Mitral regurgitation after percutaneous mitral valvuloplasty : insights into mechanisms and impact on clinical outcomes

Objectives: The aim of this study was to assess the incidence, mechanisms, and outcomes of mitral regurgitation (MR) after percutaneous mitral valvuloplasty (PMV). Background: Significant MR continues to be a major complication of PMV, with a wide range in clinical presentation and prognosis. Methods: Consecutive patients with mitral stenosis undergoing PMV were prospectively enrolled. MR severity was evaluated by using quantitative echocardiographic criteria, and its mechanism was characterized by 3-dimensional transesophageal echocardiography, divided broadly into 4 categories based on the features contributing to the valve damage. B-type natriuretic peptide levels were obtained before and 24 h after the procedure. Endpoints estimated cardiovascular death or mitral valve (MV) replacement due to predominant MR. Results: A total of 344 patients, ages 45.1 ± 12.1 years, of whom 293 (85%) were women, were enrolled. Significant MR after PMV was found in 64 patients (18.6%). The most frequent mechanism of MR was commissural, which occurred in 22 (34.4%) patients, followed by commissural with posterior leaflet in 16 (25.0%), leaflets at central scallop or subvalvular damage in 15 (23.4%), and central MR in 11 (17.2%). During the mean follow-up period of 3 years (range 1 day to 10.6 years), 60 patients reached the endpoint. The event-free survival rates were similar among patients with mild or commissural MR, whereas patients with damaged central leaflet scallop or subvalvular apparatus had the worst outcome, with an event-free survival rate at 1 year of only 7%. Long-term outcome was predicted by net atrioventricular compliance (Cn) at baseline and post-procedural variables, including valve area, mean gradient, and magnitude of decrease in B-type natriuretic peptide levels, adjusted for the mechanism of MR. Conclusions: Significant MR following PMV is a frequent event, mainly related to commissural splitting, with favorable clinical outcome. Parameters that express the relief of valve obstruction and the mechanism by which MR develops were predictors of long-term outcomes

Enraizamento de estacas de três espécies silvestres de Passiflora Cutting rooting of three wild Passiflora species

Em ambiente com nebulização controlada, estacas herbáceas com um par de folhas, contendo 2 ou 3 nós, foram testadas quanto ao enraizamento, utilizando-se de bandeja de poliestireno com célula de 95cm³ e saco plástico de 15x25x0,02cm com 1.730 cm³. Foram testadas estacas de Passiflora actinia, P. serrato-digitata e P. setacea. Observou-se que P. serrato-digitata apresentou 94,3% de estacas enraizadas com brotos e 2,4% de mortalidade; enquanto P. actinia e P. setacea apresentaram, respetivamente, 30,5% e 28,6% de estacas enraizadas com brotos e 56,8% e 60,7% de mortalidade. A alta mortalidade das estacas foi atribuída ao estado fenológico das matrizes de P. actinia e P. setacea e ao ataque de larvas de bradisia (Bradysia spp.) Estacas com dois e três nós não apresentaram diferenças significativas, e o recipiente saco plástico de 1.730 cm³ proporcionou melhor desenvolvimento das mudas.<br>Steam cuttings of three wild Passiflora species where tested for rooting in a mist regulated greenhouse. Cuttings with two or three buds were used with two kinds of containers: polystyrene trays with 95 cm³ cells and perforated plastic bags of 15x25x0.02cm, with 1,730 cm³. Passiflora serrato-digitata was the best, with 94.3% of rooted cuttings with shoots e only 2.4% of death cuttings. P. actinia and P. setacea showed , respectivelly, 30.5% and 28.6% of rooted cuttings and 56.8% and 60.7%, of death cuttings. The high death were attribute to phenological phases of P. actinia and P. setacea or injury caused by fungus-gnat larvae (Bradysia spp.). Cuttings with two or three buds didn't show differences among them. Plastic bags proporcioned the best results, increasing rooted cuttings and plant development

Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD)

Introduction: Handheld echocardiography (echo) is the tool of choice for rheumatic heart disease (RHD) screening. We aimed to assess the agreement between screening and standard echo for latent RHD diagnosis in schoolchildren from an endemic setting. Methods: Over 14 months, 3 nonphysicians used handheld machines and the 2012 WHF Criteria to determine RHD prevalence in consented schoolchildren from Brazilian low-income public schools. Studies were interpreted by telemedicine by 3 experts (Brazil, US). RHD-positive children (borderline/definite) and those with congenital heart disease (CHD) were referred for standard echo, acquired and interpreted by a cardiologist. Agreement between screening and standard echo, by WHF subgroups, was assessed. Results: 1390 students were screened in 6 schools, with 110 (7.9%, 95% CI 6.5–9.5) being screen positive (14 ± 2 years, 72% women). Among 16 cases initially diagnosed as definite RHD, 11 (69%) were confirmed, 4 (25%) reclassified to borderline, and 1 to normal. Among 79 cases flagged as borderline RHD, 19 (24%) were confirmed, 50 (63%) reclassified to normal, 8 (10%) reclassified as definite RHD, and 2 had mild CHD. Considering the 4 diagnostic categories, kappa was 0.18. In patients with borderline RHD reclassified to non-RHD, the most frequent WHF criterion was B (isolated mitral regurgitation, 64%), followed by A (2 mitral valve morphological features, 31%). In 1 patient with definite RHD reclassified to normal, the WHF criterion was D (borderline RHD in aortic and mitral valves). After standard echo, RHD prevalence was 3.2% (95% CI 2.3–4.2). Conclusions: Although practical, RHD screening with handheld devices tends to overestimate prevalence