Publications by authors named "Gosta Pettersson"

Background: The prevalence of severe calcific mitral stenosis (MS) is higher in female patients. The aim of the study was to assess the sex-related differences in clinical characteristics and prognosis in patients with severe calcific MS.

Methods: Among 7154 adult patients with MS due to mitral annular calcification who underwent echocardiography between October 2010 and August 2020, 287 patients with severe MS were retrospectively analyzed.

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Objectives: We assessed the effect of anomalous aortic origin of a coronary artery on the risk of early and late postoperative events after aortic or mitral valve replacement in adults.

Methods: Between 2005 and 2022, 29,579 adults underwent surgical aortic or mitral valve replacement at Cleveland Clinic. Among these, 29 had an unrepaired coronary artery rising anomalously from the aorta that was not intervened upon during valve surgery, 19 (65%) an anomalous circumflex, and 9 (31%) an anomalous right.

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Article Synopsis
  • Infective endocarditis (IE) is an infection affecting heart valves and implantable electronic devices, identified mainly through echocardiography.
  • However, echocardiography has limitations in detecting issues related to prosthetic valves or devices, leading to increased use of cardiac CT and PET/CT scans.
  • This review explores different guidelines on using multimodal imaging for diagnosing, managing complications, monitoring treatment, and predicting outcomes of IE.
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In this invited expert review, we focus on evolving lifetime management strategies for adolescents and young adults with congenital aortic valve disease, acknowledging that these patients often require multiple interventions during their lifetime. Our goal is to preserve the native aortic valve when feasible. Leveraging advanced multimodality imaging, a detailed assessment of the aortic valve and root complex can be obtained, and a surgically approach tailored to an individual patient's anatomy and pathology can be used.

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Objective: Anterior mitral anular calcification, particularly in radiation heart disease, and previous valve replacement with destroyed intervalvular fibrosa are challenging for prosthesis sizing and placement. The Commando procedure with intervalvular fibrosa reconstruction permits double-valve replacement in these challenging conditions. We referenced outcomes after Commando procedures to standard double-valve replacements.

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This focused review highlights the latest issues in native valve infective endocarditis. Native valve disease moderately increases the risk of developing infective endocarditis. In 2023, new diagnostic criteria were published by the Duke-International Society of Cardiovascular Infectious Diseases group.

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Article Synopsis
  • This document is the first in the ASNC I series focusing on the role of radionuclide imaging for diagnosing cardiovascular infections, notably infective endocarditis, using a detailed consensus-based approach.
  • It highlights the rising incidence of cardiovascular infections, which present high risks and complications, and discusses the limitations of current diagnostic methods like echocardiography.
  • Advanced imaging techniques such as FDG PET/CT and SPECT/CT can improve diagnostic accuracy by revealing infection in cardiac devices and surrounding areas, emphasizing the need for better imaging strategies in complex cases.
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Article Synopsis
  • * A thorough consensus was reached using a modified Delphi method to outline clinical indications, diagnostic criteria, and a structured algorithm for diagnosis due to the rising incidence and high risks associated with these infections.
  • * Advanced imaging techniques, such as F-FDG PET/CT, can improve the evaluation and management of cardiovascular infections, particularly in complicated cases involving prosthetic valves and cardiac devices, while also highlighting the need for further research to optimize these applications.
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This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality.

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Article Synopsis
  • This document is the first in a series by the American Society of Nuclear Cardiology focusing on the use of radionuclide imaging for diagnosing cardiovascular infections, particularly infective endocarditis, in a comprehensive healthcare context.
  • A modified Delphi method was used to establish clinical indications, diagnostic criteria, and a structured approach for diagnosing these infections, which are increasingly common and associated with significant health risks.
  • Advanced imaging techniques, such as 18F-FDG PET/CT and SPECT/CT leukocyte scintigraphy, can significantly boost diagnostic accuracy and guide treatment decisions, especially for patients with complex cardiovascular issues or unclear initial imaging results.
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  • Persons who inject drugs and undergo surgery for infective endocarditis face serious challenges, including high rates of loss to follow-up, relapse, and mortality despite low in-hospital death rates.
  • The study analyzed 227 patients from 2010 to 2020, revealing that heroin was the most commonly injected drug and highlighting significant psychosocial issues such as homelessness and mental health disorders.
  • Findings indicated a need for improved postoperative addiction management strategies, as a significant portion of patients experienced relapse and loss to follow-up, demonstrating the urgent requirement for effective interventions.
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  • Transcatheter aortic valve replacement (TAVR) is rarely performed in patients with congenital heart disease.* -
  • Our study shows that TAVR can be safely and effectively used in these patients in the short term.* -
  • TAVR may play an important role in managing congenital aortic valve disease throughout a patient's life, serving as a temporary solution before recovery, future surgeries, or transplants.*
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Background: The Ozaki procedure using autologous pericardium is an interesting but complex alternative for aortic valve replacement. We present a standardized approach to minimize the learning curve and confirm reproducibility.

Methods: After careful preparation, from May 2015 to February 2021, an Ozaki procedure was performed on 46 patients age 51 ± 14 years.

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Article Synopsis
  • * A study conducted from 2008 to 2022 involved 2,324 patients undergoing 2,352 multivalve reoperations, revealing that complexity and urgency of the surgery increase mortality risk.
  • * Findings suggest that elective, isolated surgeries have a low mortality rate and that understanding surgical complexity and patient health factors can guide better decision-making in surgical settings.
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Our goal was to replace the previous composite graft with a bioprosthesis. The approach involved axillary artery and femoral vein cannulation and cardiopulmonary bypass with moderate hypothermia for re-entry of the chest and deep hypothermia with circulatory arrest to get control of and to clamp the aorta when entering the pseudoaneurysm. The myocardial protection strategy was general cooling and retrograde cardioplegia through direct coronary sinus cannulation and antegrade cardioplegia in the coronary ostia when possible.

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Article Synopsis
  • The study aimed to analyze how surgeon experience and age affect hospital mortality rates after cardiac reoperations, considering institutional experience as well.
  • Over a nearly 70-year period, researchers evaluated data from 36 surgeons performing over 160,000 cardiac operations, using a complex model that included surgeon and institutional experience metrics and patient factors.
  • Findings indicated that while hospital death rates initially decreased rapidly with surgeon experience, they stabilized at a low level after a certain number of reoperations, with surgeon age up to 75 showing a positive correlation with improved outcomes, highlighting the importance of institutional experience in enhancing patient safety.
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  • The study aimed to examine the outcomes and risks associated with aortic root allograft reoperations, comparing data from before and after a previous study in 2006.
  • Researchers analyzed data from 602 patients over 33 years, focusing on reoperation causes, techniques used, and their respective morbidity and mortality rates.
  • The findings indicate that reoperations can be performed with low risks, with radical explant yielding outcomes similar to aortic valve replacement, suggesting surgeons should not hesitate to use allografts due to the risks of reoperation.
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