Cardiac valve diseases are a major cause of morbidity and mortality around the globe. In third world countries, inflammatory rheumatic valve disease in the young represents an endemic calamity, while in Western countries, degenerative valve diseases like senile calcific aortic stenosis and mitral valve prolapse as a result of mucoid degeneration with incompetence are major causes of death in adults/the elderly. Since the 1960s, surgical valve replacement has been the only treatment option, requiring sternotomy, cardiopulmonary bypass and cardiac arrest. Permanent anticoagulation for mechanical valves and the limited durability of biological valves constituted significant drawbacks; moreover, these surgeries often requires surgical replacement.
The cardiac registry at the University of Padua, Italy, has gathered more than twelve hundred cases of failed prosthetic valves, offering a unique resource for teaching and research. Conservative valve repair using minimally invasive technique showed that replacement of the native valve with sternotomy can be spared. Moreover, in the last decade venous or arterial approaches like TAVI were developed. Presenting the essential surgical and interventional anatomy and pathology in detail, this book offers a valuable tool for cardiologists, cardiac surgeons and pathologists, as well as people in training and scientists working in the field of medical devices and biological compatibility.
1. Introduction.-
2. Story Telling of Prosthetic Cardiac Valves.-
3. Anatomy Of Native Heart Valves.-
4. Pathology Of Native Heart Valves.-
5. Congenital Anomalies of the Cardiac Valves.-
6. Infective Endocarditis.-
7. Pathology Of Mechanical Prosthetic Cardiac Valves .-
8. Pathology Of Biological Prosthetic Cardiac Valves.-
9. Anticalcification Strategies to Increase Bioprosthetic Valve Durability.
Gaetano Thiene is Emeritus Full Professor of Pathological Anatomy at the University of Padua, skilled both in Cardiology and Pathology. His research interests include the broad fields of Cardiovascular Medicine and Pathology, with clinicopathologic studies and clinical translation of basic research. The beginning of his career was devoted to Congenital Heart diseases, including valve malformations. He first reported Arrhythmogenic Cardiomyopathy as a major cause of sudden death in the young and in athletes (NEJM 1988) and contributed to the elucidation of its genetic basis (Human Genetics 2004). He is a principal architect of the Italian program, in which all young individuals who want participate in sports activities, should undergo to screening for concealed cardiovascular problems. In addition, he leads a group in Padua that works at the interface between pathology and genetics to identify disease-causing mutations, correlating them with the clinical and pathological phenotypes.
Cristina Basso is a Full Professor of Pathological Anatomy at the University of Padua Medical School, Director of the Regional Register of Cardio-cerebro-vascular Pathology of the Veneto Region, and Chief of the Cardiovascular Pathology Unit, University Hospital. Prof. Basso coordinated a Task Force of the Association for European Cardiovascular Pathology (AECVP) charged with defining the guidelines for the autoptic study of sudden death. For her contributions on the topic of cardiac tumors, she was invited to serve on the committee of experts for drafting the new WHO Classification of tumors of the heart.
Stefania Rizzo works at the Department of Cardiac-Thorac-Vascular Sciences and Public Health of the Azienda Ospedaliera-University of Padua Medical School - Padua, Italy. Her Research interests are mainly in the field of cardiovascular pathology, directed to clinical-pathological studies and basic research with a translational aspect, with particular interest in the following research fields: sudden death in the young; cardiomyopathies; molecular pathology of hereditary-familial heart disease; conduction tissue; heart tumors; valvulopathies; interventional and surgical pathology; ischemic heart disease; ultrastructural pathology.
Mila Della Barbera works at the Department of Cardiac-Thoracic-Vascular Sciences and Public Health of the Azienda Ospedaliera-University of Padua Medical School - Padua, Italy. Her research interests are mainly in the field of cardiovascular pathology, directed to clinical-pathological and experimental studies and basic research with a translational aspects: heart and vascular valve substitutes, experimental pathological evaluation in tissue engineering and sudden death, ultrastructural biology and pathology.
Marialuisa Valente is a retired full Professor of Pathology at the University of Padua Medical School and Chief of Pathologic Anatomy Unit, Azienda Ospedaliera Padova (Italy). She is skilled on Electron Microscopy both for Diagnosis and Research. She collected a longstanding experience in the study of valve diseases and bioprosthetic structural valve deterioration. The University of Padua started implanting glutarhaldehyde-fixed porcine xenografts in 1970s. It soon became apparent that dystrophic calcification was the major cause of failure. She discovered that dystrophic calcification was due to deposits of calcium phosphate on cell membrane debris, full of phospholipids (Am J Pathol, 1985). Several experimental and clinical investigations were carried out on second- and third-generation valve xenografts, treated with anticalcific agents (detergents, alcohol, detoxyfing agents) achieving mineralization mitigation with improved durability up to 15-20 years.
Uberto Bortolotti is a Full Professor of Cardiac Surgery at the University of PisaMedical School, Pisa, Italy, and is a current or former member of the International Association for Cardiac Biological Implants; Society for Thoracic Surgeons; American College of Chest Physicians; American Association for Thoracic Surgery; American College of Cardiology; European Association for Cardio-thoracic Surgery; Italian Society of Cardiac Surgery, and of the Society of Heart Valve Disease.
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