Background. Mitral valve repair (MVr) combined with papillary muscle approximation (PMA) may improve repair durability in severe ischemic mitral regurgitation (MR), when compared with MVr alone. We sought to identify preoperative transthoracic echocardiographic markers associated with MR recurrence after MVr with PMA. Methods. A post-hoc analysis was performed on patients with severe ischemic MR who underwent coronary artery bypass graft surgery with MVr with PMA in the papillary muscle approximation randomized trial. The PMA was performed utilizing a 4-mm polytetrafluoroethylene graft placed around the papillary muscles. Linear regression analyses and receiver-operating characteristic curves were used to identify echocardiographic variables and diagnostic models associated with recurrent MR. Results. There were 48 patients with a mean age of 63 ± 7 years, a left ventricular ejection fraction of 35% ± 5%, and a left ventricular end-diastolic diameter of 63 ± 3 mm. Of these, 37 patients had baseline and 5-year follow-up echocardiograms, with moderate-to-severe MR recurring

Background:Sexual dimorphism refers to the differences in size, shape, etc., between males and females. The dentition's use in sex assessment has been explored and advocated owing to its strength and resistance to peri- and post-mortem insults.Objectives:The study evaluated permanent maxillary incisors and canines for sexual dimorphism and estimated the level of accuracy with which they could be used for sex determination.Materials and Methods:The study was conducted on 100 subjects (50 males, 50 females). The mesiodistal dimension of permanent maxillary incisors and canines was measured and the data were subjected to statistical analysis.Result:Univariate analysis revealed that all permanent maxillary incisors and canines exhibited larger mean values of mesiodistal dimension in males compared to females but only canines were found to be statistically significant for sexual dimorphism.Conclusion:The study showed maxillary canines exhibiting significant sexual dimorphism and can be used for sex determination along with other procedures.

Background: Transcatheter aortic valve replacement has proved its safety and effectiveness in intermediate- to high-risk and inoperable patients with severe aortic stenosis. However, despite current guideline recommendations, the use of transcatheter aortic valve replacement (TAVR) to treat severe aortic valve stenosis caused by degenerative leaflet thickening and calcification has not been widely adopted in low-risk patients. This reluctance among both cardiac surgeons and cardiologists could be due to concerns regarding clinical and subclinical valve thrombosis. Stent performance alongside increased aortic root and leaflet stresses in surgical bioprostheses has been correlated with complications such as thrombosis, migration and structural valve degeneration. Materials and Methods: Self-expandable catheter-based aortic valve replacement (Medtronic, Minneapolis, MN, USA), which was received by patients who developed transcatheter heart valve thrombosis, was investigated using high-resolution biomodelling from computed tomography scanning. Calcific blocks were extracted from a 250 CT multi-slice image for precise three-dimensional geometry image reconstruction of the root and leaflets. Results: Distortion of the stent was observed with incomplete cranial and caudal expansion of the device. The incomplete deployment of the stent was evident in the presence of uncrushed refractory bulky calcifications. This resulted in incomplete alignment of the device within the aortic root and potential dislodgment. Conclusion: A Finite Element Analysis (FEA) investigation can anticipate the presence of calcified refractory blocks, the deformation of the prosthetic stent and the development of paravalvular orifice, and it may prevent subclinical and clinical TAVR thrombosis. Here we clearly demonstrate that using exact geometry from high-resolution CT scans in association with FEA allows detection of persistent bulky calcifications that may contribute to thrombus formation after TAVR procedure.

Background. Treatment of ischemic mitral regurgitation (IMR) is in evolution as percutaneous procedures and complex surgical repair have been recently investigated in randomized clinical trials and matched studies. This study aims to review and compare the current treatment options for IMR.Methods. A comprehensive literature search was conducted using electronic databases. The primary outcome was all-cause long-term mortality. The secondary outcomes were perioperative mortality, unplanned rehospitalization, reoperation, and composite endpoints as defined in the original articles.Results. A total of 12 articles met the inclusion criteria and were included in the final metaanalysis. The MitraClip procedure did not confer a significant benefit in mortality and repeated hospitalization compared to medical therapy alone. In patients with moderate IMR, the adjunct of mitral procedure over CABG is not associated with clinical improvements.When evaluating mitral valve (MV) replacement vs repair, hospital mortality was higher among patients undergoing replacement (OR 1.91, P=0.009), but both reoperation and readmission rates were lower (OR 0.60, P=0.05 and OR 0.45, P<0.02, respectively).Comparing restrictive annuloplasty alone with adjunctive subvalvular repair, subvalvular procedures resulted in fewer readmissions (OR 0.50, P=0.06) and adverse composite endpoints(P=0.009).Conclusions. MitraClip procedure is not associated with improved outcomes compared with medical therapy. MV replacement is associated with increased early mortality but reduced reoperation rate and readmission rate compared to MV repair using annuloplasty in moderateto-severe IMR. Despite no significant benefit in isolated outcomes comparing annular and adjunct subvalvular procedures, the adjunct of subvalvular procedures reduces the risk of major postoperative adverse events.

Introduction The TAVR procedure is associated with a substantial risk of thrombosis. Current guidelines recommend catheter-based aortic valve implantation for prohibitive-high-risk patients with severe aortic valve stenosis but acknowledge that the aetiology and mechanism of thrombosis are unclear. Methods From 2015 to 2018, 607 patients with severe aortic valve stenosis underwent either self-expandable or balloon-expandable catheter-based aortic valve implantation at our institute. A complementary study was designed to support computed tomography as a predictor of complications using an advanced biomodelling process through finite element analysis (FEA). The primary evaluation of study was the thrombosis of the valve at 12 months. Results At 12 months, 546 patients had normal valvular function. 61 patients had THVT while 6 showed thrombosis and dislodgement with deterioration to NYHA Class IV requiring rehospitalization. The FEA biomodelling revealed a strong link between solid uncrushed calcifications, delayed dislodgement of TAVR and late thrombosis. We observed an interesting phenomenon of fibrosis/calcification originating at the level of the misplaced valve, which was the primary cause of coronary obstruction. Conclusion The use of cardiac CT and predictive biomodelling should be integrated into routine practice for the selection of TAVR candidates and as a predictor of negative outcomes given the lack of accurate investigations available. This would assist in effective decision-making and diagnosis especially in a high-risk cohort of patients.