Mitral valve prolapse: From new mechanisms to diagnostic challenges

Mitral valve prolapse (MVP) is the most common primary valvular abnormality, associated with various degrees of incompetence and sequelae, including heart failure and sudden cardiac death. Recent improvements in echocardiographic techniques and new insights into mitral valve anatomy and physiology have rendered the diagnosis of this condition more accurate and reliable. Here we review the genetic etiology, clinical significance, diagnosis, and treatment options for MVP patients

Clinical application of three-dimensional echocardiographic laser stereolithography: Effect of leaflet funnel geometry on the coefficient of orifice contraction, pressure loss and the Gorlin formula in aortic stenosis

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Mitral Stenosis Presenting with Acute Hearing Loss

A 47-year old woman presented with acute hearing loss, followed by dyspnea and then reduced consciousness and a hemiparesis. Investigations led to a diagnosis of cardiac emboli related to rheumatic mitral stenosis

AORTIC DISSECTION IN THE ELDERLY: COMPARING SEPTUAGENARIANS AND OCTOGENARIANS

none15siopenJabara, Justin; Peterson, Mark; Trimarchi, Santi; Myrmel, Truls; Reece, T. Brett; Bossone, Eduardo; Hutchison, Stuart; Gilon, Dan; Appoo, Jehangir; Di Eusanio, Marco; Montgomery, Daniel; Isselbacher, Eric; Nienaber, Christoph; Eagle, Kim; Patel, HimanshuJabara, Justin; Peterson, Mark; Trimarchi, Santi; Myrmel, Truls; Reece, T. Brett; Bossone, Eduardo; Hutchison, Stuart; Gilon, Dan; Appoo, Jehangir; Di Eusanio, Marco; Montgomery, Daniel; Isselbacher, Eric; Nienaber, Christoph; Eagle, Kim; Patel, Himansh

CHRONOBIOLOGICAL PATTERNS OF ACUTE AORTIC DISSECTION IN MARFAN SYNDROME PATIENTS: DATA FROM THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION (IRAD)

none17siopenSiddiqi, Hasan; Lindsay, Mark; Di Eusanio, Marco; Hutchison, Stuart; Braverman, Alan; Peterson, Mark; Gleason, Thomas; Sechtem, Udo; Myrmel, Truls; Bossone, Eduardo; Montgomery, Daniel; Manfredini, Roberto; Gilon, Dan; Nienaber, Christoph; Eagle, Kim; Isselbacher, Eric; Pyeritz, ReedSiddiqi, Hasan; Lindsay, Mark; Di Eusanio, Marco; Hutchison, Stuart; Braverman, Alan; Peterson, Mark; Gleason, Thomas; Sechtem, Udo; Myrmel, Truls; Bossone, Eduardo; Montgomery, Daniel; Manfredini, Roberto; Gilon, Dan; Nienaber, Christoph; Eagle, Kim; Isselbacher, Eric; Pyeritz, Ree

Complex Patterns of Metabolic and Ca²⁺ Entrainment in Pancreatic Islets by Oscillatory Glucose

Glucose-stimulated insulin secretion is pulsatile and driven by intrinsic oscillations in metabolism, electrical activity, and Ca(2+) in pancreatic islets. Periodic variations in glucose can entrain islet Ca(2+) and insulin secretion, possibly promoting interislet synchronization. Here, we used fluorescence microscopy to demonstrate that glucose oscillations can induce distinct 1:1 and 1:2 entrainment of oscillations (one and two oscillations for each period of exogenous stimulus, respectively) in islet Ca(2+), NAD(P)H, and mitochondrial membrane potential. To our knowledge, this is the first demonstration of metabolic entrainment in islets, and we found that entrainment of metabolic oscillations requires voltage-gated Ca(2+) influx. We identified diverse patterns of 1:2 entrainment and showed that islet synchronization during entrainment involves adjustments of both oscillatory phase and period. All experimental findings could be recapitulated by our recently developed mathematical model, and simulations suggested that interislet variability in 1:2 entrainment patterns reflects differences in their glucose sensitivity. Finally, our simulations and recordings showed that a heterogeneous group of islets synchronized during 1:2 entrainment, resulting in a clear oscillatory response from the collective. In summary, we demonstrate that oscillatory glucose can induce complex modes of entrainment of metabolically driven oscillations in islets, and provide additional support for the notion that entrainment promotes interislet synchrony in the pancreas

Complex Patterns of Metabolic and Ca²⁺ Entrainment in Pancreatic Islets by Oscillatory Glucose

Glucose-stimulated insulin secretion is pulsatile and driven by intrinsic oscillations in metabolism, electrical activity, and Ca(2+) in pancreatic islets. Periodic variations in glucose can entrain islet Ca(2+) and insulin secretion, possibly promoting interislet synchronization. Here, we used fluorescence microscopy to demonstrate that glucose oscillations can induce distinct 1:1 and 1:2 entrainment of oscillations (one and two oscillations for each period of exogenous stimulus, respectively) in islet Ca(2+), NAD(P)H, and mitochondrial membrane potential. To our knowledge, this is the first demonstration of metabolic entrainment in islets, and we found that entrainment of metabolic oscillations requires voltage-gated Ca(2+) influx. We identified diverse patterns of 1:2 entrainment and showed that islet synchronization during entrainment involves adjustments of both oscillatory phase and period. All experimental findings could be recapitulated by our recently developed mathematical model, and simulations suggested that interislet variability in 1:2 entrainment patterns reflects differences in their glucose sensitivity. Finally, our simulations and recordings showed that a heterogeneous group of islets synchronized during 1:2 entrainment, resulting in a clear oscillatory response from the collective. In summary, we demonstrate that oscillatory glucose can induce complex modes of entrainment of metabolically driven oscillations in islets, and provide additional support for the notion that entrainment promotes interislet synchrony in the pancreas

Imaging of Mitral Valve Prolapse: What Can We Learn from Imaging about the Mechanism of the Disease?

Mitral valve prolapse (MVP) is the most common mitral valve disorder affecting 2%–3% of the general population. Two histological forms for the disease exist: Myxomatous degeneration and fibroelastic disease. Pathological evidence suggests the disease is not confined solely to the valve tissue, and accumulation of proteoglycans and fibrotic tissue can be seen in the adjacent myocardium of MVP patients. MVP is diagnosed by demonstrating valve tissue passing the annular line into the left atrium during systole. In this review we will discuss the advantages and limitations of various imaging modalities in their MVP diagnosis ability as well as the potential for demonstrating extra associated valvular pathologies

The Diagnosis and Management of Immune Checkpoint Inhibitor Cardiovascular Toxicity: Myocarditis and Beyond

Recent years have brought major advancements in the use of immune therapy and specifically immune checkpoint inhibitors (ICIs) in cancer patients, with expanding indications for various malignancies resulting in the treatment of a large and increasing number of patients. While this therapy significantly improves outcomes in a variety of hematologic and solid tumors, the use of ICIs is associated with a substantial risk of immune-related adverse events. Cardiovascular toxicity, while not the most common side effect of ICIs, is associated with significant morbidity and mortality. It is therefore crucial for oncologists and cardiologists, as well as internists and emergency room physicians, to have a good understanding of this increasingly common clinical problem. In the present review, we discuss the cardiac aspects of ICI therapy with special emphasis on the clinical manifestations of their cardiovascular toxicity, diagnostic approaches, treatment and suggested surveillance

Stuck Bioprosthetic Aortic Valve--A New Entity? A Case Report

We describe herein a case of bioprosthetic valve malfunction, which closely imitates a stuck valve. Although the term "stuck" was used originally for the immovable mechanical valve leaflets, the echocardiographic manifestation of this malfunction is similar to those of a mechanical one. The clinical presentation of the stuck bioprosthesis is, however, far more benign than a stuck mechanical valve. Familiarity with this entity is important