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Article: Comparative evaluation of microprobe versus conventional transoesophageal echocardiography for PFO closure guidance.

Lanki, Jemina / Tuohinen, Suvi / Simonen, Piia / Jalanko, Mikko / Sinisalo, Juha

2024 Volume 11, Issue 1

Abstract: Background: Patent foramen ovale (PFO) closure is traditionally guided by transoesophageal echocardiography (TEE) under general anaesthesia, which prolongs procedure duration and increases costs and risks. A transnasal echocardiography with a microTEE- ... ...

Abstract	Background: Patent foramen ovale (PFO) closure is traditionally guided by transoesophageal echocardiography (TEE) under general anaesthesia, which prolongs procedure duration and increases costs and risks. A transnasal echocardiography with a microTEE-probe (microTNE) is tolerated under conscious sedation and offers an effective alternative to TEE. The aim of this study was to compare the feasibility, safety and time expenditure of PFO closure using conventional TEE versus microTNE guidance. Methods: Consecutive patients assigned for PFO losure in Helsinki University Hospital from 2003 to 2021 were included in the study (n=336). TEE with general anaesthesia was used until November 2018 (n=167) while microTNE-guided PFO closure (n=169) under conscious sedation was the principal method thereafter. Patients were followed for 3 months after PFO closure. Results: The microTNE-route success rate was 97.2% vs TEE 100% (p=0.06) and procedure success rate was 97.7% with microTNE and 96.0% with TEE-guidance (p=0.54). The procedure time was significantly shorter with microTNE 21±7 min than with TEE 30±13 min (p<0.001). At the beginning of microTNE era, nasal bleeding complication was quite frequent; however, overall complication rates were equal between the groups. However, C reactive protein (CRP) increase was significantly milder with microTNE than TEE 1.0±2.9 vs 3.0±4.0 mg/L (p<0.001). An increase in CRP was independently associated with procedure type (p=0.004) and time (p=0.003). Conclusions: MicroTNE is a feasible and safe alternative for PFO closure guidance. MicroTNE under conscious sedation shortens procedure duration and induces a milder inflammatory reaction than conventional TEE under general anaesthesia.
MeSH term(s)	Humans ; Echocardiography, Transesophageal ; Echocardiography ; C-Reactive Protein ; Hospitals, University
Chemical Substances	C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2024-01-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2747269-3
ISSN	2053-3624
ISSN	2053-3624
DOI	10.1136/openhrt-2023-002502
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Article ; Online: Cause-Specific Mortality of Patients With Atrial Septal Defect and Up to 50 Years of Follow-Up.

Muroke, Valtteri / Jalanko, Mikko / Haukka, Jari / Sinisalo, Juha

Journal of the American Heart Association

2023 Volume 12, Issue 2, Page(s) e027635

Abstract: Background This study aimed to evaluate the long-term mortality and cause-specific mortality of patients with atrial septal defect (ASD) in a nationwide cohort. Methods and Results All patients diagnosed with simple ASD in the hospital discharge registry ...

Abstract	Background This study aimed to evaluate the long-term mortality and cause-specific mortality of patients with atrial septal defect (ASD) in a nationwide cohort. Methods and Results All patients diagnosed with simple ASD in the hospital discharge registry from 1969 to 2019 were included in the study. Complex congenital defects were excluded. Each subject was matched with 5 controls according to sex, age, and municipality at the index time. Adjusted mortality risk ratios (MRRs) were calculated using Poisson regression models. The median follow-up time was 11.1 years. Patients with ASD had higher overall mortality during follow-up, with an adjusted MRR of 1.72 (95% CI, 1.61-1.83). Patients with closed ASDs also had higher total mortality (MRR, 1.29 [95% CI, 1.10-1.51]). However, no difference in mortality was detected if the defect was closed before the age of 30 (MRR, 1.58 [95% CI, 0.90-2.77]), and transcatheter closed defects had lower mortality than the control cohort (MRR, 0.65 [95% CI, 0.42-0.99]). Patients with ASD had significantly more deaths due to congenital malformations (MRR, 54.61 [95% CI, 34.03-87.64]), other diseases of the circulatory system (MRR, 2.90 [95% CI, 2.42-3.49]), stroke (MRR, 1.89 [95% CI, 1.52-2.33]), diseases of the endocrine (MRR, 1.88 [95% CI, 1.10-3.22]) and respiratory system (MRR, 1.71 [95% CI, 1.19-2.45]), ischemic heart disease (MRR, 1.62 [95% CI, 1.41-1.86]), and accidents (MRR, 1.41 [95% CI, 1.05-1.89]). Conclusions Patients with ASD had higher overall mortality compared with a matched general population cohort. Increased cause-specific mortality was seen in congenital malformations, stroke, and heart diseases.
MeSH term(s)	Humans ; Follow-Up Studies ; Cause of Death ; Heart Septal Defects, Atrial ; Stroke/epidemiology ; Registries
Language	English
Publishing date	2023-01-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.122.027635
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Article ; Online: Phenotype of ASDs Associated With 4p16 Risk Locus and Novel Genome-Wide Associations of ASD Patients in the Finnish Population.

Muroke, Valtteri / Jalanko, Mikko / Ruotsalainen, Sanni / Perola, Markus / Helle, Emmi / Sinisalo, Juha

Circulation. Genomic and precision medicine

2023 Volume 16, Issue 5, Page(s) 486–489

MeSH term(s)	Humans ; Genome-Wide Association Study ; Finland ; Heart Septal Defects, Atrial/genetics ; Phenotype ; Autism Spectrum Disorder
Language	English
Publishing date	2023-08-14
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2574-8300
ISSN (online)	2574-8300
DOI	10.1161/CIRCGEN.123.004070
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Article ; Online: Conduction Disturbance After Transcatheter Aortic Valve Implantation With Self- or Balloon-Expandable Valve According to the Implantation Depth.

Miyashita, Hirokazu / Moriyama, Noriaki / Sugiyama, Yoichi / Jalanko, Mikko / Dahlbacka, Sebastian / Vähäsilta, Tommi / Vainikka, Tiina / Viikilä, Juho / Laine, Mika

The American journal of cardiology

2023 Volume 203, Page(s) 17–22

Abstract: Membranous septum (MS) length, in conjunction with implantation depth (ID), is known as a determinant of conduction disturbance (CD) after transcatheter aortic valve implantation (TAVI). However, its impact might be dissimilar among valve types because ... ...

Abstract	Membranous septum (MS) length, in conjunction with implantation depth (ID), is known as a determinant of conduction disturbance (CD) after transcatheter aortic valve implantation (TAVI). However, its impact might be dissimilar among valve types because each valve has a different platform. This study sought to investigate the different impacts of ID and MS length on the new-onset CD between ACURATE neo and SAPIEN 3. This study included patients without a previous permanent pacemaker implantation who underwent TAVI with ACURATE neo and SAPIEN 3 and divided them into 2 groups based on the ID according to MS length (deep and shallow implantation group). Deep implantation was defined as transcatheter heart valve implantation deeper than MS length. The primary endpoint was new-onset CD (new permanent pacemaker implantation or new-onset complete left bundle branch block). A total of 688 patients (deep implantation: n = 373, shallow implantation: n = 315) were identified as a study cohort. New-onset CD developed more frequently in the deep implantation group (16.6% vs 7.0%; p = 0.0001). Deep implantation was revealed as a predictor of new-onset CD. Moreover, deep implantation was significantly associated with new-onset CD after SAPIEN 3 implantation but not after ACURATE neo. Among patients with MS shorter than 2 mm, ACURATE neo was superior in terms of avoiding new-onset CD. In conclusion, the deep implantation was associated with new-onset CD after TAVI with SAPIEN 3 but not with ACURATE neo. These results may impact device selection in patients with a preexisting high risk of CD.
MeSH term(s)	Humans ; Transcatheter Aortic Valve Replacement/methods ; Heart Valve Prosthesis ; Aortic Valve Stenosis/surgery ; Aortic Valve Stenosis/complications ; Treatment Outcome ; Cardiac Conduction System Disease/complications ; Aortic Valve/surgery ; Pacemaker, Artificial ; Prosthesis Design
Language	English
Publishing date	2023-07-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.05.025
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Article ; Online: Ultrasound-Guided Versus Conventional MANTA Vascular Closure Device Deployment After Transcatheter Aortic Valve Implantation.

Miyashita, Hirokazu / Moriyama, Noriaki / Dahlbacka, Sebastian / Vähäsilta, Tommi / Vainikka, Tiina / Jalanko, Mikko / Viikilä, Juho / Laine, Mika

The American journal of cardiology

2022 Volume 180, Page(s) 116–123

Abstract: Despite the development of device technology and operators' experience, access site vascular complications (VCs) remain one of the major concerns after transcatheter aortic valve implantation (TAVI). MANTA (Teleflex, Wayne, Pennsylvania) is a large-bore ... ...

Abstract	Despite the development of device technology and operators' experience, access site vascular complications (VCs) remain one of the major concerns after transcatheter aortic valve implantation (TAVI). MANTA (Teleflex, Wayne, Pennsylvania) is a large-bore vascular closure device (VCD) with promising incidence of VC. Previously, we demonstrated that the ultrasound-guided MANTA (US-MANTA) technique further improved the outcomes compared with conventional MANTA (C-MANTA) without ultrasound guidance. The present study was established to prove the effectiveness of the technique in a larger population. In this study, we included 1,150 patients (335 patients with C-MANTA and 815 with US-MANTA) who received MANTA after TAVI from April 2017 to September 2021. The primary endpoint was MANTA-related VC. Overall VC, VCD failure, and bleeding complications were also assessed based on the Valve Academic Research Consortium 3 criteria. MANTA-related VC occurred in 12.5% in the C-MANTA group and 6.8% in the US-MANTA group (p = 0.001). VCD failure rate were 7.5% and 3.9%, respectively (p = 0.012). Valve Academic Research Consortium 3 major and minor VC were more frequent in C-MANTA group (major: 7.8% vs 4.4%, p = 0.023; minor: 8.1% vs 4.4%, p = 0.022). Multivariate analysis revealed US-MANTA as the negative predictor of MANTA-related VC (odds ratio 0.57, 95% confidence interval 0.36 to 0.89, p = 0.013). However, subgroup analysis showed the efficacy of the US-MANTA technique was limited to the patients without severely calcified puncture site (P<sub>interaction</sub> = 0.048). In conclusion, the US-MANTA technique was an effective strategy to reduce VC after transfemoral TAVI compared with C-MANTA.
MeSH term(s)	Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Stenosis/surgery ; Femoral Artery/surgery ; Humans ; Transcatheter Aortic Valve Replacement ; Treatment Outcome ; Ultrasonography, Interventional ; Vascular Closure Devices
Language	English
Publishing date	2022-08-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2022.06.046
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Article: Non-invasive dye dilution method for measuring an atrial septal defect shunt size.

Muroke, Valtteri / Jalanko, Mikko / Simonen, Piia / Holmström, Miia / Ventilä, Markku / Sinisalo, Juha

Open heart

2020 Volume 7, Issue 2

Abstract: Aims: Objective of this study was to evaluate the feasibility of the non-invasive dye dilution method to quantify shunt size related to atrial septal defects (ASD).The diagnostic accuracy of shunt size determination in ASD's has been suboptimal with ... ...

Abstract	Aims: Objective of this study was to evaluate the feasibility of the non-invasive dye dilution method to quantify shunt size related to atrial septal defects (ASD).The diagnostic accuracy of shunt size determination in ASD's has been suboptimal with common non-invasive methods. We have previously developed a cost-effective and time-effective non-invasive dye dilution method. In this method, the indocyanine green solution is injected into the antecubital vein and the appearance of the dye is detected with an earpiece densitometer. Methods and results: We studied 192 patients with an ASD. Mean pulmonary blood flow/systemic blood flow (Qp/Qs) was measured with dye dilution technique and compared with following methods: Fick's invasive oximetry (n=49), transoesophageal echocardiography (TEE) measuring ASD size (n=143) and cardiac MR (CMR) (n=9).For the first 49 patients, Qp/Qs was 2.05±0.70 with the Fick's invasive oximetry and 2.12±0.68 with dye dilution method with an excellent correlation between the two methods (R=0.902, p<0.001). In the second study sample, the ASD size by TEE was 15±6 mm on average, and the mean Qp/Qs 2.16±0.65 measured with dye dilution method with a good correlation between the methods (R=0.674, p<0.001). Qp/Qs measured with CMR was 1.87±0.40 resulting in a good correlation with the dye dilution method (R=0.696, p=0.037). Conclusion: The dye dilution method with earpiece densitometer recording is a clinically feasible and reliable method to assess shunt size in ASDs.
MeSH term(s)	Adult ; Aged ; Coloring Agents/administration & dosage ; Echocardiography, Transesophageal ; Feasibility Studies ; Female ; Heart Septal Defects, Atrial/diagnosis ; Heart Septal Defects, Atrial/physiopathology ; Hemodynamics ; Humans ; Indicator Dilution Techniques ; Indocyanine Green/administration & dosage ; Injections, Intravenous ; Male ; Middle Aged ; Oximetry ; Predictive Value of Tests ; Reproducibility of Results ; Retrospective Studies
Chemical Substances	Coloring Agents ; Indocyanine Green (IX6J1063HV)
Language	English
Publishing date	2020-10-05
Publishing country	England
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2747269-3
ISSN	2053-3624 ; 2044-6055
ISSN	2053-3624 ; 2044-6055
DOI	10.1136/openhrt-2020-001313
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Article ; Online: Rotation and torsion of the left ventricle with cardiovascular magnetic resonance tagging: comparison of two analysis methods.

Lehmonen, Lauri / Jalanko, Mikko / Tarkiainen, Mika / Kaasalainen, Touko / Kuusisto, Johanna / Lauerma, Kirsi / Savolainen, Sauli

BMC medical imaging

2020 Volume 20, Issue 1, Page(s) 73

Abstract: Background: Left ventricle rotation and torsion are fundamental components of myocardial function, and several software packages have been developed for analysis of these components. The purpose of this study was to compare the suitability of two ... ...

Abstract	Background: Left ventricle rotation and torsion are fundamental components of myocardial function, and several software packages have been developed for analysis of these components. The purpose of this study was to compare the suitability of two software packages with different technical principles for analysis of rotation and torsion of the left ventricle during systole. Methods: A group of hypertrophic cardiomyopathy (HCM) patients (N = 14, age 43 ± 11 years), mutation carriers without hypertrophy (N = 10, age 34 ± 13 years), and healthy relatives (N = 12, age 43 ± 17 years) underwent a cardiovascular magnetic resonance examination, including spatial modulation of magnetization tagging sequences in basal and apical planes of the left ventricle. The tagging images were analyzed offline using a harmonic phase image analysis method with Gabor filtering and a non-rigid registration-based free-form deformation technique. Left-ventricle rotation and torsion scores were obtained from end-diastole to end-systole with both software. Results: Analysis was successful in all cases with both software applications. End-systolic torsion values between the study groups were not statistically different with either software. End-systolic apical rotation, end-systolic basal rotation, and end-systolic torsion were consistently higher when analyzed with non-rigid registration than with harmonic phase-based analysis (p < 0.0001). End-systolic rotation and torsion values had significant correlations between the two software (p < 0.0001), most significant in the apical plane. Conclusions: When comparing absolute values of rotation and torsion between different individuals, software-specific reference values are required. Harmonic phase flow with Gabor filtering and non-rigid registration-based methods can both be used reliably in the analysis of systolic rotation and torsion patterns of the left ventricle.
MeSH term(s)	Adult ; Cardiomyopathy, Hypertrophic/diagnostic imaging ; Cardiomyopathy, Hypertrophic/genetics ; Case-Control Studies ; Female ; Heart Ventricles/diagnostic imaging ; Humans ; Magnetic Resonance Imaging, Cine/methods ; Male ; Middle Aged ; Mutation ; Observer Variation ; Radiographic Image Interpretation, Computer-Assisted/methods ; Software ; Young Adult
Language	English
Publishing date	2020-07-01
Publishing country	England
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2061975-3
ISSN	1471-2342 ; 1471-2342
ISSN (online)	1471-2342
ISSN	1471-2342
DOI	10.1186/s12880-020-00473-4
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Article ; Online: Atrial septal defect patients have an elevated risk for infective endocarditis.

Muroke, Valtteri / Jalanko, Mikko / Haukka, Jari / Pätilä, Tommi / Hartikainen, Juha / Tahvanainen, Anna / Ukkonen, Heikki / Ylitalo, Kari / Anttila, Vesa / Pihkala, Jaana / Sinisalo, Juha

Scandinavian cardiovascular journal : SCJ

2023 Volume 57, Issue 1, Page(s) 2215490

Abstract: ... ...

Abstract	Background
MeSH term(s)	Humans ; Male ; Endocarditis, Bacterial ; Endocarditis/diagnosis ; Endocarditis/epidemiology ; Heart Septal Defects, Atrial/diagnosis ; Heart Septal Defects, Atrial/epidemiology ; Heart Septal Defects, Atrial/complications ; Heart Defects, Congenital/epidemiology ; Risk Factors
Language	English
Publishing date	2023-06-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1379906-x
ISSN	1651-2006 ; 1401-7431
ISSN (online)	1651-2006
ISSN	1401-7431
DOI	10.1080/14017431.2023.2215490
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Article ; Online: Long-Term Assessment of Survival After Transcatheter Aortic Valve Implantation　- Insights From the International Transcatheter Aortic Valve Implantation Registry.

Sugiyama, Yoichi / Moriyama, Noriaki / Miyashita, Hirokazu / Yokoyama, Hiroaki / Ochiai, Tomoki / Shishido, Koki / Jalanko, Mikko / Yamanaka, Futoshi / Vähäsilta, Tommi / Laine, Mika / Saito, Shigeru

Circulation journal : official journal of the Japanese Circulation Society

2023 Volume 88, Issue 4, Page(s) 462–471

Abstract: Background: Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis (AS), but despite estimates of life expectancy after TAVI being essential in heart team discussion, these data are scarce. Therefore, the ... ...

Abstract	Background: Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis (AS), but despite estimates of life expectancy after TAVI being essential in heart team discussion, these data are scarce. Therefore, the current study sought to assess long-term survival and its trends in relation to chronological age, surgical risk, and treatment period.Methods and Results: We included 2,414 consecutive patients who underwent TAVI for severe symptomatic AS between 2008 and 2021 at 2 international centers. For the analysis, long-term survival was evaluated according to age, surgical risk, and treatment period categorized into 3 groups, respectively. The longest follow-up was 13.5 years. Overall survival was 67.6% at 5 years and 26.9% at 10 years. Younger patients, lower surgical risk, and later treatment period showed better survival (log-rank P<0.001, respectively). In the multivariate analysis, age <75years, lower surgical risk, and later time period were significantly associated with better survival. The incidence of paravalvular leakage ≥moderate, red blood cell transfusion, and acute kidney injury were independently associated with increasing risk of 5-year death. Conclusions: In a real-world registry, survival was substantial following TAVI, especially in younger and lower surgical-risk patients, with improving outcomes over time. This should be considered in heart team discussions of life-long management for AS patients after TAVI.
MeSH term(s)	Humans ; Aged ; Transcatheter Aortic Valve Replacement/methods ; Aortic Valve/surgery ; Aortic Valve Stenosis ; Treatment Outcome ; Risk Factors ; Heart Valve Prosthesis Implantation/adverse effects ; Registries
Language	English
Publishing date	2023-11-28
Publishing country	Japan
Document type	Journal Article
ZDB-ID	2068090-9
ISSN	1347-4820 ; 1346-9843
ISSN (online)	1347-4820
ISSN	1346-9843
DOI	10.1253/circj.CJ-23-0593
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Article ; Online: Hemodynamics and Conduction Disturbance After Transcatheter Aortic Valve Implantation With SAPIEN3 Ultra Versus SAPIEN3: The HomoSAPIEN 2 Study.

Moriyama, Noriaki / Sugiyama, Yoichi / Miyashita, Hirokazu / Yokoyama, Hiroaki / Yamaguchi, Masashi / Ochiai, Tomoki / Shishido, Koki / Jalanko, Mikko / Yamanaka, Futoshi / Vähäsilta, Tommi / Laine, Mika / Saito, Shigeru

The American journal of cardiology

2023 Volume 207, Page(s) 140–149

Abstract: The optimal percent oversizing (%OS) using the SAPIEN3 Ultra (S3U) weighing the incidence of paravalvular regurgitation (PVR) ≥ mild against the risk of conduction disturbance (CD) is not known. This study sought to define an optimal extent of the ... ...

Abstract	The optimal percent oversizing (%OS) using the SAPIEN3 Ultra (S3U) weighing the incidence of paravalvular regurgitation (PVR) ≥ mild against the risk of conduction disturbance (CD) is not known. This study sought to define an optimal extent of the annulus area %OS suitable for transcatheter aortic valve implantation with the S3U compared with the SAPIEN3 (S3). A total of 350 patients with the S3U were compared with 606 patients with the S3. Patients were categorized depending on the degree of %OS. PVR ≥ mild was observed in 8.9% of patients with the S3U and in 21.8% of those with the S3 (p <0.001). The S3U demonstrated a sustainably lower incidence of PVR ≥ mild than the S3 in any extent of %OS. There was an inverse proportional relation between the extent of %OS and frequency of PVR ≥ mild in the S3, whereas the S3U group provided little change. The incidences of PVR ≥ mild were steady >5%OS in the S3 (5% to 10%OS: 13.3%, and >10%OS: 12.1%) and >0%OS in the S3U (0% to 5%OS: 5.9%, 5% to 10%OS: 6.0%, and >10%OS: 6.1%). An increasing %OS was independently associated with the occurrence of CD (<0%OS: 9.8%, 0% to 5%OS: 13.1%, 5% to 10%OS: 16.6%, and >10%OS: 19.2%, p = 0.012). The incidence of PVR ≥ mild and/or CD was the lowest (10.1%) in the 0% to 5%OS in patients with the S3U. In conclusion, the HomoSAPIEN2 study suggests that the S3U tolerates a lesser degree of %OS for mitigating PVR ≥ mild than the S3. Minimal %OS, ranging from 0% to 5%, may be optimal for the S3U with balancing the risk of PVR and CD. Trial Identifier: UMIN000040413/URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000046115.
MeSH term(s)	Humans ; Aortic Valve/surgery ; Aortic Valve Insufficiency/surgery ; Hemodynamics ; Transcatheter Aortic Valve Replacement/adverse effects ; Treatment Outcome
Language	English
Publishing date	2023-09-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.08.104
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