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1

Left sinus of valsalva aneurysm in an adult with congenital unicuspid aortic valve.  

PubMed

Unicuspid aortic valve (UAV) is rare, but well-described congenital malformation in adults. Although aortic root and ascending aortic aneurysms can develop in unicommissural UAV, coexistence with left sinus of Valsalva aneurysm is an unusual event. Surgical correction is necessary to relieve left ventricular outflow tract obstruction associated with aortic stenosis in unicuspid aortic valve, and to decrease the substantial risk of impending rupture of sinus of Valsalva aneurysm. PMID:19344967

Ucak, Alper; Inan, Kaan; Onan, Burak; Temizkan, Veysel; Kilicaslan, Fethi; Yilmaz, Ahmet Turan

2011-05-19

2

Three-dimensional echocardiographic features of unicuspid aortic valve stenosis correlate with surgical findings.  

PubMed

A unicuspid aortic valve (UAV) is a rare congenital defect that may manifest clinically as severe aortic stenosis or regurgitation in the third to fifth decade of life. This report describes two cases of UAV stenosis in adult patients diagnosed by transesophageal echocardiography (TEE). The utility of three-dimensional TEE in confirming valve morphology and its relevance to transcatheter valve replacement are discussed. PMID:22676160

Brantley, Hutton P; Nekkanti, Rajasekhar; Anderson, Curtis A; Kypson, Alan P

2012-09-01

3

Congenital rock and a hard place: unicuspid aortic valve with sinus of valsalva aneurysm.  

PubMed

Cardiac CT angiography (CTA) is an ideal tool to investigate possible cardiac malformations. In this case, careful planning of the CTA acquisition and reconstruction provided high resolution images of cardiac anatomy revealing 2 extremely rare coexisting congenital defects; a unicuspid aortic valve (UAV) and sinus of Valsalva aneurysm (SVA). Detailed planning of CTA acquisition reconstruction protocols is essential in obtaining necessary information for clinical decision-making strategies and interventions in the patients with suspected cardiac anomalies. PMID:20960233

Dandes, Eric; Kirsch, Jacobo; Novaro, Gian

2012-03-01

4

Aortic Valve  

MedlinePLUS

... in this category include " xenograft " valves made from animal tissues (most often pig aortic valves), " homograft " or " allograft " valves retrieved from human cadavers, and " pulmonary autograft " valves moved from the patient's pulmonary artery on the right side of the heart to the aortic position ...

5

Transcatheter aortic valve implantation  

PubMed Central

Transcatheter aortic valve implantation was developed to offer a therapeutic solution to patients with severe symptomatic aortic stenosis who are not candidates for conventional aortic valve replacement. The improvement in transcatheter aortic valve implantation outcomes is still of concern in the areas of stroke, vascular injury, heart block, paravalvular regurgitation and valve durability. Concomitantly, the progress, both technical and in terms of material advances of transcatheter valve systems, as well as in patient selection, renders transcatheter aortic valve implantation an increasingly viable treatment for more and more patients with structural heart disease. PMID:25374670

Oliemy, Ahmed

2014-01-01

6

Aortic valve surgery - open  

MedlinePLUS

... connects the heart and aorta. The aortic valve opens so blood can flow out. It then closes to keep blood from ... called aortic regurgitation. Your aortic valve does not open fully so blood flow through it is reduced. This is called aortic ...

7

Aortic valve disease.  

PubMed

Aortic valve disease is common and has significant impact on prognosis and quality of life. In this educational review, we cover the pathophysiology, presentation and assessment of aortic stenosis (AS) and aortic regurgitation (AR), including the role of imaging modalities beyond echocardiography. We review current treatment strategies and emphasise the use and indications for transcatheter aortic valve implantation (TAVI) in view of recent data highlighting its emergence as a novel treatment option for patients with AS, who are unsuitable for conventional aortic valve replacement (AVR). We also describe novel surgical approaches for AR and potential future strategies for percutaneous intervention. PMID:24898790

Rayner, J; Coffey, S; Newton, J; Prendergast, B D

2014-10-01

8

Aortic valve replacement: Is valve size important?  

Microsoft Academic Search

Objective: We sought to determine whether aortic prosthesis size adversely influences survival after aortic valve replacement. Methods: A total of 892 adults receiving a mechanical (n = 346), pericardial (n = 463), or allograft (n = 83) valve for aortic stenosis were observed for up to 20 years (mean, 5.0 ± 3.9 years) after primary isolated aortic valve replacement. We

Benjamin Medalion; Eugene H. Blackstone; Bruce W. Lytle; Jennifer White; John H. Arnold; Delos M. Cosgrove

2000-01-01

9

Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra  

ClinicalTrials.gov

Aortic Valve Insufficiency; Aortic Valve Regurgitation; Aortic Valve Stenosis; Aortic Valve Incompetence; Mitral Valve Insufficiency; Mitral Valve Regurgitation; Mitral Valve Stenosis; Mitral Valve Incompetence

2014-08-08

10

[Aortic valve replacement for rheumatoid aortic valve regurgitation].  

PubMed

Valve replacement for aortic regurgitation in patient with rheumatoid arthritis was rare in Japan. We report a successful case in which aortic regurgitation necessitated aortic valve replacement. A 62-year-old woman was admitted for shortness of breath, chest pain and progressive edema. She had been treated for rheumatoid arthritis for more than ten years using steroids. The aortic valve was successfully replaced by a prosthetic mechanical valve. The histopathological examination of the excised aortic valve demonstrated rheumatic nodules in the right- and non-coronary cusp. It was supported that these changes caused shrinkage of cusp and resulted in aortic regurgitation. This patient was discharged on the 20th postoperative day. There was no evidence of detachment of the prosthetic valve. PMID:7474590

Uwabe, K; Tsuchiya, K; Hosaka, S; Morishita, A; Iida, Y; Oyama, T

1995-09-01

11

[Aortic valve reconstruction of aortic root repair].  

PubMed

We report the choice of aortic valve reconstruction, surgical results and postoperative results in 22 patients who underwent aortic root replacement between June 1996 and October 1999. We chose the replacement using bio-prosthesis in six patients over 65 years of age and valve preservation or replacement using mechanical prosthesis in sixteen patients under 65 years of age. Ten patients underwent valve replacement using mechanical prosthesis. There was one hospital death and one late death. Six patients underwent valve replacement using bio-prosthesis. There was no hospital death and no late death. Six patients underwent valve preservation. There was one hospital death. There was no event among five patients in the mid-term follow-up, although a longer follow-up must be necessary. PMID:10770063

Nakano, H; Takahara, Y; Sudoh, Y; Niizuma, Y

2000-04-01

12

Transcatheter CoreValve valve-in-valve implantation in a stentless porcine aortic valve for severe aortic regurgitation  

PubMed Central

Key Clinical Message We describe the first valve-in-valve Corevalve transcatheter aortic valve replacement in the St. Jude Toronto stentless porcine aortic valve in the United States, which enabled this 59-year-old patient with a history of bacterial endocarditis and aortic regurgitation to avoid heart transplant with complete resolution of his severe left ventricular dysfunction. PMID:25548631

Yong, Celina M; Buchbinder, Maurice; Giacomini, John C

2014-01-01

13

Regression of left ventricular hypertrophy after aortic valve replacement for aortic stenosis with different valve substitutes  

Microsoft Academic Search

Objective: Stentless biologic aortic valves are less obstructive than stented biologic or mechanical valves. Their superior hemodynamic performances are expected to reflect in better regression of left ventricular hypertrophy. We compared the regression of left ventricular hypertrophy in 3 groups of patients undergoing aortic valve replacement for severe aortic stenosis. Group I (10 patients) received stentless biologic aortic valves, group

Ruggero De Paulis; Luigi Sommariva; Luisa Colagrande; Giovanni Maria De Matteis; Simona Fratini; Fabrizio Tomai; Carlo Bassano; Alfonso Penta de Peppo; Luigi Chiariello

1998-01-01

14

Central flow tilting disc valve for aortic valve replacement  

PubMed Central

A new central flow tilting disc valve has been introduced. The clinical experience from the first 50 patients treated with aortic valve replacement and followed up for 12 months is reported. The results obtained are so encouraging that the tilting disc valve is at present preferred for all aortic valve replacements in this institution. Images PMID:5485003

Björk, Viking Olov

1970-01-01

15

Echocardiography in Transcatheter Aortic Valve Implantation and Mitral Valve Clip  

PubMed Central

Transcatheter aortic valve implantation and transcatheter mitral valve repair (MitraClip) procedures have been performed worldwide. In this paper, we review the use of two-dimensional and three-dimensional transesophageal echo for guiding transcatheter aortic valve replacement and mitral valve repair. PMID:23019387

Luo, Huai

2012-01-01

16

REGRESSION OF LEFT VENTRICULAR HYPERTROPHY AFTER AORTIC VALVE REPLACEMENT FOR AORTIC STENOSIS WITH DIFFERENT VALVE SUBSTITUTES  

Microsoft Academic Search

Objective: Stentless biologic aortic valves are less obstructive than stented biologic or mechanical valves. Their superior hemodynamic perfor- mances are expected to reflect in better regression of left ventricular hypertrophy. We compared the regression of left ventricular hypertro- phy in 3 groups of patients undergoing aortic valve replacement for severe aortic stenosis. Group I (10 patients) received stentless biologic aortic

Ruggero De Paulis; Luigi Sommariva; Luisa Colagrande; Giovanni Maria De Matteis; Simona Fratini; Fabrizio Tomai; Carlo Bassano; Alfonso Penta de Peppo; Luigi Chiariello

2010-01-01

17

Aortic valve surgery - minimally invasive  

MedlinePLUS

... and aortic valve are displayed on a computer in the operating room. This method is very precise. You may need ... the hospital. You will spend the first night in an intensive care unit (ICU). Nurses will monitor your condition at all times. Most ...

18

Aortic Valve Injury Following Blunt Chest Trauma  

PubMed Central

Introduction: Heart valve injury following blunt chest trauma of car accidents is increasing. Although aortic valve involvement is rare, however, in survivors of blunt cardiac trauma it is the most commonly involved valve and the most frequent valve lesion is isolated injury of the noncoronary cusp of aortic valve. Case Presentation: A 31-year-old man with a history of car accident (five months before) was referred to our clinic because of shortness of breath. A holo-diastolic blowing murmur was heard on physical examination. Transesophageal echocardiography demonstrated severe aortic insufficiency secondary to rupture of the left coronary cusp associated with avulsion of aortic valve commissure. Conclusions: Since the aortic valve is rarely affected in blunt cardiac injury, it will be generally undiagnosed during the primary evaluation of a patient with blunt chest trauma. However, any patient presenting dyspnea after chest trauma should be examined for suspected aortic valve injury. PMID:25478541

Esmaeilzadeh, Maryam; Alimi, Hedieh; Maleki, Majid; Hosseini, Saeid

2014-01-01

19

Aortic valve replacement in systemic sclerosis.  

PubMed

Systemic sclerosis (scleroderma) is a chronic systemic autoimmune disease of the connective tissue, which can involve the cardiac valves, the mitral valve being more frequently affected, although involvement of the aortic valve has been rarely described. We report a patient with aortic stenosis and systemic sclerosis who required aortic valve replacement. Awareness of this rare association may help to provide adequate management of such patients and prevent complications related to the underlying disease. PMID:24625565

Ferrari, Gabriele; Pratali, Stefano; Pucci, Angela; Bortolotti, Uberto

2015-01-01

20

Aortic Valve Replacement With Cryopreserved Aortic Allograft: Ten-Year Experience  

Microsoft Academic Search

Objective: Cryopreserved aortic allograft can be used for aortic valve replacement in congenital, rheumatic, degenerative, and infected native valve conditions, as well as failed prosthetic valves. This study was conducted to determine the long-term results of aortic valve replacement with cryopreserved aortic allografts. Methods: Aortic valve replacement with cryopreserved aortic allografts was performed in 117 patients from July 1985 until

John R. Doty; Jorge D. Salazar; John R. Liddicoat; Jean H. Flores; Donald B. Doty

1998-01-01

21

Aortic homografts versus mechanical valves in aortic valve replacement in young patients: a retrospective study  

Microsoft Academic Search

Background. Whether aortic homografts (AH) or mechanical devices (MD) are the valves of choice for aortic valve replacement in young patients (age 20 to 50 years) is unclear. Hence, we examined all aortic valve replacements performed with AH and MD in a retrospective study.Methods. Between 1988 and 1995, 45 patients (mean age, 38.6 ± 8.5 years) underwent aortic valve replacement

Christoph Gross; Uwe Klima; Rudolf Mair; Peter Brücke

1998-01-01

22

Infective mitral valve endocarditis after transapical aortic valve implantation  

PubMed Central

An 80-year old patient underwent a transapical aortic valve implantation. On the 28th postoperative day, the patient developed acute mitral valve endocarditis. Initially, the patient was unsuccessfully treated conservatively. After 71 days, the patient was operated on with mitral valve replacement. In this report, we discuss the potentially growing problem of complications related to transcatheter valve implantation. PMID:23223669

Hirnle, Grzegorz; Holzhey, David; Borger, Michael; Mohr, Friedrich-Wilhelm

2013-01-01

23

Aortic valve repair with autologous pericardium for traumatic aortic valve regurgitation  

PubMed Central

We present a case of successful aortic valve repair for traumatic aortic valve regurgitation. A 26-year-old male who had a history of motor-cycle accident months prior to admission, was referred to our hospital for surgical treatment of severe aortic valve regurgitation. Intraoperative inspection revealed a tear in noncoronary cusp, with otherwise preserved valvular anatomy. Aortic valvuloplasty was successfully performed with closure using an autologous pericardium patch. Intraoperative transesophageal echocardiogram confirmed absence of residual regurgitation. PMID:24282768

Takakura, Hiromitsu; Hachiya, Takashi; Onoguchi, Katsuhisa

2013-01-01

24

Repair of the aortic valve in patients with aortic insufficiency and aortic root aneurysm  

Microsoft Academic Search

Patients with aneurysms of the ascending aorta or aortic root frequently have aortic insufficiency despite normal aortic leaflets. The aortic valve dysfunction is caused by dilatation of the sinotubular junction, distortion or dilatation of the sinuses of Valsalva, annuloaortic ectasia, or a combination of these problems. In the case of annuloaortic ectasia, reconstruction of the aortic root is performed by

Tirone E. David; Christopher M. Feindel; Joanne Bos

1995-01-01

25

Quadricuspid aortic valve with aortic regurgitation: a rare echocardiographic finding  

PubMed Central

We report on a middle-aged woman treated for chronic hepatitis C virus infection with pegylated interferon. Auscultation revealed a diastolic murmur and the peripheral signs of aortic regurgitation. She had shortness of breath on moderate exertion for the past 4?months, which she attributed to her liver disease. Echocardiogram showed a quadricuspid aortic valve with severe aortic regurgitation. She was referred to a cardiothoracic surgeon for aortic valve replacement (AVR). However, she decided against AVR despite detailed counselling, and opted for medical treatment. PMID:23349171

Tai, Javed Majid; Laghari, Abid Hussain; Gill, Cyrus Tariq

2013-01-01

26

Percutaneous aortic aortic valve Replacement: myth or reality?  

Microsoft Academic Search

Aortic valve replacement with mechanical or biological prosthesis with extracorporeal circulation is the gold- standard for the treatment of calcific aortic stenosis. Although the results are excellent with the conventional approach some elderly patients, with multiple high-risk comorbid conditions, reoperations and severe left ventricular dysfunction have high surgical risk. During the last years percutaneous techniques have been developed. The present

Eduardo Keller Saadi

2008-01-01

27

Transcatheter aortic valve replacement for patients with aortic valve stenosis complicated with moyamoya disease.  

PubMed

Moyamoya disease (MMD) is a rare disease characterized by occlusive intracranial arteriopathy with formation of abnormal cerebrovascular collateral networks. Conventional cardiovascular surgical procedures using cardiopulmonary bypass for patients with MMD is challenging because low cerebral perfusion pressure and nonpulsatile (continuous) flow during cardiopulmonary bypass can cause severe cerebral ischemia. We successfully performed transcatheter aortic valve replacement in 3 women with severe aortic valve stenosis complicated with MMD. Transcatheter aortic valve replacement may be useful for patients with severe aortic valve stenosis complicated with severe cerebral ischemia, including MMD. PMID:25282207

Maeda, Koichi; Kuratani, Toru; Torikai, Kei; Mizote, Isamu; Iritakenishi, Takeshi; Takeda, Yasuharu; Nakatani, Satoshi; Nanto, Shinsuke; Toda, Koichi; Sawa, Yoshiki

2014-10-01

28

Self-expandable transcatheter aortic valve implantation for aortic stenosis after mitral valve surgery  

PubMed Central

OBJECTIVES Transcatheter aortic valve implantation has emerged as a valuable option to treat patients with symptomatic severe aortic stenosis, who are not being considered for surgery because of significant comorbidities. Concerns exist over treating patients who have previously undergone mitral valve surgery for possible interference between the percutaneous aortic valve and the mitral prosthesis or ring. METHODS At our centre, from May 2008 to December 2012, 172 patients (76 male) with severe symptomatic aortic stenosis were eligible for transcatheter aortic valve implant. Nine patients, affected by severe aortic stenosis, had previously undergone mitral valve surgery (4 mono-leaflet, 3 bileaflet, 1 bioprosthesis, 1 mitral ring); they were considered high-risk surgical candidates following joint evaluation by cardiac surgeons and cardiologist and had undergone TAVI. RESULTS Seven patients underwent standard femoral retrograde CoreValve® (Medtronic Inc., Minneapolis, USA) implantation, two patients underwent a direct aortic implantation through a mini-thoracotomy. All patients experienced immediate improvement of their haemodynamic status. No deformation of the nitinol tubing of the CoreValve, nor distortion or malfunction of the mechanical valve or mitral ring, occurred as assessed by echographical and fluoroscopic evaluation. No major postoperative complications occurred. In all patients , echocardiography indicated normal valve function during follow-up. CONCLUSIONS Our experience confirms the feasibility of CoreValve implantation in patients with mechanical mitral valves or mitral annuloplasty ring. PMID:23537849

Bruschi, Giuseppe; De Marco, Federico; Barosi, Alberto; Colombo, Paola; Botta, Luca; Nonini, Sandra; Martinelli, Luigi; Klugmann, Silvio

2013-01-01

29

Aortic valve replacement with freehand autologous pericardium  

Microsoft Academic Search

Fifty-one patients with a mean age of 31.2 years underwent aortic valve replacement with glutaraldehyde-treated autologous pericardium. Pure aortic regurgitation was present in 28 (54.9%), stenosis in 9, and mixed disease in 14. Simultaneous mitral valve repair was done in 17 patients and replacement in 1. There were no hospital and two late deaths. Three patients required reoperation because of

Carlos M. G. Duran; Begonia Gometza; Naresh Kumar; Ricardo Gallo; Rafael Martin-Duran

1995-01-01

30

Surgical double valve replacement after transcatheter aortic valve implantation and interventional mitral valve repair  

PubMed Central

Transcatheter aortic valve implantation, as well as interventional mitral valve repair, offer reasonable therapeutic options for high-risk surgical patients. We report a rare case of early post-interventional aortic valve prosthesis migration to the left ventricular outflow tract, with paravalvular leakage and causing severe mitral valve regurgitation. Initial successful interventional mitral valve repair using a clipped edge-to-edge technique revealed, in a subsequent procedure, the recurrence of mitral valve regurgitation leading to progressive heart failure and necessitating subsequent surgical aortic and mitral valve replacement. PMID:23864579

Wendeborn, Jens; Donndorf, Peter; Westphal, Bernd; Steinhoff, Gustav

2013-01-01

31

Minimally invasive transaortic mitral valve repair during aortic valve replacement.  

PubMed

Herein, we report the case of a 77-year-old man who presented with congestive heart failure. Echocardiography and cardiac catheterization revealed severe aortic stenosis with severe mitral regurgitation and a left ventricular ejection fraction of 0.20. Because of comorbidities, the patient was considered to be at high risk for double-valve surgery. In order to reduce the operative risk, a minimally invasive aortic valve replacement was performed together with a transaortic edge-to-edge repair (Alfieri stitch) of the mitral valve. We discuss the surgical technique and note the positive outcome. To our knowledge, this is the 1st report of minimally invasive aortic valve replacement and transaortic mitral valve repair with use of the Alfieri stitch. PMID:21720478

Santana, Orlando; Lamelas, Joseph

2011-01-01

32

Minimally Invasive Transaortic Mitral Valve Repair during Aortic Valve Replacement  

PubMed Central

Herein, we report the case of a 77-year-old man who presented with congestive heart failure. Echocardiography and cardiac catheterization revealed severe aortic stenosis with severe mitral regurgitation and a left ventricular ejection fraction of 0.20. Because of comorbidities, the patient was considered to be at high risk for double-valve surgery. In order to reduce the operative risk, a minimally invasive aortic valve replacement was performed together with a transaortic edge-to-edge repair (Alfieri stitch) of the mitral valve. We discuss the surgical technique and note the positive outcome. To our knowledge, this is the 1st report of minimally invasive aortic valve replacement and transaortic mitral valve repair with use of the Alfieri stitch. PMID:21720478

Santana, Orlando; Lamelas, Joseph

2011-01-01

33

Structural Valve Deterioration After Aortic Valve Replacement with Medtronic Freestyle Stentless Porcine Aortic Root Bioprostheses  

PubMed Central

The Medtronic freestyle aortic root bioprosthesis (Medtronic, Inc., Minneapolis, MN, USA) is a stentless valve with an effective orifice area that is larger than that observed on other bioprostheses. However, there have been sporadic reports of structural valve deterioration (SVD), such as aortic root wall rupture, leaflet tearing, and pseudoaneurysm formation. We report five cases of SVD of freestyle aortic root bioprostheses. doi: 10.1111/jocs.12235 (J Card Surg 2014;29:22-25) PMID:24251776

Nishida, Hidefumi; Komiya, Tatsuhiko; Sakaguchi, Genichi; Shimamoto, Takeshi

2013-01-01

34

[Enterococcal infective endocarditis on native aortic valve].  

PubMed

Enterococcal endocarditis accounts for 10% of all bacterial endocardits. The infection progresses in a subacute way and when localized on the aortic valve it has a very poor prognosis since the valve is usually destroyed being death the fatal outcome. We report a case of a patient with infective endocarditis resulting from the implantion of the Enterococcus on the native aortic valve. Nor visk factors or an apparent main gate could be found. The patient was hospitalized after several months of a non especific febrile syndrome. The literature is reviewed. Diagnostic tests and clinical signs are discussed making emphasis on the refractoriness to chemotherapy. PMID:9453756

Becares Lozano, M; Chimpén Ruiz, V; Martín Oterino, J A; Sánchez Rodríguez, A; de Portugal Alvarez, J

1997-09-01

35

Heritable retinoblastoma and accelerated aortic valve disease.  

PubMed

Heritable retinoblastoma is associated with a germline mutation in the tumour suppressor gene RBI. The Rb protein (pRb) arises from the RB1 gene, which was the first demonstrated cancer susceptibility gene in humans. Second primary malignancies are recognised complications of retinoblastoma. Furthermore, pRb is implicated in valve remodelling in calcific aortic valve disease. We report a family with hereditary retinoblastoma and associated secondary primary malignancies. There are two interesting aspects to this family. The first is the concept of 'cancer susceptibility genes'; the RBI gene being the first reported in humans. A further feature of note is that two family members also have bicuspid aortic valves. We discuss a potential association between the gene defect responsible for retinoblastoma (with its associated propensity for further malignancies) and accelerated deterioration of the bicuspid aortic valve in the proband carrying this gene defect. PMID:23595191

Abeyratne, L R; Kingston, J E; Onadim, Z; Dubrey, S W

2013-01-01

36

'Fast-implantable' aortic valve implantation and concomitant mitral procedures.  

PubMed

Concomitant aortic and mitral valve replacement or concomitant aortic valve replacement and mitral repair can be a challenge for the cardiac surgeon: in particular, because of their structure and design, two bioprosthetic heart valves or an aortic valve prosthesis and a rigid mitral ring can interfere at the level of the mitroaortic junction. Therefore, when a mitral bioprosthesis or a rigid mitral ring is already in place and a surgical aortic valve replacement becomes necessary, or when older high-risk patients require concomitant mitral and aortic procedures, the new 'fast-implantable' aortic valve system (Intuity™ valve, Edwards Lifesciences, Irvine, CA, USA) can represent a smart alternative to standard aortic bioprosthesis. Unfortunately, this is still controversial (risk of interference). However, transcatheter aortic valve replacements have been performed in patients with previously implanted mitral valves or mitral rings. Interestingly, we learned that there is no interference (or not significant interference) among the standard valve and the stent valve. Consequently, we can assume that a fast-implantable valve can also be safely placed next to a biological mitral valve or next to a rigid mitral ring without risks of distortion, malpositioning, high gradient or paravalvular leak. This paper describes two cases: a concomitant Intuity™ aortic valve and bioprosthetic mitral valve implantation and a concomitant Intuity™ aortic valve and mitral ring implantation. PMID:25015540

Ferrari, Enrico; Siniscalchi, Giuseppe; Marinakis, Sotirios; Berdajs, Denis; von Segesser, Ludwig

2014-07-11

37

Conservative aortic valve surgery in adults  

Microsoft Academic Search

118\\u000aChapter 1 reviews the current knowledge of the aortic valve. The normal anatomy and\\u000apossible variations are described. The different pathological conditions are explained as\\u000awel as their natural history and the indications for intervention. The various surgical options\\u000awith regard to the pathological condition are described. In particular, the results of aortic\\u000avalve repair, when available, are presented.

F. P. A. Casselman

2000-01-01

38

Aortic valve calcification in chronic kidney disease.  

PubMed

Several clinical studies reported an increased prevalence and accelerated progression of aortic valve calcification among patients with end-stage renal disease when compared with subjects with normal kidney function. Recently, mechanisms of calcific valve degeneration have been further elucidated and many of the pathways involved could be amplified in patients with decreased renal function. In particular, calcium-phosphate balance, MGP metabolism, OPG/RANK/RANKL triad, fetuin-A mineral complexes and FGF-23/Klotho axis have been shown to be impaired among patients with advanced chronic kidney disease and could play a role during vascular/valve calcification. The scope of the present review is to summarize the clinical data and the pathophysiological mechanisms potentially involved in the link between renal function decline and the progression of aortic valve disease. PMID:24097800

Rattazzi, Marcello; Bertacco, Elisa; Del Vecchio, Antonio; Puato, Massimo; Faggin, Elisabetta; Pauletto, Paolo

2013-12-01

39

Early aortic valve cusp rupture in relapsing polychondritis  

Microsoft Academic Search

Aortic regurgitation associated with relapsing polychondritis usually occurs late in the disease as a result of aortic root dilatation. A case where aortic regurgitation occurred early and was due to cusp rupture with a normal aortic root is reported. The patient required urgent aortic valve replacement within six weeks of developing a murmur despite apparent control of inflammation with immunosuppressive

D A Marshall; R Jackson; A P Rae; H A Capell

1992-01-01

40

Aortic valve replacement with stentless xenografts.  

PubMed

Between 15th June 1991 and 15th August 1992, 40 patients underwent aortic valve replacement with the newly designed Edwards stentless aortic bioprosthesis 2500. The patients' ages ranged from 24 years to 80 years (mean 60.3 years). Preoperatively, 17 patients presented with pure aortic stenosis, three with aortic regurgitation and 20 with mixed lesion. The operations were performed with normothermic extracorporeal cardiopulmonary bypass and cold cardioplegic arrest. The implanted valves ranged in diameter from 21 mm to 27 mm. Ten patients received a subcoronary implantation, with the lower row of sutures being interrupted and the upper being continuous. The so-called miniroot technique was used in the other 30, also involving lower interrupted and running upper sutures after adaptation of the coronary ostia to the preformed openings in the graft. The aortic cross-clamp time ranged from 51 minutes to 94 minutes (mean 71 minutes). There was no operative mortality but three patients died early after the operation due to cardiac tamponade, sepsis and pneumonia. There was no late mortality or morbidity in the surviving patients up to 16 months postoperatively. Echocardiography, performed at discharge and twice a year thereafter showed no signs of significant valve incompetence in any patient, and continuous wave Doppler measurements indicated that resting pressure gradients across the aortic valve were low or absent. Our preliminary experience with the stentless aortic xenograft shows improved hemodynamic function as compared to stent mounted xenografts or mechanical prostheses. Further studies are needed, however, to establish the long-term performance of this device. PMID:1341637

Konertz, W; Hamann, P; Schwammenthal, E; Breithardt, G; Scheld, H H

1992-11-01

41

Unusual aortic valve anomaly in the fetus: a case report.  

PubMed

Aortic valve anomalies in fetal life usually concern aortic valve stenosis, in severe forms associated to left ventricular impairment - endocardial fibroelastosis and mitral valve insufficiency. Isolated aortic regurgitation in utero is infrequent and is usually considered to be due to a rare anomaly: aorto-left ventricular tunnel. We describe an unusual case of fetal aortic valve anomaly with severe dysplasia, with a marked regurgitant flow through the aortic valve, passing in a retrograde way from the duct, associated with a marked left ventricular endocardial fibroelastosis and dysfunction, resulting in the fatal outcome of the case. PMID:22922566

Fesslova, V; Boschetto, C; Brankovic, J; Bonacina, E

2012-01-01

42

Prosthetic Valve Type for Patients Undergoing Aortic Valve Replacement: A Decision Analysis  

Microsoft Academic Search

Background. In two large, randomized, clinical trials long-term survival after aortic valve replacement (AVR) was similar for patients receiving tissue and mechanical aortic heart valve prostheses. Higher bleeding rates among patients with mechanical valves, who must re- ceive permanent oral anticoagulation to prevent throm- boembolism, were offset by higher reoperation rates for valve degeneration among patients with tissue valves. Because

Nancy J. O. Birkmeyer; John D. Birkmeyer; Anna N. A. Tosteson; Gary L. Grunkemeier; Charles A. S. Marrin; Gerald T. O'Connor

2010-01-01

43

Aortic valve replacement with combined myocardial revascularisation  

Microsoft Academic Search

Early and late outcome was studied in 630 patients who underwent aortic valve replacement between 1974 and 1982. Group 1 (506 patients) did not have important coronary artery disease, group 2 (69 patients) had coronary artery disease and underwent coronary artery bypass grafting, and group 3 (55 patients) had coronary artery disease but did not undergo myocardial revascularisation. Early mortality

M Jones; P M Schofield; N H Brooks; J F Dark; H Moussalli; A K Deiraniya; R A Lawson; A N Rahman

1989-01-01

44

The Konno aortoventriculoplasty for repeat aortic valve replacementq  

Microsoft Academic Search

Objective: To evaluate the outcome of aortic root augmentation by the Konno-aortoventriculoplasty technique as part of reoperative aortic valve replacement. Methods: Since 1983, 15 patients, 12 males and three females, had repeat aortic valve replacement (AVR) with concomitant Konno aortoventriculoplasty. Age ranged from 1.2 to 18 years (mean 12.5 years). The underlying anatomic diagnoses were valve and subvalvar aortic stenosis

Eldad Erez; Vincent K. H Tam; Willis H. Williams; Kirk R. Kanter

45

The Konno aortoventriculoplasty for repeat aortic valve replacement  

Microsoft Academic Search

Objective: To evaluate the outcome of aortic root augmentation by the Konno-aortoventriculoplasty technique as part of reoperative aortic valve replacement. Methods: Since 1983, 15 patients, 12 males and three females, had repeat aortic valve replacement (AVR) with concomitant Konno aortoventriculoplasty. Age ranged from 1.2 to 18 years (mean 12.5 years). The underlying anatomic diagnoses were valve and subvalvar aortic stenosis

Eldad Erez; Vincent K. H Tam; Willis H Williams; Kirk R Kanter

2001-01-01

46

Multimodality imaging in transcatheter aortic valve replacement.  

PubMed

Transcatheter aortic valve replacement is a major advance that has dramatically changed our approach to elderly patients with severe aortic stenosis. This advance has been made possible by innovative device and delivery improvements, coupled with rapid developments in multimodality imaging. Multimodality imaging draws from multiple imaging fields and is central to patient evaluation and treatment. The primary modalities to date include transthoracic echocardiography and transesophageal echocardiography, computed tomography, and fluoroscopy. Each of these modalities carries a different weight in the various stages of patient selection, procedural guidance, monitoring, and follow-up. Multimodality imaging ensures optimal device selection, delivery, and patient safety, and will continue to advance as the next generation of aortic valve devices further advance cardiovascular care. PMID:25051125

Smith, Thomas W; Bommer, William J

2014-01-01

47

Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair  

Microsoft Academic Search

OBJECTIVESThe purpose of this study was to use transesophageal echocardiography (TEE) to define the mechanisms of aortic regurgitation (AR) in acute type A aortic dissection so as to assist the surgeon in identifying patients with mechanisms of AR suitable for valve preservation.BACKGROUNDSignificant AR frequently complicates acute type A aortic dissection necessitating either aortic valve repair or replacement at the time

Herman D. Movsowitz; Robert A. Levine; Alan D. Hilgenberg; Eric M. Isselbacher

2000-01-01

48

Aortic regurgitation after transcatheter aortic valve implantation: mechanisms and implications  

PubMed Central

In recent years, transcatheter aortic valve implantation (TAVI) has become an established treatment option for selected high-risk patients with severe aortic stenosis (AS). Favorable results with regard to both hemodynamics and clinical outcome have been achieved with transcatheter valves. Aortic regurgitation (AR) remains a major concern after TAVI. Echocardiography is the imaging modality of choice to assess AR in these patients due to its wide accessibility and low cost. Mostly mild residual AR has been observed in up to 70% of patients. However, as even a mild degree of AR has been associated with a decreased survival up to two years after TAVI, accurate evaluation and classification of AR is important. AR in transcatheter valves can be divided into three types according to different pathophysiological mechanisms. Besides the well-known transvalvular and paravalvular forms of regurgitation, a third form termed supra-skirtal has recently been observed. A thorough understanding of AR in transcatheter valves may allow to improve device design and implantation techniques to overcome this complication. The aim of this review is to provide an overview of the three types of AR after TAVI focussing on the different pathophysiological mechanisms. PMID:24282741

Stähli, Barbara E.; Maier, Willibald; Corti, Roberto; Lüscher, Thomas F.; Jenni, Rolf

2013-01-01

49

Results of allograft aortic valve replacement for complex endocarditis  

Microsoft Academic Search

Methods: Between November 1985 and July 1995, 36 patients underwent allograft aortic valve replacement for endocarditis. The mean age of the 29 men and seven women was 53 years (range 25 to 79 years). Previous procedures included mechanical (n = 9), bioprosthetic (n = 5), and allograft (n = 2) aortic valve replacement, aortic valvotomy (n = 1), and orthotopic

Joseph A. Dearani; Thomas A. Orszulak; Hartzell V. Schaff; Richard C. Daly; Betty J. Anderson; Gordon K. Danielson

1997-01-01

50

Intermediate-term results after the aortic valve replacement using bileaflet mechanical prosthetic valve in children  

Microsoft Academic Search

Objective: Intermediate\\/long-term results after aortic valve replacement using bileaflet mechanical valve in children should be clarified as a standard of treatment of aortic valve disease in children. Methods: Forty-five patients aged under 15 years underwent 46 aortic valve replacements using bileaflet mechanical prosthetic valve. Patients' ages ranged from 1 to 15 years (9 years as a median value), and follow-up

Munetaka Masuda; Hideaki Kado; Yusuke Ando; Akira Shiose; Toshihide Nakano; Kouji Fukae; Yoshihisa Tanoue; Ryuji Tominaga

51

Intermediate-term results after the aortic valve replacement using bileaflet mechanical prosthetic valve in children  

Microsoft Academic Search

Objective: Intermediate\\/long-term results after aortic valve replacement using bileaflet mechanical valve in children should be clarified as a standard of treatment of aortic valve disease in children. Methods: Forty-five patients aged under 15 years underwent 46 aortic valve replacements using bileaflet mechanical prosthetic valve. Patients’ ages ranged from 1 to 15 years (9 years as a median value), and follow-up

Munetaka Masuda; Hideaki Kado; Yusuke Ando; Akira Shiose; Toshihide Nakano; Kouji Fukae; Yoshihisa Tanoue; Ryuji Tominaga

2008-01-01

52

Biomechanics of the pulmonary autograft valve in the aortic position.  

PubMed

Pulmonary autograft valve replacement has been simulated by implanting the pulmonary valve into the aortic position of the same cadaver heart from both human and porcine sources. The forces acting on the pulmonary valve leaflets have been calculated on the basis of a triaxial ellipsoid mathematical model. These forces on the pulmonary autograft valve were shown to be essentially similar to those previously reported for aortic valve leaflets. Biomechanical measurements have been made on the simulated autograft valves and on the isolated pulmonary valve cusps. The tensile strengths of the pulmonary valve cusps in both circumferential and radial directions were roughly three times greater than those of aortic valve cusps. This indicated the ability of the pulmonary valves to accept, ab initio, aortic valve closing pressures. Pressure-induced changes in dimension, calculated on the basis of diameters of the simulated pulmonary autograft root, also indicated that the distensibility of the autograft valve was limited. It reached a maximum at 30 mm Hg (4 kPa) without any suggestion of further distension to the point of distortion and incompetence. The combination of the calculated forces acting on the valve and the biomechanical measurements have shown that pulmonary valves used as autograft aortic valve replacements are able to tolerate aortic pressures from the time of implantation. These experimental results from simulated autografts support the clinical use of this valve over the past 13 years. PMID:7135295

Gorczynski, A; Trenkner, M; Anisimowicz, L; Gutkowski, R; Drapella, A; Kwiatkowska, E; Dobke, M

1982-07-01

53

Aortic Valve Replacement Using Continuous Suture Technique in Patients with Aortic Valve Disease  

PubMed Central

Background The continuous suture (CS) technique has several advantages as a method for simple, fast, and secure aortic valve replacement (AVR). We used a simple CS technique without the use of a pledget for AVR and evaluated the surgical outcomes. Materials and Methods Between October 2007 and 2012, 123 patients with aortic valve disease underwent AVR alone (n=28) or with other concomitant cardiac procedures (n=95), such as mitral, tricuspid, or aortic surgery. The patients were divided into two groups: the interrupted suture (IS) group (n=47), in which the conventional IS technique was used, and the CS group (n=76), in which the simple CS technique was used. Results There were two hospital deaths (1.6%), which were not related to the suture technique. There were no significant differences in cardiopulmonary bypass time or aortic cross-clamp time between the two groups for AVR alone or AVR with concomitant cardiac procedures. In the IS group, two patients had prosthetic endocarditis and one patient experienced significant perivalvular leak. These patients underwent reoperations. In the CS group, there were no complications related to the surgery. Postoperatively, the two groups had similar aortic valve gradients. Conclusion The simple CS method is useful and secure for AVR in patients with aortic valve disease, and it may minimize surgical complications, as neither pledgets nor braided sutures are used. PMID:24003405

Kim, Jong Hun; Park, Hyun Kyu; Kim, Kyung Hwa; Kim, Min Ho; Kuh, Ja Hong; Jo, Jung Ku

2013-01-01

54

Institutional report - Valves Is the aortic valve pathology type different for early and late mortality in concomitant aortic valve replacement and coronary artery bypass surgery?  

Microsoft Academic Search

We assessed the effects of aortic valve pathology type on the long-term outcomes of patients who underwent concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery. We retrospectively reviewed 150 patients who underwent AVR- CABG at our institution between January 1997 and December 2006. We divided patients into aortic stenosis (AS), aortic regurgitation (AR), and mixed-type groups

Rafet Gunay; Yavuz Sensoz; Ilyas Kayacioglu; Abdullah Kemal Tuygun; Ahmet Yavuz Balci; Ugur Kisa; Mahmut Murat Demirtas; Ibrahim Yekeler

55

Reoperative minimal access aortic valve replacement  

PubMed Central

Reoperative minimal access aortic valve replacement (AVR) is performed through an upper hemisternotomy with peripheral cannulation. This approach limits dissection of mediastinum and especially the left internal mammary artery (LIMA) graft in patients with previous coronary artery bypass grafting (CABG) thus minimizing trauma to the patient. This approach is safe and feasible and may have some benefit over conventional full sternotomy in terms of mortality and morbidity. PMID:24251026

Kaneko, Tsuyoshi; Leacche, Marzia; Byrne, John

2013-01-01

56

Proposed modification for valve-sparing aortic root replacement.  

PubMed

Valve-sparing aortic root replacement (ARR) is the procedure of choice in young patients with aortic root aneurysm and preserved aortic valve leaflets; however, coronary ostial anastomoses remain an issue. Troublesome bleeding sometimes occurs during surgery, and in the long term, there is a risk of aneurysmal formation in the residual aortic wall of the ostial "button." We describe a technique of valve-sparing ARR wherein each coronary button along with its flange of aortic tissue is implanted within the prosthetic graft used for ARR, thereby eliminating the risk of both immediate surgical bleeding and late coronary button aneurysms. PMID:24792282

Mahesh, Balakrishnan; Deville, Claude; Nashef, Samer

2014-05-01

57

Technique of aortic valve replacement with the Edwards Stentless Aortic Bioprosthesis 2500  

Microsoft Academic Search

Aortic valve replacement with a stentless device ought to result in superior hemodynamic function, because obstructing stents and sewing rims are eliminated. From 15 June 1991 to 15 October 1991, 15 patients underwent aortic valve replacement with the newly designed Edwards stentless aortic bioprosthesis 2500. Patients' ages ranged from 51 to 70 years (mean 61 years). Preoperatively 4 patients presented

W. Konertz; M. Weyand; A. Sidiropoulos; E. Schwammenthal; G. Breithardt; H. H. Scheld

1992-01-01

58

Early onset of prosthesis failure after aortic valve replacement.  

PubMed

We report an unusual case of a 78-year-old male who underwent an aortic valve replacement with a 21 mm Labcor tissue porcine aortic valve due to symptomatic aortic stenosis of his native valve. Only 3 months after an uncomplicated postoperative course, on a routine follow-up, transthoracic echo showed restrictive motion of the non-coronary cusp, incomplete closure of the coaptation line and severe aortic regurgitation. The patient was scheduled for a new operation during which the previous prosthetic valve was explanted and a different model was used. PMID:25288592

Karangelis, D; Fragoulis, S; Bairaktaris, A

2014-10-01

59

Laser-assisted debridement of aortic valve calcium.  

PubMed

Experimental debridement of aortic valve calcium by means of laser phototherapy was investigated in vitro. Near-total debridement of calcific deposits observed on pretreatment x-ray films was accomplished using carbon-dioxide laser phototherapy. Analysis of liberated photoproducts suggests that debridement is effected by thermal degradation of the surrounding connective tissue envelope and thermal expansion of the calcific nodules. These results suggest that in selected patients with calcific aortic stenosis, it may be possible to perform intraoperative laser-assisted debridement of aortic valve calcium in order to preserve the native aortic valve and thus avoid prosthetic valve replacement. PMID:3919547

Isner, J M; Michlewitz, H; Clarke, R H; Donaldson, R F; Konstam, M A; Salem, D N

1985-03-01

60

Aortic valve replacement in predominant aortic stenosis: What is an appropriate size valve?  

Microsoft Academic Search

Objective  This is a retrospective analysis of 94 patients who underwent aortic valve replacement for predominant aortic stenosis between\\u000a January 1998 and December 2004.\\u000a \\u000a \\u000a \\u000a Patients and Methods  Age ranged from 16 to 70 years (mean 43.2±13.2 years). 73 were male (77.7%). Etiology was rheumatic in 71 (75.5%) and degenerative\\u000a in 23 (24.5%) patients. On transthoracic echocardiography, the diameter of the aortic annulus

Kishore Joshi; Sachin Talwar; Devagourou Velayoudham; Arkalgud Sampath Kumar

2007-01-01

61

Mathematical modeling of aortic valve dynamics during systole.  

PubMed

We have derived a mathematical model describing aortic valve dynamics and blood flow during systole. The model presents a realistic coupling between aortic valve dynamics, sinus vortex local pressure, and variations in the systemic vascular resistance. The coupling is introduced by using Hill?s classical semi-spherical vortex model and an aortic pressure-area compliance constitutive relationship. The effects of introducing aortic sinus eddy vortices and variable systemic vascular resistance on overall valve opening-closing dynamics, left ventricular pressure, aortic pressure, blood flow rate, and aortic orifice area are examined. In addition, the strength of the sinus vortex is coupled explicitly to the valve opening angle, and implicitly to the aortic orifice area in order to predict how vortex strength varies during the four descriptive phases of aortic valve motion (fast-opening, fully-opening, slow-closing, and fast-closing). Our results compare favorably with experimental observations and the model reproduces well-known phenomena corresponding to aortic valve function such as the dicrotic notch and retrograde flow at end systole. By invoking a more complete set of physical phenomena, this new model will enable representation of pathophysiological conditions such as aortic valve stenosis or insufficiency, making it possible to predict their integrated effects on cardiac load and systemic hemodynamics. PMID:25451522

Aboelkassem, Yasser; Savic, Dragana; Campbell, Stuart G

2015-01-21

62

Midterm Results After Aortic Valve Replacement With a Stentless Bioprosthesis Aortic Valve  

Microsoft Academic Search

Background. It is suggested that a simplified implant model Cryolife-O'Brien (CryoLife International, Kenne- saw, GA) offers less satisfactory outcome compared with standard stentless models. This study was conducted to prospectively evaluate the midterm results after aortic valve replacement with the Cryolife-O'Brien stentless bioprosthesis. Methods. In 1996, a prospective clinical trial using different stentless valves was initiated. From September 1996 through

Ivo Martinovic; Manfred Everlien; Ibrahim Farah; Thomas Wittlinger; Igor Knez; Hans Greve; Paul Vogt

2005-01-01

63

Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation  

Microsoft Academic Search

Background. The aim of the present study was to verify the efficacy of preserving the aortic valve in patients with acute type A aortic dissection complicated by significant aortic regurgitation.Methods. From January 1979 to December 1996, 178 patients (125 males; mean age 57 ± 9 years) underwent emergency surgery for acute type A aortic dissection, with an overall operative mortality

Renzo Pessotto; Francesco Santini; Peppino Pugliese; Giuseppe Montalbano; Giovanni Battista Luciani; Giuseppe Faggian; Paolo Bertolini; Alessandro Mazzucco

1999-01-01

64

[Surgical technique of aortic valve replacement for small aortic annulus in elderly patients].  

PubMed

Recent reports have shown that aortic valve replacement in elderly patients over 65 years with atherosclerotic aortic stenosis and a small aortic annulus is possible by using a small sized bioprosthesis (Carpentier-Edwards pericardial valve). Here we present out surgical technique. Firstly, the native calcified aortic valve was removed completely to gain total exposure of the surrounding aortic root and sinus of Valsalva like Bentall procedure. Secondly, a small sized bioprosthesis was implanted with intermittent noneverting mattress 2-0 sutures with spaghetti and small polytetrafluoroethylene (PTFE) felt. Aortic annulus is the dilated by inserting Hegar dilator sizing from 25 to 27 mm. Therefore, aortic valve replacement for small aortic annulus in intra- or supra-annular position should be easily accomplished. Good surgical results and hemodynamic state were achieved in 25 consecutive cases using this technique. PMID:16613145

Hata, T; Fujiwara, K; Furukawa, H; Tsushima, Y; Yoshitaka, H; Kuinose, M; Minami, H; Ishida, A; Tamura, K; Totsugawa, T; Kanemitsu, H; Ozawa, M

2006-04-01

65

Minimally invasive aortic valve replacement: Echocardiographic and clinical results  

Microsoft Academic Search

Background Port access has been described for mitral and bypass surgery. The purpose of this study was to review the clinical and echocardiographic outcomes of aortic valve replacement by use of port access. Methods Between 1996 and 1999, 153 port-access aortic valve replacements were performed at our institution. The mean age was 63 years (range 16-91 years); 58% were male.

Smadar Kort; Robert M. Applebaum; Eugene A. Grossi; F. Gregory Baumann; Stephen B. Colvin; Aubrey C. Galloway; Greg H. Ribakove; Bryan M. Steinberg; Bryan Piedad; Paul A. Tunick; Itzhak Kronzon

2001-01-01

66

Comparison of outcomes after aortic valve replacement with a mechanical valve or a bioprosthesis using microsimulation  

Microsoft Academic Search

BACKGROUND: Mechanical valves and bioprostheses are widely used for aortic\\u000a valve replacement. Though previous randomised studies indicate that there\\u000a is no important difference in outcome after implantation with either type\\u000a of valve, knowledge of outcomes after aortic valve replacement is\\u000a incomplete. OBJECTIVE: To predict age and sex specific outcomes of\\u000a patients after aortic valve replacement with bileaflet mechanical valves\\u000a and

J. P. A. Puvimanasinghe; M. B. Edwards; M. J. C. Eijkemans; E. W. Steyerberg; Herwerden van L. A; K. M. Taylor; G. L. Grunkemeier; J. D. F. Habbema; A. J. J. C. Bogers; J. J. M. Takkenberg

2004-01-01

67

Congenitally bicuspid aortic valves. Clinicogenetic study of 41 families.  

PubMed Central

The families of 41 patients with surgically proved isolated bicuspid aortic valves were examined. There were 275 first degree relatives of whom 220 were living, and 188 (85.5%) of these were examined. Seven first degree relatives were found to have aortic valve disease, and in a further 11 there was 'doubtful' evidence of bicuspid aortic valves. In 6 families there was more than 1 affected member and in an additional 7 families there was 1 or more 'doubtful' first degree relative. The minimum family incidence was therefore 14.6 per cent, or 31.7 per cent if 'doubtful' cases were included. The inheritance is most probably multifactorial, but occasionally the condition may occur as an autosomal dominant. The difficulties of diagnosing bicuspid aortic valves before the development of obstruction of left ventricular outflow were encountered and are discussed. The association of a bicuspid aortic valve with asymmetric septal hypertrophy, hypertrophic cardiomyopathy, and Marfan's syndrome was also noted. PMID:737099

Emanuel, R; Withers, R; O'Brien, K; Ross, P; Feizi, O

1978-01-01

68

Early clinical evaluation after aortic valve replacement with the St. Jude Medical valve in patients with a small aortic root.  

PubMed

Forty-three patients, nine men and 34 women, mean age 60 years (range 23-81 years), who had small aortic roots underwent aortic valve replacement with a St. Jude Medical valve. Preoperatively, five patients were in New York Heart Association (NYHA) class I, 19 were in class II, 15 were in class III and four were in class IV. In 30 of 36 patients with aortic stenosis, the mean gradient was 102 mm Hg (range 52-175 mm Hg; in six patients with aortic stenosis, the gradient was not measured. Seven patients underwent surgery for aortic regurgitation. Ten patients received a 19-mm valve, 29 a 21-mm valve and nine a 23-mm valve. Two patients (4.6%) died in the hospital, one immediately postoperatively and the other from low cardiac output 9 days postoperatively. There are 670 patient-months of follow-up (mean 17 months). Thirty-six patients are NYHA class I and two patients are in class II. There have been no thromboembolic episodes in 605 months of follow-up for patients maintained on warfarin. There was one partial valve thrombosis among eight patients being managed without warfarin. No mechanical valve failures have occurred. The St. Jude Medical valve provides a satisfactory early result when used to replace the aortic valve of patients who have a small aortic root. PMID:7083534

Gill, C C; King, H C; Lytle, B W; Cosgrove, D M; Golding, L A; Loop, F D

1982-08-01

69

Biological versus mechanical aortic valve replacement in children  

Microsoft Academic Search

Background. Aortic valve replacement in children remains challenging because of constraints imposed by available prosthetic devices. Potential risks of anticoagulation with mechanical valves and degeneration of other biological substitutes have kindled interest in the Ross procedure. This study outlines the evolution of our 27-year experience with prosthetic devices.Methods. Ninety-nine patients who underwent aortic valve replacement (January 1973 through September 2000)

Mark W Turrentine; Mark Ruzmetov; Palaniswamy Vijay; Randall G Bills; John W Brown

2001-01-01

70

Thalassemia and heart surgery: aortic valve repair after endocarditis.  

PubMed

Outcome after heart valve surgery in patients affected by thalassemia is an unreported issue and to the best of our knowledge only 7 cases have been described in the literature. Heart valve disease is commonly encountered in thalassemia patients and heart valve replacement carries high risk of prosthesis complications including thrombosis and embolization despite optimal anticoagulation management. We report a successful long-term outcome after a case of aortic valve repair after mycotic valve endocarditis. PMID:25555980

Raffa, Giuseppe Maria; Mularoni, Alessandra; Di Gesaro, Gabriele; Vizzini, Giovanni; Cipolla, Tommaso; Pilato, Michele

2015-01-01

71

Aortic valve replacement in geriatric patients with small aortic roots: are sutureless valves the future? †  

PubMed Central

OBJECTIVES Aortic valve replacement (AVR) in geriatric patients (>75 years) with small aortic roots is a challenge. Patient–prosthesis mismatch and the long cross-clamp time necessary for stentless valves or root enlargement are matters of concern. We compared the results of AVR with sutureless valves (Sorin Perceval), against those with conventional biological valves. METHODS Between April 2007 and December 2012, 120 isolated AVRs were performed in patients with a small annulus (<22 mm) at our centre. In 70 patients (68 females, age 77.4 ± 5.5 years), conventional valves (C group) and in 50 patients (47 females, age 79.8 ± 4.5 years), sutureless valves (P group) were implanted. The Logistic EuroSCORE of the C group was 16.7 ± 10.4 and that of the P group 20.4 ± 10.7, (P = 0.054). Minimal-access surgery was performed in 4.3% (3/70) patients in the C group and 72% (36/50) patients in the P group. RESULTS The cardiopulmonary bypass (CPB) and cross-clamp times of the C group were 75.3 ± 23 and 50.3 ± 14.2 min vs 58.7 ± 20.9 and 30.1 ± 9 min in the P group, (P < 0.001). In the C group, two annulus enlargements were performed. Thirty-day mortality was 4.3% (n = 3) in the C group and 0 in the P group, (n.s.). At follow-up (up to 5 years), mortalities were 17.4% (n = 12) in the C group and 14% (n = 7) in the P group, (n.s.). CONCLUSIONS This study highlights the advantages of sutureless valves for geriatric patients with small aortic roots reflected by shorter cross-clamp and CPB times, even though most of these patients were operated on via a minimally invasive access. Moreover, due to the absence of a sewing ring, these valves are also almost stentless, with greater effective orifice area (EOA) for any given size. This may potentially result in better haemodynamics even without the root enlargement. This is of advantage, as several studies have shown that aortic root enlargement can significantly increase the risks of AVR. Moreover, as seen in this series, these valves may also enable a broader application of minimally invasive AVR. PMID:23851988

Shrestha, Malakh; Maeding, Ilona; Höffler, Klaus; Koigeldiyev, Nurbol; Marsch, Georg; Siemeni, Thierry; Fleissner, Felix; Haverich, Axel

2013-01-01

72

Valve-in-Valve-in-Valve Transcatheter Aortic Valve Implantation to Treat a Degenerated Surgical Bioprosthesis in a Subaortic Position  

PubMed Central

Transcatheter aortic valve implantation for aortic stenosis has evolved as an alternative treatment for patients who are at high or excessive surgical risk. We report the case of an 84-year-old man with a degenerated surgically implanted valve in a subaortic position (9 mm below the native annulus) who underwent “valve-in-valve” transcatheter aortic valve implantation with use of a Medtronic CoreValve system. We planned to deploy the CoreValve at a conventional depth in the left ventricular outflow tract; we realized that this might result in paravalvular regurgitation, but it would also afford a “deep” landing site for a second valve, if necessary. Ultimately, we implanted a second CoreValve deep in the left ventricular outflow tract to seal a paravalvular leak. The frame of the first valve—positioned at the conventional depth—enabled secure anchoring of the second valve in a deeper position, which in turn effected successful treatment of the failing subaortic surgical prosthesis without paravalvular regurgitation. PMID:23914032

Nuis, Rutger-Jan; Benitez, Luis M.; Nader, Carlos A.; Perez, Sergio; de Marchena, Eduardo J.; Dager, Antonio E.

2013-01-01

73

Rupture of equine pericardial aortic-root patch after aortic valve replacement with aortic annulus enlargement: a case report.  

PubMed

There are no previous reports of rupture of a heterologous pericardial patch after aortic annulus enlargement. Our patient, a 72-year-old Japanese female, presented with congestive heart failure resulting from heart compression from pseudoaneurysm formation in the aortic root. At 57 years of age the patient had undergone replacement of the ascending aorta for Stanford type A acute aortic dissection. At 66 years of age she had undergone aortic valve replacement with a mechanical valve, accompanied by enlargement of the aortic annulus using an equine pericardial patch, for severe aortic valve stenosis with a narrow aortic annulus. Equine pericardial patch was used in the aortic annulus enlargement to form the aortic root from the ascending aortic vascular prosthesis to the non-coronary cusp of the aortic valve. We performed repeat median sternotomy under cardiopulmonary bypass with moderate hypothermia. The ascending aorta was balloon-occluded because of dense adhesions around the superior vena cava and ascending aorta due to the pseudoaneurysm. A tear in the equine pericardial patch was noted at the aortic root. The patient underwent pseudoaneurysm excision and repair of the aortic root using a double-layered, Hemashield-reinforced bovine pericardial patch. Routine follow-up with computed tomography should be performed for early detection of complications from a heterologous pericardial patch. PMID:24947732

Morisaki, Akimasa; Kato, Yasuyuki; Motoki, Manabu; Takahashi, Yosuke; Nishimura, Shinsuke; Shibata, Toshihiko

2014-01-01

74

Rupture of equine pericardial aortic-root patch after aortic valve replacement with aortic annulus enlargement: a case report  

PubMed Central

There are no previous reports of rupture of a heterologous pericardial patch after aortic annulus enlargement. Our patient, a 72-year-old Japanese female, presented with congestive heart failure resulting from heart compression from pseudoaneurysm formation in the aortic root. At 57 years of age the patient had undergone replacement of the ascending aorta for Stanford type A acute aortic dissection. At 66 years of age she had undergone aortic valve replacement with a mechanical valve, accompanied by enlargement of the aortic annulus using an equine pericardial patch, for severe aortic valve stenosis with a narrow aortic annulus. Equine pericardial patch was used in the aortic annulus enlargement to form the aortic root from the ascending aortic vascular prosthesis to the non-coronary cusp of the aortic valve. We performed repeat median sternotomy under cardiopulmonary bypass with moderate hypothermia. The ascending aorta was balloon-occluded because of dense adhesions around the superior vena cava and ascending aorta due to the pseudoaneurysm. A tear in the equine pericardial patch was noted at the aortic root. The patient underwent pseudoaneurysm excision and repair of the aortic root using a double-layered, Hemashield-reinforced bovine pericardial patch. Routine follow-up with computed tomography should be performed for early detection of complications from a heterologous pericardial patch. PMID:24947732

2014-01-01

75

Concomitant aortic valve replacement and coronary bypass: the effect of valve type on the blood flow in bypass grafts  

Microsoft Academic Search

Objective: In cases of aortic valve replacement, the downstream flow profile and turbulence in the ascending aorta differ according to the prosthetic aortic valve implanted. The objective of this work is to study the influence of prosthetic valve type on the flow in the bypass grafts implanted to the ascending aorta in cases of concomitant aortic valve replacement and coronary

Wael Hassanein; Alexander Albert; Ines Florath; Yasser Y. Hegazy; Ulrich Rosendahl; Stefan Bauer; Juergen Ennker

2010-01-01

76

Concomitant aortic valve replacement and coronary bypass: the effect of valve type on the blood flow in bypass grafts  

Microsoft Academic Search

Objective: In cases of aortic valve replacement, the downstream flow profile and turbulence in the ascending aorta differ according to the prosthetic aortic valve implanted. The objective of this work is to study the influence of prosthetic valve type on the flow in the bypass grafts implanted to the ascending aorta in cases of concomitant aortic valve replacement and coronary

Wael Hassanein; Alexander Albert; Ines Florath; Yasser Y. Hegazy; Ulrich Rosendahl; Stefan Bauer; Juergen Ennker

2007-01-01

77

A rare case of prosthetic aortic valve endocarditis complicated with multiple fistula to peri aortic structure  

PubMed Central

Multiple aorto-cardiac cavity communications is very rare but important complication of prosthetic aortic valve endocarditis. The case below illustrates multiple aorto-cardiac cavity fistula formation following prostethic aortic valve endocarditis presented with slowly progressive symptoms of heart failure. A brief review of surgical reconstruction and the existing literature are presented, including emphasis on pre and intra operative echocardiographic diagnosis and treatment.

Sabzi, Feridoun; Faraji, Reza

2014-01-01

78

Aortic cusp extension valvuloplasty for rheumatic aortic valve disease: midterm results  

Microsoft Academic Search

Background. The surgical management of rheumatic aortic insufficiency in the young remains problematic owing to the drawbacks of prosthetic valve replacement at this age. In young foreign patients, for whom long-term anticoagulation therapy is unavailable, we have used a glutaraldehyde preserved autologous pericardium cusp extension technique to repair rheumatic aortic valve insufficiencies resulting from cusp retractions.Methods. From September 1992 to

Jean-Michel Grinda; Christian Latremouille; Alain J Berrebi; Rachid Zegdi; Sylvain Chauvaud; Alain F Carpentier; Jean-Noel Fabiani; Alain Deloche

2002-01-01

79

Recurrent Ischemic Strokes in a Patient with Medtronic-Hall Prosthetic Aortic Valve and Valve Strands  

Microsoft Academic Search

Fine strands associated with prosthetic heart valves have been demonstrated with transesophageal echocardiography, but the pathologic identity of these strands is unclear. A case of a man with a prosthetic aortic Medtronic-Hall valve with prominent valve strands and recurrent strokes is discussed. The patient underwent valve replacement surgery, and histopathologic examination of the strands identified them as Lambl's excrescences. (J

Kendra Hutchinson; Faizain Hafeez; Timothy D Woods; Paramjeet S Chopra; Thomas F Warner; Ross L Levine; Timothy J Kamp

1998-01-01

80

Dicrotic pulse observed in a patient with prolapse of the aortic valve without aortic regurgitation.  

PubMed

We describe a case of dicrotic pulse in a patient who exhibited marked prolapsed aortic cusp without aortic regurgitation. Echo-Doppler in the abdominal aorta showed deep reversal flow confined to early diastole. We conclude that this prolapse was the cause of the steep dicrotic notch and the dicrotic pulse, because of the concomitance of non-leaking aortic valves. PMID:9846812

Moriya, S; Iga, K; Konishi, T

1997-01-01

81

Sutureless Medtronic 3f Enable aortic valve replacement in a heavily calcified aortic root.  

PubMed

The case is reported of a surgical aortic valvular stenosis with a severely calcified ascending aortic root in a 76-year-old woman. The morphology and size of the aortic annulus were unsuitable for transcatheter aortic valve implantation (TAVI); thus, surgery was scheduled. Aortic calcifications allowed a transverse aortotomy 4 cm superior to the sinotubular junction, with a remote endoaortic view of the valve. A Medtronic 3f Enable sutureless bioprosthesis was then implanted after aortic annular decalcification. Sutureless bioprostheses are new tools that promise to reduce technical difficulties and cross-clamp times in minimally invasive aortic valve replacement surgery. In addition, sutureless techniques may have other possible advantages in special circumstances requiring full sternotomy access, such as in the present case. PMID:24151774

Vola, Marco; Fuzellier, Jean-Francois; Kasra, Azarnoush; Morel, Jérôme; Campisi, Salvatore; Ruggeri, Gianvito; Favre, Jean Pierre

2013-05-01

82

Inflammatory Characteristics of Stenotic Aortic Valves: A Comparison between Rheumatic and Nonrheumatic Aortic Stenosis  

PubMed Central

Background. Although our comprehension of nonrheumatic aortic stenosis (NRAS) has increased substantially during the last decade, less is known about the histopathology of rheumatic aortic stenosis (RAS). The aim of this study was to investigate rheumatic aortic stenosis by means of analyses previously used in nonrheumatic stenosis. Material and Methods. Valve specimens were obtained from 39 patients referred to hospital due to significant aortic stenosis. According to established macroscopic criteria the valves were divided into two groups consisting of 29 NRAS and 10 RAS valves. Mononuclear inflammatory cells and apolipoproteins were investigated using immunohistochemical analyses. Results. The localisation of calcification differed in tricuspid nonrheumatic valves when compared to bicuspid nonrheumatic and rheumatic valves. The RAS valves revealed a lower degree of T lymphocyte infiltration compared with the NRAS valves. Infiltration of macrophages was seen in all valves and there were no differences regarding deposition of apolipoprotein. Conclusion. Rheumatic and nonrheumatic aortic stenotic valves show a similar and significant chronic inflammation. The similarities regarding the localisation of calcification indicate that the valve anomaly/morphology can influence the pathogenesis of aortic stenosis. Finally, our findings highlight the question of a postinflammatory valvular disease of other causes than rheumatic fever. PMID:23476886

Steffensen, Thora; Jonasson, Lena

2013-01-01

83

Valve-related complications in elderly patients with biological and mechanical aortic valves  

Microsoft Academic Search

Background. Controversy still exists about the choice of aortic prosthesis in elderly patients. This study investigates valve- and anticoagulant-related morbidity and mortality in elderly patients after aortic valve replacement (AVR) with a biologic (BP) or mechanical prosthesis (MP).Methods. Between 1981 and 1995, 355 consecutive patients aged 70 years or older (mean, 74 ± 4 years; range, 70 to 87 years)

Aldo Milano; Cosimo Guglielmi; Marco De Carlo; Omar Di Gregorio; Giancarlo Borzoni; Francesco Verunelli; Uberto Bortolotti

1998-01-01

84

Cerebral Protection against Left Ventricular Thrombus during Transcatheter Aortic Valve Replacement in a Patient with Critical Aortic Stenosis  

PubMed Central

Transcatheter aortic valve replacement is an increasingly common treatment of critical aortic stenosis. Many aortic stenosis patients have concomitant left ventricular dysfunction, which can instigate the formation of thrombus resistant to anticoagulation. Recent trials evaluating transcatheter aortic valve replacement have excluded patients with left ventricular thrombus. We present a case in which an 86-year-old man with known left ventricular thrombus underwent successful transcatheter aortic valve replacement under cerebral protection. PMID:24082384

Grover, Peeyush M.; O'Neill, Brian P.; Velazquez, Omaida; Heldman, Alan W.; O'Neill, William W.; Cohen, Mauricio G.

2013-01-01

85

Animal Models of Calcific Aortic Valve Disease  

PubMed Central

Calcific aortic valve disease (CAVD), once thought to be a degenerative disease, is now recognized to be an active pathobiological process, with chronic inflammation emerging as a predominant, and possibly driving, factor. However, many details of the pathobiological mechanisms of CAVD remain to be described, and new approaches to treat CAVD need to be identified. Animal models are emerging as vital tools to this end, facilitated by the advent of new models and improved understanding of the utility of existing models. In this paper, we summarize and critically appraise current small and large animal models of CAVD, discuss the utility of animal models for priority CAVD research areas, and provide recommendations for future animal model studies of CAVD. PMID:21826258

Sider, Krista L.; Blaser, Mark C.; Simmons, Craig A.

2011-01-01

86

Structural Failure of a Starr-Edwards Aortic Track Valve  

PubMed Central

Structural failure of a Model 2400 Starr-Edwards aortic track valve occurred suddenly, 4 years after implantation. At operation, the valve cage was removed from the descending aorta. Examination of the excised prosthesis disclosed minimal cloth wear and no evidence of infective growth; however, three struts were fractured above their insertion into the valve ring. To our knowledge, this type of valve malfunction has not been previously noted. Images PMID:15227160

Ringel, Richard E.; Moulton, Anthony L.; Burns, Janet E.; Brenner, Joel I.; Berman, Michael A.

1983-01-01

87

Arterial Remodeling of the Common Carotid Artery After Aortic Valve Replacement in Patients With Aortic Stenosis  

Microsoft Academic Search

Background and Purpose—Aortic stenosis, causing flow abnormalities, disturbs the normal hemodynamics in the common carotid arteries. The aim of the present study was to investigate the remodeling process of the common carotid arteries after surgical correction of aortic stenosis. Methods—Eleven subjects with aortic stenosis were studied before and 1 and 6 months after aortic valve replacement. Arterial diameter, intima-media thickness

Concetta Irace; Agostino Gnasso; Francesca Cirillo; Giuseppe Leonardo; Monica Ciamei; Andrea Crivaro; Attilio Renzulli; Maurizio Cotrufo

88

Transcatheter aortic valve replacement: postoperative CT findings of Sapien and CoreValve transcatheter heart valves.  

PubMed

Transcatheter aortic valve replacement represents one of the most exciting medical technical developments in recent years, offering a much-needed therapeutic alternative for patients with severe aortic valve stenosis who, due to comorbidities and advanced age, are considered to be inoperable or at high surgical risk. The efficacy of this procedure compared with standard surgical intervention has been properly validated in multicenter randomized controlled trials (PARTNER A and B trials), leading to widespread clinical implementation, with over 50,000 procedures currently being performed worldwide each year. Although much of the attention has rightly focused on the potential role of computed tomography (CT) in the preprocedural assessment of the aortic root and the establishment of imaging-guided valve-sizing algorithms, less is known regarding the postprocedural CT characteristics of transcatheter heart valves (THVs). However, given the increasing worldwide recognition and clinical implementation of these devices, they will no doubt be encountered with increasing frequency in patients referred for thoracic CT, either for postprocedural evaluation of the aortic root or for unrelated reasons. Familiarity with these devices and their CT characteristics will increase diagnostic confidence and the value of the radiology report. The authors describe the physical and imaging properties of the currently commercially available THVs, their normal postprocedural imaging appearances, and potential complications that can be detected at CT. In addition, they discuss the relative strengths and weaknesses of CT and echocardiography in this setting. PMID:25310415

Salgado, Rodrigo A; Budde, Ricardo P J; Leiner, Tim; Shivalkar, Bharati; Van Herck, Paul L; Op de Beeck, Bart J; Vrints, Christiaan; Buijsrogge, Marc P; Stella, Pieter R; Rodrigus, Inez; Bosmans, Johan; Parizel, Paul M

2014-10-01

89

The role of transesophageal echocardiography in aortic valve preserving procedures  

PubMed Central

In selected cases of aortic regurgitation, aortic valve (AV) repair and AV sparing root reconstruction viable alternatives to aortic valve replacement. Repair and preservation of the native valve avoids the use of long-term anticoagulation, lowers the incidence of subsequent thromboembolic events and reduces the risk of endocarditis. Additionally repair has a low operative mortality with reasonable mid-term durability. The success and longer term durability of AVPP has improved with surgical experience. An understanding of the mechanism of the AR is integral to determining feasibility and success of an AVPP. Assessment of AV morphology, anatomy of the functional aortic annulus (FAA) and the aortic root with transesophageal echocardiography (TEE) improves the understanding of the mechanisms of AR. Pre- and intra-operative TEE plays a pivotal role in guiding case selection, surgical planning, and in evaluating procedural success. Post-operative transthoracic echocardiography is useful to determine long-term success and monitor for recurrence of AR. PMID:24973839

Hall, Terri; Shah, Pallav; Wahi, Sudhir

2014-01-01

90

Detecting aortic valve bicuspidy in patients with severe aortic valve stenosis: high diagnostic accuracy of colour Doppler transoesophageal echocardiography  

PubMed Central

OBJECTIVES The diagnostic accuracy of multiplane bi-dimensional transoesophageal echocardiography (TEE) in detecting aortic valve bicuspidy is good, but is less reliable when the leaflets are moderately or severely calcified. We hypothesized that systolic colour Doppler analysis might improve the accuracy of diagnosing aortic bicuspidy by TEE in patients with severe symptomatic aortic stenosis (AS). METHODS Two colour Doppler images of a stenotic aortic valve were defined in a preliminary study using multiplane TEE. In type I, the valve opening had a linear, angular or ‘hanger-like’ configuration and in type II it was more star-like or ‘stellar’. The accuracy of this classification in detecting bicuspidy was evaluated. Fifty-one patients (mean age 71 years (range 40–90 years); 52% male) with severe symptomatic AS (defined as aortic valve area ?1 cm2), requiring surgical aortic valve replacement, were included in this prospective study. The surgical findings were compared with the echocardiographic data. RESULTS The incidence of aortic bicuspidy was 43%. The presence of type I colour Doppler configuration was significantly higher for bicuspid than for tricuspid aortic valves (95.5 vs 3.5%, respectively; P < 0.001). Diagnostic accuracy in detecting bicuspidy was high (sensitivity 95.5%; specificity 96.5%; positive predictive value 95.5%). Intra- and inter-observer agreements were excellent (Kappa coefficient = 0.88 and 0.92, respectively). CONCLUSIONS Aortic valve bicuspidy may be accurately diagnosed by colour Doppler valve analysis during TEE in patients with severe AS. Larger prospective studies are required to confirm our results. PMID:23054907

Zegdi, Rachid; Ciobotaru, Vlad; Huerre, Clémence; Allam, Bachir; Bouabdallaoui, Nadia; Berrebi, Alain; Florens, Emmanuelle; Fabiani, Jean-Noël

2013-01-01

91

Complications at the Time of Transcatheter Aortic Valve Implantation  

PubMed Central

Transcatheter aortic valve implantation (TAVI) improves the prognosis of patients with severe aortic stenosis who are deemed too high risk for surgical valve replacement.1 However, this evolving technology is associated with a wide range of potential complications — some specific to TAVI, some often fatal. Prevention, early recognition, and effective treatment of these complications will significantly improve the outcome of this procedure and are essential prerequisites before the therapy is extended to lower-risk patient subsets. PMID:22891127

Brecker, Stephen J.D.; Roy, David; Jahangiri, Marjan

2012-01-01

92

Role of Multimodality Imaging in Transcatheter Aortic Valve Replacement.  

PubMed

The treatment of aortic stenosis (AS) has reached an exciting stage with the introduction of transcatheter aortic valve replacement (TAVR). It is the treatment of choice in patients with severe AS who are considered very high risk for surgical valve replacement. Multimodality imaging (MMI) plays a crucial role in TAVR patient selection, intra-procedure guidance, and follow-up. With the ever-increasing scope for TAVR, a better understanding of MMI is essential to improve outcomes and prevent complications. PMID:25471463

Ramineni, Rajesh; Almomani, Ahmed; Kumar, Arnav; Ahmad, Masood

2014-12-01

93

Mitral annular calcification in patients undergoing aortic valve replacement for aortic valve stenosis.  

PubMed

Limited data exis t on clinical relevance of aortic valve stenosis (AVS) and mitral annular calcification (MAC), although with similar pathophysiologic basis. We sought to reveal the prevalence of MAC and its clinical features in the patients undergoing aortic valve replacement (AVR) for AVS. We reviewed 106 consecutive patients who underwent isolated AVR from 2004 to 2010. Before AVR, CT scans were performed to identify MAC, whose severity was graded on a scale of 0-4, with grade 0 denoting no MAC and grade 4 indicating severe MAC. Echocardiography was performed before AVR and at follow-up over 2 years after AVR. MAC was identified in 56 patients with grade 1 (30 %), 2 (39 %), 3 (18 %), and 4 (13 %), respectively. Patients with MAC presented older age (72 ± 8 versus 66 ± 11 years), higher rate of dialysis-dependent renal failure (43 versus 4 %), and less frequency of bicuspid aortic valve (9 versus 36 %), when compared to those without MAC. No significant differences were seen in short- and mid-term mortality after AVR between the groups. In patients with MAC, progression of neither mitral regurgitation nor stenosis was observed at follow-up of 53 ± 23 months for 102 survivors, although the transmitral flow velocities were higher than in those without MAC. In conclusion, MAC represented 53 % of the patients undergoing isolated AVR for AVS, usually appeared in dialysis-dependent elder patients with tricuspid AVS. MAC does not affect adversely upon the survival, without progression of mitral valve disease, at least within 2 years after AVR. PMID:25252778

Takami, Yoshiyuki; Tajima, Kazuyoshi

2014-09-25

94

Outcomes of aortic valve repair according to valve morphology and surgical techniques  

PubMed Central

OBJECTIVES The aim of this study was to assess the impact of aortic valve morphology and different surgical aortic valve repair techniques on long-term clinical outcomes. METHODS Between February 2003 and May 2010, 216 patients with aortic insufficiency underwent aortic valve repair in our institution. Ages ranged between 26 and 82 years (mean 53 ± 15 years). Aortic valve dysfunctions, according to functional classification, were: type I in 55 patients (25.5%), type II in 126 (58.3%) and type III in 35 (16.2%). Sixty-six patients (27.7%) had a bicuspid valve. Aortic valve repair techniques included sub-commissural plasty in 138 patients, plication in 84, free-edge reinforcement in 80, resection of raphe plus re-suturing in 40 and the chordae technique in 52. Concomitant surgical procedures were CABG in 22 (10%) patients, mitral valve repair in 12 (5.5%), aortic valve-sparing re-implantation in 78 (36%) and ascending aorta replacement in 69 (32%). Mean follow-up was 42 ± 16 months and was 100% complete. RESULTS There were six early deaths (2.7%). Overall late survival was 91.5% (18 late deaths). There were 15 (6.9%) late cardiac-related deaths. NYHA functional class was ?II in all patients. At follow-up, 28 (14.5%) patients had recurrent aortic insufficiency ? grade II. The freedom from valve-related events was significantly different between bicuspid and tricuspid valve implantation (P < 0.01), between type I + II and type III (P < 0.001) dysfunction and between the chordae technique and plication, compared to free-edge reinforcement (P < 0.01). Statistically-significant differences were found between patients who underwent aortic valve repair plus root re-implantation, compared to those who underwent isolated aortic valve repair (P = 0.02). CONCLUSIONS aortic valve repair including aortic annulus stabilization is a safe surgical option with either tricuspid or bicuspid valves; even more so if associated with root re-implantation. Patients with calcified bicuspid valves have poor results. PMID:22761124

Fattouch, Khalil; Murana, Giacomo; Castrovinci, Sebastiano; Nasso, Giuseppe; Mossuto, Claudia; Corrado, Egle; Ruvolo, Giovanni; Speziale, Giuseppe

2012-01-01

95

The mechanical properties of porcine aortic valve tissues  

Microsoft Academic Search

In uniaxial tensile experiments in vitro mechanical properties of the different parts of porcine aortic valves, i.e. the leaflets, the sinus wall and the aortic wall, have been dealt with. Tissue strips cut in different directions were investigated. The collagen bundles in the leaflets show a stiffening effect and cause a marked anisotropy: within the physiological range of strains the

A. A. H. J. Sauren; M. C. van Hout; A. A. van Steenhoven; Steenhoven van AA; FE Veldpaus

1983-01-01

96

The living aortic valve: From molecules to function  

PubMed Central

The aortic valve lies in a unique hemodynamic environment, one characterized by a range of stresses (shear stress, bending forces, loading forces and strain) that vary in intensity and direction throughout the cardiac cycle. Yet, despite its changing environment, the aortic valve opens and closes over 100,000 times a day and, in the majority of human beings, will function normally over a lifespan of 70–90 years. Until relatively recently heart valves were considered passive structures that play no active role in the functioning of a valve, or in the maintenance of its integrity and durability. However, through clinical experience and basic research the aortic valve can now be characterized as a living, dynamic organ with the capacity to adapt to its complex mechanical and biomechanical environment through active and passive communication between its constituent parts. The clinical relevance of a living valve substitute in patients requiring aortic valve replacement has been confirmed. This highlights the importance of using tissue engineering to develop heart valve substitutes containing living cells which have the ability to assume the complex functioning of the native valve. PMID:25054122

Chester, Adrian H.; El-Hamamsy, Ismail; Butcher, Jonathan T.; Latif, Najma; Bertazzo, Sergio; Yacoub, Magdi H.

2014-01-01

97

The natural course of bicuspid aortic valve in athletes.  

PubMed

The purpose of this study was to evaluate the impact of a long-term athletic training on the clinical course of bicuspid aortic valve. A group of 81 athletes (73 M, 8 F, 22.7 +/- 5.6 years) with bicuspid aortic valve was collected. Based on clinical and echocardiographic criteria, athletes were initially divided into 2 groups: the low-risk (51 athletes) and the high-risk group (30 athletes). The high-risk athletes were disqualified from training and competitions after the first evaluation. Over the follow-up period, all of them showed significant worsening of morphologic and hemodynamic features of bicuspid aortic valve; two underwent surgical valvular repair and one of them died suddenly. Over the same period, six of the initially low-risk athletes (7%) showed significant worsening of morphologic features of bicuspid aortic valve and/or incidence of symptoms which led to their disqualification from competition. At the end of follow-up, we observed that in high-risk subjects the progression of valvular disease occurred independently from the former athletic activity and that the majority of athletes with mild bicuspid aortic valve had a benign clinical course. However, athletes with bicuspid aortic valve should be viewed with caution, and continued clinical surveillance would be mandatory. PMID:17990219

Spataro, A; Pelliccia, A; Rizzo, M; Biffi, A; Masazza, G; Pigozzi, F

2008-01-01

98

Conventional aortic valve replacement for high-risk aortic stenosis patients not suitable for trans-catheter aortic valve implantation: feasibility and outcome  

Microsoft Academic Search

Objective: High-risk patients with aortic stenosis are increasingly referred to specialist multidisciplinary teams (MDTs) for consideration of trans-catheter aortic valve implantation (TAVI). A subgroup of these cases is unsuitable for TAVI, and high-risk conventional aortic valve replacement (AVR) is undertaken. We have studied our outcomes in this cohort. Methods: Data prospectively collected between March 2008 and November 2009 for patients

Ioannis Dimarakis; Syed M. Rehman; Stuart W. Grant; Duraisamy M. T. Saravanan; Richard D. Levy; Ben Bridgewater; Isaac Kadir

2011-01-01

99

Heart valve surgery - discharge  

MedlinePLUS

Aortic valve replacement - discharge; Aortic valvuloplasty - discharge; Aortic valve repair - discharge; Replacement - aortic valve - discharge; Repair - aortic valve - discharge; Ring annuloplasty - discharge; Percutaneous ...

100

A worn Björk–Shiley prosthetic valve without valve dysfunction observed during ascending aortic replacement  

PubMed Central

Key Clinical Message The implanted first-generation Björk–Shiley valve in our patient was functioning well before aortic surgery, but we replaced the valve because we confirmed disc erosion 39 years after implantation during the surgery. We judged that the implanted valve was no longer capable of maintaining the patient's life.

Komi, Misao; Sugaya, Akira; Akutsu, Hirohiko; Sato, Hirotaka; Kaminishi, Yuichiro; Misawa, Yoshio

2014-01-01

101

A difficult case of retrieval of an aortic valve and balloon during a transcatheter aortic valve implantation?  

PubMed Central

INTRODUCTION Transcatheter aortic valve implantation (TAVI) represents an emerging therapy for valve replacement in patients not suitable for traditional open repair. As awareness of the procedure grows, case numbers are increasing worldwide. Though this procedure represents a less invasive approach to aortic valve replacement, it is not without complications. PRESENTATION OF CASE This case presentation describes a serious, previously unreported, complication incurred in an 83-year-old male in whom TAVI was attempted. During deployment of the valve at the aortic annulus, both the valve and accompanying balloon embolised into the thoracic aorta and this was further complicated by migration of the balloon into the abdominal aorta and an aortic dissection. The false lumen of the dissection at the level of the infrarenal aorta was tacked to the aortic adventitial wall using interrupted sutures through a laparotomy. A completion angiogram demonstrated that a flow limited dissection did extend up to both common iliac arteries. This was managed with balloon-expandable covered stents deployed in both common iliac arteries with satisfactory outcome. DISCUSSION This case occurred as a combination of multiple factors that include lack of burst pacing and poor timing of the balloon inflation. The aortic balloon and the valve had to be removed urgently to avoid ventricular embolization of these structures that can result in a fatal situation. CONCLUSION This case presentation describes the management of these complications using a combined open and endovascular approach in a well-equipped hybrid operating theatre, resulting in the patient survival. PMID:23959416

Patrice Mwipatayi, Bibombe; Nair, Roshan; Papineau, Jean-Louis; Vijayan, Vikram

2013-01-01

102

Transcatheter aortic valve implantation in the elderly: who to refer?  

PubMed

In recent years, experience with transcatheter aortic valve implantation has led to improved outcomes in elderly patients with severe aortic stenosis (AS) who may not have previously been considered for intervention. These patients are often frail with significant comorbid conditions. As the prevalence of AS increases, there is a need for improved assessment parameters to determine the patients most likely to benefit from this novel procedure. This review discusses the diagnostic criteria for severe AS and the trials available to aid in the decision to refer for aortic valve procedures in the elderly. PMID:25216621

Finn, Matthew; Green, Philip

2014-01-01

103

Critical care management of patients following transcatheter aortic valve replacement  

PubMed Central

Transcatheter aortic valve replacement (TAVR) is rapidly gaining popularity as a technique to surgically manage aortic stenosis (AS) in high risk patients. TAVR is significantly less invasive than the traditional approach to aortic valve replacement via median sternotomy. Patients undergoing TAVR often suffer from multiple comorbidities, and their postoperative course may be complicated by a unique set of complications that may become evident in the intensive care unit (ICU). In this article, we review the common complications of TAVR that may be observed in the ICU, and different strategies for their management. PMID:24327878

Raiten, Jesse M

2013-01-01

104

Central versus femoral cannulation during minimally invasive aortic valve replacement  

PubMed Central

Minimally invasive aortic valve replacement (AVR) is rapidly becoming the preferred approach for aortic valve procedures in most centers worldwide. While femoral artery cannulation is still the most frequently used form of arterial perfusion strategy during less invasive AVR, some recent studies have showed a possible connection between retrograde perfusion and cerebral complications. In this article, we discuss the possible advantages of central aortic cannulation during right minimally invasive AVR and provide some technical aspects for a safe and efficient cannulation of the ascending aorta through a right minithoracotomy.

Glauber, Mattia

2015-01-01

105

Recently patented transcatheter aortic valves in clinical trials.  

PubMed

The most widely used heart valve worldwide is the Edwards Sapien, which currently has 60% of the worldwide transcatheter aortic valve implantation (TAVI) market. The CoreValve is next in line in popularity, encompassing 35% of the worldwide TAVI market. Although these two valves dominate the TAVI market, a number of newer transcatheter valves have been introduced and others are in early clinical evaluation. The new valves are designed to reduce catheter delivery diameter, improve ease of positioning and sealing, and facilitate repositioning or removal. The most recent transcatheter valves for transapical use include Acurate TA (Symetis), Engager (Medtronic), and JenaValve the Portico (St Jude), Sadra Lotus Medical (Boston Scientific), and the Direct Flow Medical. These new inventions may introduce more effective treatment options for high-risk patients with severe aortic stenosis. Improvements in transcatheter valves and the developing variability among them may allow for more tailored approaches with respect to patient's anatomy, while giving operators the opportunity to choose devices they feel more comfortable with. Moreover, introducing new devices to the market will create a competitive environment among producers that will reduce high prices and expand availability. The present review article includes a discussion of recent patents related to Transcatheter Aortic Valves. PMID:24279506

Neragi-Miandoab, Siyamek; Skripochnik, Edvard; Salemi, Arash; Girardi, Leonard

2013-12-01

106

Intermediate-Term Results in Pediatric Aortic Valve Replacement  

Microsoft Academic Search

Background. Aortic valve replacement (AVR) in chil- dren is now more commonly performed with human tissue valves. Methods. The results of 100 consecutive pediatric AVRs (50 mechanical, 50 human) were reviewed. Results. There were five perioperative deaths in the mechanical group and one in the human group (p 5 0.2). Late complications in the mechanical group included 4 late deaths,

Flavian M. Lupinetti; Brian W. Duncan; Aaron M. Scifres; Collette T. Fearneyhough; Karen Kilian; Geoffrey L. Rosenthal; Frank Cecchin; Thomas K. Jones; S. Paul Herndon

107

Fatal bioprosthetic aortic valve endocarditis due to Cardiobacterium valvarum.  

PubMed

Cardiobacterium valvarum was isolated from the blood of a 71-year-old man with fatal aortic valve endocarditis. The API NH system was used for phenotypic characterization of the C. valvarum strain. This is the first case of infective endocarditis caused by C. valvarum in Germany and the first case worldwide affecting a prosthetic valve and lacking an obvious dental focus. PMID:17475754

Geissdörfer, Walter; Tandler, René; Schlundt, Christian; Weyand, Michael; Daniel, Werner G; Schoerner, Christoph

2007-07-01

108

Composite aortic root replacement with a bovine pericardial valve conduit  

Microsoft Academic Search

In order to offer selected patients undergoing composite aortic root replacement the advantages of a tissue valve, we have constructed conduits intraoperatively by suturing a stented bovine pericardial valve (Edwards Lifesciences LLC, Irvine, CA) inside of a Dacron tube graft (Boston Scientific Corp, Natick, MA). The conduit is quickly made from readily available materials, is easily implanted, and can accommodate

Alan D Hilgenberg; Bassem N Mora

2003-01-01

109

The First Case of Successful Transcatheter Aortic Valve Implantation Using CoreValve in Korea  

PubMed Central

Surgical replacement of the aortic valve is the standard therapy for severe aortic valve stenosis. However, it is generally associated with increased mortality and morbidities in older individuals. Transcatheter aortic valve implantation (TAVI) is a less invasive procedure and has shown similar clinical outcomes as surgical treatment in elderly patients at high risk for conventional surgery. In this report, we describe the first case of TAVI using a CoreValve in Korea. An 84-year-old man with symptomatic severe aortic valve stenosis was successfully treated by transfemoral TAVI. The patient was discharged without any significant complications and remained free of adverse clinical event for a follow-up duration of 6 months. PMID:23236334

Kim, In-Soo; Ko, Young-Guk; Shin, Sanghoon; Shim, Ji-Young; Lee, Sak; Chang, Byung-Chul; Shim, Jae-Kwang; Kwak, Young-Ran

2012-01-01

110

Systolic closure of aortic valve in patients with prosthetic mitral valves.  

PubMed Central

Systolic closure of the aortic valve was found in 10 of 36 patients who underwent mitral valve replacement. Eight patients had early systolic closure, and two had mid-systolic closure. The left ventricular outflow tract dimension on M-mode and two dimensional echocardiograms, left ventricular posterior wall and septal thickness, left ventricular dimensions in systole and diastole, aortic valve opening, and mitral to aortic valve distance were not significantly different between patients with and without systolic closure of the aortic valve. Two of the 10 patients with systolic aortic valve closure were catheterised and in neither was there a gradient between the left ventricle and the aorta. The two patients with mid-systolic closure, however, were the patients who had the narrowest left ventricular outflow tract which could cause significant distortion of blood flow. Systolic closure of the aortic valve in patients with mitral valve replacement is probably not caused by left ventricular outflow tract obstruction, though abnormalities in laminar flow from the left ventricular outflow tract may be involved. Images PMID:7082513

Eldar, M; Motro, M; Rath, S; Schy, N; Neufeld, H N

1982-01-01

111

Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis  

PubMed Central

Background Transcatheter aortic valve implantation (TAVI) has emerged as an acceptable treatment modality for patients with severe aortic stenosis who are deemed inoperable by conventional surgical aortic valve replacement (AVR). However, the role of TAVI in patients who are potential surgical candidates remains controversial. Methods A systematic review was conducted using five electronic databases, identifying all relevant studies with comparative data on TAVI versus AVR. The primary endpoint was all-cause mortality. A number of periprocedural outcomes were also assessed according to the Valve Academic Research Consortium endpoint definitions. Results Fourteen studies were quantitatively assessed and included for meta-analysis, including two randomized controlled trials and eleven observational studies. Results indicated no significant differences between TAVI and AVR in terms of all-cause and cardiovascular related mortality, stroke, myocardial infarction or acute renal failure. A subgroup analysis of randomized controlled trials identified a higher combined incidence of stroke or transient ischemic attacks in the TAVI group compared to the AVR group. TAVI was also found to be associated with a significantly higher incidence of vascular complications, permanent pacemaker requirement and moderate or severe aortic regurgitation. However, patients who underwent AVR were more likely to experience major bleeding. Both treatment modalities appeared to effectively reduce the transvalvular mean pressure gradient. Conclusions The available data on TAVI versus AVR for patients at a higher surgical risk showed that major adverse outcomes such as mortality and stroke appeared to be similar between the two treatment modalities. Evidence on the outcomes of TAVI compared with AVR in the current literature is limited by inconsistent patient selection criteria, heterogeneous definitions of clinical endpoints and relatively short follow-up periods. The indications for TAVI should therefore be limited to inoperable surgical candidates until long-term data become available. PMID:23977554

Cao, Christopher; Ang, Su C.; Indraratna, Praveen; Manganas, Con; Bannon, Paul; Black, Deborah; Tian, David

2013-01-01

112

Aortic valve replacement with Dacron-supported grafts  

PubMed Central

A method is described for inserting grafts on carrier rings in the aortic area when conditions for free grafting are not applicable, namely, dilated aortic root and friable aortic wall. In addition these grafts are suitable for use in the atrio-ventricular position. The results of 11 cases are presented; one early post-operative death occurred, the follow-up period being 3 to 6 months. It is shown that this method is practicable, the incidence of post-operative aortic incompetence may be reduced, and post-operative gradients do not occur if a valve of sufficient internal diameter is used. Images PMID:5711770

Watson, D. A.; Pearson, K. W.; Cawley, J. C.; Rhea, W. G.; Donnelly, R. J.; Dexter, F.

1968-01-01

113

Fulminant diffuse systemic sclerosis following aortic valve replacement.  

PubMed

We present a case of fulminant diffuse systemic sclerosis (dSSc) developed after the aortic valve replacement followed by fatal congestive heart failure within the 6 months from the initial symptoms. A 61-year-old male developed rapidly progressive diffuse systemic sclerosis following aortic valve replacement due to stenosis of bicuspid aortic valve. He presented with diarrhoea, weight loss, mialgia and arthralgia after cardiac surgery. Heart failure, due to myocardial fibrosis, was noted as a cause of death. We hypothesize that artificial materials like the ones used in mechanical valves or silicon materials in breast implants may induce fulminant course of pre-existing systemic sclerosis or create a new onset in predisposed individual. PMID:24735843

Marasovic-Krstulovic, Daniela; Jurisic, Zrinka; Perkovic, Dijana; Aljinovic, Jure; Martinovic-Kaliterna, Dusanka

2014-06-01

114

Mitral and mitro-aortic valve replacement with Sorin Bicarbon valves compared with St. Jude Medical valves  

Microsoft Academic Search

Objective: We assessed the clinical results of two bileaflet mechanical valves: the St. Jude Medical (SJM) and the Sorin Bicarbon (Sorin Bicarbon) used either in single mitral valve replacement (MVR) or in double, aortic and mitral, valve replacement (DVR).Methods: Between September 1990 and November 1995, 217 patients received either a St. Jude Medical (n=134) or a Sorin Bicarbon (n=86): 136

L. F Camilleri; P Bailly; B. J Legault; B Miguel; M.-C D'Agrosa-Boiteux; C. M de Riberolles

2001-01-01

115

Aortic valve replacement after repair of pulmonary atresia and ventricular septal defect or tetralogy of fallot  

Microsoft Academic Search

Objective: Little attention has been paid to the occurrence of aortic regurgitation after complete repair in patients with pulmonary atresia and ventricular septal defect or tetralogy of Fallot. To highlight the development of aortic regurgitation or aortic root dilation severe enough to necessitate aortic valve replacement with or without aortic aneurysmorrhaphy or aortic root replacement, we retrospectively reviewed the records

G. Alfred Dodds; Carole A. Warnes; Gordon K. Danielson

1997-01-01

116

Risk of Reoperative Valve Replacement for Failed Mitral and Aortic Bioprostheses  

Microsoft Academic Search

Background. One factor influencing the choice of mechanical versus bioprosthetic valves is reoperation for bioprosthetic valve failure. To define its operative risk, we reviewed our results with valve reoperation for bioprosthetic valve failure.Methods. Records of 400 consecutive patients having reoperative mitral, aortic, or mitral and aortic bioprosthetic valve replacement from January 1985 to March 1997 were reviewed.Results. Reoperations were for

Cary W. Akins; Mortimer J. Buckley; Willard M. Daggett; Alan D. Hilgenberg; Gus J. Vlahakes; David F. Torchiana; Joren C. Madsen

1998-01-01

117

Aortic Valve Leaflet Replacement with Bovine Pericardium to Preserve Native Dynamic Capabilities of the Aortic Annulus  

PubMed Central

Valve replacement is typically the most appropriate option for treating aortic valve stenotic insufficiency. However, neither mechanical nor bioprosthetic replacement components preserve the circumferential expansion and contraction of a native aortic annulus during the cardiac cycle, because the prosthetic ring is affixed to the annulus. A 64-year-old man presented with a bicuspid and stenotic aortic valve, and the native annulus was too small to accommodate a porcine replacement valve. We fashioned new aortic leaflets from bovine pericardium with use of a template, and we affixed the sinotubular junction with use of inner and outer stabilization rings. Postoperative echocardiograms revealed coaptation of the 3 new leaflets with no regurgitation. At the patient's 5.5-year follow-up examination, echocardiograms showed flexible leaflet movement with a coaptation height of 7 mm, and expansion and contraction of the aortic annulus similar to that of a normal native annulus. The transvalvular pressure gradient was insignificant. If long-term durability of the new leaflets is confirmed, this method of leaflet replacement and fixation of the sinotubular junction might serve as an acceptable alternative to valve replacement in the treatment of aortic valve stenosis. We describe the patient's case and present our methods and observations. PMID:24512414

Kim, Kyung Hwa; Kim, Min Ho; Kim, Won Ho; Lee, Mi Kyung; Lee, Sam Youn

2014-01-01

118

Resolution of an Acute Aortic Syndrome with Aortic Valve Insufficiency Post-PCI  

PubMed Central

Patient: Female, 52 Final Diagnosis: Acute aortic syndrome with aortic valve insufficiency post-PCI Symptoms: Chest pain Medication: — Clinical Procedure: Conservative Specialty: Cardiology Objective: Unusual or unexpected effect of treatment Background: Acute aortic syndrome is the modern term that includes aortic dissection, intramural hematoma, and symptomatic aortic ulcer. Iatrogenic coronary artery dissection extending to the aorta during percutaneous coronary intervention is a very rare but life-threatening complication. Despite some reports of spontaneous recovery, most of these patients are treated surgically as a spontaneous aortic dissection, especially if there is a complication of the aortic lesion. Case Report: A 52-year-old white female was submitted to an angioplasty in the right coronary without success and the procedure was complicated by a dissection in aortic root with progressive extension to the ascending aorta. This lesion deformed the aortic valve, leaving it with an acute moderate regurgitation. Because of current use of clopidogrel and clinical stability of the patient, the local Heart Team decided to withdrawn this antiplatelet for 5 days before surgery despite the risk related to the aortic syndrome. A new echocardiogram 3 days later showed that the hematoma was reabsorbed with improvement of the aortic insufficiency. An angiotomography confirmed the reabsorption of the hematoma. The surgery was canceled and the patient was maintained in a conservative treatment and discharged. Seventeen months later, she was re-evaluated and was still asymptomatic without aortic regurgitation in the echocardiogram and showing progressive regression of the aortic hematoma in the tomography. Conclusions: Despite the conservative treatment, this case of iatrogenic aortic dissection complicated by an acute aortic regurgitation had a good evolution in a follow-up of 17 months. PMID:25413612

de Barros e Silva, Pedro G.M.; Aquino, Thiago; Resende, Marcos V.; Richter, Ivo; Barros, Cecilia M.; Andrioli, Vanessa G.; Baruzzi, Antonio C.; Medeiros, Caio C.J.; Furlan, Valter

2014-01-01

119

Left main coronary artery obstruction by dislodged native-valve calculus after transcatheter aortic valve replacement.  

PubMed

Transcatheter aortic valve replacement can be an effective, reliable treatment for severe aortic stenosis in surgically high-risk or ineligible patients. However, various sequelae like coronary artery obstruction can occur, not only in the long term, but also immediately after the procedure. We present the case of a 78-year-old woman whose left main coronary artery became obstructed with calculus 2 hours after the transfemoral implantation of an Edwards Sapien XT aortic valve. Despite percutaneous coronary intervention in that artery, the patient died. This case reminds us that early recognition of acute coronary obstruction and prompt intervention are crucial in patients with aortic stenosis who have undergone transcatheter aortic valve replacement. PMID:25120396

Durmaz, Tahir; Ayhan, Huseyin; Keles, Telat; Aslan, Abdullah Nabi; Erdogan, Kemal Esref; Sari, Cenk; Bilen, Emine; Akcay, Murat; Bozkurt, Engin

2014-08-01

120

A planning system for transapical aortic valve implantation  

NASA Astrophysics Data System (ADS)

Stenosis of the aortic valve is a common cardiac disease. It is usually corrected surgically by replacing the valve with a mechanical or biological prosthesis. Transapical aortic valve implantation is an experimental minimally invasive surgical technique that is applied to patients with high operative risk to avoid pulmonary arrest. A stented biological prosthesis is mounted on a catheter. Through small incisions in the fifth intercostal space and the apex of the heart, the catheter is positioned under flouroscopy in the aortic root. The stent is expanded and unfolds the valve which is thereby implanted into the aortic root. Exact targeting is crucial, since major complications can arise from a misplaced valve. Planning software for the perioperative use is presented that allows for selection of the best fitting implant and calculation of the safe target area for that implant. The software uses contrast enhanced perioperative DynaCT images acquired under rapid pacing. In a semiautomatic process, a surface segmentation of the aortic root is created. User selected anatomical landmarks are used to calculate the geometric constraints for the size and position of the implant. The software is integrated into a PACS network based on DICOM communication to query and receive the images and implants templates from a PACS server. The planning results can be exported to the same server and from there can be rertieved by an intraoperative catheter guidance device.

Gessat, Michael; Merk, Denis R.; Falk, Volkmar; Walther, Thomas; Jacobs, Stefan; Nöttling, Alois; Burgert, Oliver

2009-02-01

121

Transapical aortic valve and mitral valve in ring prosthesis implantation - a new advance in transcatheter procedures.  

PubMed

Transcatheter valve implantation offers a new treatment modality to those patients whose general condition makes conventional surgery very risky. However, the transcatheter option has only been available for the aortic valve. We describe a case of a successful implantation of two Edwards SAPIEN(®) 26 and 29 mm transapical valves, respectively, in aortic and mitral positions, on a 74-year-old patient with severe aortic and mitral stenosis. The procedure progressed uneventfully. Predischarge echocardiogram showed a peak aortic gradient of 20 mmHg, mild periprosthetic regurgitation, peak and mean mitral gradients of 12 and 4, respectively, and moderate (II/IV) periprosthetic regurgitation. Indications for transapical valve implantation will rapidly increase in the near future. It is essential to individualize the treatment be applied for each patient, in order to optimize the success of the procedure. PMID:24786177

Neves, Paulo C; Paulo, Nelson Santos; Gama, Vasco; Vouga, Luís

2014-08-01

122

Aortic valve reconstruction with use of pericardial leaflets in adults with bicuspid aortic valve disease: early and midterm outcomes.  

PubMed

In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm(2)/m(2). The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure. PMID:25593520

Song, Meong Gun; Yang, Hyun Suk; Choi, Jong Bum; Shin, Je Kyoun; Chee, Hyun Keun; Kim, Jun Seok

2014-12-01

123

Aortic Valve Reconstruction with Use of Pericardial Leaflets in Adults with Bicuspid Aortic Valve Disease: Early and Midterm Outcomes  

PubMed Central

In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm2/m2. The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure.

Song, Meong Gun; Yang, Hyun Suk; Shin, Je Kyoun; Chee, Hyun Keun; Kim, Jun Seok

2014-01-01

124

Transcatheter aortic valve replacement: When invasive surgery is not an option.  

PubMed

Aortic stenosis is a common problem that typically results from calcification and degenerative changes of the aortic valve that occur with advancing age. Because medical therapies have no clinically proven role, the management of severe aortic stenosis has primarily been surgical. For patients who are too high-risk for surgical aortic valve repair, transcatheter aortic valve repair (TAVR), approved by the FDA in 2011, may be an option. This article outlines what clinicians need to know about TAVR. PMID:25621964

Dameron, Matthew R; Rathore, Sulaiman

2015-02-01

125

Papillary fibroelastomas of the aortic and tricuspid valves mimicking vegetations in a patient with Turner syndrome.  

PubMed

A patient with Turner syndrome presented with shortness of breath with exertion. Three-dimensional transesophageal echocardiogram revealed a bicuspid aortic valve with severe aortic stenosis. There were multiple masses attached to the aortic valve and tricuspid valve, which mimicked vegetations. The patient underwent aortic and tricuspid valve replacement. Histology revealed papillary fibroelastomas of the aortic and tricuspid valves. To our knowledge, this is the first report of papillary fibroelastomas involving the left- and the right-sided valves in a patient with Turner syndrome. PMID:25174858

Lin, Huili; Zheng, Jingsheng; O'Beirne, Patrick; Ukrainski, Gerald; Khaw, Kenneth; Saia, John; Ewing, Lannae; Montilla, Jorge; Bousanti, Chad; Wehner, Lawrence; Wrobleski, Edward

2014-10-01

126

Impact of small prosthetic valve size on operative mortality in elderly patients after aortic valve replacement for aortic stenosis: Does gender matter?  

Microsoft Academic Search

Objective: Ideal management of the elderly patient with a small aortic root remains controversial. This retrospective analysis was performed to determine whether small prosthetic valve size is related to outcome in patients 70 years of age or older undergoing aortic valve replacement for aortic stenosis. Methods: Between December 1991 and July 1998, 366 patients 70 years of age or older

David H. Adams; Raymond H. Chen; Alexander Kadner; Sary F. Aranki; Elizabeth N. Allred; Lawrence H. Cohn

1999-01-01

127

Etiology of bicuspid aortic valve disease: Focus on hemodynamics  

PubMed Central

The bicuspid aortic valve (BAV) is the most common form of inheritable cardiac defect. Although this abnormality may still achieve normal valvular function, it is often associated with secondary valvular and aortic complications such as calcific aortic valve disease and aortic dilation. The clinical significance and economic burden of BAV disease justify the need for improved clinical guidelines and more robust therapeutic modalities, which address the root-cause of those pathologies. Unfortunately, the etiology of BAV valvulopathy and aortopathy is still a debated issue. While the BAV anatomy and its secondary complications have been linked historically to a common genetic root, recent advances in medical imaging have demonstrated the existence of altered hemodynamics near BAV leaflets prone to calcification and BAV aortic regions vulnerable to dilation. The abnormal mechanical stresses imposed by the BAV on its leaflets and on the aortic wall could be transduced into cell-mediated processes, leading ultimately to valvular calcification and aortic medial degeneration. Despite increasing evidence for this hemodynamic etiology, the demonstration of the involvement of mechanical abnormalities in the pathogenesis of BAV disease requires the investigation of causality between the blood flow environment imposed on the leaflets and the aortic wall and the local biology, which has been lacking to date. This editorial discusses the different hypothetical etiologies of BAV disease with a particular focus on the most recent advances in cardiovascular imaging, flow characterization techniques and tissue culture methodologies that have provided new evidence in support of the hemodynamic theory. PMID:25548612

Atkins, Samantha K; Sucosky, Philippe

2014-01-01

128

Etiology of bicuspid aortic valve disease: Focus on hemodynamics.  

PubMed

The bicuspid aortic valve (BAV) is the most common form of inheritable cardiac defect. Although this abnormality may still achieve normal valvular function, it is often associated with secondary valvular and aortic complications such as calcific aortic valve disease and aortic dilation. The clinical significance and economic burden of BAV disease justify the need for improved clinical guidelines and more robust therapeutic modalities, which address the root-cause of those pathologies. Unfortunately, the etiology of BAV valvulopathy and aortopathy is still a debated issue. While the BAV anatomy and its secondary complications have been linked historically to a common genetic root, recent advances in medical imaging have demonstrated the existence of altered hemodynamics near BAV leaflets prone to calcification and BAV aortic regions vulnerable to dilation. The abnormal mechanical stresses imposed by the BAV on its leaflets and on the aortic wall could be transduced into cell-mediated processes, leading ultimately to valvular calcification and aortic medial degeneration. Despite increasing evidence for this hemodynamic etiology, the demonstration of the involvement of mechanical abnormalities in the pathogenesis of BAV disease requires the investigation of causality between the blood flow environment imposed on the leaflets and the aortic wall and the local biology, which has been lacking to date. This editorial discusses the different hypothetical etiologies of BAV disease with a particular focus on the most recent advances in cardiovascular imaging, flow characterization techniques and tissue culture methodologies that have provided new evidence in support of the hemodynamic theory. PMID:25548612

Atkins, Samantha K; Sucosky, Philippe

2014-12-26

129

Noninfectious Pseudoaneurysm of Ascending Aorta Following Redo-Aortic Valve Replacement  

Microsoft Academic Search

A 46 year old man had been undergone Aortic valve replacement (AVR) due to mechanical aortic valve endocarditis two month ago. He was referred to Imam Khomeini hospital because of dyspnea since two weeks ago. Echocardiography showed the false aneurysm, with an area of flow beyond the lumen of the aorta. This patient underwent reoperation, the previously implanted aortic valve

Younes Nozari; Nehzat Akiash

130

Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement  

PubMed Central

Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models. PMID:23125924

Li, Ming; Mazilu, Dumitru; Horvath, Keith A.

2012-01-01

131

Influence of aortic valve replacement, prosthesis type, and size on functional outcome and ventricular mass in patients with aortic stenosis  

Microsoft Academic Search

Objectives: Two years after surgery for severe aortic stenosis, we prospectively evaluated the influence of aortic valve replacement, as well as valve type (mechanical or stented biologic) and size, on functional status, left ventricular function, and regression of mass. Methods: Patients who received either a mechanical (n = 95) or a biologic valve (n = 42) were studied by echocardiography

Odd Bech-Hanssen; Kenneth Caidahl; Björn Wall; Pia Mykén; Sture Larsson; Ingemar Wallentin

1999-01-01

132

Successful pregnancy and delivery after pulmonary autograft operation (Ross procedure) for rheumatic aortic valve insufficiency.  

PubMed

A young woman with aortic valve insufficiency secondary to rheumatic heart disease underwent replacement of her diseased aortic valve with her own pulmonary valve and replacement of her pulmonary valve with an aortic cadaver homograft, the Ross procedure. She went on to conceive and deliver a normal infant. The Ross procedure is the operation of choice in a young woman with aortic valve disease, since it avoids anti-coagulation fetal loss, valve deterioration and other maternal risk from pregnancy associated with other valve replacement options. PMID:12806762

Martin, T C; Idahosa, V; Ogunbiyi, A; Fevrier-Roberts, G; Winter, A

2003-03-01

133

Aortic valve replacement for aortic regurgitation in a patient with primary antiphospholipid syndrome.  

PubMed

A 42-year-old woman with the diagnosis of aortic regurgitation was admitted to hospital for surgical treatment. Ten years ago, primary antiphospholipid syndrome had been diagnosed, and she had a history of recurrent spontaneous abortions and deep vein thrombosis. She was suffering from moderate exertional dyspnea and chest pain. Catheter investigation revealed progressive dilatation of the left ventricle and a deterioration of the ejection fraction. The aortic valve was excised and replaced with a mechanical valve. A specimen of the aortic valve showed localized thickening and shrinkage of the midportion and base of each cusp, with vegetation on the surface. These localized, specific findings suggest that another mechanism may be involved in the cardiac valve pathology in patients with primary antiphospholipid syndrome. No hemostatic or thromboembolic problems were encountered after the surgery, and her postoperative course was uneventful. PMID:10496490

Matsuyama, K; Ueda, Y; Ogino, H; Sugita, T; Matsubayashi, K; Nomoto, T; Yoshimura, S; Yoshioka, T

1999-09-01

134

ECG-Gated MDCT After Aortic and Mitral Valve Surgery.  

PubMed

OBJECTIVE. The purpose of this article is to review the utility of ECG-gated MDCT in evaluating postsurgical findings in aortic and mitral valves. Normal and pathologic findings after aortic and mitral valve corrective surgery are shown in correlation with the findings of the traditionally used imaging modalities echocardiography and fluoroscopy to assist in accurate noninvasive anatomic and dynamic evaluation of postsurgical valvular abnormalities. CONCLUSION. Because of its superior spatial and adequate temporal resolution, ECG-gated MDCT has emerged as a robust diagnostic tool in the evaluation and treatment of patients with postsurgical valvular abnormalities. PMID:25415724

Ghersin, Eduard; Martinez, Claudia A; Singh, Vikas; Fishman, Joel E; Macon, Conrad J; Runco Therrien, Jennifer E; Litmanovich, Diana E

2014-12-01

135

Acute thrombosis of mechanical bi-leaflet aortic valve prosthesis  

PubMed Central

Thrombosis of mechanical aortic valve prosthesis is a rare but life-threatening complication. In most reported cases, inadequate anticoagulation or cessation of anticoagulation is the cause of prosthesis thrombosis. The case of a 70-year-old male patient hospitalized for severe dyspnoea is presented. Although the patient was under continuous anticoagulation, thrombosis of the 16 years previously implanted mechanical 31-sized aortic valve prosthesis was diagnosed. Emergency surgery was performed and postoperative course was uneventful. Patients with large size prostheses should have closer anticoagulation monitoring, even after many years of event-free postimplant course. PMID:22923942

Tirilomis, Theodor

2012-01-01

136

Composite aortic root replacement with a bovine pericardial valve conduit.  

PubMed

In order to offer selected patients undergoing composite aortic root replacement the advantages of a tissue valve, we have constructed conduits intraoperatively by suturing a stented bovine pericardial valve (Edwards Life-sciences LLC, Irvine, CA) inside of a Dacron tube graft (Boston Scientific Corp, Natick, MA). The conduit is quickly made from readily available materials, is easily implanted, and can accommodate any of the anatomic situations encountered in repair of aortic root aneurysms. It is particularly suitable for patients 65 years of age and older. PMID:12683599

Hilgenberg, Alan D; Mora, Bassem N

2003-04-01

137

Concomitant mitral valve surgery with aortic valve replacement: a 21-year experience with a single mechanical prosthesis  

Microsoft Academic Search

BACKGROUND: Long-term survival for combined aortic and mitral valve replacement appears to be determined by the mitral valve prosthesis from our previous studies. This 21-year retrospective study assess long-term outcome and durability of aortic valve replacement (AVR) with either concomitant mitral valve replacement (MVR) or mitral valve repair (MVrep). We consider only a single mechanical prosthesis. METHODS: Three hundred and

Niall C McGonigle; J Mark Jones; Pushpinder Sidhu; Simon W MacGowan

2007-01-01

138

Intermediate-term results in pediatric aortic valve replacement  

Microsoft Academic Search

Background. Aortic valve replacement (AVR) in children is now more commonly performed with human tissue valves.Methods. The results of 100 consecutive pediatric AVRs (50 mechanical, 50 human) were reviewed.Results. There were five perioperative deaths in the mechanical group and one in the human group (p = 0.2). Late complications in the mechanical group included 4 late deaths, 2 cases of

Flavian M Lupinetti; Brian W Duncan; Aaron M Scifres; Collette T Fearneyhough; Karen Kilian; Geoffrey L Rosenthal; Frank Cecchin; Thomas K Jones; S. Paul Herndon

1999-01-01

139

Repeated thromboembolic and bleeding events after mechanical aortic valve replacement  

Microsoft Academic Search

Background. The choice of a valve substitute in young adults requires a decision balancing the risks of long-term anticoagulation versus reoperation(s). This article analyzes the long-term risk and determinants of thromboembolic (TE) and bleeding (BLE) complications after mechanical aortic valve replacement (AVR).Methods. From December 1963 to January 1974, 249 patients survived a mechanical AVR at our institution. Mean age was

Filip P Casselman; Michiel L Bots; Willem Van Lommel; Paul J Knaepen; Ruud Lensen; Freddy E. E Vermeulen

2001-01-01

140

Stanford type A aortic dissection after urgent prosthetic valve replacement: case reports  

PubMed Central

Occurrence of acute aortic dissection after aortic valve replacement is rare, however, it is associated with high mortality and morbidity rates. We report two Asian cases in which acute aortic dissection occurred after urgent aortic valve replacement for infective endocarditis. Successful graft replacement was carried out with preservation of the prosthetic valves in both cases. Our experience with these cases suggests that, even in urgent or emergent situations, surgical intervention for associated aortic dilatation should be considered when aortic valve replacement is performed. PMID:24397918

2014-01-01

141

Long-term follow-up of morbidity and mortality after aortic valve replacement with a mechanical valve prosthesis  

Microsoft Academic Search

Aims The aim of this study was to determine the incidence of valve-related complications in patients with a mechanical aortic valve prosthesis and to identify risk factors for an adverse outcome. Methods and Results In the 424 patients, event-free survival rates 5 and 10 years after aortic valve replacement were 62% and 37%, respectively. The linearized incidence of thromboembolic events

P. Kvidal; R. Bergstrom; T. Malm

2000-01-01

142

Biomechanical factors in the biology of aortic wall and aortic valve diseases  

PubMed Central

The biomechanical factors that result from the haemodynamic load on the cardiovascular system are a common denominator of several vascular pathologies. Thickening and calcification of the aortic valve will lead to reduced opening and the development of left ventricular outflow obstruction, referred to as aortic valve stenosis. The most common pathology of the aorta is the formation of an aneurysm, morphologically defined as a progressive dilatation of a vessel segment by more than 50% of its normal diameter. The aortic valve is exposed to both haemodynamic forces and structural leaflet deformation as it opens and closes with each heartbeat to assure unidirectional flow from the left ventricle to the aorta. The arterial pressure is translated into tension-dominated mechanical wall stress in the aorta. In addition, stress and strain are related through the aortic stiffness. Furthermore, blood flow over the valvular and vascular endothelial layer induces wall shear stress. Several pathophysiological processes of aortic valve stenosis and aortic aneurysms, such as macromolecule transport, gene expression alterations, cell death pathways, calcification, inflammation, and neoangiogenesis directly depend on biomechanical factors. PMID:23459103

Bäck, Magnus; Gasser, T. Christian; Michel, Jean-Baptiste; Caligiuri, Giuseppina

2013-01-01

143

Effect of transcatheter aortic valve implantation on QT dispersion in patients with aortic stenosis  

PubMed Central

Background QT dispersion (QTd) is a predictor of ventricular arrhythmia. Ventricular arrhythmia is an important factor influencing morbidity and mortality in patients with aortic stenosis. Surgical aortic valve replacement reduced the QTd in this patients group. However, the effect of transcatheter aortic valve implantation (TAVI) on QTd in patients with aortic stenosis is unknown. The aim of this study was to investigate the effect of TAVI on QTd in patients with aortic stenosis. Methods Patients with severe aortic stenosis, who were not candidates for surgical aortic valve replacement due to contraindications or high surgical risk, were included in the study. All patients underwent electrocardiographic and echocardiographic evaluation before, and at the 6th month after TAVI, computed QTd and left ventricular mass index (LVMI). Results A total 30 patients were admitted to the study (mean age 83.2 ± 1.0 years, female 21 and male 9, mean valve area 0.7 ± 3 mm2). Edwards SAPIEN heart valves, 23 mm (21 patients) and 26 mm (9 patients), by the transfemoral approach were used in the TAVI procedures. All TAVI procedures were successful. Both QTd and LVMI at the 6th month after TAVI were significantly reduced compared with baseline values of QTd and LVMI before TAVI (73.8 ± 4 ms vs. 68 ± 2 ms, P = 0.001 and 198 ± 51 g/m2 vs. 184 ± 40 g/m2, P = 0.04, respectively). There was a significant correlation between QTd and LVMI (r = 0.646, P < 0.001). Conclusions QTd, which malign ventricular arrhythmia marker, and LVMI were significantly reduced after TAVI procedure. TAVI may decrease the possibility of ventricular arrhythmia in patients with aortic stenosis. PMID:25593576

Erkan, Hakan; Hatem, Engin; A?aç, Mustafa Tar?k; Korkmaz, Levent; Gökdeniz, Teyyar; Aykan, Ahmet Ça?r?; Kalayc?o?lu, Ezgi; Boyac?, Faruk; Ç?rako?lu, Ömer Faruk; Çelik, ?ükrü

2014-01-01

144

Long-term outcome after biologic versus mechanical aortic valve replacement in 841 patients  

Microsoft Academic Search

Objective: The purpose of this study was to optimize selection criteria of biologic versus mechanical valve prostheses for aortic valve replacement. Methods: Retrospective analysis was performed for 841 patients undergoing isolated, first-time aortic valve replacement with Carpentier-Edwards (n = 429) or St Jude Medical (n = 412) prostheses. Results: Patients with Carpentier-Edwards and St Jude Medical valves had similar characteristics.

David S. Peterseim; Ye-Ying Cen; Srinivas Cheruvu; Kevin Landolfo; Thomas M. Bashore; James E. Lowe; Walter G. Wolfe; Donald D. Glower

1999-01-01

145

Transcatheter aortic valve implantation: Current status and future perspectives  

PubMed Central

Although surgical aortic valve replacement is the standard therapy for severe aortic stenosis (AS), about one third of patients are considered inoperable due to unacceptable surgical risk. Under medical treatment alone these patients have a very poor prognosis with a mortality rate of 50% at 2 years. Transcatheter aortic valve implantation (TAVI) has been used in these patients, and has shown robust results in the only randomized clinical trial of severe AS treatment performed so far. In this review, we will focus on the two commercially available systems: Edwards SAPIEN valve and CoreValve Revalving system. Both systems have demonstrated success rates of over 90% with 30-d mortality rates below 10% in the most recent transfemoral TAVI studies. Moreover, long-term studies have shown that the valves have good haemodynamic performance. Some studies are currently exploring the non-inferiority of TAVI procedures vs conventional surgery in high-risk patients, and long-term clinical results of the percutaneous valves. In this article we review the current status of TAVI including selection of patients, a comparison of available prostheses, results and complications of the procedure, clinical outcomes, and future perspectives. PMID:21772944

Salinas, Pablo; Moreno, Raul; Lopez-Sendon, Jose L

2011-01-01

146

Repair of Bicuspid Aortic Valve in the Presence of Endocarditis and Leaflet Perforation  

PubMed Central

Aortic valve repair can be a good option in younger patients who have severe aortic regurgitation. A systematic, disease-directed approach can simplify repair. This case report describes how a simplified approach can be successfully applied to complex pathologic conditions of the aortic valve. A 49-year-old man with a bicuspid aortic valve and a history of endocarditis presented with severe aortic regurgitation and evidence of recurrent infection. Intraoperatively, we found congenital and degenerative aortic anatomy with endocarditis and perforation. We performed aortic valve repair to enable leaflet coaptation and to adjust the coaptation height. After 24 months, the patient remained well, with an intact repair and trivial aortic regurgitation. We describe our systematic repair approach and rationales for targeting repairs to identified lesions. To our knowledge, this is the first description of complex aortic valve repairs in a patient who had simultaneous congenital, degenerative, and infectious conditions. PMID:24512405

Kent, William D.T.; Toeg, Hadi D.

2014-01-01

147

Quality of Life After Mechanical vs. Biological Aortic Valve Replacement  

Microsoft Academic Search

To assess the quality of life after biological and mechanical aortic valve replacement, data of 136 patients were assessed retrospectively after 2 years of follow-up. Bioprostheses were implanted in 53 patients with a mean age of 74 years, and mechanical prostheses were used in 83 with a mean age of 64 years; there were 47 women and 89 men. Quality

Anas Aboud; Martin Breuer; Torsten Bossert; Jan F Gummert

2010-01-01

148

Quality of Life After Mechanical vs. Biological Aortic Valve Replacement  

Microsoft Academic Search

To assess the quality of life after biological and mechanical aortic valve replacement, data of 136 patients were assessed retrospectively after 2 years of follow-up. Bioprostheses were implanted in 53 patients with a mean age of 74 years, and mechanical prostheses were used in 83 with a mean age of 64 years; there were 47 women and 89 men. Quality

Anas Aboud; Martin Breuer; Torsten Bossert; Jan F Gummert

2009-01-01

149

Patient-specific simulations of transcatheter aortic valve stent implantation.  

PubMed

Transcatheter aortic valve implantation (TAVI) enables treatment of aortic stenosis with no need for open heart surgery. According to current guidelines, only patients considered at high surgical risk can be treated with TAVI. In this study, patient-specific analyses were performed to explore the feasibility of TAVI in morphologies, which are currently borderline cases for a percutaneous approach. Five patients were recruited: four patients with failed bioprosthetic aortic valves (stenosis) and one patient with an incompetent, native aortic valve. Three-dimensional models of the implantation sites were reconstructed from computed tomography images. Within these realistic geometries, TAVI with an Edwards Sapien stent was simulated using finite element (FE) modelling. Engineering and clinical outcomes were assessed. In all patients, FE analysis proved that TAVI was morphologically feasible. After the implantation, stress distribution showed no risks of immediate device failure and geometric orifice areas increased with low risk of obstruction of the coronary arteries. Maximum principal stresses in the arterial walls were higher in the model with native outflow tract. FE analyses can both refine patient selection and characterise device mechanical performance in TAVI, overall impacting on procedural safety in the early introduction of percutaneous heart valve devices in new patient populations. PMID:22286953

Capelli, C; Bosi, G M; Cerri, E; Nordmeyer, J; Odenwald, T; Bonhoeffer, P; Migliavacca, F; Taylor, A M; Schievano, S

2012-02-01

150

Cerebral events and protection during transcatheter aortic valve replacement.  

PubMed

Stroke has emerged as one of the most concerning complications following transcatheter aortic valve replacement (TAVR), associated with high morbidity and mortality. We discuss the potential mechanisms of stroke following TAVR, as well as the newly developed embolic protection devices aimed to reduce the risk of stroke. PMID:24550141

Freeman, Melanie; Barbanti, Marco; Wood, David A; Ye, Jian; Webb, John G

2014-11-15

151

Severe pulmonary hypertension in advanced aortic valve disease.  

PubMed Central

Review of haemodynamic data of 151 cases with isolated aortic valve disease revealed severe pulmonary hypertension (pulmonary arterial systolic pressure of 60 mmHg or more) in 17 (11%). The left ventricular end-diastolic pressure was high in all but one case, suggesting that the severe pulmonary hypertension was a reflection of the late stages of aortic valve disease. The majority (64.7%) had a low cardiac index. Premature closure of the mitral valve was seen in 12 of the 17 patients. While the incidence of premature mitral closure was the same as in others with mild and moderate pulmonary hypertension, the average reversed ventriculoatrial gradient was higher in the latter groups. PMID:718773

Basu, B; Cherian, G; Krishnaswami, S; Sukumar, I P; John, S

1978-01-01

152

Aortic root disease in athletes: aortic root dilation, anomalous coronary artery, bicuspid aortic valve, and Marfan's syndrome.  

PubMed

Two professional athletes in the U.S. National Basketball Association required surgery for aortic root dilation in 2012. These cases have attracted attention in sports medicine to the importance of aortic root disease in athletes. In addition to aortic root dilation, other forms of aortic disease include anomalous coronary artery, bicuspid aortic valve, and Marfan's syndrome. In this review, electronic database literature searches were performed using the terms "aortic root" and "athletes." The literature search produced 122 manuscripts. Of these, 22 were on aortic root dilation, 21 on anomalous coronary arteries, 12 on bicuspid aortic valves, and 8 on Marfan's syndrome. Aortic root dilation is a condition involving pathologic dilation of the aortic root, which can lead to life-threatening sequelae. Prevalence of the condition among athletes and higher risk athletes in particular sports needs to be better delineated. Normative parameters for aortic root diameter in the general population are proportionate to anthropomorphic variables, but this has not been validated for athletes at the extremes of anthropomorphic indices. Although echocardiography is the favored screening modality, computed tomography (CT) and cardiac magnetic resonance imaging (MRI) are also used for diagnosis and surgical planning. Medical management has utilized beta-blockers, with more recent use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and statins. Indications for surgery are based on comorbidities, degree of dilation, and rate of progression. Management decisions for aortic root dilation in athletes are nuanced and will benefit from the development of evidence-based guidelines. Anomalous coronary artery is another form of aortic disease with relevance in athletes. Diagnosis has traditionally been through cardiac catheterization, but more recently has included evaluation with echocardiography, multislice CT, and MRI. Athletes with this condition should be restricted from participation in competitive sports, but can be cleared for participation 6 months after surgical repair. Bicuspid aortic valve is another form of aortic root disease with significance in athletes. Although echocardiography has traditionally been used for diagnosis, CT and MRI have proven more sensitive and specific. Management of bicuspid aortic valve consists of surveillance through echocardiography, medical therapy with beta-blockers and ARBs, and surgery. Guidelines for sports participation are based on the presence of aortic stenosis, aortic regurgitation, and aortic root dilation. Marfan's syndrome is a genetic disorder with a number of cardiac manifestations including aortic root dilation, aneurysm, and dissection. Medical management involves beta-blockers and ARBs. Thresholds for surgical management differ from the general population. With regard to sports participation, the most important consideration is early detection. Athletes with the stigmata of Marfan's syndrome or with family history should be tested. Further research should determine whether more aggressive screening is warranted in sports with taller athletes. Athletes with Marfan's syndrome should be restricted from activities involving collision and heavy contact, avoid isometric exercise, and only participate in activities with low intensity, low dynamic, and low static components. In summary, many forms of aortic root disease afflict athletes and need to be appreciated by sports medicine practitioners because of their potential to lead to tragic but preventable deaths in an otherwise healthy population. PMID:23674060

Yim, Eugene Sun

2013-08-01

153

Risk-corrected impact of mechanical versus bioprosthetic valves on long-term mortality after aortic valve replacement  

Microsoft Academic Search

Supplemental material is available online. Objective: Choice of a mechanical or biologic valve in aortic valve replacement remains controversial and rotates around different complications with different time-related incidence rates. Because serious complications will always \\

Ole Lund; Martin Bland

154

Bicuspid aortic valve and severe aortic stenosis in a newborn exposed to carbamazapine during pregnancy  

PubMed Central

The use of antiepileptic drugs increases the risk of major congenital malformations during pregnancy. Here, we report an infant who had a history of in-utero carbamazepine exposure and who was born with a cardiac malformation. The infant was born at 39 weeks of gestation vaginally to an epileptic mother who had been treated with carbamazepine throughout her pregnancy. He was referred due to cardiac murmur in the second week of his life. The mother had not received folic acid supplementation. Transthoracic echocardiography revealed bicuspid aortic valve, mild aortic stenosis, patent ductus arteriosus, patent foramen ovale and the renal ultrasound revealed mild left hydronephrosis. Follow-up echocardiography performed 14 weeks later showed increased severity of aortic stenosis and percutaneous balloon aortic valvuloplasty was performed. To our knowledge, there is only one case report in the literature mentioning the association of a bicuspid aortic valve and aortic stenosis with oxcarbazepine exposure, which is a structural derivative of carbamazepine. However, there are no reports for association with carbamazepine itself. Bicuspid aorta and aortic stenosis may be among the cardiac malformations that result from the teratogenic effect of carbamazepine. PMID:25584038

Karata?, Zehra; Karata?, Ahmet; Özlü, Tülay; Goksugur, Sevil B.; Varan, Birgül

2014-01-01

155

Planimetry of aortic valve area using multiplane transoesophageal echocardiography is not a reliable method for assessing severity of aortic stenosis.  

PubMed Central

OBJECTIVE: To assess the reliability of aortic valve area planimetry by multiplane transoesophageal echocardiography (TOE) in aortic stenosis. DESIGN: Study of the diagnostic value of aortic valve area planimetry using multiplane TOE, compared with catheterisation and the continuity equation, both being considered as criterion standards. SETTING: University hospital. PATIENTS: 49 consecutive patients (29 male, 20 female, aged 44 to 82 years, average 66.6 (SD 8.5)), referred for haemodynamic evaluation of an aortic stenosis, were enrolled in a prospective study. From this sample, 37 patients were eligible for the final analysis. METHODS: Transthoracic and multiplane transoesophageal echocardiograms were performed within 24 hours before catheterisation. At transthoracic echo, aortic valve area was calculated by the continuity equation. At TOE, the image of the aortic valve opening was obtained with a 30-65 degrees rotation of the transducer. Numerical dynamic images were stored on optical discs for off-line analysis and were reviewed by two blinded observers. Catheterisation was performed in all cases and aortic valve area was calculated by the Gorlin formula. RESULTS: Feasibility of the method was 92% (48/52). The agreement between aortic valve area measured at TOE (mean 0.88 (SD 0.35) cm2) and at catheterisation (0.79 (0.24) cm2) was very poor. The same discrepancies were found between TOE and the continuity equation (0.72 (0.26) cm2). TOE planimetry overestimated aortic valve area determined by the two other methods. Predictive positive and negative values of planimetry to detect aortic valve area < 0.75 cm2 were 62% (10/16) and 43% (9/21) respectively. CONCLUSIONS: Planimetry of aortic valve area by TOE is difficult and less accurate than the continuity equation for assessing the severity of aortic stenosis. Images PMID:9290405

Bernard, Y.; Meneveau, N.; Vuillemenot, A.; Magnin, D.; Anguenot, T.; Schiele, F.; Bassand, J. P.

1997-01-01

156

Simulations of transcatheter aortic valve implantation: implications for aortic root rupture.  

PubMed

Aortic root rupture is one of the most severe complications of transcatheter aortic valve implantation (TAVI). The mechanism of this adverse event remains mostly unknown. The purpose of this study was to obtain a better understanding of the biomechanical interaction between the tissue and stent for patients with a high risk of aortic rupture. We simulated the stent deployment process of three TAVI patients with high aortic rupture risk using finite element method. The first case was a retrospective analysis of an aortic rupture case, while the other two cases were prospective studies, which ended with one canceled procedure and one successful TAVI. Simulation results were evaluated for the risk of aortic root rupture, as well as coronary artery occlusion, and paravalvular leak. For Case 1, the simulated aortic rupture location was the same as clinical observations. From the simulation results, it can be seen that the large calcified spot on the interior of the left coronary sinus between coronary ostium and the aortic annulus was pushed by the stent, causing the aortic rupture. For Case 2 and Case 3, predicated results from the simulations were presented to the clinicians at multidisciplinary pre-procedure meetings; and they were in agreement with clinician's observations and decisions. Our results indicated that the engineering analysis could provide additional information to help clinicians evaluate complicated, high-risk aortic rupture cases. Since a systematic study of a large patient cohort of aortic rupture is currently not available (due to the low occurrence rate) to clearly understand underlying rupture mechanisms, case-by-case engineering analysis is recommended for evaluating patient-specific aortic rupture risk. PMID:24736808

Wang, Qian; Kodali, Susheel; Primiano, Charles; Sun, Wei

2015-01-01

157

Mixed aortic valve disease in the young: initial observations.  

PubMed

The short-term surgical results for mixed aortic valve disease (MAVD) and the long-term effects on the left ventricle (LV) are unknown. Retrospective review identified patients with at least both moderate aortic stenosis (AS) and aortic regurgitation (AR) before surgical intervention. A one-to-one comparison cohort of patients with MAVD not referred for surgical intervention was identified. The 45 patients in this study underwent surgical management for MAVD. A control group of 45 medically managed patients with MAVD also was identified. Both groups had elevated LV end-diastolic volume (EDV), elevated LV mass, a normal LV mass:volume ratio (MVR), and a normal ejection fraction. Both groups had diastolic dysfunction shown by early diastolic pulsed-Doppler mitral inflow/early diastolic tissue Doppler velocity z-score. The LV end-diastolic pressure (EDP) was correlated with age (R = 0.4; p = 0.03) and LV MVR (R = 0.4; p = 0.03) but not with AS, AR, or the score combining gradient and LV size. As shown by 6- to 12-month postoperative echocardiograms, aortic valve gradients and AR significantly improved (gradient 65 ± 17 to 28 ± 18 mmHg, p = 0.01; median regurgitation grade moderate to mild; p < 0.01), LV EDV normalized, and LV mass significantly improved (p < 0.01). Diastolic dysfunction was unchanged. Symptoms did not correlate with any measured parameter, but the preoperative symptoms resolved. In conclusion, despite diastolic dysfunction, systolic function is invariably preserved, and symptoms are not correlated with aortic valve function or LV EDP. Current surgical practice preserves LV mechanics and results in short-term improvement in valve function and symptoms. PMID:24563072

Hill, Allison C; Brown, David W; Colan, Steven D; Gauvreau, Kimberly; del Nido, Pedro J; Lock, James E; Rathod, Rahul H

2014-08-01

158

Altered Micrornas in Bicuspid Aortic Valve: A Comparison between Stenotic and Insufficient Valves  

PubMed Central

Background Bicuspid aortic valve (BAV), the most common form of congenital heart disease, is a leading cause of aortic stenosis (AS) and aortic insufficiency (AI). AS is typically due to calcific valve disease. Recently, microRNAs (miRNAs) have been shown to modulate gene expression. This study examined miRNAs that were altered in aortic valve leaflets of patients with AS compared to patients with AI. Additionally, in vitro experiments were performed to examine if these miRNAs modulate calcification-related genes. Materials and Methods Aortic valve samples (fused or unfused leaflets) were collected from 9 patients (mean age 44.9±13.8 years) undergoing aortic valve replacement. PIQOR™ miRXplore Microarrays containing 1421 miRNAs were used and hybridized to fused leaflet samples labeled with Cy5; unfused samples were used as control and labeled with Cy3. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to validate the miRNA array results. Cultured human aortic valve cells (AVICs) were treated with miRNA mimics and qRT-PCR was performed to determine changes in mRNAs. Results Seven miRNAs were statistically different between the AS and AI patients by microarray. MiR-26a and miR-195 levels were reduced by 65% and 59% respectively with p<0.05 in the stenotic samples by qRT-PCR. MiR-30b was reduced by 62% (p<0.06) in the stenotic samples by qRT-PCR. Human AVICs treated with miR-26a or miR-30b mimics had decreased mRNA levels of calcification-related genes. MiR-26a repressed BMP2 by 36%, ALKALINE PHOSPHATASE (ALPL) by 38%, and SMAD1 by 26%. MiR-30b reduced expression of SMAD1 by 18% and SMAD3 by 12%. Whereas miR-195 treated AVICs had increased mRNA levels of calcification-related genes such as BMP2 by 68% and RUNX2 by 11%. Conclusions MiR-26a, miR-30b, and miR-195 were decreased in the aortic valves of patients requiring valve replacement due to AS compared to those being replaced due to AI. These miRNAs appear to modulate calcification related genes in vitro. PMID:20845893

Nigam, Vishal; Sievers, Hans H.; Jensen, Brian C.; Sier, Holger A.; Simpson, Paul C.; Srivastava, Deepak; Mohamed, Salah A.

2011-01-01

159

Intramedullary cervical abscess in the setting of aortic valve endocarditis.  

PubMed

Spinal cord tissue has a remarkable resistance to infection. An intramedullary abscess is an exceptional complication of infective endocarditis in the post-antibiotic era. We describe the case of a 42-year-old man who presented with fever and cephalea. Two days later, left-side numbness, lack of sphincter control, and a new aortic murmur were noticed. Magnetic resonance imaging demonstrated an 8?×15-mm intramedullary cervical abscess. Transesophageal echocardiography revealed an aortic valve perforation as a result of infective endocarditis. Conservative management was decided for the intramedullary abscess. PMID:24887857

Arnáiz-García, María Elena; González-Santos, Jose María; López-Rodriguez, Javier; Dalmau-Sorli, María José; Bueno-Codoñer, María; Arévalo-Abascal, Adolfo

2015-01-01

160

Transcatheter aortic valve implantation complicated by acute pericardial tamponade  

PubMed Central

Transcatheter aortic valve replacement (TAVR) is now an accepted standard of care for patients with symptomatic severe aortic stenosis who are not candidates for surgery or have high surgical risk. Despite its more widespread adoption as a treatment option and increasing experience of centers, TAVR is still associated with several complications. We therefore report a case of TAVR complicated by acute pericardial tamponade, one of the most severe potential complications of this procedure. We describe the way we approached the problem and we try to give a potential take-home message for others who might encounter such a situation in their own cath lab. PMID:24799924

Suwalski, Piotr; Pawlak, Agnieszka; Kulawik, Tomasz; Byczkowska, Katarzyna; Gil, Robert J.

2014-01-01

161

A rare complication with Edwards Sapien: Aortic valve embolization in TAVI.  

PubMed

One of the problems is valve embolization at the time of transcatheter aortic valve implantation, which is a rare but serious complication. In this case, we have shown balloon expandable aortic valve embolization TAVI which is a rare complication and we managed with second valve without surgery. Although there is not enough experience in the literature, embolized valve was re-positioned in the arch aorta between truncus brachiocephalicus and left common carotid artery. PMID:24788062

Ayhan, Hüseyin; Durmaz, Tahir; Kele?, Telat; Kasapkara, Hac? Ahmet; Erdo?an, Kemal E?ref; Bozkurt, Engin

2015-02-01

162

Retrograde aortic valve crossing of the corevalve prosthesis using the buddy balloon technique.  

PubMed

In rare cases, retrograde aortic valve crossing during transcatheter aortic valve implantation may be challenging despite improvements in delivery catheter profile, size, and steerability compared with the first generation devices. Herein, we report a case of challenging transfemoral Medtronic CoreValve placement that was possible, thanks to the buddy balloon technique, using a peripheral 6-F compatible balloon. PMID:24115674

Noble, Stephane; Roffi, Marco

2014-11-15

163

Is Aortic Valve Replacement with Bileaflet Prostheses Still Contraindicated in the Elderly?  

Microsoft Academic Search

Background: Prolonged survival in the Western world has increased the number of elderly patients referred for open-heart surgery during the last decade. Aortic valve disease is the most common heart valve disease in aged patients. Which aortic valve substitute is best employed in the elderly is still a debated matter. The main concern is about the thromboembolic and hemorrhagic risks

Marisa De Feo; Attilio Renzulli; Mariano Vicchio; Alessandro Della Corte; Francesco Onorati; Maurizio Cotrufo

2002-01-01

164

Apparent recurrence of Q fever endocarditis following homograft replacement of aortic valve  

Microsoft Academic Search

A 39-year-old man with aortic stenosis and regurgitation developed Q fever endocarditis. After 15 weeks of chemotherapy with tetracycline the damaged aortic valve was replaced with a homograft. Organisms were present in the excised valve. Some months later the valve began to leak and the endocarditis recurred fatally. Because of the nature of rickettsial infection neither a course of chemotherapy

H. D. Tunstall Pedoe

1970-01-01

165

A three-dimensional computational analysis of fluid–structure interaction in the aortic valve  

Microsoft Academic Search

Numerical analysis of the aortic valve has mainly been focused on the closing behaviour during the diastolic phase rather than the kinematic opening and closing behaviour during the systolic phase of the cardiac cycle. Moreover, the fluid–structure interaction in the aortic valve system is most frequently ignored in numerical modelling. The effect of this interaction on the valve's behaviour during

J. De Hart; G. W. M. Peters; P. J. G. Schreurs; F. P. T. Baaijens

2003-01-01

166

Consecutive transcatheter valve-in-valve implantations: the first in the aortic position, the second in the mitral position, in a patient with failing aortic and mitral bioprostheses.  

PubMed

A 69-year-old man with a failing aortic valve homograft and failing mitral valve xenograft was admitted with an inability to complete full sentences and pulmonary oedema with right ventricular overload. Severe aortic and mitral regurgitation, severe biventricular impairment and pulmonary hypertension were confirmed on transthoracic and transoesophageal echocardiography. An urgent transfemoral valve-in-valve transcatheter valve implantation (TAVI) was performed within the aortic valve homograft with full resolution of aortic regurgitation. Three months later, a semielective trans-apical valve-in-valve procedure was performed in the mitral position, under cardiopulmonary bypass, with full resolution of mitral regurgitation. His exercise tolerance increased from 5 yards to half a mile. This case report summarises a staged double valve-in-valve procedure in a patient who had three previous sternotomies and who had severe heart failure due to failing aortic and mitral bioprostheses. We report two different delivery approaches, using two different transcatheter devices, and describe valve-in-valve techniques, including cardiopulmonary bypass, in the catheter laboratory. PMID:25053698

Duncan, Alison; Davies, Simon; Rosendahl, Ulrich; Moat, Neil

2014-01-01

167

Hemodynamic Environments from Opposing Sides of Human Aortic Valve Leaflets Evoke Distinct Endothelial Phenotypes In Vitro  

E-print Network

The regulation of valvular endothelial phenotypes by the hemodynamic environments of the human aortic valve is poorly understood. The nodular lesions of calcific aortic stenosis (CAS) develop predominantly beneath the ...

Weinberg, Eli J.

168

Minimally invasive aortic valve replacement: the “Miami Method”  

PubMed Central

For patients undergoing aortic valve replacement (AVR), a minimally invasive approach performed via a right anterior thoracotomy is the preferred method at our institution. This method has evolved over a 10-year span, being applied to over 1,500 patients with the commitment of one surgeon seeking to offer a simplistic and reproducible minimally invasive alternative. We believe that this is truly the least invasive approach to the aortic valve since it avoids sternal invasion. By virtue of being less traumatic, the morbidity is diminished and therefore the recovery is enhanced. We believe that this approach is most beneficial in the high risk patient such as the elderly, the obese, those with chronic obstructive pulmonary, chronic kidney disease and those requiring re-operative surgery. This method has proven to be safe and effective in all patients requiring isolated AVR surgery. The only relative exclusion criteria would be a porcelain aorta with the inability to cannulate the patient.

2015-01-01

169

Cerebrovascular Events After Stentless Aortic Valve Replacement During a 9Year Follow-Up Period  

Microsoft Academic Search

Background. One major advantage of biologic aortic valve prostheses is their low thrombogenicity compared with mechanical prostheses. The purpose of this study was to evaluate the incidence of cerebrovascular events during long-term follow-up after stentless aortic valve replacement. Methods. Between 1996 and 2005, 1,014 patients (mean age, 73 years; range, 20 to 90 years) received stentless aortic valve replacement (Freestyle;

Helmut Gulbins; Ines Florath; Juergen Ennker

170

Stroke following transcatheter aortic valve implantation. Is neuroprotection justified?  

PubMed Central

Degenerative aortic stenosis (AS) is the most frequent type of valvular heart disease. In patients with symptomatic AS surgical aortic valve replacement (SAVR) is a recommended treatment strategy. Due to a high risk of perioperative mortality, up to 30% of patients with AS are considered not suitable for SAVR. In the last 10 years dynamic development of transcatheter aortic valve implantation (TAVI) has been observed as an alternative to SAVR in patients with AS and high risk for surgery. In the two randomized trials published so far and numerous registries, stroke and transient ischemic attack still remain serious periprocedural complications after TAVI. Because the majority of these episodes are driven by microembolization during the procedure, different neuroprotection devices were developed and clinically tested. Embrella and SMT are deflector devices, using a microporous membrane mounted on a nitinol frame, designed to cover the ostia of the brachiocephalic trunk and the left carotid artery. The Claret System is designed to filter cerebral blood flow within the ostia of the brachiocephalic trunk, as well as in the left common carotid artery. Randomized clinical data have demonstrated that TAVI is associated with more neurological events compared to SAVR. However, to date the efficacy of the neuroprotection systems has not been assessed in randomized trials. Before we know the results of such trials, the use of the devices should be limited to patients at high risk of neurological complications, such as patients with previous stroke, massive calcification on aortic leaflets, annulus and porcelain aorta. PMID:24570756

Witkowski, Adam

2013-01-01

171

Performance of the Smeloff aortic valve beyond ten years.  

PubMed

The Smeloff aortic valve has remained unchanged in design and material since 1966. To assess the long-term performance of this prosthesis, we reviewed 394 consecutive patients undergoing elective aortic valve replacement. Concomitant coronary artery bypass grafting was performed in 26.4% of these patients. Follow-up was complete in 96%; maximum follow-up was 13.1 years (mean 4.3 years). The operative mortality was 7.4%. Actuarial survival rate, including operative mortality, was 66.3% +/- 2.8% at 5 years and 48.7% +/- 4.5% at 10 years. Thromboembolism for the entire group occurred at a rate of 3.8% per patient-year. Patients who underwent anticoagulation continuously had a rate of embolision of 1.8% per patient-year. All patients had a 5 year embolus-free rate of 91% +/- 2% and a 10 year embolus-free rate of 85% +/- 3%. Patients receiving anticoagulants had a 5 year embolus-free rate of 92% +/- 2% and a 10 year embolus-free rate of 89% +/- 3%. There was no mechanical failure or prosthetic thrombosis in 1,690 patient-years of follow-up. The Smeloff aortic valve has excellent long-term durability and thromboembolism is low in patients receiving anticoagulants. PMID:3484530

Harlan, B J; Smeloff, E A; Miller, G E; Kelly, P B; Junod, F L; Ross, K A; Shankar, K G

1986-01-01

172

Midterm follow-up dynamic echocardiography evaluation after aortic valve repair for aortic valve insufficiency  

PubMed Central

We prospectively evaluated 46 patients who underwent aortic valve repair (AVR) for AV regurgitation. Rest/stress echocardiography follow-up was performed. Follow-up duration was 30.7 months, age 56 ± 14 years, ejection fraction% 57.5 ± 10.5%. Preoperative bicuspid AV was present in 14 (30.4%), leaflets calcifications in 8 (17.4%), thickening in 17 (37.0%) and prolapse in 22 (47.8%). Surgical technique included commissuroplasty (22, 47.8%), leaflet remodelling (17, 37.0%), decalcification (7, 15.2%) and raphe removal (14, 30.4%). At follow-up, rest/stress echocardiography median AV regurgitation (rest 1.0 vs. stress 1.0) and mean indexed AV area (IAVA) (rest 2.6 ± 0.74 cm2/m2 vs. stress 2.8 ± 0.4 cm2/m2) were unchanged (P = ns). Mean (rest 4.7 ± 3.9 mmHg vs. stress 9.7 ± 5.8 mmHg) and peak (rest 9.5 ± 7.2 mmHg vs. stress 19.0 ± 10.5 mmHg) transvalvular gradients were significantly increased (P < 0.0001). At linear regression, there was an independent inverse correlation between commissuroplasty and AV gradients during stress (B = ?9.9, P = 0.01, confidence interval= ?17.7 to ?2.1). Although follow-up haemodynamics of repaired AVs are satisfactory, there was a fixed IAVA and significant increase in AV gradients. We were not able to identify any pre-existing anatomical condition independently related to this non-physiological behaviour under stress. Moreover, commissuroplasty seems to prevent abnormal increase of the AV gradients. PMID:22368109

D'Ancona, Giuseppe; Amaducci, Andrea; Prodromo, John; Pirone, Francesco; Follis, Marco; Falletta, Calogero; Pilato, Michele

2012-01-01

173

Experimental measurement of dynamic fluid shear stress on the aortic surface of the aortic valve leaflet  

PubMed Central

Aortic valve (AV) calcification is a highly prevalent disease with serious impact on mortality and morbidity. Although exact causes and mechanisms of AV calcification are unclear, previous studies suggest that mechanical forces play a role. Since calcium deposits occur almost exclusively on the aortic surfaces of AV leaflets, it has been hypothesized that adverse patterns of fluid shear stress on the aortic surface of AV leaflets promote calcification. The current study characterizes AV leaflet aortic surface fluid shear stresses using Laser Doppler velocimetry and an in vitro pulsatile flow loop. The valve model used was a native porcine valve mounted on a suturing ring and preserved using 0.15% glutaraldehyde solution. This valve model was inserted in a mounting chamber with sinus geometries, which is made of clear acrylic to provide optical access for measurements. To understand the effects of hemodynamics on fluid shear stress, shear stress was measured across a range of conditions: varying stroke volumes at the same heart rate and varying heart rates at the same stroke volume. Systolic shear stress magnitude was found to be much higher than diastolic shear stress magnitude due to the stronger flow in the sinuses during systole, reaching up to 20 dyn/cm2 at mid-systole. Upon increasing stroke volume, fluid shear stresses increased due to stronger sinus fluid motion. Upon increasing heart rate, fluid shear stresses decreased due to reduced systolic duration that restricted the formation of strong sinus flow. Significant changes in the shear stress waveform were observed at 90 beats/ min, most likely due to altered leaflet dynamics at this higher heart rate. Overall, this study represents the most well-resolved shear stress measurements to date across a range of conditions on the aortic side of the AV. The data presented can be used for further investigation to understand AV biological response to shear stresses. PMID:21416247

Yap, Choon Hwai; Saikrishnan, Neelakantan; Tamilselvan, Gowthami

2011-01-01

174

Asymptomatic Strut Fracture in DeBakey-Surgitool Aortic Valves  

PubMed Central

From August 1971 through November 1972, we implanted 62 Model 2 DeBakey-Surgitool aortic valve prostheses in 62 patients, 4 of whom later had clinically asymptomatic strut fractures. In 1 case, the patient died suddenly, and autopsy revealed detachment of the ball-cage; in each of the other 3 cases, fractures of 2 struts close to the base of the prosthesis were diagnosed fluoroscopically, and the patients underwent successful reoperation. The interval between implantation and reoperation ranged from 11 months to 16 years, 9 months. In 1 patient, retrospective study of chest radiographs revealed that the fracture had been present for 2½ years. Larger valves (? A6) were affected significantly more often than smaller ones. We performed metallurgic analysis of 1 prosthesis: results revealed strut wear from fatigue cracking and secondary abrasion. Strut fracture was also promoted by suspension of the cage at right angles to the prosthetic ring and by use of a pyrolytic carbon ball in a titanium cage (i.e., an occluder harder than its holder). Patients with DeBakey-Surgitool aortic valve prostheses should undergo annual radiologic examinations to enable early detection of strut fractures. Prophylactic valve replacement is not indicated. (Texas Heart Institute Journal 1990;17:223-7) Images PMID:15227175

Von Der Emde, Jürgen; Eberlein, Ulrich; Breme, Jürgen

1990-01-01

175

Survival after stentless and stented xenograft aortic valve replacement: a concurrent, controlled trial  

Microsoft Academic Search

BackgroundTo define the impact of stentless versus stented valve design on survival late after xenograft aortic valve replacement, a retrospective analysis of all consecutive patients operated on between January 1992 and April 2000 was undertaken.

Giovanni Battista Luciani; Gianluca Casali; Stefano Auriemma; Francesco Santini; Alessandro Mazzucco

2002-01-01

176

State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair.  

PubMed

Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks. PMID:24429327

Rengier, Fabian; Geisbüsch, Philipp; Schoenhagen, Paul; Müller-Eschner, Matthias; Vosshenrich, Rolf; Karmonik, Christof; von Tengg-Kobligk, Hendrik; Partovi, Sasan

2014-01-01

177

Stress Variations in the Human Aortic Root and Valve: The Role of Anatomic Asymmetry  

Microsoft Academic Search

The asymmetry of the aortic valve and aortic root may influence their biomechanics, yet was not considered in previous valve models. This study developed an anatomically representative model to evaluate the regional stresses of the valve within the root environment. A finite-element model was created from magnetic-resonance images of nine human valve–root specimens, carefully preserving their asymmetry. Regional thicknesses and

K. Jane Grande; Richard P. Cochran; Per G. Reinhall; Karyn S. Kunzelman

1998-01-01

178

Portal vein thrombosis after aortic valve replacement surgery in a patient with antithrombin III deficiency - case presentation  

PubMed Central

We presented an unique case of portal vein thrombosis (PVT) after aortic valve replacement due to antithrombin III (ATIII) deficiency. PVT after aortic valve replacement (AVR) is a serious complication, which has not previously been reported. PMID:24775062

2014-01-01

179

Feature identification for image-guided transcatheter aortic valve implantation  

NASA Astrophysics Data System (ADS)

Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to open-heart surgery, and is critically dependent on imaging for accurate placement of the new valve. Augmented image-guidance for TAVI can be provided by registering together intra-operative transesophageal echo (TEE) ultrasound and a model derived from pre-operative CT. Automatic contour delineation on TEE images of the aortic root is required for real-time registration. This study develops an algorithm to automatically extract contours on simultaneous cross-plane short-axis and long-axis (XPlane) TEE views, and register these features to a 3D pre-operative model. A continuous max-flow approach is used to segment the aortic root, followed by analysis of curvature to select appropriate contours for use in registration. Results demonstrate a mean contour boundary distance error of 1.3 and 2.8mm for the short and long-axis views respectively, and a mean target registration error of 5.9mm. Real-time image guidance has the potential to increase accuracy and reduce complications in TAVI.

Lang, Pencilla; Rajchl, Martin; McLeod, A. Jonathan; Chu, Michael W.; Peters, Terry M.

2012-02-01

180

Bayesian sensitivity analysis of a model of the aortic valve.  

PubMed

Understanding the mechanics of the aortic valve has been a focus of attention for many years in the biomechanics literature, with the aim of improving the longevity of prosthetic replacements. Finite element models have been extensively used to investigate stresses and deformations in the valve in considerable detail. However, the effect of uncertainties in loading, material properties and model dimensions has remained uninvestigated. This paper presents a formal statistical consideration of a selected set of uncertainties on a fluid-driven finite element model of the aortic valve and examines the magnitudes of the resulting output uncertainties. Furthermore, the importance of each parameter is investigated by means of a global sensitivity analysis. To reduce computational cost, a Bayesian emulator-based approach is adopted whereby a Gaussian process is fitted to a small set of training data and then used to infer detailed sensitivity analysis information. From the set of uncertain parameters considered, it was found that output standard deviations were as high as 44% of the mean. It was also found that the material properties of the sinus and aorta were considerably more important in determining leaflet stress than the material properties of the leaflets themselves. PMID:21481873

Becker, W; Rowson, J; Oakley, J E; Yoxall, A; Manson, G; Worden, K

2011-05-17

181

Percutaneous balloon dilatation of calcific aortic valve stenosis: anatomical and haemodynamic evaluation.  

PubMed Central

Two groups of elderly patients with calcified aortic stenosis were treated by balloon dilatation. In group 1, the valve was dilated just before surgical replacement of the valve. The valvar and annular changes occurring during dilatation were examined visually. In 20 of the 26 patients in this group there was no change. In the six remaining patients mobilisation of friable calcific deposits (1 case), slight tearing of the commissure (4 cases), or tearing of the aortic ring (1 case) were seen. Dilatation did not appear to alter valvar rigidity. In 14 patients (group 2) the haemodynamic gradient across the aortic valve was measured before and immediately after dilatation and one week after the procedure. Dilatation produced an immediate significant decrease of the aortic mean gradient and a significant increase of the aortic valve area. Eight days later the mean gradient had increased and the aortic valve area had decreased. Nevertheless there was a significant difference between the initial gradient and the gradient eight days after dilatation. The initial aortic valve area was also significantly larger than the area eight days after dilatation. The aortic valve gradient rose significantly in the eight days after dilatation and at follow up the gradients were those of severe aortic stenosis. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 Fig 6 Fig 7 PMID:3342163

Commeau, P; Grollier, G; Lamy, E; Foucault, J P; Durand, C; Maffei, G; Maiza, D; Khayat, A; Potier, J C

1988-01-01

182

Outcome After Mechanical Aortic Valve Replacement in Children and Young Adults  

Microsoft Academic Search

Background. We asked whether aortic valve replace- ment using a mechanical prosthesis would allow normal- ization of left ventricular function and structure in chil- dren and young adults. Methods. We performed a clinical follow-up examina- tion in 30 patients with aortic valve replacement at 25 years of age or younger, including conventional and tissue Doppler echocardiography and magnetic reso- nance

Raoul Arnold; Julia Ley-Zaporozhan; Sebastian Ley; Tsvetomir Loukanov; Christian Sebening; Johann-Baptist Kleber; Björn Goebel; Siegfried Hagl; Matthias Karck; Matthias Gorenflo

2010-01-01

183

Results of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass grafting  

Microsoft Academic Search

Background. Concomitant coronary artery disease with aortic valve disease is an established risk factor for diminished late survival. This study evaluated the results of bioprosthetic (BAVR) or mechanical aortic valve replacement (MAVR) performed with coronary artery bypass grafting (CABG).Methods. From January 1984 through July 1997, combined AVR + CABG was performed in 750 consecutive patients; 469 received BAVR and 281

Cary W. Akins; Alan D. Hilgenberg; Gus J. Vlahakes; Thomas E. MacGillivray; David F. Torchiana; Joren C. Madsen

2002-01-01

184

Medium-term determinants of left ventricular mass index after stentless aortic valve replacement  

Microsoft Academic Search

Background. This study aimed to investigate the risk factors for elevated left ventricular mass index 3 to 5 years after stentless aortic valve replacement, and to elucidate the underlying physiologic mechanisms.Methods. Eighty-nine patients (age, 76 ± 6 years, 51 males) having a stentless porcine valve for aortic stenosis (n = 76) or regurgitation (n = 13) were prospectively studied by

Xu Y Jin; Ravi Pillai; Stephen Westaby

1999-01-01

185

Neurocognitive deficit following aortic valve replacement with biological\\/mechanical prosthesisq  

Microsoft Academic Search

Objective: The aim of this study was to objectively measure neurocognitive deficit following aortic valve replacement with a mechanical or biological prosthesis. Materials and methods: In this prospective, contemporary study we followed 82 consecutive patients undergoing isolated aortic valve replacement with either a mechanical (n ¼ 29, mean age ¼ 52 ^ 7 years) or a biological (n ¼ 53,

Daniel Zimpfer; Juliane Kilo; Martin Czerny; Marie-Theres Kasimir; Christian Madl; Edith Bauer; Ernst Wolner; Michael Grimm

186

Ten year clinical evaluation of Starr-Edwards 2400 and 1260 aortic valve prostheses  

Microsoft Academic Search

The long term performance characteristics of the 2400 and 1260 series of Starr-Edwards aortic prostheses were investigated by a follow up study of clinical outcome of 327 patients discharged from hospital with isolated aortic valve replacement. Follow up lasted for up to 10 years and was based on 1616 patient-years. The 2400 series cloth covered tracked valve was implanted in

D Hackett; I Fessatidis; R Sapsford; C Oakley

1987-01-01

187

Journal of Biomechanics 34 (2001) 12791289 A nonlinear anisotropic model for porcine aortic heart valves  

E-print Network

Journal of Biomechanics 34 (2001) 1279­1289 A nonlinear anisotropic model for porcine aortic heart finite element model for porcine heart valves. The model is based on the uniaxial experimental data of porcine aortic heart valve leaflet and the properties of nonlinear composite material. A finite element

Luo, Xiaoyu

188

Incidence and prognosis of congenital aortic valve stenosis in Liverpool (1960-1990)  

Microsoft Academic Search

OBJECTIVE--To determine the incidence and prognosis of congenital aortic valve stenosis in the five Health Districts of Liverpool that make up the Merseyside area. DESIGN--The records of the Liverpool Congenital Malformations Registry and the Royal Liverpool Children's Hospital identified 239 patients (155 male, 84 female) born with aortic valve stenosis between 1960 and 1990. Patients were traced to assess the

D J Kitchiner; M Jackson; K Walsh; I Peart; R Arnold

1993-01-01

189

Elastic and viscoelastic material behaviour of fresh and glutaraldehyde-treated porcine aortic valve tissue  

Microsoft Academic Search

In order to obtain better insight into the changes in material properties of aortic valve tissue due to the treatment with glutaraldehyde, comparative tensile and relaxation experiments have been performed with strips taken from porcine aortic valve tissue in a fresh condition and after the treatment. To eliminate biological deviations between different strips, the comparative experiments were done on the

E. P. M. Rousseau; EPM Rousseau; AAHJ Sauren; A. A. van Steenhoven

1983-01-01

190

Concomitant complete atrioventricular block and left main coronary artery occlusion during transcatheter aortic valve implantation.  

PubMed

Transcatheter aortic valve implantation (TAVI) is now considered a viable alternative therapy to surgery in patients with severe symptomatic aortic stenosis, considered to have a high risk for surgery. Herein, we present a case of severe aortic stenosis treated with transfemoral aortic valve implantation and complicated by complete atrioventrciular block and left main coronary artery obstruction that was successfully managed with permanent pacemaker implantation and left main coronary artery stenting. Although less invasive, TAVI can be associated with major complications. Therefore, extra care is required when performing TAVI in patients with borderline valve to coronary ostia distance. PMID:23619197

Gökdeniz, Tayyar; Aykan, Ahmet Ça?r?; A?aç, Mustafa Tar?k; Da?delen, Sinan; Çelik, ?ükrü

2013-12-01

191

Predictive factors for pacemaker requirement after transcatheter aortic valve implantation  

PubMed Central

Background Transcatheter aortic valve implantation (TAVI) has been established as a treatment option for inoperable patients with symptomatic aortic valve stenosis. However, patients suffer frequently from conduction disturbances after TAVI. Methods Baseline, procedural as well as surface and intracardiac ECG parameters were evaluated for patients treated with TAVI and a comparison between patients requiring pacemaker with those not suffering from relevant conduction disorders were done. Results TAVI was successfully in all patients (n=45). Baseline surface and intracardiac ECG recording revealed longer PQ (197.1±51.2 msec versus 154.1±32.1 msec; p<0.001), longer AH (153.6±43.4 msec versus 116.1±31.2 msec; p<0.001) and HV interval (81.7±17.8 msec versus 56.8±8.5 msec; p<0.001) in patients with need for a pacemaker (n=23) versus control group (n=22); furthermore, 7-day follow-up analysis showed a higher prevalence of new left bundle branch block (LBBB) (87.0% versus 31.9%; p<0.001). Multivariate analysis revealed that only new LBBB, QRS duration >120 msec and a PQ interval >200 msec immediately (within 60 minutes) after implantation of the aortic valve were predictors for high-grade (type II second-degree and third-degree) AV block. Other clinical parameters as well as baseline electrocardiographic parameters had no impact on critical conduction delay. Conclusion Cardiac conduction disturbances are common after TAVI. The need for pacing after TAVI is predictable by surface ECG evaluation immediately (within 60 minutes) after the procedure. PMID:23035864

2012-01-01

192

The Effect of Surgical and Transcatheter Aortic Valve Replacement on Mitral Annular Anatomy  

PubMed Central

Background The effect of aortic valve replacement on three-dimensional (3D) mitral annular geometry has not been well-described. Emerging transcatheter approaches for aortic valve replacement employ fundamentally different mechanical techniques for achieving fixation and seal of the prosthetic valve than standard surgical aortic valve replacement. This study compares the immediate impact of transcatheter aortic valve replacement (TAVR) and standard surgical aortic valve replacement (AVR) on mitral annular anatomy. Methods Real-time 3D echocardiography was performed in patients undergoing TAVR using the Edwards Sapien® valve (n=10) or AVR (n=10) for severe aortic stenosis. Mitral annular geometric indexes were measured using Tomtec EchoView to assess regional and global annular geometry. Results Mixed between-within ANOVA showed no differences between TAVR and AVR groups in any of the mitral annular geometric indices pre-operatively. However, post-operative analysis did demonstrate an effect of AVR on geometry. Patients undergoing open AVR had significant decrease in annular height, septolateral diameter, mitral valve transverse diameter and mitral annular area after valve replacement (P?.006). Similar changes were not noted in the TAVR group. Conclusions TAVR preserves mitral annular geometry better than AVR. Thus, TAVR may be a more physiological approach to aortic replacement. PMID:23245440

Vergnat, Mathieu; Levack, Melissa M.; Jackson, Benjamin M.; Bavaria, Joseph E.; Herrmann, Howard C.; Cheung, Albert T.; Weiss, Stuart J.; Gorman, Joseph H.; Gorman, Robert C.

2013-01-01

193

Replacement of the heavily calcified ascending aorta in aortic valve replacement.  

PubMed

A totally calcified ascending aorta prevents aortic crossclamping and aortotomy during aortic valve replacement, and replacement of the ascending aorta is a valid option in these cases. We describe a simple technique for calcified ascending aorta replacement using the Cavitron Ultrasonic Surgical Aspirator. This can be used in aortic endarterectomy for removal of the calcified plaque in the anastomotic part. PMID:24928643

Matsumoto, Kazuhisa; Hisashi, Yosuke; Imoto, Yutaka

2015-03-01

194

Aortic Valve Endocarditis Complicated by ST-Elevation Myocardial Infarction  

PubMed Central

Infective endocarditis complicated by abscess formation and coronary artery compression is a rare clinical event with a high mortality rate, and diagnosis requires a heightened degree of suspicion. We present the clinical, angiographic, and echocardiographic features of a 73-year-old woman who presented with dyspnea and was found to have right coronary artery compression that was secondary to abscess formation resulting from diffuse infectious endocarditis. We discuss the patient's case and briefly review the relevant medical literature. To our knowledge, this is the first reported case of abscess formation involving a native aortic valve and the right coronary artery. PMID:25593539

Jenny, Benjamin E.

2014-01-01

195

Aortic valve replacement in a patient with erythropoietic protoporphyria.  

PubMed

Erythropoietic protoporphyria (EPP) is a disorder of heme synthesis that causes excessive accumulation of protoporphyrin. The predominant clinical feature is photosensitivity triggered by light at wavelengths near 400 nm. We describe a 52-year-old man with EPP who underwent aortic valve replacement due to severe regurgitation. To prevent burn injuries, astral lamps in the operating room were covered with yellow film filters. Preoperative autologous blood donation was not undertaken. Blood priming of the extracorporeal circuit was performed to maintain adequate hemoglobin concentrations, which resulted in reduction of heme synthesis. The patient was discharged in good health without any signs or symptoms of EPP. PMID:12645734

Yotsumoto, Goichi; Masuda, Hiroshi; Iguro, Yoshifumi; Kinjo, Tamahiro; Matsumoto, Hitoshi; Sakata, Ryuzo

2003-03-01

196

Aortic valve replacement in children: Options and outcomes  

PubMed Central

Several disease pathologies such as congenital heart disease and rheumatic fever can affect the aortic valve (AV) in children frequently necessitating intervention. While percutaneous or surgical AV repair is recommended as initial management strategy in children with AV disease, AV replacement (AVR) might become necessary in children with significant valve destruction and after repair or intervention failure. AVR in children is associated with distinct clinical and technical problems owing to several anatomic, social and prosthesis-related issues. In the current review, we list different AV substitutes, discuss their advantages and shortcomings, outline AVR results in children, and explore the divergence of outcomes in various age, anatomy and pathology subgroups; all in the aim to identify optimal AVR choice for each patient taking into consideration his unique anatomic and demographic characteristics. PMID:24578598

Alsoufi, Bahaaldin

2013-01-01

197

Trace element changes in sclerotic heart valves from patients undergoing aortic valve surgery  

Microsoft Academic Search

Several trace elements are essential nutrients for an optimal functioning of organs and tissues, including the immune system\\u000a and the heart. The pathogenesis of some heart diseases has been associated with changes in the balance of certain trace elements.\\u000a The etiology of nonrheumatic aortic valve sclerosis is unknown, however. A prospective study was performed on trace element\\u000a changes in the

Christina Nyström-Rosander; Ulf Lindh; Stefan Thelin; Olle Lindquist; Göran Friman; Nils-Gunnar Ilbäck

2002-01-01

198

In vitro testing of a temporary catheter-based aortic "parachute" valve.  

PubMed

Recently developed technologies allow aortic valve implantation off-pump in a beating heart. In this procedure, the native, stenotic aortic valve is not removed, but simply crushed by a pressure balloon mounted on a percutaneous catheter. Removal of the native aortic cusps before valve replacement may reduce the incidence of annular or cuspal calcium embolization and late perivalvular leaks and increase implantable valve size. However, a temporary valve system in the ascending aorta may be necessary to maintain hemodynamic stability by reducing acute aortic regurgitation and left ventricular volume overload. This study evaluates the hemodynamic effects of a wire-mounted, monoleaflet, temporary valve apparatus in a mechanical cardiovascular simulator. Aortic flow, systemic pressure and left ventricular pressure were continuously monitored. An intraluminal camera obtained real-time proximal and distal images of the valve in operation. Insertion of the parachute valve in the simulator increased diastolic pressure from 7 to 38 mm Hg. Cardiac output increased from 2.08 to 4.66 L/min and regurgitant volume decreased from 65 to 23 mL. In conclusion, placement of a temporary valve in the ascending aorta may help maintain hemodynamic stability and improve off-pump aortic valve replacement. PMID:19033768

Vandenberghe, Stijn; Salizzoni, Stefano; Bajona, Pietro; Zehr, Kenton J; Speziali, Giovanni

2008-01-01

199

Thrombogenic potential of transcatheter aortic valve implantation with trivial paravalvular leakage  

PubMed Central

Background Significant paravalvular leakage after transcatheter aortic valve implantation (TAVI) correlates with increased morbidity and mortality, but adverse consequences of trivial paravalvular leakage have stimulated few investigations. Using a unique method distinctly different from other diagnostic approaches, we previously reported elevated backflow velocities of short duration (transients) in mechanical valve closure. In this study, similar transients were found in a transcatheter valve paravalvular leakage avatar. Methods Paravalvular leakage rate (zero to 58 mL/second) and aortic valve incompetence (volumetric back flow/forward flow; zero to 32%) were made adjustable using a mock transcatheter aortic valve device and tested in quasi-steady and pulsatile flow test systems. Projected dynamic valve area (PDVA) from the back illuminated mock transcatheter aortic valve device was measured and regional backflow velocities were derived by dividing volumetric flow rate by the PDVA over the open and closing valve phase and the total closed valve area derived from backflow leakage. Results Aortic incompetence from 1-32% generated negative backflow transients from 8 to 267 meters/second, a range not dissimilar to that measured in mechanical valves with zero paravalvular leakage. Optimal paravalvular leakage was identified; not too small generating high backflow transients, not too large considering volume overload and cardiac energy loss caused by defective valve behavior and fluid motion. Conclusions Thrombogenic potential of transcatheter aortic valves with trivial aortic incompetence and high magnitude regional backflow velocity transients was comparable to mechanical valves. This may have relevance to stroke rate, asymptomatic microembolic episodes and indications for anticoagulation therapy after transcatheter valve insertion. PMID:25333018

Siegel, Rolland

2014-01-01

200

Minimally invasive aortic valve replacement versus aortic valve replacement through full sternotomy: the Brigham and Women’s Hospital experience  

PubMed Central

Background Minimally invasive aortic valve surgery (mini AVR) is a safe and effective treatment option at many hospital centers, but there has not been widespread adoption of the procedure. Critics of mini AVR have called for additional evidence with direct comparison to aortic valve replacement (AVR) via full sternotomy (FS). Methods Our mini AVR approach is through a hemi-sternotomy (HS). We performed a propensity-score matched analysis of all patients undergoing isolated AVR via FS or HS at our institution since 2002, resulting in 552 matched pairs. Baseline characteristics were similar. Operative characteristics, transfusion rates, in-hospital outcomes as well as short and long term survival were compared between groups. Results Median cardiopulmonary bypass and cross clamp times were shorter in the HS group: 106 minutes [inter-quartile ranges (IQR) 87-135] vs. 124 minutes (IQR 90-169), P?0.001, and 76 minutes (IQR 63-97) vs. 80 minutes (IQR 62-114), P?0.005, respectively. HS patients had shorter ventilation times (median 5.7 hours, IQR 3.5-10.3 vs. 6.3 hours, IQR 3.9-11.2, P?0.022), shorter intensive care unit stay (median 42 hours, IQR 24-71 vs. 45 hours, IQR 24-87, P?0.039), and shorter hospital length of stay (median 6 days, IQR 5-8 vs. 7 days, IQR 5-10, P?0.001) compared with the FS group. Intraoperative transfusions were more common in FS group: 27.9% vs. 20.0%, P?0.003. No differences were seen in short or long term survival, or time to aortic valve re-intervention. Conclusions Our study confirms the clinical benefits of minimally invasive AVR via HS, which includes decreased transfusion requirements, ventilation times, intensive care unit and hospital length of stay without compromising short and long term survival compared to conventional AVR via FS.

Neely, Robert C.; Boskovski, Marko T.; Gosev, Igor; Kaneko, Tsuyoshi; McGurk, Siobhan; Leacche, Marzia

2015-01-01

201

Systolic fluid-structure interaction model of the congenitally bicuspid aortic valve: assessment of modelling requirements.  

PubMed

A transient fluid-structure interaction (FSI) model of a congenitally bicuspid aortic valve has been developed which allows simultaneous calculation of fluid flow and structural deformation. The valve is modelled during the systolic phase (the stage when blood pressure is elevated within the heart to pump blood to the body). The geometry was simplified to represent the bicuspid aortic valve in two dimensions. A congenital bicuspid valve is compared within the aortic root only and within the aortic arch. Symmetric and asymmetric cusps were simulated, along with differences in mechanical properties. A moving arbitrary Lagrange-Euler mesh was used to allow FSI. The FSI model requires blood flow to induce valve opening and induced strains in the region of 10%. It was determined that bicuspid aortic valve simulations required the inclusion of the ascending aorta and aortic arch. The flow patterns developed were sensitive to cusp asymmetry and differences in mechanical properties. Stiffening of the valve amplified peak velocities, and recirculation which developed in the ascending aorta. Model predictions demonstrate the need to take into account the category, including any existing cusp asymmetry, of a congenital bicuspid aortic valve when simulating its fluid flow and mechanics. PMID:24666191

Kuan, May Y S; Espino, Daniel M

2015-09-01

202

Neurocognitive deficit following aortic valve replacement with biological\\/mechanical prosthesis  

Microsoft Academic Search

Objective: The aim of this study was to objectively measure neurocognitive deficit following aortic valve replacement with a mechanical or biological prosthesis. Materials and methods: In this prospective, contemporary study we followed 82 consecutive patients undergoing isolated aortic valve replacement with either a mechanical (n=29, mean age=52±7 years) or a biological (n=53, mean age=68±10 years) valve prosthesis. Neurocognitive function was

Daniel Zimpfer; Juliane Kilo; Martin Czerny; Marie-Theres Kasimir; Christian Madl; Edith Bauer; Ernst Wolner; Michael Grimm

2003-01-01

203

The Carpentier-Edwards pericardial aortic valve: Ten-year results  

Microsoft Academic Search

To evaluate the function of the Carpentier-Edwards pericardial valve in the aortic position, we analyzed the results of 310 aortic valve replacements performed between 1982 and 1985. Mean age was 64.2 ± 10.8 years (range 22 to 95 years); 190 patients (61.3%) were male patients. There were 18 hospital deaths (5.8%), and none were valve related. Follow-up of the 292

Delos M. Cosgrove; Bruce W. Lytle; Paul C. Taylor; Margarita T. Camacho; Robert W. Stewart; Patrick M. McCarthy; Dave P. Miller; Marion R. Piedmonte; Floyd D. Loop

1995-01-01

204

Aortic valve replacement for active infective endocarditis: 5-year survival comparison of bioprostheses, homografts and mechanical prostheses  

Microsoft Academic Search

Objective: In the surgical treatment of acute aortic valve infective endocarditis (IE), the long-term outcome depending on the choice of valve replacement remains uncertain. We aimed to compare the impact on 5-year mortality of use of three types of implanted valves: bioprosthesis (heterograft), mechanical prosthesis and homograft. Methods: A total of 167 patients with a definite aortic valve IE who

Duc Trung Nguyen; François Delahaye; Jean-François Obadia; Xavier Duval; Christine Selton-Suty; Jean-Pierre Carteaux; Bruno Hoen; François Alla

2010-01-01

205

Periannular complications in infective endocarditis involving native aortic valves.  

PubMed

The extension of infection in native valve infective endocarditis (IE) from valvular structures to the periannular tissue is incompletely understood. It is unknown, for example, whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinct clinical characteristics of patients with aortocavitary fistulae and nonruptured abscesses in native valve IE and to evaluate the impact of fistulization on the outcomes of patients with native aortic valve IE complicated with periannular lesions. In a retrospective multicenter study of 2,055 native valve IE episodes, 201 patients (9.8%) with periannular complications in aortic valve IE were identified (46 with aortocavitary fistulization and 155 with nonruptured abscesses). Rates of heart failure (p = 0.07), ventricular septal defect (p <0.001), and third-degree atrioventricular block (p = 0.07) were higher in patients with fistulization. Surgical treatment was undertaken in 172 patients (86%), and in-hospital mortality in the overall population was 29%. Multivariate analysis identified age >60 years (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.3 to 5.2), renal failure (OR 3.0, 95% CI 1.5 to 6.0), and moderate or severe heart failure (OR 2.5, 95% CI 1.2 to 5.2) as independent risk factors for death. There was a trend toward increased in-hospital mortality in patients with aortocavitary fistulae (OR 1.5, 95% CI 0.7 to 3.0). The actuarial 5-year survival rate in surgical survivors was 80% in patients with fistulae and 92% in patients with nonruptured abscesses (log-rank p = 0.6). In conclusion, aortocavitary fistulous tract formation in the setting of native valve IE is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscess. Despite these higher rates of complications, fistulous tract formation in the current era of IE is not an independent risk factor for mortality. PMID:17056342

Anguera, Ignasi; Miro, Jose M; Evangelista, Artur; Cabell, Christopher H; San Roman, Jose Alberto; Vilacosta, Isidre; Almirante, Benito; Ripoll, Tomas; Fariñas, M Carmen; Anguita, Manuel; Navas, Enrique; Gonzalez-Juanatey, Carlos; Garcia-Bolao, Ignacio; Muñoz, Patricia; de Alarcon, Aristides; Sarria, Cristina; Rufi, Gabriel; Miralles, Francisco; Pare, Carles; Fowler, Vance G; Mestres, Carlos A; de Lazzari, Elisa; Guma, Joan R; Moreno, Asunción; Corey, G Ralph

2006-11-01

206

Elevated transaortic valvular gradients after combined aortic valve and mitral valve replacement: an intraoperative dilemma.  

PubMed

High transaortic valvular gradients, after combined aortic valve and mitral valve replacement, require prompt intraoperative diagnosis and appropriate management. The presence of high transaortic valvular gradients after cardiopulmonary bypass, in this setting, can be secondary to the following conditions: prosthesis dysfunction, left ventricular outflow tract obstruction, supravalvular obstruction, prosthesis-patient mismatch, hyperkinetic left ventricle from administration of inotropes, left ventricular intracavitary gradients, pressure recovery phenomenon, and increased transvalvular blood flow resulting from hyperdynamic circulation or anemia. Transesophageal echocardiography is an extremely useful tool for timely diagnosis and treatment of this complication. We describe a case of a critically ill patient with endocarditis and acute lung injury, who presented for combined aortic valve and mitral valve replacement. Transesophageal echocardiographic assessment, post-cardiopulmonary bypass, revealed high transaortic valvular gradients due to encroachment of the mitral prosthesis strut on the left ventricular outflow tract, which was compounded by a small, hypertrophied, and hyperkinetic left ventricle. Discontinuation of inotropic support, administration of fluids, phenylephrine, and esmolol led to resolution of the high gradients and prevented further surgery. PMID:25549635

Essandoh, Michael; Portillo, Juan; Zuleta-Alarcon, Alix; Castellon-Larios, Karina; Otey, Andrew; Sai-Sudhakar, Chittoor B

2015-03-01

207

Valve morphology effect in aortic coarctation flow using realistic silicon models and magnetic resonance imaging  

NASA Astrophysics Data System (ADS)

Aortic valve morphology and phenotype may alter the aortic wall structure and its normal flow hemodynamics. However, the relationship between altered flow patterns and progression of wall pathology is often not fully understood in patients with aortic coartation and needs larger experimental work. In this study, we introduced a compatible experimental setup with magnetic resonance imaging (MRI) using a realistic aortic coarctation (AoCo) silicon model which can replicate physiological flow conditions (pressure, flow-wave, and systemic load). We evaluated the aortic valve hemodynamics of a normal tricuspid valve and a stenotic bicuspid valve using valve effective orifice area (EOA), peak and mean transvalvular pressure gradient (TPG). AoCo severity was assessed by the AoCo pressure gradient. For the tricuspid valve we obtained an EOA = 1.89 cm2, a peak TPG = 10 mmHg, and a mean TPG = 5 mmHg. For the bicuspid valve we obtained an EOA = 1.03 cm2, a peak TPG = 37 mmHg and a mean TPG = 13 mmHg. Furthermore, AoCo with tricuspid valve led to a peak AoCo pressure gradient (PG) = 11 mmHg and a mean PG = 5 mmHg. AoCo with bicuspid valve led to a peak PG = 6 mmHg and a mean PG = 3 mmHg. Aortic flow reattachment was more evident in presence of bicuspid valve and helical flow was present in all cases. This study showed that silicon prototyping in combination with MRI velocity measurements could successfully be used to assess hemodynamic effects of aortic valve morphology in aortic coarctation flow.

Marrufo, Oscar; Solis-Najera, Sergio; Pibarot, Philippe; Kadem, Lyes; Kesharvarz-Motamed, Zahra; Rodriguez, Alfredo O.; Garcia, Julio

2014-11-01

208

Asymptomatic Severe Aortic Stenosis with Left Ventricular Dysfunction: Watchful Waiting or Valve Replacement?  

PubMed Central

Aortic stenosis (AS) is the most common valvular heart disorder in older adults. Patients with severe AS are generally treated nonsurgically if asymptomatic and referred to aortic valve replacement when symptoms develop. However, patients with severe asymptomatic AS with left ventricular dysfunction may benefit from early aortic valve replacement. Although operative mortality in patients with severe AS and left ventricular dysfunction is greater than in patients with preserved left ventricular function, the overall mortality risk is substantially lower than that of watchful waiting. Operative risk in patients with severe AS and left ventricular dysfunction is often overestimated and, consequently, most are not referred to surgery despite clinical data in support of early aortic valve replacement. Asymptomatic patients with echocardiographic confirmation of severe AS and left ventricular dysfunction should be referred for aortic valve replacement. PMID:23580789

Miller, Larry E.; Miller, Valerie M.; Acers, Larry D.

2013-01-01

209

Primary aortic valve replacement with allografts over twenty-five years: Valve-related and procedure-related determinants of outcome  

Microsoft Academic Search

Objectives: Allografts offer many advantages over prosthetic valves, but allograft durability varies considerably. Methods: From 1969 through 1993, 618 patients aged 15 to 84 years underwent their first aortic valve replacement with an aortic allograft. Concomitant surgery included aortic root tailoring (n = 58), replacement or tailoring of the ascending aorta (n = 56), and coronary artery bypass grafting (n

Ole Lund; V. Chandrasekaran; Richard Grocott-Mason; Hassan Elwidaa; Rashid Mazhar; Asghar Khaghani; Andrew Mitchell; Charles Ilsley; Magdi H. Yacoub

1999-01-01

210

Quantitative Evaluation of Change in Co-existent Mitral Regurgitation After Aortic Valve Replacement  

PubMed Central

Objective Management of intermediate degrees of mitral regurgitation (MR) during aortic valve replacement (AVR) for aortic stenosis remains controversial. We sought to evaluate the degree of reduction of MR in patients undergoing AVR, as well as the relationship between the pre-operative gradient across the aortic valve and the degree of reduction in MR. Methods We retrospectively analyzed demographic, intraoperative, and echocardiographic data on 802 patients that underwent AVR or aortic root replacement between January 2010 and March 2011. 578 patients underwent AVR or aortic root replacement without intervention on the mitral valve. We excluded 88 patients with severe aortic insufficiency, 3 patients that underwent ventricular assist device placement, 4 patients that underwent prior mitral valve replacement, and 21 patients with incomplete data yielding 462 patients for analysis. MR was graded for each patient and the degree of change in MR for each patient was determined by subtracting the grade of pre-operative MR from the degree of post-operative MR. Results Of the 462 patients, 289 patients had at least mild MR. On average, MR was downgraded by 0.24 degrees per patient for this cohort of 289 patients. Of the 56 patients with at least moderate MR, MR was downgraded 0.54 degrees per patient. Of 62 patients that underwent AVR only, had at least mild MR, and no evidence of structural mitral valve disease, downgrading of MR was 0.24 degrees per patient. Linear regression analysis revealed no relationship between reduction in MR and pre-operative gradient across the aortic valve. Conclusions Reduction in MR after relief of aortic outflow tract obstruction is modest at best. Further, the magnitude of the pre-operative gradient across the aortic valve has little influence on the degree of reduction in MR. These observations argue in favor of performing a prospective evaluation of the clinical benefits of addressing moderate MR at the time of aortic valve intervention. PMID:23245347

Kaczorowski, David J.; MacArthur, John W.; Howard, Jessica; Kobrin, Dale; Fairman, Alex; Woo, Y. Joseph

2013-01-01

211

In vitro study of coronary flow occlusion in transcatheter aortic valve implantation  

PubMed Central

Background Transcatheter aortic valve implantation (TAVI) has been developed recently for patients with high morbidities and who are believed to be not tolerate standard surgical aortic valve replacement. Nevertheless, the TAVI is associated with complications such as potential obstruction of coronary ostia, mitral valve insufficiency, and stent migration although it seems promising. Impairment of the coronary blood flow after TAVI is catastrophic and it was believed to be associated with the close position of the coronary orifice and the aortic leaflets and valve stent. However, few data was available as to the anatomic relationship between valve stent and aortic root anatomic structures including the coronary arterial ostia, aortic leaflets. Methods The aortic roots were observed in 40 hearts specimens. The width of aortic leaflet, height of aortic sinus annulus to the sinutubular junction (STJ), distance between aortic sinus annulus to its corresponding coronary ostia, and coronary arterial ostia to its corresponding STJ level were measured. Moreover, the relationships of valve stent, aortic leaflets and coronary ostia before/post stent implantation and after the open of aorta were evaluated respectively. Results Approximate three quarters of the coronary ostia were located below the STJ level. The mean distances from left, right and posterior aortic sinus annulus to the related STJ level was comparable, which was 18.5±2.7, 18.9±2.6, 18.7±2.6 mm, respectively. Meanwhile, the height of left and right aortic sinus annulus to its corresponding coronary ostia was 16.6±2.8 and 17.2±3.1 mm for left and right side respectively. Conclusions Most of the coronary ostia were located below the STJ level and could be covered by the leaflets. This highlights the need of modified stents to prevent occlusion of coronary flow after TAVI. PMID:25589972

He, Zheng-Fu; Zhang, Wei-Ming; Lutter, George; Quaden, Rene; Cremer, Jochen

2014-01-01

212

Decreased platelet function in aortic valve stenosis: high shear platelet activation then inactivation.  

PubMed Central

OBJECTIVE--To elucidate the mechanism of the bleeding tendency observed in patients with aortic valve stenosis. DESIGN--A prospective study of high and low shear platelet function tests in vitro in normal controls compared with that in patients with severe aortic valve stenosis with a mean (SD) systolic gradient by Doppler of 75 (18) mm Hg before and at least 4 months after aortic valve replacement. SETTING--District general hospital. RESULTS--The patients showed reduced retention in the high shear platelet function tests. (a) Platelet retention in the filter test was 53.6 (12.6)% in patients with aortic valve stenosis and 84.8 (9.6)% in the controls (P < 0.001). (b) Retention in the glass bead column test was 49.8 (19.2) in the patients and 87.4 (8.7) in the controls (P < 0.001). (c) The standard bleeding time was longer in the patients (P < 0.06). Results of the high shear tests (a, b, and c) after aortic valve replacement were within the normal range. The platelet count was low but within the normal range before surgery and increased postoperatively (P < 0.01). There were no differences in the results of standard clotting tests, plasma and intraplatelet von Willebrand's factor, or in 15 platelet aggregation tests using five agonists between patients with aortic valve stenosis and controls. CONCLUSIONS--The high shear haemodynamics of aortic valve stenosis modify platelet function in vivo predisposing to a bleeding tendency. This abnormality of platelet function is detectable only in vitro using high shear tests. The abnormal function is reversed by aortic valve replacement. High shear forces in vitro activate and then inactivate platelets. By the same mechanisms aortic valve stenosis seems to lead to high shear damage in vivo, resulting in a clinically important bleeding tendency in some patients. PMID:8541170

O'Brien, J. R.; Etherington, M. D.; Brant, J.; Watkins, J.

1995-01-01

213

Coronary blood flow in patients with severe aortic stenosis before and after transcatheter aortic valve implantation.  

PubMed

Patients with severe aortic stenosis and no obstructed coronary arteries are reported to have reduced coronary flow. Doppler evaluation of proximal coronary flow is feasible using transesophageal echocardiography. The present study aimed to assess the change in coronary flow in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The left main coronary artery was visualized using transesophageal echocardiography in 90 patients undergoing TAVI using the Edwards SAPIEN valve. The peak systolic and diastolic velocities of the coronary flow and the time-velocity integral were obtained before and after TAVI using pulse-wave Doppler. Mean aortic gradients decreased from 47.1 ± 15.7 mm Hg before TAVI to 3.6 ± 2.6 mm Hg after TAVI (p <0.001). The aortic valve area increased from 0.58 ± 0.17 to 1.99 ± 0.35 cm(2) (p <0.001). The cardiac output increased from 3.4 ± 1.1 to 3.8 ± 1.0 L/min (p <0.001). Left ventricular end-diastolic pressure (LVEDP) decreased from 19.8 ± 5.4 to 17.3 ± 4.1 mm Hg (p <0.001). The following coronary flow parameters increased significantly after TAVI: peak systolic velocity 24.2 ± 9.3 to 30.5 ± 14.9 cm/s (p <0.001), peak diastolic velocity 49.8 ± 16.9 to 53.7 ± 22.3 cm/s (p = 0.04), total velocity-time integral 26.7 ± 10.5 to 29.7 ± 14.1 cm (p = 0.002), and systolic velocity-time integral 6.1 ± 3.7 to 7.7 ± 5.0 cm (p = 0.001). Diastolic time-velocity integral increased from 20.6 ± 8.7 to 22.0 ± 10.1 cm (p = 0.04). Total velocity-time integral increased >10% in 43 patients (47.2%). Pearson's correlation coefficient revealed the change in LVEDP as the best correlate of change in coronary flow (R = -0.41, p = 0.003). In conclusion, TAVI resulted in a significant increase in coronary flow. The change in coronary flow was associated mostly with a decrease in LVEDP. PMID:25173443

Ben-Dor, Itsik; Malik, Rahul; Minha, Sa'ar; Goldstein, Steven A; Wang, Zuyue; Magalhaes, Marco A; Weissman, Gaby; Okubagzi, Petros G; Torguson, Rebecca; Lindsay, Joseph; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

2014-10-15

214

Recurrent Primary Cardiac Lymphoma on Aortic Valve Allograft: Implications for Therapy  

PubMed Central

Primary malignant cardiac lymphomas associated with grafts are extremely rare: to our knowledge, only 6 cases of prosthesis-associated B-cell lymphoma have been reported. Ours is the first report of recurrent diffuse large B-cell lymphoma associated with aortic valve allografts. We treated a 60-year-old man who presented in early 2007 with aortic valve endocarditis. He underwent aortic valve replacement with an allograft; the resected native valve showed active endocarditis without tumor. In January 2011, the patient underwent repeat aortic valve replacement because of symptomatic aortic regurgitation. The explanted valve specimen displayed diffuse large B-cell lymphoma. In September 2011, the patient presented with fever and a mass around the aortic valve. He died in January 2012. On autopsy, the explanted replacement valve displayed recurrent diffuse large B-cell lymphoma. The recurrent lymphoma on a new graft leads us to believe that this tumor is more aggressive than had been thought. We propose early systemic chemotherapy, in addition to tumor resection, for the possibility of a better prognosis. We discuss our patient's case and review the relevant medical literature. PMID:25425992

Farah, Fahmi J.

2014-01-01

215

Totally biological composite aortic stentless valved conduit for aortic root replacement: 10-year experience  

Microsoft Academic Search

Objectives  To retrospectively analyze the clinical outcome of a totally biological composite stentless aortic valved conduit (No-React® BioConduit) implanted using the Bentall procedure over ten years in a single centre.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Between 27\\/10\\/99 and 19\\/01\\/08, the No-React® BioConduit composite graft was implanted in 67 patients. Data on these patients were collected from the in-hospital database,\\u000a from patient notes and from questionnaires. A

Manuel Galiñanes; Ayo Meduoye; Ignacio Ferreira; Andrzej Sosnowski

2011-01-01

216

Preprocedural CT evaluation of transcatheter aortic valve replacement: what the radiologist needs to know.  

PubMed

Aortic valve stenosis is the most common valvular heart disease in the Western world. When symptomatic, aortic valve stenosis is a debilitating disease with a dismal short-term prognosis, invariably leading to heart failure and death. Elective surgical valve replacement has traditionally been considered the standard of care for symptomatic aortic valve stenosis. However, several studies have identified various subgroups of patients with a significantly elevated risk for surgery-related complications and death. Thus, not every patient is a suitable candidate for surgery. Recent developments in transcatheter-based therapies have provided an alternative therapeutic strategy for the nonsurgical patient population known as transcatheter aortic valve replacement (TAVR) (also called transcatheter aortic valve implantation or percutaneous aortic valve replacement). In TAVR, the native aortic valve is replaced with a bioprosthetic valve via a nonsurgical endovascular, transaortic, or transapical pathway. Nevertheless, several anatomic and technical criteria must be met to safeguard patient eligibility and procedural success. Therefore, noninvasive imaging plays a crucial role in both patient selection and subsequent matching to a specific transcatheter valve size in an effort to ensure accurate prosthesis deployment and minimize peri- and postprocedural complications. The authors review the relevant anatomy of the aortic root, emphasizing the implications of anatomic pitfalls for correct reporting of imaging-derived measurements and important differences between findings obtained with different imaging modalities. They also discuss the evolving role of computed tomography and the role of the radiologist in patient triage in light of current viewpoints regarding patient selection, device size selection, and the preprocedural evaluation of possible access routes. Online supplemental material is available for this article. PMID:25310413

Salgado, Rodrigo A; Leipsic, Jonathon A; Shivalkar, Bharati; Ardies, Lenz; Van Herck, Paul L; Op de Beeck, Bart J; Vrints, Christiaan; Rodrigus, Inez; Parizel, Paul M; Bosmans, Johan

2014-10-01

217

Bench repair of donor aortic valve with minimal access orthotopic heart transplantation.  

PubMed

While the number of people waiting heart transplantation increases, the number of organ donors decreases. This shrinking donor pool has prompted reassessment of donor selection for heart transplantation. Bench repair of a donor aortic valve was performed before minimal access orthotopic heart transplantation. Aortic insufficiency in the structurally normal tricuspid aortic valve was due to annular dilatation and was corrected with subcommissural annular plication. The postoperative period was uneventful. Follow-up at 4.5 years showed good results and no evidence of aortic regurgitation. PMID:15975390

Navia, José L; Atik, Fernando A; Marullo, Antonino; Starling, Randall C; Garcia, Mario; Vega, Pablo Ruda; Smedira, Nicholas G; McCarthy, Patrick M

2005-07-01

218

Acute dilatation of the ascending aorta and aortic valve regurgitation in Loeys-Dietz syndrome.  

PubMed

Loeys-Dietz syndrome (LDS) is a recently recognized connective tissue disorder caused by mutations of the transforming growth factor (TGF)-? receptors. It is an autosomal dominant syndrome characterized by the triad of arterial tortuosity and aneurysms, hypertelorism, and bifid uvula or cleft palate. We treated an 18-year-old woman with a 100-mm-diameter aortic root aneurysm and severe aortic valve regurgitation. She underwent urgent aortic root replacement and bioprosthetic valve implantation. LDS was diagnosed by postoperative genetic screening results. Histopathologic examination of the aortic wall showed diffuse degeneration and elastin fragmentation in the media. PMID:24882305

Nakajima, Tomohiro; Tachibana, Kazutoshi; Miyaki, Yasuko; Takagi, Nobuyuki; Morisaki, Takayuki; Higami, Tetsuya

2014-06-01

219

Cardiac tamponade after transcatheter aortic valve replacement using a transaortic approach.  

PubMed

Transcatheter aortic valve replacement (TAVR) is considered an option for patients with severe aortic stenosis who are not surgical candidates. We describe the case of a patient who presented with cardiac tamponade shortly after uneventful TAVR by a direct aortic approach. The patient was brought to the operating room for exploration and repair. Although TAVR is less invasive than traditional open aortic valve replacement, TAVR nonetheless poses serious risk. This case highlights a potential complication of the less commonly used transaortic approach for TAVR and the importance of taking a multidisciplinary approach when identifying and managing all TAVR-associated complications. PMID:25611860

Wang, Cindy; Hamburger, Joshua; Bhatt, Himani

2014-11-01

220

Experimental technique of measuring dynamic fluid shear stress on the aortic surface of the aortic valve leaflet.  

PubMed

Aortic valve (AV) calcification is a highly prevalent disease with serious impact on mortality and morbidity. The exact cause and mechanism of the progression of AV calcification is unknown, although mechanical forces have been known to play a role. It is thus important to characterize the mechanical environment of the AV. In the current study, we establish a methodology of measuring shear stresses experienced by the aortic surface of the AV leaflets using an in vitro valve model and adapting the laser Doppler velocimetry (LDV) technique. The valve model was constructed from a fresh porcine aortic valve, which was trimmed and sutured onto a plastic stented ring, and inserted into an idealized three-lobed sinus acrylic chamber. Valve leaflet location was measured by obtaining the location of highest back-scattered LDV laser light intensity. The technique of performing LDV measurements near to biological surfaces as well as the leaflet locating technique was first validated in two phantom flow systems: (1) steady flow within a straight tube with AV leaflet adhered to the wall, and (2) steady flow within the actual valve model. Dynamic shear stresses were then obtained by applying the techniques on the valve model in a physiologic pulsatile flow loop. Results show that aortic surface shear stresses are low during early systole (<5 dyn/cm²) but elevated to its peak during mid to late systole at about 18-20 dyn/cm². Low magnitude shear stress (<5 dyn/cm²) was observed during early diastole and dissipated to zero over the diastolic duration. Systolic shear stress was observed to elevate only with the formation of sinus vortex flow. The presented technique can also be used on other in vitro valve models such as congenitally geometrically malformed valves, or to investigate effects of hemodynamics on valve shear stress. Shear stress data can be used for further experiments investigating effects of fluid shear stress on valve biology, for conditioning tissue engineered AV, and to validate numerical simulations. PMID:21744927

Yap, Choon Hwai; Saikrishnan, Neelakantan; Tamilselvan, Gowthami; Yoganathan, Ajit P

2011-06-01

221

Distal embolization of Edwards SAPIEN prosthesis during transcatheter aortic valve implantation  

PubMed Central

Summary Aim Transcatheter aortic valve implantation (TAVI) is considered an alternative therapy in high risk patients with severe aortic stenosis. Despite this, such a minimally invasive procedure is not free from complications. Case report An 86-year-old woman underwent a 26-mm SAPIEN TAVI for aortic valve stenosis. Procedure was complicated by valve embolization into the ascending aorta likely due to a sub-optimal positioning of prosthesis during its deployment. Patient was treated by surgical removal of stent-valve and conventional valve replacement. Patient was discharged from hospital 7 days after surgery. At six months follow-up she was asymptomatic and the valve had a good competence with a mean transaortic gradient of 8 mmHg. Conclusions After TAVI prosthesis embolization, conversion to conventional surgical treatment is imperative and can be associated with excellent outcome. PMID:24629815

CUTTONE, F.; IVASCAU, C.; GROLLIER, G.; MASSETTI, M.

2013-01-01

222

Ten year clinical evaluation of Starr-Edwards 2400 and 1260 aortic valve prostheses.  

PubMed

The long term performance characteristics of the 2400 and 1260 series of Starr-Edwards aortic prostheses were investigated by a follow up study of clinical outcome of 327 patients discharged from hospital with isolated aortic valve replacement. Follow up lasted for up to 10 years and was based on 1616 patient-years. The 2400 series cloth covered tracked valve was implanted in 182 patients from 1974 to 1980 and the 1260 series bare strut silastic ball valve was inserted in 145 patients from 1979 to 1983. Total 10 year mortality and valve related morbidity were low and no cases of mechanical valve failure were recorded. There were no significant actuarial differences in mortality or valve related morbidity between the 2400 and 1260 valves. Starr-Edwards models 2400 and 1260 aortic valve prostheses showed excellent durability without any mechanical failures over a 10 year period. The long term outcome of isolated aortic valve replacement with these models is associated with a low frequency of valve related complications. PMID:3580223

Hackett, D; Fessatidis, I; Sapsford, R; Oakley, C

1987-04-01

223

Ten year clinical evaluation of Starr-Edwards 2400 and 1260 aortic valve prostheses.  

PubMed Central

The long term performance characteristics of the 2400 and 1260 series of Starr-Edwards aortic prostheses were investigated by a follow up study of clinical outcome of 327 patients discharged from hospital with isolated aortic valve replacement. Follow up lasted for up to 10 years and was based on 1616 patient-years. The 2400 series cloth covered tracked valve was implanted in 182 patients from 1974 to 1980 and the 1260 series bare strut silastic ball valve was inserted in 145 patients from 1979 to 1983. Total 10 year mortality and valve related morbidity were low and no cases of mechanical valve failure were recorded. There were no significant actuarial differences in mortality or valve related morbidity between the 2400 and 1260 valves. Starr-Edwards models 2400 and 1260 aortic valve prostheses showed excellent durability without any mechanical failures over a 10 year period. The long term outcome of isolated aortic valve replacement with these models is associated with a low frequency of valve related complications. PMID:3580223

Hackett, D; Fessatidis, I; Sapsford, R; Oakley, C

1987-01-01

224

Evaluation of closed cardiopulmonary bypass circuit for aortic valve replacement.  

PubMed

Since 2005, we have used a novel technique based on the closed cardiopulmonary bypass system without cardiotomy suction (minimal cardiopulmonary bypass [mini-CPB]) for aortic valve replacement (AVR). In this study, we investigated the clinical advantages of this approach. We prospectively studied 32 patients who underwent isolated AVR using the mini-CPB (group M, n = 13) or conventional CPB (group C, n = 19). We compared the hemodilution ratio, serum interleukin (IL)-6 and IL-8 levels, and blood transfusion volume between the two groups. The characteristics, duration of CPB, and aortic cross-clamping time did not differ between the two groups. The hemodilution ratio was significantly lower in group M just after starting CPB (M vs. C: 14% +/- 2% vs. 25% +/- 3%, p = 0.0009). IL-6 levels increased significantly after surgery in both groups, but the postoperative levels were significantly lower in group M at 6 (84.9 +/- 24.9 pg/ml vs. 152 +/- 78 pg/ml, p = 0.042) and 12 (72.7 +/- 36.1 pg/ml vs. 123 +/- 49.6 pg/ml, p = 0.029) hours after CPB. There were no differences in IL-8 or blood transfusion volume after CPB. Mini-CPB offers an alternative to conventional CPB for AVR and has some advantages regarding hemodilution and serum IL-6 levels. However, it is unlikely to become the standard approach for AVR because there are no marked clinical advantages of mini-CPB. PMID:20559134

Kobayashi, Yasuhiko; Mitsuno, Masataka; Yamamura, Mitsuhiro; Tanaka, Hiroe; Ryomoto, Masaaki; Fukui, Shinya; Tsujiya, Noriko; Kajiyama, Tetsuya; Miyamoto, Yuji

2010-01-01

225

Patient-Specific Modeling of Biomechanical Interaction in Transcatheter Aortic Valve Deployment  

PubMed Central

The objective of this study was to develop a patient-specific computational model to quantify the biomechanical interaction between the transcatheter aortic valve (TAV) stent and the stenotic aortic valve during TAV intervention. Finite element models of a patient-specific stenotic aortic valve were reconstructed from multi-slice computed tomography (MSCT) scans, and TAV stent deployment into the aortic root was simulated. Three initial aortic root geometries of this patient were analyzed: (a) aortic root geometry directly reconstructed from MSCT scans, (b) aortic root geometry at the rapid right ventricle pacing phase, and (c) aortic root geometry with surrounding myocardial tissue. The simulation results demonstrated that stress, strain, and contact forces of the aortic root model directly reconstructed from MSCT scans were significantly lower than those of the model at the rapid ventricular pacing phase. Moreover, the presence of surrounding myocardium slightly increased the mechanical responses. Peak stresses and strains were observed around the calcified regions in the leaflets, suggesting the calcified leaflets helped secure the stent in position. In addition, these elevated stresses induced during TAV stent deployment indicated a possibility of tissue tearing and breakdown of calcium deposits, which might lead to an increased risk of stroke. The potential of paravalvular leak and occlusion of coronary ostia can be evaluated from simulated post-deployment aortic root geometries. The developed computational models could be a valuable tool for pre-operative planning of TAV intervention and facilitate next generation TAV device design. PMID:22698832

Wang, Qian; Sirois, Eric; Sun, Wei

2012-01-01

226

Self-expanding aortic valve stent-material optimization.  

PubMed

Vascular support structures are important devices for treating valve stenosis. Large population of patients is treated for valvular disease and the principal mode of treatment is the use of percutaneous valvuloplasty. Stent devices are proving to be an improved technology in minimal invasive cardiac surgery. This technology now accounts for 20% of treatments in Europe. This new technology provides highly effective results at minimal cost and short duration of hospitalization. During the development process, a number of specific designs and materials have come and gone, and a few have remained. Many design changes were successful, and many were not. This paper discusses the physical behavior of a hooked percutaneous aortic valve stent design using a finite element analysis. Specifically, the effects of crimping was simulated and analyzed for two types of realistic but different Nitinol materials (NITI-1 and NITI-2). The results show that both NITI-1 and NITI-2 had good crimping performance. The analysis performed in this paper may aid in understanding the stent's displacement ranges when subjected to physiological pressures exerted by the heart and cardiac blood flow during abnormal cardiovascular conditions. It may also help to evaluate the suitability of a Nitinol for fabrication purposes. PMID:22981766

Kumar, Gideon Praveen; Mathew, Lazar

2012-11-01

227

Aortic valve replacement in children: are mechanical prostheses a good option?q  

Microsoft Academic Search

Objective: The choice of the most appropriate substitute in children with irreparable aortic valve lesions remains controversial. The aim of this study was to assess early and late outcomes following aortic valve replacement (AVR) with mechanical prostheses in children. Paitents: Fifty-six patients (42 male, 14 female, mean age 11.2, range 1-16 years) undergoing AVR with mechanical prostheses between October 1972

Christos Alexiou; Angus McDonald; Stephen M. Langley; Malcolm J. R. Dalrymple-Hay; Marcus P. Haw; James L. Monro

228

Minimally-invasive versus conventional aortic valve replacement – perioperative course and mid-term results  

Microsoft Academic Search

Objective: We performed a case-control-study to compare perioperative and mid-term results of minimally invasive with conventional aortic valve replacement. Methods: Between 8\\/96 and 7\\/97, 113 patients underwent isolated aortic valve replacement (minimally invasive: 29, conventional: 84) in our Department. Diagnosis, ejection fraction, pressure gradient\\/regurgitation fraction, age, gender and body-mass-index were used as matching criteria for the case-control-study. For qualitative data

S Christiansen; J Stypmann; T. D. T Tjan; Th Wichter; H Van Aken; H. H Scheld; D Hammel

1999-01-01

229

Aortic valve replacement in children: are mechanical prostheses a good option?  

Microsoft Academic Search

Objective: The choice of the most appropriate substitute in children with irreparable aortic valve lesions remains controversial. The aim of this study was to assess early and late outcomes following aortic valve replacement (AVR) with mechanical prostheses in children. Paitents: Fifty-six patients (42 male, 14 female, mean age 11.2, range 1–16 years) undergoing AVR with mechanical prostheses between October 1972

Christos Alexiou; Angus McDonald; Stephen M. Langley; Malcolm J. R. Dalrymple-Hay; Marcus P. Haw; James L. Monro

2000-01-01

230

Minimally-invasive versus conventional aortic valve replacement - perioperative course and mid-term resultsq  

Microsoft Academic Search

Objective: We performed a case-control-study to compare perioperative and mid-term results of minimally invasive with conventional aortic valve replacement. Methods: Between 8\\/96 and 7\\/97, 113 patients underwent isolated aortic valve replacement (minimally invasive: 29, conventional: 84) in our Department. Diagnosis, ejection fraction, pressure gradient\\/regurgitation fraction, age, gender and body-mass- index were used as matching criteria for the case-control-study. For qualitative

S. Christiansen; J. Stypmann; T. D. T. Tjan; H. Van Aken; D. Hammel

231

Absence of the aortic valve cusps with mitral atresia, normal left ventricle, and intact ventricular septum.  

PubMed Central

A case of a previously unreported anomaly is presented in which absence of the aortic valve cusps, mitral atresia, a normal left ventricle, and an intact ventricular septum were diagnosed by cross sectional echocardiography. The development of a normal left ventricle, rather than the hypoplastic ventricle usually associated with mitral atresia, is explained by filling of the ventricular cavity via the regurgitant aortic valve. Images PMID:2328173

Cabrera, A; Galdeano, J M; Pastor, E

1990-01-01

232

Biological Aortic Valve Replacement. Long-Term Follow-Up and Predictors of Mortality, Rehospitalization and Reintervention  

Microsoft Academic Search

Background Aortic valve replacement is the conventional procedure in aortic valve disease; neverthe- less, choosing the most suitable model of prosthesis is a complex decision. The use of novel biological models specially treated to reduce long-term structural deterioration has been encouraged, even in young populations. Objective To assess long-term survival of biological valve replacement, quality of life, rates of re-

FERNANDO PICCININI; JUAN M. VRANCIC; GUILLERMO VACCARINO; HERNÁN D. RAICH; JORGE THIERER; DANIEL O. NAVIA; Blanco Encalada

233

Difference in hemodynamic and wall stress of ascending thoracic aortic aneurysms with bicuspid and tricuspid aortic valve  

PubMed Central

The aortic dissection (AoD) of an ascending thoracic aortic aneurysm (ATAA) initiates when the hemodynamic loads exerted on the aneurysmal wall overcome the adhesive forces holding the elastic layers together. Parallel coupled, two-way fluid–structure interaction (FSI) analyses were performed on patient-specific ATAAs obtained from patients with either bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) to evaluate hemodynamic predictors and wall stresses imparting aneurysm enlargement and AoD. Results showed a left-handed circumferential flow with slower-moving helical pattern in the aneurysm's center for BAV ATAAs whereas a slight deviation of the blood flow toward the anterolateral region of the ascending aorta was observed for TAV ATAAs. Blood pressure and wall shear stress were found key hemodynamic predictors of aneurysm dilatation, and their dissimilarities are likely associated to the morphological anatomy of the aortic valve. We also observed discontinues, wall stresses on aneurysmal aorta, which was modeled as a composite with two elastic layers (i.e., inhomogeneity of vessel structural organization). This stress distribution was caused by differences on elastic material properties of aortic layers. Wall stress distribution suggests AoD just above sinotubular junction. Moreover, abnormal flow and lower elastic material properties that are likely intrinsic in BAV individuals render the aneurysm susceptible to the initiation of AoD. PMID:23664314

Pasta, Salvatore; Rinaudo, Antonino; Luca, Angelo; Pilato, Michele; Scardulla, Cesare; Gleason, Thomas G.; Vorp, David A.

2014-01-01

234

Aortic Valve Replacement for Aortic Stenosis and Concomitant Coronary Artery Bypass: Long-term Outcomes and Predictors of Mortality  

PubMed Central

Background We evaluated the surgical results and predictors of long-term survival in patients who underwent coronary artery bypass grafting (CABG) at the time of an aortic valve replacement (AVR) due to aortic stenosis. Materials and Methods Between January 1990 and December 2009, 183 consecutive patients underwent CABG and concomitant aortic valve replacement for aortic stenosis. The mean follow-up period was 59.8±3.3 months and follow-up was possible in 98.3% of cases. Predictors of mortality were determined by Cox regression analysis. Results There were 5 (2.7%) in-hospital deaths. Follow-up of the in-hospital survivors documented late survival rates of 91.5%, 74.8%, and 59.6% at 1, 5, and 10 postoperative years, respectively. Age (p<0.001), a glomerular filtration rate (GFR) less than 60 mL/min (p=0.006), and left ventricular (LV) mass (p<0.001) were significant predictors of mortality in the multivariate analysis. Conclusion The surgical results and long-term survival of aortic valve replacement with concomitant CABG in patients with aortic stenosis and coronary artery disease were acceptable. Age, a GFR less than 60 mL/min, and LV mass were significant predictors of mortality. PMID:22263139

Cho, Won-chul; Yoo, Dong-Gon; Kim, Joon-Bum; Choo, Suk-Jung; Jung, Sung-Ho; Chung, Cheol-Hyun

2011-01-01

235

Aortic valve replacement in patients over 80 years of age: a comparative standard for balloon valvuloplasty  

Microsoft Academic Search

Elderly patients who develop symptomatic aortic valvular malfunction have a grave prognosis. Until recently they have not been seriously considered for active treatment, such as valvular surgery or balloon valvuloplasty. Between January 1972 and July 1989,88 patients over the age of 80 years underwent aortic valve replacement and have been prospectively followed for a total of 185 patient-years. The majority

M. Azariades; C. L. Fessler; A. Ahmad; A. Starr

1991-01-01

236

[Aortic valve stenosis in children. Surgical valvuloplasty long-term results].  

PubMed

From 1960 through 1992, 67 children with congenital aortic stenosis aged 6-228 months (M 105.7 +/- 52) were submitted to aortic valvuloplasty at our institution. There was no hospital mortality. During the follow-up of 127.5 +/- 66.7 months, there were two late valve related deaths. Eight patients (11.9%) developed aortic regurgitation 5 to 125 months (M 66.6 +/- 35) following surgical valvuloplasty and one of them required aortic valve replacement. Because of restenosis, 15 patients required a second operation. Of them five children underwent a second aortic valvuloplasty without mortality and, in four of them, the functional result has been excellent after a mean follow-up of 75.4 +/- 12 months. Ten patients required an aortic valve replacement 62 to 208 months post-op (M 100.9 +/- 50.8). Mechanical prosthesis were used in 6 and bioprosthesis in 4. Two patients required a Konno and one patient a Ross procedure. There were no early nor late deaths following reoperations. The 20 year survival rate following the first valvuloplasty was 94%, the freedom from reoperation 63% and the freedom from aortic valve replacement 73% for the same time period. Our results demonstrate that congenital aortic valvar stenosis in children can be surgically well controlled until adulthood. Our study also illustrates that surgical valvuloplasty is a safe and efficacious procedure and that its beneficial effect is maintained over 20 years in the majority of children. PMID:10584382

Chartrand, C; Saro-Servando, E; Vobecky, J S

1999-01-01

237

Form Follows Function: Advances in Trilayered Structure Replication for Aortic Heart Valve Tissue Engineering  

PubMed Central

Tissue engineering the aortic heart valve is a challenging endeavor because of the particular hemodynamic and biologic conditions present in the native aortic heart valve. The backbone of an ideal valve substitute should be a scaffold that is strong enough to withstand billions of repetitive bending, flexing and stretching cycles, while also being slowly degradable to allow for remodeling. In this review we highlight three overlooked aspects that might influence the long term durability of tissue engineered valves: replication of the native valve trilayered histoarchitecture, duplication of the three-dimensional shape of the valve and cell integration efforts focused on getting the right number and type of cells to the right place within the valve structure and driving them towards homeostatic maintenance of the valve matrix. We propose that the trilayered structure in the native aortic valve that includes a middle spongiosa layer cushioning the motions of the two external fibrous layers should be our template for creation of novel scaffolds with improved mechanical durability. Furthermore, since cells adapt to micro-loads within the valve structure, we believe that interstitial cell remodeling of the valvular matrix will depend on the accurate replication of the structures and loads, resulting in successful regeneration of the valve tissue and extended durability. PMID:23355946

Simionescu, Dan T.; Chen, Joseph; Jaeggli, Michael; Wang, Bo; Liao, Jun

2013-01-01

238

An experimental study of steady flow patterns of a new trileaflet mechanical aortic valve.  

PubMed

Hemodynamic research shows that thrombosis formation is closely tied to flow field turbulent stress. Design limitations cause flow separation at leaflet edges and the annular valve base, vortex mixing downstream, and high turbulent shear stress. The trileaflet design opens like a physiologic valve with central flow. Leaflet curvature approximates a completely circular orifice, maximizing effective flow area of the open valve. Semicircular aortic sinuses downstream of the valve allow vortex formation to help leaflet closure. The new trileaflet design was hemodynamically evaluated via digital particle image velocimetry and laser-Doppler anemometry. Measurements were made during peak flow of the fully open valve, immediately downstream of the valve, and compared with the 27-mm St. Jude Medical (SJM) bileaflet valve. The trileaflet valve central flow produces sufficient pressure to inhibit separation shear layers. Absence of downstream turbulent wake eddies indicates smooth, physiologic blood flow. In contrast, SJM produces strong turbulence because of unsteady separated shear layers where the jet flow meets the aortic sinus wall, resulting in higher turbulent shear stresses detrimental to blood cells. The trileaflet valve simulates the physiologic valve better than previous designs, produces smoother flow, and allows large scale recirculation in the aortic sinuses to help valve closure. PMID:16156295

Liu, Jia-Shing; Lu, Po-Chien; Lo, Chi-Wen; Lai, Ho-Cheng; Hwang, Ned H C

2005-01-01

239

3D Bioprinting of Heterogeneous Aortic Valve Conduits with Alginate/Gelatin Hydrogels  

PubMed Central

Heart valve disease is a serious and growing public health problem for which prosthetic replacement is most commonly indicated. Current prosthetic devices are inadequate for younger adults and growing children. Tissue engineered living aortic valve conduits have potential for remodeling, regeneration, and growth, but fabricating natural anatomical complexity with cellular heterogeneity remain challenging. In the current study, we implement 3D bioprinting to fabricate living alginate/gelatin hydrogel valve conduits with anatomical architecture and direct incorporation of dual cell types in a regionally constrained manner. Encapsulated aortic root sinus smooth muscle cells (SMC) and aortic valve leaflet interstitial cells (VIC) were viable within alginate/gelatin hydrogel discs over 7 days in culture. Acellular 3D printed hydrogels exhibited reduced modulus, ultimate strength, and peak strain reducing slightly over 7-day culture, while the tensile biomechanics of cell-laden hydrogels were maintained. Aortic valve conduits were successfully bioprinted with direct encapsulation of SMC in the valve root and VIC in the leaflets. Both cell types were viable (81.4±3.4% for SMC and 83.2±4.0% for VIC) within 3D printed tissues. Encapsulated SMC expressed elevated alpha-smooth muscle actin when printed in stiff matrix, while VIC expressed elevated vimentin in soft matrix. These results demonstrate that anatomically complex, heterogeneously encapsulated aortic valve hydrogel conduits can be fabricated with 3D bioprinting. PMID:23015540

Duan, Bin; Hockaday, Laura A.; Kang, Kevin H.; Butcher, Jonathan T.

2013-01-01

240

3D bioprinting of heterogeneous aortic valve conduits with alginate/gelatin hydrogels.  

PubMed

Heart valve disease is a serious and growing public health problem for which prosthetic replacement is most commonly indicated. Current prosthetic devices are inadequate for younger adults and growing children. Tissue engineered living aortic valve conduits have potential for remodeling, regeneration, and growth, but fabricating natural anatomical complexity with cellular heterogeneity remain challenging. In the current study, we implement 3D bioprinting to fabricate living alginate/gelatin hydrogel valve conduits with anatomical architecture and direct incorporation of dual cell types in a regionally constrained manner. Encapsulated aortic root sinus smooth muscle cells (SMC) and aortic valve leaflet interstitial cells (VIC) were viable within alginate/gelatin hydrogel discs over 7 days in culture. Acellular 3D printed hydrogels exhibited reduced modulus, ultimate strength, and peak strain reducing slightly over 7-day culture, while the tensile biomechanics of cell-laden hydrogels were maintained. Aortic valve conduits were successfully bioprinted with direct encapsulation of SMC in the valve root and VIC in the leaflets. Both cell types were viable (81.4 ± 3.4% for SMC and 83.2 ± 4.0% for VIC) within 3D printed tissues. Encapsulated SMC expressed elevated alpha-smooth muscle actin, while VIC expressed elevated vimentin. These results demonstrate that anatomically complex, heterogeneously encapsulated aortic valve hydrogel conduits can be fabricated with 3D bioprinting. PMID:23015540

Duan, Bin; Hockaday, Laura A; Kang, Kevin H; Butcher, Jonathan T

2013-05-01

241

Detection of Cardiobacterium valvarum in a patient with aortic valve infective endocarditis by broad-range PCR.  

PubMed

Cardiobacterium valvarum, a fastidious Gram-negative bacterium, was detected in the aortic valve of a previously healthy 63-year-old man by broad-range PCR and 16S rRNA gene sequencing. In contrast to the patients in five previously published cases, our patient had neither a congenital bicuspid nor a prosthetic aortic valve. Here, we present a case of C. valvarum native tricuspid aortic valve infective endocarditis and a review of the literature. PMID:19797468

Vanerková, Martina; Zaloudíková, Barbora; Nemcová, Eva; Juránková, Jana; Pol, Jirí; Cerný, Jan; Nemec, Petr; Freiberger, Tomás

2010-02-01

242

Complex interventional procedures for the management of early postoperative left main coronary artery embolism after bioprosthetic aortic valve insertion.  

PubMed

The incidence of calcified debris coronary embolism after aortic valve replacement (AVR) with a bioprosthesis is a rare but potentially life-threatening condition. We sought to describe a case of immediate postoperative left main coronary artery embolism, resulting to severe acute coronary syndrome and cardiogenic shock, after aortic valve surgery due to severe aortic valve stenosis, with the use of bioprosthesis. Complex interventional procedures and possible diagnostic challenges are being described. PMID:21241978

Gavrielatos, Gerasimos; Buttner, Heinz J; Lehane, Con; Neumann, Franz J

2011-01-01

243

Influence of atrial fibrillation in trans-catheter aortic valve replacement.  

PubMed

In high-risk patients with severe aortic stenosis transcatheter aortic valve replacement (TAVR) procedures have been found to be beneficial. Up to now TAVR has been preferably performed on elderly patients, who cannot undergo conventional aortic valve replacement (AVR). Usually, due to their advanced age, these patients suffer from atrial fibrillation (AF) and are also more predisposed to present left ventricular dysfunction. Both conditions influence short and long-term prognosis in conventional AVR surgery. We do not really know how this translates in new procedures such as TAVR. The purpose of the present paper was to review how AF could affect TAVR procedures. PMID:25300896

Cartier, R; Vistarini, N

2014-12-01

244

Downstream turbulence and high intensity transient signals (HITS) following aortic valve replacement with Medtronic Hall or St. Jude Medical valve substitutes  

Microsoft Academic Search

Objective: High intensity transient signals (HITS) representing microembolization to the brain have been found to contribute to cognitive impairment and psychoneurological dysfunction in patients carrying a mechanical aortic valve. It is unknown, whether HITS represent gaseous or solid emboli. This animal study evaluates the impact of valve orientation on HITS for two different mechanical valves with both valves implanted in

Peter Kleine; Mathias Perthel; J. Michael Hasenkam; Hans Nygaard; Søren B. Hansen; Joachim Laas

2000-01-01

245

Long-term survival and complications in patients with mechanical aortic valves without anticoagulation  

Microsoft Academic Search

In aortic valve replacement most centres prefer to use a mechanical valve for younger patients without special bleeding risks and treat the patient with lifelong anticoagulation. However, a few patients do not receive anticoagulation at all or have this withdrawn after some time. We examined the prognosis of 43 patients, 37 men and 6 women (mean age 52 years), who

P. V. Andersen

246

Modified Lipoprotein-Derived Lipid Particles Accumulate in Human Stenotic Aortic Valves  

PubMed Central

In aortic stenosis plasma lipoprotein-derived lipids accumulate in aortic valves. Here, we first compared the lipid compositions of stenotic aortic valves and atherosclerotic plaque cores. Both pathological tissues were found to be enriched in cholesteryl linoleate, a marker of extracellularly accumulated lipoproteins. In addition, a large proportion of the phospholipids were found to contain arachidonic acid, the common precursor of a number of proinflammatory lipid mediators. Next, we isolated and characterized extracellular lipid particles from human stenotic and non-stenotic control valves, and compared them to plasma lipoproteins from the same subjects. The extracellular valvular lipid particles were isolated from 15 stenotic and 14 non-stenotic aortic valves. Significantly more apoB-100-containing lipid particles were found in the stenotic than in the non-stenotic valves. The majority of the lipid particles isolated from the non-stenotic valves had sizes (23±6.2 nm in diameter) similar to those of plasma low density lipoprotein (LDL) (22±1.5 nm), while the lipid particles from stenotic valves were not of uniform size, their sizes ranging from 18 to more than 500 nm. The lipid particles showed signs of oxidative modifications, and when compared to isolated plasma LDL particles, the lipid particles isolated from the stenotic valves had a higher sphingomyelin/phosphatidylcholine –ratio, and also higher contents of lysophosphatidylcholine and unesterified cholesterol. The findings of the present study reveal, for the first time, that in stenotic human aortic valves, infiltrated plasma lipoproteins have undergone oxidative and lipolytic modifications, and become fused and aggregated. The generated large lipid particles may contribute to the pathogenesis of human aortic stenosis. PMID:23762432

Lehti, Satu; Käkelä, Reijo; Hörkkö, Sohvi; Kummu, Outi; Helske-Suihko, Satu; Kupari, Markku; Werkkala, Kalervo; Kovanen, Petri T.; Öörni, Katariina

2013-01-01

247

Automated segmentation and geometrical modeling of the tricuspid aortic valve in 3D echocardiographic images  

PubMed Central

The aortic valve has been described with variable anatomical definitions, and the consistency of 2D manual measurement of valve dimensions in medical image data has been questionable. Given the importance of image-based morphological assessment in the diagnosis and surgical treatment of aortic valve disease, there is considerable need to develop a standardized framework for 3D valve segmentation and shape representation. Towards this goal, this work integrates template-based medial modeling and multi-atlas label fusion techniques to automatically delineate and quantitatively describe aortic leaflet geometry in 3D echocardiographic (3DE) images, a challenging task that has been explored only to a limited extent. The method makes use of expert knowledge of aortic leaflet image appearance, generates segmentations with consistent topology, and establishes a shape-based coordinate system on the aortic leaflets that enables standardized automated measurements. In this study, the algorithm is evaluated on 11 3DE images of normal human aortic leaflets acquired at mid systole. The clinical relevance of the method is its ability to capture leaflet geometry in 3DE image data with minimal user interaction while producing consistent measurements of 3D aortic leaflet geometry. PMID:24505702

Pouch, Alison M.; Wang, Hongzhi; Takabe, Manabu; Jackson, Benjamin M.; Sehgal, Chandra M.; Gorman, Joseph H.; Gorman, Robert C.; Yushkevich, Paul A.

2013-01-01

248

Minimally invasive concomitant aortic and mitral valve surgery: the “Miami Method”  

PubMed Central

Valve surgery via a median sternotomy has historically been the standard of care, but in the past decade various minimally invasive approaches have gained increasing acceptance. Most data available on minimally invasive valve surgery has generally involved single valve surgery. Therefore, robust data addressing surgical techniques in patients undergoing double valve surgery is lacking. For patients undergoing combined aortic and mitral valve surgery, a minimally invasive approach, performed via a right lateral thoracotomy (the “Miami Method”), is the preferred method at our institution. This method is safe and effective and leads to an enhanced recovery in our patients given the reduction in surgical trauma. The following perspective details our surgical approach, concepts and results for combined aortic and mitral valve surgery.

2015-01-01

249

Beyond PARTNER: appraising the evolving trends and outcomes in transcatheter aortic valve replacement.  

PubMed

Transcatheter aortic valve replacement (TAVR) has become the preferred treatment in patients with symptomatic severe aortic stenosis deemed to be at prohibitive or high risk for surgical aortic valve replacement. With evolving technology, improving practices and patient selection, outcomes in TAVR have improved. In the not so distant future, TAVR may become an alternative to surgical aortic valve replacement even for patients who are not at high risk for open surgery. However, issues such as stroke, paravalvular leak and pacemaker need remain, and the unknown limitations of TAVR, including durability and undefined options for reintervention for prosthesis dysfunction, must be addressed before this therapy can be extended to younger, lower risk patients. PMID:25275716

Tang, Gilbert H L; Lansman, Steven L; Panza, Julio A

2015-01-01

250

Pre- and postoperative left ventricular contractile function in patients with aortic valve disease.  

PubMed Central

In 43 patients left ventricular micromanometry and cineangiography were performed preoperatively and and 20 months after aortic valve replacement. A score of left ventricular functional impairment, derived from 5 to 8 haemodynamic variables, was calculated as: number of pathological indices x 100/total number of determined indices. Preoperatively the score of left ventricular functional impairment amounted to 35 per cent in group 1 (aortic stenosis: n = 19), to 61 per cent in group 2 (combined lesion:n = 15) (P less than 0.05), and to 87 per cent in group 3 (aortic regurgitation: n = 9) (P less than 0.001). In contrast, the functional classification according to the NYHA showed similar impairment in the 3 groups. Postoperatively the score of left ventricular functional impairment decreased significantly in all 3 groups to 10, 16, and 27 per cent, respectively, but the score of group 3 remained raised (P less than 0.05) as compared with that of group 1. The patients with residual left ventricular dysfunction had a higher preoperative left ventricular muscle mass than the patients with normal or near normal postoperative left ventricular function. It is concluded that (1) at similar functional impairment according to the NYHA classification left ventricular contractile function is more severely impaired in aortic regurgitation and in aortic regurgitation + aortic stenosis than in aortic stenosis alone, (2) left ventricular function improves significantly after valve replacement in all three forms of aortic valve disease, (3) residual functional impairment is greater in aortic regurgitation than in aortic stenosis or aortic stenosis + aortic regurgitation, and (4) persistent postoperative left ventricular functional impairment is found in the patients with severe preoperative hypertrophy. PMID:154914

Krayenbuehl, H P; Turina, M; Hess, O M; Rothlin, M; Senning, A

1979-01-01

251

Comparison of complications and outcomes to one year of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis.  

PubMed

Comparisons of transcatheter aortic valve implantation (TAVI) to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis remain sparse or limited by a short follow-up. We sought to evaluate early and midterm outcomes of consecutive patients (n = 618) undergoing successful TAVI (n = 218) or isolated SAVR (n = 400) at 2 centers. The primary end point was incidence of Valvular Academic Research Consortium-defined major adverse cerebrovascular and cardiac events (MACCEs) up to 1 year. Control of potential confounders was attempted with extensive statistical adjustment by covariates and/or propensity score. In-hospital MACCEs occurred in 73 patients (11.8%) and was more frequent in patients treated with SAVR compared to those treated with TAVI (7.8% vs 14.0%, p = 0.022). After addressing potential confounders using 3 methods of statistical adjustment, SAVR was consistently associated with a higher risk of MACCEs than TAVI, with estimates of relative risk ranging from 2.2 to 2.6 at 30 days, 2.3 to 2.5 at 6 months, and 2.0 to 2.2 at 12 months. This difference was driven by an adjusted increased risk of life-threatening bleeding at 6 and 12 months and stroke at 12 months with SAVR. Conversely, no differences in adjusted risk of death, stroke and myocardial infarction were noted between TAVI and SAVR at each time point. In conclusion, in a large observational registry with admitted potential for selection bias and residual confounding, TAVI was not associated with a higher risk of 1-year MACCEs compared to SAVR. PMID:22356793

Tamburino, Corrado; Barbanti, Marco; Capodanno, Davide; Mignosa, Carmelo; Gentile, Maurizio; Aruta, Patrizia; Pistritto, Anna Maria; Bonanno, Claudio; Bonura, Salvatore; Cadoni, Alessandra; Gulino, Simona; Di Pasqua, Maria Concetta; Cammalleri, Valeria; Scarabelli, Marilena; Mulè, Massimiliano; Immè, Sebastiano; Del Campo, Giuliana; Ussia, Gian Paolo

2012-05-15

252

Eight-year follow-up after prospectively randomized implantation of different mechanical aortic valves  

Microsoft Academic Search

Objective  The aim of this prospectively randomized study was to evaluate the hemodynamic and functional outcomes after aortic valve\\u000a replacement with three different bileaflet mechanical valves.\\u000a \\u000a \\u000a \\u000a Methods  From March 1996 to August 1998, 300 consecutive patients were randomly assigned to receive ATS (n = 100), Carbomedics (n = 100), or St Jude Medical Hemodynamic Plus (n = 100) mechanical aortic valve replacement. There were no significant differences regarding

Sven Lehmann; Thomas Walther; Sergey Leontyev; Jörg Kempfert; Ardawan Rastan; Volkmar Falk; Friedrich W. Mohr

2008-01-01

253

Insights into the Use of Biomarkers in Calcific Aortic Valve Disease  

PubMed Central

Calcific aortic valve disease (CAVD) is the most common acquired valvular disorder in developed countries. CAVD ranges from mild thickening of the valve, known as aortic valve sclerosis (AVSc), to severe impairment of the valve motion, which is termed aortic valve stenosis (AVS). The prevalence of CAVD is nearing epidemic status: its preceding stage, in which there is aortic sclerosis without obstruction of the left ventricular outflow, is present in nearly 30% of adults over 65 years of age. Since there is no existing medical therapy to treat or slow the progression of CAVD, surgery for advanced disease represents the only available treatment. Aortic valve replacement is the second most frequently performed cardiac surgical procedure after coronary artery bypass grafting. Therefore, CAVD represents a major societal and economic burden. The pathophysiological development of CAVD is incompletely defined. At the present time, the major methods to diagnose CAVD are clinical examination, echocardiography and cardiac catheterization. Due to the multiple biological pathways leading to CAVD, there are many potential biomarkers that might be suitable for deriving clinically useful information about the presence, severity, progression and prognosis of CAVD. Although the data available does not permit recommendations for clinicians at this time, they do support a paradigm of screening patients based on multiple biomarkers to provide the information necessary to optimize future therapeutic interventions. This review summarizes the results of several studies investigating the value of potential biomarkers that have been used to predict the severity, progression and prognosis of CAVD. PMID:20845891

Beckmann, Erik; Grau, Juan B.; Sainger, Rachana; Poggio, Paolo; Ferrari, Giovanni

2010-01-01

254

Functional annulus remodelling using a prosthetic ring in tricuspid aortic valve repair: mid-term results†  

PubMed Central

OBJECTIVES The functional aortic valve annulus (FAVA) is a complex unit with proximal (aorto-ventricular junction) and distal (sinotubular junction) components. The aim of our study was to evaluate the impact of the total FAVA remodelling, using a prosthetic ring, on mid-term clinical and echocardiographic results after aortic valve repair. METHODS Since February 2003, 250 patients with tricuspid aortic valve insufficiency (AI) underwent aortic valve repair. FAVA dilatation was treated by prosthetic ring in 52 patients, by isolated subcommissural plasty in 62, by subcommissural plasty plus ascending aortic replacement in 57 and by David's reimplantation procedure in 79. Survival rate and freedom from recurrent AI greater than or equal to moderate were evaluated by Kaplan–Meier. RESULTS Overall late survival was 90.4%. Late cardiac-related deaths occurred in 15 patients. At follow-up, 36 (16%) patients had recurrent AI greater than or equal to moderate because of cusp reprolapse and/or FAVA redilatation. Freedom from recurrent AI was significantly higher for patients who underwent David's procedure or FAVA remodelling by prosthetic ring than those who underwent isolated subcommissural plasty (P < 0.01) or subcommissural plasty plus ascending aortic replacement (P = 0.02). There was no statistical difference between David's procedure and prosthetic ring annuloplasty (P = 0.26). CONCLUSION FAVA remodelling using a prosthetic ring is a safe procedure in aortic valve repair surgery thanks to long-term annulus stabilization and it is a pliable alternative to David's procedure in selected patients. This technique may be used in all patients with slight root dilatation to avoid aggressive root reimplantation. We also recommended total FAVA annuloplasty in all patients who underwent aortic valve repair to improve long-term repair results. PMID:24065345

Fattouch, Khalil; Castrovinci, Sebastiano; Murana, Giacomo; Nasso, Giuseppe; Guccione, Francesco; Dioguardi, Pietro; Salardino, Massimo; Bianco, Giuseppe; Speziale, Giuseppe

2014-01-01

255

Analysis of aortic valve commissural fusion after support with continuous-flow left ventricular assist device  

PubMed Central

OBJECTIVES Continuous-flow left ventricular assist devices (cf-LVADs) may induce commissural fusion of the aortic valve leaflets. Factors associated with this occurrence of commissural fusion are unknown. The aim of this study was to examine histological characteristics of cf-LVAD-induced commissural fusion in relation to clinical variables. METHODS Gross and histopathological examinations were performed on 19 hearts from patients supported by either HeartMate II (n = 17) or HeartWare (n = 2) cf-LVADs and related to clinical characteristics (14 heart transplantation, 5 autopsy). RESULTS Eleven of the 19 (58%) aortic valves showed fusion of single or multiple commissures (total fusion length 11 mm [4–20] (median [interquartile range]) per valve), some leading to noticeable nodular displacements or considerable lumen diameter narrowing. Multiple fenestrations were observed in one valve. Histopathological examination confirmed commissural fusion, with varying changes in valve layer structure without evidence of inflammatory infiltration at the site of fusion. Commissural fusion was associated with continuous aortic valve closure during cf-LVAD support (P = 0.03). LVAD-induced aortic valve insufficiency developed in all patients with commissural fusion and in 67% of patients without fusion. Age, duration of cf-LVAD support and aetiology of heart failure (ischaemic vs dilated cardiomyopathy) were not associated with the degree of fusion. CONCLUSIONS Aortic valve commissural fusion after support with cf-LVADs is a non-inflammatory process leading to changes in valve layer structure that can be observed in >50% of cf-LVAD patients. This is the first study showing that patients receiving full cf-LVAD support without opening of the valve have a significantly higher risk of developing commissural fusion than patients on partial support. PMID:23798641

Martina, Jerson R.; Schipper, Marguerite E.I.; de Jonge, Nicolaas; Ramjankhan, Faiz; de Weger, Roel A.; Lahpor, Jaap R.; Vink, Aryan

2013-01-01

256

Intraoperative Tracking of Aortic Valve Plane* DLH Nguyen, M Garreau, V Auffret, H Le Breton, JP Verhoye, P Haigron  

E-print Network

high risk of operative mortality. Compared to the standard aortic valve replacement surgery, the TAVI complications can arise from a misplaced valve. These complications have been reported [1] such as high

Paris-Sud XI, Université de

257

Quantification of aortic valve area and left ventricular muscle mass in healthy subjects and patients with symptomatic aortic valve stenosis by MRI.  

PubMed

MRI allows visualization and planimetry of the aortic valve orifice and accurate determination of left ventricular muscle mass, which are important parameters in aortic stenosis. In contrast to invasive methods, MRI planimetry of the aortic valve area (AVA) is flow independent. AVA is usually indexed to body surface area. Left ventricular muscle mass is dependent on weight and height in healthy individuals. We studied AVA, left ventricular muscle mass (LMM) and ejection fraction (EF) in 100 healthy individuals and in patients with symptomatic aortic valve stenosis (AS). All were examined by MRI (1.5 Tesla Siemens Sonate) and the AVA was visualized in segmented 2D flash sequences and planimetry of the performed AVA was manually. The aortic valve area in healthy individuals was 3.9+/-0.7 cm(2), and the LMM was 99+/-27 g. In a correlation analysis, the strongest correlation of AVA was to height (r=0.75, p<0.001) and for LMM to weight (r=0.64, p<0.001). In a multiple regression analysis, the expected AVA for healthy subjects can be predicted using body height: AVA=-2.64+0.04 x(height in cm) -0.47 x w (w=0 for man, w=1 for female).In patients with aortic valve stenosis, AVA was 1.0+/-0.35 cm(2), in correlation to cath lab r=0.72, and LMM was 172+/-56 g. We compared the AS patients results with the data of the healthy subjects, where the reduction of the AVA was 28+/-10% of the expected normal value, while LMM was 42% higher in patients with AS. There was no correlation to height, weight or BSA in patients with AS. With cardiac MRI, planimetry of AVA for normal subjects and patients with AS offered a simple, fast and non-invasive method to quantify AVA. In addition LMM and EF could be determined. The strong correlation between height and AVA documented in normal subjects offered the opportunity to integrate this relation between expected valve area and definitive orifice in determining the disease of the aortic valve for the individual patient. With diagnostic MRI in patients with AS, invasive measurements of the systolic transvalvular gradient does not seem to be necessary. PMID:15747039

Haimerl, J; Freitag-Krikovic, A; Rauch, A; Sauer, E

2005-03-01

258

Patient radiation exposure during transcatheter aortic valve replacement procedures  

PubMed Central

Aims To describe patient radiation utilisation during transcatheter aortic valve replacement (TAVR) on a series of consecutive patients. Methods and results Data on radiation exposure were prospectively collected for consecutive patients undergoing TAVR and percutaneous coronary interventions at our centre. Radiation dose during the procedure was recorded using the US Food and Drug Administration (FDA) reference point (Ka,r) and the dose area product (PKA). In addition to quantifying overall radiation doses during TAVR, radiation exposure during transfemoral (TF) (n=79) and transapical (TA) (n=26) cases was compared. The median radiation dose during TAVR was 1,639 mGy (983–2,420), or 188 (106–321) Gy*cm2. Radiation dose was significantly lower among TA patients using either the reference point (TA: 946 [777–1,261] vs. TF: 1,932 [1,383–2,614] mGy; p<0.001) or the dose area product (TA: 89 [60–115] vs. TF: 236 [164–338] Gy*cm2; p<0.001). Fluoroscopy time was lower for TA patients (TA: 10 [8–11] vs. TF: 30 [24–34] minutes; p<0.001). Operators experience did not affect radiation exposure for TF cases. Conclusions Radiation exposure during TAVR appears similar to other percutaneous coronary interventions of moderate complexity. Radiation doses were significantly lower for TA procedures. A higher dose of radiation in TF patients may be related to additional imaging requirements to optimise percutaneous vascular access and closure. PMID:23086785

Daneault, Benoit; Balter, Stephen; Kodali, Susheel K.; Williams, Mathew R.; Généreux, Philippe; Reiss, George R.; Paradis, Jean-Michel; Green, Philip; Kirtane, Ajay J.; Smith, Craig; Moses, Jeffrey W.; Leon, Martin B.

2013-01-01

259

RAGE influences the development of aortic valve stenosis in mice on a high fat diet.  

PubMed

Advanced glycation end product (AGE) accumulations as well as a high fat diet are associated with cardiovascular diseases. AGEs are recognized by several receptor molecules of which the receptor of AGEs (RAGE) is currently the most intensively studied. Activation of RAGE causes an unfavorable pro-inflammatory state. The hypothesis of this study was that metabolic stress due to a high fat diet results in the development of aortic valve stenosis and that knockout of RAGE should be protective. Six week old male C57BL/6N and C57BL/6N RAGE-/- mice (n=28) were randomly assigned to 4 groups and fed with normal or high fat diet for 32weeks. Weight gain was determined weekly. At the start of the experiment and after 2, 4 and 7months, echocardiographic assessments of the aortic valve were made. At the end of the experiment, plasma lipid levels and histological changes of the valves were determined. The high fat diet resulted in accelerated weight gain. However, after 7month, only C57BL/6 mice developed increased trans-aortic-valve velocities, leaflet thickness and reduced valve area index (p<0.0001). Immunohistochemistry of the aortic valves revealed in C57BL/6N mice on a high fat diet more calcification, AGE accumulation and RAGE expression when compared to normal fed control. Hearts and aortic valves of RAGE-/- mice showed less morphometric changes, calcification and AGE accumulation. After 7months of high fat feeding C57BL/6 mice (p<0.0001) as well as RAGE-/- mice (p=0.007) had significantly increased cholesterol levels compared to normal fed control, however RAGE-/- mice were probably protected due to a better HDL/LDL ratio when compared to wild type animals (p=0.003). These data suggest that AGEs and RAGE are involved in the development of obesity, hypercholesterolemia and aortic valve changes due to metabolic stress from high fat intake. PMID:24818652

Hofmann, Britt; Yakobus, Yuliana; Indrasari, Mailiza; Nass, Norbert; Santos, Alexander Navarrete; Kraus, Frank Bernhard; Silber, Rolf-Edgar; Simm, Andreas

2014-11-01

260

Improvement of aortic valve stenosis by ApoA-I mimetic therapy is associated with decreased aortic root and valve remodelling in mice  

PubMed Central

Background and Purpose We have shown that infusions of apolipoprotein A-I (ApoA-I) mimetic peptide induced regression of aortic valve stenosis (AVS) in rabbits. This study aimed at determining the effects of ApoA-I mimetic therapy in mice with calcific or fibrotic AVS. Experimental Approach Apolipoprotein E-deficient (ApoE?/?) mice and mice with Werner progeria gene deletion (Wrn?hel/?hel) received high-fat diets for 20 weeks. After developing AVS, mice were randomized to receive saline (placebo group) or ApoA-I mimetic peptide infusions (ApoA-I treated groups, 100 mg·kg?1 for ApoE?/? mice; 50 mg·kg?1 for Wrn mice), three times per week for 4 weeks. We evaluated effects on AVS using serial echocardiograms and valve histology. Key Results Aortic valve area (AVA) increased in both ApoE?/? and Wrn mice treated with the ApoA-I mimetic compared with placebo. Maximal sinus wall thickness was lower in ApoA-I treated ApoE?/? mice. The type I/III collagen ratio was lower in the sinus wall of ApoA-I treated ApoE?/? mice compared with placebo. Total collagen content was reduced in aortic valves of ApoA-I treated Wrn mice. Our 3D computer model and numerical simulations confirmed that the reduction in aortic root wall thickness resulted in improved AVA. Conclusions and Implications ApoA-I mimetic treatment reduced AVS by decreasing remodelling and fibrosis of the aortic root and valve in mice. PMID:23638718

Trapeaux, J; Busseuil, D; Shi, Y; Nobari, S; Shustik, D; Mecteau, M; El-Hamamsy, I; Lebel, M; Mongrain, R; Rhéaume, E; Tardif, J-C

2013-01-01

261

Factors Determining Patient-Prosthesis Mismatch after Aortic Valve Replacement – A Prospective Cohort Study  

PubMed Central

Objective “Patient-prosthesis mismatch” (PPM) after aortic valve replacement (AVR) has been reported to increase morbidity and mortality. Although algorithms have been developed to avoid PPM, factors favouring its occurrence have not been well defined. Design and Setting This was a prospective cohort study performed at the Medical University of Vienna. Patients 361 consecutive patients who underwent aortic valve replacement for isolated severe aortic stenosis were enrolled. Main Outcome Measures Patient- as well as prosthesis-related factors determining the occurrence of moderate and severe PPM (defined as effective orifice area indexed to body surface area ? 0.8 cm2/m2) were studied. Results Postoperatively, 172 patients (48%) were diagnosed with PPM. The fact that predominantly female patients were affected (58% with PPM diagnosis in women versus 36% in men, p<0.001) was explained by the finding that they had smaller aortic root diameters (30.5±4.7 mm versus 35.3±4.2 mm, p<0.0001) and a higher proportion of bioprosthetic valves (82% versus 62%, p<0.0001), both independent predictors of PPM (aortic root diameter: OR 0.009 [95% CI, 0.004;0.013]; p?=?0.0003, presence of bioprosthetic valve: OR 0.126 [95% CI, 0.078;0.175]; p<0.0001). Conclusions The occurrence of PPM is determined by aortic root diameter and prosthesis type. Novel sutureless bioprostheses with optimized hemodynamic performance or transcatheter aortic valves may become a promising alternative to conventional bioprosthetic valves in the future. PMID:24312608

Bonderman, Diana; Graf, Alexandra; Kammerlander, Andreas A.; Kocher, Alfred; Laufer, Guenter; Lang, Irene M.; Mascherbauer, Julia

2013-01-01

262

Huge thrombus growing on an aortic prosthetic valve detected in acute coronary syndrome.  

PubMed

A 74-year-old woman with a history of aortic valve replacement (AVR) with a tilting prosthesis at the age of 59 was referred to our hospital with chest pain at rest. Following conservative treatment after admission, the laboratory findings demonstrated acute myocardial infarction. Although bilateral coronary arteries exhibited no significant stenosis and embolism on the emergency coronary angiogram, a huge mobile mass above the prosthetic valve was recognized on the aortography, computed tomography, and trans-esophageal echocardiography. Operative findings demonstrated that the huge mobile thrombus was growing from the sawing ring on the side of minor orifice and almost covered the ostium of the left coronary artery. Emergency re-AVR with 21 mm SJM HP valve was performed. This clinical course suggested that the acute coronary syndrome might be caused by the isolated thrombus on the aortic prosthetic valve without any insufficiency of prosthesis and embolic findings due to the thrombosed valve. PMID:16095241

Chikazawa, Genta; Nakano, Hideaki; Nagata, Hiroyuki; Tabuchi, Takafumi

2005-07-01

263

Dez anos de experiência com a substituição da valva aórtica com homoenxertos valvares aórticos implantados pela técnica da substituição total da raiz Ten years experience of aortic valve replacement with aortic homograft root replacement  

Microsoft Academic Search

Objective: To evaluate the immediate and late results of 10 years of aortic valve root replacement with aortic homografts and to identify possible risk factors related with homograft primary tissue failure. Methods: Between May 1995 and January 2006, 282 patients with a mean age of 52.8 ± 16.6 years were submitted to aortic valve root replacement with aortic homografts. The

Francisco COSTA; Daniele de Fátima; Camila Naomi MATSUDA; Rafael de Almeida; Evandro SARDETTO; Andreia Dumsch de Aragon FERREIRA; Claudinei COLATUSSO; Carlos Henrique

264

Experimental analysis of fluid mechanical energy losses in aortic valve stenosis: importance of pressure recovery.  

PubMed

Current methods for assessing the severity of aortic stenosis depend primarily on measures of maximum systolic pressure drop at the aortic valve orifice and related calculations such as valve area. It is becoming increasingly obvious, however, that the impact of the obstruction on the left ventricle is equally important in assessing its severity and could potentially be influenced by geometric factors of the valve, causing variable degrees of downstream pressure recovery. The goal of this study was to develop a method for measuring fluid mechanical energy losses in aortic stenosis that could then be directly related to the hemodynamic load placed on the left ventricle. A control volume form of conservation of energy was theoretically analyzed and modified for application to aortic valve stenosis measurements. In vitro physiological pulsatile flow experiments were conducted with different types of aortic stenosis models, including a venturi meter, a nozzle, and 21-mm Medtronic-Hall tilting disc and St. Jude bileaflet mechanical valves. The energy loss created by each model was measured for a wide range of experimental conditions, simulating physiological variation. In all cases, there was more energy lost for the nozzle (mean = 0.27 J) than for any other model for a given stroke volume. The two prosthetic valves generated approximately the same energy losses (mean = 0.18 J), which were not statistically different, whereas the venturi meter had the lowest energy loss for all conditions (mean = 0.037 J). Energy loss correlated poorly with orifice pressure drop (r2 = 0.34) but correlated well with recovered pressure drop (r2 = 0.94). However, when the valves were considered separately, orifice and recovered pressure drop were both strongly correlated with energy loss (r2 = 0.99, 0.96). The results show that recovered pressure drop, not orifice pressure drop, is directly related to the energy loss that determines pump work and therefore is a more accurate measure of the hemodynamic significance of aortic stenosis. PMID:8923988

Heinrich, R S; Fontaine, A A; Grimes, R Y; Sidhaye, A; Yang, S; Moore, K E; Levine, R A; Yoganathan, A P

1996-01-01

265

Rapid 3D printing of anatomically accurate and mechanically heterogeneous aortic valve hydrogel scaffolds  

PubMed Central

The aortic valve exhibits complex three-dimensional (3D) anatomy and heterogeneity essential for long-term efficient biomechanical function. These are, however, challenging to mimic in de novo engineered living tissue valve strategies. We present a novel simultaneous 3D-printing/photocrosslinking technique for rapidly engineering complex, heterogeneous aortic valve scaffolds. Native anatomic and axisymmetric aortic valve geometries (root wall and tri-leaflets) with 12 to 22 mm inner diameters (ID) were 3D printed with poly-ethylene glycol-diacrylate (PEG-DA) hydrogels (700 or 8000 MW) supplemented with alginate. 3D printing geometric accuracy was quantified and compared using Micro-CT. Porcine aortic valve interstitial cells (PAVIC) seeded scaffolds were cultured for up to 21 days. Results showed that blended PEG-DA scaffolds could achieve over 10-fold range in elastic modulus (5.3±0.9 to 74.6±1.5 kPa). 3D printing times for valve conduits with mechanically contrasting hydrogels were optimized to 14 to 45 minutes, increasing linearly with conduit diameter. Larger printed valves had greater shape fidelity (93.3±2.6, 85.1±2.0, and 73.3±5.2% for 22, 17, and 12 mm ID porcine valves; 89.1±4.0, 84.1±5.6, and 66.6±5.2% for simplified valves). PAVIC seeded scaffolds maintained near 100% viability over 21 days. These results demonstrate that 3D hydrogel printing with controlled photocrosslinking can rapidly fabricate anatomical heterogeneous valve conduits that support cell engraftment. PMID:22914604

Hockaday, L A; Kang, K H; Colangelo, N W; Cheung, P Y C; Duan, B; Malone, E; Wu, J; Girardi, L N; Bonassar, L J; Lipson, H; Chu, C C; Butcher, J T

2013-01-01

266

Incidence and prognosis of congenital aortic valve stenosis in Liverpool (1960-1990).  

PubMed Central

OBJECTIVE--To determine the incidence and prognosis of congenital aortic valve stenosis in the five Health Districts of Liverpool that make up the Merseyside area. DESIGN--The records of the Liverpool Congenital Malformations Registry and the Royal Liverpool Children's Hospital identified 239 patients (155 male, 84 female) born with aortic valve stenosis between 1960 and 1990. Patients were traced to assess the severity of stenosis at follow up. Information on the severity at presentation and all subsequent events was obtained. RESULTS--Congenital aortic valve stenosis occurred in 5.7% of patients with congenital heart disease born in the Merseyside area. The median age at presentation was 16 months (range 0-20 years). Stenosis was mild at presentation in 145 patients, moderate in 33, severe in one and critical in 21 and 39 had a bicuspid valve without stenosis. Additional cardiac lesions were significantly more common in children presenting under one year of age and in those with critical stenosis. The median duration of follow up was 9.2 years (range 1-28 years) and seven patients were lost to follow up. 81 operations were performed in 60 patients. The reoperation rate was 28.3% after a median duration of 8.7 years (range 2.5-18 years). 15% of patients who presented with mild stenosis subsequently required operation compared with 67% of those with moderate stenosis. There were no sudden unexpected deaths and no deaths after aortic valvotomy, except in those presenting with critical stenosis. Mortality was 16.7% but patients presenting with critical aortic stenosis had a much worse prognosis. Actuarial and hazard analysis showed that the survival and absence of serious events (aortic valve surgery or balloon dilatation, endocarditis, or death) were significantly better in patients who presented with mild aortic stenosis than in those who presented with moderate aortic stenosis. 75% of patients presenting with mild stenosis had not progressed to moderate stenosis after 10 years of follow up. CONCLUSIONS--Congenital aortic valve stenosis may be progressive even when it is mild at presentation. Patients presenting with mild stenosis, however, have a significantly better prognosis than those presenting with moderate stenosis. An accurate clinical and echocardiographic assessment of the severity of aortic valve stenosis at presentation provides a good guide to prognosis into early adult life. PMID:8457400

Kitchiner, D J; Jackson, M; Walsh, K; Peart, I; Arnold, R

1993-01-01

267

Comparison 30-day clinical complications between transfemoral versus transapical aortic valve replacement for aortic stenosis: a meta-analysis review  

PubMed Central

Background Since 2002, transapical aortic valve replacement has been developed as a clinical pathway for transcatheter aortic valve implantation (TAVI). However the appropriate role of TA in the AS population versus TF remains unclear. We performed a meta-analysis to assess if TF has any benefit in reduction of 30-day clinical complications in AS. Methods We conducted a comprehensive search on pub-med and web of knowledge from 2002 through September 2012 using following terms: aortic stenosis, aortic valve replacement, transcatheter aortic valve implantation, TAVI, trans-artery, transfemoral, trans-apical. Studies in the original research or review articles were also considered. Included studies must meet the preconditioned criterias. Two investigators independently browsed the studies by title and abstract, finally making decision according to full-text. Disagreements were discussed in group. Results A total of 20 studies met inclusion criteria’s and were included in the analysis (including 4267 patients in TF group, 2242 in TA group). No random clinical trial, one was a retrospective study, others were prospective trials. Our meta-analysis found that TF had the low incidence of 30-day mortality compared with TA procedure (7.5% versus 11.3%). The incidence of stroke at???30 days was relatively low (3.8% in TF versus 4.0% in TA). Although the incidence of post-operative heart block was high (8.5% versus 7.5%), but no differences were indicated [1.06,95% CI(0.85,1.33)]. Conclusions The result of our meta-analysis suggested that TF may have a low risk for 30-day mortality against TA procedure. No difference was found in the incidence of post-operative stroke and heart block. PMID:23819523

2013-01-01

268

Coronary Artery Disease and Outcomes of Aortic Valve Replacement for Severe Aortic Stenosis  

PubMed Central

Objectives We contrast risk profiles and compare outcomes of patients with severe aortic stenosis (AS) and coronary artery disease (CAD) who underwent aortic valve replacement (AVR) and coronary artery bypass grafting (AS+CABG) with those of patients with isolated AS who underwent AVR alone. Background In patients with severe AS, CAD is often an incidental finding with underappreciated survival implications. Methods From 10/1991–7/2010, 2,286 patients underwent AVR+CABG and 1,637 AVR alone. A propensity score was developed and used for matched comparisons of outcomes (1,082 patient pairs). Analyses of long-term mortality were performed for each group, then combined to identify common and unique risk factors. Results Patients with AS+CAD vs. isolated AS were older, more symptomatic, more likely to be hypertensive, had lower ejection fraction and greater arteriosclerotic burden, but less severe AS. Hospital morbidity and long-term survival were poorer (43% vs. 59% at 10 years). Both groups shared many mortality risk factors; however, early risk among AS+CAD patients reflected effects of CAD; late risk reflected diastolic left ventricular dysfunction expressed as ventricular hypertrophy and left atrial enlargement. Patients with isolated AS and few comorbidities had the best outcome, those with CAD without myocardial damage had intermediate outcome equivalent to propensity-matched isolated AS patients, and those with CAD, myocardial damage, and advanced comorbidities had the worst outcome. Conclusions Cardiovascular risk factors and comorbidities must be considered in managing patients with severe AS. Patients with severe AS and CAD risk factors should undergo early diagnostics and AVR+CABG before ischemic myocardial damage occurs. PMID:23428216

Beach, Jocelyn M.; Mihaljevic, Tomislav; Svensson, Lars G.; Rajeswaran, Jeevanantham; Marwick, Thomas; Griffin, Brian; Johnston, Douglas R.; Sabik, Joseph F.; Blackstone, Eugene H.

2014-01-01

269

Comparison of exercise and dobutamine echocardiography in the haemodynamic assessment of small size mechanical aortic valve prostheses  

Microsoft Academic Search

Objective: Doppler echocardiographic evaluation of prosthetic heart valve function is usually performed at rest although this situation is not representative of patients' daily activities. Following aortic valve replacement, patients most likely to remain symptomatic are those with a small aortic root and dobutamine or exercise echocardiography has been proposed to elicit the presence of abnormal haemodynamics or persistently elevated transvalvular

Isaac Kadir; Catherine Walsh; Peter Wilde; Alan J. Bryan; Gianni D. Angelini

2002-01-01

270

Comparison of exercise and dobutamine echocardiography in the haemodynamic assessment of small size mechanical aortic valve prostheses  

Microsoft Academic Search

Objective: Doppler echocardiographic evaluation of prosthetic heart valve function is usually performed at rest although this situation is not representative of patients' daily activities. Following aortic valve replacement, patients most likely to remain symptomatic are those with a small aortic root and dobutamine or exercise echocardiography has been proposed to elicit the presence of abnormal haemodynamics or persistently elevated transvalvular

Isaac Kadir; Catherine Walsh; Peter Wilde; Alan J. Bryan; Gianni D. Angelini

2010-01-01

271

Initial non-opioid based anesthesia in a parturient having severe aortic stenosis undergoing cesarean section with aortic valve replacement.  

PubMed

Pregnancy in presence of severe aortic stenosis (AS) causes worsening of symptoms needing further intervention. In the advanced stages of pregnancy, some patients may even require aortic valve replacement (AVR) and cesarean delivery in the same sitting. Opioid based general anesthesia for combined lower segment cesarean section (LSCS) with AVR has been described. However, the use of opioid may lead to fetal morbidity and need of respiratory support for the baby. We describe successful anesthetic management for LSCS with AVR in a >33 week gravida with severe AS and congestive heart failure. We avoided opioids till delivery of the baby AVR; the delivered neonate showed a normal APGAR score. PMID:25566720

Podder, Subrata; Kumar, Ajay; Mahajan, Sachin; Saha, Pradip Kumar

2015-01-01

272

Minimally invasive aortic valve replacement: the Leipzig experience  

PubMed Central

Background Minimally invasive techniques are progressively challenging traditional approaches in cardiothoracic surgery. Minimally invasive aortic valve replacement (AVR) has become a routine procedure at our institution. Methods We retrospectively analyzed all patients undergoing minimally invasive isolated AVR between January 2003 and March 2014, at our institution. Mean follow-up was 4.7±4.3 years (range: 0-18 years) and was 99.8% complete. Results There were 1,714 patients who received an isolated minimally invasive AVR. The mean (± SD) patient age was 65±12.8 years, ejection fraction 60%±12% and log EuroSCORE 5.3%±5.1%. Mean cross-clamp time was 58±18 minutes and mean cardiopulmonary bypass (CPB) time was 82.9±26.7 minutes. Thirty-day survival was 97.8%±0.4%, and 69.4%±1.7% at 10-years. The multivariate analysis revealed age at surgery [P=0.016; odds ratio (OR), 1.1], length of surgery time (P=0.002; OR, 1.01), female gender (P=0.023; OR, 3.54), preoperative myocardial infarction (MI) (P=0.006; OR, 7.87), preoperative stroke (P=0.001; OR, 13.76) and preoperative liver failure (P=0.015; OR, 10.28) as independent risk factors for mortality. Cox-regression analysis revealed the following predictors for long term mortality: age over 75 years (P<0.001; OR, 3.5), preoperative dialysis (P<0.01; OR, 2.14), ejection fraction less than 30% (P=0.003; OR, 3.28) and urgent or emergency operation (P<0.001; OR, 2.3). Conclusions Minimally invasive AVR can be performed safely and effectively with very few perioperative complications. The early and long-term outcomes in these patients are acceptable.

Merk, Denis R.; Etz, Christian D.; Seeburger, Joerg; Schroeter, Thomas; Oberbach, Andreas; Uhlemann, Madlen; Hoellriegel, Robert; Haensig, Martin; Leontyev, Sergey; Garbade, Jens; Misfeld, Martin; Mohr, Friedrich W.

2015-01-01

273

Aortic valve replacement with mechanical and biologic prostheses in middle-aged patients  

Microsoft Academic Search

Background. Mechanical prostheses are used in young patients and bioprostheses in the elderly because of the higher rate of structural failure of bioprostheses. The objective of the present study was to compare results after aortic valve replacement with mechanical (CarboMedics) and biologic (Carpentier-Edwards pericardial) in middle-aged patients.Methods. Five hundred twenty-one patients, aged between 55 and 65 years, who underwent aortic

Michel Carrier; Michel Pellerin; Louis P Perrault; Pierre Pagé; Yves Hébert; Raymond Cartier; Ihor Dyrda; L. Conrad Pelletier

2001-01-01

274

Recombinant factor VIIa after aortic valve replacement in a patient with osteogenesis imperfecta  

Microsoft Academic Search

A 26-year-old man with osteogenesis imperfecta and severe aortic regurgitation was scheduled for aortic valve replacement. As previously described by other authors the operation was difficult owing to the friability and weakness of the tissues. Mean blood losses of 153 mL per hour during the first 7 postoperative hours were observed. Despite normal coagulation indicators the bleeding did not stop

Marc Kastrup; Christian von Heymann; Holger Hotz; Wolfgang F Konertz; Sabine Ziemer; Wolfgang J Kox; Claudia Spies

2002-01-01

275

[Anesthesia with transfemoral and transapical aortic valve implantation. Periinterventional management and hemodynamic observations].  

PubMed

Percutaneous transfemoral and transapical aortic valve implantations are novel procedures that often confront the anesthesiologist with bigger challenges than surgical aortic valve replacements using cardiopulmonary bypass. Due to old age and the presence of severe comorbidities including pulmonary vascular hypertension, most patients have a very high risk. Individual comorbidities and their severity are as important for the choice of the anesthetic technique as pharmacological cardiovascular therapy and communication during the respective phases of the intervention. Since severe hemodynamic alterations (cardiogenic shock, coronary ischemia, arrhythmias) and potential interventional complications (bleeding, ventricular and vascular injury) may occur, the authors routinely perform an extended cardiovascular monitoring. General endotracheal anesthesia may be advantageous even for transfemoral valve implantation and was not associated with a worse outcome. Following valve implantation a substantial increase in cardiac index, but also of all filling pressures was measured. Anesthesia coverage time for the first 100 cases averaged 263 min (+/- 96) for transfemoral and 297 (+/- 78) for transapical valve implantation, which appears greater than for conventional aortic valve replacement surgery, but it decreased significantly for transfemoral valve implantation over the course of interventions. Accordingly, the anesthesiologist, besides providing anesthesia and managing the airway, assumes responsibility for invasive cardiopulmonary monitoring, cardiovascular pharmacotherapy tailored to intervention phases, and "troubleshooting" in the event of complications for these still developing interventions. PMID:19711034

Bergmann, Lars; Kottenberg, Eva; Heine, Torsten; Kahlert, Philipp; Eggebrecht, Holger; Wendt, Daniel; Thielmann, Matthias; Jakob, Heinz; Erbel, Raimund; Peters, Jürgen

2009-08-01

276

Identification of Reference Genes for Quantitative RT-PCR in Ascending Aortic Aneurysms  

PubMed Central

Hypertension and congenital aortic valve malformations are frequent causes of ascending aortic aneurysms. The molecular mechanisms of aneurysm formation under these circumstances are not well understood. Reference genes for gene activity studies in aortic tissue that are not influenced by aortic valve morphology and its hemodynamic consequences, aortic dilatation, hypertension, or antihypertensive medication are not available so far. This study determines genes in ascending aortic tissue that are independent of these parameters. Tissue specimens from dilated and undilated ascending aortas were obtained from 60 patients (age ?70 years) with different morphologies of the aortic valve (tricuspid undilated n?=?24, dilated n?=?11; bicuspid undilated n?=?6, dilated n?=?15; unicuspid dilated n?=?4). Of the studied individuals, 36 had hypertension, and 31 received ACE inhibitors or AT1 receptor antagonists. The specimens were obtained intraoperatively from the wall of the ascending aorta. We analyzed the expression levels of 32 candidate reference genes by quantitative RT-PCR (RT-qPCR). Differential expression levels were assessed by parametric statistics. The expression analysis of these 32 genes by RT-qPCR showed that EIF2B1, ELF1, and PPIA remained constant in their expression levels in the different specimen groups, thus being insensitive to aortic valve morphology, aortic dilatation, hypertension, and medication with ACE inhibitors or AT1 receptor antagonists. Unlike many other commonly used reference genes, the genes EIF2B1, ELF1, and PPIA are neither confounded by aortic comorbidities nor by antihypertensive medication and therefore are most suitable for gene expression analysis of ascending aortic tissue. PMID:23326585

Henn, Dominic; Bandner-Risch, Doris; Perttunen, Hilja; Schmied, Wolfram; Porras, Carlos; Ceballos, Francisco; Rodriguez-Losada, Noela; Schäfers, Hans-Joachim

2013-01-01

277

Fluid-Structure Interaction Simulation of Aortic Valve Closure with Various Sinotubular Junction and Sinus Diameters.  

PubMed

This study was designed to investigate the effect of sinotubular junction and sinus diameters on aortic valve closure to prevent the regurgitation of blood from the aorta into the left ventricle during ventricular diastole. The 2-dimensional geometry of a base aortic valve was reconstructed using the geometric constraints and modeling dimensions suggested by literature as the reference model A (aortic annulus diameter (DAA) = 26, diameters of sinotubular junction (DSTJ) = 26, sinus diameter (DS) = 40), and then the DSTJ and DS were modified to create five geometric models named as B (DSTJ = 31.2, DS = 40), C (DSTJ = 20.8, DS = 40), D (DSTJ = 26, DS = 48), E (DSTJ = 26, DS = 32) and F (DSTJ = 31.2, DS = 48) with different dimensions. Fluid structure interaction method was employed to simulate the movement and mechanics of aortic root. The performance of the aortic root was quantified in terms of blood flow velocity through aortic valve, annulus diameter as well as leaflet contact pressure. For comparison among A, B and C, the differences of annulus diameter and leaflet contact pressure do not exceed 5% with DSTJ increased by 1.2 times and decreased by 0.8 times. For comparison among A, D and E, annulus diameter was increased by 6.92% and decreased by 7.87%, and leaflet contact pressure was increased by 8.99% and decreased by 12.14% with DS increased by 1.2 times and decreased by 0.8 times. For comparison between A and F, annulus diameter was increased by 5.10%, and leaflet contact pressure was increased by 13.54% both with DSTJ and DS increased by 1.1 times. The results of leaflet contact pressure presented for all models were consistent with those of aortic annulus diameters. For the Ross operation involves replacing the diseased aortic valve, aortic valve closure function can be affected by various sinotubular junction and sinus diameter. Compared with the sinus diameters, sinotubular junction diameters have less effect on the performance of aortic valve closure, when the diameter difference is within a range of 20%. So surgical planning might give sinus diameter more consideration. PMID:25224079

Pan, Youlian; Qiao, Aike; Dong, Nianguo

2014-09-16

278

Meta-analysis of patients taking statins before revascularization and aortic valve surgery.  

PubMed

Statin intake before cardiac surgery is associated with favorable outcomes. We sought to analyze the evidence for statin pretreatment before isolated coronary artery bypass graft surgery and aortic valve replacement surgery. In this meta-analysis, we demonstrate beneficial results for the endpoints mortality, stroke, atrial fibrillation, and length of stay in hospital in 36,053 statin-pretreated coronary artery bypass graft surgery patients compared with control subjects retrieved from 32 studies, but fail to detect relevant advantages through preoperative statin therapy for 3,091 patients undergoing aortic valve replacement from four trials. Strict adherence to guidelines recommending statin treatment before CABG surgery is therefore mandatory. PMID:23993896

Kuhn, Elmar W; Liakopoulos, Oliver J; Stange, Sebastian; Deppe, Antje-Christin; Slottosch, Ingo; Scherner, Maximilian; Choi, Yeong-Hoon; Wahlers, Thorsten

2013-10-01

279

Feasibility of transapical aortic valve replacement through a left ventricular apical diverticulum  

PubMed Central

Transapical aortic valve replacement is an established technique performed in high-risk patients with symptomatic aortic valve stenosis and vascular disease contraindicating trans-vascular and trans-aortic procedures. The presence of a left ventricular apical diverticulum is a rare event and the treatment depends on dimensions and estimated risk of embolisation, rupture, or onset of ventricular arrhythmias. The diagnosis is based on standard cardiac imaging and symptoms are very rare. In this case report we illustrate our experience with a 81 years old female patient suffering from symptomatic aortic valve stenosis, respiratory disease, chronic renal failure and severe peripheral vascular disease (logistic euroscore: 42%), who successfully underwent a transapical 23 mm balloon-expandable stent-valve implantation through an apical diverticulum of the left ventricle. Intra-luminal thrombi were absent and during the same procedure were able to treat the valve disease and to successfully exclude the apical diverticulum without complications and through a mini thoracotomy. To the best of our knowledge, this is the first time that a transapical procedure is successfully performed through an apical diverticulum. PMID:23294524

2013-01-01

280

Doppler echocardiographic comparison of small (19 mm) bileaflet and pericardial heart valve prostheses in aortic position.  

PubMed

The resting haemodynamics of five types of small (19 mm) aortic valve prosthesis (2 bileaflet, 3 pericardial) were evaluated with Doppler echocardiography in 43 patients. Two received St Jude Medical and six CarboMedics bileaflet valves and 35 were given bioprostheses--16 Ionescu-Shiley, four Mitroflow and 15 Labcor-Santiago. No significant differences in peak or mean transvalvular pressure drop or in effective valve area were found between the bileaflet and the pericardial valves or among the three types of bioprosthesis. All but one of the bileaflet prostheses showed a characteristic regurgitation pattern, with two lateral and one central jet, and 16 (46%) of the bioprostheses showed central regurgitation, but in no case were these jets haemodynamically significant. Thus the 19 mm bileaflet and the studied pericardial prostheses all have satisfactory resting haemodynamics, and all are suitable for implanting in small aortic roots. PMID:7644906

González-Juanatey, J R; Garcia Acuña, J M; Amaro, A; Castelo, V; Pedreira, M; Garcia Bengoechea, J; Gil, M

1995-01-01

281

Thrombotic aortic restenosis after transapical SAPIEN valve implantation.  

PubMed

We describe a patient previously implanted with a SAPIEN Edwards valve by the transapical approach, who subsequently experienced a valve thrombosis. The literature on this subject is reviewed. PMID:24330134

Pergolini, Amedeo; Pino, Paolo Giuseppe; Zampi, Giordano; Polizzi, Vincenzo; Musumeci, Francesco

2014-03-01

282

Inclusion cylinder method for aortic valve replacement utilising the Ross operation in adults with predominant aortic stenosis – 99% freedom from re-operation on the aortic valve at 15 years  

PubMed Central

Background: To report our experience with the Ross operation in patients with predominant aortic stenosis (AS) using an inclusion cylinder (IC) method. Methods: Out of 324 adults undergoing a Ross operation, 204 patients of mean age of 41.3 years (limits 16–62) underwent this procedure for either AS or mixed AS and regurgitation (AS/AR) between October, 1992 and February, 2012, implanting the PA with an IC method. Clinical follow up and serial echo data for this group is 97% complete with late mortality follow up 99% complete. Results: There has been zero (0%) early mortality, and late survival at 15 years is 98% (96%, 100%). Only one re-operation on the aortic valve for progressive aortic regurgitation (AR) has been required with freedom from re-operation on the aortic valve at 15 years being 99% (96%, 100%). The freedom from all re-operations on the aortic and pulmonary valves at 15 years is 97% (94%, 100%). Echo analysis at the most recent study shows that 98% have nil, trivial or mild AR. Aortic root size has remained stable, shown by long-term (15 year) echo follow up. Conclusions: In an experience spanning 19 years, the Ross operation used for predominant AS using the IC method described, results in 99% freedom from re-operation on the aortic valve at 15 years, better than any other tissue or mechanical valve. For adults under 65 years without significant co-morbidities who present with predominant AS, the pulmonary autograft inserted with this technique gives excellent results. PMID:24749112

Skillington, Peter D.; Mokhles, M. Mostafa; Wilson, William; Grigg, Leeanne; Larobina, Marco; O'Keefe, Michael; Takkenberg, Johanna

2013-01-01

283

Review of molecular and mechanical interactions in the aortic valve and aorta: implications for the shared pathogenesis of aortic valve disease and aortopathy.  

PubMed

Aortic valve disease (AVD) and aortopathy are associated with substantial morbidity and mortality, representing a significant cardiovascular healthcare burden worldwide. These mechanobiological structures are morphogenetically related and function in unison from embryonic development through mature adult tissue homeostasis, serving both coordinated and distinct roles. In addition to sharing common developmental origins, diseases of the aortic valve and proximal thoracic aorta often present together clinically. Current research efforts are focused on identifying etiologic factors and elucidating pathogenesis, including genetic predisposition, maladaptive cell-matrix remodeling processes, and hemodynamic and biomechanical perturbations. Here, we review the impact of these processes as they pertain to translational research efforts, emphasizing the overlapping relationship of these two disease processes. The successful application of new therapeutic strategies and novel tissue bioprostheses for AVD and/or aortopathy will require an understanding and integration of molecular and biomechanical processes for both diseases. PMID:25410134

Krishnamurthy, Varun K; Godby, Richard C; Liu, G R; Smith, J Michael; Hiratzka, Loren F; Narmoneva, Daria A; Hinton, Robert B

2014-12-01

284

Orthotopic Replacement of Aortic Heart Valves with Tissue-Engineered Grafts  

PubMed Central

Aims Heart valve tissue engineering aims to create a graft with improved durability compared to routinely used valve substitutes. This study presents the function and morphological changes of a tissue-engineered aortic valve (TEV) compared to the cryopreserved valve (CPV), aortic valve (AV) allografts in an orthotopic position in sheep. Methods and Results Ovine AV conduits (n=5) were decellularized with detergents. Autologous endothelial cells (ECs) were seeded onto the valve surface and cultured under physiological conditions using a high pulsatile flow. Grafts were implanted as a root with reimplantation of coronary ostia in sheep. Crystalloid cardioplegia and isogenic blood transfusions from previous sacrificed sheep were used. Only antiplatelet aggregation therapy was used postoperatively. CPVs (n=4) served as controls. The grafts were investigated for function (echocardiography, magnetic resonance investigation), morpho/histological appearance, graft rejection, and calcification at 3 months. Decellularization led to cell-free scaffolds with preserved extracellular matrices, including the basement membrane. TEVs were covered with ECs expressing typical endothelial markers. Neither dilatation, stenosis, reductions of cusp mobility nor a significant transvalvular gradient, were observed in the TEV group. Explanted valves exhibited normal morphology without signs of inflammation. An endothelial monolayer covered cusps and the valve sinus. In the CPV group, sporadic, macroscopic, calcified degeneration with mild AV insufficiency was noted. Histology revealed signs of rejection and incipient calcification of the tissue. Conclusion Tissue-engineered AV based on decellularized valve allografts satisfy short-term requirements of the systemic circulation in sheep. Although results of long-term experiments are pending, the lack of degenerative traits thus far, makes these grafts a promising alternative for future aortic heart valve surgery. PMID:23488793

Calistru, Alex; Baraki, Hassina; Meyer, Tanja; Höffler, Klaus; Sarikouch, Samir; Bara, Christopher; Görler, Adelheid; Hartung, Dagmar; Hilfiker, Andres; Haverich, Axel; Cebotari, Serghei

2013-01-01

285

Haemodynamics and left ventricular mass regression: a comparison of the stentless, stented and mechanical aortic valve replacement 1  

Microsoft Academic Search

Objective: Our objective was to compare the degree of change in hemodynamics and left ventricular mass (LVM) regression after aortic valve replacement (AVR) with stentless, stented and mechanical valves. Methods: Patients greater than 59 years of age had AVR for aortic stenosis with the stentless xenograft (Cryolife-O'Brien, CLOB), stented xenograft (Carpentier-Edwards, C-E) or mechanical valve (ATS). One-hundred and forty-two patients

Helen L. Thomson; Mark F. O'Brien; Aubrey A. Almeida; Peter J. Tesar; Malcolm B. Davison; Darryl J. Burstow

286

Recurrent posterior circulatory emboli from a mildly stenosed bicuspid aortic valve.  

PubMed

Bicuspid aortic valve (BAV) is a common condition but is only rarely associated with embolic complications. We describe a 42-year-old man with recurrent posterior circulatory ischemic strokes that resulted in ataxia and cognitive impairment. Transesophageal echocardiography demonstrated a BAV with mild stenosis, moderate calcification, and a dilated ascending aorta. The degree of calcification and the valve phenotype might be important factors implicating the BAV as a rare cause of ischemic stroke. PMID:20833085

Purvis, John; Gordon, Patricia; Flynn, Peter; McCarron, Mark

2011-11-01

287

Twenty-year follow-up of the Hancock modified orifice porcine aortic valve  

Microsoft Academic Search

Background. The entire experience with the Hancock modified orifice porcine bioprosthetic aortic valve from 1976 to 1996 at the Brigham and Women’s Hospital has been reviewed. Eight hundred forty-three patients received this valve with a total follow-up of 61,114 months, and a mean follow-up of approximately 72.5 months. There were 490 men and 353 women, and the predominate lesion was

Lawrence H Cohn; John J Collins; Robert J Rizzo; David H Adams; Gregory S Couper; Sary F Aranki

1998-01-01

288

Periannular complications in infective endocarditis involving prosthetic aortic valves.  

PubMed

The periannular extension of infection in prosthetic valve endocarditis (PVE) is a serious complication of infective endocarditis associated with high mortality. Periannular lesions in PVE occasionally rupture into adjacent cardiac chambers, leading to aortocavitary fistulae and intracardiac shunting. It is unknown whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinctive clinical characteristics of patients with PVE and either aortocavitary fistulization or nonruptured abscesses. In a retrospective multicenter study of >872 PVE episodes, 150 patients (17%) with periannular complications in PVE in the aortic position were identified (29 with aortocavitary fistulization and 121 with nonruptured abscesses). Early-onset PVE was present in 73 patients (49%). Rates of heart failure (p = 0.09), ventricular septal defect (p <0.01), and third-degree atrioventricular block (p = 0.07) were higher in patients with fistulization. Surgical treatment was undertaken in 128 patients (83%). In-hospital mortality in the overall population was 39%. Multivariate analysis identified heart failure (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.6 to 6.8), renal failure (OR 2.5, 95% CI 1.2 to 5.2), and co-morbidity (OR 2.4, 95% CI 1.1 to 5.1) as independent risk factors for death. Fistulous tract formation was not associated with increased in-hospital mortality (OR 1.6, 95% CI 0.7 to 3.7). The actuarial 5-year survival rate in surgical survivors was 100% in patients with fistulae and 78% in patients with nonruptured abscesses (log-rank p = 0.14). In conclusion, aortocavitary fistulous tract formation in PVE complicated with periannular complications is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscesses. Despite the frequent complications, fistulous tract formation in the current era of infective endocarditis is not an independent risk factor for mortality. PMID:17056343

Anguera, Ignasi; Miro, Jose M; San Roman, Jose Alberto; de Alarcon, Aristides; Anguita, Manuel; Almirante, Benito; Evangelista, Artur; Cabell, Christopher H; Vilacosta, Isidre; Ripoll, Tomas; Muñoz, Patricia; Navas, Enrique; Gonzalez-Juanatey, Carlos; Sarria, Cristina; Garcia-Bolao, Ignacio; Fariñas, M Carmen; Rufi, Gabriel; Miralles, Francisco; Pare, Carles; Fowler, Vance G; Mestres, Carlos A; de Lazzari, Elisa; Guma, Joan R; del Río, Ana; Corey, G Ralph

2006-11-01

289

Immersed smoothed finite element method for fluid-structure interaction simulation of aortic valves  

NASA Astrophysics Data System (ADS)

This paper presents a novel numerical method for simulating the fluid-structure interaction (FSI) problems when blood flows over aortic valves. The method uses the immersed boundary/element method and the smoothed finite element method and hence it is termed as IS-FEM. The IS-FEM is a partitioned approach and does not need a body-fitted mesh for FSI simulations. It consists of three main modules: the fluid solver, the solid solver and the FSI force solver. In this work, the blood is modeled as incompressible viscous flow and solved using the characteristic-based-split scheme with FEM for spacial discretization. The leaflets of the aortic valve are modeled as Mooney-Rivlin hyperelastic materials and solved using smoothed finite element method (or S-FEM). The FSI force is calculated on the Lagrangian fictitious fluid mesh that is identical to the moving solid mesh. The octree search and neighbor-to-neighbor schemes are used to detect efficiently the FSI pairs of fluid and solid cells. As an example, a 3D idealized model of aortic valve is modeled, and the opening process of the valve is simulated using the proposed IS-FEM. Numerical results indicate that the IS-FEM can serve as an efficient tool in the study of aortic valve dynamics to reveal the details of stresses in the aortic valves, the flow velocities in the blood, and the shear forces on the interfaces. This tool can also be applied to animal models studying disease processes and may ultimately translate to a new adaptive methods working with magnetic resonance images, leading to improvements on diagnostic and prognostic paradigms, as well as surgical planning, in the care of patients.

Yao, Jianyao; Liu, G. R.; Narmoneva, Daria A.; Hinton, Robert B.; Zhang, Zhi-Qian

2012-12-01

290

Initial in vivo results of the new Medtronic Advantage TM bileaflet valve in aortic position and comparison to the SJM  

Microsoft Academic Search

The present study investigated the Medtronic Advantage (MA) bileaflet valve in an animal model and compared the results to the St. Jude Medical (SJM) valve. Systolic performance and coronary artery flow in different orientations were studied.A rotation device holding either a MA or SJM aortic valve size 23 mm was implanted into eight pigs. Transvalvular pressure gradients and ventricular dimensions

Peter Kleine; Armin A Klesius; Mirella Scherer; Ulf Abdel-Rahman; Anton Moritz

2002-01-01

291

Correlation dimension analysis of Doppler signals in children with aortic valve disorders.  

PubMed

In this study, the correlation dimension analysis has been applied to the aortic valve Doppler signals to investigate the complexity of the Doppler signals which belong to aortic stenosis (AS) and aortic insufficiency (AI) diseases and healthy case. The Doppler signals of 20 healthy subjects, ten AS and ten AI patients were acquired via the Doppler echocardiography system that is a noninvasive and reliable technique for assessment of AS and AI diseases. The correlation dimension estimations have been performed for different time delay values to investigate the influence of time delay on the correlation dimension calculation. The correlation dimension of healthy group has been found lower those found in AI and AS disorder groups and the correlation dimension of AS group has also been found higher than those found in AI group, significantly. The results of this study have indicated that the aortic valve Doppler signals exhibit high level chaotic behaviour in AI and AS diseases than healthy case. Additionally, the correlation dimension analysis is sensitive to the time delay and has successfully characterized the blood flow dynamics for proper time delay value. As a result, the correlation dimension can be used as an efficient method to determine the healthy or pathological cases of aortic valve. PMID:20703615

Y?lmaz, Derya; Güler, N Fatma

2010-10-01

292

Aortic valve sclerosis in mice deficient in endothelial nitric oxide synthase.  

PubMed

Risk factors for fibrocalcific aortic valve disease (FCAVD) are associated with systemic decreases in bioavailability of endothelium-derived nitric oxide (EDNO). In patients with bicuspid aortic valve (BAV), vascular expression of endothelial nitric oxide synthase (eNOS) is decreased, and eNOS(-/-) mice have increased prevalence of BAV. The goal of this study was to test the hypotheses that EDNO attenuates profibrotic actions of valve interstitial cells (VICs) in vitro and that EDNO deficiency accelerates development of FCAVD in vivo. As a result of the study, coculture of VICs with aortic valve endothelial cells (vlvECs) significantly decreased VIC activation, a critical early phase of FCAVD. Inhibition of VIC activation by vlvECs was attenuated by N(G)-nitro-l-arginine methyl ester or indomethacin. Coculture with vlvECs attenuated VIC expression of matrix metalloproteinase-9, which depended on stiffness of the culture matrix. Coculture with vlvECs preferentially inhibited collagen-3, compared with collagen-1, gene expression. BAV occurred in 30% of eNOS(-/-) mice. At age 6 mo, collagen was increased in both bicuspid and trileaflet eNOS(-/-) aortic valves, compared with wild-type valves. At 18 mo, total collagen was similar in eNOS(-/-) and wild-type mice, but collagen-3 was preferentially increased in eNOS(-/-) mice. Calcification and apoptosis were significantly increased in BAV of eNOS(-/-) mice at ages 6 and 18 mo. Remarkably, these histological changes were not accompanied by physiologically significant valve stenosis or regurgitation. In conclusion, coculture with vlvECs inhibits specific profibrotic VIC processes. In vivo, eNOS deficiency produces fibrosis in both trileaflet and BAVs but produces calcification only in BAVs. PMID:24610917

El Accaoui, Ramzi N; Gould, Sarah T; Hajj, Georges P; Chu, Yi; Davis, Melissa K; Kraft, Diane C; Lund, Donald D; Brooks, Robert M; Doshi, Hardik; Zimmerman, Kathy A; Kutschke, William; Anseth, Kristi S; Heistad, Donald D; Weiss, Robert M

2014-05-01

293

Comparison of transprosthetic mean pressure gradients between Medtronic Hall and ATS valves in the aortic position  

Microsoft Academic Search

Aim of the study: Several studies have shown the inferior performance of small prostheses in the narrow aortic root. However, modern low-profile mechanical prostheses have improved hemodynamic performance characteristics. By measuring the transprosthetic pressure gradient in vivo, we were able to characterize the hemodynamic features of two prostheses: the ATS Medical (ATS) and the Medtronic Hall (MH) valves. Methods: From

Kiick Sung; Pyo Won Park; Kay-Hyun Park; Tae-Gook Jun; Young Tak Lee; Ji-Hyuk Yang

2005-01-01

294

Bivalirudin for treatment of aortic valve thrombosis after left ventricular assist device implantation.  

PubMed

Ventricular assist devices are increasingly being used for mechanical support in patients with advanced heart failure. However, thromboembolism remains a leading cause of mortality in this population. We describe the successful treatment of native aortic valve thrombosis with bivalirudin in a patient with factor V Leiden mutation, who had undergone left ventricular assist device implantation, preventing the need for further surgical intervention. PMID:23820287

Sarsam, Sinan H; Civitello, Andrew B; Agunanne, Enoch E; Delgado, Reynolds M

2013-01-01

295

A novel aortic valve segmentation from ultrasound image using continuous max-flow approach.  

PubMed

Geometric features of aortic valve can be applied in diagnostic, modeling and image-guided cardiac intervention, however methods to accurately and effectively delineate aortic valve from ultrasound (US) image are not well addressed. This paper proposes a novel aortic valve segmentation algorithm for intra-operative 2D short-axis US image using probability estimation and continuous max-flow (CMF) approach. The algorithm first calculates composite probability estimation (CPE) and single probability estimation (SPE) over 5 prior images based on both intensity and distance to the corresponding centroid, then the energy function for the current input image is constructed, followed by a Graphic Processing Unit (GPU) accelerated CMF approach to achieve aortic valve contours in approximately real time. Quantitative evaluations over 270 images acquired from 3 subjects indicated the results of the algorithm had good correlation with the manual segmentation results (ground truth) by an expert. The Average Symmetric Contour Distance (ASCD), Dice Metric (DM), and Reliability were employed to evaluate our algorithm, and the evaluation results of these three metrics were 1.79±0.46 (in pixels), 0.96±0.01 and 0.84 (d=0.95) respectively, where the computational time was 39.23±5.02 ms per frame. PMID:24110436

Nie, Yuanyuan; Luo, Zhe; Cai, Junfeng; Gu, Lixu

2013-01-01

296

Current determinants of operative mortality in 1400 patients requiring aortic valve replacement  

Microsoft Academic Search

BackgroundDeterminants of operative mortality after aortic valve replacement vary with a changing patient population due to advances in operative management and increasing life expectancy. In order to predict current groups of high risk patients, a statistically valid large study population base recruited over a short period of time is required.

Ines Florath; Ulrich P Rosendahl; Amir Mortasawi; Stefan F Bauer; Fatmir Dalladaku; Ina C Ennker; Juergen C Ennker

2003-01-01

297

Septicemia and Aortic Valve Endocarditis due to Erysipelothrix rhusiopathiae in a Homeless Man  

PubMed Central

We report a case of bacterial endocarditis due to Erysipelothrix rhusiopathiae in a homeless man with no animal exposure. His course was complicated by an allergic reaction to ampicillin, urinary bladder infection, respiratory failure, and acute kidney injury. He recovered completely after aortic valve replacement and a 6-week course of intravenous ceftriaxone. PMID:23662222

2013-01-01

298

The use of pulsatile perfusion during aortic valve replacement in pregnancy  

Microsoft Academic Search

Cardiac operations are occasionally required during pregnancy. Despite a low maternal mortality, fetal mortality remains high. Previous reports have suggested maintenance of high perfusion pressure and flow rate as protective measures to maintain fetal viability. Recent experimental data suggest pulsatile perfusion may help preserve placental hemodynamic function. The successful use of pulsatile bypass to replace the aortic valve in a

Henry F Tripp; Robert M Stiegel; Joseph P Coyle

1999-01-01

299

Quantification of Biomechanical Interaction of Transcatheter Aortic Valve Stent Deployed in Porcine and Ovine Hearts  

PubMed Central

Success of the deployment and function in transcatheter aortic valve replacement (TAVR) is heavily reliant on the tissue-stent interaction. The present study quantified important tissue-stent contact variables of self-expanding transcatheter aortic valve (TAV) stents when deployed into ovine and porcine aortic roots, such as the stent radial expansion force, stent pullout force, the annulus deformation response and the coefficient of friction on the tissue-stent contact interface. Braided Nitinol stents were developed, tested to determine stent crimped diameter vs. stent radial force from a stent crimp experiment, and deployed in vitro to quantify stent pullout, aortic annulus deformation, and the coefficient of friction between the stent and the aortic tissue from an aortic root-stent interaction experiment. The results indicated that when crimped at body temperature from 26 mm to 19, 21 and 23 mm stent radial forces were approximately 30-40% higher than those crimped at room temperature. Coefficients of friction leveled to approximately 0.10 ± 0.01 as stent wire diameter increased and annulus size decreased from 23 to 19 mm. Regardless of aortic annulus size and species tested, it appeared that a minimum of about 2.5 mm in annular dilatation, caused by about 60N of radial force from stent expansion, was needed to anchor the stent against a pullout into the left ventricle. The study of the contact biomechanics in animal aortic tissues may help us better understand characteristics of tissue-stent interactions and quantify the baseline responses of non-calcified aortic tissues. PMID:23161165

Mummert, Joseph; Sirois, Eric; Sun, Wei

2012-01-01

300

A new non-invasive estimation of the stenotic aortic valve area by pulsed Doppler mapping.  

PubMed

A new pulsed Doppler mapping technique has been used to measure the severity of aortic valve stenosis. The Doppler examination was performed at the site of the aortic orifice in the parasternal short axis echocardiographic view and the method was based on the detection of the area of systolic flow through the stenotic orifice. This area was derived by planimetry and the measurements obtained by the Doppler method were compared with the aortic valve area calculated at catheterisation according to the Gorlin formula. The method was applicable in 41 of the 44 patients studied. The Doppler data were consistent with the haemodynamic measurements even in patients with decreased cardiac index. It is concluded that this new application of the flow mapping procedure is reliable and is easily applied to adult patients with a wide range of clinical conditions. PMID:3801258

Veyrat, C; Gourtchiglouian, C; Dumora, P; Abitbol, G; Sainte Beuve, D; Kalmanson, D

1987-01-01

301

A new non-invasive estimation of the stenotic aortic valve area by pulsed Doppler mapping.  

PubMed Central

A new pulsed Doppler mapping technique has been used to measure the severity of aortic valve stenosis. The Doppler examination was performed at the site of the aortic orifice in the parasternal short axis echocardiographic view and the method was based on the detection of the area of systolic flow through the stenotic orifice. This area was derived by planimetry and the measurements obtained by the Doppler method were compared with the aortic valve area calculated at catheterisation according to the Gorlin formula. The method was applicable in 41 of the 44 patients studied. The Doppler data were consistent with the haemodynamic measurements even in patients with decreased cardiac index. It is concluded that this new application of the flow mapping procedure is reliable and is easily applied to adult patients with a wide range of clinical conditions. Images Fig 2 Fig 3 PMID:3801258

Veyrat, C; Gourtchiglouian, C; Dumora, P; Abitbol, G; Sainte Beuve, D; Kalmanson, D

1987-01-01

302

Long-term results of pulmonary autograft for aortic valve replacement.  

PubMed Central

Eighty-five survivors who left hospital after pulmonary autograft replacement for severe aortic regurgitation have been followed critically. Five patients died in the first five years and 80 were followed for six to 11 years. Important aortic regurgitation occurred only early and was always related to technical malpositioning of one autograft cusp. Seven patients with fascial pulmonary valves had problems, requiring removal in four. There was a small (2%) morbidity from the right sided homograft and six were removed five to seven years later for progressive calcification; three of these had been irradiated. Despite a high incidence of trivial diastolic murmurs this valve replacement is still preferred for young patients without dilated aortic roots since the survivors remain well, with excellent, maintained relief of outflow obstruction, without problems from haemolysis and thromboembolism, and without deteriorating autograft function or need for anticoagulants. Histology of five autografts examined up to seven years after operation has shown normal living architecture. Images PMID:518778

Somerville, J; Saravalli, O; Ross, D; Stone, S

1979-01-01

303

Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study  

PubMed Central

Background Before trans-catheter aortic valve implantation (TAVI), assessment of cardiac function and accurate measurement of the aortic root are key to determine the correct size and type of the prosthesis. The aim of this study was to compare cardiovascular magnetic resonance (CMR) and trans-thoracic echocardiography (TTE) for the assessment of aortic valve measurements and left ventricular function in high-risk elderly patients submitted to TAVI. Methods Consecutive patients with severe aortic stenosis and contraindications for surgical aortic valve replacement were screened from April 2009 to January 2011 and imaged with TTE and CMR. Results Patients who underwent both TTE and CMR (n = 49) had a mean age of 80.8 ± 4.8 years and a mean logistic EuroSCORE of 14.9 ± 9.3%. There was a good correlation between TTE and CMR in terms of annulus size (R2 = 0.48, p < 0.001), left ventricular outflow tract (LVOT) diameter (R2 = 0.62, p < 0.001) and left ventricular ejection fraction (LVEF) (R2 = 0.47, p < 0.001) and a moderate correlation in terms of aortic valve area (AVA) (R2 = 0.24, p < 0.001). CMR generally tended to report larger values than TTE for all measurements. The Bland-Altman test indicated that the 95% limits of agreement between TTE and CMR ranged from -5.6 mm to + 1.0 mm for annulus size, from -0.45 mm to + 0.25 mm for LVOT, from -0.45 mm2 to + 0.25 mm2 for AVA and from -29.2% to 13.2% for LVEF. Conclusions In elderly patients candidates to TAVI, CMR represents a viable complement to transthoracic echocardiography. PMID:22202669

2011-01-01

304

Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium†  

PubMed Central

Objectives To propose standardized consensus definitions for important clinical endpoints in transcatheter aortic valve implantation (TAVI), investigations in an effort to improve the quality of clinical research and to enable meaningful comparisons between clinical trials. To make these consensus definitions accessible to all stakeholders in TAVI clinical research through a peer reviewed publication, on behalf of the public health. Background Transcatheter aortic valve implantation may provide a worthwhile less invasive treatment in many patients with severe aortic stenosis and since its introduction to the medical community in 2002, there has been an explosive growth in procedures. The integration of TAVI into daily clinical practice should be guided by academic activities, which requires a harmonized and structured process for data collection, interpretation, and reporting during well-conducted clinical trials. Methods and results The Valve Academic Research Consortium established an independent collaboration between Academic Research organizations and specialty societies (cardiology and cardiac surgery) in the USA and Europe. Two meetings, in San Francisco, California (September 2009) and in Amsterdam, the Netherlands (December 2009), including key physician experts, and representatives from the US Food and Drug Administration (FDA) and device manufacturers, were focused on creating consistent endpoint definitions and consensus recommendations for implementation in TAVI clinical research programs. Important considerations in developing endpoint definitions included (i) respect for the historical legacy of surgical valve guidelines; (ii) identification of pathophysiological mechanisms associated with clinical events; (iii) emphasis on clinical relevance. Consensus criteria were developed for the following endpoints: mortality, myocardial infarction, stroke, bleeding, acute kidney injury, vascular complications, and prosthetic valve performance. Composite endpoints for TAVI safety and effectiveness were also recommended. Conclusion Although consensus criteria will invariably include certain arbitrary features, an organized multidisciplinary process to develop specific definitions for TAVI clinical research should provide consistency across studies that can facilitate the evaluation of this new important catheter-based therapy. The broadly based consensus endpoint definitions described in this document may be useful for regulatory and clinical trial purposes. PMID:21216739

Leon, Martin B.; Piazza, Nicolo; Nikolsky, Eugenia; Blackstone, Eugene H.; Cutlip, Donald E.; Kappetein, Arie Pieter; Krucoff, Mitchell W.; Mack, Michael; Mehran, Roxana; Miller, Craig; Morel, Marie-angèle; Petersen, John; Popma, Jeffrey J.; Takkenberg, Johanna J.M.; Vahanian, Alec; van Es, Gerrit-Anne; Vranckx, Pascal; Webb, John G.; Windecker, Stephan; Serruys, Patrick W.

2011-01-01

305

Minimally invasive aortic valve surgery: state of the art and future directions  

PubMed Central

Minimally invasive aortic valve replacement (MIAVR) is defined as an aortic valve replacement (AVR) procedure that involves a small chest wall incision as opposed to conventional full sternotomy (FS). The MIAVR approach is increasingly being used with the aim of reducing the “invasiveness” of the surgical procedure, while maintaining the same efficacy, quality and safety of a conventional approach. The most common MIAVR techniques are ministernotomy (MS) and right anterior minithoracotomy (RT) approaches. Compared with conventional surgery, MIAVR has been shown to reduce postoperative mortality and morbidity, providing faster recovery, shorter hospital stay and better cosmetics results, requires less rehabilitations resources and consequently cost reduction. Despite these advantages, MIAVR is limited by the longer cross-clamp and cardiopulmonary bypass (CPB) times, which have raised some concerns in fragile and high risk patients. However, with the introduction of sutureless and fast deployment valves, operative times have dramatically reduced by 35-40%, standardizing this procedure. According to these results, the MIAVR approach using sutureless valves may be the “real alternative” to the transcatheter aortic valve implantation (TAVI) procedures in high risk patients “operable” patients. Prospective randomized trials are required to confirm this hypothesis.

Glauber, Mattia; Ferrarini, Matteo

2015-01-01

306

Impact of obesity and nonobesity on grading the severity of aortic valve stenosis.  

PubMed

We tested the hypothesis that the disproportionate increase of body surface area in obesity may lead to the overestimation of aortic stenosis (AS) severity when the aortic valve area (AVA) is indexed (AVAI) for body surface area in 1,524 patients enrolled in the Simvastatin and Ezetimibe in AS study. Obesity was defined as a body mass index of ?30 kg/m(2). Peak aortic jet velocity, mean aortic gradient, AVA, and energy loss (EL) did not differ, although AVAI and EL indexed (ELI) for body surface area were significantly smaller in the obese group (n = 321) compared with the nonobese (n = 1,203) group (both p <0.05). Severe AS by AVAI (<0.6 cm(2)/m(2)) but nonsevere by AVA (>1.0 cm(2); AVAI/AVA discordance) was found in 15% of the patients, whereas severe AS by ELI (<0.6 cm(2)/m(2)) but nonsevere by EL (>1.0 cm(2); ELI/EL discordance) was found in 9% of the patients. Obesity was associated with a 2.4-fold higher prevalence of AVAI/AVA discordance and a 1.6-fold higher prevalence of ELI/EL discordance. Discordant grading was also associated with male gender, larger body size, higher mean aortic gradient, and stroke volume (all p <0.05). During a median follow-up of 4.3 years, 419 patients were referred for aortic valve replacement and 177 patients died or were hospitalized because of heart failure. In the Cox regression analyses, AVAI/AVA discordance was associated with a 28% higher rate of aortic valve replacement (p <0.05) but did not predict the rate of combined death and hospitalization for heart failure. In conclusion, using AVAI and ELI for the grading of stenosis in patients with obesity may lead to overestimation of true AS severity. PMID:24630788

Rogge, Barbara P; Gerdts, Eva; Cramariuc, Dana; Bahlmann, Edda; Jander, Nikolaus; Gohlke-Bärwolf, Christa; Pedersen, Terje R; Lønnebakken, Mai Tone

2014-05-01

307

A Combined Proteomic and Transcriptomic Approach Shows Diverging Molecular Mechanisms in Thoracic Aortic Aneurysm Development in Patients with Tricuspid- And Bicuspid Aortic Valve*  

PubMed Central

Thoracic aortic aneurysm is a pathological local dilatation of the aorta, potentially leading to aortic rupture or dissection. The disease is a common complication of patients with bicuspid aortic valve, a congenital disorder present in 1–2% of the population. Using two dimensional fluorescence difference gel electrophoresis proteomics followed by mRNA expression, and alternative splicing analysis of the identified proteins, differences in dilated and nondilated aorta tissues between 44 patients with bicuspid and tricuspid valves was examined. The pattern of protein expression was successfully validated with LC-MS/MS. A multivariate analysis of protein expression data revealed diverging protein expression fingerprints in patients with tricuspid compared with the patients with bicuspid aortic valves. From 302 protein spots included in the analysis, 69 and 38 spots were differentially expressed between dilated and nondilated aorta specifically in patients with tricuspid and bicuspid aortic valve, respectively. 92 protein spots were differentially expressed between dilated and nondilated aorta in both phenotypes. Similarly, mRNA expression together with alternative splicing analysis of the identified proteins also showed diverging fingerprints in the two patient groups. Differential splicing was abundant but the expression levels of differentially spliced mRNA transcripts were low compared with the wild type transcript and there was no correlation between splicing and the number of spots. Therefore, the different spots are likely to represent post-translational modifications. The identification of differentially expressed proteins suggests that dilatation in patients with a tricuspid aortic valve involves inflammatory processes whereas aortic aneurysm in patients with BAV may be the consequence of impaired repair capacity. The results imply that aortic aneurysm formation in patients with bicuspid and tricuspid aortic valves involve different biological pathways leading to the same phenotype. PMID:23184916

Kjellqvist, Sanela; Maleki, Shohreh; Olsson, Therese; Chwastyniak, Maggy; Branca, Rui Miguel Mamede; Lehtiö, Janne; Pinet, Florence; Franco-Cereceda, Anders; Eriksson, Per

2013-01-01

308

Long-term Results After Transcatheter Aortic Valve Implantation: What do we Know Today?  

PubMed Central

Transcatheter aortic valve implantation (TAVI) is evolving rapidly as a therapeutic option in patients deemed to be at high risk for surgical aortic valve replacement. Early outcome and survival of controlled feasibility trials and single- center experience with TAVI have been previously reported. Valve performance and hemodynamics seem to improve significantly after TAVI. Long-term outcome up to 3 years have been demonstrated in recent studies. Admittedly, the results are encouraging with a survival rate at 2 and 3 years ranging from 62 to 74% and from 56 to 61% respectively. The improvement in hemodynamical and clinical status sustained beyond the 3 years follows up. However, paravalvular leakage after TAVI remains an important issue in this rapidely evolving field. PMID:24313645

Elhmidi, Y.; Bleiziffer, S.; Piazza, N.; Voss, B.; Krane, M.; Deutsch, M-A.; Lange, R.

2013-01-01

309

Propensity matched analysis of longterm outcomes following transcatheter based aortic valve implantation versus classic aortic valve replacement in patients with previous cardiac surgery  

PubMed Central

Background The aim of this study was to compare outcome of patients with previous cardiac surgery undergoing transapical aortic valve implantation (Redo-TAVI) to those undergoing classic aortic valve replacement (Redo-AVR) by using propensity analysis. Methods From January 2005 through May 2012, 52 high-risk patients underwent Redo-TAVI using a pericardial xenograft fixed within a stainless steel, balloon-expandable stent (Edwards SAPIEN™). During the same period of time 167 patients underwent classic Redo-AVR. Logistic regression analysis was used to identify covariates among 11 baseline patient variables including the type of initial surgery. Using the significant regression coefficients, each patient’s propensity score was calculated, allowing selectively matched subgroups of 40 patients each. Initial surgery included coronary artery bypass grafting in 30 patients, aortic valve replacement in 7 patients and mitral valve reconstruction in 3 patients in each group. Follow-up was 4?±?2 years and was 100% complete. Results Postoperative chest tube drainage (163?±?214 vs. 562?±?332 ml/24 h, p?=?0.02) and incidence of early permanent neurologic deficit (0 vs. 13%, p?=?0.04) was lower in patients with Redo-TAVI and there was a trend towards improved 30-day survival (p?=?0.06). Also we detected a decreased ventilation time (p?=?0.04) and lower transfusion rate of allogenic blood products (p???0.05) in the Redo-TAVI group. At late follow up differences regarding incidence of major adverse events, including death and permanent neurologic deficits (25% vs. 43%, p?=?0.01) statistically supported early postoperative findings. Conclusion The encouraging results regarding early and long-term outcomes following TAVI in patients with previous cardiac surgery show, that this evolving approach may be particularly beneficial in this patient cohort. PMID:24915763

2014-01-01

310

Novel use of an apical-femoral wire rail to assist with transfemoral transcatheter aortic valve replacement.  

PubMed

The inability to reposition or retrieve balloon-expandable transcatheter aortic valves once they have been deployed requires implantation of the valve in the descending aorta or open surgical procedures to extract the valve. We describe the challenging transfemoral delivery of an Edwards Lifesciences Sapien valve wherein we had difficulty crossing the aortic valve and the guidewire position was compromised. We performed a transapical puncture to snare the guidewire and create a left ventricular to femoral wire rail, allowing us to deliver the transfemoral transcatheter valve, salvaging a situation where we would have been required to implant the valve in the descending aorta. We believe this is the first time this technique has been reported and represents an important method to facilitate delivery of transcatheter valves where guidewire support is insufficient or lost. PMID:24907088

Don, Creighton W; Kim, Michael S; Verrier, Edward D; Aldea, Gabriel S; Dean, Larry S; Reisman, Mark; Mokadam, Nahush A

2014-06-01

311

Exercise Hemodynamics and Quality of Life after Aortic Valve Replacement for Aortic Stenosis in the Elderly Using the Hancock II Bioprosthesis  

PubMed Central

Background and Aim. While aortic valve replacement for aortic stenosis can be performed safely in elderly patients, there is a need for hemodynamic and quality of life evaluation to determine the value of aortic valve replacement in older patients who may have age-related activity limitation. Materials and Methods. We conducted a prospective evaluation of patients who underwent aortic valve replacement for aortic stenosis with the Hancock II porcine bioprosthesis. All patients underwent transthoracic echocardiography (TTE) and completed the RAND 36-Item Health Survey (SF-36) preoperatively and six months postoperatively. Results. From 2004 to 2007, 33 patients were enrolled with an average age of 75.3?±?5.3 years (24 men and 9 women). Preoperatively, 27/33 (82%) were New York Heart Association (NYHA) Functional Classification 3, and postoperatively 27/33 (82%) were NYHA Functional Classification 1. Patients had a mean predicted maximum VO2 (mL/kg/min) of 19.5?±?4.3 and an actual max VO2 of 15.5?±?3.9, which was 80% of the predicted VO2. Patients were found to have significant improvements (P ? 0.01) in six of the nine SF-36 health parameters. Conclusions. In our sample of elderly patients with aortic stenosis, replacing the aortic valve with a Hancock II bioprosthesis resulted in improved hemodynamics and quality of life.

Long, Theodore; Lopez, Becky M.; Berberian, Christopher; Cunningham, Mark J.; Starnes, Vaughn A.; Cohen, Robbin G.

2014-01-01

312

Aortic stiffness as a marker of cardiac function and myocardial strain in patients undergoing aortic valve replacement  

PubMed Central

Background Cardiac function and myocardial strain are affected by cardiac afterload, which is in part due to the stiffness of the aortic wall. In this study, we hypothesize that aortic pulse wave velocity (PWV) as a marker of aortic stiffness correlates with conventional clinical and biochemical markers of cardiac function and perioperative myocardial strain in aortic valve replacement (AVR). Methods Patients undergoing AVR for aortic stenosis between June 2010 and August 2012 were recruited for inclusion in this study. PWV, NYHA class and left ventricular (LV) function were assessed pre-operatively. PWV was analysed both as a continuous and dichotomous variable according to age-standardized reference values. B-type natriuretic peptide (BNP) was measured pre-operatively, and at 3 h and 18-24 h after cardiopulmonary bypass (CPB). NYHA class, leg edema, and LV function were recorded at follow-up (409?±?159 days). Results Fifty-six patients (16 females) with a mean age of 71?±?8.4 years were included, with 50 (89%) patients completing follow-up. The NYHA class of PWV-norm patients was significantly lower than PWV-high patients both pre- and post-operatively. Multiple logistic regression also highlighted PWV-cut off as an independent predictor of NYHA class pre- and post-operatively (OR 8.3, 95%CI [2.27,33.33] and OR 14.44, 95%CI [1.49,139.31] respectively). No significant relationship was observed between PWV and either LV function or plasma BNP. Conclusion In patients undergoing AVR for aortic stenosis, PWV is independently related to pre- and post-operative NYHA class but not to LV function or BNP. These findings provisionally support the use of perioperative PWV as a non-invasive marker of clinical functional status, which when used in conjunction with biomarkers of myocardial strain such as BNP, may provide a holistic functional assessment of patients undergoing aortic valve surgery. However, in order for PWV assessment to be translated into clinical practice and utilised as more than simply a research tool, further validation is required in the form of larger prospective studies specifically designed to assess the relationship between PWV and these functional clinical outcomes. PMID:24938692

2014-01-01

313

Fluid Dynamics of Coarctation of the Aorta and Effect of Bicuspid Aortic Valve  

PubMed Central

Up to 80% of patients with coarctation of the aorta (COA) have a bicuspid aortic valve (BAV). Patients with COA and BAV have elevated risks of aortic complications despite successful surgical repair. The development of such complications involves the interplay between the mechanical forces applied on the artery and the biological processes occurring at the cellular level. The focus of this study is on hemodynamic modifications induced in the aorta in the presence of a COA and a BAV. For this purpose, numerical investigations and magnetic resonance imaging measurements were conducted with different configurations: (1) normal: normal aorta and normal aortic valve; (2) isolated COA: aorta with COA (75% reduction by area) and normal aortic valve; (3) complex COA: aorta with the same severity of COA (75% reduction by area) and BAV. The results show that the coexistence of COA and BAV significantly alters blood flow in the aorta with a significant increase in the maximal velocity, secondary flow, pressure loss, time-averaged wall shear stress and oscillatory shear index downstream of the COA. These findings can contribute to a better understanding of why patients with complex COA have adverse outcome even following a successful surgery. PMID:24015239

Keshavarz-Motamed, Zahra; Garcia, Julio; Kadem, Lyes

2013-01-01

314

Intra-operative 2-D ultrasound and dynamic 3-D aortic model registration for magnetic navigation of transcatheter aortic valve implantation.  

PubMed

We propose a navigation system for transcatheter aortic valve implantation that employs a magnetic tracking system (MTS) along with a dynamic aortic model and intra-operative ultrasound (US) images. This work is motivated by the desire of our cardiology and cardiac surgical colleagues to minimize or eliminate the use of radiation in the interventional suite or operating room. The dynamic 3-D aortic model is constructed from a preoperative 4-D computed tomography dataset that is animated in synchrony with the real time electrocardiograph input of patient, and then preoperative planning is performed to determine the target position of the aortic valve prosthesis. The contours of the aortic root are extracted automatically from short axis US images in real-time for registering the 2-D intra-operative US image to the preoperative dynamic aortic model. The augmented MTS guides the interventionist during positioning and deployment of the aortic valve prosthesis to the target. The results of the aortic root segmentation algorithm demonstrate an error of 0.92±0.85 mm with a computational time of 36.13±6.26 ms. The navigation approach was validated in porcine studies, yielding fiducial localization errors, target registration errors, deployment distance, and tilting errors of 3.02±0.39 mm, 3.31±1.55 mm, 3.23±0.94 mm, and 5.85±3.06(°) , respectively. PMID:23912499

Luo, Zhe; Cai, Junfeng; Peters, Terry M; Gu, Lixu

2013-11-01

315

Comparison of the early haemodynamics of stented pericardial and porcine aortic valves.  

PubMed

Data comparing the haemodynamic performance of stented pericardial and porcine aortic valves are conflicting. Hence, we performed a systematic review and meta-analysis comparing the early haemodynamic parameters of stented pericardial and porcine valves in patients undergoing isolated aortic valve replacement. Medline, EMBASE and Web of Science were queried for English language original publications from 2000 to 2013. Studies comparing porcine (PoV) and pericardial (PeV) with regard to their haemodynamic parameters were included in this review. Continuous data were pooled using the mean difference (MD) or the standardized mean difference (SMD). A random-effect inverse weighted analysis was conducted; a P-value <0.05 is considered statistically significant. Results are presented with 95% confidence intervals. Thirteen studies (1265 PeV patients and 871 PoV patients) were included in this analysis. The pooled transvalvular mean gradient was lower for PeV [MD -4.6 (-6.45 to -2.77) mmHg; P < 0.01]. Limiting this analysis to small valves (19 and 21 mm; eight studies; 714 patients) revealed that the PeV gradients were significantly lower [MD -4.5 (-5.7 to -3.2); P = 0.001]. The corresponding effective orifice area of PeV was significantly larger than PoV [SMD 0.42 (0.15-0.69); P < 0.01]. A sensitivity analysis comprising only randomized controlled trials did not significantly alter results. When compared with porcine valves, stented pericardial aortic valves have lower mean transvalvular gradients early after implant. Even pericardial valves in smaller sizes (19 and 21 mm) have a better haemodynamic profile when compared with their counterparts. PMID:25123674

Sharma, Vikas; Deo, Salil V; Altarabsheh, Salah E; Cho, Yan Hyun; Erwin, Patricia J; Park, Soon J

2014-08-14

316

Simulation of transcatheter aortic valve implantation through patient-specific finite element analysis: two clinical cases.  

PubMed

Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure introduced to treat aortic valve stenosis in elder patients. Its clinical outcomes are strictly related to patient selection, operator skills, and dedicated pre-procedural planning based on accurate medical imaging analysis. The goal of this work is to define a finite element framework to realistically reproduce TAVI and evaluate the impact of aortic root anatomy on procedure outcomes starting from two real patient datasets. Patient-specific aortic root models including native leaflets, calcific plaques extracted from medical images, and an accurate stent geometry based on micro-tomography reconstruction are key aspects included in the present study. Through the proposed simulation strategy we observe that, in both patients, stent apposition significantly induces anatomical configuration changes, while it leads to different stress distributions on the aortic wall. Moreover, for one patient, a possible risk of paravalvular leakage has been found while an asymmetric coaptation occurs in both investigated cases. Post-operative clinical data, that have been analyzed to prove reliability of the performed simulations, show a good agreement with analysis results. The proposed work thus represents a further step towards the use of realistic computer-based simulations of TAVI procedures, aiming at improving the efficacy of the operation technique and supporting device optimization. PMID:24998989

Morganti, S; Conti, M; Aiello, M; Valentini, A; Mazzola, A; Reali, A; Auricchio, F

2014-08-22

317

Comparing Aortic Valve Replacement through Right Anterolateral Thoracotomy with Median Sternotomy  

PubMed Central

Background Aortic Valve Replacement (AVR) is usually done through median sternotomy. The present study aimed to compare the right anterolateral thoracotomy and median sternotomy approaches for AVR. Materials and Methods The present prospective study was conducted on 60 patients who had aortic valve disease and were subjected to AVR. Thirty patients underwent aortic valve replacement via right anterolateral thoracotomy (study group) and thirty patients via median sternotomy (control group). Statistical analysis was done using Mann Whitney U test and Fischer’s Exact test. Statistical Package SPSS ­17 was used for data analysis. Results The mean length of the incision was 18.7±1.8 cm in the patients who had undergone AVR through median sternotomy, while 7.8±0.9 cm in the study group patients. Besides, the mean bypass time was 121.8±18.6 minutes for the patients who had undergone AVR through median sternotomy, while 122.1±20.8 minutes for the study group. In addition, the mean aortic cross clamp time was 67.7±13.4 minutes for the patients who had undergone AVR through median sternotomy, while 68.0±8.9 minutes for the study group. The mean operating time was 181.6±31.5 minutes for the patients who had undergone AVR through median sternotomy, while 190.8±29.8 minutes for the study group. Patient satisfaction with respect to cosmesis was higher in the study group. Only 50% of the patients who had undergone AVR through median sternotomy in comparison to 73.3% of those in the study group were satisfied with the cosmesis. Conclusions The right anterolateral thoracotomy approach for aortic valve replacement proved to be easy to perform whilst maintaining the maximum security for the patients. Besides its better cosmetic result especially in female patients, this approach proved to have several advantages. PMID:24757629

Ahangar, Abdul Gani; Charag, Aakib Hamid; Wani, Mohd Lateef; Ganie, Farooq Ahmad; Singh, Shyam; Ahmad Qadri, Syed Asrar; Ahmad Shah, Zameer

2013-01-01

318

Impact of progressive sinotubular junction dilatation on valve competence of the 3F Aortic and Sorin Solo stentless bioprosthetic heart valves  

Microsoft Academic Search

Objective: The use of stentless bioprostheses for aortic valve replacement provides excellent haemodynamics; however, these valves bear the potential risk of progressive regurgitation over time. To overcome this disadvantage, a new generation of pericardial stentless prostheses has been developed. This study aims to assess the tolerance of such bioprotheses against progressive sinotubular junction dilatation. Methods: Five specimens of both the

Michael Scharfschwerdt; Hans-H. Sievers; Adel Hussein; Ernst G. Kraatz; Martin Misfeld

2010-01-01

319

Mid-term results in patients having tricuspidization of the quadricuspid aortic valve  

PubMed Central

Background Quadricuspid aortic valve (QAV) is a rare congenital anomaly. We investigate the mid-term results of aortic valve reconstruction by tricuspidization in patients with QAV. Methods We analyzed the outcome of eight consecutive patients who underwent aortic valve reconstruction surgery (AVRS) with pericardial leaflets with symptomatic quadricuspid aortic valve (QAV) disease between December 2007 and May 2012. AVRS consists of leaflet reconstruction and fixation of the sino-tubular junction in order to maintain coaptation of the new valve. Results Six males and two females were included; ages ranged from 19 to 63 years (mean age, 51 years). According to Hurwitz and Roberts’s classification, three patients had type A, three patients had type B, one patient had type C, and one patient had type E. All patients had significant aortic regurgitation (AR): moderate in three patients, moderate to severe in one patient, and severe in four patients. Concomitant ascending aorta wrapping with an artificial vascular graft was performed in one case. There was no occurrence of mortality during the follow-up period (42.4?±?18.0 months). No redo-operation was required. The NYHA functional class showed improvement from 2.1?±?0.2 to 1.1?±?0.2 (p?=?0.008). The latest echocardiograms showed AR absent or trivial in seven patients, and mild in one patient. The aortic valve orifice area index (AVAI) was 1.03?±?0.49 cm2/m2. Compared with preoperative echocardiograms, the left ventricular (LV) ejection fraction showed improvement from 57.6?±?17.0 to 63.7?±?13.2% (p?=?0.036); the end-diastolic and end-systolic LV dimensions showed a significant decrease, from 63.5?±?9.6 to 49.5?±?3.1 mm (p?=?0.012) and 43.6?±?11.8 to 32.1?±?5.4 mm (p?=?0.012), respectively. Conclusion In patients with QAV, AVRS with tricuspidization showed satisfactory early and mid-term results. Long-term follow-up will be necessary in order to study the durability of AVRS; however, it can be considered as a potential standard procedure. PMID:24506947

2014-01-01

320

Consequence of patient substitution of nattokinase for warfarin after aortic valve replacement with a mechanical prosthesis.  

PubMed

This report describes a patient's self-substitution of nattokinase for the vitamin K antagonist warfarin after aortic valve replacement with a mechanical prosthesis. Nattokinase is an enzyme derived from a popular fermented soybean preparation in Japan (natto), which has fibrinolytic properties and is gaining popularity in nontraditional health journals and nonmedical health websites as an over-the-counter thrombolytic. After nearly a year of use of nattokinase without warfarin, the patient developed thrombus on the mechanical valve and underwent successful repeat valve replacement. We believe this is the first documented case of nattokinase being used as a substitute for warfarin after valve replacement, and we strongly discourage its use for this purpose. PMID:25552810

Elahi, Maqsood M; Choi, Charles H; Konda, Subbareddy; Shake, Jay G

2015-01-01

321

Consequence of patient substitution of nattokinase for warfarin after aortic valve replacement with a mechanical prosthesis  

PubMed Central

This report describes a patient's self-substitution of nattokinase for the vitamin K antagonist warfarin after aortic valve replacement with a mechanical prosthesis. Nattokinase is an enzyme derived from a popular fermented soybean preparation in Japan (natto), which has fibrinolytic properties and is gaining popularity in nontraditional health journals and nonmedical health websites as an over-the-counter thrombolytic. After nearly a year of use of nattokinase without warfarin, the patient developed thrombus on the mechanical valve and underwent successful repeat valve replacement. We believe this is the first documented case of nattokinase being used as a substitute for warfarin after valve replacement, and we strongly discourage its use for this purpose. PMID:25552810

Elahi, Maqsood M.; Choi, Charles H.; Konda, Subbareddy

2015-01-01

322

Infective Endocarditis Associated with Transcatheter Aortic Valve Replacement: Potential Importance of Local Trauma for a Deadly Nidus  

PubMed Central

Recently, transcatheter aortic valve replacement (TAVR) has emerged as an alternative for the treatment of severe symptomatic aortic stenosis patients. Although experience with TAVR is increasing exponentially, few cases of post-TAVR endocarditis are reported. We present a case of 76-year-old man with infective endocarditis after TAVR who was definitely diagnosed by echocardiography. PMID:25309690

Lee, Hak Seung; Jung, Ji-Hyun; Kim, Hyue Mee; Kim, Chee Hae; Park, Jun-Bean; Kim, Hyung-Kwan; Kim, Yong-Jin; Kim, Hyo-Soo; Sohn, Dae-Won

2014-01-01

323

When is concomitant aortic valve replacement indicated in patients with mild to moderate stenosis undergoing coronary revascularization?  

Microsoft Academic Search

Mild to moderate aortic stenosis is a common finding in patients presenting for coronary artery bypass grafting (CABG), and\\u000a its management is controversial. However, review of available data suggests a surgical strategy for these patients. Recent\\u000a data demonstrate that 1) progression of aortic stenosis is more rapid in those with leaflet calcification; 2) the addition\\u000a of aortic valve replacement to

A. Marc Gillinov; Mario J. Garcia

2005-01-01

324

Hematoma of a congenitally bicuspid aortic valve in a patient with polycythemia vera and the antiphospholipid antibody syndrome.  

PubMed

We present a novel case of a hematoma involving a congenitally bicuspid aortic valve. The patient was a 47-year-old woman with polycythemia vera and antiphospholipid antibody syndrome. She was treated with anagrelide for thrombocytosis. The patient developed a valvular hematoma which caused clinically significant aortic stenosis and regurgitation. Consequently, the patient underwent surgery with insertion of a porcine bioprosthesis. Eighteen months postoperatively the patient developed a large prosthetic thrombus with severe aortic stenosis requiring reoperation. PMID:17138043

Webber, Geoffrey V; Fallon, John; Silbiger, Jeffrey J

2006-12-01

325

The change in mitral regurgitation severity after trans-catheter aortic valve implantation  

PubMed Central

Background Mitral regurgitation (MR) is a frequent finding in patients with aortic stenosis (AS). The objective of this study is to assess the change in MR severity following transcatheter aortic valve implantation (TAVI). Methods MR changes were assessed by comparing transthoracic echocardiography before and after the procedure. Results The prosthetic aortic valve was successfully implanted in 65 patients. The number of patients with pre-procedure MR was reduced from 58 (85.3%) to 43 (63.2%) (p < 0.001). Vena contracta width was decreased from 0.47 ± 0.28 to 0.25 ± 0.21, (p = 0.043). About 59.4% (19/32) of those who had moderate to severe MR and 85.7% (12/14) of those with severe MR experienced a significant improvement in MR after the procedure (p < 0.001). Improvement in MR was independent of prosthetic valve type with 54.2% in CoreValve and 43.9% in Edwards SAPIEN, p = 0.424; valve sizes were 25.8 ± 1.9 in those who improved vs. 25.0 ± 1.9 mm in those who did not improve, p = 0.105; femoral approach was 51.2% and apical approach was 41.7%, p = 0.457; MR etiology was 48.1% in organic and 48.6% in functional, p = 0.968; and operative risk was 50.0% in EuroScore >20 and 48.6% in EuroScore <20, p = 0.356. Conclusions TAVI is associated with a significant improvement in MR, especially in severe types. The lack of influence of MR improvement by the etiology of MR, the type of valve implanted, and the operative risk need to be confirmed in a larger multi-center study.

Almasood, Ali; Al Ahmari, Saeed; El-shurafa, Haytham; Alotaibi, Mohammed; al kasab, saad; AlAbdallah, Moheeb; Al-moghairi, abdulrahman; Al khushail, Abdullah; Al-Amri, Husain

2014-01-01

326

Multidetector row computed tomography parameters associated with paravalvular regurgitation after transcatheter aortic valve implantation.  

PubMed

Multidetector row computed tomographic (MDCT) assessment of aortic annulus dimensions and frame position and deployment have been associated with paravalvular aortic regurgitation (PAVR) after transcatheter aortic valve implantation (TAVI). The present evaluation investigated the (pre- and postprocedure) MDCT associates of PAVR ?2+. In total, 123 patients referred for TAVI underwent clinical evaluation, transthoracic echocardiography, and pre- and post-TAVI MDCT. Pre-TAVI MDCT measurements of the aortic annular dimensions and post-TAVI MDCT evaluation of the position and deployment of the prosthesis in the native annulus were performed. At 1-month follow-up, PAVR ?2+ was observed in 25 patients (20%). The difference between the MDCT-derived maximum aortic annulus and the nominal diameters of the implanted prosthesis (odds ratio 1.912, p = 0.002) and shallow position of the frame in the left ventricular outflow tract (<2 mm) (odds ratio 4.865, p = 0.017) were independently related to significant PAVR. A maximum annulus diameter ?2 mm larger than the nominal frame diameter had 72% sensitivity and 61% specificity to predict PAVR. In conclusion, in patients undergoing TAVI, ?2-mm difference between maximum aortic annulus and nominal prosthesis diameters and depth of the frame into the left ventricular outflow tract of <2 mm are independently associated with PAVR ?2+. PMID:24035163

Katsanos, Spyridon; Ewe, See Hooi; Debonnaire, Philippe; van der Kley, Frank; de Weger, Arend; Palmen, Meindert; Scholte, Arthur J H A; Schalij, Martin J; Bax, Jeroen J; Marsan, Nina Ajmone; Delgado, Victoria

2013-12-01

327

Numerical simulation of steady turbulent flow through trileaflet aortic heart valves--II. Results on five models.  

PubMed

Turbulent flow simulations are run for five aortic trileaflet valve geometries, ranging from a valve leaflet orifice area of 1.1 cm2 (Model A1--very stenotic) to 5.0 cm2 (Model A5--natural valve). The simulated data compares well with experimental measurements made downstream of various aortic trileaflet valves by Woo (PhD Thesis, 1984). The location and approximate width and length of recirculation regions are correctly predicted. The less stenotic valve models reattach at the end of the aortic sinus region, 1.1 diameters downstream of the valve. The central jet exiting the less stenotic valve models is not significantly different from fully developed flow, and therefore recovers very quickly downstream of the reattachment point. The more stenotic valves disturb the flow to a greater degree, generating recirculation regions large enough to escape the sinuses and reattach further downstream. Peak turbulent shear stress values downstream of the aortic valve models which approximated prosthetic valves are 125 and 300 Nm-2, very near experimental observations of 150 to 350 Nm-2. The predicted Reynolds stress profiles also present the correct shape, a double peak profile, with the location of the peak occurring at the location of maximum velocity gradient, which occurs near the recirculation region. The pressure drop across model A2 (leaflet orifice area 1.6 cm2) is 20 mmHg at 1.6 diameters downstream. This compares well with values ranging from 19.5 to 26.2 mmHg for valves of similar orifice areas. The pressure drop decreases with decreasing valve stenosis, to a negligible value across the least stenotic valve model. Based on the good agreement between experimental measurements of velocity, shear stress and pressure drop, compared to the simulated data, the model has the potential to be a valuable tool in the analysis of heart valve designs. PMID:4077859

Stevenson, D M; Yoganathan, A P; Williams, F P

1985-01-01

328

Fibrocalcific aortic valve disease: Opportunity to understand disease mechanisms using mouse models  

PubMed Central

Studies in vitro and in vivo continue to identify complex regulated mechanisms leading to overt fibrocalcific aortic valve disease (FCAVD). Assessment of the functional impact of those processes requires careful studies of models of FCAVD in vivo. Although the genetic basis for FCVAD is unknown for most patients with FCAVD, several disease-associated genes have been identified in humans and mice. Some gene products which regulate valve development in utero also protect against fibro-calcific disease during postnatal aging. Valve calcification can occur via processes that resemble bone formation. But valve calcification can also occur by non-osteogenic mechanisms, such as formation of calcific apoptotic nodules. Anti-calcific interventions might preferentially target either osteogenic or non-osteogenic calcification. Although FCAVD and atherosclerosis share several risk factors and mechanisms, there are fundamental differences between arteries and the aortic valve, with respect to disease mechanisms and responses to therapeutic interventions. Both innate and acquired immunity are likely to contribute to FCAVD. Angiogenesis is a feature of inflammation, but may also contribute independently to progression of FCAVD, possibly by actions of pericytes that are associated with new blood vessels. Several therapeutic interventions appear to be effective in attenuating development of FCAVD in mice. Therapies which are effective early in the course of FCAVD, however, are not necessarily effective in established disease. PMID:23833295

Weiss, Robert M.; Miller, Jordan D.; Heistad, Donald D.

2013-01-01

329

TGF-? mediates early angiogenesis and latent fibrosis in an Emilin1-deficient mouse model of aortic valve disease  

PubMed Central

Aortic valve disease (AVD) is characterized by elastic fiber fragmentation (EFF), fibrosis and aberrant angiogenesis. Emilin1 is an elastin-binding glycoprotein that regulates elastogenesis and inhibits TGF-? signaling, but the role of Emilin1 in valve tissue is unknown. We tested the hypothesis that Emilin1 deficiency results in AVD, mediated by non-canonical (MAPK/phosphorylated Erk1 and Erk2) TGF-? dysregulation. Using histology, immunohistochemistry, electron microscopy, quantitative gene expression analysis, immunoblotting and echocardiography, we examined the effects of Emilin1 deficiency (Emilin1?/?) in mouse aortic valve tissue. Emilin1 deficiency results in early postnatal cell-matrix defects in aortic valve tissue, including EFF, that progress to latent AVD and premature death. The Emilin1?/? aortic valve displays early aberrant provisional angiogenesis and late neovascularization. In addition, Emilin1?/? aortic valves are characterized by early valve interstitial cell activation and proliferation and late myofibroblast-like cell activation and fibrosis. Interestingly, canonical TGF-? signaling (phosphorylated Smad2 and Smad3) is upregulated constitutively from birth to senescence, whereas non-canonical TGF-? signaling (phosphorylated Erk1 and Erk2) progressively increases over time. Emilin1 deficiency recapitulates human fibrotic AVD, and advanced disease is mediated by non-canonical (MAPK/phosphorylated Erk1 and Erk2) TGF-? activation. The early manifestation of EFF and aberrant angiogenesis suggests that these processes are crucial intermediate factors involved in disease progression and therefore might provide new therapeutic targets for human AVD. PMID:25056700

Munjal, Charu; Opoka, Amy M.; Osinska, Hanna; James, Jeanne F.; Bressan, Giorgio M.; Hinton, Robert B.

2014-01-01

330

Aortic valve myxoma at the extreme age: a review of literature.  

PubMed

Primary cardiac tumours are a rare finding, with cardiac myxoma and fibroelastoma representing the majority of these tumours. Cardiac myxomas are most commonly found in the left atrium but are rarely found with attachment to the cardiac valves. The authors describe a case of aortic myxoma found in an 81-year-old man presented with peripheral arterial disease. CT angiogram of the thorax was performed to find the source of emboli and it showed a mass attached to the aortic valve and protruding into the aorta. Details of the location and texture were studied on transoesophageal echocardiography. Preoperative coronary angiography showed coronary artery disease and the patient underwent successful coronary artery bypass grafting and simultaneous resection of the mass. Histopathology revealed the mass as a myxoma. PMID:24642215

Javed, Arshad; Zalawadiya, Sandip; Kovach, Julie; Afonso, Luis

2014-01-01

331

Histological and genetic studies in patients with bicuspid aortic valve and ascending aorta complications†  

PubMed Central

OBJECTIVES Aneurysm diameter and growing rate does not represent a definite parameter for operation in bicuspid aortic valve (BAV), ascending aortic aneurysm and normal root patients. Thus, we investigated histological and immunohistochemical aspects of different segments of ascending aorta (precisely, aortic root without dilatation, aneurysmatic tubular portion, dissected ascending aorta) and genetic features of patients with BAV and ascending aorta complication (aneurysm or dissection). METHODS Aorta tissue samples of 24 BAV patients were examined. The patients comprised of 18 men and 6 women; the mean age was 54.2 ± 14.3 years. All patients underwent composite aortic root replacement (button Bentall operation). Multiple histological sections were prepared from each aortic specimen. The evaluated features included elastic fibre fragmentation, cystic medial change, smooth muscle cell necrosis, medial fibrosis, and the markers of medial apoptosis and the metalloproteinases. Furthermore, genetic risk factors were also investigated. RESULTS The same medial degenerative lesions in tissue samples of different aorta segments (precisely of aortic root without dilatation, and aneurysmatic ascending aorta portion) were observed. More significant associations between single nucleotide polymorphisms (?786T/C endothelial nitric oxide synthase enzyme, D/I angiotensin-converting enzyme, ?1562C/T metalloproteinase-9 and ?735C/T metalloproteinase-2) and aneurysm risk were detected in BAV patients than in controls. CONCLUSIONS Based on our histological and genetic data, we underline that a surgical approach in patients with BAV, ascending aortic aneurysm and normal root, should consider not only the diameter of the aneurysmatic aortic portion but also the histological features of the whole ascending aorta and the genetic risk profile. PMID:22194275

Pisano, Calogera; Maresi, Emiliano; Balistreri, Carmela Rita; Candore, Giuseppina; Merlo, Daniele; Fattouch, Khalil; Bianco, Giuseppe; Ruvolo, Giovanni

2012-01-01

332

Rare complication of circumflex artery occlusion during transfemoral aortic valve replacement (TAVR).  

PubMed

Circumflex artery occlusion is an unusual but grave complication that can be intra-operatively challenging to identify. Various modalities of imaging are possible during transfemoral aortic valve replacement (TAVR). Fluoroscopy and/or trans-esophageal echocardiography maybe used for assessment during and after TAVR. Imaging dilemma can cause delay or alter diagnosis. We report a case of an imaging complication during TAVR which might have modified the outcome of the procedure. PMID:25001897

Mukherjee, Chirojit; Banusch, Joergen; Ender, Joerg

2014-12-01

333

A Clinical Study of Isolated Aortic Valve Replacement: A Univariate Analysis of Risk Factors  

Microsoft Academic Search

Between 1979 and 1990, 190 patients underwent isolated aortic valve replacement at Seoul National University Hospital in Korea. There were 11 (5.8%) in-hospital deaths. Univariate analysis identified advanced age (p = 0.026), preoperative serum GOT or GPT greater than 40 IU\\/1 (p < 0.001, p = 0.003), NYHA Class III or IV (p = 0.029), preoperative mean pulmonary arterial pressure

Wook Sung Kim; Jeong Ryul Lee; Ki Bong Kim; Sook Whan Sung; Hyuk Ahn; Yong Jin Kim; Hurn Chae; Joo Hyun Kim; Joon Ryang Rho; Chong Whan Kim; Kyung Phill Suh; Young Kyun Lee

1993-01-01

334

Extended follow up after isolated aortic valve replacement in the elderly  

Microsoft Academic Search

The present paper reviews the extended follow up of all patients aged ?70 who underwent isolated aortic valve replacement at our institution in the 1980s. Patients were identified from the surgical database and clinical information was gathered. Long-term follow up information was obtained from the patient, their family, or doctor. Ninety-three patients aged ?70 years (median 73, range 70–80) comprised

Cara A. Wasywich; Peter N. Ruygrok; Teena M. West; David A. Haydock

2003-01-01

335

Quality of life and NYHA class 30 years after mechanical aortic valve replacement  

Microsoft Academic Search

Objective: (1) To evaluate the quality of life (QoL) scores, assessed with SF36 and EuroQol (EQ-5D), of long term survivors after mechanical aortic valve replacement (mAVR); (2) to study the association of QoL with NYHA score, number of major bleeding and thrombo-embolic events and follow-up time; (3) to compare QoL scores of long term mAVR survivors with QoL scores of

M. A. Maliwa; G. J. M. G. van der Heijden; M. L. Bots; B. A. van Hout; F. P. Casselman; H. van Swieten; F. E. E. Vermeulen

2003-01-01

336

Progressive aortic valve calcification: Three-dimensional visualization and biomechanical analysis.  

PubMed

Calcific aortic valve disease (CAVD) is a progressive pathology characterized by calcification mainly within the cusps of the aortic valve (AV). As CAVD advances, the blood flow and associated hemodynamics are severely altered, thus influencing the mechanical performance of the AV. This study proposes a new method, termed reverse calcification technique (RCT) capable of re-creating the different calcification growth stages. The RCT is based on three-dimensional (3D) spatial computed tomography (CT) distributions of the calcification density from patient-specific scans. By repeatedly subtracting the calcification voxels with the lowest Hounsfield unit (HU), only high calcification density volume is presented. RCT posits that this volume re-creation represents earlier calcification stages and may help identify CAVD initiation sites. The technique has been applied to scans from 12 patients (36 cusps) with severe aortic stenosis who underwent CT before transcatheter aortic valve implantation (TAVI). Four typical calcification geometries and growth patterns were identified. Finite elements (FE) analysis was applied to compare healthy AV structural response with two selected CAVD-RCT configurations. The orifice area decreased from 2.9cm(2) for the healthy valve to 1.4cm(2) for the moderate stenosis case. Local maximum strain magnitude of 0.24 was found on the edges of the calcification compared to 0.17 in the healthy AV, suggesting a direct relation between strain concentration and calcification geometries. The RCT may help predict CAVD progression in patients at early stages of the disease. The RCT allows a realistic FE mechanical simulation and performance of calcified AVs. PMID:25553668

Halevi, Rotem; Hamdan, Ashraf; Marom, Gil; Mega, Mor; Raanani, Ehud; Haj-Ali, Rami

2015-02-01

337

Two-patch repair of a bicuspid aortic valve with vegetation on its raphe.  

PubMed

We report the successful repair of a bicuspid aortic valve with vegetation on its thickened raphe by using two pericardial patches. After excising the vegetation and thickened raphe, the first patch was sewn between the remaining leaflets. Another patch was then sewn at the base of the cusp to create sufficient geometrical height for good coaptation. Our two-patch technique may facilitate intraoperative accommodation of the 3-D shape of the new cusp. PMID:23360715

Shimamoto, Takeshi; Komiya, Tatsuhiko; Sakaguchi, Genichi; Maruo, Takeshi

2013-05-01

338

Complex Collagen Fiber and Membrane Morphologies of the Whole Porcine Aortic Valve  

PubMed Central

Objectives Replacement aortic valves endeavor to mimic native valve function at the organ, tissue, and in the case of bioprosthetic valves, the cellular levels. There is a wealth of information about valve macro and micro structure; however, there presently is limited information on the morphology of the whole valve fiber architecture. The objective of this study was to provide qualitative and quantitative analyses of whole valve and leaflet fiber bundle branching patterns using a novel imaging system. Methods We developed a custom automated microscope system with motor and imaging control. Whole leaflets (n?=?25) were imaged at high resolution (e.g. 30,000×20,000 pixels) using elliptically polarized light to enhance contrast between structures without the need for staining or other methods. Key morphologies such as fiber bundle size and branching were measured for analyses. Results The left coronary leaflet displayed large asymmetry in fiber bundle organization relative to the right coronary and non-coronary leaflets. We observed and analyzed three main patterns of fiber branching; tree-like, fan-like, and pinnate structures. High resolution images and quantitative metrics are presented such as fiber bundle sizes, positions, and branching morphological parameters. Significance To our knowledge there are currently no high resolution images of whole fresh leaflets available in the literature. The images of fiber/membrane structures and analyses presented here could be highly valuable for improving the design and development of more advanced bioprosthetic and/or bio-mimetic synthetic valve replacements. PMID:24465887

Rock, Christopher A.; Han, Lin; Doehring, Todd C.

2014-01-01

339

[Characteristics of jets in adult bicuspid aortic valve by color Doppler imaging].  

PubMed

Color flow mapping of 15 adults with bicuspid aortic valves confirmed angiographically and at surgery comprising 8 regurgitations and 7 stenoses was analysed, retrospectively in 12 cases. The object was to detect any special features of the jets of this congenital abnormality. The site of emergence of the jet at the aortic orifice and its direction in the left ventricle were studied in the long axis, short transaortic and left ventricular axes by sequential analysis. Two types of regurgitant jet were observed: eccentric anterior origin (5, Type I), eccentric posterior origin (3, Type II), extending towards the structure opposite to their origin in the left ventricular outflow tract. In cases of stenosis, the cross-sectional view of the jet had an almost transverse slit-like appearance extending from one side of the aortic orifice to the other or an anterior or posterior eccentric oval shape. The Type I cases and the slit-like anterior stenoses had fusion of the coronary cusps whilst the Type II and posterior slit-like stenoses had fusion of the right coronary and non-coronary cusps. This preliminary study suggests that bicuspid aortic valves are associated with jet characteristics related to the abnormal commissural axis which allows diagnosis and precision of the anatomic type in adults despite the presence of calcification. PMID:1793316

Veyrat, C; el Yafi, W; Gourtchiglouian, C; Sainte Beuve, D; Abitbol, G; Kalmanson, D

1991-12-01

340

Left ventricular reverse remodeling after transcatheter aortic valve implantation: a cardiovascular magnetic resonance study  

PubMed Central

Background In patients with severe aortic stenosis, left ventricular hypertrophy is associated with increased myocardial stiffness and dysfunction linked to cardiac morbidity and mortality. We aimed at systematically investigating the degree of left ventricular mass regression and changes in left ventricular function six months after transcatheter aortic valve implantation (TAVI) by cardiovascular magnetic resonance (CMR). Methods Left ventricular mass indexed to body surface area (LVMi), end diastolic volume indexed to body surface area (LVEDVi), left ventricular ejection fraction (LVEF) and stroke volume (SV) were investigated by CMR before and six months after TAVI in patients with severe aortic stenosis and contraindications for surgical aortic valve replacement. Results Twenty-sevent patients had paired CMR at baseline and at 6-month follow-up (N=27), with a mean age of 80.7±5.2 years. LVMi decreased from 84.5±25.2 g/m2 at baseline to 69.4±18.4 g/m2 at six months follow-up (P<0.001). LVEDVi (87.2±30.1 ml /m2vs 86.4±22.3 ml/m2; P=0.84), LVEF (61.5±14.5% vs 65.1±7.2%, P=0.08) and SV (89.2±22 ml vs 94.7±26.5 ml; P=0.25) did not change significantly. Conclusions Based on CMR, significant left ventricular reverse remodeling occurs six months after TAVI. PMID:23692630

2013-01-01

341

Advanced age and the clinical outcomes of transcatheter aortic valve implantation  

PubMed Central

Aortic valve stenosis (AS) is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the effect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular injures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality. PMID:25009568

Alsara, Osama; Alsarah, Ahmad; Laird-Fick, Heather

2014-01-01

342

Acute inferior myocardial infarction in a patient with a prosthetic aortic valve and high international normalized ratio  

PubMed Central

ST elevation acute myocardial infarction in patients with a mechanical prosthetic valve is rare and usually due to inadequate anticoagulation. We present a case of acute inferior myocardial infarction in a patient with a prosthetic aortic valve and high international normalized ratio, which has not been reported previously. PMID:24799934

Sari, Ibrahim; Delil, Kenan; Ileri, Cigdem; Samadov, Fuad

2014-01-01

343

Hemodynamics of various designs of 19 mm pericardial aortic valve bioprosthesis.  

PubMed

The hemodynamics of five designs of 19 mm pericardial aortic valve bioprostheses were examined in 47 resting patients by Doppler echocardiography. The salient differences among the five designs are that valve leaflets are mounted inside the support frame in one (the Carpentier-Edwards valve, evaluated in 4 patients) and outside the frame in the other four (the Ionescu-Shiley (16 patients), Mitroflow (4), Bioflo (8) and Labcor-Santiago (15)); and that two models have either total (Bioflo) or partial (Labcor-Santiago) protective pericardial sheaths on the stent, while the other three do not. The hemodynamic parameters determined included transvalvular pressure drop, valve area, left ventricular outflow tract diameter, subvalvular/valvular velocity ratio and subvalvular/valvular velocity-time integral ratio. There were no significant differences among the various valves as regards left ventricular outflow tract diameter, subvalvular/valvular velocity ratio or subvalvular/valvular velocity-time integral ratio. Negative correlation between left ventricular outflow tract diameter and subvalvular velocity (r = -0.66, P < 0.001) confirmed the need to correct for prevalvular velocities when using the Bernouilli equation to calculate the pressure drop across small pericardial aortic valve bioprostheses. The Bioflo design caused significantly greater pressure drops (peak 38.3 +/- 8.3 mmHg, mean 24.6 +/- 4.8 mmHg) and smaller areas (0.82 +/- 0.17 cm2) than the Ionescu-Shiley (20.3 +/- 5.6 and 11.7 +/- 3.8 mmHg, 1.19 +/- 5.3 and 10.1 +/- 3.1 mmHg, 1.27 +/- 0.12 cm2) valves. PMID:8664021

González-Juanatey, J R; García-Acuña, J M; Vega Fernandez, M; Amaro Cendón, A; Castelo Fuentes, V; García-Bengoechea, J B; Gil de la Peña, M

1996-01-01

344

Prognostic impact of pulmonary artery systolic pressure in patients undergoing transcatheter aortic valve replacement for aortic stenosis.  

PubMed

Baseline pulmonary hypertension (PH) is a predictor of poor outcomes in patients with severe aortic stenosis (AS). Surgical aortic valve replacement is thought to alleviate PH. The aim of this study was to determine the prognostic impact of PH in patients who underwent transcatheter aortic valve replacement (TAVR). An observational cohort study was conducted using prospectively collected data on 277 consecutive patients with severe AS who underwent TAVR at the Mayo Clinic (Rochester, Minnesota) from November 1, 2008, to June 31, 2013. Clinical and echocardiographic data, pulmonary function characteristics, and outcomes stratified by tertiles of pulmonary artery systolic pressure (PASP) were analyzed. From 277 patients who underwent TAVR, 251 patients had PASP assessment at baseline. Those in the highest PASP tertile (PASP ?49 mm Hg) had more severe chronic lung disease and worse diastolic dysfunction. Being in the highest PASP tertile was an independent predictor of long-term mortality (hazard ratio 2.88, 95% confidence interval 1.15 to 7.23). Patients in the highest PASP tertile had longer lengths of hospital stay, while other short-term outcomes (30-day mortality and readmission, stroke, prolonged ventilation, and reoperation for bleeding) were similar across PASP tertiles. TAVR was associated with a decrease in PASP in the highest PASP tertile at 1 week after the procedure (-8 ± 14 mm Hg) and at 3 months (-7 ± 15 mm Hg) compared with baseline. In conclusion, among patients with severe AS who underwent TAVR, higher baseline PASP was strongly associated with diastolic dysfunction and chronic lung disease. Patients with higher baseline PASP tolerated TAVR relatively well in the early postprocedural phase, with diminished long-term survival. PH should not disqualify patients with severe AS from consideration for TAVR. PMID:25260946

Bishu, Kalkidan; Suri, Rakesh M; Nkomo, Vuyisile T; Kane, Garvan C; Greason, Kevin L; Reeder, Guy S; Mathew, Verghese; Holmes, David R; Rihal, Charanjit S; Melduni, Rowlens M

2014-11-15

345

The First Korean Patient With Severe Aortic Stenosis and Bilateral Iliofemoral Artery Disease Treated With Transcatheter Aortic Valve Implantation by Transsubclavian Approach  

PubMed Central

Transcatheter aortic valve implantation (TAVI) is indicated as an alternative treatment modality to surgical aortic valve replacement for high risk patients. The standard retrograde approach through the femoral artery is not feasible in the case of unfavorable iliofemoral anatomy or severe peripheral arterial disease (PAD). However, patients with aortic stenosis (AS) have a higher prevalence of for PAD because both diseases are consequences of atherosclerotic degenerative changes. Transsubclavian, transapical, and direct access to the ascending aorta by thoracotomy are alternative routes for the TAVI procedure. In this report, we present the first Korean patient with symptomatic severe AS and bilateral iliofemoral artery disease who was successfully treated with TAVI using a CoreValve (Medtronic, Minneapolis, MN, USA) by transsubclavian approach. PMID:23236336

Lee, Seung-Jun; Ko, Young-Guk; Shim, Ji-Young; Lee, Sak; Chang, Byung-Chul; Shim, Jae-Kwang; Kwak, Young-Ran

2012-01-01

346

Biomarkers in Aortic Stenosis - B.A.S.S.  

ClinicalTrials.gov

Aortic Stenosis; Mitral Valve Replacement; Aortic Valve Replacement; Prosthetic Heart Valve Dysfunction; Aortic Insufficiency; Mitral Insufficiency; Hypertrophic Cardiomyopathy; Tricuspid Regurgitation With Pacemaker/Defibrillator Leads

2013-01-15

347

Peculiar patterns of aortic regurgitation and carotid pulse due to dysfunction of a Medtronic Hall prosthetic valve: a case report.  

PubMed

We describe a patient with dysfunction of a Medtronic Hall prosthetic valve showing peculiar patterns of aortic regurgitation and carotid pulse caused by valvular thrombosis. The aortic regurgitation was considered to be caused by a significant delay in prosthetic valve closure, manifested by a peculiar regurgitation pattern limited to early diastole, in association with widely split closing clicks and an abnormally low dicrotic notch in the carotid pulse. At surgery, fibrin thrombi were noted just below the prosthetic ring in the minor outflow region which restricted disc movement. The fibrin thrombi were removed and the valve was rotated 90 degrees. Following reoperation, all abnormalities disappeared. PMID:8793677

Fukuda, N; Oki, T; Iuchi, A; Tabata, T; Manabe, K; Sasaki, M; Yamada, H; Ito, S

1996-05-01

348

Transcriptional and phenotypic changes in aorta and aortic valve with aging and MnSOD deficiency in mice.  

PubMed

The purpose of this study was to characterize changes in antioxidant and age-related gene expression in aorta and aortic valve with aging, and test the hypothesis that increased mitochondrial oxidative stress accelerates age-related endothelial and aortic valve dysfunction. Wild-type (MnSOD(+/+)) and manganese SOD heterozygous haploinsufficient (MnSOD(+/-)) mice were studied at 3 and 18 mo of age. In aorta from wild-type mice, antioxidant expression was preserved, although there were age-associated increases in Nox2 expression. Haploinsufficiency of MnSOD did not alter antioxidant expression in aorta, but increased expression of Nox2. When compared with that of aorta, age-associated reductions in antioxidant expression were larger in aortic valves from wild-type and MnSOD haploinsufficient mice, although Nox2 expression was unchanged. Similarly, sirtuin expression was relatively well-preserved in aorta from both genotypes, whereas expression of SIRT1, SIRT2, SIRT3, SIRT4, and SIRT6 were significantly reduced in the aortic valve. Expression of p16(ink4a), a marker of cellular senescence, was profoundly increased in both aorta and aortic valve from MnSOD(+/+) and MnSOD(+/-) mice. Functionally, we observed comparable age-associated reductions in endothelial function in aorta from both MnSOD(+/+) and MnSOD(+/-) mice. Interestingly, inhibition of NAD(P)H oxidase with apocynin or gp91ds-tat improved endothelial function in MnSOD(+/+) mice but significantly impaired endothelial function in MnSOD(+/-) mice at both ages. Aortic valve function was not impaired by aging or MnSOD haploinsufficiency. Changes in antioxidant and sirtuin gene expression with aging differ dramatically between aorta and aortic valve. Furthermore, although MnSOD does not result in overt cardiovascular dysfunction with aging, compensatory transcriptional responses to MnSOD deficiency appear to be tissue specific. PMID:23997094

Roos, Carolyn M; Hagler, Michael; Zhang, Bin; Oehler, Elise A; Arghami, Arman; Miller, Jordan D

2013-11-15

349

Manufacturing and hydrodynamic assessment of a novel aortic valve made of a new nanocomposite polymer.  

PubMed

Synthetic leaflet heart valves have been widely studied as possible alternatives to the current mechanical and bioprosthetic valves. Assessing the in vitro hydrodynamic function of these prostheses is of great importance to predict their hemodynamic behaviour prior to implantation. This study introduces an innovative concept of a low-profile semi-stented surgical aortic valve (SSAV) made of a novel nanocomposite polyurethane with a polycarbonate soft segment (PCU) and polyhedral oligomeric silsesquioxane (POSS) nanoparticles covalently bonded as a pendant cage to the hard segment. The POSS-PCU is already used in surgical implants, including lacrimal duct, bypass graft, and recently, a tracheal replacement. Nine valves of three leaflet thicknesses (100, 150 and 200 ?m) and 21 mm internal diameter were prepared using an automated dip-coating procedure, and assessed in vitro for their hydrodynamic performance on a pulse duplicator system. A commercially available porcine bioprosthetic valve (Epic™, St. Jude Medical) of equivalent size was selected as a control model. Compared to the bioprosthetic valve, the SSAVs showed a considerably lower transvalvular pressure drop and larger effective orifice area (EOA). They were also characterised by a lower systolic energy loss, especially at high cardiac outputs. The leaflet thickness was found to significantly affect the hydrodynamics of these valves (P<0.01). The SSAVs with 100 ?m leaflets demonstrated improved flow characteristics compared to the bioprosthetic valve. The enhanced hydrodynamic function of the SSAV suggests that the proposed design together with the advanced POSS-PCU material can represent a significant step towards the introduction of polyurethane valves into the clinical application. PMID:22336198

Rahmani, Benyamin; Tzamtzis, Spyridon; Ghanbari, Hossein; Burriesci, Gaetano; Seifalian, Alexander M

2012-04-30

350

Use of a ventricular septal defect occluder for apical closure in transapical aortic valve replacement.  

PubMed

During transapical transcatheter aortic valve replacement (TA-TAVR), the apical closure remains a challenge for the surgeon, having the risk for ventricular tear and massive bleeding. Apical closure devices are already under clinical evaluation, but only a few can lead to a full percutaneous TA-TAVR. We describe the successful use of a 9-mm myocardial occluder (ventricular septal defect occluder) that was used to seal the apex after a standard TA-TAVR (using the Sapien XT 23-mm transcatheter valve and the Ascendra + delivery system). The placement of the nonmodified myocardial occluder was performed through the Ascendra + delivery system, with a very small amount of blood loss and an acceptable sealing of the apical tear. This approach is feasible and represents a further step toward true-percutaneous transapical heart valve procedures. Modified apical occluders are under evaluation in animal models. PMID:25621876

Ferrari, Enrico; Locca, Didier; Berdajs, Denis; Marcucci, Carlo; Gronchi, Fabrizio; Lavanchy, Jerome; Prêtre, René; Tozzi, Piergiorgio

2015-01-01

351

Impaired Collagen Biosynthesis and Cross?linking in Aorta of Patients With Bicuspid Aortic Valve  

PubMed Central

Background Patients with bicuspid aortic valve (BAV) have an increased risk of developing ascending aortic aneurysm. In the present study, collagen homeostasis in nondilated and dilated aorta segments from patients with BAV was studied, with normal and dilated aortas from tricuspid aortic valve (TAV) patients as reference. Methods and Results Ascending aortas from 56 patients were used for biochemical and morphological analyses of collagen. mRNA expression was analyzed in 109 patients. Collagen turnover rates were similar in nondilated and dilated aortas of BAV patients, showing that aneurysmal formation in BAV is, in contrast to TAV, not associated with an increased collagen turnover. However, BAV in general was associated with an increased aortic collagen turnover compared with nondilated aortas of TAV patients. Importantly, the ratio of hydroxylysyl pyridinoline (HP) to lysyl pyridinoline (LP), 2 distinct forms of collagen cross?linking, was lower in dilated aortas from patients with BAV, which suggests that BAV is associated with a defect in the posttranslational collagen modification. This suggests a deficiency at the level of lysyl hydroxylase (PLOD1), which was confirmed by mRNA and protein analyses that showed reduced PLOD1 expression but normal lysyl oxidase expression in dilated aortas from patients with BAV. This suggests that impaired collagen cross?linking in BAV patients may be attributed to changes in the expression and/or activity of PLOD1. Conclusions Our results demonstrate an impaired biosynthesis and posttranslational modification of collagen in aortas of patients with BAV, which may explain the increased aortic aneurysm formation in BAV patients. PMID:23525417

Wågsäter, Dick; Paloschi, Valentina; Hanemaaijer, Roeland; Hultenby, Kjell; Bank, Ruud A.; Franco?Cereceda, Anders; Lindeman, Jan H. N.; Eriksson, Per

2013-01-01

352

Long-Term Results of Mechanical Valve Replacement: Isolated Mitral Valve Replacement and Mitral-Aortic Valve Replacement  

Microsoft Academic Search

The long-term results of mechanical valve replace- ment are satisfactory in terms of both survival and quality of life. In a series of 440 isolated mitral valve replacements (MVR) with a St. Jude Medical prosthesis (1), the overall actuarial survival rate was 63 ± 3.3% at 19 years, while the valve-related actuarial survival was 83 ± 2.7%. The operative mortality

J.-P. Remadi; D. Duveau

353

Comparison of accuracy of aortic root annulus assessment with cardiac magnetic resonance versus echocardiography and multidetector computed tomography in patients referred for transcatheter aortic valve implantation.  

PubMed

The evaluation of the aortic root in patients referred for transcatheter aortic valve implantation is crucial. The aim of the present study was to compare the accuracy of cardiac magnetic resonance (CMR) evaluation of the aortic annulus (AoA) with transthoracic and transesophageal echocardiography and multidetector computed tomography (MDCT) in patients referred for transcatheter aortic valve implantation. In 50 patients, maximum diameter, minimum diameter and AoA, length of the left coronary, right coronary, and noncoronary aortic leaflets, degree (grades 1 to 4) of aortic leaflet calcification, and distance between AoA and coronary artery ostia were assessed. AoA maximum diameter, minimum diameter, and area by CMR were 26.4 ± 2.8 mm, 20.6 ± 2.3 mm, 449.8 ± 86.2 mm(2), respectively. The length of left coronary, right coronary, and noncoronary leaflets by CMR were 13.9 ± 2.2, 13.3 ± 2.1, and 13.4 ± 1.8 mm, respectively, whereas the score of aortic leaflet calcifications was 2.9 ± 0.8. Finally, the distances between AoA and left main and right coronary artery ostia were 16.1 ± 2.8 and 16.1 ± 4.4 mm, respectively. Regarding AoA area, transthoracic and transesophageal echocardiography showed an underestimation (p <0.01), with a moderate agreement (r: 0.5 and 0.6, respectively, p <0.01) compared with CMR. No differences and excellent correlation were observed between CMR and MDCT for all parameters (r: 0.9, p <0.01), except for aortic leaflet calcifications that were underestimated by CMR. In conclusion, aortic root assessment with CMR including AoA size, aortic leaflet length, and coronary artery ostia height is accurate compared with MDCT. CMR may be a valid imaging alternative in patients unsuitable for MDCT. PMID:24045059

Pontone, Gianluca; Andreini, Daniele; Bartorelli, Antonio L; Bertella, Erika; Mushtaq, Saima; Gripari, Paola; Loguercio, Monica; Cortinovis, Sarah; Baggiano, Andrea; Conte, Edoardo; Beltrama, Virginia; Annoni, Andrea; Formenti, Alberto; Tamborini, Gloria; Muratori, Manuela; Guaricci, Andrea; Alamanni, Francesco; Ballerini, Giovanni; Pepi, Mauro

2013-12-01

354

[A semiquantitative assessment of aortic valve insufficiency by cine-MR compared to Doppler color echocardiography and cardioangiography].  

PubMed

A simple, reliable semiquantitative method for evaluating aortic valve insufficiency by means of cine MR is described. Ten normal persons and 36 patients with aortic valve abnormalities were examined in a 1.5 Tesla apparatus using ECG-triggered gradient echo sequences. The heart was imaged along its short axis. Semiquantitative evaluation of aortic valve insufficiency was calculated from an MRI index, which depends on the diameter of the aortic regurgitant jet and on its length; the results were compared with colour Doppler echocardiography and cardioangiography. The MRI index showed better correlation with cardioangiography (r = 0.92) than the correlation between the colour Doppler echocardiography and cardioangiography (r = 0.78). Over and under estimates are less common with MRI than with colour Doppler echocardiography. MRI showed very little interobserver variability (r = 0.96, p less than 0.001). Cine MR is a reliable method for demonstrating aortic valve insufficiency. Using the short axis of the heart, rapid semiquantitative evaluation of the aortic regurgitant jet is regularly possible. PMID:2176311

Dulce, M C; Friese, K; Gast, D; Albrecht, A; Hamm, B; Wolf, K J

1990-12-01

355

A supra-annular malposition of the Perceval S sutureless aortic valve: the ‘?-movement’ removal technique and subsequent reimplantation  

PubMed Central

The Perceval S sutureless valve prosthesis has recently been introduced as a new biological aortic valve prosthesis, but a specific learning curve is required, as for every cardiac surgical centre dealing with a new technique. After the removal of the stenotic valve, the prosthetic valve is correctly positioned within the mildly decalcified aortic annulus. When a supra-annular malposition occurs, due to an excessively rapid release of the prosthesis in the aorta or incomplete annular visualization, the Perceval S valve can safely be removed even after balloon dilation. The procedure performed is a ‘?-movement’ with the aid of anatomical forceps. If the prosthesis does not show any malformation after the procedure, it can be reimplanted in the correct intra-annular position. PMID:22535542

Santarpino, Giuseppe; Pfeiffer, Steffen; Concistrè, Giovanni; Fischlein, Theodor

2012-01-01

356

Comparison between three types of stented pericardial aortic valves (Trivalve trial): study protocol for a randomized controlled trial  

PubMed Central

Background Aortic valve stenosis is one of the most common heart diseases in older patients. Nowadays, surgical aortic valve replacement is the ‘gold standard’ treatment for this pathology and the most implanted prostheses are biological ones. The three most implanted bovine bioprostheses are the Trifecta valve (St. Jude Medical, Minneapolis, MN, USA), the Mitroflow valve (Sorin Group, Saluggia, Italy), and the Carpentier-Edwards Magna Ease valve (Edwards Lifesciences, Irvine, CA, USA). We propose a randomized trial to objectively assess the hemodynamic performances of these bioprostheses. Methods and design First, we will measure the aortic annulus diameter using CT-scan, echocardiography and by direct sizing in the operating room after native aortic valve resection. The accuracy of information, in terms of size and spatial dimensions of each bioprosthesis provided by manufacturers, will be checked. Their hemodynamic performances will be assessed postoperatively at the seventh day and the sixth month after surgery. Discussion This prospective controlled randomized trial aims to verify and compare the hemodynamic performances and the sizing of these three bioprostheses. The data obtained may help surgeons to choose the best suitable bioprosthesis according to each patient’s morphological characteristics. Trial registration ClinicalTrials.gov Identifier: NCT01522352 PMID:24299218

2013-01-01

357

Regenerative Potential of Low-Concentration SDS-Decellularized Porcine Aortic Valved Conduits In Vivo  

PubMed Central

The aims of this study were to determine the functional biocompatibility of low-concentration SDS-decellularized porcine aortic roots in vivo. A previously developed process was modified for 9- and 15-mm-diameter aortic roots to facilitate implantation into the porcine abdominal aorta (n=3) and juvenile sheep right ventricular outflow tract (n=7), respectively. Native allogeneic aortic roots were used as controls. Acellular porcine roots explanted from pigs at weeks were largely repopulated with stromal cells of appropriate phenotype, and there was evidence that macrophages were involved in the regenerative process. Native allogeneic roots were subject to a classic allograft rejection response. Acellular porcine roots explanted from sheep at 6 months showed evidence of appropriate cellular repopulation, again with evidence of a role for macrophages in the regenerative process. There was some degree of calcification of two of the explanted acellular roots, likely due to incomplete removal of DNA before implantation. Native allogeneic ovine roots were subject to a classic allograft rejection response involving T cells, which resulted in overtly calcified and damaged tissues. The study highlighted (1) the importance of removal of DNA from acellular porcine valved roots to avoid calcification and (2) a role for macrophages in the regeneration of low-concentration SDS-decellularized aortic roots, as has been reported for other acellular biological extracellular matrix scaffolds. PMID:25156153

Paniagua Gutierrez, José Rodolfo; Berry, Helen; Korossis, Sotirios; Mirsadraee, Saeed; Lopes, Sergio Veiga; da Costa, Francisco; Kearney, John; Watterson, Kevin; Fisher, John

2015-01-01

358

Effect of valve orientation on flow development past aortic valve prostheses in a model human aorta.  

PubMed

The effect of valve orientation on flow development in a model human aorta was studied by means of a qualitative flow visualization technique. The model replicated the geometry of the human aorta and the experiment simulated a physiologically realistic pulsatile flow. The following valves were studied: Starr-Edwards Stellite, Starr-Edwards silicone, Björk-Shiley spherical disc, Björk-Shiley convexo-concave disc, and Hall-Kaster tilting disc. All the valves had a tissue anulus diameter of 27 mm. With the ball-in-cage valves, the flow in the ascending aorta was predominantly axial and uniform throughout systole, while vortex formation was observed downstream from the ball. With the tilting disc valves, the flow development in the aorta was a function of the orientation of the valves. With the major flow orifice directed toward the commissure between the right and noncoronary cusps, the fluid motion was predominantly in the axial direction through early systole. A vortex developed along the wall of lesser curvature of the aorta with the progression of systole. In early diastole, a well-defined flow reversal was observed along the lesser curvature of the aorta. With the major flow orifice directed toward the left coronary cusp, the fluid motion, although predominantly axial, was not uniform in the ascending aorta. Regions of relative stasis present near the wall of greater curvature subsequently developed into a trapped vortex throughout the cardiac cycle. With the major flow orifice directed more posteriorly, an improved fluid dynamic characteristic was observed, and there was no trapped vortex present near the wall of greater curvature. The flow visualization study in the model human aorta suggests that, from a fluid dynamic point of view, orientation of the major flow orifice of the tilting disc valve toward the wall of lesser curvature is not advisable. PMID:6855259

Chandran, K B; Khalighi, B; Chen, C J; Falsetti, H L; Yearwood, T L; Hiratzka, L F

1983-06-01

359

Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis  

Microsoft Academic Search

INTRODUCTION: Left ventricular (LV) dysfunction frequently occurs after cardiac surgery, requiring inotropic treatment and\\/or mechanical circulatory support. In this study, we aimed to identify clinical, surgical and echocardiographic factors that are associated with LV dysfunction during weaning from cardiopulmonary bypass (CPB) in high-risk patients undergoing valve replacement for aortic stenosis. METHODS: Perioperative data were prospectively collected in 108 surgical candidates

Marc Licker; Mustafa Cikirikcioglu; Cidgem Inan; Vanessa Cartier; Afksendyios Kalangos; Thomas Theologou; Tiziano Cassina; John Diaper

2010-01-01

360

Late results of aortic valve replacement with the Starr-Edwards prosthesis.  

PubMed Central

Details are presented concerning 59 patients who left hospital between January 1964 and January 1969 after aortic valve replacement with the Starr-Edwards prosthesis. Of the 14 late deaths, 7 are known to have been due to causes related to the prosthesis and 4 to other causes. The 45 surviving patients have nearly all shown clinical improvement and only 3 are unable to work as a result of some complication of the operation. Aortic regurgitation and its consequences appear to be the most significant factor leading to symptoms. In 11 of 16 patients with anaemia there was evidence of intravascular haemolysis. The long-term consequence of this complication is not known. Images PMID:5212355

Morgans, C M; Barritt, D W; Belsey, R H; Keen, G; Wensley, R

1970-01-01

361

Left main coronary artery bifurcation angioplasty and stenting after aortic valve replacement: a case report  

PubMed Central

A 43-year-old young lady had closed mitral valvotomy (CMV) in 1994 and aortic valve replacement (AVR) in June 2007. Shortly thereafter, she presented with unstable angina in October 2007 with on-going pain and haemodynamic instability. Coronary angiogram showed tight left main bifurcation stenosis in a left dominant system. Having had open heart surgery (AVR) recently, and being on oral anticoagulation, with on-going ischaemia and unstable haemodynamics, percutaneous coronary intervention (PCI) was considered the most suitable option. She underwent successful PCI with two drug-eluting stents (T-stenting) to left main bifurcation through transradial approach and intra-aortic balloon support. Clinically she remained symptom free and coronary angiogram after 5 months and 15 months of follow-up showed patent stents. This case demonstrates the acute effectiveness of PCI for the treatment of critical left main disease following open heart surgery in patients who are not appropriate surgical candidates. PMID:22572431

Roy, Sanjeeb; Bana, Ajeet; Gupta, Rajeev; Chittora, Rakesh; Sharma, Sameer; Mehta, Navneet

2012-01-01

362

Early cell changes and TGF? pathway alterations in the aortopathy associated with bicuspid aortic valve stenosis.  

PubMed

Previous studies on BAV (bicuspid aortic valve)-related aortopathy, whose aetiology is still debated, have focused mainly on severe dilatations. In the present study, we aimed to detect earlier signs of aortopathy. Specimens were collected from the 'concavity' (lesser curvature) and the 'convexity' (greater curvature) of mildly dilated AAs (ascending aortas; diameter ?4 cm) with stenotic TAV (tricuspid aortic valve) or BAV and from donor normal aortas. Specimens were submitted to morphometry, immunohistochemistry and differential gene-expression analysis, focusing on SMC (smooth muscle cell) phenotype, remodelling, MF (myofibroblast) differentiation and TGF? (transforming growth factor ?) pathway. Smoothelin and myocardin mRNAs decreased in all the samples from patients, with the exception of those from BAV convexity, where a change in orientation of smoothelin-positive SMCs and an increase of ?-SMA (?-smooth muscle actin) mRNA occurred. Dilated aortas from BAV and TAV patients showed both shared and distinct alterations concerning the TGF? pathway, including an increased TGF? and TGF?R2 (TGF? receptor 2) expression in both groups and a decreased TGF?R1 expression in BAV samples only. Despite a decrease of the mRNA coding for the ED-A (extra domain-A) isoform of FN (fibronectin) in the BAV convexity, the onset of the expression of the corresponding protein in the media was observed in dilated aortas, whereas the normal media from donors was negative for this isoform. This discrepancy could be related to modifications in the intima, normally expressing ED-A FN and showing an altered structure in mild aortic dilatations in comparison with donor aorta. Our results suggest that changes in SMC phenotype and, likely, MF differentiation, occur early in the aortopathy associated with valve stenosis. The defective expression of TGF?R1 in BAV might be a constitutive feature, while other changes we reported could be influenced by haemodynamics. PMID:22857993

Forte, Amalia; Della Corte, Alessandro; Grossi, Mario; Bancone, Ciro; Provenzano, Raffaela; Finicelli, Mauro; De Feo, Marisa; De Santo, Luca S; Nappi, Gianantonio; Cotrufo, Maurizio; Galderisi, Umberto; Cipollaro, Marilena

2013-01-01

363

A meta-analysis of minimally invasive versus conventional sternotomy for aortic valve replacement.  

PubMed

Minimally invasive aortic valve replacement (AVR) is increasingly used as an alternative to conventional AVR, despite limited randomized evidence available. To assess the evidence base, a systematic search identified 50 comparative studies with a total of 12,786 patients. A meta-analysis demonstrated that minimally invasive AVR is associated with reduced transfusion incidence, intensive care stay, hospitalization, and renal failure, and has a mortality rate that is comparable to conventional AVR. The evidence quality was mostly very low. Given the inadequate statistical power and heterogeneity of available studies, prospective randomized trials are needed to assess the benefits and risks of minimally invasive AVR approaches. PMID:25064516

Phan, Kevin; Xie, Ashleigh; Di Eusanio, Marco; Yan, Tristan D

2014-10-01

364

Multi-embolic ST-elevation Myocardial Infarction Secondary to Aortic Valve Endocarditis.  

PubMed

We present the case of a 42 year-old woman admitted to hospital with ST-elevation myocardial infarction involving two separate coronary territories. Angiography revealed multi-embolic occlusions of her left anterior descending (LAD) and first obtuse marginal (OM1) coronary arteries. Transoesophageal echocardiogram (TOE) showed a lesion attached to the left cusp of the aortic valve and she was treated for infective endocarditis. We discuss the management issues raised from this unique patient, including reperfusion strategies in endocarditis-associated myocardial infarction. PMID:25150649

Rischin, Adam P; Carrillo, Philip; Layland, Jamie

2015-01-01

365

Coronary artery bypass grafting associated to aortic valve replacement in the elderly: survival and quality of life.  

PubMed

Myocardial ischemia is often associated to aortic valve stenosis in the elderly. Aim of this study was to evaluate the impact on survival and quality of life of CABG associated to aortic valve replacement in the septuagenarians and octogenarians.Between January 1991 and January 2010, 520 patients ageing > 70 years underwent aortic valve replacement with a mechanical prosthesis in two Institutions. They were divided into 2 groups: Group A included 406 patients undergoing isolated aortic valve replacement; Group B 114 patients receiving aortic valve replacement and CABG. A comparative analysis of long-term survival and quality of life (SF-36 test) was performed.Mean age was 74.2 ± 3.6 years (74.3 ± 3.6 in Group A, 74 ± 3.3 in Group B; p = 0.33). Hospital mortality was 9.5% (46 patients). Twenty-nine (7.8%) in Group A and 17 in Group B (15.2%)(p = 0.019). Actuarial survival was 88.5% ± 0.015 at 1 year, 81.9% ± 0.02 at 5 years, 76.6% ± 0.032 at 10 and 57.3 ± 0.1 at 15 years. Ten-year survival was 77% ± 0.034 in Group A and 77.8% ± 0.045 in Group B (p = 0.2). Multivariate analysis did not reveal associated CABG as a predictor of long term mortality. The scores obtained in the SF-36 test were similar in the two groups and significantly higher than those of the general population matched for country, age and sex (p < 0.001 in all domains).Associated CABG determines a significant increase of hospital mortality in the elderly undergoing aortic valve replacement. Survivors did not show differences in long-term outcome and quality of life according to the presence of associated CABG. PMID:22309837

Vicchio, Mariano; Feo, Marisa De; Giordano, Salvatore; Provenzano, Raffaella; Cotrufo, Maurizio; Nappi, Gianantonio

2012-01-01

366

Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation  

PubMed Central

Transcatheter aortic valve implantation (TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths (16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques. PMID:25228962

Dato, Ilaria; Burzotta, Francesco; Trani, Carlo; Crea, Filippo; Ussia, Gian Paolo

2014-01-01

367

Topography of aortic heart valves. [applied to the development of a prosthetic heart valve  

NASA Technical Reports Server (NTRS)

The cooperative effort towards the development of a tri-leaflet prosthetic heart valve is described. The photogrammetric studies were conducted on silicone rubber molds. Information on data acquisition and data reduction phases is given, and certain accuracy aspects of the project are explained. The various outputs which are discussed include digital models, profiles, and contour maps.

Karara, H. M.

1974-01-01

368

Simulation of motor current waveform as an index for aortic valve open-close condition during ventricular support.  

PubMed

Monitoring of aortic valve (AV) opening and closure during heart pump support by a left ventricular assist device (LVAD) is crucial in preventing adverse events such as thrombus formation near the AV. In preventing adverse events such as thrombus formation near the AV. In this paper, simulations of LVAD motor current waveform were undertaken to evaluate its suitability for ascertaining aortic valve status. A two-dimensional fluid-structure interaction finite-element model is presented to predict AV closure during LVAD outflow, useful in the development of a pump speed controller. PMID:25570625

Alonazi, Khalid A; Lovell, Nigel H; Dokos, Socrates

2014-08-01

369

Controversies and complications in the perioperative management of transcatheter aortic valve replacement.  

PubMed

Transcatheter aortic valve replacement (TAVR) is performed with increasing frequency in the United States since Food and Drug Administration approval in 2011. The procedure involves the replacement of a severely stenosed native or bioprosthetic aortic valve with a specially constructed valvular prosthesis that is mounted onto a stent, without the use of cardiopulmonary bypass and the complications of a major open surgical procedure. TAVR has been performed mostly in elderly patients with multiple comorbidities or who have undergone previous cardiac surgery. The most commonly used access routes are the femoral artery (transfemoral) or the cardiac apex (transapical), but the transaortic and transubclavian approaches are also used with varying frequency. Conscious sedation may be used in patients undergoing transfemoral TAVR, but the use of general anesthesia has not been shown to carry greater risk and permits the use of transesophageal echocardiography to assist in valve positioning and diagnose complications. Cardiovascular instability during TAVR is relatively common, necessitating invasive monitoring and frequent use of vasoactive medications. Complications of the procedure are still relatively common and the most frequent is vascular injury to the access sites or the aorta. Cardiovascular collapse may be the result of major hemorrhage pericardial effusion with tamponade or coronary occlusion due to incorrect valve placement. Persistent hypotension, myocardial stunning, or injury requiring open surgical intervention may necessitate the use of cardiopulmonary bypass, the facilities for which should always be immediately available. Ongoing and planned trials comparing conventional surgery with TAVR in lower risk and younger patients should determine the place of TAVR in the medium- to long-term future. PMID:25232691

Klein, Andrew A; Skubas, Nikolas J; Ender, Joerg

2014-10-01

370

Unicuspid and bicuspid tooth crown formation in squamates.  

PubMed

The molecular and developmental factors that regulate tooth morphogenesis in nonmammalian species, such as snakes and lizards, have received relatively little attention compared to mammals. Here we describe the development of unicuspid and bicuspid teeth in squamate species. The simple, cone-shaped tooth crown of the bearded dragon and ball python is established at cap stage and fixed in shape by the differentiation of cells and the secretion of dental matrices. Enamel production, as demonstrated by amelogenin expression, occurs relatively earlier in squamate teeth than in mouse molars. We suggest that the early differentiation in squamate unicuspid teeth at cap stage correlates with a more rudimentary tooth crown shape. The leopard gecko can form a bicuspid tooth crown despite the early onset of differentiation. Cusp formation in the gecko does not occur by the folding of the inner enamel epithelium, as in the mouse molar, but by the differential secretion of enamel. Ameloblasts forming the enamel epithelial bulge, a central swelling of cells in the inner enamel epithelium, secrete amelogenin at cap stage, but cease to do so by bell stage. Meanwhile, other ameloblasts in the inner enamel epithelium continue to secrete enamel, forming cusp tips on either side of the bulge. Bulge cells specifically express the gene Bmp2, which we suggest serves as a pro-differentiation signal for cells of the gecko enamel organ. In this regard, the enamel epithelial bulge of the gecko may be more functionally analogous to the secondary enamel knot of mammals than the primary enamel knot. PMID:21932327

Handrigan, Gregory R; Richman, Joy M

2011-12-15

371

Late aortic homograft valve endocarditis caused by Cardiobacterium hominis: a case report and review of the literature.  

PubMed

An unusual case of Cardiobacterium hominis endocarditis involving an aortic homograft valve is presented. Although the patient was young (a 17 year old man) and showed few of the characteristic features of the disease, the report does illustrate a number of the problems associated with this illness and highlights the need for the careful assessment of apparent culture negative endocarditis. The organism itself is susceptible to most antibiotics but further treatment, including surgery, may be necessary. Patients must therefore be examined repeatedly and assessed for haemodynamic deterioration, valve destruction or embolic phenomena. Homograft valve replacement may offer some benefits in the setting of aortic valve endocarditis and is therefore an attractive option in this situation. PMID:10768915

Currie, P F; Codispoti, M; Mankad, P S; Godman, M J

2000-05-01

372

Rupture of an aortic dissection into the right atrium in a patient with a previous aortic valve replacement: a case report.  

PubMed

We report the case of a 73-year-old man with a history of previous aortic valve replacement in 1990 and rupture of an aortic dissection into the right atrium. The patient was admitted to the emergency room because of chest pain, stopped not long after. The electrocardiogram did not show any signs of ischemia and myocardial enzymes were not increased. Transthoracic echocardiography revealed aortic root dilation (maximum diameter 60 mm) extended to the aortic arch, and the presence of a flow from the ascending aorta to the right atrium (evocative of a fistula between the two chambers). The aortic valvular prosthesis function was good. Transesophageal echocardiography confirmed an aorta-right atrium fistula. Cardiac catheterization did not show any luminal obstructions in the coronary arteries; there was a small shunt from the aorta to the right atrium. The ascending aorta and the aortic root were replaced with a Dacron graft. Right and left sinuses were reimplanted to the graft. The fistula was repaired with 4-0 pledgeted Prolene sutures. The surgeon's diagnosis was "type A aortic dissection in a patient with an ascending aorta aneurysm and an old ascending aorta-right atrium fistula". PMID:16161500

Panzarella, Gaetano; Carlino, Gabriella; Fattouch, Kahlil; Ruvolo, Giovanni; Messina, Luigi; Hoffmann, Enrico; Incalcaterra, Egle; Novo, Salvatore

2005-08-01

373

Balloon Valvuloplasty of Aortic Valve Stenosis in Childhood: Midterm Results in a Children’s Hospital, Mansoura University, Egypt  

PubMed Central

Background: Balloon valvuloplasty was established as an alternative to surgery for treatment of aortic valve stenosis in childhood. Acute complications after balloon dilatation including aortic insufficiency or early death were described. Aim of Work: To analyze early outcome and midterm results of balloon aortic valvuloplasty (BAV) in Children’s Hospital, Mansoura University, Egypt. Subjects and Methods: Between April 2005–June 2008, all consecutive patients of age <18 years treated for aortic valve stenosis (AVS) with BAV were analyzed retrospectively. The study included 21 patients; 17 males, and 4 females. Their age ranged from the neonatal period to 10 years (mean age 5.6 ± 3.7 years). Patients with gradient ?50 mmHg and aortic valve insufficiency (AI) up to grade I were included. All patients had isolated aortic valve stenosis except 3 patients (14.3%) had associated aortic coarctation. Six patients (28.6%) had bicuspid aortic valve. All patients had normal myocardial function except one (4.8%) had FS 15%. The duration of follow up was (mean ± SD: 18.5 ± 11.7 months). Results: Femoral artery approach was used in 20 patients (95.2%) and carotid artery in one neonate (4.8%). Balloon/annulus ratio was 0.83 ± 0.04. Significant reduction in pressure gradient was achieved (mean 66.7 ± 9.8 mmHg to 20.65 ± 2.99 mmHg) (P < 0.001). Nine patients (42.8%) developed grade I AI, 2 patients (9.5%) developed grade II AI and 1 patient (4.8%) developed grade III AI. Two early deaths (9.5%); one died due to heart failure caused by grade IV AI and a neonate died because of severely compromised LV function. One patient (4.8%) had femoral artery occlusion necessitating anticoagulation. Patients remained free from re-intervention during follow up. Conclusion: Balloon valvuloplasty of aortic valve stenosis significantly reduces gradient with low morbidity and mortality in children. PMID:22412302

Al Marshafawy, Hala; Al Sawah, Gehan Attia; Hafez, Mona; Matter, Mohammed; El Gamal, Adel; Sheishaa, Abdel Gawad; El Kair, Magdy Abu

2012-01-01

374

Quadricuspid aortic valve and a ventricular septal defect in a horse  

PubMed Central

Background Quadricuspid aortic valve (QAV) and ventricular septal defect (VSD) are congenital heart defects and have been described in both human and veterinary medical literature. Case presentation A 5-year-old half-bred bay stallion was referred for surgical castration. Cardiac murmurs were heard on the presurgical clinical examination and the cardiac examination revealed subcutaneous oedema, tachycardia with a precodrial thrill and a grade 5/6 pansystolic murmur, which was heard on auscultation of the right and left side of the chest. Examination of the B-mode echocardiograms revealed the presence of a QAV (one small cusp, two equal-sized cusps, and one large cusp) and VSD in the membranous portion of the intraventricular septum. These two congenital cardiac defects were accompanied by mild aortic valve regurgitation and severe tricuspid regurgitation. Despite the presence of these cardiac defects, the horse underwent surgical castration under general anesthesia. Surgery, anaesthesia and recovery from anaesthesia were uneventful. The gelding was euthanasied after 17 months because of a progressive loss of body weight, weakness and recumbency. Conclusion A QAV in combination with VSD in a horse is an interesting finding, because to the best of our knowledge, this has not been previously described in equine literature. PMID:24981768

2014-01-01

375

[Cine MRI of the ascending aorta in the elderly with respect to the flow signal void and aortic valve morphology].  

PubMed

Cine flow MRI was performed on a 1.5 Tesla system to observe signal intensity of blood flow within the ascending aorta in the elderly who had no aortic stenosis and to determine frequency of the flow signal void. Coronal and sagittal imaging planes of the ascending aorta were obtained in 27 aged patients with no known cardiac diseases (14 men and 13 women, mean age of 76) and 7 young volunteers (7 men, mean age of 24), utilizing ECG-gating. GRASS (gradient-recalled acquisition in steady state), and a flow compensation sequence. The young volunteers presented little or no signal void within the ascending aorta. In 26 (96%) of the 27 aged patients, on the other hand, signal void was demonstrated in the blood flow distal to the aortic valve during systole. The maximum length of the signal void that was measured at 318-632 msec after the R wave of ECG ranged from 33 to 97 mm. Conventional and Doppler echocardiography was used to evaluate motion and morphology of the aortic valve in 19 of the 27 aged patients. Eighteen of these 19 subjects had aortic signal void on cine MRI. Echocardiography showed sclerotic changes of the aortic valve (i.e., increased echogenicity of the cusps and/or commissure fusion) in 10 (53%) of the 19 subjects. The mean maximum length of the signal void in the 10 patients with aortic valve sclerosis was significantly greater than that in the 9 patients with echocardiographically normal valve (68 vs. 45 mm, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2079760

Nakayama, M; Kyomasu, Y; Suzuki, Y; Mashima, Y; Tanno, M; Endo, K; Yamada, H

1990-11-01

376

Echocardiography Underestimates Stroke Volume and Aortic Valve Area: Implications for Patients With Small-Area Low-Gradient Aortic Stenosis  

PubMed Central

Background Discordance between small aortic valve area (AVA; < 1.0 cm2) and low mean pressure gradient (MPG; < 40 mm Hg) affects a third of patients with moderate or severe aortic stenosis (AS). We hypothesized that this is largely due to inaccurate echocardiographic measurements of the left ventricular outflow tract area (LVOTarea) and stroke volume alongside inconsistencies in recommended thresholds. Methods One hundred thirty-three patients with mild to severe AS and 33 control individuals underwent comprehensive echocardiography and cardiovascular magnetic resonance imaging (MRI). Stroke volume and LVOTarea were calculated using echocardiography and MRI, and the effects on AVA estimation were assessed. The relationship between AVA and MPG measurements was then modelled with nonlinear regression and consistent thresholds for these parameters calculated. Finally the effect of these modified AVA measurements and novel thresholds on the number of patients with small-area low-gradient AS was investigated. Results Compared with MRI, echocardiography underestimated LVOTarea (n = 40; ?0.7 cm2; 95% confidence interval [CI], ?2.6 to 1.3), stroke volumes (?6.5 mL/m2; 95% CI, ?28.9 to 16.0) and consequently, AVA (?0.23 cm2; 95% CI, ?1.01 to 0.59). Moreover, an AVA of 1.0 cm2 corresponded to MPG of 24 mm Hg based on echocardiographic measurements and 37 mm Hg after correction with MRI-derived stroke volumes. Based on conventional measures, 56 patients had discordant small-area low-gradient AS. Using MRI-derived stroke volumes and the revised thresholds, a 48% reduction in discordance was observed (n = 29). Conclusions Echocardiography underestimated LVOTarea, stroke volume, and therefore AVA, compared with MRI. The thresholds based on current guidelines were also inconsistent. In combination, these factors explain > 40% of patients with discordant small-area low-gradient AS. PMID:25151288

Chin, Calvin W.L.; Khaw, Hwan J.; Luo, Elton; Tan, Shuwei; White, Audrey C.; Newby, David E.; Dweck, Marc R.

2014-01-01

377

Impact of previous coronary artery bypass grafting on patients undergoing transcatheter aortic valve implantation for aortic stenosis.  

PubMed

Re-operation after coronary artery bypass grafting (CABG) is associated with increased risk for morbidity and mortality. Transcatheter aortic valve implantation (TAVI) is an alternative for patients with aortic stenosis, but the outcomes of patients with a history of CABG are unknown. The aim of this study was to explore the association between previous CABG and the outcome of patients undergoing TAVI. Out of 372 consecutive patients who underwent TAVI from 2007 to 2013, 122 (32.8%) had previous CABG, whereas 250 (67.2%) did not. A comparison was made between groups. Subgroup analysis compared patients with and without previous CABG in 3 patient subsets: inoperable, operable, and those who underwent transapical TAVI. Patients with previous CABG were younger (81.99±6.78 vs 84.81±7.06 years, respectively, p<0.001). These patients also had more high-risk features (e.g., peripheral vascular disease, previous myocardial infarction, past cerebrovascular disease, and lower average left ventricular ejection fraction (p<0.05 for all). Procedural aspects were mostly similar between groups. No disparities in mortality rates at 1 year were noted (22.1% vs 21.6%, respectively, p=0.91). Subgroup analyses yielded similar outcomes for all 3 groups. In conclusion, although patients with previous CABG present with more high-risk features, they share similar short- and long-term outcomes with patients without previous CABG, irrespective of their surgical risk. This includes patients who underwent transapical access. TAVI in patients with previous CABG is safe and does not confer a significant risk for adverse outcome. PMID:24513466

Minha, Sa'ar; Magalhaes, Marco A; Barbash, Israel M; Ben-Dor, Itsik; Dvir, Danny; Okubagzi, Petros G; Chen, Fang; Torguson, Rebecca; Kent, Kenneth M; Suddath, William O; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

2014-04-01

378

Impact of preprocedural mitral regurgitation upon mortality after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis  

PubMed Central

Objective To identify the effects of preprocedural significant mitral regurgitation (MR) and change in MR severity upon mortality after transcatheter aortic valve implantation (TAVI) using the Edwards SAPIEN system. Methods A retrospective analysis of 316 consecutive patients undergoing TAVI for aortic stenosis at a single centre in the UK between March 2008 and January 2013. Patients were stratified into two groups according to severity of MR: ?grade 3 were classed as significant and ?grade 2 were non-significant. Change in MR severity was assessed by comparison of baseline and 30-day echocardiograms. Results 60 patients had significant MR prior to TAVI (19.0%). These patients were of higher perioperative risk (logistic EuroScore 28.7±16.6% vs 20.3±10.7%, p=0.004) and were more dyspnoeic (New York Heart Association class IV 20.0% vs 7.4%, p=0.014). Patients with significant preprocedural MR displayed greater 12-month and cumulative mortality (28.3% vs 20.2%, log-rank p=0.024). Significant MR was independently associated with mortality (HR 4.94 (95% CI 2.07 to 11.8), p<0.001). Of the 60 patients with significant MR only 47.1% had grade 3–4 MR at 30?days (p<0.001). Patients in whom MR improved had lower mortality than those in whom it deteriorated (log-rank p=0.05). Conclusions Significant MR is frequently seen in patients undergoing TAVI and is independently associated with increased all-cause mortality. Yet almost half also exhibit significant improvements in MR severity. Those who improve have better outcomes, and future work could focus upon identifying factors independently associated with such an improvement. PMID:25155800

Khawaja, M Z; Williams, R; Hung, J; Arri, S; Asrress, K N; Bolter, K; Wilson, K; Young, C P; Bapat, V; Hancock, J; Thomas, M; Redwood, S

2014-01-01

379

Comparison of aortic root dimension changes during cardiac cycle between the patients with and without aortic valve calcification using ECG-gated 64-slice and dual-source 256-slice computed tomography scanners: results of a multicenter study.  

PubMed

With advent of transcatheter aortic valve implantation, using multislice computed tomography (MSCT) to provide detailed data about aortic root has become more crucial. We compared aortic dimension changes during cardiac cycle in patients with and without aortic valve calcification and evaluated its correlation with aortic valve calcium score in former group. Fifty-two patients with and 52 subjects without aortic valve calcification underwent coronary MSCT using two 64-slice and a dual-source 256-slice CT scanners. Aortic root dimensions were measured in both systolic and diastolic phases. Changes in annular maximum diameter (D(max)), minimum diameter (D(min)), cross sectional area and perimeter, three diameters of sinuses of Valsalva (V(a), V(b) and V(c)), sinotubular junction maximum (STJ(max)) and minimum (STJ(min)) diameters between systolic and diastolic phases (systole minus diastole) were -0.59 mm, -0.05 mm, -2.53 mm(2), -1.48 mm, +0.91 mm, +1.08 mm, +0.42 mm, +0.63 mm, +0.40 mm and in those without aortic calcification -0.33 mm, 0.00 mm, -6.92 mm(2), -0.41 mm, +0.30 mm, +0.38 mm, +0.61 mm, +0.33 mm, +0.20 mm in patients with aortic calcification, respectively. Apart from two diameters in sinuses of Valsalva (V(a) and V(b)), changes in all other diameters of aortic root during cardiac cycle were not significantly different between the two groups. Furthermore, in patients with aortic calcification, no significant correlation was detected between changes in nearly all aortic root dimensions during cardiac cycle and aortic valve calcium score or location of calcification (annular, commissural or both). PMID:23584562

Arjmand Shabestari, Abbas; Pourghorban, Ramin; Tehrai, Mahmood; Pouraliakbar, Hamidreza; Faghihi Langroudi, Taraneh; Bakhshandeh, Hooman; Abdi, Seifollah

2013-08-01

380

Sex differences in cardiovascular outcome during progression of aortic valve stenosis  

PubMed Central

Objective Women with severe aortic valve stenosis (AS) have better LV systolic function and more concentric LV geometry than their male counterparts. However, sex differences in cardiovascular (CV) outcome during progression of AS have not been reported from a longitudinal prospective study. Methods Doppler echocardiography and CV events were recorded during a median of 4.0?years in 979 men and 632 women aged 28–86 (mean 67±10) years in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study. LV systolic function was assessed by EF and midwall shortening (MWS). Study outcomes were AS-related events, ischaemic CV events and total mortality. Results The annular cumulative incidence of AS events, ischaemic CV events and death was 8.1%, 3.4% and 2.8% in women, and 8.9%, 4.4% and 2.4% in men, respectively. Women and men had similar AS progression rate whether measured by peak jet velocity, mean gradient or valve area. In multivariate analyses, female sex independently predicted less reduction in LV MWS and EF during follow-up (both p<0.05). In time-varying Cox analyses, women had a 40% lower rate of ischaemic CV events (95% CI 21% to 54%), in particular, more than 50% lower rate of stroke and coronary artery bypass grafting, and a 31% lower all-cause mortality (95% CI 1% to 51%), independent of active study treatment, age and hypertension, as well as time-varying valve area, low systolic function and abnormal LV geometry. AS event rate did not differ by sex. Conclusions In the SEAS study, women and men had similar rates of AS progression and AS-related events. However, women had lower total mortality and ischaemic CV event rate than men independent of confounders. Trial registration number ClinicalTrials.gov identifier: NCT00092677. PMID:25301859

Cramariuc, Dana; Rogge, Barbara Patricia; Lønnebakken, Mai Tone; Boman, Kurt; Bahlmann, Edda; Gohlke-Bärwolf, Christa; Chambers, John B; Pedersen, Terje R; Gerdts, Eva

2015-01-01

381

The flexural rigidity of the aortic valve leaflet in the commissural region.  

PubMed

Flexure is a major deformation mode of the aortic valve (AV) leaflet, particularly in the commissural region where the upper portion of the leaflet joins the aortic root. However, there are no existing data known on the mechanical properties of leaflet in the commissural region. To address this issue, we quantified the effective stiffness of the commissural region using a cantilever beam method. Ten specimens were prepared, with each specimen flexed in the direction of natural leaflet motion (forward) and against the natural motion (reverse). At a flexure angle (phi) of 30 degrees , the effective forward direction modulus E was 42.63+/-4.44 kPa and the reverse direction E was 75.01+/-14.53 kPa (p=0.049). Further, E-phi response was linear (r(2) approximately 0.9) in both flexural directions. Values for dE/dphi were -2.24+/-0.6 kPa/ degrees and -1.90+/-0.3 kPa/ degrees in the forward and reverse directions, respectively (not statistically different, p=0.424), indicating a consistent decrease in stiffness with increased flexure. In comparison, we have reported that the effective tissue stiffness of AV leaflet belly region was 150-200 kPa [Merryman, W.D., Huang, H.Y.S., Schoen, F.J., Sacks, M.S. (2006). The effects of cellular contraction on AV leaflet flexural stiffness. Journal of Biomechanics 39 (1), 88-96], which was also independent of direction and amount of flexure. Histological studies of the commissure region indicated that tissue buckling was a probable mechanism for decrease in E with increasing flexure. The observed change in E with flexural angle in the commissural region is a subtle aspect of valve function. From a valve design perspective, these findings can be used as design criteria in fabricating prosthetic devices AV resulting in better functional performance. PMID:16360160

Mirnajafi, Ali; Raymer, Jeremy M; McClure, Leigh R; Sacks, Michael S

2006-01-01

382

Mid Term Results of Transapical Aortic Valve Replacement via real-time MRI Guidance  

PubMed Central

Objective Percutaneous valve replacements are presently being evaluated in clinical trials. As delivery of the valve is catheter based, the safety and efficacy of these procedures may be influenced by the imaging employed. To assist the operator and improve the success of the operation, we have performed transapical aortic valve replacements (AVR) using real-time MRI guidance (rtMRI). Methods 28 swine underwent rtMRI AVR on the beating heart. Stentless bioprostheses mounted on balloon-expandable stents was used. MR imaging (1.5T) was used to identify the critical anatomic landmarks. In addition to anatomic confirmation of adequate placement of the prosthesis, functional assessment of the valve and left ventricle and perfusion was also obtained with MRI. A series of acute feasibility experiments were conducted (n=18) in which the animals were sacrificed after valve placement and MRI assessment. Ten additional animals were allowed to survive and had follow-up MRI scans and confirmatory echocardiography at 1, 3, and 6 months postoperatively. Results rtMRI provided superior visualization of the landmarks needed. The time to implantation after apical access was 74±18 seconds. Perfusion scanning demonstrated adequate coronary flow and functional imaging documented preservation of ventricular contractility in all animals following successful deployment. Phase contrast imaging revealed minimal intra or para-valvular leaks. Longer term results demonstrated stability of the implants with preservation of myocardial perfusion and function over time. Conclusions rtMRI provides excellent visualization for intraoperative guidance of AVR on the beating heart. Additionally it allows assessment of tissue perfusion and organ function that are not obtainable by conventional imaging alone. PMID:19969312

Horvath, Keith A.; Mazilu, Dumitru; Guttman, Michael A.; Zetts, Arthur; Hunt, Timothy; Li, Ming

2009-01-01

383

Aortic valve replacement with or without concomitant coronary artery bypass grafting in the ninth decade of life  

Microsoft Academic Search

Due to demographic changes in average life expectancy, the age of patients undergoing cardiac surgery is increasing. We have reviewed the short- and long-term outcome after aortic valve replacement with or without concomitant coronary artery bypass grafting in patients over 80 years of age. From 1 January 1995 until 30 June 1999, 114 patients (83 women and 31 men, 80-89

Jürgen Ennker; Amir Mortasawi; Stefan Gehle; Mehran Yaghmaie; Thomas Schröder; Ulrich Rosendahl; Ina Carolin Ennker

2001-01-01

384

Indexed effective orifice area after mechanical aortic valve replacement does not affect left ventricular mass regression in elderly  

Microsoft Academic Search

Objective: After aortic valve replacement, the effects of a small functional prosthesis on the extent and pattern of regression of left ventricular hypertrophy and on clinical outcomes may be less significant in older patients with low cardiac output requirements. The objective of this study was therefore to determine whether patient-prosthesis mismatch affects left ventricular mass regression in the elderly. Methods:

Antonino Roscitano; Umberto Benedetto; Alfonso Sciangula; Eusebio Merico; Filippo Barberi; Roberto Bianchini; Euclide Tonelli; Riccardo Sinatra

2010-01-01

385

Indexed effective orifice area after mechanical aortic valve replacement does not affect left ventricular mass regression in elderly  

Microsoft Academic Search

Objective: After aortic valve replacement, the effects of a small functional prosthesis on the extent and pattern of regression of left ventricular hypertrophy and on clinical outcomes may be less significant in older patients with low cardiac output requirements. The objective of this study was therefore to determine whether patient-prosthesis mismatch affects left ventricular mass regression in the elderly. Methods:

Antonino Roscitano; Umberto Benedetto; Alfonso Sciangula; Eusebio Merico; Filippo Barberi; Roberto Bianchini; Euclide Tonelli; Riccardo Sinatra

2006-01-01

386

Continuity equation and Gorlin formula compared with directly observed orifice area in native and prosthetic aortic valves  

Microsoft Academic Search

Orifice areas calculated by the continuity and Gorlin equations have been shown to correlate well in vivo. The continuity equation, however, gives underestimates compared with the Gorlin formula and it is not clear which is the more accurate. Both equations have therefore been tested against maximal orifice area measured by planimetry in eight prepared native aortic valves and four bioprostheses.

J B Chambers; D C Sprigings; T Cochrane; J Allen; R Morris; M M Black; G Jackson

1992-01-01

387

Quantification of congenital aortic valve stenosis in pediatric patients: comparison between cardiac magnetic resonance imaging and transthoracic echocardiography.  

PubMed

Previous studies showed the reliability of cardiac magnetic resonance imaging (cMRI) in the quantification of aortic valve stenosis in adults. The aim of this retrospective study was to assess the ability of cMRI in the quantification of congenital aortic valve stenosis (CAS) in children. Nineteen patients (mean age 14.0 ± 3.2 years, 15 boys and 4 girls) with CAS were imaged by cMRI and transthoracic echocardiography (TTE). cMRI was performed on a 1.5-Tesla MR scanner (Magnetom Avanto; Siemens Healthcare, Erlangen, Germany) using cine steady-state free precession sequences for the assessment of the aortic valve area (AVA) by MR planimetry and left-ventricular function. Phase-contrast measurement was used in cMRI to assess peak flow velocity above the aortic valve. A positive correlation was found between maximum systolic pressure gradient (MPG) as assessed by cMRI and TTE (28.9 ± 21.2 vs. 41.3 ± 22.7 mmHg, r = 0.84, p = 0.001) with a mean underestimation of 12.4 mmHg by cMRI. Only a weak correlation could be observed between AVA by cMRI and MPG at the aortic valve by TTE (r = -0.50, p = 0.029) and cMRI (r = -0.27, p = 0.40). Furthermore, a positive correlation between myocardial mass (cMRI) and MPG (TTE, r = 0.57, p = 0.01), but not between myocardial mass (cMRI) and AVA (cMRI, r = 0.07, p = 0.77), was found. The assessment of MPG by cMRI in patients with CAS is feasible with a trend toward underestimatation compared with TTE. Moreover, MPG seems to be a more accurate parameter than AVA regarding the prediction of myocardial hypertrophy. PMID:24343730

Sirin, Selma; Nassenstein, Kai; Neudorf, Ulrich; Jensen, Christoph J; Mikat, Christian; Schlosser, Thomas

2014-06-01

388

[Mitral valve prolapse associated with the aortic bicuspid valve. Discription of a clinical case].  

PubMed

In the literature, the mitral valve prolapse and bicuspid aorta have been widely discussed as isolated cases or in association with other congenital heart pathologies or systematic illnesses. Nevertheless, they have not been documented contemporarily in the same clinical case. The following case describes a healthy, young, asymptomatic athlete, who has a double valvular heart failure. The defect is occasionally evident during transthoracic echocardiographic examination. The role of echocardiography is stressed taking into consideration the natural lineage and unfavourable reciprocal effect on cardiac hemodynamics, omitting relative implications of familial pathologies. This method is suggested as the means of suitable evaluation for athletes. In fact, this is the best technique to reveral the most precocious modification of cardiac hemodynamic. Consequently, echocardiography allows us to guide and monitor the most appropriate therapy. PMID:9213833

Fedeli, F

1997-04-01

389

Comparison of Transcatheter and Surgical Aortic Valve Replacement in Severe Aortic Stenosis: A Longitudinal Study of Echo Parameters in Cohort A of the PARTNER Trial  

PubMed Central

Objectives To compare echocardiographic findings in patients with critical aortic stenosis following surgical (SAVR) or transcatheter aortic valve replacement (TAVR Background The Placement of Aortic Transcatheter Valves trial randomized patients 1:1 to SAVR or TAVR Methods Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years post procedure and analyzed in a core laboratory. For the analysis of post-implant variables, the first interpretable study (? 6 mos) was used. Results Both groups showed a decrease in aortic valve gradients and increase in effective orifice area (EOA) (p < 0.0001) which remained stable over 2 years. Compared to SAVR, TAVR resulted in: larger indexed EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (AR) (p < 0.0001). Baseline echocardiographic univariate predictors of death were: lower peak transaortic gradient in TAVR patients; low left ventricular diastolic volume (LVDV), low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger LVDV, systolic volume (LVSV) and EOA, decreased ejection fraction, and greater AR in TAVR patients; smaller LVSV and LVDV, low stroke volume, smaller EOA and prosthesis-patient mismatch in SAVR patients. Conclusions Patients randomized to either SAVR or TAVR experience enduring, significant reductions in transaortic gradients and increase in EOA. Compared to SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch and more AR. Univariate predictors of death for the TAVR group and SAVR groups differed and may allow future refinement in patient selection. PMID:23623915

Hahn, Rebecca T.; Pibarot, Philippe; Stewart, William J.; Weissman, Neil J.; Gopalakrishnan, Deepika; Keane, Martin G.; Anwaruddin, Saif; Wang, Zueyue; Bilsker, Martin; Lindman, Brian R.; Herrmann, Howard C.; Kodali, Susheel K.; Thourani, Vinod H.; Svensson, Lars G.; Akin, Jodi J.; Anderson, William N.; Leon, Martin; Douglas, Pamela S.

2014-01-01

390

Aortic valve replacement with concomitant aortoventriculoplasty in children and young adults: long-term follow-up.  

PubMed

Sixteen patients (9 male, 7 female) underwent aortic valve replacement (AVR) with a Konno aortoventriculoplasty at the University of Nebraska Medical Center from August, 1976, to May, 1986. There was 1 early death (6%), but no operative deaths have occurred since 1977. There was 1 late death from unknown cause 51 months postoperatively. One patient has been lost to follow-up. Long-term follow-up of 14 patients was 923 months (mean, 66 months; range, 9 to 120 months). Of the 16 patients, 12 (75%) had had previous cardiovascular procedures. A total of thirty-five operations, including the aortoventriculoplasties, were done in the 16 patients. Of the aortic valves inserted, 11 were tissue valves (Carpentier-Edwards, 10; Ionescu-Shiley, 1) and 5 were mechanical valves (St. Jude, 3; Björk-Shiley, 2). Patient age at the time of aortoventriculoplasty ranged from 2 years 3 months to 24 years (median, 11 years 8 months). Size of the aortic annulus ranged from 10 to less than 21 mm (median, 16 mm). Valves inserted ranged from 21 to 29 mm; 13 (81%) of them were 25 mm or larger. In 2 patients, degenerated tissue valves were replaced with mechanical valves after 110 and 33 months. At present, all patients are in New York Heart Association Functional Class I. One female patient married and delivered a normal child approximately five years after AVR with a Carpentier-Edwards valve plus aortoventriculoplasty; she never received anticoagulant medications. We conclude that AVR with a concomitant Konno aortoventriculoplasty can be safely performed in the pediatric and young-adult age groups with satisfactory results for up to ten years. PMID:3592829

Fleming, W H; Sarafian, L B

1987-06-01

391

Numerical simulation of patient-specific left ventricular model with both mitral and aortic valves by FSI approach.  

PubMed

Intraventricular flow is important in understanding left ventricular function; however, relevant numerical simulations are limited, especially when heart valve function is taken into account. In this study, intraventricular flow in a patient-specific left ventricle has been modelled in two-dimension (2D) with both mitral and aortic valves integrated. The arbitrary Lagrangian-Eulerian (ALE) approach was employed to handle the large mesh deformation induced by the beating ventricular wall and moving leaflets. Ventricular wall deformation was predefined based on MRI data, while leaflet dynamics were predicted numerically by fluid-structure interaction (FSI). Comparisons of simulation results with in vitro and in vivo measurements reported in the literature demonstrated that numerical method in combination with MRI was able to predict qualitatively the patient-specific intraventricular flow. To the best of our knowledge, we are the first to simulate patient-specific ventricular flow taking into account both mitral and aortic valves. PMID:24332277

Su, Boyang; Zhong, Liang; Wang, Xi-Kun; Zhang, Jun-Mei; Tan, Ru San; Allen, John Carson; Tan, Soon Keat; Kim, Sangho; Leo, Hwa Liang

2014-02-01

392

Transcatheter Aortic Valve Implantation (TAVI): Is it Time for This Intervention to be Applied in a Lower Risk Population?  

PubMed Central

Patients with severe aortic stenosis are sometimes not candidates for conventional open heart surgery because of severe deconditioning, excessive risk factors, and multiple comorbidities. Transcatheter aortic valve implantation (TAVI) is a relatively recent intervention, which was initially addressed to individuals with severe symptomatic aortic stenosis at substantial or prohibitive surgical risk. Despite the documented beneficial effects of this therapeutic intervention in certain carefully selected individuals, it has not yet been applied to lower risk patients. This is a review of the current literature and accumulated clinical data of this rapidly evolving invasive procedure in an attempt to resolve whether it can now be applied to a wider portion of patients with aortic stenosis. PMID:25452701

Panayiotides, Ioannis M; Nikolaides, Evagoras

2014-01-01

393

Tissue engineering of heart valves: PEGylation of decellularized porcine aortic valve as a scaffold for in vitro recellularization  

PubMed Central

Background Poly (ethylene glycol) (PEG) has attracted broad interest for tissue engineering applications. The aim of this study was to synthesize 4-arm -PEG-20kDa with the terminal group of diacrylate (4-arm-PEG-DA) and evaluate its dual functionality for decellularized porcine aortic valve (DAV) based on its mechanical and biological properties. Methods 4-arm-PEG-DA was synthesized by graft copolymerization of linear PEG 20,000 monomers, and characterized by IR1H NMR and 13C NMR; PEGylation of DAV was achieved by the Michael addition reaction between propylene acyl and thiol, its effect was tested by uniaxial planar tensile testing, hematoxylin and eosin (HE) and scanning electron microscopy (SEM). Gly-Arg-Gly-Asp-Ser-Pro-Cys (GRGDSPC) peptides and vascular endothelial growth factor-165 (VEGF165) were conjugated onto DAV by branched PEG-DA (GRGDSPC-PEG-DAV-PEG-VEGF165). Results Mechanical testing confirmed that PEG-cross-linking significantly enhanced the tensile strength of DAV. Immunofluoresce confirmed the GRGDSPC peptides and VEGF165 were conjugated effectively onto DAV; the quantification of conjunction was completed roughly using spectrophotometry and ELISA. The human umbilical vein endothelial cells (HUVECs) grew and spread well on the GRGDSPC-PEG-DAV-PEG-VEGF165. Conclusions Therefore, PEGylation of DAV not only can improve the tensile strength of DAV, and can also mediate the conjugation of bioactive molecule (VEGF165 and GRGDSPC peptides) on DAV, which might be suitable for further development of tissue engineered heart valve. PMID:24006837

2013-01-01

394

Vascular complications after transcatheter aortic valve implantation and their association with mortality reevaluated by the valve academic research consortium definitions.  

PubMed

Vascular complications (VC) after transcatheter aortic valve implantation (TAVI) are reported using various criteria and several access site approaches. We aimed to describe them in a solely percutaneous transfemoral TAVI approach and their association with survival using both the updated Valve Academic Research Consortium (VARC)-2 criteria and the former VARC-1 criteria. From March 2009 to September 2013, 403 consecutive patients at a mean age (±SD) of 83 ± 6 years underwent percutaneous transfemoral TAVI. VC were defined by both VARC-1 and VARC-2 criteria and analyzed separately. Cox proportional hazard ratio models for all-cause mortality were adjusted separately as defined by each criteria. VARC-1-defined and VARC-2-defined VC occurred in 71 (18%) and 78 (19%) patients, respectively, with 15 (4%) and 33 (8%) defined as major VC. The difference in frequency of major and minor VC was mainly driven by VARC-2 implementation of major bleeding events. With either VARC definition, patients with minor VC had similar mortality and complications rates as those patients without VC. In multivariate analyses, referenced to patients with minor or no VC, only VARC-1-defined major VC were significantly associated with increased mortality (hazard ratio 3.52; confidence interval 1.5 to 8.4; p = 0.005), whereas VARC-2-defined major VC were found to be only marginally significant (hazard ratio 1.9; confidence interval 0.9 to 3.9; p = 0.08). In conclusion, the implementation of the VARC-2 criteria resulted in a higher rate of reported major VC after TAVI compared with VARC-1 criteria, mainly by the inclusion of major bleeding events and a reduced association with patient mortality. PMID:25456874

Steinvil, Arie; Leshem-Rubinow, Eran; Halkin, Amir; Abramowitz, Yigal; Ben-Assa, Eyal; Shacham, Yacov; Bar-Dayan, Avner; Keren, Gad; Banai, Shmuel; Finkelstein, Ariel

2015-01-01

395

Modification of the Secretion Pattern of Proteases, Inflammatory Mediators, and Extracellular Matrix Proteins by Human Aortic Valve is Key in Severe Aortic Stenosis*  

PubMed Central

One of the major challenges in cardiovascular medicine is to identify candidate biomarker proteins. Secretome analysis is particularly relevant in this search as it focuses on a subset of proteins released by a cell or tissue under certain conditions. The sample can be considered as a plasma subproteome and it provides a more direct approximation to the in vivo situation. Degenerative aortic stenosis is the most common worldwide cause of valve replacement. Using a proteomic analysis of the secretome from aortic stenosis valves we could identify candidate markers related to this pathology, which may facilitate early diagnosis and treatment. For this purpose, we have designed a method to validate the origin of secreted proteins, demonstrating their synthesis and release by the tissue and ruling out blood origin. The nLC-MS/MS analysis showed the labeling of 61 proteins, 82% of which incorporated the label in only one group. Western blot and selective reaction monitoring differential analysis, revealed a notable role of the extracellular matrix. Variation in particular proteins such as PEDF, cystatin and clusterin emphasizes the link between aortic stenosis and atherosclerosis. In particular, certain proteins variation in secretome levels correlates well, not only with label incorporation trend (only labeled in aortic stenosis group) but, more importantly, with alterations found in plasma from an independent cohort of samples, pointing to specific candidate markers to follow up in diagnosis, prognosis, and therapeutic intervention. PMID:23704777

Alvarez-Llamas, Gloria; Martín-Rojas, Tatiana; de la Cuesta, Fernando; Calvo, Enrique; Gil-Dones, Felix; Dardé, Veronica M.; Lopez-Almodovar, Luis F.; Padial, Luis R.; Lopez, Juan-Antonio; Vivanco, Fernando; Barderas, Maria G.

2013-01-01

396

Biglycan induces the expression of osteogenic factors in human aortic valve interstitial cells via Toll-like receptor 2  

PubMed Central

Background While biglycan and oxidized low-density lipoprotein (oxLDL) accumulation has been observed in calcific, stenotic aortic valves, their role in the pathogenesis of calcific aortic valve disease is poorly understood. We hypothesized that soluble biglycan induces the osteogenic response in human aortic valve interstitial cells (AVICs) via Toll-like receptor (TLR) 2 and TLR4, and mediates the pro-osteogenic effect of oxLDL. Methods and Results AVICs of stenotic valves express higher levels of biglycan. Stimulation of cells from normal valves with biglycan increased the expression of bone morphogenetic protein-2 (BMP-2) and alkaline phosphatase (ALP) among the chondrogenic/osterogenic markers examined, and caused accumulation of calcium deposits. TLR2 silencing, but not TLR4 silencing, reduced BMP-2 and ALP levels following biglycan stimulation although co-immunoprecipitation revealed that biglycan intercts with both TLR2 and TLR4. Biglycan induced the phosphorylation of ERK1/2, p38 MAPK and NF-?B. Inhibition of ERK1/2 markedly reduced the up-regulation of BMP-2 and ALP expression by biglycan while inhibition of p38 MAPK or NF-?B had a moderate effect. Stimulation of AVICs with oxLDL up-regulated biglycan expression and release. Knockdown neutralization of biglycan reduced the effect of oxLDL on BMP-2 and ALP expression. Conclusion Extracellular soluble biglycan induces the expression of BMP-2 and ALP in human AVICs primarily via TLR2 and contributes to the the pro-osteogenic effect of oxLDL. These findings highlight the potential role of soluble biglycan and oxLDL in the development of calcific aortic valve disease. PMID:22982459

Song, Rui; Zeng, Qingchun; Ao, Lihua; Yu, Jessica A.; Cleveland, Joseph C.; Zhao, Ke-seng; Fullerton, David A.; Meng, Xianzhong

2012-01-01

397

Aortic Stiffness Is Related to the Ischemic Brain Injury Biomarker N-Methyl-D-aspartate Receptor Antibody Levels in Aortic Valve Replacement  

PubMed Central

Background. Aortic stiffness changes the flow pattern of circulating blood causing microvascular damage to different end-organ tissues, such as brain cells. The relationship between aortic stiffness measured by pulse wave velocity (PWV) and serum ischemic brain injury biomarker N-methyl-D-aspartate receptor antibody (NR2Ab) levels in aortic valve replacement has not been assessed. Methods. Patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS) had their PWV and NR2Ab serum levels measured preoperatively. We analyzed PWV and NR2Ab in two ways: (1) as continuous variables using the actual value and (2) as dichotomous variables (PWV-norm and PWV-high groups) and (NR2Ab-low and NR2Ab-high groups). Results. Fifty-six patients (71 ± 8.4 years) were included in this study. The NR2Ab level (ng/mL) was significantly higher in the PWV-high group (n = 21) than in PWV-norm group (n = 35; median 1.8 ± 1.2 versus 1.2 ± 0.7, resp., P = 0.003). NR2Ab level was positively associated with PWV and negatively associated with male gender. Multiple regression revealed PWV independently related to NR2Ab level, and PWV cut-off was associated with a 7.23 times increase in the likelihood of having high NR2Ab (>1.8?ng/mL). Conclusion. Higher PWV in patients with surgical aortic stenosis is associated with higher levels of the ischemic brain biomarker NR2Ab. PMID:25054065

Patel, Vanash M.; Nihoyannopoulos, Petros; Anderson, Jon R.; Chukwuemeka, Andrew; Francis, Darrel P.; Ashrafian, Hutan; Athanasiou, Thanos

2014-01-01

398

Mechanisms of regional ischaemic changes during dipyridamole echocardiography in patients with severe aortic valve stenosis and normal coronary arteries.  

PubMed Central

OBJECTIVE: Vasodilator stress echocardiography can cause myocardial ischaemia in patients with severe aortic valve stenosis and angiographically normal coronary arteries. The aim of the study was to determine the mechanism of ischaemia in this clinical model. METHODS: The study group comprised patients with severe aortic valve stenosis and normal coronary arteries: 25 patients (17 males, eight females; age 63 (SD 11) years) underwent a high dose (up to 0.84 mg/kg over 10 min) dipyridamole echocardiography test both before (2-4 d) and after (10-15 d) aortic valve replacement. Mean aortic pressure gradient was 96 (15) mm Hg, with a left ventricular mass index of 228 (49) g/m2. The dipyridamole echocardiography test was well tolerated and interpretable in all patients. RESULTS: Dipyridamole infusion induced chest pain in seven patients before and in no patient after surgery (28 v 0%, P < 0.01), ST segment depression in 12 patients before and two after surgery (48 v 8%, P < 0.01), and a transient regional dyssynergy in 10 patients before and two after surgery (40 v 8%, P < 0.01). In the preoperative evaluation, patients with an echocardiographically positive dipyridamole echocardiography test were comparable with patients with negative test as far as left ventricular mass index [240 (67) v 230 (64) g/m2, NS] and mean aortic pressure gradient [95 (22) v 92 (21) mm Hg, NS] were concerned. When compared to the preoperative assessment, the resting echo assessment in the postoperative evaluation showed unchanged values of left ventricular mass index [pre 228 (49) g/m2 v post 220 (36) g/m2, NS], but markedly decreased values of mean aortic gradient [pre 95 (15) mm Hg v post 22 (5) mm Hg, P < 0.01] and left ventricular wall stress index [pre 134 (30) g/cm2 v post 89 (19) g/cm2]. CONCLUSIONS: Dipyridamole echocardiography is a suitable clinical technique for assessing the ischaemic vulnerability of the left ventricle in severe aortic valve stenosis with angiographically normal coronary arteries. The frequent disappearance of the ischaemic response early after aortic valve replacement suggests that haemodynamic factors such as compressive diastolic wall stress or afterload reduction are important components of myocardial ischaemic vulnerability under these circumstances. Images PMID:8665343

Baroni, M.; Maffei, S.; Terrazzi, M.; Palmieri, C.; Paoli, F.; Biagini, A.

1996-01-01

399

Occurrence and prognostic impact of systemic inflammatory response syndrome in transfemoral and transapical aortic valve implantation with balloon- and self-expandable valves.  

PubMed

Aims: Transcatheter aortic valve implantation (TAVI) is an alternative therapeutic option for patients with severe aortic valve stenosis (AS) and elevated surgical risk. Previous studies have suggested that the occurrence of systemic inflammatory response syndrome (SIRS) in patients undergoing TAVI is associated with an unfavourable outcome. We sought to assess the impact of different interventional access routes (transapical [TA] vs. transfemoral [TF]) and valve types (Medtronic CoreValve® [CV] vs. Edwards SAPIEN XT® [ES]) on the incidence of SIRS. In addition, the prognostic value of SIRS was evaluated. Methods and results: Between January 2009 and July 2011 a total of 192 (out of 228) consecutive patients with severe aortic stenosis underwent TAVI at the University Hospital Frankfurt and were included in the current retrospective analysis. SIRS criteria were evaluated within the first 48 hours after TAVI. SIRS was defined according to existing definitions of the ACCP/SCCM Consensus Conference. A total of 75 (39.1%) patients developed SIRS at some time during the first 48 hours following TAVI. The occurrence of SIRS was independent from access route (TA 42.3% vs. TF 37.0%; p=0.28) as well as from type of valve used (ES 42.5% vs. CV 32.3%; p=0.11). However, the occurrence of SIRS was associated with a more than twofold higher one-year mortality rate (21.3%) compared to patients without SIRS in the first 48 hours (5.3%; p=0.04). Conclusions: The occurrence of SIRS in the first 48 hours post procedure is associated with impaired prognosis following TAVI, but is independent from the chosen valve type and access route. PMID:24970670

Schwietz, Thomas; Behjati, Sohil; Gafoor, Sameer; Seeger, Florian; Doss, Mirko; Sievert, Horst; Zeiher, Andreas M; Fichtlscherer, Stephan; Lehmann, Ralf

2014-06-28

400

Myocardial Protection Using del Nido Cardioplegia Solution in Adult Reoperative Aortic Valve Surgery  

PubMed Central

Background and Aims The immediate post-ischemic period is marked by elevated intracellular calcium levels which can lead to irreversible myocyte injury. Del Nido cardioplegia was developed for use in the pediatric population to address the inability of immature myocardium to tolerate high levels of intracellular calcium following cardiac surgery. Our aim in this study is to determine if this solution can be used safely and effectively in an adult, re-operative population. Methods All patients undergoing isolated re-operative aortic valve replacement at our institution from 2010 to 2012 were retrospectively reviewed. Demographics, co-morbidities, operative variables, post-operative complications, and patient outcomes were collected. Patients were divided into 2 groups based on cardioplegia strategy used: Whole blood cardioplegia (WB, n=61) and del Nido cardioplegia (DN, n=52). Results Mean age in the study was 73.4 ± 14.3 years and 86 patients were male (76.1%). Eighty-four patients had undergone prior CABG (74.3%). Patients in the DN group required significantly lower total volume of cardioplegia (1147.6 ± 447.2 mL DN vs. 1985.4 ± 691.1 mL WB, p<0.001) and retrograde cardioplegia dose (279.3 ± 445.1 mL DN vs. 1341.2 ± 690.8 mL WB, p<0.001). There were no differences in cross-clamp time, bypass time, post-operative complication rate, or patient outcomes between groups. Conclusions Del Nido cardioplegia use in an adult, re-operative aortic valve population offers equivalent post-operative outcomes when compared with whole blood cardioplegia. In addition, use of del Nido solution requires lower total and retrograde cardioplegia volumes in order to achieve adequate myocardial protection. PMID:24861160

Sorabella, Robert A.; Akashi, Hiro; Yerebakan, Halit; Najjar, Marc; Mannan, Ayesha; Williams, Mathew R.; Smith, Craig R.; George, Isaac

2014-01-01

401

Ministernotomy or minithoracotomy for minimally invasive aortic valve replacement: a Bayesian network meta-analysis  

PubMed Central

Background Establishing the relative merits of ministernotomy (MS) and minithoracotomy (MT) approaches to minimally invasive aortic valve replacement (MIAVR) is difficult given the limited available direct evidence. Network meta-analysis is a Bayesian approach that can combine direct and indirect evidence to better define the benefits and risks of MS and MT. Methods Electronic searches were performed using six databases from their inception to June 2014. Relevant studies utilizing a minimally invasive approach for aortic valve replacement were identified. Data were extracted and analyzed according to predefined clinical endpoints. Both traditional and Bayesian meta-analysis approaches were conducted. Results Compared to full sternotomy, MT was associated with longer cardiopulmonary bypass (CPB) duration (WMD, 9.99; 95% CI, 3.91, 16.07; I2=55%; P=0.001) and cross-clamp duration (WMD, 7.64; 95% CI, 2.86, 12.42; P=0.002; I2=74%). When compared to MS using network meta-analysis, no significant difference in duration was detected. Postoperative outcomes including 30-day mortality, stroke, and reoperation for bleeding and wound infection were comparable between MS and MT using both traditional and Bayesian meta-analysis techniques. Conclusions The current evidence demonstrates that MIAVR via MS or MT is a safe and efficacious alternative to conventional median sternotomy. MT may be associated with longer CPB and cross-clamp durations, but has similar post-operative outcomes compared to MS. An individualized approach tailored to both the patient and surgical team is likely to provide optimal outcomes.

Phan, Kevin; Xie, Ashleigh; Tsai, Yi-Chin; Black, Deborah; Di Eusanio, Marco

2015-01-01

402

Palytoxin-induced increase in endothelial Ca2+ concentration in the rabbit aortic valve.  

PubMed

Palytoxin (PTX) is one of the most potent toxins isolated from marine coelenterates of the genus Palythoa. It induces depolarization in various types of cells by increasing the permeability for monovalent cations. It has been reported that PTX induces endothelium-dependent relaxation of vascular smooth muscle. In this study, we examined the effect of PTX on the cytosolic Ca2+ concentration ([Ca2+]i) in the endothelium of rabbit aortic valves loaded with fluorescent Ca2+ indicators, fura-PE3 or fluo-3. PTX (10 pM-300 nM) irreversibly increased endothelial [Ca2+]i in a concentration-dependent manner. ATP and thapsigargin also increased [Ca2+]i. Imaging of [Ca2+]i with a confocal microscope revealed that PTX increased [Ca2+]i in all endothelial cells studied (n = 13). An inorganic Ca2+ entry blocker, La3+ (30 microM), had no effect on the increase in [Ca2+]i induced by PTX whereas it inhibited the sustained phase of the increase in [Ca2+]i induced by ATP or thapsigargin. The PTX-induced increase in [Ca2+]i was partially inhibited by ouabain and was abolished by removal of external Ca2+ although decrease of Na+ concentration in the incubation medium was ineffective. Activation of protein kinase C by 1 microM 12-deoxyphorbol 13-isobutyrate or inhibition of phosphatase by 10 nM calyculin-A had no effect on the increase in [Ca2+]i induced by PTX, whereas both agents inhibited the sustained phase of the increase in [Ca2+]i induced by ATP or thapsigargin. Mn2+ influx, measured by the quenching of fura-PE3 fluorescence, was accelerated by ATP or thapsigargin, but not by PTX. These results suggest that PTX increases [Ca2+]i in the endothelium of the rabbit aortic valve by increasing Ca2+ influx through a pathway which is different from that activated by ATP or thapsigargin. PMID:9205960

Amano, K; Sato, K; Hori, M; Ozaki, H; Karaki, H

1997-06-01

403

Local versus general anesthesia for transcatheter aortic valve implantation (TAVR) – systematic review and meta-analysis  

PubMed Central

Background The hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR). TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported. Methods This is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR. Trials were identified through a literature search covering publications from 1 January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and duration of hospital stay. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals. Results Seven observational studies and a total of 1,542 patients were included in this analysis. None of the studies were randomized. Compared to GA, MAC was associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0); P?=?0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0 minutes); P <0.001). Overall 30-day mortality was not significantly different between MAC and GA (RR 0.77 (0.38 to 1.56); P?=?0.460), also cardiac- and procedure-related mortality was similar between both groups (RR 0.90 (0.34 to 2.39); P?=?0.830). Conclusion These data did not show a significant difference in short-term outcomes for MAC or GA in TAVR. MAC may be associated with reduced procedural time and shorter hospital stay. Now randomized trials are needed for further evaluation of MAC in the setting of TAVR. PMID:24612945

2014-01-01

404

Evaluation of Aortic Valve Replacement via the Right Parasternal Approach without Rib Removal.  

PubMed

Background: Although right parasternal approach (RPA) decreases the incidence of mediastinal infection, this approach is associated with lung hernia and flail chest. Our RPA employs thoracotomy with bending rib cartilages and wound closure performed by repositioning the ribs with underlying sheet reinforcement. Methods: We evaluated 16 patients who underwent aortic valve replacement via the RPA from January 2010 to August 2013. We compared outcomes of 15 male patients had the RPA with 30 male patients had full median sternotomy. Results: One patient with a history of radical breast cancer treatment underwent RPA with concomitant right coronary artery bypass grafting. No hospital deaths occurred. Four patients developed hospital-associated morbidity (re-exploration for bleeding, prolonged ventilation, cardiac tamponade, and perioperative myocardial infarction). There were no conversions to full median sternotomy, mediastinal infections, and lung hernias. Preoperative computed tomography showed that the distance from the right sternal border to the aortic root was significantly associated with operation times. With RPA, there was no significant difference in outcomes, despite significantly longer operation times compared with full median sternotomy. Conclusion: Our RPA provides satisfactory outcomes without lung hernia, especially in patients unsuitable for sternotomy. Preoperative computed tomography is useful for identifying appropriate candidates for the RPA. PMID:25167927

Morisaki, Akimasa; Hattori, Koji; Kato, Yasuyuki; Motoki, Manabu; Takahashi, Yosuke; Nishimura, Shinsuke; Shibata, Toshihiko

2014-08-29

405

[Embolizing aortic valve endocarditis in the differential diagnosis of thrombotic thrombocytopenic purpura].  

PubMed

A 50-year-old man complained of lumbar pains, lack of energy, dysarthria and ataxic gait. Investigation revealed progressive anaemia (haemoglobin initially 10.5 g/dl, later 6.8 g/dl) and thrombocytopenia (initially 67,000/microliters, later 25,000/microliters). In addition he had unexplained pyrexia of up to 39.8 degrees C. Lactate dehydrogenase was 780 U/l and fragmented red cells were noted in the blood film. Because of suspicion of thrombotic thrombocytopenic purpura, treatment with fresh plasma by infusion was immediately initiated. On the third day of treatment he developed left ventricular failure; auscultation revealed a blowing early diastolic murmur over Erb's point together with a spindle-shaped early diastolic murmur over the right second intercostal space. Computed tomography of the skull showed recent haemorrhage into the left half of the cerebellum and an older right posterior infarct. The abdominal ultrasound scan suggested a haemorrhagic spleen infarct. In view of these findings the diagnosis was revised to embolizing