A 19-year-old female with a 2-day history of involuntary fast jerk-like movements of the left upper and lower extremities presented at the emergency department. Patient had no other known comorbidities and family history was unremarkable. Anti-streptolysin O titer (ASO) and C-reactive protein (CRP) were all normal. Two-dimensional echocardiography (2D Echo) revealed thickened anterior mitral valve leaflet with prolapsed A2 scallop, mild mitral regurgitation, thickened right coronary cusp of aortic valve without restriction of motion, trivial aortic regurgitation, other findings were unremarkable. Patient was managed as a case of Sydenham’s chorea secondary to acute rheumatic fever, with valvular heart disease secondary. Patient was initially started on valproic acid 500mg tablet every 8 hours, benzathine penicillin 1.2M units intramuscular, and carvedilol 12.5mg/tablet twice a day. The patient was then shifted to haloperidol 5mg ¼ tablet twice a day, diphenhydramine 50mg intravenously coinciding with haloperidol doses due to visual side effects of valproic acid. This report highlights the importance of a high index of suspicion and complete history and physical examination in order to diagnose and manage movement disorders in a low-income setting.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Movement Disorders ; Diphenhydramine ; Aortic Valve Insufficiency ; Heart Valve Diseases ; C-reactive Protein

Suicide left ventricle describes the development of dynamic intraventricular gradients after aortic valve replacement due to acute hemodynamic changes that happen after relieving the obstruction leading to hemodynamic collapse. This is a rare complication in transcatheter aortic valve replacement and is underreported in surgical aortic valve replacement (SAVR). We present the case of a male patient who presented with suicide left ventricle after SAVR.

World Health Organization ; Transcatheter Aortic Valve Replacement ; Suicide ; Research Report ; Hemodynamics ; Heart Ventricles ; Aortic Valve

This is the case of a 62-year-old male with prior modified Bentall’s procedure using a 23-mm bioprosthetic valve last 2013 who came in with progressive heart failure symptoms. On physical examination, vital signs are stable. Physical exam revealed rhonchi on both lung fields and irregular rhythm with a grade 3 systolic ejection murmur at the aortic area. A 2-dimensional transthoracic echocardiogram showed an ejection fraction of 25%, aortic valve area of 1.0 cm2 and mean gradient of 21 mmHg consistent with severe low-flow, low-gradient aortic stenosis (AS). Options for re-do surgical aortic valve replacement (SAVR) were discussed. Since the patient was deemed high risk for another surgery, the option for transcatheter aortic valve in surgical aortic valve (TAV-in-SAV) was considered. The patient underwent successful TAV-in-SAV using a 26-mm self-expanding bioprosthetic valve. Post-procedure, there was significant improvement of functional capacity from class IV to class I.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; World Health Organization ; Vital Signs ; Respiratory Sounds ; Research Report ; Physical Examination ; Constriction, Pathologic ; Aortic Valve Stenosis

OBJECTIVES: To analyze sex and age distribution of global disease burden of calcific aortic valve disease (CAVD) from 1990 to 2021. METHODS: CAVD data during 1990-2021 were obtained from the IHME website for Global Burden of Disease (GBD). The prevalence, mortality, years lived with disability (YLDs), and disability-adjusted life years (DALYs) were analyzed by gender and age groups. Joinpoint regression was used to calculate annual percentage change (APC) and average annual percentage change (AAPC). RESULTS: In 2021, there were 13.32 million CAVD patients and 142 000 deaths caused by CAVD globally. Age-standardized prevalence was higher in males (193.2/10⁵) than that in females (128.9/10⁵). Patients in 65-<85 age group accounted for 64.0% of total cases, while those ≥85 years old accounted for 16.1%. From 1990 to 2021, prevalence increased in both sexes with an AAPC of 0.72% for males and 0.57% for females, respectively. Prevalence grew fastest from 2000 to 2010, slowed thereafter, and declined from 2015 to 2021. In <65 years old, the mortality of males was 2.4 times higher than that of females, while in ≥85 years old, mortality of females (117.3/10⁵) exceeded that of males (99.1/10⁵). YLD rates increased with age, and were higher in males for all age groups. DALY rates decreased overall but increased in ≥85 years old, with a greater increase in females. CONCLUSIONS There are significant gender and age disparities in global disease burden of CAVD, with the elderly, especially super-elderly females deserving particular attention. It is recommended to develop personalized intervention strategies for these populations.
Humans ; Male ; Female ; Aged ; Calcinosis/mortality* ; Prevalence ; Global Burden of Disease ; Aged, 80 and over ; Middle Aged ; Aortic Valve/pathology* ; Aortic Valve Stenosis/epidemiology* ; Age Distribution ; Adult ; Disability-Adjusted Life Years ; Sex Distribution ; Global Health ; Aortic Valve Disease/epidemiology* ; Sex Factors

Transcatheter aortic valve replacement (TAVR) has emerged as the standard treatment for severe aortic stenosis, demonstrating comparable efficacy to traditional surgery in low and intermediate-risk patients. However, the bioprosthetic valves utilized in TAVR have a limited lifespan, and bioprosthetic valve failure, including calcification, rupture or infection may develop, leading to poor clinical outcomes. Elevated blood pressure has been identified as a key factor in aortic valve calcification, and its role in bioprosthetic valve failure is gaining increasing attention. Hypertension may accelerate the calcification process and exacerbate valve failure due to increased mechanical stress on the valve, activation of the renin-angiotensin system, and enhanced thrombus formation. Furthermore, elevated blood pressure interacts with prosthesis mismatch and paravalvular leak, jointly affecting valve durability. This review explores the impact of elevated blood pressure on bioprosthetic valve calcification and failure after TAVR, and emphasizes the importance of blood pressure control, optimized preoperative assessment, and appropriate valve selection in reducing valve failures.
Humans ; Transcatheter Aortic Valve Replacement/adverse effects* ; Calcinosis/etiology* ; Bioprosthesis ; Heart Valve Prosthesis/adverse effects* ; Prosthesis Failure ; Aortic Valve Stenosis/surgery* ; Aortic Valve/surgery* ; Hypertension/physiopathology*

OBJECTIVES: To analyze the early clinical outcomes of the Xcor^TM transcatheter aortic valve replacement (TAVR) system in treating severe aortic stenosis. This study has been registered at Chinese Clinical Trial Registry (ChiCTR2200065593). METHODS: This single-arm, prospective clinical trial enrolled patients with severe aortic stenosis treated with the Xcor^TM TAVR system at the Section of Heart Valve & Coronary Artery Surgery, Guangdong Provincial People's Hospital. Perioperative and follow-up parameters were compared to evaluate differences in hemodynamic outcomes. All-cause mortality, aortic regurgitation, paravalvular leakage, cerebrovascular events, and reoperation were analyzed. RESULTS: Thirty-two patients with severe aortic stenosis were included (20 males, 12 females), with (70.9±4.3) years old and a Society of Thoracic Surgeons (STS) score of 6.45% (6.07%, 7.28%). Notably, 87.5% of patients had New York Heart Association (NYHA) class≥Ⅲ. All patients underwent successful Xcor^TM bioprosthesis implantation, achieving an immediate technical success rate of 100.0% and device success rate of 96.9%. Mean aortic valve gradient decreased from (55.21±23.17) mmHg (1 mmHg=0.133 kPa) to (8.45±5.30) mmHg, peak aortic jet velocity decreased from (4.66±0.85) m/s to (1.99±0.48) m/s, aortic valve area increased from (0.66±0.21) cm² to (2.09±0.67) cm² (all P<0.01). Intraoperative ventricular fibrillation occurred in one patient, while one case exhibited moderate prosthetic valve regurgitation and paravalvular leakage post-procedure. At 12-month follow-up, sustained improvements were observed in cardiac function, left ventricular ejection fraction, hemodynamic parameters, and SF-12 quality-of-life scores (all P<0.01). All-cause mortality was 12.5% (4/32), with 13.8% (4/29) developing moderate paravalvular leakage. CONCLUSIONS The Xcor^TM TAVR system demonstrated favorable early outcomes in severe aortic stenosis patients, significantly improving symptoms and hemodynamics while exhibiting excellent performance in preventing malignant arrhythmias and coronary obstruction.
Humans ; Male ; Female ; Aortic Valve Stenosis/surgery* ; Transcatheter Aortic Valve Replacement/methods* ; Aged ; Follow-Up Studies ; Prospective Studies ; Treatment Outcome ; Aged, 80 and over ; Heart Valve Prosthesis ; Middle Aged

A case of an elderly patient with severe aortic insufficiency who carried high risks for surgical valve replacement. After a detailed preoperative evaluation, the patient successfully received transapical transcatheter aortic valve replacement. Postoperatively, complete left bundle branch block developed, resulting in impaired left ventricular function. Despite guideline-directed medical therapy for heart failure, cardiac function showed no significant recovery. At 4.5 months post-surgery, left bundle branch pacing was performed, leading to a marked improvement in cardiac function.
Aged ; Humans ; Male ; Aortic Valve Insufficiency/surgery* ; Bundle-Branch Block/etiology* ; Cardiac Pacing, Artificial ; Postoperative Complications/therapy* ; Transcatheter Aortic Valve Replacement/adverse effects*

A 72-year-old patient with quadricuspid aortic valve underwent transcatheter aortic valve replacement due to severe valve stenosis accompanied by moderate insufficiency. As initially planned, the right coronary artery was protected during the procedure. However, after the artificial valve was released, the left coronary artery was found to be blocked, so a coronary protection stent was implanted in the left coronary artery ostium under the guidance of intravascular ultrasonography. This case indicates that for patients with a quadricuspid aortic valve undergoing transcatheter aortic valve replacement, in addition to preoperative measurement of the aortic root, attention should also be paid to the coronary artery obstruction caused by the displacement of the artificial valve frame during the procedure.
Aged ; Humans ; Aortic Valve/surgery* ; Aortic Valve Stenosis/surgery* ; Coronary Vessels ; Stents ; Transcatheter Aortic Valve Replacement/methods*

With the clinical generalization and popularization of transcatheter aortic valve replacement (TAVR), cerebrovascular events related to TAVR occur more frequently, which significantly impairs neurocognitive function, increases mortality, and seriously affects prognosis and quality of life in these patients. However, the reported incidence rates of TAVR-related stroke differ in literature due to inconsistent diagnostic criteria. According to the onset time, TAVR-related stroke can be divided into acute (≤24 h), subacute (24 h-30 d), early (31 d-1 year) and late (>1 year) types, and the cause of stroke generally varies according to the onset time. Both surgical (balloon aortic valvuloplasty, types of transcatheter heart valve, alternative access) and non-surgical (valvular calcium burden, bicuspid aortic valve, subclinical leaflet thrombosis, postoperative new-onset atrial fibrillation) can be related to the occurrence of TAVR-related stroke. Postprocedural monitoring, postprocedural antithrombotic therapy, and cerebral embolic protection devices are important for the prevention of TAVR-related stoke. This article reviews the research progress on TAVR-related stroke, focusing on its epidemiology, risk factors and preventive measures, aiming to provide reference for the clinical management of stroke in TAVR.
Humans ; Transcatheter Aortic Valve Replacement/adverse effects* ; Stroke/epidemiology* ; Postoperative Complications/etiology* ; Aortic Valve Stenosis/surgery* ; Risk Factors

Transcatheter aortic valve replacement (TAVR) has emerged as the first-line treatment for aortic valve stenosis. Coronary obstruction is a severe complication of TAVR, with mortality rates exceeding 30%. Coronary obstruction can be classified as acute or delayed based on the timing of the onset, and as direct or indirect obstruction according to the underlying mechanism. Risk factors for predicting coronary obstruction include a small sinus of Valsalva diameter, excessively long native leaflets, low coronary height, and small sinotubular junction height and diameter. Accurate preoperative assessment of these anatomical parameters using CT is crucial for selecting the appropriate valve type, size, and implantation depth. Preventive technical strategies for coronary obstruction include intraoperative interventional treatments (such as the "Chimney" stenting technique), leaflet modification (such as the BASILICA technique), and alignment of the annulus and coronaries. These techniques have demonstrated significant efficacy in reducing the incidence of coronary obstruction and associated mortality. This paper reviews the epidemiology, classification, and mechanisms of coronary obstruction, with a particular focus on the identification, prevention, and treatment of high-risk patients. The aim is to highlight the importance of recognizing and managing coronary risks during TAVR and to provide actionable recommendations for the prevention and treatment of coronary obstruction in clinical practice.
Humans ; Transcatheter Aortic Valve Replacement/methods* ; Risk Factors ; Aortic Valve Stenosis/surgery* ; Postoperative Complications/prevention & control* ; Coronary Occlusion/etiology*