DOI: 10.3897/bgcardio.31.e178367

Authors: D. Farandzha

Abstract: Acenocoumarol, a vitamin K antagonist (VKA), has played a pivotal role in anticoagulant therapy for over 60 years. Derived from the coumarin family, acenocoumarol inhibits vitamin K epoxide reductase, disrupting the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X) and effectively preventing thromboembolic events. Compared to warfarin, acenocoumarol offers a rapid onset and shorter half-life, providing clinicians greater therapeutic fl exibility. Despite advances and widespread adoption of direct oral anticoagulants (DOACs), acenocoumarol continues to hold clinical signifi cance, particularly in Europe, Latin America, and Asia, owing to extensive clinical experience, reversibility, and cost-effectiveness. However, its use necessitates regular monitoring of international normalized ratio (INR), with individualized dosage adjustments required due to genetic variability (CYP2C9, VKORC1 polymorphisms), drug-drug interactions, dietary infl uences, and special considerations in the elderly and patients with chronic kidney disease (CKD). Recent clinical trials have expanded our understanding of its effi cacy, safety, and optimal use. Precision dosing strategies, including genotype guidance and advanced INR monitoring based on body-surface area-adjusted estimated glomerular fi ltration rate (BSA-adjusted eGFR) dosing, promise enhanced safety and personalized treatment. Although DOACs are now widely adopted due to their predictable pharmacokinetics and lack of routine monitoring requirements, acenocoumarol remains indispensable in well-defi ned clinical scenarios such as in patients with mechanical heart valves, rheumatic mitral stenosis–associated atrial fi brillation, antiphospholipid syndrome, and other conditions in which individualized dose adjustment offers a therapeutic advantage.

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DOI: 10.3897/bgcardio.31.e169255

Authors: G. Vassilev

Abstract: Minimally invasive surgical techniques in cardiac surgery are increasingly applied, particularly in elderly and high-risk patients. One of the most universal and promising approaches is the transaxillary access, which allows surgical interventions on all cardiac valves and their combinations. This access does not require bone transection and leaves practically an invisible scar, making it exceptionally sparing. In combination with sutureless valve prostheses (e.g., Perceval S), this approach shortens aortic cross-clamp and cardiopulmonary bypass times, improves hemodynamic outcomes, and facilitates work in a limited surgical fi eld. In the Department of Cardiac Surgery at Tokuda Hospital, 19 operations have been performed using this method over the past year and a half: 8 aortic valves, 10 mitral valves, and 1 tricuspid valve. The present article reviews the advantages and specifi c features of the transaxillary approach in valve replacement.

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DOI: 10.3897/bgcardio.31.e147010

Authors: M. M. Yusuf, M. P. Doss, R. Kannaiyan, R. Valliammai, A. M. Kumar

Abstract: Stent infection is a rare but serious complication that can lead to signifi cant morbidity and mortality. A 75-year-old man with a known history of diabetes underwent percutaneous coronary intervention (PCI) for coronary artery disease involving the right coronary artery (RCA). The patient presented to our hospital with stent infection and a subsequent pseudoaneurysm formation in the RCA. A multidisciplinary team decided on surgical intervention to manage stent-related infection. Infected stents were removed, the pseudoaneurysm was excised, and the RCA was reinforced. Additionally, the aortic valve was inspected and debrided. This case highlights the intricate management of complex coronary stent infections and the importance of a timely and coordinated multidisciplinary approach.

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DOI: 10.3897/bgcardio.30.e133175

Authors: V. Goranovska, V. Velchev, N. Stoyanov, V. Gegouskov

Abstract: Background: Infective endocarditis (IE) of Automated Implantable Cardioverter Defibrillator (AICD) is a rare and potentially fatal disease with a significant morbidity and mortality. Case Summary: We report on a case of 23-years-old male patient with device - related endocarditis after multiple implantation of (AICD) associated with ventricular tachyarrhythmias. Due to infective endocarditis we performed surgical extraction of AICD and tricuspid valve replacement (TVR). In age of 4 and 10 years the patient had previous cardiac surgeries for perimembranous ventricular septal defect (VSD) and right-vetricular outflow tract obstruction, respectively. Discussion: Device-related endocarditis is a severe complication after AICD implantation. For diagnosis verification we routinely use the echocardiography and 18F-FDG PET/CT scan as nuclear imaging. Tricuspid valve replacement is always recommended if the native valve is completely destructed.

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DOI: 10.3897/bgcardio.30.e123529

Authors: A. Venkatesh, A.R. Raghuram, A.M. Kumar

Abstract: Introduction: Heyde syndrome is a multisystem disorder characterized by the triad of aortic stenosis, acquired coagulopathy (von Willebrand syndrome type 2A) and gastrointestinal angiodysplasia. The diagnosis of Heyde syndrome in adults is challenging because of high frequency of aortic stenosis and gastrointestinal angiodysplasia. Clinical suspicion is therefore essential for diagnosis. Case Presentation: We present the case of a male with recurrent hospital admissions and transfusions for anemia post bleeding per rectum who was diagnosed to have Heyde’s syndrome. The patient was managed with aortic valve replacement and coronary artery bypass surgery involving left anterior descending artery. He remained symptom free 1 year after appropriate therapy. Conclusions: The management of aortic stenosis in patients with Heyde syndrome results in resolution of anemia. Hence, treatment decisions are based on correct identification.

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DOI: 10.3897/bgcardio.30.e130390

Authors: E. Nuellari, E. Kapedani, S. Kuci, A. Kenga

Abstract: The aim of this study was to demonstrate a case of aorto-carotid bypass in a patient with carotid artery stenosis as a reasonable and necessary method for preventing ischemic stroke. The study was conducted at the University Hospital Center “Mother Teresa” (QSUT), Tirana. A 63-year-old patient with atherosclerotic arteriopathy and hypertension presented with episodes of dizziness and syncope. Doppler echocardiography revealed an increase in blood flow velocity in the right and left carotid arteries by more than 2.5 times. Computed tomography angiography visualised stenosis of the right and left common carotid arteries, stenosis of the brachiocephalic trunk at the beginning, and occlusion of the left subclavian artery. Performed revascularization of the common carotid arteries using a bifurcated 14×7 mm Dacron graft. The proximal end of the graft was anastomosed to the ascending aorta, and the distal ends were connected to both common carotid arteries. Follow-up Doppler echocardiography showed normalization of blood flow velocity in the carotid arteries. The patient’s neurological symptoms completely disappeared. The patient was discharged without complications after 10 days. The method of resolving complex multisegmental stenosis by aorto-carotid bypass ensures optimal perfusion of the brain and is proposed for use in appropriate conditions for the prevention of ischemic stroke.

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DOI: 10.3897/bgcardio.30.e120323

Authors: E. Dimitrova, D. Kyuchukov, M. Peneva, B. Kunev

Abstract: Chronic thromboembolic pulmonary hypertension is a rare condition that is usually a consequence of prior acute pulmonary embolism. It is caused by persistent obstruction of pulmonary arteries by organized thrombi resulting in redistribution of blood flow and secondary pulmonary microvascular remodelling. Thus, pulmonary vascular resistance and pulmonary artery pressure are increased leading to right ventricle pressure overload, development of right heart failure and death. In eligible patients pulmonary endarterectomy is the standard of care and it can result in complete normalization of haemodynamics and right ventricular morphology and function. We present the case of a patient with chronic thromboembolic pulmonary hypertension with severe right ventricular dilation and dysfunction and refractory heart failure. After successful pulmonary endarterectomy we observed almost complete normalization of hemodynamics and restoration of right ventricular dimensions and function, as well as significant clinical improvement.

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DOI: 10.3897/bgcardio.30.e116069

Authors: V. Netiazhenko, S. Mostovyi, O. Safonova

Abstract: The research relevance is predefined by the need to establish the relationship and identify new markers and potential contributions to clinical practice and scientific progress. This opens up new opportunities for further development in the field of cardiology and infectious diseases, which is of great importance for improving diagnosis and treatment. The research aims to establish the relationship between indicators and the role of endothelial dysfunction in the pathogenesis of various conditions. The clinical observation method was used, and data such as symptoms, medical history, and laboratory and instrumental studies were collected. The conclusions of the study are based on the analysis of the collected data and indicate the existence of a relationship between the indicators. The study revealed an increased activity of von Willebrand factor in the majority of patients. When comparing groups of patients depending on the presence of concomitant coronavirus disease, it was found that the highest level of von Willebrand factor was observed in patients with coronary heart disease in combination with coronavirus disease, a lower level in patients with coronavirus disease alone, and the lowest level in patients with chronic coronary heart disease. This indicates a correlation between the level of von Willebrand factor and the presence of concomitant coronavirus disease, which emphasises the importance of vascular endothelial dysfunction in the pathogenesis of coronary heart disease. It was found that the value of the von Willebrand factor correlates with the left ventricular end-diastolic size in both patients with coronary heart disease and patients with coronary heart disease in combination with coronavirus disease. This demonstrates that there is a strong association between von Willebrand factor and the clinical manifestation of coronary heart disease in combination with coronavirus disease, which may indicate a dysfunction of the vascular endothelium in these patients.

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DOI: 10.3897/bgcardio.29.e109296

Authors: M.M. Yusuf, A.M. Kumar

Abstract: Background: Ruptured Sinus of Valsalva aneurysm (RSOV) has poor prognosis and a high mortality rate. Clinical suspicion is critical for prompt diagnosis and management. Case Presentation: A 33-year-old woman with no comorbidities, presented with persistent cough and recurrent lower respiratory tract infection for 2 years. Echocardiogram showed ruptured right sinus of Valsalva into right ventricle with calcifi ed ruptured membrane forming wind-sock morphology. When the patient was taken to the operating room, it was discovered that the RSOV had ruptured into the right atrium. She underwent excision of calcifi ed wind-sock tissue along with pericardial patch closure of ruptured right sinus. Conclusions: We discuss a case of an RSOV with atypical presentation, as well as a disparity in imaging features and surgical fi ndings.

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DOI: 10.3897/bgcardio.29.e113537

Authors: E. Dimitrova, I. Bayraktarova, D. Kyuchukov, V. Kostova, E. Trendafilova

Abstract: Prosthetic valve thrombosis is one of the life-threatening complications in patients with prosthetic heart valves. It is more common in mechanical prosthetic valves in the setting of inadequate or missing anticoagulation. Besides optimization of anticoagulation urgent surgery or thrombolytic therapy should be considered but both are associated with an increased risk for complications and mortality. We report a case of a patient with imaging data for mechanical prosthetic mitral valve thrombosis. Considering the individual patient’s characteristics and the published guidelines we decided to perform systemic thrombolysis with ultra-slow low-dose infusion of tissue-type plasminogen activator. The therapy was successful without any bleeding or thromboembolic complications.

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DOI: 10.3897/bgcardio.29.e114208

Authors: S. Vasilev, S. Ivanova, A. Keltchev

Abstract: Cardiac implantable electronic devices (CIEDs) implantation procedure has a complication rate of 5-6% according to most studies. Lead perforation is a possible and serious adverse event which can present with a spectrum of symptoms from asymptomatic to sudden death. Diagnostic tools in case of suspected lead perforation are X-ray, transthoracic echocardiography, pacemaker interrogation and computed tomography with the last one being the gold standard. Lead extraction could be done endovascularly or surgically. Transvenous removal is a possible option for active fi xation leads, while removal of passive fi xation leads is preferably done surgically, because of the bulky tip of the lead, which could damage the heart chambers and the vessels. In this article, we present a case of a massive ventricular perforation from a passive fi xation lead, further complicated by a cardiac tamponade. Surgical removal was the treatment of choice with subsequent implantation of a permanent dual-chamber pacemaker.

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DOI: 10.3897/bgcardio.29.e116198

Authors: M Szotek, W. Kula, A. Malik, A. Czunko, J. Lelakowski, V. Traykov, P. Matusik

Abstract: We present a case of a 78-year-old patient with persistent atrial fl utter, history of atrial fi brillation and atrioventricular conduction disturbances, including fi rst-degree atrioventricular block (AVB) and paroxysmal complete AVB. Echocardiography revealed mildly reduced left ventricular ejection fraction (LVEF, 44%). The patient had high thromboembolic risk, had previous ischemic stroke, suffered from chronic coronary artery disease treated with hybrid coronary revascularization (minimally invasive direct coronary artery bypass grafting and subsequent percutaneous coronary intervention) as well as left atrial appendage closure. Because of high bleeding risk, double antiplatelet therapy (acetylsalicylic acid and clopidogrel) combined with low dose of low-molecular-weight heparin after cardiac surgery were introduced. Due to persistent atrial fl utter, complete AVB, lack of intraventricular conduction abnormalities, mildly reduced LVEF and expected high right ventricle pacing burden, the patient was referred for dual-chamber pacemaker implantation using conduction system pacing (CSP), preferentially His bundle pacing (HBP). The procedure was performed with good outcome and CSP was utilized via HBP. After reassessment of thromboembolic and bleeding risk, the patient was discharged home on reduced dose of dabigatran. Short-term follow-up showed stable HBP parameters along with no additional symptoms. Despite good short-term outcomes and no complications in studied patient, large randomized controlled trials are needed to verify long-term safety and effi cacy of HBP to optimize clinical care of patients with atrioventricular conduction abnormalities using a personalized approach.

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DOI: 10.3897/bgcardio.29.e117816

Authors: Vassil Traykov, Tchavdar Shalganov

Abstract:

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DOI: 10.3897/bgcardio.29.e106722

Authors: D. Panayotova, R. Grigorov

Abstract: Primary cardiac tumors are rare and most frequently benign. The most common primary cardiac tumors are myxomas. Early clinical symptoms can resemble different cardiovascular and systemic diseases. The heterogeneity in their presentation is due to the different localization of myxomas and different structural characteristics. In most cases an echocardiographic examination is sufficient to establish the diagnosis. Early diagnosis and referral for surgery can prevent debilitating complications. The definitive treatment is surgical extirpation of the tumor. We present two clinical cases of cardiac myxomas, the first of which was localized in the left atrium and had villous characteristics, presenting mainly with embolic events. In the second case, the tumor formation was in the right atrium, solid in nature, causing angina and dyspnea.

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DOI: 10.3897/bgcardio.29.e105978

Authors: B. Dobreva-Yatseva, F. Nikolov, R. Raycheva, K. Stanev, N. Ivanova, P. Nikolov, M. Tokmakova

Abstract: Infective endocarditis (IE) marks an increasing morbidity and unchanged mortality despite advances in its diagnosis and treatment. In about 20% of IE cases are acute, with signs of sepsis and septic shock. Septic shock dramatically worsens prognosis and is an independent predictor of in – hospital death. Timely diagnosis and urgent surgical intervention can improve survival in these patients. We present a case of a 47-year-old man, with no history of past or concomitant diseases, who was admitted as an emergency to the Cardiology Intensive Care Unit, during the COVID-19 pandemic, with pronounced febrile-intoxication syndrome, shortness of breath, precordial discomfort and pain, cough, haemoptysis. From laboratory studies with a pronounced infl ammatory constellation, troponin I and D-dimers are also increased. This case shows the diffi culties in the diagnosis of acute IE, the specifi cs in the clinical course of the disease, as well as the importance of urgent surgical intervention to improve survival.

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DOI: 10.3897/bgcardio.29.e105505

Authors: B. Dobreva-Yatseva, F. Nikolov, R. Raycheva, I. Manolov, K. Stanev, N. Ivanova, M. Tokmakova

Abstract: Infective endocarditis (IE) is an infl ammatory disease of the endocardium of the heart affecting heart valves (native or prosthetic) and, in the last few decades, also available intracardiac permanent devices or catheters. Despite technological progress and accumulated experience, this disease continues to be a huge challenge for doctors in terms of diagnosis, treatment and improvement of survival. The clinical picture is atypical and heterogeneous, with different clinical "masks" of other diseases – infectious, oncological, hematological, rheumatological, neurological, etc. Embolic complications are often the fi rst manifestation of the disease and are most often cerebral. We present a clinical case of a 29-year-old woman with acute neurological symptoms as a fi rst manifestation of IE. This case refl ects the atypical clinical presentation of the disease, the importance of new imaging modalities for the precise diagnosis of neurological complications, and the decision on the timing of operative intervention when indicated. The question of IE prophylaxis in moderate-risk patients, such as those with mitral valve prolapse and bicuspid aortic valve, remains open.

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DOI: 10.3897/bgcardio.29.e100372

Authors: D. Kyuchukov

Abstract: Percutaneous coronary revascularization of the „culprit“ lesion is the most contemporary method of treating patients with acute coronary syndrome (ACS) of all forms. In the management of acute ST-elevation myocardial infarction (STEMI), cardiac surgery remains, in most cases, a third option following PCI and thrombolysis, nevertheless serves an important role in a select subgroups of patients. This review will discuss current indications and potentiality of cardiac surgery in the treatment of patients with STEMI.

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DOI: 10.3897/bgcardio.28.e93503

Authors: R. Grigorov, P. Panayotov, D, Panayotova, I. Borisov

Abstract: Left ventricle pseudoaneurysm is a rare but serious complication, most often secondary to myocardial infarction. It is associated with high mortality due to a significant risk of rupture. We present a case of a patient with a large basal pseudoaneurysm of the lateral wall of the left ventricle. The pseudoaneurysm is discovered from a chest radiography performed after a COVID-19 infection. The diagnosis is confirmed by echocardiography and ventriculography. The patient underwent surgical treatment by endoventricular patch plasty – Dor procedure. The patient in our case lacked the typical symptoms and ECG features, furthermore he had no history of myocardial infarction, cardiac surgery, trauma or endocarditis.

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DOI: 10.3897/bgcardio.28.e96612

Authors: I. Todorov

Abstract: Patients with Marfan syndrome often have severe life-threatening cardiovascular complications, including aortic aneurysmal dilatation or aortic dissection. Approximately two-thirds of people who have this syndrome suffer from chest wall deformities such as pectus excavatum (cobbler's chest) or pectus carinatum (bird's chest). When a patient with cobbler's chest requires aortic root surgery, the operator may face a major clinical challenge in selecting the optimal surgical access and approach. We present a case of a patient with Marfan syndrome and severe pectus excavatum who underwent aortic valve replacement, aortic root and ascending aorta reconstruction, coronary artery reimplantation (Bentall de Bono procedure ) via upper partial L-sternotomy and anterior left thoracotomy.

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DOI: 10.3897/bgcardio.28.e91105

Authors: I. Petrov, Z. Stankov, J. Stoykova, G. Zlatancheva, S. Vasilev, I. Tasheva, K. Vaseva

Abstract: The most common localizations for upper extremity atherosclerosis are the subclavian artery and the brachiocephalic trunk. Significant stenosis of the subclavian artery occurs in 2% of the population and in 7-11% of patients with manifest cardiovascular disease. Revascularization is indicated in symptomatic or asymptomatic patients with coronary disease with planned surgical revascularization. In addition to atherosclerosis, other causes of the appearance of subclavian artery stenosis include dissection, radiation-induced inflammation of the fibromusculature, and various vasculities, especially Takayasu arteritis. The left subclavian artery is about four times more commonly affected than the right. It usually occurs over the age of 50 years and in 1.5-2 times more common in men than in women. Disease of the subclavian artery is usually focal and the lesion is predominantly in the first 2 cm proximal to the origin of the aorta. Between 2016-2021 in the clinic of cardiology and angiology we treated endovascularly 81 patients (41 men and 40 females, median age 64 ± 11) with either intraluminal balloon dilatation and/or primary stent implantation followed by balloon post dilatation. We achieved a high technical success rate (93.8%) and immediate clinical success, with only a few minor complications.

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DOI: 10.3897/bgcardio.28.e89568

Authors: Z. Stankov, I. Petrov, D. Boychev

Abstract: During the period from March 2014 to May 2018, endovascular treatment of aortic dissection type A and type B was carried out in a total of 70 patients. Patients were divided into two groups, aortic dissection type A (14 patients) and type B (56 patients), a group-by-group descriptive analysis was conducted, and then a comparison was done between the two patient groups. The aim of the study was to establish the effective use of endovascular treatment in type A and type B aorta dissection. As a result of the survey, data on the demographic characteristics and risk profile of these patients are accumulated for the first time in Bulgaria. Endovascular treatment options for the treatment of aortic dissection type A and type B, as well as malperfusion syndrome, are examined, demonstrating their effectiveness and safety. As a result of the study, it is proven that endovascular treatment in aortic dissection type A and type B leads to a significant increase in the size of the true lumen and reduction of the false lumen, which leads to an improvement in perfusion and reduces the risk of developing an aneurysm and rupture. The presence of endoleak and persistent communication between the false and the real lumen are the most common causes of re-intervention, such as endovascular options are most often the first line for their dealing and are proven to be effective and safe. Treatment of dissection of the aorta type A and B is not a one-time act, but requires periodic diagnostic control and, if necessary, surfery and/or endovascular corrections of the complications that have arisen.

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DOI: 10.3897/bgcardio.28.e81189

Authors: M. Ivanov, M. Peneva, I. Ivanov, N. Gotcheva, L. Boyadzhiev

Abstract: Right-sided endocarditis, and endocarditis of the tricuspid valve in particular, is a relatively uncommon condition, encountered in approximately 5 to 10 percent of all cases of infectious endocarditis (IE). The recent increase in the prevalence of right-sided IE is attributed to intravenous drug abuse as well as the increased utilization of implantable cardiac devices such as pacemakers, implantable cardioverter-defi brillators, and cardiac resynchronization therapy devices. These cases pose signifi cant therapeutic challenges, especially when right-sided devices are involved. We present a case of 45-year-old male patient with proven IE with involvement of the tricuspid valve and implantable cardiac device lead and demonstrate the results of an antibacterial treatment and surgical interventions carried out in two steps – explanation of the lead of the implantable cardiac device, excision of the tricuspid valve, and implantation of an epicardial implantable device; subsequent tricuspid valve replacement with mechanical valve, surgical revascularization, and fi nally replacement of the thrombosed mechanical valve with a biological valve. The optimal preoperative management and the following comprehensive surgical intervention resulted in resolution of IE as it has been demonstrated by the lack of recurrence of systemic infl ammatory response syndrome and no further hospitalisations due to cardiovascular events.

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DOI: 10.3897/bgcardio.28.e82414

Authors: P. Simeonov, B. Barzashka, D. Trendafilova, J. Jorgova, D. Petkov, P. Abedinov

Abstract: In recent years the trend towards surgical bioprosthetic valve implantation, especially among young patients, has increased in order to avoid anticoagulant therapy. The patient’s age remains one of the leading risk factors for valve dysfunction. Gold standard for treating such diseases was surgical reintervention until the development of transcatheter heart valves. By 2050 the annual number of patients undergoing surgical bioprosthetic valve implantation is expected to triple from an average of 290,000 in 2003 to over 850,000. This study presents the literature review of Valve in Valve and Valve in Ring procedures, as well as our experience in ViV and ViR transcatheter valve implantation.

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DOI: 10.3897/bgcardio.28.e81388

Authors: Dimitar Pechilkov, Lyudmil Simeonov, Ventsislav Boshnakov, Anna Kaneva

Abstract: Introduction. Prolonged mechanical ventilation (PMV) is a well-recognized factor as a quality metric for pediatric cardiac surgical programs. Most of the risk factors for PMV are described and analyzed. Some authors had established predictive models to detect proactively patients in risk for PMV. This study aims to develop a new predictive model, based on vasoactive-ventilation-renal (VVR) score, for PMV after congenital heart surgery (CHS) in pediatric patients. Material and Methods. Medical fi les of patients 0-18 y who underwent heart surgery in 2016 and 2017 were reviewed. Patients that met the inclusion criteria were studied. PMV was defi ned as invasive mechanical ventilation ≥ 96 h. The patients were divided in two groups according to duration of mechanical ventilation: group 1-patients with PMV, group 2-patients without PMV. The focus was set on VVR score and fl uid overload in the fi rst 48 hours after the operation. Data were presented as medians with IQR or as means ± standard deviation. A non-parametric Mann-Whitney U test, binary logistic regression test and ROC curve analysis integrated in the statistical software SPSS 24.0 were used. A value of P < 0.05 was considered signifi cant. Results. 438 patients were operated in 2016 and 2017 and 384 of them were included in the study. 80 patients (20.8%) needed PMV (group 1) and 304 (79.2%) did not need PMV (group 2). There was a statistical signifi cance between group 1 and group 2 concerning the peak VVR for the day of operation 58,25(33,48) vs. 25,65(19,8) and cumulative fl uid overload in % for the fi rst 48hours +2,54(13,29) vs. – 1,19(3,4). After combining this two factors in a predictive model, the ROC curve analysis showed AUC 0,903 (95% CI 0,863-0,944) with sensitivity of 86.25% and specifi city of 82,57%. Conclusion. Combining VVR and cumulative fl uid overload, resulted in establishment of a new reliable predictive model for PMV after CHS in pediatric patients in our Center.

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DOI: 10.3897/bgcardio.27.e77297

Authors: Galina Zlatancheva, Tzenka Boneva, Kiril Karamfiloff, Dobrin Vasilev

Abstract: Valvular diseases are a leading cause of morbidity, mortality and impaired quality of life in all over the world with different epidemiology. It is extremely important to know the hemodynamic changes for the proper development of a strategy for future interventions. The recent years shows progress in various methodologies of the field of surgery and interventional treatments of valvular diseases. In this section, we focus mainly on aortic regurgitation and its clinical significance.

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