Survival rate of patients undergoing aortic, mitral, and tricuspid valve replacement with prosthetic valves

Objectives: The burden of valvular heart disease (VHD) is high and increasing all around the world due to aging of the population. The etiologic factors of VHD are different among countries. There is little data about etiologic factors of VHD in Iran. The aim of present study was to determine the associated factors related to the 5-year survival and mortality rate of patients undergoing bileaflet mechanical valve replacement. Methods: In this retrospective cohort study, demographic, electrocardiographic and echocardiographic data of patients who had underwent aortic, mitral and tricuspid valve replacement with bileaflet valves in the Afshar Hospital in Yazd, Iran, between March 2008 to February 2015 were obtained from their records. Supplementary information like hemorrhagic or thromboembolic events, rehospitalization and death during follow-up were gathered through contact with patients. For analysis of the data, SPSS ver. 19 was used. Results: Four hundred and thirty eight patients entered the study. Male gender was slightly predominant (%53). Mean age of the patients was 51.6 ± 17.4 years. The rate of in-hospital mortality was 9.8% while the 5-year survival rate was 82.42%. The rate of major thromboembolic events was 0.97%/year and that of major hemorrhagic events was 0.5%/year. Patients with older age, lower cardiac ejection fraction (less than 30%) and with atrial fibrillation had a higher rate of mortality (P = 0.001). In-hospital mortalities were 3%, 9%, 12% and 15% for AVR, AVR+MVR, MVR and CABG+valvular surgery, respectively. Conclusions: Higher rate of mitral valve surgery in this study may be due to possible predominance of rheumatic valvular pathology similar to other developing countries. Rate of 5-year survival, thromboembolic and hemorrhagic rates were acceptable and comparable to global reports.

Double-valve Replacement for Aortic and Tricuspid Autoimmune Endocarditis

Libman–Sacks endocarditis (LSE) is a cardiac manifestation of systemic lupus erythematosus and antiphospholipid syndrome and is characterized by non-bacterial verrucous vegetations with thrombogenic potential, causing stenosis and/or regurgitation in left heart predominantly, which can be asymptomatic in most of the cases but in the acute form it may present an infective form (pseudoinfective endocarditis) and complicate diagnosis and treatment. We present a case of aortic and tricuspid valve destruction due to Libman-Sacks endocarditis in a patient with antiphospholipid syndrome requiring surgical treatment by aortic and tricuspid valve replacement.

Neonatal Marfan syndrome with missense variant of c.3706T>C undergoing bilateral atrioventricular valve replacement

Neonatal Marfan syndrome is a rare condition with poor prognosis because of severe mitral and/or tricuspid valve insufficiency. Mitral valve replacement is sometimes required in early infancy, while tricuspid valve replacement is rarely done. We report the first infant neonatal Marfan syndrome case with a missense variant of c.3706T>C in the fibrillin-1 gene that was successfully managed by mitral and tricuspid valve replacement. Early multiple-valve replacement may sometimes be required during infant age in this genetic syndrome.

Successful One and One-half Ventricular Circulation with Bioprosthetic Tricuspid Valve Replacement and Total Chordal Preservation in a Patient with Ebstein’s Anomaly: A Video Presentation

Ebstein’s anomaly is a rare congenital malformation of the right ventricle and tricuspid valve which is characterized by several features that can exhibit an infinite spectrum of malformation.The abnormalities include: i) adherence of the tricuspid leaflets to the underlying myocardium (failure of delamination); ii) anterior and apical rotational displacement of the functional tricuspid annulus (septal > posterior > anterior leaflet); iii) dilatation of the right atrioventricular junction (the true tricuspid annulus) with variable degrees of hypertrophy and thinning of the wall; iv) dilatation of the “atrialized” portion of the right ventricle; and v) redundancy, fenestration, and tethering of the anterior leaflet.