Objectives: Redo mitral valve replacement (MVR) is an important therapeutic approach in patients with the malfunction of the prosthetic mitral valve, especially in patients with severe dyspnea or a large thrombus burden. Redo replacement (MVR) and thrombectomy are different surgical approaches in these patients. This study evaluated the outcome of the second mitral valve surgery including mechanical MVR (M-MVR), biologic MVR (B-MVR), and surgical thrombectomy. Materials and Methods: To this end, 71 patients were included in this study, who underwent second mitral valve surgery following the malfunction of the prosthetic mitral valve in the last 10 years. These patients were divided into M-MVR, B-MVR, and surgical thrombectomy groups and their demographic, clinical, echocardiographic, and laboratory findings were gathered as well. Then, the patients were evaluated for their third MV surgery if it was performed, followed by evaluating the pump time and cross-clamp time Results: Fifty-seven, 8, and 6 patients underwent M-MVR, B-MVR, and thrombectomy, respectively. Based on the results, the mortality rate was not significantly different between the 3 groups (P = 0. 059). In addition, 12 patients underwent the third surgery with the highest (100%) and lowest (0%) rates at thrombectomy and B-MVR groups, respectively. Higher pump time and cross-clamp time were significantly associated with an increased mortality rate (P = 0. 014 and P = 0. 026, respectively). Conclusions: In the malfunction of the prosthetic mitral valve, mortality rate failed to significantly differ between the patients undergoing M-MVR, B-MVR, and thrombectomy but third surgery is often needed after thrombectomy. It seems that the replacement of previous prosthetic valve with a new mechanical or biological valve yields better results in the case of prosthetic valve malfunction.

Mitral valve replacement (MVR) is usually performed in two methods of running and interrupted suturing. In running method, the suturing of the valve is usually with some traction on the annulus and also there is a risk of aortic valve injury. This study was conducted to evaluate a new technique for suturing to avoid these complications and decrease the time of cardiac arrest. One hundred and seventy-seven cases undergoing isolated MVR or MVR with other valve replacements were operated by the new method and compared with 77 cases of routine method, as control group. The patients were followed up 1-4years. In the control group, one case of mortality occurred due to Heart failure. In both groups one case of late mortality was observed not related to surgical operation. No paravalvular leakage or aortic valve injury was observed. The highlights of this technique are the simplicity of operation, short period of valve implantation and aortic clamp time, which indicated 6 and 11 minutes decrease in average time, respectively. This method is recommended for all cases of rheumatic mitral valve disease, especially for those having a small atrium.      

In recent years, transcatheter aortic valve implantation has become an emerging alternative for high-risk patients with severe aortic stenosis. A promising new indication in this modality could be the interventional treatment of degenerated bioprostheses. We used a vascular prosthesis access in our patient to facilitate the procedure in the absence of an adequate vascular access.

Background: Studies have shown a decline in the admission rates of various diseases during the COVID-19 pandemic. Prosthetic valve thrombosis (PVT) is a rare condition followed by surgical or transcatheter valvular interventions. Considering the lack of data on hospitalization rates due to PVT during the pandemic, this study evaluated the implications of the COVID-19 pandemic on PVT admissions and characteristics in a tertiary referral center. Methods: Data from all the consecutive patients hospitalized due to PVT between February 2020 and February 2021 (the first year of the pandemic) were collected from medical records and compared clinically with the corresponding time before the pandemic (February 2019 through February 2020). Variables of interest included the number of hospitalization, patient and valve characteristics, diagnostic and management strategies, and in-hospital events. Results: Forty patients (32. 5% male, age: 54. 0 [46. 5-62. 0 y] comprised the study population. We observed a considerable decline in hospitalization rates during the pandemic, from 31 to 9 patients. Admitted patients were 8 years younger, had a higher proportion of the New York Heart Association functional class III or IV symptoms (44. 4% vs 22. 6%), were more often treated with fibrinolysis (33. 3% vs 22. 6%) or surgical approaches (33. 3% vs 22. 6%), and were discharged 6 days sooner. Conclusion: We described a reduction in PVT hospitalization. Patients presented with a higher proportion of severe dyspnea and had increased treatment with fibrinolysis/surgical approaches. These observations highlight the necessity of the active surveillance of patients with prosthetic valves by caregivers for timely diagnosis and appropriate management during the pandemic.

Introduction: Bacterial endocarditis is one of the high mortality complications after the valve surgery. Despite the medical advancements, the mortality rate of Bacterial Endocarditis has not been decreased. We designed this study to determine the epidemiology of Bacterial Endocarditis following surgery. Materials and Methods: This is retrospective study from 2012 to 2016 in Mashhad University of Medical Science. Patients with history of Cardiac Surgery with Implantation of Prosthetic valve. The diagnostic method of bacterial endocarditis was based on the Duke’, s criteria, Transthoracic echocardiography, and culture lab. Results: Among 2802 patients with cardiac valve surgery, 9 patients had developed Bacterial endocarditis. The common infectious valve was mitral (58. 4%) and prosthetic valves were mostly used in general (77%). There was no relationship between gender (p=0. 47), marital status (p=0. 68), and type of surgery (p=0. 29) and Bacterial endocarditis. But there was a significant relationship between the type of valve surgery and Bacterial endocarditis (p=0. 01). Also, 3 patients with Bacterial endocarditis had a history of smoking and drugs. Three patients also died and were excluded. Conclusion: Bacterial endocarditis differ according to the different studies and our results were compatible with previous studies. Our study confirmed that the utilization rate of the prosthetic valve was higher than the homograft valve. The use of antibiotics should be evaluated prior to performing a culture test which could affect the test results and consequences of the study.

Background- The purpose of this study was to determine how frequently prosthetic valve nonobstructive thrombosis is associated with prosthetic mitral and aortic valves and to assess their correlation with the anticoagulant status and symptoms of patients. Methods- From January 2006 to April 2007, all the patients with prosthetic Heart valves who were referred for clinically-indicated transesophageal echocardiography (TEE) were evaluated for the presence of non-obstructive thrombosis. Clinical information was collected through patient interviews. Non-obstructive thrombosis was defined as a distinct mass (more than 1 mm in width and 2 - 15 mm in length) with abnormal echoes attached to the normally functioning prosthesis and clearly seen throughout the cardiac cycle via two-dimensional, Doppler, and cinefluoroscopy studies. Masses were classified according to their size as small (<5 mm), moderate (5-10 mm), and large (>10 mm).Results- The study recruited 102 consecutive patients (64 female) with a mean age of 51 ±11.4 years with non-obstructive thrombosis. There were 132 prosthetic valves (PVs), of which 94 were prosthetic mitral valves (PMVs) and 38 were prosthetic aortic valves (PAVs). The mean time between surgery and TEE examination (age of the prosthesis) was 12 ± 7 years. INR value was less than 1.5 in 50 (49%) cases, between 1.5 – 2.5 in 42 (41.2%) patients, and more than 2.5 in 10 (9.8%). Additionally, 34 (33.3%) patients had recent systemic emboli, 32 (31.9%) had exacerbation of dyspnea, and 14 (13.7%) were asymptomatic. Conclusions- Sub-therapeutic anticoagulation (INR values < 2.5), systemic emboli, and dyspnea are the key factors for the detection of non-obstructive thrombosis. Moreover, TEE is particularly useful when the thrombus is not visualized by TTE.

BACKGROUND: Since some degrees of functional mitral regurgitation (MR) may be seen in patients who are candidate for undergoing isolated aortic valve replacement (AVR), determining the effectiveness of AVR surgery on MR rate improvement can be effective in designing a protocol to deal with patients with functional MR. The purpose of this study was to examine the echocardiographic changes after AVR surgery with a focus on changes in MR.METHODS: The research was conducted as a before-after observational study on patients hospitalized in Baqiyatallah Hospital, Tehran, Iran, who were undergone AVR surgery between 2011 and 2012. After selecting the patients and obtaining informed consent to participate in the project, transthoracic echocardiographic data were collected by a specialist in Cardiology Echocardiography using ViVid 7 device before and till one week after AVR surgery. The MR rate was measured using methods; including Color Flow Doppler, PISA, Vena Cava Width and Effective Regurgitant Orifice.RESULTS: Finally, the study was conducted on 85 patients (mean age: 56.23±6.10 years, 27 women: 31.8%). Of 21 patients with preoperative MR more than mild (moderate, mild to moderate), 20 patients (95%) showed at least one degree decrease in MR. Among 64 patients who had mild MR before the surgery, 29 patients improved (45%), that this difference was statistically significant (P<0.001).CONCLUSION: The study results showed that in patients with preoperative MR degree higher than mild, after AVR the MR rate improved 24 times more than those who had preoperative MR degree equivalent to mild and lower. However, these changes are not affected by other echocardiographic changes and patients demographic characteristics.

A 46 year old man had been undergone Aortic valve replacement (AVR) due to mechanical aortic valve endocarditis two month ago. He was referred to Imam Khomeini hospital because of dyspnea since two weeks ago. Echocardiography showed the false aneurysm, with an area of flow beyond the lumen of the aorta. This patient underwent reoperation, the previously implanted aortic valve was removed, meticulous debridement was performed in aortic valve annulus and adjacent part of the ascending aorta, and aortic valve and root replacement were performed.

Background: Thrombotic and thromboembolic events are important causes of mortality and morbidity in patients with prosthetic Heart valve. The aim of this study is to evaluate the factors that may contribute to prosthetic Heart valve thrombosis. Methods: This was a cross-sectional study in Rajaie Heart Center on patients with prosthetic Heart valve malfunction, within a year. According to the echocardiographic and fluoroscopic findings, the patients were divided into two groups (thrombosis and non-thrombosis groups). The patients’ demographic, clinical and laboratory data were recorded and analyzed with SPSS software. Results: A total of 142 patients participated in this study. Ninety-four patients (66. 2%) were diagnosed with thrombosis. There was a significant relationship between thrombosis and inadequate anti-coagulation (international normalized rati [INR] <2. 5) (odds ratio [OR]: 4. 15, 95% CI: 1. 98-9. 87, P = 0. 003), history of infection (OR: 12. 81, 95% CI: 3. 52-19. 02, P < 0. 001), prothrombin time (PT) check interval (OR: 2. 38, 95% CI: 1. 63-8. 47, P = 0. 019), atrial fibrillation (AF) rhythm (OR: 3. 96, 95% CI: 1. 75-8. 09, P = 0. 019), and plasma fibrinogen level (OR: 6. 90, 95% CI: 2. 58-14. 69). Conclusion: Based on this study, inadequate anti-coagulation, AF rhythm, recent infection and plasma fibrinogen level were the factors most contributing to prosthetic valve thrombosis. As there were many cases of thrombosis in patients with history of infection, this factor can be considered for risk assessment in prosthetic valve.