Influence of anesthesia on hemodynamic assessment of mitral stenosis severity

Background: The treatment of choice for severe rheumatic mitral stenosis (MS) is balloon mitral valvuloplasty (BMV). Assessment of MS severity is usually performed by echocardiography. Before performing BMV, invasive hemodynamic assessment is also performed. The effect of anesthesia on the invasive assessment of MS severity has not been studied. The purpose of the present study was to assess changes in invasive hemodynamic measurement of MS severity before and after induction of general anesthesia. Methods: The medical files of 22 patients who underwent BMV between 2014 and 2020 were reviewed. Medical history, laboratory, echocardiographic and invasive measurements were collected. Anesthesia induction was performed with etomidate or propofol. Pre-procedural echocardiographic measurements of valve area using pressure half time, and continuity correlated well with invasive measurements using the Gorlin formula. Results: After induction of anesthesia the mean mitral valve gradient dropped by 2.4 mmHg (p = 0.153) and calculated mitral valve area (MVA) increased by 0.2 cm2 (p = 0.011). A wide variability in individual response was observed. While a drop in gradient was noted in 14 patients, it increased in 7. Gorlin derived MVA rose in most patients but dropped in 4. Assuming a calculated MVA of 1.5 cm2 and below to define clinically significant MS, 4 patients with pre-induction MVA of 1.5 cm2 or below had calculated MVA above 1.5 cm2 after induction. Conclusions: The impact of general anesthesia on the hemodynamic assessment of MS is heterogeneous and may lead to misclassification of MS severity

Left atrial size predicts long-term outcome after balloon mitral valvuloplasty

Background: The treatment of choice for severe rheumatic mitral stenosis is balloon mitral valvuloplasty (BMV). Numerous predictors of immediate and long-term procedural success have been described. The aims of this study were to describe our experience with BMV over the last decade and to evaluate predictors of long-term event-free survival.  Methods: Medical records were retrospectively analyzed of patients who underwent BMV between 2009 and 2021. The primary outcome was a composite endpoint of all-cause mortality, mitral valve replacement (MVR), and repeat BMV. Long-term event-free survival was estimated using the Kaplan-Meier curves. Logistic regression was used to create a multivariate model to assess pre-procedural predictors of the primary outcome. Results: A total of 96 patients underwent BMV during the study period. The primary outcome occurred in 36 patients during 12-year follow-up: 1 (1%) patient underwent re-BMV, 28 (29%) had MVR, and 8 (8%) died. Overall event-free survival was 62% at 12 years. On multivariate analysis, pre-procedural left atrial volume index (LAVI) > 80 mL/m2 had a significant independent influence on event-free survival, as did previous mitral valve procedure and systolic pulmonary arterial pressure above 50 mmHg. Conclusion: Despite being a relatively low-volume center, excellent short and long-term results were demonstrated, with event-free survival rates consistent with previous studies from high-volume centers. LAVI independently predicted long-term event-free survival

Cultural comparison of the Soviet and American animation in the 20th century : key points of the origins, development and notable examples

Animation is principally associated with the American production of cartoons which to this day takes the leading position in the worldwide industry. Simultaneously, animated films created in the Soviet Union are mostly unknown be-yond the post-Soviet states due to the decades-long Iron Curtain and isolation despite their immense cultural value and impact to the people acquainted with them. The objective of this work was to gather information about the origins of the American and Soviet animation, to study the key points of the development of animation in both countries in the 20th century and to compare the animated films produced by the United States and the Soviet Union. Firstly, the thesis provided an outlook on the key points of the development of animation and historical impact on its cultural role in the USA and USSR based on an extensive review of scientific literature. Secondly, the examples of the American and Soviet animated adaptations of the same books were presented, analysed and compared. The findings demonstrated that against the censorship and lack of access to the innovative technologies, Soviet animation developed its unique way of ex-pression acquiring profound, hidden sense, aiming to deliver cultural values to both children and adults and mastering the sound and the image to deepen the meaning of the story and characters. In its turn, American animation, being a pioneer in the technical development, was able to innovate and master the techniques of creating animated films, yet being perceived as a genre for chil-dren from its origins, it maintained the entertaining spirit rather than attempted to hide a deeper meaning and concentrate on the delivery of the moral value of the story