Mechanical mitral valve (MV) prostheses have evolved considerably over the past few decades, with early designs still being seen in patients because of their proven durability. Although these early-generation valves like the caged-ball prosthesis demonstrated remarkable longevity, their long-term use was eventually limited by the risk of thromboembolic complications and gradual development of gradients due to pannus formation. Despite discontinuation of their manufacture, such valves continue to be encountered in current clinical practice due to their extensive historical implantation. In this report, we discuss a case of a 30-year-old female who underwent an MV replacement with a Starr-Edwards (SE) caged-ball valve prosthesis 15 years back and had now come with a significant gradient. This case highlights the durability of the SE valve and how the need for later replacement is not due to a structural issue of the valve.
Background: Heart failure (HF) is a growing global health challenge, yet regional data from India’s northeastern states remain scarce. This study describes the spectrum, care patterns, and outcomes of cardiovascular diseases (CVDs), with a focus on HF, using data from a 17-month hospital-based registry in Sikkim. Methods: A prospective observational registry was conducted at the Central Referral Hospital, Sikkim Manipal Institute of Medical Sciences, from November 2022 to March 2024. Consecutive patients aged ≥16 years diagnosed with CVD were enrolled and followed. HF cases were categorized by ejection fraction (EF) (HF with preserved EF [HFpEF], HF with mildly reduced EF [HFmrEF], and HF with reduced EF) and followed up at 30, 90, and 180 days. Data were analyzed using SPSS (version 25.0) with descriptive statistics. Results: Among 793 CVD cases (mean age – 58.2 years), 130 had HF. Male and female patients were nearly equal. Predominant CVDs were hypertensive heart disease and other nonrheumatic structural heart diseases. HFpEF was most frequent (40.0%), followed by HFmrEF (32.3%) and reduced EF (27.7%). Most presented with acute decompensated HF (63.1%) and New York Heart Association Class IV symptoms (60.0%). Thirteen patients died during hospitalization. The HF readmission rate was 17.1% during follow-up, with no additional deaths. Conclusion: This registry provides prospective hospital-based insights into CVD and HF patterns from Sikkim. The predominance of HFpEF and advanced presentations highlights the need for early diagnosis, structured follow-up, and region-specific strategies within India’s noncommunicable disease framework. Strengthening regional HF registries can enhance evidence-based care and guide public health planning in resource-limited settings.
Background: Prosthetic heart valve thrombosis (PHVT) is a serious complication, particularly after mitral valve replacement. Obstructive PHVT, often leading to “stuck valve” syndrome, requires immediate intervention, either thrombolysis or surgery. This study investigated the early outcomes and 1-year functional status of patients undergoing mitral valve thrombectomy for obstructive PHVT. Methods: This was a prospective observational study enrolling 30 patients who underwent redo mitral valve thrombectomy for obstructive PHVT between June 2022 and December 2024. Patients with acute PHVT of the aortic valve, combined surgeries, or recurrence were excluded. Follow-up involved clinical assessment, functional status (New York Heart Association [NYHA] class), and trans-thoracic echocardiography at 6 months and 1 year, focusing on maintaining a therapeutic international normalized ratio (INR 2.5–3.5). Results: Among 30 patients, the mean age was 36.83 ± 6.98 years, with females comprising 53.3%. Mitral valve thrombectomy significantly improved hemodynamic parameters; survivors (n = 26) demonstrated a successful reduction in mean gradients and a significant shift in median INR from 1.7 at admission to 2.9 at 1-year follow-up (P < 0.0001). Chronic kidney disease was more frequently observed among nonsurvivors (13.34%) and severe preoperative hemodynamic collapse. At 1 year, all survivors remained clinically stable and reached NYHA Class I status, confirming that the procedure provides durable functional recovery when coupled with strict anticoagulation monitoring. Conclusion: Mitral valve thrombectomy is a feasible treatment strategy for obstructive PHVT, particularly in patients who fail thrombolysis. Maintaining strict therapeutic anticoagulation (INR 2.5–3.5) postsurgery is crucial for preventing recurrence, ensuring long-term symptomatic and functional stability.
Background: Right ventricular myocardial infarction (RVMI) complicates approximately one-third of inferior wall ST elevation myocardial infarction (IWMI) cases and substantially increases in-hospital morbidity and mortality. Despite its clinical significance, the trajectory and completeness of right ventricular functional recovery following reperfusion and the relative benefit of mechanical versus pharmacological revascularization remain incompletely characterized in Indian populations. Objective: This study aims to prospectively evaluate serial multiparametric echocardiographic (ECHO) recovery of right ventricular function following reperfusion therapy in Indian IWMI patients with right ventricular involvement. Materials and Methods: A prospective observational cohort of 100 patients with first-presentation IWMI and electrocardiogram-confirmed RVMI (ST elevation ≥ 1 mm in V4R) was enrolled at a tertiary care center over 12 months. Serial two-dimensional ECHO was performed at admission and at 1-month follow-up, guided by ASE/EACVI 2015 guidelines. RV morphological injury was graded using the Isner–Roberts classification (Grades I–IV). Reperfusion was achieved by primary percutaneous transluminal coronary angioplasty (PTCA, n = 72) or thrombolysis (n = 28). Paired comparisons used the Student’s t-test or Wilcoxon signed–rank test as appropriate; categorical shifts were assessed using the Stuart–Maxwell test. Results: The cohort was predominantly male (77%), with a 94% of patients aged 40–80 years. At 1 month, Right ventricular (RV) ejection fraction improved significantly from 49.1% ±8.1% to 53.7% ±7.2% (P < 0.01), and RV fractional area change increased from 39.0% ±7.4% to 44.3% ±7.7% (P < 0.01). LV ejection fraction also improved (58.1% ±6.9% → 60.7% ±5.7%; P < 0.01), consistent with biventricular interdependence. Global RV performance (right ventricular myocardial performance index) decreased from 47.9 ± 9.1 to 44.6 ± 7.6 (P < 0.01), and RV systolic pressure fell from 25.8 ± 5.5 to 24.7 ± 4.5 mmHg (P < 0.01). Morphologically, high-grade infarction (Grade III) fell from 29% to 7%, and no patients remained at Grade IV at follow-up, while Grade I prevalence rose from 12% to 36% (P < 0.01). PTCA was the only clinical variable that significantly correlated with improvement in RV morphological grade (P = 0.042), outperforming thrombolysis. Tricuspid annular plane systolic excursion (TAPSE) improved significantly from 19.57 ± 4.78 mm to 20.72 ± 4.40 mm (P < 0.01); the proportion of patients with normal TAPSE values increased from 77% to 85% (P = 0.008). Despite reaching statistical significance, the absolute improvement was modest compared to other RV parameters, underscoring the need for a multiparametric ECHO approach. Conclusion: Timely reperfusion produces substantial and measurable right ventricular functional recovery within 1 month of IWMI complicated by RVMI, with morphological grade regression closely mirroring ECHO improvement. Patients undergoing PTCA demonstrated greater improvement in right ventricular functional parameters compared with thrombolysis alone in this cohort. A multiparametric ECHO approach is essential, as no single parameter, including TAPSE, adequately captures the full extent of early right ventricular functional restoration.
