and right atrium in 171 patients (67.1%) and 80 patients (31.4%), respectively. AR presented in 142 patients (55.7%), 60 patients underwent AVR, and 13 patients underwent aortic valvuloplasty (3 patients eventually received AVR for valvuloplasty failure).</p><p><b>Results:</b> All patients survived the operation. Late death occurred in 2 patients (0.8%), and 2 patients (0.8%) experienced anticoagulation-related complications. Logistic regression analysis revealed that infective endocarditis, the cardiothoracic ratio, and a nonruptured SVA were risk factors for AVR. Late follow-up of 150 patients by echocardiographic assessment revealed that AR improved in 17 patients and worsened in 20 patients. Cox regression analysis revealed AR at discharge to be an independent risk factor for AR aggravation at late follow-up.</p><p><b>Conclusions:</b> SVA can be repaired with low mortality and excellent long-term results. AR at discharge is an important factor in determining AR aggravation at late follow-up after the operation. We recommend early diagnosis and aggressive treatment for SVA.</p>

Risk Factors for Aortic Regurgitation Progression After Repair of Sinus of Valsalva Aneurysm

2021 ◽  
Author(s):  
Xiaokang Luo ◽  
Baotong Li ◽  
Fan Ju ◽  
Chenyu Zhao ◽  
Zhenpeng Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Regurgitation ◽  
Sinus Of Valsalva ◽  
Sinus Of Valsalva Aneurysm

scholarly journals Role of Disease Modifying Treatment in the Risk of Alloimmunization in Transfused Patients with Myelodysplastic Syndromes: A Population-Based Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4253-4253
Author(s):  
Hanne Rozema ◽  
Robby Kibbelaar ◽  
Nic Veeger ◽  
Mels Hoogendoorn ◽  
Eric van Roon
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cox Regression ◽  
Population Based ◽  
Incidence Rates ◽  
Blood Products ◽  
Cox Regression Analysis ◽  
In The Beginning ◽  
Observation Period

The majority of patients with myelodysplastic syndromes (MDS) require regular red blood cell (RBC) transfusions. Alloimmunization (AI) against blood products is an adverse event, causing time-consuming RBC compatibility testing. The reported incidence of AI in MDS patients varies greatly. Even though different studies on AI in MDS patients have been performed, there are still knowledge gaps. Current literature has not yet fully identified the risk factors and dynamics of AI in individual patients, nor has the influence of disease modifying treatment (DMT) been explored. Therefore, we performed this study to evaluate the effect of DMT on AI. An observational, population-based study, using the HemoBase registry, was performed including all newly diagnosed MDS patients between 2005 and 2017 in Friesland, a province of the Netherlands. All available information about treatment and transfusions, including transfusion dates, types, and treatment regimens, was collected from the electronic health records and laboratory systems. Follow-up occurred through March 2019. For our patient cohort, blood products were matched for AB0 and RhD, and transfused per the 'type and screen' policy (i.e. electronic matching of blood group phenotype between patient and donor). After a positive antibody screening, antibody identification and Rh/K phenotyping was performed and subsequent blood products were (cross)matched accordingly. The observation period was counted from first transfusion until last transfusion or first AI event. Univariate analyses and cumulative frequency distributions were performed to study possible risk factors and dynamics of AI. DMT was defined as hypomethylating agents, lenalidomide, chemotherapy and monoclonal antibodies. The effect of DMT as a temporary risk period on the risk of AI was estimated with incidence rates, relative risks (RR) and hazard ratios (HR) using a cox regression analysis. Follow-up was limited to 24 months for the cox regression analysis to avoid possible bias by survival differences. Statistical analyses were performed using IBM SPSS 24 and SAS 9.4. Out of 292 MDS patients, 236 patients received transfusions and were included in this study, covering 463 years of follow-up. AI occurred in 24 patients (10%). AI occurred mostly in the beginning of the observation period: Eighteen patients (75%) were alloimmunized after receiving 20 units of RBCs, whereas 22 patients (92%) showed AI after 45 units of RBCs (Figure 1). We found no significant risk factors for AI in MDS patients at baseline. DMT was given to 67 patients (28%) during the observation period. Patients on DMT received more RBC transfusions than patients that did not receive DMT (median of 33 (range: 3-154) and 11 (range: 0-322) RBC units respectively, p<0,001). Four AI events (6%) occurred in patients on DMT and 20 AI events (12%) occurred in patients not on DMT. Cox regression analysis of the first 24 months of follow-up showed an HR of 0.30 (95% CI: 0.07-1.31; p=0.11). The incidence rates per 100 person-years were 3.19 and 5.92 respectively. The corresponding RR was 0.54 (95% CI: 0.16-1.48; p=0.26). Based on our results, we conclude that the incidence of AI in an unselected, real world MDS population receiving RBC transfusions is 10% and predominantly occurred in the beginning of follow-up. Risk factors for AI at baseline could not be identified. Our data showed that patients on DMT received significantly more RBC transfusions but were less susceptible to AI. Therefore, extensive matching of blood products may not be necessary for patients on DMT. Larger studies are needed to confirm the protective effect of DMT on AI. Disclosures Rozema: Celgene: Other: Financial support for visiting MDS Foundation conference.

Predictive value of ankle–brachial index for long-term events of ischemic stroke in hemodialysis patients

Vascular ◽  
2020 ◽  
pp. 170853812092595
Author(s):  
Kai-Ni Lee ◽  
Li-Ping Chou ◽  
Chi-Chu Liu ◽  
Tsang-Shan Chen ◽  
Eric Kim-Tai Lui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Cox Regression ◽  
Ankle Brachial Index ◽  
Hemodialysis Patients ◽  
Serum Phosphate ◽  
Cox Regression Analysis

Objectives The ankle–brachial index is a noninvasive modality to evaluate atherosclerosis and is a predictive role for future cardiovascular events and mortality. However, few studies have evaluated its relation to long-term future ischemic stroke in hemodialysis patients. Therefore, we examined the relationship between ankle–brachial index and ischemic stroke events among hemodialysis patients in a seven-year follow-up. Methods A total of 84 patients were enrolled. Ankle–brachial index was assessed in January 2009. Primary outcomes included ischemic stroke. An ankle–brachial index < 0.9 was considered abnormal and 1.4 ≥ ankle–brachial index ≥ 0.9 to be normal ankle–brachial index. Results Mean values for ankle–brachial index were 0.98 ± 0.21at study entrance. In addition, 28 patients encountered ischemic stroke in the seven-year follow-up. In univariate Cox regression analysis, old age (hazard ratio (HR): 1.065, 95% confidence interval (CI): 1.030–1.102, p < 0.001), low seven-year averaged serum phosphate levels (HR: 0.473, 95% CI: 0.306–0.730, p = 0.001), and abnormal ankle–brachial index (HR: 0.035, 95% CI: 0.009–0.145, p < 0.001) were risk factors for ischemic stroke. In multivariate Cox regression analysis for significant variables in univariate analysis, abnormal ankle–brachial index (HR: 0.058, 95% CI: 0.012–0.279, p < 0.001) and low seven-year averaged serum phosphate levels (HR: 0.625, 95% CI: 0.404–0.968, p = 0.035) remained the risk factors for ischemic stroke. The risk of ischemic stroke was 3.783-fold in patients with abnormal ankle–brachial index compared with patients with normal ankle–brachial index (HR: 3.783, 95% CI: 1.731–8.269, p = 0.001). Conclusions These findings suggest that ankle–brachial index is an impressive predictor of future ischemic stroke among hemodialysis patients.

scholarly journals Risk Factors for Liver Decompensation and HCC in HCV-Cirrhotic Patients after DAAs: A Multicenter Prospective Study

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3810
Author(s):  
Filomena Morisco ◽  
Alessandro Federico ◽  
Massimo Marignani ◽  
Mariarita Cannavò ◽  
Giuseppina Pontillo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cox Regression ◽  
Independent Predictor ◽  
Liver Stiffness ◽  
Cox Regression Analysis ◽  
Liver Decompensation ◽  
Cirrhotic Patients ◽  
Multicenter Prospective Study

Background: Prospective studies on predictors of liver-related events in cirrhotic subjects achieving SVR after DAAs are lacking. Methods: We prospectively enrolled HCV cirrhotic patients in four Italian centers between November 2015 and October 2017. SVR and no-SVR cases were compared according to the presence or absence of liver-related events during a 24-month follow-up. Independent predictors of liver-related events were evaluated by Cox regression analysis. Results: A total of 706 subjects started DAAs therapy. SVR was confirmed in 687 (97.3%). A total of 61 subjects (8.9%) in the SVR group and 5 (26.3%) in the no-SVR group had liver-related events (p < 0.03). The incidence rate x 100 p/y was 1.6 for HCC, 1.7 for any liver decompensation, and 0.5 for hepatic death. Baseline liver stiffness (LSM) ≥ 20 kPa (HR 4.0; 95% CI 1.1–14.1) and genotype different from 1 (HR 7.5; 95% CI 2.1–27.3) were both independent predictors of liver decompensation. Baseline LSM > 20 KPa (HR 7.2; 95% CI 1.9–26.7) was the sole independent predictor of HCC. A decrease in liver stiffness (Delta LSM) by at least 20% at the end of follow-up was not associated with a decreased risk of liver-related events. Conclusion: Baseline LSM ≥ 20 kPa identifies HCV cirrhotic subjects at higher risk of liver-related events after SVR.

scholarly journals Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0006
Author(s):  
Eliezer Sidon ◽  
Ryan Rogero ◽  
Timothy Bell ◽  
Elizabeth McDonald ◽  
Daniel Fuchs ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pain Relief ◽  
Retrospective Studies ◽  
Cox Regression ◽  
Hallux Rigidus ◽  
Long Term Results ◽  
Cox Regression Analysis ◽  
Long Term Follow Up

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is the most common arthritic condition in the foot. The surgical treatment options involve cheilectomy, interposition arthroplasty, or arthrodesis of the 1st metatarsophalangeal joint (MTPJ). 1st MTPJ cheilectomy has been shown to produce satisfactory results in retrospective studies. Previous retrospective studies have reported up to 97% good to excellent results and 92% success in pain relief and function. The results of cheilectomy for higher grades of HR are less favorable, with conversion rates ranging from 25 to 56%. The purpose of this study is to evaluate the long-term functional results and survivorship of cheilectomy for treatment of HR. Methods: This is a retrospective study investigating the long-term results of cheilectomy for treatment of HR, performed by 3 fellowship-trained foot & ankle surgeons. Patient demographics, diagnoses, medical comorbidities, and physical examination notes were collected from our electronic medical record system. A fellowship-trained foot & ankle surgeon not involved in any patient’s care evaluated preoperative radiographs and assigned a HR grade (1-3, Hattrup & Johnson). All patients without available preoperative radiographs or who underwent concomitant procedures other than cheilectomy were excluded. A questionnaire was administered via email or telephone that included questions regarding pain recurrence following surgery, current functional status, satisfaction with surgery, shoe wear limitations, and details about need for further intervention of the great toe, including MTPJ injections or revision procedures. Cox regression analysis was performed to investigate patient factors contributing to lack of pain recurrence, which was treated as survival time. Results: One-hundred sixty-five patients (169 cases) were included, with a mean follow-up time of 6.6 years (range, 5.0-10.9 years). Most cases (118, 70%) were grade 2, with 30 (18%) grade 1 and 21 (12%) grade 3 cases. One-hundred forty-three of 169 (85%) cases experienced pain relief in the immediate period following surgery. The satisfaction rate was 69% (117/169), and the overall pain-free survival rate was 68%, without any significant difference between arthritic grades. In 75% of cases with pain recurrence, pain returned within the first 2 years following surgery. Nine cases (5%) required a revision procedure at a mean postoperative 3.6 years (range, 1.6-7.4 years). Cox regression analysis revealed older age (p=.062) and male sex (p=.058) to be marginally related to having less pain recurrence. Conclusion: Our study supports the use of cheilectomy for treatment of HR as a reliable procedure with favorable results. At long-term follow-up, patients who underwent cheilectomy had a low revision surgery rate and a moderately low rate of pain recurrence, with most pain recurrence occurring within the first 2 years. These results were not influenced by the preoperative arthritic grade, as long as the cheilectomy was performed on patients with no mid-range pain. These results can be used in treatment selection and anticipatory guidance for patients presenting with HR.

scholarly journals POS0772 PREVALENCE AND RISK FACTORS FOR HERPES ZOSTER REACTIVATION IN 1542 PATIENTS WITH RHEUMATIC DISEASES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 640.1-640
Author(s):  
C. C. Mok ◽  
L. Y. Ho ◽  
S. M. Tse ◽  
K. L. Chan ◽  
C. H. To
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Regression Analysis ◽  
Herpes Zoster ◽  
Rheumatic Diseases ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

Objectives:To study the prevalence and risk factors of herpes zoster (HZ) infection in patients with rheumatic diseases.Methods:Medical records of patients with rheumatic diseases who attended our out-patient rheumatology clinics between 2019 March and 2019 August were retrospectively reviewed. Patients who were using biological or targeted DMARDs were excluded. Episodes of HZ infection since disease diagnosis were identified and the prevalence over time was calculated. Laboratory parameters (total white cell count, neutrophil-to-lymphocyte ratio, serum albumin, globulin & creatinine), history of diabetes mellitus and the highest doses of immunosuppressive medications within 6 months of the first episode of HZ infection were compared with those within 6 months of last follow-up in patients who did not have HZ infection. Cox regression analysis was performed to identify factors associated with the first HZ infection in all patients.Results:1542 patients were studied (88% women, age 46.4±15.0 years). The underlying diseases were systemic lupus erythematosus (SLE) (38%), rheumatoid arthritis (26%) and other rheumatic diseases (36%). After a total follow-up of 11,515 patient-years since diagnosis (7.5±7.0 years), 122 (7.9%) patients developed 146 episodes of HZ infection, giving an overall prevalence of 1.27/100-patient years. The prevalence rates of HZ in SLE, RA and non-SLE/RA patients were 1.70, 0.64 and 0.76 per 100 patient-years, respectively. Patients who experienced HZ reactivation were younger (41.6±14.7 vs 46.8±15.0 years; p<0.001), more likely to have SLE (74% vs 35%; p<0.001) and diabetes mellitus (17% vs 7.3%; p=0.01), and had a significantly lower albumin (38.6±5.6 vs 41.3±3.5; p<0.001) and higher neutrophil-to-lymphocyte ratio (4.9±6.2 vs 2.8±2.6; p<0.001). More patients with HZ reactivation were treated with prednisolone (54% vs 22%; p<0.001), azathioprine (20% vs 8%; p<0.001), mycophenolate mofetil [MMF] (21% vs 12%; p=0.006), cyclophosphamide [CYC] (4.9% vs 0.1%; p<0.001) and hydroxychloroquine (48% vs 34%; p=0.002) in the preceding 6 months compared with those who did not have HZ infection. Among those using immunosuppressive drugs, the doses of MMF (1.42±0.64 vs 1.02±0.31g; p=0.005) and prednisolone (15.6±15.9 vs 5.5±4.5mg; p<0.001) were significantly higher in those with HZ infection. The cumulative risk of having HZ reactivation in SLE patients at 24 and 48 months since diagnosis was 5.9% and 8.6%, respectively, which was significantly higher than that in non-SLE patients (1.9% and 2.5%, respectively; p<0.001 by log rank test). Cox regression analysis revealed that having a diagnosis of SLE (HR 1.97 [1.17-3.31]), albumin level (HR 0.93 [0.90-0.97] per g/L; p=0.001), serum creatinine (HR 0.995 [0.990-1.00] per umol/L), higher neutrophil/lymphocyte ratio (HR 1.08 [1.05-1.11]) and the use of CYC (HR 6.69 [2.56-17.5]) and prednisolone (HR 1.61 [1.02-2.45]) in the preceding 6 months were independently associated with the development of HZ infection.Conclusion:Reactivation of HZ is fairly common in patients with rheumatic diseases. Underlying SLE, prednisolone/cyclophosphamide therapy and the neutrophil/lymphocyte ratio, but not age, sex or other laboratory parameters, are the major risk factors for HZ reactivation.Disclosure of Interests:None declared

scholarly journals Association of ruptured sinus of Valsalva aneurysm and congenital ventricular septal defect: a case series

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Hatem Hemdan Taha Sarhan ◽  
Abdel Haleem Shawky ◽  
Smitha Anilkumar ◽  
Ahmed Elmaghraby ◽  
Praveen C Sivadasan ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Surgical Repair ◽  
Case Series ◽  
Long Term Results ◽  
Sinus Of Valsalva ◽  
Sinus Of Valsalva Aneurysm ◽  
First Case ◽  
The Right

Abstract Background Ruptured sinus of Valsalva aneurysm (RSOVA) is rare, and it is more common in Asians. Typically, the patient presents with acute/subacute shortness of breath (SOB) and chest pain. Echocardiography is the gold standard for diagnosis in most of these cases. Surgery has remained the first line of management. Case summary We present two cases of RSOVA in which the patients presented to the emergency department with SOB. Their preoperative echocardiography results showed RSOVA into the right ventricle. During surgical repair, ventricular septal defect (VSD) was also found. Discussion RSOVA is frequently associated with other congenital anomalies, and most often with VSD. In our cases, we believe that VSDs were missed preoperatively because either the large aneurysmal sacs covered the VSD or there was overlap between the two shunts. Additionally, in the first case, right ventricular pressure was high approaching systemic pressure, which probably reduced the shunt across the VSD. Early intervention is recommended to prevent endocarditis or enlargement of the ruptured aneurysm; long-term results were excellent after surgical repair. Most patients undergo surgery between 20 and 40 years of age, and the reported survival rate is 95% at 20 years. If left untreated, patients typically die of heart failure or endocarditis within 1 year after onset of symptoms.

scholarly journals Sinus of Valsalva Aneurysm: A Rare Cause of Dyspnea

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Aiman Smer ◽  
Osama Elsallabi ◽  
Mohamed Ayan ◽  
Haitam Buaisha ◽  
Hamza Rayes ◽  
...  
Keyword(s):  
Incidental Finding ◽  
Clinical Manifestations ◽  
Imaging Study ◽  
Sinus Of Valsalva ◽  
Sinus Of Valsalva Aneurysm ◽  
Bentall Procedure ◽  
Life Threatening ◽  
The Right ◽  
Left Sinus Of Valsalva

Sinus of Valsalva aneurysm (SOVA) is a rare clinical entity. Clinical manifestations can vary from an incidental finding on an imaging study to a life-threatening emergency. We report a case of a 51-year-old female with a large symptomatic left SOVA. Echocardiogram and computed tomography angiography (CTA) of the chest revealed marked dilatation of the left sinus of Valsalva, measuring 7.5 cm. This resulted in superior displacement of the left main coronary artery. Surgical repair of the aneurysm with reimplantation of the right and left coronary arteries was performed in addition to aortic valve replacement (Bentall procedure). The patient had an uneventful postoperative course and remains asymptomatic at the three-month follow-up visit.

scholarly journals Aneurysm wall enhancement on magnetic resonance imaging as a risk factor for progression of unruptured vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment

2018 ◽  
Vol 128 (3) ◽  
pp. 747-755 ◽  
Author(s):  
Yisen Zhang ◽  
Binbin Sui ◽  
Jian Liu ◽  
Yang Wang ◽  
Zhongbin Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Endovascular Treatment ◽  
Cox Regression ◽  
Maximum Diameter ◽  
Cox Regression Analysis ◽  
Aneurysm Wall ◽  
Average Maximum ◽  
Dissecting Aneurysms

OBJECTIVEThe recurrence rate of vertebrobasilar dissecting aneurysms (VBDAs) after reconstructive endovascular treatment (EVT) is relatively high. The aneurysm wall enhancement on high-resolution MRI (HRMRI) reportedly predicts an unsteady state of an intracranial aneurysm. The authors used HRMRI to investigate the relationship between wall enhancement on HRMRI and progression of VBDAs after reconstructive EVT.METHODSFrom January 2012 to December 2015, patients with an unruptured VBDA who underwent reconstructive EVT were enrolled in this study. Preoperative enhanced HRMRI was performed to evaluate radiological characteristics. The relationships between aneurysm wall enhancement and various potential risk factors were statistically analyzed. Follow-up angiographic examination was performed with digital subtraction angiography and conventional HRMRI. Cox regression analysis was performed to identify predictors of VBDA progression after reconstructive EVT.RESULTSEighty-two patients (12 women and 70 men, mean age 53.48 ± 9.23 years) with 83 VBDAs were evaluated in the current study. The average maximum diameter of the VBDAs was 11.30 ± 7.90 mm. Wall enhancement occurred in 43 VBDAs (51.81%). Among all 83 VBDAs, 62 (74.70%) were treated by stent-assisted coil embolization and 21 (25.30%) by stenting alone. The mean duration of imaging follow-up among all 82 patients was 10.55 months (range 6–45 months), and 15 aneurysms (18.07%) exhibited progression. The statistical analysis indicated no significant differences in age, sex, risk factors (high blood pressure, smoking, diabetes mellitus, and a high cholesterol level), VBDA stage, or VBDA size between enhanced and unenhanced VBDAs. Univariate Cox regression analysis showed that both the maximum diameter of the VBDAs and wall enhancement were associated with recurrence (p < 0.05). Multivariate Cox proportional hazard regression analysis showed that the maximum diameter of the VBDAs and wall enhancement on HRMRI were independent risk factors for aneurysm progression (p < 0.05).CONCLUSIONSAneurysm size and wall enhancement on HRMRI can predict the progression of VBDAs after reconstructive EVT.

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