Chaliki, Hari P.

Background Valvuloarterial impedance (Zva) was introduced as a prognostic measure in patients with aortic stenosis (AS). However, it is unclear whether Zva has a prognostic impact on survival after surgical aortic valve replacement (AVR) in patients with severe AS with preserved ejection fraction (EF). Methods We retrospectively reviewed 929 consecutive patients who had AVR. We investigated 170 elderly patients (age >65 years, mean 76 years) who had AVR secondary to severe AS (mean gradient ≥40 mm Hg; aortic valve area ≤1 cm2; peak velocity ≥4 m/s). Patients with EF <50%, greater than moderate aortic regurgitation, prior heart surgery and concomitant mitral or tricuspid valve surgery were excluded. Zva was calculated and the patients were divided into two groups; low Zva, Zva <4.3 (n=82) and high Zva, Zva ≥4.3 (n=88). The end point was all-cause of death. Survival curves were calculated according to Kaplan-Meier method. Results Age, prevalence of hypertension, diabetes, chronic kidney disease (CKD), atrial fibrillation, symptoms, EF, E/e′ and concomitant coronary artery bypass graft were not different between the groups. Survival was not different between the groups at 5 years (70% in low Zva and 81% in high Zva; p=0.21) and for the entire follow-up period (p=0.23). Only age was a significant factor in predicting survival by multivariate analyses in Cox proportional hazards model after adjusting for Zva, CKD, atrial fibrillation and hypertension. Conclusions Our results suggest that preoperative Zva does not have a prognostic impact on postoperative survival in elderly patients with severe AS with preserved EF. Further investigation is needed to elucidate the controversial results.

Objective To determine the association between serum vitamin D level and left ventricular (LV) diastolic dysfunction. Background Vitamin D deficiency has been shown in observational and prospective studies to be associated with cardiovascular diseases including coronary artery disease, LV hypertrophy and systolic heart failure. Even though diastolic LV dysfunction is an early manifestation of cardiac disease, there is no study that examines whether a deficiency of vitamin D is associated with LV diastolic dysfunction. Method A retrospective observational review of 1011 patients (679 women) was conducted to examine if low 25-OH-vitamin D levels were associated with LV diastolic dysfunction. Results All the LV diastolic dysfunction parameters: left atrial volume index, E/e', e' velocity, LV mass index and deceleration time were not significantly different between patients with 25-OH vitamin D level ≤20 ng/mL vs 25-OH vitamin D level >20 ng/mL. Conclusions Despite growing medical literature suggesting vitamin D deficiency is associated with cardiovascular disease, in this present study there is no significant association of vitamin D levels and LV diastolic performance, including left atrial volume index.

Mini‐AbstractWe present a case of a 25‐year‐old man with aortic regurgitation secondary to infective endocarditis. A preoperative transesophageal echocardiography demonstrated an abnormal aortic valve with possible vegetation or torn leaflet with severe aortic regurgitation, markedly dilated left coronary arteries, and a fistulous communication between the circumflex artery and the coronary sinus. The aortic valve was repaired and the coronary sinus arteriovenous fistula was ligated. At 1‐year follow‐up, there was no evidence of recurrent arteriovenous fistula or aortic regurgitation.

Mini‐AbstractWe present a case of a 76‐year‐old woman with new‐onset atrial flutter who underwent transesophageal echocardiography, which demonstrated a large left atrial mass consistent with myxoma and a “shimmering” mobile mass on the aortic side of the right coronary cusp, with fronds consistent with a papillary fibroelastoma. Such concurrent primary cardiac tumors of different histology are a rare occurence.