Normal and abnormal prosthetic valve function as assessed by doppler echocardiography

Doppler echocardiography was performed in 136 patients with a normally functioning prosthetic valve in the aortic (n = 59), mitral (n = 74) and tricuspid (n = 3) positions. These included patients with St. Jude (n = 82), Björk-Shiley (n = 18), Beall (n = 13), Starr-Edwards (n = 7) or tissue (n = 16) valves. Peak and mean pressure gradients across the prostheses were measured using the simplified Bernoulli equation. The prosthetic valve orifice (PVO, in square centimeters), only in the mitral position, was calculated by the equation: PVO = 220/pressure half-time.In the aortic position, the St. Jude valve had a lower peak velocity (2.3 ± 0.6 m/s, range 1.0 to 3.9), peak gradient (22 ± 12 mm Hg, range 4 to 61) and mean gradient (12 ± 7 mm Hg, range 2 to 32) than the other valves (p < 0.05 when compared with Starr-Edwards). In the mitral position, the St. Jude valve had the largest orifice (3.0 ± 0.6 cm2, range 1.8 to 5.0) (p < 0.0001 compared with all other valves). Insignificant regurgitation was commonly found by pulsed mode Doppler technique in patients with a St. Jude or Björk-Shiley valve in the aortic or mitral position and in patients with a Starr-Edwards or tissue valve in the aortic position. In 17 other patients with a malfunctioning prosthesis (four St. Jude, two Björk-Shiley, four Beall and seven tissue valves) proven by cardiac catheterization, surgery or autopsy, Doppler echocardiography correctly identified the complication (significant regurgitation or obstruction) in all but 2 patients who had a Beall valve.It is concluded that 1) the St. Jude valve appears to have the most optimal hemodynamics; mild regurgitation can be detected by the Doppler technique in normally functioning St. Jude and Björk-Shiley valves in the aortic or mitral position and in Starr-Edwards and tissue valves in the aortic position, and 2) Doppler echocardiography is a useful method for the detection of prosthetic valve malfunction, especially when the St. Jude, Björk-Shiley and tissue valves are assessed

OCT for the Identification of Vulnerable Plaque in Acute Coronary Syndrome

AbstractAfter 2 decades of development and use in interventional cardiology research, optical coherence tomography (OCT) has now become a core intravascular imaging modality in clinical practice. Its unprecedented spatial resolution allows visualization of the key components of the atherosclerotic plaque that appear to confer “vulnerability” to rupture—namely the thickness of the fibrous cap, size of the necrotic core, and the presence of macrophages. The utility of OCT in the evaluation of plaque composition can provide insights into the pathophysiology of acute coronary syndrome and the healing that occurs thereafter. A brief summary of the principles of OCT technology and a comparison with other intravascular imaging modalities is presented. The review focuses on the current evidence for the use of OCT in identifying vulnerable plaques in acute coronary syndrome and its limitations

Human development index - the influencing factors, ways of development on the example of Russia and the countries of the former Soviet Union

According to the name of article, in it dynamics of an Human Development index over the countries of the former Soviet Union is considered. Lagging of Russia from the leading countries is especially noted, comparison is carried out them. Also Years of Life Lost index is mentioned in article, its influence on human development is specified. Much attention is paid to prospects of development of the country in all directions which influence HDI. In the conclusion a number of open questions which our state should solve is emphasized

Right ventricular infarction complicated by right to left shunt

A case of right ventricular infarction complicated by a right to left shunt through a patent foramen ovale is presented. The diagnosis was confirmed by two-dimensional echocardiography with contrast injection and indicator dye-dilution curve and oximetry at cardiac catheterization

IVUS-based Fluid-structure Interaction Models for Novel Plaque Vulnerability Indices: A Study in Patients with Coronary Artery Disease

AbstractIt is believed that mechanical stresses play an important role in atherosclerotic plaque rupture process and may be used for better plaque vulnerability assessment and rupture risk predictions. IVUS data were acquired from 14 patients (11M, 3F, Mean age: 59,) for constructing 3D computational models combining fluid-structure interaction (FSI), cyclic bending due to cardiac contraction and patient-specific pressure loading to quantify mechanical conditions in the human coronary. The computational models were solved by a finite element package ADINA to obtain plaque wall stress (PWS), strain (PWSn) and flow shear stress (FSS) and investigate correlation between the mechanical conditions and morphological characteristics. For all 617 IVUS slices yielded from the 14 patients, plaque morphological features lipid percentage and min cap thickness were calculated for each slice, and three types of plaque morphology related indices: lipid index, cap index and morphological index (MPVI) were introduced as quantitative measures of plaque vulnerability. PWS, PWSn and FSS values at critical sites were denoted as critical plaque wall stress (CPWS), critical plaque wall strain (CPWSn) and critical flow shear stress (CFSS) for each slice, and a stress index was proposed based on the value of the CPWS. The conventional Pearson's correlation is used to analyze the correlation between each of the mechanical conditions and each plaque morphological feature indices. Our results suggest there is significant correlation between the CPWS and min cap thickness, cap index with the correlation coefficient r=-0.6570, r=0.8016 respectively, while the correlation between CPWS and lipid percentage and the lipid index are weaker (r=0.2209, r=0.2304) even though they are significantly correlated. The correlation results between CPWS and morphological index (r=0.7725, p-value<0.0001) showed there is a strong positive relationship between the mechanical stress and morphological features. For all 617 slices, the stress index has a 66.77% agreement with morphological index. More patient follow-up data and large-scale studies are needed to continue our investigations

Serial intravascular ultrasound assessment of changes in coronary atherosclerotic plaque dimensions and composition: an update

This manuscript reviews the use of serial intravascular ultrasound (IVUS) examination of coronary atherosclerosis in recent observational studies and randomized trials that revealed the effects of cholesterol-lowering and lipid-modifying therapies and offered novel insight into plaque progression and regression. We discuss the value of plaque progression–regression as complementary imaging endpoint and potential surrogate marker of cardiovascular event risk. In addition, the progress in serial assessment of coronary plaque composition and plaque vulnerability by radiofrequency-based analyses is reviewed. Finally, we report on the evaluation of true vessel remodelling in recent serial IVUS trials and discuss the future perspective of serial invasive imaging of coronary atherosclerosis