Stented Porcine and Pericardial Bioprostheses - A historical review

Stented bioprostheses have been extensively used clinically to replace diseased cardiac valves with the clear advantage over mechanical prostheses of avoiding the use of chronic anticoagulation in most cases. During the past five decades, however, based on clinical and pathological experience, tissue calcification and cusp tears were identified as the main determinants of failure of porcine and pericardial bioprostheses, respectively. Tissue treatments to mitigate dystrophic calcification together with structural modifications in valve design have produced a current generation of bioprosthetic valves which show excellent overall performance and considerably increased durability when compared with old models. Further ongoing research aims to provide even more durable bioprostheses in order to allow reduction of the age threshold for implantation also in younger subjects, helping to contrast effectively the rapidly expanding role of catheter-based interventions

Quadricuspid aortic valve associated with hypoplastic aortic annulus

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Intimal Sarcoma of the Descending Aorta Mimicking Aortitis

We describe a 74-year-old male patient with an intimal sarcoma of the descending aorta mimicking aortitis. The patient presented with lower back pain, fever, and increased C-reactive protein, erythrocyte sedimentation rate, and immunoglobulin G4 (IgG4) serum levels, together with Staphylococcus epidermidis-positive blood cultures. These findings, together with evidence of a 49-mm pseudoaneurysm of the descending thoracic aorta, caused us to suspect aortitis. However, postoperative histology and immunohistochemistry demonstrated the presence of an intimal aortic sarcoma. At the 8-month follow-up, local recurrence of the neoplasm and lung metastases were noted

Micro‑RNA‑21 (biomarker) and global longitudinal strain (functional marker) in detection of myocardial fibrotic burden in severe aortic valve stenosis: a pilot study

Aims: Myocardial fibrosis (MF) is a deleterious consequence of aortic valve stenosis (AVS). Global longitudinal strain (GLS) is a novel left ventricular (LV) functional parameter potentially useful to non-invasively estimate MF. MicroRNAs (miRNAs) are non-coding small ribonucleic acids (RNA) modulating genes function, mainly through RNA degradation. miRNA-21 is a biomarker associated with MF in pressure overload. The aim of the present study was to find an integrated algorithm for detection of MF using a combined approach with both bio- and functional markers. Methods: Thirty-six patients (75.2±8 y.o.; 63% Female) with severe AVS and preserved LV ejection fraction (EF), candidate to surgical aortic valve replacement (sAVR) were enrolled. Clinical, bio-humoral evaluation (including plasmatic miRNA-21 collected using specific tubes, PAXgene, for stabilization of peripheral RNA) and a complete echocardiographic study, including GLS and septal strain, were performed before sAVR. Twenty-eight of those patients underwent sAVR and, in 23 of them, an inter-ventricular septum biopsy was performed. Tissues were fixed in formalin and embedded in paraffin. Sections were stained with Hematoxylin and Eosin for histological evaluation and with histochemical Masson trichrome for collagen fibers. The different components were calculated and expressed as micrometers2. To evaluate tissue miRNA components, sections2-μm thick were cut using a microtome blade for each slide. Regression analysis was performed to test association between dependent variable and various predictors included in the model. Results: Despite a preserved EF (66±11%), patients presented altered myocardial deformation parameters (GLS -14,02±3.8%; septal longitudinal strain, SSL -9.63±2.9%; septal longitudinal strain rate, SL-Sr -0.58±0.17 1/s; Septal Longitudinal early-diastolic strain rate, SL-SrE 0.62±0.32 1/s). The extent of MF showed an inverse association with both GLS and septal longitudinal deformation indices (GLS: R2=0.30; p=0.02; SSL: R2=0.36; p=0.01; SL-Sr: R2=0.39; p<0.001; SL-SrE: R2=0.35; p=0.001). miRNA-21 was mainly expressed in fibrous tissue (p<0.0001). A significant association between MF and plasmatic miRNA-21, alone and weighted for measures of structural (LVMi R2=0.50; p=0.0005) and functional (SSL R2=0.35; p=0.006) remodeling, was found. Conclusions: In AVS, MF is associated with alterations of regional and global strain. Plasmatic miRNA-21 is directly related to MF and associated with LV structural and functional impairment. © 2016 The Author(s)