In this issue of JACC: Cardiovascular Interventions, Nombella-Franco and the Quebec Heart and Lung Institute (1) report their experience with balloon post-dilation in patients with residual paravalvular aortic regurgitation after transcatheter heart valve (THV) implantation. Paravalvular regurgitation grade 2 was documented by transesophageal echocardiography in approximately one-third of their...

Heart valve disease and coronary heart disease are very prevalent in the general population and often coincide in the same patient. Cardiac computed tomography (CT) makes it possible to noninvasively rule out coronary disease before valve surgery and to potentially avoid invasive heart catheterization in 66% to 75% of patients. The same imaging test provides abundant anatomic and functional inf...

To determine compliance with 1977 American Heart Association (AHA) recommendations for antibiotic prophylaxis (AbP) of subacute bacterial endocarditis (SBE), we mailed a questionnaire to 1019 licensed dentists from Dade County, Florida. Of the 614 practicing dentists who responded, 97.7% believe that AbP prevents SBE and 94.2% always obtain a cardiac history from new patients. AbP is given to p...

Since most complications related to operation of prosthetic heart valves are due to disturbances of flow, its hydrodynamic characterization is a useful aid in the design of new prostheses. Besides durability and biological response to implant, these prostheses should provide a favorable hemodynamic profile, considering that there is a great clinical interest focused on the haemolysis of blood. ...

Heart valve anomalies are some of the most common congenital heart defects, yet neither the genetic nor the epigenetic forces guiding heart valve development are well understood. When functioning normally, mature heart valves prevent intracardiac retrograde blood flow; before valves develop, there is considerable regurgitation, resulting in reversing (or oscillatory) flows between the atrium an...

Although mechanical heart valves (MHV) are more durable than tissue valves, they are more thrombogenic. Consequently, patients with MHV require long-term anticoagulation with vitamin K antagonists, such as warfarin. Although effective, warfarin has well-known limitations, including multiple drug and food interactions, and the challenges of coagulation monitoring and maintaining the internationa...

To the Editor: Pregnant women with mechanical heart valves are an ultrahigh-risk group, in whom all anticoagulant options pose maternal and/or fetal risks. It is unclear why the authors of the recent update1 selected 4 studies, neither the most recent nor of the highest quality, to give a warfarin embryopathy rate of 1.6%. This anomaly rate is not supported by evidence in their Table 1 (3.9% of...