Transcatheter aortic valve implantation in patients with bicuspid aortic valve: a series of cases

Wstęp: Obecność dwupłatkowej zastawki aortalnej (BAV) uważa się za względne przeciwwskazanie do zabiegu przezcewnikowej implantacji zastawki aortalnej (TAVI), a leczenie chirurgiczne pozostaje metodą z wyboru w przypadku jej ciasnego zwężenia. Procedura TAVI nie jest zalecana w tej grupie chorych m.in. ze względu na owalny kształt pierścienia zastawki dwupłatkowej w porównaniu z pierścieniem prawidłowej (trójpłatkowej) zastawki, co zwiększa ryzyko dysfunkcji i zniekształcenia protezy. Dwupłatkowa zastawka aortalna stanowiła kryterium wyłączenia w większości badań klinicznych dotyczących TAVI i brakuje dokładnych danych na temat bezpieczeństwa i skuteczności takiego postępowania w tej grupie chorych. Cel: Celem pracy była ocena bezpieczeństwa i skuteczności TAVI u pacjentów z ciasnym zwężeniem BAV. Metody: Analizie poddano grupę 104 pacjentów przyjętych do Instytutu Kardiologii w celu wykonania TAVI w okresie od stycznia 2009 r. do maja 2012 r. W ramach kwalifikacji do zabiegu wykonano echokardiograficzne badania przezklatkowe i przezprzełykowe oraz tomografię komputerową serca, aorty i jej rozgałęzień. Odpowiednie pomiary i analiza danych z badań obrazowych umożliwiły wybór optymalnego dostępu przeznaczyniowego, dobranie protezy zastawkowej i właściwe zaplanowanie zabiegu. Dwupłatkową zastawkę aortalną zidentyfikowano u 7 pacjentów (6,7%; średni wiek 77,7 roku), których poddano bardziej szczegółowej analizie. Pacjenci ci mieli zdiagnozowaną ciasną objawową stenozę aortalną ze średnim polem powierzchni przekroju zastawki 0,55 cm2 (0,46–0,7 cm2). Wszyscy zostali zdyskwalifikowani z zabiegu chirurgicznej wymiany zastawki aortalnej ze względu na wysokie ryzyko operacyjne (uśredniony wynik logistic Euroscore 19,9%). Wykonano TAVI z wykorzystaniem systemow CoreValve (5 osób) lub Sapien (2 chorych). Następnie przeanalizowano prospektywne wyniki długoterminowej obserwacji klinicznej i echokardiograficznej w punktach czasowych: 30 dni, 6 miesięcy i 12 miesięcy po zabiegu. Wyniki: U 1 pacjenta w tomografii komputerowej zaobserwowano eliptyczne zniekształcenie implantowanej protezy, jednak bez istotnej klinicznie dysfunkcji zastawki. Jeden pacjent zmarł w ciągu 30 dni po TAVI z powodu infekcyjnego zapalenia wsierdzia. Pozostali, którzy przeżyli, charakteryzowali się małą do umiarkowanej niedomykalnością aortalną w punkcie czasowym wynoszącym 30 dni. W kolejnych punktach czasowych nie zaobserwowano progresji niedomykalności aortalnej. Po roku od zabiegu 6 spośród 7 pacjentów pozostawało przy życiu. Wszyscy oni osiągnęli istotną poprawę funkcjonalną ocenianą wg klasyfikacji New York Heart Association. Wnioski: Zabieg TAVI może stanowić alternatywną opcję terapeutyczną dla pacjentów z ciasną stenozą BAV. Według obserwacji autorów niniejszej pracy metoda ta cechuje się względnie niską śmiertelnością i dobrymi wynikami w obserwacji 30-dniowej, 6- oraz 12-miesięcznej.Background: Bicuspid aortic valve (BAV) has been considered a relative contraindication for transcatheter aortic valve implantation (TAVI). Due to more oval shape of the BAV annulus compared to tricuspid aortic valve, the procedure has been discouraged because of an increased risk of stent assembly displacement, uneven expansion, post-procedure paravalvular leakage, stent valve distortion, or other malfunction after implantation. For the same reasons patients with BAV have been excluded from the majority of clinical TAVI trials. Aim: To evaluate the efficacy and safety of TAVI in patients with BAV stenosis. Methods: We analysed a group of 104 patients admitted to our institution for TAVI between January 2009 and May 2012. During pre-procedure evaluation, transthoracic and transoesophageal (TEE) echocardiography as well as angio-computed tomography (CT) scan were performed to assess aortic valve anatomy and morphology. Appropriate measurements and detailed analyses of imaging data have been accomplished to select optimal access site, prosthesis size as well as to plan the procedure. BAVs were recorded in seven patients (6.7%; mean age 77.7 years). These patients presented with severe symptomatic aortic valve stenosis with a mean aortic valve area of 0.55 cm2 (0.46–0.7 cm2) as measured in TEE. All of the patients had been disqualified from surgical valve replacement due to high surgical risk with a mean logistic Euroscore of 19.9%. All of them successfully underwent TAVI using CoreValve (n = 5) or Sapien (n = 2) valves. Follow-up was completed at 30 days, and six and 12 months after the procedure. Results: During follow-up one patient developed an elliptic distortion of the aortic prosthesis in CT, although it did not result in significant malfunctioning of the implant. One patient died of infective endocarditis 30 days after the procedure. Survivors at 30-day follow-up had mild to moderate aortic insufficiency, and it did not deteriorate after six months. At one year follow-up six out of seven patients remained alive. They achieved significant functional improvement by New York Heart Association class compared to baseline. Conclusions: TAVI may constitute an alternative treatment option for high-risk patients with BAV, resulting in a low periprocedural mortality rate, and good 30-day, six-month, and one-year outcomes

Subchondral Bone Relative Area and Density in Human Osteoarthritic Femoral Heads Assessed with Micro-CT before and after Mechanical Embedding of the Innovative Multi-Spiked Connecting Scaffold for Resurfacing THA Endoprostheses: A Pilot Study

The multi-spiked connecting scaffold (MSC-Scaffold) prototype is the essential innovation in the fixation of components of resurfacing total hip arthroplasty (THRA) endoprostheses in the subchondral trabecular bone. We conducted the computed micro-tomography (micro-CT) assessment of the subchondral trabecular bone microarchitecture before and after the MSC-Scaffold embedding in femoral heads removed during long-stem endoprosthesis total hip arthroplasty (THA) of different bone densities from 4 patients with hip osteoarthritis (OA). The embedding of the MSC-Scaffold in subchondral trabecular bone causes the change in its relative area (BA/TA, bone area/total area ratio) ranged from 18.2% to 24.7% (translating to the calculated density ρB relative change 11.1–14.4%, and the compressive strength S relative change 75.3–122.7%) regardless of its initial density (before the MSC-Scaffold embedding). The densification of the trabecular microarchitecture of subchondral trabecular bone due to the MSC-Scaffold initial embedding gradually decreases with the increasing distance from the apexes of the MSC-Scaffold’s spikes while the spatial extent of this subchondral trabecular bone densification ranged from 1.5 to 2.5 mm (which is about half the height of the MSC-Scaffold’s spikes). It may be suggested, despite the limited number of examined femoral heads, that: (1) the magnitude of the effect of the MSC-Scaffold embedding on subchondral trabecular bone densification may be a factor contributing to the maintenance of the MSC-Scaffold also for decreased initial bone density values, (2) the deeper this effect of the subchondral trabecular bone densification, the better strength of subchondral trabecular bone, and as consequence, the better post-operative embedding of the MSC-Scaffold in the bone should be expected

Diffuse Idiopathic Skeletal Hyperostosis of Cervical Spine with Dysphagia—Molecular and Clinical Aspects

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by the calcification and ossification of the ligaments of the cervical spine; in some cases, it may result in dysphagia. The condition is more common in men over 50 years of age with metabolic disorders, and it is often asymptomatic and not a major issue for patients. The etiology of DISH is poorly understood, and known genetic factors indicate multiple signal pathways and multigene inheritance. In this review, we discuss the epidemiological, clinical, and etiological aspects of DISH with a special focus on dysphagia

Aktualne techniki rekonstrukcji 3D w tomografii komputerowej i rezonansie magnetycznym w diagnostyce obrazowej kręgosłupa

This review article presents an analysis of 36 scientific papers focusing on modern three-dimensional (3D) reconstruction techniques in computed tomography (CT) and magnetic resonance imaging (MRI) for their applications in medical diagnostics. The objective of this review is to present the current state of knowledge regarding the development and utilization of 3D reconstruction techniques, as well as to identify key trends and challenges in this field. The first part of the study focuses on the advancements in MRI and CT. The analysis reveals the major trends in the evolution of these diagnostic methods, such as increased accessibility of CT and MRI examinations for patients, reduced scan duration, greater utilization of artificial intelligence, and expanded applications in interventional radiology. The second part of the article highlights the potential and effectiveness of 3D modelling in diagnostic imaging. Creating 3D models of anatomical structures is a complex and multi-step process. Through the review, it was determined that 3D models derived from MRI can be equally accurate and diagnostically valuable compared to the more commonly used CT-based reconstructions. In the future, fusion imaging of MRI/CT is expected to play an increasingly significant role in orthopaedic imaging. The review demonstrates the significant potential of 3D modelling in diagnostic imaging. However, further research is still required to better understand the capabilities of 3D modelling in diagnosing complex anatomical structures. The integration of information technology in medicine will be crucial in advancing this field.Przedstawiono analizę 36 artykułów naukowych dotyczących nowoczesnych technik rekonstrukcji trójwymiarowych (3D) w tomografii komputerowej (CT) oraz rezonansie magnetycznym (MRI) w kontekście zastosowania tych technik w diagnostyce medycznej. Celem przeglądu jest zaprezentowanie aktualnego stanu wiedzy na temat rozwoju i zastosowania rekonstrukcji 3D oraz identyfikacja najważniejszych trendów i wyzwań w tej dziedzinie. W pierwszej części pracy skoncentrowano się na kierunkach rozwoju MRI i CT. Analiza wskazała główne trendy w ewolucji obu tych metod diagnostycznych, takie jak zwiększenie dostępności badań CT i MRI dla pacjentów, skrócenie czasu trwania badania, zwiększenie roli sztucznej inteligencji oraz szersze wykorzystanie tych modalności w radiologii interwencyjnej. Druga część pracy skupia się na możliwościach użycia modelowania 3D w diagnostyce obrazowej i jego skuteczności. Tworzenie trójwymiarowych modeli struktur anatomicznych to złożony i wieloetapowy proces. W toku przeglądu ustaliliśmy, że modele 3D uzyskane na podstawie MRI mogą być równie dokładne i posiadać podobną wartość diagnostyczną co wykorzystywane do tej pory rekonstrukcje oparte o obrazy CT. W przyszłości coraz większą rolę w diagnostyce obrazowej w ortopedii będą odgrywać obrazy fuzyjne MRI/CT. Przegląd pokazuje, że modelowanie 3D ma duży potencjał w diagnostyce obrazowej. Wciąż są jednak potrzebne dalsze badania, aby lepiej zrozumieć możliwości modelowania 3D w diagnostyce złożonych struktur anatomicznych. Wykorzystanie technologii informatycznych w medycynie będzie miało kluczowe znaczenie w tym procesie

New model of lumbar spine biomechanics with the use of simulation analysis

The existing biomechanical models of the lumbo-sacral spine do not explain the role of the dorsal extensor muscle and fascia. The study attempts to explain the action of paraspinal muscles based on the mechanism of contraction and “hydro skeleton”. It was assumed that the muscle contracting produces hydrostatic pressure and in this way is able to resist and transfer loads. In this mechanism, inside ventricular pressure can modify the load transfer through the spine. To confirm the hypothesis discussed above, a simplified simulation model of the lumbar spine was built. For this purpose, scientific software named ABAQUS, using finite element methods was used. The model of the spine was mainly a kinematic model aimed at reflecting the impact of the spinal muscle function on lumbar lordosis

Clinical and Demographic Factors Influencing the Asymmetry of Gait in Lower-Limb Prosthetic Users

(1) Background: A lower limb prosthesis replaces a lost body part with a differential representation of gait function and its symmetry. Many physical, personal, and specific factors in amputees influence gait asymmetry. The aim of this study was to determine the factors influencing the asymmetry of gait in amputated patients. (2) Methods: The study group consisted of 12 people. Gait quality was assessed using the MoCap OptiTrack® Motion Capture System and the results were correlated with demographic factors (age, gender), morphological features (height, weight), amputation-related factors (cause and side of amputation, prosthesis time, and prosthesis fixation), and ailment pain. The control group consisted of 12 people. (3) Results: In the study group, a positive correlation between the mean walking speed and height in the study group was demonstrated, as well as a positive correlation between the difference in ROM and height, and a negative correlation between the mean walking speed and age. A negative correlation between the difference in ROM and age was found in both groups. A positive correlation was found between the width of the support and the weight in the control group. No other statistical relationship with the parameters describing gait asymmetry was found. (4) Conclusions: Statistical analysis showed that mean walking speed and ROM difference in the study group were positively related to height and negatively to age. No other statistical relationship with the parameters describing gait asymmetry was found

The Influence of Osteon Orientation on Surface Topography Parameters after Machining of Cortical Bone Tissue

Mechanical processing of cortical bone tissue is one of the most common surgical procedures. A critical issue accompanying this processing is the condition of the surface layer, which can stimulate tissue growth and serve as a drug carrier. A comparison of the surface condition before and after orthogonal and abrasive processing was conducted to validate the influence of bone tissue’s processing mechanism and orthotropic properties on the surface topography. A cutting tool with a defined geometry and a custom-made abrasive tool was used. The bone samples were cut in three directions, depending on the orientation of the osteons. The cutting forces, acoustic emission, and surface topography were measured. The level of isotropy and the topography of the grooves showed statistical differences relative to the anisotropy directions. After orthogonal processing, the surface topography parameter Ra was determined from 1.38 ± 0.17 μm to 2.82 ± 0.32. In the case of abrasive processing, no correlation was found between the orientation of osteons and topographical properties. The average groove density for abrasive machining was below 1004 ± 0.7, and for orthogonal, it was above 1156 ± 58. Due to the positive properties of the developed bone surface, it is advisable to cut in the transverse direction and parallel to the axis of the osteons

Towards the First Generation of Biomimetic Fixation for Resurfacing Arthroplasty Endoprostheses

This paper presents advances in designs of resurfacing arthroplasty endoprostheses that occurred through their historical generations. The critical characteristics of contemporary generation hip resurfacing arthroplasty endoprostheses are given and the failures resulting from the specific generation cemented and short stem fixation of the femoral component are reviewed. On the background of these failures, the critical need arises for an alternative approach to the fixation of components of resurfacing arthroplasty leading towards the first generation of biomimetic fixation for resurfacing arthroplasty endoprostheses. The state of the art of the completed bioengineering research on the first biomimetic fixation for resurfacing arthroplasty endoprostheses is presented. This new design type of completely cementless and stemless resurfacing arthroplasty endoprostheses of the hip joint (and other joints), where endoprosthesis components are embedded in the surrounding bone via the prototype biomimetic multi-spiked connecting scaffold (MSC-Scaffold), initiates the first at all generations of biomimetic endoprostheses of diarthrodial joints

Clinical and Demographic Factors Influencing the Asymmetry of Gait in Lower-Limb Prosthetic Users

(1) Background: A lower limb prosthesis replaces a lost body part with a differential representation of gait function and its symmetry. Many physical, personal, and specific factors in amputees influence gait asymmetry. The aim of this study was to determine the factors influencing the asymmetry of gait in amputated patients. (2) Methods: The study group consisted of 12 people. Gait quality was assessed using the MoCap OptiTrack® Motion Capture System and the results were correlated with demographic factors (age, gender), morphological features (height, weight), amputation-related factors (cause and side of amputation, prosthesis time, and prosthesis fixation), and ailment pain. The control group consisted of 12 people. (3) Results: In the study group, a positive correlation between the mean walking speed and height in the study group was demonstrated, as well as a positive correlation between the difference in ROM and height, and a negative correlation between the mean walking speed and age. A negative correlation between the difference in ROM and age was found in both groups. A positive correlation was found between the width of the support and the weight in the control group. No other statistical relationship with the parameters describing gait asymmetry was found. (4) Conclusions: Statistical analysis showed that mean walking speed and ROM difference in the study group were positively related to height and negatively to age. No other statistical relationship with the parameters describing gait asymmetry was found