Late outcome of percutaneous mitral commissurotomy: Randomized comparison of Inoue versus double-balloon technique

Lee, Sahmin,Kang, Duk-Hyun,Kim, Dae-Hee,Song, Jong-Min,Song, Jae-Kwan,Park, Seong-Wook,Park, Seung-Jung Elsevier 2017 American Heart Journal Vol.194 No.-

<P><B>Background</B></P> <P>Late prognosis after successful percutaneous mitral commissurotomy (PMC) is unclear. We compared late results of PMC using Inoue versus double-balloon techniques up to 25 years in a randomized trial.</P> <P><B>Methods</B></P> <P>Between 1989 and 1995, 302 patients (77 men, 41 ± 11 years) with severe mitral stenosis were randomly assigned to undergo PMC using Inoue (n = 152; group I) or double-balloon technique (n = 150; group D). The end points were the composite events of death, mitral surgery, repeat PMC, or deterioration of New York Heart Association (NYHA) class ≥3.</P> <P><B>Results</B></P> <P>During median follow-up of 20.7 years (maximum, 25.6), clinical events occurred in 82 (53.9%) patients in group I (37 deaths, 44 mitral surgeries, 9 repeat PMCs, 3 NYHA class ≥3) and in 79 (52.7%) patients in group D (34 deaths, 51 mitral surgeries, 5 repeat PMCs, 4 NYHA class ≥3). Event-free survival rates at 24 years were not significantly different between group I and group D (40.8% and 42.6%, respectively; hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.65–1.20; <I>P</I> = .423). On multivariate analysis, absence of post-PMC commissural mitral regurgitation (MR) (HR, 1.84; 95% CI, 1.28–2.63; <I>P</I> = .001) and immediate post-PMC mitral valve area (MVA) <1.8 cm<SUP>2</SUP> (HR, 1.53; 95% CI, 1.04–2.25; <I>P</I> = .031) were independently correlated with clinical events after successful PMC.</P> <P><B>Conclusions</B></P> <P>The Inoue and double-balloon methods showed similar good clinical outcomes up to 25 years, and the achievement of effective commissurotomy to develop post-PMC commissural MR or immediate post-PMC MVA ≥1.8 cm<SUP>2</SUP> is important in optimizing the late results of PMC.</P>

Real-Time 3D TEE for Diagnosis of Subvalvular Pannus Formation in Mechanical Aortic Valves : Comparison With Multidetector CT and Surgical Findings

Lee, Sahmin,Lee, Seung-Pyo,Park, Eun-Ah,Hong, Mi-Kyeong,Kim, Ji-Hyun,Kim, Hyung-Kwan,Lee, Whal,Kim, Yong-Jin,Sohn, Dae-Won American College of Cardiology 2015 JACC CARDIOVASCULAR IMAGING Vol.8 No.12

Variable Hemodynamic Responses during Diastolic Stress Echocardiography in Patients Who Have Relaxation Abnormality with Possible Elevated Filling Pressure

Jang, Jeong Yoon,Lee, Sahmin,Kim, Dae-Hee,Song, Jong-Min,Kang, Duk-Hyun,Song, Jae-Kwan The Korean Society of Cardiology 2018 Korean Circulation Journal Vol.48 No.8

<P><B>Background and Objectives</B></P><P>The clinical characteristics of patients with diastolic dysfunction characterized by a relaxation abnormality with possible elevated filling pressure is remain to be determined. We sought to test whether diastolic stress echocardiography (DSE) is useful for characterization of these patients.</P><P><B>Methods</B></P><P>A total of 120 patients (58 men, mean age of 64±7 years) with E/A ratio <1.0 (mean±SD, 0.7±0.1) and 10≤ E/e' <15 at rest echocardiography was enrolled prospectively for supine bicycle exercise up to 50 W.</P><P><B>Results</B></P><P>During exercise, 47 patients (39%) showed high left ventricular filling pressure (E/e' >15, hLVFP) and 40 (30%) developed exercise-induced pulmonary hypertension (systolic pulomary arterial pressure >50 mmHg, EiPH) without hLVFP. The remaining 33 patients did not show hLVFP or EiPH. The incidence of EiPH with hLVFP was 21% (25/120). By multivariate analysis, age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.00–1.13; p=0.039) and systolic pulmonary artery pressure at rest (OR, 1.14; 95% CI, 1.02–1.27; p=0.02) were associated with EiPH, whereas late diastolic transmitral velocity (OR, 1.04; 95% CI, 1.00–1.08; p=0.03) and diastolic blood pressure (OR, 0.94; 95% CI, 0.90–0.99; p=0.02) were associated with hLVFP during exercise.</P><P><B>Conclusions</B></P><P>Patients with relaxation abnormality and possibly hLVFP showed markedly heterogeneous hemodynamic changes during low-level exercise and DSE was useful to characterize these patients.</P>

Performance of a Simplified Dichotomous Phenotypic Classification of Bicuspid Aortic Valve to Predict Type of Valvulopathy and Combined Aortopathy

Sun, Byung Joo,Lee, Sahmin,Jang, Jeong Yoon,Kwon, Osung,Bae, Jae Seok,Lee, Ji Hye,Kim, Dae-Hee,Jung, Sung-Ho,Song, Jong-Min,Kang, Duk-Hyun,Chung, Cheol Hyun,Song, Jae-Kwan Elsevier 2017 Journal of the American Society of Echocardiograph Vol.30 No.12

<P><B>Background</B></P> <P>A simplified classification of bicuspid aortic valve (BAV) morphology using only the orientation of fused cusps was recently proposed. The aim of this study was to test whether it is useful for showing an association with the type of valvulopathy or aortopathy.</P> <P><B>Methods</B></P> <P>BAV phenotype was retrospectively classified in 681 patients (mean age, 59 ± 12 years; 424 men) who underwent aortic valve surgery. Each BAV was classified using both dichotomous (right and left coronary cusp fusion [CCF] vs mixed cusp fusion [MCF]) and conventional methods, and its association with the dominant valvulopathy (aortic stenosis [AS] vs regurgitation) and concomitant aortic surgery was analyzed. Four cardiologists individually reviewed transthoracic echocardiographic images of 100 randomly selected patients to compare the feasibility and accuracy of the two classification methods.</P> <P><B>Results</B></P> <P>The frequencies of BAV CCF and MCF were 53% (<I>n</I> = 361) and 47% (<I>n</I> = 320), respectively. AS was the predominant cause of surgery (<I>n</I> = 546 [80%]), and concomitant aortic surgery was done in 31% (<I>n</I> = 214). Patients with BAV MCF showed a higher frequency of AS (89% vs 73%, <I>P</I> < .001) and aortic surgery (38% vs 26%, <I>P</I> < .001) than those with BAV CCF. There were independent associations between BAV MCF and AS (odds ratio, 3.32; 95% CI, 1.99–5.54; <I>P</I> < .001) as well as aortic surgery (odds ratio, 1.76; 95% CI, 1.26–2.45; <I>P</I> = .001). The feasibility of the classification methods did not differ, but dichotomous classification revealed higher accuracy than conventional (87% [95% CI, 84.1%–90.7%] vs 70% [95% CI, 65.0%–74.3%]) for all four examiners, with higher κ coefficients representing interrater agreement (κ = 0.73 ± 0.06 to 0.83 ± 0.06 [dichotomous method] vs 0.51 ± 0.06 to 0.73 ± 0.06 [conventional method]).</P> <P><B>Conclusions</B></P> <P>The dichotomous classification method is useful for showing the association with the type of valvulopathy or aortopathy, with better diagnostic performance than the conventional method.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Simplified dichotomous BAV classification (BAV CCF vs BAV MCF) based on spatial orientation is useful for predicting patterns of valvulopathy and aortopathy. </LI> <LI> Using routine TTE images alone, this simplified method demonstrates better diagnostic performance compared to the conventional classification, which requires information regarding the individual cusps that are fused and the position of raphe. </LI> <LI> Simplified dichotomous BAV classification can be easily incorporated into the routine evaluation of BAV patients. </LI> </UL> </P>

Dipeptidyl Peptidase-4 Induces Aortic Valve Calcification by Inhibiting Insulin-Like Growth Factor-1 Signaling in Valvular Interstitial Cells

Choi, Bongkun,Lee, Sahmin,Kim, Sang-Min,Lee, Eun-Jin,Lee, Sun Ro,Kim, Dae-Hee,Jang, Jeong Yoon,Kang, Sang-Wook,Lee, Ki-Up,Chang, Eun-Ju,Song, Jae-Kwan American Heart Association 2017 Circulation Vol.135 No.20

<P>CONCLUSIONS: DPP-4-dependent insulin-like growth factor-1 inhibition in VICs contributes to aortic valve calcification, suggesting that DPP-4 could serve as a potential therapeutic target to inhibit calcific aortic valve disease progression.</P>

Clinical Characteristics of Korean Patients with Bicuspid Aortic Valve Who Underwent Aortic Valve Surgery

Sun, Byung Joo,Jin, Xin,Song, Jae-Kwan,Lee, Sahmin,Lee, Ji Hye,Park, Jun-Bean,Lee, Seung-Pyo,Kim, Dae-Hee,Park, Sung-Ji,Kim, Yong-Jin,Cho, Goo-Yeong,Song, Jong-Min,Kang, Duk-Hyun,Sohn, Dae-Won The Korean Society of Cardiology 2018 Korean Circulation Journal Vol.48 No.1

<P><B>Background and Objectives</B></P><P>Clinical data for Korean patients with bicuspid aortic valve (BAV) that underwent aortic valve (AV) surgery are currently limited.</P><P><B>Methods</B></P><P>Data for 1,160 consecutive adult BAV patients who underwent AV surgery from 2000 to 2014 in 4 tertiary referral centers were retrospectively analyzed. A standard case report form was used for clinical and echocardiographic parameters.</P><P><B>Results</B></P><P>Mean age at the time of AV surgery was 59±13 years. The most common cause of AV surgery was aortic stenosis (AS, 892 [77%]), followed by aortic regurgitation (AR, 199 [17%]), and infective endocarditis (69 [6%]). AS showed a skewed peak in the aged population and was the predominant cause of AV surgery (87%) in patients ≥50 years of age, whereas AR (46%) and active infective endocarditis (19%) were more common in younger patients (p<0.001). Echocardiographic determination of the BAV phenotype revealed that fusion of the right coronary cusp (RCC) and left coronary cusp (LCC) was most common (622 [53%]), followed by fusion of RCC and non-coronary cusp (NCC) (313 [27%]), and fusion of LCC and NCC (42 [4%]); the BAV phenotype could not be determined in the remaining 183 patients (16%). Fusion of RCC and LCC was more commonly observed in patients with AR than in those with AS (74% vs. 49%; p<0.001).</P><P><B>Conclusion</B></P><P>BAV patients were characterized by distinct surgical indications according to their age. Possible associations between BAV phenotypes and surgical indications with potential impacts of ethnicity need to be tested in further studies.</P>

Mid-term Clinical Outcomes in a Cohort of Asymptomatic or Mildly Symptomatic Korean Patients with Bicuspid Aortic Valve in a Tertiary Referral Hospital

Byung Joo Sun,Jin Kyung Oh,Sun Hack Lee,Jeong Yoon Jang,Ji Hye Lee,Sahmin Lee,Dae-Hee Kim,JongMinSong,Duk-Hyun Kang,Jae-Kwan Song 한국심초음파학회 2019 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.27 No.2

BACKGROUND: Although bicuspid aortic valve (BAV) is one of the most common congenital heart diseases, clinical outcome data regarding BAV are still limited. We evaluated clinical characteristics and mid-term clinical outcomes of asymptomatic Korean patients with bicuspid aortic valve. METHODS: We initiated a prospective registry in 2014 at a tertiary referral hospital. To develop a cohort of asymptomatic patients, we excluded patients who previously underwent open heart surgery (OHS) or who had OHS within 6 months of referral. RESULTS: A total of 170 patients (117 male [69%], age 50 ± 13 years) were enrolled. More than 70% (n = 124, 73%) were incidentally diagnosed with BAV during routine health examinations or preoperative screening for non-cardiac surgery. At the time of enrollment, moderate to severe aortic stenosis (AS) or regurgitation (AR) was present in 77 patients (45%) and 98 (58%) showed aortic dilation: 42 (25%) had non-significant valvular dysfunction without aortic dilation. During a median follow-up of 4 years, AS severity increased significantly (p < 0.001), while there was no significant change in AR severity (p = 0.361). A total of 27 patients (16%) underwent OHS, including isolated aortic valve (AV) surgery (n = 11, 41%), AV with combined aortic surgery (n = 12, 44%), and isolated aortic surgery (n = 4, 15%): no patient developed aortic dissection. Moderate to severe AS (hazard ratio [HR] 4.61; 95% confidence interval [CI] 1.83-11.62; p = 0.001), NYHA class ≥ 2 (HR 2.53; 95% CI 1.01-6.35; p = 0.048) and aortic dilation (HR 2.13; 95% CI 0.87-5.21; p = 0.099) were associated with surgical events. CONCLUSIONS: Progression patterns of valvular dysfunction and impacts of BAV phenotype on OHS should be explored in future studies with longer follow-up durations.

Epidemiologic Profile of Patients With Valvular Heart Disease in Korea: A Nationwide Hospital-Based Registry Study

You-Jung Choi,Jung-Woo Son,Eun Kyoung Kim,In-Cheol Kim,Hyung Yoon Kim,Jeong-Sook Seo,Byung Joo Sun,Chi Young Shim,Se-Jung Yoon,Sahmin Lee,Sun Hwa Lee,Jun-Bean Park,DukHyunKang 한국심초음파학회 2023 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.31 No.1

BACKGROUND: Valvular heart disease (VHD) is a common cause of cardiovascular morbidity and mortality worldwide; however, its epidemiological profile in Korea requires elucidation. METHODS: In this nationwide retrospective cohort study from the Korean valve survey, which collected clinical and echocardiographic data on VHD from 45 medical centers, we identified 4,089 patients with VHD between September and October 2019. RESULTS: The aortic valve was the most commonly affected valve (n = 1,956 [47.8%]), followed by the mitral valve (n = 1,598 [39.1%]) and tricuspid valve (n = 1,172 [28.6%]). There were 1,188 cases of aortic stenosis (AS) and 926 cases of aortic regurgitation. The most common etiology of AS was degenerative disease (78.9%). The proportion of AS increased with age and accounted for the largest proportion of VHD in patients aged 80–89 years. There were 1,384 cases of mitral regurgitation (MR) and 244 cases of mitral stenosis (MS). The most common etiologies for primary and secondary MR were degenerative disease (44.3%) and non-ischemic heart disease (63.0%), respectively, whereas rheumatic disease (74.6%) was the predominant cause of MS. There were 1,172 tricuspid regurgitation (TR) cases, of which 46.9% were isolated and 53.1% were associated with other valvular diseases, most commonly with MR. The most common type of TR was secondary (90.2%), while primary accounted for 6.1%. CONCLUSIONS: This report demonstrates the current epidemiological status of VHD in Korea. The results of this study can be used as fundamental data for developing Korean guidelines for VHD.